Prostate Cancer and Prostatic Diseases最新文献

Background: Postoperative medication use is an important yet relatively unexplored element of the benign prostatic hyperplasia patient journey. We assessed and compared the percentage of patients who required medication postoperatively after the three most common BPH surgeries in the real world: transurethral resection of the prostate (TURP), photovaporization procedure with GreenLight Laser (PVP), and prostatic urethral lift (PUL) with the UroLift system.

Methods: Within a random representative sample of US Medicare and commercial insurance claims, patients with at least one year of follow-up data available after an outpatient TURP, PVP, or PUL procedure were linked to pharmaceutical claims to elucidate rates of continuous and de novo use of alpha-blockers, 5-alpha reductase inhibitors, or combination medical therapy. Periods of interest were perioperative (use within three months postoperatively and not beyond) and one and five years postoperatively.

Results: 36 629 men diagnosed with BPH underwent outpatient TURP (n = 20 319), GreenLight PVP (n = 10 517) and PUL (n = 5 793) procedures within the claims dataset. The rate of medical therapy use through one year was lowest for PUL (4.1%) compared to TURP (6.2%) and PVP (6.6%), and was equivalent between procedures through five years (10.6% TURP, 10.4% PVP, and 10.3% PUL).

Conclusions: Patients who undergo surgery to treat BPH may desire to discontinue or bypass BPH medications. However, these data demonstrated that approximately 10% of BPH patients used medication through five years postoperatively, regardless of which procedure they underwent.

Background: ARTO trial was a phase II randomized trial suggesting the benefit of a concomitant treatment strategy including Abiraterone acetate plus predisone (AAP) and stereotactic body radiotherapy (SBRT) in oligometastatic castrate resistant prostate cancer (omCRPC). The object of the current analysis is to explore whether the benefit provided by SBRT to AAP is maintained at later stages of disease after oligoprogression METHODS: Patients enrolled in ARTO trial in whom a first progression event was reported were divided in two groups according to the treatment approach received, regardless of the initial randomization. After first progression event, Patients in Group A received SBRT on oligoprogressive disease, while patients in group B received second line systemic treatment. Palliative RT was not considered for the purpose of this analysis. Progression-Free survival (PFS) 1 and 2 were defined as time between AAP start and first progression event and time between first and second progression event, death or last follow up, (whichever came first), respectively. Cox regression analysis was performed to compare PFS1 + PFS2 in patients in group A vs Group B. Kaplan-Meier analysis was performed to compare overall survival between the two groups RESULTS: Median PFS1 + PFS2 was 45.9 months vs. not reached in group A (n = 43) vs Group B (n = 20), respectively (HR 0.63, 95% CI 0.17-2.33, p value 0.489), no significant difference was detected. Median OS was not reached in neither of the two arms of treatment, with a non-significant trend in favour of the experimental arm (HR 0.50, 95% CI 0.14-1.78, p = 0.284) CONCLUSIONS: Results from the present analysis show that SBRT after progression may be a viable and feasible option for omCRPC after progression if compared to second line systemic therapy.

Introduction: Focal therapy (FT) is a promising alternative to radical treatments for localized Prostate Cancer (PCa) in selected patients. However, it is not yet considered a standard treatment option, and there is currently no consensus on managing patients after FT. In this context, Prostate-Specific Membrane Antigen Positron Emission Tomography (PSMA-PET) may support multiparametric MRI (mpMRI) for both pre-operative planning and follow-up. The aim of this systematic review was to provide a comprehensive overview of the current applications of PSMA-PET in the field of FT and to analyze its future perspectives.

Evidence acquisition: A literature search was performed using PubMed and Scopus databases, following the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement recommendations. All studies reporting data on PSMA-PET performed before and/or after FT for PCa were included. A narrative synthesis was employed to summarize the review findings. No quantitative synthesis was performed due to the heterogeneity and limitations of the studies.

Evidence synthesis: Seven studies (2 case reports, 1 retrospective, and 4 prospective single-center studies) were included in this review. A moderate-severe risk of bias was assessed for the included studies. In the field of FT, PSMA-PET showed promising but yet not validated results with several possible applications: (1) pre-operative planning and staging, aiming to improve patient selection trough the identification of intraprostatic suspected lesions and more accurate local and systemic staging; (2) guidance for biopsy and Region of Interest (ROI) definition; (3) follow-up imaging tool, aiming to decrease the number of unnecessary surveillance biopsies.

Conclusions: Limited evidence exists regarding the use of PSMA-PET in the field of FT, considering pre-operative setting, treatment guidance and its use as a non-invasive tool to evaluate treatment success or failure and for follow-up. In this scenario, even if the current evidence is still limited and inconclusive, PSMA-PET showed promising results with several possible applications.

Background: Urinary incontinence significantly impacts on health-related quality of life of patients undergoing radical prostatectomy. In the last decades, several approaches (extraperitoneal, Retzius-sparing (RS), perineal and, transvesical) for robot-assisted radical prostatectomy (RARP) have proposed with the aim to improve functional outcomes in comparison with transperitoneal, anterior ones.

Methods: We performed a systematic review and meta-analysis of studies published in English language, in the last ten years, comparing the different approaches used to perform RARP. We included only studies reporting urinary continence rates at different follow-up time points. From each eligible study, we extracted the number of analyzed patients; the study design; the continence definition; and, when available, immediate, 1-, 3-, 6-, and 12-mo urinary continence rates. Statistical analyses were performed using RevMan version 5.4 (Cochrane Collaboration, Oxford, United Kingdom, UK). The Odds Ratio (OR) with 95% confidence intervals (CIs) was calculated using the generic inverse variance. A p value of <0.05 was set as significance level when comparing studies.

Results: The meta-analyses of studies comparing anterior, transperitoneal RARP and RS-RARP in terms of immediate (OR = 3.73; 95% CI: 2.17-6.43; p < 0.0001), 1-mo (OR = 4.16; 95% CI: 2.68-6.48; p < 0.00001), 3-mo (OR 4.71; 95% CI: 3.70-6.00; p < 0.0001), 6-mo (OR 4.12; 95% CI: 2.95-5.75; p < 0.00001) and 12-mo (OR = 3.25; 95% CI: 1.76-5.99; p < 0.00001) urinary continence rates showed a statistically significant advantage in favor of RS approach. However, a sub-analysis of Randomized Controlled Trials showed overlapping urinary continence rates between the two approaches at 6-mo (OR = 1.99; 95% CI: 0.90-4.42; p = 0.09) and 12-mo (OR = 1.36; 95% CI: 0.43-4.31; p = 0.60) after surgery. The meta-analysis of studies comparing extraperitoneal and transperitoneal approaches showed that 6-mo urinary continence rates were overlapping between the two approaches (OR = 1.18; 95% CI: 0.85-1.65; p = 0.32). The meta-analysis of studies comparing single-port (SP) and multi-port (MP) RARP showed comparable 6-mo urinary continence rates (OR = 0.93; 95% CI 0.65-1.33; p = 0.69).

Conclusions: Within the limitations of mainly low to moderate quality of evidence, the RS  approach offers significant advantages compared to an anterior, transperitoneal, approach in terms of urinary continence recovery at different follow-up time points in patients who underwent MP-RARP. MP perineal and transvesical approaches need to be further tested and might be of interest in the setting of SP-RARP. Our meta-analysis showed comparable results between SP- and MP-RARP in terms of urinary continence rates.