Prog Urol . 2022 Nov;32(15):1275-1372. doi: 10.1016/j.purol.2022.07.148.
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G Ploussard 1, G Fiard 2, E Barret 3, L Brureau 4, G Créhange 5, C Dariane 6, G Fromont 7, M Gauthé 8, R Mathieu 9, R Renard-Penna 10, G Roubaud 11, F Rozet 3, A Ruffion 12, P Sargos 13, J-B Beauval 14, M Rouprêt 15
- PMID: 36400483 DOI: 10.1016/j.purol.2022.07.148
Abstract
Objective: The objective of the French Urology Association Cancer Committee is to propose an update of the recommendations for the diagnosis and management of prostate cancer (PC).
Methods: A systematic review of the literature from 2020 to 2022 was conducted by the CCAFU on the diagnosis and therapeutic management of localised PC, while evaluating the references and their levels of evidence.
Results: The recommendations specify the genetics, epidemiology and means of diagnosing prostate cancer, as well as the notions of screening and early detection. MRI, the gold standard imaging examination for localised cancer, is recommended before prostate biopsies are performed. The transperineal approach reduces the risks of infection. The therapeutic methods are described and recommended according to the clinical context. Active surveillance is the gold standard of treatment for tumours with a low risk for progression. Early salvage radiotherapy is recommended in case of biochemical recurrence after radical prostatectomy. Imaging, particularly molecular imaging, helps to guide the decision-making in the event of biochemical recurrence after local treatment, but should not delay early salvage radiotherapy in the event of biological recurrence after radical prostatectomy.
Conclusion: This update of the French recommendations should help to improve the management of patients with PC.
Keywords: Cancer de la prostate; Diagnosis; Diagnostic; Guidelines; Prostate cancer; Recommandations; Traitement; Treatment.
Copyright © 2022 Elsevier Masson SAS. All rights reserved.
Randomized Controlled Trial
J Urol . 2024 Feb;211(2):205-213. doi: 10.1097/JU.0000000000003788. Epub 2023 Nov 17.
Complications Following Transrectal and Transperineal Prostate Biopsy: Results of the ProBE-PC Randomized Clinical Trial
Badar M Mian 1, Paul J Feustel 2, Asef Aziz1, Ronald P Kaufman Jr 1, Adrien Bernstein 1, Svetlana Avulova 1, Hugh A G Fisher 1
- PMID: 37976319 DOI: 10.1097/JU.0000000000003788
Abstract
Purpose: Transrectal prostate biopsy has come under scrutiny due to potential for postbiopsy infections and transperineal prostate biopsy is being offered as the safer alternative. However, there is a lack of randomized comparative studies. Our goal was to directly evaluate infectious and noninfectious complications following the 2 biopsy procedures.
Materials and methods: We conducted a prospective, pragmatic, randomized clinical study in men undergoing prostate biopsy. The participants underwent either transrectal or transperineal prostate biopsy in the office under local anesthesia. The primary outcome was a 30-day composite infectious complication rate, comprising of 1 or more components including fever, genitourinary infection, antibiotic prescriptions, office or emergency visits, hospitalization, or sepsis. Secondary outcomes included 30-day composite noninfectious complications (urinary or hemorrhagic).
Results: Of the 763 randomized participants, 718 underwent either transrectal (351) or transperineal (367) prostate biopsy. A composite infectious complication event occurred in 9 participants (2.6%) in the transrectal and 10 participants (2.7%) in the transperineal group (odds ratio, 1.06; 95% CI, 0.43 to 2.65; P = .99). None of the participants developed sepsis in either group. There were no between-group differences in any of the individual component infectious events. A composite noninfectious complication occurred in 6 (1.7%) and 8 (2.2%) participants in the transrectal and transperineal groups, respectively (odds ratio, 1.28; 95% CI, 0.44 to 3.73; P = .79). No participants required hospitalization or other interventions.
Conclusions: Among men undergoing transperineal or transrectal prostate biopsy, we could not demonstrate any difference in the infectious or noninfectious complications. Both biopsy approaches remain clinically viable and safe.
Keywords: biopsy; bleeding; complications; infection; prostate.
Review
Urologie . 2024 Sep;63(9):934-942. doi: 10.1007/s00120-024-02408-1. Epub 2024 Aug 19.
