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INTRODUCTION: In the present study, we aim to provide more evidence about benefits of salvage radical prostatectomy (SRP). Our main objective is to assess prostatic-specific antigen control and postoperative urinary incontinence in open and robotic approaches as primary outcomes. MATERIALS AND METHODS: After the Institutional Review Board approval (IRB00010193), we retrospectively analyzed 76 consecutive patients who underwent open or robot-assisted SRP for locally relapsed prostate cancer between 2004 and 2019 at the Urology Department of Hospital Italiano de Buenos Aires, Argentina. Data were collected from our electronic medical record and prospective database.Postoperative variables, such as urinary incontinence, erectile function preservation, and vesicourethral anastomosis stricture development, were analyzed. RESULTS: Before SRP, 59 patients (76.6%) were treated with 3D external beam radiotherapy, 11 (14.3%) with brachytherapy, and 6 (7.8%) with intensity-modulated radiotherapy. Fifty patients underwent open SRP, and 26, robot-assisted SRP. Comparing surgical approaches, the global incontinence rate was 34.2% versus 9.1% in open versus robot-assisted approach, respectively (p: 0.01).Vesicourethral anastomosis stricture occurred in six patients (8.7%), all in the open approach group (p: 0.07). Five patients of 69 (7.2%) preserved erectile function with/without use of phosphodiesterase 5 inhibitors. Two patients in the open approach group needed blood transfusion. Estimated 2-year biochemical recurrence-free survival rate in the open approach group and robot-assisted group was 67% (95% confidence interval: 53.7-80.3) and 60.9% (95% confidence interval: 40.5-81.3), respectively, with no statistical difference (log-rank test p: 0.873). CONCLUSIONS: Robot-assisted SRP is a reliable procedure to treat local recurrences after external beam radiotherapy or brachytherapy, reducing the risk of anastomotic strictures and blood loss and improving continence outcomes.

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OBJECTIVE: Technical improvements in prostate magnetic resonance imaging (MRI) have resulted in the use of MRI to target prostate biopsy. This allowed urologists to progress from blind biopsies to target biopsies with a better performance in prostate cancer (PC) diagnosis. We herein review the current status of Magnetic Resonance Imaging Guided Biopsy (MRGB) for the detection of PC. METHODS: A systematic review of the literature was conducted using PubMed, Embase and Cochrane using the search criteria: "PC and MRI/US fusion" or "PC and guided biopsy" or "PC and multiparametric MRI" or "PC and MRI guided prostate biopsy". Four reviewers coindependently assessed 8228 records and 38 records directly comparing MRGB with transrectal ultrasoundguided biopsy (TRUS) were chosen. However, a risk bias assessment was not performed. RESULTS: In naive patients, MRGB detected similar PC (51% vs 47.5%) than TRUS, more significant PC (SPC [41% vs 33%]) and less not significant PC (NSPC [7.7% vs 14.5%]) with less number of biopsies. In patients with previous negative prostate biopsy MRGB detected more PC (46.3% vs 26.6%), more SPC (32 % vs 16%) and less NSPC (9.5% vs 14.5%) than TRUS, with less number of biopsies. Besides, in previous biopsy patients group MRGB is better at detecting anterior PC than TRUS. CONCLUSION: MRGB increased PC detection in patients with previous biopsies and also increased SPC detection at the expense of decreasing NSPC detection in both groups of patients with fewer biopsies when compared with TRUS. These results demonstrate the value of MRGB in PC diagnosis.

