The perioperative charge equivalence of interstitial brachytherapy and radical prostatectomy with 1-year followup

PURPOSE: We compare the comprehensive 1-year charges in a consecutive group of patients undergoing radical prostatectomy and transperineal interstitial brachytherapy for clinically localized prostate cancer at a single urban institution. MATERIALS AND METHODS: A total of 60 consecutive men with clinically localized prostate cancer (T1-T2, N0, M0) were treated during a 15-month period with radical prostatectomy or interstitial brachytherapy. Hospital and outpatient records were analyzed for each patient in regard to preoperative, operative and postoperative charges. Parameters included number of encounters, diagnostic and therapeutic interventions, hospitalization and operative charges, and followup visits, diagnostic tests and interventions for 1 year. All charge calculations were based arbitrarily on the 1996 Medicare fee schedule, factoring in the mandated global charge reimbursement period of 90 days for both procedures. RESULTS: Of the patients 38 underwent radical prostatectomy (prostatectomy group) and 22 underwent interstitial brachytherapy (brachytherapy group). The brachytherapy group was older with higher pretreatment serum prostate specific antigen and clinical stage disease, and more frequently received neoadjuvant hormonal therapy compared to the prostatectomy group. The 2 groups were similar in Gleason score and, when applicable, duration of neoadjuvant hormonal therapy. Preoperative charges were 15.3% lower for prostatectomy than for brachytherapy (not statistically significant). Conversely, operative charges for prostatectomy were 13.5% higher (p = 0.04). The major difference among preoperative, operative and postoperative charges was for those incurred postoperatively by the brachytherapy group, which were 56.0% higher than those for the prostatectomy group ($2,285.20 versus $1,007.20, p = 0.0004). CONCLUSIONS: Transperineal interstitial seed implantation is perceived by many as more cost-effective than radical prostatectomy for patients with clinically localized prostate cancer. We demonstrated that when such patients were followed for 1 year, the comprehensive charges for radical prostatectomy and interstitial brachytherapy were equivalent.     

Risk-adjusted analysis of positive surgical margins following laparoscopic and retropubic radical prostatectomy

OBJECTIVES: To prospectively compare in a contemporary and contemporaneous series the positive surgical margin (PSM) rate between laparoscopic (LRP) and retropubic (RRP) radical prostatectomy at the same institution. METHODS: Between 1 January 2003 and 30 June 2005, 1177 consecutive men with clinically localized adenocarcinoma of the prostate underwent radical prostatectomy at the same institution: 485 laparoscopically and 692 through a retropubic approach. Partin table probability of organ-confined (OC) disease was used as an index of disease aggressiveness: The PSM rate between the two approaches was compared, with adjustment for the OC probability. RESULTS: Overall both surgical approaches had a comparable PSM rate of 11.3% after LRP and 11% after RRP. In a logistic regression analysis adjusting for OC probability, there was no statistically significant difference between LRP and RRP (odds ratio [OR]: 1.156; 95% confidence interval [%95 CI], 0.792, 1.686; p=0.5). There was a statistically significant decrease over time in the rate of PSM for LRP (OR: 0.71 per 100 patients treated; %95 CI, 0.57, 0.89; p=0.003), while that of RRP was unchanged (OR: 1.06 per 100 patients treated; %95 CI, 0.94, 1.21; p=0.3; p=0.002 for interaction between change over time and procedure). CONCLUSIONS: In our institution, laparoscopic and retropubic radical prostatectomy provide comparable PSM rates for patients with clinically localized prostate cancer. The PSM rate over the study period remained unchanged in the RRP experience, indicating a mature and well-established operative technique, while that of LRP underwent a significant decrease, demonstrating that the procedure and therefore the results continued to evolve during the study.     

