scholarly journals Functional and oncological outcomes of salvage external beam radiotherapy following robot-assisted radical prostatectomy in a Canadian cohort

2017 ◽  
Vol 12 (2) ◽  
pp. 45-9
Author(s):  
Khaled Ajib ◽  
Marc Zanaty ◽  
Mansour Alnazari ◽  
Emad Rajih ◽  
Pierre-Alain Hueber ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
External Beam Radiotherapy ◽  
Specific Antigen ◽  
Urinary Continence ◽  
Robot Assisted ◽  
Time Points ◽  
Canadian Experience ◽  
Significant Difference ◽  
The Impact

Introduction: We sought to determine the impact of salvage radiotherapy (SRT) on oncological and functional outcomes of patients with prostate cancer after biochemical recurrence (BCR) following robot-assisted radical prostatectomy (RARP).Methods: Data of 70 patients with prostate cancer treated with SRT after developing BCR were retrospectively analyzed from a prospectively collected RARP database of 740 men. Oncological (prostate- specific antigen [PSA]) and functional (pads/day, International Prostate Symptom Score [IPSS], and Sexual Health Inventory for Men [SHIM]) outcomes were reported at six, 12, and 24 months after RT and adjusted for pre-SRT status.Results: Men who underwent SRT had a mean age, PSA, and time from radical prostatectomy (RP) to RT of 61.8 years (60.1‒63.6), 0.5 ng/ml (0.2‒0.8), and 458 days (307‒747), respectively. Freedom from biochemical failure (FFBF) post-SRT, defined as a PSA nadir <0.2 ng/mL, was observed in 89%, 93%, and 81%, at six, 12, and 24 months, respectively. Undetectable PSA was observed in 14%, 35%, and 40% at the same time points, respectively. There was no significant difference in urinary continence post-SRT (p=0.56). Rate of strict continence (0 pads/day) was 71% at 24 months compared to 78% pre-SRT. Mean IPSS at six, 12, and 24 months was 3.4, 3.6, and 3.6, respectively compared to pre-RT score of 3.3 (p=0.61). The mean SHIM score pre-SRT was comparable at all time points following treatment (p=0.86).Conclusions: In this unique Canadian experience, it appears that early SRT is highly effective for the treatment of BCR following RARP with little impact on urinary continence and potency outcomes.

scholarly journals Transvesical Retzius-Sparing Versus Standard Robot-Assisted Radical Prostatectomy: A Retrospective Propensity Score-Adjusted Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Wen Deng ◽  
Hao Jiang ◽  
Xiaoqiang Liu ◽  
Luyao Chen ◽  
Weipeng Liu ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Propensity Score ◽  
Specific Antigen ◽  
Urinary Continence ◽  
Positive Surgical Margin ◽  
Robot Assisted ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Functional Scores

ObjectivesTo estimate the safety and efficiency of transvesical Retzius-sparing robot-assisted radical prostatectomy (T-RARP) compared with standard robot-assisted radical prostatectomy (S-RARP) for localized prostate cancer (PCa).Materials and Methods174 patients bearing localized PCa and undergoing T-RARP or S-RARP between October 2017 and January 2020 were retrospectively enrolled in our analysis. All potential baseline confounders were strictly restrained with propensity-score matching (PM) method (1: 1). Within the matched setting, the perioperative and functional outcomes were compared between the T-RARP and S-RARP groups, while the oncological results and functional recovery of the two arms were presented with Kaplan-Meier curves.ResultsFinally, 114 and 60 eligible patients harbouring localized PCa were identified in the S-RARP and T-RARP group, respectively. No significant differences between the two groups were found in all baseline characteristics after PM. Within the matched cohort, no case was converted to open surgery in either group. The T-RARP group was significantly related to a higher mean operative time (p = 0.001) and shorter median hospital stay length (p &lt; 0.001). There were not significant differences in the median estimated blood loss and specimen Gleason score between the two arms. The proportions of transfusion, pT3a disease, postoperative complication, and positive surgical margin in the T-RARP group were also comparable to that in the S-RARP group. The mean prostate-specific antigen and median erectile functional scores did not differ significantly between the two groups at postoperative 3 months and last follow-up. T-RARP vs. S-RARP had significantly improved urinary continence (UC) rates at the removal of catheter (p &lt; 0.001) and postoperative 3 months (p &lt; 0.001), but the significant difference between the two groups in UC recovery disappeared at last follow-up (p = 0.119). No significant difference in biochemical recurrence-free survival was observed following the two surgeries (p = 0.727).ConclusionsT-RARP by experienced hands was feasible for selected patients with clinically localized PCa, yielding significantly improved early return to UC and similar erectile functional preservation without compromising oncological control when compared with the standard approach.

scholarly journals Intravesical prostatic protrusion may affect early postoperative continence undergoing robot-assisted radical prostatectomy