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Objetivo: La mejora en la resonancia magnética (RM) prostática permitió pasar de la biopsia prostática (BP) a ciegas, a dirigir la biopsia a un área prostática sospechosa, con un mejor rendimiento diagnóstico en la detección del cáncer de próstata (CP). El objetivo de este artículo fue evaluar el estado actual de la BP dirigida por RM (BDRM). Métodos: Se realizó una revisión sistemática de la literatura mediante PubMed, Embase y Cochrane con los criterios de búsqueda: CP y fusión RM/US (ultrasonido) o CP y biopsia dirigida (BD) o CP y RM multiparamétrica o CP y BDRM. Cuatro revisores evaluaron 8228 registros y escogieron 38 artículos que comparaban la BDRM con la biopsia sistemática (BS). Sin embargo, no se realizó una valoración del riesgo de sesgo. Resultados: En los pacientes naïve la BDRM detectó similar CP (51% vs 47,5%), más CP significativo (CPS [41% vs 33%]) y menos CP no significativo (CPNS [7,7% vs 14,5%]) que la BS; con un menor número de biopsias. En los pacientes con antecedentes de BS previamente negativa, la BDRM detectó más CP (46,3% vs 26,6%), más CPS (32% vs 16%) y menos CPNS (9,5% vs 14,5%) que la BS; con un menor número de biopsias. Además la BDRM detectó más CP en la región prostática anterior que la BS en este último grupo de pacientes. Conclusión: La BDRM aumentó la detección de CP en los pacientes con una biopsia previa. También aumentó la detección de CPS a expensas de la disminución de la detección CPNS en ambos grupos de pacientes, con una menor cantidad de biopsias, al compararla con la BS. Estos resultados demuestran el valor de BDRM en el diagnóstico de CP (AU)

Objective: Technical improvements in prostate magnetic resonance imaging (MRI) have resulted in the use of MRI to target prostate biopsy. This allowed urologists to progress from blind biopsies to target biopsies with a better performance in prostate cancer (PC) diagnosis. We herein review the current status of Magnetic Resonance Imaging Guided Biopsy (MRGB) for the detection of PC. Methods: A systematic review of the literature was conducted using PubMed, Embase and Cochrane using the search criteria: "PC and MRI/US fusion" or "PC and guided biopsy" or "PC and multiparametric MRI" or "PC and MRI guided prostate biopsy". Four reviewers independently assessed 8228 records and 38 records directly comparing MRGB with transrectal ultrasound-guided biopsy (TRUS) were chosen. However, a risk bias assessment was not performed. Results: In naive patients, MRGB detected similar PC (51% vs 47.5%) than TRUS, more significant PC (SPC [41% vs 33%]) and less not significant PC (NSPC [7.7% vs 14.5%]) with less number of biopsies. In patients with previous negative prostate biopsy MRGB detected more PC (46.3% vs 26.6%), more SPC (32 % vs 16%) and less NSPC (9.5% vs 14.5%) than TRUS, with less number of biopsies. Besides, in previous biopsy patients group MRGB is better at detecting anterior PC than TRUS. Conclusion: MRGB increased PC detection in patients with previous biopsies and also increased SPC detection at the expense of decreasing NSPC detection in both groups of patients with fewer biopsies when compared with TRUS. These results demonstrate the value of MRGB in PC diagnosis (AU)

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OBJECTIVES: To evaluate the results of patients treated with Radical Prostatectomy (RP) and Brachytherapy for low- and intermediate-risk localized prostate cancer and to determine the Biochemical Recurrence (BCR) risk according to the treatment performed. METHODS: The study included 129 patients treated with iodine-125 seeds Brachytherapy, 98 patients treated with Laparoscopic RP (LRP), and 61 patients treated with Robotic RP (RRP) at our institution between December 1999 and January 2010, who had a low-risk disease according to D'Amico criteria (PSA <10 ng/mL, Gleason < or = 6, cT1c-T2a), or an intermediate-risk disease (PSA = or >10 and < 20 ng/mL, Gleason = 7, cT2b), but with a tumor burden of up to 30%. Follow-up was conducted with PSA at 1, 3, and 6 months, and then every six months. As for Brachytherapy, annual digital rectal examinations were also performed. A PSA level increase of 2 ng/mL above the nadir in Brachytherapy (confirmed in 2 cases) and a PSA value greater than 0.2 ng/mL after RP were considered BCR. RESULTS: Overall mean follow-up was 60.5 months (R:1-152), with a mean time for BCR of 51.7 months (R:1-138). Estimated 5-year Biochemical Recurrence-free Survival (BCRFS) in patients with D'Amico low-risk was 85.7%, 77.2% and 90.7% (p 0.336), while for intermediate-risk it was 75.8%, 68.1% and 65.1% (p 0.114), for Brachytherapy, LRP and RRP respectively. In the univariate analysis, the Gleason score 7, a clinical stage T2b, and a D'Amico intermediate-risk were associated with an increased BCR risk, and treatment with Brachytherapy was associated with a decreased BCR risk, all these being statistically significant. In the multivariate analysis, only the Gleason score 7 was significant; treatment with LRP, RRP or Brachytherapy was not associated with a greater BCR risk. CONCLUSION: Brachytherapy and Laparoscopic or Robotic Radical Prostatectomy showed no difference in terms of Biochemical Recurrence risk in patients treated for low-risk or intermediate-risk tumors, with low tumor volume.