Complications, urinary continence, and oncologic outcome of 1000 laparoscopic transperitoneal radical prostatectomies-experience at the Charité Hospital Berlin, Campus Mitte

OBJECTIVES: Laparoscopic transperitoneal radical prostatectomy (LRP) is an alternative to open radical prostatectomy, but data based on large populations are not frequently available. This study was initiated to evaluate LRP with regard to complications, urinary continence, and oncologic outcome. METHODS: We retrospectively reviewed 1000 consecutive patients with a mean age of 62 yr (SD+/-6 yr) and clinically localized prostate cancer. Between May 1999 and October 2004, all 1000 patients underwent LRP performed by eight urologists at one institution (Charité Hospital Berlin, Campus Mitte). The review procedure was based on complete patient documents (hospital stay, n=1000) and an interview by one physician. Histopathologic results, intraoperative and early and late complications, continence rate, and time to first PSA increase (n=952) were recorded. Erectile function was not part of this review. Twenty-two patients received neoadjuvant treatment for >2 mo. RESULTS: The median follow-up was 28.8 mo (range: 7.2 to 69.7). Intraoperative and early complications occurred in 11.8% of patients. In 77.6% the urethrovesical anastomosis tested by cystography at day 5 or 6 after LRP was intact; 76% used none or not more than one pad per 24h. The overall PSA-free survival was more than 90% for pT2, 80.3% for pT3a, and 72.4% for pT3b until July 2005. The mortality rate was 0.3%. CONCLUSIONS: In the present series of 1000 patients, a specific disadvantage of LRP compared with the open approach, as reported in the literature, could not be shown. On the basis of short-term follow-up data, our retrospective evaluation confirms that LRP provides satisfactory results. We believe that laparoscopic radical prostatectomy can be the technique of choice in the future.     

Neoadjuvant hormonal therapy before radical prostatectomy and risk of prostate specific antigen failure

PURPOSE: To date there is little information on the long-term effect of neoadjuvant hormonal therapy on prostate cancer progression. We performed a prospective study to determine whether patients with prostate cancer receiving neoadjuvant hormonal therapy before radical prostatectomy (hormonal therapy group) have a lower risk of prostate specific antigen (PSA) failure than those treated with radical prostatectomy alone (prostatectomy group). We also evaluated whether type of neoadjuvant hormonal therapy and duration were associated with the risk of PSA failure. MATERIALS AND METHODS: We followed 680 men initially treated for prostate cancer with radical prostatectomy between January 1988 and December 1997 at our university hospital. Of the patients 292 received neoadjuvant hormonal therapy. Median followup was 38 months. Cox regression analysis was used to assess the association between neoadjuvant hormonal therapy and PSA failure (greater than 0.3 ng./ml.) controlling for age, clinical stage, grade, initial PSA and adjuvant therapies. RESULTS: Surgical margins were positive less often in the hormonal therapy (25%) than the prostatectomy (47%) group (p = 0.0001). PSA failure was observed in 163 patients and the 5-year failure rate was 33%. No difference in risk of PSA failure was observed overall between the hormonal therapy and prostatectomy groups (hazards ratio 0.94, 95% confidence interval 0.68 to 1.30). Treatments with antiandrogen alone for any duration, and those combining antiandrogen and luteinizing hormone-releasing hormone analogue for 3 months or less were not associated with improved survival. However, patients receiving combined therapy for more than 3 months had a significantly lower risk of PSA failure than those treated with radical prostatectomy alone (hazards ratio 0.52, 95% confidence interval 0.29 to 0.93). CONCLUSIONS: Prolonged neoadjuvant hormonal therapy combining antiandrogen and luteinizing hormone-releasing hormone analogue may improve disease-free survival after radical prostatectomy.     

Laparoscopic versus open radical prostatectomy: Urodynamic evaluation of vesicourethral function

Objectives:   To assess the impact of laparoscopic radical prostatectomy on vesicourethral function and compare it to that of open radical prostatectomy.
Methods:   Sixty-three patients undergoing laparoscopic radical prostatectomy for localized prostate cancer were included in this retrospective analysis. Urodynamic parameters, including maximum urethral closing pressure (MUCP), functional profile length (FPL), bladder compliance, maximum cystometric capacity (MCC) and detrusor overactivity, were considered. Continence status and changes in urodynamic findings before and after surgery were evaluated. In addition, postoperative urodynamic findings were compared with those in 58 patients undergoing open radical prostatectomy.
Results:   After laparoscopic radical prostatectomy, MUCP and FPL showed a significant postoperative decrease. Continence rates after surgery were 82% in the laparoscopic and 78% in the open group. Comparison of postoperative data between continent and incontinent patients in both surgical groups showed significantly lower MUCP, shorter FPL, lower bladder compliance and higher incidence of detrusor overactivity in incontinent patients. Although there was no significant difference in postoperative MUCP and FPL between the two groups, bladder compliance was significantly lower and incidence of detrusor overactivity was significantly higher in the open prostatectomy group.
Conclusions:   Laparoscopic radical prostatectomy has a negative impact on storage function by impairing function of the urethral sphincter and decreasing bladder compliance. There is no difference in postoperative urethral function between open and laparoscopic radical prostatectomy. Laparoscopic surgery might be associated with less impairment of bladder function than open surgery.     