Perineal prostate biopsy
[Article in German]
Paulo Leonardo Pfitzinger 1, Darjusch Andreas Askari2, Troya Ivanova 2, Marina Hoffmann 2, Iulia Blajan 2, Michael Atzler 2, Leo Federico Stadelmeier 2, Maria Apfelbeck 2, Michael Chaloupka 2, Philipp Kazmierczak 2, Christian Stief 2, Benazir Enzinger 2
- PMID: 39158686 DOI: 10.1007/s00120-024-02408-1
Abstract
The prostate biopsy is an essential tool for diagnosing prostate cancer (PCa). While transrectal biopsy (TR-Bx) continues to be considered the gold standard in Germany, the European Association of Urology (EAU) guidelines increasingly recommend transperineal biopsy (TP-Bx) due to lower infection rates and higher tumor detection rates. This article provides an overview of the history and development of the perineal biopsy, compares TR-Bx and TP-Bx and discusses the need for antibiotic prophylaxis before TP-Bx. Current studies have shown that TP-Bx can be performed without antibiotic prophylaxis and new techniques such as robotic-assisted and vector biopsy show very precise results. The establishment of TP-Bx is being promoted by extrabudgetary funding and technological advancements, with the choice of biopsy method remaining an individual decision jointly made in dialogue with the patient.
Keywords: Antibiotic prophylaxis; Biopsy method; Local anesthesia; Prostatic neoplasms; Tissue sample.
© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.
J Urol . 2024 Jan;211(1):11-19. doi: 10.1097/JU.0000000000003698. Epub 2023 Sep 14.
Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia (BPH): AUA Guideline Amendment 2023
Jaspreet S Sandhu 1, Brooke R Bixler 2, Philipp Dahm 3, Ramy Goueli4, Erin Kirkby 2, John T Stoffel 5, Timothy J Wilt 3
- PMID: 37706750 DOI: 10.1097/JU.0000000000003698
Abstract
Purpose: The purpose of this American Urological Association (AUA) Guideline amendment is to provide a useful reference on the effective evidence-based management of male lower urinary tract symptoms secondary/attributed to BPH (LUTS/BPH).
Materials and methods: The Minnesota Evidence Review Team searched Ovid MEDLINE, the Cochrane Library, and the Agency for Healthcare Research and Quality (AHRQ) database to identify studies relevant to the management of BPH. The guideline was updated in 2023 to capture eligible literature published between September 2020 and October 2022. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions.
Results: The BPH amendment resulted in changes to statements/supporting text on combination therapy, photoselective vaporization of the prostate (PVP), water vapor thermal therapy (WVTT), laser enucleation, and prostate artery embolization (PAE). A new statement on temporary implanted prostatic devices (TIPD) was added. In addition, statements on transurethral needle ablation (TUNA) and transurethral microwave thermotherapy (TUMT) were removed and information regarding these legacy technologies was added to the background section. References and the accompanying treatment algorithms were updated to align with the updated text.
Conclusion: This guideline seeks to improve clinicians’ ability to evaluate and treat patients with BPH/LUTS based on currently available evidence. Future studies will be essential to further support these statements to improve patient care.
Keywords: BPH; HoLEP; IPSS; LUTS; MIST; PVP; TURP; ThuLEP; alpha blocker; anticholinergic; laser enucleation; prostate; prostate surgery; water vapor thermal therapy.
Review
Radiol Clin North Am . 2024 Jan;62(1):121-133. doi: 10.1016/j.rcl.2023.06.012. Epub 2023 Jul 28.
MR Imaging-Guided Prostate Cancer Therapies
Daniel A Adamo 1, Bernadette Marie Greenwood 2, Pejman Ghanouni3, Sandeep Arora4
- PMID: 37973238 DOI: 10.1016/j.rcl.2023.06.012
Abstract
Prostate cancer is the most common malignancy diagnosed in men. MR imaging-guided therapies for prostate cancer have become an increasingly common treatment alternative to traditional whole-gland therapies, such as radical prostatectomy or radiation therapy. This is especially true in men with localized, low- to intermediate-risk prostate cancer. Although long-term oncologic data remain limited, the authors describe several MR imaging-guided therapeutic options for the treatment of prostate cancer, including cryoablation, laser ablation, transrectal high-intensity focused ultrasound, and transurethral ultrasound ablation.
Keywords: Cryoablation; Focal therapy; HIFU; Laser ablation; MR imaging-guided; Prostate cancer; TULSA.
Copyright © 2023 Elsevier Inc. All rights reserved.
Cell Genom . 2024 Mar 13;4(3):100511. doi: 10.1016/j.xgen.2024.100511. Epub 2024 Feb 29.