BMC Urology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Katsuya Hikita ◽  
Masashi Honda ◽  
Shogo Teraoka ◽  
Ryoma Nishikawa ◽  
Yuske Kimura ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Symptom Score ◽  
Multivariate Analyses ◽  
Specific Antigen ◽  
Robot Assisted ◽  
Significant Difference ◽  
Group 2 ◽  
The Impact ◽  
Intravesical Prostatic Protrusion ◽  
Group 1

Abstract Background In this study, we investigated the effect of preoperative prostate morphology, especially intravesical prostatic protrusion (IPP), on continence after robot-assisted radical prostatectomy (RARP). Methods Retrospective analysis was applied to patients who underwent RARP between October 2010 and July 2014. The following parameters were assessed in all patients: age, body mass index (BMI), prostate-specific antigen, magnetic resonance imaging and pressure-flow studies findings. The impact of preoperative and intraoperative factors on postoperative urinary incontinence (UI) was assessed using multivariate logistic regression analysis. To evaluate the effects of IPP, the patients were divided into groups according to the IPP length: Group 1, < 5 mm and Group 2, ≥ 5 mm. The International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score, Quality of Life index and the number of pads used were assessed. Results A total of 119 patients were eligible for this study. Multivariate analyses showed that IPP (odds ratio (OR) 1.14, 95% confidence interval (CI) 1.02–1.28, p < 0.05) and nerve-sparing (NS) (OR 0.23, 95% CI 0.18–0.61, p < 0.01) were significant factors related to UI in the first month after RARP. Twelve months after RARP, multivariate analyses revealed that only NS is a factor related to postoperative UI (OR 0.23, 95% CI 0.18–0.61, p < 0.01). The comparison of Groups 1 and 2 indicated significant differences in age (p < 0.01), prostate volume (p < 0.01), total IPSS and voiding symptom score (p < 0.05), compliance (p < 0.01), and detrusor pressure at maximum flow (p < 0.01). Group 1 had a higher continence rate (38.0%) than Group 2 (20.8%) in the first month after RARP (p < 0.05), but the difference was no longer significant from the third month after RARP. The total IPSS and voiding symptom scores were significantly different between the two groups before RARP, however, the significant difference disappeared from the first month after RARP. Conclusions The data suggest that IPP affects early postoperative UI. Although NS was strongly involved in UI in the early and later stages after RARP, IPP had no effect on UI in the later stages.

The impact of Gleason pattern 4 ratio on recurrence following radical prostatectomy in Japanese patients with prostate cancer.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 114-114
Author(s):  
Masashi Kato
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Specific Antigen ◽  
Progression Free Survival ◽  
Japanese Patients ◽  
Gleason Grade ◽  
Gleason Pattern ◽  
Significant Difference ◽  
Psa Progression ◽  
The Impact

114 Background: The 2014 International Society of Urological Pathology (ISUP) classified the Gleason grade into five groups and the Gleason score (GS) 7 was divided into groups 2 (GS3+4) and 3 (GS4+3). The ISUP recommended recording the Gleason pattern (GP) 4 ratio. However, no data are available on Japanese patients, and no studies have reported any difference between GS3+3 and a part of GS3+4. In this study, we evaluated the effect of the GP 4 ratio on recurrence following radical prostatectomy in Japanese patients with prostate cancer and revealed the equivalent between GS3+3 and part of GS3+4. Methods: We retrospectively evaluated 1,000 patients with prostate cancer who underwent radical prostatectomy at the author’s affiliated hospitals between 2005 and 2013. All prostatectomy specimen slides were reviewed by a single genitourinary pathologist according to ISUP 2014. Recurrence following radical prostatectomy was defined according to American Urological Association guidelines. The endpoint was defined as an increase in prostate-specific antigen (PSA) level. Results: Median patient age was 67 years (range, 42–77 years). Median serum PSA level was 6.8 ng/mL (range, 0.4–82 ng/mL). Median follow-up period was 59 months (range, 0.2–134 months). PSA progression was observed in 13.9% of pT2, 39.5% of pT3a, and 59.5% of pT3b. There were 164 group 1 cases (GS6), 484 group 2 (GS3+4), 212 group 3 (GS4+3), 39 group 4 (GS8), and 95 group 5 (GS9–10) cases. PSA progression-free survival was significantly different among the five groups (log rank; P = 0.0001). A significant difference was observed among the four groups with regard to the proportion by which the GP4 ratio increased (P = 0.0001) when groups 2 and 3 were divided by the GP4 ratio ( < 20%, 236 cases; 20–50%, 240 cases; 51–80%, 188 cases; and 81–100%, 17 cases). On the other hand, no difference was detected between GS3+3 and GS3+4 (GS4 < 20%) (P = 0.481). Conclusions: An increase in the GP4 ratio was correlated with PSA progression following radical prostatectomy in Japanese patients with prostate cancer. In addition, no difference was observed between GS3+3 and GS3+4 (GP4 < 20%), and GS3+4 (GP4 < 20%) patients may be an indication for active surveillance.

