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Sample records for comparing radical prostatectomy

  1. Radical prostatectomy - discharge

    MedlinePlus

    ... prostatectomy - discharge; Laparoscopic radical prostatectomy - discharge; LRP - discharge; Robotic-assisted laparoscopic prostatectomy - discharge ; RALP - discharge; Pelvic lymphadenectomy - ...

  2. Characteristics of positive surgical margins in robotic-assisted radical prostatectomy, open retropubic radical prostatectomy, and laparoscopic radical prostatectomy: a comparative histopathologic study from a single academic center.

    PubMed

    Albadine, Roula; Hyndman, Matthew E; Chaux, Alcides; Jeong, J Y; Saab, Shahrazad; Tavora, Fabio; Epstein, Jonathan I; Gonzalgo, Mark L; Pavlovich, Christian P; Netto, George J

    2012-02-01

    Studies detailing differences in positive surgical margin among open retropubic radical prostatectomy, laparoscopic radical prostatectomy, and robotic-assisted laparoscopic radical prostatectomy are lacking. A retrospective review of all prostatectomies with positive surgical margin performed at our center in 2007 disclosed 99 cases, 6 (5%) of which were reinterpreted cases as having negative margins. Ninety-three cases were, therefore, included, corresponding to 37 retropubic radical prostatectomies, 19 laparoscopic radical prostatectomies, and 37 robotic-assisted laparoscopic radical prostatectomies. The relationship of positive surgical margin characteristics to clinicopathologic parameters and biochemical recurrence was assessed. The most commonly found positive surgical margin site was the apex/distal third in all groups (62% retropubic prostatectomies, 79% laparoscopic prostatectomies, 60% robotic-assisted prostatectomies). Total linear length of positive surgical margin sites was significantly correlated with preoperative prostate-specific antigen, preoperative prostate-specific antigen density, pT stage, and tumor volume (P ≤ .001). We found no significant differences among the 3 groups with respect to total linear length, number of foci, laterality, or location of positive surgical margin. The rate of biochemical recurrence was also comparable in the 3 groups. On univariate analyses, biochemical recurrence was significantly associated with preoperative prostate-specific antigen values, preoperative prostate-specific antigen density, Gleason score, number of positive surgical margins, and total linear length of positive surgical margin (P ≤ .02). Only preoperative prostate-specific antigen density and number of positive surgical margin foci were statistically significant (P ≤ .03) independent predictors of biochemical recurrence. We found no significant difference in positive surgical margin characteristics or biochemical recurrence among the 3

  3. Short-term results after robot-assisted laparoscopic radical prostatectomy compared to open radical prostatectomy.

    PubMed

    Wallerstedt, Anna; Tyritzis, Stavros I; Thorsteinsdottir, Thordis; Carlsson, Stefan; Stranne, Johan; Gustafsson, Ove; Hugosson, Jonas; Bjartell, Anders; Wilderäng, Ulrica; Wiklund, N Peter; Steineck, Gunnar; Haglind, Eva

    2015-04-01

    Robot-assisted laparoscopic radical prostatectomy has become a widespread technique despite a lack of randomised trials showing its superiority over open radical prostatectomy. To compare in-hospital characteristics and patient-reported outcomes at 3 mo between robot-assisted laparoscopic and open retropubic radical prostatectomy. A prospective, controlled trial was performed of all men who underwent radical prostatectomy at 14 participating centres. Validated patient questionnaires were collected at baseline and after 3 mo by independent health-care researchers. The difference in outcome between the two treatment groups were analysed using logistic regression analysis, with adjustment for identified confounders. Questionnaires were received from 2506 (95%) patients. The robot-assisted surgery group had less perioperative bleeding (185 vs 683 ml, p<0.001) and shorter hospital stay (3.3 vs 4.1 d, p<0.001) than the open surgery group. Operating time was shorter with the open technique (103 vs 175 min, p<0.001) compared with the robot-assisted technique. Reoperation during initial hospital stay was more frequent after open surgery after adjusting for tumour characteristics and lymph node dissection (1.6% vs 0.7%, odds ratio [OR] 0.31, 95% confidence interval [CI 95%] 0.11-0.90). Men who underwent open surgery were more likely to seek healthcare (for one or more of 22 specified disorders identified prestudy) compared to men in the robot-assisted surgery group (p=0.03). It was more common to seek healthcare for cardiovascular reasons in the open surgery group than in the robot-assisted surgery group, after adjusting for nontumour and tumour-specific confounders, (7.9% vs 5.8%, OR 0.63, CI 95% 0.42-0.94). The readmittance rate was not statistically different between the groups. A limitation of the study is the lack of a standardised tool for the assessment of the adverse events. This large prospective study confirms previous findings that robot-assisted laparoscopic

  4. Transperitoneal versus extraperitoneal robot-assisted laparoscopic radical prostatectomy: A prospective single surgeon randomized comparative study.

    PubMed

    Akand, Murat; Erdogru, Tibet; Avci, Egemen; Ates, Mutlu

    2015-10-01

    To compare operative, pathological, and functional results of transperitoneal and extraperitoneal robot-assisted laparoscopic radical prostatectomy carried out by a single surgeon. After having experience with 32 transperitoneal laparoscopic radical prostatectomies, 317 extraperitoneal laparoscopic radical prostatectomies, 30 transperitoneal robot-assisted laparoscopic radical prostatectomies and 10 extraperitoneal robot-assisted laparoscopic radical prostatectomies, 120 patients with prostate cancer were enrolled in this prospective randomized study and underwent either transperitoneal or extraperitoneal robot-assisted laparoscopic radical prostatectomy. The main outcome parameters between the two study groups were compared. No significant difference was found for age, body mass index, preoperative prostate-specific antigen, clinical and pathological stage, Gleason score on biopsy and prostatectomy specimen, tumor volume, positive surgical margin, and lymph node status. Transperitoneal robot-assisted laparoscopic radical prostatectomy had shorter trocar insertion time (16.0 vs 25.9 min for transperitoneal robot-assisted laparoscopic radical prostatectomy and extraperitoneal robot-assisted laparoscopic radical prostatectomy, P < 0.001), whereas extraperitoneal robot-assisted laparoscopic radical prostatectomy had shorter console time (101.5 vs 118.3 min, respectively, P < 0.001). Total operation time and total anesthesia time were found to be shorter in extraperitoneal robot-assisted laparoscopic radical prostatectomy, without statistical significance (200.9 vs 193.2 min; 221.8 vs 213.3 min, respectively). Estimated blood loss was found to be lower for extraperitoneal robot-assisted laparoscopic radical prostatectomy (P = 0.001). Catheterization and hospitalization times were observed to be shorter in extraperitoneal robot-assisted laparoscopic radical prostatectomy (7.3 vs 5.8 days and 3.1 vs 2.3 days for transperitoneal robot-assisted laparoscopic

  5. A comparative study of complications and outcomes associated with radical retropubic prostatectomy and robot assisted radical prostatectomy

    NASA Astrophysics Data System (ADS)

    Gettman, Matthew T.

    2008-02-01

    Purpose: To evaluate outcomes among a matched cohort of prostate cancer patients treated with radical retropubic prostatectomy (RRP) and robot assisted radical prostatectomy (RARP). Materials and methods: Between 2002 and 2005, 294 patients underwent RARP at our institution. Comparison RRP patients were matched 2:1 for surgical year, age, PSA, clinical stage, and biopsy grade (n=588). Outcomes among groups were compared. From an oncologic standpoint, pathologic features among groups were assessed and Kaplan-Meier estimates of PSA recurrence free survival were compared. Results: Overall margin positivity was not significantly different between groups (RARP, 15.6%, RRP, 17%), yet risk of apical margin was significantly less with RARP. RARP was associated with significantly shorter hospitalization (p<0.01) and lower incidence of blood transfusion (p < 0.01). Early complications were higher in the RARP group (16% vs 10%, p<0.01). Among late complications, risk of bladder neck contracture was lower with RARP (1.2%, p=0.02). Adjuvant hormonal therapy was significantly higher in the RRP group (6.6% p<0.01). Continence at 1 year among groups was equivalent (p=0.15). Potency at 1 year was better among RARP patients (p=0.02). At a median followup of 1.3 years, PSA recurrence free estimates were not significantly different (92% vs 92%, p=0.69). Conclusions: Early complications were higher in this RARP group, but this experience includes cases performed in the learning curve. Oncologic, quality of life, and functional data in this study revealed encouraging results for RARP when compared to RRP.

  6. Comparative Effectiveness of Cancer Control and Survival after Robot-Assisted versus Open Radical Prostatectomy.

    PubMed

    Hu, Jim C; O'Malley, Padraic; Chughtai, Bilal; Isaacs, Abby; Mao, Jialin; Wright, Jason D; Hershman, Dawn; Sedrakyan, Art

    2017-01-01

    Robot-assisted surgery has been rapidly adopted in the U.S. for prostate cancer. Its adoption has been driven by market forces and patient preference, and debate continues regarding whether it offers improved outcomes to justify the higher cost relative to open surgery. We examined the comparative effectiveness of robot-assisted vs open radical prostatectomy in cancer control and survival in a nationally representative population. This population based observational cohort study of patients with prostate cancer undergoing robot-assisted radical prostatectomy and open radical prostatectomy during 2003 to 2012 used data captured in the SEER (Surveillance, Epidemiology, and End Results)-Medicare linked database. Propensity score matching and time to event analysis were used to compare all cause mortality, prostate cancer specific mortality and use of additional treatment after surgery. A total of 6,430 robot-assisted radical prostatectomies and 9,161 open radical prostatectomies performed during 2003 to 2012 were identified. The use of robot-assisted radical prostatectomy increased from 13.6% in 2003 to 2004 to 72.6% in 2011 to 2012. After a median followup of 6.5 years (IQR 5.2-7.9) robot-assisted radical prostatectomy was associated with an equivalent risk of all cause mortality (HR 0.85, 0.72-1.01) and similar cancer specific mortality (HR 0.85, 0.50-1.43) vs open radical prostatectomy. Robot-assisted radical prostatectomy was also associated with less use of additional treatment (HR 0.78, 0.70-0.86). Robot-assisted radical prostatectomy has comparable intermediate cancer control as evidenced by less use of additional postoperative cancer therapies and equivalent cancer specific and overall survival. Longer term followup is needed to assess for differences in prostate cancer specific survival, which was similar during intermediate followup. Our findings have significant quality and cost implications, and provide reassurance regarding the adoption of more

  7. [Radical prostatectomy - pro robotic].

    PubMed

    Gillitzer, R

    2012-05-01

    Anatomical radical prostatectomy was introduced in the early 1980s by Walsh and Donker. Elucidation of key anatomical structures led to a significant reduction in the morbidity of this procedure. The strive to achieve similar oncological and functional results to this gold standard open procedure but with further reduction of morbidity through a minimally invasive access led to the establishment of laparoscopic prostatectomy. However, this procedure is complex and difficult and is associated with a long learning curve. The technical advantages of robotically assisted surgery coupled with the intuitive handling of the device led to increased precision and shortening of the learning curve. These main advantages, together with a massive internet presence and aggressive marketing, have resulted in a rapid dissemination of robotic radical prostatectomy and an increasing patient demand. However, superiority of robotic radical prostatectomy in comparison to the other surgical therapeutic options has not yet been proven on a scientific basis. Currently robotic-assisted surgery is an established technique and future technical improvements will certainly further define its role in urological surgery. In the end this technical innovation will have to be balanced against the very high purchase and running costs, which remain the main limitation of this technology.

  8. [Simultaneous radical retropubic prostatectomy, diverticulectomy].

    PubMed

    Loran, O B; Sokolov, A E; Guspanov, R I; Polegen'kiĭ, V V

    2014-01-01

    Presented clinical case demonstrates a combination of rare congenital abnormality - giant true diverticula of the bladder - and high-risk prostate cancer, as well as a successful result of simultaneous operation - a radical prostatectomy with diverticulectomy.

  9. Prostate volume estimations using magnetic resonance imaging and transrectal ultrasound compared to radical prostatectomy specimens

    PubMed Central

    Paterson, Nicholas R.; Lavallée, Luke T.; Nguyen, Laura N.; Witiuk, Kelsey; Ross, James; Mallick, Ranjeeta; Shabana, Wael; MacDonald, Blair; Scheida, Nicola; Fergusson, Dean; Momoli, Franco; Cnossen, Sonya; Morash, Christopher; Cagiannos, Ilias; Breau, Rodney H.

    2016-01-01

    Introduction: We sought to evaluate the accuracy of prostate volume estimates in patients who received both a preoperative transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI) in relation to the referent pathological specimen post-radical prostatectomy. Methods: Patients receiving both TRUS and MRI prior to radical prostatectomy at one academic institution were retrospectively analyzed. TRUS and MRI volumes were estimated using the prolate ellipsoid formula. TRUS volumes were collected from sonography reports. MRI volumes were estimated by two blinded raters and the mean of the two was used for analyses. Pathological volume was calculated using a standard fluid displacement method. Results: Three hundred and eighteen (318) patients were included in the analysis. MRI was slightly more accurate than TRUS based on interclass correlation (0.83 vs. 0.74) and absolute risk bias (higher proportion of estimates within 5, 10, and 20 cc of pathological volume). For TRUS, 87 of 298 (29.2%) prostates without median lobes differed by >10 cc of specimen volume and 22 of 298 (7.4%) differed by >20 cc. For MRI, 68 of 298 (22.8%) prostates without median lobes differed by >10 cc of specimen volume, while only 4 of 298 (1.3%) differed by >20 cc. Conclusions: MRI and TRUS prostate volume estimates are consistent with pathological volumes along the prostate size spectrum. MRI demonstrated better correlation with prostatectomy specimen volume in most patients and may be better suited in cases where TRUS and MRI estimates are disparate. Validation of these findings with prospective, standardized ultrasound techniques would be helpful. PMID:27878049

  10. [COMPARATIVE ANALYSIS OF POSITIVE SURGICAL MARGIN RATES IN PATIENTS UNDERGOING ROBOT- ASSISTED OR RETROPUBIC RADICAL PROSTATECTOMY FOR PROSTATE CANCER].

    PubMed

    Veliev, E L; Sokolov, E A; Loran, O B

    2015-01-01

    The issue of comparative evaluation of oncological and functional outcomes of robot-assisted radical prostatectomy (RARP) and radical retropubic prostatectomy (RRP) is widely discussed in the international literature. A key point in studying the oncological efficacy of both techniques is a comparative evaluation of positive surgical margin (PSM) rates as one of the main prognostic factors influencing the further course of prostate cancer. Available data so far are inconsistent, which prompted us to conduct our own research. A retrospective analysis was performed in two groups of patients who underwent RARP (n = 63) and RRP (n = 116) from January 2014 to April 2015. Despite a general trend towards lower PSM rates in RARP group compared to RRP group (12.7 and 21.6%, respectively, p = 0.09), no significant differences were found in the stratification of patients in both groups depending on the risk of prostate cancer progression and pathological stage. These data show the potential equality of the two methods regarding intraoperative control of resection margins.

  11. Neuroprotective strategies in radical prostatectomy.

    PubMed

    Schiff, Jonathan D; Mulhall, John P

    2005-01-01

    In this section, authors from New York give their views on the various neuroprotective strategies for patients having a radical prostatectomy, such as the use of nerve grafts and other approaches. A joint study from Korea, the USA, Canada and the UK is presented in a paper on the importance of patient perception in the clinical assessment and management of BPH. There is also a review of robotic urological surgery. Finally, authors from New York give a review on the life of Isaac Newton. This is a new historical review in the journal, but one that will be of general interest.

  12. Perineal radical prostatectomy in the minimally invasive era.

    PubMed

    Rioja, Jorge; Rincon Mayans, Anibal; Parra, Raul O

    2012-10-01

    Radical prostatectomy is currently the standard of care for localized prostate cancer. In the last decade, the minimally invasive surgery, especially the robotic surgery has been growing and open techniques are less frequent performed. A non-systematic review of the literature is performed, highlighting the current situation of the perineal radical prostatectomy in the minimally invasive era, its indications, and functional and oncological outcomes. Radical perineal prostatectomy, when compared with other surgical approaches, still experience favorable outcomes. Urologist might be abandoning an underused surgical approach.

  13. Chromatin changes predict recurrence after radical prostatectomy

    PubMed Central

    Hveem, Tarjei S; Kleppe, Andreas; Vlatkovic, Ljiljana; Ersvær, Elin; Wæhre, Håkon; Nielsen, Birgitte; Kjær, Marte Avranden; Pradhan, Manohar; Syvertsen, Rolf Anders; Nesheim, John Arne; Liestøl, Knut; Albregtsen, Fritz; Danielsen, Håvard E

    2016-01-01

    Background: Pathological evaluations give the best prognostic markers for prostate cancer patients after radical prostatectomy, but the observer variance is substantial. These risk assessments should be supported and supplemented by objective methods for identifying patients at increased risk of recurrence. Markers of epigenetic aberrations have shown promising results in several cancer types and can be assessed by automatic analysis of chromatin organisation in tumour cell nuclei. Methods: A consecutive series of 317 prostate cancer patients treated with radical prostatectomy at a national hospital between 1987 and 2005 were followed for a median of 10 years (interquartile range, 7–14). On average three tumour block samples from each patient were included to account for tumour heterogeneity. We developed a novel marker, termed Nucleotyping, based on automatic assessment of disordered chromatin organisation, and validated its ability to predict recurrence after radical prostatectomy. Results: Nucleotyping predicted recurrence with a hazard ratio (HR) of 3.3 (95% confidence interval (CI), 2.1–5.1). With adjustment for clinical and pathological characteristics, the HR was 2.5 (95% CI, 1.5–4.1). An updated stratification into three risk groups significantly improved the concordance with patient outcome compared with a state-of-the-art risk-stratification tool (P<0.001). The prognostic impact was most evident for the patients who were high-risk by clinical and pathological characteristics and for patients with Gleason score 7. Conclusion: A novel assessment of epigenetic aberrations was capable of improving risk stratification after radical prostatectomy. PMID:27124335

  14. Comparative cost-effectiveness of robot-assisted and standard laparoscopic prostatectomy as alternatives to open radical prostatectomy for treatment of men with localised prostate cancer: a health technology assessment from the perspective of the UK National Health Service.

    PubMed

    Close, Andrew; Robertson, Clare; Rushton, Stephen; Shirley, Mark; Vale, Luke; Ramsay, Craig; Pickard, Robert

    2013-09-01

    Robot-assisted laparoscopic prostatectomy is increasingly used compared with a standard laparoscopic technique, but it remains uncertain whether potential benefits offset higher costs. To determine the cost-effectiveness of robotic prostatectomy. We conducted a care pathway description and model-based cost-utility analysis. We studied men with localised prostate cancer able to undergo either robotic or laparoscopic prostatectomy for cure. We used data from a meta-analysis, other published literature, and costs from the UK National Health Service and commercial sources. Care received by men for 10 yr following radical prostatectomy was modelled. Clinical events, their effect on quality of life, and associated costs were synthesised assuming 200 procedures were performed annually. Over 10 yr, robotic prostatectomy was on average (95% confidence interval [CI]) £1412 (€1595) (£1304 [€1473] to £1516 [€1713]) more costly than laparoscopic prostatectomy but more effective with mean (95% CI) gain in quality-adjusted life-years (QALYs) of 0.08 (0.01-0.15). The incremental cost-effectiveness ratio (ICER) was £18 329 (€20 708) with an 80% probability that robotic prostatectomy was cost effective at a threshold of £30 000 (€33 894)/QALY. The ICER was sensitive to the throughput of cases and the relative positive margin rate favouring robotic prostatectomy. Higher costs of robotic prostatectomy may be offset by modest health gain resulting from lower risk of early harms and positive margin, provided >150 cases are performed each year. Considerable uncertainty persists in the absence of directly comparative randomised data. Copyright © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  15. Comparative Study of Inguinal Hernia Repair Rates After Radical Prostatectomy or External Beam Radiotherapy

    SciTech Connect

    Lughezzani, Giovanni; Sun, Maxine; Perrotte, Paul; Alasker, Ahmed; Jeldres, Claudio; Isbarn, Hendrik; Budaeus, Lars; Lattouf, Jean-Baptiste; Valiquette, Luc; Benard, Francois; Saad, Fred; Graefen, Markus; Montorsi, Francesco; Karakiewicz, Pierre I.

    2010-12-01

    Purpose: We tested the hypothesis that patients treated for localized prostate cancer with radical prostatectomy (RP) have a higher risk of requiring an inguinal hernia (IH) repair than their counterparts treated with external beam radiotherapy (EBRT). Methods and Materials: Within the Quebec Health Plan database, we identified 6,422 men treated with RP and 4,685 men treated with EBRT for localized prostate cancer between 1990 and 2000, in addition to 6,933 control patients who underwent a prostate biopsy. From among that population, we identified patients who underwent a unilateral or bilateral hernia repair after either RP or EBRT. Kaplan-Meier plots showed IH repair-free survival rates. Univariable and multivariable Cox regression models tested the predictors of IH repair after RP or EBRT. Covariates consisted of age, year of surgery, and Charlson Comorbidity Index. Results: IH repair-free survival rates at 1, 2, 5, and 10 years were 96.8, 94.3, 90.5, and 86.2% vs. 98.9, 98.0, 95.4, and 92.2%, respectively, in RP vs. EBRT patients (log-rank test, p < 0.001). IH repair-free survival rates in the biopsy population were 98.3, 97.1, 94.9, and 90.2% at the same four time points. In multivariable Cox regression models, RP predisposed to a 2.3-fold higher risk of IH repair than EBRT (p < 0.001). Besides therapy type, patient age (p < 0.001) represented the only other independent predictor of IH repair. Conclusions: RP predisposes to a higher rate of IH repair relative to EBRT. This observation should be considered at informed consent.

  16. [Initial series of radical prostatectomy in a general hospital: review and comparative of national and international series].

    PubMed

    Crego Tapias, M; Puig Duran, P; Juaneda Castell, B; Segura Forcada, J; Vallejo Gil, C; Cortadellas Angel, A I

    2008-10-01

    The radical prostatectomy is a technique that has shown competitive oncological and functional results, that is why it has become to be a routine procedure in many leading centers. Nevertheless, the difficulty of learning and its initial cost, could question its implantation as a routine technique in centers that are not a point of reference. We have carried out a descriptive study of our initial series analyzing the surgical technique, post surgical immediate results, and oncological and functional short-term outcomes, comparing them with other series in national and international centers. From February, 2006 to August, 2007 we performed 69 laparoscopical procedures in our center, of which 34 were radical prostatectomies. The average age of the series were 63 years (50-72), with a prostate average weight by transrectal ultrasound of 35 gr. (17-72), and a median PSA of 6ng/ml (4-35). The clinical stages were: T1c 59%, T2a 12%, T2b 17%, T2c 12%; with Gleason combined of: 2+2 in 3%, 3+3 in 35%, 3+4 in 15%, 4+3 in 44%, 4+5 in 3%. Out of the 34 cases initiated by laparoscopy, 30 were concluded laparoscopically, with a surgical average time of 261 minutes (150-380). The pathological stages were: pT2a 3%, pT2b 18%, pT2c 41%, pT3a 32%, pT3b 6%. With Gleason of: 3+3 in 26%, 3+4 in 14%, 4+3 in 47%, 4+4 in 9%, 4+5 in 3%. We obtained 29% of positive margins (50% pT3a, 20% pT3b, 20% pT2b, 10% pT2c). Four cases were converted to open surgery, one due to subcutaneous emphysema, one to enlarged surgical time, one bleeding, and one rectal injury. The continence (0-1 pads) at the first month was 62%, reaching 84% at 6 months. The erection, remained in 50% of the patients at the first month, in the four cases of intrafascial dissection. Laparoscopic radical prostatectomy is a technique of difficult learning, and initially requires higher surgical time than open surgery. Nevertheless, we prove that it is a reliable technique with competitive oncological and functional results, early

  17. Robotic Surgical System for Radical Prostatectomy: A Health Technology Assessment

    PubMed Central

    Wang, Myra; Xie, Xuanqian; Wells, David; Higgins, Caroline

    2017-01-01

    Background Prostate cancer is the second most common type of cancer in Canadian men. Radical prostatectomy is one of the treatment options available, and involves removing the prostate gland and surrounding tissues. In recent years, surgeons have begun to use robot-assisted radical prostatectomy more frequently. We aimed to determine the clinical benefits and harms of the robotic surgical system for radical prostatectomy (robot-assisted radical prostatectomy) compared with the open and laparoscopic surgical methods. We also assessed the cost-effectiveness of robot-assisted versus open radical prostatectomy in patients with clinically localized prostate cancer in Ontario. Methods We performed a literature search and included prospective comparative studies that examined robot-assisted versus open or laparoscopic radical prostatectomy for prostate cancer. The outcomes of interest were perioperative, functional, and oncological. The quality of the body of evidence was examined according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group criteria. We also conducted a cost–utility analysis with a 1-year time horizon. The potential long-term benefits of robot-assisted radical prostatectomy for functional and oncological outcomes were also evaluated in a 10-year Markov model in scenario analyses. In addition, we conducted a budget impact analysis to estimate the additional costs to the provincial budget if the adoption of robot-assisted radical prostatectomy were to increase in the next 5 years. A needs assessment determined that the published literature on patient perspectives was relatively well developed, and that direct patient engagement would add relatively little new information. Results Compared with the open approach, we found robot-assisted radical prostatectomy reduced length of stay and blood loss (moderate quality evidence) but had no difference or inconclusive results for functional and oncological outcomes

  18. A comparative analysis of primary and secondary Gleason pattern predictive ability for positive surgical margins after radical prostatectomy.

    PubMed

    Sfoungaristos, S; Kavouras, A; Kanatas, P; Polimeros, N; Perimenis, P

    2011-01-01

    To compare the predictive ability of primary and secondary Gleason pattern for positive surgical margins in patients with clinically localized prostate cancer and a preoperative Gleason score ≤ 6. A retrospective analysis of the medical records of patients undergone a radical prostatectomy between January 2005 and October 2010 was conducted. Patients' age, prostate volume, preoperative PSA, biopsy Gleason score, the 1st and 2nd Gleason pattern were entered a univariate and multivariate analysis. The 1st and 2nd pattern were tested for their ability to predict positive surgical margins using receiver operating characteristic curves. Positive surgical margins were noticed in 56 cases (38.1%) out of 147 studied patients. The 2nd pattern was significantly greater in those with positive surgical margins while the 1st pattern was not significantly different between the 2 groups of patients. ROC analysis revealed that area under the curve was 0.53 (p=0.538) for the 1st pattern and 0.60 (p=0.048) for the 2nd pattern. Concerning the cases with PSA <10 ng/ml, it was also found that only the 2nd pattern had a predictive ability (p=0.050). When multiple logistic regression analysis was conducted it was found that the 2nd pattern was the only independent predictor. The second Gleason pattern was found to be of higher value than the 1st one for the prediction of positive surgical margins in patients with preoperative Gleason score ≤ 6 and this should be considered especially when a neurovascular bundle sparing radical prostatectomy is planned, in order not to harm the oncological outcome.

  19. Orgasmic Dysfunction after Radical Prostatectomy

    PubMed Central

    Ventimiglia, Eugenio; Cazzaniga, Walter; Montorsi, Francesco; Salonia, Andrea

    2017-01-01

    In addition to urinary incontinence and erectile dysfunction, several other impairments of sexual function potentially occurring after radical prostatectomy (RP) have been described; as a whole, these less frequently assessed disorders are referred to as neglected side effects. In particular, orgasmic dysfunctions (ODs) have been reported in a non-negligible number of cases, with detrimental impacts on patients' overall sexual life. This review aimed to comprehensively discuss the prevalence and physiopathology of post-RP ODs, as well as potential treatment options. Orgasm-associated incontinence (climacturia) has been reported to occur in between 20% and 93% of patients after RP. Similarly, up to 19% of patients complain of postoperative orgasm-associated pain, mainly referred pain at the level of the penis. Moreover, impairment in the sensation of orgasm or even complete anorgasmia has been reported in 33% to 77% of patients after surgery. Clinical and surgical factors including age, the use of a nerve-sparing technique, and robotic surgery have been variably associated with the risk of ODs after RP, although robust and reliable data allowing for a proper estimation of the risk of postoperative orgasmic function impairment are still lacking. Likewise, little evidence regarding the management of postoperative ODs is currently available. In general, physicians should be aware of the prevalence of ODs after RP, in order to properly counsel all patients both preoperatively and immediately post-RP about the potential occurrence of bothersome and distressful changes in their overall sexual function. PMID:28459142

  20. Erectile preservation following radical prostatectomy

    PubMed Central

    Segal, Robert; Burnett, Arthur L.

    2011-01-01

    Prostate cancer is the most common cancer among men, representing approximately 25% of all new cancer diagnoses in the USA. For clinically localized prostate cancer, the gold standard for therapy remains radical prostatectomy. One of the main adverse effects of this procedure is erectile dysfunction, which can have a significant impact on the patient’s quality of life. There are several mechanisms of erectile dysfunction postprostatectomy, including arteriogenic, venogenic and neurogenic types, as well as the potentially heightened risk of postprostatectomy patients to develop Peyronie’s disease. The purpose of this review is to explain the various treatment options available, including phosphodiesterase type 5 inhibitors, intracavernosal injections, intraurethral alprostadil suppositories, vacuum erection devices, and penile prostheses. The role of these therapies in an erectile-dysfunction-treatment function, as well as in penile rehabilitation, will be discussed. Finally, a review of research on novel therapies will also be presented. A comprehensive literature review was performed using the PubMed database. Articles were chosen based on topical relevance and assessed for methodology and major findings. There are data to support the use of each of the therapeutic options in both treatment and rehabilitative roles. More study is needed, however, specifically in regard to penile rehabilitation, to confirm its benefits, as well as to determine optimal rehabilitation protocols. PMID:21789097

  1. Erectile preservation following radical prostatectomy.

    PubMed

    Segal, Robert; Burnett, Arthur L

    2011-02-01

    Prostate cancer is the most common cancer among men, representing approximately 25% of all new cancer diagnoses in the USA. For clinically localized prostate cancer, the gold standard for therapy remains radical prostatectomy. One of the main adverse effects of this procedure is erectile dysfunction, which can have a significant impact on the patient's quality of life. There are several mechanisms of erectile dysfunction postprostatectomy, including arteriogenic, venogenic and neurogenic types, as well as the potentially heightened risk of postprostatectomy patients to develop Peyronie's disease. The purpose of this review is to explain the various treatment options available, including phosphodiesterase type 5 inhibitors, intracavernosal injections, intraurethral alprostadil suppositories, vacuum erection devices, and penile prostheses. The role of these therapies in an erectile-dysfunction-treatment function, as well as in penile rehabilitation, will be discussed. Finally, a review of research on novel therapies will also be presented. A comprehensive literature review was performed using the PubMed database. Articles were chosen based on topical relevance and assessed for methodology and major findings. There are data to support the use of each of the therapeutic options in both treatment and rehabilitative roles. More study is needed, however, specifically in regard to penile rehabilitation, to confirm its benefits, as well as to determine optimal rehabilitation protocols.

  2. Improving postoperative radiotherapy following radical prostatectomy.

    PubMed

    Lipman, D; Pieters, B R; De Reijke, Theo M

    2017-10-01

    Prostate cancer has one of the highest incidences in the world, with good curative treatment options like radiotherapy and radical prostatectomy. Unfortunately, about 30% of the patients initially treated with curative intent will develop a recurrence and need adjuvant treatment. Five randomized trials covered the role of postoperative radiotherapy after radical prostatectomy, but there is still a lot of debate about which patients should receive postoperative radiotherapy. Areas covered: This review will give an overview on the available literature concerning post-operative radiotherapy following radical prostatectomy with an emphasis on the five randomized trials. Also, new imaging techniques like prostate-specific membrane antigen positron emission tomography (PSMA-PET) and multiparametric magnetic resonance imaging (mp-MRI) and the development of biomarkers like genomic classifiers will be discussed in the search for an improved selection of patients who will benefit from postoperative radiotherapy following radical prostatectomy. With new treatment techniques like Intensity Modulated Radiotherapy, toxicity profiles will be kept low. Expert commentary: Patients with biochemical recurrence following radical prostatectomy with an early rise in prostate-specific antigen (PSA) will benefit most from postoperative radiotherapy. In this way, patients with only high risk pathological features can avoid unnecessary treatment and toxicity, and early intervention in progressing patients would not compromise the outcome.

  3. Day case laparoscopic radical prostatectomy.

    PubMed

    Abboudi, Hamid; Doyle, Patrick; Winkler, Mathias

    2017-10-03

    To evaluate the feasibility of performing laparoscopic radical prostatectomy (LRP) as a day case procedure while maintaining patient satisfaction and safety. Herein we report our experience, selection criteria, and discharge criteria for day case LRP. We performed a prospective study with 32 patients undergoing extraperitoneal LRP. These patients were counselled before the procedure that they would go home the same evening of the procedure. Pain scores and quality of life data were recorded day 1 postoperatively via a telephone consultation. The patients underwent routine blood tests on day 2 and an outpatient review on day 7 and regularly thereafter via an assigned key worker. Socio-demographic data, comorbidities, and outcomes were collected for analysis. All patients were successfully discharged the same day of surgery. Mean patient age was 62 years with a mean body mass index of 25. Mean operative time was 147 minutes, and estimated blood loss was 101 ml. Three patients were treated for post operative urinary tract infections; two patients developed infected lymphoceles which required percutaneous drainage and one patient required re-catheterisation due to a burst catheter balloon. Of these six complications four patients required re-admission. Post-operative pain, nausea and vomiting were low whilst patient satisfaction scores were unanimously high in all patients surveyed. The early experience with extraperitoneal LRP as a same day surgery is promising although patients who are at high risk of lymphocele should be excluded. Preoperative patient counselling and selection is paramount. Patient satisfaction is not adversely affected by the shortened stay. Surgeon experience, a well-motivated patient, meticulous attention to detail through an integrated pathway, a multidisciplinary team and adequate postoperative assessment are essential.

  4. [Radical prostatectomy--100 years of evolution].

    PubMed

    Gofrit, Ofer N; Shalhav, Arieh L

    2008-07-01

    Prostate cancer is the most common malignant disease in men. The incidence of prostate cancer has been rising since the early 1990s. Not all men inflicted by prostate cancer will develop clinical disease. Therefore, sorting these cases is a great clinical challenge. Radical prostatectomy has undergone evolution in the last 100 years. Better understanding of the pelvic anatomy has led to a decrease in the blood loss during surgery and in the rate of urinary incontinence and erectile dysfunction following surgery. The introduction of laparoscopy in the late 1990s to this surgery provided the surgeon with a magnified multi-angle field of view and facilitated accurate dissection and suturing. Decreased damage to neighboring tissue made recovery hastier. Nevertheless, laparoscopic radical prostatectomy is a technically challenging surgery and did not become popular. The last step in the evolution of radical prostatectomy is the introduction of robotic systems for assistance in laparoscopic radical prostatectomy. A master-slave robotic system is composed of console and mechanical arms. The surgeon is provided with a magnified three dimensional view of the operative field and with two mechanical arms that accurately replicate its fingers movements. The initial results of robotic-assisted laparoscopic prostatectomy seem promising, however, long-term follow-up and comparison to open surgeries are lacking. Robotic systems were rapidly implemented in the American market and in the year 2006, 40% of all radical prostatectomies were robotic assisted. Future systems may reveal deep structures to the visualized surface by superimposing MRI images on the surgical field.

  5. Comparative investigation on clinical outcomes of robot-assisted radical prostatectomy between experienced open prostatic surgeons and novice open surgeons in a laparoscopically naïve center with a limited caseload.

    PubMed

    Sumitomo, Makoto; Kanao, Kent; Kato, Yoshiharu; Yoshizawa, Takahiko; Watanabe, Masahito; Zennami, Kenji; Nakamura, Kogenta

    2015-05-01

    To compare perioperative, oncological and functional outcomes of robot-assisted radical prostatectomy between experienced and novice open radical prostatectomy surgeons in a laparoscopically naïve center with a limited caseload. Six surgeons carried out robot-assisted radical prostatectomy in 154 patients, which were divided into the following three groups: group 1 (n = 90), including patients operated on by a surgeon with experience in both open radical prostatectomy and robot-assisted radical prostatectomy; group 2 (n = 36), including patients operated on by two surgeons with experience in open radical prostatectomy only; and group 3 (n = 28), including patients operated on by three surgeons with limited experience in both open radical prostatectomy or robot-assisted radical prostatectomy. Groups 2 and 3 did not differ significantly in their median values of external blood loss (P = 0.165) or console time (P = 0.103). Positive surgical margin rates for pT2 patients were also similar in these two groups: 21.2% (7/33) in group 2 and 22.7% (5/22) in group 3 (P = 0.894). Kaplan-Meier analysis showed that 12 months after robot-assisted radical prostatectomy the prostate-specific antigen-free rate for pT2 patients was 96.0% in group 2 and 100% in group 3, but the pad-free continence rate was just 91.0% in group 1, 88.0% in group 2 and 75.5% in group 3 (group 1 vs group 3, P = 0.037; group 2 vs group 3, P = 0.239). The major complication rate after robot-assisted radical prostatectomy was 3.3% (3/90) in group 1, 11.1% (4/36) in group 2 and 17.9% (5/28) in group 3 (group 1 vs group 3, P = 0.008; group 2 vs group 3; P = 0.441). Robot-assisted radical prostatectomy offers satisfactory postoperative outcomes even when carried out by surgeons with limited experience in open radical prostatectomy. © 2015 The Japanese Urological Association.

  6. Combined radical retropubic prostatectomy and rectal resection.

    PubMed

    Klee, L W; Grmoljez, P

    1999-10-01

    To present our experience with a small series of men who underwent simultaneous radical retropubic prostatectomy and rectal resection. Three men with newly diagnosed prostate cancer were found to have concurrent rectal tumors requiring resection. All three men underwent non-nerve-sparing radical retropubic prostatectomy and abdominoperineal resection (APR) or low anterior resection (LAR) of the rectum at the same operation. In the 2 patients undergoing APR, the levators were approximated posterior to the urethra, and the bladder was secured to the pubis. The patient undergoing LAR had urinary diversion stents placed and a diverting transverse loop colostomy. All 3 patients had excellent return of urinary continence. One patient required reoperation in the early postoperative period for small bowel adhesiolysis and stoma revision. Another patient had a mild rectal anastomotic stricture and a bladder neck stricture; both were successfully treated with a single dilation. No other significant complications occurred in these patients. Radical retropubic prostatectomy can safely be performed with partial or complete rectal resection in a single operation. A few minor modifications of the standard radical retropubic prostatectomy in this setting are suggested.

  7. A comparative study of radical prostatectomy and permanent seed brachytherapy for low- and intermediate-risk prostate cancer

    PubMed Central

    Taussky, Daniel; Ouellet, Véronique; Delouya, Guila; Saad, Fred

    2016-01-01

    Introduction: We sought to compare the outcomes between radical prostatectomy (RP) and permanent seed prostate brachytherapy (PB) in patients with low- and low-intermediate-risk prostate cancer from a single tertiary care centre. Methods: Patients were selected from our institute’s internal database based on preoperative selection criteria from the National Comprehensive Cancer Network (NCCN) guidelines (2015) for low- and intermediate-risk patients. No patient had received any neo-adjuvant androgen-deprivation therapy. The endpoint was biochemical recurrence (BCR) or any salvage treatment for both RP and PB at 48 ± 4 months after treatment. The biochemical relapse threshold was set at prostate-specific antigen (PSA) ≥0.5 ng/mL for PB and two PSA values of ≥0.2 ng/mL for RP. Patients from both treatment groups were compared using non-parametric tests. A binary logistic regression analysis was performed to determine an association of treatment and pretreatment factors with a BCR at 48 months. Results: A total of 575 patients were included in this study; 254 were treated with RP and 321 with PB. BCR was not different between both groups (p=0.84, Chi-square test), and occurred in 21.2% of patients treated with RP and in 20.6% with PB. Based on univariate and multivariate logistic regression analyses, younger age, higher percentage of positive biopsies, and initial PSA were predictive of BCR. Treatment modality was not predictive in either univariate (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.64–1.44; p=0.84) or multivariate (OR 1.43, 95% CI 0.89–2.30; p=0.14) analyses. Conclusions: Using closely related cutoff values for BCR, both RP and PB did not have significantly different outcomes at four years post-treatment. A longer followup may be necessary to detect a difference between treatments. PMID:27878044

  8. Comparative Analysis of Partial Gland Ablation and Radical Prostatectomy to Treat Low and Intermediate Risk Prostate Cancer: Oncologic and Functional Outcomes.

    PubMed

    Garcia-Barreras, Silvia; Sanchez-Salas, Rafael; Sivaraman, Arjun; Barret, Eric; Secin, Fernando; Nunes-Silva, Igor; Linares-Espinós, Estefania; Rozet, François; Galiano, Marc; Cathelineau, Xavier

    2017-08-18

    We analyzed the oncologic and functional outcomes of partial gland ablation compared with robot-assisted radical prostatectomy in patients with low and intermediate risk prostate cancer. A total of 1,883 patients underwent robot-assisted radical prostatectomy and 373 underwent partial gland ablation from July 2009 to September 2015. We selected 1,458 of these participants for analysis, including 1,222 and 236 treated with robot-assisted radical prostatectomy and partial gland ablation, respectively. Patients had a Gleason score of 3 + 3 or 3 + 4, clinical stage T2b or less, prostate specific antigen 15 ng/dl or less, unilateral disease and life expectancy greater than 10 years. Propensity score matching analysis (1:2) was applied in the overall robot-assisted radical prostatectomy sample, which selected 472 patients for comparison. For partial gland ablation 188 men underwent high intensity focused ultrasound and 48 underwent cryotherapy. Oncologic outcomes were analyzed in terms of the need for salvage treatment. Partial gland ablation failure was defined as any positive control biopsy after treatment. Functional outcomes were assessed by validated questionnaires. Matching was successful across the 2 groups, although men treated with partial gland ablation were older (p <0.001). Mean followup in the partial gland ablation group was 38.44 months. Partial gland ablation failure was observed in 68 men (28.8%), including 53 (28.1%) treated with high intensity focused ultrasound and 15 (31.2%) treated with cryotherapy. Partial gland ablation was associated with a higher risk of salvage treatment (HR 6.06, p <0.001). Complications were comparable between the groups (p = 0.06). Robot-assisted radical prostatectomy was associated with less continence recovery and a lower potency rate 3, 6 and 12 months after surgery (p <0.001). In select patients with organ confined prostate cancer partial gland ablation offered good oncologic control with fewer adverse effects that

  9. Gum chewing promotes bowel motility after a radical retropubic prostatectomy.

    PubMed

    Choi, Hoon; Kim, Jae Heon; Park, Jae Young; Ham, Byeong Kuk; Shim, Ji sung; Bae, Jae Hyun

    2014-03-01

    To investigate the efficacy of gum chewing in aiding the recovery of bowel motility after a radical retropubic prostatectomy Thirty-seven patients who underwent retropubic radical prostatectomy from January 2010 to February 2012 for localized prostate cancer were enrolled. They were divided, in an alternate pattern, into the gum-chewing group and the control group. Patient demographics and operative outcomes were compared. The time to first postoperative passage of flatus and bowel movement, the duration of hospital stay and the side effects were recorded. The patients' demographics and operative outcomes showed no differences between the control (n = 19) and gum-chewing (n = 18) groups. The time to flatus was significantly shorter in the gum-chewing group than in the control group (27.1 vs 39.8 h), and the time-to-first bowel movement was faster in gum-chewing patients (46.1 vs 60.7 h). Surgical hospital stay was shorter in gum-chewing group than in the control group (5.1 vs 6.4 days). Gum chewing has a positive effect on the recovery of bowel motility and reduction of surgical hospital stay after a radical prostatectomy. Although retropubic radical prostatectomy does not involve bowel manipulation, gum chewing is an effective and side-effect-free method for the resolution of ileus after surgery. © 2013 Wiley Publishing Asia Pty Ltd.

  10. Radical prostatectomy in oligometastatic prostate cancer.

    PubMed

    Mandel, Philipp; Steuber, Thomas; Graefen, Markus

    2017-08-18

    Although cytoreductive surgery is accompanied with prolonged survival in many other malignancies in a metastatic stage, its role in oligometastatic prostate cancer is unclear. Radical prostatectomy (RP) in patients with oligometastatic prostate cancer seems to be feasible. Perioperative complication rates vary between 20 and 50% (Clavien 1-3) and are comparable to patients with locally advanced tumors. Postoperative functional outcomes (urinary continence and erectile function) can be slightly worse than in patients with locally advanced tumor. In literature, an oncological benefit of surgery is so far only described for retrospective multiinstitutional databases and a case-control study but not for prospective studies. Still, men undergoing RP clearly seem to develop severe local complications less frequently than patients receiving best systemic therapy (up to more than 50% versus less than10%). Patients should be counseled about the potential significant reduction of local complications whenever undergoing RP for oligometastatic prostate cancer. Nevertheless, as complication rates are relatively high, functional outcome can be slightly worse compared with RP with curative intent and especially as oncological benefit so far is shown using retrospective but not prospective data, patients should only undergo surgery within the ongoing prospective, randomized trials.

  11. Lymphatic vessel density in radical prostatectomy specimens.

    PubMed

    Cheng, Liang; Bishop, Elena; Zhou, Honghong; Maclennan, Gregory T; Lopez-Beltran, Antonio; Zhang, Shaobo; Badve, Sunil; Baldridge, Lee Ann; Montironi, Rodolfo

    2008-04-01

    Formation of new lymphatic channels, or lymphangiogenesis, has been associated with poor prognosis in a number of human cancers. Its prognostic significance in prostate cancer is uncertain. We analyzed 122 radical prostatectomy specimens. Immunohistochemistry for lymphatic vessels was performed using a mouse monoclonal antibody reactive with an O-linked sialoglycoprotein found on lymphatic endothelium (clone D2-40, Signet Laboratories, Dedham, Mass). The mean lymphatic vessel densities (LVDs) of the 3 prostate compartments were compared. Lymphatic vessel densities were correlated with other clinical and pathologic characteristics. Mean values for intratumoral, peritumoral, and normal prostate LVD were 3.0, 5.2, and 4.8 lymphatic vessels per 200x field, respectively. The intratumoral LVD was significantly lower than the peritumoral or normal LVD (P < .001), and the LVD of the latter 2 compartments was not significantly different (P = .29). The prostate LVD did not correlate with other clinical and pathologic parameters. In conclusion, LVD is reduced in the intratumoral compartment compared with the peritumoral and normal prostate compartments, whereas the latter 2 have similar LVD. In contrast to other malignancies, quantitation of lymphangiogenesis in prostatic adenocarcinoma does not appear to offer useful prognostic information.

  12. Robotic radical prostatectomy: The new gold standard

    PubMed Central

    Chopra, Sameer; Srivastava, Abhishek; Tewari, Ashutosh

    2012-01-01

    Objectives Open radical prostatectomy (RP) has been the standard and primary treatment for focal prostate cancer. However, in recent years this view has changed, as robot-assisted laparoscopic RP has gained acceptance among urologists. In this review we evaluate the importance and place of robotics in laparoscopic urological surgery, discussing several techniques that are currently being used and potentially new techniques that might be used in the future. Methods We systematically reviewed papers published between 1998 and 2011 using the keywords ‘robotic prostatectomy’ ‘gold standard’ and the Medline database. In addition, after selecting relevant reports we searched ‘related citations’ of the documents to find further supporting published papers. Results In all, 50 original papers were identified using the search criteria; we also found 28 through ‘related citations’ browsing. Papers were selected according to their relevance to the current topic (i.e. RP, original articles) and incorporated into this review. These papers were used for their information on the advantages of using robotics, as well as innovative ideas being used in the field of robotic urological surgery. Conclusion Almost a decade after the first robotic RP many reports show the benefits and advantages of incorporating robotics into urological surgery. Robotic surgery decreases the learning curve necessary for surgeons when compared with laparoscopic techniques. In addition, patients prefer robotics, as the procedure is less invasive, diminishes the duration of hospitalisation and speeds the return to function. PMID:26558001

  13. Comparison of Acute Kidney Injury After Robot-Assisted Laparoscopic Radical Prostatectomy Versus Retropubic Radical Prostatectomy

    PubMed Central

    Joo, Eun-Young; Moon, Yeon-Jin; Yoon, Syn-Hae; Chin, Ji-Hyun; Hwang, Jai-Hyun; Kim, Young-Kug

    2016-01-01

    Abstract Acute kidney injury (AKI) is associated with extended hospital stay, a high risk of progressive chronic kidney diseases, and increased mortality. Patients undergoing radical prostatectomy are at increased risk of AKI because of intraoperative bleeding, obstructive uropathy, older age, and preexisting chronic kidney disease. In particular, robot-assisted laparoscopic radical prostatectomy (RALP), which is in increasing demand as an alternative surgical option for retropubic radical prostatectomy (RRP), is associated with postoperative renal dysfunction because pneumoperitoneum during RALP can decrease cardiac output and renal perfusion. The objective of this study was to compare the incidence of postoperative AKI between RRP and RALP. We included 1340 patients who underwent RRP (n = 370) or RALP (n = 970) between 2013 and 2014. Demographics, cancer-related data, and perioperative laboratory data were evaluated. Postoperative AKI was determined according to the Kidney Disease: Improving Global Outcomes criteria. Operation and anesthesia time, estimated blood loss, amounts of administered fluids and transfused packed red blood cells, and the lengths of the postoperative intensive care unit and hospital stays were evaluated. Propensity score matching analysis was performed to reduce the influence of possible confounding variables and adjust for intergroup differences between the RRP and RALP groups. After performing 1:1 propensity score matching, the RRP and RALP groups included 307 patients, respectively. The operation time and anesthesia time in RALP were significantly longer than in the RRP group (both P < 0.001). However, the estimated blood loss and amount of administered fluids in RALP were significantly lower than in RRP (both P < 0.001). Also, RALP demonstrated a significantly lower incidence of transfusion and smaller amount of transfused packed red blood cells than RRP (both P < 0.001). Importantly, the incidence of AKI in RALP

  14. Bilateral nerve sparing robotic-assisted radical prostatectomy is associated with faster continence recovery but not with erectile function recovery compared with retropubic open prostatectomy: the need for accurate selection of patients.

    PubMed

    Ludovico, Giuseppe Mario; Dachille, Giuseppe; Pagliarulo, Giovanni; D'Elia, Carolina; Mondaini, Nicola; Gacci, Mauro; Detti, Beatrice; Malossini, Gianni; Bartoletti, Riccardo; Cai, Tommaso

    2013-06-01

    Robotic-assisted radical prostatectomy (RARP) shows measurable advantages, compared to conventional open surgery, even if some aspects are, still, under debate. The aim of this study was to compare the potency recovery rate of patients with clinically localised prostate cancer treated by bilateral nerve-sparing (BNS) RARP or retropubic radical prostatectomy (RRP), and secondarily, the urinary continence recovery evaluation and the oncological efficacy. All patients treated with BNS-RARP or BNS-RRP for clinically localised prostate cancer, performed by a single dedicated surgeon, between January 2004 and December 2008, were enrolled in this non-randomised prospective comparative study. The International Index of Erectile Function (IIEF) and erection hardness score (EHS), in the form of a questionnaire, were self-administered to each patient pre-operatively and after 12 months. The presence of surgical margins was considered as oncological outcome measure. Eighty-two patients underwent BNS-RARP while 48 underwent BNS-RRP. For BNS-RARP and BNS-RRP the median operative time was 221 and 103 min, respectively (P<0.001; df=128; t=721.43),and intra-operative blood loss was 280 and 565 ml, respectively (P<0.001; df=128; t=1742.44). At a mean follow-up period of 12.4±2.3 months, 12 patients (25%) in the BNS-RRP group and 22 (26.8%) in the BNS-RARP group were considered potent with or without drugs (P=0.81). Moreover, we did not find any statistically significant difference between the 2 groups in terms of IEFF and EHS scores after treatment (17.21 vs. 16.98; P=0.16 and 2.1 vs. 2.0; P=0.54). On the other hand, statistically significant differences between the 2 groups were found in terms of faster urinary continence recovery and the presence of positive surgical margins (P<0.001, P=0.009). Shorter catheterization duration (7 vs. 3 days) and post-operative hospital stays (8 vs. 4 days; P<0.001) were found in the BNS-RARP group compared to the BNS

  15. [Detrusor underactivity following laparoscopic radical prostatectomy].

    PubMed

    Ishida, Yoko; Matsukawa, Yoshihisa; Komatsu, Tomonori; Yoshikawa, Yoko; Hattori, Ryohei; Goton, Momokazu

    2008-04-01

    Strain voiding has been reported to be a frequent symptom following radical prostatectomy. However, pathophysiology of vesicourethral function underlying voiding difficulty has not been well studied. In the present study, we investigated detrusor underactivity following radical prostatectomy. The records on urodynamic study (pressure-flow study, urethral pressure profile) were retrospectively investigated in 80 patients undergoing laparoscopic radical prostatectomy and all urodynamic studies pre- and post-operatively. We extracted the cases with detrusor underactivity according to the criteria of overt strain voiding pattern on post-operative pressure flow study; detrusor pressure at the maximum flow rate (Pdet Q(max)) of less than 10 cmH2O in conjunction with an increase of abdominal pressure. Of the 80 patients, 6 (7.5%) were found to have detrusor underactivity. In all patients, good detrusor contraction was confirmed on the pre-operative urodynamic study performed before surgery. On the voiding phase of pressure-flow study in these patients, mean Pdet Q(max) showed a significant decrease postoperatively from 58.5 cmH2O to 3.0 cmH2O (p < 0.01), although mean abdominal pressure at Q(max) significantly increased from 24.2 cmH2O to 105.8 cmH2O (p < 0.05). Mean Q(max) on free uroflowmetry showed a significant increase from 12.8 ml/sec to 22.1 ml/sec (p < 0.05). No patient had significant post-void residual urine. On the storage phase of the study, however, maximum cystometric capacity, maximum urethral closing pressure showed no significant change between pre- and post-operative studies. Five patients acquired continence and one had mild urinary incontinence using one pad a day. The present study showed that detrusor contaractility could be impaired during radical prostatectomy, but, no apparent operative procedure related to detrusor dysfunction could be identified in the present patients.

  16. Risk of Small Bowel Obstruction After Robot-Assisted vs Open Radical Prostatectomy.

    PubMed

    Loeb, Stacy; Meyer, Christian P; Krasnova, Anna; Curnyn, Caitlin; Reznor, Gally; Kibel, Adam S; Lepor, Herbert; Trinh, Quoc-Dien

    2016-12-01

    Whereas open radical prostatectomy is performed extraperitoneally, minimally invasive radical prostatectomy is typically performed within the peritoneal cavity. Our objective was to determine whether minimally invasive radical prostatectomy is associated with an increased risk of small bowel obstruction compared with open radical prostatectomy. In the U.S. Surveillance, Epidemiology and End Results (SEER)-Medicare database, we identified 14,147 men found to have prostate cancer from 2000 to 2008 treated by open (n = 10,954) or minimally invasive (n = 3193) radical prostatectomy. Multivariable Cox proportional hazard models were used to examine the impact of surgical approach on the diagnosis of small bowel obstruction, as well as the need for lysis of adhesions and exploratory laparotomy. During a median follow-up of 45 and 76 months, respectively, the cumulative incidence of small bowel obstruction was 3.7% for minimally invasive and 5.3% for open radical prostatectomy (p = 0.0005). Lysis of adhesions occurred in 1.1% of minimally invasive and 2.0% of open prostatectomy patients (p = 0.0003). On multivariable analysis, there was no significant difference between minimally invasive and open prostatectomy with respect to small bowel obstruction (HR 1.17, 95% CI 0.90, 1.52, p = 0.25) or lysis of adhesions (HR 0.87, 95% CI 0.50, 1.40, p = 0.57). Limitations of the study include the retrospective design and use of administrative claims data. Relative to open radical prostatectomy, minimally invasive radical prostatectomy is not associated with an increased risk of postoperative small bowel obstruction and lysis of adhesions.

  17. Single port radical prostatectomy: current status.

    PubMed

    Martín, Oscar Darío; Azhar, Raed A; Clavijo, Rafael; Gidelman, Camilo; Medina, Luis; Troche, Nelson Ramirez; Brunacci, Leonardo; Sotelo, René

    2016-06-01

    The aim of this study is to analyze the current literature on single port radical prostatectomy (LESS-RP). Single port radical prostatectomy laparoendoscopic (LESS-RP) has established itself as a challenge for urological community, starting with the proposal of different approaches: extraperitoneal, transperitoneal and transvesical, initially described for laparoscopy and then laparoscopy robot-assisted. In order to improve the LESS-RP, new instruments, optical devices, trocars and retraction mechanisms have been developed. Advantages and disadvantages of LESS-RP are controversial, while some claim that it is a non-trustable approach, regarding the low cases number and technical difficulties, others acclaim that despite this facts some advantages have been shown and that previous described difficulties are being overcome, proving this is novel proposal of robotics platform, the Da Vinci SP, integrating the system into "Y". The LESS-RP approach gives us a new horizon and opens the door for rapid standardization of this technique. The few studies and short series available can be result of a low interest in the application of LESS-RP in prostate, probably because of the technical complexity that it requires. The new robotic platform, the da Vinci SP, shows that it is clear that the long awaited evolution of robotic technologies for laparoscopy has begun, and we must not lose this momentum.

  18. Outcomes of robotic assisted radical prostatectomy.

    PubMed

    Dasgupta, Prokar; Kirby, Roger S

    2009-03-01

    Robot-assisted radical prostatectomy (RARP) is a rapidly evolving technique for the treatment of localized prostate cancer. However, cynics point to the increasing role of market forces in the robotic revolution. As yet, Europe has not taken up RARP in large numbers and this may in part relate to the high level of expertise in laparoscopy previously gained. Furthermore, setting up a robotic program is a major undertaking for many surgical units. This article reviews the current literature on RARP with regard to oncologic, continence and potency outcomes - the so called 'trifecta'. Preliminary data appears to show an advantage of RARP over open prostatectomy with reduced blood loss, decreased pain, early mobilization, shorter hospital stay and lower margin rates. Most intra-institutional studies demonstrate good postoperative continence and potency with RARP; however this needs to be viewed in the context of a paucity of randomized data available in the literature. There is no definitive data to show an advantage over standard laparoscopy, but the fact that this technique has reached parity with laparoscopy within 5 years is encouraging.

  19. Robotic radical prostatectomy: present and future.

    PubMed

    Bianco, Fernando J

    2011-10-01

    The last 10 years have witnessed unprecedented evolution regarding de surgical removal of the prostate gland. Laparoscopic radical prostatectomy broke the open paradigm and started to generate great excitement and expectations. Shortly however, robot-assisted, laparoscopic - Robotic Surgery - emerged to address a fundamental pitfall of prostate laparoscopic surgery: execution reproducibility. Today, robotic assisted laparoscopic prostatectomy is the most used surgical approach to remove the prostate gland. Consistent advantages of this technique are: a shorter convalescent state, marked decrease in blood loss and in experienced hands, shorter average surgical times. Importantly it served to highlight the importance of outcomes as ultimate judge of a procedure success. The data suggest equivalency in long-term functional and oncological outcomes, while clear advantages in the short run: perioperative outcomes with patient rapid return to productive state. That said, the major challenge for robotic surgeons still remains: establish a paradigm that breaks with the tradition and prevents biased reporting due to technology and marketing enthusiasm, but rather takes a critical approach based in prospective, controlled, randomize clinical trials. If the latter objective is reached, urologic robotic surgeons will deliver counseling based on clinical evidence delivering major progress for our Urology field.

  20. Level of education and mortality after radical prostatectomy

    PubMed Central

    Froehner, Michael; Koch, Rainer; Propping, Stefan; Liebeheim, Dorothea; Hübler, Matthias; Baretton, Gustavo B; Hakenberg, Oliver W; Wirth, Manfred P

    2017-01-01

    Estimating the risk of competing mortality is of importance in men with early prostate cancer to choose the most appropriate way of management and to avoid over- or under-treatment. In this study, we investigated the impact of the level of education in this context. The study sample consisted of 2630 patients with complete data on level of education (college, university degree, master craftsmen, comparable profession, or others), histopathological tumor stage (organ confined or extracapsular), lymph node status (negative or positive), and prostatectomy specimen Gleason score (<7, 7, or 8–10) who underwent radical prostatectomy between 1992 and 2007. Overall, prostate cancer-specific, competing, and second cancer-related mortalities were study endpoints. Cox proportional hazard models for competing risks were used to study combined effects of the variables on these endpoints. A higher level of education was independently associated with decreased overall mortality after radical prostatectomy (hazard ratio [HR]: 0.75, 95% confidence interval [95% CI]: 0.62–0.91, P = 0.0037). The mortality difference was attributable to decreased second cancer mortality (HR: 0.59, 95% CI: 0.40–0.85, P = 0.0052) and noncancer mortality (HR: 0.73, 95% CI: 0.55–0.98, P = 0.0345) but not to differences in prostate cancer-specific mortality (HR: 1.16, 95% CI: 0.79–1.69, P = 0.4536 in the full model). In conclusion, the level of education might serve as an independent prognostic parameter supplementary to age, comorbidity, and smoking status to estimate the risk of competing mortality and to choose optimal treatment for men with early prostate cancer who are candidates for radical prostatectomy. PMID:28051039

  1. Level of education and mortality after radical prostatectomy.

    PubMed

    Froehner, Michael; Koch, Rainer; Propping, Stefan; Liebeheim, Dorothea; Hübler, Matthias; Baretton, Gustavo B; Hakenberg, Oliver W; Wirth, Manfred P

    2017-01-01

    Estimating the risk of competing mortality is of importance in men with early prostate cancer to choose the most appropriate way of management and to avoid over- or under-treatment. In this study, we investigated the impact of the level of education in this context. The study sample consisted of 2630 patients with complete data on level of education (college, university degree, master craftsmen, comparable profession, or others), histopathological tumor stage (organ confined or extracapsular), lymph node status (negative or positive), and prostatectomy specimen Gleason score (<7, 7, or 8-10) who underwent radical prostatectomy between 1992 and 2007. Overall, prostate cancer-specific, competing, and second cancer-related mortalities were study endpoints. Cox proportional hazard models for competing risks were used to study combined effects of the variables on these endpoints. A higher level of education was independently associated with decreased overall mortality after radical prostatectomy (hazard ratio [HR]: 0.75, 95% confidence interval [95% CI]: 0.62-0.91, P = 0.0037). The mortality difference was attributable to decreased second cancer mortality (HR: 0.59, 95% CI: 0.40-0.85, P = 0.0052) and noncancer mortality (HR: 0.73, 95% CI: 0.55-0.98, P = 0.0345) but not to differences in prostate cancer-specific mortality (HR: 1.16, 95% CI: 0.79-1.69, P = 0.4536 in the full model). In conclusion, the level of education might serve as an independent prognostic parameter supplementary to age, comorbidity, and smoking status to estimate the risk of competing mortality and to choose optimal treatment for men with early prostate cancer who are candidates for radical prostatectomy.

  2. Effect of Single Compared to Repeated Doses of Intravenous S(+) Ketamine on the Release of Pro-inflammatory Cytokines in Patients Undergoing Radical Prostatectomy.

    PubMed

    Ali, Hassan Mohamed; Mokhtar, Ali M

    2017-01-01

    Radical prostatectomy is a major surgical procedure that is associated with marked inflammatory response and impairment of the immune system which may affect the postoperative outcome. The aim of this study was to evaluate the effect of preincision single or multiple doses of S(+) ketamine on the pro-inflammatory cytokines, namely tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). This is a randomized controlled trial including 60 American Society of Anesthesiologists Physical Status I and II patients scheduled for radical prostatectomy under combined general-epidural anesthesia in Cairo university Teaching Hospital. Patients were randomly divided into three groups each of twenty patients: Group I received no S(+) ketamine (control group), Group II received S(+) ketamine as a single preincision dose, and Group III received preincision and repeated doses of S(+) ketamine. S(+) ketamine was injected as a single intravenous dose of 0.5 mg/kg in Group II and III, repeated as 0.2 mg/kg at 20 min interval until 30 min before the end of surgery. The three groups were comparable in age, weight, and duration of the operation. The study also revealed that a single preincision dose of S(+) ketamine decreased TNF-α to reach 1027.04 ± 50.13 μ/ml and IL-6 to reach 506.89 ± 25.35 pg/ml whereas the repeated doses of S(+) ketamine decreased TNF-α to reach 905.64 ± 35065 μ/ml and IL-6 to reach 412.79 ± 16.5 pg/ml (P < 0.05). S(+) ketamine suppresses pro-inflammatory cytokine production, especially when given in repeated doses.

  3. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study.

    PubMed

    Yaxley, John W; Coughlin, Geoffrey D; Chambers, Suzanne K; Occhipinti, Stefano; Samaratunga, Hema; Zajdlewicz, Leah; Dunglison, Nigel; Carter, Rob; Williams, Scott; Payton, Diane J; Perry-Keene, Joanna; Lavin, Martin F; Gardiner, Robert A

    2016-09-10

    The absence of trial data comparing robot-assisted laparoscopic prostatectomy and open radical retropubic prostatectomy is a crucial knowledge gap in uro-oncology. We aimed to compare these two approaches in terms of functional and oncological outcomes and report the early postoperative outcomes at 12 weeks. In this randomised controlled phase 3 study, men who had newly diagnosed clinically localised prostate cancer and who had chosen surgery as their treatment approach, were able to read and speak English, had no previous history of head injury, dementia, or psychiatric illness or no other concurrent cancer, had an estimated life expectancy of 10 years or more, and were aged between 35 years and 70 years were eligible and recruited from the Royal Brisbane and Women's Hospital (Brisbane, QLD). Participants were randomly assigned (1:1) to receive either robot-assisted laparoscopic prostatectomy or radical retropubic prostatectomy. Randomisation was computer generated and occurred in blocks of ten. This was an open trial; however, study investigators involved in data analysis were masked to each patient's condition. Further, a masked central pathologist reviewed the biopsy and radical prostatectomy specimens. Primary outcomes were urinary function (urinary domain of EPIC) and sexual function (sexual domain of EPIC and IIEF) at 6 weeks, 12 weeks, and 24 months and oncological outcome (positive surgical margin status and biochemical and imaging evidence of progression at 24 months). The trial was powered to assess health-related and domain-specific quality of life outcomes over 24 months. We report here the early outcomes at 6 weeks and 12 weeks. The per-protocol populations were included in the primary and safety analyses. This trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), number ACTRN12611000661976. Between Aug 23, 2010, and Nov 25, 2014, 326 men were enrolled, of whom 163 were randomly assigned to radical retropubic

  4. Radical Retropubic Prostatectomy: Comparison of the Open and Robotic Approaches for Treatment of Prostate Cancer

    PubMed Central

    Tosoian, Jeffrey J; Loeb, Stacy

    2012-01-01

    Radical prostatectomy represents the standard of care for surgical treatment of clinically localized prostate cancer. First described in 1904, the operation became widely performed only after advances in diagnostic and surgical techniques occurred later in the century. Over time, open retropubic radical prostatectomy (RRP) became the most common operation for prostate cancer, and excellent long-term survival outcomes have been reported. More recently, minimally invasive techniques such as the robotic-assisted laparoscopic radical prostatectomy (RALRP) were introduced. Despite a lack of prospectively collected, long-term data supporting its use, RALRP has overtaken RRP as the most frequently performed prostate cancer operation in the United States. This article uses currently available data to compare oncologic, functional, and quality-of-life outcomes associated with both the open and robotic approaches to radical prostatectomy. PMID:23172996

  5. Efficacy and safety of transurethral alprostadil in patients with erectile dysfunction following radical prostatectomy.

    PubMed

    Costabile, R A; Spevak, M; Fishman, I J; Govier, F E; Hellstrom, W J; Shabsigh, R; Nemo, K J; Rapport, J L; Tam, P Y; Weldon, K L; Gesundheit, N

    1998-10-01

    A retrospective analysis of the MUSE clinical trial was performed to evaluate the efficacy and safety of transurethral alprostadil in patients with erectile dysfunction after radical prostatectomy. Patients received doses of transurethral alprostadil in the clinic and those for whom a suitable dose was determined were treated at home with active drug or placebo for 3 months. Patients had undergone radical prostatectomy no less than 3 months before study entry. Of the 384 patients in whom radical prostatectomy was identified as a cause of erectile dysfunction 70.3% had an erection believed sufficient for intercourse in the clinic and 57.1% on active medication had sexual intercourse at least once at home. The product of clinic and home success rates (70.3 x 57.1%) was an overall success rate (the likelihood of active treatment to lead to intercourse at home) of 40.1%. The frequency of most adverse effects of radical prostatectomy was comparable to that of other organic etiologies of erectile dysfunction (1,127 patients). The percentage of patients with hypotension in the clinic was lower after radical prostatectomy compared to other erectile dysfunction etiologies (0.8 versus 4.2%, p < 0.001) but the percentage of patients with urethral pain/burning was higher (18.3 versus 10.4%, p = 0.027). No urinary tract infection, fibrosis or priapism occurred in the post-radical prostatectomy patients. Transurethral alprostadil is a well tolerated and efficacious method of treating erectile dysfunction after radical prostatectomy, although psychological changes associated with cancer and surgery may limit home response. The severe neurovascular deficit associated with prostatectomy neither limits the efficacy of transurethral alprostadil nor increases the risks.

  6. Comparative Oncologic and Toxicity Outcomes of Salvage Radical Prostatectomy Versus Nonsurgical Therapies for Radiorecurrent Prostate Cancer: A Meta-Regression Analysis.

    PubMed

    Philippou, Yiannis; Parker, Richard A; Volanis, Dimitrios; Gnanapragasam, Vincent J

    2016-06-01

    In the absence of randomised controlled trials comparing the oncologic, toxicity, and functional outcomes of salvage radical prostatectomy (SRP), salvage high-intensity focused ultrasound (SHIFU), salvage brachytherapy (SBT), and salvage cryotherapy (SCT), controversy exists as to the optimal salvage modality in radiorecurrent prostate cancer. We carried out a meta-regression analysis to determine whether there is a difference in oncologic, toxicity, and functional outcomes using data from original publications of salvage modalities in the postradiation setting. We performed a systematic review of PubMed/Medline citations according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. We included 63 articles in the analysis (25 on SRP, 8 on SHIFU, 16 on SCT, 14 on SBT). Median values of the following variables were extracted from each study: patient age, length of follow-up, prostate-specific antigen (PSA) before radiotherapy (RT), PSA before salvage therapy, Gleason score before RT, and time interval between RT and salvage therapy. Functional, toxicity, and oncologic outcomes were measured according to rates of impotence, incontinence, fistula formation, urethral strictures, and biochemical recurrence. Meta-regression adjusting for confounders found no significant difference in oncologic outcomes between SRP and nonsurgical salvage modalities. SBT, SCT, and SHIFU appeared to have better continence outcomes than SRP. No significant difference in toxicity outcomes between modalities was found, although limitations such as reporting, selection, and publication bias and between-study heterogeneity must also be considered with these conclusions. Oncologic outcomes are comparable for SRP and all three nonsurgical salvage modalities. We found no significant differences in toxicity outcomes among modalities; however, SRP appears to be associated with worse rates of urinary incontinence than SBT, SCT, and SHIFU. We performed a meta

  7. Peri-operative comparison between daVinci-assisted radical prostatectomy and open radical prostatectomy in obese patients

    NASA Astrophysics Data System (ADS)

    Le, Carter Q.; Ho, Khai-Linh V.; Slezak, Jeffrey M.; Blute, Michael L.; Gettman, Matthew T.

    2007-02-01

    Introduction: While the effects of increasing body mass index on prostate cancer epidemiology and surgical approach have recently been studied, its effects on surgical outcomes are less clear. We studied the perioperative outcomes of obese (BMI >= 30) men treated with daVinci-assisted laparoscopic radical prostatectomy (DLP) and compared them to those treated with open radical retropubic prostatectomy (RRP) in a contemporary time frame. Method: After Institutional Review Board approval, we used the Mayo Clinic Radical Prostatectomy database to identify patients who had undergone DLP by a single surgeon and those who had undergone open RRP by a single surgeon between December 2002 and March 2005. Baseline demographics, peri- and post-operative courses, and complications were collected by retrospective chart review, and variables from the two cohorts compared using chi-square method and least-squares method of linear regression where appropriate. Results: 59 patients who had DLP and 76 undergoing RRP were available for study. Baseline demographics were not statistically different between the two cohorts. Although DLP had a significantly lower clinical stage than RRP (p=0.02), pathological stage was not statistically different (p=0.10). Transfusion rates, hospital stay, overall complications, and pathological Gleason were also not significantly different, nor were PSA progression, positive margin rate, or continence at 1 year. After bilateral nerve-sparing, erections suitable for intercourse with or without therapy at 1 year was 88.5% (23/26) for DLP and 61.2% (30/49) for RRP (p=0.01). Follow-up time was similar. Conclusion: For obese patients, DLP appears to have similar perioperative, as well as short-term oncologic and functional outcomes when compared to open RRP.

  8. Consumerism and its impact on robotic-assisted radical prostatectomy.

    PubMed

    Alkhateeb, Sultan; Lawrentschuk, Nathan

    2011-12-01

    • Many experts consider that media coverage, marketing and/or direct-to-consumer advertising, particularly Internet-based forms, are fundamental to the widespread adoption of robotic-assisted prostatectomy (RARP). However, this has not been explored previously. • The primary objective of the present study was to delineate the role of media coverage and marketing of RARP on the Internet, whereas the secondary goal focused on website quality with respect to the presentation of prostatectomy. • Website content was evaluated for direct-to-consumer advertising after the retrieval of the first 50 websites using Google and Yahoo for each of the terms: 'robotic prostatectomy, laparoscopic prostatectomy (LP) and open radical prostatectomy (ORP)'. • A linear regression analysis was performed for the annual number of Internet news hits over the last decade for each procedure. Website quality assessment was performed using WHO Honesty on the Internet (HON) code principles. • Of the retrieved sites, the proportion containing direct-to-consumer advertising for RARP vs LP vs ORP using Google was 64% vs 14% vs 0%, respectively (P < 0.001) and, using Yahoo, 80% vs 16% vs 0%, respectively (P < 0.001). • In a linear regression analysis, the r(2) values for news hits for each year over the last 10 years were 0.89, 0.74 and 0.76 for RARP, LP and ORP, respectively. • Website quality assessment found that a minority of the websites were accredited with HONcode principles, with no difference between procedure types (P > 0.05). • Media coverage and marketing of RARP on the Internet is more widespread compared to LP and ORP. • Disturbingly, the quality of websites using any technique for prostatectomy was of poor quality when using principles of honest information presenting and such findings need to be discussed with respect to obtaining informed consent from patients. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

  9. Comprehensive approach for post-prostatectomy incontinence in the era of robot-assisted radical prostatectomy.

    PubMed

    Haga, Nobuhiro; Takinami, Ruriko; Tanji, Ryo; Onagi, Akifumi; Matsuoka, Kanako; Koguchi, Tomoyuki; Akaihata, Hidenori; Hata, Junya; Ogawa, Soichiro; Kataoka, Masao; Sato, Yuichi; Ishibashi, Kei; Aikawa, Ken; Kojima, Yoshiyuki

    2017-08-09

    Robot-assisted radical prostatectomy (RARP) has enabled steady and stable surgical procedures due to both meticulous maneuvers and magnified, clear, 3-dimensional vision. Therefore, better surgical outcomes have been expected with RARP than with other surgical modalities. However, even in the RARP era, post-prostatectomy incontinence has a relatively high incidence as a bothersome complication. To overcome post-prostatectomy incontinence, it goes without saying that meticulous surgical procedures and creative surgical procedures, i.e., "Preservation", "Reconstruction", and "Reinforcement" of the anatomical structures of the pelvis, are most important. In addition, medication and appropriate pad usage might sometimes be helpful for patients with post-prostatectomy incontinence. However, patients who have 1) BMI > 26 kg/m(2), 2) prostate volume > 70 mL, 3) eGFR < 60 mL/min, or a 4) Charlson comorbidity index > 2 have a tendency to develop post-prostatectomy incontinence despite undergoing the same surgical procedures. It is important for patients who have a high risk for post-prostatectomy incontinence to be given information about delayed recovery of post-prostatectomy incontinence. Thus, not only the surgical procedures, but also a comprehensive approach, as mentioned above, are important for post-prostatectomy incontinence.

  10. Urinary prostate specific antigen levels after radical prostatectomy.

    PubMed

    Takayama, T K; Vessella, R L; Brawer, M K; True, L D; Noteboom, J; Lange, P H

    1994-01-01

    It was recently demonstrated that urinary prostate specific antigen (PSA) is discordant with serum PSA in many patients after radical prostatectomy. This observation led to the speculation that elevated urinary PSA in the face of undetectable serum PSA may indicate early disease recurrence. We measured urinary PSA levels in 30 patients who had undergone radical prostatectomy for prostate carcinoma and 7 patients who had undergone cystoprostatectomy for bladder cancer. PSA levels of randomly collected urine samples ranged from 0.00 to 22.9 ng./ml. and 0.01 to 8.37 ng./ml., respectively. There was no correlation among urinary and serum PSA levels, pathological stage or type of operation. In 14 patients who had undergone radical prostatectomy and who had measurable levels of urinary PSA voided specimens were divided into initial stream and end stream voided samples. The PSA levels in the end stream voided samples were significantly less than the initial stream sample in 12 of the 14 patients. In men who had undergone radical prostatectomy urethral swab samples were analyzed for PSA. Of 26 patients 24 had detectable levels of urethral swab PSA (range 0.01 to 39.04 ng./ml., median 0.93 ng./ml.). Urethral swab PSA levels did not correlate with serum PSA values or pathological stage of disease. Of 7 patients who had defunctionalized urethras after radical cystoprostatectomy 5 had significantly elevated PSA in the urethral wash or swab samples (range 4.3 to 24.5 ng./ml.). Immunohistochemical analysis of urethrectomy specimens demonstrated positive staining for PSA in 3 of 4 specimens. We conclude that the major source of urinary PSA following total prostatectomy is the urethra itself rather than residual prostate tissue. Measuring serial urinary PSA appears to have limited value in monitoring patients after radical prostatectomy. Whether this urethral PSA can ever contaminate the serum levels of PSA after radical prostatectomy is currently under investigation.

  11. A prospective longitudinal study comparing a radical retropubic prostatectomy and permanent prostate brachytherapy regarding the health-related quality of life for localized prostate cancer.

    PubMed

    Hashine, Katsuyoshi; Kusuhara, Yoshito; Miura, Noriyoshi; Shirato, Akitomi; Sumiyoshi, Yoshiteru; Kataoka, Masaaki

    2008-07-01

    The health-related quality of life (HRQOL) after a radical retropubic prostatectomy (RRP) or a permanent prostate brachytherapy (PPB) was prospectively compared at a single institute. Between 2003 and 2005, 122 patients were treated by RRP and 82 patients were treated by PPB. A QOL survey was completed at baseline, and 1, 3, 6 and 12 months after treatment, prospectively. The general HRQOL was not different between the RRP and PPB groups after 3 months. However, at 1 month after treatment, the general HRQOL scores, except for general health, were significantly better in the PPB group than that in the RRP group. Moreover, the disease-specific QOL was worse in urinary and sexual functions in the RRP group. Urinary function in the RRP group had not recovered to baseline after 12 months. Although the urinary function in the PPB group was better than that of the RRP group, urinary bother continued to worsen until 6 months and thereafter it recovered gradually. The bowel function was not worse in the PPB group but bowel bother was worse at 6 months in the PPB group. In the RRP group, the patients with nerve sparing demonstrated better in sexual function than those without nerve sparing, but the recovery did not reach the level of the PPB group. This prospective study revealed the differences in the QOL after RRP and PPB. These results will be helpful for making treatment decisions.

  12. A prospective longitudinal study comparing the impact of external radiation therapy with radical prostatectomy on health related quality of life (HRQOL) in prostate cancer patients.

    PubMed

    van Andel, G; Visser, A P; Zwinderman, A H; Hulshof, M C C M; Horenblas, S; Kurth, K H

    2004-03-01

    The objective of the present study is to compare the impact on the general and disease-specific health related quality of life (HRQOL) of external radiation therapy (ERT) with radical prostatectomy (RP) in patients with localized prostate cancer, and to explore which factors, and to what extent, contribute to the assessed changes in HRQOL. One hundred and thirty eight patients participated in this prospective longitudinal study. They completed before treatment (T0) and after 12 months (T1) a questionnaire constructed of validated instruments, measuring HRQOL and several psychosocial factors (PF). Among other things, multiple regression analyses including all baseline characteristics, HRQOL and PF were executed in order to meet the objectives. RP patients showed significantly more improvement in their emotional function, while they reported more incontinence and a worse sexual function. There was significantly more improvement in the overall HRQOL of ERT patients, while the changes in the gastrointestinal function of these patients were significantly worse. Only the differences with respect to incontinence can be attributed to the treatment itself. Almost all HRQOL change scores are primarily influenced by their own baseline score. The influence of other factors, like age, socioeconomic status, and several PF, is limited. The impact on HRQOL of ERT is similar to that of RP, except for incontinence. RP patients suffer more from incontinence than ERT patients. Changes in the assessed HRQOL are mainly influenced by the pre-treatment HRQOL scores. Copyright 2003 Wiley-Liss, Inc.