Genomic evolution shapes prostate cancer disease type
Dan J Woodcock 1, Atef Sahli 2, Ruxandra Teslo3, Vinayak Bhandari4, Andreas J Gruber 5, Aleksandra Ziubroniewicz 6, Gunes Gundem7, Yaobo Xu8, Adam Butler 8, Ezequiel Anokian 9, Bernard J Pope 10, Chol-Hee Jung 11, Maxime Tarabichi 12, Stefan C Dentro 13, J Henry R Farmery 14; CRUK ICGC Prostate Group; Peter Van Loo 15, Anne Y Warren 16, Vincent Gnanapragasam 17, Freddie C Hamdy 18, G Steven Bova 19, Christopher S Foster 20, David E Neal 21, Yong-Jie Lu 22, Zsofia Kote-Jarai9, Michael Fraser 4, Robert G Bristow 23, Paul C Boutros 24, Anthony J Costello 25, Niall M Corcoran 25, Christopher M Hovens 25, Charlie E Massie 26, Andy G Lynch 27, Daniel S Brewer 28, Rosalind A Eeles 29, Colin S Cooper 30, David C Wedge 31
- PMID: 38428419 PMCID: PMC10943594 DOI: 10.1016/j.xgen.2024.100511
Abstract
The development of cancer is an evolutionary process involving the sequential acquisition of genetic alterations that disrupt normal biological processes, enabling tumor cells to rapidly proliferate and eventually invade and metastasize to other tissues. We investigated the genomic evolution of prostate cancer through the application of three separate classification methods, each designed to investigate a different aspect of tumor evolution. Integrating the results revealed the existence of two distinct types of prostate cancer that arise from divergent evolutionary trajectories, designated as the Canonical and Alternative evolutionary disease types. We therefore propose the evotype model for prostate cancer evolution wherein Alternative-evotype tumors diverge from those of the Canonical-evotype through the stochastic accumulation of genetic alterations associated with disruptions to androgen receptor DNA binding. Our model unifies many previous molecular observations, providing a powerful new framework to investigate prostate cancer disease progression.
Keywords: AR binding; cancer evolution; evotype model; evotypes; ordering; prostate cancer.
Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.
Review
World J Urol . 2024 Apr 20;42(1):245. doi: 10.1007/s00345-024-04914-5.
Single-port robot-assisted radical prostatectomy
Nicolas A Soputro 1, Jihad Kaouk 2
- PMID: 38643347 PMCID: PMC11032265 DOI: 10.1007/s00345-024-04914-5
Abstract
Purpose: To provide a comprehensive update on the different techniques and outcomes of contemporary Single-Port (SP) Robotic Radical Prostatectomy (RARP) approaches.
Methods: A literature review was performed to identify cohort studies that have utilized the purpose-built SP robotic platform (Intuitive Surgical Inc., Sunnyvale, California) for RARP. All published approaches of SP-RARP were included in our review. Baseline clinical, perioperative, and postoperative oncological and functional outcomes were collected from the included studies.
Results: A total of 16 studies involving 1159 patients were identified. To date, five approaches of SP-RARP have been described, namely Transperitoneal, Extraperitoneal, Retzius-Sparing, Transperineal, and Transvesical. The surgical steps and clinical outcomes of the aforementioned approaches were discussed. While operating times were still faster in the Transperitoneal and Extraperitoneal cohorts, the novel and more regionalized Transvesical approach allowed for radical prostatectomy to be pursued in more patients with previous abdominal surgeries and contributed to significantly improved postoperative outcomes, including the earlier return of urinary continence and with most patients being discharged on the same day without any opioids.
Conclusion: Based on the existing literature, the introduction of SP-RARP not only enriched the repertoire of minimally-invasive surgical treatment options for prostate cancer but also provided the opportunity for urologists to develop new techniques that can improve perioperative outcomes and postoperative quality of life. Given the limited number of patients and heterogeneity in the patient selection and reporting of postoperative outcomes, further research remains necessary to better understand the different benefits and improve patient selection algorithms for the different techniques.
Keywords: Minimally invasive surgery; Prostate cancer; Radical prostatectomy; Robotic surgery; Single port.
© 2024. The Author(s).
Clinical Trial
Eur Urol . 2024 Mar;85(3):217-226. doi: 10.1016/j.eururo.2023.08.026. Epub 2023 Oct 26.
