scholarly journals Management of Localized Prostate Cancer by Focal Transurethral Resection of Prostate Cancer: An Application of Radical TUR-PCa to Focal Therapy

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Masaru Morita ◽  
Takeshi Matsuura
Keyword(s):  
Prostate Cancer ◽  
Bladder Neck ◽  
Peripheral Zone ◽  
Focal Therapy ◽  
Localized Prostate Cancer ◽  
Transurethral Resection Of Prostate ◽  
Bladder Neck Contracture ◽  
Psa Failure ◽  
The Mean

Background. We analyzed radical TUR-PCa against localized prostate cancer.Patients and Methods. Seventy-nine out of 209 patients with prostate cancer in one lobe were studied. Patients’ age ranged from 58 to 91 years and preoperative PSA, 0.70 to 17.30 ng/mL. In other 16 additional patients we performed focal TUR-PCa. Patients’ age ranged from 51 to 87 years and preoperative PSA, 1.51 to 25.74 ng/mL.Results. PSA failure in radical TUR-PCa was 5.1% during the mean follow-up period of 58.9 months. The actuarial biochemical non-recurrence rate was 98.2% for pT2a and 90.5% for pT2b. Bladder neck contracture occurred in 28 patients (35.4%). In 209 patients, pathological study revealed prostate cancer of the peripheral zone near the neurovascular bundle bilaterally in 25%, unilaterally in 39% and no cancer bilaterally in 35%, suggesting the possibility of focal TUR-PCa. Postoperative PSA of 16 patients treated by focal TUR-PCa was stable between 0.007 and 0.406 ng/mL at 24.2 months’ follow-up. No patients suffered from urinary incontinence. Bladder neck contracture developed in only 1 patient and all 5 patients underwent nerve-preserving TUR-PCa did not show erectile dysfunction.Conclusion. Focal TUR-PCa was considered to be a promising option among focal therapies against localized prostate cancer.

scholarly journals High-Intensity Focused Ultrasound (HIFU) Focal Therapy for Localized Prostate Cancer with MRI-US Fusion Platform

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Chi-Hang Yee ◽  
Peter Ka-Fung Chiu ◽  
Jeremy Yuen-Chun Teoh ◽  
Chi-Fai Ng ◽  
Chi-Kwok Chan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Functional Outcomes ◽  
Case Series ◽  
Focal Therapy ◽  
High Intensity Focused Ultrasound ◽  
Localized Prostate Cancer ◽  
Lesion Volume ◽  
Significant Difference ◽  
The Mean

Objective. The study aimed at investigating the outcome of prostate HIFU focal therapy using the MRI-US fusion platform for treatment localization and delivery. Methods. It is a prospectively designed case series of HIFU focal therapy for localized prostate cancer. The inclusion criteria include clinical tumor stage ≤T2, visible index lesion on multiparametric MRI less than 20 mm in diameter, absence of Gleason 5 pattern on prostate biopsy, and PSA ≤ 20 ng/ml. HIFU focal therapy was performed in the conventional manner in the beginning 50% of the series, whereas the subsequent cases were performed with MRI-US fusion platform. The primary outcome was treatment failure rate which is defined by the need of salvage therapy. Secondary outcomes included tumor recurrence in follow-up biopsy, PSA change, perioperative complications, and postoperative functional outcomes. Results. Twenty patients underwent HIFU focal ablation. HIFU on an MRI-US fusion platform had a trend of a longer total operative time than the conventional counterpart (124.2 min vs. 107.1 min, p = 0.066 ). There was no difference in the mean ablation volume to lesion volume ratio between the two. The mean PSA percentage change from baseline to 6-month is more significant in the conventional group (63.3% vs. 44.6%, p = 0.035 ). No suspicious lesion was seen at 6-month mpMRI in all 20 patients. Two patients, one from each group, eventually underwent radical treatment because of the presence of clinically significant prostate cancer in the form of out-of-field recurrences during follow-up biopsy. No significant difference was observed before and after HIFU concerning uroflowmetry, SF-12 score, and EPIC-26 score. It was observed that energy used per volume was positively correlated with PSA density of the patient (r = 0.6364, p = 0.014 ). Conclusion. In conclusion, HIFU with conventional or MRI-US fusion platform provided similar oncological and functional outcomes.

scholarly journals Can We Consider the Possibility of Transurethral Resection of the Prostate (TURP) Becoming Another Gateway to the Focal Therapy of Localized Prostate Cancer?