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OBJETIVO: Analizar los resultados de pacientes tratados con prostatectomía radical (PR) y braquiterapia para cáncer localizado de próstata de riesgo bajo e intermedio y establecer el riesgo de recaída bioquímica (RB) según el tratamiento realizado. MÉTODOS: Se incluyeron 129 pacientes tratados con Braquiterapia con semillas de Iodo 125, 98 tratados con PR Laparoscópica (PRL) y 61 con PR Robótica (PRR), en nuestra institución desde diciembre de 1999 hasta enero de 2010, que presentaban una enfermedad de bajo riesgo según criterios de D'amico (PSA <10 ng/ml, Gleason < o = 6, cT1c-T2a), o un riesgo intermedio (PSA = o >10 y < 20 ng/ml, Gleason = 7, cT2b), pero con una carga tumoral de hasta un 30%. El seguimiento se realizó mediante PSA al mes, a los 3 meses, a los 6 meses, y luego semestralmente. También con tacto rectal anual en el caso de braquiterapia. Se consideró RB a la elevación del PSA en 2 ng/ml sobre el valor del nadir en la braquiterapia (confirmado en 2 oportunidades) y un valor de PSA mayor a 0,2 ng/ml luego de la PR. RESULTADOS: El seguimiento global medio fue de 60,5 meses (R:1-152), con un tiempo medio a la RB de 51,7 meses (R:1-138). La supervivencia estimada libre de recaída bioquímica a los 5 años en pacientes con riesgo bajo de D'amico fue 85,7%, 77,2% y 90,7% (p 0,336), mientras que para riesgo intermedio fue 75,8%, 68,1% y 65,1% (p 0,114), para braquiterapia, PRL y PRR respectivamente. En el análisis univariado el score de Gleason 7, un estadio clínico T2b, y un riesgo de D'amico intermedio se asociaron a un incremento del riesgo de RB y el tratamiento con Braquiterapia se asocio a una disminución del riesgo de RB, siendo todas estas estadísticamente significativas. En el análisis multivariado solo el score de Gleason 7 fue significativo; el tratamiento con PRL, PRR o Braquiterapia no se asoció con mayor riesgo de RB. CONCLUSIÓN: La braquiterapia y la prostatectomía radical laparoscópica o robótica, no mostraron diferencias en términos de riesgo de recaída bioquímica en pacientes tratados por tumores de bajo riesgo, o riesgo intermedio con bajo volumen tumoral