  13. [Risk factors of ISUP Modified Gleason score upgrading after radical prostatectomy].

    PubMed

    Li, Xiao-dong; Qu, Gen-yi; Xu, Ning; Xue, Xue-yi; Wei, Yong; Zheng, Qing-shui; Li, Jun-feng; Cai, Hai; Lin, Yun-zhi

    2016-05-01

    To investigate the factors upgrading the International Society of Urological Pathology (ISUP) Gleason score using the specimens from preoperative prostatic biopsy and radical prostatectomy. A total of 164 patients diagnosed with prostate cancer by biopsy underwent radical prostatectomy. We retrospectively analyzed their age, prostate volume, preoperative PSA level, PSA density (PSAD) , the time interval between biopsy and surgery, the number of positive punctures, positive surgical margin, seminal vesicle invasion, lymphatic invasion, and Gleason scores from biopsy and prostatectomy. We also determined the predictors of Gleason score upgrading by logistic regression analysis. Of the 164 cases analyzed, 95 (57.93% ) showed a consistency between the Gleason score of preoperative prostatic biopsy and that after radical prostatectomy, 55 (33.54% ) increased and 14 (8.52%) decreased after prostatectomy as compared with preoperative biopsy. The prostate volume (P < 0.01) and biopsy score (P < 0.05) were independent predictors of Gleason score upgrading. The risk of Gleason score upgrading was 27 times higher in the patients with the prostate volume ≤ 25 ml and 9 times higher in the 25-40 ml group than in the > 60 ml group (P < 0.05). Low Gleason score of biopsy (≤ 6) and small prostate volume (≤ 40 ml) may be the predictors of Gleason score upgrading after radical prostatectomy.

  14. Increasing use of radical prostatectomy for locally advanced prostate cancer in the USA and Germany: a comparative population-based study.

    PubMed

    Hager, B; Kraywinkel, K; Keck, B; Katalinic, A; Meyer, M; Zeissig, S R; Scheufele, R; Wirth, M P; Huber, J

    2017-03-01

    Current guidelines do not recommend a preferred treatment modality for locally advanced prostate cancer. The aim of the study was to compare treatment patterns found in the USA and Germany and to analyze possible trends over time. We compared 'Surveillance Epidemiology and End Results' (SEER) data (USA) with reports from four German federal epidemiological cancer registries (Eastern Germany, Bavaria, Rhineland-Palatinate, Schleswig-Holstein), both from 2004 to 2012. We defined locally advanced prostate cancer as clinical stage T3 or T4. Exclusion criteria were metastatic disease and age over 79 years. We identified 9127 (USA) and 11 051 (Germany) patients with locally advanced prostate cancer. The share was 2.1% in the USA compared with 6.0% in Germany (P<0.001). In the United States, the utilization of radiotherapy (RT) and radical prostatectomy (RP) was comparably high with 42.0% (RT) and 42.8% (RP). In Germany, the major treatment option was RP with 36.7% followed by RT with 22.1%. During the study period, the use of RP increased in both countries (USA P=0.001 and Germany P=0.003), whereas RT numbers declined (USA P=0.003 and Germany P=0.002). The share of adjuvant RT (aRT) was similar in both countries (USA 21.7% vs Germany 20.7%). We found distinctive differences in treating locally advanced prostate cancer between USA and Germany, but similar trends over time. In the last decade, a growing number of patients underwent RP as a possible first step within a multimodal concept.

  15. Novel anatomical identification of nerve-sparing radical prostatectomy: fascial-sparing radical prostatectomy

    PubMed Central

    Huri, Emre

    2014-01-01

    Radical prostatectomy (RP) became a first choice of treatment for prostate cancer after the advance in nerve-sparing techniques. However, the difficult technical details still involved in nerve-sparing RP (nsRP) can invite unwanted complications. Therefore, learning to recognize key anatomical features of the prostate and its surrounding structures is crucial to further improve RP efficacy. Although the anatomical relation between the pelvic nerves and pelvic fascias is still under investigation, this paper characterizes the periprostatic fascias in order to define a novel fascial-sparing approach to RP (fsRP), which will help spare neurovascular bundles. In uroanatomic perspective, it can be stated that nsRP is a functional identification of the surgical technique while fsRP is an anatomic identification as well. The functional and oncological outcomes related to this novel fsRP are also reviewed. PMID:24693527

  16. Evaluation of quality of life after radical prostatectomy-experience in Serbia.

    PubMed

    Dragićević, Svetomir M; Krejović-Marić, Snežana P; Hasani, Bajram H; Soldatović, Ivan A; Bojić, Svetlana D; Canović, Predrag

    2012-08-01

    The aim of this study was to compare health related quality of life (QoL) of patients with prostate cancer, who had undergone radical prostatectomy (RP), with patients who were carefully monitored. This prospective study included 56 patients who had undergone the radical prostatectomy (RP) and 48 non-operated patients (watchful waiting, WW). All patients filled EPIC questionnaire at baseline, 1th, 3rd, 6th and 12th month. At baseline, mean scores were similar in both groups, but one month after the surgery in RP group, patients had statistically significant lower score of urinary incontinency, urinary function and sexual function compared with WW patients. These scores were significantly higher in the 3rd, 6th and 12th month in operated patients, but there was no improvement in the WW group. Radical prostatectomy does not significantly improve quality of life. Prostatectomized patients had worse scores on the QoL scale, with exception of the urinary disturbance dimension.

  17. Prospective evaluation of short-term impact and recovery of health related quality of life in men undergoing robotic assisted laparoscopic radical prostatectomy versus open radical prostatectomy.

    PubMed

    Miller, Javier; Smith, Angela; Kouba, Erik; Wallen, Eric; Pruthi, Raj S

    2007-09-01

    In the last few years there have been increasing claims that robotic assisted laparoscopic radical prostatectomy decreases short-term morbidity in patients undergoing surgical treatment for prostate cancer. However, there is surprisingly little objective evidence to support this point, which is often used to market the procedure to patients. To address this issue we prospectively evaluated patients undergoing open and robotic assisted laparoscopic radical prostatectomy at baseline and weekly through the postoperative period using a validated questionnaire. A total of 162 men undergoing radical prostatectomy, including open radical prostatectomy in 120 and robotic assisted laparoscopic radical prostatectomy in 42, for clinically localized prostate cancer completed the SF-12, version 2 Physical and Mental Health Survey Acute Form preoperatively and each week postoperatively for 6 weeks. Physical and Mental Component Scores were calculated from the questionnaires at each time point. Comparisons between the 2 surgical approaches were made at each time point. No significant differences were seen between the open and robotic assisted laparoscopic radical prostatectomy groups with regard to patient age, clinical stage or preoperative prostate specific antigen. Mean surgical blood loss was significantly higher in the open group compared to that in the robotic assisted laparoscopic group. Physical Component Scores in the robotic assisted laparoscopic group were significantly higher than those in the open cohort beginning postoperative week 1 and extending through week 6. On statistical extrapolation Physical Component Scores returned to baseline between weeks 5 and 6 postoperatively in the robotic assisted laparoscopic group and between weeks 6 and 7 in the open group. Mental Component Score scores were not statistically different between the groups except preoperatively. This study helps prospectively define short-term health related quality of life in patients undergoing

  18. Radical prostatectomy and quality of life among African Americans.

    PubMed

    Ukoli, Flora A; Lynch, Barlow S; Adams-Campbell, Lucile L

    2006-01-01

    Prostate-specific antigen screening has led to an increase in the number of men who present with localized prostate cancer. Patients must engage in decision-making regarding treatment, which is influenced by several factors including patient age at diagnosis, tumor stage, and co-morbidities. Among those patients who decide to undergo potentially curative treatment, quality of life is extremely important. However, quality of life among men with prostate cancer has not been studied extensively compared to other sites. The proposed study addressed the quality of life in 100 African American men who underwent radical prostatectomy. The men had a mean age of 63.7 +/- 7.5 and mean age at diagnosis of 59.7 +/- 6.9 years. The most common problems or symptoms were erection failure (84.7%), urinary incontinence and frequency (63.3%), pain 54.1%, and fatigue 53.1%. Problems with either sleep or appetite were recorded by 39.8%, and psychological problems related to sadness, worry, nervousness, or feeling of loneliness were reported by 32.6%. Problems most often reported by patients as being moderate to severe in intensity were sex life (67.3%), sexual dysfunction (55.7%), erection (50.0%), and urination frequency (40.8%). These data present patient perception of adverse quality of life outcomes after prostatectomy and underscore the importance of considering both their short- and long-term expectations of treatment options.

  19. Contemporaneous comparison of open vs minimally-invasive radical prostatectomy for high-risk prostate cancer

    PubMed Central

    Pierorazio, Phillip M.; Mullins, Jeffrey K.; Eifler, John B.; Voth, Kipp; Hyams, Elias S.; Han, Misop; Pavlovich, Christian P.; Bivalacqua, Trinity J.; Partin, Alan W.; Allaf, Mohamad E.; Schaeffer, Edward M.

    2014-01-01

    Objectives • To analyze pathological and short-term oncological outcomes in men undergoing open and minimally-invasive radical prostatectomy (MIRP) for high-risk prostate cancer (HRPC; prostate-specific antigen level [PSA] >20 ng/mL, ≥cT2c, Gleason score 8–10) in a contemporaneous series. Patients and Methods • In total, 913 patients with HRPC were identified in the Johns Hopkins Radical Prostatectomy Database subsequent to the inception of MIRP at this institution (2002–2011) • Of these, 743 (81.4%) underwent open radical retropubic prostatectomy (ORRP), 105 (11.5%) underwent robot-assisted laparoscopic radical prostatectomy (RALRP) and 65 (7.1%) underwent laparoscopic radical prostatectomy (LRP) for HRPC. • Appropriate comparative tests were used to evaluate patient and prostate cancer characteristics. • Proportional hazards regression models were used to predict biochemical recurrence. Results • Age, race, body mass index, preoperative PSA level, clinical stage, number of positive cores and Gleason score at final pathology were similar between ORRP and MIRP. • On average, men undergoing MIRP had smaller prostates and more organ-confined (pT2) disease (P = 0.02). • The number of surgeons and surgeon experience were greatest for the ORRP cohort. • Overall surgical margin rate was 29.4%, 34.3% and 27.7% (P = 0.52) and 1.9%, 2.9% and 6.2% (P = 0.39) for pT2 disease in men undergoing ORRP, RALRP and LRP, respectively. • Biochemical recurrence-free survival among ORRP, RALRP and LRP was 56.3%, 67.8% and 41.1%, respectively, at 3 years (P = 0.6) and the approach employed did not predict biochemical recurrence in regression models. Conclusions • At an experienced centre, MIRP is comparable to open radical prostatectomy for HRPC with respect to surgical margin status and biochemical recurrence. PMID:23356390

  20. Radical prostatectomy in high-risk prostate cancer.

    PubMed

    Ischia, Joseph; Gleave, Martin

    2013-03-01

    One consistent finding in the studies regarding treating men with prostate cancer is that men with high-risk disease have the most to gain from treatment with curative intent. Men with high-risk or locally-advanced prostate cancer require treatment to the primary cancer or risk dying prematurely from their disease. Increasingly, combined androgen deprivation therapy + radiation treatment is seen as the standard treatment as a result of prospective studies in this space, and the perceived increased morbidity of radical prostatectomy in the setting of a "low" cure rate as monotherapy. In the absence of a well-conducted randomized trial, there is no definite evidence that one treatment is superior to the other. The advantages of radical prostatectomy are that it provides excellent local control of the primary tumor without an increase in morbidity, accurately stages the disease to guide further therapy, and removes benign sources of prostate-specific antigen so that failures can be promptly identified and subsequent treatment can be initiated in a timely manner. Although several guidelines recommend radiation treatment over radical prostatectomy as first-line treatment, there is no evidence that surgery is inferior and radical prostatectomy should remain part of any informed discussion regarding treatment options for men with high-risk prostate cancer.

  1. Robot-assisted radical prostatectomy: tips, tricks and pitfalls.

    PubMed

    Mottrie, A; De Naeyer, G; Schatteman, P; Frumenzio, E; Rossanese, M; Ficarra, V

    2012-06-01

    In the last decade, we have assisted to the progressive standardization of the surgical technique of robot-assisted radical prostatectomy (RARP). This article describes in details our current surgical technique to perform nerve-sparing RARP. Specifically, we took in consideration the tips, tricks and pitfalls of each step of RARP according to our experience.

  2. Pain and quality of life following radical retropubic prostatectomy.

    PubMed

    Haythornthwaite, J A; Raja, S N; Fisher, B; Frank, S M; Brendler, C B; Shir, Y

    1998-11-01

    We assess pain and quality of life following radical retropubic prostatectomy and determine whether intraoperative anesthetic management has any long-term effects on outcomes. A total of 110 patients undergoing radical retropubic prostatectomy were randomly assigned to receive epidural and/or general anesthesia. Patients responded to a questionnaire mailed 3 and 6 months following surgery that assessed prostate symptoms, pain related to surgery, quality of life and mood. No long-term effects of anesthesia were observed. Of the 103 respondents (94%) at 3 months 49% had some pain related to surgery. Although pain was not related to anesthesic technique, patients who had it at 3 months used significantly more pain medication on postoperative day 3. Pain at 3 months was mild, averaging 1.5 on a scale of 0 to 10, and associated with poor perceptions of overall health (p <0.02), and reduced physical (p <0.01) and social (p <0.01) functioning. Pain at 3 months was associated with higher levels of preoperative anxiety (p <0.05). At 6 months 36 of 90 patients (35%) had some pain related to surgery and the impact was similar. Long-term effects of intraoperative anesthesic technique were not apparent. Mild pain following radical retropubic prostatectomy was common and associated with reduced quality of life, particularly social functioning. Affective distress, particularly anxiety, before surgery and use of pain medications following surgery may be predictors of chronic pain following radical retropubic prostatectomy.

  3. The Learning Curve for Laparoscopic Radical Prostatectomy: An International Multicenter Study

    PubMed Central

    Secin, Fernando P.; Savage, Caroline; Abbou, Claude; de La Taille, Alexandre; Salomon, Laurent; Rassweiler, Jens; Hruza, Marcel; Rozet, François; Cathelineau, Xavier; Janetschek, Gunther; Nassar, Faissal; Turk, Ingolf; Vanni, Alex J.; Gill, Inderbir S.; Koenig, Philippe; Kaouk, Jihad H.; Pineiro, Luis Martinez; Pansadoro, Vito; Emiliozzi, Paolo; Bjartell, Anders; Jiborn, Thomas; Eden, Christopher; Richards, Andrew J.; Van Velthoven, Roland; Stolzenburg, Jens-Uwe; Rabenalt, Robert; Su, Li-Ming; Pavlovich, Christian P.; Levinson, Adam W.; Touijer, Karim A.; Vickers, Andrew; Guillonneau, Bertrand

    2012-01-01

    Purpose It is not yet possible to estimate the number of cases required for a beginner to become expert in laparoscopic radical prostatectomy. We estimated the learning curve of laparoscopic radical prostatectomy for positive surgical margins compared to a published learning curve for open radical prostatectomy. Materials and Methods We reviewed records from 8,544 consecutive patients with prostate cancer treated laparoscopically by 51 surgeons at 14 academic institutions in Europe and the United States. The probability of a positive surgical margin was calculated as a function of surgeon experience with adjustment for pathological stage, Gleason score and prostate specific antigen. A second model incorporated prior experience with open radical prostatectomy and surgeon generation. Results Positive surgical margins occurred in 1,862 patients (22%). There was an apparent improvement in surgical margin rates up to a plateau at 200 to 250 surgeries. Changes in margin rates once this plateau was reached were relatively minimal relative to the CIs. The absolute risk difference for 10 vs 250 prior surgeries was 4.8% (95% CI 1.5, 8.5). Neither surgeon generation nor prior open radical prostatectomy experience was statistically significant when added to the model. The rate of decrease in positive surgical margins was more rapid in the open vs laparoscopic learning curve. Conclusions The learning curve for surgical margins after laparoscopic radical prostatectomy plateaus at approximately 200 to 250 cases. Prior open experience and surgeon generation do not improve the margin rate, suggesting that the rate is primarily a function of specifically laparoscopic training and experience. PMID:20952022

  4. Radical prostatectomy, sparing of the seminal vesicles, and painful orgasm.

    PubMed

    Mogorovich, Andrea; Nilsson, Andreas E; Tyritzis, Stavros I; Carlsson, Stefan; Jonsson, Martin; Haendler, Leif; Nyberg, Tommy; Steineck, Gunnar; Wiklund, N Peter

    2013-05-01

    Erectile dysfunction has been widely investigated as the major factor responsible for sexual bother in patients after radical prostatectomy (RP); painful orgasm (PO) is one element of this bother, but little is known about its prevalence and its effects on sexual health. This study aims to investigate the prevalence of PO and to identify potential risk factors. A total of 1,411 consecutive patients underwent open (radical retropubic prostatectomy) or robot-assisted laparoscopic RP between 2002 and 2006. The patients were asked to complete a study-specific questionnaire. Of a total of 145 questions, 5 dealt with the orgasmic characteristics. The questionnaire was also administered to a comparison group of 442 persons, matched for age and area of residency. The response rate was 91% (1,288 patients). A total of 143 (11%) patients reported PO. Among the 834 men being able to have an orgasm, the prevalence was 18% vs. 6% in the comparison group (relative risk [RR] 2.8, 95% confidence interval [CI] 1.7-4.5). When analyzed as independent variables, bilateral seminal vesicle (SV)-sparing approach (RR 2.33, 95% CI 1.0-5.3, P = 0.045) and age <60 years were significantly related to the presence of PO (95% CI 0.5-0.9, P = 0.019). After adjustment for age, bilateral SV-sparing still remained a significant predictor for occurrence of PO. We found that PO occurs significantly more often in patients undergoing bilateral SV-sparing RP when compared with age-matched comparison population. © 2013 International Society for Sexual Medicine.

  5. DaVinci-assisted laparoscopic radical prostatectomy: the learning curve

    NASA Astrophysics Data System (ADS)

    Le, Carter Q.; Ho, Khai-Linh V.; Gettman, Matthew T.

    2007-02-01

    Objective: To define the learning curve for daVinci-assisted laparoscopic radical prostatectomy (DLP) at our institution. Methods: The data from 170 patients who underwent DLP between August 2002 and December 2004 by a single surgeon (MTG) were reviewed. Operative time, hemoglobin decrease, conversion to open procedure, positive margin rates, complications, length of stay (LOS), length of catheterization, continence, and erectile function were analyzed. Results: Hemoglobin decrease (p=0.11), positive margin rates (p=0.80), and early urinary continence (p=0.17) did not significantly correlate with surgical experience. A trend towards lower complications (p=0.07) and an earlier return of erectile function (p=0.09) was noted with increased experience with DLP. Operative time, hospital stay, catheterization time, and open conversion showed significant association with patient sequence. Median operative time for the first 60 and the last 110 patients was 323.5 and 239.5 minutes (p=<0.0001), respectively. Median LOS for the aforementioned groups was 53 and 51 hours (p=0.009). Length of catheterization declined significantly between the first 60 and the remaining 110 patients, 14 as compared to 11.5 days (p=<0.0001). Eight open conversions occurred, six were in the first 30 patients (p=0.03). Conclusion: As an indicator of the learning curve, the operative time in our series showed no correlation with sequence after the 60 th patient. Thus, despite the advantages of robotics, the learning curve to efficient performance of daVinciassisted laparoscopic radical prostatectomy is long. Oncological and functional outcomes should not be affected during the learning curve.

  6. Bladder neck preservation during radical retropubic prostatectomy and postoperative urinary continence.

    PubMed

    Razi, Ali; Yahyazadeh, Seyed Reza; Sedighi Gilani, Mohammad Ali; Kazemeyni, Seyed Mohammad

    2009-01-01

    Bladder neck-sparing modification of radical retropubic prostatectomy has been reported to lower the risk of urinary incontinence after prostatectomy. We reviewed the outcomes in men with prostate cancer who had undergone prostatectomy with either bladder neck preservation or bladder neck reconstruction. In this retrospective study, a total of 103 patients who had undergone radical retropubic prostatectomy were assessed. The patients were divided into two groups of bladder neck preservation (51 patients) and bladder neck reconstruction (52 patients). We compared frequency of biochemical failure, bladder neck stricture, and urinary incontinence between these two groups. Biochemical failure was defined as a serum prostate-specific antigen level higher than 0.2 ng/mL and its rising trend in at least 2 postoperative subsequent measurements. Continence was defined as no need to use sanitary pads or diapers. The two groups were comparable in terms of age, serum prostate-specific antigen level, Gleason score, and prostate volume. After a mean follow-up period of 32.5 months, all patients with bladder neck preservation and 46 (88.5%) with bladder neck reconstruction were continent (P = .03). There were no significant differences in the frequency of biochemical failure and bladder neck stricture that required dilation between the two groups of patients. Bladder neck preservation during radical retropubic prostatectomy may improve long-term results of urinary continence and be effective in eradicating prostate cancer without increasing recurrence rate.

  7. Contemporary Open and Robotic Radical Prostatectomy Practice Patterns Among Urologists in the United States

    PubMed Central

    Lowrance, William T.; Eastham, James A.; Savage, Caroline; Maschino, A. C.; Laudone, Vincent P.; Dechet, Christopher B.; Stephenson, Robert A.; Scardino, Peter T.; Sandhu, Jaspreet S.

    2012-01-01

    Purpose We describe current trends in robotic and open radical prostatectomy in the United States after examining case logs for American Board of Urology certification. Materials and Methods American urologists submit case logs for initial board certification and recertification. We analyzed logs from 2004 to 2010 for trends and used logistic regression to assess the impact of urologist age on robotic radical prostatectomy use. Results A total of 4,709 urologists submitted case logs for certification between 2004 and 2010. Of these logs 3,374 included 1 or more radical prostatectomy cases. Of the urologists 2,413 (72%) reported performing open radical prostatectomy only while 961 (28%) reported 1 or more robotic radical prostatectomies and 308 (9%) reported robotic radical prostatectomy only. During this 7-year period we observed a large increase in the number of urologists who performed robotic radical prostatectomy and a smaller corresponding decrease in those who performed open radical prostatectomy. Only 8% of patients were treated with robotic radical prostatectomy by urologists who were certified in 2004 while 67% underwent that procedure in 2010. Median age of urologists who exclusively performed open radical prostatectomy was 43 years (IQR 38–51) vs 41 (IQR 35–46) for those who performed only robotic radical prostatectomy. Conclusions While the rate was not as high as the greater than 85% industry estimate, 67% of radical prostatectomies were done robotically among urologists who underwent board certification or recertification in 2010. Total radical prostatectomy volume almost doubled during the study period. These data provide nonindustry based estimates of current radical prostatectomy practice patterns and further our understanding of the evolving surgical treatment of prostate cancer. PMID:22498227

  8. Comparison of Robot-Assisted Radical Prostatectomy and Open Radical Prostatectomy Outcomes: A Systematic Review and Meta-Analysis

    PubMed Central

    Seo, Hyun-Ju; Lee, Na Rae; Son, Soo Kyung; Kim, Dae Keun

    2016-01-01

    Purpose To systematically update evidence on the clinical efficacy and safety of robot-assisted radical prostatectomy (RARP) versus retropubic radical prostatectomy (RRP) in patients with prostate cancer. Materials and Methods Electronic databases, including ovidMEDLINE, ovidEMBASE, the Cochrane Library, KoreaMed, KMbase, and others, were searched, collecting data from January 1980 to August 2013. The quality of selected systematic reviews was assessed using the revised assessment of multiple systematic reviews and the modified Cochrane Risk of Bias tool for non-randomized studies. Results A total of 61 studies were included, including 38 from two previous systematic reviews rated as best available evidence and 23 additional studies that were more recent. There were no randomized controlled trials. Regarding safety, the risk of complications was lower for RARP than for RRP. Among functional outcomes, the risk of urinary incontinence was lower and potency rate was significantly higher for RARP than for RRP. Regarding oncologic outcomes, positive margin rates were comparable between groups, and although biochemical recurrence (BCR) rates were lower for RARP than for RRP, recurrence-free survival was similar after long-term follow up. Conclusion RARP might be favorable to RRP in regards to post-operative complications, peri-operative outcomes, and functional outcomes. Positive margin and BCR rates were comparable between the two procedures. As most of studies were of low quality, the results presented should be interpreted with caution, and further high quality studies controlling for selection, confounding, and selective reporting biases with longer-term follow-up are needed to determine the clinical efficacy and safety of RARP. PMID:27401648

  9. 'Trifecta' after radical prostatectomy: is there a standard definition?

    PubMed

    Borregales, Leonardo D; Berg, William T; Tal, Oded; Wambi, Chris; Kaufman, Sarah; Gaya, Jose M; Urzúa, Cristian; Badani, Ketan K

    2013-07-01

    To determine the extent of variability in the definitions of the 'trifecta' after radical prostatectomy (undetectable PSA, urinary continence and potency) to be found in the literature. To establish a consensus definition of the trifecta in an effort to standardize criteria and reporting. A systematic review of published articles found in the PubMed database for the period from January 2003 to March 2012 was performed. The search queries included the keywords 'radical prostatectomy,' 'prostatectomy outcome,' and 'trifecta'. A total of 86 publications were identified of which 14 were used for analysis. Eight different definitions of biochemical recurrence were reported, the most common definition being PSA ≥0.2 ng/mL. The definition of potency was the most variable. Ten different definitions of potency were found, with the most common being 'having erections sufficient for intercourse with or without a phosphodiesterase-5 inhibitor'. Nine different definitions of continence were found. The most common definition of continence was 'wearing no pads'. Only six of the 14 articles used validated questionnaires in their outcome measures. The definitions of trifecta reported in the literature are highly variable. We propose the following consensus definition based on our analysis: (1) PSA >0.2 ng/mL with confirmatory value; (2) attainment of erections sufficient for intercourse with or without oral pharmacological agents; (3) wearing zero pads. This consensus definition should be considered when designing studies and reporting outcomes of radical prostatectomy. © 2013 BJU International.

  10. [Relationship between tumor volume and PSA recurrence after radical prostatectomy].

    PubMed

    Hashimoto, Yasuhiro; Momose, Akishi; Okamoto, Akiko; Yamamoto, Hayato; Hatakeyama, Shingo; Iwabuchi, Ikuya; Yoneyama, Takahiro; Koie, Takuya; Kamimura, Noritaka; Ohyama, Chikara

    2010-02-01

    We examined whether the tumor volume (TV) is a good predictor of PSA recurrence after radical prostatectomy. Data were collected for 158 patients with clinically localized prostate cancer undergoing radical prostatectomy without neoadjuvant hormonal therapy in our hospital since April 2005 to September 2007. Along with the routine pathological assessment, TV was assessed in all prostatectomy specimens. PSA recurrence was defined as PSA levels of greater than 0.2 ng/ml. The TVs were 1.81+/-1.66 ml (mean +/-SD) ranging from 0.02 to 8.20 ml. The TV in cT1c was 1.77+/-1.64, and 1.89+/-1.72 ml in cT2 (not significant). Significant differences were observed between TV and pT. The TVs in pT2a, pT2b and pT3/4 were 0.54+/-0.54, 1.63+/-1.47 and 2.67+/-1.80 ml, respectively. The median follow-up period was 32.3 months (range from 15 to 45) after radical prostatectomy, and PSA recurrence was observed in 32 cases. Patients with smaller TV (TV <1.3 ml) had a higher PSA-free survival rate (89.5%) than those with a larger TV (TV > or = 1.3 ml, 66.7%) with a significant difference atp <0.001 (log-rank test). A multivariate analysis was performed for PSA, TV, pT, Gleason Score (GS), and surgical margins. Significant differences were observed for GS, and surgical margins, but not for TV. Clinically organ-confined disease in Japanese patients with prostate cancer included various cancers from clinically insignificant to locally advanced ones. In our series, TV was not regarded as a predictor of PSA recurrence after radical prostatectomy.

  11. Associations Between Serum Vitamin D and Adverse Pathology in Men Undergoing Radical Prostatectomy

    PubMed Central

    Nyame, Yaw A.; Bowen, Diana K.; Jordan, Gregory; Batai, Ken; Dixon, Michael; Hollowell, Courtney M.P.; Kielb, Stephanie; Meeks, Joshua J.; Gann, Peter H.; Macias, Virgilia; Kajdacsy-Balla, Andre; Catalona, William J.; Kittles, Rick

    2016-01-01

    Purpose Lower serum vitamin D levels have been associated with an increased risk of aggressive prostate cancer. Among men with localized prostate cancer, especially with low- or intermediate-risk disease, vitamin D may serve as an important biomarker of disease aggression. The aim of this study was to assess the relationship between adverse pathology at the time of radical prostatectomy and serum 25-hydroxyvitamin D (25-OH D) levels. Methods This cross-sectional study was carried out from 2009 to 2014, nested within a large epidemiologic study of 1,760 healthy controls and men undergoing prostate cancer screening. In total, 190 men underwent radical prostatectomy in the cohort. Adverse pathology was defined as the presence of primary Gleason 4 or any Gleason 5 disease, or extraprostatic extension. Descriptive and multivariate analyses were performed to assess the relationship between 25-OH D and adverse pathology at the time of prostatectomy. Results Eighty-seven men (45.8%) in this cohort demonstrated adverse pathology at radical prostatectomy. The median age in the cohort was 64.0 years (interquartile range, 59.0 to 67.0). On univariate analysis, men with adverse pathology at radical prostatectomy demonstrated lower median serum 25-OH D (22.7 v 27.0 ng/mL, P = .007) compared with their counterparts. On multivariate analysis, controlling for age, serum prostate specific antigen, and abnormal digital rectal examination, serum 25-OH D less than 30 ng/mL was associated with increased odds of adverse pathology (odds ratio, 2.64; 95% CI, 1.25 to 5.59; P = .01). Conclusion Insufficiency/deficiency of serum 25-OH D is associated with increased odds of adverse pathology in men with localized disease undergoing radical prostatectomy. Serum 25-OH D may serve as a useful biomarker in prostate cancer aggressiveness, which deserves continued study. PMID:26903577

  12. High radical prostatectomy surgical volume is related to lower radical prostatectomy total hospital charges.

    PubMed

    Ramirez, Alvaro; Benayoun, Serge; Briganti, Alberto; Chun, Jongi; Perrotte, Paul; Kattan, Michael W; Graefen, Markus; McCormack, Michael; Neugut, Alfred I; Saad, Fred; Karakiewicz, Pierre I

    2006-07-01

    To test the hypothesis that individual surgical volume (SV) is an independent predictor of radical prostatectomy (RP) total charges. We used the Florida State Inpatient Data File. ICD-9 codes 60.5 (RP) and 185 (prostate cancer) identified all men treated with RP for prostate cancer between January 1 and December 31, 1998. Among 1,923,085 records, 3167 RPs were selected. SV represented the predictor. Total RP charges represented the outcome. Age, race, and comorbidity represented covariates. Univariate and multivariate linear regression models were used. All 3167 RPs were performed by 81 surgeons. SV ranged from 2 to 162 (mean, 68). Charges were 4755 dollars to 140,201 dollars (mean, 18,200 dollars). In the multivariate model, each SV increment corresponding to one RP reduced hospital charges by 25 dollars (p < or = 0.001). Redistribution of RPs from low to high SV users could result in significant savings. For example, 4 million dollars could be saved if 1000 RPs were redistributed from surgeons with an SV of 18 to surgeons with an SV of 200.

  13. Costs of radical prostatectomy for prostate cancer: a systematic review.

    PubMed

    Bolenz, Christian; Freedland, Stephen J; Hollenbeck, Brent K; Lotan, Yair; Lowrance, William T; Nelson, Joel B; Hu, Jim C

    2014-02-01

    Robot-assisted laparoscopic radical prostatectomy (RALP) has been rapidly adopted as a new approach for radical prostatectomy (RP) in patients with prostate cancer (PCa). The use of new technology may increase costs for RP. To summarize data on direct costs of various approaches to RP and to discuss the consequences of cost differences. A systematic literature search was performed in March 2012 using the PubMed, Web of Science, and Cochrane Library databases. A complex search strategy was applied. Articles were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Articles reporting on direct costs of RP (open retropubic [RRP], radical perineal [RPP], laparoscopic [LRP], RALP) in men with clinically localized PCa were eligible for study inclusion. Of 1218 articles initially screened by title, the multistep, systematic search identified 11 studies presenting direct costs of different approaches to RP. Of the 11 studies, 7 compared the costs of different RP approaches. Minimally invasive RP (MIRP) (ie, LRP or RALP) was more expensive than RRP in most studies, mainly due to increased surgical instrumentation costs. In the comparative studies, costs ranged from (in US dollars) $5058 to $11,806 for MIRP and from $4075 to $6296 for RRP, with RALP having the highest direct costs. In one study applying standardized, health economic-evaluation criteria, RALP was not found to be cost effective. Limitations of this review include significant differences in observational study designs and an absence of prospective comparative studies. Moreover, there are limited post-RP data on the costs of adjuvant treatments and other health care-related expenses after PCa surgery. Few studies compared direct costs of different approaches to RP. The use of new technology, particularly RALP, results in added costs for the procedure. Cost effectiveness of new technologies should be assessed before widespread adoption. To date, in the lone study

  14. The Comparative Harms of Open and Robotic Prostatectomy in Population Based Samples.

    PubMed

    O'Neil, Brock; Koyama, Tatsuki; Alvarez, JoAnn; Conwill, Ralph M; Albertsen, Peter C; Cooperberg, Matthew R; Goodman, Michael; Greenfield, Sheldon; Hamilton, Ann S; Hoffman, Karen E; Hoffman, Richard M; Kaplan, Sherrie H; Stanford, Janet L; Stroup, Antoinette M; Paddock, Lisa E; Wu, Xiao-Cheng; Stephenson, Robert A; Resnick, Matthew J; Barocas, Daniel A; Penson, David F

    2016-02-01

    Robotic assisted radical prostatectomy has largely replaced open radical prostatectomy for the surgical management of prostate cancer despite conflicting evidence of superiority with respect to disease control or functional sequelae. Using population cohort data, in this study we examined sexual and urinary function in men undergoing open radical prostatectomy vs those undergoing robotic assisted radical prostatectomy. Subjects surgically treated for prostate cancer were selected from 2 large population based prospective cohort studies, the Prostate Cancer Outcomes Study (enrolled 1994 to 1995) and the Comparative Effectiveness Analysis of Surgery and Radiation (enrolled 2011 to 2012). Subjects completed baseline, 6-month and 12-month standardized patient reported outcome measures. Main outcomes were between-group differences in functional outcome scores at 6 and 12 months using linear regression, and adjusting for baseline function, sociodemographic and clinical characteristics. Sensitivity analyses were used to evaluate outcomes between patients undergoing open radical prostatectomy and robotic assisted radical prostatectomy within and across CEASAR and PCOS. The combined cohort consisted of 2,438 men, 1,505 of whom underwent open radical prostatectomy and 933 of whom underwent robotic assisted radical prostatectomy. Men treated with robotic assisted radical prostatectomy reported better urinary function at 6 months (mean difference 3.77 points, 95% CI 1.09-6.44) but not at 12 months (1.19, -1.32-3.71). Subjects treated with robotic assisted radical prostatectomy also reported superior sexual function at 6 months (8.31, 6.02-10.56) and at 12 months (7.64, 5.25-10.03). Sensitivity analyses largely supported the sexual function findings with inconsistent support for urinary function results. This population based study reveals that men undergoing robotic assisted radical prostatectomy likely experience less decline in early urinary continence and sexual function

  15. The Comparative Harms of Open and Robotic Prostatectomy in Population Based Samples

    PubMed Central

    O’Neil, Brock; Koyama, Tatsuki; Alvarez, JoAnn; Conwill, Ralph M.; Albertsen, Peter C.; Cooperberg, Matthew R.; Goodman, Michael; Greenfield, Sheldon; Hamilton, Ann S.; Hoffman, Karen E.; Hoffman, Richard M.; Kaplan, Sherrie H.; Stanford, Janet L.; Stroup, Antoinette M.; Paddock, Lisa E.; Wu, Xiao-Cheng; Stephenson, Robert A.; Resnick, Matthew J.; Barocas, Daniel A.; Penson, David F.

    2016-01-01

    Purpose Robotic assisted radical prostatectomy has largely replaced open radical prostatectomy for the surgical management of prostate cancer despite conflicting evidence of superiority with respect to disease control or functional sequelae. Using population cohort data, in this study we examined sexual and urinary function in men undergoing open radical prostatectomy vs those undergoing robotic assisted radical prostatectomy. Materials and Methods Subjects surgically treated for prostate cancer were selected from 2 large population based prospective cohort studies, the Prostate Cancer Outcomes Study (enrolled 1994 to 1995) and the Comparative Effectiveness Analysis of Surgery and Radiation (enrolled 2011 to 2012). Subjects completed baseline, 6-month and 12-month standardized patient reported outcome measures. Main outcomes were between-group differences in functional outcome scores at 6 and 12 months using linear regression, and adjusting for baseline function, sociodemographic and clinical characteristics. Sensitivity analyses were used to evaluate outcomes between patients undergoing open radical prostatectomy and robotic assisted radical prostatectomy within and across CEASAR and PCOS. Results The combined cohort consisted of 2,438 men, 1,505 of whom underwent open radical prostatectomy and 933 of whom underwent robotic assisted radical prostatectomy. Men treated with robotic assisted radical prostatectomy reported better urinary function at 6 months (mean difference 3.77 points, 95% CI 1.09–6.44) but not at 12 months (1.19, −1.32–3.71). Subjects treated with robotic assisted radical prostatectomy also reported superior sexual function at 6 months (8.31, 6.02–10.56) and at 12 months (7.64, 5.25–10.03). Sensitivity analyses largely supported the sexual function findings with inconsistent support for urinary function results. Conclusions This population based study reveals that men undergoing robotic assisted radical prostatectomy likely experience

  16. Relationship between biopsy Gleason score and radical prostatectomy specimen Gleason score in patients undergoing sextant vs 12 core biopsies.

    PubMed

    Arrabal-Polo, Miguel Angel; Jiménez-Pacheco, Antonio; Mijan-Ortiz, José Luis; Arrabal-Martín, Miguel; Valle-Díaz de la Guardia, Francisco; López-Carmona Pintado, Fernando; López-León, Victor Manuel; Merino-Salas, Sergio; Tinaut-Ranera, Javier; Zuluaga-Gómez, Armando

    2010-11-01

    Our goal is to analyze the degree of concordance between the Gleason score (GS) obtained in prostate biopsies and the one after radical prostatectomy. The intention is to know whether 12-core biopsy, instead of 6 (sextant biopsy), improves, or not, this correlation. A Cohort/prevalence study was conducted on 128 patients who underwent prostate biopsy and subsequent radical prostatectomy. Patients showing biopsy Gleason values greater or equal to 6 were selected as candidates for radical prostatectomy. Mean age of the group of 128 patients was 62.9 years, with a mean PSA value of 8.53ng/ml. There was concordance between biopsy Gleason score and that obtained after radical prostatectomy in 63.28% of cases, while discordance was found in 36.72% of cases. There were not significant statistical differences after comparing results obtained between Gleason score concordance after 6 or 12-core biopsies and that obtained after radical prostatectomy. We have noticed a low correlation between Gleason score after biopsy when it was compared with that obtained after radical prostatectomy, while these results are similar to those found in the literature. We did not find better results regarding Gleason score correlation after biopsies performed with 12 cores instead of 6.

  17. Cost comparison of robotic, laparoscopic, and open radical prostatectomy for prostate cancer.

    PubMed

    Bolenz, Christian; Gupta, Amit; Hotze, Timothy; Ho, Richard; Cadeddu, Jeffrey A; Roehrborn, Claus G; Lotan, Yair

    2010-03-01

    Demand and utilization of minimally invasive approaches to radical prostatectomy have increased in recent years, but comparative studies on cost are lacking. To compare costs associated with robotic-assisted laparoscopic radical prostatectomy (RALP), laparoscopic radical prostatectomy (LRP), and open retropubic radical prostatectomy (RRP). The study included 643 consecutive patients who underwent radical prostatectomy (262 RALP, 220 LRP, and 161 RRP) between September 2003 and April 2008. Direct and component costs were compared. Costs were adjusted for changes over the time of the study. Disease characteristics (body mass index, preoperative prostate-specific antigen, prostate size, and Gleason sum score 8-10) were similar in the three groups. Nerve sparing was performed in 85% of RALP procedures, 96% of LRP procedures, and 90% of RRP procedures (p<0.001). Lymphadenectomy was more commonly performed in RRP (100%) compared to LRP (22%) and RALP (11%) (p<0.001). Mean length of hospital stay was higher for RRP than for LRP and RALP. The median direct cost was higher for RALP compared to LRP or RRP (RALP: $6752 [interquartile range (IQR): $6283-7369]; LRP: $5687 [IQR: $4941-5905]; RRP: $4437 [IQR: $3989-5141]; p<0.001). The main difference was in surgical supply cost (RALP: $2015; LRP: $725; RRP: $185) and operating room (OR) cost (RALP: $2798; LRP: $2453; RRP: $1611; p<0.001). When considering purchase and maintenance costs for the robot, the financial burden would increase by $2698 per patient, given an average of 126 cases per year. RALP is associated with higher cost, predominantly due to increased surgical supply and OR costs. These costs may have a significant impact on overall cost of prostate cancer care. 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  18. Robot-Assisted Radical Prostatectomy After Previous Prostate Surgery

    PubMed Central

    Tugcu, Volkan; Sahin, Selcuk; Kargi, Taner; Gokhan Seker, Kamil; IlkerComez, Yusuf; IhsanTasci, Ali

    2015-01-01

    Background and Objectives: Our objective is to clarify the effect of previous transurethral resection of the prostate (TURP) or open prostatectomy (OP) on surgical, oncological, and functional outcomes after robot-assisted radical prostatectomy (RARP). Methods: Between August 1, 2009, and March 31, 2013, 380 patients underwent RARP. Of these, 25 patients had undergone surgery for primary bladder outlet obstruction (TURP, 20 patients; OP, 5 patents) (group 1). A match-paired analysis was performed to identify 36 patients without a history of prostate surgery with equivalent clinicopathologic characteristics to serve as a control group (group 2). Patients followed up for 12 months were assessed. Results: Both groups were similar with respect to preoperative characteristics, as mean age, body mass index, median prostate-specific antigen, prostate volume, clinical stage, the biopsy Gleason score, D'Amico risk, the American Society of Anesthesiologists (ASA) classification score, the International Prostate Symptom Score, continence, and potency status. RARP resulted in longer console and anastomotic time, as well as higher blood loss compared with surgery-naive patients. We noted a greater rate of urinary leakage (pelvic drainage, >4 d) in group 1 (12% vs 2,8%). The anastomotic stricture rate was significantly higher in group 1 (16% vs 2.8%). No difference was found in the pathologic stage, positive surgical margin, and nerve-sparing procedure between the groups. Biochemical recurrence was observed in 12% (group 1) and 11.1% (group 2) of patients, respectively. No significant difference was found in the continence and potency rates. Conclusions: RARP after TURP or OP is a challenging but oncologically promising procedure with a longer console and anastomosis time, as well as higher blood loss and higher anastomotic stricture rate. PMID:26648678

  19. Long-term quality of life after radical prostatectomy: 8-year longitudinal study in Japan.

    PubMed

    Namiki, Shunichi; Kaiho, Yasuhiro; Mitsuzuka, Koji; Saito, Hideo; Yamada, Shigeyuki; Nakagawa, Haruo; Ito, Akihiro; Arai, Yoichi

    2014-12-01

    To assess long-term health-related quality of life in patients undergoing radical prostatectomy. A total of 120 patients with at least 5 years of follow up after radical prostatectomy were included in the present study. Health-related quality of life outcomes were assessed using three questionnaires, the Short Form 36-Item Health Survey, the University of California, Los Angeles Prostate Cancer Index and the International Prostate Symptom Score. A total of 91 patients (73%) responded at a median follow-up time of 102 months (range 85-123 months). Among general health-related quality of life domains, mental and role composite summary score remained stable throughout the follow-up period. At the final survey, no significant differences were observed in any of the domains compared with the age-matched average score of the Japanese population. Although the slight decrease in urinary function scores and International Prostate Symptom Score beyond 5 years postoperatively compared with 5 years, the differences were not significant. The sexual function summary score showed a substantially lower score just after radical prostatectomy and remained at a deteriorated level (P < 0.001). Responders at the final survey were more likely to report favorable general, urinary and sexual outcomes at 60 months compared with non-responders. When taking age-related changes into account, general health-related quality of life seems to remain stable in the long term after radical prostatectomy: patients with favorable health-related quality of life outcomes during the first 5 years after radical prostatectomy maintain favorable outcomes thereafter. © 2014 The Japanese Urological Association.

  20. Six additional systematic lateral cores enhance sextant biopsy prediction of pathological features at radical prostatectomy.

    PubMed

    Singh, Herb; Canto, Eduardo I; Shariat, Shahrokh F; Kadmon, Dov; Miles, Brian J; Wheeler, Thomas M; Slawin, Kevin M

    2004-01-01

    We evaluated the contribution of 6 additional systematically obtained, laterally directed biopsy cores to traditional sextant biopsy for the prediction of final pathological findings in the radical prostatectomy specimen. We studied 178 consecutive patients with no history of prostate biopsy in whom prostate cancer was diagnosed during an initial systematic 12 core biopsy and who subsequently underwent radical prostatectomy. Of the systematic 12 cores we compared the subset of the 6 traditional sextant cores (S6C), the set of 6 laterally directed cores (L6C) and the complete 12 core set, which included the 6 traditional sextant and the 6 laterally directed cores. Biopsy Gleason score, number of positive cores, total cancer length and percent of tumor in the biopsy sets were examined for their ability to predict extracapsular extension, total tumor volume and pathological Gleason score. On univariable analyses the biopsy parameters of the complete 12 core set correlated more strongly with extracapsular extension and total tumor volume than the biopsy parameters of S6C or L6C. On multivariable analyses S6C and L6C were independent predictors of pathological features at prostatectomy. The addition of 6 systematically obtained, laterally directed cores to traditional sextant biopsy improved the ability to predict pathological features at prostatectomy by a statistically and prognostically significant margin. Preoperative nomograms that use data from a full complement of 12 systematic cores, specifying sextant and laterally directed biopsy cores, should demonstrate improved performance in predicting prostatectomy pathology.

  1. Ability of sextant biopsies to predict radical prostatectomy stage.

    PubMed

    Wills, M L; Sauvageot, J; Partin, A W; Gurganus, R; Epstein, J I

    1998-05-01

    There are few studies evaluating multiple variables on sextant biopsies with the intent to predict stage in radical prostatectomy specimens. We studied 113 sextant biopsies with corresponding totally submitted radical prostatectomy specimens. Variables evaluated on sextant biopsies included total length and percent of cancer; maximum length and percent of cancer on one core; location (apex, mid, base); bilaterality; Gleason grade; number of cores involved; serum prostate-specific antigen (PSA) level; and serum PSA density (PSAD). Radical prostatectomy stage was classified as organ versus non-organ confined. The following variables individually correlated with radical prostatectomy stage: total cancer measured in millimeters (P <0.0001) or percent (P <0.0005); biopsy Gleason score (P <0.0001); number of involved cores (P <0.0001); maximum cancer on one core measured in millimeters (P = 0.0001); maximum percent of cancer on one core (P = 0.01); bilaterality (P = 0.01); PSA level (P = 0.03), and PSAD (P = 0.001). The most predictive sets of two variables that correlated with stage included high Gleason score (P <0.0001) combined with numbers of cores involved (P = 0.002). When biopsies had Gleason scores of 6 or less, two or fewer positive cores, and serum PSA of 0 to 4 ng/mL, 89% were organ confined. When biopsies had Gleason scores of 6 or less with two unilaterally positive cores, 87% were organ confined. In biopsies with Gleason scores of 7 or more and more than one positive core, only 10% were organ confined. The most important predictors of stage by sextant needle biopsy evaluation are numbers of cores involved with carcinoma and high Gleason score. Bilaterality and serum PSA values improved prediction in two small subgroups. In 37% of our population we were able to predict with a greater than 87% probability the organ-confined versus non-organ-confined status.

  2. Robotic Salvage Lymph Node Dissection After Radical Prostatectomy.

    PubMed

    Torricelli, Fabio C M; Cividanes, Arnaldo; Guglielmetti, Giuliano B; Coelho, Rafael F

    2015-01-01

    Radical prostatectomy is a first-line treatment for localized prostate cancer. However, in some cases, biochemical recurrence associated with imaging-detected nodal metastases may happen. Herein, we aim to present the surgical technique for salvage lymph node dissection after radical prostatectomy. A 70 year-old asymptomatic man presented with a prostate-specific antigen (PSA) of 7.45 ng/mL. Digital rectal examination was normal and trans-rectal prostate biopsy revealed a prostate adenocarcinoma Gleason 7 (3+4). Pre-operative computed tomography scan and bone scintigraphy showed no metastatic disease. In other service, the patient underwent a robotic-assisted radical prostatectomy plus obturador lymphadenectomy. Pathologic examination showed a pT3aN0 tumor. After 6 months of follow-up, serum PSA was 1.45 ng/mL. Further investigation with 11C--Choline PET/CT revealed only a 2-cm lymph node close to the left internal iliac artery. The patient was counseled for salvage lymph node dissection. Salvage lymph node dissection was uneventfully performed. Operative time was 1.5 hour, blood loss was minimal, and there were no intra- or postoperative complications. The patient was discharged from hospital in the 1st postoperative day. After 12 months of follow-up, his PSA was undetectable with no other adjuvant therapy. Robotic salvage pelvic lymph node dissection is an effective option for treatment of patients with biochemical recurrence after radical prostatectomy and only pelvic lymph node metastasis detected by C11-Choline PET/CT.

  3. The role of radical prostatectomy as an initial approach for the treatment of high-risk prostate cancer.

    PubMed

    Jaunarena, J H; Villamil, W; Martínez, P F; Gueglio, G; Giudice, C R

    2016-01-01

    The treatment of high-risk prostate cancer requires a multimodal approach to improve control of the disease. There is still no consensus as to the initial strategy of choice. The aim of this study is to review the results of radical prostatectomy as first step in management of patients with high-risk disease. A search was conducted on PubMed of English and Spanish texts. We included those studies that reported the results of radical prostatectomy in patients with high-risk prostate cancer, as well as those that compared radical prostatectomy with other treatment alternatives. The last search was conducted in November 2015. The advantages of radical prostatectomy include a better pathological analysis, more accurate staging, better local control of the disease and better follow-up and adjuvant therapy strategies. When compared with external radiation therapy plus hormonal blockade, the patients who underwent prostatectomy had greater chances of healing and longer cancer-specific survival. The patients who most benefit from this approach are younger, have fewer comorbidities and no evidence of organ metastases. The available scientific evidence to date is not without bias and confounders; however, they appear to favour radical prostatectomy as the initial approach of choice for high-risk prostate cancer. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Influencing factors leading to malpractice litigation in radical prostatectomy.

    PubMed

    Colaco, Marc; Sandberg, Jason; Badlani, Gopal

    2014-06-01

    The litigious nature of the medical-legal environment is a major concern for American physicians with an estimated cost of $10 billion. In this study we identify the causes of litigation in cases of radical prostatectomy as well as the factors that contribute to verdicts or settlements resulting in indemnity payments. Publicly available verdict reports were recorded using the Westlaw® legal database. To identify pertinent cases we used the search terms "medical malpractice" and "prostate" or "prostatectomy" with dates ranging from 2000 to 2013. Cases were evaluated for alleged cause of malpractice, resulting injury, findings and indemnity payment (if any). The database search yielded 222 cases, with 25 being relevant to radical prostatectomy. Of these cases 24.0% were settled out of court and the remaining 76.0% went to trial. Of those cases that went to trial 20.8% saw patients awarded damages. There was no significant difference in awards between verdict and settlement. Overall 36.0% of patients claimed that they did not receive proper informed consent and 16.0% claimed that the surgery was not the proper standard of care. Thirteen of the cases claimed negligence in the performance of the surgery with the bulk of these claims being the result of rectal perforation. The main issues that arise in radical prostatectomy malpractice litigation are those of informed consent and clinical performance. Comprehensive preoperative counseling, when combined with proper surgical technique, may minimize the impact of litigation. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  5. Single plus one port laparoscopic radical prostatectomy: a report of 8 cases in one center.

    PubMed

    Gao, Yi; Xu, Dan-Feng; Liu, Yu-Shan; Cui, Xin-Gang; Che, Jian-Ping; Yao, Ya-Cheng; Yin, Lei

    2011-05-01

    Laparoscopic radical prostatectomy is considered the first treatment of choice for local prostate cancer due to its minimal invasion advantage. To further achieve the goal of minimal invasion, single port laparoscopic radical prostatectomy has been developed to minimize the complications associated with puncture tracks. The aim of this study was to illustrate the technique for single port laparoscopic radical prostatectomy and evaluate its efficacy and safety. We reported 8 cases of radical prostatectomy with excellent early outcome carried out in Shanghai Changzheng Hospital from June 2009 to August 2009 using a home-made multiple instrument access port and adding an additional small incision at McBurney point.

  6. Incontinence after radical prostatectomy: Anything new in its management?

    PubMed Central

    Caremel, Romain; Corcos, Jacques

    2014-01-01

    Introduction: With the increasing number of radical prostatectomies (RP) performed, male stress urinary incontinence (SUI) has become common. The artificial urinary sphincter (AUS) is the gold standard to treat SUI post-RP, but new devices have recently been developed. We review the recent studies on the treatment of SUI post-RP; we also describe the surgical techniques, mechanisms of action and results of these new procedures. Methods: We conducted a literature review search in the PubMed/Medline and Embase databases. Our search was restricted to recent articles. We included studies even if the urinary incontinence was due to sphincter deficiency after RP in non-neurologic patients. Results: We found 8 cohort studies for the surgical procedure: 3 studies concerning slings, 1 involving balloons adjustable implant, and 4 involving new devices. The only randomized controlled trial (RCT) was a pharmacologic clinical trial comparing duloxetine to placebo. The social continence rates were analyzed for 6 studies and were up to 66%. Conclusion: New minimally invasive surgical procedures have emerged as the main alternative to AUS, with social continence rates up to 60% despite just 1 RCT studying the pharmacologic approach. There is an urgent need for well-designed clinical trials to clarify the role of new surgical alternatives in the management of SUI post-RP. New technologies should continue to be evaluated and compared with the AUS, which remains the gold standard. PMID:25024791

  7. Detection of circulating prostatic cells during radical prostatectomy.

    PubMed

    Planz, B; Szyska, P; Valdor, M; Boeckmann, W; Füzesi, L; Jakse, G

    1997-01-01

    The detection of micrometastasis of prostate cancer could help to decide more appropriate therapeutic strategies in an individual patient. We have developed a flow cytometric method for detecting cytokeratin-positive cells in the peripheral blood before, during and after radical prostatectomy in patients with prostatic carcinoma. By means of this technique we were able to detect a higher number of cytokeratin-positive cells in the intraoperative blood sample than in the pre- and postoperative blood sample in 15 patients with prostate cancer (P < 0.05). Our results show an increase in the number of cytokeratin-positive cells with increasing tumor stage and grade, as well a good correlation of prostate-specific antigen (PSA) value with the number of cytokeratin-positive cells (r > 0.6). Our results underline the importance of no-touch techniques at prostatectomy to minimize release of tumor cells into the circulation during surgery. In the light of our results we consider that the indication for cell savers during radical prostatectomy should be reevaluated. The possibility of detecting single metastatic cells in peripheral blood will enable better individual patient management, and open up new modalities for diagnosing early prostate cancer and enhancing patient monitoring in relapse and tumor progression.

  8. Management of erectile dysfunction post-radical prostatectomy

    PubMed Central

    Saleh, Alan; Abboudi, Hamid; Ghazal-Aswad, MB; Mayer, Erik K; Vale, Justin A

    2015-01-01

    Radical prostatectomy is a commonly performed procedure for the treatment of localized prostate cancer. One of the long-term complications is erectile dysfunction. There is little consensus on the optimal management; however, it is agreed that treatment must be prompt to prevent fibrosis and increase oxygenation of penile tissue. It is vital that patient expectations are discussed, a realistic time frame of treatment provided, and treatment started as close to the prostatectomy as possible. Current treatment regimens rely on phosphodiesterase 5 inhibitors as a first-line therapy, with vacuum erection devices and intraurethral suppositories of alprostadil as possible treatment combination options. With nonresponders to these therapies, intracavernosal injections are resorted to. As a final measure, patients undergo the highly invasive penile prosthesis implantation. There is no uniform, objective treatment program for erectile dysfunction post-radical prostatectomy. Management plans are based on poorly conducted and often underpowered studies in combination with physician and patient preferences. They involve the aforementioned drugs and treatment methods in different sequences and doses. Prospective treatments include dietary supplements and gene therapy, which have shown promise with there proposed mechanisms of improving erectile function but are yet to be applied successfully in human patients. PMID:25750901

  9. The controversy surrounding penile rehabilitation after radical prostatectomy

    PubMed Central

    Clavell-Hernández, Jonathan

    2017-01-01

    Radical prostatectomy (RP) techniques have been refined in the last few decades. Despite nerve-sparing surgery, erectile dysfunction (ED) still seems to be affecting more than half of patients undergoing RP. Penile rehabilitation consists of understanding the mechanisms that affect erectile function (EF) and utilizing pharmacologic agents, devices or interventions to promote male sexual function before and after any insult to the penile erectile physiologic axis. There currently is a limited amount of clinical trials that assess treatments with the goal of recovering post-prostatectomy EF. The goal of this article is to assess a contemporary series of trials that study penile rehabilitation. Although the current evidence lacks to prove its irrefutable effectiveness, advancements in research and technology forecast a promising future in penile rehabilitation management. PMID:28217445

  10. Effect of age on biochemical recurrence after radical prostatectomy.

    PubMed

    Ozden, Cuneyt; Aktas, Binhan Kagan; Bulut, Suleyman; Erbay, Guven; Tagci, Suleyman; Gokkaya, Cevdet S; Baykam, Mehmet M; Memis, Ali

    2017-02-01

    The aim of the study was to evaluate the relationship between patient's age and biochemical recurrence (BCR) after radical retropubic prostatectomy (RRP). Data from RRP applied to 305 patients with clinically localized prostate cancer were included in the study. Patients were divided into the three age groups, < 60 years, 60-70 years, and > 70 years. The groups were compared regarding adverse pathological findings on RRP specimen, BCR, and biochemical recurrence-free survival (bRFS) rates. The rates of positive surgical margin, seminal vesicle invasion, lymph node involvement, RRP specimens' Gleason score, and BCR were not significantly different among the three age groups. bRFS rates were not different either. Nonorgan-confined disease and extracapsular extension (ECE) rates were significantly higher in the group of 60-70 years group than in the other two age groups. Factors associated with BCR in multivariate Cox regression analysis were ECE, seminal vesicle invasion, positive surgical margin, and RRP specimens' Gleason score of ≥ 4+3. Patient age and preoperative prostate specific antigen levels were not identified to be associated with BCR. Post-RRP nonorgan-confined disease and ECE are more frequently seen in patients of 60-70 years of age group than in other age groups. However, patient age is not an independent prognostic factor associated with bRFS.

  11. Penile rehabilitation after radical prostatectomy: what the evidence really says.

    PubMed

    Fode, Mikkel; Ohl, Dana A; Ralph, David; Sønksen, Jens

    2013-11-01

    The pathophysiology of erectile dysfunction after radical prostatectomy (RP) is believed to include neuropraxia, which leads to temporarily reduced oxygenation and subsequent structural changes in penile tissue. This results in veno-occlusive dysfunction, therefore, penile rehabilitation programmes focus on tissue oxygenation. Animal studies support the use of phosphodiesterase type 5 inhibitors (PDE5Is) after cavernous nerve damage but results from human studies are contradictory. The largest study to date found no long-term effect of either daily or on-demand PDE5I administration after RP compared with placebo. The effects of prostaglandin and vacuum erection devices are questionable and high-quality studies are lacking. Better documentation for current penile rehabilitation and/or better rehabilitation protocols are needed. One must be careful not to repeat the statement that penile rehabilitation improves erectile function after RP so many times that it becomes a truth even without the proper scientific backing. © 2013 The Authors. BJU International © 2013 BJU International.

  12. Postoperative mortality 90 days after robot-assisted laparoscopic prostatectomy and retropubic radical prostatectomy: a nationwide population-based study.

    PubMed

    Björklund, Johan; Folkvaljon, Yasin; Cole, Alexander; Carlsson, Stefan; Robinson, David; Loeb, Stacy; Stattin, Pär; Akre, Olof

    2016-08-01

    To assess 90-day postoperative mortality after robot-assisted laparoscopic radical prostatectomy (RARP) and retropubic radical prostatectomy (RRP) using nationwide population-based registry data. We conducted a cohort study using the National Prostate Cancer Register of Sweden, including 22 344 men with localized prostate cancer of clinical stage T1-T3, whose prostate-specific antigen levels were <50 μg/mL and who had undergone primary radical prostatectomy in the period 1998-2012. Vital status was ascertained through the Total Population Register. The rates for 90-day postoperative mortality were analysed using logistic regression analysis, and comparisons of 90-day mortality with the background population were made using standardized mortality ratios (SMRs). Of the 14 820 men who underwent RRP, 29 (0.20%) died, and of the 7 524 men who underwent RARP, 10 (0.13%) died. Mortality in the cohort during the 90-day postoperative period was lower than in an age-matched background population: SMR 0.57 (95% confidence interval [CI] 0.39-0.75). There was no statistically significant difference in 90-day mortality according to surgical method: RARP vs RRP odds ratio (OR) 1.14; 95% CI 0.46-2.81. Postoperative 90-day mortality decreased over time: 2008-2012 vs 1998-2007 OR 0.44; 95% CI 0.21-0.95, mainly because of lower mortality after RARP. The 90-day postoperative mortality rates were low after RARP and RRP and there was no statistically significant difference between the methods. Given the long life expectancy among men with low- and intermediate-risk prostate cancer, very low postoperative mortality is a prerequisite for RP, which was fulfilled by both RRP and RARP. The selection of healthy men for RP is highlighted by the lower 90-day mortality after RP compared with the background population. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

  13. Oncologic outcomes at 10 years following robotic radical prostatectomy.

    PubMed

    Diaz, Mireya; Peabody, James O; Kapoor, Victor; Sammon, Jesse; Rogers, Craig G; Stricker, Hans; Lane, Zhaoli; Gupta, Nilesh; Bhandari, Mahendra; Menon, Mani

    2015-06-01

    Reports on long-term oncologic outcomes for patients who undergo robot-assisted radical prostatectomy (RARP) are scant, as for radical prostatectomy covering only the contemporary prostate-specific antigen (PSA) era. To evaluate cancer control in men who underwent RARP at least 10 yr ago. From 2001 to 2003, we followed 483 consecutive men with localized prostate cancer who underwent RARP at a high-volume tertiary center. RARP as first-line therapy. We calculated biochemical recurrence -free survival (BCRFS), metastasis-free survival (MFS), and cancer-specific survival (CSS). Actuarial rates were estimated via Kaplan-Meier. Cox proportional hazards models were used to identify variables predictive of biochemical recurrence (BCR), receipt of salvage therapy, and metastases. There were 108 patients with BCR at a median follow-up of 121 mo (interquartile range: 97-132). Actuarial BCRFS, MFS, and CSS rates at 10 yr were 73.1%, 97.5%, and 98.8%, respectively. On multivariable analysis, D'Amico risk groups or pathologic Gleason grade, stage, and margins were the strongest predictors of BCR depending on whether preoperative or postoperative variables were considered. The value of the detectable PSAs together with disease severity were independent predictors of receipt of salvage therapy, together with a persistent PSA for metastases. In contemporary patients with localized prostate cancer, RARP confers effective 10-yr cancer control. Disease severity and PSA measurements can be used to guide more personalized and cost-effective postoperative surveillance regimens. Robot-assisted radical prostatectomy confers effective 10-yr cancer control for men with localized disease, similar to the open approach. Recurrence is best predicted by postoperative disease severity. Persistent disease signals the risk of progression likely requiring early salvage treatment; lower postoperative risk warrants protracted surveillance beyond 5 yr from surgery, and those with higher risk may

  14. The Prostate Cancer Intervention Versus Observation Trial: VA/NCI/AHRQ Cooperative Studies Program #407 (PIVOT): design and baseline results of a randomized controlled trial comparing radical prostatectomy with watchful waiting for men with clinically localized prostate cancer.

    PubMed

    Wilt, Timothy J

    2012-12-01

    Prostate cancer is the most common noncutaneous malignancy and the second leading cause of cancer death in men. In the United States, 90% of men with prostate cancer are more than age 60 years, diagnosed by early detection with the prostate-specific antigen (PSA) blood test, and have disease believed confined to the prostate gland (clinically localized). Common treatments for clinically localized prostate cancer include watchful waiting (WW), surgery to remove the prostate gland (radical prostatectomy), external-beam radiation therapy and interstitial radiation therapy (brachytherapy), and androgen deprivation. Little is known about the relative effectiveness and harms of treatments because of the paucity of randomized controlled trials. The Department of Veterans Affairs/National Cancer Institute/Agency for Healthcare Research and Quality Cooperative Studies Program Study #407:Prostate Cancer Intervention Versus Observation Trial (PIVOT), initiated in 1994, is a multicenter randomized controlled trial comparing radical prostatectomy with WW in men with clinically localized prostate cancer. We describe the study rationale, design, recruitment methods, and baseline characteristics of PIVOT enrollees. We provide comparisons with eligible men declining enrollment and men participating in another recently reported randomized trial of radical prostatectomy vs WW conducted in Scandinavia. We screened 13 022 men with prostate cancer at 52 US medical centers for potential enrollment. From these, 5023 met initial age, comorbidity, and disease eligibility criteria, and a total of 731 men agreed to participate and were randomized. The mean age of enrollees was 67 years. Nearly one-third were African American. Approximately 85% reported that they were fully active. The median PSA was 7.8ng/mL (mean 10.2ng/mL). In three-fourths of men, the primary reason for biopsy leading to a diagnosis of prostate cancer was a PSA elevation or rise. Using previously developed tumor risk

  15. Anaesthetic considerations for endoscopic extraperitoneal and laparoscopic transperitoneal radical prostatectomy.

    PubMed

    Stolzenburg, Jens-Uwe; Aedtner, Bernd; Olthoff, Derk; Koenig, Fritjoff; Rabenalt, Robert; Filos, Kriton S; McNeill, Alan; Liatsikos, Evangelos N

    2006-09-01

    We focus on the anaesthesiology and requirements for minimally invasive procedures for treating localized prostate cancer. The management of anaesthesia for laparoscopic and endoscopic radical prostatectomy (RP) can be more complex than expected. Numerous groups, especially early in their experience, have had problems (e.g. hypercarbia) with the anaesthesiology of the procedure. Co-operation between the surgeon and the anaesthesiologist is of paramount importance for a safe and effective laparoscopic or endoscopic RP. Nevertheless, the relative anaesthetic equipment and trained personnel should be available before embarking on such technically proficient procedures.

  16. Pharmacological Prevention and Reversion of Erectile Dysfunction after Radical Prostatectomy, By Modulation of Nitric Oxide/Cgmp Pathways

    DTIC Science & Technology

    2008-03-01

    Reversion of Erectile Dysfunction after Radical Prostatectomy, By Modulation of Nitric Oxide/Cgmp Pathways...in the rat, as an experimental model for erectile dysfunction subsequent to radical prostatectomy for prostate cancer. This condition seriously...clinic, once the appropriate dosing is established, as a treatment to prevent or counteract erectile dysfunction after radical prostatectomy. 15

  17. Diffusion of Surgical Innovations, Patient Safety, and Minimally Invasive Radical Prostatectomy

    PubMed Central

    Parsons, J. Kellogg; Messer, Karen; Palazzi, Kerrin; Stroup, Sean; Chang, David

    2015-01-01

    IMPORTANCE Surgical innovations disseminate in the absence of coordinated systems to ensure their safe integration into clinical practice, potentially exposing patients to increased risk for medical error. OBJECTIVE To investigate associations of patient safety with the diffusion of minimally invasive radical prostatectomy (MIRP) resulting from the development of the da Vinci robot. DESIGN, SETTING, AND PARTICIPANTS A cohort study of 401 325 patients in the Nationwide Inpatient Sample who underwent radical prostatectomy during MIRP diffusion between January 1, 2003, and December 31, 2009. MAIN OUTCOMES AND MEASURES We used Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs), which measure processes of care and surgical provider performance. We estimated the prevalence of MIRP among all prostatectomies and compared PSI incidence between MIRP and open radical prostatectomy in each year during the study. We also collected estimates of MIRP incidence attributed to the manufacturer of the da Vinci robot. RESULTS Patients who underwent MIRP were more likely to be white (P = .004), have fewer comorbidities (P = .02), and have undergone surgery in higher-income areas (P = .005). The incidence of MIRP was substantially lower than da Vinci manufacturer estimates. Rapid diffusion onset occurred in 2006, when MIRP accounted for 10.4% (95% CI, 10.2-10.7) of all radical prostatectomies in the United States. In 2005, MIRP was associated with an increased adjusted risk for any PSI (adjusted odds ratio, 2.0; 95% CI, 1.1-3.7; P = .02) vs open radical prostatectomy. Stratification by hospital status demonstrated similar patterns: rapid diffusion onset among teaching hospitals occurred in 2006 (11.7%; 95% CI, 11.3-12.0), with an increased risk for PSI for MIRP in 2005 (adjusted odds ratio, 2.7; 95% CI, 1.4-5.3; P = .004), and onset among nonteaching hospitals occurred in 2008 (27.1%; 95% CI, 26.6-27.7), with an increased but nonsignificant risk for PSI in 2007

  18. [Radical prostatectomy and adjuvant endocrine treatment of prostatic cancer with lymphatic metastasis?].

    PubMed

    Schröder, F H

    1991-11-01

    The limits of curability of prostate cancer still have not been exactly defined. Data derived of randomized, retrospective comparative studies of patients with positive lymph nodes suggest an advantage in overall survival and cancer mortality if such tumors are treated by means of radical prostatectomy with immediate adjuvant endocrine therapy. An analysis of such publications, however, shows that the more favourable results are based on the unequal distribution of important prognostic factors. Several publications agree that adjuvant endocrine treatment in N+ disease leads to a prolongation of time to progression which is clinically and statistically significant. Up to now, however, a significant prolongation of survival has not been shown with early endocrine treatment. Patients have a choice between an initial short period of time until progression occurs if endocrine treatment is delayed. During this time they will be sexually potent. On the other hand, for the price of loss of potency and libido an initial longer period of time free of progression can be expected. It is unclear at this moment whether it makes sense to carry out a radical prostatectomy for palliative reasons. To come to a proper decision it is necessary to compare the risk of the untreated primary tumour and the risk of the radical prostatectomy in this situation. This comparison is very difficult and depends on factors which are not ready for comparison at this moment. Local progression under endocrine treatment is relatively rare and can usually be controlled by conservative means (TUR, radiotherapy). At this moment there are insufficient arguments to carry out palliative radical prostatectomy as a routine in lymph node positive patients.

  19. [Significance of transrectal ultrasound and sextant systematic core biopsy for performing radical prostatectomy].

    PubMed

    Fujimoto, H; Tobisu, K; Niwakawa, M; Kume, H; Tomita, K; Mizutani, T; Tsutsumi, M; Kakizoe, T

    1997-04-01

    To estimate the usefulness of sextant systematic core biopsy or transrectal ultrasonography (TURS) for performing radical prostatectomy. The findings of sextant biopsy and TRUS were compared with 52 step-sectioned specimens obtained from radical prostatectomy. In 34 cases with no influence of hormonal therapy at the time of TRUS and biopsy, sextant systematic core biopsy provided tumor distribution rather precisely. In 33% of the cases who had received hormonal therapy, tumor cells were not detected by this sextant biopsy series. In these cases, majority of residual cancer existed in transition zone, paraurethral or fibromuscular stroma. Six cases showed small adenocarcinoma in only one biopsy tip obtained from sextant biopsy, while 4 cases were revealed well differentiated adenocarcinoma (Gleason score less than 4) by these core biopsies. Comparing with tumor mapping, Gleason score, PSA level and pT stage of the radical prostatectomy specimens, these tumors presented as, not clinically insignificant, but clinically significant prostate cancer. Playing special attention to distraction of normal ultrasound zonal configuration, TRUS detected neurovascular invasion with 94.7% sensitivity, 78.3% positive predictive value and 90. 9% negative predictive value, while seminal vesicle invasion with 75% sensitivity, 50% positive predictive value, 90.9% negative value. Sextant biopsy tended to underestimate the tumors located in the transition zone, paraurethral and fibromuscular lesion. Additional or direct biopsies in transition zone are indispensable for accurate diagnosis. Findings of TRUS and distribution of positive core biopsy from sextant biopsy enable to extract stage C prostate cancer providing negative surgical margin.

  20. Enhanced recovery pathway for radical prostatectomy: Implementation and evaluation in a universal healthcare system.

    PubMed

    Abou-Haidar, Hiba; Abourbih, Samuel; Braganza, David; Qaoud, Talal Al; Lee, Lawrence; Carli, Franco; Watson, Deborah; Aprikian, Armen G; Tanguay, Simon; Feldman, Liane S; Kassouf, Wassim

    2014-11-01

    Enhanced recovery pathways are standardized, multidisciplinary, consensus-based tools that provide guidelines for evidence-based decision-making. This study evaluates the impact of the implementation of a clinical care pathway on patient outcomes following radical prostatectomy in a universal healthcare system. Medical charts of 200 patients with prostate cancer who underwent open and minimally invasive radical prostatectomy at a single academic hospital from 2009 to 2012 were reviewed. A group of 100 consecutive patients' pre-pathway implementation was compared with 99 consecutive patients' post-pathway implementation. Duration of hospital stay, complications, post-discharge emergency department visits and readmissions were compared between the 2 groups. Length of hospital stay decreased from a median of 3 (inter-quartile range [IQR] 4 to 3 days) days in the pre-pathway group to a median of 2 (IQR 3 to 2 days) days in the post-pathway group regardless of surgical approach (p < 0.0001). Complication rates, emergency department visits and hospital readmissions were not significantly different in the pre- and post-pathway groups (17% vs. 21%, p = 0.80; 12% vs. 12%, p = 0.95; and 3% vs. 7%, p = 0.18, respectively). These findings were consistent after stratification by surgical approach. Limitations of our study include lack of assessment of patient satisfaction, and the retrospective study design. The implementation of a standardized, multidisciplinary clinical care pathway for patients undergoing radical prostatectomy improved efficiency without increasing complication rates or hospital readmissions.

  1. Optimization of an early discharge program after laparoscopic radical prostatectomy.

    PubMed

    Díaz, F J; de la Peña, E; Hernández, V; López, B; de La Morena, J M; Martín, M D; Jiménez-Valladolid, I; Llorente, C

    2014-01-01

    To assess the safety of hospital discharge 24 hours after laparoscopic radical prostatectomy and to identify possible factors associated with longer hospital stays. Retrospective study of patients diagnosed with localized prostate cancer underwent to laparoscopic radical prostatectomy consecutively between May of 2007 and December of 2010. Those patients who met the following requirements were discharged in less than 24 hours: absence of complications, drainage debit minor than 50 cc, normal oral tolerance, no significant bladder haematuria and good functional recovery. Logistic regression analysis was conducted in order to assess the possible associated variables with longer hospital stays. A total of 266 patients were analysed. The follow-up median was 34 months. Eighty patients (30.1%) were discharged in less than 24 hours. Average stay (SD) of all series was 2.9 days (3.08). Solely HTA, neurovascular bundles sparing and the development of lymphadenectomy were statistically significant between both groups in univariate analysis (discharge<24 hours vs. discharge>24 hours). In multivariate analysis, only HTA (OR=1.98 [CI 95%:1.13-3.47], P=.016) and lymphadenectomy performance (OR=2.56 [CI 95%:1.18-5.56] P=.017) were independent predictive variables of hospital stays longer than 24 hours. Early hospital discharge of patients underwent to LRP is feasible and safe. In our series, the lymphadenectomy performance and the HTA were associated factors to longer hospital stay. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  2. A neurophysiological study of patients undergoing radical prostatectomy.

    PubMed

    Hansen, M V; Ertekin, C; Larsson, L E; Pedersen, K

    1989-01-01

    24 men suffering from localized prostatic cancer undergoing radical retropubic nerve-sparing prostatectomy were investigated by the following electrophysiological methods: Bulbocavernosus reflexes elicited from the penile skin or the posterior urethra, sensory thresholds in the posterior urethra, cerebral evoked potentials after stimulation of the pudendal nerve or the posterior urethra. 15 men were examined 4-33 months postoperatively only, 5 men were examined only preoperatively and 4 men were examined both pre- and postoperatively. 10 men suffering from minor problems due to benign prostatic hyperplasia served as controls. In patients with localized cancer of the prostate, the findings did not differ from those in the control group. In the operated group the findings were pathological in a large proportion of the patients, indicating injuries both to nervous pathways running through the pelvic nerve plexus and in the pudendal nerve. The conclusions were: Localized cancer of the prostate has minimal or no risk at all of impaired functioning in the pelvic nervous pathways. Radical retropubic prostatectomy may in some cases be undertaken without any objective evidence of injury to these nervous pathways, but is often followed by findings indicating such injury. The dorsal nerve of the penis may be affected by the operation. Transcranial stimulation of the motor cortex is a useful method in the evaluation of prolonged or absent bulbocavernosus reflexes.

  3. Impact of trainee involvement with robotic-assisted radical prostatectomy.

    PubMed

    Thomas, Anil A; Derboghossians, Armen; Chang, Allen; Karia, Rajiv; Finley, David S; Slezak, Jeff; Jacobsen, Steven J; Chien, Gary W

    2013-09-01

    Robotic-assisted surgery has been rapidly adopted within urology practice. As a result, academic centers are challenged with the burden of how to effectively train residents and fellows to perform robotic-assisted surgery without compromising outcomes. We evaluated the perioperative outcomes of trainee involvement with robotic-assisted radical prostatectomy (RARP) within our healthcare organization. We retrospectively reviewed RARP cases performed at our institution between September 2008 and December 2010 using a single da Vinci robotic platform. Trainees consisted of urology residents and fellows who operated with staff surgeons on select operating days, whereas two staff surgeon teams performed RARP on alternate days. We compared clinicopathologic variables including operating time, estimated blood loss, surgical margin rates, and complication rates between the trainee and staff-only surgeon groups. Overall, 1,019 RARP surgeries were performed within the study period and trainees participated in 162 cases (16 %). Clinical characteristics were similar between men undergoing surgery with a trainee and those without. Positive surgical margin rates were lower for patients with pT2 disease for cases with trainee involvement (11 vs. 19 %, p = 0.02), although overall margin rates and margin rates for patients with pT3 disease were similar between the groups (p = 0.34). Surgical cases involving trainees were longer (241 vs. 200 min, p < 0.001) and resulted in higher estimated blood loss (190 vs. 120 mL, p < 0.001) than the two staff surgeon cases. However, transfusion rates as well as intraoperative and postoperative complication rates did not differ significantly between groups. In conclusion, surgical margin rates were lower in teaching cases for patients with pT2 disease. Importantly, trainee involvement in RARP is safe, with similar perioperative outcomes to staff-only surgical cases. This information may be useful for training and surgical planning.

  4. Quality of life in young men after radical prostatectomy.

    PubMed

    Wright, J L; Lin, D W; Cowan, J E; Carroll, P R; Litwin, M S

    2008-01-01

    Urinary and sexual function and bother are important outcomes following radical prostatectomy (RP). Since urinary and sexual function are age-related, post-operative bother may vary by age. This study explores the disease-specific quality-of-life outcomes in young men compared with older men undergoing RP. Using CaPSURE data, we identified men who underwent RP and completed the UCLA Prostate Cancer Index (PCI) before and 1-year post-RP. Men were stratified by age (< 55 years, 55-64, > or = 65). Multivariate regression models were created: a linear model for predictors of PCI scores and a logistic model for predictors of severe declines in PCI domains. Younger men scored significantly better than older men in urinary function (P=0.04), urinary bother (P=0.02) and sexual function (P<0.0001) 1-year post-RP. Severe declines in urinary bother (odds ratio (OR)=1.54, 1.01-2.35) and sexual function (OR=3.20, 1.97-5.19) were more common in men > or = 65 years. Men with relationships had less urinary bother (P=0.03) and were less likely to experience severe worsening of urinary bother (OR=0.32, 0.17-0.60) while having a greater risk of severe worsening of sexual bother (OR=2.74, 1.28-5.89). The use of sexual aids was associated with worse sexual bother (P<0.0001) and greater risk of severe worsening of sexual bother (OR=2.29, 1.54-3.30). Baseline PCI scores were independent predictors in all models. One year after RP, younger men (age < 55) have similar, or better, urinary and sexual function and bother. Baseline scores are strongly associated with post-RP scores and severity of declines. Current relationships and use of sexual aids have significant roles in post-RP bother.

