Oncologic Outcomes at 10 Years Following Robotic Radical Prostatectomy

Diaz, Mireya; Peabody, James O.; Kapoor, Victor; Sammon, Jesse D.; Rogers, Craig G.; Stricker, Hans; Lane, Zhaoli; Gupta, Nilesh; Bhandari, Mahendra; Menon, Mani

doi:10.1016/j.eururo.2014.06.025

Cited by 113 publications

(62 citation statements)

References 30 publications

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“…18) from our cohort of predominantly low‐to‐intermediate risk patients (median follow‐up time of 48.3 months; range 23–64.4 months) has experienced biochemical recurrence (BCR). This is consistent with the reported 5‐year BCR rate of 10–20% in low‐to‐intermediate risk patients undergoing robotic‐radical prostatectomy (Diaz et al ., 2015) and highlights the need for longer‐term follow‐up to correlate PDE results with individual patient outcomes. A more feasible clinical context to ascertain whether PDE culture is correlated with clinical outcome is neoadjuvant clinical trials that allow direct comparison of pre‐ and post‐treated tumors.…”

Section: Resultsmentioning

confidence: 99%

A patient‐derived explant (PDE) model of hormone‐dependent cancer

et al. 2018

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Breast and prostate cancer research to date has largely been predicated on the use of cell lines in vitro or in vivo. These limitations have led to the development of more clinically relevant models, such as organoids or murine xenografts that utilize patient‐derived material; however, issues related to low take rate, long duration of establishment, and the associated costs constrain use of these models. This study demonstrates that ex vivo culture of freshly resected breast and prostate tumor specimens obtained from surgery, termed patient‐derived explants (PDEs), provides a high‐throughput and cost‐effective model that retains the native tissue architecture, microenvironment, cell viability, and key oncogenic drivers. The PDE model provides a unique approach for direct evaluation of drug responses on an individual patient's tumor, which is amenable to analysis using contemporary genomic technologies. The ability to rapidly evaluate drug efficacy in patient‐derived material has high potential to facilitate implementation of personalized medicine approaches.

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Section: Resultsmentioning

confidence: 99%

A patient‐derived explant (PDE) model of hormone‐dependent cancer

et al. 2018

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“…It has also previously been shown, with multivariable analysis, D'Amico risk groups or pathologic Gleason grade, stage, and margins were the strongest predictors of biochemical recurrence in salvage therapy [4]. Detectable PSAs and high risk disease were independent predictors of receipt of salvage therapy [4].…”

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confidence: 92%

“…Detectable PSAs and high risk disease were independent predictors of receipt of salvage therapy [4]. Persistent disease signals the risk of progression likely requiring early salvage treatment [4]. However, if this is detected early, and disease is localised, outcomes will be better.…”

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confidence: 99%

Salvage prostatectomy and high risk disease: push your limits - robotics is better

Goonewardene¹

2016

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Open Access Letter to Editorknown to be common, but less so than open surgery (39%) [6]. This is comparable to other robotic series. Although some patients had limited follow-up, 6 (33%) were continent and 67% were free of biochemical progression.Many SRALP patients have localised disease recurrence and therefore potentially curable disease [2]. The key to decreased morbidity SRALP outcomes are to have experienced centers and fellowship training, a standardisation of training [2]. The robotic surgery curriculum is welcomed as part of this. These centre have demonstrated the advantages of the robotic platform in the performance of salvage radical prostatectomy. This includes decreased blood loss, short length of stay and improved haptic feedback. This was confirmed with a decreasing positive surgical margin rate with each consecutive group of 50 cases, including pT3 and high-risk patients [7]. The 3-year, 5-year, and 7-year BCR-free survival rates were 79.2%, 75.3%, and 70.2%, respectively [7]. 250 cases have become a landmark for lowest positive surgical margin rates, although, it may take more experience than this to manage SRALP cases [7].Increasingly complex cases can be taken on as the learning curve progress [5]. Very often with salvage cases, significant intra-abdominal adhesions, dense periprostatic inflammation post URP; large prostate gland size and median lobes may alter bladder neck anatomy. This makes for a difficult urethro-vesical anastomosis [5]. This highlights the importance of a having a good robotic pelvic experience, prior to taking on salvage cases.Compared to open and laparoscopic procedures perioperative SRALP outcomes were positive, with low complication rates and estimated blood loss equivocal to open or lap procedures [1]. This demonstrates robotic technology can aid the surgeon in salvage prostatectomy [1]. However, experience and training are key to minimal morbidity [3]. This procedure has significant advantages over open surgery in selected patients and is an excellent alternative to other salvage therapies, and allows a broader spectrum of patients to be treated compared to open surgery [3]. SRALP also offers complete staging of high-risk prostate cancer thereby allowing optimum planning of adjuvant and salvage therapies [8]. However, many high-risk prostate cancers are subsequently downgraded or down staged on final histopathology [8], rendering the patient disease free.

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“…Two multiple cause-specific Cox proportional hazard regression models were fitted, one for BR adjusted for preoperative PSA, pT category, surgical margin status, and RP Gleason score (GS), and one for death without BR adjusted for age. These four parameters were chosen as they have consistently been demonstrated to be significant predictors of BR in multivariate modeling across large cohorts [1,2,[15][16][17]. The models were used to predict the absolute risk of BR [18].…”

Section: Statisticsmentioning

confidence: 99%

“…The incidence of biochemical recurrence (BR) following radical prostatectomy (RP) for prostate cancer (PCa) is on average 25-30% across patient populations [1][2][3]. Although BR is not necessarily associated with later development of metastasis and subsequent PCa mortality [4], early detection of BR is crucial if salvage radiotherapy is considered [5,6].…”

Section: Introductionmentioning

confidence: 99%