Administering [177Lu]Lu-PSMA-617 Prior to Radical Prostatectomy in Men with High-risk Localised Prostate Cancer (LuTectomy): A Single-centre, Single-arm, Phase 1/2 Study
Renu S Eapen 1, James P Buteau 2, Price Jackson 3, Catherine Mitchell 4, Sheng F Oon 5, Omar Alghazo 6, Lachlan McIntosh 7, Nattakorn Dhiantravan7, Mark J Scalzo 8, Jonathan O’Brien 6, Shahneen Sandhu9, Arun A Azad 9, Scott G Williams 10, Gaurav Sharma11, Mohammad B Haskali 12, Mathias Bressel 13, Kenneth Chen 6, Pocharapong Jenjitranant6, Aoife McVey14, Daniel Moon 6, Nathan Lawrentschuk 6, Paul J Neeson 15, Declan G Murphy 16, Michael S Hofman 2
- PMID: 37891072 DOI: 10.1016/j.eururo.2023.08.026
Abstract
Background: High-risk localised prostate cancer (HRCaP) has high rates of biochemical recurrence; [177Lu]Lu-PSMA-617 is effective in men with advanced prostate cancer.
Objective: To investigate the dosimetry, safety, and efficacy of upfront [177Lu]Lu-PSMA-617 in men with HRCaP prior to robotic radical prostatectomy (RP).
Design, setting, and participants: In this single-arm, phase I/II trial, we recruited men with HRCaP (any of prostate-specific antigen [PSA] >20 ng/ml, International Society of Urological Pathology (ISUP) grade group [GG] 3-5, and ≥cT2c), with high tumour uptake on [68Ga]Ga-PSMA-11 positron emission tomography/computed tomography (PSMA PET/CT), and scheduled for RP.
Intervention: Cohort A (n = 10) received one cycle and cohort B (n = 10) received two cycles of [177Lu]Lu-PSMA-617 (5 GBq) followed by surgery 6 weeks later.
Outcome measurements and statistical analysis: The primary endpoint was tumour radiation absorbed dose. Adverse events (AEs; Common Terminology Criteria for Adverse Events (CTCAE) version 5.0), surgical safety (Clavien-Dindo), imaging, and biochemical responses were evaluated (ClinicalTrials.gov: NCT04430192).
Results and limitations: Between May 29, 2020 and April 28, 2022, 20 patients were enrolled. The median PSA was 18 ng/ml (interquartile range [IQR] 11-35), Eighteen (90%) had GG ≥3, and six (30%) had N1 disease. The median (IQR) highest tumour radiation absorbed dose after cycle 1 for all lesions was 35.5 Gy (19.5-50.1), with 19.6 Gy (11.3-48.4) delivered to the prostate. Five patients received radiation to lymph nodes. Nine (45%) patients achieved >50% PSA decline. The most common AEs related to [177Lu]Lu-PSMA-617 were grade 1 fatigue in eight (40%), nausea in seven (35%), dry mouth in six (30%), and thrombocytopenia in four (20%) patients. No grade 3/4 toxicities or Clavien 3-5 complications occurred. Limitations include small a sample size.
Conclusions: In men with HRCaP and high prostate-specific membrane antigen (PSMA) expression, [177Lu]Lu-PSMA-617 delivered high levels of targeted radiation doses with few toxicities and without compromising surgical safety. Further studies of [177Lu]Lu-PSMA-617 in this population are worthwhile to determine whether meaningful long-term oncological benefits can be demonstrated.
Patient summary: In this study, we demonstrate that up to two cycles of [177Lu]Lu-PSMA-617 given prior to radical prostatectomy in patients with high-risk localised prostate cancer are safe and deliver targeted doses of radiation to tumour-affected tissues. It is tolerated well with minimal treatment-related adverse events, and surgery is safe with a low rate of complications. Activity measured through PSA reduction, repeat PSMA PET/CT, and histological response is promising.
Keywords: Lutetium PSMA; Neoadjuvant; Prostate cancer; Radical prostatectomy; Theranostics.
Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Editorial
Eur J Radiol . 2024 Jan:170:111255. doi: 10.1016/j.ejrad.2023.111255. Epub 2023 Dec 9.