  5. Morbidity and mortality of radical prostatectomy differs by insurance status.

    PubMed

    Trinh, Quoc-Dien; Schmitges, Jan; Sun, Maxine; Sammon, Jesse; Shariat, Shahrokh F; Zorn, Kevin; Sukumar, Shyam; Bianchi, Marco; Perrotte, Paul; Graefen, Markus; Rogers, Craig G; Peabody, James O; Menon, Mani; Karakiewicz, Pierre I

    2012-04-01

    Private insurance status may favorably affect various health outcomes including those associated with radical prostatectomy (RP). We explored the effect of insurance status on 5 short-term RP outcomes. Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS) we focused on RPs performed within the 5 most contemporary years (2003-2007). We tested the rates of blood transfusions, extended length of stay, intraoperative and postoperative complications, as well as in-hospital mortality, stratified according to insurance status. Multivariable logistic regression analyses, fitted with general estimation equations for clustering among hospitals, adjusted for confounding factors. Overall, 61,167 RPs were identified. Of those, private insurance accounted for the majority of cases (n = 41,312, 67.5%), followed by Medicare (n = 18,759, 30.7%) and Medicaid (n = 1096, 1.8%). Insurance status other than private was associated with higher rates of blood transfusions (P < .001), higher overall postoperative complication rates (P < .001), higher rates of hospital stay above the median (P < .001), as well as higher in-hospital mortality (P = .01). In multivariable analyses, compared with patients with private insurance, Medicaid patients had higher rates of blood transfusion (odds ratio [OR] = 1.45, P < .001), length of stay beyond the median (OR = 1.61, P < .001) postoperative complications (OR= 1.24, P = .02), and in-hospital mortality (OR = 4.91, = .01). Similarly, Medicare patients had higher rates of blood transfusions (OR = 1.21, P < .001), overall postoperative complications (OR = 1.17, P×< .001) and length of stay beyond the median (OR = 1.25, P < .001). Even after adjusting for confounding factors, patients with private insurance have better outcomes than their counterparts with nonprivate insurance. Copyright © 2011 American Cancer Society.

  6. Orgasm-associated urinary incontinence and sexual life after radical prostatectomy.

    PubMed

    Nilsson, Andreas E; Carlsson, Stefan; Johansson, Eva; Jonsson, Martin N; Adding, Christofer; Nyberg, Tommy; Steineck, Gunnar; Wiklund, N Peter

    2011-09-01

    Involuntary release of urine during sexual climax, orgasm-associated urinary incontinence, occurs frequently after radical prostatectomy. We know little about its prevalence and its effect on sexual satisfaction. To determine the prevalence of orgasm-associated incontinence after radical prostatectomy and its effect on sexual satisfaction. Consecutive series, follow-up at one point in calendar time of men having undergone radical prostatectomy (open surgery or robot-assisted laparoscopic surgery) at Karolinska University Hospital, Stockholm, Sweden, 2002-2006. Of the 1,411 eligible men, 1,288 (91%) men completed a study-specific questionnaire. Prevalence rate of orgasm-associated incontinence. Of the 1,288 men providing information, 691 were sexually active. Altogether, 268 men reported orgasm-associated urinary incontinence, of whom 230 (86%) were otherwise continent. When comparing them with the 422 not reporting the symptom but being sexually active, we found a prevalence ratio (with 95% confidence interval) of 1.5 (1.2-1.8) for not being able to satisfy the partner, 2.1 (1.1-3.5) for avoiding sexual activity because of fear of failing, 1.5 (1.1-2.1) for low orgasmic satisfaction, and 1.4 (1.2-1.7) for having sexual intercourse infrequently. Prevalence ratios increase in prostate-cancer survivors with a higher frequency of orgasm-associated urinary incontinence. We found orgasm-associated urinary incontinence to occur among a fifth of prostate cancer survivors having undergone radical prostatectomy, most of whom are continent when not engaged in sexual activity. The symptom was associated with several aspects of sexual life. © 2011 International Society for Sexual Medicine.

  7. Administrative data sets are inaccurate for assessing functional outcomes after radical prostatectomy.

    PubMed

    Tollefson, Matthew K; Gettman, Matthew T; Karnes, R Jeffrey; Frank, Igor

    2011-05-01

    A recent report examined rates of urinary incontinence and erectile dysfunction following radical prostatectomy by evaluating administrative claims data. However, the validity of this approach for reporting functional outcomes has not been established. Therefore, we determined the prognostic value of administrative claims data for reporting urinary incontinence and erectile dysfunction after radical prostatectomy. We identified 562 patients who underwent radical prostatectomy from 2004 to 2007 and were followed at our institution with self-reported standardized survey data available at least 1 year after surgery. Urinary incontinence was assessed by self-reported pad use and the urinary function domain of the Expanded Prostate Cancer Index. Erectile dysfunction was assessed with the International Index of Erectile Function. These results were then compared with administrative claims data using ICD-9 and Hospital International Classification of Diseases Adapted codes for urinary incontinence and erectile dysfunction. Administrative claims data demonstrated a poor correlation with patient self-reported questionnaire data. The administrative identification of erectile dysfunction was associated with a sensitivity of 0.598 and a specificity of 0.591. Poor correlation was also illustrated by the low kappa correlation coefficient of 0.184. Similarly urinary incontinence was poorly correlated with self-reported pad use and the urinary function domain of the Expanded Prostate Cancer Index (correlation coefficient 0.195). Administrative claims data correlate poorly with validated questionnaire data when assessing functional outcomes after radical prostatectomy such as urinary incontinence and erectile dysfunction. Therefore, outcomes data generated using this approach may not reflect the development or severity of such complications. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  8. Intraoperative Optical Biopsy during Robotic Assisted Radical Prostatectomy Using Confocal Endomicroscopy.

    PubMed

    Lopez, Aristeo; Zlatev, Dimitar V; Mach, Kathleen E; Bui, Daniel; Liu, Jen-Jane; Rouse, Robert V; Harris, Theodore; Leppert, John T; Liao, Joseph C

    2016-04-01

    Intraoperative optical biopsy technologies may aid in the identification of important anatomical landmarks and improve surgical outcomes of robotic assisted radical prostatectomy. We evaluate the feasibility of confocal laser endomicroscopy during robotic assisted radical prostatectomy. A total of 21 patients with biopsy proven prostate cancer scheduled for robotic assisted radical prostatectomy were recruited. After intravenous administration of fluorescein 15 patients underwent in vivo intraoperative confocal laser endomicroscopy of prostatic and periprostatic structures using a 2.6 or 0.85 mm imaging probe. Standard robotic instruments were used to grasp and maneuver the confocal laser endomicroscopy probes for image acquisition. Confocal laser endomicroscopy imaging was performed ex vivo on fresh prostate specimens from 20 patients. Confocal video sequences acquired in vivo and ex vivo were reviewed and analyzed, with additional image processing using a mosaicing algorithm. Processed confocal images were compared with standard hematoxylin and eosin analysis of imaged regions. Confocal laser endomicroscopy was successfully integrated with robotic surgery, including co-registration of confocal video sequences with white light and probe handling with standard robotic instrumentation. Intraoperative confocal laser endomicroscopy imaging of the neurovascular bundle before and after nerve sparing dissection revealed characteristic features including dynamic vascular flow and intact axon fibers. Ex vivo confocal imaging of the prostatic parenchyma demonstrated normal prostate glands, stroma and prostatic carcinoma. We report the initial feasibility of optical biopsy of prostatic and periprostatic tissue during robotic assisted radical prostatectomy. Image guidance and tissue interrogation using confocal laser endomicroscopy offer a new intraoperative imaging method that has the potential to improve the functional and oncologic outcomes of prostate cancer surgery

  9. Rectal injury during robot-assisted radical prostatectomy: incidence and management.

    PubMed

    Wedmid, Alexei; Mendoza, Pierre; Sharma, Saurabh; Hastings, Rachel L; Monahan, Kelly P; Walicki, Mary; Ahlering, Thomas E; Porter, James; Castle, Erik P; Ahmed, Faisal; Engel, Jason D; Frazier, Harold A; Eun, Daniel; Lee, David I

    2011-11-01

    Rectal injury during robot-assisted radical prostatectomy is a rare but significant complication. Since the Clavien grading classification of complications does not include intraoperative injury without further sequelae, rectal injury may be underreported in the literature. We present what is to our knowledge the largest retrospective review to date of rectal injury and subsequent management. We reviewed the records of 6,650 patients who underwent robot-assisted radical prostatectomy at a total of 6 institutions. Patient characteristics, perioperative parameters, pathological findings and rectal injury management were tabulated and analyzed for intraoperative predictors of outcome and subsequent management. A total of 11 rectal injury cases were identified of the 6,650 robot-assisted radical prostatectomies for a combined 0.17% incidence of rectal injury. Of rectal injuries 72.7% were identified intraoperatively and most did well with primary closure. Delayed recognition injury presented as rectourethral fistula without septic complications and required delayed fistula repair after primary diversion. We found no conclusive association of rectal injury with any patient parameter, intraoperative differences, pathological finding or surgeon experience. Posterior prostate plane dissection, including seminal vesicle dissection, is the crucial stage when rectal injury can occur and be identified. Our review of the records at 6 centers revealed a combined 0.17% incidence of rectal injury. This compares favorably to the incidence in modern open and laparoscopic radical prostatectomy series. No preoperative, intraoperative or pathological differences correlated with injury. Cases in which rectal injury was identified intraoperatively required fewer surgical repeat interventions but ultimately each group had acceptable long-term urinary and bowel function results. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All

  10. Trends in radical prostatectomy: centralization, robotics, and access to urologic cancer care.

    PubMed

    Stitzenberg, Karyn B; Wong, Yu-Ning; Nielsen, Matthew E; Egleston, Brian L; Uzzo, Robert G

    2012-01-01

    Robotic surgery has been widely adopted for radical prostatectomy. We hypothesized that this change is rapidly shifting procedures away from hospitals that do not offer robotics and consequently increasing patient travel. A population-based observational study of all prostatectomies for cancer in New York, New Jersey, and Pennsylvania from 2000 to 2009 was performed using hospital discharge data. Hospital procedure volume was defined as the number of prostatectomies performed for cancer in a given year. Straight-line travel distance to the treating hospital was calculated for each case. Hospitals were contacted to determine the year of acquisition of the first robot. From 2000 to 2009, the total number of prostatectomies performed annually increased substantially. The increase occurred almost entirely at the very high-volume centers (≥ 106 prostatectomies/year). The number of hospitals performing prostatectomy fell 37% from 2000 to 2009. By 2009, the 9% (21/244) of hospitals that had very high volume performed 57% of all prostatectomies, and the 35% (86/244) of hospitals with a robot performed 85% of all prostatectomies. The median travel distance increased 54% from 2000 to 2009 (P<.001). The proportion of patients traveling ≥ 15 miles increased from 24% to 40% (P < .001). Over the past decade, the number of radical prostatectomies performed has risen substantially. These procedures have been increasingly centralized at high-volume centers, leading to longer patient travel distances. Few prostatectomies are now performed at hospitals that do not offer robotic surgery. Copyright © 2011 American Cancer Society.

  11. Minimising postoperative incontinence following radical prostatectomy: considerations and evidence.

    PubMed

    Cambio, Angelo J; Evans, Christopher P

    2006-11-01

    To review evidence regarding perioperative predictors of incontinence after radical prostatectomy (RP), related anatomic and patient factors, and surgical techniques used to minimise incontinence. A search of the Pubmed, Cancerlit, Cochrane, and ISI Web of Science databases was performed for the key words prostatectomy, incontinence, and continence. Relevant articles were reviewed, summarised, and analysed. Enhanced understanding of pelvic anatomy applied to surgical approaches has improved continence rates following RP; however, incontinence remains a potential adverse outcome. Evidence suggests that increasing patient body weight and prostate volume are not associated with continence outcomes, but increasing patient age may be predictive. Behavioural therapy may aid in early return to continence although the timing of therapy and benefit of biofeedback assistance are unclear. Various surgical techniques are used to improve continence, but no evidence overwhelmingly supports any specific technique. At best, evidence supports early return to continence with some techniques. No technique significantly increased margin positivity solely at the experimental anatomic site. Despite enhanced knowledge of anatomy and improved surgical approach, incontinence persists as a potential adverse outcome of RP. Urologists may not find an evidence-based rationalisation for any particular surgical technique due to the nature of surgical series, variability in the definition of incontinence, and individual surgical skills, preferences, and techniques. Giving careful consideration to the trial design can potentially improve the resulting level of evidence.

  12. Impact of obesity on early erectile function recovery after robotic radical prostatectomy.

    PubMed

    Uffort, Ekong E; Jensen, James C

    2011-01-01

    Studies are limited regarding the impact of obesity on early erectile functional outcomes after robotic radical prostatectomy. Our goal was to determine this impact using patient-reported validated questionnaires. International Index of Erectile Function (IIEF-6) scores were prospectively collected with institutional review board approval, for patients who underwent robotic radical prostatectomy with bilateral nerve sparing from February 2007 to October 2009. The data were categorized into nonobese and obese groups and subsequently into 2 subgroups based on risk for postprostatectomy erectile dysfunction. Low risk is preoperative IIEF-6 ≥19 and high risk is IIEF-6 <19. The groups and subgroups were compared using chi-square analysis. Of 190 consecutive patients, 67 were excluded for preoperative severe erectile dysfunction (IIEF-6<7), or lack of IIEF-6 scores, or both. There were 69 nonobese patients of which 88% were potent preoperatively and 20% regained potency at 12 months postoperatively. Of 54 obese patients, 85% were potent preoperatively and 25% at 12 months. There was no difference in erectile function recovery rates between the groups (P=0.755). In both groups, patients with low risk of postoperative erectile dysfunction had statistically similar postoperative mean IIEF-6 scores at 6 and 12 months (P=0.580 and P=0.389, respectively), and no difference in erectile function recovery rates existed at 12 months (P=0.735). Obesity has no major contribution to the rate of early erectile function recovery after robotic radical prostatectomy. Preoperative erectile function remains the determining factor in postradical prostatectomy erectile dysfunction.

  13. Literature review of factors affecting continence after radical prostatectomy

    PubMed Central

    Pacik, Dalibor; Fedorko, Michal

    2017-01-01

    Radical prostatectomy (RP) is the most common cause of stress urinary incontinence (UI) in men. Several anatomic structures affect or may affect urinary continence - urethral sphincter, levator ani muscle, puboprostatic ligaments, bladder neck, endopelvic fascia, neurovascular bundle - and understanding of the anatomy of pelvic floor and urethra is crucial for satisfactory functional outcome of the procedure. Surgical techniques implemented to improve continence rates include nerve-sparing procedure, bladder neck preservation/plication, urethral length preservation, musculofascial reconstruction, puboprostatic ligaments preservation or seminal vesicle preservation. Perioperative (preoperative and postoperative) pelvic floor muscle training (PFMT) aims to shorten the duration of postoperative UI and thus, improve early continence rates postoperatively. In the review, complex information regarding anatomical, intra- and perioperative factors affecting urinary continence after RP is provided, including description of important anatomical structures, possible implications for surgical technique and evaluation of different PFMT strategies in perioperative period. PMID:28042624

  14. Literature review of factors affecting continence after radical prostatectomy.

    PubMed

    Pacik, Dalibor; Fedorko, Michal

    2017-01-01

    Radical prostatectomy (RP) is the most common cause of stress urinary incontinence (UI) in men. Several anatomic structures affect or may affect urinary continence - urethral sphincter, levator ani muscle, puboprostatic ligaments, bladder neck, endopelvic fascia, neurovascular bundle - and understanding of the anatomy of pelvic floor and urethra is crucial for satisfactory functional outcome of the procedure. Surgical techniques implemented to improve continence rates include nerve-sparing procedure, bladder neck preservation/plication, urethral length preservation, musculofascial reconstruction, puboprostatic ligaments preservation or seminal vesicle preservation. Perioperative (preoperative and postoperative) pelvic floor muscle training (PFMT) aims to shorten the duration of postoperative UI and thus, improve early continence rates postoperatively. In the review, complex information regarding anatomical, intra- and perioperative factors affecting urinary continence after RP is provided, including description of important anatomical structures, possible implications for surgical technique and evaluation of different PFMT strategies in perioperative period.

  15. Current status of penile rehabilitation after radical prostatectomy

    PubMed Central

    Kim, Jae Heon

    2015-01-01

    Although disease-free survival remains the primary goal of prostate cancer treatment, erectile dysfunction (ED) remains a common complication that affects the quality of life. Even though several preventive and therapeutic strategies are available for ED after radical prostatectomy (RP), no specific recommendations have been made on the optimal rehabilitation or treatment strategy. Several treatment options are available, including phosphodiesterase-5 inhibitors, vacuum erection devices, intracavernosal or intraurethral prostaglandin injections, and penile prostheses. Urologists must consider more effective ways to establish optimal treatments for ED after RP. ED is an important issue among patients with prostate cancer, and many patients hope for early ED recovery after surgery. This review highlights the currently available treatment options for ED after RP and discusses the limitations of each. PMID:25685296

  16. Analysis of the pentafecta learning curve for laparoscopic radical prostatectomy.

    PubMed

    Good, D W; Stewart, G D; Stolzenburg, J U; McNeill, S A

    2014-10-01

    Laparoscopic radical prostatectomy (LRP) has a long learning curve; however, little is known about the pentafecta learning curve for LRP. We analysed the learning curve for a fellowship trained surgeon with regard to the pentafecta with up to 6-year follow-up. A retrospective review was performed in 550 cases, by dividing these cases into 11 groups of 50 patients. Outcomes analysed were the following: (1) the pentafecta (complication rate, positive surgical margin (PSM) rate, continence, potency and biochemical recurrence); (2) operative time and blood loss; and (3) overall pentafecta attainment. The mean complication rate for the entire series was 9 %; this plateaued after 150 cases. The overall PSM rate for the series was 23.5 %, 16.3 % for pT2 and 40.5 % for pT3. PSM plateaued after 200 cases. Excluding the first 100 cases, the overall PSM rate for pT2 was 10.9 % and 37.8 % for pT3. The continence rate stabilised after approximately 250 cases. The rate of male sling/artificial urinary sphincter plateaued after 200 cases. The potency learning curve continues to improve after 250 cases of nerve-sparing (ns) endoscopic extraperitoneal radical prostatectomy (EERPE) as does the pentafecta learning curve which closely follows the pattern of the potency learning curve. The last group of nsEERPE achieved pentafecta in 63 %. This study shows multiple learning curves: an initial for peri-operative outcomes, then stabilisation of oncologic outcomes and the final for stabilisation of functional outcomes. In this series over 250 cases were required to achieve the learning curve.

  17. Controversies in the management of localized prostate cancer: radical prostatectomy still the standard of care.

    PubMed

    Budäus, Lars; Huland, Hartwig; Graefen, Markus

    2012-12-01

    The optimal treatment for clinically localized prostate cancer is an ongoing subject of controversy. Treatment decisions must take tumour staging, risk assessment, life expectancy and consideration of the major side effects of multiple available treatment regimens into account. Despite technical advances reduced the side effects of radiation therapy, the majority of patients with newly diagnosed organ confined prostate cancer decide to undergo radical prostatectomy. Refinements of radical prostatectomy surgical techniques during the last decade are influenced by better understanding of the anatomy of the small pelvis and resulted in excellent functional and oncological outcomes. Additionally, the surgeons experience was identified as a key determinant for improved surgical outcomes. Recently, retrospective studies revealed that also patients with locally advanced disease benefit from radical prostatectomy. Advantages of radical prostatectomy include a precise pathological staging that assesses the need for additional therapies. Moreover, PSA can easily be used as an accurate surrogate marker during follow-up in such patients.

  18. Comprehensive preoperative evaluation and repair of inguinal hernias at the time of open radical retropubic prostatectomy decreases risk of developing post-prostatectomy hernia.

    PubMed

    Marien, Tracy; Taouli, Bachir; Telegrafi, Shpetim; Babb, James S; Lepor, Herbert

    2012-12-01

    What's known on the subject? and What does the study add? Some studies have evaluated preoperative and intraoperative examination for inguinal hernias and their repair, noting a decrease in the rate of post-prostatectomy hernias. However, this did not eradicate post-prostatectomy hernias, indicating that this method probably missed subclinical hernias. Other studies looked at prophylactic procedures to prevent the formation of inguinal hernias at the time of prostatectomy and showed a decrease in the rate of postoperative hernias. To our knowledge this is the only series evaluating a multi-modal approach with magnetic resonance imaging, ultrasonography and examination to identify all clinical and subclinical hernias and repair them at the time of prostatectomy. This approach only subjects those patients at risk for symptomatic hernias to an additional procedure and decreases the post-prostatectomy hernia rate to <1%. • To assess if a comprehensive evaluation to diagnose clinical and subclinical hernias and repair of these hernias at the time of open radical retropubic prostatectomy (ORRP) decreases the incidence of clinical inguinal hernias (IHs) after ORRP. • Between 1 July 2007 and 31 July 2010, 281 consecutive men underwent ORRP by a single surgeon. • Of these men, 207 (74%) underwent comprehensive preoperative screening for IH, which included physical examination, upstanding ultrasonography and magnetic resonance imaging. • Between 12 and 24 months after ORRP, 178 (86%) of these men completed a questionnaire designed to capture development of clinical IHs. • Of the 178 evaluable patients, 92 (52%) were diagnosed preoperatively with IH by at least one diagnostic modality. • Forty-one and 51 of the men had bilateral or unilateral IHs, respectively for a total of 133 IHs. • No preoperative factor was significantly associated with the presence of an IH before prostatectomy. • No groin subjected to IH repair (IHR) at the time of ORRP developed a

  19. Surgeon and Hospital Level Variation in the Costs of Robot-Assisted Radical Prostatectomy.

    PubMed

    Cole, Alexander P; Leow, Jeffrey J; Chang, Steven L; Chung, Benjamin I; Meyer, Christian P; Kibel, Adam S; Menon, Mani; Nguyen, Paul L; Choueiri, Toni K; Reznor, Gally; Lipsitz, Stuart R; Sammon, Jesse D; Sun, Maxine; Trinh, Quoc-Dien

    2016-10-01

    We assessed surgeon and hospital level variation in robot-assisted radical prostatectomy costs and predictors of high and low cost surgery. The study population consisted of a weighted sample of 291,015 men who underwent robot-assisted radical prostatectomy for prostate cancer by 667 surgeons at 197 U.S. hospitals from 2003 to 2013. We evaluated 90-day direct hospital costs (2014 USD) in the Premier Hospital Database. High costs per robot-assisted radical prostatectomy were those above the 90th percentile and low costs were those below the 10th percentile. Mean hospital cost per robot-assisted radical prostatectomy was $11,878 (95% CI $11,804-$11,952). Mean cost was $2,837 (95% CI $2,805-$2,869) in the low cost group vs $25,906 (95% CI $24,702-$25,490) in the high cost group. Nearly a third of the variation in robot-assisted radical prostatectomy cost was attributable to hospital characteristics and more than a fifth was attributable to surgeon characteristics (R-squared 30.43% and 21.25%, respectively). High volume surgeons and hospitals (90th percentile or greater) had decreased odds of high cost surgery (surgeons: OR 0.24, 95% CI 0.11-0.54; hospitals: OR 0.105, 95% CI 0.02-0.46). The performance of robot-assisted radical prostatectomy at a high volume hospital was associated with increased odds of low cost robot-assisted radical prostatectomy (OR 839, 95% CI 122-greater than 999). This study provides insight into the role of surgeons and hospitals in robot-assisted radical prostatectomy costs. Given the substantial variability, identifying and remedying the root cause of outlier costs may yield substantial benefits. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  20. [International Society of Urological Pathology (ISUP) Consensus Conference on handling and staging of radical prostatectomy specimens].

    PubMed

    Compérat, Eva; Camparo, Philippe; Srigley, John; Delahunt, Brett; Egevad, Lars

    2013-06-01

    The 2009 International Society of Urological Pathology (ISUP) consensus conference on handling and staging of radical prostatectomy specimens issued recommendations for standardization of pathology reporting of radical prostatectomy specimens. The conference addressed specimen handling, T2 substaging, prostate cancer volume, extraprostatic extension, lymphovascular invasion, seminal vesicle invasion, lymph node metastases and surgical margins. This review summarizes the conclusions and recommendations resulting from the consensus process. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  1. Respiratory gas exchange during robotic-assisted laparoscopic radical prostatectomy.

    PubMed

    Lebowitz, Philip; Yedlin, Adam; Hakimi, A Ari; Bryan-Brown, Christopher; Richards, Mahesan; Ghavamian, Reza

    2015-09-01

    Robotic-assisted laparoscopic prostatectomy requires patients to be secured in a steep Trendelenburg position for several hours. Added to the CO2 pneumoperitoneum that is created, this positioning invariably restricts diaphragmatic and chest wall excursion, which can adversely affect respiratory gas exchange. This study sought to measure the extent of respiratory gas change during this procedure. Retrospective, institutional review board approved. Operating room. N = 186 males, American Society of Anesthesiologists 2-3, with prostatic carcinoma undergoing robotic-assisted laparoscopic radical prostatectomy. Arterial blood gases and noninvasive respiratory measurements were recorded for those patients (n = 32) in whom a radial arterial catheter had been inserted intraoperatively, specifically timed to different phases of the procedure: supine lithotomy, steep Trendelenburg, and return to supine. Ventilatory parameters were standardized. Systemic blood pressure, heart rate, respiratory rate, Pao2, Paco2, oxygen saturation as measured by pulse oximetry, and end-tidal carbon dioxide pressure. Although no patients developed perioperative respiratory complications, the Pao2 invariably fell (395 vs 316 mm Hg; P = .001) while the patients were in steep Trendelenburg, and the Paco2-end-tidal carbon dioxide pressure rose (10.0 vs 13.4 mm Hg; P < .0001). Upon return to supine, patients' respiratory measurements promptly returned to within 15% of baseline. Subgroup analysis for high-BMI vs low-BMI patients as well as for patients with pulmonary disease and/or a smoking history showed similar individual effects and only small, although significant, respiratory gas exchange aberrations. Positioning patients with a CO2 pneumoperitoneum in steep Trendelenburg for several hours imposes restriction of diaphragmatic and chest wall movement sufficient for respiratory gas exchange to be adversely affected. Return of function to within 15% of baseline occurred within minutes after

  2. Overactive bladder is a negative predictor of achieving continence after robot-assisted radical prostatectomy.

    PubMed

    Yamada, Yuta; Fujimura, Tetsuya; Fukuhara, Hiroshi; Sugihara, Toru; Miyazaki, Hideyo; Nakagawa, Tohru; Kume, Haruki; Igawa, Yasuhiko; Homma, Yukio

    2017-10-01

    To investigate predictors of continence outcomes after robot-assisted radical prostatectomy. Clinical records of 272 patients who underwent robot-assisted radical prostatectomy were investigated. Preoperative Overactive Bladder Symptom Score, International Prostate Symptom Score and clinicopathological factors were investigated, and relationships between factors and recovery of continence after robot-assisted radical prostatectomy were assessed. The presence of overactive bladder was defined as having urgency for more than once a week and having ≥3 points according to the Overactive Bladder Symptom Score. Age (≤66 years) was significantly associated with continence within 6 months after robot-assisted radical prostatectomy (P = 0.033). The absence of overactive bladder and lower Overactive Bladder Symptom Score (<3) were significantly associated with recovery of continence within 12 months after surgery (both variables P = 0.009). In terms of achieving recovery of continence after robot-assisted radical prostatectomy, Kaplan-Meier curves showed earlier recovery in "age ≤66 years," "prostate weight ≤40 g" and "overactive bladder symptom score <3" (P = 0.0072, 0.0172 and 0.0140, respectively). Multivariate analysis showed that the presence of overactive bladder was an independent negative predictor for recovery of continence within 12 months after surgery (P = 0.019). The presence of baseline overactive bladder seems to represent an independent negative predictor for recovery of continence at 12 months after robot-assisted radical prostatectomy. © 2017 The Japanese Urological Association.

  3. Radical prostatectomy versus watchful waiting for prostate cancer.

    PubMed

    Hegarty, Josephine; Beirne, Paul V; Walsh, Ella; Comber, Harry; Fitzgerald, Tony; Wallace Kazer, Meredith

    2010-11-10

    The lack of evidence regarding the effectiveness of treatment options for clinically localised prostate cancer continues to impact on clinical decision-making. Two such options are radical prostatectomy (RP) and watchful waiting (WW). WW involves providing no initial treatment and monitoring the patient with the intention of providing palliative treatment if there is evidence of disease progression. To compare the beneficial and harmful effects of RP versus WW for the treatment of localised prostate cancer. MEDLINE, EMBASE, The Cochrane Library, ISI Science Citation Index, DARE and LILACS were searched through 30 July 2010. Randomised or quasi-randomised controlled trials comparing the effects of RP versus WW for clinically localised prostate cancer. Data extraction and quality assessment were carried out independently by two authors. Two trials met the inclusion criteria. Both trials commenced prior to the widespread availability of prostate-specific antigen (PSA) screening; hence the results may not be applicable to men with PSA-detected disease.One trial (N = 142), conducted in the US, was judged to be of poor quality. All cause (overall) mortality was not significantly different between RP and WW groups after fifteen years of follow up (Hazard Ratio (HR) 0.9 (95% Confidence Interval (CI) 0.56 to 1.43).The second trial (N = 695), conducted in Scandinavia, was judged to be of good quality. After 12 years of follow up, the trial results were compatible with a beneficial effect of RP on the risks of overall mortality, prostate cancer mortality and distant metastases compared with WW but the precise magnitude of the effect is uncertain as indicated by the width of the confidence intervals for all estimates (risk difference (RD) -7.1% (95% CI -14.7 to 0.5); RD -5.4% (95% CI -11.1 to 0.2); RD -6.7% (95% CI -13.2 to -0.2), respectively).        Compared to WW, RP increased the absolute risks of erectile dysfunction (RD 35% (95% CI 25 to 45)) and urinary leakage

  4. Effect of methylprednisolone on return of sexual function after nerve-sparing radical retropubic prostatectomy.

    PubMed

    Parsons, J Kellogg; Marschke, Penny; Maples, Patricia; Walsh, Patrick C

    2004-11-01

    To determine whether postoperative methylprednisolone improves the recovery of sexual function after nerve-sparing radical retropubic prostatectomy. We randomized men undergoing bilateral nerve-sparing radical retropubic prostatectomy by a single surgeon to receive 6 days of placebo or methylprednisolone beginning on postoperative day 1. At 3, 6, and 12 months postoperatively, we assessed potency with the abbreviated International Index of Erectile Function questionnaire and urinary continence with participant-reported pad use. We used the chi-square test, Fisher's exact test, and the two-sample t test with equal variances for comparisons between study groups. No operative complications occurred and 70 (100%) of 70 participants experienced normal wound healing. The odds of being potent for participants who received methylprednisolone (n = 34) compared with those who received placebo (n = 36) did not significantly differ at 3 (odds ratio 0.29, 95% confidence interval 0.08 to 1.05), 6 (odds ratio 0.63, 95% confidence interval 0.17 to 2.4), or 12 (odds ratio 1.18, 95% confidence interval 0.29 to 4.8) months. The mean International Index of Erectile Function scores did not significantly differ at 3 (P = 0.08), 6 (P = 0.50), or 12 (P = 0.71) months. At 12 months, 74% of the methylprednisolone and 71% of the placebo participants were potent (P = 0.8). The proportions of participants who were continent did not differ significantly at 3 (P = 0.89), 6 (P = 0.25), or 12 (P = 0.49) months. At 12 months, 96% of the methylprednisolone and 100% of the placebo participants were continent. At doses sufficient to produce a systemic anti-inflammatory effect, postoperative methylprednisolone was not associated with improved potency at up to 12 months after bilateral nerve-sparing radical retropubic prostatectomy in men 40 to 60 years old.

  5. Best practices in robot-assisted radical prostatectomy: recommendations of the Pasadena Consensus Panel.

    PubMed

    Montorsi, Francesco; Wilson, Timothy G; Rosen, Raymond C; Ahlering, Thomas E; Artibani, Walter; Carroll, Peter R; Costello, Anthony; Eastham, James A; Ficarra, Vincenzo; Guazzoni, Giorgio; Menon, Mani; Novara, Giacomo; Patel, Vipul R; Stolzenburg, Jens-Uwe; Van der Poel, Henk; Van Poppel, Hein; Mottrie, Alexandre

    2012-09-01

    Radical retropubic prostatectomy (RRP) has long been the most common surgical technique used to treat clinically localized prostate cancer (PCa). More recently, robot-assisted radical prostatectomy (RARP) has been gaining increasing acceptance among patients and urologists, and it has become the dominant technique in the United States despite a paucity of prospective studies or randomized trials supporting its superiority over RRP. A 2-d consensus conference of 17 world leaders in prostate cancer and radical prostatectomy was organized in Pasadena, California, and at the City of Hope Cancer Center, Duarte, California, under the auspices of the European Association of Urology Robotic Urology Section to systematically review the currently available data on RARP, to critically assess current surgical techniques, and to generate best practice recommendations to guide clinicians and related medical personnel. No commercial support was obtained for the conference. A systematic review of the literature was performed in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. The results of the systematic literature review were reviewed, discussed, and refined over the 2-d conference. Key recommendations were generated using a Delphi consensus approach. RARP is associated with less blood loss and transfusion rates compared with RRP, and there appear to be minimal differences between the two approaches in terms of overall postoperative complications. Positive surgical margin rates are at least equivalent with RARP, but firm conclusions about biochemical recurrence and other oncologic end points are difficult to draw because the follow-up in existing studies is relatively short and the overall experience with RARP in locally advanced PCa is still limited. RARP may offer advantages in postoperative recovery of urinary continence and erectile function, although there are methodological limitations in most studies to date and a need for

  6. Extended lymph node dissection in robotic radical prostatectomy: Current status

    PubMed Central

    Chopra, Sameer; Alemozaffar, Mehrdad; Gill, Inderbir; Aron, Monish

    2016-01-01

    Introduction: The role and extent of extended pelvic lymph node dissection (ePLND) during radical prostatectomy (RP) for prostate cancer patients remains unclear. Materials and Methods: A PubMed literature search was performed for studies reporting on treatment regimens and outcomes in patients with prostate cancer treated by RP and extended lymph node dissection between 1999 and 2013. Results: Studies have shown that RP can improve progression-free and overall survival in patients with lymph node-positive prostate cancer. While this finding requires further validation, it does allow urologists to question the former treatment paradigm of aborting surgery when lymph node invasion from prostate cancer occurred, especially in patients with limited lymph node tumor infiltration. Studies show that intermediate- and high-risk patients should undergo ePLND up to the common iliac arteries in order to improve nodal staging. Conclusions: Evidence from the literature suggests that RP with ePLND improves survival in lymph node-positive prostate cancer. While studies have shown promising results, further improvements and understanding of the surgical technique and post-operative treatment are required to improve treatment for prostate cancer patients with lymph node involvement. PMID:27127352

  7. The Histopathological Parameters Affecting Biochemical Recurrence in Radical Prostatectomies.

    PubMed

    Dere, Yelda; Altinboga, Aysegu Aksoy; Bal, Kaan; Calli, Aylin; Ermete, Murat; Sari, Aysegul Akder

    2017-04-01

    To determine the relationship between biochemical recurrence and other histopathological factors in prostate cancer. Analytical study. Pathology and Urology Departments, Izmir Ataturk Training and Research Hospital, between 2001 - 2013. 117 cases diagnosed with prostatic adenocarcinoma and treated by radical prostatectomy were reviewed retrospectively for histopathological features; whereas, other prognostic findings were noted. PSA levels and many other histopathological parameters were assessed in order to put forth their effect on biochemical recurrence. PSA level (p<0.001), tumor volume (p<0.001), Gleason score (p<0.001), extraprostatic extension (p<0.001), perineural invasion (p<0.001), ganglion involvement (p=0.040), vascular invasion (p<0.001), positive surgical margins (p<0.001), presence of tertiary pattern (p=0.004) and the involvement of the seminal vesicles (p<0.001) were found to be statistically related to the pathological stage. Age, perineural invasion, high grade tertiary pattern, intraluminal mucin, collagenous micronodules and foamy cytoplasmic changes were unrelated to recurrence. Histopathological features can be helpful in predicting prognosis in prostatic adenocarcinomas. However some of the histopathological factors such as intraluminal mucin and foamy cytoplasmic changes may not reflect high recurrence.

  8. Predictors of costs for robotic-assisted laparoscopic radical prostatectomy.

    PubMed

    Bolenz, Christian; Gupta, Amit; Roehrborn, Claus G; Lotan, Yair

    2011-01-01

    Information on the association of perioperative parameters with costs for robotic-assisted laparoscopic radical prostatectomy (RALP) is lacking. Understanding factors that impact cost may allow reduction in cost of prostate cancer care. We identified factors associated with higher costs in a contemporary series of RALP. Total direct cost and clinicopathologic data were available for 264 patients who underwent RALP at our institution between May 2005 and April 2008. We performed linear regression analyses to identify predictors of direct cost using preoperative, intraoperative, and postoperative variables. On univariable analyses, operating room (OR) time, placement of a pelvic drain (both P<0.001), complications during surgery (P=0.002) or hospitalization, blood transfusion, and length of stay (all P<0.001) were associated with higher direct costs. On multivariable analysis, none of the preoperative features were found to predict direct costs. Of the intraoperative factors, OR time (P<0.001) and pelvic drain placement (P=0.006) were associated with higher direct costs. A longer OR time, length of stay, and usage of transfusions (all P<0.001) during the postoperative course were independently associated with higher direct costs. Of factors that are available preoperatively, none seems to be useful to predict added costs for individual patients undergoing RALP. Higher costs for RALP are driven by events occurring during the procedure or postoperative hospital stay. Copyright © 2011 Elsevier Inc. All rights reserved.

  9. Does prior abdominal surgery influence outcomes or complications of robotic-assisted laparoscopic radical prostatectomy?

    PubMed

    Ginzburg, Serge; Hu, Frances; Staff, Ilene; Tortora, Joseph; Champagne, Alison; Salner, Andrew; Shichman, Steven J; Kesler, Stuart S; Wagner, Joseph R; Laudone, Vincent P

    2010-11-01

    To determine whether robotic-assisted laparoscopic radical prostatectomy (RALP) in patients with prior abdominal surgery is associated with increased operating times, positive surgical margins, or complications. An institutional review board-approved retrospective review of a prospective, prostatectomy database was performed. Patients undergoing surgery between January 1, 2004, and February 29, 2008 were included. Transition from open retropubic prostatectomy to RALP took place through 2004, at which point all surgical candidates were offered RALP, regardless of prior surgical history. Learning curves from all surgeons were included. Patients with prior abdominal surgery were compared with those patients without prior surgery with respect to total operating time, robotic-assist time, surgical margin positivity, and rate of complications. A total of 1083 patients underwent RALP between January 1, 2004, and February 29, 2008, at our institution; of these, 839 had sufficient data available for analysis. In all, 251 (29.9%) patients had prior abdominal surgery, whereas 588 (70.1%) had no prior abdominal surgery. Total operating times were 209 and 204 minutes (P = .20), robotic console times were 165 and 163 minutes (P = .59), and surgical margin positivity was 21.1% and 27.2% (P = .08) for patients with and without prior abdominal surgery, respectively. The incidence of complications was 14.3% and 17.3% for patients with and without prior abdominal surgery (P = .33). Prior abdominal surgery was not associated with a statistically significant increase in overall operating time, robotic assist time, margin positivity, or incidence of complications in patients undergoing RALP. Robotic prostatectomy can be safely and satisfactorily performed in patients who have had a wide variety of prior abdominal surgery types. Copyright © 2010 Elsevier Inc. All rights reserved.

  10. Intussusception of the reconstructed bladder neck leads to earlier continence after radical prostatectomy.

    PubMed

    Walsh, Patrick C; Marschke, Penny L

    2002-06-01

    Although there is no evidence that the reconstructed bladder neck actively contributes to post-radical prostatectomy continence, we set out to determine whether buttressing sutures, which prevent the bladder neck from pulling open as the bladder fills, would result in the earlier return of urinary control. Forty-five men (mean age 57 years, range 37 to 67) with clinical localized prostate cancer underwent anatomic radical retropubic prostatectomy with standard tennis racket bladder neck reconstruction. The bladder neck was then intussuscepted using two 2-0 Maxon Lembert sutures placed lateral and posterior to the reconstructed bladder neck. Filling of the bladder with saline at this point revealed little leakage. Patient-reported continence at 3 months was compared with the published outcome of 64 men using the same quality-of-life instrument (the UCLA Prostate Cancer Index). At 3 months, 82% of men who underwent intussusception of the bladder neck were continent (no pad/dry pad) compared with 54% in our prior report (P = 0.0035). The occurrence of bladder neck contracture was similar: 7% versus 5%. Intussusception of the bladder neck led to a significant improvement in urinary control at 3 months postoperatively. Longer follow-up will be necessary to determine whether this approach may eliminate the 2% probability of long-term significant problems with urinary control.

  11. Preoperative erythropoietin administration in patients with prostate cancer undergoing radical prostatectomy without transfusion.

    PubMed

    Lee, Byung Woo; Park, Min Gu; Cho, Dae Yeon; Park, Seok San; Yeo, Jeong Kyun

    2014-02-01

    In this study, we administered erythropoietin preoperatively to patients who underwent open radical prostatectomy without transfusion to increase their hemoglobin levels and investigated the efficacy of this procedure. We evaluated 62 patients who underwent open radical prostatectomy performed by the same surgeon between June 2005 and January 2011. The 22 patients who refused transfusion were assigned to group 1; the patients who accepted transfusion were assigned to group 2. Before surgery, we administered erythropoietin beta to group 1 patients whose hemoglobin levels were <12 g/dL and retrospectively compared the clinical data of the two groups. We used the t-test and the chi-square test for statistical analysis. Mean preoperative hemoglobin levels in group 1 after erythropoietin administration (14.5 g/dL) were significantly higher than those in group 2 (13.59 g/dL, p=0.003). Moreover, the difference in the mean hemoglobin levels before and after surgery for group 1 patients (3.55 g/dL) significantly exceeded that for group 2 patients (2.08 g/dL, p=0.000). Additional analysis revealed no statistically significant differences in perioperative complications between the groups. Preoperative erythropoietin administration increased the safety margin of hemoglobin levels, and this strategy worked sufficiently well in our experience.

  12. Urinary Incontinence and Erectile Dysfunction After Robotic Versus Open Radical Prostatectomy: A Prospective, Controlled, Nonrandomised Trial.

    PubMed

    Haglind, Eva; Carlsson, Stefan; Stranne, Johan; Wallerstedt, Anna; Wilderäng, Ulrica; Thorsteinsdottir, Thordis; Lagerkvist, Mikael; Damber, Jan-Erik; Bjartell, Anders; Hugosson, Jonas; Wiklund, Peter; Steineck, Gunnar

    2015-08-01

    Robot-assisted laparoscopic radical prostatectomy (RALP) has become widely used without high-grade evidence of superiority regarding long-term clinical outcomes compared with open retropubic radical prostatectomy (RRP), the gold standard. To compare patient-reported urinary incontinence and erectile dysfunction 12 mo after RALP or RRP. This was a prospective, controlled, nonrandomised trial of patients undergoing prostatectomy in 14 centres using RALP or RRP. Clinical-record forms and validated patient questionnaires at baseline and 12 mo after surgery were collected. Odds ratios (ORs) were calculated with logistic regression and adjusted for possible confounders. The primary end point was urinary incontinence (change of pad less than once in 24h vs one time or more per 24h) at 12 mo. Secondary end points were erectile dysfunction at 12 mo and positive surgical margins. Of 2625 eligible men, 2431 (93%) could be evaluated for the primary end point. At 12 mo after RALP, 366 men (21.3%) were incontinent, as were 144 (20.2%) after RRP. The adjusted OR was 1.08 (95% confidence interval [CI], 0.87-1.34). Erectile dysfunction was observed in 1200 men (70.4%) 12 mo after RALP and 531 (74.7%) after RRP. The adjusted OR was 0.81 (95% CI, 0.66-0.98). The frequency of positive surgical margins did not differ significantly between groups: 21.8% in the RALP group and 20.9% in the RRP group (adjusted OR: 1.09; 95% CI, 0.87-1.35). The nonrandomised design is a limitation. In a Swedish setting, RALP for prostate cancer was modestly beneficial in preserving erectile function compared with RRP, without a statistically significant difference regarding urinary incontinence or surgical margins. We compared patient-reported urinary incontinence after prostatectomy with two types of surgical technique. There was no statistically significant improvement in the rate of urinary leakage, but there was a small improvement regarding erectile function after robot-assisted operation. Copyright

  13. [Prostatectomy-pros and cons on open surgery/laparoscopic surgery/robot-assisted surgery].

    PubMed

    Abe, Mitsuhiro; Kawano, Yoshiyuki; Kameyama, Shuji

    2011-12-01

    We have 3 options when perfoming prostatectomy for the treatment of localized prostate cancer. Those are retropubic radical prostatectomy, laparoscopic radical prostatectomy and robot-assisted laparoscopic radical prostatectomy. We compared the characteristics and results of these techniques. Robot-assisted laparoscopic radical prostatectomy could be superior to the others in many ways. However, it would be very difficult to adopt it in Japan because it would pose economical difficulties. The administrative assistance in the insurance systems requireds much more than we have.

  14. Hypertension, obesity and prostate cancer biochemical recurrence after radical prostatectomy

    PubMed Central

    Asmar, R; Beebe-Dimmer, JL; Korgavkar, K; Keele, GR; Cooney, KA

    2013-01-01

    Background The metabolic syndrome (MetS) comprises a constellation of risk factors associated with an increased risk for cardiovascular disease. Components of MetS have emerged as putative risk factors for prostate carcinoma. In this study, we examine the association between three features of the MetS (obesity, hypertension and diabetes) and the risk of biochemical recurrence (BCR) after radical prostatectomy (RP). Methods We examined data from 1428 men in the University of Michigan Prostate Cancer Data Bank who elected to have RP as their primary treatment. We calculated body mass index from patients' weight and height measured at the time of prostate cancer diagnosis. We used the University of Michigan's Electronic Medical Record Search Engine to identify subjects with hypertension and/or diabetes before their prostate cancer diagnosis. Results Of 1428 men who underwent RP, 107 (8%) subsequently developed BCR with a median length of follow-up post-surgery of 3.6 years. Obesity and hypertension were each associated with an increased risk of BCR (adjusted hazard ratio (aHR) = 1.37; 95% CI 0.92–2.09 and aHR = 1.51, 95% CI 1.01–2.26), whereas no association was observed between diabetes and BCR (aHR = 0.73; 95% CI 0.40–1.33). Conclusions Obesity and hypertension were each associated with an increased risk for BCR of prostate cancer after RP, independent of age at diagnosis and tumor pathological features. Given the increasing rates of obesity, hypertension and prostate cancer, a better understanding of the relationship between these entities is of significant public health importance. Elucidation of the involved pathogenic mechanisms will be needed to establish causality. PMID:22907512

  15. Allogeneic versus autologous blood transfusion and survival after radical prostatectomy

    PubMed Central

    Chalfin, Heather J.; Frank, Steven M.; Feng, Zhaoyong; Trock, Bruce J.; Drake, Charles G.; Partin, Alan W.; Humphreys, Elizabeth; Ness, Paul M.; Jeong, Byong C.; Lee, Seung B.; Han, Misop

    2016-01-01

    BACKGROUND Potential adverse effects of blood transfusion (BT) remain controversial, especially for clinical outcomes after curative cancer surgery. Some postulate that immune modulation after allogeneic BT predisposes to recurrence and death, but autologous superiority is not established. This study assessed whether BT is associated with long-term prostate cancer recurrence and survival a large single-institutional radical prostatectomy (RP) database. STUDY DESIGN AND METHODS Between 1994 and 2012, a total of 11,680 patients had RP with available outcome and transfusion data. A total of 7443 (64%) had complete covariate data. Clinical variables associated with biochemical recurrence-free survival (BRFS), cancer-specific survival (CSS), and overall survival (OS) were identified with Cox proportional hazards models for three groups: no BT (reference, 27.7%, n = 2061), autologous BT only (68.8%, n = 5124), and any allogeneic BT (with or without autologous, 3.5%, n = 258). RESULTS Median (range) follow-up was 6 (1–18) years. Kaplan-Meier analysis showed significantly decreased OS (but not BRFS or PCSS) in the allogeneic group versus autologous and no BT groups (p = 0.006). With univariate analysis, any allogeneic BT had a hazard ratio (HR) of 2.29 (range, 1.52–3.46; p < 0.0001) for OS, whereas autologous BT was not significant (HR, 1.04 [range, 0.82–1.32], p = 0.752). In multivariable models, neither autologous nor allogeneic BT was independently associated with BRFS, CSS, or OS, and a dose response was not observed for allogeneic units and BRFS. CONCLUSION Although allogeneic but not autologous BT was associated with decreased long-term OS, after adjustment for confounding clinical variables, BT was not independently associated with OS, BRFS, or CSS regardless of transfusion type. Notably, no association was observed between allogeneic BT and cancer recurrence. Observed differences in OS may reflect confounding. PMID:24601996

  16. [Counselling for erectile dysfunction during inpatient rehabilitation after radical prostatectomy].

    PubMed

    Vahlensieck, W; Sommer, F; Mathers, M J; Gilbert, T; Waidelich, R

    2011-04-01

    For men erectile function is essential for quality of life. Besides urine incontinence postsurgical erectile dysfunction (ED) following radical prostatectomy (RPE) represents a significant and prevalent problem. One of the first approaches to this condition should be a consultation performed by professionals in a rehabilitation clinic.A total of 149 patients post RPE participated in this prospective study. All patients were questioned about their understanding of postoperative surgical ED after RPE and if affected they were asked about their own psychological burden as well as their knowledge of possible therapy options. The qualities of presurgical patient information as well as the modules of information pertaining to ED during the rehabilitation were evaluated. Of the patients, 53% expressed that they experienced a considerable burden due to postsurgical ED during their follow-up rehabilitation (AR group) and 70% of the patients during oncological rehabilitation treatment (rehab group). Men who were sexually more active prior to surgery suffered more from postsurgical ED than their less active counterparts. A negative correlation between psychological burden and age was found in the AR group, which however was levelled in the rehab group. Particularly in older patients the burden of ED increases with more time elapsing after the operation. The medical information on ED therapy options provided during the inpatient rehabilitation was considered to be essential by 60% of the men in the AR group and 48% of the patients in the rehab group.Therapeutic possibilities for postsurgical ED following RPE cannot always be given to patients in the preoperative phase or during their stay in the hospital. Since however a large majority of men suffer from postoperative ED following RPE a specialized inpatient urological rehabilitation is suited for a comprehensive consultation.

  17. Salvage Radiation Therapy for Biochemical Failure Following Radical Prostatectomy.

    PubMed

    Spieler, Benjamin; Goldstein, Jeffrey; Lawrence, Yaacov R; Saad, Akram; Berger, Raanan; Ramon, Jacob; Dotan, Zohar; Laufer, Menachem; Weiss, Ilana; Tzvang, Lev; Poortmans, Philip; Symon, Zvi

    2017-01-01

    Radiotherapy to the prostate bed is used to eradicate residual microscopic disease following radical prostatectomy for prostate cancer. Recommendations are based on historical series. To determine outcomes and toxicity of contemporary salvage radiation therapy (SRT) to the prostate bed. We reviewed a prospective ethics committee-approved database of 229 patients referred for SRT. Median pre-radiation prostate-specific antigen (PSA) was 0.5 ng/ml and median follow-up was 50.4 months (range 13.7-128). Treatment was planned and delivered using modern three-dimensional radiation techniques. Mean bioequivalent dose was 71 Gy (range 64-83 Gy). Progression was defined as two consecutive increases in PSA level > 0.2 ng/ml, metastases on follow-up imaging, commencement of anti-androgen treatment for any reason, or death from prostate cancer. Kaplan-Meier survival estimates and multivariate analysis was performed using STATA. Five year progression-free survival was 68% (95%CI 59.8-74.8%), and stratified by PSA was 87%, 70% and 47% for PSA < 0.3, 0.3-0.7, and > 0.7 ng/ml (P < 0.001). Metastasis-free survival was 92.5%, prostate cancer-specific survival 96.4%, and overall survival 94.9%. Low pre-radiation PSA value was the most important predictor of progression-free survival (HR 2.76, P < 0.001). Daily image guidance was associated with reduced risk of gastrointestinal and genitourinary toxicity (P < 0.005). Contemporary SRT is associated with favorable outcomes. Early initiation of SRT at PSA < 0.3 ng/ml improves progression-free survival. Daily image guidance with online correction is associated with a decreased incidence of late toxicity.

  18. Hypertension, obesity and prostate cancer biochemical recurrence after radical prostatectomy.

    PubMed

    Asmar, R; Beebe-Dimmer, J L; Korgavkar, K; Keele, G R; Cooney, K A

    2013-03-01

    The metabolic syndrome (MetS) comprises a constellation of risk factors associated with an increased risk for cardiovascular disease. Components of MetS have emerged as putative risk factors for prostate carcinoma. In this study, we examine the association between three features of the MetS (obesity, hypertension and diabetes) and the risk of biochemical recurrence (BCR) after radical prostatectomy (RP). We examined data from 1428 men in the University of Michigan Prostate Cancer Data Bank who elected to have RP as their primary treatment. We calculated body mass index from patients' weight and height measured at the time of prostate cancer diagnosis. We used the University of Michigan's Electronic Medical Record Search Engine to identify subjects with hypertension and/or diabetes before their prostate cancer diagnosis. Of 1428 men who underwent RP, 107 (8%) subsequently developed BCR with a median length of follow-up post-surgery of 3.6 years. Obesity and hypertension were each associated with an increased risk of BCR (adjusted hazard ratio (aHR) = 1.37; 95% CI 0.92-2.09 and aHR = 1.51, 95% CI 1.01-2.26), whereas no association was observed between diabetes and BCR (aHR = 0.73; 95% CI 0.40-1.33). Obesity and hypertension were each associated with an increased risk for BCR of prostate cancer after RP, independent of age at diagnosis and tumor pathological features. Given the increasing rates of obesity, hypertension and prostate cancer, a better understanding of the relationship between these entities is of significant public health importance. Elucidation of the involved pathogenic mechanisms will be needed to establish causality.

  19. Spinal Anesthesia Does Not Impact Prostate Cancer Recurrence in a Cohort of Men Undergoing Radical Prostatectomy: An Observational Study

    PubMed Central

    Tseng, Kenneth S.; Kulkarni, Sachin; Humphreys, Elizabeth B; Carter, H. Ballentine; Mostwin, Jacek L.; Partin, Alan W; Han, Misop; Wu, Christopher L.

    2014-01-01

    Background and Objectives Prior studies suggest a possible association between the use of neuraxial-general anesthesia and a decrease in prostate cancer recurrence after radical prostatectomy. We examine the correlation of a spinal anesthesia-only technique on prostate cancer recurrence. Methods Charts from consecutive radical prostatectomy patients of 3 experienced urologists from January 1999 to December 2005 were reviewed. In addition to the usual clinical and pathologic predictors of disease recurrence, patient records were queried for the type of anesthesia (general versus spinal) performed. A Cox proportional hazards model was used to determine the statistical significance of predictors of biochemical recurrence. Results A total of 1,964 patients—1,166 and 798 receiving spinal with sedation or general anesthesia, respectively—had complete preoperative and follow-up data. In univariate proportional hazards analysis, the use of general anesthesia was associated with a trend towards an increased risk of biochemical recurrence when compared with the use of spinal anesthesia (hazard ratio = 1.29, 95% confidence interval [CI] 0.99–1.66, P=0.053). In multi-variable analysis, the effect size (hazard ratio = 1.10, 95% CI 0.85–1.42, P=0.458) was diminished by clinical and pathologic variables. Conclusions This was a retrospective study of patients with prostate cancer who have undergone radical prostatectomy during a time period when the practice of anesthesia for prostatectomy at our institution was transitioned from spinal to general anesthesia. In our study, when controlling for other predictors of advanced prostate cancer, the type of anesthetic given during prostatectomy had no effect on the risk of biochemical recurrence. PMID:24918335

  20. Impact of metabolic syndrome on early recovery of continence after robot-assisted radical prostatectomy.

    PubMed

    Nishikawa, Masatomo; Watanabe, Hiromitsu; Kurahashi, Toshifumi

    2017-09-01

    To evaluate the impact of metabolic syndrome on the early recovery of urinary continence after robot-assisted radical prostatectomy. The present study included a total of 302 consecutive Japanese patients with clinically localized prostate cancer who underwent robot-assisted radical prostatectomy. In this study, postoperative urinary continence was defined as no leak or the use of a security pad. The continence status was assessed by interviews before and 1 and 3 months after robot-assisted radical prostatectomy. Metabolic syndrome was defined as follows: body mass index ≥25 kg/m(2) and two or more of the following: hypertension, diabetes mellitus and dyslipidemia. The effect of the presence of metabolic syndrome on the continence status of these patients was retrospectively examined. A total of 116 (38.4%) and 203 (67.2%) of the 302 patients were continent at 1 and 3 months after robot-assisted radical prostatectomy, respectively. A total of 31 (10.3%) patients were judged to have metabolic syndrome. Despite the operative time being longer in patients with metabolic syndrome, no significant differences were observed in the remaining preoperative, intraoperative or postoperative variables between patients with or without metabolic syndrome. On multivariate logistic regression analysis, metabolic syndrome and the duration of hospitalization were significantly correlated with the 1-month continence status. Similarly, metabolic syndrome and estimated blood loss during surgery were independent predictors of continence rates at 3 months after robot-assisted radical prostatectomy. These findings suggest that the presence of metabolic syndrome could have a significant impact on the early recovery of urinary continence after robot-assisted radical prostatectomy. © 2017 The Japanese Urological Association.

  1. Surgical and postoperative factors affecting length of hospital stay after radical prostatectomy.

    PubMed

    Gardner, T A; Bissonette, E A; Petroni, G R; McClain, R; Sokoloff, M H; Theodorescu, D

    2000-07-15

    model included six main effects and three interaction terms. Overall, LOS decreased over time with LOS decreasing at a faster rate in patients who underwent RPP. In general, patients who underwent RRP had an increased LOS compared with patients who underwent RPP. Complications from surgery and age increased the LOS for all patients; however, the increase was greater in patients who underwent RPP. In addition, the use of intraoperative epidural anesthesia and the increased use of postoperative narcotics were associated with increased LOS for patients undergoing both surgical approaches. TTF and TTS were significantly longer for patients who underwent the retropubic approach compared with those patients who underwent the perineal approach. After adjustment for surgical approach no other covariables were found to be associated with TTF. After adjustment for surgical approach, the occurrence of complications was found to be associated with TTS, indicating that patients who experienced complications took longer before they could tolerate solid foods. In view of the importance of clinical care pathways in reducing medical expenditures from radical prostatectomy, the results of the current study may contribute to the further refining of these pathways by highlighting the differences and similarities among the variables affecting LOS as a function of surgical approach. Copyright 2000 American Cancer Society.

  2. Predictors of positive surgical margins and their location in Korean men undergoing radical prostatectomy.

    PubMed

    Choo, Min Soo; Cho, Sung Yong; Jeong, Chang Wook; Lee, Seung Bae; Ku, Ja Hyeon; Hong, Sung Kyu; Byun, Seok-Soo; Kwak, Cheol; Kim, Hyeon Hoe; Lee, Sang Eun; Jeong, Hyeon

    2014-09-01

    To evaluate preoperative predictors of positive surgical margins and their location in Korean men undergoing radical prostatectomy. A total of 3227 patients who had undergone radical prostatectomy (open, robotic or laparoscopic) for clinically localized prostate cancer at three centers between 2000 and 2010 were analyzed. Patients were stratified by using the D'Amico risk criteria. Positive surgical margins were categorized according to their location. Patients were divided depending on their prostate volume: <29, 29-36, 36-46 and ≥46 mL. All of the patients had a minimum of six. A total of 2041 patients (84.9%) underwent 12-14 core biopsies. In each patient, the number and location of positive cores with cancer were assessed. In the analysis of predictive factors for positive surgical margin locations, regression analysis was carried out using only open and robotic prostatectomy. The preoperative prostate-specific antigen, prostate volume, biopsy Gleason scores and clinical stage were significantly associated with an increased risk of positive surgical margins. The predictive variables for positive apical margin were small prostate volume (less than 29 mL) and positive apical biopsy. There were no statistically significant predictors for positive posterolateral or basal margin. Positive apical biopsy was the predictor of positive apical margin in open (odds ratio 1.7, P = 0.009) and robotic prostatectomy (odds ratio 2.2, P = 0.041). Small prostate volume was the predictor of positive apical margin in open prostatectomy (odds ratio 1.6, P = 0.012), but for positive basal margin in robotic radical prostatectomy (odds ratio 4.5, P < 0.001). In survival analysis, positive basal margin showed worse prognoses on biochemical recurrence than positive apical margin. High prostate-specific antigen and small prostate volume are predictive factors of positive surgical margin in Korean patients undergoing radical prostatectomy. Apical positivity on

  3. Results From the Scandinavian Prostate Cancer Group Trial Number 4: A Randomized Controlled Trial of Radical Prostatectomy Versus Watchful Waiting

    PubMed Central

    2012-01-01

    In the Scandinavian Prostate Cancer Group Trial Number 4 (SPCG-4), 347 men were randomly assigned to radical prostatectomy and 348 to watchful waiting. In the most recent analysis (median follow-up time = 12.8 years), the cumulative mortality curves had been stable over the follow-up. At 15 years, the absolute risk reduction of dying from prostate cancer was 6.1% following randomization to radical prostatectomy, compared with watchful waiting. Hence, 17 need to be randomized to operation to avert one death. Data on self-reported symptoms, stress from symptoms, and quality of life were collected at 4 and 12.2 years of median follow-up. These questionnaire studies show an intricate pattern of symptoms evolving after surgery, hormonal treatments, signs of tumor progression, and also from natural aging. This article discusses some of the main findings of the SPCG-4 study. PMID:23271778

  4. A laparoscopic radical prostatectomy assisted by the "ZEUS" robotic system: an initial case report.

    PubMed

    Eto, Masatoshi; Yokomizo, Akira; Koga, Hirofumi; Tsunoda, Toshiyuki; Kakeji, Yoshihiro; Hashizume, Makoto; Naito, Seiji

    2005-02-01

    A 68-year-old man with prostate cancer, T1cN0M0, was treated with laparoscopic radical prostatectomy (LRP) assisted by the ZEUS robotic system. The ZEUS system was utilized only for vesico-urethral anastomosis, one of the most difficult procedures to perform during LRP. We could complete the vesico-urethral anastomosis using the ZEUS system for 100 min without any intraoperative complications. The urethral catheter was removed 7 days after operation. To our knowledge, this is the initial case of robot-assisted radical prostatectomy using the ZEUS system.

  5. Robotic-Assisted Radical Prostatectomy after the First Decade: Surgical Evolution or New Paradigm

    PubMed Central

    Skarecky, Douglas W.

    2013-01-01

    Early studies indicate that robotic-assisted radical prostatectomy (RARP) has promising short-term outcomes; however, RARP is beyond its infancy, and the long-term report cards are now beginning. The important paradigm shift introduced by RARP is the reevaluation of the entire open radical prostatectomy experience in surgical technique by minimizing blood loss and complications, maximizing cancer free outcomes, and a renewed assault in preserving quality of life outcomes by many novel mechanisms. RARP provides a new technical “canvas” for surgical masters to create upon, and in ten years, has reinvigorated a 100-year-old “gold standard” surgery. PMID:23691367

  6. Anatomical basis for carrying out a state-of-the-art radical prostatectomy.

    PubMed

    Takenaka, Atsushi; Tewari, Ashutosh K

    2012-01-01

    Robotic-assisted laparoscopic prostatectomy has consolidated the position of surgical treatment for localized prostate cancer in the USA. In a few years, it is expected to spread rapidly worldwide. However, surgical anatomy has trailed the advance in surgical techniques of robotic-assisted laparoscopic prostatectomy. Therefore, we reviewed the recent literature, which sometimes refutes the established consensus on pelvic anatomy, for the state-of-the-art technique. We also describe the anatomical findings for each basic step during robotic-assisted laparoscopic prostatectomy, and show evidence-based surgical techniques. Of course, these findings will also be useful for radical retropubic, perineal and conventional laparoscopic prostatectomy. Surgical anatomy should always be developing and changing with advances in surgical approaches.

  7. Intra-operative prostate motion tracking using surface markers for robot-assisted laparoscopic radical prostatectomy

    NASA Astrophysics Data System (ADS)

    Esteghamatian, Mehdi; Sarkar, Kripasindhu; Pautler, Stephen E.; Chen, Elvis C. S.; Peters, Terry M.

    2012-02-01

    Radical prostatectomy surgery (RP) is the gold standard for treatment of localized prostate cancer (PCa). Recently, emergence of minimally invasive techniques such as Laparoscopic Radical Prostatectomy (LRP) and Robot-Assisted Laparoscopic Radical Prostatectomy (RARP) has improved the outcomes for prostatectomy. However, it remains difficult for the surgeons to make informed decisions regarding resection margins and nerve sparing since the location of the tumor within the organ is not usually visible in a laparoscopic view. While MRI enables visualization of the salient structures and cancer foci, its efficacy in LRP is reduced unless it is fused into a stereoscopic view such that homologous structures overlap. Registration of the MRI image and peri-operative ultrasound image using a tracked probe can potentially be exploited to bring the pre-operative information into alignment with the patient coordinate system during the procedure. While doing so, prostate motion needs to be compensated in real-time to synchronize the stereoscopic view with the pre-operative MRI during the prostatectomy procedure. In this study, a point-based stereoscopic tracking technique is investigated to compensate for rigid prostate motion so that the same motion can be applied to the pre-operative images. This method benefits from stereoscopic tracking of the surface markers implanted over the surface of the prostate phantom. The average target registration error using this approach was 3.25+/-1.43mm.

  8. Abdominal obesity, hypertension, antihypertensive medication use and biochemical recurrence of prostate cancer after radical prostatectomy.

    PubMed

    Ohwaki, Kazuhiro; Endo, Fumiyasu; Hattori, Kazunori

    2015-03-01

    The aim of this study was to determine whether abdominal obesity, including visceral adipose tissue (VAT) measured by computed tomography and blood pressure (BP) were associated with biochemical recurrence of prostate cancer after prostatectomy. We investigated 283 patients who underwent radical prostatectomy for prostate cancer retrospectively. We obtained information on body mass index (BMI), waist circumference (WC), VAT, BP, antihypertensive drug use, pretreatment prostate-specific antigen levels, pathological Gleason scores and postoperative surgical margin status. Hypertension was defined as systolic BP (SBP)⩾130mmHg or diastolic BP⩾85mmHg. Among 283 patients, 41 (14%) developed biochemical recurrence subsequently. We performed a Cox proportional hazard regression analysis to assess the association of each obesity measurement and SBP with biochemical recurrence using clinical predictors as potential confounders. No association was observed between any obesity measurement assessed and biochemical recurrence. Adjusting for each of BMI, WC and VAT, a higher SBP was associated significantly with biochemical recurrence (hazard ratio [HR], adjusted for VAT=1.04; 95% confidence interval [CI]=1.02-1.07). Adjusting for obesity (BMI⩾25kg/m(2)), hypertension was also associated significantly with biochemical recurrence (HR=2.08; 95% CI=1.09-3.97). Compared with normotensive patients, those with untreated and uncontrolled hypertension had a significantly increased risk of biochemical recurrence (HR=2.45; 95% CI=1.06-5.66). A higher BP and untreated, uncontrolled hypertension were independent risk factors for biochemical recurrence after prostatectomy. Control of hypertension could be an important treatment strategy for preventing biochemical recurrence. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. VEGFR1 and NRP1 endothelial expressions predict distant relapse after radical prostatectomy in clinically localized prostate cancer.

    PubMed

    Talagas, Matthieu; Uguen, Arnaud; Garlantezec, Ronan; Fournier, Georges; Doucet, Laurent; Gobin, Eric; Marcorelles, Pascale; Volant, Alain; DE Braekeleer, Marc

    2013-05-01

    Prostate cancer can usually be treated at a clinically localized stage by radical prostatectomy. Unfortunately, within 10 years following surgery, 30% of patients experience local or distant relapse. Few data exist on the association of markers of angiogenesis and distant relapse after radical prostatectomy. By immunohistochemistry in tissue microarray, we compared the expression pattern of hypoxia inducible factor 1, alpha subunit (HIF1α) and vascular endothelial growth factor (VEGF) and its receptors in 45 patients with distant relapse and 68 patients without relapse after radical prostatectomy. Expressions of HIF1α and VEGF were assessed in prostate tumor cells and those of VEGFR1, VEGFR2 and neuropilin 1 in tumor and endothelial cells. The five molecules studied were expressed by all tumors, with the exception of neuropilin 1 in endothelial cells for one tumor. Strong endothelial expression of VEGFR1 appeared to be an independent predictor of distant relapse. A moderate to strong endothelial expression of neuropilin 1 was in turn an independent predictor of absence of distant relapse. No significant difference was found for HIF1α, VEGF, VEGFR1, VEGFR2 and neuropilin 1 expression in tumor cells, nor for VEGFR2 in endothelial cells, between the two groups. To our knowledge, this is the first study to evaluate the prognostic value of VEGFR1, VEGFR2 and neuropilin 1 in endothelial cells in prostate cancer after radical prostatectomy. The evaluation by immunohistochemistry of endothelial expression of neuropilin 1 and VEGFR1 could be an additional tool in the assessment of tumor aggressiveness of clinically localized prostate cancer to better identify patients at high risk of distant relapse.

  10. Avoiding and managing vascular injury during robotic-assisted radical prostatectomy

    PubMed Central

    Nunez Bragayrac, Luciano A.; Machuca, Victor; Garza Cortes, Roberto; Azhar, Raed A.

    2015-01-01

    There has been an increase in the number of urologic procedures performed robotically assisted; this is the case for radical prostatectomy. Currently, in the USA, 67% of prostatectomies are performed robotically assisted. With this increase in robotic urologic surgery it is clear that there are more surgeons in their learning curve, where most of the complications occur. Among the complications that can occur are vascular injuries. These can occur in the initial stages of surgery, such as in accessing the abdominal cavity, as well as in the intraoperative or postoperative setting. We present the most common vascular injuries in robot-assisted radical prostatectomy, as well as their management and prevention. We believe that it is of vital importance to be able to recognize these injuries so that they can be prevented. PMID:25642293

  11. Cystolithotomy during robotic radical prostatectomy: Single-stage procedure for concomitant bladder stones

    PubMed Central

    Tan, Gerald Y.; Sooriakumaran, Prasanna; Peters, David L.; Srivastava, Abhishek; Tewari, Ashutosh

    2012-01-01

    Asymptomatic concomitant vesical calculi are an occasional finding on routine radiologic staging and evaluation of patients with early prostate cancer. We report the first case of single-stage robotic cystolithotomy for multiple bladder stones in a 64-year-old man undergoing robotic-assisted radical prostatectomy, and discuss the approaches available for ensuring complete stone clearance in this unique setting. We show that concomitant bladder stone extraction during robotic-assisted radical prostatectomy is feasible and does not add significantly to operative time. This technique avoids the need to undergo additional general anesthetic procedures with potential complications such as bleeding, urethral stricture formation, and bladder perforation, prior to the prostatectomy. PMID:22557729

  12. Avoiding and managing vascular injury during robotic-assisted radical prostatectomy.

    PubMed

    Sotelo, René; Nunez Bragayrac, Luciano A; Machuca, Victor; Garza Cortes, Roberto; Azhar, Raed A

    2015-02-01

    There has been an increase in the number of urologic procedures performed robotically assisted; this is the case for radical prostatectomy. Currently, in the USA, 67% of prostatectomies are performed robotically assisted. With this increase in robotic urologic surgery it is clear that there are more surgeons in their learning curve, where most of the complications occur. Among the complications that can occur are vascular injuries. These can occur in the initial stages of surgery, such as in accessing the abdominal cavity, as well as in the intraoperative or postoperative setting. We present the most common vascular injuries in robot-assisted radical prostatectomy, as well as their management and prevention. We believe that it is of vital importance to be able to recognize these injuries so that they can be prevented.

  13. The association between metabolic syndrome and advanced prostate cancer in Chinese patients receiving radical prostatectomy

    PubMed Central

    Zhang, Gui-Ming; Zhu, Yao; Dong, Da-Hai; Han, Cheng-Tao; Gu, Cheng-Yuan; Gu, Wei-Jie; Qin, Xiao-Jian; Sun, Li-Jiang; Ye, Ding-Wei

    2015-01-01

    The global incidence of metabolic syndrome (MetS) is dramatically increasing. Considerable interest has been devoted to the relationship between MetS and prostate cancer (PCa) risk. However, few studies have examined the association between MetS and PCa progression. This retrospective study consisted of 1016 patients with PCa who received radical prostatectomy. The association between MetS and pathological features was evaluated using logistic regression analysis. Compared with patients without MetS, those with MetS indicated an increased risk of prostatectomy Gleason score (GS) ≥8 (odds ratio [OR] =1.670, 95% confidence interval (CI) 1.096–2.545, P= 0.017), and a 1.5-fold increased risk of pT3–4 disease (OR = 1.583, 95% CI 1.106–2.266, P= 0.012). The presence of MetS was an independent predictor of lymph node involvement (OR = 1.751, 95% CI 1.038–2.955, P= 0.036). Furthermore, as the number of MetS components accumulated, the risk of a GS ≥ 8 increased. The present study indicates a significant association between MetS and advanced PCa. The results need to be evaluated in large-scale prospective cohorts. PMID:25652638

  14. Effect of Soy Protein Isolate Supplementation on Biochemical Recurrence of Prostate Cancer After Radical Prostatectomy

    PubMed Central

    Bosland, Maarten C; Kato, Ikuko; Zeleniuch-Jacquotte, Anne; Schmoll, Joanne; Rueter, Erika Enk; Melamed, Jonathan; Xiangtian Kong, Max; Macias, Virgilia; Kajdacsy-Balla, Andre; Lumey, L. H.; Xie, Hui; Gao, Weihua; Walden, Paul; Lepor, Herbert; Taneja, Samir S.; Randolph, Carla; Schlicht, Michael J.; Meserve-Watanabe, Hiroko; Deaton, Ryan J.; Davies, Joanne A.

    2013-01-01

    IMPORTANCE Soy consumption has been suggested to reduce risk or recurrence of prostate cancer, but this has not been tested in a randomized trial with prostate cancer as the end point. OBJECTIVE To determine whether daily consumption of a soy protein isolate supplement for 2 years reduces the rate of biochemical recurrence of prostate cancer after radical prostatectomy or delays such recurrence. DESIGN, SETTING, AND PARTICIPANTS Randomized, double-blind trial conducted from July 1997 to May 2010 at 7 US centers comparing daily consumption of a soy protein supplement vs placebo in 177 men at high risk of recurrence after radical prostatectomy for prostate cancer. Supplement intervention was started within 4 months after surgery and continued for up to 2 years, with prostate-specific antigen (PSA) measurements made at 2-month intervals in the first year and every 3 months thereafter. INTERVENTION Participants were randomized to receive a daily serving of a beverage powder containing 20 g of protein in the form of either soy protein isolate (n=87)or, as placebo, calcium caseinate (n=90). MAIN OUTCOMES AND MEASURES Biochemical recurrence rate of prostate cancer (defined as development of a PSA level of ≥0.07 ng/mL) over the first 2 years following randomization and time to recurrence. RESULTS The trial was stopped early for lack of treatment effects at a planned interim analysis with 81 evaluable participants in the intervention group and 78 in the placebo group. Overall, 28.3% of participants developed biochemical recurrence within 2 years of entering the trial (close to the a priori predicted recurrence rate of 30%). Among these, 22 (27.2%) occurred in the intervention group and 23 (29.5%) in the placebo group. The resulting hazard ratio for active treatment was 0.96 (95% CI, 0.53–1.72; log-rank P = .89). Adherence was greater than 90% and there were no apparent adverse events related to supplementation. CONCLUSION AND RELEVANCE Daily consumption of a beverage

  15. Hemostatic hydrodissection of the neurovascular bundles during robotic assisted laparoscopic radical prostatectomy: safety and efficacy trial

    NASA Astrophysics Data System (ADS)

    Parekattil, Sijo J.; Dahm, Philipp; Vieweg, Johannes W.

    2009-02-01

    Preservation of continence and potency after Robotic Assisted Laparoscopic Radical Prostatectomy (RALP) are two key outcome measures that patients consider when comparing different treatment options for localized prostate cancer. Ensuring that positive surgical margins are as low as possible provides oncologic control. Various techniques to optimize these outcomes have been employed. This study presents the early outcomes for Hemostatic Hydrodissection of the Neurovascular Bundles during 86 consecutive RALPs. Positive margin rates were 12.5% overall (9% for pT2 and 28.6% for pT3); continence at 6 months was 100%, at 3 months 90% and at 1 month 66%. In patients with no preoperative erectile dysfunction (preoperative SHIM of 25), 79% had return of erections sufficient for intercourse by 6 months. 2 of these patients were able to have intercourse 2 weeks after surgery. These preliminary findings appear promising.

  16. [The quality of life after radical prostatectomy measured by general health questionnaire and visual analogue scales].

    PubMed

    Sasaki, R; Habuchi, T; Osamu, O; Kato, T; Matsuo, S; Sasaki, S; Miura, K; Takemura, T; Masuda, Y; Shimizu, T

    2000-01-01

    The impact of radical prostatectomy on the quality of life (QOL) of patients were evaluated. A total of 22 patients who underwent radical prostatectomy for clinically localized prostate cancer entered this study. Patients were asked to complete a questionnaire containing the general health questionnaire (GHQ) and a series of questions evaluating voiding function, incontinence and sexual dysfunction before and after the operation. In addition, the visual analogue scaled (VAS) questionnaire containing incontinence and sexual dysfunction was applied. No significant differences in GHQ were found between pre- and post operative status, but disease-targeted QOL such as sexual function was affected after the radical prostatectomy. In the points of incontinence and sexual dysfunction, VAS questionnaire significantly correlated with those of categorical questionnaires. There results suggest that GHQ is not affected, but disease-targeted QOL in some categories of sexual function is affected by radical prostatectomy, and that VAS questionnaires are not only useful for assessing the disease-targeted QOL but also easy to quantify QOL of the patients.

  17. A Novel Approach for Performing Bone Marrow Aspiration at the Time of Radical Prostatectomy

    PubMed Central

    Tosoian, Jeffrey J.; Reyes, Diane K.; Gorin, Michael A.; Hortopan, Steven; Partin, Alan W.; Pienta, Kenneth J.; Ross, Ashley E.; Schaeffer, Edward M.

    2016-01-01

    The bone marrow microenvironment represents a “metastatic niche” in which prostate cancer cells may persist and evade cytotoxic therapy. In order to study the biology of prostate cancer dissemination, we have established a safe and efficient method for performing pubic bone marrow aspiration at the time of radical prostatectomy. We herein describe our experience with this technique. PMID:27175343

  18. A Novel Approach for Performing Bone Marrow Aspiration at the Time of Radical Prostatectomy.

    PubMed

    Tosoian, Jeffrey J; Reyes, Diane K; Gorin, Michael A; Hortopan, Steven; Partin, Alan W; Pienta, Kenneth J; Ross, Ashley E; Schaeffer, Edward M

    2016-05-01

    The bone marrow microenvironment represents a "metastatic niche" in which prostate cancer cells may persist and evade cytotoxic therapy. In order to study the biology of prostate cancer dissemination, we have established a safe and efficient method for performing pubic bone marrow aspiration at the time of radical prostatectomy. We herein describe our experience with this technique.

  19. The Effect of Intensive Education On Urinary Incontinence Following Radical Prostatectomy: A Randomized Control Trial.

    PubMed

    Novick, Besma Jassani; Angie, Michelle; Walker, Esteban; Kitay, Renee; Monday, Kathryn; Albert, Nancy M

    2014-01-01

    Intense bladder control education failed to improve bladder control among patients who underwent a radical prostatectomy as treatment of their prostate cancer. Despite this educational intervention, participants continued to experience post-operative bladder control problems. Nurses need to develop and implement novel interventions that might enhance bladder control.