scholarly journals Clinical significance and risk factors of urethrovesical anastomotic urinary leakage following robot-assisted radical prostatectomy: a multi-institutional study

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shigenori Kakutani ◽  
Yuta Takeshima ◽  
Yuta Yamada ◽  
Tetsuya Fujimura ◽  
Shoichi Nagamoto ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Radical Prostatectomy ◽  
Clinical Significance ◽  
Final Analysis ◽  
Urinary Continence ◽  
Robot Assisted ◽  
Urinary Leakage ◽  
Postoperative Continence ◽  
The University

Abstract Background There has been a limited number of reports on the significance and risk factors of urethrovesical anastomotic urinary leakage (AUL) following robot-assisted radical prostatectomy (RARP). We aimed to analyze the clinical significance of AUL and evaluated its risk factors. Methods We conducted a multi-institutional study to review patients with prostate cancer undergoing RARP in three centers (The University of Tokyo Hospital, Mitsui Memorial Hospital, and Chiba Tokushukai Hospital). “Positive AUL” was defined as urinary extravasation at the anastomosis detected by post-operative cystogram and was further categorized into minor or major AUL. Univariate and multivariate analyses were performed to identify predictors of AUL. Postoperative continence rates and time to achieve continence were also analyzed. Results A total of 942 patients underwent RARP for prostate cancer in 3 centers. Of these patients, a cystogram after the RARP procedure was not performed in 26 patients leaving 916 patients for the final analysis. AUL was observed in 56 patients (6.1%); 34 patients (3.7%) with minor AUL and 22 patients (2.4%) with major AUL. Patients with major AUL exhibited a significantly longer time to achieve continence than those without major AUL. Multivariate analysis demonstrated that longer console time (≥ 184 min) was significantly associated with overall AUL, and higher body mass index (≥ 25 g/kg2) was a significant predictor of both major and overall AUL. Conclusions The presence of major AUL was associated with the achievement of urinary continence, suggesting clinical relevance of its diagnosis by postoperative cystogram. A selective cystogram has been proposed for high-risk cases. Furthermore, identification of the risk factors of AUL will lead to optimal application.

scholarly journals Comparison of Retzius-Sparing Robot-Assisted Radical Prostatectomy vs. Conventional Robot-Assisted Radical Prostatectomy: An Up-to-Date Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Jiang-Nan Xu ◽  
Zhen-Yu Xu ◽  
Hu-Ming Yin
Keyword(s):  
Radical Prostatectomy ◽  
Lower Incidence ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Urinary Continence ◽  
Robot Assisted ◽  
Postoperative Continence ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Anterior Prostate

Background: The Retzius space-sparing robot-assisted radical prostatectomy (RS-RARP) has shown better results in urinary continence, but its efficacy and safety compared to conventional robot-assisted radical prostatectomy (c-RARP) remain controversial.Material and Methods: A research was conducted in Medline via PubMed, Cochrane Library, EMBASE, and Web of Science up to January 4, 2021, to identify studies comparing RS-RARP to c-RARP. We used RevMan 5.3 and STATA 14.0 for meta-analysis.Results: A total of 14 studies involving 3,129 participants were included. Meta-analysis showed no significant difference in positive surgical margins (PSMs), but the RS-RARP group had significantly higher PSM rates in the anterior site [odds ratio (OR) = 2.25, 95% CI: 1.22–4.16, P = 0.01]. Postoperative continence in RS-RARP group at 1 month (OR = 5.72, 95% CI: 3.56–9.19, P &lt; 0.01), 3 months (OR = 6.44, 95% CI: 4.50–9.22, P &lt; 0.01), 6 months (OR = 8.68, 95% CI: 4.01–18.82, P &lt; 0.01), and 12 months (OR = 2.37, 95% CI: 1.20–4.70, P = 0.01) was significantly better than that in the c-RARP group. In addition, the RS-RARP group had a shorter console time (mean difference = −16.28, 95% CI: −27.04 to −5.53, P = 0.003) and a lower incidence of hernia (OR = 0.35, 95% CI: 0.19–0.67, P = 0.001). However, there were no significant differences in estimated blood loss, pelvic lymph node dissection rate, postoperative complications, 1-year-biochemical recurrence rate, and postoperative sexual function.Conclusions: Compared with c-RARP, RS-RARP showed better recovery of continence, shorter console time, and lower incidence of hernia. Although there was no significant difference in overall PSM, we suggest that the surgeon should be more careful if the lesion is in the anterior prostate.

The Impact of Lateral Bladder Neck Preservation on Urinary Continence Recovery After Robot-Assisted Radical Prostatectomy

2018 ◽  
Vol 32 (1) ◽  
pp. 40-45 ◽  
Author(s):  
Takeshi Hashimoto ◽  
Kunihiko Yoshioka ◽  
Tatsuo Gondo ◽  
Kazuki Hasama ◽  
Yosuke Hirasawa ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Bladder Neck ◽  
Urinary Continence ◽  
Robot Assisted ◽  
Neck Preservation ◽  
The Impact
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