Urinary incontinence as a factor in prostate cancer treatment selection.

Urinary incontinence is a common adverse effect associated with treatment for early stage prostate cancer. The influence of this factor on treatment selection decisions by patients and their partners has been explored only minimally in the literature. Data regarding the actual incidence of incontinence associated with prostate cancer treatment are confusing because of the lack of standardized definitions of incontinence. Radical prostatectomy is associated with higher rates of urinary adverse effects than is radiation therapy. Brachytherapy appears to be associated with a low risk of incontinence, whereas cryosurgery is associated with significant urinary adverse effects. Including incontinence, urethral sloughing, and bladder neck obstruction. The influence of these adverse effects on decision making regarding prostate cancer treatment selection is difficult to ascertain. Research indicates that both men and their partners appear to have difficulty processing information presented to them regarding the probability of urinary adverse effects and the degree to which these adverse effects may have an impact on their daily lives.     

Salvage prostate cryoablation for recurrent localized prostate cancer after radiotherapy

Salvage prostate cryoablation (SCA) for recurrent localized prostate cancer after radiotherapy has been studied in Western countries for more than a decade. We present our experience of SCA in a Taiwanese medical center. We performed four cases of SCA for recurrent localized prostate cancer after radiotherapy. The data recorded included age, cancer stage, prostate-specific antigen (PSA) level, Gleason score, prostate volume and patient outcome. The median follow-up period was 17 months. All cases were biopsy-proven to have residual cancer before cryoablation. After SCA, 25% of the patients reached undetectable PSA levels, 50% showed response but did not reach undetectable levels, and 25% showed no decrease in PSA. The median recurrence-free duration after SCA was 18 months in the patients who experienced a decrease in PSA. ADT was initiated after SCA for the patient who did not show any response, and bone metastasis was later diagnosed in that patient. Most patients experienced obstructive voiding problems after SCA, which improved over time. SCA is a safe salvage option for prostate cancer patients with local recurrence after RT. The preliminary results are encouraging. More extensive imagery to exclude extra-glandular disease is warranted before SCA. A longer follow-up period and larger sample size are necessary to delineate the benefits more conclusively.     

Surgery for localized prostate cancer after renal transplantation

OBJECTIVE: To investigate the feasibility of perineal radical prostatectomy (RP) in renal transplant recipients with localized prostate cancer. PATIENTS AND METHODS: The study comprised seven consecutive renal transplant patients who had a perineal RP between May 1991 and February 2004. All available clinicopathological data were reviewed. Results All seven patients successfully tolerated RP with no major complications. The mean (sd, range) age at surgery was 62.3 (2.5, 55-74) years and the mean interval from renal transplant to RP 86.5 (25.25, 24-192) months. There was no evidence of increased blood loss, operative duration, transfusion requirement, hospital stay or deterioration of graft function. The presence of an allograft did not alter the surgical approach or management of the patients after RP. The mean follow-up was 22 (2-130) months and all seven patients were followed. One patient had evidence of biochemical recurrence with no radiographic evidence of metastatic disease. Serum prostate-specific antigen was undetectable in the remaining patients. CONCLUSION: A perineal RP in renal transplant recipients for treating localized prostate cancer offers many advantages over other treatments.     

Making decisions about treatment for localized prostate cancer

OBJECTIVE: To describe the decision-making processes used by men diagnosed with localized prostate cancer who were considering treatment. PATIENTS AND METHODS: Men newly diagnosed with localized prostate cancer from outpatient urology clinics and urologists' private practices were approached before treatment. Their decision-making processes and information-seeking behaviour was assessed; demographic information was also obtained. RESULTS: Of 119 men approached, 108 (90%) were interviewed; 91% reported non-systematic decision processes, with deferral to the doctor, positive and negative recollections of others' cancer experiences, and the pre-existing belief that surgery is a better cancer treatment being most common. For systematic information processing the mean (sd, range) number of items considered was 4.19 (2.28, 0-11), with 57% of men considering four or fewer treatment/medical aspects of prostate cancer. Men most commonly considered cancer stage (59%), urinary incontinence (55%) and impotence (51%) after surgery, and low overall mortality (45%). Uncertainty about probabilities for cure was reported by 43% of men and fear of cancer spread by 37%. Men also described uncertainty about the probabilities of side-effects (27%), decisional uncertainty (25%) and anticipated decisional regret (18%). Overall, 73% of men sought information about prostate cancer from external sources, most commonly the Internet, followed by family and friends. CONCLUSIONS: In general, men did not use information about medical treatments comprehensively or systematically when making treatment decisions, and their processing of medical information was biased by their previous beliefs about cancer and health. These findings have implications for the provision of informational and decisional support to men considering prostate cancer treatment.     