  20. Ceramic foam plates: a new tool for processing fresh radical prostatectomy specimens.

    PubMed

    Vlajnic, Tatjana; Oeggerli, Martin; Rentsch, Cyrill; Püschel, Heike; Zellweger, Tobias; Thalmann, George N; Ruiz, Christian; Bubendorf, Lukas

    2014-12-01

    Procurement of fresh tissue of prostate cancer is critical for biobanking and generation of xenograft models as an important preclinical step towards new therapeutic strategies in advanced prostate cancer. However, handling of fresh radical prostatectomy specimens has been notoriously challenging given the distinctive physical properties of prostate tissue and the difficulty to identify cancer foci on gross examination. Here, we have developed a novel approach using ceramic foam plates for processing freshly cut whole mount sections from radical prostatectomy specimens without compromising further diagnostic assessment. Forty-nine radical prostatectomy specimens were processed and sectioned from the apex to the base in whole mount slices. Putative carcinoma foci were morphologically verified by frozen section analysis. The fresh whole mount slices were then laid between two ceramic foam plates and fixed overnight. To test tissue preservation after this procedure, formalin-fixed and paraffin-embedded whole mount sections were stained with hematoxylin and eosin (H&E) and analyzed by immunohistochemistry, fluorescence, and silver in situ hybridization (FISH and SISH, respectively). There were no morphological artifacts on H&E stained whole mount sections from slices that had been fixed between two plates of ceramic foam, and the histological architecture was fully retained. The quality of immunohistochemistry, FISH, and SISH was excellent. Fixing whole mount tissue slices between ceramic foam plates after frozen section examination is an excellent method for processing fresh radical prostatectomy specimens, allowing for a precise identification and collection of fresh tumor tissue without compromising further diagnostic analysis.

  1. Role of frozen section analysis of surgical margins during robot-assisted laparoscopic radical prostatectomy: a 2608-case experience.

    PubMed

    Kakiuchi, Yasuhiro; Choy, Bonnie; Gordetsky, Jennifer; Izumi, Koji; Wu, Guan; Rashid, Hani; Joseph, Jean V; Miyamoto, Hiroshi

    2013-08-01

    It remains unanswered whether and how intraoperative frozen section analysis contributes to the surgical margin status on radical prostatectomy specimens. We aimed to determine whether frozen section analysis during radical prostatectomy reduces the incidence of positive surgical margins. We retrospectively analyzed a consecutive series of patients undergoing robot-assisted laparoscopic radical prostatectomy performed at our institution between 2004 and 2011. We identified 2608 cases, including 1128 (43.3%) where intraoperative frozen section analysis was performed to assess surgical margins. Of the cases with positive (n = 60; 5.3%)/negative (n = 1029; 91.2%)/atypical or indeterminate (n = 39; 3.5%) frozen section analyses, 22 (36.7%)/83 (8.1%)/4 (10.3%) were found to have positive surgical margins on radical prostatectomy specimens, respectively. Thus, 109 (9.7%) of 1128 cases with frozen section analysis had positive surgical margins, compared with 163 (11.0%) of 1480 cases with no frozen section analysis (P = .264). When the patients were subgrouped by histopathologic characteristics, frozen section analysis led to a considerable reduction in the rate of positive surgical margins in cases with biopsy Gleason score 7 (12.4% → 8.7%; P = .087)/8 (28.6% → 16.3%; P = .048)/≥7 (15.3% → 10.1%; P = .012) tumor or pT3b (36.6% → 23.2%; P = .075)/≥pT3b (38.1% → 25.4%; P = .091) disease. Multivariate analysis further revealed that performing frozen section analysis in biopsy Gleason score 7 or higher tumors was an independent predictor of negative surgical margins (odds ratio, 0.61; P = .018). In addition, frozen section analysis of the distal urethra or apex of the prostate (7.5%, P = .035) as well as multiple negative frozen section analyses (≥2: 6.2%, P = .001; ≥4: 2.2%, P = .007) correlated with significantly lower rates of positive surgical margin, compared with no frozen section analysis. Overall, intraoperative frozen section analysis did not

  2. Biochemical Recurrence Prediction in High-Risk Prostate Cancer Patients, Following Robot-Assisted Radical Prostatectomy

    PubMed Central

    Yamaguchi, Noriya; Yumioka, Tetsuya; Iwamoto, Hideto; Masago, Toshihiko; Morizane, Shuichi; Honda, Masashi; Sejima, Takehiro; Takenaka, Atsushi

    2016-01-01

    Background High-risk prostate cancer treatment has been controversial. Some high-risk prostate cancer patients fail to respond to radical prostatectomy only. Thus, we aimed to investigate the predictive factors for biochemical recurrence (BCR) and identify patients who could achieve sufficient therapeutic effect by radical prostatectomy only. Methods Of 264 medical records reviewed, 141 low-intermediate-risk and 100 high-risk prostate cancer patients, excluding those who had received neoadjuvant hormone therapy, were analyzed. BCR was defined as the first increase in prostate-specific antigen levels (≥ 0.2 ng/mL), with levels not decreasing to undetectable limits, after radical prostatectomy. Log-rank test and Cox proportional hazards regression analyses were performed to determine the prognostic factors. We investigated the perioperative predictive factors for BCR and BCR-free survival rates, with the number of National Comprehensive Cancer Network (NCCN) high-risk factors for high-risk prostate cancer patients who underwent robot-assisted radical prostatectomy. Results Multivariate analyses showed that clinical T3 was significantly associated with BCR [hazard ratio (HR) = 4.052; 95% confidence interval (CI), 1.26–12.99; P = 0.019]. Of the 100 patients, 77 had 1 high-risk factor and 23 had ≥ 2 high-risk factors; the 1-year BCR-free survival rate of patients with 1 high-risk factor and those with ≥ 2 high-risk factors was 94.8% and 69.6%, respectively. Patients with ≥ 2 high-risk factors were significantly associated with BCR (P = 0.002). No difference in BCR rate between patients with 1 high-risk factor and those with low- and intermediate-risk was found. Conclusion High-risk prostate cancer patients with 1 NCCN high-risk factor can be considered for robot-assisted radical prostatectomy treatment only. PMID:28070166

  3. Statin use and risk of disease recurrence and death after radical prostatectomy.

    PubMed

    Keskiväli, Teemu; Kujala, Paula; Visakorpi, Tapio; Tammela, Teuvo L J; Murtola, Teemu J

    2016-04-01

    Statins have been linked with improved prostate cancer survival and lower risk of recurrence in men treated with radiation therapy. However, the association is unclear for surgically-treated men. We studied the risk of prostate cancer recurrence and death by statin usage after radical prostatectomy in a cohort of prostate cancer patients treated with radical prostatectomy. A cohort of 1,314 men who underwent curative-intent radical prostatectomy at the Tampere University Hospital, Tampere, Finland during 1995-2009 were linked to national prescription database to obtain detailed information on statin purchases. The risk of PSA recurrence and death (overall and prostate cancer-specific) by statin use before and after the surgery were evaluated using Cox regression with model adjustment for tumor characteristics, total cholesterol and simultaneous use of antidiabetic and antihypertensive drugs. Tissue expression of putative prognostic markers were measured from a subgroup of 323 men. During the median follow-up of 8.6 years after surgery 484 men recurred, while 244 men died (32 due to prostate cancer). In general statin use before or after prostatectomy was not associated with risk of disease recurrence or death. Tissue expression of Ki-67 and ERG modified the association between statin use and risk of disease recurrence; the risk estimates were lower in men with Ki-67 expression above the median (P for interaction 0.001 and 0.004 for statin use before and after prostatectomy, respectively) and no ERG expression in the tumor tissue (P for interaction 0.006 and 0.011). Statin use generally did not affect prostate cancer prognosis after prostatectomy. The effect on disease recurrence may depend on tumor properties, such as proliferation activity. Thus possible future prospective studies should recognize and enroll subgroups of prostate cancer patients most likely to benefit from statins. © 2015 Wiley Periodicals, Inc.

  4. The Timing of Salvage Radiotherapy After Radical Prostatectomy: A Systematic Review

    SciTech Connect

    King, Christopher R.

    2012-09-01

    Purpose: Salvage radiotherapy (SRT) after radical prostatectomy can potentially eradicate residual microscopic disease. Defining the optimal patient and treatment factors is essential and is particularly relevant within the context of adjuvant vs early vs delayed postoperative radiotherapy (RT). Methods and Materials: A systematic review of all published SRT studies was performed to identify the pathologic, clinical, and treatment factors associated with relapse-free survival (RFS) after SRT. A total of 41 studies encompassing 5597 patients satisfied the study entry criteria. Radiobiologic interpretation of biochemical tumor control was used to provide the framework for the observed relationships. Results: Prostate-specific antigen (PSA) level before SRT (P<.0001) and RT dose (P=.0052) had a significant and independent association with RFS. There was an average 2.6% loss of RFS for each incremental 0.1 ng/mL PSA at the time of SRT (95% CI, {approx}2.2-3.1). With a PSA level of 0.2 ng/mL or less before SRT, the RFS approached 64%. The dose for salvage RT in the range of 60-70 Gy seemed to be on the steep part of the sigmoidal dose-response curve, with a dose of 70 Gy achieving 54% RFS compared with only 34% for 60 Gy. There was a 2% improvement in RFS for each additional Gy (95% CI, {approx}0.9-3.2). The observed dose-response was less robust on sensitivity analysis. Conclusions: This study provides Level 2a evidence for initiating SRT at the lowest possible PSA. Dose escalation is also suggested by the data. Progressively better tumor control rates with SRT after radical prostatectomy are achieved with a lower PSA at initiation and with a higher RT dose. Early salvage RT may be an equivalent strategy to adjuvant RT.

  5. Technical Note: Method to correlate whole-specimen histopathology of radical prostatectomy with diagnostic MR imaging

    SciTech Connect

    McGrath, Deirdre M. Lee, Jenny; Foltz, Warren D.; Samavati, Navid; Jewett, Michael A. S.; Kwast, Theo van der; Chung, Peter; Ménard, Cynthia; Brock, Kristy K.

    2016-03-15

    Purpose: Validation of MRI-guided tumor boundary delineation for targeted prostate cancer therapy is achieved via correlation with gold-standard histopathology of radical prostatectomy specimens. Challenges to accurate correlation include matching the pathology sectioning plane with the in vivo imaging slice plane and correction for the deformation that occurs between in vivo imaging and histology. A methodology is presented for matching of the histological sectioning angle and position to the in vivo imaging slices. Methods: Patients (n = 4) with biochemical failure following external beam radiotherapy underwent diagnostic MRI to confirm localized recurrence of prostate cancer, followed by salvage radical prostatectomy. High-resolution 3-D MRI of the ex vivo specimens was acquired to determine the pathology sectioning angle that best matched the in vivo imaging slice plane, using matching anatomical features and implanted fiducials. A novel sectioning device was developed to guide sectioning at the correct angle, and to assist the insertion of reference dye marks to aid in histopathology reconstruction. Results: The percentage difference in the positioning of the urethra in the ex vivo pathology sections compared to the positioning in in vivo images was reduced from 34% to 7% through slicing at the best match angle. Reference dye marks were generated, which were visible in ex vivo imaging, in the tissue sections before and after processing, and in histology sections. Conclusions: The method achieved an almost fivefold reduction in the slice-matching error and is readily implementable in combination with standard MRI technology. The technique will be employed to generate datasets for correlation of whole-specimen prostate histopathology with in vivo diagnostic MRI using 3-D deformable registration, allowing assessment of the sensitivity and specificity of MRI parameters for prostate cancer. Although developed specifically for prostate, the method is readily

  6. Pentafecta outcomes after robot-assisted laparoscopic radical prostatectomy: first 100 cases in Latinoamerican Hospital.

    PubMed

    Gárate, J; Sánchez-Salas, R; Valero, R; Matheus, R; León, A; Dávila, H

    2015-01-01

    Radical prostatectomy (RP) is the standard treatment for cancer control in the long term. The rise of minimally invasive surgery and new technologies have yielded better results and enabled us to pursue more ambitious objectives. The main works still use the trifecta as classic presentation, but this does not cover all aspects of surgery. Pentafecta is a new and more comprehensive methodology to report outcomes after RP, including complications and surgical margin status with the three major outcomes classically reported. The purpose of this study is to report our experience with robot-assisted laparoscopic radical prostatectomy (RALRP) by applying the concept of pentafecta. Describe the experience in this institution from March 2009 to December 2012 of RALRP by pentafecta. We performed 101 interventions and obtained the following results: Average age 60.89 ± 7.32 years (40-77), total PSA 8.5 ± 5.57 ng/dl (0.2-29); D'Amico classification: Low 29 (28.71%), Medium 65 (64.36%), High 7 (6.93%); Operative time 253.44 ± 51.51 min (90-540), Complications 12.9% (Clavien I-II 10.89% and Clavien IIIa 1.98%); Positive surgical margins 20.83%; Biochemistry recurrence 12.5% follow-up (6-44 months); and Continence 87.5% per year and Potency 59.52%. RALRP is a safe and reproducible procedure with excellent results in terms of pentafecta, inclusive during the initial experience at a low volumen center for prostate cancer. A longer follow-up study and experience with higher volume of patients are required to obtain better results and data to be compared with excellence centers. Copyright © 2013 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Robot-assisted radical prostatectomy in low- and high-risk prostate cancer patients

    PubMed Central

    Boylu, Uğur; Bindayi, Ahmet; Küçük, Eyüp Veli; Önol, Fikret Fatih; Gümüş, Eyüp

    2017-01-01

    Objective To evaluate the benefit of robot-assisted radical prostatectomy (RARP) in the low-risk prostate cancer (PCa) patients suitable for active surveillance and in the high-risk PCa patients who would be considered for alternative treatments such as radiotherapy (RT) and androgen deprivation therapy (ADT) instead of radical prostatectomy. Material and methods Of 548 patients, who underwent RARP, 298 PCa patients (258 low-risk and 40 high-risk) with a mean of 3.6 years follow-up, were included into this study. Oncological outcomes were compared separately in low- and high-risk PCa patients. Results The pathologic Gleason scores were ≥7 in 73 (28%), and 68 (26%) patients had a pathologic stage of T3, 29 (11%) patients had a positive surgical margin (PSM), and 20 (7%) patients had biochemical recurrence (BCR) in the first year follow-up in the low-risk group. Of 258 low-risk PCa patients, a total of 93 (36%) patients had not either BCR, pathologic Gleason score ≥7, or ≥pT3 disease with PSM. In the high-risk group, the pathologic stage was pT2 in 14 (35%) patients and 29 (72%) patients had no biochemical recurrence in the follow-up of these high-risk PCa patients. Of 40 high-risk PCa patients, in a total of 25 (62.5%) patients ≥pT3b disease, BCR, pT3a disease with PSM were not detected. Conclusion Approximately two thirds of high-risk PCa patients benefit from RARP without additional RT or ADT. Besides, more than one third of low-risk PCa patients who fit active surveillance criteria would have unfavorable results. PMID:28270949

  8. Technical Note: Method to correlate whole-specimen histopathology of radical prostatectomy with diagnostic MR imaging

    PubMed Central

    McGrath, Deirdre M.; Lee, Jenny; Foltz, Warren D.; Samavati, Navid; Jewett, Michael A. S.; van der Kwast, Theo; Chung, Peter; Ménard, Cynthia; Brock, Kristy K.

    2016-01-01

    Purpose: Validation of MRI-guided tumor boundary delineation for targeted prostate cancer therapy is achieved via correlation with gold-standard histopathology of radical prostatectomy specimens. Challenges to accurate correlation include matching the pathology sectioning plane with the in vivo imaging slice plane and correction for the deformation that occurs between in vivo imaging and histology. A methodology is presented for matching of the histological sectioning angle and position to the in vivo imaging slices. Methods: Patients (n = 4) with biochemical failure following external beam radiotherapy underwent diagnostic MRI to confirm localized recurrence of prostate cancer, followed by salvage radical prostatectomy. High-resolution 3-D MRI of the ex vivo specimens was acquired to determine the pathology sectioning angle that best matched the in vivo imaging slice plane, using matching anatomical features and implanted fiducials. A novel sectioning device was developed to guide sectioning at the correct angle, and to assist the insertion of reference dye marks to aid in histopathology reconstruction. Results: The percentage difference in the positioning of the urethra in the ex vivo pathology sections compared to the positioning in in vivo images was reduced from 34% to 7% through slicing at the best match angle. Reference dye marks were generated, which were visible in ex vivo imaging, in the tissue sections before and after processing, and in histology sections. Conclusions: The method achieved an almost fivefold reduction in the slice-matching error and is readily implementable in combination with standard MRI technology. The technique will be employed to generate datasets for correlation of whole-specimen prostate histopathology with in vivo diagnostic MRI using 3-D deformable registration, allowing assessment of the sensitivity and specificity of MRI parameters for prostate cancer. Although developed specifically for prostate, the method is readily

  9. Influence of pathologist experience on positive surgical margins following radical prostatectomy.

    PubMed

    Tallman, Jacob E; Packiam, Vignesh T; Wroblewski, Kristen E; Paner, Gladell P; Eggener, Scott E

    2017-07-01

    A positive surgical margin (PSM) following radical prostatectomy (RP) for prostate cancer is associated with increased risk of biochemical recurrence. We sought to examine whether the pathologist is an independent predictor of PSMs. We performed a retrospective review of 3,557 men who underwent RP for localized prostate cancer at our institution from 2003 to 2015. We evaluated 29 separate pathologists. Univariate and multivariable logistic regression were used to test variables previously shown to influence PSM rates. Overall rate of PSM was 18.9%. Compared with patients without PSM, patients with PSM had higher body mass index (mean: 28.8 vs. 28.3), Gleason score≥7 (84% vs. 66%), extracapsular extension (51% vs. 20%), and median prostate-specific antigen (5.9 vs. 5.1ng/ml) (all P<0.05). Univariate logistic regression showed that surgeon experience, pathologist experience, and pathologist genitourinary fellowship training were all predictors of PSMs (all P<0.05). Multivariable regression analysis confirmed that decreased surgeon experience, increased pathologist experience, higher pathologic Gleason score, higher pathologic stage, and higher prostate-specific antigen were significant predictors of PSMs. Increasing surgeon experience was associated with decreased odds of PSM (odds ratio = 0.79 per 1 standard deviation increase, 95% CI [0.70-0.89]). In contrast, increasing pathologist experience was associated with increased odds of PSM (odds ratio = 1.11 per 1 standard deviation increase, 95% CI [1.03-1.19]). The relationship between pathologist experience and PSM appeared to be nonlinear (Fig. 2). Greater pathologist experience appears to be associated with greater odds of PSMs following radical prostatectomy, even after controlling for case mix, pathologist fellowship training, and surgeon experience. Based on these findings, pathologists with less experience reviewing RP specimens may consider requesting rereview by a dedicated genitourinary pathologist

  10. Robotic-assisted radical prostatectomy learning curve for experienced laparoscopic surgeons: does it really exist?

    PubMed Central

    Tobias-Machado, Marcos; Mitre, Anuar Ibrahim; Rubinstein, Mauricio; da Costa, Eduardo Fernandes; Hidaka, Alexandre Kyoshi

    2016-01-01

    ABSTRACT Background Robotic-assisted radical prostatectomy (RALP) is a minimally invasive procedure that could have a reduced learning curve for unfamiliar laparoscopic surgeon. However, there are no consensuses regarding the impact of previous laparoscopic experience on the learning curve of RALP. We report on a functional and perioperative outcome comparison between our initial 60 cases of RALP and last 60 cases of laparoscopic radical prostatectomy (LRP), performed by three experienced laparoscopic surgeons with a 200+LRP cases experience. Materials and Methods Between January 2010 and September 2013, a total of 60 consecutive patients who have undergone RALP were prospectively evaluated and compared to the last 60 cases of LRP. Data included demographic data, operative duration, blood loss, transfusion rate, positive surgical margins, hospital stay, complications and potency and continence rates. Results The mean operative time and blood loss were higher in RALP (236 versus 153 minutes, p<0.001 and 245.6 versus 202ml p<0.001). Potency rates at 6 months were higher in RALP (70% versus 50% p=0.02). Positive surgical margins were also higher in RALP (31.6% versus 12.5%, p=0.01). Continence rates at 6 months were similar (93.3% versus 89.3% p=0.43). Patient’s age, complication rates and length of hospital stay were similar for both groups. Conclusions Experienced laparoscopic surgeons (ELS) present a learning curve for RALP only demonstrated by longer operative time and clinically insignificant blood loss. Our initial results demonstrated similar perioperative and functional outcomes for both approaches. ELS were able to achieve satisfactory oncological and functional results during the learning curve period for RALP. PMID:27136471

  11. Preservation of penile length after radical prostatectomy: early intervention with a vacuum erection device.

    PubMed

    Dalkin, B L; Christopher, B A

    2007-01-01

    Radical prostatectomy has been shown to have a potential negative impact on penile health. Stretched penile length (SPL), which most closely correlates with erect penile length, was significantly reduced in almost half of men undergoing surgery in several studies. The purpose of this study was to test whether early intervention after surgery with a vacuum erection device could prevent the changes in penile health, as defined by SPL, found in prior studies. Forty-two men with good preoperative sexual function undergoing nerve-sparing radical prostatectomy underwent measurement of SPL preoperative and at 3 months postoperative by a single investigator. Daily use of a vacuum erection device (VED) was begun the day after catheter removal, and continued for 90 days. Men kept a log of their compliance with daily VED use. A decrease in SPL of > or = 1.0 cm was considered significant. Out of 42 men, 39 completed the study. In men who used the VED >50% of possible days, only 1/36 (3%) had a decrease in SPL of > or = 1.0 cm. Of the three men with poor VED compliance, two (67%) had a reduction in SPL of > or = 1.0 cm. When compared to prior studies where 48% of men after surgery had a significant reduction in SPL, early intervention with the daily use of a VED resulted in a significantly lower risk of loss of penile length (P<0.0001). For men wishing to preserve penile health/length after surgery, early intervention with the daily use of a VED should be strongly recommended.

  12. Focal positive surgical margins decrease disease-free survival after radical prostatectomy even in organ-confined disease.

    PubMed

    Lake, Alison M; He, Chang; Wood, David P

    2010-11-01

    To investigate the significance of focal positive margins (FPM) in prostatectomy patients. The significance of FPM after radical prostatectomy is unclear. The implication is that FPM are surgically induced, may not represent true tumor extension beyond the prostate, and thus would not affect disease-free survival (DFS). Data were retrospectively reviewed from 2468 patients undergoing radical prostatectomy between January 1996 and October 2008. The DFS probabilities were compared among different margin statuses (negative [NM], FPM, and extensively positive [EPM]) with the log-rank test. FPM was defined as less than/equal to 3 mm. EPM was greater than 3 mm. A multivariate Cox analysis was performed to evaluate the significance of FPM in patients with prostate cancer. Of all patients, 2022 (82%) had NM, 344 (14%) had FPM, and 99 (4%) had EPM. Of the 1997 patients with pT2 disease, 1716 (86%) had NM, 229 (11.5%) had FPM, and 52 (2.6%) had EPM. The 10-year DFS for all patients was 84%, 64%, 38% for NM, FPM, and EPM, respectively (P < .0001). The 10-year DFS for organ-confined disease was 90%, 76%, and 53% for NM, FPM, and EPM, respectively (P < .0001). The risk of biochemical recurrence for all patients increases with worsening margin status. Margin status affects biochemical recurrence and depends on the Gleason grade on surgical pathology for all patients (P = .0005) and patients with pT2 disease (P = .0233). FPM and EPM after radical prostatectomy confer a decreased DFS even in patients with otherwise organ-confined disease. Copyright © 2010. Published by Elsevier Inc.

  13. Laparoscopic radical prostatectomy and resection of rectum performed together: first experience

    PubMed Central

    Orhalmi, Julius; Kosina, Josef; Balik, Michal; Pacovsky, Jaroslav

    2015-01-01

    Introduction Laparoscopy is an increasingly used approach in the surgical treatment of rectal cancer and prostate cancer. The anatomical proximity of the two organs is the main reason to consider performing both procedures simultaneously. Aim To present our first experience of laparoscopic rectal resection and radical prostatectomy, performed simultaneously, in 3 patients. Material and methods The first patient was diagnosed with locally advanced rectal cancer and tumor infiltration of the prostate and seminal vesicles. The other 2 patients were diagnosed with tumor duplicity. The surgery of the first patient started with laparoscopic prostatectomy except division of the prostate from the rectal wall. The next step was resection of the rectum, extralevator amputation of the rectum and vesicourethral anastomosis. In the other patients, resection of the rectum, followed by radical prostatectomy, was performed. Results The median follow-up was 12 months. The median operation time was 4 h 40 min, with blood loss of 300 ml. The operations and postoperative course were without incident in the case of 2 patients. However, 1 patient had stercoral peritonitis and a vesicorectal fistula in the early postoperative stage. Sigmoidostomy and postponed ureteroileal conduit were carried out. All patients were in oncologic remission. Conclusions Combined laparoscopic rectal resection and radical prostatectomy is a viable option for selected patients with locally advanced rectal cancer or tumor duplication. The procedures were completed without complications in 2 out of 3 patients. PMID:26649093

  14. Comparison of 90-day re-admission rates between open retropubic radical prostatectomy (RRP), laparoscopic RP (LRP) and robot-assisted laparoscopic prostatectomy (RALP).

    PubMed

    Chung, Shiu-Dong; Kelle, Joseph J; Huang, Chao-Yuan; Chen, Yi-Hua; Lin, Herng-Ching

    2012-12-01

    Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? With the increased use of laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic prostatectomy (RALP), a growing number of publications have sought to compare these more advanced techniques to retropubic RP (RRP). Many studies have found RALP and LRP to be associated with lower blood loss, postoperative pain, and hospital stay when compared with RRP. The present study showed that, after adjusting for potential confounders, patients undergoing RALP had a lower risk of 90-day re-admission than patients undergoing RRP. However, there was no significant difference in the odds of being re-admitted ≤ 90 days after RP between patients undergoing a LRP and RRP. • To examine the risk of 90-day re-admission among patients undergoing retropubic radical prostatectomy (RRP), laparoscopic RP (LRP), and robot-assisted laparoscopic prostatectomy (RALP) in Taiwan. • We identified 2741 hospitalised patients who underwent a RP. Of these 2741 cases, 1773 patients underwent RRP, 694 LRP, and 274 RALP. • We performed a conditional (fixed-effect) logistic regression model to explore the odds of 90-day re-admission from RP among patients undergoing RRP, LRP, and RALP. • In all, 257 of the 2741 (9.4%) sampled subjects were re-admitted ≤ 90 days of the index RP. • Patients undergoing a RALP had a significantly lower incidence rate of 90-day re-admission than patients undergoing a RRP or LRP (3.6% vs 10.7% vs 8.2%, P < 0.001). • Compared with patients undergoing a RRP, the odds ratio (OR) of 90-day re-admission for patients undergoing a RALP was only 0.35 (95% confidence interval [CI] 0.19-0.68) after adjusting for patient age, geographic region, year of surgery, Charlson Co-morbidity Index score, and surgeon age and the number of RP cases/year. • However, there was no significant difference in the odds of being re-admitted ≤ 90 days of RP

  15. Comparison of Biochemical Recurrence-Free Survival after Radical Prostatectomy Triggered by Grade Reclassification during Active Surveillance and in Men Newly Diagnosed with Similar Grade Disease.

    PubMed

    Diniz, Clarissa P; Landis, Patricia; Carter, H Ballentine; Epstein, Jonathan I; Mamawala, Mufaddal

    2017-09-01

    We compared biochemical recurrence between men on active surveillance who underwent radical prostatectomy triggered by grade reclassification and men diagnosed with similar grade disease treated with immediate radical prostatectomy. We retrospectively analyzed the records of men who underwent surgery from 1995 to 2015 at our institution. We identified 4 groups, including 94 and 56 men on active surveillance who underwent radical prostatectomy following reclassification to Gleason 7 (3 + 4) or greater (grade groups 2 or greater) and Gleason 7 (3 + 4) (grade group 2), and 3,504 and 1,979 in the immediate prostatectomy group diagnosed with grade group 2 or greater and 2, respectively. Biochemical recurrence was assessed by Kaplan-Meir analysis and a multivariable Cox model. Men on active surveillance had a lower incidence of biochemical recurrence than men in the immediate radical prostatectomy groups for biopsy grade groups 2 or greater and 2 (each p <0.05). One, 5 and 10-year biochemical recurrence-free survival for men in the active surveillance group vs the immediate radical prostatectomy group was 97.9% vs 85.5%, 76.6% vs 65.1% and 69.0% vs 54.2% in biopsy grade groups 2 or greater (p = 0.009) and 96.4% vs 91.2%, 89.6% vs 74.0% and 89.6% vs 63.9%, respectively, in biopsy grade group 2 (p = 0.071). For biopsy grade groups 2 or greater there was no significant difference in the risk of biochemical recurrence between the groups after adjusting for age, biopsy extent of cancer and prostate specific antigen density. Patients on active surveillance reclassified to grade groups 2 or greater are at no greater risk for treatment failure than men newly diagnosed with similar grades. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  16. Open radical retropubic prostatectomy 2007: the true minimally invasive surgery for localized prostate cancer?

    PubMed

    Nosnik, Israel P; Gan, Tong J; Moul, Judd W

    2007-09-01

    The introduction of robotic laparoscopic assisted prostatectomy at our institution and nationwide has been a great advancement and has caused us to focus and fine-tune our goal for improvements in prostate cancer outcomes whether the patient elects for robotic laparoscopic assisted prostatectomy or open minimally invasive radical retropubic prostatectomy. While these authors favor the open technique performed by highly skilled urologic surgical oncologists, the lessons we have learned to date suggest that it is the skill of the surgeon that determines outcome, regardless of whether or not the operation is performed by an open or robotic laparoscopic technique. The concepts we have articulated here are related to resection and avoidance of positive margins, limited intraoperative blood loss and pain control, which allow equivalence in these outcome areas, regardless of technique.

  17. Reducing laparoscopic radical prostatectomy false-positive margin rates using cyanoacrylate tissue glue.

    PubMed

    Kumar, Manal; Mansour, Paul; Vesey, Sean G

    2009-10-01

    Trauma to the prostate surface from laparoscopic instruments may have a role in creating false-positive margins during laparoscopic radical prostatectomy (LRP). To determine the feasibility of using cyanoacrylate glue to repair iatrogenic lacerations and to evaluate the glue's effect on the positive surgical margin rates of LRP specimens. We used porcine kidneys as a surrogate experimental tissue to help determine the quality, robustness, and adequacy of glued repairs in experimentally created lacerations. A matched control group of unrepaired kidney specimens and kidney specimens repaired with glue were subjected to full histopathologic processing. Exposure of a nephron to surface marker ink was considered to be a "positive margin." The efficacy and impact of glue repairs on LRP specimens that had sustained iatrogenic intraoperative surface trauma were also assessed. We evaluated the success of glue repair in preventing subcapsular renal parenchymal staining. We also compared the rate of positive margins in LRP specimens with and without routine glue repair of the surface of the prostate. The glue remained effective throughout the entire laboratory process and did not interfere with histopathologic assessment. As hypothesised, cyanoacrylate glue repair of the renal lacerations prevented staining of subcapsular tissues with marker dye and therefore prevented what might otherwise be considered false-positive staining. The rate of positive margins of the 40 LRP specimens without glue repair was 35%, compared with a rate of 10% for 40 glue-repaired specimens. The limitations of the study are that follow-up was short and that the prostatectomy specimens were compared with consecutive controls rather than with matched randomised controls. Cyanoacrylate glue is a novel, inexpensive, and very effective prostate repair agent that does not interfere with histologic processing. It is possible to accurately repair iatrogenic prostate lacerations with cyanoacrylate glue and

  18. Concordance between biopsy and radical prostatectomy specimen Gleason score in internal and external pathology facilities.

    PubMed

    Grasso, Angelica A C; Cozzi, Gabriele; Palumbo, Carlotta; Albo, Giancarlo; Rocco, Bernardo

    2014-10-01

    Biopsy Gleason score (bGS) is an important tool for staging and decision making in patients with prostate cancer. Therefore, the data from biopsy should be both reproducible across different pathologists and predictive of the true underlying tumour. We evaluated the agreement between bGS with prostatectomy Gleason score (pGS) comparing patients who underwent prostate biopsy at our hospital with those who did it at an outside facility. We retrospectively analyzed patients who underwent robot-assisted radical prostatectomy at our Hospital in 2011 and 2012. Patients were divided depending on the site of prostate biopsy. We calculated a weighted κ statistic to evaluate the concordance from bGS and pGS in the two groups and to evaluate the Gleason score (GS) concordance comparing the proportion of positive cores at biopsy. A total of 124 patients with completed data were identified (70 patients performed biopsy at our institution and 54 at an outside facility). The weighted κ score for GS agreement was 0.40 for our Institution and 0.27 for other facilities. The weighted κ score stratified by biopsy hospital for patients with at least 30% of positive cores was 0.46 for our hospital and 0.42 for other facilities. Internal prostate biopsy predicted better pGS than outside facility biopsy reports. When the percentage of biopsy-positive cores increases, the agreement between bGS and pGS is similar between the two groups. For certain cases in which an outside laboratory biopsy results in equivocal clinical decision, biopsy re-evaluation by internal pathologists can help reveal the true underlying tumor architecture and extension. Copyright© 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  19. Local cost structures and the economics of robot assisted radical prostatectomy.

    PubMed

    Scales, Charles D; Jones, Peter J; Eisenstein, Eric L; Preminger, Glenn M; Albala, David M

    2005-12-01

    Robot assisted prostatectomy (RAP) is more costly than traditional radical retropubic prostatectomy (RRP) under the cost structures at certain hospitals. However, this finding may not be the case in all care settings. We investigated the sensitivity of RAP and RRP inpatient costs to variations in length of stay (LOS), local hospitalization costs and robotic case volume in the specialist and generalist settings. We developed a model of RAP vs RRP costs in the specialist and generalist settings using published data on operative time and LOS, and cost data from our academic medical center. All inpatient cost centers were included, namely surgery costs, professional fees, postoperative care, robotic equipment and service. Extensive 1 and 2-way sensitivity analyses were performed. Our base case model demonstrated a cost premium for RAP vs RRP of USD $783 and $195 in the specialist and generalist settings, respectively. Sensitivity analysis of our model assumptions demonstrated that RAP could achieve cost equivalence with RRP at a surgical volume of 10 cases weekly. If case volume increased to 14 cases weekly, RAP would be less expensive than RRP in some practice settings in which RAP LOS was less than 1.5 days. The inpatient costs of robotic assisted prostatectomy are volume dependent and cost equivalence with generalist radical retropubic prostatectomy is possible at higher volume RAP specialty centers. While RAP may be cost competitive with RRP at high cost hospitals or high volume RAP specialist centers, this procedure would exist at a cost premium to RRP in other practice settings.

  20. Quality of life and satisfaction with information after radical prostatectomy, radical external beam radiotherapy and postoperative radiotherapy: a long-term follow-up study.

    PubMed

    Nicolaisen, Marianne; Müller, Stig; Patel, Hitendra R H; Hanssen, Tove Aminda

    2014-12-01

    To assess patients' symptoms, quality of life and satisfaction with information three to four years after radical prostatectomy, radical external beam radiotherapy and postoperative radiotherapy and to analyse differences between treatment groups and the relationship between disease-specific, health-related and overall quality of life and satisfaction with information. Radical prostate cancer treatments are associated with changes in quality of life. Differences between patients undergoing different treatments in symptoms and quality of life have been reported, but there are limited long-term data comparing radical prostatectomy with radical external beam radiotherapy and postoperative radiotherapy. A cross-sectional survey design was used. The study sample included 143 men treated with radical prostatectomy and/or radical external beam radiotherapy. Quality of life was measured using the 12-item Short Form Health Survey and the 50-item Expanded Prostate Cancer Index Composite Instrument. Questions assessing overall Quality of life and satisfaction with information were included. Descriptive statistics and interference statistical methods were applied to analyse the data. Radical external beam radiotherapy was associated with less urinary incontinence and better urinary function. There were no differences between the groups for disease-specific quality of life sum scores. Sexual quality of life was reported very low in all groups. Disease-specific quality of life and health-related quality of life were associated with overall quality of life. Patients having undergone surgery were more satisfied with information, and there was a positive correlation between quality of life and patient satisfaction. Pretreatment information and patient education lead to better quality of life and satisfaction. This study indicates a need for structured, pretreatment information and follow-up for all men going through radical prostate cancer treatment. Long-term quality of life

  1. Effect of minimizing tension during robotic-assisted laparoscopic radical prostatectomy on urinary function recovery.

    PubMed

    Kowalczyk, Keith J; Huang, Andy C; Hevelone, Nathanael D; Lipsitz, Stuart R; Yu, Hua-yin; Lynch, John H; Hu, Jim C

    2013-06-01

    Although most prostatectomy studies emphasize optimal nerve-sparing dissection planes, subtle technical variation also affects functional outcomes. The impact of minimizing assistant/surgeon tension on urinary function has not been quantified. We assess urinary function after attenuating neurovascular bundle (NVB) and rhabdosphincter tension during robotic-assisted radical prostatectomy (RARP). Retrospective study of prospectively collected data for 268 (RARP-T) versus 342 (RARP-0T) men with versus without tension on the NVB and rhabdosphincter during RARP. Outcomes compared include Expanded Prostate Cancer Index (EPIC) urinary function, estimated blood loss (EBL), operative time, and positive surgical margins (PSM). In unadjusted analysis, men undergoing RARP-T versus RARP-0T were older, had higher biopsy and pathologic Gleason grade, and higher preoperative prostate specific antigen (all p ≤ 0.023). Baseline urinary function was similar. Postoperatively, RARP-0T versus RARP-T was associated with higher 5-month urinary function scores (69.7 versus 64, p = 0.049). In adjusted analyses, RARP-0T versus RARP-T was associated with improved 5-month urinary function [Parameter Estimate (PE) 7.37, Standard Error (SE) 2.67, p = 0.006], while bilateral versus non-/unilateral nerve-sparing was associated with improved 12-month urinary function and continence (both p ≤ 0.035). RARP-0T versus RARP-T was associated with shorter operative times (PE 6.66, SE 1.90, p = 0.001) and higher EBL (PE 20.88, SE 6.49, p = 0.001). There were no significant differences in PSM. While the use of tension aids in dissection of anatomic planes, avoidance of NVB counter-traction and minimizing tension on the rhabdosphincter during apical dissection attenuates neuropraxia and leads to earlier urinary function recovery. Bilateral versus non-/unilateral nerve-sparing also improves urinary function recovery.

  2. Histological evaluation of nerve sparing technique in robotic assisted radical prostatectomy.

    PubMed

    Tanaka, Kazushi; Shigemura, Katsumi; Hinata, Nobuyuki; Muramaki, Mototsugu; Miyake, Hideaki; Fujisawa, Masato

    2014-07-01

    The objective of this study is to compare intrafascial nerve-sparing (NS), interfascial NS and non-NS prostatecomy specimens to assess the feasibility of NS technique in Robot-assisted radical prostatectomies (RARP). The records of the first 43 consecutive patients (86 prostatic sides (lobe) who underwent NS RARP (6 intrafascial NS, 46 interfacial NS, 34 non-NS) were reviewed and histopathological examinations were performed. The presence and distribution of periprostatic neurovascular structures were histologically evaluated using mid-gland section of each prostate lobe in the prostatectomy specimen and it was immunostained with the S-100 antibody for quantitative analysis of nerves. The average number of nerve fibers per prostatic half was 37.2 ± 20.6. The number of resected peri-prostatic nerves counted was 13.7 ± 13.5, 30.5 ± 15.0 and 50.4 ± 20.4 in intrafascial NS, interfascial NS and non-NS specimens, respectively. The difference in the number of nerve bundle counts in the three groups was statistically significant (P < 0.05). Patients with urinary continence at 6 months after surgery had significantly less number of nerve fibers resected with the prostate than the incontinence group (P = 0.013) and the number of nerve fibers resected in the potent group were lower than in the impotent group but did not reach statistical significance (P = 0.057). Our study showed that NS RARP could be performed according to surgeons' intention (intrafascial, interfascial or non-NS) and urinary continence significantly correlated to the number of nerve fibers resected with the prostate.

  3. Robot assisted radical prostatectomy: how I do it. Part II: Surgical technique.

    PubMed

    Valdivieso, Roger F; Hueber, Pierre-Alain; Zorn, Kevin C

    2013-12-01

    The introduction of the "da Vinci Robotic Surgical System" (Intuitive Surgical, Sunnyvale, CA, USA) has been an important step towards a minimally invasive approach to radical prostatectomy. Technologic peculiarities, such as three-dimensional vision, wristed instrumentation with seven degrees of freedom of motion, lack of tremor, a 10x-magnification and a comfortable seated position for the surgeon has added value to the procedure for the surgeon and the patient. In this article, we describe the 9 step surgical technique for robot assisted radical prostatectomy (RARP) that is currently used in our institution (University of Montreal Hospital Center (CHUM) - Hopital St-Luc). We use the four-arm da Vinci Surgical System. Our experience with RARP is now over 250 cases with the senior surgeon having performed over 1200 RARPs and we have continually refined our technique to improve patient outcomes.

  4. Erectile function post robotic radical prostatectomy: technical tips to improve outcomes?

    PubMed

    Goonewardene, S S; Persad, R; Gillatt, D

    2016-09-01

    Robotic surgery is becoming more and more commonplace. At the same time, so are complications, especially related to erectile function. The population being diagnosed with cancer is younger, with more aggressive cancers and higher expectations for good erectile function postoperatively. We conduct a retrospective analysis of literature over 20 years for Embase and Medline. Search terms used include (Robotic) AND (prostatectomy) AND (erectile function). There are a variety of multifactorial causes, resulting in worsening ED post-robotic radical prostatectomy; however, there are a number of treatments that can support this. There is much we can do to help prevent patients getting postoperative erectile dysfunction post-radical surgery. However, part of this is management of realistic patient expectations.

  5. The Role of Robot-Assisted Radical Prostatectomy in High-Risk Prostate Cancer.

    PubMed

    Srougi, Victor; Tourinho-Barbosa, Rafael R; Nunes-Silva, Igor; Baghdadi, Mohammed; Garcia-Barreras, Silvia; Rembeyo, Gregory; Eiffel, Sophie S; Barret, Eric; Rozet, Francois; Galiano, Marc; Sanchez-Salas, Rafael; Cathelineau, Xavier

    2017-03-01

    Prostate cancer (PCa) is stratified into different risk categories based on the patient's prognosis. High-risk disease was formerly characterized by an increased risk of metastasis and lethality, requiring complex treatments. Surgery was recently highlighted to have a pivotal role for the treatment of such cases, even as monotherapy. In the past, open radical prostatectomy was performed for most patients with high-risk PCa; however, robot-assisted radical prostatectomy (RARP) emerged as a reasonable option because it provided optimal outcomes for low- and intermediate-risk PCa. Robust studies are lacking to properly assess the role of RARP for high-risk PCa. We summarize this knowledge and present a literature review on the perioperative recovery and functional and oncologic outcomes of RARP for the treatment of patients with high-risk PCa.

  6. Salvage external beam radiotherapy for prostate cancer after radical prostatectomy: current status and controversy.

    PubMed

    Raldow, Ann; Hamstra, Daniel A; Kim, Sung; Yu, James B

    2010-07-01

    Prostate cancer is the second most common cause of cancer death in American men. What to do when prostate cancer recurs months or years after a patient undergoes radical prostatectomy is an area of active research. Patients who underwent radical prostatectomy without immediate adjuvant radiation therapy (ART) but subsequently have evidence of recurrent disease are candidates for Salvage Radiation Therapy (SRT). Though there are three prospective randomized trials illustrating the efficacy of post-operative ART for selected patients, similarly strong evidence is lacking for SRT. In this article, we define the biochemical recurrence of prostate cancer, distinguish SRT from ART, outline the evidence for SRT, and make recommendations with regard to radiotherapy volume and dose. We discuss the known side effects from SRT, weigh the cost and benefit of SRT, and discuss possible tools that may improve the cost/benefit ratio for SRT by helping to select patients whom SRT may be more likely to benefit.

  7. Transperitoneal Robot-Assisted Radical Prostatectomy Should Be Considered in Prostate Cancer Patients with Pelvic Kidneys

    PubMed Central

    Plagakis, Sophie; Foreman, Darren; Sutherland, Peter

    2016-01-01

    Abstract We highlight two cases of transperitoneal robot-assisted radical prostatectomy (RARP) in patients with pelvic kidneys because of congenital development and renal transplant. These uncommon cases present a challenge to the surgeon contemplating surgery because of access and anomalous vascular and ureteral anatomy. We describe the technical considerations that are paramount in effectively completing transperitoneal RARP, and believe it should be considered as a treatment option in men with pelvic kidneys. PMID:27579412

  8. Robotic radical prostatectomy in the community setting--the learning curve and beyond: initial 200 cases.

    PubMed

    Patel, Vipul R; Tully, A S; Holmes, R; Lindsay, J

    2005-07-01

    The introduction of robotic assistance has the potential to improve surgical outcomes and reduce the steep learning curve associated with conventional laparoscopic radical prostatectomy. We report on our experience with robotic radical prostatectomy in the community setting. A total of 200 patients underwent robotic radical prostatectomy during 18 months. Prospective data collection included a quality of life (Expanded Prostate Cancer Index Composite) questionnaire, basic demographics, prostate specific antigen (PSA), clinical stage and Gleason grade. Operative outcome measures included operative time, estimated blood loss and complications. Postoperative outcome measures included hospital stay, catheter time, pathology, PSA and return of continence. Average operative time was 141 minutes with an estimated blood loss of 75 cc. The intraoperative complication rate was 1% with no mortality, reexploration or transfusion. Of the patients 95% were discharged home on postoperative day 1 (1 to 3) with hematocrit averaging 34.5 (range 25 to 45). The average difference in preoperative and postoperative hematocrit was 3 points (range -2 to 15). Average catheter time was 7.2 days (range 5 to 15). The positive margin rate was 10.5% for the entire series, 5.7% for T2 tumors, 28.5% (T3a), 20% (T3b) and 33% (T4a). Of the patients 95% had undetectable PSA (less than 0.1 ng/ml) at average followup of 9.7 months. Continence at 1, 3, 6, 9 and 12 months was 47%, 78%, 89%, 92% and 98%, respectively. Our initial experience with robotic radical prostatectomy is promising. The learning curve was approximately 20 to 25 cases. With a structured methodical approach we were able to implement robotics safely and effectively into our community practice with minimal patient morbidity, and good oncological and functional outcomes.

  9. Number of positive systematic sextant biopsies predicts surgical margin status at radical prostatectomy.

    PubMed

    Tigrani, V S; Bhargava, V; Shinohara, K; Presti, J C

    1999-10-01

    To determine whether the number of positive sextant biopsies contributes to the prediction of positive surgical margins, as the value of systematic prostate biopsies in predicting margin status at radical prostatectomy is unclear. Consecutive patients (n = 108) who underwent radical retropubic prostatectomy and systematic sextant biopsies were retrospectively evaluated. Serum prostate-specific antigen, digital rectal examination, primary Gleason grade, Gleason score, and the number and location of positive sextant biopsies were recorded for each patient. Radical prostatectomy specimens were evaluated by step-section techniques at 3 to 5-mm intervals. Univariate comparisons for each of these variables was performed between the positive and negative margin groups using the Mann-Whitney U test or chi-square analysis. Logistic regression analysis was performed for these variables. Twenty-two (20.4%) of 108 patients had a positive surgical margin because of extension of the tumor through the capsule. Patients with three or more positive biopsies were at higher risk of having a positive surgical margin (P = 0.009). Patients with bilaterally positive biopsies at either the base or midprostate were more likely to have a positive surgical margin. The risk of a positive surgical margin was not significantly determined by the primary Gleason grade, Gleason score, or prostate-specific antigen. Multivariate logistic regression models were created that consistently demonstrate that the number of positive biopsies was the best predictor of margin status. This study demonstrated that the number of positive sextant biopsies contributes to the prediction of margin status at radical prostatectomy.

  10. Robot assisted radical prostatectomy: how I do it. Part I: Patient preparation and positioning.

    PubMed

    Valdivieso, Roger F; Hueber, Pierre-Alain; Zorn, Kevin C

    2013-10-01

    Radical prostatectomy remains the standard treatment for long term cure of clinically localized prostate cancer, offering excellent oncologic outcomes, with cancer-specific survival approaching 95% at 15 years after surgery. The introduction of the "da Vinci Robotic Surgical System" (Intuitive Surgical, Sunnyvale, CA, USA) has been another important step toward a minimally invasive approach to radical prostatectomy. Technologic peculiarities, such as three-dimensional vision, wristed instrumentation with seven degrees of freedom of motion, lack of tremor, a 10x-magnification and a comfortable seated position for the surgeon has added value to the surgeon and patient. In this first part of a two article series, we describe preoperative patient preparation and positioning protocols for robot assisted radical prostatectomy (RARP) that are currently used in our institution (University of Montreal Hospital Center (CHUM)-Hopital St-Luc). We use the four-arm da Vinci Si Surgical System. Our experience with RARP is now over 250 cases with the senior surgeon having performed over 1200 RARPs and we have continually refined our technique to improve patient outcomes.

  11. Anatomic and technical considerations for optimizing recovery of sexual function during robotic-assisted radical prostatectomy.

    PubMed

    Carter, Stacey; Le, Jesse D; Hu, Jim C

    2013-01-01

    Although cure of prostate cancer is the primary goal of radical prostatectomy, preserving erectile function is also tantamount, given the indolent clinical course of most prostate cancers, particularly low-risk disease. In order to optimize postprostatectomy erectile function during a robotic-assisted radical prostatectomy, there must be a detailed understanding of pelvic anatomy to recognize the optimal nerve-sparing plane and technical finesse to minimize stretch injury to the neurovascular bundle. The magnified, well illuminated robotic-operative field coupled with less blood loss has paralleled greater understanding of the periprostatic 'fascial' planes, leading to differentiation of intrafascial versus interfascial nerve-sparing approaches. However, refinement of tissue handling during nerve-sparing to minimize lateral displacement of the neurovascular bundle and attenuate neurapraxia enables earlier and better recovery of erectile function. The critical maneuvers to preserving erectile function are atraumatic dissection of the prostate away from the optimal nerve-sparing plane to maximally preserve nerve fibers while minimizing neurapraxia. Therefore, attaining these principles involves a conceptual paradigm shift from 'radical' prostatectomy to neurosurgery of the prostate.

  12. [Orgasm and its impact on quality of life after radical prostatectomy].

    PubMed

    Martínez-Salamanca García, J I; Jara Rascón, J; Moncada Iribarren, I; García Burgos, J; Hernández Fernández, C

    2004-01-01

    Orgasm is a neurophysiological event, which produces bulbous cavernous muscle contraction that usually coincided with ejaculation. The aim of this study was to assess the orgasm's presence and quality in patients treated with radical prostatectomy, as well as its impact on quality of life of these patients. The medical records of 152 patients with radical prostatectomy were reviewed retrospectively. Patients were operated between january 1999 and december 01, with an average age of 64.4 (44-75) years and the follow-up period was 33 (21-45) months. 42 (31.6%) patients showed erectile dysfunction (ED) previous to surgery. The research was performed by a personal interview through a questionnaire. 134 patients (96.4%) treated showed post operative ED, 91.6% of patients had stable relationship and 44.4% have sexual intercourse, 23.3% masturbation only and 32.3% no sexual activity. 84 patients (55.2%) were not interested in receiving treatment and 25 (16.4%) referred a reduced libido. Concerning to orgasm sensation, 140 patients (92.1%) preserved a subjectively normal orgasm, 4 (2.6%) referred lack of it and 8 (5.2%) a weakened or anomalous sensation. Furthermore 24 patients (15.7) had urine loss during orgasm. After radical prostatectomy, both the orgasmic function and libido were kept by the majority of patients despite the neuro vascular bundle damaged caused. Only a minority of patients having urine loss, as a consequence of surgical procedure.

  13. Erectile dysfunction after radical prostatectomy: prevalence, medical treatments, and psychosocial interventions.

    PubMed

    Emanu, Jessica C; Avildsen, Isabelle K; Nelson, Christian J

    2016-03-01

    This review will discuss erectile dysfunction in prostate cancer patients following radical prostatectomy . It will focus on the prevalence and current treatments for erectile dysfunction as well as the emotional impact of erectile dysfunction and the current psychosocial interventions designed to help patients cope with this side effect. Although there is a large discrepancy in prevalence rates of erectile dysfunction after radical prostatectomy, several recent studies have cited rates as high as 85%. The concept of 'penile rehabilitation' is now the standard of practice to treat erectile dysfunction following radical prostatectomy. However, many men avoid seeking help or utilizing erectile dysfunction treatments. This avoidance is related to the shame, frustration, and distress many men with erectile dysfunction and their partners experience. Recent psychosocial interventions have been developed to facilitate the use of treatments and help men cope with erectile dysfunction. These interventions have shown initial promise, however, continued intervention development is needed to reduce distress and improve long-term erectile function outcomes. Erectile dysfunction is a significant problem following prostate cancer surgery. Although there are effective medical treatments, the development of psychosocial interventions should continue to evolve to maximize the assistance we can give to men and their partners.

  14. [Prostate cancer management and factors associated with radical prostatectomy in France in 2001].

    PubMed

    Jegu, J; Tretarre, B; Velten, M; Guizard, A-V; Danzon, A; Buemi, A; Colonna, M; Kadi-Hanifi, A-M; Ganry, O; Molinie, F; Bara, S; Rebillard, X; Grosclaude, P

    2010-01-01

    Prostate cancer was the most common cancer in men in France in 2005, and the second cause of male death from cancer. In this study, we analyzed clinical characteristics of patients with prostate cancer diagnosed in France in 2001 with a focus on therapeutic management of localized prostate cancers. A total of 2181 cases of prostate cancer diagnosed in 2001 from 11 French counties covered by a cancer registry were analyzed. A descriptive study of the clinical characteristics of patients was performed. Parameters studied included age, county, TNM stage, PSA value, Gleason score, D'Amico prognostic group, Charlson's comorbidity index and initial treatment modalities. For localized cancers, multivariate logistic regression analysis identified factors associated with radical prostatectomy. The proportion of localized prostate cancer (T1 or T2) was 86.6 %. The use of invasive curative treatment (radical prostatectomy and radiotherapy) was 58.4 % for localized cancers. Significant differences in therapeutic management were found between counties. Radical prostatectomy was associated with age at diagnosis, D'Amico prognostic group and the presence of comorbidities. Most of prostate cancers diagnosed in France in 2001 were clinically localized and were treated by invasive therapy. The consequences of these practices remain to be determined given the limited evolution of many prostate cancers and the frequency of adverse events related to invasive treatments. Copyright 2009 Elsevier Masson SAS. All rights reserved.

  15. Long-Term Oncological Outcomes for Young Men Undergoing Radical Prostatectomy for Localized Prostate Cancer

    PubMed Central

    Venclovas, Zilvinas; Gudinaviciene, Inga; Zviniene, Kristina; Matjosaitis, Aivaras Jonas

    2017-01-01

    Aim. The aim of this study was to describe PCa characteristics and long-term outcomes in young men aged ≤55 years after radical prostatectomy (RP) and to compare them with older men cohort. Methods. Among 2,200 patients who underwent RP for clinically localized PCa at our centre between 2001 and 2015, 277 (10.3%) men aged ≤55 years were identified. All preoperative and pathological parameters were compared between groups. Biochemical progression free survival (BPFS) and disease progression free survival (DPFS) were assessed at 5 and 10 years. Results. Men aged ≤55 years had similar pathological tumor characteristics and biochemical recurrence rate (BCR) compared to their older counterparts. Disease progression rate 2.5% versus 0.4% was higher in older patients (p = 0.026). BPFS rate was not different in both study groups. Estimated 10-year DPFS was 98.8% in younger men compared to 89.2% in their older counterparts (p = 0.031). Multivariate Cox regression showed that Gleason score lymph-nodes and surgical margins status were significant predictors for disease progression. Conclusions. In our cohort, men aged ≤55 years had similar pathological PCa characteristics and BCR rate in comparison with older men. RP can be performed with excellent long-term DPFS results in men with localized PCa at ≤55 years of age. PMID:28299340

  16. Comparison of oncological and functional outcomes of pure versus robotic-assisted laparoscopic radical prostatectomy performed by a single surgeon.

    PubMed

    Park, Bumsoo; Kim, Woojung; Jeong, Byong Chang; Jeon, Seong Soo; Lee, Hyun Moo; Choi, Han Yong; Seo, Seong Il

    2013-02-01

    The aim of this study was to compare oncological and functional outcomes of pure laparoscopic radical prostatectomy (LRP) and robotic-assisted laparoscopic radical prostatectomy (RALRP) performed by a single surgeon. In total, 327 consecutive patients with prostate cancer who underwent radical prostatectomy (144 with LRP and 183 with RALRP) were enrolled. No significant differences were found in prostate-specific antigen level, biopsy Gleason score, clinical T stage or D'Amico risk stratification between the two groups. The operating time was longer in the LRP group (p < 0.001). The RALRP group patients had significantly lower postoperative pain numerical rating scale (NRS) (p = 0.016) and catheter duration (p < 0.001). There were no differences in pathological Gleason score, pathological T stage or positive surgical margin rate. No differences were found in biochemical recurrence-free survival. Postoperative pad-free continence rates revealed a more rapid recovery in the RALRP group, but rates at 12 months were not significantly different. Multivariate analysis showed that the type of surgery was a strong independent factor to predict early postoperative pad use. Postoperative potency rates were not significantly different at 3, 6 and 12 months in patients who underwent nerve-sparing procedures. LRP and RALRP performed by a single surgeon yielded similar results in terms of safety and oncological outcomes. More favorable outcomes were noted in operating time, pain NRS and catheter duration, as well as urinary continence recovery time. Therefore, RALRP showed more favorable components in terms of postoperative quality of life than LRP.

  17. Impact of Tissue Sealing Sheet on Erectile Dysfunction in a Rat Model of Nerve-Sparing Radical Prostatectomy.

    PubMed

    Yamashita, Shinichi; Fujii, Shinji; Kamiyama, Yoshihiro; Kawasaki, Yoshihide; Izumi, Hideaki; Kawamorita, Naoki; Mitsuzuka, Koji; Adachi, Hisanobu; Kaiho, Yasuhiro; Ito, Akihiro; Arai, Yoichi

    2016-10-01

    The tissue sealing sheet has recently been used to prevent intraoperative bleeding from the neurovascular bundles in radical prostatectomy. Surgical stress or inflammatory changes likely play a role in erectile dysfunction after cavernous nerve injury. However, the efficacy of a tissue sealing sheet for preventing erectile function after nerve-sparing radical prostatectomy remains unclear. To evaluate the effect of a tissue sealing sheet on erectile dysfunction after cavernous nerve dissection. Male Sprague-Dawley rats were randomly divided into three groups and subjected to sham operation or bilateral cavernous nerve dissection with (sheet group) or without (non-sheet group) a tissue sealing sheet. In the sheet group, cavernous nerves were sealed with a tissue sealing sheet immediately after cavernous nerve dissection. Erectile function was assessed by measuring intracavernous pressure and arterial pressure during pelvic nerve electrostimulation at 4 weeks after surgery. Expressions of interleukin-6, tumor growth factor-β1, and heme-oxygenase-1 in the major pelvic ganglion were examined by real-time polymerase chain reaction. Mean intracavernous pressure along with mean arterial pressure in the sheet group were similar to those in the sham group and showed a significant positive response compared with the non-sheet group (P < .05). Furthermore, expressions of interleukin-6, tumor growth factor-β1, and heme-oxygenase-1 were significantly lower in the sheet group than in the non-sheet group (P < .05). Use of a tissue sealing sheet attenuated postoperative inflammatory changes and oxidative stress and improved erectile function after cavernous nerve injury in rats. The tissue sealing sheet might become a useful therapeutic approach to preserve erectile function after nerve-sparing radical prostatectomy. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

  18. Evolution of the patient characteristics of candidates for radical prostatectomy and the results obtained with the technique.

    PubMed

    Sanchís-Bonet, A; Arribas-Gómez, I; Sánchez-Rodríguez, C; Sánchez-Chapado, M

    2015-03-01

    To evaluate the oncological profile and risk of biochemical recurrence of patients with prostate cancer who underwent radical prostatectomy based on the time period in which the patients were operated. To evaluate the differences in prostate-specific antigen (PSA) at diagnosis of patients with or without biochemical recurrence based on these time periods. Observation carried forward study of a cohort of 972 radical prostatectomies performed during 3 time periods (1994-2000, 2001-2006, 2007-2011). The importance of PSA at diagnosis on the time periods and on biochemical recurrence was assessed using a generalized linear model. The independent predictive behavior of biochemical recurrence was analyzed using Cox regression. The median follow-up was 38 (16-76) months. PSA levels at diagnosis were higher in the period 1994-2000 (12.97ng/mL, P<.001). Seventy-two percent of the patients from the period 2007-2011 were diagnosed as clinical stage T1c (P<.001), compared with 55% from the period 1994-2000. The percentage of extracapsular extension in the specimen decreased from 27% to 18% from the period 1994-2000 to the period 2007-2011 (p<.001). The percentage of patients with biochemical recurrence went from 38% to 14% from the first to the third period (P>.001). The difference between PSA levels at diagnosis for the patients with or without biochemical recurrence was independent of the period (P=.84). The period during which surgery was performed was not an independent predictive factor for biochemical recurrence (P=.09). Patients from the 2007-2011 period had less extracapsular disease in the radical prostatectomy. The period was not an independent predictive factor for biochemical recurrence. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Transrectal implantation of electromagnetic transponders following radical prostatectomy for delivery of IMRT.

    PubMed

    Canter, Daniel; Kutikov, Alexander; Horwitz, Eric M; Greenberg, Richard E

    2011-08-01

    Surgical treatment for men with localized prostate cancer -open, laparoscopic, or robotically-assisted-- remains one of the therapeutic mainstays for this group of patients. Despite the stage migration witnessed in patients with prostate cancer since the introduction of prostate-specific antigen (PSA) screening, detection of extraprostatic disease at the time of surgery and biochemical recurrence following prostatectomy pose significant therapeutic challenges. Radiation therapy (RT) after radical prostatectomy (RP) has been associated with a survival benefit in both the adjuvant and salvage setting. Nevertheless, optimal targeting of the prostate bed following surgery remains challenging. The Calypso 4D Localization System (Calypso Medical Technologies, Seattle, WA, USA) is a target positioning device that continuously monitors the location of three implantable electromagnetic transponders. These transponders can be placed into the empty prostatic bed after prostatectomy to facilitate the delivery of radiation therapy in the post-surgical setting. In this article, we detail our technique for transrectal placement of electromagnetic transponders into the post-prostatectomy bed for the delivery of adjuvant or salvage intensity-modulated radiation therapy. We prefer this technique of post-surgical radiation therapy because it allows for improved localization of the target area allowing for the maximal delivery of the radiation dose while minimizing exposure of surrounding normal tissues. Although emerging, our initial oncologic and functional outcomes have been promising.

  20. Re-constructing masculinity following radical prostatectomy for prostate cancer.

    PubMed

    Gannon, Kenneth; Guerro-Blanco, Monica; Patel, Anup; Abel, Paul

    2010-12-01

    Prostate cancer is common in older men. Surgical treatment involving removal of the prostate can result in temporary or permanent erectile dysfunction (ED) and incontinence and have a major impact on men's masculine identity. Seven men were interviewed about their experiences and concerns following prostatectomy, and the transcripts were analysed employing Foucauldian Discourse Analysis to identify the ways in which they constructed their masculinity. Participants drew upon four main discourses when discussing the impact of surgical treatment on their sense of masculinity: masculine identity and sexual activity, ED as a normative experience, mental resilience and vulnerability. Penetrative sex was constructed as central to a masculine identity, but inability to achieve this was normalised in terms of the ageing process. Stereotypically masculine qualities of emotional control and rationality were drawn on in describing their reaction to the diagnosis and treatment of cancer but they also experienced a new-found sense of physical vulnerability. The findings are discussed in terms of their implications for the clinical management of ED post-surgery and helping men adjust to life following treatment.

  1. Outcome of radical retropubic prostatectomy at the Lagos State University Teaching Hospital

    PubMed Central

    Ikuerowo, Stephen Odunayo; Doherty, Alaba Fredrick; Bioku, Muftau Jimoh; Abolarinwa, Abimbola Ayodeji; Adebayo, Adekunle Azeez; Oyeleke, Steves Olaide; Omisanjo, Olufunmilade Akinfolarin

    2016-01-01

    Background: Prostate cancer is the most commonly diagnosed cancer in men in Nigeria and most cases present when the disease is already in an advanced stage. Radical prostatectomy for early prostate cancer is therefore not a commonly performed operation by urologists in Nigeria. We have had training and significant experience in radical retropubic prostatectomy. We, therefore, report the outcome of our initial experience. Materials and Methods: We review the record of men with early prostate cancer who had radical retropubic prostatectomy in our institution from 2007 to 2015. Results: There were 34 men who had radical retropubic prostatectomy in the 8-year period of review. The youngest and oldest patients were aged 50 and 71 years, respectively. The mean age was 64.2 years. All the patients were diagnosed following 12-core ultrasound-guided transrectal prostate biopsy for elevated serum prostate specific antigen (PSA). The mean serum PSA was 15.3 (range 8.5-100.3) ng/ml. The disease was pT1, pT2, and pT3 in 6, 20, and 8 patients respectively. General anesthesia was employed in 28 (82.4%) patients and combined epidural and subarachnoid block anesthesia for 6 (17.6%) patients. The total duration of operation was 128-252 min (mean = 160 min). No blood transfusion was given in 5 (14.7%) patients while each of the remaining 29 (85.3%) patients had 2-5 units of blood intra- or post-operatively. There was no perioperative mortality. Complications include operation-induced erectile dysfunction in 12 (35.3%), major urinary incontinence in 1 (2.9%), lymphocele in 2 (5.9%), and reoperation due to anastomotic leak and right ureteric injury in 1 (2.9%). After a median follow-up of 42 months, disease recurrence has occurred in 3 (8.8%) patients 1 (2.9%) of whom has died of diabetic renal failure. Conclusion: Radical prostatectomy can be safely performed in men with early prostate cancer in Nigeria and should be offered to suitable patients. PMID:27630388

  2. Robot-assisted versus other types of radical prostatectomy: population-based safety and cost comparison in Japan, 2012-2013.

    PubMed

    Sugihara, Toru; Yasunaga, Hideo; Horiguchi, Hiromasa; Matsui, Hiroki; Fujimura, Tetsuya; Nishimatsu, Hiroaki; Fukuhara, Hiroshi; Kume, Haruki; Changhong, Yu; Kattan, Michael W; Fushimi, Kiyohide; Homma, Yukio

    2014-11-01

    In 2012, Japanese national insurance started covering robot-assisted surgery. We carried out a population-based comparison between robot-assisted and three other types of radical prostatectomy to evaluate the safety of robot-assisted prostatectomy during its initial year. We abstracted data for 7202 open, 2483 laparoscopic, 1181 minimal incision endoscopic, and 2126 robot-assisted radical prostatectomies for oncological stage T3 or less from the Diagnosis Procedure Combination database (April 2012-March 2013). Complication rate, transfusion rate, anesthesia time, postoperative length of stay, and cost were evaluated by pairwise one-to-one propensity-score matching and multivariable analyses with covariants of age, comorbidity, oncological stage, hospital volume, and hospital academic status. The proportion of robot-assisted radical prostatectomies dramatically increased from 8.6% to 24.1% during the first year. Compared with open, laparoscopic, and minimal incision endoscopic surgery, robot-assisted surgery was generally associated with a significantly lower complication rate (odds ratios, 0.25, 0.20, 0.33, respectively), autologous transfusion rate (0.04, 0.31, 0.10), homologous transfusion rate (0.16, 0.48, 0.14), lower cost excluding operation (differences, -5.1%, -1.8% [not significant], -10.8%) and shorter postoperative length of stay (-9.1%, +0.9% [not significant], -18.5%, respectively). However, robot-assisted surgery also resulted in a + 42.6% increase in anesthesia time and +52.4% increase in total cost compared with open surgery (all P < 0.05). Introduction of robotic surgery led to a dynamic change in prostate cancer surgery. Even in its initial year, robot-assisted radical prostatectomy was carried out with several favorable safety aspects compared to the conventional surgeries despite its having the longest anesthesia time and the highest cost.

  3. Reporting Gleason grade/score in synoptic reports of radical prostatectomies

    PubMed Central

    Renshaw, Andrew A.; Mena-Allauca, Mercy; Gould, Edwin W.

    2016-01-01

    Context: The format of a synoptic report can significantly affect the accuracy, speed, and preference with which a reader can retrieve information. Objective: The objective of this study is to compare different formats of Gleason grading/score in synoptic reports of radical prostatectomies. Methods: The performance of 16 nonpathologists (cancer registrars, MDs, medical non-MDs, and nonmedical) at identifying specific information in various formatted synoptic reports using a computerized quiz that measured both accuracy and speed. Results: Compared to the standard format (primary, secondary, tertiary grades, and total score on separate lines), omitting tertiary grade when Not applicable reduced accuracy (72 vs. 97%, P < 0.001) and increased time to retrieve information 63% (P < 0.001). No user preferred to have tertiary grade omitted. Both the biopsy format (primary + secondary = total score, tertiary on a separate line) and the single line format (primary + secondary + (tertiary) -> total score) were associated with increased speed of data extraction (18 and 24%, respectively, P < 0.001). The single line format was more accurate (100% vs. 97%, P = 0.02). No user preferred the biopsy format, and only 7/16 users preferred the single line format. Conclusions Different report formats for Gleason grading significantly affect users speed, accuracy, and preference; users do not always prefer either speed or accuracy. PMID:28163976

  4. Postoperative wound dealing and superficial surgical site infection in open radical prostatectomy.

    PubMed

    Yamamichi, Fukashi; Shigemura, Katsumi; Yamashita, Mauso; Tanaka, Kazushi; Arakawa, Soishi; Fujisawa, Masato

    2016-10-01

    The number of open radical prostatectomy (RP) surgeries has been decreasing owing to the spread of laparoscopic and robotic surgery, which has implications for postoperative wound healing. The purpose of this study was to investigate and document the current status of postoperative wound healing and superficial surgical site infection (SSI) in open RPs. One hundred and seventy-five antegrade RPs with the same or similar kinds of prophylactic antibiotic administration were divided into two groups: (i) 'no intervention' (wound covering group) and (ii) 'washing', using a washing solution from the second postoperative day to the day of skin staple removal (wound washing group). We compared these groups for the occurrence of superficial SSI. The wound covering group had three (3·03%) cases of superficial SSI, with one case caused by methicillin sensitive Staphylococcus aureus (MSSA). The wound washing group had nine (11·8%) cases of superficial SSI, with three cases caused by MSSA, two cases caused by methicillin resistant Staphylococcus aureus (MRSA) and one by Pseudomonas aeruginosa. The wound covering group showed a significantly lower ratio of superficial SSI (P = 0·0472). In conclusion, the postoperative wound status data in this study suggests that no wound intervention after RP resulted in a comparatively lower ratio of superficial SSI than in the wound washing group. © 2014 The Authors. International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  5. Reality of nerve sparing and surgical margins in surgeons' early experience with robot-assisted radical prostatectomy in Japan.

    PubMed

    Tatsugami, Katsunori; Yoshioka, Kunihiko; Shiroki, Ryoichi; Eto, Masatoshi; Yoshino, Yasushi; Tozawa, Keiichi; Fukasawa, Satoshi; Fujisawa, Masato; Takenaka, Atsushi; Nasu, Yasutomo; Kashiwagi, Akira; Gotoh, Momokazu; Terachi, Toshiro

    2017-03-01

    To analyze nerve sparing performance at an early stage of robot-assisted radical prostatectomy, and the correlation between the surgeons' experience and the risk of a positive surgical margin in patients treated with robot-assisted radical prostatectomy. Patients' records from January 2009 to March 2013 were retrospectively reviewed, and 3469 patients with localized prostate cancer were identified at 45 institutions. Individual surgeon's experience with nerve sparing was recorded as the number of nerve sparing cases among total robot-assisted radical prostatectomies beginning with the first case during which nerve sparing was carried out. Patients were selected by propensity score matching for nerve sparing, and predictive factors of positive surgical margins were analyzed in patients with and without positive surgical margins. A total of 152 surgeons were studied, and the median number of robot-assisted radical prostatectomy cases for all surgeons was 21 (range 1-511). In all, 54 surgeons (35.5%) undertook nerve sparing during their first robot-assisted radical prostatectomy case. For 2388 patients selected with (1194) and without (1194) nerve sparing, predictive factors for positive surgical margin were high initial prostate-specific antigen level (P < 0.0001), high biopsy Gleason score (P = 0.0379), presence of neoadjuvant hormone therapy (P = 0.0002) and surgeon's experience with >100 cases (P = 0.0058). Thus, nerve sparing was not associated with positive surgical margins. The surgeon's experience influences the occurrence of positive surgical margins, although a considerable number of surgeons carried out nerve sparing during their early robot-assisted radical prostatectomy cases. Surgeons should consider their own experience and prostate cancer characteristics before carrying out a nerve sparing robot-assisted radical prostatectomy. © 2017 The Japanese Urological Association.

  6. Robotic transrectal ultrasonography during robot-assisted radical prostatectomy.

    PubMed

    Hung, Andrew J; Abreu, André Luís De Castro; Shoji, Sunao; Goh, Alvin C; Berger, Andre K; Desai, Mihir M; Aron, Monish; Gill, Inderbir S; Ukimura, Osamu

    2012-08-01

    We evaluate the use of robotically manipulated transrectal ultrasound (TRUS) for real-time monitoring of prostate and periprostatic anatomy during robot-assisted prostatectomy (RAP). Ten patients with clinically organ-confined prostate cancer undergoing RAP underwent preoperative and real-time intraoperative biplanar TRUS evaluation using a robotically manipulated TRUS device (ViKY System; EndoControl Medical, Grenoble, France). Median patient age was 66 yr (range: 54-88), baseline prostate-specific antigen (PSA) was 5.3 (range: 1.3-17.9), and four patients (40%) had clinical high-grade and high-stage disease. Bilateral or unilateral nerve sparing was performed in nine patients (90%). Median time for ViKY System setup to insertion of the TRUS probe was 7 min (range: 4-12). Complete robotic TRUS evaluation was successful in all patients. Five patients (50%) had TRUS-visible hypoechoic lesions, confirmed cancerous on preoperative biopsy. Relevant intraoperative TRUS findings were relayed in real time to the robotic surgeon, particularly during dissection of the bladder neck and prostatic apex, during neurovascular bundle preservation, and when hypoechoic prostate lesions approximated nerve-preserving dissection. Negative margins were achieved in nine patients (90%), including cases where significant intraprostatic lesions abutted or extended through the prostate capsule. No complications occurred. We concluded that real-time robotic TRUS guidance during RAP is feasible and safe. Robotic TRUS can provide the console surgeon with valuable anatomic information, thus maximizing functional preservation and oncologic success. Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  7. Post-operative drain output as a predictor of bladder neck contracture following radical prostatectomy.

    PubMed

    Hanson, Gregory R; Odom, Erin; Borden, Lester S; Neil, Nancy; Corman, John M

    2008-01-01

    Bladder neck contracture (BNC) following prostatectomy has been reported in 0.5-32% of cases. While the etiology of a BNC is unclear, several factors have been associated with this complication, including blood loss, devascularization of bladder neck tissue, poor mucosal apposition and urinary extravasation. To study the impact of urinary extravasation on BNC formation, we used postoperative drain output as a surrogate measure for anastomotic leakage. All patients undergoing a radical retropubic prostatectomy (RRP) or a robotic assisted radical prostatectomy (RARP) from January 2000 to April 2006 have been entered into a prospective review board-approved database. All RRP patients had their anastomosis performed in an interrupted fashion using six monofilament 2-0 sutures. All robotic-assisted radical prostatectomy anastomoses were performed in a running fashion using 2-0 monofilament sutures. A single, closed suction Jackson Pratt drain was placed over the surgical bed at the conclusion of the case. Post-operative drain outputs were recorded. All patients were evaluated at 3, 6, 9, 12 and 24 months post-operatively. All patients who reported a diminished urinary stream or incontinence were evaluated by office cystoscopy. The inability to navigate an 18 French cystoscope through the bladder neck was defined as a bladder neck contracture. A total of 576 patients underwent a radical prostatectomy over this time span. Complete records were available for 535 (93%) of these patients. There were 21 bladder neck contractures (3.9%) overall. The post-operative drain output ranged from 5-5,465 ml (median 119 ml). Eight patients who had drain outputs less than 119 ml developed a BNC while 13 BNC developed in patients with Jackson Pratt drain output > 119 ml (P = 0.343). In patients who underwent an open RRP, 19/424 (4.5%) developed contractures while 2/108 (1.9%) RARP patients developed a BNC (P = 0.105). The amount of post-operative drain output is not statistically

  8. Telephone follow-up of patients after radical prostatectomy: a systematic review1

    PubMed Central

    da Mata, Luciana Regina Ferreira; da Silva, Ana Cristina; Pereira, Maria da Graça; de Carvalho, Emilia Campos

    2014-01-01

    Objective to assess and summarize the best scientific evidence from randomized controlled clinical trials about telephone follow-up of patients after radical prostatectomy, based on information about how the phone calls are made and the clinical and psychological effects for the individuals who received this intervention. Method the search was undertaken in the electronic databases Medline, Web of Science, Embase, Cinahl, Lilacs and Cochrane. Among the 368 references found, five were selected. Results two studies tested interventions focused on psychological support and three tested interventions focused on the physical effects of treatment. The psychoeducative intervention to manage the uncertainty about the disease and the treatment revealed statistically significant evidences and reduced the level of uncertainty and anguish it causes. Conclusion the beneficial effects of telephone follow-up could be determined, as a useful tool for the monitoring of post-prostatectomy patients. PMID:26107844

  9. Radical prostatectomy in the presence of ongoing refractory ESBL Escherichia coli bacterial prostatitis

    PubMed Central

    McLoughlin, Louise Catherine; McDermott, T E D; Thornhill, John Alan

    2014-01-01

    A 44-year-old Indian national with a prostate-specific antigen of 5.4 ng/mL underwent 12-core transrectal ultrasound-guided prostate biopsies. Following this, he had three hospital admissions with severe urosepsis secondary to extended spectrum β lactamase (ESBL) producing Escherichia coli. He had recurrent sepsis immediately after discontinuation of intravenous meropenem to which the ESBL was sensitive. He proceeded to radical prostatectomy for intermediate-high risk Gleason 7 prostate cancer, while still on intravenous meropenem, 2 months after his biopsy. His prostatectomy involved a difficult dissection due to inflammatory changes and fibrosis after multiple septic episodes. He had complete resolution of infection after surgery with discontinuation of antibiotics on the third postoperative day, without any recurrence of sepsis. PMID:25315803

  10. Zero positive surgical margins after radical prostatectomy: is the end in sight.

    PubMed

    Skarecky, Douglas W; Brenner, Mattew; Rajan, Sudhir; Rodriguez, Esequiel; Narula, Navneet; Melgoza, Frank; Ahlering, Thomas E

    2008-11-01

    Positive surgical margins represents incomplete resection by the surgeon, and the elimination of positive margins represents the only clinical feature during radical prostatectomy that can lead directly to improved cancer outcomes. The introduction of new robot-assisted technology and technical refinements has led to declines of positive surgical margins. Although margins induced by incomplete cancer resection by the surgeon have been reduced for organ-confined disease, the 'Holy Grail' of zero margins is not yet attainable in prostatectomy, and is more problematic in cancer that has penetrated beyond the prostate. Intraoperative frozen biopsies are imprecise. The union of real-time optical coherence tomography technology of the da Vinci robotic platform for identification of positive margin sites, and technical advances with wider excisions during surgery may provide promise for further reduction of surgical margins to zero.

  11. Handling of radical prostatectomy specimens: total embedding with large-format histology.

    PubMed

    Montironi, Rodolfo; Lopez Beltran, Antonio; Mazzucchelli, Roberta; Cheng, Liang; Scarpelli, Marina

    2012-01-01

    A problem when handling radical prostatectomy specimens (RPS) is that cancer is often not visible at gross examination, and the tumor extent is always underestimated by the naked eye. The challenge is increased further by the fact that prostate cancer is a notoriously multifocal and heterogeneous tumor. For the pathologist, the safest method to avoid undersampling of cancer is evidently that the entire prostate is submitted. Even though whole mounts of sections from RPS appear not to be superior to sections from standard blocks in detecting adverse pathological features, their use has the great advantage of displaying the architecture of the prostate and the identification and location of tumour nodules more clearly, with particular reference to the index tumour; further, it is easier to compare the pathological findings with those obtained from digital rectal examination (DRE), transrectal ultrasound (TRUS), and prostate biopsies. We are in favour of complete sampling of the RPS examined with the whole mount technique. There are reasons in favour and a few drawbacks. Its implementation does not require an additional amount of work from the technicians' side. It gives further clinical significance to our work of uropathologists.

