Identifying the Best Candidate for Radical Prostatectomy Among Patients with High-Risk Prostate Cancer

Briganti, Alberto; Joniau, Steven; Gontero, Paolo; Abdollah, Firas; Passoni, Niccolò; Tombal, Bertrand; Marchioro, G.; Kneitz, Burkhard; Walz, Jochen; Frohneberg, D.; Bangma, Chris H.; Graefen, Markus; Tizzani, A; Frea, Bruno; Karnes, R. Jeffrey; Montorsi, Francesco; Poppel, Hendrik Van; Spahn, Martin

doi:10.1016/j.eururo.2011.11.043

Cited by 122 publications

(95 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…High and very high-risk prostate cancers currently comprise around 15-20% of diagnosed cases [7,13]. This is a tumor that displays more variable and aggressive behaviour than the norm.…”

Section: Discussionmentioning

confidence: 99%

“…or postoperative (positive surgical margins, final Gleason score, disease stage, tumor volume etc.) factors that could influence such variable behaviour and help us to derive the best treatment for each case [7][8][9][10]. Some of the studies conclude that the presence of positive surgical margins is an independent predictive factor in the development of the BR, but does not affect the specific cancer mortality [11].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Biochemical recurrence risk factors in surgically treated high and very high-risk prostate tumors

Aguilera¹,

Bañuelos²,

Dı́ez³

et al. 2015

CEJU

View full text Add to dashboard Cite

Introduction High and very high-risk prostate cancers are tumors that display great variation in their progression, making their behaviour and consequent prognosis difficult to predict. We analyse preoperative and postoperative risk factors that could influence biochemical recurrence of these tumors. Material and methods We carried out univariate and multivariate analyses in an attempt to establish statistically significant preoperative (age, rectal examination, PSA, biopsy Gleason score, uni/bilateral tumor, affected cylinder percentage) and postoperative (pT stage, pN lymph node affectation, Gleason score, positive surgical margins, percentage of tumor affectation, perineural infiltration) risk factors, as well as their relationship with biochemical recurrence (PSA >0.2 ng/mL). Results We analysed 276 patients with high and very high-risk prostate cancer that were treated with laparoscopic radical prostatectomy (LRP) between 2003-2007, with a mean follow-up of 84 months. Incidence of biochemical recurrence is 37.3%. Preoperative factors with the greatest impact on recurrence are suspicious rectal exam (OR 2.2) and the bilateralism of the tumor in the biopsy (OR 1.8). Among the postoperative factors, the presence of a LRP positive surgical margins (OR 3.4) showed the greatest impact, followed by the first grade of the Gleason score (OR 3.3). Conclusions The factor with the greatest influence on biochemical recurrence when it comes to surgery and high and very high-risk prostate cancer is the presence of a positive margin, followed by the Gleason score. Preoperative factors (PSA, biopsy Gleason score, rectal examination, number of affected cylinders) offered no guidance concerning the incidence of BCR.

show abstract

“…High and very high-risk prostate cancers currently comprise around 15-20% of diagnosed cases [7,13]. This is a tumor that displays more variable and aggressive behaviour than the norm.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Biochemical recurrence risk factors in surgically treated high and very high-risk prostate tumors

Aguilera¹,

Bañuelos²,

Dı́ez³

et al. 2015

CEJU

View full text Add to dashboard Cite

show abstract

“…These findings, while somewhat counterintuitive, may be explained by increased RP volume over time, which increased by 124% between 2004-2005 and 2010-2011 in our study, and by increased interest in the surgical treatment of high-risk PC. 3,16 Increased RP volume appears to have improved access to care for underserved men despite greater travel burden and longer treatment delays. To further explore the impact of robotic use on access to care, we investigated RP practice patterns in 2010-2011 stratified by approach.…”

Section: Discussionmentioning

confidence: 99%

Robotic prostatectomy is associated with increased patient travel and treatment delay

Maurice

Zhu

Kim

et al. 2016

CUAJ

View full text Add to dashboard Cite

Introduction: New technologies may limit access to treatment. We investigated radical prostatectomy (RP) access over time since robotic introduction and the impact of robotic use on RP access relative to other approaches in the modern era.Methods: Using the National Cancer Data Base, RPs performed during the eras of early (2004‒2005) and late (2010‒2011) robotic dissemination were identified. The primary endpoints, patient travel distance and treatment delay, were compared by era, and for 2010‒2011, by surgical approach. Analyses included multivariable and multinomial logistic regression.Results: 138 476 cases were identified, 32% from 2004‒2005 and 68% from 2010‒2011. In 2010‒2011, 74%, 21%, and 4.3% of RPs were robotic, open, and laparoscopic, respectively. Treatment in 2010‒2011 and robotic approach were independently associated with increased patient travel distance and longer treatment delay (p<0.001). Men treated robotically had 1.1‒1.2 times higher odds of traveling medium-to-long-range distances and 1.2‒1.3 higher odds of delays 90 days or greater compared to those treated open (p<0.001). Laparoscopic approach was associated with increased patient travel and treatment delay, but to a lesser extent than the robotic approach (p<0.001). In high-risk patients, treatment delays remained significantly longer for minimally invasive approaches (p<0.001). Other factors associated with the robotic approach included referral from an outside facility, treatment at an academic or high-volume hospital, higher income, and private insurance. Potential limitations include the retrospective observational design and lack of external validation of the primary outcomes.Conclusions: The robotic approach is associated with increased travel burden and treatment delay, potentially limiting access to surgical care.

show abstract

“…It is possible that routine MRI in higher-risk men may identify those with evidence of extensive T3 disease, whom are inappropriate for radical prostatectomy. MRI could be added to existing nomograms for prediction of organ-confined disease in high-risk men [119]. Likewise in intermediate risk PCA, men with evidence of higher volume/ grade disease on MRI may be at higher risk of failure with low dose rate brachytherapy, and those with or extensive EPE or SVI on MRI may be inappropriate for radical prostatectomy [120].…”

Section: Mri In T-staging Treatment Selection and Planningmentioning

confidence: 99%

The role of magnetic resonance imaging in the diagnosis and management of prostate cancer

et al. 2013

View full text Add to dashboard Cite

Background• The diagnosis of prostate cancer has long been plagued by the absence of an imaging tool that reliably detects and localises significant tumours. Recent evidence suggests that multi-parametric MRI could improve the accuracy of diagnostic assessment in prostate cancer. This review serves as a background to a recent USANZ position statement. It aims to provide an overview of MRI techniques and to critically review the published literature on the clinical application of MRI in prostate cancer. Technical Aspects• The combination of anatomical (T2-weighted) MRI with at least two of the three functional MRI parameterswhich include diffusion-weighted imaging, dynamic contrast-enhanced imaging and spectroscopy -will detect greater than 90% of significant (moderate to high risk) tumours; however MRI is less reliable at detecting tumours that are small (<0.5 cc), low grade (Gleason score 6) or in the transitional zone. The higher anatomical resolution provided by 3-Tesla magnets and endorectal coils may improve the accuracy, particularly in primary tumour staging.

show abstract

Identifying the Best Candidate for Radical Prostatectomy Among Patients with High-Risk Prostate Cancer

Cited by 122 publications

References 29 publications

Biochemical recurrence risk factors in surgically treated high and very high-risk prostate tumors

Biochemical recurrence risk factors in surgically treated high and very high-risk prostate tumors

Robotic prostatectomy is associated with increased patient travel and treatment delay

The role of magnetic resonance imaging in the diagnosis and management of prostate cancer

Contact Info

Product

Resources

About