Is extended pelvic lymph node dissection for prostate cancer the only recommended option? A systematic over-view of the literature

Rees, Thomas D.; Raison, Nicholas; Sheikh, Mohammed Iqbal; Jaffry, Zahra; Madaan, Sanjeev; Challacombe, Benjamin; Ahmed, Kamran

doi:10.5152/tud.2016.52893

Cited by 7 publications

(3 citation statements)

References 37 publications

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“…Показаниями для нервосбережения были данные, полученные на основании номограммы Бриганти (Briganti nomogram), таблицы Партина (Partin table), а также желание пациента сохранить ЭФ [8,9]. Пациентам среднего онкологического риска (уровень ПСА -10-20 нг / мл или индекс Глисона -7, или стадия cT2b), а также при риске поражения лимфатических узлов, превышающем 5 % по номограмме Бриганти, была выполнена тазовая лимфаденэктомия в расширенном объеме (с целью повышения точности патоморфологического стадирования и улучшения онкологического прогноза) [3,10]. Для контроля ранних онкологических результатов учитывался уровень ПСА в динамике с интервалом в 3 месяца: повторное превышение порогового значения 0,2 нг / мл [11].…”

Section: материалы и методыunclassified

Comparative results of nerve-sparing robotic-assisted prostatectomy

Shpot

Chinenov

Чернов

et al. 2021

Androl. genit. hir.

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Background. Considering decreasing age of patients with prostate cancer, increasing cancer alertness of first-line doctors as well as increased frequency of radical prostatectomies (RP), the problem of preservation of erectile function (EF) is vitally important (erectile dysfunction develops in 25–75 % of all patients who underwent surgery).The study objective is to analyze preservation of EF after RP depending on the type of endoscopic access and nerve preservation.Materials and methods. Between February of 2015 and February of 2016, in the Urology Clinic of the Sechenov University, 507 RPs were performed; the retrospective single-center study included 231 patients with localized prostate cancer. Surgery was performed with the following accesses: laparoscopic, extraperitoneal laparoscopic, and robotic. Indications for nerve preservation were formulated based on the Briganti nomogram, Partin table as well as patient’s desire to preserve EF. Further evaluation of EF was performed using the International Index of Erectile Function (IIEF5), evaluation of quality of life – using the QoL (Quality of Life) scale.Results. RP with nerve preservation was performed in 150 patients. Surgical time and blood loss did not significantly differ for surgeries with and without nerve preservation (р = 0.064 and р = 0.073 respectively). Pathomorphological examination showed that in all cases (n = 231) integrity of the prostatic capsule and negative surgical margin were achieved. Frequent significant erectile dysfunction and full loss of EF were observed in patients after RP without nerve preservation compared to the group with preserved neurovascular bundles (5.0 (0.0–10.0) points compared to 6.5 (0.8–19.0) points per the IIEF5 scale, р = 0.271): 96.2 % versus 72.2 % (p <0.001). Nerve preservation significantly improved quality of life: 1.63 ± 1.16 points versus 1.88 ± 1.02 points per the QoL scale (р = 0.035).Conclusions. The best results were achieved in the robotic access group. Surgery with nerve preservation decreased frequency of EF loss. This benefit in conjunction with the radical nature of the operative intervention allows to consider RP techniques with nerve preservation as reasonable approach to erectile dysfunction prevention in patients with localized prostate cancer.

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Section: материалы и методыunclassified

Comparative results of nerve-sparing robotic-assisted prostatectomy

Shpot

Chinenov

Чернов

et al. 2021

Androl. genit. hir.

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“…In primary PC, the goal of primary lymph node dissection is twofold: to stage disease status accurately and to achieve a potential cure in a selected group of men with node-positive disease. However, there is no prospective evidence that ePLND benefits oncologic outcomes (61)(62)(63)(64)(65)(66). This lack of evidence, combined with the perceived increased morbidity of the added procedure, is driving a decline in the practice of lymphadenectomy, except in the presence of high-grade or high-volume disease.…”

Section: Comparison Of Psma-guided Primary Lymph Node Dissection To Smentioning

confidence: 99%

Prostate-Specific Membrane Antigen–Guided Surgery

et al. 2019

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Since its introduction to the diagnostic pathway for prostate cancer management, prostate-specific membrane antigen (PSMA)-ligand PET has demonstrated great potential. PSMA-ligand imaging is increasingly influencing therapeutic decision making, although its impact on patient outcomes still needs to be defined. One relatively new application, enabled through chemical and engineering efforts, is PSMA-guided surgery. This review highlights the potential of PSMA-guided surgery and discusses its implications in lymph node dissection in primary and recurrent prostate cancer.

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“…En varones adultos con cáncer de próstata localizado de riesgo bajo, intermedio o alto o localmente avanzado, en quienes se decida realizar prostatectomía radical (PR) más linfadenectomía pélvica (LP) como primera opción terapéutica, ¿se debería realizar linfadenectomía extendida (LPex) o linfadenectomía estándar (Lpe)?Evidencia: En la búsqueda sistemática se encontraron cuatro[23][24][25][26] …”

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Guía de práctica clínica para el tamizaje, diagnóstico y tratamiento inicial de cáncer de próstata localizado y localmente avanzado en el Seguro Social del Perú (EsSalud)

Cuentas-Jara

Goicochea-Lugo

Delgado‐Flores

et al. 2021

Rev. Cuerpo Med. HNAAA

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Introducción: El presente artículo resume la guía de práctica clínica (GPC) para el tamizaje, diagnóstico, y tratamiento inicial del cáncer de próstata localizado y localmente avanzado en el Seguro Social del Perú (EsSalud). Objetivo: Proveer recomendaciones clínicas basadas en evidencia para el tamizaje, diagnóstico, y tratamiento inicial de adultos con cáncer de próstata localizado y localmente avanzado en EsSalud. Material y Métodos: Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos, el cual formuló preguntas clínicas. Se realizaron búsquedas sistemáticas de revisiones sistemáticas y –cuando fue considerado pertinente– estudios primarios en PubMed durante el 2020 y 2021. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. Se evaluó la certeza de evidencia usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones. La GPC fue revisada por expertos externos antes de su aprobación. Resultados: La GPC abordó 06 preguntas clínicas, divididas en 03 temas: tamizaje, diagnóstico, y tratamiento inicial. En base a dichas preguntas se formularon 08 recomendaciones (04 fuertes y 04 condicionales), 10 puntos de buena práctica clínica, y 04 flujogramas. Conclusión: Se emitieron recomendaciones basadas en evidencia para el manejo de pacientes con esta patología..

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Is extended pelvic lymph node dissection for prostate cancer the only recommended option? A systematic over-view of the literature

Cited by 7 publications

References 37 publications

Comparative results of nerve-sparing robotic-assisted prostatectomy

Comparative results of nerve-sparing robotic-assisted prostatectomy

Prostate-Specific Membrane Antigen–Guided Surgery

Guía de práctica clínica para el tamizaje, diagnóstico y tratamiento inicial de cáncer de próstata localizado y localmente avanzado en el Seguro Social del Perú (EsSalud)

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