  12. Preoperative hormonal pattern in patients undergoing radical prostatectomy due to prostate cancer.

    PubMed

    García-Cruz, E; Castañeda-Argáiz, R; Carrión, A; Alcover, J; Sallent, A; Leibar-Tamayo, A; Romero-Otero, J; Alcaraz, A

    2013-05-01

    There is controversial evidence regarding preoperative testosterone (T) levels related to poor prognosis factors after radical prostatectomy (RP). The aim of this manuscript is to determine the relationship between preoperative T levels and final pathologic report together to biochemical recurrence after RP. We prospectively analysed 143 patients submitted to RP from February 2008 to June 2010 in our centre. Pretreatment T and sex hormone-binding globulin levels were determined as part of our clinical protocol. Free calculated (fT) and bioavailable (bioT) T were calculated using Vermeulen's formula. Low T levels were defined as 346 ng/dL or less. A comparative analysis with variables pTNM, positive margins, tumour burden, Gleason score, multifocality and biochemical recurrence (using both PSA>0.4 ng/dL and PSA>0.2 ng/dL as cut-off values) was performed, according to preoperative levels of T. Variables Gleason score, rate and number of positive margins, tumour burden, tumour multifocality, time to biochemical recurrence and pathological stage were not related to preoperative hormonal levels. Preoperative T<346 ng/dL was not found to be related to PSA recurrence (PSA>0,4 ng/dL log-rank, P=.512), although a trend was observed when PSA>0,2 ng/dL (log-rank, P=.097). Preoperative T levels were not related to final pathological report or to biochemical recurrence. Copyright © 2012 AEU. Published by Elsevier Espana. All rights reserved.

  13. Oncologic Outcome of Radical Prostatectomy as Monotherapy for Men with High-risk Prostate Cancer

    PubMed Central

    Furukawa, Junya; Miyake, Hideaki; Inoue, Taka-aki; Ogawa, Takayoshi; Tanaka, Hirokazu; Fujisawa, Masato

    2016-01-01

    Background The objective of this study was to review our experience with radical prostatectomy (RP) as monotherapy for men with high-risk prostate cancer (PCa). Patients and Methods This study included 382 consecutive patients who were diagnosed with high-risk PCa according to the D'Amico definition and subsequently underwent RP without neoadjuvant therapy. Biochemical recurrence (BR) was defined as a serum prostate-specific antigen (PSA) level ≥ 0.2 ng/ml on two consecutive measurements, and none of the patients received any adjuvant therapies until their serum PSA levels reached ≥ 0.4 ng/ml. Results The median preoperative serum PSA level in these 382 patients was 15.9 ng/ml. Pathological stages ≥ pT2c and Gleason scores ≥ 8 were observed in 288 and 194 patients, respectively. During the observation period (median, 48.0 months), BR occurred in 134 patients, and the 5-year BR-free survival rate was 60.1%; however, no patient died of cancer progression. Multivariate analysis identified capsular invasion, seminal vesicle invasion, and surgical margin status as independent predictors of BR. Conclusions Comparatively favorable cancer control could be achieved using RP as monotherapy for men with high-risk PCa; however, RP alone may be insufficient for patients with capsular invasion, seminal vesicle invasion, and/or surgical margin positivity. PMID:27390578

  14. A cost-utility analysis of laparoscopic radical prostatectomy and robotic-assisted laparoscopic radical prostatectomy in men with localized prostate cancer in Thailand.

    PubMed

    Ratchanon, Supoj; Apiwattanasawee, Polporn; Prasopsanti, Kriangsak

    2015-01-01

    Robotic machines are being used with increasing frequency in the treatment of clinically localized prostate cancer in Thailand. While robotics may offer some advantages, it remains unclear whether potential benefits offset higher costs. The objective of this study was to evaluate and compare cost utility between standard and robotic-assisted laparoscopic prostatectomy from a health system perspective. The authors created a care pathway and a model to facilitate a comprehensive cost utility analysis. All variables used in our model were derived from our review of the literature, exceptfor cost, utility for erectile dysfunction, and utility for urinary incontinence, which were derived from Chulalongkorn Hospital patient records. All costs described in this report are denominated in Thai baht, with a 2012 currency value. A positive margin was used to simulate the model. Sensitivity analysis was performed to estimate the robustness of the outcome. Thailand utility values for erectile dysfunction and urinary incontinence were 0.86 and 0.81, respectively. The cost of robotic laparoscopy was, on average, 120,359 baht (95% CI, 89,368-151,350 baht) higher than standard laparoscopy and was more effective with a mean gain of 0.05 quality-adjusted life years (QALYs) (95% CI, 0.03-0.08) for the 100 procedures performed each year. The incremental cost effectiveness (ICER) ratio was 2,407,180 baht per QALYs, with a very low probability that robotic prostatectomy would be cost effective at the Thai-willingness-to pay (WTP) threshold of 160,000 baht/ QALY. Robotic-assisted laparoscopic prostatectomy is not more cost effective than standard laparoscopic prostatectomy for the 100 cases performed each year. An increase in the number of cases may result in better economies of scale and a lower ICER, an outcome that may increase the overall value and cost effectiveness of an investment in this technology.

  15. Discordance between location of positive cores in biopsy and location of positive surgical margin following radical prostatectomy.

    PubMed

    Kim, Ji Won; Park, Hyoung Keun; Kim, Hyeong Gon; Ham, Dong Yeub; Paick, Sung Hyun; Lho, Yong Soo; Choi, Woo Suk

    2015-10-01

    We compared location of positive cores in biopsy and location of positive surgical margin (PSM) following radical prostatectomy. This retrospective analysis included patients who were diagnosed as prostate cancer by standard 12-core transrectal ultrasonography guided prostate biopsy, and who have PSM after radical prostatectomy. After exclusion of number of biopsy cores <12, and lack of biopsy location data, 46 patients with PSM were identified. Locations of PSM in pathologic specimen were reported as 6 difference sites (apex, base and lateral in both sides). Discordance of biopsy result and PSM was defined when no positive cores in biopsy was identified at the location of PSM. Most common location of PSM were right apex (n=21) and left apex (n=15). Multiple PSM was reported in 21 specimens (45.7%). In 32 specimens (69.6%) with PSM, one or more concordant positive biopsy cores were identified, but 14 specimens (28%) had no concordant biopsy cores at PSM location. When discordant rate was separated by locations of PSM, right apex PSM had highest rate of discordant (38%). The discordant group had significantly lower prostate volume and lower number of positive cores in biopsy than concordant group. This study showed that one fourth of PSM occurred at location where tumor was not detected at biopsy and that apex PSM had highest rate of discordant. Careful dissection to avoid PSM should be performed in every location, including where tumor was not identified in biopsy.

  16. Extended versus limited pelvic lymph node dissection during bilateral nerve-sparing radical prostatectomy and its effect on continence and erectile function recovery: long-term results and trifecta rates of a comparative analysis.

    PubMed

    Hatzichristodoulou, Georgios; Wagenpfeil, Stefan; Wagenpfeil, Gudrun; Maurer, Tobias; Horn, Thomas; Herkommer, Kathleen; Hegemann, Marie; Gschwend, Jürgen E; Kübler, Hubert

    2016-06-01

    To assess continence and erectile function (EF) recovery of extended pelvic lymph node dissection (ePLND) versus limited PLND (lPLND) after bilateral nerve-sparing radical prostatectomy (BNSRP). Consecutive prostate cancer (PCa) patients undergoing BNSRP were stratified according to D'Amico into two groups: low-risk-PCa lPLND (obturator) and intermediate-/high-risk-PCa ePLND (obturator, external iliac artery, internal iliac artery, common iliac artery). Continence (no pad/one safety pad) and EF (IIEF-5 ≥ 17) recovery were assessed. Patients with phosphodiesterase type 5 inhibitors, neoadjuvant/adjuvant therapy, positive lymph nodes or positive surgical margins were excluded. From January 2007 to May 2012, a total 966 consecutive patients were included. Four hundred and sixty patients met the inclusion/exclusion criteria: 262 patients had ePLND and 198 patients had lPLND. Mean number of lymph nodes was 20.4 (range 10-65) and 4.7 (range 0-10), respectively (p < 0.001). Continence and spontaneous EF recovery after 12 months were 89.7 versus 93.4 % and 40.4 versus 47.5 %, respectively (all p > 0.05). Patient age at surgery (p = 0.001), preoperative EF (p < 0.001) and pathological tumor stage (p = 0.008), but not ePLND (p = 0.561), were independent predictors of EF recovery. No association was detected for continence recovery. Seven-year BCR-free survival for pT2 PCa was 100 and 94.8 % in lPLND and ePLND, respectively (p = 0.011). For pT3 PCa, this was 94.7 and 81.2 %, respectively (p = 0.287). At 2 years, the trifecta of continence, potency and recurrence freedom was achieved in 47.5 and 44.1 % in lPLND and ePLND, respectively (p = 0.451). ePLND is not associated with increased risk of postoperative incontinence or erectile dysfunction. Only patient age at surgery, preoperative EF and pathological tumor stage represent predictors of EF recovery.

  17. Effect of Sulforaphane in Men with Biochemical Recurrence after Radical Prostatectomy.

    PubMed

    Cipolla, Bernard G; Mandron, Eric; Lefort, Jean Marc; Coadou, Yves; Della Negra, Emmanuel; Corbel, Luc; Le Scodan, Ronan; Azzouzi, Abdel Rahmene; Mottet, Nicolas

    2015-08-01

    Increases in serum levels of prostate-specific antigen (PSA) occur commonly in prostate cancer after radical prostatectomy and are designated "biochemical recurrence." Because the phytochemical sulforaphane has been studied extensively as an anticancer agent, we performed a double-blinded, randomized, placebo-controlled multicenter trial with sulforaphane in 78 patients (mean age, 69 ± 6 years) with increasing PSA levels after radical prostatectomy. Treatment comprised daily oral administration of 60 mg of a stabilized free sulforaphane for 6 months (M0-M6) followed by 2 months without treatment (M6-M8). The study was designed to detect a 0.012 log (ng/mL)/month decrease in the log PSA slope in the sulforaphane group from M0 to M6. The primary endpoint was not reached. For secondary endpoints, median log PSA slopes were consistently lower in sulforaphane-treated men. Mean changes in PSA levels between M6 and M0 were significantly lower in the sulforaphane group (+0.099 ± 0.341 ng/mL) than in placebo (+0.620 ± 1.417 ng/mL; P = 0.0433). PSA doubling time was 86% longer in the sulforaphane than in the placebo group (28.9 and 15.5 months, respectively). PSA increases >20% at M6 were significantly greater in the placebo group (71.8%) than in the sulforaphane group (44.4%); P = 0.0163. Compliance and tolerance were very good. Sulforaphane effects were prominent after 3 months of intervention (M3-M6). After treatment, PSA slopes from M6 to M8 remained the same in the 2 arms. Daily administration of free sulforaphane shows promise in managing biochemical recurrences in prostate cancer after radical prostatectomy.

  18. Intraoperative Radiotherapy During Radical Prostatectomy for Locally Advanced Prostate Cancer: Technical and Dosimetric Aspects

    SciTech Connect

    Krengli, Marco; Terrone, Carlo; Ballare, Andrea; Loi, Gianfranco; Tarabuzzi, Roberto; Marchioro, Giansilvio; Beldi, Debora; Mones, Eleonora; Bolchini, Cesare R.T.; Volpe, Alessandro; Frea, Bruno

    2010-03-15

    Purpose: To analyze the feasibility of intraoperative radiotherapy (IORT) in patients with high-risk prostate cancer and candidates for radical prostatectomy. Methods and Materials: A total of 38 patients with locally advanced prostate cancer were enrolled. No patients had evidence of lymph node or distant metastases, probability of organ-confined disease >25%, or risk of lymph node involvement >15% according to the Memorial Sloan-Kettering Cancer Center Nomogram. The IORT was delivered after exposure of the prostate by a dedicated linear accelerator with beveled collimators using electrons of 9 to 12 MeV to a total dose of 10-12 Gy. Rectal dose was measured in vivo by radiochromic films placed on a rectal probe. Administration of IORT was followed by completion of radical prostatectomy and regional lymph node dissection. All cases with extracapsular extension and/or positive margins were scheduled for postoperative radiotherapy. Patients with pT3 to pT4 disease or positive nodes received adjuvant hormonal therapy. Results: Mean dose detected by radiochromic films was 3.9 Gy (range, 0.4-8.9 Gy) to the anterior rectal wall. The IORT procedure lasted 31 min on average (range, 15-45 min). No major intra- or postoperative complications occurred. Minor complications were observed in 10/33 (30%) of cases. Of the 27/31 patients who completed the postoperative external beam radiotherapy, 3/27 experienced Grade 2 rectal toxicity and 1/27 experienced Grade 2 urinary toxicity. Conclusions: Use of IORT during radical prostatectomy is feasible and allows safe delivery of postoperative external beam radiotherapy to the tumor bed without relevant acute rectal toxicity.

  19. Improved prediction of biochemical recurrence after radical prostatectomy by genetic polymorphisms.

    PubMed

    Morote, Juan; Del Amo, Jokin; Borque, Angel; Ars, Elisabet; Hernández, Carlos; Herranz, Felipe; Arruza, Antonio; Llarena, Roberto; Planas, Jacques; Viso, María J; Palou, Joan; Raventós, Carles X; Tejedor, Diego; Artieda, Marta; Simón, Laureano; Martínez, Antonio; Rioja, Luis A

    2010-08-01

    Single nucleotide polymorphisms are inherited genetic variations that can predispose or protect individuals against clinical events. We hypothesized that single nucleotide polymorphism profiling may improve the prediction of biochemical recurrence after radical prostatectomy. We performed a retrospective, multi-institutional study of 703 patients treated with radical prostatectomy for clinically localized prostate cancer who had at least 5 years of followup after surgery. All patients were genotyped for 83 prostate cancer related single nucleotide polymorphisms using a low density oligonucleotide microarray. Baseline clinicopathological variables and single nucleotide polymorphisms were analyzed to predict biochemical recurrence within 5 years using stepwise logistic regression. Discrimination was measured by ROC curve AUC, specificity, sensitivity, predictive values, net reclassification improvement and integrated discrimination index. The overall biochemical recurrence rate was 35%. The model with the best fit combined 8 covariates, including the 5 clinicopathological variables prostate specific antigen, Gleason score, pathological stage, lymph node involvement and margin status, and 3 single nucleotide polymorphisms at the KLK2, SULT1A1 and TLR4 genes. Model predictive power was defined by 80% positive predictive value, 74% negative predictive value and an AUC of 0.78. The model based on clinicopathological variables plus single nucleotide polymorphisms showed significant improvement over the model without single nucleotide polymorphisms, as indicated by 23.3% net reclassification improvement (p = 0.003), integrated discrimination index (p <0.001) and likelihood ratio test (p <0.001). Internal validation proved model robustness (bootstrap corrected AUC 0.78, range 0.74 to 0.82). The calibration plot showed close agreement between biochemical recurrence observed and predicted probabilities. Predicting biochemical recurrence after radical prostatectomy based on

  20. Preoperative predictive model of recovery of urinary continence after radical prostatectomy

    PubMed Central

    Matsushita, Kazuhito; Kent, Matthew T.; Vickers, Andrew J.; von Bodman, Christian; Bernstein, Melanie; Touijer, Karim A.; Coleman, Jonathan; Laudone, Vincent; Scardino, Peter T.; Eastham, James A.; Akin, Oguz; Sandhu, Jaspreet S.

    2016-01-01

    Objective ● To build a predictive model of urinary continence recovery following radical prostatectomy that incorporates magnetic resonance imaging parameters and clinical data. Patients and Methods ● We conducted a retrospective review of data from 2,849 patients who underwent pelvic staging magnetic resonance imaging prior to radical prostatectomy from November 2001 to June 2010. ● We used logistic regression to evaluate the association between each MRI variable and continence at 6 or 12 months, adjusting for age, body mass index (BMI), and American Society of Anesthesiologists (ASA) score and then used multivariable logistic regression to create our model. ● A nomogram was constructed using the multivariable logistic regression models. Results ● In total, 68% (n=1,742/2,559) and 82% (n=2,205/2,689) regained function at 6 and 12 months, respectively. ● In the base model, age, BMI, and ASA score were significant predictors of continence at 6 or 12 months on univariate analysis (p <0.005). ● Among the preoperative magnetic resonance imaging measurements, membranous urethral length, which showed great significance, was incorporated into the base model to create the full model. ● For continence recovery at 6 months, the addition of membranous urethral length increased the AUC to 0.664 for the validation set, an increase of 0.064 over the base model. For continence recovery at 12 months, the AUC was 0.674, an increase of 0.085 over the base model. Conclusions ● Using our model, the likelihood of continence recovery increases with membranous urethral length and decreases with age, body mass index, and ASA score. ● This model could be used for patient counseling and for the identification of patients at high risk for urinary incontinence in whom to study changes in operative technique that improve urinary function after radical prostatectomy. PMID:25682782

  1. Diabetes mellitus is associated with short prostate-specific antigen doubling time after radical prostatectomy.

    PubMed

    Oh, Jong Jin; Hong, Sung Kyu; Lee, Sangchul; Sohn, Seung June; Lee, Sang Eun

    2013-02-01

    To investigate whether diabetes mellitus (DM) was associated with postoperative outcomes, including prostate-specific antigen doubling time, among men who underwent radical prostatectomy (RP) for clinically localized prostate cancer (PCa). Data of 661 patients who underwent radical prostatectomy for node-negative prostate cancer and were followed up for ≥3 years postoperatively at our institution were analyzed. Associations between diabetes mellitus at surgery and outcomes following radical prostatectomy, such as biochemical recurrence-free survival and prostate-specific antigen doubling time, were examined. Aggressive recurrence was defined as biochemical recurrence with prostate-specific antigen doubling time <9 months. Of the 661 total subjects, DM (n = 67, 10.1 %) and non-DM group (n = 594, 89.9 %) showed no significant differences in various clinicopathologic parameters including age and PSA. DM group had lower postoperative biochemical recurrence-free survival than non-DM group, with observed difference approaching statistical significance (log-rank, p = 0.077). On multivariate analysis, DM at surgery was significantly associated with aggressive recurrence following RP (p = 0.048). Pathologic Gleason score (p = 0.008) and seminal vesicle invasion (p = 0.010) were also significantly associated with aggressive recurrence on multivariate analysis. Our results show that pre-existing DM in men with PCa is associated with more aggressive recurrence, suggesting that DM may affect disease progression following RP. Further investigation would be needed to elucidate exact biologic interaction between DM and PCa and also assess causal relationships that potentially could be modified to improve long-term outcome in patients with the two diseases.

  2. Does index tumor predominant location influence prognostic factors in radical prostatectomies?

    PubMed

    Billis, Athanase; Freitas, Leandro L L; Costa, Larissa B E; Angelis, Camila M; Carvalho, Kelson R; Magna, Luis A; Ferreira, Ubirajara

    2017-01-01

    To find any influence on prognostic factors of index tumor according to predominant location. Prostate surgical specimens from 499 patients submitted to radical retropubic prostatectomy were step-sectioned. Each transverse section was subdivided into 2 anterolateral and 2 posterolateral quadrants. Tumor extent was evaluated by a semi-quantitative point-count method. The index tumor (dominant nodule) was recorded as the maximal number of positive points of the most extensive tumor area from the quadrants and the predominant location was considered anterior (anterolateral quadrants), posterior (posterolateral quadrants), basal (quadrants in upper half of the prostate), apical (quadrants in lower half of the prostate), left (left quadrants) or right (right quadrants). Time to biochemical recurrence was analyzed by Kaplan-Meier product-limit analysis and prediction of shorter time to biochemical recurrence using univariate and multivariate Cox proportional hazards model. Index tumors with predominant posterior location were significantly associated with higher total tumor extent, needle and radical prostatectomy Gleason score, positive lymph nodes and preoperative prostate-specific antigen. Index tumors with predominant basal location were significantly associated with higher preoperative prostate-specific antigen, pathological stage higher than pT2, extra-prostatic extension, and seminal vesicle invasion. Index tumors with predominant basal location were significantly associated with time to biochemical recurrence in Kaplan-Meier estimates and significantly predicted shorter time to biochemical recurrence on univariate analysis but not on multivariate analysis. The study suggests that index tumor predominant location is associated with prognosis in radical prostatectomies, however, in multivariate analysis do not offer advantage over other well-established prognostic factors. Copyright® by the International Brazilian Journal of Urology.

  3. Stage pT0 after radical prostatectomy with previous positive biopsy sets: a multicenter study.

    PubMed

    Bessède, Thomas; Soulié, Michel; Mottet, Nicolas; Rebillard, Xavier; Peyromaure, Michaël; Ravery, Vincent; Salomon, Laurent

    2010-03-01

    We analyzed preoperative data, pathological results and followup of pT0 tumors after radical prostatectomy for prostate cancer diagnosed on previous positive biopsy. At 6 centers a total of 30 of 7,693 radical prostatectomy specimens were classified as pT0 despite prior biopsy proven prostate cancer. No patients were diagnosed after transurethral prostate resection or received neoadjuvant hormonal treatment. All biopsy cores and radical prostatectomy specimens were reanalyzed by a second pathologist. Followup comprised clinical examination and postoperative prostate specific antigen assay at 1 and 3 months, and every 6 months thereafter. Median patient age was 63 years (range 46 to 73). Median preoperative prostate specific antigen was 7.4 ng/ml (range 1.3 to 23). Of the cases 24 were T1c and 6 were T2a. The median number of biopsy cores was 10 (range 6 to 21) with 1 positive (range 1 to 4). On biopsies median tumor length was 1 mm (range 0.3 to 18) and there was tumor in 11.1% (range 3.4% to 64%). In 25 cases (83.3%) there was only 1 positive biopsy. Gleason score was 3 + 3 in 23 cases and less than 6 in 5 with grade 4 in 2. Only 9 cases filled all nonsignificant tumor criteria. Median specimen weight was 61 gm (range 40 to 160). At a median 82-month followup (range 14 to 226) there was no biochemical progression. After biopsy proven cancer pT0 prostate cancer is an unpredictable pathological finding. Despite its excellent prognosis it has medicolegal repercussions that justify DNA based tissue analysis. There is no evidence that finding focal cancer after extensive prostate resection changes patient prognosis and postoperative treatment. 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  4. Does index tumor predominant location influence prognostic factors in radical prostatectomies?

    PubMed Central

    Billis, Athanase; Freitas, Leandro L. L.; Costa, Larissa B. E.; de Angelis, Camila M.; Carvalho, Kelson R.; Magna, Luis A.; Ferreira, Ubirajara

    2017-01-01

    ABSTRACT Purpose To find any influence on prognostic factors of index tumor according to predominant location. Materials and Methods Prostate surgical specimens from 499 patients submitted to radical retropubic prostatectomy were step-sectioned. Each transverse section was subdivided into 2 anterolateral and 2 posterolateral quadrants. Tumor extent was evaluated by a semi-quantitative point-count method. The index tumor (dominant nodule) was recorded as the maximal number of positive points of the most extensive tumor area from the quadrants and the predominant location was considered anterior (anterolateral quadrants), posterior (posterolateral quadrants), basal (quadrants in upper half of the prostate), apical (quadrants in lower half of the prostate), left (left quadrants) or right (right quadrants). Time to biochemical recurrence was analyzed by Kaplan-Meier product-limit analysis and prediction of shorter time to biochemical recurrence using univariate and multivariate Cox proportional hazards model. Results Index tumors with predominant posterior location were significantly associated with higher total tumor extent, needle and radical prostatectomy Gleason score, positive lymph nodes and preoperative prostate-specific antigen. Index tumors with predominant basal location were significantly associated with higher preoperative prostate-specific antigen, pathological stage higher than pT2, extra-prostatic extension, and seminal vesicle invasion. Index tumors with predominant basal location were significantly associated with time to biochemical recurrence in Kaplan-Meier estimates and significantly predicted shorter time to biochemical recurrence on univariate analysis but not on multivariate analysis. Conclusions The study suggests that index tumor predominant location is associated with prognosis in radical prostatectomies, however, in multivariate analysis do not offer advantage over other well-established prognostic factors. PMID:28379672

  5. Robotic radical prostatectomy in patients with preexisting inflatable penile prosthesis (IPP).

    PubMed

    Rehman, Jamil; Guru, Khurshid; Chughtai, Bilal; Shabsigh, Ridwan; Samadi, David

    2008-10-01

    We present our initial experience with performing robotic-assisted prostatectomies in men with a 3-piece inflatable penile prosthesis with a pelvic reservoir. Four patients underwent transperitoneal robotic-assisted radical prostatectomies with a penile prosthetic implant in place. The reservoir was left inflated for easy identification. A flaccid reservoir may be more difficult to identify, and be prone to damage. The reservoir was left attached to the abdominal wall. Dissection was performed outside the fibrous capsule of the reservoir. The tissue around the capsule of the reservoir peeled off without difficulty. Cutting current close to the capsule can be used if needed as per American Medical System with no limit to voltage. The penile prosthesis is then inflated to empty the reservoir creating more prevesical space and preventing the reservoir from obscuring visualization. The remaining portion of the procedure is completed using our standard technique. After completing the urethrovesical anastomosis using the 16 French Foley, the prosthesis is cycled under direct vision and the penile prosthesis is deflated (reservoir full). The prosthesis is not used for 6 weeks to prevent stretching of the urethrovesical anastomosis. All patients (n = 4) had no reported complications and all prostheses are functioning properly. The margin status was negative postoperatively. Robotic prostatectomy is technically feasible in patients with inflatable penile prostheses by surgeons experienced in robotic surgery. However, the presence of an indwelling penile prosthesis does increase the complexity of surgery.

  6. Prospective Quality of Life Outcomes for Low-Risk Prostate Cancer: Active Surveillance versus Radical Prostatectomy

    PubMed Central

    Jeldres, Claudio; Cullen, Jennifer; Hurwitz, Lauren M.; Wolff, Erika M.; Levie, Katherine; Odem-Davis, Katherine; Johnston, Richard B.; Pham, Khanh N.; Rosner, Inger L; Brand, Timothy C.; L’Esperance, James O.; Sterbis, Joseph R.; Etzioni, Ruth B.; Porter, Christopher R.

    2015-01-01

    Background For low-risk prostate cancer (PCa), active surveillance (AS) may confer comparable oncological outcomes to radical prostatectomy (RP). Health-related quality of life (HRQoL) outcomes are important to consider, yet few studies have examined HRQoL for patients managed with AS. This study compared longitudinal HRQoL in a prospective, racially diverse, and contemporary cohort of patients who underwent RP or AS for low-risk PCa. Methods Beginning in 2007, HRQoL data from validated questionnaires (EPIC and SF-36) were collected by the Center for Prostate Disease Research in a multi-center national database. Patients aged ≤75 that were diagnosed with low-risk PCa and elected RP or AS for initial disease management were followed for three years. Mean scores were estimated using generalized estimating equations, adjusting for baseline HRQoL, demographic and clinical patient characteristics. Results Of the patients with low-risk PCa, 228 underwent RP and 77 underwent AS. Multivariable analysis revealed that RP patients had significantly worse sexual function, sexual bother, and urinary function at all time points compared to patients on AS. Differences in mental health between groups were below the threshold for clinical significance at one year. Conclusions This study found no differences in mental health outcomes but worse urinary and sexual HRQoL for RP patients compared to AS patients for up to three years. These data offer support for management of low risk PCa with AS as a means for postponing the morbidity associated with RP without concomitant mental health declines. PMID:25845467

  7. Incidence of Second Malignancies in Prostate Cancer Patients Treated With Low-Dose-Rate Brachytherapy and Radical Prostatectomy

    SciTech Connect

    Hamilton, Sarah Nicole; Tyldesley, Scott; Hamm, Jeremy; Jiang, Wei Ning; Keyes, Mira; Pickles, Tom; Lapointe, Vince; Kahnamelli, Adam; McKenzie, Michael; Miller, Stacy; Morris, W. James

    2014-11-15

    Purpose: To compare the second malignancy incidence in prostate cancer patients treated with brachytherapy (BT) relative to radical prostatectomy (RP) and to compare both groups with the cancer incidence in the general population. Methods and Materials: From 1998 to 2010, 2418 patients were treated with Iodine 125 prostate BT monotherapy at the British Columbia Cancer Agency, and 4015 referred patients were treated with RP. Cancer incidence was compared with the age-matched general population using standardized incidence ratios (SIRs). Pelvic malignancies included invasive and noninvasive bladder cancer and rectal cancer. Cox multivariable analysis was performed with adjustment for covariates to determine whether treatment (RP vs BT) was associated with second malignancy risk. Results: The median age at BT was 66 years and at RP 62 years. The SIR comparing BT patients with the general population was 1.06 (95% confidence interval [CI] 0.91-1.22) for second malignancy and was 1.53 (95% CI 1.12-2.04) for pelvic malignancy. The SIR comparing RP patients with the general population was 1.11 (95% CI 0.98-1.25) for second malignancy and was 1.11 (95% CI 0.82-1.48) for pelvic malignancy. On multivariable analysis, older age (hazard ratio [HR] 1.05) and smoking (HR 1.65) were associated with increased second malignancy risk (P<.0001). Radical prostatectomy was not associated with a decreased second malignancy risk relative to BT (HR 0.90, P=.43), even when excluding patients who received postprostatectomy external beam radiation therapy (HR 1.13, P=.25). Older age (HR 1.09, P<.0001) and smoking (HR 2.17, P=.0009) were associated with increased pelvic malignancy risk. Radical prostatectomy was not associated with a decreased pelvic malignancy risk compared with BT (HR 0.57, P=.082), even when excluding postprostatectomy external beam radiation therapy patients (HR 0.87, P=.56). Conclusions: After adjustment for covariates, BT patients did not have an increased second

  8. Penile Prosthesis Implantation for End-Stage Erectile Dysfunction after Radical Prostatectomy

    PubMed Central

    Montague, Drogo K

    2005-01-01

    When erectile dysfunction occurs after radical prostatectomy and phosphodiesterase-5 inhibitor therapy fails, second-line therapies such as vacuum constriction devices, intraurethral prostaglandins, and penile injection therapy should be offered. When second-line therapies are not effective or acceptable to the man and his partner, penile prosthesis implantation becomes the treatment of choice. Today’s 3-piece inflatable devices offer flaccidity and erection that approach the natural state. Design improvements have resulted in devices that have freedom from mechanical failure ranging from 92% to 94%. Antibiotic and hydrophilic coatings have reduced infection rates. PMID:16985898

  9. High anterior release of the levator fascia improves sexual function following open radical retropubic prostatectomy.

    PubMed

    Nielsen, Matthew E; Schaeffer, Edward M; Marschke, Penny; Walsh, Patrick C

    2008-12-01

    Recent anatomical studies have shown that branches of the cavernous nerves running adjacent to the prostate at the apex travel more anteriorly than previously recognized. Outcomes of robot assisted radical prostatectomy suggest improved postoperative sexual outcomes following high anterior release of the levator fascia. We prospectively evaluated the effect of high anterior release on oncological and sexual function outcomes following open radical retropubic prostatectomy. A total of 167 patients with clinically localized prostate cancer with a preoperative Sexual Health Inventory for Men score of greater than 21 underwent radical retropubic prostatectomy with bilateral nerve sparing and selective high anterior release, as performed by a single surgeon. Data on postoperative sexual function were collected by an independent third party. Sexual function outcomes at 12 months were defined as 1) a Sexual Health Inventory for Men score of 16 or greater and/or a satisfaction score of 4 or greater and 2) a Sexual Health Inventory for Men score of 22 or greater. Because unilateral high anterior release was equivalent to bilateral high anterior release for both definitions (p >0.3), they were combined into 1 group for analyses. Patients undergoing high anterior release were more likely to achieve a Sexual Health Inventory for Men score of 16 or greater and/or a satisfaction score of 4 (93% vs 77%, p = 0.007), and a Sexual Health Inventory for Men score of 22 or greater (70% vs 54%, p = 0.07) at 1 year. Return to baseline (a Sexual Health Inventory for Men score of 22 or greater) was even higher among patients receiving high anterior release who were more sexually active (greater than 1 attempt per week) preoperatively (78% vs 52%, p <0.05). The improved outcomes in potency achieved with high anterior release did not increase the likelihood of a positive surgical margin. Unilateral or bilateral high anterior release of the levator fascia in open radical retropubic

  10. Outcome of radical prostatectomy in primary circulating prostate cell negative prostate cancer

    PubMed Central

    Murray, Nigel P; Aedo, Sócrates; Reyes, Eduardo; Fuentealba, Cynthia; Jacob, Omar

    2016-01-01

    Introduction Around 90% of prostate cancers detected using the serum prostate specific antigen (PSA) as a screening test are considered to be localised. However, 20–30% of men treated by radical prostatectomy experience biochemical failure within two years of treatment. The presence of primary circulating prostate cells (CPCs) in the blood of these men implies a dissemination of the tumour and could indicate a greater risk of treatment failure. Objective To evaluate the use of the number of primary CPCs detected before surgery in the prediction of biochemical failure at ten years. Hypothesis The dissemination of cancer cells to distant sites will determine the patient’s prognosis. The absence of primary CPCs in men undergoing radical prostatectomy for prostate cancer may imply a less aggressive disease and therefore could be utilised as a prognostic factor to predict biochemical failure after surgery. Methods and patients A single-centre observational study of a cohort of 285 men who underwent radical prostatectomy as monotherapy for prostate cancer, in whom the number of CPCs prior to treatment was determined, and who were followed up for ten years to determine biochemical failure. A Cox proportional risks with polynomial fractions analysis was used to predict biochemical failure based on the number of primary CPCs detected. A decision curve analysis was performed for the model obtained. Results Kaplan–Meier curves for biochemical free survival at ten years was 47.34% (95% CI 38.71–55.48%). It is important to note that in CPC negative men, the ten years Kaplan–Meier biochemical-free survival was 90.35% (95% CI 75.0–96.27) whereas in men who were primary CPC positive, the biochemical free survival rate was 30.00% (95% CI 20.34–40.60%). The Coxs´model to predict biochemical failure using transformed data with a power of minus one for the number of primary CPCs detected, showed a Harrell´s C concordance index of 0.74 and a decision analysis curve

  11. Correlation of diffusion-weighted MRI with whole mount radical prostatectomy specimens.

    PubMed

    Van As, N; Charles-Edwards, E; Jackson, A; Jhavar, S; Reinsberg, S; Desouza, N; Dearnaley, D; Bailey, M; Thompson, A; Christmas, T; Fisher, C; Corbishley, C; Sohaib, S

    2008-06-01

    The purpose of this study was to compare the apparent diffusion coefficient (ADC) of benign central gland (bCG), benign peripheral zone (bPZ) and cancer using diffusion-weighted MRI and whole mount specimens. 11 patients with biopsy-proven prostate cancer underwent diffusion-weighted MRI prior to radical prostatectomy. A single-shot echo planar image technique was used with b-values of 0 s mm(-2), 300 s mm(-2), 500 s mm(-2) and 800 s mm(-2). Whole mount specimens were compared with ADC maps. Areas of cancer, bCG and bPZ were identified, and regions of interest were drawn on ADC maps. Mean ADC values were recorded for all regions of interest, and paired t-tests were performed to compare mean values. Cancer was outlined in nine patients. In two patients, the tumours were too small to correlate with images; bCG was identified in 11 patients and bPZ was identified in 10 patients. Mean ADC values for bCG, bPZ and cancer were, 1.5 x 10(-3) mm(2) s(-1) (standard error (SE) = 0.04), 1.7 x 10(-3) mm(2) s(-1) (SE = 0.1), and 1.3 x 10(-3) mm(2) s(-1) (SE = 0.09), respectively. The most significant difference between benign tissue and cancer existed at b-values of 0-300 s mm(-2) (bCG vs cancer: mean difference = 0. 29, p = 0.001, 95% confidence interval (CI) = 0.17-0.41; bPZ vs cancer: mean difference = 0.34, p = 0.003, 95% CI = 0.18-0.61). In conclusion, we have confirmed, using whole mount verification, a significant difference in the ADC between benign tissue and cancer.

  12. Racial Disparities in Oncologic Outcomes After Radical Prostatectomy: Long-term Follow-up

    PubMed Central

    Faisal, Farzana A.; Sundi, Debasish; Cooper, John L.; Humphreys, Elizabeth B.; Partin, Alan W.; Han, Misop; Ross, Ashley E.; Schaeffer, Edward M.

    2015-01-01

    OBJECTIVE To report race-based outcomes after radical prostatectomy (RP) in a cohort stratified by National Comprehensive Cancer Network (NCCN) risk category with updated follow-up. MATERIALS AND METHODS Studies describing racial disparities in outcomes after RP are conflicting. We studied 15,993 white and 1634 African American (AA) pretreatment-naïve men who underwent RP at our institution (1992–2013) with complete preoperative and pathologic data. Pathologic outcomes were compared between races using appropriate statistical tests; biochemical recurrence (BCR) for men with complete follow-up was compared using multivariate models that controlled separately for preoperative and postoperative covariates. RESULTS Very low- and low-risk AA men were more likely to have positive surgical margins (P <.01), adverse pathologic features (P <.01), and be upgraded at RP (P <.01). With a median follow-up of 4.0 years after RP, AA race was an independent predictor of BCR among NCCN low-risk (HR, 2.16; P <.001) and intermediate-risk (hazard ratio [HR], 1.34; P = .024) classes and pathologic Gleason score ≤6 (HR, 2.42; P <.001) and Gleason score 7 (HR, 1.71; P <.001). BCR-free survival for very low-risk AA men was similar to low-risk white men (P = .890); BCR-free survival for low-risk AA men was similar to intermediate-risk white men (P = .060). CONCLUSION When stratified by NCCN risk, AA men with very low-, low-, or intermediate-risk prostate cancer who undergo RP are more likely to have adverse pathologic findings and BCR compared with white men. AA men with “low risk” prostate cancer, especially those considering active surveillance, should be counseled that their recurrence risks can resemble those of whites in higher risk categories. PMID:25432835

  13. Total pelvic floor reconstruction during non-nerve-sparing laparoscopic radical prostatectomy: impact on early recovery of urinary continence.

    PubMed

    Hoshi, Akio; Nitta, Masahiro; Shimizu, Yuuki; Higure, Taro; Kawakami, Masayoshi; Nakajima, Nobuyuki; Hanai, Kazuya; Nomoto, Takeshi; Usui, Yukio; Terachi, Toshiro

    2014-11-01

    To develop a modified technique of "total pelvic floor reconstruction" during non-nerve-sparing laparoscopic radical prostatectomy, and to determine its effect on postoperative urinary outcomes. A total of 128 patients who underwent non-nerve-sparing laparoscopic radical prostatectomy were evaluated, including 81 with total pelvic floor reconstruction and 47 with non-total pelvic floor reconstruction. Nerve-sparing cases were excluded. Urinary outcomes were assessed with self-administrated questionnaires (Expanded Prostate Cancer Index Composite) at 1, 3, 6 and 12 months after laparoscopic radical prostatectomy. The total pelvic floor reconstruction technique included two concepts involving posterior and anterior reconstructions. In posterior reconstruction, Denonvilliers' fascia was approximated to the bladder neck and the median dorsal raphe by slipknot. The anterior surface of the bladder-neck was approximated to the anterior detrusor apron and the puboprostatic ligament collar for anterior reconstruction. There were no significant differences between the two groups in the patients' characteristics, and in perioperative and oncological outcomes. In the total pelvic floor reconstruction group, the continence rates at 3, 6 and 12 months after laparoscopic radical prostatectomy were 45.7%, 71.4%, and 84.6%, respectively. In the non-total pelvic floor reconstruction group, the continence rates were 26.1%, 46.8% and 60.9%, respectively. The total pelvic floor reconstruction technique resulted in significantly higher continence rates at 3, 6 and 12 months after laparoscopic radical prostatectomy, respectively (all P < 0.05). The mean interval to achieve continence was significantly shorter in the total pelvic floor reconstruction group (mean 7.7 months) than in the non-total pelvic floor reconstruction group (mean 9.8 months; P = 0.0003). The total pelvic floor reconstruction technique allows preservation of the blood supply to the urethra and physical

  14. Preoperative predictors of blood loss at the time of radical prostatectomy: results from the SEARCH database.

    PubMed

    Lloyd, J C; Bañez, L L; Aronson, W J; Terris, M K; Presti, J C; Amling, C L; Kane, C J; Freedland, S J

    2009-01-01

    The literature contains conflicting data on preoperative predictors of estimated blood loss (EBL) at radical retropubic prostatectomy (RRP). We sought to examine preoperative predictors of EBL at the time of RRP among patients from the SEARCH database to lend clarity to this issue. A total of 1154 patients were identified in the SEARCH database who underwent RRP between 1988 and 2008 and had EBL data available. We examined multiple preoperative factors for their ability to predict EBL using multivariate linear regression analysis. Median EBL was 900 ml (s.d. 1032). The 25th and 75th percentile for EBL were 600 and 1500 ml, respectively. EBL increased significantly with increasing body mass index (BMI) and increasing prostate size and decreased with more recent year of RRP (all P<0.001). The mean-adjusted EBL in normal-weight men (BMI<25 kg/m(2)) was 807 ml compared to 1067 ml among severely obese men (BM I>or=35 kg/m(2)). Predicted EBL for men with the smallest prostates (<20 g) was 721 ml, compared to 1326 ml for men with prostates >or=100 g. Finally, statistically significant differences between centers were observed, with mean-adjusted EBL ranging from 844 to 1094 ml. Both BMI and prostate size are predictors of increased EBL. Prostate size is of particular note, as a nearly twofold increased EBL was seen from the smallest (<20 g) to the largest prostates (>or=100 g). Over time, average EBL significantly decreased. Finally, significant differences in EBL were observed between centers. Patients with multiple risk factors should be forewarned they are at increased risk for higher EBL, which may translate into a greater need for blood transfusion.

  15. Comparison of Gleason scores from sextant prostate biopsies and radical prostatectomy specimens.

    PubMed

    Altay, B; Kefi, A; Nazli, O; Killi, R; Semerci, B; Akar, I

    2001-01-01

    We compared the Gleason scores obtained from sextant prostate biopsy and radical prostatectomy (RP) specimens in patients with localized prostate cancer. Sixty-one patients having a clinical diagnosis of localized prostate cancer underwent needle biopsy under transrectal ultrasonography (TRUS) and RP. Grading and staging were assigned based on Gleason scores and the TNM system, respectively. Mean patient age was 65.5 +/- 13.43 years and mean PSA level was 14.69 +/- 3.95. Mean Gleason score for prostate biopsy and RP specimen were 5.85 +/- 0.7 and 6.34 +/- 1.44, respectively. With respect to clinical stage, there were 20 patients in stage 1 and 41 patients in stage 2 prostate cancer. Comparing the Gleason scores, the biopsy score was lower in 26 (42.26%) and higher than RP specimens in 7 (11.84%) cases, and there was agreement between the biopsy and RP specimens in 28 (45.9%) patients. The difference between the two Gleason scores was +/- 1 for 18 patients (29.5%) and +/- 2 or more for 17 patients (27.86%). In our study, high Gleason score biopsies with elevated PSA level (>10 ng/ml) were risk factors for extraprostatic extension, and we demonstrated that Gleason scores were significantly correlated with seminal vesicle and lymph node invasion (p < 0.05). The Gleason scores of biopsy and RP specimens agreed with 45.9% of TRUS-guided sextant prostate biopsies, and this ratio was 91.1% in moderately differentiated tumors Copyright 2001 S. Karger AG, Basel

  16. National trends and differences in morbidity among surgical approaches for radical prostatectomy in Germany.

    PubMed

    Stolzenburg, Jens Uwe; Kyriazis, Iason; Fahlenbrach, Claus; Gilfrich, Christian; Günster, Christian; Jeschke, Elke; Popken, Gralf; Weißbach, Lothar; von Zastrow, Christoph; Leicht, Hanna

    2016-11-01

    In this study, we document trends in radical prostatectomy (RP) employment in Germany during the period 2005-2012 and compare the morbidity of open (ORP), laparoscopic and robotic-assisted RP based on nationwide administrative data of Allgemeine Ortskrankenkassen (AOK) German local healthcare funds. Administrative claims data of all AOK patients subjected to RP during 2005-2012 (57,156 cases) were used to evaluate the employment of minimally invasive RP (MIRP) procedures, pelvic lymph node dissection (PLND) and nerve-sparing approaches during this period. In addition, data from the most recent three-year period of our dataset (2010-2012) were used to compare the morbidity among the different surgical approaches. Study end points comprised 30-day mortality, 30-day transfusion, 1-year reintervention and 30-day adverse events, as well as 1-year overall complications. A 20 % reduction in RP utilization from 2007 to 2012 was documented. ORP remained the predominant RP approach in Germany. MIRP approaches carried a lower risk of 30-day transfusions, 1-year reinterventions and 1-year overall complications than ORP when adjusting for confounding factors. PLND was associated with an increased risk of complications, while age in the highest quintile and the presence of comorbidities were independent risk factors for morbidity and mortality. Lack of pathological data was the main limitation of the study. RP utilization in Germany is dropping, but the use of MIRP has risen steadily during the years 2005-2012, which is expected to have a positive impact on the morbidity of the operation.

  17. Urinary Bother as a Predictor of Postsurgical Changes in Urinary Function After Robotic Radical Prostatectomy.

    PubMed

    Murphy, Gregory; Haddock, Peter; Doak, Hoyt; Jackson, Max; Dorin, Ryan; Meraney, Anoop; Kesler, Stuart; Staff, Ilene; Wagner, Joseph R

    2015-10-01

    To characterize changes in indices of urinary function in prostatectomy patients with presurgical voiding symptoms. A retrospective analysis of our prostate cancer database identified robot-assisted radical prostatectomy patients between April 2007 and December 2011 who completed pre- and postsurgical (24 months) Expanded Prostate Cancer Index Composite-26 surveys. Gleason score, margins, D'Amico risk, prostate-specific antigen, radiotherapy, and nerve-sparing status were tabulated. Survey questions addressed urinary irritation/obstruction, incontinence, and overall bother. Responses were averaged to calculate a urinary sum (US) score. Patients were stratified according to the severity of their baseline urinary bother (UB), and changes in urinary indices determined at 24 months. A total of 737 patients were included. Postsurgical improvement in urinary obstruction, bother, and sum score was related to baseline UB (P <.001). Men with severe baseline bother had the greatest improvement in US (+9.3), whereas those with asymptomatic baseline UB experienced a decline in US (-2.8). All patients experienced a decline in urinary incontinence of 6.3-8.3 that was independent of baseline bother (P = .507). Patients with severe UB experienced positive outcomes, whereas those at asymptomatic baseline experienced negative US outcomes. Negative urinary incontinence outcomes were unrelated to baseline UB. Age, radiotherapy, and nerve-sparing status were not associated with improved UB (P = .029). However, baseline UB was significantly associated with improvement in postsurgical UB (P = .001). Baseline UB is a predictor of postsurgical improvement in urinary function. These data are helpful when counseling a subset of robot-assisted laparoscopic radical prostatectomy patients with severe preoperative urinary symptoms. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Artificial urinary sphincter for urinary incontinence after radical prostatectomy: a historical cohort from 2004 to 2015

    PubMed Central

    dos Santos, Augusto Cesar Soares; Rodrigues, Luíza de Oliveira; Azevedo, Daniela Castelo; Carvalho, Lélia Maria de Almeida; Fernandes, Mariana Ribeiro; Avelar, Sandra de Oliveira Sapori; Horta, Maria da Glória Cruvinel; Kelles, Silvana Márcia Bruschi

    2017-01-01

    ABSTRACT This study aimed to retrospectively evaluate a cohort of patients with prostate cancer and persistent urinary incontinence after radical prostatectomy. From January 2004 to December 2015, eighty-six individuals were identified to have received an AUS implant, provided by a private nonprofit HMO operating in Belo Horizonte, Brazil. On total, there were 91 AUS implants, with a median interval between radical prostatectomy and AUS implant of 3.6 years (IQR 1.9 to 5.5). The rate of AUS cumulative survival, after a median follow-up of 4.1 years (IQR 1.7-7.2 years), was 44% (n=40). The median survival of AUS implants was 2.9 years (IQR 0.5-7.9 years). Thirty-seven AUS implants (40.7%) resulted in grade III surgical complications. There were 5 deaths at 2.1, 4.7, 5.7, 5.7 and 6.5 years of follow-up, but none due to causes directly associated to the AUS implant. Persistent severe incontinence was documented in 14 (15.3%) additional patients. From the 51 AUS implants which resulted in grade III surgical complications or persistent severe incontinence, 24 (47.1%) underwent surgical revisions. Explantation of the sphincter or its components was observed in 6 cases (25.0%). Mechanical failure, described as fluid loss and/or inability to recycle the AUS device, was observed in 4 devices (16.7%). In conclusion, although AUS implants are recommended as the gold-standard treatment of severe urinary incontinence after prostatectomy, the observed high rates of malfunction and grade III adverse events are a matter of concern warranting further assessment on the safety and efficacy of these devices. PMID:28124538

  19. Postoperative urinary incontinence exacerbates nocturia-specific quality of life after robot-assisted radical prostatectomy.

    PubMed

    Haga, Nobuhiro; Aikawa, Ken; Hoshi, Seiji; Yabe, Michihiro; Akaihata, Hidenori; Hata, Junya; Satoh, Yuichi; Ogawa, Soichiro; Ishibashi, Kei; Kojima, Yoshiyuki

    2016-10-01

    To elucidate the effect of postoperative urinary incontinence on nocturia-related quality of life after robot-assisted radical prostatectomy. A total of 100 consecutive patients who underwent robot-assisted radical prostatectomy completed a nocturia quality of life questionnaire score and a frequency-volume chart before and after surgery. These patients were divided into two groups by continence status (continent and incontinent) according to the number of pad exchanges per day and the 1-h pad test after surgery. Assessment was carried out before surgery, and then at 3 and 12 months after surgery. The Nocturia Quality of Life questionnaire total score and the Bother/Concern subscore were significantly lower in incontinent patients at 3 and 12 months after surgery (Nocturia Quality of Life questionnaire total score: Bother/Concern subscores P = 0.006: P = 0.04 at 3 months after surgery; and P = 0.04: P = 0.02 at 12 months). Both nocturnal maximum voided volume and nocturnal frequency were not significantly different between continent and incontinent patients. On multivariate analysis, nocturnal urinary frequency (P = 0.01) and urinary incontinence (P = 0.005) were significantly associated with nocturia-specific quality of life. Although the number of nocturia episodes was not significantly different between the continent and incontinent patients after surgery, the Nocturia Quality of Life questionnaire score was significantly worse in incontinent patients. In these patients, other than the number of nocturia episodes, psychological stress might worsen the Nocturia Quality of Life questionnaire score. Therefore, prevention of post-prostatectomy incontinence might be important to avoid aggravating the Nocturia Quality of Life questionnaire score. © 2016 The Japanese Urological Association.

  20. Artificial urinary sphincter for urinary incontinence after radical prostatectomy: a historical cohort from 2004 to 2015.

    PubMed

    Santos, Augusto Cesar Soares Dos; Rodrigues, Luíza de Oliveira; Azevedo, Daniela Castelo; Carvalho, Lélia Maria de Almeida; Fernandes, Mariana Ribeiro; Avelar, Sandra de Oliveira Sapori; Horta, Maria Glória Cruvinel; Kelles, Silvana Márcia Bruschi

    2017-01-01

    This study aimed to retrospectively evaluate a cohort of patients with prostate cancer and persistent urinary incontinence after radical prostatectomy. From January 2004 to December 2015, eighty-six individuals were identified to have received an AUS implant, provided by a private nonprofit HMO operating in Belo Horizonte, Brazil. On total, there were 91 AUS implants, with a median interval between radical prostatectomy and AUS implant of 3.6 years (IQR 1.9 to 5.5). The rate of AUS cumulative survival, after a median follow-up of 4.1 years (IQR 1.7-7.2 years), was 44% (n=40). The median survival of AUS implants was 2.9 years (IQR 0.5-7.9 years). Thirty-seven AUS implants (40.7%) resulted in grade III surgical complications. There were 5 deaths at 2.1, 4.7, 5.7, 5.7 and 6.5 years of follow-up, but none due to causes directly associated to the AUS implant. Persistent severe incontinence was documented in 14 (15.3%) additional patients. From the 51 AUS implants which resulted in grade III surgical complications or persistent severe incontinence, 24 (47.1%) underwent surgical revisions. Explantation of the sphincter or its components was observed in 6 cases (25.0%). Mechanical failure, described as fluid loss and/or inability to recycle the AUS device, was observed in 4 devices (16.7%). In conclusion, although AUS implants are recommended as the gold-standard treatment of severe urinary incontinence after prostatectomy, the observed high rates of malfunction and grade III adverse events are a matter of concern warranting further assessment on the safety and efficacy of these devices.

  1. Anatomic and technical considerations for optimizing recovery of urinary function during robotic-assisted radical prostatectomy.

    PubMed

    Vora, Anup A; Dajani, Daoud; Lynch, John H; Kowalczyk, Keith J

    2013-01-01

    The advent of robotic-assisted radical prostatectomy purported fewer complications including postprostatectomy incontinence (PPI). PPI is associated with worse quality of life. We evaluate recently reported robot-assisted radical prostatectomy surgical techniques aimed at limiting PPI, describe their anatomic basis and summarize their outcomes. RARP techniques to reduce PPI include bladder neck preservation, bladder neck reconstruction, urethral length preservation, periurethral suspension stitch, posterior reconstruction, combined anterior and posterior reconstruction, preservation of the endopelvic fascia, complete anterior preservation, selective suturing of dorsal venous complex and nerve sparing approach. Outcomes of reconstructive techniques seem to be conflicting, whereas outcomes of techniques aiming to preserve the native urinary continence system seem to hasten urinary function recovery. However, few of these techniques have been shown to affect long-term urinary continence. Surgical techniques preserving the natural urinary continence mechanism appear to improve short-term urinary continence, whereas techniques reconstructing pelvic anatomy have mixed results. The search for the ideal technique to minimize PPI remains hampered by the lack of prospective multi-institutional studies and the long-term follow up. Although reconstructive techniques are safe with few drawbacks, meticulous surgical technique and preservation of the natural continence mechanism should remain the mainstay of PPI prevention.

  2. Postoperative self-efficacy and psychological morbidity in radical prostatectomy1

    PubMed Central

    da Mata, Luciana Regina Ferreira; de Carvalho, Emilia Campos; Gomes, Cássia Regina Gontijo; da Silva, Ana Cristina; Pereira, Maria da Graça

    2015-01-01

    Objective: evaluate the general and perceived self-efficacy, psychological morbidity, and knowledge about postoperative care of patients submitted to radical prostatectomy. Identify the relationships between the variables and know the predictors of self-efficacy. Method: descriptive, cross-sectional study, conducted with 76 hospitalized men. The scales used were the General and Perceived Self-efficacy Scale and the Hospital Anxiety and Depression Scale, in addition to sociodemographic, clinical and knowledge questionnaires. Results: a negative relationship was found for self-efficacy in relation to anxiety and depression. Psychological morbidity was a significant predictor variable for self-efficacy. An active professional situation and the waiting time for surgery also proved to be relevant variables for anxiety and knowledge, respectively. Conclusion: participants had a good level of general and perceived self-efficacy and small percentage of depression. With these findings, it is possible to produce the profile of patients about their psychological needs after radical prostatectomy and, thus, allow the nursing professionals to act holistically, considering not only the need for care of physical nature, but also of psychosocial nature. PMID:26487129

  3. Vacuum erection devices to treat erectile dysfunction and early penile rehabilitation following radical prostatectomy.

    PubMed

    Zippe, Craig D; Pahlajani, Geetu

    2008-11-01

    Vacuum erection devices (VED) are becoming first-line therapies for erectile dysfunction and preservation (rehabilitation) of erectile function following treatment for prostate cancer. Currently, phosphodiesterase-5 inhibitors have limited efficacy in elderly patients or patients with moderate to severe diabetes, hypertension, and coronary artery disease. Alternative therapies, such as VED, have emerged as a primary option for patients refractory to oral therapy. VED has also been successfully used in combination treatment with oral therapy and penile injections. More recently, there has been interest in the use of VED in early intervention protocols to encourage corporeal rehabilitation and prevention of post-radical prostatectomy venoocclusive dysfunction. This is evident by the preservation of penile length and girth seen with the early use of the VED following radical prostatectomy. There are ongoing studies to help preserve penile length and girth with early use of VED following prostate brachytherapy and external beam radiation for prostate cancer. Recently, there has also been interest in VED to help maintain penile length following surgical correction of Peyronie's disease and to increase penile size before implantation of the penile prosthesis.

  4. Multimedia support in preoperative patient education for radical prostatectomy: the physicians' point of view.

    PubMed

    Ihrig, Andreas; Herzog, Wolfgang; Huber, Christian G; Hadaschik, Boris; Pahernik, Sascha; Hohenfellner, Markus; Huber, Johannes

    2012-05-01

    To systematically assess the physicians' point of view of multimedia support in preoperative patient education for radical prostatectomy. We evaluated the view of physicians performing multimedia supported preoperative educations within a randomized controlled trial. Therein 8 physicians educated 203 patients for radical prostatectomy. All physicians rated multimedia supported education better than the standard procedure. Main reasons were better comprehensibility, the visual presentation, and greater ease in explaining complex issues. Objective time measurement showed no difference between both educations. The major disadvantage was the impression, that multimedia supported education lasted longer. Moreover, they had the impression that some details could be further improved. Given the choice, every physician would decide for multimedia support. Physicians appreciate multimedia support in preoperative education and contrary to their impression, multimedia support does not prolong patient education. Therefore, patients and physicians likewise profit from multimedia support for education and counseling. The readiness of physicians is a possible obstacle to this improvement, as their view is a key factor for the transition to everyday routine. Therefore, our results could alleviate this possible barrier for establishing multimedia supported education in clinical routine. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  5. Incidental retroperitoneal paraganglioma in patient candidate to radical prostatectomy: Concurrent surgical treatments by robotic approach

    PubMed Central

    Ferrari, Matteo; Sangalli, Mattia; Zanoni, Matteo; Ghezzi, Massimo; Fabbri, Fabio; Sozzi, Francesco; Rigatti, Patrizio; Cestari, Andrea

    2015-01-01

    We report a case of a 75-year-old male with biopsy-proven prostate cancer and candidate for radical prostatectomy. The patient’s medical history includes hypertension and atrial fibrillation in prophylactic treatment; however, he was suffering from recurrent paroxysmal episodes of supraventricular tachycardia. Abdominal magnetic resonance performed for prostate cancer staging detected a non-lymphatic inter-cavo-aortic mass of 42 × 37 × 43 cm. Results of biochemical screening confirmed the clinical diagnosis of symptomatic paraganglioma. The patient was subjected in a single robotic session for concurrent excision of the inter-aortocaval mass and radical prostatectomy with bilateral pelvic lymph-node dissection. During the procedure, there were no anesthesiological or surgical complications. The postoperative course was uneventful and the patient was discharged on postoperative day 5. Six months after surgery, his prostate-specific antigen level was undetectable and the abdominal magnetic resonance imaging was negative for local recurrence or metastasis of paraganglioma. No more episodes of tachycardia were reported or antihypertensive therapy was necessary. PMID:26279735

  6. Incidental retroperitoneal paraganglioma in patient candidate to radical prostatectomy: Concurrent surgical treatments by robotic approach.

    PubMed

    Ferrari, Matteo; Sangalli, Mattia; Zanoni, Matteo; Ghezzi, Massimo; Fabbri, Fabio; Sozzi, Francesco; Rigatti, Patrizio; Cestari, Andrea

    2015-01-01

    We report a case of a 75-year-old male with biopsy-proven prostate cancer and candidate for radical prostatectomy. The patient's medical history includes hypertension and atrial fibrillation in prophylactic treatment; however, he was suffering from recurrent paroxysmal episodes of supraventricular tachycardia. Abdominal magnetic resonance performed for prostate cancer staging detected a non-lymphatic inter-cavo-aortic mass of 42 × 37 × 43 cm. Results of biochemical screening confirmed the clinical diagnosis of symptomatic paraganglioma. The patient was subjected in a single robotic session for concurrent excision of the inter-aortocaval mass and radical prostatectomy with bilateral pelvic lymph-node dissection. During the procedure, there were no anesthesiological or surgical complications. The postoperative course was uneventful and the patient was discharged on postoperative day 5. Six months after surgery, his prostate-specific antigen level was undetectable and the abdominal magnetic resonance imaging was negative for local recurrence or metastasis of paraganglioma. No more episodes of tachycardia were reported or antihypertensive therapy was necessary.

  7. Robotic-assisted laparoscopic radical prostatectomy: initial 15 cases in Japan.

    PubMed

    Yoshioka, K; Hatano, T; Nakagami, Y; Ozu, C; Horiguchi, Y; Yonou, H; Tachibana, M; Coughlin, G; Patel, V R

    2008-07-01

    Recently, we have introduced robotic-assisted laparoscopic radical prostatectomy (RALP) in Japan. This article describes the details of a training program to shorten the learning curve in the absence of an urologist with expertise in robotic surgery. Five months after a 2-day training course of robotic surgery, RALP was first performed in Japan, and a total of 15 cases were performed in the subsequent 4 months. Our training program consisted of: (1) image training using surgical operation videos, (2) dry lab training using a sham pelvic cavity model, and (3) intraoperative mentoring. The operative procedure was divided into five consecutive stages, and time required to complete each stage was recorded. Robotic radical prostatectomy was completed in all patients without conversion to open surgery, except for the first patient in whom a restriction to a 2-h operation had been imposed by the ethics committee. The mean console time and the mean intraoperative blood loss (including urine) reduced from 264.2 min and 459.4 ml, respectively, in the first 11 cases, to 151 min and 133.3 ml, respectively, in the last three cases. With direct intraoperative guidance by the mentor during cases 13 and 14, the operation time was reduced at all five stages of the operative procedure. Our training program proved remarkably effective in reducing the learning curve of RALP in Japan, where there is no person with expertise in robotic surgery.

  8. Direct Administration of Nerve-Specific Contrast to Improve Nerve Sparing Radical Prostatectomy

    PubMed Central

    Barth, Connor W.; Gibbs, Summer L.

    2017-01-01

    Nerve damage remains a major morbidity following nerve sparing radical prostatectomy, significantly affecting quality of life post-surgery. Nerve-specific fluorescence guided surgery offers a potential solution by enhancing nerve visualization intraoperatively. However, the prostate is highly innervated and only the cavernous nerve structures require preservation to maintain continence and potency. Systemic administration of a nerve-specific fluorophore would lower nerve signal to background ratio (SBR) in vital nerve structures, making them difficult to distinguish from all nervous tissue in the pelvic region. A direct administration methodology to enable selective nerve highlighting for enhanced nerve SBR in a specific nerve structure has been developed herein. The direct administration methodology demonstrated equivalent nerve-specific contrast to systemic administration at optimal exposure times. However, the direct administration methodology provided a brighter fluorescent nerve signal, facilitating nerve-specific fluorescence imaging at video rate, which was not possible following systemic administration. Additionally, the direct administration methodology required a significantly lower fluorophore dose than systemic administration, that when scaled to a human dose falls within the microdosing range. Furthermore, a dual fluorophore tissue staining method was developed that alleviates fluorescence background signal from adipose tissue accumulation using a spectrally distinct adipose tissue specific fluorophore. These results validate the use of the direct administration methodology for specific nerve visualization with fluorescence image-guided surgery, which would improve vital nerve structure identification and visualization during nerve sparing radical prostatectomy. PMID:28255352

  9. Direct Administration of Nerve-Specific Contrast to Improve Nerve Sparing Radical Prostatectomy.

    PubMed

    Barth, Connor W; Gibbs, Summer L

    2017-01-01

    Nerve damage remains a major morbidity following nerve sparing radical prostatectomy, significantly affecting quality of life post-surgery. Nerve-specific fluorescence guided surgery offers a potential solution by enhancing nerve visualization intraoperatively. However, the prostate is highly innervated and only the cavernous nerve structures require preservation to maintain continence and potency. Systemic administration of a nerve-specific fluorophore would lower nerve signal to background ratio (SBR) in vital nerve structures, making them difficult to distinguish from all nervous tissue in the pelvic region. A direct administration methodology to enable selective nerve highlighting for enhanced nerve SBR in a specific nerve structure has been developed herein. The direct administration methodology demonstrated equivalent nerve-specific contrast to systemic administration at optimal exposure times. However, the direct administration methodology provided a brighter fluorescent nerve signal, facilitating nerve-specific fluorescence imaging at video rate, which was not possible following systemic administration. Additionally, the direct administration methodology required a significantly lower fluorophore dose than systemic administration, that when scaled to a human dose falls within the microdosing range. Furthermore, a dual fluorophore tissue staining method was developed that alleviates fluorescence background signal from adipose tissue accumulation using a spectrally distinct adipose tissue specific fluorophore. These results validate the use of the direct administration methodology for specific nerve visualization with fluorescence image-guided surgery, which would improve vital nerve structure identification and visualization during nerve sparing radical prostatectomy.

  10. Laparoscopic versus open radical prostatectomy in high prostate volume cases: impact on oncological and functional results

    PubMed Central

    Alessandro, Sciarra; Alessandro, Gentilucci; Susanna, Cattarino; Michele, Innocenzi; Francesca, Di Quilio; Andrea, Fasulo; heland, Magnus Von; Vincenzo, Gentile; Stefano, Salciccia

    2016-01-01

    ABSTRACT Background and objective: To prospectively compare the laparoscopic versus open approach to RP in cases with high prostate volume and to evaluate a possible different impact of prostate volume. Materials and Methods: From March 2007 to March 2013 a total of 120 cases with clinically localized prostate cancer (PC) and a prostate volume>70cc identified for radical prostatectomy (RP), were prospectively analyzed in our institute. Patients were offered as surgical technique either an open retropubic or an intraperitoneal laparoscopic (LP) approach. In our population, 54 cases were submitted to LP and 66 to open RP. We analyzed the association of the surgical technique with perioperative, oncological and postoperative functional parameters. Results: In those high prostate volume cases, the surgical technique (laparoscopic versus open) does not represent a significant independent factor able to influence positive surgical margins rates and characteristics (p=0.4974). No significant differences (p>0.05) in the overall rates of positive margins was found, and also no differences following stratification according to the pathological stage and nerve sparing (NS) procedure. The surgical technique was able to significantly and independently influence the hospital stay, time of operation and blood loss (p<0.001). On the contrary, in our population, the surgical technique was not a significant factor influencing all pathological and 1-year oncological or functional outcomes (p>0.05). Conclusions: In our prospective non randomized analysis on high prostate volumes, the laparoscopic approach to RP is able to guarantee the same oncological and functional results of an open approach, maintaining the advantages in terms of perioperative outcomes. PMID:27256175

  11. 4-Ports endoscopic extraperitoneal radical prostatectomy: preliminary and learning curve results

    PubMed Central

    Barbosa, Humberto do Nascimento; Siqueira, Tiberio Moreno; Barreto, Françualdo; Menezes, Leonardo Gomes; Luna, Mauro José Catunda; Calado, Adriano Almeida

    2016-01-01

    ABSTRACT Introduction There is a lack of studies in our national scenario regarding the results obtained by laparoscopic radical prostatectomy technique (LRP). Except for a few series, there are no consistent data on oncological, functional, and perioperative results on LRP held in Brazil. As for the LRP technique performed by extraperitoneal access (ELRP), when performed by a single surgeon, the results are even scarcer. Objective To analyze the early perioperative and oncologic results obtained with the ELRP, throughout the technical evolution of a single surgeon. Patients and methods A non-randomized retrospective study was held in a Brazilian hospital of reference. In the 5-year period, 115 patients underwent the ELRP procedure. Patients were divided into two groups, the first 57 cases (Group 1) and the following 58 cases, (Group 2). A comparative analysis between the groups of efficacy results and ELRP safety was carried out. Results The average age of patients was 62.8 year-old and the PSA of 6.9ng/dl. The total surgery time was 135.8 minutes on average, and the urethral-bladder anastomosis was 21.9 min (23.3 min versus 20.7 min). The positive surgical margins (PSM) rate was 17.1%, showing no difference between groups (16.4% versus 17.9%; p=0.835). There was statistical difference between the groups in relation to the anastomosis time, estimated blood loss and the withdrawal time of the urinary catheter. Conclusion The ELRP technique proved to be a safe and effective procedure in the treatment of prostate cancer, with low morbidity. PMID:27286105

  12. A risk-adjusted definition of biochemical recurrence after radical prostatectomy.

    PubMed

    Morgan, T M; Meng, M V; Cooperberg, M R; Cowan, J E; Weinberg, V; Carroll, P R; Lin, D W

    2014-06-01

    To determine whether a variable definition of biochemical recurrence (BCR) based on clincopathologic features facilitates early identification of patients likely to suffer from disease progression. The definition of BCR after radical prostatectomy (RP) bears important implications for patient counseling and management; however, there remains a significant debate regarding the appropriate definition. The study cohort consisted of 3619 men who underwent RP for localized prostate cancer from 1989 to 2007, with data abstracted from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry. Patients were stratified into three risk groups according to Cancer of the Prostate Risk Assessment post-Surgical (CAPRA-S) score. Three single threshold PSA cut-points for BCR were evaluated (PSA > or =0.05, > or =0.2 and > or =0.4 ng ml(-1)) as well as a variable cut-point defined by risk group. After reaching the cut-points, patients were followed for further PSA progression. The proportion of patients with BCR differed by cut-point and risk group, ranging from 7 to 37% (low risk), 22 to 58% (intermediate risk) and 60 to 86% (high risk). The positive-predictive value (PPV) for predicting further PSA progression was 49% for the PSA > or =0.05 ng ml(-1), 62% for the PSA > or =0.2 ng ml(-1), 65% for the PSA > or =0.4 ng ml(-1) and 68% for the risk-adjusted definition. Five-year progression-free survival was 39% for the risk-adjusted definition compared with 45-52% for the other definitions of BCR. These data suggest that a variable definition of BCR determined by clinicopathologic risk may improve the identification of early recurrence after RP without increasing the overdiagnosis of BCR. By using a risk-adjusted BCR definition, clinicians can better predict future PSA progression and more appropriately counsel patients regarding salvage therapies.

  13. Nerve sparing can preserve orgasmic function in most men after robotic-assisted laparoscopic radical prostatectomy.

    PubMed

    Tewari, Ashutosh; Grover, Sonal; Sooriakumaran, Prasanna; Srivastava, Abhishek; Rao, Sandhya; Gupta, Amit; Gray, Robert; Leung, Robert; Paduch, Darius A

    2012-02-01

    •  To investigate orgasmic outcomes in patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALP) and the effects of age and nerve sparing on these outcomes. •  Between January 2005 and June 2007, 708 patients underwent RALP at our institution. •  We analysed postoperative potency and orgasmic outcomes in the 408 men, of the 708, who were potent, able to achieve orgasm preoperatively and available for follow-up. •  Of men aged ≤60 years, 88.4% (198/224) were able to achieve orgasm postoperatively in comparison to 82.6% (152/184) of older men (P < 0.001). •  Of patients who received bilateral nerve sparing (BNS) during surgery, 273/301 (90.7%) were able to achieve orgasm postoperatively compared with 46/56 (82.1%) patients who received unilateral nerve sparing and 31/51 (60.8%) men who received non-nerve-sparing surgery (P < 0.001). •  In men ≤60 years who also underwent BNS, decreased sensation of orgasm was present in 3.2% of men, and postoperative orgasmic rates were significantly better than men ≤60 years who underwent unilateral or no nerve sparing (92.9% vs 83.3% vs 65.4%, respectively; P < 0.001). •  Potency rates were also significantly higher in men ≤60 years and in those who underwent BNS. •  Age and nerve sparing influence recovery of orgasm and erectile function after RALP. •  Men ≤60 years old and those who undergo BNS are most likely to maintain normal sexual function. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

  14. Intraoperative Optical Biopsy During Robotic-Assisted Radical Prostatectomy Using Confocal Endomicroscopy

    PubMed Central

    Mach, Kathleen E.; Bui, Daniel; Liu, Jen-Jane; Rouse, Robert V.; Harris, Theodore; Leppert, John T.; Liao, Joseph C.

    2015-01-01

    Purpose Intraoperative optical biopsy technologies may aid identification of important anatomic landmarks and improve surgical outcomes of robotic-assisted radical prostatectomy (RARP).We sought to evaluate the feasibility of confocal laser endomicroscopy (CLE) during RARP. Materials and Methods Twenty-one patients with biopsy-proven prostate cancer scheduled for RARP were recruited. After intravenous administration of fluorescein, 15 patients underwent in vivo intraoperative CLE of prostatic and periprostatic structures using either a 2.6-mm or 0.85-mm imaging probe. Standard robotic instruments were used to grasp and maneuver the CLE probes for image acquisition. CLE imaging was performed ex vivo on fresh prostate specimens from 20 patients. Confocal video sequences acquired in vivo and ex vivo were reviewed and analyzed, with additional image processing using a mosaicing algorithm. Processed confocal images were compared with standard hematoxylin and eosin analysis of imaged regions. Results CLE was successfully integrated with robotic surgery, including co-registration of confocal video sequences with white light and probe handling with standard robotic instrumentation. Intraoperative CLE imaging of the neurovascular bundle prior to and following nerve-sparing dissection revealed characteristic features including dynamic vascular flow and intact axon fibers. Ex vivo confocal imaging of the prostatic parenchyma demonstrated the normal prostatic glands, stroma, and prostate carcinoma. Conclusions We report the initial feasibility of optical biopsy of prostatic and periprostatic tissue during RARP. Image guidance and tissue interrogation using CLE offers a new intraoperative imaging method that has the potential to improve the functional and oncologic outcomes of prostate cancer surgery. PMID:26626214

  15. Effects of Bowel Preparation and Fluid Restriction in Robot-Assisted Radical Prostatectomy Patients

    PubMed Central

    Karaören, Gülşah Yılmaz; Bakan, Nurten; Yürük, Cafer Tayyar; Çetinkaya, Ali Osman

    2015-01-01

    Objective In Robot-assisted radical prostatectomy (RARP) patients, preoperative bowel preparation and intraoperative fluid restriction may cause dehydration and electrolyte imbalance. In these patients, laboratory results that are considered “normal” in the pre-anaesthesia clinic may be misleading, and cardiac arrhythmia due to hypokalaemia and hypocalcaemia, as well as problems, such as prolonged non-depolarising blockade and delayed recovery from anaesthesia, may be observed during anaesthesia practice. In this study, we aimed to determine these disturbances by comparing the preoperative (T1) laboratory values with those at the beginning of the operation (T2) and at the 6th hour of the operation (T3) and values at discharge. Methods This prospective study comprised 49 American Society of Anesthesiologists (ASA) I-II patients. Bowel preparation was made with a rectal enema (NaP) twice in 12 hours and with one single dose of oral laxative soda (NaP). During surgery, 1 mL kg−1 h−1 0.09% NaCl and 1 mL kg−1 h−1 6% HES 200/05 infusions were applied. Results The potassium level at T2 was significantly lower than at T1 and T3. The calcium levels at T2 and T3 were significantly lower than at T1, and the level at T3 was significantly lower than at T2. The creatinine level at T3 was significantly higher than at T1 and T2. Conclusion Although there were no severe increases or decreases in laboratory test values due to bowel preparation and fluid restriction in RARP operations, which reflected on the clinical outcome in this ASA I–II patient group, these changes may be important in critically ill or ASA III–IV patients. PMID:27366475

  16. Effects of Bowel Preparation and Fluid Restriction in Robot-Assisted Radical Prostatectomy Patients.

    PubMed

    Karaören, Gülşah Yılmaz; Bakan, Nurten; Yürük, Cafer Tayyar; Çetinkaya, Ali Osman

    2015-04-01

    In Robot-assisted radical prostatectomy (RARP) patients, preoperative bowel preparation and intraoperative fluid restriction may cause dehydration and electrolyte imbalance. In these patients, laboratory results that are considered "normal" in the pre-anaesthesia clinic may be misleading, and cardiac arrhythmia due to hypokalaemia and hypocalcaemia, as well as problems, such as prolonged non-depolarising blockade and delayed recovery from anaesthesia, may be observed during anaesthesia practice. In this study, we aimed to determine these disturbances by comparing the preoperative (T1) laboratory values with those at the beginning of the operation (T2) and at the 6(th) hour of the operation (T3) and values at discharge. This prospective study comprised 49 American Society of Anesthesiologists (ASA) I-II patients. Bowel preparation was made with a rectal enema (NaP) twice in 12 hours and with one single dose of oral laxative soda (NaP). During surgery, 1 mL kg(-1) h(-1) 0.09% NaCl and 1 mL kg(-1) h(-1) 6% HES 200/05 infusions were applied. The potassium level at T2 was significantly lower than at T1 and T3. The calcium levels at T2 and T3 were significantly lower than at T1, and the level at T3 was significantly lower than at T2. The creatinine level at T3 was significantly higher than at T1 and T2. Although there were no severe increases or decreases in laboratory test values due to bowel preparation and fluid restriction in RARP operations, which reflected on the clinical outcome in this ASA I-II patient group, these changes may be important in critically ill or ASA III-IV patients.

  17. Testing of the Incontinence Impact Questionnaire (IIQ-7) with men after radical prostatectomy.

    PubMed

    Moore, K N; Jensen, L

    2000-11-01

    The objective of this study was to test the validity and reliability of the Incontinence Impact Questionnaire (IIQ-7), a 7-item self-report instrument designed to assess the impact of urinary incontinence (UI), in men. Fifty-eight men with incontinence after radical prostatectomy were the subjects of the study. Content validity was assessed by a panel of experts. Construct and criterion validity were examined with 3 groups of men who had UI in a randomized controlled trial comparing pelvic muscle exercises with pelvic muscle exercises plus electrical stimulation. Internal consistency and stability coefficients for the IIQ-7 were determined. The content validity index was 0.88. Four items were below the designated content validity index level. A 2-factor analysis solution (factor I-impact on daily activities; factor II-emotional impact) explained 84.94% of the variance. No significant group differences were recorded on impact of UI (F = 0.37, P =.70), nor were any differences among subjects found over time (F = 0.90, P =.50). A positive relationship was found between grams of urine loss on a 24-hour pad test and IIQ-7 scores (r = 0.34, P =.003 to.51, P =.001). When the IIQ-7 score decreased, self-reported quality of life improved as measured by the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Version 2 (r = -0.57, P =.0001 to -.49, P =.001). A strong relationship was found between responses to the question "Does leakage affect your life?" and the IIQ-7 scores. Internal consistency ranged between 0.88 and 0.92. IIQ-7 scores were consistent when urine loss was stabilized between 16 and 24 weeks after entry into the study (r = 0.89, P =.0001). The IIQ-7 is a reliable measure of the impact of UI; however, the scale requires additional testing regarding construct validity in men.

  18. Influence of obesity on localized prostate cancer patients treated with radical prostatectomy.

    PubMed

    Qu, Yuan-Yuan; Dai, Bo; Kong, Yun-Yi; Chang, Kun; Ye, Ding-Wei; Yao, Xu-Dong; Zhang, Shi-Lin; Zhang, Hai-Liang; Yang, Wei-Yi

    2013-11-01

    This study aimed to investigate the association between different anthropometric measures of obesity and clinicopathological characteristics in Chinese patients with clinically localized prostate cancer (PCa). A total of 734 patients with clinically localized PCa who underwent radical prostatectomy (RP) were included in this study. Clinical and pathological data from each patient were collected. Anthropometric measures of abdominal adiposity were measured from T2-weighted sagittal localisation images from magnetic resonance imaging (MRI) for 413 (56.3%) patients. Patient clinical and pathological characteristics were compared across body mass index (BMI) groups. Univariable and multivariable logistic regression models were used to address the influence of the preoperative total testosterone level and anthropometric measures of obesity on pathological outcomes. In the multivariate analysis, BMI was not significantly associated with any pathological outcomes. However, the percentage of visceral adipose tissue (VAT%) was an independent predictor of a pathological Gleason score ≥8 (P<0.001), extracapsular extension (ECE; P=0.002) and seminal vesicle invasion (SVI; P=0.007). More importantly, we found that the preoperative total testosterone level was significantly correlated with the VAT% (Pearson's correlation coefficient: -0.485, P<0.001) and subcutaneous adipose tissue (SAT; Pearson's correlation coefficient: 0.413, P<0.001). In conclusion, the results of this study suggest that abdominal fat distribution, and particularly VAT%, is associated with a risk of advanced PCa. Moreover, our present study confirms a significant inverse correlation between visceral adiposity and testosterone. Further studies are warranted to elucidate the biological mechanisms underlying the relationship between abdominal adiposity and the aggressiveness of PCa.

