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1.
Clin Transl Oncol ; 20(8): 1004-1010, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29243074

RESUMO

PURPOSE: To evaluate predictive factors associated with detectable prostate-specific antigen (PSA) and describe clinical recurrence (CR) and cancer-specific mortality (CSM) after robot-assisted radical prostatectomy (RARP). METHODS: The study included 2500 patients who were treated with RARP at a single institution between 2000 and 2016. All patients had clinically localized PCa. Patients were divided into two groups according to PSA value at 6 weeks after surgery: undetectable (n = 2271; PSA < 0.1 ng/dl) and persistently elevated (n = 229; PSA ≥ 0.1 ng/dl). The association between various covariates and: (1) detectable PSA and (2) CR was evaluated. Kaplan-Meier analyses estimated CR and CSM rates according to PSA persistence. RESULTS: Inside the group of detectable PSA, 146 men (63.75%) received adjuvant treatments, 44 patients (19.21%) salvages therapies and 38 men (16.5%) experienced CR. Factors associated with aggressive disease predicted PSA persistence. Within patients with detectable PSA, pathologic stage ≥ pT3a (HR 2.71; p < 0.029) and to received adjuvant androgen deprivation therapy (ADT) due to bad prognosis tumors (HR 13.36; p < 0.001) were associated with CR. Overall 14 (0.56%) died of PCa. 5 and 10-year CSM rates were higher for patients with CR (9.6 and 23.7%, p < 0.001), and Gleason ≥ 8 (5.7 and 6.9%, p = 0.003). CONCLUSIONS: A detectable PSA is affected by factors associated with aggressive prostate cancer. Within men with persistent PSA, those with higher pathologic stage and who received adjuvant ADT are more likely to have CR. Patients with CR, Gleason ≥ 8, and those who received adjuvant ADT must have a close monitoring due to the high rate of mortality.


Assuntos
Adenocarcinoma/mortalidade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/mortalidade , Antígeno Prostático Específico/sangue , Prostatectomia/mortalidade , Neoplasias da Próstata/mortalidade , Procedimentos Cirúrgicos Robóticos/mortalidade , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Idoso , Seguimentos , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/sangue , Prognóstico , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Taxa de Sobrevida
2.
Actas Urol Esp ; 41(3): 155-161, 2017 Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27890493

RESUMO

INTRODUCTION: The local inflammatory process after prostate biopsies can have a negative impact on functional outcomes of radical prostatectomy. There is no evidence in literature demonstrating its impact on radical prostatectomy. OBJECTIVES: To evaluate the impact of the number of TRUS core biopsies in the surgical morbidity and rate of positive margin on robot assisted radical prostatectomy (RARP). MATERIAL AND METHODS: A prospectively maintained database of 2,054 RARPs in a single institution. Patients were further grouped into 2 groups based on the number of TRUS biopsy cores (G1≤12 cores; G2>12 cores). Multivariable logistic regression model was applied to analyze the impact of number of cores on complications. RESULTS: A total number of 1,042 patients in the group 1 (≤12 cores) and 1,012 patients in the group 2 (>12 cores) were included. The rate of perioperative complications increased with higher number of biopsies (G1 6.4 vs. G2 8.5%; P=.03), but high grade complication (Clavien 3-4) were similar (G1 1.4 vs. G2 2.2%; P=.16). Positive surgical margin rates were similar in both groups (G1 11.8 vs. 9.98%; P=.2). At the multivariable logistic regression analysis shown that G2 had a 39% (OR 0.645) higher rate to experience perioperative complications during RARP. CONCLUSION: Higher number of TRUS biopsy cores (>12) is associated to higher blood loss and perioperative complications during RARP. Careful preoperative evaluation for those patients underwent multiple biopsies or saturation protocols is mandatory. Application of longer intervals (>6 weeks) between biopsy and surgery may be advisable to minimize potential risks of surgical complications in patients may benefit from RARP. Further studies are still necessary to confirm these results.


Assuntos
Perda Sanguínea Cirúrgica/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Próstata/patologia , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos , Ultrassonografia de Intervenção , Humanos , Biópsia Guiada por Imagem/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Próstata/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/secundário
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