Current Management of pT3b Prostate Cancer After Robot-assisted Laparoscopic Prostatectomy

Poelaert, Filip; Joniau, Steven; Roumeguère, Thierry; Coster, Greet De; Dekuyper, Peter; Quackels, Thierry; Cleynenbreugel, Ben Van; Damme, Nancy Van; Eycken, E. Van; Mottrie, Alexander; Lumen, Nicolaas

doi:10.1016/j.euo.2018.05.005

Cited by 16 publications

(7 citation statements)

References 29 publications

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“…Our findings confirm that SNB should always be combined with ePLND, as supported by a recent SN consensus panel (21). Despite being in line with previous series based on tertiary care referral centers (6,22) or population-based (23) data repositories, it may be argued that the lower number of lymph nodal yield in the non SNB group (median 11 nodes) compared to hybrid SNB or ICG SNB group might have affected the reported differences in LNI. However, it is of note to underline that for the first time ever, we demonstrated that at a multivariable model, which accounted for multiple confounders including number of nodes removed, the diagnostic added value remained operational exclusively for hybrid SNB groups (OR 1.65) but not for ICG SNB-group (OR 1.35).…”

Section: Discussionsupporting

confidence: 89%

Diagnostic Value, Oncologic Outcomes, and Safety Profile of Image-Guided Surgery Technologies During Robot-Assisted Lymph Node Dissection with Sentinel Node Biopsy for Prostate Cancer

et al. 2021

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Rationale: Despite good sensitivity and negative predictive value, the implementation of sentinel node biopsy (SNB) in robot-assisted radical prostatectomy (RARP) with extended pelvic lymph node dissection (ePLND) for prostate cancer (PCa) is still controversial.Based on this premise, we aimed to define the added value of SNB (with different tracer modalities) to ePLND in the identification of nodal metastases. Complications rates and oncological outcomes were also assessed.Methods: From January 2006 to December 2019, prospectively collected data were retrospectively analyzed from a single institutional database regarding PCa patients all treated with RARP and ePLND with or without additional use of SNB, either with hybrid tracer indocyanine green (ICG)-99m Tc-nanocolloid (ICG-99mTc-nanocolloid) or free ICG.Multivariable logistic and Cox regression models tested the impact of adding SNB (either with hybrid tracer or free-ICG) on lymph nodal invasion detection, complications and oncological outcomes.Results: Overall, 1680 patients were included in the final analysis. 1,168 (69.5%) were in the non SNB-group, 161 (9.6%) in the ICG SNB-group and 351 (20.9%) patients in the Hybrid SNB-group. Hybrid SNB-group (OR 1.61, 95%CI 1.18-2.20, p=0.002) was an independent predictor of nodal involvement, while ICG SNB-group did not reach the independent predictor status when compared to non SNB group (OR 1.35, 95%CI 0.89-2.03, p=0.1). SNB techniques were not associated with higher rates of complications. Lastly, use of Hybrid SNB was associated with lower rates of biochemical recurrence (0.79, 95%CI 0.63-0.98) and of clinical recurrence (HR 0.76, p=0.035) compared to non SNB group. Conclusions:The implementation of hybrid sentinel node biopsy technique with ICG-99m Tc-nanocolloid in prostate cancer improves detection of positive nodes and potentially lowers recurrence rates with subsequent optimization of patient management, without harming patient safety.

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Section: Discussionsupporting

confidence: 89%

Diagnostic Value, Oncologic Outcomes, and Safety Profile of Image-Guided Surgery Technologies During Robot-Assisted Lymph Node Dissection with Sentinel Node Biopsy for Prostate Cancer

et al. 2021

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“…Recent studies have suggested that 43% of patients with pathological T3b have involved pelvic lymph nodes. [19] Management of patients with pathological T3b can vary from surveillance, to adjuvant and salvage RT and ADT. The presence of a positive margin has a bearing on the most appropriate treatment offered to the patient.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have suggested that 43% of patients with pathological T3b have involved pelvic lymph nodes. [ 19 ]…”

Section: Discussionmentioning

confidence: 99%

Single tertiary cancer center experience on the management of pT3b prostate cancer after robotic-assisted laparoscopic prostatectomy