  19. Influence of obesity on localized prostate cancer patients treated with radical prostatectomy

    PubMed Central

    Qu, Yuan-Yuan; Dai, Bo; Kong, Yun-Yi; Chang, Kun; Ye, Ding-Wei; Yao, Xu-Dong; Zhang, Shi-Lin; Zhang, Hai-Liang; Yang, Wei-Yi

    2013-01-01

    This study aimed to investigate the association between different anthropometric measures of obesity and clinicopathological characteristics in Chinese patients with clinically localized prostate cancer (PCa). A total of 734 patients with clinically localized PCa who underwent radical prostatectomy (RP) were included in this study. Clinical and pathological data from each patient were collected. Anthropometric measures of abdominal adiposity were measured from T2-weighted sagittal localisation images from magnetic resonance imaging (MRI) for 413 (56.3%) patients. Patient clinical and pathological characteristics were compared across body mass index (BMI) groups. Univariable and multivariable logistic regression models were used to address the influence of the preoperative total testosterone level and anthropometric measures of obesity on pathological outcomes. In the multivariate analysis, BMI was not significantly associated with any pathological outcomes. However, the percentage of visceral adipose tissue (VAT%) was an independent predictor of a pathological Gleason score ≥8 (P<0.001), extracapsular extension (ECE; P=0.002) and seminal vesicle invasion (SVI; P=0.007). More importantly, we found that the preoperative total testosterone level was significantly correlated with the VAT% (Pearson's correlation coefficient: −0.485, P<0.001) and subcutaneous adipose tissue (SAT; Pearson's correlation coefficient: 0.413, P<0.001). In conclusion, the results of this study suggest that abdominal fat distribution, and particularly VAT%, is associated with a risk of advanced PCa. Moreover, our present study confirms a significant inverse correlation between visceral adiposity and testosterone. Further studies are warranted to elucidate the biological mechanisms underlying the relationship between abdominal adiposity and the aggressiveness of PCa. PMID:24036920

  20. Changes in sex hormone levels after radical prostatectomy: Results of a longitudinal cohort study

    PubMed Central

    GACCI, MAURO; TOSI, NICOLA; VITTORI, GIANNI; MINERVINI, ANDREA; CORONA, GIOVANNI; CAI, TOMMASO; MORELLI, ANNA MARIA; VIGNOZZI, LINDA; SERNI, SERGIO; MAGGI, MARIO; CARINI, MARCO

    2013-01-01

    The changes in testosterone and gonadotropin levels in patients who have undergone radical prostatectomy (RP) for clinically localized prostate cancer (PCa) remain unclear. The aim of the present study was to prospectively evaluate the changes in serum testosterone (Te), luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels in the early months after RP for PCa and the correlation between these hormones at various follow-up times. A total of 100 male patients with clinically localized PCa were consecutively included in the study. The serum levels of Te, LH and FSH were measured prior to RP (baseline) and at 1 and 3 months post-operatively. Changes in the levels of Te, LH and FSH between the baseline and at 1 and 3 months after RP were analyzed with paired sample t-tests. The correlations between LH and Te levels at the various follow-up times were evaluated with a Spearman’s rank correlation coefficient. At 1 month subsequent to RP, the Te levels were significantly decreased (baseline vs. 1 month, P=0.021) and subsequently recovered to the pre-operative value at 3 months (baseline vs. 3 months, P=0.372). The mean Te level at baseline was 15.3 nmol/l, while at 1 and 3 months it was 13.8 and 14.4 nmol/l, respectively. By contrast, the levels of LH and FSH were significantly increased at 1 and 3 months post-surgery, compared with the baseline value (baseline vs. 1 or 3 months, P<0.0001). The pre-operative correlation between LH and Te was lost 1 month after RP and recovered after 3 months. Notably, the LH level at 1 month was markedly correlated with the Te levels recorded after 3 months. In the present study, patients developed compensated hypergonadotropic hypogonadism 3 months after RP. PMID:24137361

  1. [Penile rehabilitation with vacuum erection device for erectile dysfunction after radical prostatectomy].

    PubMed

    Shen, Yi-Jun; Ye, Ding-Wei; Yao, Xu-Dong; Zhang, Shi-Lin; Dai, Bo; Zhang, Hai-Liang; Zhu, Yao

    2012-08-01

    To investigate the efficacy and safety of vacuum erection device (VED) for erectile dysfunction (ED) after radical prostatectomy (RP). Six cases of ED after open RP were reviewed. Three of the patients started a daily rehabilitation protocol using VED 10 min/d within 3 months after RP (group A, early intervention), while the other 3 initiated the same protocol after 12 months (group B, late intervention). We compared the IIEF-5 scores as well as stretched penile lengths and mid-shaft circumferences before and after 3 and 6 months of VED rehabilitation. We also assessed the safety of the device and sexual satisfaction of the patients and their partners. The mean IIEF-5 score of the six cases was remarkably increased at 3 and 6 months of VED rehabilitation (P < 0.05), significantly higher in group A than in B at 3 months (8.7 +/- 0.6 vs 6.7 +/- 0.6, P < 0.05) and 6 months (13.0 +/- 1.0 vs 8.3 +/- 1.5, P < 0.05). After 6 months of VED rehabilitation, there were no significant changes in stretched penile length or mid-shaft circumference in group A, both significantly decreased in group B (P < 0.05), and sexual satisfaction of the patients and their partners were 83.3% and 50%, respectively. No serious adverse events were observed except mild complaint of pe- nile skin darkening in 1 case and numb feeling during the intercourse in 2. Early use of VED after RP improves erectile function and helps to preserve the length and mid-shaft circumference of the penis.

  2. The natural history of voiding function after robot-assisted laparoscopic radical prostatectomy.

    PubMed

    Wang, Lushun; Chung, Stephanie Fook-Chong Man; Yip, Sidney Kam Hung; Lau, Weber Kam On; Cheng, Christopher Wai Sam; Sim, Hong Gee

    2011-01-01

    We report the natural history of voiding function in men with clinically localized prostate cancer after robot-assisted laparoscopic radical prostatectomy (RLRP), describing the trend of functional recovery, which is currently not well described using the robot-assisted laparoscopic approach. We determined the impact on voiding function by prospectively evaluating 100 consecutive men who underwent RLRP between May 2005 and December 2006 and compared their reported International Prostate Symptom Score (IPSS) and Quality of Life (QOL) scores at 3, 6, and 12 months with preoperative scores after surgery. Patients with preoperative IPSS of 0-7 and 8-35 were defined as having mild lower urinary tract symptoms (LUTS) and moderate to severe LUTS, respectively. Continence was achieved in 82%, 87%, and 91% of men at 3, 6, and 12 months after RLRP, respectively. There were statistically and clinically significant improvements in both IPSS and QOL preoperative scores at all studied time points for patients with moderate to severe preexisting LUTS. The mean IPSS scores for these patients preoperatively and at 3, 6, and 12 months after surgery were 14.1, 5.2, 3.0, and 2.9, respectively and the corresponding mean QOL scores were 3.4, 2.1, 1.6, and 1.6, respectively. Patients with mild preexisting LUTS showed no statistically significant improvement in IPSS at 3 and 6 months after surgery but significant improvement was found at 1 year (P = 0.04). Good continence recovery is expected in most patients undergoing RLRP. Patients with moderate to severe preexisting LUTS can expect early and clinically significant symptom and QOL improvements after RLRP. Patients with mild preexisting LUTS show significant symptom improvement at 1 year. Copyright © 2011 Elsevier Inc. All rights reserved.

  3. Hormonal changes after localized prostate cancer treatment. Comparison between external beam radiation therapy and radical prostatectomy.

    PubMed

    Planas, J; Celma, A; Placer, J; Maldonado, X; Trilla, E; Salvador, C; Lorente, D; Regis, L; Cuadras, M; Carles, J; Morote, J

    2016-11-01

    To determine the influence of radical prostatectomy (RP) and external beam radiation therapy (EBRT) on the hypothalamic pituitary axis of 120 men with clinically localized prostate cancer treated with RP or EBRT exclusively. 120 patients with localized prostate cancer were enrolled. Ninety two patients underwent RP and 28 patients EBRT exclusively. We measured serum levels of luteinizing hormone, follicle stimulating hormone (FSH), total testosterone (T), free testosterone, and estradiol at baseline and at 3 and 12 months after treatment completion. Patients undergoing RP were younger and presented a higher prostate volume (64.3 vs. 71.1 years, p<0.0001 and 55.1 vs. 36.5 g, p<0.0001; respectively). No differences regarding serum hormonal levels were found at baseline. Luteinizing hormone and FSH levels were significantly higher in those patients treated with EBRT at three months (luteinizing hormone 8,54 vs. 4,76 U/l, FSH 22,96 vs. 8,18 U/l, p<0,0001) while T and free testosterone levels were significantly lower (T 360,3 vs. 414,83ng/dl, p 0,039; free testosterone 5,94 vs. 7,5pg/ml, p 0,018). At 12 months FSH levels remained significantly higher in patients treated with EBRT compared to patients treated with RP (21,01 vs. 8,51 U/l, p<0,001) while T levels remained significantly lower (339,89 vs. 402,39ng/dl, p 0,03). Prostate cancer treatment influences the hypothalamic pituitary axis. This influence seems to be more important when patients with prostate cancer are treated with EBRT rather than RP. More studies are needed to elucidate the role that prostate may play as an endocrine organ. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Transverse Versus Vertical Camera Port Incision in Robotic Radical Prostatectomy: Effect on Incisional Hernias and Cosmesis

    PubMed Central

    Beck, Shawn; Skarecky, Douglas; Osann, Kathy; Juarez, Reina; Ahlering, Thomas E.

    2014-01-01

    OBJECTIVE To examine the incidence of incisional hernias (IHs) and propose a simple modification to reduce the incidence of IHs. Robot-assisted radical prostatectomy (RARP) historically uses a vertical midline camera port incision to extract the prostate. METHODS Of 900 consecutive RARPs, the initial 735 had a vertical and subsequent 165 transverse incisions. Two methods were used to identify IHs: clinic visits noted in the prospective database and screening using electronic mail. We compared the baseline factors between the vertical IH and IH-free cohorts. The maximal scar width was recorded in 178 consecutive men presenting to our clinic: vertical (n = 107) and transverse (n = 71). RESULTS IHs occurred significantly more often after a vertical incision (5.3% vs 0.6%, P = .005). The IH rates after a vertical incision could be estimated to be as great as 16.7% (18 of 108) using the electronic mail respondents or as low as 3.3% (21 of 627) according to clinic follow-up. On univariate analysis, baseline age, International Index of Erectile Function 5-item questionnaire, prostate weight, bother score (all P ≤ .05), and body mass index (P = .058) were associated with an increased risk of an IH. After adjusting for baseline factors on multivariate logistic regression analysis, the relative odds of developing an IH with a vertical versus transverse incision was 11 (95% confidence interval 1.5–82). The average maximal scar width was reduced from 5.5 to 2.0 mm (P < .0001). CONCLUSION In the present sample population, the vertical IH rate was estimated to be potentially as low as 3.3% or as great as 16.7%. On multivariate analysis, a greater body mass index and larger prostate size significantly increased the risk of hernia development. Transverse incisions dramatically reduced the rate of IHs and the maximal scar width. The IH rates varied significantly by reporting method. PMID:21741689

  5. Statin Medication Use and the Risk of Biochemical Recurrence After Radical Prostatectomy

    PubMed Central

    Hamilton, Robert J.; Banez, Lionel L.; Aronson, William J.; Terris, Martha K.; Platz, Elizabeth A.; Kane, Christopher J.; Presti, Joseph C.; Amling, Christopher L.; Freedland, Stephen J.

    2011-01-01

    BACKGROUND Although controversial, evidence suggests statins may reduce the risk of advanced prostate cancer (PC), and recently statin use was associated with prostate-specific antigen (PSA) reductions among men without PC. The authors sought to examine the association between statin use and PSA recurrence after radical prostatectomy (RP). METHODS The authors examined 1319 men treated with RP from the Shared Equal Access Regional Cancer Hospital (SEARCH) Database. Time to PSA recurrence was compared between users and nonusers of statin at surgery using Cox proportional hazards models adjusted for multiple clinical and pathological features. RESULTS In total, 236 (18%) men were taking statins at RP. Median follow-up was 24 months for statin users and 38 for nonusers. Statin users were older (P < .001) and underwent RP more recently (P < .001). Statin users were diagnosed at lower clinical stages (P = .009) and with lower PSA levels (P = .04). However, statin users tended to have higher biopsy Gleason scores (P = .002). After adjusting for multiple clinical and pathological factors, statin use was associated with a 30% lower risk of PSA recurrence (hazard ratio “HR”, 0.70; 95% confidence interval “CI”, 0.50–0.97; P = .03), which was dose dependent (relative to no statin use; dose equivalentsimvastatin 20 mg: HR, 0.50; 95% CI, 0.27–0.93; P = .03). CONCLUSIONS In this cohort of men undergoing RP, statin use was associated with a dose-dependent reduction in the risk of biochemical recurrence. If confirmed in other studies, these findings suggest statins may slow PC progression after RP. PMID:20586112

  6. Laparoscopic radical prostatectomy: Oncological outcome analysis from a single-center Indian experience of 6 years

    PubMed Central

    Mishra, Shashikant; Agrawal, Vikas; Khatri, Naushad; Sharma, Rajan; Kurien, Abraham; Ganpule, Arvind; Muthu, V.; Sabnis, Ravindra B.; Desai, Mahesh R.

    2012-01-01

    Background: There is a lack of published data on laparoscopic radical prostatectomy (LRP) in India. Although the published short-term oncologic outcomes after LRP are encouraging, intermediate and long-term data are lacking. Objective: We analyzed the oncological outcome after LRP based on 6 years of experience and compared it with the other single-center published literature. Materials and Methods: Of the 90 patients who underwent LRP for a clinical T2 localized disease, 73 patients with at least a follow up of one year were analyzed. Patients were classified as low-, intermediate-, and high-risk D′Amico groups in 22 (30%), 26 (36%), and 25 (34%) of the patient population, respectively. Progression of disease was defined as a PSA of 0.4ng/ml with a confirmatory rise. We used Kaplan-Meier product limit estimates to calculate actuarial 5-year probabilities of biochemical progression-free survival. Univariate analysis of risk factors for biochemical recurrence (BCR) was done. Results: The mean age of the patients was 63.3 ± 6.6 years. The average follow-up for patients was 22 (12-72) months. There was no prostatic cancer-specific mortality. Fourteen patients had BCR. The 5-year progression-free probability for men with low-, intermediate-, and high-risk prostate cancers was 91%, 82%, and 58%, respectively. High-risk group, Gleason sum more than 8, extracapsular extension, and positive surgical margin were significantly associated with biochemical progression. Conclusions: LRP provided a similar level of oncological success as reported by the other contemporary single-center published literature PMID:22557714

  7. [Mid-term outcomes and survival rates in patients with radical retropubic prostatectomy (RRP) under current Czech healthcare system].

    PubMed

    Safarík, L; Bílek, R; Vísek, J A; Novák, K; Tuíková, J; Pesl, M; Stolz, J; Dvorácek, J

    2009-01-01

    The mid-term results (5 yr) after radical retropubic prostatectomy (RRP) are outlined and compared with pre- and postoperative parameters of patients. While 5 years survival could be expected in as many as 92.4%, relatively higher age (majority over 65) brings a higher risk of complications with it, though fully comparable with international standards. No perioperative mortality was recorded (0%), obstructive symptoms post-operatively developed in 13.4% patients, who were subsequently managed successfully endoscopically. Continence with maximum one pad per 24 hours was recorded in 77.2%, the severe incontinence was only in 3.3%. Spontaneous erection was reported in 4.3%, but except for higher age, the other objective factors were involved.

  8. Prognostic value of seminal vesicle involvement due to prostate cancer in radical prostatectomy specimens.

    PubMed

    Algarra, R; Barba, J; Merino, I; Tienza, A; Tolosa, E; Robles, J E; Zudaire, J

    2015-04-01

    To study the influence, in terms of prognosis, of the finding of seminal vesicle involvement in patients with prostate adenocarcinoma treated with radical prostatectomy. We reviewed a series of patients with seminal vesicle involvement with clinically localized prostate adenocarcinoma who underwent radical prostatectomy between 1989 and 2009, focusing on their clinical-pathological characteristics, biochemical progression-free survival (BPFS) and specific survival (SS). We assessed the variables that influenced BPFS and designed a risk model. A total of 127 out of 1,132 patients who underwent surgery (11%) presented seminal vesicle invasion (i.e., pT3b). In the multivariate study of the entire series (Cox model), pT3b affects the BPFS (HR: 2; 95% CI: 1.4-3.3; P=.001). Other influential factors were the affected borders, initial prostate-specific antigen levels, pathological Gleason score and the presence of palpated tumor. The pT3b tumors have poorer clinical-pathological variables when compared with pT2 and pT3a tumors. Sixty-five percent of the patients evidenced biochemical progression. The BPFS was significantly poorer for pT3b (40 ± 4% and 28 ± 4% at 5 and 10 years, respectively) than for pT2 and pT3a (P<.0001). The SS was also poorer in patients with pT3b tumors (91 ± 2% and 76 ± 4% at 5 and 10 years, respectively) (P<.0001). The predictors within the pT3b patient group were: PSA levels >10 ng/mL (HR: 1.9; 95% CI: 1.04-3.6; P=.04) and pathological Gleason score 8-10 (HR: 2.1; 95% CI: 1.2-3.5; P=.03). We designed a risk model that accounts for the variables involved, which entails 2 groups with different BPFS (P=.004): Group 1 (0-1 variable), with a BPFS of 46 ± 7% and 27 ± 8% at 5 and 10 years, respectively; and Group 2 (2 variables), with a BPFS of 14 ± 7% and 5 ± 5% at 5 and 10 years, respectively. Seminal vesicle involvement severely and negatively affects the BPFS and SS. We designed a risk model with the independent influential variables in BPFS

  9. [Current value of seminal vesicle biopsy in patients with prostate cancer and influence of radical prostatectomy in patients with seminal vesicle invasion].

    PubMed

    Losa, Carlos Alberto Allepuz; Fernando, Angel Borque; Lázaro, Vicente Andrés; Berlanga, Francesc Filipo; Frago, Patricia Serrano; López, Marta Allúe; Sanz, María Jesús Gil; Martínez, Pedro Gil; Sanz, Luis Angel Rioja

    2006-12-01

    To evaluate if radical prostatectomy may positively influence cancer-specific survival (CSS), hormone-resistance-free time, metastasis-free time, and quality of life(QoL) of patients with prostate adenocarcinoma and seminal vesicle invasion, and also to update our thoughts about seminal vesicle biopsy. 114 patients were included. Forty-six cases were diagnosed of seminal vesicle invasion after radical prostatectomy; 68 cases were diagnosed of seminal vesicle invasion after biopsy, not undergoing then surgery. Cancer specific survival, time to hormone resistance from the start of hormonal treatment, metastasis free time and QoL, measured as need for hospital care, were compared between groups. Median follow-up time was 52.6 mos. There were not statistically significant differences between groups in CSS, time to hormone resistance, metastasis free time and QoL. Three and five-year cancer specific survival were 100% and 80.77% for the radical prostatectomy group and 74.4% and 56.2% for the biopsy group. Primary grade and Gleason Score were independent predictors for CSS in the Cox regression test; clinical stage was independent predictor for time to hormone resistance. Radical prostatectomy as monotherapy does not show a statistically significant influence on followup time, CSS, time to hormone resistance, metastasis free time or QoL in patients with prostate cancer and seminal vesicle invasion associated with other bad prognostic factors (unfavourable Gleason and PSA). The value of seminal vesicle biopsy remains for the study of new multimodal treatments, such as chemotherapy + surgery, and it is to be defined in the planning of radio and cryosurgery.

  10. Erectile Function Outcomes after Robot-Assisted Radical Prostatectomy: Is It Superior to Open Retropubic or Laparoscopic Approach?

    PubMed

    Isgoren, Abidin Egemen; Saitz, Theodore R; Serefoglu, Ege Can

    2014-01-01

    Erectile dysfunction (ED) is one of the most commonly affected domains of health-related quality of life after prostate cancer therapy. Functional outcomes after radical prostatectomy (RP) have continued to improve through refinement of surgical techniques and development of several procedural modifications. In this context, it has been hypothesized that robotic technologies should simplify the preservation of the neurovascular bundle, thus possibly providing improved functional outcomes. To compare the prevalence of post-RP ED and identify whether recently developed robotic technologies are able to improve erectile function (EF) recovery after RP. Literature Review. To evaluate whether post-therapy ED rates after robotic surgery have shown improvement when compared with the other forms of nerve-sparing RP. Previously published series have shown EF recovery rates after robot-assisted RP (RARP) ranging between 40% and 90% of patients at 12 months, postoperatively. Some claim that the RARP procedure can also significantly shorten recovery time in return of EF when compared with open RP. On the other hand, some authors have reported that patients undergoing minimally invasive RP have experienced even more ED on comparison. Although it has been widely promoted by the industry and hospitals, at the moment there are not enough evidence-based data to answer the question, "Does RARP surgery provide better EF outcomes?." Because of the current market trends and patient preferences, the perfect randomized study will probably never be performed, and thus the question of which procedure's results are superior will most likely remain unanswered. Isgoren AE, Saitz TR, and Serefoglu EC. Erectile function outcomes after robot-assisted radical prostatectomy: Is it superior to open retropubic or laparoscopic approach? Sex Med Rev 2014;2:10-23. Copyright © 2014 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

  11. Robotic vs. Retropubic radical prostatectomy in prostate cancer: A systematic review and a meta-analysis update

    PubMed Central

    Chen, Hongbo; Chen, Zhiqiang; Xu, Hua; Ye, Zhangqun

    2017-01-01

    CONTEXT The safety and feasibility of robotic-assisted radical prostatectomy (RARP) compared with retropubic radical prostatectomy(RRP) is debated. Recently, a number of large-scale and high-quality studies have been conducted. OBJECTIVE To obtain a more valid assessment, we update the meta-analysis of RARP compared with RRP to assessed its safety and feasibility in treatment of prostate cancer. METHODS A systematic search of Medline, Embase, Pubmed, and the Cochrane Library was performed to identify studies that compared RARP with RRP. Outcomes of interest included perioperative, pathologic variables and complications. RESULTS 78 studies assessing RARP vs. RRP were included for meta-analysis. Although patients underwent RRP have shorter operative time than RARP (WMD: 39.85 minutes; P < 0.001), patients underwent RARP have less intraoperative blood loss (WMD = -507.67ml; P < 0.001), lower blood transfusion rates (OR = 0.13; P < 0.001), shorter time to remove catheter (WMD = -3.04day; P < 0.001), shorter hospital stay (WMD = -1.62day; P < 0.001), lower PSM rates (OR:0.88; P = 0.04), fewer positive lymph nodes (OR:0.45;P < 0.001), fewer overall complications (OR:0.43; P < 0.001), higher 3- and 12-mo potent recovery rate (OR:3.19;P = 0.02; OR:2.37; P = 0.005, respectively), and lower readmission rate (OR:0.70, P = 0.03). The biochemical recurrence free survival of RARP is better than RRP (OR:1.33, P = 0.04). All the other calculated results are similar between the two groups. CONCLUSIONS Our results indicate that RARP appears to be safe and effective to its counterpart RRP in selected patients. PMID:27852051

  12. Short-, Intermediate-, and Long-term Quality of Life Outcomes Following Radical Prostatectomy for Clinically Localized Prostate Cancer

    PubMed Central

    Prabhu, Vinay; Lee, Ted; McClintock, Tyler R; Lepor, Herbert

    2013-01-01

    Many clinically localized prostate cancers that are diagnosed today are low risk, and prevention of disease-specific mortality may only be realized decades after treatment. Radical prostatectomy (RP) may adversely impact health-related quality of life (HRQOL) by causing both transient or permanent urinary incontinence and erectile dysfunction. In contrast, RP may also improve HRQOL via relief of lower urinary tract symptoms in men suffering from these symptoms prior to surgery. Because the average man treated for prostate cancer has a life expectancy of approximately 14 years, it is imperative to consider the long-term impact of RP on both survival and HRQOL in treatment decision making. This comprehensive literature review examines short-, intermediate-, and long-term HRQOL following RP. In addition, the long-term results of RP are compared with other treatment modalities for treating clinically localized prostate cancer. PMID:24659913

  13. Radical prostatectomy

    MedlinePlus

    ... AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016: ... AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016: ...

  14. Testosterone replacement therapy in patients with prostate cancer after radical prostatectomy.

    PubMed

    Pastuszak, Alexander W; Pearlman, Amy M; Lai, Win Shun; Godoy, Guilherme; Sathyamoorthy, Kumaran; Liu, Joceline S; Miles, Brian J; Lipshultz, Larry I; Khera, Mohit

    2013-08-01

    Testosterone replacement therapy in men with prostate cancer is controversial, with concern that testosterone can stimulate cancer growth. We evaluated the safety and efficacy of testosterone in hypogonadal men with prostate cancer treated with radical prostatectomy. We performed a review of 103 hypogonadal men with prostate cancer treated with testosterone after prostatectomy (treatment group) and 49 nonhypogonadal men with cancer treated with prostatectomy (reference group). There were 77 men with low/intermediate (nonhigh) risk cancer and 26 with high risk cancer included in the analysis. All men were treated with transdermal testosterone, and serum hormone, hemoglobin, hematocrit and prostate specific antigen were evaluated for more than 36 months. Median (IQR) patient age in the treatment group was 61.0 years (55.0-67.0), and initial laboratory results included testosterone 261.0 ng/dl (213.0-302.0), prostate specific antigen 0.004 ng/ml (0.002-0.007), hemoglobin 14.7 gm/dl (13.3-15.5) and hematocrit 45.2% (40.4-46.1). Median followup was 27.5 months, at which time a significant increase in testosterone was observed in the treatment group. A significant increase in prostate specific antigen was observed in the high risk and nonhigh risk treatment groups with no increase in the reference group. Overall 4 and 8 cases of cancer recurrence were observed in treatment and reference groups, respectively. Thus, testosterone therapy is effective and, while followed by an increase in prostate specific antigen, does not appear to increase cancer recurrence rates, even in men with high risk prostate cancer. However, given the retrospective nature of this and prior studies, testosterone therapy in men with history of prostate cancer should be performed with a vigorous surveillance protocol. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  15. Health-Related Quality of Life 2 Years After Treatment With Radical Prostatectomy, Prostate Brachytherapy, or External Beam Radiotherapy in Patients With Clinically Localized Prostate Cancer

    SciTech Connect

    Ferrer, Montserrat Suarez, Jose Francisco; Guedea, Ferran; Fernandez, Pablo; Macias, Victor; Marino, Alfonso; Hervas, Asuncion; Herruzo, Ismael; Ortiz, Maria Jose; Villavicencio, Humberto; Craven-Bratle, Jordi; Garin, Olatz; Aguilo, Ferran

    2008-10-01

    Purpose: To compare treatment impact on health-related quality of life (HRQL) in patients with localized prostate cancer, from before treatment to 2 years after the intervention. Methods and Materials: This was a longitudinal, prospective study of 614 patients with localized prostate cancer treated with radical prostatectomy (134), three-dimensional external conformal radiotherapy (205), and brachytherapy (275). The HRQL questionnaires administered before and after treatment (months 1, 3, 6, 12, and 24) were the Medical Outcomes Study 36-Item Short Form, the Functional Assessment of Cancer Therapy (General and Prostate Specific), the Expanded Prostate Cancer Index Composite (EPIC), and the American Urological Association Symptom Index. Differences between groups were tested by analysis of variance and within-group changes by univariate repeated-measures analysis of variance. Generalized estimating equations (GEE) models were constructed to assess between-group differences in HRQL at 2 years of follow-up after adjusting for clinical variables. Results: In each treatment group, HRQL initially deteriorated after treatment with subsequent partial recovery. However, some dimension scores were still significantly lower after 2 years of treatment. The GEE models showed that, compared with the brachytherapy group, radical prostatectomy patients had worse EPIC sexual summary and urinary incontinence scores (-20.4 and -14.1; p < 0.001), and external radiotherapy patients had worse EPIC bowel, sexual, and hormonal summary scores (-3.55, -5.24, and -1.94; p < 0.05). Prostatectomy patients had significantly better EPIC urinary irritation scores than brachytherapy patients (+4.16; p < 0.001). Conclusions: Relevant differences between treatment groups persisted after 2 years of follow-up. Radical prostatectomy had a considerable negative effect on sexual functioning and urinary continence. Three-dimensional conformal radiotherapy had a moderate negative impact on bowel

  16. Erectile dysfunction after radical prostatectomy: hemodynamic profiles and their correlation with the recovery of erectile function.

    PubMed

    Mulhall, John P; Slovick, Ron; Hotaling, James; Aviv, Nadid; Valenzuela, Rolando; Waters, W Bedford; Flanigan, Robert C

    2002-03-01

    Despite the advent of nerve sparing radical prostatectomy some men experience erectile dysfunction. Many of these men have vasculogenic erectile impairment in the form of arterial insufficiency or venous leakage. Recent data imply that early postoperative injection therapy may decrease the rate of erectile dysfunction. We defined hemodynamic patterns in patients who underwent bilateral nerve sparing radical prostatectomy to assess the chronology of venous leakage development and explore the correlation of hemodynamic profiles with the return of functional erection 12 months postoperatively. Patients with excellent preoperative erectile function who underwent bilateral nerve sparing surgery and had no pharmacological support for erectile dysfunction in the initial 12 months after surgery received vascular evaluation at presentation. Vascular evaluation involved cavernosometry or penile ultrasonography. Patients were then interviewed again at least 12 months postoperatively to assess the ability to achieve sexual intercourse. Our study group comprised 96 men with a mean age plus or minus standard deviation of 54 +/- 12 years who met all inclusion criteria. All patients had pathologically proved organ confined disease. Mean time to the initial postoperative presentation was 6 +/- 5 months. Patients were divided into 4 groups according to the time of vascular studies postoperatively, namely less than 4 to 8, 9 to 12 and greater than 12 months. Normal vascular status, arterial insufficiency and venous leakage were diagnosed in 35%, 59% and 26% of the group, respectively. No difference in the incidence of arterial insufficiency was noted in the 4 time groups. Time postoperatively was significantly associated with the incidence of venous leakage (14% at less than 4 months and 35% at between 9 and 12). In regard to the correlation of the vascular diagnosis with the return to functional erection 47% of the normal, 31% of the arteriogenic and 9% of the venous leakage group

  17. Impact of robotic technique and surgical volume on the cost of radical prostatectomy.

    PubMed

    Hyams, Elias S; Mullins, Jeffrey K; Pierorazio, Phillip M; Partin, Alan W; Allaf, Mohamad E; Matlaga, Brian R

    2013-03-01

    Our present understanding of the effect of robotic surgery and surgical volume on the cost of radical prostatectomy (RP) is limited. Given the increasing pressures placed on healthcare resource utilization, such determinations of healthcare value are becoming increasingly important. Therefore, we performed a study to define the effect of robotic technology and surgical volume on the cost of RP. The state of Maryland mandates that all acute-care hospitals report encounter-level and hospital discharge data to the Health Service Cost Review Commission (HSCRC). The HSCRC was queried for men undergoing RP between 2008 and 2011 (the period during which robot-assisted laparoscopic radical prostatectomy [RALRP] was coded separately). High-volume hospitals were defined as >60 cases per year, and high-volume surgeons were defined as >40 cases per year. Multivariate regression analysis was performed to evaluate whether robotic technique and high surgical volume impacted the cost of RP. There were 1499 patients who underwent RALRP and 2565 who underwent radical retropubic prostatectomy (RRP) during the study period. The total cost for RALRP was higher than for RRP ($14,000 vs 10,100; P<0.001) based primarily on operating room charges and supply charges. Multivariate regression demonstrated that RALRP was associated with a significantly higher cost (β coeff 4.1; P<0.001), even within high-volume hospitals (β coeff 3.3; P<0.001). High-volume surgeons and high-volume hospitals, however, were associated with a significantly lower cost for RP overall. High surgeon volume was associated with lower cost for RALRP and RRP, while high institutional volume was associated with lower cost for RALRP only. High surgical volume was associated with lower cost of RP. Even at high surgical volume, however, the cost of RALRP still exceeded that of RRP. As robotic surgery has come to dominate the healthcare marketplace, strategies to increase the role of high-volume providers may be needed to

  18. Treatment of recurrent prostate cancer following radical prostatectomy: the radiation-oncologists point of view.

    PubMed

    Rischke, H C; Knippen, S; Kirste, S; Grosu, A L

    2012-10-01

    Recurrence of prostate cancer after radical prostatectomy is a common event. Salvage radiation therapy (RT) is the mainstay of treatment in cases with recurrence defined as PSA failure, offering the chance of cure. Multiple studies showed that the lower the PSA level at the beginning of salvage RT, the better the treatment outcome. There is evidence that higher radiation doses are associated with improved PSA relapse free rates. Four different recurrence patterns exist: 1) local recurrence in the prostatectomy bed only; 2) loco-regional metastases in the pelvic lymph nodes; 3) distant metastases (most commonly nodal or osseous); 4) a combination of local and distant recurrence. Modern functional imaging modalities like magnetic resonance imaging (MRI) and choline-PET/CT offer additional information to clinical and therapeutic variables and provide high accuracy depending on the level of PSA recurrence and PSA kinetics. These image modalities are valuable tools that can be used for gross tumor volume (GTV) definition in the RT-planning process in the salvage RT setting and guide interdisciplinary salvage therapy strategies in case of locoregional relapse. We discuss the impact of MRI and choline-PET/CT in the salvage setting from the radiation-oncologist point of view.

  19. Interobserver variability between expert urologic pathologists for extraprostatic extension and surgical margin status in radical prostatectomy specimens.

    PubMed

    Evans, Andrew J; Henry, Pauline C; Van der Kwast, Theodorus H; Tkachuk, Douglas C; Watson, Kemp; Lockwood, Gina A; Fleshner, Neil E; Cheung, Carol; Belanger, Eric C; Amin, Mahul B; Boccon-Gibod, Liliane; Bostwick, David G; Egevad, Lars; Epstein, Jonathan I; Grignon, David J; Jones, Edward C; Montironi, Rodolfo; Moussa, Madeleine; Sweet, Joan M; Trpkov, Kiril; Wheeler, Thomas M; Srigley, John R

    2008-10-01

    Accurate Gleason score, pathologic stage, and surgical margin (SM) information is critical for the planning of post-radical prostatectomy management in patients with prostate cancer. Although interobserver variability for Gleason score among urologic pathologists has been well documented, such data for pathologic stage and SM assessment are limited. We report the first study to address interobserver variability in a group of expert pathologists concerning extraprostatic soft tissue (EPE) and SM interpretation for radical prostatectomy specimens. A panel of 3 urologic pathologists selected 6 groups of 10 slides designated as being positive, negative, or equivocal for either EPE or SM based on unanimous agreement. Twelve expert urologic pathologists, who were blinded to the panel diagnoses, reviewed 40x whole-slide scans and provided diagnoses for EPE and SM on each slide. On the basis of panel diagnoses, as the gold standard, specificity, sensitivity, and accuracy values were high for both EPE (87.5%, 95.0%, and 91.2%) and SM (97.5%, 83.3%, and 90.4%). Overall kappa values for all 60 slides were 0.74 for SM and 0.63 for EPE. The kappa values were higher for slides with definitive gold standard EPE (kappa=0.81) and SM (kappa=0.73) diagnoses when compared with the EPE (kappa=0.29) and SM (kappa=0.62) equivocal slides. This difference was markedly pronounced for EPE. Urologic pathologists show good to excellent agreement when evaluating EPE and SM. Interobserver variability for EPE and SM interpretation was principally related to the lack of a clearly definable prostatic capsule and crush/thermal artifact along the edge of the gland, respectively.

  20. Prostate cancer recurrence after radical prostatectomy: the role of 3-T diffusion imaging in multi-parametric magnetic resonance imaging.

    PubMed

    Panebianco, Valeria; Barchetti, Flavio; Sciarra, Alessandro; Musio, Daniela; Forte, Valerio; Gentile, Vincenzo; Tombolini, Vincenzo; Catalano, Carlo

    2013-06-01

    To validate the role of 3-T diffusion-weighted imaging (DWI) in the detection of local prostate cancer recurrence after radical prostatectomy (RP). T2-weighted imaging, DWI and dynamic contrast-enhanced MRI (DCE-MRI) were performed with a 3-T magnet in 262 patients after RP. Twenty out of 262 patients evaluated were excluded. MRI results were validated by prostate-specific antigen (PSA) reduction after external beam radiotherapy in group A (126 patients, local recurrence size range 4-8 mm) and by transrectal ultrasound biopsy in group B (116 patients, local recurrence size range 9-15 mm). In group A combined T2-weighted and DCE-MRI (T2+DCE) shows 98 % sensitivity, 94 % specificity and 93 % accuracy in identifying local recurrence; combined T2-weighted and DWI with a b value of 3,000 s/mm(2) (T2+DW3) displays 97 % sensitivity, 95 % specificity and 92 % accuracy, while with a b value of 1,000 s/mm(2) (T2+DW1) affords 93 % sensitivity, 89 % specificity and 88 % accuracy. In group B T2+DCE shows 100 % sensitivity, 97 % specificity and 91 % accuracy in detecting local cancer recurrence; T2+DW3 displays 98 % sensitivity, 96 % specificity and 89 % accuracy; T2+DW1 has 94 % sensitivity, 92 % specificity and 86 % accuracy. DCE-MRI is the most reliable technique in detecting local prostate cancer recurrence after RP, though DWI can be proposed as a reliable alternative. • Diffusion-weighted magnetic resonance imaging (DWI-MRI) is being increasingly used in oncology. • PSA analysis does not distinguish prostate cancer recurrence from distant metastasis. • DWI-MR can diagnose local prostate cancer recurrence after radical prostatectomy. • DWI-MR is almost comparable to DCE-MRI in detecting local recurrence.

  1. Orgasm-associated incontinence (climacturia) after bladder neck-sparing radical prostatectomy: clinical and video-urodynamic evaluation.

    PubMed

    Manassero, Francesca; Di Paola, Giuseppe; Paperini, Davide; Mogorovich, Andrea; Pistolesi, Donatella; Valent, Francesca; Selli, Cesare

    2012-08-01

    Orgasm-Associated Incontinence (OAI) or climacturia has been observed in male patients maintaining sexual potency after radical prostatectomy and cystectomy. We investigated the incidence and video-urodynamic aspects of this event in continent and potent patients after bladder neck-sparing (BNS) radical prostatectomy (RP). Comparing functional and morphological aspects between climacturic and non-climacturic patients to identify a possible explanation of this unusual kind of leakage that could seriously impact the sexual life after surgery. In a pool of 84 men, potent and continent at least 1 year after BNS RP, 24 (28.6%) reported climacturia and 7 agreed to undergo video-urodynamic evaluation (group 1), which was performed also in 5 controls (group 2). Those 12 men were also evaluated with 24-hour pad test, 5-item International Index of Erectile Function and International Prostate Symptom Score questionnaires. Functional urethral length (FUL) was significantly lower in the climacturia group (P=0.02) and time to continence recovery was significantly longer (P=0.05). No other significant differences were found between the two groups. The radiological appearance of the vesicourethral junction at voiding cystourethrography was similar. To the best of our knowledge, this is the first functional and morphological evaluation of climacturia after RP. In our experience, this event is indirectly associated with a reduced FUL in the sphincter area, although both patients and controls were continent during daily activities. BNS technique seems to reduce time to continence recovery, although climacturic patients need longer time than control patients. Since in our series no rigidity of the vesicourethral anastomosis was radiographically evident, we believe that differences in FUL could explain OAI. Anatomical difference in membranous urethra length could explain the occurrence of this symptom in patients treated with the same surgical technique. © 2012 International Society

  2. The Value of Open Conversion Simulations During Robot-Assisted Radical Prostatectomy: Implications for Robotic Training Curricula.

    PubMed

    Zattoni, Fabio; Guttilla, Andrea; Crestani, Alessandro; De Gobbi, Alberto; Cattaneo, Francesco; Moschini, Marco; Vianello, Fabio; Valotto, Claudio; Dal Moro, Fabrizio; Zattoni, Filiberto

    2015-11-01

    There is a lack of protocols, formal guidance, and procedural training regarding open conversions from robot-assisted radical prostatectomy (RARP) to open radical prostatectomy (ORP). An open conversion places complex demands on the healthcare team and has recently been shown to be associated with adverse perioperative outcomes. To perform a root cause analysis of open conversion simulations from RARP to ORP to identify errors that may contribute to adverse events. From May 2013 to December 2013, with a team of two surgeons, an anesthesiologist, and three nurses, we simulated 20 emergencies during RARP that require open conversion. A human simulation model was intubated and prepared in the Trendelenburg position; a robot da Vinci SI was locked to it. All simulations were timed, transcribed, and filmed to identify errors and areas for improvement. An institutional conversion protocol was developed at the end of the conversion training. The average conversion time was 130.9 (interquartile range [IQR] 90-201) seconds. Frequencies of the observed errors were as follows: lack of task sequence (70%), errors in robot movements (50%), loss of sterility (50%), space conflict (40%), communication errors (25%), lack of leadership (25%), and accidental fall of surgical devices (25%). Four main strategies were implemented to reduce errors: improving leadership, clearly defining roles, improving knowledge base, and surgical room reorganization. By the last simulation, conversions were performed without errors and using 55.2% less time compared with initial simulations. In this preliminary study, repeated simulations, increased leadership, improved role delineation, and surgical room reorganization enabled faster and less flawed conversions. Further studies are needed to identify if such protocols may translate to actual safety improvement during open conversions.

  3. Loss of Expression of AZGP1 Is Associated With Worse Clinical Outcomes in a Multi-Institutional Radical Prostatectomy Cohort.

    PubMed

    Brooks, James D; Wei, Wei; Pollack, Jonathan R; West, Robert B; Shin, Jun Ho; Sunwoo, John B; Hawley, Sarah J; Auman, Heidi; Newcomb, Lisa F; Simko, Jeff; Hurtado-Coll, Antonio; Troyer, Dean A; Carroll, Peter R; Gleave, Martin E; Lin, Daniel W; Nelson, Peter S; Thompson, Ian M; True, Lawrence D; McKenney, Jesse K; Feng, Ziding; Fazli, Ladan

    2016-11-01

    Given the uncertainties inherent in clinical measures of prostate cancer aggressiveness, clinically validated tissue biomarkers are needed. We tested whether Alpha-2-Glycoprotein 1, Zinc-Binding (AZGP1) protein levels, measured by immunohistochemistry, and RNA expression, by RNA in situ hybridization (RISH), predict recurrence after radical prostatectomy independent of clinical and pathological parameters. AZGP1 IHC and RISH were performed on a large multi-institutional tissue microarray resource including 1,275 men with 5 year median follow-up. The relationship between IHC and RISH expression levels was assessed using the Kappa analysis. Associations with clinical and pathological parameters were tested by the Chi-square test and the Wilcoxon rank sum test. Relationships with outcome were assessed with univariable and multivariable Cox proportional hazards models and the Log-rank test. Absent or weak expression of AZGP1 protein was associated with worse recurrence free survival (RFS), disease specific survival, and overall survival after radical prostatectomy in univariable analysis. AZGP1 protein expression, along with pre-operative serum PSA levels, surgical margin status, seminal vesicle invasion, extracapsular extension, and Gleason score predicted RFS on multivariable analysis. Similarly, absent or low AZGP1 RNA expression by RISH predicted worse RFS after prostatectomy in univariable and multivariable analysis. In our large, rigorously designed validation cohort, loss of AZGP1 expression predicts RFS after radical prostatectomy independent of clinical and pathological variables. Prostate 76:1409-1419, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  4. Chemotherapy and novel therapeutics before radical prostatectomy for high-risk clinically localized prostate cancer.

    PubMed

    Cha, Eugene K; Eastham, James A

    2015-05-01

    Although both surgery and radiation are potential curative options for men with clinically localized prostate cancer, a significant proportion of men with high-risk and locally advanced disease will demonstrate biochemical and potentially clinical progression of their disease. Neoadjuvant systemic therapy before radical prostatectomy (RP) is a logical strategy to improve treatment outcomes for men with clinically localized high-risk prostate cancer. Furthermore, delivery of chemotherapy and other systemic agents before RP affords an opportunity to explore the efficacy of these agents with pathologic end points. Neoadjuvant chemotherapy, primarily with docetaxel (with or without androgen deprivation therapy), has demonstrated feasibility and safety in men undergoing RP, but no study to date has established the efficacy of neoadjuvant chemotherapy or neoadjuvant chemohormonal therapies. Other novel agents, such as those targeting the vascular endothelial growth factor receptor, epidermal growth factor receptor, platelet-derived growth factor receptor, clusterin, and immunomodulatory therapeutics, are currently under investigation.

  5. Seperation of dorsal vein complex from the urethra by blunt finger dissection during radical retropubic prostatectomy

    PubMed Central

    Atan, Ali; Tuncel, Altuğ; Polat, Fazlı; Balcı, Melih; Yeşil, Süleyman; Köseoğlu, Ersin

    2015-01-01

    We present our initial experience on the isolation of dorsal vein complex by blunt finger dissection in 26 patients with localised prostate cancer who underwent open retropubic radical prostatectomy. Loss of blood was between 300 and 500 mL (mean 350 mL). Two of 26 patients (7.6%) required blood transfusion. There was no positive surgical margin at prostatic apex in the patients. Twenty four of our patients (92.4%) were continent on the 3rd month. Control of dorsal vein complex is very important to decrease blood loss and to improve intraoperative exposure of retropubic area in order to get negative margin of prostatic apex and to provide the urethra long enough for a nice urethrovesical anastomosis. According to our initial experience, this technique seems to provide these aims. PMID:26328213

  6. Nerve-sparing techniques and results in robot-assisted radical prostatectomy

    PubMed Central

    Aytac, Omer; Atug, Fatih

    2016-01-01

    Nerve-sparing techniques in robot-assisted radical prostatectomy (RARP) have advanced with the developments defining the prostate anatomy and robotic surgery in recent years. In this review we discussed the surgical anatomy, current nerve-sparing techniques and results of these operations. It is important to define the right and key anatomic landmarks for nerve-sparing in RARP which can demonstrate individual variations. The patients' risk assessment before the operation and intraoperative anatomic variations may affect the nerve-sparing technique, nerve-sparing degree and the approach. There is lack of randomized control trials for different nerve-sparing techniques and approaches in RARP, therefore accurate preoperative and intraoperative assessment of the patient is crucial. Current data shows that, performing the maximum possible nerve-sparing using athermal techniques have better functional outcomes. PMID:27995221

  7. Incidence, Risk Factors, Management, and Complications of Rectal Injuries During Radical Prostatectomy.

    PubMed

    Mandel, Philipp; Linnemannstöns, Anna; Chun, Felix; Schlomm, Thorsten; Pompe, Raisa; Budäus, Lars; Rosenbaum, Clemens; Ludwig, Tim; Dahlem, Roland; Fisch, Margit; Graefen, Markus; Huland, Hartwig; Tilki, Derya; Steuber, Thomas

    2017-02-07

    Rectal injury (RI) during radical prostatectomy (RP) is a severe complication. So far, only limited data describing the incidence, risk factors, management, and complications of RI are available. In an analysis of data for 24178 patients, we identified 113/24076 patients (0.47%) undergoing open or robotic RP and 7/102 patients (6.86%) after salvage RP who experienced an RI. Besides salvage RP, local tumor stage, Gleason grade, lymph node status, and surgical experience, but not surgical approach (robotic vs open), could be identified as risk factors for RI in univariate and multivariate analysis. Intraoperative management of RI comprised closure with two to three layers. In 13/109 patients (11.9%), a diverting colostomy/ileostomy was carried out. Some 12% of men with closure of an RI developed a recto-anastomosis fistula, and 57% of those who had an additional diverting enterostomy. Thus, the overall incidence of recto-anastomosis fistula after RP was <0.1%. The extent of rectal laceration, prior radiation, and intraoperative signs of rectal infiltration were associated with the development of a subsequent recto-anastomosis fistula. Some 83% of patients with a recto-anastomosis fistula needed further intervention. We analyzed the incidence, risk factors, management, and complications of rectal injury during radical prostatectomy. Overall, the incidence of rectal injury and subsequent development of recto-anastomosis fistulas is low unless the patient has significant risk factors. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  8. Intraoperative cavernous nerve stimulation and Laser-Doppler flowmetry during radical prostatectomy.

    PubMed

    Axelson, Hans W; Johansson, Eva; Bill-Axelson, Anna

    2013-11-01

    Erectile dysfunction is a common side effect following radical prostatectomy mainly due to damage of the pelvic autonomic nerve fibers (cavernous nerves). Intraoperative electrical stimulation of the cavernous nerves while measuring changes in penile girth has previously been shown to provide the surgeon with feedback of nerve integrity. To test the feasibility of recording changes in glans penis blood flow by Laser Doppler flowmetry from cavernous nerve stimulation. Fifteen patients with localized prostate cancer undergoing radical prostatectomy had electrical stimulation of the proximal and distal parts of the neurovascular bundles after prostate removal. The stimulation consisted of 30-40 seconds biphasic constant current (10-30 mA) with 0.5 millisecond pulse duration. Stimulus induced changes in penile blood flow was recorded from a Laser Doppler probe attached to the glans penis. Changes in penile girth were simultaneously recorded from a mercury-in rubber strain gauge. Erectile function was evaluated three months after surgery. Ten patients had stimulus induced increase in Laser Doppler flow unilaterally (N=7) or bilaterally (N=3). Out of 10 patients, 6 reported some preserved erectile function postoperatively at 3 months follow-up (indicating 6 true and 4 false positives). Three patients had no Doppler response from stimulation and had no postoperative erectile function postoperatively (indicating three true negatives). Two patients were excluded from the study due to bad signal quality in the Laser Doppler signal. In the majority of patients, stimulation produced increase in penile girth sensed by the strain gauge. This preliminary report provides evidence that Laser Doppler Flowmetry is able to detect increased penile blood flow from intraoperative electrical stimulation of the neurovascular bundles. However, further improvement in the recording technique is required. Laser Doppler Flowmetry may also be feasible to confirm autonomic nerve sparing in women

  9. Half-life determination of serum free prostate-specific antigen following radical retropubic prostatectomy.

    PubMed

    Richardson, T D; Wojno, K J; Liang, L W; Giacherio, D A; England, B G; Henricks, W H; Schork, A; Oesterling, J E

    1996-12-01

    Prostate-specific antigen (PSA) continues to be the the most clinically useful tumor marker for prostate cancer. Recently, several molecular forms of PSA have been detected and characterized. These specific forms, including free PSA and PSA complexed to alpha 1-antichymotrypsin, can be measured and their proportions determined. In doing so, the sensitivity of PSA as a tumor marker can be maintained while the specificity is improved. In order to maximize the clinical utility of free PSA, the half-life and elimination kinetics of free PSA from the serum were determined. Twenty-five patients, ages 43-74 years (mean 60 years) with biopsy proven, organ-confined adenocarcinoma of the prostate who underwent anatomic radical retropubic prostatectomy, were identified. For each patient, venous blood samples were obtained preoperatively, and at 60-minute intervals beginning 1 hour after the prostate was removed. The specimens were handled and stored in a consistent fashion. Using the AxSYM immunoassay analyzer (Abbott Diagnostics, Abbott Park, IL), the serum free PSA values were determined and plotted as a function of time for each patient. From the 25 individual elimination curves that were generated, the half-life of serum free PSA was determined. The mean half-life of serum free PSA was 110 minutes +/- 18.6 minutes (SD). Analysis of the individual and cumulative elimination curves indicates that the elimination of free PSA from the serum following radical prostatectomy follows a biphasic pattern. Unlike PSA, which has a half life of 2-3 days, the half-life of serum free PSA is 110 minutes (1.83 hours). This short half-life may have significant implications for the use of percentage of free PSA as a clinically useful tool in distinguishing patients with early, curable prostate cancer from men with benign prostatic hyperplasia (BPH) only.

  10. Findings of routine apical margin biopsy during robot-assisted radical prostatectomy.

    PubMed

    Wambi, Chris O; Patel, Trushar; Shapiro, Edan Y; Tal, Oded; Hruby, Greg W; Berg, William T; Benson, Mitchell C; Badani, Ketan K

    2013-06-01

    Intraoperative biopsy of the apical margin during radical prostatectomy has been recommended as a way to reduce the positive margin rate at this location. However, the enhanced visibility of the apex during robot-assisted radical prostatectomy (RARP) may obviate this need, allowing for the preservation of maximal urethral length. We assessed pathologic findings of routine apical margin biopsy intraoperative frozen section (IFS) during RARP. The Columbia University Robotic Database was retrospectively reviewed to identify men who underwent RARP with biopsy of the apical soft tissue (urethroprostatic junction). Both IFS and permanent section samples were analyzed. The clinical characteristics associated with IFS and permanent section histological findings were assessed. In total, 335 men underwent RARP with apical biopsy from December 2007 to August 2011. Of these, 329 had IFS available for analysis. Median age and prostate-specific antigen level were 60 years (range, 42-78 years) and 5.2 ng/mL (interquartile range, 4.1-6.9 ng/mL), respectively. Of the 329 apical IFS cases, cancer was detected in 9 patients (2.7%), benign prostatic glands in 135 (41%), and nonprostatic tissue in 185 (56.3%). On permanent section, cancer was seen in 9 patients (2.7%), benign prostatic glands in 125 (38%), and nonprostatic tissue in 195 (59.3%). False-positive and false-negative rates of detecting cancer on IFS were 33% (3/9) and 1% (3/320), respectively. The overall positive surgical margin rate was 11%. Cancer is rarely detected by IFS analysis of routine biopsy of the apical margin during RARP. Although routine IFS may not be beneficial for all patients, selective utilization of IFS may be useful in directing apical dissection in men with apical tumors, allowing for the preservation of maximal urethral length.

  11. Comparison of three different tools for prediction of seminal vesicle invasion at radical prostatectomy.

    PubMed

    Lughezzani, Giovanni; Zorn, Kevin C; Budäus, Lars; Sun, Maxine; Lee, David I; Shalhav, Arieh L; Zagaya, Gregory P; Shikanov, Sergey A; Gofrit, Ofer N; Thong, Alan E; Albala, David M; Sun, Leon; Cronin, Angel; Vickers, Andrew J; Karakiewicz, Pierre I

    2012-10-01

    Statistical prediction tools are increasingly common, but there is considerable disagreement about how they should be evaluated. Three tools--Partin tables, the European Society for Urological Oncology (ESUO) criteria, and the Gallina nomogram--have been proposed for the prediction of seminal vesicle invasion (SVI) in patients with clinically localized prostate cancer who are candidates for a radical prostatectomy. Using different statistical methods, we aimed to determine which of these tools should be used to predict SVI. The independent validation cohort consisted of 2584 patients treated surgically for clinically localized prostate cancer at four North American tertiary care centers between 2002 and 2007. Robot-assisted laparoscopic radical prostatectomy. Primary outcome was the presence of SVI. Traditional (area under the receiver operating characteristic [ROC] curve, calibration plots, the Brier score, sensitivity and specificity, positive and negative predictive value) and novel (decision curve analysis and predictiveness curves) statistical methods quantified the predictive abilities of the three models. Traditional statistical methods (ie, ROC plots and Brier scores) could not clearly determine which one of the three SVI prediction tools should be preferred. For example, ROC plots and Brier scores seemed biased against the binary decision tool (ESUO criteria) and gave discordant results for the continuous predictions of the Partin tables and the Gallina nomogram. The results of the calibration plots were discordant with those of the ROC plots. Conversely, the decision curve indicated that the Partin tables represent the best strategy for stratifying the risk of SVI, resulting in the highest net benefit within the whole range of threshold probabilities. When predicting SVI, surgeons should prefer the Partin tables over the ESUO criteria and the Gallina nomogram because this tool provided the highest net benefit. In contrast to traditional statistical

  12. [Minimally invasive radical prostatectomy: Contribution of robotic support, functional and oncological outcomes].

    PubMed

    Hoepffner, Jean-Luc; Gaston, Richard; Mugnier, Camille; Rey, Denis; Lopez, Laurent; Roche, Jean-Baptiste; Riviere, Julien; Piechaud, Pierre-Thierry

    2016-05-01

    Radical prostatectomy (RP) remains a standard for localized prostate cancer treatment. The objective of this study is to present this operating technique of the robot-assisted radical prostatectomy (PR-RA) and to evaluate oncological and functional results as well as on the surgical safety. A first series of 1679 patients consecutively operated in our institution with this technique from 2005 to 2010 and with a 5-year follow-up evaluated in 2014. The oncology monitoring is ensured with a PSA test every six months during the first three years and once a year the years after if the level remains undetectable. The oncologic outcomes show 17.4% for pT2 stages and 36.9% for pT3 stages positive margins. The level of biological recurrence is 21.27% with an average delay of 88 months as the time needed for the recurrence to occur. At 12 months, urinary continence (0-1pad/day) returned at 94% of all patients and potency with successful penetration for all men is 61.1% and 88.8% for men with sexual activity before surgery. The technique PRRA seems to be a reliable technique whose functional results studied from meta-analysis seem to be superior in terms of rapidity of recovery of the continence and erection in comparison with classical surgical or laparoscopic approach. Copyright © 2016 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  13. Temporal Trends and Predictors of Pelvic Lymph Node Dissection in Open or Minimally Invasive Radical Prostatectomy

    PubMed Central

    Feifer, Andrew H.; Elkin, Elena B.; Lowrance, William T.; Denton, Brian; Jacks, Lindsay; Yee, David S.; Coleman, Jonathan A.; Laudone, Vincent P.; Scardino, Peter T.; Eastham, James A.

    2011-01-01

    Background Pelvic lymph node dissection (PLND) is an important component of prostate cancer staging and treatment, especially for surgical patients with high-risk tumor features. It is not clear how the shift from open radical prostatectomy (ORP) to minimally invasive radical prostatectomy (MIRP) has affected use of PLND. Our objective was to identify predictors of PLND and assess the impact of surgical technique in a contemporary, population-based cohort. Methods In Surveillance, Epidemiology, and End Results (SEER) cancer registry data linked with Medicare claims, we identified men who had ORP or MIRP for prostate cancer in 2003–2007. We evaluated the impact of surgical approach on PLND and examined interactions between surgical procedure, PSA and Gleason score, controlling for patient and tumor characteristics. Results Of 6,608 men who had ORP or MIRP, 70% (n=4,600) had PLND. Use of PLND declined over time, overall and within subgroups defined by procedure type. PLND was 5 times more likely in men receiving ORP than MIRP, controlling for patient and tumor characteristics. Elevated PSA and biopsy Gleason score, but not clinical stage, were associated with greater odds of PLND in both ORP and MIRP groups. However, the magnitude of the association between these factors and PLND was significantly greater for ORP patients. Conclusion PLND was less common in men who received MIRP, independent of tumor risk factors. A decline in PLND rates was not fully explained by an increase in MIRP. These trends may signal a surgical approach-dependent disparity in prostate cancer staging and therapy. PMID:21412757

  14. The Association of Fatty Acid Levels and Gleason Grade among Men Undergoing Radical Prostatectomy

    PubMed Central

    Zhao, Zhiguo; Reinstatler, Lael; Klaassen, Zachary; Xu, Yi; Yang, Xiaoyu; Madi, Rabii; Terris, Martha K.; Qian, Steven Y.; Kelavkar, Uddhav; Moses, Kelvin A.

    2016-01-01

    Background Epidemiological data suggest that omega-6 (ω-6) fatty acids (FAs) may be associated with cancer incidence and/or cancer mortality, whereas ω-3 FAs are potentially protective. We examined the association of the ratio of ω-6 to ω-3 FA (ω-6:ω-3) and individual FA components with pathological results among men with prostate cancer (PCa) undergoing radical prostatectomy. Methods Sixty-nine men were included in the study. Components of ω-6 (linoleic acid (LA), arachidonic acid (AA), and dihomo-γ-linolenic acid (DGLA)) and ω-3 (docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)) were analyzed by liquid chromatography/mass selective detector separation. Logistic regression analysis was performed to determine association of FA with pathological high grade (Gleason ≥4+3) disease. Results The were 35 men with low grade disease (Gleason ≤3+4) and 34 men with high grade disease. Men with low grade disease were significantly younger (58y vs 61y, p = 0.012) and had lower D’Amico clinical classification (p = 0.001) compared to men with high grade disease. There was no significant association of ω-6:ω-3 with high grade disease (OR 0.93, p = 0.78), however overall ω-6, ω-3, and individual components of ω-6 and ω-3 FAs except EPA were significantly associated with high grade disease (ω-6: OR 3.37, 95% CI: 1.27,8.98; LA: OR 3.33, 95% CI:1.24,8.94; AA: OR 2.93, 95% CI:1.24,6.94; DGLA: OR 3.21, 95% CI:1.28,8.04; ω-3: OR 3.47, 95% CI:1.22,9.83; DHA: OR 3.13, 95% CI:1.26,7.74). ω-6 and ω-3 FA components were highly correlated (Spearman ρ = 0.77). Conclusion Higher levels of individual components of ω-6 and ω-3FAs may be associated with higher-grade PCa. Impact Studies into the causative factors/pathways regarding FAs and prostate carcinogenesis may prove a potential association with PCa aggressiveness. PMID:27880795

  15. Prognostic Factors for Anastomotic Urinary Leakage Following Retropubic Radical Prostatectomy and Correlation With Voiding Outcomes

    PubMed Central

    Cormio, Luigi; Di Fino, Giuseppe; Scavone, Carmen; Maroscia, Domenico; Mancini, Vito; Ruocco, Nicola; Bellanti, Francesco; Selvaggio, Oscar; Sanguedolce, Francesca; Lucarelli, Giuseppe; Carrieri, Giuseppe

    2016-01-01

    Abstract This study aimed to determine the occurrence and grade of cystographically detected urinary leakage (UL) in a contemporary series of open retropubic radical prostatectomy (RP), whether patients’ clinical variables predict occurrence of UL, and whether occurrence of UL correlates with patients’ voiding outcomes in terms of urinary continence and anastomotic stricture (AS). Enrolled patients underwent cystography 7 days after retropubic RP; in case of UL, the catheter was left in situ and cystography repeated at 7 days intervals until demonstrating absence of UL. Leakage was classified as grade I = extraperitoneal leak <6 cm, grade II = extraperitoneal leak >6 cm, grade III = leak freely extending in the small pelvis. Voiding was evaluated at 3, 6, and 12 months after RP using the 24-hour pad test and uroflowmetry; in cases of maximum flow rate <10 mL/s, urethrocystoscopy was carried out to determine presence and location of an AS. The first postoperative cystogram showed UL in 52.6% of patients (grade I in 48.1%, grade II in 21.5%, and grade III in 30.4% of the cases). Multivariate analysis demonstrated that patients with UL had significantly greater prostate volume (64.5 vs 34.8 cc, P < 0.001), loss of serum hemoglobin (4.77 vs 4.19 g/dL, P < 0.001), lower postoperative serum total proteins (4.85 vs 5.4 g/dL, P < 0.001), and higher rate of AS (20.6% vs. 2.8%, p < 0.001) than those without UL. Continence rate at 3, 6, and 12 months postoperatively was 34.2%, 76%, and 90%, respectively, in patients with UL compared with 77.5%, 80.3%, and 93% in patients without UL; such difference was statistically significant (P < 0.001) only at 3 months follow-up. ROC curve analysis showed that prostate volume and postoperative serum total proteins had the best AUC (0.821 and 0.822, respectively) and when combined, their positive and negative predictive values for UL were 90% and 93%, respectively. In conclusion, half of the patients

  16. Evolution of the clinical presentation of men undergoing radical prostatectomy for high-risk prostate cancer

    PubMed Central

    Pierorazio, Phillip M.; Ross, Ashley E.; Han, Misop; Epstein, Jonathan I.; Partin, Alan W.; Schaeffer, Edward M.

    2011-01-01

    Objectives To investigate the outcomes and potential effect of improved longitudinal screening in men presenting with high-risk (advanced clinical stage [> T2b], Gleason score 8–10 or prostate-specific antigen [PSA] level > 20 ng/mL) prostate cancer (PC). Patients and methods The Institutional Review Board approved, Institutional Radical Prostatectomy Database (1992–2010) was queried for men with high-risk PC based on D’Amico criteria. Year of surgery was divided into two cohorts: the Early PSA Era (EPE, 1992–2000) and the Contemporary PSA Era (CPE, 2001–2010). PC features and outcomes were evaluated using appropriate comparative tests. Results In total, 667 men had high-risk PC in the EPE and 764 in the CPE. In the EPE, 598 (89.7%) men presented with one high-risk feature; 173 (29.0%) men had a Gleason score of 8–10 on biopsy. In the CPE, 717 (93.9%) men presented with one high-risk feature (P = 0.004) and 494 (68.9%) men had a Gleason score of 8–10. At 10 years, biochemical-free survival (BFS) was 44.1% and 36.4% in the EPE and CPE, respectively (P = 0.04); metastases-free survival (MFS) was 77.1% and 85.1% (P = 0.6); and PC-specific survival (CSS) was 83.3% and 96.2% (P = 0.5). BFS, MFS and CSS were worse for men with more than one high-risk feature in both eras. Conclusions Over the PSA era, an increasing percentage of men with high-risk PC were categorized by a biopsy Gleason score of 8–10. The accumulation of multiple high-risk features increases the risk of biochemical recurrence, the development of metastases and death from PC. BFS, MFS and CSS are stable over the PSA era for these men. The balance between a greater proportion of men having high Gleason disease and a greater proportion with small, less advanced tumours may explain the stability in MFS and CSS over time. PMID:21880104

  17. Risk Factors for Intraprostatic Incision into Malignant Glands at Radical Prostatectomy

    PubMed Central

    Park, Sung-Woo; Readal, Nathaniel; Jeong, Byong Chang; Humphreys, Elizabeth B.; Epstein, Jonathan I.; Partin, Alan W.; Han, Misop

    2014-01-01

    Background Histologically identified intraprostatic incision (IPI) into malignant glands is associated with an increase in biochemical recurrence following radical prostatectomy (RP). However, the predictor of IPI is poorly evaluated. Objective To evaluate the risk factors for IPI into cancer during RP for clinically localized prostate cancer (PCa). Design, setting, and participants Between January 1993 and July 2013, 19 986 men with clinically localized PCa underwent RP at our institution. This study includes 14 434 cases that had complete clinicopathologic data. IPI was defined as an iatrogenic incision into the prostate resulting in the presence of malignant glands at the inked surgical margin, regardless of accompanying pathologic features. Intervention Open, retropubic, robot-assisted laparoscopic and pure laparoscopic RP. Outcome measurements and statistical analysis Univariate and multivariable logistic regression analyses were conducted for risk factors of IPI in RP specimens. Results and limitations The overall incidence of IPI into malignant tissue was noted in 410 (2.8%) cases. In multivariable analysis, obesity, lower prostate weight, surgeon experience, and pure laparoscopic RP were associated with a higher risk of IPI. The odds ratios (OR) for body mass index and prostate weight were 1.05 (95% confidence interval [CI], 1.03–1.08; p < 0.001) and 0.99 (95% CI, 0.98–0.99, p < 0.001), respectively. The ORs for surgeon experience (>250 cases) and pure laparoscopic RP compared to open RP were 0.71 (95% CI, 0.55–0.90, p = 0.005) and 2.05 (95% CI, 1.35–3.11; p = 0.001), respectively. Conclusions The risk of IPI during RP is higher in men with obesity and lower prostate weight. In addition, a pure laparoscopic RP and the early series of each surgeon were associated with a higher risk of IPI. However, tumor characteristics were not associated with the IPI occurrence. Patient summary Intraprostatic incision occurrence is associated with obesity, small

  18. Machine learning approaches to analyze histological images of tissues from radical prostatectomies.

    PubMed

    Gertych, Arkadiusz; Ing, Nathan; Ma, Zhaoxuan; Fuchs, Thomas J; Salman, Sadri; Mohanty, Sambit; Bhele, Sanica; Velásquez-Vacca, Adriana; Amin, Mahul B; Knudsen, Beatrice S

    2015-12-01

    Computerized evaluation of histological preparations of prostate tissues involves identification of tissue components such as stroma (ST), benign/normal epithelium (BN) and prostate cancer (PCa). Image classification approaches have been developed to identify and classify glandular regions in digital images of prostate tissues; however their success has been limited by difficulties in cellular segmentation and tissue heterogeneity. We hypothesized that utilizing image pixels to generate intensity histograms of hematoxylin (H) and eosin (E) stains deconvoluted from H&E images numerically captures the architectural difference between glands and stroma. In addition, we postulated that joint histograms of local binary patterns and local variance (LBPxVAR) can be used as sensitive textural features to differentiate benign/normal tissue from cancer. Here we utilized a machine learning approach comprising of a support vector machine (SVM) followed by a random forest (RF) classifier to digitally stratify prostate tissue into ST, BN and PCa areas. Two pathologists manually annotated 210 images of low- and high-grade tumors from slides that were selected from 20 radical prostatectomies and digitized at high-resolution. The 210 images were split into the training (n=19) and test (n=191) sets. Local intensity histograms of H and E were used to train a SVM classifier to separate ST from epithelium (BN+PCa). The performance of SVM prediction was evaluated by measuring the accuracy of delineating epithelial areas. The Jaccard J=59.5 ± 14.6 and Rand Ri=62.0 ± 7.5 indices reported a significantly better prediction when compared to a reference method (Chen et al., Clinical Proteomics 2013, 10:18) based on the averaged values from the test set. To distinguish BN from PCa we trained a RF classifier with LBPxVAR and local intensity histograms and obtained separate performance values for BN and PCa: JBN=35.2 ± 24.9, OBN=49.6 ± 32, JPCa=49.5 ± 18.5, OPCa=72.7 ± 14.8 and Ri=60.6

  19. [Interest of surgical companionship during the training period of robot-assisted radical prostatectomy].

    PubMed

    du Pouget, L; Nouhaud, F X; Blah, M; Defortescu, G; Ndangang, M; Grise, P; Pfister, C

    2017-04-01

    Study of the learning curve of robot-assisted radical prostatectomy, evaluating intraoperative difficulties and postoperative complications according to Clavien-Dindo classification. Retrospective study of our first 157 consecutive patients treated with robot-assisted prostatectomy for localized prostate cancer between September 2011 and December 2014. Comparison of learning for each group of 50 procedures and then comparison between patients operated on by a pair of two seniors specially trained for robotic surgery and patients operated on by one mixed pair including a surgeon junior coached by one senior of the first group. Only postoperative complications decreased significantly from the 51st patient (P=0.04). The curves showing the evolution of the operative time decreased with a parallel trend between the two pairs, but with more variability in the mixed pair. There was no significant difference in terms of intraoperative difficulties (P=0.59), nor postoperative complications (P=0.56) mainly of grade 2. The blood loss, transfusion rate, duration of hospitalization and readmission rates did not differ. Lymph node dissection did not affect outcomes. For oncological results, the overall rate of positive surgical margins (R+) was 30.6 % in the initial pair against 24.2 % in the mixed group with no significant difference. Nevertheless, the subpopulation study objectified a R+ rate of 12.86 % for pT2 against 42.85 % for pT3. The early involvement of a junior surgeon who did not receive specific training, but benefiting from the guidance of a senior surgeon, did not compromise the results while allowing a faster learning curve with a rate of operative complications close to the one observed by the senior pair. 4. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  20. AIM1 PROMOTER HYPERMETHYLATION AS A PREDICTOR OF DECREASED RISK OF RECURRENCE FOLLOWING RADICAL PROSTATECTOMY

    PubMed Central

    Rosenbaum, Eli; Begum, Shahnaz; Brait, Mariana; Zahurak, Marianna; Maldonado, Leonel; Eisenberger, Mario A; Epstein, Jonathan I; Partin, Alan W; Sidransky, David; Hoque, Mohammad Obaidul

    2012-01-01

    Purpose To evaluate the prognostic significance of six epigenetic biomarkers (AIM1, CDH1, KIF1A, MT1G, PAK3 and RBM6 promoter hypermethlation) in a homogeneous group of prostate cancer patients, following radical prostatectomy. Patients and Methods Biomarker analyses were performed retrospectively on tumors from 95 prostate cancer patients all with a Gleason score of 3+4=7 and a minimum follow up period of 8 years. Using Quantitative Methylation Specific PCR (QMSP), we analyzed the promoter region of six genes in primary prostate tumor tissues. Time to any progression was the primary endpoint and development of metastatic disease and/or death from prostate cancer was a secondary endpoint. The association of clinicopathological and biomolecular risk factors to recurrence was performed using the Log-rank test and Cox proportional hazards model for multivariate analysis. To identify independent prognostic factors, a stepwise selection method was used. Results At a median follow-up time of 10 years, 48 patients (50.5%) had evidence of recurrence: biochemical/PSA relapse, metastases, or death from prostate cancer. In the final multivariate analysis for time to progression, the significant factors were: older age, HR=0.95 (95% CI: 0.91, 1.0) (P=0.03), positive lymph nodes HR=2.11 (95%CI: 1.05, 4.26) (P=0.04) and decreased hypermethylation of AIM1 HR=0.45 (95%CI: 0.2, 1.0) (P=0.05). Conclusions Methylation status of AIM1 in the prostate cancer specimen may predict for time to recurrence in Gleason 3+4=7 patients undergoing prostatectomy. These results should be validated in a larger and unselected cohort. PMID:22127895

  1. Rectourinary Fistula after Radical Prostatectomy: Review of the Literature for Incidence, Etiology, and Management

    PubMed Central

    Kitamura, Hiroshi; Tsukamoto, Taiji

    2011-01-01

    Although rectourinary fistula (RUF) after radical prostatectomy (RP) is rare, it is an important issue impairing the quality of life of patients. If the RUF does not spontaneously close after colostomy, surgical closure should be considered. However, there is no standard approach and no consensus in the literature. A National Center for Biotechnology Information (NVBI) PubMed search for relevant articles published between 1995 and December 2010 was performed using the medical subject headings “radical prostatectomy” and “fistula.” Articles relevant to the treatment of RUF were retained. RUF developed in 0.6% to 9% of patients after RP. Most cases required colostomy, but more than 50% of them needed surgical fistula closure thereafter. The York-Mason technique is the most common approach, and closure using a broad-based flap of rectal mucosa is recommended after excision of the RUF. New techniques using a sealant or glue are developing, but further successful reports are needed. PMID:22110993

  2. Does a history of previous surgery or radiation to the prostate affect outcomes of robot-assisted radical prostatectomy?

    PubMed

    Martin, Aaron D; Desai, Premal J; Nunez, Rafael N; Martin, George L; Andrews, Paul E; Ferrigni, Robert G; Swanson, Scott K; Pacelli, Anna; Castle, Erik P

    2009-06-01

    To evaluate retrospectively whether or not previous treatment to the prostate alters the perioperative outcomes from robot-assisted radical prostatectomy (RARP) after the initial 'learning curve', as there are conflicting data on outcomes of RP in patients with previous treatment to the prostate. We retrospectively reviewed the charts of patients who had RARP between March 2005 and August 2007, and analysed demographic, perioperative variables and pathological data. In all, 510 patient charts were reviewed, identifying 24 patients with a history of previous treatment to the prostate including transurethral resection or incision of the prostate, transurethral microwave therapy, transurethral needle ablation, photoselective vaporization, simple prostatectomy, external beam radiotherapy, brachytherapy, and open bladder neck reconstruction (group 1) and 486 with no previous treatment (group 2). There was no significant difference between the groups in body mass index, clinical stage, grade or prostate volume, but the patients in group 1 were older (70 vs 65 years, P = 0.001). Outcome analysis comparing groups 1 and 2 showed an estimated blood loss of 155 vs 137 mL, length of hospital stay of 2.2 vs 1.5 days, operative duration of 200 vs 186 min and catheter time of 12 vs 8 days, respectively; only the last was statistically significant (P = 0.03). There was an 8.3% and 6.8% complication rate in groups 1 and 2, respectively, and the respective overall positive margin rate was 20.8% and 22.6%. A history of previous treatment of the prostate does not appear to compromise the perioperative outcomes of RARP.

  3. Improved biochemical outcome with adjuvant radiotherapy after radical prostatectomy for prostate cancer with poor pathologic features

    SciTech Connect

    Vargas, Carlos; Kestin, Larry L. . E-mail: lkestin@beaumont.edu; Weed, Dan W.; Krauss, Daniel; Vicini, Frank A.; Martinez, Alvaro A.

    2005-03-01

    Purpose: The indications for adjuvant external beam radiotherapy (EBRT) after radical prostatectomy (RP) are poorly defined. We performed a retrospective comparison of our institution's experience treating prostate cancer with RP vs. RP followed by adjuvant EBRT. Methods and materials: Between 1987 and 1998, 617 patients with clinical Stage T1-T2N0M0 prostate cancer underwent RP. Patients who underwent preoperative androgen deprivation and those with positive lymph nodes were excluded. Of the 617 patients, 34 (5.5%) with an undetectable postoperative prostate-specific antigen (PSA) level underwent adjuvant prostatic fossa RT at a median of 0.25 year (range, 0.1-0.6) postoperatively because of poor pathologic features. The median total dose was 59.4 Gy (range, 50.4-66.6 Gy) in 1.8-2.0-Gy fractions. These 34 RP+RT patients were compared with the remaining 583 RP patients. Biochemical failure was defined as any postoperative PSA level {>=}0.1 ng/mL and any postoperative PSA level {>=}0.3 ng/mL (at least 30 days after surgery). Administration of androgen deprivation was also scored as biochemical failure when applying either definition. The median clinical follow-up was 8.2 years (range, 0.1-11.2 years) for RP and 8.4 years (range, 0.3-13.8 years) for RP+RT. Results: Radical prostatectomy + radiation therapy patients had a greater pathologic Gleason score (mean, 7.3 vs. 6.5; p < 0.01) and pathologic T stage (median, T3a vs. T2c; p < 0.01). Age (median, 65.7 years) and pretreatment PSA level (median, 7.9 ng/mL) were similar between the treatment groups. Extracapsular extension was present in 72% of RP+RT patients vs. 27% of RP patients (p < 0.01). The RP+RT patients were more likely to have seminal vesicle invasion (29% vs. 9%, p < 0.01) and positive margins (73% vs. 36%, p < 0.01). Despite these poor pathologic features, the 5-year biochemical control (BC) rate (PSA < 0.1 ng/mL) was 57% for RP+RT and 47% for RP (p = 0.28). For patients with extracapsular extension, the

  4. Prostatic fascia and recovery of sexual function after radical prostatectomy: Is it a "Veil of Aphrodite" or "Veil of mystery"!

    PubMed

    Mandhani, Anil

    2009-01-01

    Sexual dysfunction is one of the most controversial aspects associated with radical prostatectomy. Since Walsh's description of neurovascular bundle there have been number of articles describing various modification to the technique of bilateral nerve sparing to augment the recovery of sexual function. There is a very thin line between performing an ideal nerve sparing and giving equally good oncological outcome in terms of negative surgical margin. "Veil of Aphrodite" nerve sparing technique was conceptualized by Menon et al. Lately other related terms have emerged in the literature e.g., "high anterior release, "curtain dissection," or "incremental nerve sparing. Does veil technique of radical prostatectomy help improve recovery of sexual function? Do mere presence of nerves in veil account for potency? Are these nerve parasympathetic? This short review tries to find the answer of these questions in contemporary world literature.

  5. International Society of Urological Pathology (ISUP) consensus conference on handling and staging of radical prostatectomy specimens: rationale and organization.

    PubMed

    Egevad, Lars; Srigley, John R; Delahunt, Brett

    2011-01-01

    The 2009 International Society of Urological Pathology consensus conference in Boston, made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. The activities of the conference were coordinated through five workgroups. The results are presented in five separate reports covering (1) specimen handling, (2) T2 substaging and prostate cancer volume, (3) extraprostatic extension, lymphovascular invasion and locally advanced disease, (4) seminal vesicles and lymph node metastases and (5) surgical margins. In this introductory article we describe some novel features of the organization of the consensus process. Following the completion of a pre-meeting survey conference, participants discussed and voted on 43 specific issues of contention relating to the pathological reporting of radical prostatectomy specimens. Consensus, defined as agreement by at least 65% of participants present, was achieved for 30 questions.

  6. Stratified analysis of 800 Asian patients after robot-assisted radical prostatectomy with a median 64 months of follow up.