2020 ◽  
Vol 3 (2) ◽  
pp. e22-e30
Author(s):  
Masaru Morita ◽  
Akira Morita ◽  
Takeshi Matsuura
Keyword(s):  
Prostate Cancer ◽  
Transurethral Resection ◽  
Risk Group ◽  
Radical Resection ◽  
Focal Therapy ◽  
Localized Prostate Cancer ◽  
Transurethral Resection Of Prostate ◽  
Low Grade ◽  
Psa Testing ◽  
Number Of Patients

Background and ObjectivesMinimally invasive methods are expected to avoid the risk of overtreatment and overtreatment of radical therapy to manage the increased number of patients with low-volume, low-grade localized prostate cancer. Based on our experience of radical transurethral resection of prostate cancer (TURPCa) as a radical treatment, we studied the efficacy and safety of focal TURPCa as a focal therapy for patients with localized prostate cancer. Materials and MethodsWe performed focal TURPCa in 49 patients during the period from July 2007 to August 2016 and followed them with prostate-specific antigen (PSA) testing for the mean period of 68.0 months. We selected the patient as a candidate for the study if the biopsy revealed that cancer foci were limited in one lobe, or the foci were several or less even found in both lobes. Standard TURP was followed by further resection and fulguration of the peripheral zone where cancer was considered to exist. We selected one of our three methods of focal TURPCa as follows: one lobe radical TURPCa, radical resection of the affected lobe with unaffected lobe being resected less vigorously; nerve-sparing radical TURPCa, radical resection of both lobes except for the posterolateral part of the prostate; target radical TURPCa, radical resection of the cancer focus and the surrounding prostate when the target is suggested single. ResultsTwelve patients were in the low-risk group (D’Amico), 29 in the intermediate-risk group, and 8 in the high-risk group. Pathological stages were as follows: pT0, three cases; pT2a-b, 17 cases; pT2c, 29 cases. The preoperative PSA of 6.15±2.73 ng/mL (mean±SD) dropped to 0.172±0.283 ng/mL postoperatively. PSA failure occurred in only two patients (4.1%). Incontinence did not develop and erectile function was preserved in eight (44.4%) of the 18 potent patients. The most frequent complication was bladder neck contracture (20.4%). Other complications included acute epididymitis (8.1%), bladder tamponade (2.0%). No patients died of prostate cancer. ConclusionsThough the final assessment of efficacy will require long-term follow-up results with more cases, we may think focal TURPCa can be another treatment option as a focal therapy for localized prostate cancer.

Technical Aspects of Focal Therapy in Localized Prostate Cancer: Follow-Up After Focal Therapy

2014 ◽  
pp. 199-208
Author(s):  
Lukman Hakim ◽  
Lorenzo Tosco ◽  
Wahjoe Djatisoesanto ◽  
Thomas Van den Broeck ◽  
Willemien van den Bos ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Focal Therapy ◽  
Localized Prostate Cancer ◽  
Technical Aspects

Target focal therapy in early prostate cancer: Initial single institution results

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15574-15574 ◽  
Author(s):  
A. Barqawi ◽  
J. Lugg ◽  
E. D. Crawford
Keyword(s):  
Prostate Cancer ◽  
Early Stage ◽  
Focal Therapy ◽  
Urinary Continence ◽  
Minimal Impact ◽  
Alternative Option ◽  
Early Results ◽  
The Mean ◽  
Mapping Biopsy

