1,721,131 research outputs found
Risk of Biochemical Recurrence and Metastasis in Prostate Cancer Patients Treated with Radical Prostatectomy After a 10-year Disease-free Interval
No full textBackground and objective: Prostate-specific antigen (PSA) testing is used to follow up prostate cancer (PCa) patients treated with radical prostatectomy (RP). Research on PSA thresholds for identifying PCa patients with biochemical recurrence (BCR) who are at a higher risk of progression yielded inconclusive results. This study aims to investigate the risk of late BCR in PCa patients treated with RP and long postoperative (120 mo) undetectable PSA follow-up, and to identify prognostic factors for late BCR within this patient cohort. Methods: PCa patients treated with curative RP (1992-2012) and free of BCR during the first 120 mo following RP were retrospectively identified within five European tertiary centers; BCR was defined as two consecutive PSA values of ≥0.2 ng/ml. Kaplan-Meier and Cox regression models tested for an association between BCR and patient or tumor characteristics. Key findings and limitations: The study cohort consisted of 4639 patients, of whom 243 (5.2%) developed BCR at a medium follow-up of 147 mo. Of those with BCR, 23 (9.5%) subsequently developed metastatic progression. In Kaplan-Meier models, BCR-free survival differed according to advanced tumor status. In multivariable Cox regression models, pT stage (pT3a: hazard ratio [HR]: 1.46; pT3b: HR: 2.42), pathological Gleason score (pGS 3 + 4: HR: 1.71; pGS ≥4 + 3: HR: 2.47), surgical margin (R1/Rx: HR: 1.72), and pNx stage (pNx: HR: 0.72) represented independent predictors for BCR (all p < 0.05). Conversely, age, PSA at diagnosis, and year of surgery failed to achieve independent predictor status for BCR. Conclusions and clinical implications: Among PCa patients with an uneventful follow-up of at least 10 yr after RP, still one in 20 patients subsequently develop late BCR. Nevertheless, late BCR and subsequent progression to metastasis (0.3%) rates in patients with pT2 stage and pGS ≤3 + 4 were strikingly low, implicating that abandoning follow-up beyond an uneventful period of 10 yr is justifiable within this cohort of patients. Patient summary: In this study, prostate cancer patients treated with a radical prostatectomy and at least 10 yr of uneventful prostate-specific antigen testing were identified within five European centers. Relying on these patients, the rate of subsequent late biochemical recurrence was calculated and risk factors were identified for biochemical recurrence following 10 yr of uneventful prostate-specific antigen testing
New Insights in the Detection and Staging of Prostate Cancer
Full text linkProstate cancer (PCa) is a prevalent malignancy with a significant gap between its incidence and mortality rates, indicating that not all forms are life-threatening. The disease ranges from indolent to aggressive types, making accurate detection and staging vital for effective treatment. This thesis explores recent advancements in imaging techniques that have improved the precision in detecting and staging clinically significant prostate cancer (csPCa), aiming to enhance patient outcomes while minimizing unnecessary interventions. Part I of the thesis focuses on the role of Prostate-Specific Membrane Antigen (PSMA) Positron Emission Tomography/Computed Tomography (PET/CT) in detecting and characterising PCa. Chapter 2 investigates the effectiveness of the 18F-PSMA-1007 tracer for identifying intraprostatic PCa. The study finds significant correlations between the maximum standardised uptake value (SUVmax) on PET/CT scans and both the International Society of Urologic Pathology (ISUP) Grade Group (GG) and the PSMA Immune Reactive Score on histology, independent of tumour size. A key finding is that a SUVmax threshold of 4 captures almost all csPCa cases. In Chapter 3, the study evaluates SUVmax’s added value in predicting ISUP GG ≥ 2 and ≥ 3 on prostate biopsy, demonstrating that SUVmax significantly enhances predictive accuracy, particularly for GG ≥ 3. This suggests that high SUVmax levels could help identify patients at high risk of csPCa. In Chapter 4 the of adding PSMA PET/CT and targeted biopsy in patient recently started with active surveillance (AS) after MRI at diagnosis revealed that the number needed to scan (NNS) to detect biopsy upgrading was 11. Upgrading was more frequent in patients with negative MRI findings. Chapter 5 discusses the possibility of treating suspected PCa without histological confirmation due to the capabilities of PSMA PET/CT. The study finds that all patients with a SUVmax greater than 16 had csPCa. This raises the potential for a diagnostic pathway where prostatectomy could be performed without biopsy when clinical characteristics and imaging strongly suggest csPCa. Part II of the thesis addresses challenges in staging PCa, focusing on the effective use of imaging modalities. Chapter 6 validates four MRI-based nomograms for predicting side-specific extraprostatic extension (EPE). While the nomograms show fair accuracy, the Nyarangi-Dix nomogram stands out but is possibly less practical due to the extra time required for documentation. Chapter 7 demonstrates the clinical value of the Soeterik nomogram, which helped reduce positive surgical margins on the ipsilateral side of histological EPE. In Chapter 8, the thesis examines whether the cribriform pattern (CP) in prostate biopsy is an independent risk factor for metastatic disease. The study concludes that CP is not an independent risk factor, highlighting the need for further research to refine staging methods for PCa