Prostate MRI and image quality: The urologist’s perspective
Amir Khan 1, Caroline M Moore 2, M Minhaj Siddiqui 3
- PMID: 38101197 DOI: 10.1016/j.ejrad.2023.111255
Abstract
The development of different imaging modalities of the prostate has significantly improved tumor detection, patient risk stratification, and quality of care.Among these, multiparametric magnetic resonance imaging (mp-MRI) has emerged as the most sensitive tool.It is useful in the diagnosis, localization, risk stratification, and staging of clinically significant prostate cancer, PCa. As a result, mp-MRI of the prostate is recommended as the initial diagnostic test for men with suspected PCa. A multidisciplinary approach is crucial in the diagnosis and management of prostate cancer and mp-MRI plays a fundamental role in this scenario.While many aspects of image quality certainly fall within the purview of radiology, it is important to recognize that urologists must also be attentive to imaging quality when utilizing mp-MRI to facilitate PCa management. We present our viewpoint as urologists on how image quality impacts the management of men diagnosed with PCa andattempt to identify the factors that impact mp-MRI image quality, consequences of poor image quality, and finally suggestions for improvements.
Keywords: Image quality; Multiparametric MRI; Patient care; Prostate cancer.
Copyright © 2023 Elsevier B.V. All rights reserved.
Randomized Controlled Trial
Eur Urol . 2024 Jul;86(1):61-68. doi: 10.1016/j.eururo.2023.12.015. Epub 2024 Jan 11.
Transperineal Versus Transrectal Magnetic Resonance Imaging-targeted and Systematic Prostate Biopsy to Prevent Infectious Complications: The PREVENT Randomized Trial
Jim C Hu 1, Melissa Assel 2, Mohamad E Allaf 3, Behfar Ehdaie4, Andrew J Vickers 2, Andrew J Cohen 3, Benjamin T Ristau 5, David A Green 6, Misop Han3, Michael E Rezaee 3, Christian P Pavlovich 3, Jeffrey S Montgomery 7, Keith J Kowalczyk 8, Ashley E Ross 9, Shilajit D Kundu9, Hiten D Patel9, Gerald J Wang 6, John N Graham 10, Jonathan E Shoag 11, Ahmed Ghazi 3, Nirmish Singla3, Michael A Gorin 12, Anthony J Schaeffer 9, Edward M Schaeffer 9
Affiliations Expand
- PMID: 38212178 DOI: 10.1016/j.eururo.2023.12.015
Abstract
Background and objective: The transrectal biopsy approach is traditionally used to detect prostate cancer. An alternative transperineal approach is historically performed under general anesthesia, but recent advances enable transperineal biopsy to be performed under local anesthesia. We sought to compare infectious complications of transperineal biopsy without antibiotic prophylaxis versus transrectal biopsy with targeted prophylaxis.
Methods: We assigned biopsy-naïve participants to undergo transperineal biopsy without antibiotic prophylaxis versus transrectal biopsy with targeted prophylaxis (rectal culture screening for fluoroquinolone-resistant bacteria and antibiotic targeting to culture and sensitivity results) through a multicenter, randomized trial. The primary outcome was post-biopsy infection captured by a prospective medical review and patient report on a 7-d survey. The secondary outcomes included cancer detection, noninfectious complications, and a numerical rating scale (0-10) for biopsy-related pain and discomfort during and 7-d after biopsy.
Key findings and limitations: A total of 658 participants were randomized, with zero transperineal versus four (1.4%) transrectal biopsy infections (difference -1.4%; 95% confidence interval [CI] -3.2%, 0.3%; p = 0.059). The rates of other complications were very low and similar. Importantly, detection of clinically significant cancer was similar (53% transperineal vs 50% transrectal, adjusted difference 2.0%; 95% CI -6.0, 10). Participants in the transperineal arm experienced worse periprocedural pain (0.6 adjusted difference [0-10 scale], 95% CI 0.2, 0.9), but the effect was small and resolved by 7-d.
Conclusions and clinical implications: Office-based transperineal biopsy is tolerable, does not compromise cancer detection, and did not result in infectious complications. Transrectal biopsy with targeted prophylaxis achieved similar infection rates, but requires rectal cultures and careful attention to antibiotic selection and administration. Consideration of these factors and antibiotic stewardship should guide clinical decision-making.
Patient summary: In this multicenter randomized trial, we compare prostate biopsy infectious complications for the transperineal versus transrectal approach. The absence of infectious complications with transperineal biopsy without the use of preventative antibiotics is noteworthy, but not significantly different from transrectal biopsy with targeted antibiotic prophylaxis.
Keywords: Cancer detection; Infections; Transperineal biopsy; Transrectal biopsy.
Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.
IT – Pubblicazione N° 00 del 01/10/2024
The Mediterranean Journal of Surgery, Medicine and Forensic Sciences 1(2024), XX-XX
ISSN: xxxxxx
Ricevuto: 26/09/2024
Accettato: 28/09/2024
Pubblicato online il 01 Ottobre 2024