15574 Background: Currently the potential for over- and under-treatment using radical and watchful waiting options respectively constitutes a challenge in the management of patients with early organ-confined prostate cancer. Target focal therapy (TFT) is emerging as an intermediary alternative option for such men. The goal is to provide ablative treatment with minimal impact on morbidity. Methods: As part of an IRB approved study protocol a total of 24 patients initially underwent a 3 dimensional transperineal mapping biopsy under TRUS guidance to confirm the extent of tumor burden and localize the cancer foci within the prostate. Only 12 men qualified to undergo target focal cryotherapy. The remaining patients did not qualify due to upgrading or downgrading of their stage and opted for other treatment options. Follow- up consisted of serial PSA measurements at 3 months interval, disease specific QOL questionnaires, IPSS, and SHIM scores. Results: The mean age was 62.4 years. The mean (SD) prostate size at the time of mapping biopsy was 39 ±14.8g. After mapping biopsy all patients reported time limited hematuria and 2 patients developed urinary retention and were managed successfully with Foley’s catheter for 5 days. Mean PSA before treatment was 5.2 ± 4.1 ng/dl. 10/12 patients had Gleason score (GS) of 3+3, the remaining 2 patients had GS of 3+4. At 3 months follow-up. A median drop of PSA of 1.9 (0, 9.5) ng/dl. All patients reported full urinary continence post operatively. IPSS median drop of 0 (2, -16). Sexual health as assessed by SHIM score showed a median drop of 6 (1, -15) points. In general 4 patients reported a significant change in sexual performance. 2 of which opted for PDE inhibitor with successful regaining of erection at 6 months follow-up. Overall EPIC QOL scores showed no change in rectal, urinary and hormonal components. Sexual component registered a drop of 5 points. Conclusions: The current initial early results appear to be encouraging for future implementation of TFT on select patients with organ confined early stage cancer. Future larger randomized studies are needed to better understand the value of this alternative option in the management of prostate cancer. No significant financial relationships to disclose.

scholarly journals Post Prostatectomy Vesicourethral Stenosis or Bladder Neck Contracture with Concomitant Urinary Incontinence: Our Experience and Recommendations

2016 ◽  
Vol 10 (1) ◽  
pp. 32-39 ◽  
Author(s):  
Shieh L. Bang ◽  
Sachin Yallappa ◽  
Fatima Dalal ◽  
Yahia Z. Almallah
Keyword(s):  
Bladder Neck ◽  
Urinary Continence ◽  
Male Sling ◽  
Bladder Neck Contracture ◽  
Initial Management ◽  
Flexible Cystoscopy ◽  
Bladder Neck Incision ◽  
The Mean ◽  
Sling Placement

Objectives: To present our experience in the management of bladder neck contracture with concomitant post prostatectomy incontinence and to provide our recommendations based on the updated literature. Materials and Methods: Between Jan 2010 and June 2015, 37 patients from our cohort of 341 patients with post prostatectomy incontinence were evaluated. Patient data were retrospectively collected. Patients with bladder neck contracture confirmed on flexible cystoscopy underwent subsequent rigid cystoscopy and deep endoscopic bladder neck incision (BNI). A follow up flexible cystoscopy would be performed 3 months later. If there was no recurrence of the bladder neck contracture, an artificial urethral sphincter (AUS) or a male sling was recommended. Results: The mean age of patients was 68 years (range 59-77) and the mean BMI was 31 (range 21-41) kg/m2. Twenty-five (67.7%) patients had open prostatectomy and 12 (32.4%) patients had laparoscopic prostatectomy. Fourteen patients (37.8%) underwent adjuvant radiotherapy. Twenty-four (64.8%) patients had one BNI procedure, 8 (21.6%) patients had two procedures and 5 (13.5%) patients had more than 2 procedures. Twenty-one (91.3%) patients had AUS implantation and 2 (8.7%) patients had male sling placement. Besides, 85.7% of AUS and 50% of male sling patients managed to achieve successful outcomes with a mean follow up period of 13.1 months ( range 2-33 months). Conclusion: Initial management with aggressive BNI followed by implantation of an AUS or male sling when bladder neck is stable is essential to achieve a satisfactory urinary continence outcome.

Urinary toxicity in men treated with stereotactic body radiation therapy (SBRT) for localized prostate cancer following procedures for benign prostatic hyperplasia (BPH).