Laparoscopic radical prostatectomy a review of the literature and comparison with open techniques

BACKGROUND: The development of laparoscopic radical prostatectomy (LRP) has been one of the surgical advances in the treatment of localized prostate cancer. The procedure aims to combine the advantages of minimal access surgery with resection based on established oncological principles with cure rates and functional results that are at least comparable to open radical prostatectomy (ORP). OBJECTIVES: This review compares the advantages and disadvantages of the LRP to the ORP with regard to the real benefits to the patient. The impact on the urological practice was also addressed by the review.Methods: A comprehensive literature review of the published series/cases of both open and laparoscopic radical prostatectomy was performed. RESULTS: LRP is a feasible and reproducible procedure for the treatment of localized prostate cancer. Although its technique is standardized, LRP is technically demanding and it takes longer time than ORP. CONCLUSION: The current published results of LRP show no advantages over that of the ORP. If long-term data shows better results in terms of functional and oncological outcomes, LRP may challenge or even replace the standard ORP in the treatment of localized prostate cancer.     

腹腔镜前列腺癌根治术治疗早期前列腺癌

目的：探讨腹腔镜前列腺癌根治术(LRP)治疗早期前列腺癌的疗效。方法：对30例T＼M分期T1b～T2期的前列腺癌患者，行腹腔镜下经腹途径LRP术。将30例按时间顺序分前、后两组，统计两组的手术时间、出血量、围手术期并发症，提出预防和处理并发症的措施。结果：30例手术均获成功。前、后两组平均手术时间分别为390和270min；平均出血量430和160ml。在前组(早期)发生耻骨后静脉丛损伤导致大出血3例，术中分离损伤膀胱5例，直肠损伤2例，术后出现尿外渗7例，出现膀胱尿道吻合口狭窄2例。后组1例出现尿外渗和1例直肠损伤。30例术后3周拔除尿管排尿通畅。术后复查PSA值小于0．3mg／L。结论：随着术式的改进和并发症的减少，LRP已成为我们治疗早期前列腺癌的标准术式之一。     

The impact of neoadjuvant hormonal therapy on the outcome of laparoscopic radical prostatectomy: a matched pair analysis

PURPOSE: We evaluated the effect of androgen ablation treatment on laparoscopic radical prostatectomy operative and postoperative parameters. MATERIALS AND METHODS: A total of 50 patients (group 1) on neoadjuvant androgen deprivation, followed by laparoscopic radical prostatectomy, were compared to 50 (group 2) without any treatment who were matched for prostate volume, laparoscopic pelvic lymphadenectomy, nerve sparing procedure, surgical access type and pathological stage. We analyzed operative time, blood loss, intraoperative and postoperative complications, catheter time, procedure difficulty as scored by the surgeon and surgical margin status. RESULTS: There was no significant difference between the neoadjuvant and nonneoadjuvant groups with respect to mean operative time +/- SD (228.6 +/- 62.9 vs 219.4 +/- 65.1 minutes), mean blood loss (667.6.1 +/- 217.1 vs 729.8 +/- 285.1 ml) and median catheter time (7 vs 7.5 days). We also found no difference related to the complication rate. Ten of 50 prostate dissections (20%) in group 1 were classified as difficult, whereas in group 2 only 4 of 50 (8%) were scored as difficult (p = 0.084). The positive surgical margin rates did not differ. CONCLUSIONS: There was no significant difference with respect to operative or postoperative parameters in patients undergoing neoadjuvant androgen ablation therapy compared to controls. At centers where there is experience laparoscopic radical prostatectomy can be safely performed in patients who have undergone neoadjuvant hormonal therapy.     