Cryosurgery as primary treatment for localized prostate cancer

Objective  

To present the early results of the use of third-generation cryotherapy as primary treatment for localized prostate cancer in China.     

Quality of life after treatment for localized prostate cancer: differences based on treatment modality

PURPOSE: Brachytherapy with 103palladium (103Pd) is an increasingly administered treatment modality for localized prostate cancer. We compared general and disease specific health related quality of life after 103Pd treatment, radical prostatectomy and external beam radiation therapy given during the same time frame. MATERIALS AND METHODS: We performed a retrospective cross-sectional survey study of patients treated at a single community medical center between 1995 and 1999. We mailed 5 validated health related quality of life survey instruments to 269, 142 and 222 men who underwent radical prostatectomy, 103Pd treatment and external beam radiation therapy, respectively, with a response rate of greater than 80% in all groups. RESULTS: General health related quality of life assessed by the SF-36 showed the same scores in patients who underwent prostatectomy and 103Pd treatment. The University of California-Los Angeles Prostate Cancer Index was used to assess bowel, urinary and sexual function/bothersomeness. External beam radiation therapy reported was associated with worse bowel function and greater bowel bothersomeness. Prostatectomy was associated with worse urinary function compared to 103Pd and external beam radiation therapy. Prostatectomy was associated with worse sexual function than 103Pd or external beam radiation therapy, although nerve sparing surgery and erectile aids minimized the difference. American Urological Association symptom scores were initially higher for 103Pd but became equal to those in the other groups in patients treated greater than 12 months from survey time. Disease-free men who underwent prostatectomy and 103Pd brachytherapy were equally confident that cancer would not recur in the future. Satisfaction rates were equivalent and biochemical failure significantly decreased satisfaction in all groups. CONCLUSIONS: While general health related quality of life was mostly unaffected by the 3 most common treatments for prostate cancer, there were differences in bowel, urinary and sexual function. This information may aid patients in the decision making process.     

Urinary incontinence and erectile dysfunction in patients with localized or locally advanced prostate cancer: A nationwide observational study

BackgroundAlthough urinary adverse events after treatment of prostate cancer (CaP) are common, population-based studies on functional outcomes are scarce. The aim of this study is to evaluate the occurrence of urinary incontinence (UI) and erectile dysfunction (ED) in daily clinical practice using a nationwide Dutch cohort of patients with localized or locally advanced CaP.Basic proceduresPatients were invited to complete the EPIC-26 questionnaire before treatment (baseline) and at 12 and 24 months after diagnosis. We calculated the mean EPIC-26 domain scores, stratified by treatment modality (i.e., radical prostatectomy, external radiotherapy, and no active treatment), and the proportions of patients with UI (defined as ≥ 2 pads per day) and ED (defined as erections not firm enough for sexual intercourse). Logistic regression modeling was used to explore the factors related to UI and ED after surgery.Main findingsIn total 1,759 patients participated in this study. Patients undergoing radical prostatectomy experienced clinically relevant worsening in the urinary incontinence domain. After excluding patients who reported UI at baseline, 15% of patients with prostatectomy reported UI 24 months after diagnosis. Only comorbidity was associated with UI in surgically treated patients. Regardless of treatment, patients reported a clinically significant reduced sexual functioning over time. Before treatment, 54% of patients reported ED. Among the 46% remaining patients, 87% of patients treated with radical prostatectomy reported ED 24 months after diagnosis, 41% after radiotherapy, and 46% in patients without active treatment. Bilateral nerve-sparing surgery was the only factor associated with ED after 24 months.Principal conclusionsUI and ED frequently occur in patients with localized and locally advanced CaP, in particular after radical prostatectomy. The higher occurrence rate of UI and ED, compared with clinical trial participants, supports the importance of real-world data, which can be used for local treatment recommendations and patient information, but also to evaluate effects of future initiatives, such as treatment centralization and research aimed at improving functional outcomes.     

局限性前列腺癌治疗进展

局限性前列腺癌的治疗近年发展很快,本文就局限性前列腺癌初次治疗前危险分类,治疗方法的合理选择,初次治疗后肿瘤的生化进展及临床复发处理的进展作一综述。     

Urinary incontinence after transurethral resection of prostate in myasthenia gravis patients

An unusually high incidence of urinary incontinence following transurethral resection of the prostate has been reported in patients with myasthenia gravis who were operated on for prostatism. It has been documented that this may be due to the vulnerability of the external sphincter to the electrothermal changes during transurethral resection of the prostate. In the case we studied, neuropathic changes were observed in the external sphincter; thus transvesical prostatectomy was performed instead, and no compromise of continence occurred.     