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 91-91
Author(s):  
Shaan Kataria ◽  
Harry Tsou ◽  
Subhradeep Datta ◽  
Marie Kate Gurka ◽  
Siyuan Lei ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Bladder Neck ◽  
Prostatic Urethra ◽  
Localized Prostate Cancer ◽  
Incontinence Score ◽  
Fractionation Schedule ◽  
History Of ◽  
Grade 3 ◽  
Dose Constraints

91 Background: Patients with a history of procedures for BPH experience worse urinary toxicity following interstitial brachytherapy for localized prostate cancer. This retrospective study sought to evaluate the rates of urinary toxicity following SBRT in men with a history of procedures for BPH. Methods: Localized prostate cancer patients, treated with SBRT from August 2009 to February 2015 and a minimum follow up of 2 years, with a history of at least 1 procedure for BPH associated with a prostatic defect identified on the treatment planning MRI were evaluated. Radiotherapy was delivered in 5 fractions to a dose of 35 or 36.25 Gy using the CyberKnife system with fiducial tracking. Urinary QOL was assessed pre- and post-treatment using the International Prostate Symptom Score (IPSS) and the Expanded Prostate Cancer Index Composite (EPIC-26). Cystoscopy findings were retrospectively reviewed. Toxicities were scored using the CTCAE v4. Results: Thirty nine men with a median age of 72 years, 7 with a history of more than 1 procedure for BPH, were treated with a median follow up of 49 months. Grade 1, grade 2, and grade 3 urinary toxicity occurred in 11, 24, and 3 men, respectively; there were no grade 4 or 5 toxicities. Overall, 22 men experienced hematuria; the median time to the onset hematuria from the start of SBRT was 13 months (range 1-70). Cystoscopy was performed on 12 of these patients and bladder neck/prostatic urethra hyperemia were found in a majority of cases. Active bleeding from the bladder neck or prostatic urethra was found in 4 men. A mean baseline IPSS score of 9 did not significantly change at any point during follow up. A mean baseline EPIC-26 obstructive/irritative score of 84 significantly decreased to 76 at 1 month (p = 0.023). There was no significant change from the mean baseline EPIC-26 urinary incontinence score at any point during follow up. Conclusions: A history of procedures for BPH may lead to worse urinary quality of life and high rates of hematuria following SBRT for localized prostate cancer. Stricter urethra/bladder neck dose constraints or an alternative fractionation schedule may be required to decrease the risk of urinary toxicity.

Clinical Results of Long-Term Follow-Up of a Large, Active Surveillance Cohort With Localized Prostate Cancer

2010 ◽  
Vol 28 (1) ◽  
pp. 126-131 ◽  
Author(s):  
Laurence Klotz ◽  
Liying Zhang ◽  
Adam Lam ◽  
Robert Nam ◽  
Alexandre Mamedov ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Cancer Mortality ◽  
Doubling Time ◽  
Localized Prostate Cancer ◽  
Definitive Treatment ◽  
Prostate Cancer Mortality ◽  
Psa Doubling Time ◽  
Psa Failure

Purpose We assessed the outcome of a watchful-waiting protocol with selective delayed intervention by using clinical prostate-specific antigen (PSA), or histologic progression as treatment indications for clinically localized prostate cancer. Patients and Methods This was a prospective, single-arm, cohort study. Patients were managed with an initial expectant approach. Definitive intervention was offered to those patients with a PSA doubling time of less than 3 years, Gleason score progression (to 4 + 3 or greater), or unequivocal clinical progression. Survival analysis and Cox proportional hazard model were applied to the data. Results A total of 450 patients have been observed with active surveillance. Median follow-up was 6.8 years (range, 1 to 13 years). Overall survival was 78.6%. The 10-year prostate cancer actuarial survival was 97.2%. Overall, 30% of patients have been reclassified as higher risk and have been offered definitive therapy. Of 117 patients treated radically, the PSA failure rate was 50%, which was 13% of the total cohort. PSA doubling time of 3 years or less was associated with an 8.5-times higher risk of biochemical failure after definitive treatment compared with a doubling time of more than 3 years (P < .0001). The hazard ratio for nonprostate cancer to prostate cancer mortality was 18.6 at 10 years. Conclusion We observed a low rate of prostate cancer mortality. Among the patients who were reclassified as higher risk and who were treated, PSA failure was relatively common. Other-cause mortality accounted for almost all of the deaths. Additional studies are warranted to improve the identification of patients who harbor more aggressive disease despite favorable clinical parameters at diagnosis.

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