新辅助内分泌治疗结合机器人辅助根治性前列腺切除术治疗高危前列腺癌的优势

目的：探讨高危前列腺癌患者行新辅助内分泌治疗（neoadjuvant hormonal therapy, NHT）后,行机器人辅助腹腔镜根治性前列腺切除术（robot-assisted laparoscopic radical prostatectomy, RALRP）较腹腔镜根治性前列腺切除术（laparoscopic radical prostatectomy, LRP） 和耻骨后根治性前列腺切除术 （ retropubic radical prostatectomy, RRP）的优势。方法：回顾性分析我院自2010年3月-2012年1月以新辅助内分泌治疗结合根治性前列腺切除术治疗的16例高危前列腺癌的临床资料。术前采取3-6个月的LHRH-a＋抗雄药物的最大程度雄激素阻断方法（maximal androgen blockage,MAB）作为NHT方案,NHT后PSA均降至0．2μg／L以下。之后,其中5例接受RALRP,5例接受LRP,6例接受RRP。三组患者治疗前基线情况（年龄、PSA水平、Gleason评分）差异无统计学意义（P〉0．05）。结果：手术均获成功。中位手术时间（operating time,OT）、失血量（esti-mated blood loss,EBL）、住院天数（hospital stay,HS）在RALRP组为225min（包括机器人到位15min）、600mI、7d,在LRP组为280min、900mi、7d,在RRP组为150min、675ml、14．5d。三组患者术后均无尿漏,术后3天拔除双侧引流管。术后病理均无切缘阳性。三组各有1例患者在术后3个月时因PSA复燃而接受辅助性内分泌治疗（P=1．00）。术后3个月时,除2例RRP组患者尚存压力性尿失禁,其余患者均恢复尿控（P=0．29）。结论：对于接受NHT的高危前列腺癌患者而言,相对于开放手术和腹腔镜根治性前列腺切除术,机器人辅助腹腔镜根治性前列腺切除术仍然是这些患者的更佳选择。     

Surgical margin status of open versus laparoscopic radical prostatectomy specimens

Objectives:   To compare the surgical margin (SM) status between open and laparoscopic radical prostatectomy (RRP and LRP, respectively) specimens.
Methods:   Surgical specimens from 137 patients undergoing LRP and 220 patients undergoing RRP for clinically localized prostate cancer were included in the analysis. SM status in each resected specimen, including the number of positive SM as well as their location, was examined.
Results:   The incidence of positive SM in the LRP group was significantly greater than that in the RRP group. Despite the lack of significant difference in the proportion of solitary positive SM between these two groups, the proportion of multiple positive SM in the LRP group was significantly greater than that in the RRP group. There was no significant difference in the incidence of anterior positive SM between the two groups, while the incidences of positive SM at the apex, posterior site and bladder neck in the LRP group were significantly greater than those in the RRP group. Furthermore, there were no significant preoperative parameters predicting positive SM in the LRP group. On the other hand, the biopsy Gleason score and clinical T stage were identified as significant predictors of positive SM in the RRP group, of which the biopsy Gleason score was independently related to the presence of positive SM.
Conclusions:   Clinical T stage and Gleason score could be useful predictors of SM status following RRP, while positive SM in LRP specimens were detected irrespective of preoperative parameters, suggesting the need for an effort for further refining the LRP procedure.     

Long-term outcome following radical prostatectomy in men with clinical stage T3 prostate cancer

PURPOSE: We evaluated patients at our institution who underwent radical prostatectomy for clinical stage T3 prostate cancer to determine their long-term clinical outcomes. MATERIALS AND METHODS: We reviewed our prospective surgical database and identified 176 men who underwent radical retropubic prostatectomy for clinical stage T3 prostate cancer from 1983 to 2003. Clinical and pathological data were reviewed and evaluated in a Cox proportional hazards model to determine preoperative predictors of biochemical recurrence. Clinical progression following biochemical recurrence was evaluated and clinical failure was defined as the development of clinical metastases or progression to hormone refractory prostate cancer. RESULTS: Of the 176 patients with cT3 prostate cancer 64 (36%) received neoadjuvant hormonal therapy. At a mean followup of 6.4 years 84 (48%) patients had disease recurrence with a median time to biochemical recurrence of 4.6 years. The actuarial 10-year probability of freedom from recurrence was 44%. On multivariate analysis biopsy Gleason score, pretreatment serum prostate specific antigen and year of surgery were independent predictors of biochemical recurrence. Neoadjuvant hormonal therapy was not a significant predictor of biochemical recurrence. Following biochemical recurrence clinical failure developed in 30 of 84 (36%) men with a median time of 11 years. Overall the 5, 10 and 15-year probabilities of death from prostate cancer were 6%, 15% and 24%, respectively. CONCLUSIONS: More than half (52%) of our patients remained free of disease recurrence following radical prostatectomy. In our series neoadjuvant hormonal therapy offered no advantage with respect to disease recurrence. Radical prostatectomy remains an integral component in the treatment of select patients with clinical stage T3 prostate cancer.     