OBJECTIVES: To evaluate the results of patients treated with Radical Prostatectomy (RP) and Brachytherapy for low- and intermediate-risk localized prostate cancer and to determine the Biochemical Recurrence (BCR) risk according to the treatment performed. METHODS: The study included 129 patients treated with iodine-125 seeds Brachytherapy, 98 patients treated with Laparoscopic RP (LRP), and 61 patients treated with Robotic RP (RRP) at our institution between December 1999 and January 2010, who had a low-risk disease according to D'Amico criteria (PSA < or = 6, cT1c-T2a), or an intermediate-risk disease (PSA = or >10 and < 20 ng/mL, Gleason = 7, cT2b), but with a tumor burden of up to 30%. Follow-up was conducted with PSA at 1, 3, and 6 months, and then every six months. As for Brachytherapy, annual digital rectal examinations were also performed. A PSA level increase of 2 ng/mL above the nadir in Brachytherapy (confirmed in 2 cases) and a PSA value greater than 0.2 ng/mL after RP were considered BCR. RESULTS: Overall mean follow-up was 60.5 months (R:1-152), with a mean time for BCR of 51.7 months (R:1-138). Estimated 5-year Biochemical Recurrence-free Survival (BCRFS) in patients with D'Amico low-risk was 85.7%, 77.2% and 90.7% (p 0.336), while for intermediate-risk it was 75.8%, 68.1% and 65.1% (p 0.114), for Brachytherapy, LRP and RRP respectively. In the univariate analysis, the Gleason score 7, a clinical stage T2b, and a D'Amico intermediate-risk were associated with an increased BCR risk, and treatment with Brachytherapy was associated with a decreased BCR risk, all these being statistically significant. In the multivariate analysis, only the Gleason score 7 was significant; treatment with LRP, RRP or Brachytherapy was not associated with a greater BCR risk. CONCLUSION: Brachytherapy and Laparoscopic or Robotic Radical Prostatectomy showed no difference in terms of Biochemical Recurrence risk in patients treated for low-risk or intermediate-risk tumors, with low tumor volume

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OBJECTIVES: To determine the oncological and functional results obtained after salvage radical prostatectomy (SRP) in patients with recurrence following radiotherapy (3 consecutive PSA rises after a nadir until the year 2006, then 2 ng/mL above nadir ) for prostate cancer (PC), and to analyze the impact of different pre-and postoperative variables on biochemical recurrence-free survival (BCR-free survival). METHODS: Retrospective analysis of 29 cases treated with SRP, 23 cases of conventional technique and 6 cases assisted by the Da Vinci surgical system between August 2004 and March 2012 at the Hospital Italiano de Buenos Aires. There was an attempt to preserve neurovascular bundles in cT1c patients with low tumor volume, Gleason score 7 or less, and favorable surgical anatomy. The degrees of postoperative incontinence and erectile function were recorded. The overall survival, the disease-specific survival, and the BCR-free survival were assessed. The BCR-free survival was compared among groups in accordance with the pre-and post-operative variables. RESULTS. No complications,injury to nearby organs or blood transfusions were recorded. Of all the patients, 85.7% showed normal continence (no pads used). Eight patients (27.5%) preserved their potency with sildenafil. There were 6 positive margins for tumor extension, 44.8% of pT3a, and 10.3% pT3b. All patients are alive at present, and 58.6% with at least 1 year of follow-up have a PSA with recovery criteria (less than 0.02 ng/mL). The biochemical recurrence (BCR) was 41.3%, and the estimated 4-year BCR-free survival was 51.7%. Of the groups analyzed, the presence of a preoperative Gleason score ≥8 and the presence of positive surgical margins (PSMs) significantly influenced the BCR-free survival, both in the univariate as well as the multivariate analysis (p=0.02 and 0.017, respectively). CONCLUSIONS. SRP is a challenging and achievable surgery with an acceptable complication rate, and constitutes a chance to cure patients with biochemical recurrence following prostate radiotherapy. The presence of a preoperative Gleason score ≥8, and the presence of PSMs in the specimen increase the chances of a BCR after four years post-SRP.