Long-term Outcomes of Focal Cryotherapy for Low- to Intermediate-risk Prostate Cancer: Results and Matched Pair Analysis with Active Surveillance
Full text linkBackground: To date, only one trial compared focal therapy and active surveillance (AS) for low-risk prostate cancer (PCa). In addition, long-term outcomes of focal cryotherapy (FC) are lacking. Objective: Our aim was to evaluate long-term outcomes of FC and compare them with AS. Design, setting, and participants: We included two prospective series of 121 (FC) and 459 (AS) consecutive patients (2008-2018) for low- to intermediate-risk PCa. Outcome measurements and statistical analysis: Study outcomes were radical therapy-free or androgen deprivation therapy (ADT)-free, any treatment-free, metastasis-free, and overall survival. A matched pair analysis was performed using seven covariates. Results and limitations: The median FC follow-up was 85 mo (interquartile range 58-104); 92 (76%) men had International Society of Urological Pathology (ISUP) grade 1. Among matched variables, no significant differences were present except for cT stage and year of entry (both p 0.05), with the exception of time to radical therapy, time to radical therapy and ADT, and time to any treatment, all being shorter for AS (all p 2, n = 3); three men developed incontinence (p = 0.0814), while both International Index of Erectile Function 5 and International Prostate Symptom Score scores increased (p = 0.0287 and p = 0.0165, respectively). Limitations include absence of randomization. Conclusions: At an early long-term follow-up, FC in the context of mainly low-risk PCa is safe and increases time to radical therapy but does not provide meaningful oncological advantages compared with AS. Patient summary: We compared focal cryotherapy with active surveillance mainly for low-risk prostate cancer. Focal cryotherapy, despite having fewer complications, did not yield meaningful advantages over active surveillance at 10 yr. Active surveillance should be preferred to focal cryotherapy for these patients
Focal High-Intensity Focused Ultrasound vs. Active Surveillance for ISUP Grade 1 Prostate Cancer: Medium-Term Results of a Matched-Pair Comparison
No full textOnly 1 randomized controlled trial has compared focal therapy and active surveillance (AS) for the low-risk prostate cancer (PCa). We investigated whether focal HIFU (fHIFU) yields oncologic advantages over AS for low-risk PCa
Has the COVID-19 outbreak changed the way we are treating prostate cancer? An EAU - YAU Prostate Cancer Working Group multi-institutional study
Full text linkIntroduction: The COVID-19 outbreak has become the dominant issue throughout the world whilst the governments, nations and health services are trying to deal with its impact. The aim of our study is to assess the impact of COVID-19 on patients treated with radical prostatectomy (RP) for prostate cancer (PCa) at European referral centers in terms of surgical volume (SV), waiting list meant as time from biopsy to surgery (WL) and risk of adverse pathologic findings at RP due to the selection of men with more adverse disease characteristics at final pathology. Material and methods: Consecutive patients with a diagnosis of histologically proven PCa treated with RP between March 2020 (WHO declaration of pandemic) and December 2020 were identified. Patients with metastatic disease not eligible to local treatment and recurrent prostate cancer after RP or RT were excluded. Patients treated at the same institutions between March 2019 and December 2019 were considered as the control group. Multivariable logistic regression analysis tested the impact of the COVID-19 outbreak on the risk of adverse pathologic findings at RP after adjusting for confounders. The percentage change of SV and WL was assessed comparing the months of pandemic with the equivalent timespan of the previous year. Results: A total of 2,574 patients treated with RP (927 cases and 1647 controls) were identified in 8 European tertiary referral centers. At multivariable analysis patients who were treated during the pandemic had higher risk of extra prostatic disease (OR:1.35, p = 0.038) and lymph node invasion (LNI) (OR:1.72, p = 0.048). An average 23% reduction of the SV with the equivalent timespan of the previous year allowed an illusory reduction of the WL after the peak gained during the first wave of COVID-19. Conclusions: Our results showed that the COVID-19 outbreak resulted in a delay in the administration of curative-intent therapies in patients with localized PCa. This, in turn, resulted in a stage migration phenomenon with a potential impact on oncologic control