Radical prostatectomy for high-risk prostate cancer: Biochemical outcome

Objectives:   To determine the biochemical outcome following radical prostatectomy alone in patients with high-risk prostate cancer.
Methods:   Between January 2002 and August 2007, 252 patients underwent radical retropubic prostatectomy. Those who received neoadjuvant hormone therapy were excluded from this analysis. Based on pre-operative data, we stratified the patients into low, intermediate, and high-risk groups according to the risk criteria of the National Comprehensive Cancer Network in 2003, respectively. Prostate-specific antigen (PSA) failure was defined as any detectable PSA level higher than 0.2 ng/mL.
Results:   The PSA failure-free survival rate for the high-risk group ( n  = 46) was 64.5% after a median follow-up period of 39 months. Among patients with high-risk disease, none with pathologically organ-confined cancer ( n  = 19) and a negative surgical margin had PSA failure. The PSA failure-free rate in patients with non organ-confined cancer ( n  = 27) was 39.5%. Among the pretreatment variables, a positive biopsy core percentage (the number of positive biopsy cores/total biopsy core) ≥30 was a significant independent predictor of extra prostatic extension.
Conclusions:   Radical prostatectomy is feasible in high-risk prostate cancer patients, only if they have a pathologically organ-confined disease.     

Laparoscopic transperitoneal radical prostatectomy in renal transplant recipients: a review of the literature

OBJECTIVES

To report our experience with laparoscopic radical prostatectomy (LRP) for the treatment of localized prostate carcinoma in two renal transplant recipients and a review of the literature.

PATIENTS AND METHODS

We retrospectively identified all patients who had undergone LRP for clinically localized prostate cancer between 2002 and 2008 at our institution (n = 1150). Of these patients, two were renal transplant recipients (one with donor renal transplant cadaver and the other with prior transplantectomy). We reviewed all available clinicopathological data and the scientific literature.

RESULTS

The two patients underwent successful LRP with no major complications. The mean (range) operative time was 200 (180–220) min with a mean estimated blood loss of 300 (200–400) mL. There were no changes in renal graft function as measured by serum creatinine level. At pathology, the surgical margins were negative and disease was organ‐confined in each case. The two patients tolerated the procedure well and had a mean (range) hospital stay of 3.5 (3–4) days.

CONCLUSIONS

The data from our two patients suggest that LRP, as an accepted minimally invasive treatment for a middle‐aged man with organ‐confined prostate cancer, is a technically feasible and safe treatment of localized prostate cancer in renal transplant recipients.     

Clinicopathological significance of neoadjuvant hormonal therapy prior to radical prostatectomy: whole section analysis

We investigated whether the histopathological effect (cell viability) of neoadjuvant hormonal treatment before radical prostatectomy for clinically localized prostate cancer is involved in the biochemical outcome, i.e., androgen independency. Non-randomized prospective trial was carried out between September 1996 and April 2001 involving the patients with clinical stage T1-3 prostate cancer, including 62 who underwent radical prostatectomy after receiving neoadjuvant hormonal treatment for an average of 6.3 months and 76 who underwent radical prostectomy only. All resected specimens were histopathologically diagnosed by whole section analysis. The patients receiving neoadjuvant hormonal treatment were categorized into 4 groups according to the histological change in the resected prostate. There were 8 patients in G0 (all viable cells), 11 patients in G1 (more than 50% viable cells), 26 patients G2 (more than 50% non-viable cells) and 17 patients in G3 (no cancer cells). No difference in the patient background (prostate specific antigen, stage, Gleason score, positive core Nr, duration of neoadjuvant therapy) was observed in any group, except for the duration of (p < 0.05). Multivariate hazards analyses revealed that only the duration of neoadjuvant hormonal treatment was independently associated with excellent responders with grade 3 histological effect. Neoadjuvant hormonal therapy prior to radical operation resulted in various histopathological changes in the prostate, but it is not clear whether the histological effects of hormonal treatment might be involved in the outcome. A longer follow-up randomized prospective trial is necessary.     