et al. 2022

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BackgroundPathological involvement of the seminal vesicle poses a treatment dilemma following robotic prostatectomy. Margin status plays an important role in deciding further management. A wide range of treatment options are available, including active monitoring, adjuvant radiotherapy, salvage radiotherapy, and occasionally androgen deprivation therapy. Patients undergoing postoperative radiotherapy tend to have higher risk of urinary and bowel morbidities. The recent RADICALS-RT concluded that adjuvant radiotherapy did not have any benefit compared with salvage radiotherapy. We aim to audit the incidence, margin status, and management of T3b cancer cases at our center.Materials and methodsA retrospective analysis was conducted of all patients diagnosed with pathological T3b (pT3b) prostate cancer following robotic-assisted laparoscopic prostatectomy from January 2012 to July 2020. Preoperative parameters analyzed included prostate-specific antigen (PSA), T stage, and age. A chi-square test and 2-tailed t test were used to determine the relationship between categorical and continuous variables, respectively. Kaplan-Meier survival curves were generated to assess overall survival in patients with pT3b prostate cancer and used to compare unadjusted progression-free survival among those who underwent adjuvant and salvage radiotherapy.ResultsA total of 83 (5%) of 1665 patients who underwent robotic prostatectomy were diagnosed with pT3b prostate cancer between January 2012 and July 2020. Among these, 36 patients (44%) did not receive any radiotherapy during follow-up, compared with 26 patients (31%) who received adjuvant radiotherapy and 21 (25%) who received salvage radiotherapy. The median age of our cohort was 64 (SD, 6.4) years. Mean PSA at presentation was 12.7 μg/L. Positive margins were seen in 36 patients (43%); however, there was no statistically significant difference between treatment groups (p = 0.49). The median overall survival was 96%. There was no significant difference between the adjuvant and salvage groups in terms of biochemical progression-free survival (p = 0.66). Five-year biochemical progression-free survival was 94% for those in the adjuvant radiotherapy group and 97% for those in the salvage radiotherapy group.ConclusionsOur audit corroborates with the recently concluded RADICALS-RT study, although we had fewer patients with positive margins. Radiotherapy can be avoided in patients with T3b prostate cancer, even if margin is positive, until there is definitive evidence of PSA recurrence. In keeping with the conclusion of RADICALS-RT, salvage radiotherapy may be preferable to adjuvant radiotherapy.

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“…A primary benefit of radical surgery in patients with VHRPCa is the evaluation of surgical specimens. Accurate staging of progressive disease is important when making decisions about adjuvant therapy, and there is often a discrepancy between diagnostic imaging and pathological diagnosis 21 , 22 eRALP‐ePLND is the only treatment that enables clinical restaging with pathological findings. Therefore, this surgery may prevent over‐diagnosed patients from being unnecessarily exposed to the adverse effects inherent to adjuvant therapy.…”

Section: Discussionmentioning

confidence: 99%

Extended robot‐assisted laparoscopic prostatectomy and extended pelvic lymph node dissection as a monotherapy in patients with very high‐risk prostate cancer Patients

et al. 2021

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Background Patients with very‐high‐risk prostate cancer (VHRPCa) have earlier biochemical recurrences (BCRs) and higher mortality rates. It remains unknown whether extended robot‐assisted laparoscopic prostatectomy (eRALP) without neoadjuvant or adjuvant therapy can improve the outcomes of VHRPCa patients. We aimed to determine the feasibility and efficacy of eRALP as a form of monotherapy for VHRPCa. Methods Data from 76 men who were treated with eRALP without neoadjuvant/adjuvant therapy were analyzed. eRALP was performed using an extrafascial approach. Extended pelvic lymph node (LN) dissection (ePLND) included nodes above the external iliac axis, in the obturator fossa, and around the internal iliac artery up to the ureter. The outcome measures were BCR, treatment failure (defined as when the prostate‐specific antigen level did not decrease to <0.1 ng/ml postoperatively), and urinary continence (UC). Kaplan–Meier, logistic regression, and Cox proportional‐hazards model were used to analyze the data. Results The median operative time was 246 min, and median blood loss was 50 ml. Twenty‐one patients experienced postoperative complications. Median follow‐up was 25.2 months; 19.7% of patients had treatment failure. Three‐year, BCR‐free survival rate was 62.0%. Castration‐resistant prostate cancer‐free survival rate was 86.1%. Overall survival was 100%. In 55 patients who had complete postoperative UC data, 47 patients (85.5%) recovered from their UC within 12 months. Clinical stage cT3b was an independent preoperative treatment failure predictor (p = 0.035), and node positivity was an independent BCR predictor (p = 0.037). The small sample size and retrospective nature limited the study. Conclusions This approach was safe and produced acceptable UC‐recovery rates. Preoperative seminal vesicle invasion is associated with treatment failure, and pathological LN metastases are associated with BCR. Therefore, our results may help informed decisions about neoadjuvant or adjuvant therapies in VHRPCa cases. Precis Extended robot‐assisted laparoscopic prostatectomy and extended pelvic lymph node dissection without adjuvant therapy is safe and effective for some patients with very‐high‐risk prostate cancer. The clinical stage and node positivity status predicted monotherapy failure, which may indicate good adjuvant therapy candidate.

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Current Management of pT3b Prostate Cancer After Robot-assisted Laparoscopic Prostatectomy

Cited by 16 publications

References 29 publications

Diagnostic Value, Oncologic Outcomes, and Safety Profile of Image-Guided Surgery Technologies During Robot-Assisted Lymph Node Dissection with Sentinel Node Biopsy for Prostate Cancer

Diagnostic Value, Oncologic Outcomes, and Safety Profile of Image-Guided Surgery Technologies During Robot-Assisted Lymph Node Dissection with Sentinel Node Biopsy for Prostate Cancer

Single tertiary cancer center experience on the management of pT3b prostate cancer after robotic-assisted laparoscopic prostatectomy

Extended robot‐assisted laparoscopic prostatectomy and extended pelvic lymph node dissection as a monotherapy in patients with very high‐risk prostate cancer Patients

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