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OBJETIVO: Determinar los resultados oncológicos y funcionales obtenidos tras prostatectomía radical de rescate (PR-R) en pacientes recidivados post radioterapia (elevación del PSA en 3 oportunidades consecutivas hasta 2006, luego 2ng/ml sobre el nadir) por cáncer de próstata (CP), y analizar el impacto en la supervivencia libre de recaída bioquímica de diferentes variables pre y postoperatorias. MÉTODOS: Análisis retrospectivo de 29 casos tratados con PR-R, 23 técnica convencional y 6 asistidos por el sistema robótico da Vinci, entre agosto de 2004 y marzo de 2012 en el Hospital Italiano de Buenos Aires. Se intento realizar conservación neurovascular en pacientes cT1c con bajo volumen tumoral, gleason 7 o menor y anatomía quirúrgica favorable. Se objetivó el grado de incontinencia y erección postoperatoria. Se evaluó la supervivencia global y especifica por enfermedad así como también la supervivencia libre de recaída bioquímica (SLRB). Se comparó la SLRB entre grupos de acuerdo a variables pre y postoperatorias. RESULTADOS: No se registraron complicaciones ni lesiones a órganos vecinos, ni transfusiones de sangre. El 85,7 % presenta continencia normal (no utiliza paño). Ocho pacientes (27,5%) conservan su potencia con sildenafil. Hubieron 6 márgenes positivos para extensión tumoral, 44,8% de pT3a y 10,3% pT3b. Todos los pacientes se encuentran vivos al momento y 58.6% con por lo menos 1 año de seguimiento presentan un PSA con criterio de curación (menor de 0,02ng/ml). La recaída bioquímica fue del 41,3% y la SLRB estimada a 4 años fue del 51,7%. De los grupos analizados, tanto la presencia de un score de gleason preoperatorio ≥ 8 y la presencia de márgenes quirúrgicos positivos (MQP) influyeron de manera significativa en la SLRB tanto en el análisis univariado como en el multivariado (p=0,02 y 0,017, respectivamente). CONCLUSIONES: La PR-R es una cirugía desafiante y realizable con un índice de complicaciones aceptable, siendo una oportunidad de curación en pacientes con recidiva bioquímica tras radioterapia de próstata. La presencia de un score de gleason preoperatorio ≥ 8 y la presencia de MQP en la pieza aumentan las posibilidades de tener una recaída bioquímica a los cuatro años post PR-R

OBJECTIVES: To determine the oncological and functional results obtained after salvage radical prostatectomy (SRP) in patients with recurrence following radiotherapy (3 consecutive PSA rises after a nadir until the year 2006, then 2 ng/mL above nadir) for prostate cancer (PC), and to analyze the impact of different pre- and postoperative variables on biochemical recurrence-free survival (BCR-free survival). METHODS: Retrospective analysis of 29 cases treated with SRP, 23 cases of conventional technique and 6 cases assisted by the Da Vinci surgical system between August 2004 and March 2012 at the Hospital Italiano de Buenos Aires. There was an attempt to preserve neurovascular bundles in cT1c patients with low tumor volume, Gleason score 7 or less, and favorable surgical anatomy. The degrees of postoperative incontinence and erectile function were recorded. The overall survival, the disease-specific survival, and the BCR-free survival were assessed. The BCR-free survival was compared among groups in accordance with the pre- and post-operative variables. RESULTS. No complications, injury to nearby organs or blood transfusions were recorded. Of all the patients, 85.7% showed normal continence (no pads used). Eight patients (27.5%) preserved their potency with sildenafil. There were 6 positive margins for tumor extension, 44.8% of pT3a, and 10.3% pT3b. All patients are alive at present, and 58.6% with at least 1 year of follow-up have a PSA with recovery criteria (less than 0.02 ng/mL). The biochemical recurrence (BCR) was 41.3%, and the estimated 4-year BCR-free survival was 51.7%. Of the groups analyzed, the presence of a preoperative Gleason score ≥8 and the presence of positive surgical margins (PSMs) significantly influenced the BCR-free survival, both in the univariate as well as the multivariate analysis (p=0.02 and 0.017, respectively). CONCLUSIONS: SRP is a challenging and achievable surgery with an acceptable complication rate, and constitutes a chance to cure patients with biochemical recurrence following prostate radiotherapy. The presence of a preoperative Gleason score ≥8, and the presence of PSMs in the specimen increase the chances of a BCR after four years post-SRP

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