    PubMed

    Abdel Raheem, Ali; Kim, Dae Keun; Santok, Glen Denmer; Alabdulaali, Ibrahim; Chung, Byung Ha; Choi, Young Deuk; Rha, Koon Ho

    2016-09-01

    To report the 5-year oncological outcomes of robot-assisted radical prostatectomy from the largest series ever reported from Asia. A retrospective analysis of 800 Asian patients who were treated with robot-assisted radical prostatectomy from July 2005 to May 2010 in the Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea was carried out. The primary end-point was to evaluate the biochemical recurrence. The secondary end-point was to show the biochemical recurrence-free survival, metastasis-free survival and cancer-specific survival. A total of 197 (24.65%), 218 (27.3%), and 385 (48.1%) patients were classified as low-, intermediate- and high-risk patients according to the D'Amico risk stratification risk criteria, respectively. The median follow-up period was 64 months (interquartile range 28-71 months). The overall incidence of positive surgical margin was 36.6%. There was biochemical recurrence in 183 patients (22.9%), 38 patients (4.8%) developed distant metastasis and 24 patients (3%) died from prostate cancer. Actuarial biochemical recurrence-free survival, metastasis-free survival, and cancer-specific survival rates at 5 years were 76.4%, 94.6% and 96.7%, respectively. Positive lymph node was associated with lower 5-year biochemical recurrence-free survival (9.1%), cancer-specific survival (75.7%) and metastasis-free survival (61.9%) rates (P < 0.001). On multivariable analysis, among all the predictors, positive lymph node was the strongest predictor of biochemical recurrence, cancer-specific survival and metastasis-free survival (P < 0.001). Herein we report the largest robot-assisted radical prostatectomy series from Asia. Robot-assisted radical prostatectomy is confirmed to be an oncologically safe procedure that is able to provide effective 5-year cancer control, even in patients with high-risk disease. © 2016 The Japanese Urological Association.

  7. Biochemical failure after radical prostatectomy in intermediate-risk group men increases with the number of risk factors

    PubMed Central

    Furubayashi, Nobuki; Negishi, Takahito; Iwai, Hidenori; Nagase, Kei; Taguchi, Kenichi; Shimokawa, Mototsugu; Nakamura, Motonobu

    2017-01-01

    Introduction: We aimed to determine whether the number and type of risk factors are associated with biochemical recurrence-free survival after radical prostatectomy in men with D’Amico intermediate-risk prostate cancer. Materials and Methods: Between August 1998 and May 2013, 481 Japanese patients underwent antegrade radical prostatectomy. The relationships between the rate of PSA failure after radical prostatectomy and the number and type of risk factors were examined in the intermediate-risk group. Results: According to the D’Amico criteria, the low-, intermediate-, and high-risk groups comprised 107, 222, and 152 patients, respectively. The median follow-up period after surgery was 54.1 months. The 5-year PSA failure-free rates in the low-, intermediate-, and high-risk groups were 96.5%, 88.9%, and 72.6%, respectively (P < 0.001). The 5-year PSA failure-free rate in the intermediate-risk group with one, two, and three intermediate risk factors was 94.9%, 88.4%, and 49.0%, respectively (P < 0.001). The difference between the high- and intermediate-risk group with three intermediate risk factors was statistically significant based on the log-rank test (P = 0.039). Conclusion: The number of intermediate risk factors is significantly associated with the PSA failure-free survival rate after radical prostatectomy in the intermediate-risk group. Patients classified into the intermediate-risk group based on all three intermediate risk factors are less likely to achieve a complete cure through surgery alone. PMID:28197033

  8. Influence of magnetic resonance imaging in the decision to preserve or resect neurovascular bundles at robotic assisted laparoscopic radical prostatectomy.

    PubMed

    Park, Bong Hee; Jeon, Hwang Gyun; Jeong, Byong Chang; Seo, Seong Il; Lee, Hyun Moo; Choi, Han Yong; Jeon, Seong Soo

    2014-07-01

    We evaluated the accuracy of preoperative multiparametric 3.0-T magnetic resonance imaging for local staging of prostate cancer and its influence in the decision to preserve neurovascular bundles at robotic assisted laparoscopic radical prostatectomy. The study included 353 patients who had confirmed prostate cancer and underwent preoperative magnetic resonance imaging and robotic assisted laparoscopic radical prostatectomy between 2008 and 2011. The extent of neurovascular bundle sparing was initially determined on the basis of the clinical information and the nerve sparing surgical plan was reevaluated after review of the magnetic resonance imaging report. The value of preoperative magnetic resonance imaging in the prediction of extracapsular extension and in the decision of surgical plan according to D'Amico risk classification was analyzed. The magnetic resonance imaging performed correct staging, over staging and under staging in 261 (73.9%), 43 (12.2%), and 49 (13.9%) patients, respectively. After review of the magnetic resonance imaging reports, the initial surgical plan was not changed in 260 patients (74%) and was changed in 93 patients (26%). Robotic assisted laparoscopic radical prostatectomy was changed to a more preservable neurovascular bundle sparing procedure in 53 patients (57%) and changed to a more aggressive neurovascular bundle resecting procedure in 40 patients (43%). For the patients with a change to more conservative surgery, the appropriateness was 91%. The sensitivity of magnetic resonance imaging in predicting extracapsular extension showed a tendency to increase from low to high risk groups (33%, 46%, 80%, respectively, p <0.001). In intermediate and high risk groups, there was a surgical plan change in 40 patients (of 129, 31%) and 27 patients (of 67, 40%), respectively. Preoperative magnetic resonance imaging significantly improves the decision making to preserve or resect the neurovascular bundle at robotic assisted laparoscopic

  9. Prostate Cancer Expression Profiles of Cytoplasmic ERβ1 and Nuclear ERβ2 are Associated with Poor Outcomes following Radical Prostatectomy.

    PubMed

    Schade, George R; Holt, Sarah K; Zhang, Xiaotun; Song, Dan; Wright, Jonathan L; Zhao, Shanshan; Kolb, Suzanne; Lam, Hung-Ming; Levin, Linda; Leung, Yuet-Kin; Ho, Shuk-Mei; Stanford, Janet L

    2016-06-01

    Existing data regarding the expression of estrogen receptors (ERs) and prostate cancer outcomes have been limited. We evaluated the relationship of expression profiles of ERβ subtypes and the ER GPR30 (G-protein-coupled receptor-30) with patient factors at diagnosis and outcomes following radical prostatectomy. Tissue microarrays constructed using samples from 566 men with long-term clinical followup were analyzed by immunohistochemistry targeting ERβ1, ERβ2, ERβ5 and GPR30. An experienced pathologist scored receptor distribution and staining intensity. Tumor staining characteristics were evaluated for associations with patient characteristics, recurrence-free survival and prostate cancer specific mortality following radical prostatectomy. Prostate cancer cells had unique receptor subtype staining patterns. ERβ1 demonstrated predominantly nuclear localization while ERβ2, ERβ5 and GPR30 were predominantly cytoplasmic. After controlling for patient factors intense cytoplasmic ERβ1 staining was independently associated with time to recurrence (HR 1.7, 95% CI 1.1-2.6, p = 0.01) and prostate cancer specific mortality (HR 6.6, 95% CI 1.8-24.9, p = 0.01). Intense nuclear ERβ2 staining was similarly independently associated with prostate cancer specific mortality (HR 3.9, 95% CI 1.1-13.4, p = 0.03). Patients with cytoplasmic ERβ1 and nuclear ERβ2 co-staining had significantly worse 15-year prostate cancer specific mortality than patients with expression of only cytoplasmic ERβ1, only nuclear ERβ2 and neither ER (16.4%, 4.3%, 0.0% and 2.0 %, respectively, p = 0.001). Increased cytoplasmic ERβ1 and nuclear ERβ2 expression is associated with worse cancer specific outcomes following radical prostatectomy. These findings suggest that tumor ERβ1 and ERβ2 staining patterns provide prognostic information on patients treated with radical prostatectomy. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All

  10. The normal post-surgical anatomy of the male pelvis following radical prostatectomy as assessed by magnetic resonance imaging.

    PubMed

    Allen, Steven D; Thompson, Alan; Sohaib, S Aslam

    2008-06-01

    The magnetic resonance imaging (MRI) appearances of recurrent prostate cancer following radical prostatectomy have been documented in the radiology literature; however little has been written on the range of normal post-operative appearances. Common routes of surgical access for radical prostatectomy include retropubic and transperineal, although newer minimally invasive methods are gaining increasing acceptance. Specifically the range of appearances of the anastomotic site, the prostatic bed, the position of the bladder base, periurethral tissue, levator sling, rectum and residual seminal vesicles (if present) are demonstrated. A non-enhancing low signal nodule is frequently seen at the vesicourethral anastomosis or within the seminal vesicle remnant and usually represents fibrosis. Appearances following different surgical accesses do not differ tremendously, although the retropubic fat pad is reduced or absent following a retropubic approach. Anterior rectal-wall scarring may be present following a transperineal approach. Other post-surgical findings that may mimic disease include a lymphocoele and injected bladder-neck bulking agent. Many patients referred for MRI following radical prostatectomy will have a pathological study showing disease recurrence, although in non-pathological studies the radiological features can differ significantly. It is important for the radiologist to be aware of the spectrum of normal post-surgical appearances so not to confuse these with locally recurrent disease.

  11. Statins and prostate cancer recurrence following radical prostatectomy or radiotherapy: a systematic review and meta-analysis

    PubMed Central

    Park, H. S.; Schoenfeld, J. D.; Mailhot, R. B.; Shive, M.; Hartman, R. I.; Ogembo, R.; Mucci, L. A.

    2013-01-01

    Background In this meta-analysis, we evaluated associations between statins and recurrence-free survival (RFS) following treatment of localized prostate cancer, with attention to potential benefits among patients treated primarily with radiotherapy (RT) versus radical prostatectomy. Patients and methods We identified original studies examining the effect of statins on men who received definitive treatment of localized prostate cancer using a systematic search of the PubMed and EMBASE databases through August 2012. Our search yielded 17 eligible studies from 794 references; 13 studies with hazard ratios (HRs) for RFS were included in the formal meta-analysis. Results Overall, statins did not affect RFS (HR 0.90, 95% CI 0.74–1.08). However, in RT patients (six studies), statins were associated with a statistically significant improvement in RFS (HR 0.68; 95% CI 0.49–0.93); this benefit was not observed in radical prostatectomy patients (seven studies). Sensitivity analyses suggested that primary treatment modality may impact the effect of statins on prostate cancer recurrence. Conclusions Our meta-analysis suggests a potentially beneficial effect of statins on prostate cancer patients treated with RT but not among radical prostatectomy patients. Although limited by the lack of randomized data, these results suggest that primary treatment modality should be considered in future studies examining associations between statins and oncologic outcomes. PMID:23508824

  12. Influential factors in the response to salvage radiotherapy after radical prostatectomy.

    PubMed

    Algarra, R; Tienza, A; Hevia, M; Zudaire, J; Rosell, D; Robles, J E; Pascual, I

    2014-12-01

    To analyze the influential factors in the response in prostatectomized patients with subsequent biochemical relapse (BCR) and treated with salvage radiotherapy (RTP). We analyzed 313 patients with pT2/pT3 prostate cancer who were receiving salvage therapy due to biochemical relapse (from a series of 1,310 radical prostatectomies between 1989-2012). Of the 313 patients; 159 (50.8%) only received androgen deprivation (AD), 63 (20.1%) Radiotherapy (RTP) plus concomitant AD and 91 (29.1%) only RTP. Of these, 57 (62.6%) have maintained complete response and 34 (37.4%) had failure response with post-RTP BCR. Study of the group treated exclusively with salvage RTP. Ninety-one patients were treated with salvage RTP. Median follow-up was 6.4 years and median to recurrence 11 months. Post-RTP biochemical relapse-free survival (PRBRFS) was 68 ± 7% and 30 ± 10% in 5 to 10 years. Median PRBRFS was 7.3 years (6.3-8.3). Initial PSA (HR: 1.08; 95% CI: 1.01-1.1 P=.02) with best PSA cut-off point PSA>20 ng/ml (HR: 13.6; 95% CI: 2.1-86 P=.005) and PSA pre-RTP (HR: 1.9; 95% CI: 1.2-3.3; P=.009), best PSA cut-off point PSA preRTP 0.92 ng/ml (HR: 4.5; 95% CI: 1.3-15.6; P=.01) showed independent influence in the response in the multivariate study. PRBRFS at 5 years, 81 ± 9% versus 58 ± 9% with initial PSA <20 or >20 ng/ml (P=.03). PRBRFS at 5 years, 93 ± 5% versus 53 ± 10% according to PSA pre-RTP <0.9 or >0.9 ng/ml (P=.02). In patients treated with salvage RTP after radical prostatectomy, the preoperative PSA>20 ng/ml and PSA preRTP>0.92 ng/ml shows an independent influence on the response. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  13. The Benefits and Harms of Different Extents of Lymph Node Dissection During Radical Prostatectomy for Prostate Cancer: A Systematic Review.

    PubMed

    Fossati, Nicola; Willemse, Peter-Paul M; Van den Broeck, Thomas; van den Bergh, Roderick C N; Yuan, Cathy Yuhong; Briers, Erik; Bellmunt, Joaquim; Bolla, Michel; Cornford, Philip; De Santis, Maria; MacPepple, Ekelechi; Henry, Ann M; Mason, Malcolm D; Matveev, Vsevolod B; van der Poel, Henk G; van der Kwast, Theo H; Rouvière, Olivier; Schoots, Ivo G; Wiegel, Thomas; Lam, Thomas B; Mottet, Nicolas; Joniau, Steven

    2017-07-01

    There is controversy regarding the therapeutic role of pelvic lymph node dissection (PLND) in patients undergoing radical prostatectomy for prostate cancer (PCa). To systematically review the relevant literature assessing the relative benefits and harms of PLND for oncological and non-oncological outcomes in patients undergoing radical prostatectomy for PCa. MEDLINE, MEDLINE In-Process, Embase, and the Cochrane Central Register of Controlled Trials were searched up to December 2015. Comparative studies evaluating no PLND, limited, standard, and (super)-extended PLND that reported oncological and non-oncological outcomes were included. Risk-of-bias and confounding assessments were performed. A narrative synthesis was undertaken. Overall, 66 studies recruiting a total of 275,269 patients were included (44 full-text articles and 22 conference abstracts). Oncological outcomes were addressed by 29 studies, one of which was a randomized clinical trial (RCT). Non-oncological outcomes were addressed by 43 studies, three of which were RCTs. There were high risks of bias and confounding in most studies. Conflicting results emerged when comparing biochemical and clinical recurrence, while no significant differences were observed among groups for survival. Conversely, the majority of studies showed that the more extensive the PLND, the greater the adverse outcomes in terms of operating time, blood loss, length of stay, and postoperative complications. No significant differences were observed in terms of urinary continence and erectile function recovery. Although representing the most accurate staging procedure, PLND and its extension are associated with worse intraoperative and perioperative outcomes, whereas a direct therapeutic effect is still not evident from the current literature. The current poor quality of evidence indicates the need for robust and adequately powered clinical trials. Based on a comprehensive review of the literature, this article summarizes the benefits

  14. Need for High Radiation Dose (>=70 Gy) in Early Postoperative Irradiation After Radical Prostatectomy: A Single-Institution Analysis of 334 High-Risk, Node-Negative Patients

    SciTech Connect

    Cozzarini, Cesare; Montorsi, Francesco; Fiorino, Claudio; Alongi, Filippo; Bolognesi, Angelo; Da Pozzo, Luigi Filippo; Guazzoni, Giorgio; Freschi, Massimo; Roscigno, Marco; Scattoni, Vincenzo; Rigatti, Patrizio; Di Muzio, Nadia

    2009-11-15

    Purpose: To determine the clinical benefit of high-dose early adjuvant radiotherapy (EART) in high-risk prostate cancer (hrCaP) patients submitted to radical retropubic prostatectomy plus pelvic lymphadenectomy. Patients and Methods: The clinical outcome of 334 hrCaP (pT3-4 and/or positive resection margins) node-negative patients submitted to radical retropubic prostatectomy plus pelvic lymphadenectomy before 2004 was analyzed according to the EART dose delivered to the prostatic bed, <70.2 Gy (lower dose, median 66.6 Gy, n = 153) or >=70.2 Gy (median 70.2 Gy, n = 181). Results: The two groups were comparable except for a significant difference in terms of median follow-up (10 vs. 7 years, respectively) owing to the gradual increase of EART doses over time. Nevertheless, median time to prostate-specific antigen (PSA) failure was almost identical, 38 and 36 months, respectively. At univariate analysis, both 5-year biochemical relapse-free survival (bRFS) and disease-free survival (DFS) were significantly higher (83% vs. 71% [p = 0.001] and 94% vs. 88% [p = 0.005], respectively) in the HD group. Multivariate analysis confirmed EART dose >=70 Gy to be independently related to both bRFS (hazard ratio 2.5, p = 0.04) and DFS (hazard ratio 3.6, p = 0.004). Similar results were obtained after the exclusion of patients receiving any androgen deprivation. After grouping the hormone-naive patients by postoperative PSA level the statistically significant impact of high-dose EART on both 5-year bRFS and DFS was maintained only for those with undetectable values, possibly owing to micrometastatic disease outside the irradiated area in case of detectable postoperative PSA values. Conclusion: This series provides strong support for the use of EART doses >=70 Gy after radical retropubic prostatectomy in hrCaP patients with undetectable postoperative PSA levels.

  15. [Individual learning curve for radical robot-assisted prostatectomy based on the example of three professionals working in one clinic].

    PubMed

    Rasner, P I; Pushkar', D Iu; Kolontarev, K B; Kotenkov, D V

    2014-01-01

    The appearance of new surgical technique always requires evaluation of its effectiveness and ease of acquisition. A comparative study of the results of the first three series of successive robot-assisted radical prostatectomy (RARP) performed on at time by three surgeons, was conducted. The series consisted of 40 procedures, and were divided into 4 groups of 10 operations for the analysis. When comparing data, statistically significant improvement of intra- and postoperative performance in each series was revealed, with increase in the number of operations performed, and in each subsequent series compared with the preceding one. We recommend to perform the planned conversion at the first operation. In our study, previous laparoscopic experience did not provide any significant advantages in the acquisition of robot-assisted technology. To characterize the individual learning curve, we recommend the use of the number of operations that the surgeon looked in the life-surgery regimen and/or in which he participated as an assistant before his own surgical activity, as well as the indicator "technical defect". In addition to the term "individual learning curve", we propose to introduce the terms "surgeon's individual training phase", and "clinic's learning curve".

  16. Biobanking after robotic-assisted radical prostatectomy: a quality assessment of providing prostate tissue for RNA studies

    PubMed Central

    2011-01-01

    Background RNA quality is believed to decrease with ischaemia time, and therefore open radical prostatectomy has been advantageous in allowing the retrieval of the prostate immediately after its devascularization. In contrast, robotic-assisted laparoscopic radical prostatectomies (RALP) require the completion of several operative steps before the devascularized prostate can be extirpated, casting doubt on the validity of this technique as a source for obtaining prostatic tissue. We seek to establish the integrity of our biobanking process by measuring the RNA quality of specimens derived from robotic-assisted laparoscopic radical prostatectomy. Methods We describe our biobanking process and report the RNA quality of prostate specimens using advanced electrophoretic techniques (RNA Integrity Numbers, RIN). Using multivariate regression analysis we consider the impact of various clinicopathological correlates on RNA integrity. Results Our biobanking process has been used to acquire 1709 prostates, and allows us to retain approximately 40% of the prostate specimen, without compromising the histopathological evaluation of patients. We collected 186 samples from 142 biobanked prostates, and demonstrated a mean RIN of 7.25 (standard deviation 1.64) in 139 non-stromal samples, 73% of which had a RIN ≥ 7. Multivariate regression analysis revealed cell type - stromal/epithelial and benign/malignant - and prostate volume to be significant predictors of RIN, with unstandardized coefficients of 0.867(p = 0.001), 1.738(p < 0.001) and -0.690(p = 0.009) respectively. A mean warm ischaemia time of 120 min (standard deviation 30 min) was recorded, but multivariate regression analysis did not demonstrate a relationship with RIN within the timeframe of the RALP procedure. Conclusions We demonstrate the robustness of our protocol - representing the concerted efforts of dedicated urology and pathology departments - in generating RNA of sufficient concentration and quality, without

  17. [Effects of urinary function and erectile function on the use of mecobalamin after nerve sparing radical prostatectomy].

    PubMed

    Matsushita, Mabumi; Nakagawa, Haruo; Namiki, Shunichi; Ikeda, Yoshihiro; Kaiho, Yasuhiro; Kawamorita, Naoki; Ito, Akihiro; Ishidoya, Shigeto; Saito, Seiichi; Arai, Yoichi

    2009-01-01

    Mecobalamin has been reported to be useful for peripheral nerve disorder. There have been no previous reports of the effects of mecobalamin on urinary and sexual function after nerve sparing radical prostatectomy. We examined the effects of the use of mecobalamin on urinary and erectile functions after nerve sparing radical prostatectomy. A total of 54 patients with localized prostatic cancer were prospectively randomized into 2 groups. The 27 patients in group A were treated with nerve sparing prostatectomy and mecobalamin 1,500 microg/day for 6 months. The 27 patients in group B were treated with nerve sparing prostatectomy alone. Urinary function (URF), urinary bother (URB), sexual function (SXF) and sexual bother (SXB) were evaluated using the University of California at Los Angeles Prostate Cancer Index (UCLA-PCI) before surgery, and 3, 6 and 12 months after surgery. There were no significant differences in URF, URB, SXF or SXB between the two groups at any postoperative period. At 3 months after surgery, however, group A tended to have a better URF than group B (85.7 +/- 4.7 (mean +/- standard error) vs. 66.9 +/- 10.2) and URB (85.7 +/- 7.4 vs. 63.9 +/- 11.8) (p = 0.121, p = 0.168). At 12 months after surgery, both groups showed similar URF (86.4 +/- 7.4 vs. 81.8 +/- 4.2) and URB (86.5 +/- 8.3 vs. 84.5 +/- 4.7). Although the two groups had similar recovery phase of SXF, group A tended to report better SXB throughout the postoperative period. This study did not demonstrate any significant effect of the use of mecobalamin on the recovery of urinary or sexual function after nerve sparing prostatectomy, although an early recovery effect on urinary function was suggested. A randomized controlled study with a larger population is warranted to fully elucidate the role of mecobalamin in the improvement of functional outcome after radical prostatectomy.

  18. Penile vascular evaluation and sexual function before and after radical retropubic prostatectomy: 5-year follow-up.

    PubMed

    Dubbelman, Yvette D; Wildhagen, Mark F; Dohle, Gert R

    2008-09-01

    Sexual dysfunction is common after surgery for prostate cancer. The aetiology of changes in sexual potency after radical prostatectomy is probably multifactorial, including neurogenic, vascular and psychosexual factors. A prospective study was designed to investigate haemodynamic and psychosexual changes before and after radical retropubic prostatectomy (RRP) for organ-confined prostate cancer. Penile haemodynamic evaluation and an assessment of sexual excitement were performed preoperatively and 3 months after RRP by colour Doppler ultrasonography (CDU) with visual erotic stimulation combined with a single intracavernous injection of a mixture of papaverine/phentolamine. Questionnaires on sexual function [International Index of Erectile Function (IIEF)], general health and quality of life were sent to the patients preoperative, 3 months and 5 years after operation. Forty-eight men participated in the study. Mean age was 62.6 years (range 55-69). CDU did not show any significant reduction in mean peak systolic flow velocity and mean resistance index. From the men who preoperatively had normal arterial inflow 18% developed arteriogenic insufficiency. Some form of veno-occlusive insufficiency and low resistance indices were already present in the majority of normal potent men preoperatively. Surgical technique did not influence penile arterial blood flow after the operation. Three months and 5 years postoperatively, there was a highly significant reduction in erectile function, intercourse satisfaction, overall satisfaction, orgasmic function and sexual desire. However, with respect to the outcome at 3 months there was a significant improvement of orgasmic function 5 years after operation, especially after a bilateral nerve sparing procedure. Erections sufficient for vaginal penetration (questions 3 and 4 of the IIEF, score >or=8) improved from 2% to 11% 3 months and 5 years after RRP respectively. Total IIEF score was significantly better after a bilateral nerve

  19. Number of metastatic lymph nodes as determinant of outcome after salvage radical prostatectomy for radiation-recurrent prostate cancer.

    PubMed

    Gugliemetti, G; Sukhu, R; Conca Baenas, M A; Meeks, J; Sjoberg, D D; Eastham, J A; Scardino, P T; Touijer, K

    2016-09-01

    Presence of lymph node metástasis (LNM) at salvage radical prostatectomy (sRP) is associated with poor outcome. Predictors of outcome in this context remain undetermined. ThE objective was to assess the role of number of positive lymph node on outcome of patients with LNM after sRP and for radio-recurrent prostate cancer. We analyzed data from a consecutive cohort of 215 men treated with sRP at a single institution. We used univariate Cox proportional hazard regression models for biochemical recurrence (BCR) and metastatic outcomes, with prostate-specific antigen, Gleason score, extraprostatic extension, seminal vesicle invasion, time between radiation therapy and sRP, and number of positive nodes as predictors. Of the 47 patients with LNM, 37 developed BCR, 11 developed distant metastasis and 4 died with a median follow-up of 2.3 years for survivors. The risk of metastases increased with higher pre-operative PSA levels (HR 1.19 per 1ng/ml; 95% CI: 1.06-1.34; P=.003). The remaining predictors did not reach conventional levels of significance. However, removal of 3 or more positive lymph nodes demonstrated a positive association, as expected, with metastatic disease (HR 3.44; 95% CI: 0.91-13.05; P=.069) compared to one or 2 positive nodes. Similarly, the presence of extraprostatic extension, seminal vesicle invasion and Gleason grade greater than 7 also demonstrated a positive association with higher risk of metástasis, with hazard ratios of 3.97 (95% CI: 0.50, 31.4; P=.2), 3.72 (95% CI: 0.80-17.26; P=.1), and 1.45 (95% CI: 0.44-4.76; P=.5), respectively. In patients with LNM after sRP for radio-recurrent prostate cancer, the risk of distant metástasis is likely to be influenced by the number of positive nodes (3 or more), high preoperative PSA, Gleason grade and advanced pathologic stage. These results are consistent with the findings of number of nodes (1 to 2 vs. 3 or more nodes positive) as a prognostic indicator after primary radical prostatectomy and

  20. Vacuum therapy in penile rehabilitation after radical prostatectomy: review of hemodynamic and antihypoxic evidence

    PubMed Central

    Qian, Sheng-Qiang; Gao, Liang; Wei, Qiang; Yuan, Jiuhong

    2016-01-01

    Generally, hypoxia is a normal physiological condition in the flaccid penis, which is interrupted by regular nocturnal erections in men with normal erectile function.1 Lack of spontaneous and nocturnal erections after radical prostatectomy due to neuropraxia results in persistent hypoxia of cavernosal tissue, which leads to apoptosis and degeneration of cavernosal smooth muscle fibers. Therefore, overcoming hypoxia is believed to play a crucial role during neuropraxia. The use of a vacuum erectile device (VED) in penile rehabilitation is reportedly effective and may prevent loss of penile length. The corporal blood after VED use is increased and consists of both arterial and venous blood, as revealed by color Doppler sonography and blood gas analysis. A similar phenomenon was observed in negative pressure wound therapy (NPWT). However, NPWT employs a lower negative pressure than VED, and a hypoperfused zone, which increases in response to negative pressure adjacent to the wound edge, was observed. Nonetheless, questions regarding ideal subatmospheric pressure levels, modes of action, and therapeutic duration of VED remain unanswered. Moreover, it remains unclear whether a hypoperfused zone or PO2 gradient appears in the penis during VED therapy. To optimize a clinical VED protocol in penile rehabilitation, further research on the mechanism of VED, especially real-time PO2 measurements in different parts of the penis, should be performed. PMID:26289397

  1. The Da Vinci Xi and robotic radical prostatectomy-an evolution in learning and technique.

    PubMed

    Goonewardene, S S; Cahill, D

    2017-06-01

    The da Vinci Xi robot has been introduced as the successor to the Si platform. The promise of the Xi is to open the door to new surgical procedures. For robotic-assisted radical prostatectomy (RARP)/pelvic surgery, the potential is better vision and longer instruments. How has the Xi impacted on operative and pathological parameters as indicators of surgical performance? This is a comparison of an initial series of 42 RARPs with the Xi system in 2015 with a series using the Si system immediately before Xi uptake in the same calendar year, and an Si series by the same surgeon synchronously as the Xi series using operative time, blood loss, and positive margins as surrogates of surgical performance. Subjectively and objectively, there is a learning curve to Xi uptake in longer operative times but no impact on T2 positive margins which are the most reflective single measure of RARP outcomes. Subjectively, the vision of the Xi is inferior to the Si system, and the integrated diathermy system and automated setup are quirky. All require experience to overcome. There is a learning curve to progress from the Si to Xi da Vinci surgical platforms, but this does not negatively impact the outcome.

  2. [Treatment of erectile dysfunction after nerve-preserving radical retropubic prostatectomy].

    PubMed

    Veliev, E I; Loran, O B

    2006-01-01

    The aim of the study was evaluation of erectile function (EF) recovery and effects of PDE-5 inhibitor tadalafil in the treatment of erectile impairment one year after conduction of nerve-preserving retropubic radical prostatectomy (RRP). Thirty patients with intact EF before surgery who had RRP were divided into two groups. In 18 patients of group I vasculonervous fascicles (VNF) were preserved on both sides. A unilateral nerve-preserving technique was used in 12 patients of group 2. Tadalafil administration was started 3 months after operation in the dose 20 mg. In group I partial erection was observed in 11 patients, was absent in 33% (6 patients), a complete erection was in one (6%) patient. Thus, 67% (12 patients) could maintain erection sufficient for coitus. Out of 12 patients of group 2, a complete erection was achieved in none patients, partial erection was observed in 5 (42%) patients, erection did not occur in 7 (58%) patients. Thus, EF is better in patients with bilateral preservation of VNF than in unilateral one. Pharmacotherapy of erectile dysfunction after nerve-preserving RRP is most effective. It is desirable to adhere to early postoperative policy in the treatment of EF. PDE-5 inhibitors are rather effective if the patient has a partial erection. They fail in the absence of spontaneous erections. Early therapy prevents subsequent progression of erectile dysfunction.

  3. Multiparametric MRI for Recurrent Prostate Cancer Post Radical Prostatectomy and Postradiation Therapy

    PubMed Central

    2014-01-01

    The clinical suspicion of local recurrence of prostate cancer (PCa) after radical prostatectomy (RP) and after radiation therapy (RT) is based on the onset of biochemical failure. The aim of this paper was to review the current role of multiparametric-MRI (mp-MRI) in the detection of locoregional recurrence. A systematic literature search using the Medline and Cochrane Library databases was performed from January 1995 up to November 2013. Bibliographies of retrieved and review articles were also examined. Only those articles reporting complete data with clinical relevance for the present review were selected. This review article is divided into two major parts: the first one considers the role of mp-MRI in the detection of PCa local recurrence after RP; the second part provides an insight about the impact of mp-MRI in the depiction of locoregional recurrence after RT (interstitial or external beam). Published data indicate an emerging role for mp-MRI in the detection and localization of locally recurrent PCa both after RP and RT which represents an information of paramount importance to perform focal salvage treatments. PMID:24967355

  4. Vacuum therapy in penile rehabilitation after radical prostatectomy: review of hemodynamic and antihypoxic evidence.

    PubMed

    Qian, Sheng-Qiang; Gao, Liang; Wei, Qiang; Yuan, Jiuhong

    2016-01-01

    Generally, hypoxia is a normal physiological condition in the flaccid penis, which is interrupted by regular nocturnal erections in men with normal erectile function. [1] Lack of spontaneous and nocturnal erections after radical prostatectomy due to neuropraxia results in persistent hypoxia of cavernosal tissue, which leads to apoptosis and degeneration of cavernosal smooth muscle fibers. Therefore, overcoming hypoxia is believed to play a crucial role during neuropraxia. The use of a vacuum erectile device (VED) in penile rehabilitation is reportedly effective and may prevent loss of penile length. The corporal blood after VED use is increased and consists of both arterial and venous blood, as revealed by color Doppler sonography and blood gas analysis. A similar phenomenon was observed in negative pressure wound therapy (NPWT). However, NPWT employs a lower negative pressure than VED, and a hypoperfused zone, which increases in response to negative pressure adjacent to the wound edge, was observed. Nonetheless, questions regarding ideal subatmospheric pressure levels, modes of action, and therapeutic duration of VED remain unanswered. Moreover, it remains unclear whether a hypoperfused zone or PO 2 gradient appears in the penis during VED therapy. To optimize a clinical VED protocol in penile rehabilitation, further research on the mechanism of VED, especially real-time PO 2 measurements in different parts of the penis, should be performed.

  5. Significance and management of positive surgical margins at the time of radical prostatectomy.

    PubMed

    Silberstein, Jonathan L; Eastham, James A

    2014-10-01

    Positive surgical margins (PSM) at the time of radical prostatectomy (RP) result in an increased risk of biochemical recurrence (BCR) and secondary treatment. We review current literature with a focus on stratifying the characteristics of the PSM that may define its significance, the impact of modern imaging and surgical approaches in avoidance of PSM, and management strategies when PSM do occur. We performed a review of the available literature to identify factors associated with PSM and their management. PSM have been repeatedly demonstrated to be associated with an increased risk of BCR following RP. The specific characteristics (size, number, location, Gleason score at the margin) of the PSM may influence the risk of recurrence. Novel imaging and surgical approaches are being investigated and may allow for reductions of PSM in the future. The use of adjuvant treatment for a PSM remains controversial and should be decided on an individual basis after a discussion about the risks and benefits. The goal of RP is complete resection of the tumor. PSM are associated with increased risk of BCR and secondary treatments. Of the risk factors associated with BCR after RP, a PSM is directly influenced by surgical technique.

  6. Standardized 4-step technique of bladder neck dissection during robot-assisted radical prostatectomy

    PubMed Central

    Zanaty, Marc; Rajih, Emad; El-Hakim, Assaad; Zorn, Kevin C.

    2016-01-01

    Bladder neck (BN) dissection is considered one of the most challenging steps during robot-assisted radical prostatectomy. Better understanding of the BN anatomy, coupled with a standardized approach may facilitate dissection while minimizing complications. We describe in this article the 4 anatomic spaces during standardized BN dissection, as well other technical maneuvers of managing difficult scenarios including treatment of a large median lobe or patients with previous transurethral resection of the prostate. The first step involves the proper identification of the BN followed by slow horizontal dissection of the first layer (the dorsal venous complex and perivesicle fat). The second step proceeds with reconfirming the location of the BN followed by midline dissection of the second anatomical layer (the anterior bladder muscle and mucosa) using the tip of the monopolar scissor until the catheter is identified. The deflated catheter is then grasped by the assistant to apply upward traction on the prostate from 2 directions along with downward traction on the posterior bladder wall by the tip of the suction instrument. This triangulation allows easier, and safer visual, layer by layer, dissection of the third BN layer (the posterior bladder mucosa and muscle wall). The forth step is next performed by blunt puncture of the fourth layer (the retrotrigonal fascia) aiming to enter into the previously dissected seminal vesical space. Finally, both vas deferens and seminal vesicles are pulled through the open BN and handed to the assistant for upper traction to initiate Denovillier's dissection and prostate pedicle/neurovascular bundle control. PMID:27995220

  7. Advanced Imaging for the Early Diagnosis of Local Recurrence Prostate Cancer after Radical Prostatectomy

    PubMed Central

    Musio, Daniela; Proietti, Camilla; Indino, Elena Lucia; Megna, Valentina; Schillaci, Orazio; Catalano, Carlo

    2014-01-01

    Currently the diagnosis of local recurrence of prostate cancer (PCa) after radical prostatectomy (RT) is based on the onset of biochemical failure which is defined by two consecutive values of prostate-specific antigen (PSA) higher than 0.2 ng/mL. The aim of this paper was to review the current roles of advanced imaging in the detection of locoregional recurrence. A nonsystematic literature search using the Medline and Cochrane Library databases was performed up to November 2013. Bibliographies of retrieved and review articles were also examined. Only those articles reporting complete data with clinical relevance for the present review were selected. This review article is divided into two major parts: the first one considers the role of PET/CT in the restaging of PCa after RP; the second part is intended to provide the impact of multiparametric-MRI (mp-MRI) in the depiction of locoregional recurrence. Published data indicate an emerging role for mp-MRI in the depiction of locoregional recurrence, while the performance of PET/CT still remains unclear. Moreover Mp-MRI, thanks to functional techniques, allows to distinguish between residual glandular healthy tissue, scar/fibrotic tissue, granulation tissue, and tumour recurrence and it may also be able to assess the aggressiveness of nodule recurrence. PMID:24757679

  8. Multiparametric MRI for recurrent prostate cancer post radical prostatectomy and postradiation therapy.

    PubMed

    Barchetti, Flavio; Panebianco, Valeria

    2014-01-01

    The clinical suspicion of local recurrence of prostate cancer (PCa) after radical prostatectomy (RP) and after radiation therapy (RT) is based on the onset of biochemical failure. The aim of this paper was to review the current role of multiparametric-MRI (mp-MRI) in the detection of locoregional recurrence. A systematic literature search using the Medline and Cochrane Library databases was performed from January 1995 up to November 2013. Bibliographies of retrieved and review articles were also examined. Only those articles reporting complete data with clinical relevance for the present review were selected. This review article is divided into two major parts: the first one considers the role of mp-MRI in the detection of PCa local recurrence after RP; the second part provides an insight about the impact of mp-MRI in the depiction of locoregional recurrence after RT (interstitial or external beam). Published data indicate an emerging role for mp-MRI in the detection and localization of locally recurrent PCa both after RP and RT which represents an information of paramount importance to perform focal salvage treatments.

  9. Advanced imaging for the early diagnosis of local recurrence prostate cancer after radical prostatectomy.

    PubMed

    Panebianco, Valeria; Barchetti, Flavio; Musio, Daniela; De Felice, Francesca; Proietti, Camilla; Indino, Elena Lucia; Megna, Valentina; Schillaci, Orazio; Catalano, Carlo; Tombolini, Vincenzo

    2014-01-01

    Currently the diagnosis of local recurrence of prostate cancer (PCa) after radical prostatectomy (RT) is based on the onset of biochemical failure which is defined by two consecutive values of prostate-specific antigen (PSA) higher than 0.2 ng/mL. The aim of this paper was to review the current roles of advanced imaging in the detection of locoregional recurrence. A nonsystematic literature search using the Medline and Cochrane Library databases was performed up to November 2013. Bibliographies of retrieved and review articles were also examined. Only those articles reporting complete data with clinical relevance for the present review were selected. This review article is divided into two major parts: the first one considers the role of PET/CT in the restaging of PCa after RP; the second part is intended to provide the impact of multiparametric-MRI (mp-MRI) in the depiction of locoregional recurrence. Published data indicate an emerging role for mp-MRI in the depiction of locoregional recurrence, while the performance of PET/CT still remains unclear. Moreover Mp-MRI, thanks to functional techniques, allows to distinguish between residual glandular healthy tissue, scar/fibrotic tissue, granulation tissue, and tumour recurrence and it may also be able to assess the aggressiveness of nodule recurrence.

  10. Postoperative Mycoplasma hominis infection after robot-assisted laparoscopic radical prostatectomy: A case report.

    PubMed

    Yokoyama, Hitoshi; Domen, Takahisa; Hiragata, Shiro; Ogawa, Teruyuki; Matsumoto, Takehisa; Ishizuka, Osamu

    2016-05-01

    A 59-year-old man developed a high fever, elevated white blood cell count, elevated C-reactive protein level, and perineal pain 5 days after robot-assisted laparoscopic radical prostatectomy. Treatment with cefmetazole was ineffective. A urine specimen was submitted for culture on postoperative day 7, and Mycoplasma hominis (M. hominis) was detected 1 week later. Cefmetazole was therefore switched to quinolone. The clinical symptoms and laboratory data immediately showed marked improvement. M. hominis has been shown to inhabit the genitourinary tract. Although it is considered to induce urethritis, its pathogenicity in healthy male subjects has not been investigated. M. hominis is difficult to detect and is resistant to β-lactams because it lacks a cell wall. Urine culture sometimes results in false-negative results. In cases where empirical therapy for postoperative infection is ineffective, surgeons should recognize the possibility of M. hominis involvement and consider changing the antibiotic used. © 2016 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  11. Frozen section evaluation of margins in radical prostatectomy specimens: a contemporary study and literature review.

    PubMed

    Nunez, Amberly L; Giannico, Giovanna A; Mukhtar, Faisal; Dailey, Virginia; El-Galley, Rizk; Hameed, Omar

    2016-10-01

    The utility of routine frozen section (FS) analysis for margin evaluation during radical prostatectomy (RP) remains controversial. A retrospective search was conducted to identify RPs evaluated by FS over a 5-year period. The potential of FS to discriminate between benign and malignant tissue and to predict final margins was evaluated. During the study period, 71 (12.3%) of 575 cases underwent FS evaluation of margins, generating 192 individual FSs. There were 8 FSs diagnosed as atypical/indeterminate because of significant freezing, crushing, and/or thermal artifacts; 11 as positive for carcinoma; and 173 as benign. Two FSs classified as benign were diagnosed as positive for carcinoma on subsequent permanent section. Frozen sections' sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for diagnosis of prostatic adenocarcinoma were 85%, 100%, 100%, 99%, and 99%, respectively. Overall RP final margin predictive accuracy was 81%. Positive FS was significantly associated with perineural invasion on biopsy and extraprostatic extension and higher stage disease on RP, but not with the overall final margin status. The high FS accuracy supports its use to guide the extent of surgery. However, FS cannot be used to predict the overall final margin status. Recognition of the histological artifacts inherent to the FS procedure is important to ensure appropriate utilization.

  12. Erectile dysfunction post-radical prostatectomy – a challenge for both patient and physician

    PubMed Central

    Bratu, O; Oprea, I; Marcu, D; Spinu, D; Niculae, A; Geavlete, B; Mischianu, D

    2017-01-01

    Post-radical prostatectomy erectile dysfunction (post RP ED) is a major postoperative complication with a great impact on the quality of life of the patients. Until present, no proper algorithm or guideline based on the clinical trials has been established for the management of post RP ED. According to literature, it is better to initiate a penile rehabilitation program as soon as possible after surgery than doing nothing, in order to prevent and limit the postoperative local hypoxygenation and fibrosis. The results of numerous clinical trials regarding the effectiveness of the phosphodiesterase 5 inhibitors therapy on post RP ED have made them the gold standard treatment. Encouraging results have been achieved in studies with vacuum erectile devices, intraurethral suppositories with alprostadil and intracavernosal injections, but due to their side effects, especially in the cases of intracavernosal injections and intraurethral suppositories, their clinical use was limited therefore making them a second line option for the post RP ED treatment. What should not be forgotten is that penile implant prosthesis has proven very effective, numerous studies confirming high rates of satisfaction for both patients and partners. PMID:28255370

  13. Urinary incontinence after radical retropubic prostatectomy: the outcome of a surgical technique.

    PubMed

    Moinzadeh, A; Shunaigat, A N; Libertino, J A

    2003-09-01

    To analyse the incidence of incontinence after radical retropubic prostatectomy (RRP) and the time to return of continence, using an RRP technique including a novel posterior bladder plication We retrospectively reviewed the medical records of 200 consecutive patients who underwent RRP between September 1995 and February 1997, by one surgeon, at our institution. Patient characteristics including age, preoperative prostate-specific antigen (PSA) level and Gleason grade, were assessed. Continence was assessed before and after RRP by either a third-party patient interview or a prospective validated questionnaire. Continence was defined as not requiring the use of any sanitary pads or diapers. The continence rate was determined immediately after catheter removal, and at 3, 6, 12 and 15 months after RRP. The mean age of the patients was 59.4 years, the preoperative PSA level 8.5 ng/mL and the Gleason grade 6.1. The time to continence and percentage of continent patients was 63.5% immediately, 82% at 3 months, 91% at 6 months, and 98.5% at 12 months after RRP. At 15 months, 199 of 200 consecutive patients were continent (99.5%). With our technique there was an early return to continence and only a minor incontinence rate at 15 months. The cumulative effect of sequential technical manoeuvres in our RRP technique, including posterior bladder plication, is critical for continence after RRP.

  14. Independent Predictors of Recovery of Continence 3 Months After Robot-Assisted Laparoscopic Radical Prostatectomy

    PubMed Central

    Kim, Jung Jun; Ha, Yun-Sok; Kim, Jeong Hyun; Jeon, Seong Soo; Lee, Dong-Hyeon; Kim, Wun-Jae

    2012-01-01

    Abstract Purpose To investigate the factors that predict recovery of continence within 3 months after robot-assisted radical prostatectomy (RARP). Patients and Methods The charts of 452 patients who underwent RARP with a minimum follow-up period of 3 months were collected prospectively and reviewed retrospectively. Urinary continence was determined using the self-administered validated Expanded Prostate Cancer Index Composite questionnaire during the routine follow-up visits. Results The overall continence rate 3 months after RARP was 79.9%. In an univariate logistic regression test, age<70 years, higher preoperative Sexual Health Inventory for Men (SHIM) score, lower clinical T1 stage, lower biopsy and pathologic Gleason score, shorter operative time, lower estimated blood loss, smaller prostate volume (<40 cc) were associated with recovery of urinary continence within 3 months after RARP (P<0.05). In multivariate logistic regression analysis, younger age, higher SHIM score, lower clinical T1 stage, lower body mass index (BMI), and smaller prostate volume were independent factors that predicted return of continence within 3 months after RARP (P<0.05). Conclusions Younger age (<70 years), higher preoperative SHIM score, clinical T1 stage, lower BMI, and smaller prostate volume (<40 cc) independently predicted recovery of continence within 3 months after RARP. PMID:22651546

  15. Urethtral Approach in Retroperitoneoscopic Radical Prostatectomy: A Novel Technique for Safe Prostate Dissection

    PubMed Central

    Nozaki, Tetsuo; Morii, Akihiro; Fujiuchi, Yasuyoshi; Fuse, Hideki

    2013-01-01

    Background and Objectives Laparoscopic radical prostatectomy (LRP) remains technically challenging and is associated with a steep learning curve. Prostate apex dissection (PAD) is one the most challenging elements of LRP. This study describes a novel technique for PAD using a transurethral approach (urethral assistance). Methods Through the transurethral route, Young's foreign body forceps is introduced under laparoscopic vision and both vas deferens are grasped for efficient traction of the prostate. The forceps is quickly clamped to the laparoscope holder. Urethral assistance facilitates more efficient dissection during dissection of the bladder neck, vas deferens, and seminal vesicles, transaction of the posterior prostatovesical junction, mobilization of the prostate off the rectum, and ligation of the dorsal venous complex. Results In 10 patients with localized prostate cancer who underwent LRP using the urethral assistance technique, sufficient retraction of the prostate was maintained in the appropriate direction. No complications related to urethral assistance were observed. No internal or external instrument collisions occurred during PAD. Conclusion Urethral assistance provides a simple, reliable, cost-effective approach for performing PAD during LRP. PMID:24917766

  16. Significance and management of positive surgical margins at the time of radical prostatectomy

    PubMed Central

    Silberstein, Jonathan L.; Eastham, James A.

    2014-01-01

    Positive surgical margins (PSM) at the time of radical prostatectomy (RP) result in an increased risk of biochemical recurrence (BCR) and secondary treatment. We review current literature with a focus on stratifying the characteristics of the PSM that may define its significance, the impact of modern imaging and surgical approaches in avoidance of PSM, and management strategies when PSM do occur. We performed a review of the available literature to identify factors associated with PSM and their management. PSM have been repeatedly demonstrated to be associated with an increased risk of BCR following RP. The specific characteristics (size, number, location, Gleason score at the margin) of the PSM may influence the risk of recurrence. Novel imaging and surgical approaches are being investigated and may allow for reductions of PSM in the future. The use of adjuvant treatment for a PSM remains controversial and should be decided on an individual basis after a discussion about the risks and benefits. The goal of RP is complete resection of the tumor. PSM are associated with increased risk of BCR and secondary treatments. Of the risk factors associated with BCR after RP, a PSM is directly influenced by surgical technique. PMID:25378825

  17. Erectile Dysfunction after Radical Prostatectomy: Prevalence, Medical Treatments, and Psychosocial Interventions

    PubMed Central

    Emanu, Jessica C.; Avildsen, Isabelle K.; Nelson, Christian J.

    2016-01-01

    Purpose of review This review will discuss erectile dysfunction (ED) in prostate cancer patients following radical prostatectomy (RP). It will focus on the prevalence and current treatments for ED as well as the emotional impact of ED and the current psychosocial interventions designed to help patients cope with this side effect. Recent findings While there is a large discrepancy in prevalence rates of ED after RP, several recent studies have cited rates as high as 85%. The concept of “penile rehabilitation” is now the standard of practice to treat ED following RP. However, many men avoid seeking help or utilizing ED treatments. This avoidance is related to the shame, frustration, and distress many men with ED and their partners experience. Recent psychosocial interventions have been developed to facilitate the use of treatments and help men cope with ED. These interventions have shown initial promise, however, continued intervention development is needed to reduce distress and improve long-term erectile function (EF) outcomes. Summary ED is a significant problem following prostate cancer surgery. While there are effective medical treatments, the development of psychosocial interventions should continue to evolve to maximize the assistance we can give to men and their partners. PMID:26808052

  18. High Chance of Late Recovery of Urinary and Erectile Function Beyond 12 Months After Radical Prostatectomy.

    PubMed

    Mandel, Philipp; Preisser, Felix; Graefen, Markus; Steuber, Thomas; Salomon, Georg; Haese, Alexander; Michl, Uwe; Huland, Hartwig; Tilki, Derya

    2016-10-12

    Urinary incontinence (UI) and erectile dysfunction (ED) after radical prostatectomy (RP) can impose a strong burden. While most studies focus on certain time points after RP when analyzing functional outcome, there is paucity of evidence on late functional recovery in patients with UI or ED at 12 mo after RP. Using longitudinal patient data from a large European single-center, we show that the chance of regaining continence among patients (n=974) with UI (≥1 pad/24h) at 12 mo after RP was 38.6% after 24 mo and 49.7% after 36 mo. The corresponding rates for patients (n=1115) with ED (defined as International Index of Erectile Function-5 score <18) at 12 mo after RP were 30.8% at 24 mo and 36.5% at 36 mo after RP. Patients with postoperative UI or ED 12 mo after RP should be counseled about their good chance of achieving continence or potency in the course of time.

  19. Do tumor volume, percent tumor volume predict biochemical recurrence after radical prostatectomy? A meta-analysis.

    PubMed

    Meng, Yang; Li, He; Xu, Peng; Wang, Jia

    2015-01-01

    The aim of this meta-analysis was to explore the effects of tumor volume (TV) and percent tumor volume (PTV) on biochemical recurrence (BCR) after radical prostatectomy (RP). An electronic search of Medline, Embase and CENTRAL was performed for relevant studies. Studies evaluated the effects of TV and/or PTV on BCR after RP and provided detailed results of multivariate analyses were included. Combined hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) were calculated using random-effects or fixed-effects models. A total of 15 studies with 16 datasets were included in the meta-analysis. Our study showed that both TV (HR 1.04, 95% CI: 1.00-1.07; P=0.03) and PTV (HR 1.01, 95% CI: 1.00-1.02; P=0.02) were predictors of BCR after RP. The subgroup analyses revealed that TV predicted BCR in studies from Asia, PTV was significantly correlative with BCR in studies in which PTV was measured by computer planimetry, and both TV and PTV predicted BCR in studies with small sample sizes (<1000). In conclusion, our meta-analysis demonstrated that both TV and PTV were significantly associated with BCR after RP. Therefore, TV and PTV should be considered when assessing the risk of BCR in RP specimens.

  20. Combined Whole Body and Multiparametric Prostate Magnetic Resonance Imaging as a 1-Step Approach to the Simultaneous Assessment of Local Recurrence and Metastatic Disease after Radical Prostatectomy.

    PubMed

    Robertson, Nicola L; Sala, Evis; Benz, Matthias; Landa, Jonathan; Scardino, Peter; Scher, Howard I; Hricak, Hedvig; Vargas, Hebert A

    2017-07-01

    prostate magnetic resonance imaging is feasible in a clinical practice setting. It can provide incremental information compared to standard imaging in men with suspected prostate cancer recurrence after radical prostatectomy. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  1. [11C]Choline PET/CT in therapy response assessment of a neoadjuvant therapy in locally advanced and high risk prostate cancer before radical prostatectomy

    PubMed Central

    Schwarzenböck, Sarah M.; Knieling, Anna; Souvatzoglou, Michael; Kurth, Jens; Steiger, Katja; Eiber, Matthias; Esposito, Irene; Retz, Margitta; Kübler, Hubert; Gschwend, Jürgen E.; Schwaiger, Markus; Krause, Bernd J.; Thalgott, Mark

    2016-01-01

    Purpose Recent studies have shown promising results of neoadjuvant therapy in prostate cancer (PC). The aim of this study was to evaluate the potential of [11C]Choline PET/CT in therapy response monitoring after combined neoadjuvant docetaxel chemotherapy and complete androgen blockade in locally advanced and high risk PC patients. Results In [11C]Choline PET/CT there was a significant decrease of SUVmax and SUVmean (p = 0.004, each), prostate volume (p = 0.005) and PSA value (p = 0.003) after combined neoadjuvant therapy. MRI showed a significant prostate and tumor volume reduction (p = 0.003 and 0.005, respectively). Number of apoptotic cells was significantly higher in prostatectomy specimens of the therapy group compared to pretherapeutic biopsies and the control group (p = 0.02 and 0.003, respectively). Methods 11 patients received two [11C]Choline PET/CT and MRI scans before and after combined neoadjuvant therapy followed by radical prostatectomy and pelvic lymph node dissection. [11C]Choline uptake, prostate and tumor volume, PSA value (before/after neoadjuvant therapy) and apoptosis (of pretherapeutic biopsy/posttherapeutic prostatectomy specimens of the therapy group and prostatectomy specimens of a matched control group without neoadjuvant therapy) were assessed and tested for differences and correlation using SPSS. Conclusions The results showing a decrease in choline uptake after combined neoadjuvant therapy (paralleled by regressive and apoptotic changes in histopathology) confirm the potential of [11C]Choline PET/CT to monitor effects of neoadjuvant therapy in locally advanced and high risk PC patients. Further studies are recommended to evaluate its use during the course of neoadjuvant therapy for early response assessment. PMID:27572317

  2. AB269. Optimizing recovery of potency and continence during radical prostatectomy

    PubMed Central

    Kim, Sae Woong

    2016-01-01

    To date, prostate cancer is the most common cancer in men in the United States, with an estimated 218,000 new cases and 27,000 deaths expected each year. The prevalence of prostate cancer in Korea quadrupled between 2002 and 2008, with the highest increased incidence rate in total forms of malignancy. The incidence of prostate cancer in Korea increased up to 24.8 per 100,000 men in 2009 in comparison with 13 per 100,000 men in 2008. Radical prostatectomy (RP), radiation therapy, brachytherapy and androgen ablation are well established options for the treatment of various stages of prostate cancers. However, erectile dysfunction (ED) or postprostatectomy incontinence (PPI) following prostate cancer treatment remains a significant quality of life issue for men. Despite advancements in understanding the anatomy of the prostate and the neurovascular bundle with improved surgical techniques and improved technologies, the incidence of ED after prostate cancer treatment with above mentioned modalities is still very high and ranges from 26% to 100%. RP is the oldest and the most frequent treatment modality for patients with an organ-confined prostate cancer. The challenge for the urologist treating patients with prostate cancer is cancer control with the preservation of erectile function. Since initiation of penile erection is dependent on nerves, preservation of the cavernous nerves during RP is the most important factor for the recovery of erectile function. The pathophysiology of ED after RP involves neural injury, vascular injury, and corporal smooth muscle damage. The neuropraxia and endothelial dysfunction resulting in ischemia, hypoxia, fibrosis and apoptosis are all believed to contribute to ED and penile atrophy associated with prostate cancer treatment. There have been a number of studies that have attempted to prevent or reverse these deleterious changes. However, there are no clear guidelines for penile rehabilitation regimens even though these have become the

  3. A single institution study on patient's self-reporting appraisal and functional outcomes of the first set of men following radical perineal prostatectomy

    PubMed Central

    Słupski, Piotr; Wiśniewski, Przemysław

    2012-01-01

    Introduction This study evaluates the functional outcomes and satisfaction of an initial series of 47 patients after radical perineal prostatectomy performed in our department. Material and methods The first set of 47 consecutive patients underwent perineal prostatectomy during 2008 and 2009. Continence, sexual outcomes, and satisfaction of the treatment were evaluated using a self-reporting questionnaire, which was mailed to all patients after 15 to 33 months of follow-up. 26 patients (55.3%) returned a completed form and participated in the study. Additionally, final outcomes were compared to results reported elsewhere. Results Amid respondents, 91.7% were satisfied with the chosen treatment and 8.3% regret the previous decision. 38.5% patients reported any urine leakage, 15.4% drip up to 100 ml a day, and only one patient (3.8%) was totally incontinent. 76.9% men report a decline in prior sexual function. Six patients (23.1%) patients have any degree of spontaneous erections and undertake sexual activity. However, as erectile outcomes are adjusted to nine nerve-sparing cases, 66.7% have spontaneous erections and 55.5% undertake sexual activity, but only 40% of them describe their sexual function as satisfying. Conclusions Our survey demonstrates that, because of short operating time, fast recovery, low postoperative pain score, early patient mobilization and feeding, and a small (8-10 cm) and inconspicuous skin incision, radical perineal prostatectomy fully deserves to be recognized as a low-morbidity procedure. The perineal approach provides a quality of life and patients satisfaction rate comparable to trendy, highly equipped procedures and emerges as an attractive alternative to them. Even novice “perineal surgeons” may achieve favorable results. PMID:24578947

  4. Multimodal analgesic approach incorporating paravertebral blocks for open radical retropubic prostatectomy: a randomized double-blind placebo-controlled study.

    PubMed

    Chelly, Jacques E; Ploskanych, Taras; Dai, Feng; Nelson, Joel B

    2011-04-01

    Perioperative pain management influences both the quality as well as the speed of recovery following surgery. This was a randomized double-blind placebo-controlled study designed to assess the effectiveness of a multimodal analgesic approach (MMA) vs patient-controlled analgesia (PCA) alone in patients undergoing open prostatectomy. Prior to surgery, paravertebral blocks (PVBs) were performed with either 0.5% ropivacaine in the MMA group or saline in the PCA group. Patients in the MMA group also received celecoxib (400 mg po prior to surgery and 200 mg po bid for seven days following surgery) and ketamine 10 mg iv. Following surgery, every patient had free access to morphine PCA. A pain numerical rating scale (NRS) at 24 hr was chosen as the primary endpoint. Secondary endpoints included morphine consumption at 24 hr and SF-36 (36-Item Short-Form Health Survey) scores from two weeks to 24 weeks following surgery. The primary endpoint, average pain NRS at 24 hr, was 2.6 in the MMA group compared with 3.9 in the PCA group (difference = -1.6, 95% confidence interval [CI]: -2.3 to -0.4; P = 0.01). The average morphine consumption at 24 hr was 4.8 mg in the MMA group compared with 10.5 mg in the PCA group (difference = -5.7, 95% CI: -13.0 to 0.5; P = 0.01). Higher SF-36 scores at two, four, eight, and 12 weeks were observed in the MMA group compared with the PCA group, but no statistically significant (P < 0.05) between-group difference was found after Bonferroni correction of comparisons conducted repeatedly over time. Postoperative adverse effects included low episodes of postoperative nausea and vomiting, bladder spasms, constipation, and pruritus. This study demonstrates that PVBs combined with celecoxib and ketamine provide better immediate postoperative pain control and facilitate earlier functional recovery in patients undergoing an open radical prostatectomy when compared with PCA alone.

  5. Evaluation of Lymphorrhea and Incidence of Lymphoceles: 4DryField® PH in Radical Retropubic Prostatectomy

    PubMed Central

    Karsch, Johannes-J.; Berthold, Martin; Breul, Jürgen

    2016-01-01

    Purpose. To investigate impact of polysaccharide hemostat 4DryField PH (4DF) applied on lymph node dissection area after radical retropubic prostatectomy (RRP) on lymphorrhea and lymphocele (LC) formation. Methods. 104 consecutive patients underwent RRP, 51 without 4DF treatment (CT-group) and 53 with 4DF treatment (4DF-group). Groups were comparable (age, risk profile, and lymph node numbers). Postoperative drain loss (PDL) and development of early and late LC were analyzed (mean follow-up at 7 months: 100%). Results. PDL was 452.5 ± 634.2 mL without and 308.5 ± 214 mL with 4DF treatment. PDL > 1000 mL only occurred in CT-group (5/51). Overall, 45 LC (26 in CT- versus 19 in the 4DF-group) were diagnosed. At day 8, LC were equally distributed between groups. Incidence of late LC, however, was twice in controls (16/51) versus 4DF-patients (8/53). Symptomatic LC (4 in untreated patients, 2 in 4DF-patients) were treated with percutaneous drainage (duration: 45 days in untreated patients versus 12 days in 4DF-patients). Conclusion. Application of 4DF on lymph node dissection areas lessened total drain loss and significantly lowered high volume drain loss. Furthermore, 4DF reduced frequency of late lymphoceles and lymphoceles requiring treatment by half, as well as duration of percutaneous drainage by more than two-thirds. PMID:27418927

  6. Feasibility of Neoadjuvant Ad-REIC Gene Therapy in Patients with High-Risk Localized Prostate Cancer Undergoing Radical Prostatectomy.

    PubMed

    Kumon, Hiromi; Sasaki, Katsumi; Ariyoshi, Yuichi; Sadahira, Takuya; Araki, Motoo; Ebara, Shin; Yanai, Hiroyuki; Watanabe, Masami; Nasu, Yasutomo

    2015-12-01

    In a phase I/IIa study of in situ gene therapy using an adenovirus vector carrying the human REIC/Dkk-3 gene (Ad-REIC), we assessed the inhibitory effects of cancer recurrence after radical prostatectomy (RP), in patients with high risk localized prostate cancer (PCa). After completing the therapeutic interventions with initially planned three escalating doses of 1.0 × 10(10) , 1.0 × 10(11) , and 1.0 × 10(12) viral particles (VP) in 1.0-1.2 mL (n = 3, 3, and 6), an additional higher dose of 3.0 × 10(12) VP in 3.6 mL (n = 6) was further studied. Patients with recurrence probability of 35% or more within 5 years after RP as calculated by Kattan's nomogram, were enrolled. They received two ultrasound-guided intratumoral injections at 2-week intervals, followed by RP 6 weeks after the second injection. Based on the findings of MRI and biopsy mapping, as a rule, one track injection to the most prominent cancer area was given to initial 12 patients and 3 track injections to multiple cancer areas in additional 6 patients. As compared to the former group, biochemical recurrence-free survival of the latter showed a significantly favorable outcome. Neoadjuvant Ad-REIC, mediating simultaneous induction of cancer selective apoptosis and augmentation of antitumor immunity, is a feasible approach in preventing cancer recurrence after RP. (199).

  7. How significant is upgrade in Gleason score between prostate biopsy and radical prostatectomy pathology while discussing less invasive treatment options?

    PubMed

    Suer, Evren; Gokce, Mehmet Ilker; Gulpinar, Omer; Guclu, Adil Gucal; Haciyev, Perviz; Gogus, Cagatay; Turkolmez, Kadir; Baltaci, Sumer

    2014-04-01

    This study aimed to assess the oncological outcomes of patients experiencing an upgrade from their initial biopsy pathology, and to determine whether these tumours have characteristics resembling their initial biopsy Gleason score (GS) or final radical prostatectomy (RP) GS. Data on 632 patients undergoing open retropubic RP between January 1994 and May 2011 at Ankara University were investigated retrospectively. Data included age, preoperative prostate-specific antigen (PSA), clinical stage, biopsy GS, prostate volume, RP specimen GS, surgical margin positivity, pathological T stage and biochemical recurrence. Biochemical recurrence of GS concordant and upgraded tumours was compared. GS concordance was found in 378 cases (59.8%) and GS upgrading was observed in 183 patients (28.9%). GS upgraded tumours were found to have higher biochemical recurrence rates than their corresponding concomitant GS group. Multivariate analysis revealed that serum PSA level, pathological T stage and GS upgrading were independent prognostic factors for biochemical recurrence. Age and prostate volume were not found to be independent prognostic factors. Upgrade in biopsy GS is a predictor for aggressive tumours with a higher risk for biochemical recurrence than concordant tumours. It may be observed in about a quarter of patients. As it was not possible to identify correctly those patients who may experience an upgrade in GS, patients who are candidates for less invasive treatment options must be informed about the risk of upgrading and the possibility of a worse clinical course.

  8. Evaluation of Lymphorrhea and Incidence of Lymphoceles: 4DryField® PH in Radical Retropubic Prostatectomy.

    PubMed

    Karsch, Johannes-J; Berthold, Martin; Breul, Jürgen

    2016-01-01

    Purpose. To investigate impact of polysaccharide hemostat 4DryField PH (4DF) applied on lymph node dissection area after radical retropubic prostatectomy (RRP) on lymphorrhea and lymphocele (LC) formation. Methods. 104 consecutive patients underwent RRP, 51 without 4DF treatment (CT-group) and 53 with 4DF treatment (4DF-group). Groups were comparable (age, risk profile, and lymph node numbers). Postoperative drain loss (PDL) and development of early and late LC were analyzed (mean follow-up at 7 months: 100%). Results. PDL was 452.5 ± 634.2 mL without and 308.5 ± 214 mL with 4DF treatment. PDL > 1000 mL only occurred in CT-group (5/51). Overall, 45 LC (26 in CT- versus 19 in the 4DF-group) were diagnosed. At day 8, LC were equally distributed between groups. Incidence of late LC, however, was twice in controls (16/51) versus 4DF-patients (8/53). Symptomatic LC (4 in untreated patients, 2 in 4DF-patients) were treated with percutaneous drainage (duration: 45 days in untreated patients versus 12 days in 4DF-patients). Conclusion. Application of 4DF on lymph node dissection areas lessened total drain loss and significantly lowered high volume drain loss. Furthermore, 4DF reduced frequency of late lymphoceles and lymphoceles requiring treatment by half, as well as duration of percutaneous drainage by more than two-thirds.

  9. Robot-assisted nerve-sparing radical prostatectomy using near-infrared fluorescence technology and indocyanine green: initial experience.

    PubMed

    Mangano, Mario S; De Gobbi, Alberto; Beniamin, Francesco; Lamon, Claudio; Ciaccia, Matteo; Maccatrozzo, Luigino

    2017-05-23

    Indocyanine green (ICG) is a fluorescent molecule that provokes detectable photon emission. The use of ICG with near-infrared (NIR) imaging system (Akorn, Lake Forest, IL) has been described during robotic partial nephrectomy (RAPN) as an adjunctive means of identifying renal artery and parenchymal perfusion.We propose the use of the ICG with NIR fluorescence during laparoscopic robot-assisted radical prostatectomy (RARP), to identify the benchmark artery improving the preservation of neurovascular bundle and to improve the visualization of the vascularization and then the hemostasis. From April 2015 to February 2016, 62 patients underwent to RARP in our Urology Unit. In 26 consecutive patients, in the attempt to have a better visualization of neurovascular bundles, we used to inject ICG during the procedure. We evaluated the percentage of identification of neurovascular bundles using NIR fluorescence. Then, we evaluated complications related to injection of ICG and operative time differences between RARP with and without ICG injection performed by the same surgeons. We identified prostatic arteries and neurovascular bundles using NIR fluorescence technology in all patients (100%). There was not any increase in the operative time compared with RARP without ICG injection performed by the same surgeons. Complications related to injection of ICG did not occurred. In our experience, even if on a limited number of patients, the application of ICG with NIR fluorescence during RARP is helpful to identify the benchmark artery of neurovascular bundle.

  10. Effects of Nonlinear Aerobic Training on Erectile Dysfunction and Cardiovascular Function Following Radical Prostatectomy for Clinically Localized Prostate Cancer

    PubMed Central

    Jones, Lee W.; Hornsby, Whitney E.; Freedland, Stephen J.; Lane, Amy; West, Miranda J.; Moul, Judd W.; Ferrandino, Michael N.; Allen, Jason D.; Kenjale, Aarti A.; Thomas, Samantha M.; Herndon, James E.; Koontz, Bridget F.; Chan, June M.; Khouri, Michel G.; Douglas, Pamela S.; Eves, Neil D.

    2014-01-01

    Erectile dysfunction (ED) is a major adverse effect of radical prostatectomy (RP). We conducted a randomized controlled trial to examine the efficacy of aerobic training (AT) compared with usual care (UC) on ED prevalence in 50 men (n = 25 per group) after RP. AT consisted of five walking sessions per week at 55– 100% of peak oxygen uptake (VO2peak) for 30–60 min per session following a nonlinear prescription. The primary outcome was change in the prevalence of ED, as measured by the International Index of Erectile Function (IIEF), from baseline to 6 mo. Secondary outcomes were brachial artery flow–mediated dilation (FMD), VO2peak, cardiovascular (CV) risk profile (eg, lipid profile, body composition), and patient-reported outcomes (PROs). The prevalence of ED (IIEF score ≤21) decreased by 20% in the AT group and by 24% in the UC group (difference: p = 0.406). There were no significant between-group differences in any erectile function subscale (p > 0.05). Significant between-group differences were observed for changes in FMD and VO2peak, favoring AT. There were no group differences in other markers of CV risk profile or PROs. In summary, nonlinear AT does not improve ED in men with localized prostate cancer in the acute period following RP. PMID:24315706

  11. Role of short-term antibiotic therapy at the moment of catheter removal after laparoscopic radical prostatectomy.

    PubMed

    Pinochet, Rodrigo; Nogueira, Lucas; Cronin, Angel M; Katz, Darren; Rabbani, Farhang; Guillonneau, Bertrand; Touijer, Karim

    2010-01-01

    To assess the role of short-term antibiotic therapy (ABT) in preventing urinary tract infection (UTI) after catheter removal following laparoscopic radical prostatectomy (LRP). 729 consecutive patients underwent LRP by one of two surgeons. One surgeon systematically prescribed a 3-day course of ABT (ciprofloxacin) starting the day before catheter removal; the other surgeon did not. The groups were compared for the incidence of symptomatic UTI occurring within 6 weeks after catheter removal. ABT was given to 261 of 713 patients (37%), while the remaining 452 patients (63%) did not receive ABT. After catheter removal, UTI was observed less frequently among patients receiving ABT: 3.1 vs. 7.3% in those not receiving ABT (p = 0.019). A number needed to treat to prevent 1 UTI is 24. Hospital readmission for febrile UTI was observed only in patients who did not receive ABT (n = 5, 1.1 vs. 0%, p = 0.16). One would need to prescribe ABT for 91 LRP patients to prevent 1 case of febrile UTI. ABT at the time of catheter removal reduced the risk of postoperative UTI after LRP. One would need to prescribe ABT to 24 patients to prevent 1 case of UTI. Copyright © 2010 S. Karger AG, Basel.

  12. Erectile Function and Oncologic Outcomes Following Open Retropubic and Robot-assisted Radical Prostatectomy: Results from the LAParoscopic Prostatectomy Robot Open Trial.

    PubMed

    Sooriakumaran, Prasanna; Pini, Giovannalberto; Nyberg, Tommy; Derogar, Maryam; Carlsson, Stefan; Stranne, Johan; Bjartell, Anders; Hugosson, Jonas; Steineck, Gunnar; Wiklund, Peter N

    2017-09-04

    Whether surgeons perform better utilising a robot-assisted laparoscopic technique compared with an open approach during prostate cancer surgery is debatable. To report erectile function and early oncologic outcomes for both surgical modalities, stratified by prostate cancer risk grouping. In a prospective nonrandomised trial, we recruited 2545 men with prostate cancer from seven open (n=753) and seven robot-assisted (n=1792) Swedish centres (2008-2011). Clinometrically-validated questionnaire-based patient-reported erectile function was collected before, 3 mo, 12 mo, and 24 mo after surgery. Surgeon-reported degree of neurovascular-bundle preservation, pathologist-reported positive surgical margin (PSM) rates, and 2-yr prostate-specific antigen-relapse rates were measured. Among 1702 preoperatively potent men, we found enhanced erectile function recovery for low/intermediate-risk patients in the robot-assisted group at 3 mo. For patients with high-risk tumours, point estimates for erectile function recovery at 24 mo favoured the open surgery group. The degree of neurovascular bundle preservation and erectile function recovery were greater correlated for robot-assisted surgery. In pT2 tumours, 10% versus 17% PSM rates were observed for open and robot-assisted surgery, respectively; corresponding rates for pT3 tumours were 48% and 33%. These differences were associated with biochemical recurrence in pT3 but not pT2 disease. The study is limited by its nonrandomised design and relatively short follow-up. Earlier recovery of erectile function in the robot-assisted surgery group in lower-risk patients is counterbalanced by lower PSM rates for open surgeons in organ-confined disease; thus, both open and robotic surgeons need to consider this trade-off when determining the plane of surgical dissection. Robot-assisted surgery also facilitates easier identification of nerve preservation planes during radical prostatectomy as well as wider dissection for pT3 cases. For

  13. Retrospective Comparison of External Beam Radiotherapy and Radical Prostatectomy in High-Risk, Clinically Localized Prostate Cancer

    SciTech Connect

    Arcangeli, Giorgio; Strigari, Lidia; Arcangeli, Stefano; Petrongari, Maria Grazia; Saracino, Biancamaria; Gomellini, Sara; Papalia, Rocco; Simone, Giuseppe; De Carli, Piero; Gallucci, Michele

    2009-11-15

    Purpose: Because of the lack of conclusive and well-conducted randomized studies, the optimal therapy for prostate tumors remains controversial. The aim of this study was to retrospectively compare the results of radical surgery vs. a conservative approach such as external beam radiotherapy (EBRT) plus androgen deprivation therapy using an intent-to-treat analysis on two pretreatment defined, concurrently treated, high-risk patient populations. Methods and Materials: Between January 2003 and December 2007, 162 patients with high-risk prostate cancer underwent an EBRT plus androgen deprivation therapy program at the RT department of our institute. In the same period, 122 patients with the same high-risk disease underwent radical prostatectomy (RP) at the urologic department of our institute. Patients with adverse pathologic factors also underwent adjuvant EBRT with or without androgen deprivation therapy. The primary endpoint was freedom from biochemical failure. Results: The two groups of high-risk patients were homogeneous in terms of freedom from biochemical failure on the basis of the clinical T stage, biopsy Gleason score, and initial prostate-specific antigen level. The median follow-up was 38.6 and 33.8 months in the EBRT and RP groups, respectively. The actuarial analysis of the freedom from biochemical failure showed a 3-year rate of 86.8% and 69.8% in the EBRT and RP group, respectively (p = .001). Multivariate analysis of the whole group revealed the initial prostate-specific antigen level and treatment type (EBRT vs. RP) as significant covariates. Conclusion: This retrospective intention-to-treat analysis showed a significantly better outcome after EBRT than after RP in patients with high-risk prostate cancer, although a well-conducted randomized comparison would be the best procedure to confirm these results.

  14. Association Between Choice of Radical Prostatectomy, External Beam Radiotherapy, Brachytherapy, or Active Surveillance and Patient-Reported Quality of Life Among Men With Localized Prostate Cancer.

    PubMed

    Chen, Ronald C; Basak, Ramsankar; Meyer, Anne-Marie; Kuo, Tzy-Mey; Carpenter, William R; Agans, Robert P; Broughman, James R; Reeve, Bryce B; Nielsen, Matthew E; Usinger, Deborah S; Spearman, Kiayni C; Walden, Sarah; Kaleel, Dianne; Anderson, Mary; Stürmer, Til; Godley, Paul A

    2017-03-21

    Patients diagnosed with localized prostate cancer have to decide among treatment strategies that may differ in their likelihood of adverse effects. To compare quality of life (QOL) after radical prostatectomy, external beam radiotherapy, and brachytherapy vs active surveillance. Population-based prospective cohort of 1141 men (57% participation among eligible men) with newly diagnosed prostate cancer were enrolled from January 2011 through June 2013 in collaboration with the North Carolina Central Cancer Registry. Median time from diagnosis to enrollment was 5 weeks, and all men were enrolled with written informed consent prior to treatment. Final follow-up date for current analysis was September 9, 2015. Treatment with radical prostatectomy, external beam radiotherapy, brachytherapy, or active surveillance. Quality of life using the validated instrument Prostate Cancer Symptom Indices was assessed at baseline (pretreatment) and 3, 12, and 24 months after treatment. The instrument contains 4 domains-sexual dysfunction, urinary obstruction and irritation, urinary incontinence, and bowel problems-each scored from 0 (no dysfunction) to 100 (maximum dysfunction). Propensity-weighted mean domain scores were compared between each treatment group vs active surveillance at each time point. Of 1141 enrolled men, 314 pursued active surveillance (27.5%), 469 radical prostatectomy (41.1%), 249 external beam radiotherapy (21.8%), and 109 brachytherapy (9.6%). After propensity weighting, median age was 66 to 67 years across groups, and 77% to 80% of participants were white. Across groups, propensity-weighted mean baseline scores were 41.8 to 46.4 for sexual dysfunction, 20.8 to 22.8 for urinary obstruction and irritation, 9.7 to 10.5 for urinary incontinence, and 5.7 to 6.1 for bowel problems. Compared with active surveillance, mean sexual dysfunction scores worsened by 3 months for patients who received radical prostatectomy (36.2 [95% CI, 30.4-42.0]), external beam

  15. Comparison of two adjuvant hormone therapy regimens in patients with high-risk localized prostate cancer after radical prostatectomy: primary results of study CU1005.

    PubMed

    Chang, Kun; Qin, Xiao-Jian; Zhang, Hai-Liang; Dai, Bo; Zhu, Yao; Shi, Guo-Hai; Shen, Yi-Jun; Zhu, Yi-Ying; Ye, Ding-Wei

    2016-01-01

    The role of adjuvant hormonal therapy and optimized regimens for high-risk localized prostate cancer after radical prostatectomy remains controversial. Herein, the clinical trial CU1005 prospectively evaluated two regimens of maximum androgen blockage  or bicalutamide 150 mg daily as immediate adjuvant therapy for high-risk localized prostate cancer. Overall, 209 consecutive patients were recruited in this study, 107 of whom received 9 months of adjuvant maximum androgen blockage, whereas 102 received 9 months of adjuvant bicalutamide 150 mg. The median postoperative follow-up time was 27.0 months. The primary endpoint was biochemical recurrence. Of the 209 patients, 59 patients developed biochemical recurrence. There was no difference between the two groups with respect to clinical characteristics, including age, pretreatment prostate-specific antigen, Gleason score, surgical margin status, or pathological stages. The maximum androgen blockage group experienced longer biochemical recurrence-free survival (P = 0.004) compared with the bicalutamide 150 mg group. Side-effects in the two groups were similar and could be moderately tolerated in all patients. In conclusion, immediate, 9-month maximum androgen blockage should be considered as an alternative to bicalutamide 150 mg as adjuvant treatment for high-risk localized prostate cancer patients after radical prostatectomy.

  16. Comparison of two adjuvant hormone therapy regimens in patients with high-risk localized prostate cancer after radical prostatectomy: primary results of study CU1005

    PubMed Central

    Chang, Kun; Qin, Xiao-Jian; Zhang, Hai-Liang; Dai, Bo; Zhu, Yao; Shi, Guo-Hai; Shen, Yi-Jun; Zhu, Yi-Ying; Ye, Ding-Wei

    2016-01-01

    The role of adjuvant hormonal therapy and optimized regimens for high-risk localized prostate cancer after radical prostatectomy remains controversial. Herein, the clinical trial CU1005 prospectively evaluated two regimens of maximum androgen blockage or bicalutamide 150 mg daily as immediate adjuvant therapy for high-risk localized prostate cancer. Overall, 209 consecutive patients were recruited in this study, 107 of whom received 9 months of adjuvant maximum androgen blockage, whereas 102 received 9 months of adjuvant bicalutamide 150 mg. The median postoperative follow-up time was 27.0 months. The primary endpoint was biochemical recurrence. Of the 209 patients, 59 patients developed biochemical recurrence. There was no difference between the two groups with respect to clinical characteristics, including age, pretreatment prostate-specific antigen, Gleason score, surgical margin status, or pathological stages. The maximum androgen blockage group experienced longer biochemical recurrence-free survival (P = 0.004) compared with the bicalutamide 150 mg group. Side-effects in the two groups were similar and could be moderately tolerated in all patients. In conclusion, immediate, 9-month maximum androgen blockage should be considered as an alternative to bicalutamide 150 mg as adjuvant treatment for high-risk localized prostate cancer patients after radical prostatectomy. PMID:26323560

  17. Robot-assisted radical prostatectomy: histopathologic and biochemical recurrence data at one-year follow-up

    NASA Astrophysics Data System (ADS)

    Patel, Vipul; Thaly, Rahul; Shah, Ketul

    2007-02-01

    Introduction: Robotically assisted laparoscopic radical prostatectomy is a minimally invasive alternative for the treatment of prostate cancer. We report the histopathologic and short term PSA outcomes of 500 robotic prostatectomies. Materials and Methods: Five hundred patients underwent robotic radical prostatectomy. The procedure was performed via a six trocar transperitoneal technique. Prostatectomy specimens were analyzed for TNM Stage, Gleason's grade, tumor location, volume, specimen weight, seminal vesicle involvement and margin status. A positive margin was reported if cancer cells were found at the inked specimen margin. PSA data was collected every three months for the first year, then every six months for a year, then yearly. Results: Average pre-operative PSA was 6.9 (1-90) with Gleason's score of 5 (2%), 6 (52%), 7 (40%), 8 (4%), 9(2%). Post operatively histopathologic analysis showed Gleason's 6 (44%), 7(42%), 8(10%), 9(4%). 10%, 5%, 63%, 15%, 5% and 2% had pathologic stage T2a, T2b, T2c, T3a, T3b and T4 respectively. Positive margin rate was 9.4% for the entire series. The positive margin rate per 100 cases was: 13% (1-100), 8% (101-200), 13% (201-300), 5% (301-400) and 8% (401-500). By stage it was 2%, 4%, 2.5% for T2a, T2b, T2c tumors, 23% (T3a), 46% (T3b) and 53% (T4a). For organ confined disease (T2) the margin rate was 2.5% and 31% for non organ confined disease. There were a total of 47 positive margins, 26 (56%) posterolateral, 4 (8.5%) apical, 4 (8.5%) bladder neck, 2 (4%) seminal vesicle and 11 (23%) multifocally. Ninety five percent of patients (n=500) have undetectable PSA (<0.1) at average follow up of 9.7 months. Recurrence has only been seen with non organ confined tumors. Those patients with a minimum follow up of 1 year (average 15.7 months) 95% have undetectable PSA (<.1). Conclusion: Our initial experience with robotic radical prostatectomy is promising. Histopathologic outcomes are acceptable with a low overall margin positive rate

  18. Optimal strategy for penile rehabilitation after robot-assisted radical prostatectomy based on preoperative erectile function.