11C-choline positron emission tomography for the evaluation after treatment of localized prostate cancer

RATIONALE: The evaluation of the efficacy of the treatment of men with prostate cancer is largely based on post treatment levels of PSA. An increase in PSA or biochemical recurrence is the first sign of recurrent disease and precedes a clinically detectable recurrence by months to years. Digital rectal examination and conventional imaging techniques are not sensitive to detect a local recurrence. A metabolic imaging technique, which is not dependent on anatomical distortions, could be of use. In this study we investigated 11C-choline positron emission tomography (PET) for the evaluation after treatment of localized prostate cancer. METHODS: Thirty-six patients with localized prostate cancer, treated by either radical prostatectomy (n=20) or by external beam radiotherapy (n=16) were studied with 11C-choline PET. The results of PET were compared with the results of histology and with clinical follow up. RESULTS: Fourteen patients had no biochemical failure after therapy. 11C-choline PET was true negative in 14/14 patients. Twenty-two patients had a biochemical failure. In the radical prostatectomy patients 11C-choline PET was true positive in 5/13 (38%) cases. In the external beam radiotherapy patients 11C-choline PET was true positive in 7/9 (78%). The recurrent tumor was confirmed by biopsy or by bone scan in eleven of the twelve true positive patients. In ten patients with a negative 11C-choline PET scan, no recurrent tumor could be proven yet clinically, by biopsy or during follow up. CONCLUSION: 11C-choline PET is a feasible technique for evaluation of treatment for localized prostate cancer. The site of recurrence was detected correctly in 78% of the patients after external beam radiotherapy compared to 38% of the patients after radical prostatectomy. No positive PET scans were observed sofar in patients with a serum PSA <5ng/ml. Confirmatory studies and longer follow up are needed to determine the efficacy of 11C-choline PET compared to other imaging techniques.     

放射性粒子组织间植入治疗局限性前列腺癌

目的：探讨放射性粒子组织间植入治疗局限性前列腺癌的安全性和有效性。方法：采用实时直肠超声引导经会阴穿刺放射性^125I粒子组织间植入治疗T1～T2c期前列腺癌患者45例。结果：45例患者手术均顺利完成,手术时间60～120（平均90）min,植入^125I粒子数40～75（平均56）枚。术后随访12～48个月,血PSA〈1μg／L29例,血PSA为1～2μg／L 11例,血PSA≥2μg／L5例。结论：放射性粒子组织间植入治疗局限性前列腺癌安全有效。     

Inguinal hernia after a radical prostatectomy for localized prostate cancer

Since prostate-specific antigen (PSA) screening began in the 1980s in Taiwan, there has been a significant increase in the detection of prostate cancers (PCs) at an earlier stage. For clinically localized PC, a radical prostatectomy (RP) remains the gold standard treatment. However, patients undergoing a RP for PC are at risk of onset or worsening of inguinal hernias (IHs). We reviewed the current status of IHs after a RP. We reviewed literature published from PubMed using the key words of “inguinal hernia”, “prostatectomy”, and “prostate cancer”. The postprostatectomy mechanism was illustrated. The incidences of various prostatectomies were recorded. The prediction and prevention of postprostatectomy IHs were analyzed. Disruption of the transversalis fascia caused by surgical procedures was proposed as contributing to postprostatectomy-related IH formation because it assaults the anatomic-physiological balance in the abdominal wall. The myopectineal orifice is traversed by the spermatic cord and femoral vessels, and its inner surface is sealed by the transversalis fascia. A body mass index of <23 kg/m² and a history of previous IH repair were significant risk factors for postoperative IH. The incidence of IHs after surgery was reported to range from 12.4% to 23.9%, and most IHs occur within 6–24 months postprostatectomy. The incidence of IHs is greater with the extraperitoneal approach than with the transperitoneal approach. A preoperative abdominal computed tomography (CT)-scan might identify asymptomatic IHs, but the test lacks sensitivity and is inferior to a simple physical examination (PE). A PE of the groin should be performed before a RP, and careful surgical manipulation is essential to prevent postoperative IHs. The concurrent repair of any detectable IHs at the time of a prostatectomy could significantly reduce the incidence of postoperative IHs.