Prostatectomies for localized prostate cancer: a mixed comparison network and cumulative meta-analysis

No consensus has been attained regarding the utility of open retropubic radical prostatectomy (RRP), laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RALRP) for localized prostate cancer (PCa). We carried out a network meta-analysis and cumulative meta-analysis comparing RRP, LRP and RALRP on peri-operative and functional outcome measures. Electronic databases were searched for either randomized clinical trials or cohort studies comparing RALRP either with LRP or RRP in patients with localized PCa. Outcome measures were as follows: overall, pT2 and pT3-positive surgical margins (PSMs); biochemical recurrence (BCR); complication rates; estimated blood loss; blood transfusion rate; continence and potency rates; duration of catheterization and hospital stay. Publication bias, risk of bias and inconsistency were assessed. Inverse heterogeneity model was used for analysis. A total of 45 studies were included for the final analysis. We observed that RALRP and LRP did not differ significantly from RRP with regard to the following outcomes: overall PSM; pT2 and pT3 PSMs; OT; complication rate; continence and potency rates; total blood loss and hospital stay. Duration of catheterization was significantly shorter in RALRP than LRP and RRP while significant reductions in the need for blood transfusion and BCR were observed for both RALRP and LRP in comparison with RRP. To conclude, similar functional, operative and oncologic outcomes were observed for both RALRP and LRP compared to RRP.     

Extraperitoneal laparoscopic radical prostatectomy: early experience in Thailand

OBJECTIVE: The transperitoneal approach is the conventional technique for laparoscopic radical prostatectomy. There are, however, several disadvantages of the approach, such as damage to intraperitoneal organs and long-term ileus. To prevent these complications, we propose an extraperitoneal approach that has been successfully used for open radical prostatectomy in treating patients with localized prostate cancer. The aim of this study was to evaluate the feasibility of extraperitoneal laparoscopic radical prostatectomy (ELRP). The outcomes of ELRP and open radical prostatectomy were also assessed and compared. METHODS: There were two groups of patients with localized prostate cancer confirmed by transrectal ultrasound biopsy. Patients were included if they had no previous hormonal treatment and no previous transurethral prostatectomy. Group I comprised patients in whom open radical prostatectomy was performed between February 2001 and August 2005 ( n = 55). Group II comprised patients in whom ELRP was performed between December 2005 and October 2006 (n = 41). Early postoperative results, clinical outcomes and complications were analysed among the two groups using Chi-squared, t and Mann-Whitney tests. RESULTS: Group I and Group II did not show significant differences regarding age, clinical staging, hospitalization time, or pathological stage. Group II had a longer mean operative time than Group I (t test, p< 0.001). Median blood loss was significantly less in Group I (Mann-Whitney test, p < 0.001). Group II also demonstrated shorter catheter removal time (Mann-Whitney test, p = 0.003). In Group II, there were two rectal complications, including rectal injury and rectal necrosis, which were treated laparoscopically and conservatively without long-term problems.CONCLUSION: With experience, ELRP is feasible with equal oncological outcomes to open radical prostatectomy. Although a certain disadvantage was presented by ELRP, the less invasive surgery and reduction in operative blood loss were major advantages. It is suggested that a large and longitudinal trial be conducted to investigate the effectiveness of such an approach in managing functional outcomes.     

Neoadjuvant hormonal ablative therapy before radical prostatectomy: a review. Is it indicated?