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Role of multiparametric magnetic resonance imaging in early detection of prostate cancer
Full text linkMost prostate cancers (PC) are currently found on the basis of an elevated PSA, although this biomarker has only moderate accuracy. Histological confirmation is traditionally obtained by random transrectal ultrasound guided biopsy, but this approach may underestimate PC. It is generally accepted that a clinically significant PC requires treatment, but in case of an non-significant PC, deferment of treatment and inclusion in an active surveillance program is a valid option. The implementation of multiparametric magnetic resonance imaging (mpMRI) into a screening program may reduce the risk of overdetection of non-significant PC and improve the early detection of clinically significant PC. A mpMRI consists of T2-weighted images supplemented with diffusion-weighted imaging, dynamic contrast enhanced imaging, and/or magnetic resonance spectroscopic imaging and is preferably performed and reported according to the uniform quality standards of the Prostate Imaging Reporting and Data System (PIRADS). International guidelines currently recommend mpMRI in patients with persistently rising PSA and previous negative biopsies, but mpMRI may also be used before first biopsy to improve the biopsy yield by targeting suspicious lesions or to assist in the selection of low-risk patients in whom consideration could be given for surveillance. Teaching Points . MpMRI may be used to detect or exclude significant prostate cancer. . MpMRI can guide targeted rebiopsy in patients with previous negative biopsies. . In patients with negative mpMRI consideration could be given for surveillance. . MpMRI may add valuable information for the optimal treatment selection
Solutions for ureteral obstructions between UPJ and UVJ in adult patients
No full textThe ureter is a small muscular tube (25-30 cm long and 5 mm in outer diameter) that transports urine from the kidney to the bladder. Given this long trajectory, the ureter can be affected by many pathological processes. The general public is aware of the extremely painful condition of ureteral colic caused by stones, but there are numerous other reasons for ureteral obstruction. Unfortunately, approximately one-third of obstructions are caused by interventions performed by gynecologists, vascular surgeons, and urologists. The challenge in addressing these ureteral issues is to minimize patient harm. This thesis describes the results of using locally anesthetized insertion of metal stents to relieve obstructions (similar to stents in coronary arteries) and compares it with open surgery. Additionally, a technique (psoas hitch procedure) is evaluated to bridge obstructions in the lower part of the ureter by lifting and fixing the bladder on one side, allowing the healthy ureter to be re-implanted into the bladder wall. The long-term results of this procedure are very favorable. A connection between an artery and ureter can be fatal. Before 2000, 1 in 5 patients with this diagnosis died; nowadays, due to the use of new techniques, this rate has decreased to 7%. This dangerous condition predominantly occurs in individuals who have undergone abdominal surgery, sometimes combined with external radiation. In 80% of cases, a stent has been present in the ureter for an extended period
Features and management of men with pN1 cM0 prostate cancer after radical prostatectomy and lymphadenectomy: a systematic review of population-based evidence
Full text linkPURPOSE OF REVIEW: To investigate the features and optimal management of pN+ cM0 prostate cancer (PCa) according to registry-based studies. RECENT FINDINGS: Up to 15% of PCa patients harbor lymph node invasion (pN+) at radical prostatectomy plus lymph node dissection. Nonetheless, the optimal management strategy in this setting is not well characterized. SUMMARY: We performed a systematic review including n = 13 studies. Management strategies comprised 13 536 men undergoing observation, 11 149 adjuvant androgen deprivation therapy (aADT), 7,075 adjuvant radiotherapy (aRT) +aADT and 705 aRT. Baseline features showed aggressive PCa in the majority of men. At a median follow-up ranging 48-134months, Cancer-related death was 5% and overall-mortality 16.6%. aADT and aRT alone had no cancer-specific survival or overall survival advantages over observation only and over not performing aRT, respectively. aADT plus aRT yielded a survival benefit compared to observation and aADT, which in one study, were limited to certain intermediate-risk categories. Age, Gleason, Charlson score, positive surgical margins, pathological stage, and positive nodes number, but not prostate specific antigen, were most relevant prognostic factors. Our work further confirmed pN+ PCa is a multifaceted disease and will help future research in defining its optimal management based on different risk categories to maximize survival and patient's quality of life
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