    PubMed

    Basal, Seref; Wambi, Chris; Acikel, Cengizhan; Gupta, Mantu; Badani, Ketan

    2013-04-01

    WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Removing of prostate for the treatment of localized prostate cancer is associated with a variable loss of erectile function due to injury of the nerves of erection during operation. Some researchers have reported that after nerve-sparing radical prostatectomy (RP), the natural recovery time of erectile function is at least 2 years. Factors such as thermal damage, ischaemic injury, mechanically induced nerve stretching and the local inflammatory effects of surgical trauma may also impair the cavernous nerves during RP. The concept of penile rehabilitation was first studied by Montorsi et al. in 1997. They showed that the use of any drug or device at or after RP could maximize the recovery of erectile function. Penile rehabilitation programmes (PRPs) with vasoactive agents, such as oral phosphodiesterase-5 inhibitors (PDE5Is), intraurethral and intracavernosal vasoactive agents, and vacuum erection devices (VEDs) can protect erectile tissue integrity and prevent corporal smooth muscle atrophy and diminish collagen formation. The present findings are consistent with previous reports that PRPs have a significant beneficial effect on early erectile function recovery and that preoperative erectile function is one of the important predictors of erectile function after RP. Patients can be referred for penile rehabilitation if they have any degree of erectile function (mild, moderate or normal) before operation. We also showed that the combination of PDE5Is and VEDs for PRPs offers the shortest erectile function recovery period. To define the optimal penile rehabilitation programme (PRP) based on preoperative Sexual Health Inventory for Men (SHIM) scores after robot-assisted radical prostatectomy (RARP). The medical records of 203 patients who underwent bilateral nerve-sparing RARP between 2007 and 2011 were reviewed for the present retrospective study. According to patients' preoperative erection status, group 1

  19. Impact of surgeon-defined capsular incision during radical prostatectomy on biochemical recurrence rates.

    PubMed

    Mandel, Philipp; Oh, Su J; Hagner, Christoph; Tennstedt, Pierre; Kriegmair, Maximilian C; Huland, Hartwig; Graefen, Markus; Tilki, Derya

    2016-11-01

    To determine the impact of intraoperative surgeon-defined incision of the prostatic capsule (CapI) on cancer recurrence and to give an overview of the different definitions of CapI. CapI during radical prostatectomy (RP) occurs in a non-negligible number of patients; still, its impact on biochemical recurrence (BCR) remains controversial as definition of CapI differs in literature. We analyzed the data of 3253 consecutive RP between 2009 and 2011. Occurrence and side of intraoperative CapI was documented by the surgeon. Factors influencing CapI were addressed using logistic regressions. The impact of CapI on BCR was analyzed using Cox regressions including traditional prognosticators. Median follow-up was 36.2 months. Unilateral (bilateral) CapI occurred in 22.2 % (12.1 %) of patients. CapI was reported more often following open RP (p < 0.0001) and nerve-sparing procedure (p = 0.0004). Three-year BCR-free survival was 78.8, 79.9 and 82.1 % (p = 0.13) for patients with no, unilateral and bilateral CapI. In multivariate analysis, pT-stage (p < 0.0001), Gleason grade (p < 0.0005) and nodal status (p < 0.0005) were significantly associated with BCR. However, CapI had no independent impact on BCR (unilateral vs. no CapI, p = 0.55, bilateral vs. no CapI, p = 0.32). Intraoperative CapI occurs in a relevant number of RP and is more frequent during nerve-sparing procedure and open RP. However, there seems to be no impact of CapI and its extent on the incidence of early BCR.

  20. Synchronous penoscrotal implantation of penile prosthesis and artificial urinary sphincter after radical prostatectomy.

    PubMed

    Bolat, Deniz; Kozacioglu, Zafer; Polat, Salih; Koras, Omer; Arslan, Murat; Minareci, Suleyman

    2017-04-01

    To evaluate the results of synchronous dual implantation of penile (PP) and artificial urinary sphincter prosthesis (AUSP) in patients with severe erectile dysfunction (ED) and urinary incontinence (UI) after radical prostatectomy (RP). Between January 2006 and March 2015, patients who underwent synchronous dual implantation of PP for severe post-RP ED and AUSP for moderate to severe post-RP UI in our clinic were screened retrospectively. The erectile function and the continence status were evaluated by the questionnaires of IIEF-5 and ICIQ-SF. Results for the preoperative period and for the 1st postoperative year were revealed from patient charts. Long term results were evaluated by telephone interviews. Comorbidities, infection rates and complications were noted. A total of 14 patients underwent synchronous dual implantation; out of which, 11 had a long enough follow up period for a sufficient long term evaluation. 3/11 had MPP and 8/11 had two-piece IPP implantation together with an AUSP. All of the implantations were carried out through an upper transverse scrotal incision. Mean follow up time was 61.3 ± 20 months. In 1 patient who had received adjuvant radiotherapy, both of the devices were removed due to infection and cuff erosion. Mean daily usage of pads diminished from 4 to 1 while ICIQ-SF score decreased from 19 to 2 and IIEF-5 score increased from 3 to 23. Synchronous implantation of PP and AUSP is a safe and effective treatment option for patients with severe ED and moderate to severe UI after RP.

  1. The impact of hospital volume, residency, and fellowship training on perioperative outcomes after radical prostatectomy.

    PubMed

    Trinh, Quoc-Dien; Sun, Maxine; Kim, Simon P; Sammon, Jesse; Kowalczyk, Keith J; Friedman, Ariella A; Sukumar, Shyam; Ravi, Praful; Muhletaler, Fred; Agarwal, Piyush K; Shariat, Shahrokh F; Hu, Jim C; Menon, Mani; Karakiewicz, Pierre I

    2014-01-01

    Although high-volume hospitals have been associated with improved outcomes for radical prostatectomy (RP), the association of residency or fellowship teaching institutions or both and this volume-outcome relationship remains poorly described. We examine the effect of teaching status and hospital volume on perioperative RP outcomes. Within the Nationwide Inpatient Sample, we focused on RPs performed between 2003 and 2007. We tested the rates of prolonged length of stay beyond the median of 3 days, in-hospital mortality, and intraoperative and postoperative complications, stratified according to teaching status. Multivariable logistic regression analyses further adjusted for confounding factors. Overall, 47,100 eligible RPs were identified. Of these, 19,193 cases were performed at non-teaching institutions, 24,006 at residency teaching institutions, and 3,901 at fellowship teaching institutions. Relative to patients treated at non-teaching institutions, patients treated at fellowship teaching institutions were healthier and more likely to hold private insurance. In multivariable analyses, patients treated at residency (OR = 0.92, P = 0.015) and fellowship (OR = 0.82, P = 0.011) teaching institutions were less likely to experience a postoperative complication than patients treated at non-teaching institutions. Patients treated at residency (OR = 0.73, P<0.001) and fellowship (OR = 0.91, P = 0.045) teaching institutions were less likely to experience a prolonged length of stay. More favorable postoperative complication profile and shorter length of stay should be expected at residency and fellowship teaching institutions following RP. Moreover, postoperative complication rates were lower at fellowship teaching than at residency teaching institutions, despite adjustment for potential confounders. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Is rhabdomyolysis an anaesthetic complication in patients undergoing robot-assisted radical prostatectomy?

    PubMed

    Karaoren, Gulsah; Bakan, Nurten; Kucuk, Eyüp Veli; Gumus, Eyup

    2017-01-01

    In patients undergoing robot-assisted radical prostatectomy (RARP), pneumoperitoneum, intraoperative fluid restriction and prolonged Trendelenburg position may cause rhabdomyolysis (RM) due to hypoperfusion in gluteal muscles and lower extremities. In this study, it was aimed to assess effects of body mass index (BMI), comorbidities, intra-operative positioning, fluid restriction and length of surgery on the development of RM in RARP patients during the perioperative period. The study included 52 American Society of Anesthesiologists I-II patients aged 50-80 years with BMI >25 kg/m2, who underwent RARP. Fluid therapy with normal saline (1 ml/kg/h) and 6% hydroxyethyl starch 200/05 (1 ml/kg/h) was given during the surgery. Charlson comorbidity index (CCI), operation time (OT) and Trendelenburg time (TT) were recorded. Blood samples for creatine phosphokinase (CPK), blood urea nitrogen, creatinine (Cr), aspartate aminotransferase (AST), alanine transferase (ALT), lactate dehydrogenase (LDH), creatinine kinase-MB, cardiac troponin I and arterial blood gases were drawn at baseline and on 6, 12, 24 and 48 h. RM was defined by serum CPK level exceeding 5000 IU/L. Seven patients met predefined criteria for RM. There were positive correlations among serum CPK and Cr, AST, ALT and LDH levels. However, there was no significant difference in BMI, OT and TT between patients with or without RM (P > 0.05). CCI scores were higher in patients with RM than those without (3.00 ± 0.58 vs. 2.07 ± 0.62; P< 0.01). No renal impairment was detected among patients with RM at the post-operative period. It was found that comorbid conditions are more important in the development of RM during RARP rather than BMI, OT or TT. Patients with higher comorbidity are at risk for RM development and that this should be kept in mind at follow-up and when informing patients.

  3. Extraperitoneal robot-assisted laparoscopic radical prostatectomy: a single-center experience beyond the learning curve.

    PubMed

    Ploussard, Guillaume; Salomon, Laurent; Parier, Bastien; Abbou, Claude Clément; de la Taille, Alexandre

    2013-06-01

    To report our surgical technique and outcomes after extraperitoneal robot-assisted laparoscopic radical prostatectomy (RALRP). At Henri Mondor's Hospital, we performed the first RALRP in 2001 and started to perform routinely RALRP since 2006. Preoperative characteristics, perioperative parameters, functional and oncological outcomes were collected in a prospective database and studied. All parameters were tested in patients undergoing RALRP beyond the learning curve of each surgeon. The overall cohort included 792 patients. RALRP offers interesting results in terms of hospital stay, operative time, and blood loss. The overall rate of complications was low, especially concerning the rates of anastomosis' complications. An extraprostatic extension was seen in 42.8 % of specimens. The overall rate of positive margins was 30.7 % of specimens. In our cohort, after a mean follow-up of 19 months, 8.7 % of PSA failure has been reported. The rate of continence was 77.4 % at 6 months and 96.8 % at 2 years. The rate of potency was 17 % at 3 months and 60.9 % at 2 years. The 2-year rate was 86.7 % in case of intrafascial dissection. A trifecta outcome was achieved in 44 and 53 % of men at 12 and 24 months, respectively. The extraperitoneal approach confers interesting results in terms of perioperative parameters as previously described in series using a transperitoneal approach. Functional outcomes in terms of continence and potency recovery after extraperitoneal seem equivalent to those reported after transperitoneal RALRP. Longer follow-up is warranted to confirm our favorable mid-term oncologic outcomes.

  4. [The interdisciplinary approach to improve treatment quality of prostate cancer. Optimized nerve sparing in radical prostatectomy].

    PubMed

    Sievert, K-D; Anastasiadis, A G; Hennenlotter, J; Schilling, D; Merseburger, A S; Nagele, U; Lichy, M P; Schlemmer, H-P; Ulmer, A; Vogel, U; Sotlar, K; Kuczyk, M; Stenzl, A

    2007-09-01

    After sufficient oncological treatment of prostate cancer the life quality becomes most important. A multi disciplinary research network aims to optimize the diagnostics and the resulting treatment of prostate cancer. Main characteristics of the interdisciplinary cooperation are the interlocked individual projects. A major research field is investigation of the whole mounted prostate sections to study the peripheral nerves and the comparison of histological tumor locations with the MRI. Using serial sections of prostate specimens, three-dimensional computer-animated models are created illustrating the tumors histological and immunohistochemical distributions. For nodal staging, a new methodology is investigated to demonstrate single tumor cells in lymphatic tissue lysates. A retrospective evaluation of life quality including the functional outcome is performed by using questionnaire surveys. Anatomical studies gave new insights into the exact localizations of peripheral nerves which may lead to an improvement of the surgical approach in nerve-sparing radical prostatectomy. For the preoperative planning the MRI imaging might need a different interpretation in relation to the topographic location. Studies using molecular markers and their relation and distribution patterns gave new insights regarding interpretation of histological biopsy results concerning the tumor extension. Numerical quantification of tumor cells in each lymph node demonstrated micro metastases in histological negative nodes contributing to the nodal staging. A close connection of the nerve-sparing technique was demonstrated with quality of life aspects and functional results. An interdisciplinary approach is mandatory for translational prostate cancer research. As a result, individualized diagnostic and therapeutic approaches improve oncological results and at the same time provide the best quality of life in these patients.

  5. Gleason sum upgrading between biopsy and radical prostatectomy in Chinese population: Updated nomograms.

    PubMed

    Xu, H; Bai, P D; Hu, M B; Mao, S H; Zhu, W H; Hu, J M; Liu, S H; Yang, T; Hou, J Y; Hu, Y; Ding, Q; Jiang, H W

    2017-04-01

    To assess the risk factors of Gleason sum upgrading between biopsy and radical prostatectomy (RP) and update the nomogram for the prediction of Gleason sum upgrading. The study cohort consisted of 237 Chinese prostate adenocarcinoma patients who underwent 10-core prostate biopsy and subsequently received RP in Huashan Hospital from February 2011 to May 2015. The main outcome of our study was Gleason sum upgrading between biopsy and RP pathology. Univariate and multivariate logistic regression models were conducted to explore the potential predictors, and ultimately to build the nomograms. The prediction model was further evaluated for its ability to predict significant upgrading in patients with biopsy Gleason sum<8. In the main cohort of all the patients, Gleason sum upgrading was observed in 62 (26.16%) patients. The pre-operative prostate-specific antigen (PSA) level, biopsy Gleason sum, and digital rectal examination were used in building the nomogram, which was validated internally with a bootstrap-corrected concordance index of 0.787. In the sub-cohort of 115 patients with standardized biopsy details, Gleason sum upgrading was observed in 31 (26.96%) patients. The pre-operative PSA level, biopsy Gleason sum, and number of positive cores were used in the nomogram, which was also validated internally with a bootstrap-corrected concordance index of 0.833. These two nomograms both demonstrated satisfactory statistical performance for predicting significant upgrading. Updated nomograms to predict Gleason sum upgrading in Chinese population between biopsy and RP were developed, demonstrating good statistical performance upon internal validation. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Identification of men with the highest risk of early disease recurrence after radical prostatectomy

    PubMed Central

    Sundi, Debasish; Wang, Vinson; Pierorazio, Phillip M.; Han, Misop; Partin, Alan W.; Tran, Phuoc T.; Ross, Ashley E.; Bivalacqua, Trinity J.

    2014-01-01

    Background Men destined to have early biochemical recurrence (BCR) following radical prostatectomy (RP) may be optimal candidates for multimodal treatment. Here we identified pre-operative predictors of early BCR within a surgical cohort who recurred. Methods An institutional prostate cancer (PCa) database containing over 20,000 patients was queried to identify 1471 men who had BCR after RP, and pre-operative predictors of early versus late BCR were assessed. Early BCR was defined as recurrence within one year after RP. Within the recurrence cohort, those with National Comprehensive Cancer Network (NCCN) high-risk features were more likely to experience early BCR. Therefore, in all NCCN high-risk men in the database, we abstracted detailed pathologic biopsy data. Among 753 high-risk men, 41 alternate multivariable criteria were assessed for their ability to predict early BCR in crude and adjusted logistic regression models. Results The criteria that best identified those likely to experience early BCR are primary Gleason pattern 5 on biopsy or ≥4 cores containing pattern 4 (odds ratio 3.17, p <0.001). These criteria included 26.7% of NCCN high-risk men. Additionally, these criteria selected for men within the high-risk classification who were at significantly higher risk of subsequent metastasis (adjusted hazard ratio 3.04, p<0.001) and cancer-specific death (adjusted hazard ratio 3.27, p<0.001). Conclusions In men with PCa who present with high-risk features, pre-operative criteria have the ability to discriminate the subgroup most likely to experience early BCR after RP. Men at risk for early disease recurrence may be the most suitable candidates for multimodal therapy. PMID:24453066

  7. Multiple cores of Gleason score 6 correlate with favourable findings at radical prostatectomy

    PubMed Central

    Ellis, Carla L.; Walsh, Patrick C.; Partin, Alan W.; Epstein, Jonathan I.

    2014-01-01

    Objective To establish whether the good prognosis of Gleason score 6 (GS6) is maintained in the setting of multiple involved cores. Patients and Methods In total, 6156 men (from 1 April 2000 to 30 April 2007) with GS6 on biopsy underwent radical prostatectomy (RP) at our institution. The number of positive cores was correlated with the outcome at RP. Results More positive cores correlated with less organ-confined disease (P < 0.001), positive margins (P < 0.012), increasing RP grade (P < 0.001) and increased seminal vesicles/lymph node involvement (P = 0.012). For men with data available, the actuarial risk of being biochemically free of disease at 5 years was 93.2% when ≤6 cores were positive (812 men followed to 5 years) vs 89.1% if >6 cores were positive (41 men followed to 2 years) (P = 0.6). Although the predicted ‘cure rate’ of >75% probability of a tumour showing no evidence of biochemical recurrence at 10 years after RP was statistically different between cases with ≤6 vs >6 positive cores (P < 0.0001), the outcome in both groups was still favourable (90.5% vs 84%). Partin-like tables were generated factoring in the number of positive cores to predict organ-confined disease as a guide for urologists to perform nerve-sparing surgery. For example, with T1c disease, there was a ≥75% probability of organ-confined disease with one to three positive cores regardless of prostate-specific antigen (PSA) level, and the same probability was present with four to six positive cores and a PSA level of 0–4 ng/mL. Conclusion A low Gleason score on biopsy is a powerful prognostic finding, such that this favourable outcome is maintained even in the setting of multiple positive cores with GS6. PMID:23350787

  8. Robot assisted laparoscopic radical prostatectomy: assistant's seniority has no influence on perioperative course.

    PubMed

    Abu-Ghanem, Yasmin; Erlich, Tomer; Ramon, Jacob; Dotan, Zohar; Zilberman, Dorit E

    2016-11-09

    An experienced surgical team, in general, and the surgeon assistant in particular are believed to play a critical role in the operation's safety and success. We sought to explore whether the assistant's seniority influences perioperative course following robot assisted laparoscopic radical prostatectomy (RALP). We reviewed our prospective registry database of RALP cases performed by a single surgeon who during the study period was beyond his learning curve. The following parameters were documented and analyzed: patient's age, body mass index (BMI), associated comorbidities, previous abdominal surgeries, assistant's identity, total and skin-to-skin operative time (tOT, ssOT, respectively), estimated blood loss (EBL), immediate post-operative complications, length of stay (LOS), and prostate weight per final pathology report. Univariate analysis and Spearman's correlation test were used to evaluate whether the assistant's seniority influenced perioperative course. Between the years 2011-2015, 106 consecutive cases were retrieved and analyzed. Prostate weight was found to be associated with longer tOT (Spearman's ρ = 0.34, p < 0.001), ssOT (0.3, p < 0.01) and increased EBL (0.28, p < 0.01). Patient's age, BMI, associated comorbidities, and previous abdominal surgeries were found to have no influence on neither tOT, ssOT nor EBL. Three assistants' subgroups were identified (seniors, PGY 1-3, PGY 4-6). The assistant's seniority was found to have no influence on tOT, ssOT, EBL, immediate post-operative complications and LOS. Same results were obtained following prostate size adjustments. The assistant's seniority has no influence on perioperative course following RALP. Consequently, given a highly experienced primary surgeon, a less experienced assistant can be safely incorporated into this procedure.

  9. Discrepancies in perception of urinary incontinence between patient and physician after robotic radical prostatectomy.

    PubMed

    Lee, Seung Ryeol; Kim, Hong Wook; Lee, Jae Won; Jeong, Woo Ju; Rha, Koon Ho; Kim, Jang Hwan

    2010-11-01

    Reported incidence of urinary incontinence after a radical prostatectomy (RP) varies between studies. This may be due not only to the definition of incontinence applied, but also how the information is acquired. We investigated the differences in perception of post robot-assisted laparoscopic RP (RALP) urinary incontinence acquired through doctor interviews and patient-reported questionnaires. Of 238 consecutive men who underwent RALP by a single surgeon between July 2005 and February 2008, we evaluated 66 men using the International Consultation on Incontinence Questionnaire (ICIQ) at various time points after surgery. Each patient's ICIQ results were considered to be the patient's perceptions of urinary incontinence. The physician at the same time directly interviewed the patients about the number of pads used and considered complete continence to be equivalent to the use of no pads or safety liners. Of the 66 patients, the physician reported that 34 (51.5%) had obtained complete continence. However, analysis of the questionnaires of these 34 patients revealed that only 5 (14.7%) patients reported that they never leaked during the past 4 weeks. Most patients (11 patients, 32.4%) who did not use any pad did in fact reported leakage of a small or moderate amount of urine about once a day. Our results indicate that there are discrepancies in the perception of urinary incontinence between doctor and patient after RALP. Nonuse of pads is not equivalent to obtaining complete urinary continence. Therefore, the number of pads used is not a good measure to determine the status of complete urinary continence.

  10. Laparoscopic radical prostatectomy--an analysis of factors affecting operating time.

    PubMed

    El-Feel, Ahmed; Davis, John W; Deger, Serdar; Roigas, Jan; Wille, Andreas H; Schnorr, Dietmar; Loening, Stefan; Hakiem, Amr Abdel; Tuerk, Ingolf A

    2003-08-01

    Although laparoscopic radical prostatectomy (LRP) is accomplished within 2 to 3 hours by experienced surgeons, less is known about the operating times (OTs) for recently trained surgeons or the influence of additional factors. As of November 2001 at our institution, two senior surgeons had each performed more than 100 cases of LRP and two junior surgeons had each performed fewer than 30. We prospectively studied the next 100 consecutive LRPs to assess the factors influencing the OT. Transperitoneal LRPs were performed by two senior (n = 62) and two junior surgeons (n = 38) with random case assignment. We assessed body mass index, prostate size, prior abdominal surgery, androgen deprivation, surgeon experience, procedures in addition to LRP, lymph node dissection, nerve sparing, and sural nerve grafting as potential predictors of the OT. Prostate weight, androgen deprivation, and prior abdominal surgery did not significantly affect the OT, but grade 1 obesity increased the OT by an average of 38 minutes. The mean OT by surgeon experience was 214 minutes for seniors and 347 minutes for juniors (P <0.001). By procedure type, the OT ranged from 180 minutes for LRP only by seniors to 459 minutes for LRP plus lymph node dissection plus sural nerve grafting by juniors. Lymph node dissection and sural nerve grafting significantly increased the OT by 46 and 101 minutes, respectively, and nerve sparing did not. For each combination of procedures, seniors averaged significantly shorter times than did juniors. A multiple regression model with stepwise selection showed that prostate weight, sural nerve grafting, pelvic lymph node dissection, use of a surgical robot, and surgeon experience significantly affected the OT. The results of this prospective study of 100 cases of LRP showed that the OT for senior surgeons averaged 2 to 3 hours, but less experienced surgeons, and additional procedures, add significantly to the OT.

  11. Postoperative statin use and risk of biochemical recurrence following radical prostatectomy: Results from the SEARCH database

    PubMed Central

    Allott, Emma H.; Howard, Lauren E.; Cooperberg, Matthew R.; Kane, Christopher J.; Aronson, William J.; Terris, Martha K.; Amling, Christopher L.; Freedland, Stephen J.

    2014-01-01

    Objective • To investigate the effect of postoperative statin use on biochemical recurrence (BCR) in PC patients treated with radical prostatectomy (RP) who never used statins before surgery. Patients and Methods • We conducted a retrospective analysis of 1,146 RP patients within the Shared Equal Access Regional Cancer Hospital (SEARCH) database. • Multivariable Cox proportional hazards analyses were used to examine differences in risk of BCR between postoperative statin users versus nonusers. • To account for varying start dates and duration of statin use during follow-up, postoperative statin use was treated as a time-dependent variable. • In secondary analysis, models were stratified by race to examine the association of postoperative statin use with BCR among black and non-black men. Results • After adjusting for clinical and pathological characteristics, postoperative statin use was significantly associated with 36% reduced risk of BCR (HR 0.64; 95%CI 0.47-0.87; p=0.004). • Postoperative statin use remained associated with reduced risk of BCR after adjusting for preoperative serum cholesterol levels. • In secondary analysis, following stratification by race, this protective association was significant in non-black (HR 0.49; 95%CI 0.32-0.75; p=0.001) but not black men (HR 0.82; 95%CI 0.53-1.28; p=0.384). Conclusion • In this retrospective cohort of men undergoing RP, postoperative statin use was significantly associated with reduced risk of BCR. • Whether the association between postoperative statin use and BCR differs by race requires further study. • Given these findings, coupled with other studies suggesting that statins may reduce risk of advanced PC, randomized controlled trials are warranted to formally test the hypothesis that statins slow PC progression. PMID:24588774

  12. Histopathological features of ductal adenocarcinoma of the prostate in 1,051 radical prostatectomy specimens.

    PubMed

    Seipel, Amanda H; Wiklund, Fredrik; Wiklund, N Peter; Egevad, Lars

    2013-04-01

    Ductal adenocarcinoma (DAC) of the prostate is thought to have worse prognosis than prostatic acinar carcinoma (PAC). We aimed to evaluate the prognostic significance of histopathological patterns of DAC. A series of 1,051 radical prostatectomy specimens from Karolinska University Hospital 1998-2005 was reviewed. A ductal component was classified as classical DAC (DACC) if it had columnar, pseudostratified epithelium, elongated nuclei, and papillary, glandular, or cribriform architecture; borderline DAC (DACB) if it lacked elongated nuclei or classical architecture; and prostatic adenocarcinoma with ductal features (PCDF) if stratified high-grade nuclei were found. DACC, DACB, and PCDF were seen in 2.6, 4.0, and 1.6 % of the cases. DAC was usually mixed with PAC and constituted 10-100 % (mean 40 %) of the main tumor. Location was periurethral, peripheral, or both in 69.8, 3.5, and 26.7 %. Necrosis was seen in 31.3 %, stromal invasion of DAC in 52.3 %, and intraductal spread in 91.9 %. In DACC/DACB and PAC, extraprostatic extension was seen in 66.7 and 42.4 % (p < 0.001) and seminal vesicle invasion in 13.0 and 5.0 % (p = 0.0045). DACC, DACB, and PCDF had a hazard ratio for biochemical recurrence of 1.5 (0.7-2.8), 1.4 (0.8-2.6) and 1.2 (0.5-2.7). When PCDF was excluded from DAC, hazard ratio was 1.4 (95 % CI 0.9-2.3, p = 0.12). Location, % DAC, necrosis, stromal invasion, or Gleason score were not predictive of recurrence. This suggests that DACC and DACB are more aggressive than average PAC, while cancers with acinar architecture and pseudostratified high-grade nuclei should not be included in DAC.

  13. Anatomic Boundaries of the Clinical Target Volume (Prostate Bed) After Radical Prostatectomy

    SciTech Connect

    Wiltshire, Kirsty L.; Brock, Kristy K.; Haider, Masoom A.; Zwahlen, Daniel; Kong, Vickie; Chan, Elisa; Moseley, Joanne; Bayley, Andrew; Catton, Charles; Chung, Peter W.M.; Gospodarowicz, Mary; Milosevic, Michael; Kneebone, Andrew; Warde, Padraig; Menard, Cynthia

    2007-11-15

    Purpose: We sought to derive and validate an interdisciplinary consensus definition for the anatomic boundaries of the postoperative clinical target volume (CTV, prostate bed). Methods and Materials: Thirty one patients who had planned for radiotherapy after radical prostatectomy were enrolled and underwent computed tomography and magnetic resonance imaging (MRI) simulation prior to radiotherapy. Through an iterative process of consultation and discussion, an interdisciplinary consensus definition was derived based on a review of published data, patterns of local failure, surgical practice, and radiologic anatomy. In validation, we analyzed the distribution of surgical clips in reference to the consensus CTV and measured spatial uncertainties in delineating the CTV and vesicourethral anastomosis. Clinical radiotherapy plans were retrospectively evaluated against the consensus CTV (prostate bed). Results: Anatomic boundaries of the consensus CTV (prostate bed) are described. Surgical clips (n = 339) were well distributed throughout the CTV. The vesicourethral anastomosis was accurately localized using central sagittal computed tomography reconstruction, with a mean {+-} standard deviation uncertainty of 1.8 {+-} 2.5 mm. Delineation uncertainties were small for both MRI and computed tomography (mean reproducibility, 0-3.8 mm; standard deviation, 1.0-2.3); they were most pronounced in the anteroposterior and superoinferior dimensions and at the superior/posterior-most aspect of the CTV. Retrospectively, the mean {+-} standard deviation CTV (prostate bed) percentage of volume receiving 100% of prescribed dose was only 77% {+-} 26%. Conclusions: We propose anatomic boundaries for the CTV (prostate bed) and present evidence supporting its validity. In the absence of gross recurrence, the role of MRI in delineating the CTV remains to be confirmed. The CTV is larger than historically practiced at our institution and should be encompassed by a microscopic tumoricidal dose.

  14. Bacteriuria and antibiotic resistance in catheter urine specimens following radical prostatectomy.

    PubMed

    Banks, Jessica A; McGuire, Barry B; Loeb, Stacy; Shrestha, Sanjina; Helfand, Brian T; Catalona, William J

    2013-10-01

    There are increasing reports of infectious complications following prostate biopsy due to fluoroquinolone resistance. To determine infectious complications at catheter removal following radical prostatectomy (RP), another setting in daily urological practice where fluoroquinolone prophylaxis is frequently used. We prospectively examined urine culture results collected from 334 RP patients immediately prior to catheter removal. Patients received prophylactic antibiotics 1 day before, the day of, and for 5 days after catheter removal. Culture results were reviewed for bacterial species and antimicrobial susceptibilities. Patients with positive urine cultures resistant to the prophylactic antibiotic were switched to culture-specific antibiotic therapy and underwent follow-up culture. The frequency of urinary tract infection (UTI), complications, additional antibiotic therapy, and repeat urine cultures was determined within 60 days. Of the 334 patients identified, 203 (61%) had cultures with no bacterial growth, and 48 (14%) had colony counts of <1,000 bacteria or Candida albicans and received no further antibiotics. The remaining 83 (25%) had positive culture results, of which 7% were resistant to ciprofloxacin. Twenty-four bacterial species were identified, with Pseudomonas aeruginosa (5%) Escherichia coli (4%), and Staphylococcus epidermidis (3%) being the most frequent. Only two (0.6%) men developed clinical symptoms consistent with UTI (i.e., suprapubic pain, fever) prior to catheter removal, and no serious complications occurred. A substantial proportion of RP patients have positive urine cultures at the time of catheter removal, despite the administration of prophylactic fluoroquinolone antibiotics. Potentially virulent organisms are commonly cultured, and ciprofloxacin resistance is frequent. However, outcomes are favorable when culture-specific oral antibiotic therapy is initiated. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Radical prostatectomy neutralizes obesity-driven risk of prostate cancer progression.

    PubMed

    Schiffmann, Jonas; Salomon, Georg; Tilki, Derya; Budäus, Lars; Karakiewicz, Pierre I; Leyh-Bannurah, Sami-Ramzi; Pompe, Raisa S; Haese, Alexander; Heinzer, Hans; Huland, Hartwig; Graefen, Markus; Tennstedt, Pierre

    2017-05-01

    Obesity negatively affects several prostate cancer (PCa) outcomes, including mortality to PCa. However, the validity of several such associations is still under debate, including its effect on pathological stage at radical prostatectomy (RP) and subsequent biochemical recurrence (BCR), which represents the focus of this study. We relied on patients with PCa treated with RP at the Martini-Klinik Prostate Cancer Center between 2004 and 2015. First, multivariable logistic regression analyses tested for association between obesity and non-organ-confined disease (≥pT3 or pN1). Second, multivariable Cox regression analyses examined obesity effect on BCR. Last, in a propensity score-matched cohort, Kaplan-Meier analyses assessed BCR-free survival according to body mass index (kg/m(2)) (BMI) strata (≥30 vs.<25). Of 16,014 individuals, 2,403 (15%) men were obese (BMI≥30). Median follow-up was 36.4 months (interquartile range: 13.3-60.8). Obese patients were more likely to harbor non-organ-confined disease at final pathology (odds ratio = 1.27; 95% CI: 1.13-1.43; P<0.001) but did not have higher BCR rates (hazard ratio = 0.98; 95% CI: 0.86-1.11; P = 0.7). Similarly, BCR-free survival was not different between obese and nonobese men, after propensity score matching (log rank P = 0.9). Obesity (BMI ≥30) might predispose to higher rates of non-organ-confined disease at RP. However, obesity was not an independent predictor of BCR after surgery. Consequently, the unfavorable effect of obesity on PCa might be limited to local spread of the disease and might be neutralized after RP. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Is rhabdomyolysis an anaesthetic complication in patients undergoing robot-assisted radical prostatectomy?

    PubMed Central

    Karaoren, Gulsah; Bakan, Nurten; Kucuk, Eyüp Veli; Gumus, Eyup

    2017-01-01

    BACKGROUND: In patients undergoing robot-assisted radical prostatectomy (RARP), pneumoperitoneum, intraoperative fluid restriction and prolonged Trendelenburg position may cause rhabdomyolysis (RM) due to hypoperfusion in gluteal muscles and lower extremities. In this study, it was aimed to assess effects of body mass index (BMI), comorbidities, intra-operative positioning, fluid restriction and length of surgery on the development of RM in RARP patients during the perioperative period. SUBJECTS AND METHODS: The study included 52 American Society of Anesthesiologists I–II patients aged 50–80 years with BMI >25 kg/m2, who underwent RARP. Fluid therapy with normal saline (1 ml/kg/h) and 6% hydroxyethyl starch 200/05 (1 ml/kg/h) was given during the surgery. Charlson comorbidity index (CCI), operation time (OT) and Trendelenburg time (TT) were recorded. Blood samples for creatine phosphokinase (CPK), blood urea nitrogen, creatinine (Cr), aspartate aminotransferase (AST), alanine transferase (ALT), lactate dehydrogenase (LDH), creatinine kinase-MB, cardiac troponin I and arterial blood gases were drawn at baseline and on 6, 12, 24 and 48 h. RM was defined by serum CPK level exceeding 5000 IU/L. RESULTS: Seven patients met predefined criteria for RM. There were positive correlations among serum CPK and Cr, AST, ALT and LDH levels. However, there was no significant difference in BMI, OT and TT between patients with or without RM (P > 0.05). CCI scores were higher in patients with RM than those without (3.00 ± 0.58 vs. 2.07 ± 0.62; P < 0.01). No renal impairment was detected among patients with RM at the post-operative period. CONCLUSIONS: It was found that comorbid conditions are more important in the development of RM during RARP rather than BMI, OT or TT. Patients with higher comorbidity are at risk for RM development and that this should be kept in mind at follow-up and when informing patients. PMID:27251811

  17. Glutathione-S-Transferase (GST) polymorphisms are associated with relapse after radical prostatectomy

    PubMed Central

    Cotignola, Javier; Leonardi, Daiana B.; Shahabi, Ahva; Acuña, Alejandro D.; Stern, Mariana C.; Navone, Nora; Scorticati, Carlos; De Siervi, Adriana; Mazza, Osvaldo; Vazquez, Elba

    2013-01-01

    Background Organ confined prostate cancer (PCa) can be cured by radical retropubic prostatectomy (RRP); however, some tumors will still recur. Current tools fail to identify patients at risk of recurrence. Glutathione-S-Transferases (GSTs) are involved in the metabolism of carcinogens, hormones and drugs. Thus, genetic polymorphisms that modify the GSTs activities may modify the risk of PCa recurrence. Methods We retrospectively recruited Argentine PCa patients treated with RRP to study the association between GSTs polymorphisms and PCa biochemical relapse after RRP. We genotyped germline DNA in 105 patients for: GSTP1 c.313 A>G (p.105 Ile>Val, rs1695) by PCR-RFLP; and GSTT1 null and GSTM1 null polymorphisms by multiplex-PCR. Kaplan-Meier curves and Cox proportional hazard models were used to evaluate these associations. Results Patients with GSTP1 c.313 GG genotype showed shorter biochemical relapse-free survival (BRFS) (p=0.003) and higher risk for recurrence in unadjusted (Hazard Ratio (HR)=3.16, 95% Confidence Interval (95% CI)=1.41–7.06, p=0.005) and multivariate models (HR=3.01, 95% CI=1.13–8.02, p=0.028). We did not find significant associations for GSTT1 and GSTM1 genotypes. In addition, we found shorter BRFS (p=0.010) and increased risk for recurrence for patients having 2 or more risk alleles when we combined the genotypes of the three GSTs in multivariate models (HR=3.06, 95% CI=1.20–7.80, p=0.019). Conclusions Our results give support to the implementation of GSTs genotyping for personalized therapies as a novel alternative for PCa management for patients who undergo RRP. This is the first study that examined GST polymorphisms in PCa progression in Argentine men. Replication of our findings in larger cohort is warranted. PMID:23146971

  18. A 2D to 3D ultrasound image registration algorithm for robotically assisted laparoscopic radical prostatectomy

    NASA Astrophysics Data System (ADS)

    Esteghamatian, Mehdi; Pautler, Stephen E.; McKenzie, Charles A.; Peters, Terry M.

    2011-03-01

    Robotically assisted laparoscopic radical prostatectomy (RARP) is an effective approach to resect the diseased organ, with stereoscopic views of the targeted tissue improving the dexterity of the surgeons. However, since the laparoscopic view acquires only the surface image of the tissue, the underlying distribution of the cancer within the organ is not observed, making it difficult to make informed decisions on surgical margins and sparing of neurovascular bundles. One option to address this problem is to exploit registration to integrate the laparoscopic view with images of pre-operatively acquired dynamic contrast enhanced (DCE) MRI that can demonstrate the regions of malignant tissue within the prostate. Such a view potentially allows the surgeon to visualize the location of the malignancy with respect to the surrounding neurovascular structures, permitting a tissue-sparing strategy to be formulated directly based on the observed tumour distribution. If the tumour is close to the capsule, it may be determined that the adjacent neurovascular bundle (NVB) needs to be sacrificed within the surgical margin to ensure that any erupted tumour was resected. On the other hand, if the cancer is sufficiently far from the capsule, one or both NVBs may be spared. However, in order to realize such image integration, the pre-operative image needs to be fused with the laparoscopic view of the prostate. During the initial stages of the operation, the prostate must be tracked in real time so that the pre-operative MR image remains aligned with patient coordinate system. In this study, we propose and investigate a novel 2D to 3D ultrasound image registration algorithm to track the prostate motion with an accuracy of 2.68+/-1.31mm.

  19. Implantation of electromagnetic transponders following radical prostatectomy for delivery of IMRT.

    PubMed

    Canter, Daniel; Greenberg, Richard E; Horwitz, Eric M; Kutikov, Alexander; Li, Jinsheng; Long, Christopher; Buyyounouski, Mark; Boorjian, Stephen A

    2010-10-01

    Radiation therapy (RT) after radical prostatectomy (RP) has been associated with a survival benefit in both the adjuvant and salvage setting. Nevertheless, optimal targeting of the prostate bed following surgery remains challenging. The Calypso 4D Localization System (Calypso Medical Technologies, Seattle, WA, USA) is a target positioning device that continuously monitors the location of three implantable electromagnetic transponders. We describe our technique of ultrasound-guided placement of these transponders into the prostate bed for adjuvant and salvage RT. Seventeen patients presenting to Fox Chase Cancer Center for postoperative RT underwent transrectal ultrasound-guided placement of Calypso beacons. The three transponders were placed approximately 1 cm apart in a triangular fashion around the vesico-urethral anastomosis and in the retrovesicular tissue. All patients were successfully implanted without periprocedural complications. Appropriate beacon position was confirmed by CT scan performed at the time of RT simulation. Intensity-modulated radiation therapy was delivered at a dose of 68 Gy (range 64-68). Treatment was well-tolerated with no Grade 3 or 4 toxicities. Grade > 2 enteritis was not observed, and there were no cases of rectal bleeding. Genitourinary toxicity was noted in 10 patients and consisted of Grade 1 and 2 frequency and dysuria. No patient developed gross hematuria or urinary retention. All patients (9/9) with at least 6 months of follow up after treatment had an undetectable PSA. The placement of Calypso transponders for adjuvant/salvage RT is a safe and efficacious method for treatment targeting with an acceptable acute toxicity profile.

  20. Phase I-II Study of Intraoperative Radiation Therapy (IORT) After Radical Prostatectomy for Prostate Cancer

    SciTech Connect

    Saracino, Biancamaria Gallucci, Michele; De Carli, Piero; Soriani, Antonella; Papalia, Rocco; Marzi, Simona; Landoni, Valeria; Petrongari, Maria Grazia; Arcangeli, Stefano; Forastiere, Ester; Sentinelli, Steno; Arcangeli, Giorgio

    2008-07-15

    Purpose: Recent studies have suggested an {alpha}/{beta} ratio in prostate cancer of 1.5-3 Gy, which is lower than that assumed for late-responsive normal tissues. Therefore the administration of a single, intraoperative dose of irradiation should represent a convenient irradiation modality in prostate cancer. Materials and Methods: Between February 2002 and June 2004, 34 patients with localized prostate cancer with only one risk factor (Gleason score {>=}7, Clinical Stage [cT] {>=}2c, or prostate-specific antigen [PSA] of 11-20 ng/mL) and without clinical evidence of lymph node metastases were treated with radical prostatectomy (RP) and intraoperative radiotherapy on the tumor bed. A dose-finding procedure based on the Fibonacci method was employed. Dose levels of 16, 18, and 20 Gy were selected, which are biologically equivalent to total doses of about 60-80 Gy administered with conventional fractionation, using an {alpha}/{beta} ratio value of 3. Results: At a median follow-up of 41 months, 24 (71%) patients were alive with an undetectable PSA value. No patients died from disease, whereas 2 patients died from other malignancies. Locoregional failures were detected in 3 (9%) patients, 2 in the prostate bed and 1 in the common iliac node chain outside the radiation field. A PSA rise without local or distant disease was observed in 7 (21%) cases. The overall 3-year biochemical progression-free survival rate was 77.3%. Conclusions: Our dose-finding study demonstrated the feasibility of intraoperative radiotherapy in prostate cancer also at the highest administered dose.

  1. Anesthesiologic Effects of Transperitoneal Versus Extraperitoneal Approach During Robot-Assisted Radical Prostatectomy: Results of a Prospective Randomized Study

    PubMed Central

    Moro, Fabrizio Dal; Crestani, Alessandro; Valotto, Claudio; Guttilla, Andrea; Soncin, Rodolfo; Mangano, Angelo; Zattoni, Filiberto

    2015-01-01

    ABSTRACT Objectives: To compare the effects of CO2 insufflation on hemodynamics and oxygen levels and on acid-base level during Robot-Assisted Radical Prostatectomy (RARP) with transperitoneal (TP) versus extra-peritoneal (EP) accesses. Materials and Methods: Sixty-two patients were randomly assigned to TP (32) and EP (30) to RARP. Pre-operation data were collected for all patients. Hemodynamic, respiratory and blood acid-base parameters were measured at the moment of induction of anesthesia (T0), after starting CO2 insuffation (T1), and at 60 (T2) and 120 minutes (T3) after insufflation. In all cases, the abdominal pressure was set at 15 mmHg. Complications were reported according to the Clavien-Dindo classification. Student's two–t-test, with a significance level set at p<0.05, was used to compare categorical values between groups. The Mann-Whitney U-test was used to compare the median values of two nonparametric continuous variables. Results: The demographic characteristics of the patients in both groups were statistically comparable. Analysis of intra-operative anesthesiologic parameters showed that partial CO2 pressure during EP was significantly higher than during TP, with a consequent decrease in arterial pH. Other parameters analysed were similar in the two groups. Postoperative complications were comparable between groups. The most important limitations of this study were the small size of the patient groups and the impossibility of maintaining standard abdominal pressure throughout the operational phases, despite attempts to regulate it. Conclusions: This prospective randomized study demonstrates that, from the anesthesiologic viewpoint, during RARP the TP approach is preferable to EP, because of lower CO2 reabsorption and risk of acidosis. PMID:26200539

  2. Nanoparticle-based bio-barcode assay redefines “undetectable” PSA and biochemical recurrence after radical prostatectomy

    PubMed Central

    Thaxton, C. Shad; Elghanian, Robert; Thomas, Audrey D.; Stoeva, Savka I.; Lee, Jae-Seung; Smith, Norm D.; Schaeffer, Anthony J.; Klocker, Helmut; Horninger, Wolfgang; Bartsch, Georg; Mirkin, Chad A.

    2009-01-01

    We report the development of a previously undescribed gold nanoparticle bio-barcode assay probe for the detection of prostate specific antigen (PSA) at 330 fg/mL, automation of the assay, and the results of a clinical pilot study designed to assess the ability of the assay to detect PSA in the serum of 18 men who have undergone radical prostatectomy for prostate cancer. Due to a lack of sensitivity, available PSA immunoassays are often not capable of detecting PSA in the serum of men after radical prostatectomy. This new bio-barcode PSA assay is ≈300 times more sensitive than commercial immunoassays. Significantly, with the barcode assay, every patient in this cohort had a measurable serum PSA level after radical prostatectomy. Patients were separated into categories based on PSA levels as a function of time. One group of patients showed low levels of PSA with no significant increase with time and did not recur. Others showed, at some point postprostatectomy, rising PSA levels. The majority recurred. Therefore, this new ultrasensitive assay points to significant possible outcomes: (i) The ability to tell patients, who have undetectable PSA levels with conventional assays, but detectable and nonrising levels with the barcode assay, that their cancer will not recur. (ii) The ability to assign recurrence earlier because of the ability to measure increasing levels of PSA before conventional tools can make such assignments. (iii) The ability to use PSA levels that are not detectable with conventional assays to follow the response of patients to adjuvant or salvage therapies. PMID:19841273

  3. Prospective quality-of-life outcomes for low-risk prostate cancer: Active surveillance versus radical prostatectomy.

    PubMed

    Jeldres, Claudio; Cullen, Jennifer; Hurwitz, Lauren M; Wolff, Erika M; Levie, Katherine E; Odem-Davis, Katherine; Johnston, Richard B; Pham, Khanh N; Rosner, Inger L; Brand, Timothy C; L'Esperance, James O; Sterbis, Joseph R; Etzioni, Ruth; Porter, Christopher R

    2015-07-15

    For patients with low-risk prostate cancer (PCa), active surveillance (AS) may produce oncologic outcomes comparable to those achieved with radical prostatectomy (RP). Health-related quality-of-life (HRQoL) outcomes are important to consider, yet few studies have examined HRQoL among patients with PCa who were managed with AS. In this study, the authors compared longitudinal HRQoL in a prospective, racially diverse, and contemporary cohort of patients who underwent RP or AS for low-risk PCa. Beginning in 2007, HRQoL data from validated questionnaires (the Expanded Prostate Cancer Index Composite and the 36-item RAND Medical Outcomes Study short-form survey) were collected by the Center for Prostate Disease Research in a multicenter national database. Patients aged ≤75 years who were diagnosed with low-risk PCa and elected RP or AS for initial disease management were followed for 3 years. Mean scores were estimated using generalized estimating equations adjusting for baseline HRQoL, demographic characteristics, and clinical patient characteristics. Of the patients with low-risk PCa, 228 underwent RP, and 77 underwent AS. Multivariable analysis revealed that patients in the RP group had significantly worse sexual function, sexual bother, and urinary function at all time points compared with patients in the AS group. Differences in mental health between groups were below the threshold for clinical significance at 1 year. In this study, no differences in mental health outcomes were observed, but urinary and sexual HRQoL were worse for patients who underwent RP compared with those who underwent AS for up to 3 years. These data offer support for the management of low-risk PCa with AS as a means for postponing the morbidity associated with RP without concomitant declines in mental health. © 2015 American Cancer Society.

  4. Effect of Bladder Neck Preservation and Posterior Urethral Reconstruction during Robot-Assisted Laparoscopic Radical Prostatectomy for Urinary Continence

    PubMed Central

    You, Youn Chul; Kim, Tae Hyo

    2012-01-01

    Purpose To report our results on urinary continence after bladder neck preservation (BNP) and posterior urethral reconstruction (PUR) during robot-assisted laparoscopic radical prostatectomy (RALP). Materials and Methods Data from 107 patients who underwent RALP were compared on the basis of whether the patients underwent BNP and PUR, BNP only, or the standard technique (ST). In group A (n=31 patients), ST was performed by using Ven velthoven continuous suturing for urethrovesical anastomosis. In group B (n=28 patients), ST with only PUR was performed. In group C (n=48 patients), both the BNP and PUR techniques were used. "Recovery of continence" was defined as the use of 1 pad (50 ml) or less within 24 hours. Results The three groups were comparable in terms of patient demographics. The mean operative time and the mean blood loss decreased significantly from group A to group C (p=0.021 for mean operative time and p=0.004 for the mean blood loss). Mean catheterization time was 8.9, 7.8, and 7.1 days in each group (p=0.047). Early return of urinary continence at 3 months was observed in group B (89.2%) and group C (90.6%) compared with group A (71%). However, continence at 6 months was comparable in the 3 groups (87.5% in group A, 92.8% in group B, and 92.3% in group C). Rates of positive surgical margins decreased from 30.2% in group A to 20% in group B and 12% in group C. Conclusions BNP and PUR during RALP showed a favorable impact on the early postoperative recovery of continence while not affecting positive surgical margins. PMID:22323971

  5. Realistic Anatomical Prostate Models for Surgical Skills Workshops Using Ballistic Gelatin for Nerve-Sparing Radical Prostatectomy and Fruit for Simple Prostatectomy

    PubMed Central

    Lindner, Uri; Klotz, Laurence

    2011-01-01

    Purpose Understanding of prostate anatomy has evolved as techniques have been refined and improved for radical prostatectomy (RP), particularly regarding the importance of the neurovascular bundles for erectile function. The objectives of this study were to develop inexpensive and simple but anatomically accurate prostate models not involving human or animal elements to teach the terminology and practical aspects of nerve-sparing RP and simple prostatectomy (SP). Materials and Methods The RP model used a Foley catheter with ballistics gelatin in the balloon and mesh fabric (neurovascular bundles) and balloons (prostatic fascial layers) on either side for the practice of inter- and intrafascial techniques. The SP model required only a ripe clementine, for which the skin represented compressed normal prostate, the pulp represented benign tissue, and the pith mimicked fibrous adhesions. A modification with a balloon through the fruit center acted as a "urethra." Results Both models were easily created and successfully represented the principles of anatomical nerve-sparing RP and SP. Both models were tested in workshops by urologists and residents of differing levels with positive feedback. Conclusions Low-fidelity models for prostate anatomy demonstration and surgical practice are feasible. They are inexpensive and simple to construct. Importantly, these models can be used for education on the practical aspects of nerve-sparing RP and SP. The models will require further validation as educational and competency tools, but as we move to an era in which human donors and animal experiments become less ethical and more difficult to complete, so too will low-fidelity models become more attractive. PMID:21379431

  6. Long-term adverse effects after curative radiotherapy and radical prostatectomy: population-based nationwide register study

    PubMed Central

    Fridriksson, Jón Ö.; Folkvaljon, Yasin; Nilsson, Per; Robinson, David; Franck-Lissbrant, Ingela; Ehdaie, Behfar; Eastham, James A.; Widmark, Anders; Karlsson, Camilla T.; Stattin, Pär

    2016-01-01

    Abstract Objective: The aim of this study was to assess the risk of serious adverse effects after radiotherapy (RT) with curative intention and radical prostatectomy (RP). Materials and methods: Men who were diagnosed with prostate cancer between 1997 and 2012 and underwent curative treatment were selected from the Prostate Cancer data Base Sweden. For each included man, five prostate cancer-free controls, matched for birth year and county of residency, were randomly selected. In total, 12,534 men underwent RT, 24,886 underwent RP and 186,624 were controls. Adverse effects were defined according to surgical and diagnostic codes in the National Patient Registry. The relative risk (RR) of adverse effects up to 12 years after treatment was compared to controls and the risk was subsequently compared between RT and RP in multivariable analyses. Results: Men with intermediate- and localized high-risk cancer who underwent curative treatment had an increased risk of adverse effects during the full study period compared to controls: the RR of undergoing a procedures after RT was 2.64 [95% confidence interval (CI) 2.56–2.73] and after RP 2.05 (95% CI 2.00–2.10). The risk remained elevated 10–12 years after treatment. For all risk categories of prostate cancer, the risk of surgical procedures for urinary incontinence was higher after RP (RR 23.64, 95% CI 11.71–47.74), whereas risk of other procedures on the lower urinary tract and gastrointestinal tract or abdominal wall was higher after RT (RR 1.67, 95% CI 1.44–1.94, and RR 1.86, 95% CI 1.70–2.02, respectively). Conclusion: The risk of serious adverse effects after curative treatment for prostate cancer remained significantly elevated up to 12 years after treatment. PMID:27333148

  7. Predicting tumour location in radical prostatectomy specimens: same-patient comparisons of 21-sample versus sextant biopsy.

    PubMed

    De Laet, Kevin; de la Taille, Alexandre; Ploussard, Guillaume; Hoznek, Andras; Vordos, Dimitrios; Yiou, René; Allory, Yves; Azoulay, Sandy; Abbou, Claude; Salomon, Laurent

    2009-09-01

    To determine the value of a 21-sample biopsy protocol in predicting tumour localization in radical prostatectomy (RP) specimens, compared with sextant biopsies. In all, 300 consecutive patients underwent 21-sample prostate biopsies, followed by RP. The protocol consisted of sextant, three midline, six far lateral and six transitional zone biopsies. Tumour locations on biopsies and RP specimens were compared. The sensitivity, specificity, positive (PPV) and negative predictive value (NPV) and accuracy were calculated. There was no difference between sextant and 21-sample biopsies for sensitivity (38% vs 36%; P=0.50) and specificity (84% vs 87%; P=0.46), but the NPV was higher for 21-sample biopsies (57% vs 68% ; P<0.001). The PPV was higher in the sextant biopsies (74% vs 59%; P=0.007). Sextant, transitional zone and far lateral biopsies were re-grouped in six regions. Compared with 21-sample biopsies, sensitivity (54%) and PPV (79%) were higher (P<0.001), while specificity (74%) and NPV (46%) were lower (P=0.05 and P=0.001, respectively). A negative biopsy does not confirm the absence of cancer in the corresponding site in the RP specimen in a sextant or 21-sample biopsy protocol and cannot be used as a prognostic element before RP. A positive biopsy does not always correspond with a tumour in the same zone of the RP specimen. When 21-sample biopsies are re-grouped in to six regions, the value of a positive biopsy increases. A positive biopsy corresponds thus to a tumour in the same region, rather than in precisely the same location. The results of this study could help in the biopsy protocol used for making surgical decisions, e.g. preserving the bladder neck or neurovascular bundles.

  8. Early clinical experience with water-jet dissection (hydro-jet) during nerve-sparing radical retropubic prostatectomy.

    PubMed

    Fernández De la Maza, S; Conrad, S; Graefen, M; Noldus, J; Huland, H

    2002-01-01

    Successful preservation of the neuro-vascular bundle (NVB) during anatomical nerve-sparing radical retropubic prostatectomy (NS-RRP) for patients with clinically localized prostate cancer is a great operative challenge. We employed a new dissection method using water-jet technology for the preservation of the NVB. We evaluated intraoperative parameters, complications and early functional results regarding continence and potency. The results were compared to a conventional operative technique. Bilateral NS-RRP was performed by the same urologist in 36 consecutive cases between January and December 2000. Eighteen patients underwent NS-RRP using water-jet dissection (ERBE Helix Hydro-Jet). Eighteen patients underwent a standard NS-RRP. Water-jet dissection was used exclusively for nerve-sparing. We assessed blood loss, operation time, complications and incidence of blood transfusions. Early continence and potency rates were evaluated. Nerve-sparing using the Hydro-Jet technique appeared to be easier, more subtle and faster compared with the standard surgical technique. The exact dissection of the layers allowed a selective dissection and better control of crossing vessels to the prostate. Blood loss was reduced by 36% (p=0.02), no blood transfusion was necessary and the operation time was reduced by 20% (p=0.02). There were no major complications. Continence rates 3 months after RRP were 77.7% in the water jet group and 66.6% in the standard group, and overall potency rates (any grade of erection) were 77.7% and 55.5% respectively. Water-jet dissection is a feasible, safe and efficient technique to facilitate NS-RRP. There is a minimal learning curve with comparable functional results to the conventional procedure. Further improvements in the water-jet application and a longer follow-up might lead to further improvements in continence and potency rates in patients undergoing NS-RRP.

  9. Patterns-of-care and health economic analysis of robot-assisted radical prostatectomy in the Australian public health system.

    PubMed

    Basto, Marnique; Sathianathen, Niranjan; Te Marvelde, Luc; Ryan, Shane; Goad, Jeremy; Lawrentschuk, Nathan; Costello, Anthony J; Moon, Daniel A; Heriot, Alexander G; Butler, Jim; Murphy, Declan G

    2016-06-01

    To compare patterns of care and peri-operative outcomes of robot-assisted radical prostatectomy (RARP) with other surgical approaches, and to create an economic model to assess the viability of RARP in the public case-mix funding system. We retrospectively reviewed all radical prostatectomies (RPs) performed for localized prostate cancer in Victoria, Australia, from the Victorian Admitted Episode Dataset, a large administrative database that records all hospital inpatient episodes in Victoria. The first database, covering the period from July 2010 to April 2013 (n = 5 130), was used to compare length of hospital stay (LOS) and blood transfusion rates between surgical approaches. This was subsequently integrated into an economic model. A second database (n = 5 581) was extracted to cover the period between July 2010 and June 2013, three full financial years, to depict patterns of care and make future predictions for the 2014-2015 financial year, and to perform a hospital volume analysis. We then created an economic model to evaluate the incremental cost of RARP vs open RP (ORP) and laparoscopic RP (LRP), incorporating the cost-offset from differences in LOS and blood transfusion rate. The economic model constructs estimates of the diagnosis-related group (DRG) costs of ORP and LRP, adds the gross cost of the surgical robot (capital, consumables, maintenance and repairs), and manipulates these DRG costs to obtain a DRG cost per day, which can be used to estimate the cost-offset associated with RARP in comparison with ORP and LRP. Economic modelling was performed around a base-case scenario, assuming a 7-year robot lifespan and 124 RARPs performed per financial year. One- and two-way sensitivity analyses were performed for the four-arm da Vinci SHD, Si and Si dual surgical systems (Intuitive Surgical Ltd, Sunnyvale, CA, USA). We identified 5 581 patients who underwent RP in 20 hospitals in Victoria with an open, laparoscopic or robot-assisted surgical approach in the

  10. Prediction of biochemical recurrence and prostate cancer specific death in men after radical retropublic prostatectomy: Use of pathology and computer-assisted quantitative nuclear grading information

    NASA Astrophysics Data System (ADS)

    Khan, Masood Ahmed

    Prostate cancer is the most common solid tumour in man. Accordingly, it is expected that 1 in 6 men will experience prostate cancer during their lifetime. Over the past 20 years there have been tremendous advancements in both diagnostic as well as surgical approach to prostate cancer. This has led not only to earlier detection of the disease in its natural history, but also the availability of effective surgical management. Furthermore, the discovery of serum prostate specific antigen as a marker for prostate cancer along with greater acceptance of prostate cancer screening has resulted in an increase in the incidence of prostate cancer in men younger than 50 years of age. This is an age group that has traditionally been associated with a poor prognosis after radical prostatectomy. In addition, despite being able to effectively remove the whole of the gland with limited morbidity, approximately 25% of men after radical prostatectomy will experience biochemical recurrence with time. Moreover, the majority will progress to distant metastases and/or die from prostate cancer. We firstly investigated whether radical prostatectomy is a viable option for men younger than 50 years of age diagnosed with clinically localised prostate cancer. We also determined factors that predict disease recurrence after radical prostatectomy. As many men demonstrate evidence of biochemical recurrence with some showing further progression after radical prostatectomy, we, therefore, investigated whether pathological variables as well as nuclear morphometry could be used to predict those that are at an increased risk for disease recurrence after radical prostatectomy. Our results demonstrated that 1) radical prostatectomy can be safely performed in younger men as it can provide excellent long-term disease-free survival; 2) We determined that there are a number of factors that are associated with an increased risk for disease recurrence after radical prostatectomy; 3) We have constructed a new

  11. Intraoperative frozen section of the prostate decreases positive margin rate while ensuring nerve sparing procedure during radical prostatectomy.

    PubMed

    von Bodman, Christian; Brock, Marko; Roghmann, Florian; Byers, Anne; Löppenberg, Björn; Braun, Katharina; Pastor, Jobst; Sommerer, Florian; Noldus, Joachim; Palisaar, Rein Jüri

    2013-08-01

    We evaluated whether intraoperative frozen section analysis of the prostate surface might provide significant information to ensure nerve sparing and minimize the positive margin rate. In 236 patients treated with radical prostatectomy between June 2011 and September 2012 whole surface frozen section analysis of the removed prostate was done intraoperatively. The apex and base were circumferentially dissected as well as the whole posterolateral tissue corresponding to the neurovascular bundles. Multiple perpendicular sections were cut systematically for frozen section analysis. Pathology results were reported to navigate the procedure. Frozen section analysis identified positive surgical margins in 22% of cases, including the neurovascular bundles in 56.9%, apex in 34.5% and base in 8.6%. Of positive frozen section cases 92.3% could be converted to negative status, while 7.7% remained positive. The final positive margin rate in the total cohort was 3%, including a false-negative frozen section rate of 1.6%. In 14.8% of cases the initial nerve sparing plan was changed intraoperatively due to the positive frozen section and the secondary resected specimen detected cancer in 25%. Final pathology results showed Gleason upgrading or up-staging in 40.7% of cases compared to preoperative variables. When comparing patients with positive vs negative frozen sections, preoperative variables did not significantly differ, while postoperatively pathological stage, tumor volume, operative time and final margin status differed significantly. Of patients with exclusively unilateral positive biopsies 13% had a positive surgical margin intraoperatively on the opposite, biopsy negative side. The surface frozen section technique is associated with a low false-negative surgical margin rate. It might allow for safer preservation of functional anatomical structures in misclassified patients or even patients at higher preoperative risk. Copyright © 2013 American Urological Association

  12. Teaching laparoscopic radical prostatectomy during the primary surgeon's early learning curve--analysis of our first 207 cases.

    PubMed

    Luke, Serge; Delprado, Warick; Louie-Johnsun, Mark

    2014-11-01

    To assess the feasibility of introducing laparoscopic radical prostatectomy (LRP) training during the primary surgeon's early learning curve in a regional Australian centre. From a prospective single surgeon database perioperative, oncological and functional outcome data was collected from the first 207 consecutive patients who underwent LRP immediately after a 12-month LRP Fellowship in a high-volume centre by the primary surgeon (M.L.J.). A training case was defined as the successful completion of at least two of 10 steps by a training Fellow. Perioperative and oncological outcomes were compared in training and non-training cohorts and overall learning curve was assessed by comparing consecutive 50-patient cohorts. In all, 31% of cases were training cases with a median (range) of 7 (2-10) steps of 10 steps performed by the training Fellow. Operative times were significantly longer in training cases (mean 269 vs 209 min; P < 0.001). There was no statistically significant difference in perioperative outcomes of length of stay (2.7 vs 2.6 days), transfusion rates (3.1% vs 2.1%), major complication (Clavien >3a) rates (1.6% vs 2.1%) or positive surgical margins (PSMs: pT2 2.8% vs 15.3% and pT3 52.0% vs 45.1%) between training and non-training groups, respectively. Overall, there were two open conversions (1.0%). Despite the challenging learning curve, LRP training can be commenced safely with a stepwise modular approach, even when the primary surgeon is in their early learning curve. Perioperative outcomes including PSMs and major complications were unaffected by trainee involvement. © 2014 The Authors. BJU International © 2014 BJU International.

  13. Quantifying severe urinary complications after radical prostatectomy: the development and validation of a surgical performance indicator using hospital administrative data.

    PubMed

    Sujenthiran, Arunan; Charman, Susan C; Parry, Matthew; Nossiter, Julie; Aggarwal, Ajay; Dasgupta, Prokar; Payne, Heather; Clarke, Noel W; Cathcart, Paul; van der Meulen, Jan

    2017-08-01

    To develop and validate a surgical performance indicator based on severe urinary complications that require an intervention within 2 years of radical prostatectomy (RP), identified in hospital administrative data. Men who underwent RP between 2008 and 2012 in England were identified using hospital administrative data. A transparent coding framework based on procedure codes was developed to identify severe urinary complications which were grouped into 'stricture', 'incontinence' and 'other'. Their validity as a performance indicator was assessed by evaluating the consistency with diagnosis codes and association with patient and surgical characteristics. Kaplan-Meier methods were used to assess time to first occurrence and multivariable logistic regression was used to estimate adjusted odds ratios (ORs) for patient and surgical characteristics. A total of 17 299 men were included, of whom 2695 (15.6%) experienced at least one severe urinary complication within 2 years. High proportions of men with a complication had relevant diagnosis codes: 86% for strictures and 93% for incontinence. Urinary complications were more common in men from poorer socio-economic backgrounds (OR comparing lowest with highest quintile: 1.45; 95% confidence interval [CI] 1.26-1.67) and in those with prolonged length of hospital stay (OR 1.54, 95% CI 1.40-1.69), and were less common in men who underwent robot-assisted surgery (OR 0.65, 95% CI 0.58-0.74). These results show that severe urinary complications identified in administrative data provide a medium-term performance indicator after RP. They can be used for research assessing outcomes of treatment methods and for service evaluation comparing performance of prostate cancer surgery providers. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

  14. Interobserver Variability in Histologic Evaluation of Radical Prostatectomy Between Central and Local Pathologists: Findings of TAX 3501 Multinational Clinical Trial

    PubMed Central

    Netto, George J.; Eisenberger, Mario; Epstein, Jonathan I.

    2012-01-01

    OBJECTIVES To determine the agreement between the local pathologist findings and central pathologist findings using data from the TAX 3501 trial. TAX 3501 was a randomized, multinational trial comparing the outcomes of patients with high-risk prostate cancer treated with androgen deprivation with or without docetaxel after radical prostatectomy (RP). Patient eligibility was determined by a minimal 5-year progression-free survival estimate of 60% using Kattan’s nomogram. METHODS The pathologic findings were reassessed in 257 consecutive RP specimens by 2 central pathologists and compared with the local pathologist data. RESULTS For the Gleason score, agreement was found in 181 (70%) of 257 cases, upgrading in 57 (75%), and downgrading in 25% of the RP specimens The most frequent upgrade was from Gleason score 7 to 8 or 9 and downgrading from Gleason score 8 to 7. Of the upgrades and downgrades, 37% and 21% were of 2 Gleason score points, respectively. For the tumor extent, agreement was found in 179 (70%) of 256 specimens, with upstaging in 70 (91%) and downstaging in 9%. The most frequent upstage was from focal to extensive extraprostatic extension (45%). For seminal vesicle invasion, agreement was found for 238 (93%) of 256 RP specimens Almost equal rates of underdiagnosing and overdiagnosing seminal vesicle invasion was observed. For margin status, agreement was present for 229 (89%) of 256 cases. The central pathologist review led to reclassification as a positive margin in 17 cases and a negative margin in 10. For lymph node status, 2 (1%) of 210 RP specimens had positive nodes identified only by the central pathologist. Agreement was observed in 154 negative and 54 positive cases. CONCLUSIONS Significant interobserver variations were found between the central and local pathologists. From the central pathologist review, the progression-free survival estimates were altered in 31 patients (13%), including 22 who were reassigned a greater risk estimate

  15. Preoperative pain as a risk factor for chronic post-surgical pain - six month follow-up after radical prostatectomy.

    PubMed

    Gerbershagen, Hans J; Ozgür, Enver; Dagtekin, Oguzhan; Straub, Karin; Hahn, Moritz; Heidenreich, Axel; Sabatowski, Rainer; Petzke, Frank

    2009-11-01

    Chronic post-surgical pain (CPSP) by definition develops for the first time after surgery and is not related to any preoperative pain. Preoperative pain is assumed to be a major risk factor for CPSP. Prospective studies to endorse this assumption are missing. In order to assess the incidence and the risk factors for CPSP multidimensional pain and health characteristics and psychological aspects were studied in patients prior to radical prostatectomy. Follow-up questionnaires were completed three and six months after surgery. CPSP incidences in 84 patients after three and six months were 14.3% and 1.2%. Preoperatively, CPSP patients were assigned to higher pain chronicity stages measured with the Mainz Pain Staging System (MPSS) (p=0.003) and higher pain severity grades (Chronic Pain Grading Questionnaire) (p=0.016) than non-CPSP patients. CPSP patients reported more pain sites (p=0.001), frequent pain in urological body areas (p=0.047), previous occurrence of CPSP (p=0.008), more psychosomatic symptoms (Symptom Check List) (p=0.031), and worse mental functioning (Short Form-12) (p=0.019). Three months after surgery all CPSP patients suffered from moderate to high-risk chronic pain (MPSS stages II and III) compared to 66.7% at baseline and 82.3% had high disability pain (CPGQ grades III and IV) compared to 41.7% before surgery. CPSP patients scored significantly less favorably in physical and mental health, habitual well-being, and psychosomatic dysfunction three months after surgery. All patients with CPSP reported on preoperative chronic pain. Patients with preoperative pain, related or not related to the surgical site were significantly at risk to develop CPSP. High preoperative pain chronicity stages and pain severity grades were associated with CPSP. CPSP patients reported poorer mental health related quality of life and more severe psychosomatic dysfunction before and 3 months after surgery.

  16. The effect of steep Trendelenburg positioning on intraocular pressure and visual function during robotic-assisted radical prostatectomy.

    PubMed

    Hoshikawa, Yuko; Tsutsumi, Noriko; Ohkoshi, Kisiko; Serizawa, Satoshi; Hamada, Masafumi; Inagaki, Keiji; Tsuzuki, Kentaro; Koshimizu, Junko; Echizen, Nariaki; Fujitani, Syuko; Takahashi, Osamu; Deshpande, Gautam A

    2014-03-01

    To evaluate intraocular pressure (IOP) changes in patients undergoing robotic-assisted radical prostatectomy and to evaluate complications from increased IOP. Thirty-one eyes scheduled for robotic prostatectomy were included. Perioperative IOP measurements were performed as follows: prior to induction of anaesthesia while supine and awake (T1); immediately post-induction while supine (T2); every hour from 0 to 5 h while anaesthetised in a steep Trendelenburg position (T3-T8); prior to awakening while supine (T9); and 30 min after awakening while supine (T10). A complete ophthalmic examination including visual acuity and retinal nerve fibre layer thickness (RNFL) was performed at enrolment and 1 month postoperatively. Average IOP (mm Hg) for each time point was as follows: T1=18.0, T2=9.8, T3=18.9, T4=21.6, T5=22.5, T6=22.3, T7=24.2, T8=24.0, T9=15.7 and T10=17.9. The proportion of eyes with intraoperative IOP ≧30 mm Hg were as follows: T3=0%, T4=3.23%, T5=9.68%, T6=6.45%, T7=22.22%, and T8=25%. Maximum IOP was 36 mm Hg. Mean visual acuity (logarithm of the minimal angle of resolution) and RNFL showed no statistically significant difference before and after operation and no other ocular complications were found at final examination. While IOP increased in a time-dependent fashion in anesthaetised patients undergoing robotic-assisted radical prostatectomy in a steep Trendelenburg position, visual function showed no significant change postoperatively and no complications were seen. Steep Trendelenburg positioning during time-limited procedures appears to pose little or no risk from IOP increases in patients without pre-existing ocular disease.

  17. Salvage radiotherapy for macroscopic local recurrences after radical prostatectomy : A national survey on patterns of practice.

    PubMed

    Dal Pra, Alan; Panje, Cedric; Zilli, Thomas; Arnold, Winfried; Brouwer, Kathrin; Garcia, Helena; Glatzer, Markus; Gomez, Silvia; Herrera, Fernanda; Kaouthar, Khanfir; Papachristofilou, Alexandros; Pesce, Gianfranco; Reuter, Christiane; Vees, Hansjörg; Zwahlen, Daniel Rudolf; Engeler, Daniel; Putora, Paul Martin

    2017-06-27

    Although salvage radiotherapy (SRT) for PSA recurrence after radical prostatectomy provides better oncological outcomes when delivered early, in the absence of detectable disease many patients are treated for macroscopic locally recurrent tumors. Due to limited data from prospective studies, we hypothesized an important variability in the SRT management of these patients. Our aim was to investigate current practice patterns of SRT for local macroscopic recurrence after radical prostatectomy. A total of 14 Swiss radiation oncology centers were asked to complete a survey on treatment specifications for macroscopic locally recurrent disease including information on pretherapeutic diagnostic procedures, dose prescription, radiation delivery techniques and androgen deprivation therapy (ADT). Treatment recommendations on ADT were analyzed using the objective consensus methodology. The majority of centers recommended pretreatment magnetic resonance imaging (MRI) of the pelvis and choline positron emission tomography (PET). The median prescribed dose to the prostate bed was 66 Gy (range 65-72 Gy) with a boost to the macroscopic lesion used by 79% of the centers with a median total dose of 72 Gy (range 70-80 Gy). Intensity-modulated rotational techniques were used by all centers and daily cone beam computed tomography (CT) was recommended by 43%. The use of concomitant ADT for any macroscopic recurrence was recommended by 43% of the centers while the remaining centers recommended it only for high-risk disease, which was not consistently defined. We observed a high variability of treatment paradigms when SRT is indicated for macroscopic local recurrences after prostatectomy. These data reflect the need for more standardized approaches and ultimately further research in this field.

  18. Robotic surgical education: a systematic approach to training urology residents to perform robotic-assisted laparoscopic radical prostatectomy.

    PubMed

    Rashid, Hani H; Leung, Yuk-Yuen M; Rashid, Megan J; Oleyourryk, Gregory; Valvo, John R; Eichel, Louis

    2006-07-01

    Robotic-assisted surgery using the da Vinci Surgical System is gaining popularity among urologists. However, training residents to use this system presents new challenges for surgical educators. We describe a method for training residents to perform robotic-assisted radical prostatectomy. Residents first received da Vinci certification training followed by table-side assistance with a second attending urologist present to provide real-time instruction. After demonstrating proficiency with assistance, residents performed segments of robotic prostatectomies as the console surgeon. The procedure was divided into five steps: (a) bladder take-down, (b) endopelvic fascia and dorsal venous complex, (c) bladder neck and posterior dissection, (d) neurovascular bundles, and (e) urethral anastomosis. Performance was rated using an analog scale (0, very poor to 5, outstanding). The resident was allowed to proceed to the next step once proficiency (score greater than 3 of 5) had been demonstrated on three separate occasions. In addition, each procedure was digitally recorded and reviewed with the attending physician after the operation. Two chief residents underwent this training regimen. All 83 cases with surgical console involvement during a 7-month period were reviewed. The combined residents' mean operative time in minutes and overall performance (score 0 of 5 to 5 of 5) for each step were recorded. Using logistic regression analysis, a statistically significant trend was seen, with faster operative times and greater analog scores over time for both residents (P <0.005). A systematic approach can be used to safely and effectively train urology residents to perform robotic radical prostatectomy using the da Vinci robotic system.

  19. Psychotherapy and phosphodiesterase-5 inhibitor in early rehabilitation after radical prostatectomy: a prospective randomised controlled trial.

    PubMed

    Naccarato, A M E P; Reis, L O; Ferreira, U; Denardi, F

    2016-12-01

    The aim of this study was to evaluate the impact of group psychotherapy and the use of a phosphodiesterase-5 inhibitor (PDE-5i) in the early rehabilitation stage of patients with prostate cancer undergoing radical prostatectomy (RP). Fifty-six patients undergoing RP for prostate cancer were randomised into four groups, and 53 completed the protocol: Group 1 - control (n = 11), Group 2 - group psychotherapy (n = 16), Group 3 - lodenafil 80 mg/one tablet per week (n = 12) and Group 4 - group psychotherapy + lodenafil 80 mg/one tablet per week (n = 14). The groups were individually evaluated for erectile function (IIEF-5) and quality of life - QoL (SF-36) weekly, with two meetings held a week apart before the RP and 12 weekly meetings after surgery. The ages ranged from 39 to 76 years, average 61.84. There were no significant medication side effects. Only Group 4 showed improvement in intimacy with a partner and satisfaction with their sex life (P = 0.045 and P = 0.013 respectively), and with no significant worsening of the IIEF-5 (P = 0.250) reported. All groups showed worsening in the final result of the role limitations caused by physical problems (P = 0.009) and role limitations caused by emotional problems (P = 0.002) of the SF-36, but Group 4 had a significantly higher score for the role limitations caused by physical problems (P = 0.009) than the other groups. In conclusion, precocious integral treatment involving group psychotherapy and PDE-5i before and after RP led to less deterioration of erectile function and other domains related to physical aspects (SF-36), with improvement in intimacy with their partner and satisfaction in their sex life, being superior to single treatments. © 2016 Blackwell Verlag GmbH.

  20. High-Dose Adjuvant Radiotherapy After Radical Prostatectomy With or Without Androgen Deprivation Therapy

    SciTech Connect

    Ost, Piet; Cozzarini, Cesare; De Meerleer, Gert; Fiorino, Claudio; De Potter, Bruno; Briganti, Alberto; Nagler, Evi V.T.; Montorsi, Francesco; Fonteyne, Valerie; Di Muzio, Nadia

    2012-07-01

    Purpose: To retrospectively evaluate the outcome and toxicity in patients receiving high-dose (>69 Gy) adjuvant radiotherapy (HD-ART) and the impact of androgen deprivation therapy (ADT). Methods and Materials: Between 1999 and 2008, 225 node-negative patients were referred for HD-ART with or without ADT to two large academic institutions. Indications for HD-ART were extracapsular extension, seminal vesicle invasion (SVI), and/or positive surgical margins at radical prostatectomy (RP). A dose of at least 69.1 Gy was prescribed to the prostate bed and seminal vesicle bed. The ADT consisted of a luteinizing hormone-releasing hormone analog. The duration and indication of ADT was left at the discretion of the treating physician. The effect of HD-ART and ADT on biochemical (bRFS) and clinical (cRFS) relapse-free survival was examined through univariate and multivariate analysis, with correction for known patient- and treatment-related variables. Interaction terms were introduced to evaluate effect modification. Results: After a median follow-up time of 5 years, the 7-year bRFS and cRFS were 84% and 88%, respectively. On multivariate analysis, the addition of ADT was independently associated with an improved bRFS (hazard ratio [HR] 0.4, p = 0.02) and cRFS (HR 0.2, p = 0.008). Higher Gleason scores and SVI were associated with decreased bRFS and cRFS. A lymphadenectomy at the time of RP independently improved cRFS (HR 0.09, p = 0.009). The 7-year probability of late Grade 2-3 toxicity was 29% and 5% for genitourinary (GU) and gastrointestinal (GI) symptoms, respectively. The absolute incidence of Grade 3 toxicity was <1% and 10% for GI and GU symptoms, respectively. The study is limited by its retrospective design and the lack of a standardized use of ADT. Conclusions: This retrospective study shows significantly improved bRFS and cRFS rates with the addition of ADT to HD-ART, with low Grade 3 gastrointestinal toxicity and 10% Grade 3 genitourinary toxicity.