Delay of Surgery in Men With Low Risk Prostate Cancer

O’Brien, Daniel R.; Loeb, Stacy; Carvalhal, Gustavo F.; McGuire, Barry B.; Kan, Donghui; Hofer, Matthias; Casey, Jessica T.; Helfand, Brian T.; Catàlona, William J.

doi:10.1016/j.juro.2011.02.009

Cited by 70 publications

(54 citation statements)

References 15 publications

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“…11,[26][27][28][29] Understandably, this is one of a few ways to ethically study SWT with prolonged delays. Otherwise, in most other global centres, men who are not eligible for AS are operated with minimal delay, considering greater access to surgical resources.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, very few studies have reported a trend toward increased risk of biochemical recurrence (BCR)-associated with surgical delays for prostate cancer. [9][10][11] Therefore, the true impact of surgical delay remains controversial and the acceptable wait time is currently unknown. As such, we sought to address the impact of SWT to RARP on pathological outcomes for patients in two major academic centres in Canada.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Does surgical delay for radical prostatectomy affect patient pathological outcome? A retrospective analysis from a Canadian cohort

Zanaty¹,

Alnazari²,

Lawson³

et al. 2017

CUAJ

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Introduction: We sought to assess the impact of surgical wait time (SWT) to robot-assisted radical prostatectomy (RARP) on final pathological outcome. After stratification by D'Amico risk group, no significant association was observed between SWT and CAPRA-S score in the three risk categories on UVA and MVA. Predictors of higher CAPRA-S score in the multivariable model in the overall cohort were: older age (p=0.014), biopsy Gleason score (p<0.001), percentage of positive cores (p<0.001), and clinical stage (p<0.001). Conclusions: In the present study evaluating SWT for RARP in a Canadian socialized system, increased delay for surgery does not appear to impact the pathological outcome. Further studies are required to evaluate the impact of wait time on biochemical recurrence-free survival, cancer-specific survival, and overall survival.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Does surgical delay for radical prostatectomy affect patient pathological outcome? A retrospective analysis from a Canadian cohort

Zanaty¹,

Alnazari²,

Lawson³

et al. 2017

CUAJ

View full text Add to dashboard Cite

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“…Recently, an analysis of 17,943 patients with low-risk prostate cancer (i.e., candidates for active surveillance) treated with radical prostatectomy (RP) in the US between 2010–2011 showed that upgrading, upstaging, or nodal metastases occurred in 45% of men and that the deferral of radical prostatectomy for more than 12 months was associated with an 1.7-fold increased risk of non-organ confined disease after surgery (4). Additionally, in men with low risk prostate cancer, the deferral of radical prostatectomy is associated with significantly worse radical prostatectomy outcomes, including more pathology upgrading and a higher rate of biochemical progression (5). Therefore, additional tools beyond clinical staging are needed to improve risk stratification and optimize effective use of active surveillance (3).…”

Section: Introductionmentioning

confidence: 99%

Prostate cancer radiomics and the promise of radiogenomics

Stoyanova

Takhar

Tschudi

et al. 2016

Transl. Cancer Res.

109

104

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Prostate cancer exhibits intra-tumoral heterogeneity that we hypothesize to be the leading confounding factor contributing to the underperformance of the current pre-treatment clinicalpathological and genomic assessment. These limitations impose an urgent need to develop better computational tools to identify men with low risk of prostate cancer versus others that may be at risk for developing metastatic cancer. The patient stratification will directly translate to patient treatments, wherein decisions regarding active surveillance or intensified therapy are made. Multiparametric MRI (mpMRI) provides the platform to investigate tumor heterogeneity by mapping the individual tumor habitats. We hypothesize that quantitative assessment (radiomics) of these habitats results in distinct combinations of descriptors that reveal regions with different physiologies and phenotypes. Radiogenomics, a discipline connecting tumor morphology described by radiomic and its genome described by the genomic data, has the potential to derive "radio phenotypes" that both correlate to and complement existing validated genomic risk stratification biomarkers. In this article we first describe the radiomic pipeline, tailored for analysis of prostate mpMRI, and in the process we introduce our particular implementations of radiomics modules. We also summarize the efforts in the radiomics field related to prostate cancer diagnosis and assessment of aggressiveness. Finally, we describe our results from radiogenomic analysis, based on mpMRI-Ultrasound (MRI-US) biopsies and discuss the potential of future applications of this technique. The mpMRI radiomics data indicate that the platform would significantly improve the biopsy targeting of prostate habitats through better recognition of indolent versus aggressive disease, thereby facilitating a more personalized approach to prostate cancer management. The expectation to non-invasively identify habitats with high probability of housing Author Manuscript aggressive cancers would result in directed biopsies that are more informative and actionable. Conversely, providing evidence for lack of disease would reduce the incidence of non-informative biopsies. In radiotherapy of prostate cancer, dose escalation has been shown to reduce biochemical failure. Dose escalation only to determinate prostate habitats has the potential to improve tumor control with less toxicity than when the entire prostate is dose escalated. HHS Public Access

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“…In practice, the 10-year disease-specific survival of men who select AS is between 97% and 100%, 19,20 but although small, there is always the risk of missing the curative window. Recent analyses reveal that men who defer treatment have higher incidences of biochemical progression following definitive treatment, 21 with up to 50% treatment failure in a large cohort of patients. 19 This could be a reason for poor acceptance and adherence to AS by patients and physicians.…”

Section: Ftmentioning

confidence: 99%

The new era of minimally invasive interventions for prostate cancer: robot-assisted laparoscopic radical prostatectomy and focal therapy

Schatloff¹,

Louis²,

Lindner³

2011

OAS

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Prostate cancer remains a common but highly treatable disease. Innovations in prostate cancer treatment have allowed a transition toward minimally invasive approaches in an attempt to avoid treatment-related morbidities. In the middle of the treatment spectrum between radical open surgeries and active surveillance lies robot-assisted laparoscopic radical prostatectomy (RALP) and focal therapy (FT). This review sets out the most current information on RALP and FT (including laser ablation, cryotherapy, high-intensity focused ultrasound, photodynamic therapy, and irreversible electroporation).

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Delay of Surgery in Men With Low Risk Prostate Cancer

Cited by 70 publications

References 15 publications

Does surgical delay for radical prostatectomy affect patient pathological outcome? A retrospective analysis from a Canadian cohort

Does surgical delay for radical prostatectomy affect patient pathological outcome? A retrospective analysis from a Canadian cohort

Prostate cancer radiomics and the promise of radiogenomics

The new era of minimally invasive interventions for prostate cancer: robot-assisted laparoscopic radical prostatectomy and focal therapy

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