PURPOSE: Neoadjuvant hormonal ablation therapy has been used to decrease the rate of positive surgical margins in patients treated with radical prostatectomy. We reviewed the available literature to determine whether this therapy is indicated and beneficial. MATERIALS AND METHODS: We performed a MEDLINE key word search and assessed randomized prospective articles. Data were analyzed for the rate of positive surgical margins, seminal vesicle invasion and lymph node metastasis as well as surgical characteristics, including operative time, blood loss, hospital stay, rate of complications and difficulty of surgical dissection. In addition, these data were evaluated for prostate specific antigen-free survival. RESULTS: Neoadjuvant hormonal therapy decreased the rate of positive margins in 6 of the 7 randomized prospective studies. In none of 4 randomized prospective series was there an improved rate of seminal vesicle invasion with neoadjuvant hormonal therapy. Of 4 studies 3 showed no improvement in the rate of lymph node metastasis after neoadjuvant hormonal therapy compared with that in controls. Similarly there was no improvement in prostate specific antigen-free survival and no significant difference in operative time, operative blood loss, transfusion or hospital stay in patients treated with neoadjuvant hormonal therapy and controls. In addition, in 2 of 3 studies there was no difference in the complication rate. CONCLUSIONS: Analysis of the available literature revealed no significant improvement in outcome to support the routine administration of neoadjuvant hormonal therapy before prostatectomy.     

Health-related quality of life in Japanese men with localized prostate cancer: Assessment with the SF-8

Objectives:   To evaluate health related quality of life (HRQOL) using the Medical Outcomes Study 8-items Short Form Health Survey (SF-8) questionnaire in Japanese patients with early prostate cancer.
Methods:   A cross-sectional analysis was done in 457 patients with prostate cancer treated with radical prostatectomy, external beam radiotherapy, brachytherapy, androgen deprivation therapy, and watchful waiting or a combination these therapies. General HRQOL was measured using the Japanese version of the SF-8 questionnaire and disease-specific HRQOL was assessed using the Japanese version of the Extended Prostate Cancer Index Composite.
Results:   The external beam radiotherapy group reported significantly lower values for the physical health component summary score (PCS) in comparison to the radical prostatectomy and brachytherapy groups ( P  < 0.05). In the analysis of both the PCS and the mental health component summary score (MCS) over time after treatment, higher scores with time were found in the radical prostatectomy group. No significant change over time after androgen deprivation therapy in the PCS was found. In contrast, the MCS was found to deteriorate in the early period, showing a significant increase over time.
Conclusions:   SF-8 in combination with the Extended Prostate Cancer Index Composite has shown to be a helpful tool in the HRQOL assessment of Japanese patients treated for localized prostate cancer.     

Three-month neoadjuvant hormonal therapy before radical prostatectomy: a 7-year follow-up of a randomized controlled trial

OBJECTIVE: To describe the outcome, assessed as the level of prostate specific antigen (PSA), of a mature (more than half the events recorded) prospective randomized study with a median follow-up of 82 months of neoadjuvant hormonal therapy before radical prostatectomy, as this has been suggested to decrease the rate of positive surgical margins (i.e. provide greater potential to completely excise the tumour). PATIENTS AND METHODS: From December 1991 to March 1994, 126 patients with clinically localized prostate cancer were randomized between direct radical prostatectomy or a 3-month course of a gonadotrophin-releasing hormone analogue before surgery. The patients were followed by PSA determinations and a value of > 0.5 ng/mL used to define progression. RESULTS: The incidence of positive surgical margins decreased from 45.5% to 23.6% (P = 0.016) with hormone treatment. Despite this there was no difference in PSA progression-free survival at the last follow-up; it was 51.5% for those undergoing radical prostatectomy only and 49.8% for those who received hormonal pretreatment (P = 0.588). CONCLUSIONS: Three months of neoadjuvant hormonal therapy before radical prostatectomy offers no benefit to the patient and cannot be recommended for routine clinical use.     

腹腔镜与开腹手术治疗局限性前列腺癌的比较研究

目的:比较腹腔镜与开腹手术治疗局限性前列腺癌的临床效果。方法:回顾分析经腹膜外途径腹腔镜前列腺癌根治术19例和耻骨后前列腺癌根治术14例的临床资料,比较两种术式的手术时间、术中出血量、术后胃肠功能恢复时间、术后住院天数、围手术期并发症等指标。结果:两组在手术时间和盆腔引流管保留时间差异无统计学意义(P>0.05)。腹腔镜组比开放组术中出血少、胃肠功能恢复快、术后住院时间短且并发症发生率低(P<0.05)。结论:与耻骨后前列腺癌根治术相比,腹膜外途径腹腔镜前列腺癌根治术具有患者创伤小、术后康复快、并发症发生率低等优点,值得临床推广应用。