Is it Necessary to Remove the Seminal Vesicles Completely at Radical Prostatectomy? Decision Curve Analysis of European Society of Urologic Oncology Criteria

Secín, Fernando P.; Bianco, Fernando J.; Cronin, Angel M.; Eastham, James A.; Scardino, Peter T.; Guillonneau, Bertrand; Vickers, Andrew J.

doi:10.1016/j.juro.2008.10.035

Cited by 20 publications

(10 citation statements)

References 18 publications

(14 reference statements)

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“…The 5-year PSA recurrence rate was 18% for stage pT2 cancer, and the 10-year survival rate was 85% for stage pT3. These results are equivalent to those of similar surgery reported in recent studies [16-30]. PSA recurrence occurred in one case in our series although the short follow-up duration.…”

Section: Discussionsupporting

confidence: 92%

Continence Rate and Oncological Feasibility after Total Transurethral Resection of the Prostate as an Alternative Therapy for the Treatment of Prostate Cancer: A Pilot Study

Jeong

Kwon

2011

Int Neurourol J

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PurposeThe value of total transurethral resection of prostate cancer (TURPC) as an alternative therapy was first recognized by Hans J. Reuter. Thus, we conducted the study of prospectively collected data to verify total TURPC as an alternative therapy forlocalized prostate cancer.MethodsFrom January 2008 to July 2011, 14 patients with a mean age of 76.1 years (range, 66 to 89 years) with clinically localized prostate cancer were treated by prostatic resection by the corresponding author with curative intention.ResultsThe mean duration of TURPC was 51.7 minutes (range, 30 to 120 minutes) and the mean amount of prostatic tissue resected was 21.2 g (range, 5 to 66 g). An intra- and/or postoperative blood transfusion was necessary in 2 cases. Hyponatremia was found in 7 patients. Six months after TURPC, 3 cases of grade 1 and 1 case of grade 2 incontinence were observed. Three patients in the high-risk group did not achieve a prostate specific antigen (PSA) nadir of ≤0.2 ng/mL. PSA recurrence occurred in one case in our series. Newly developed lymph node or distant metastases were not observed during the follow-up period.ConclusionsAccording to our results, transurethral resection for prostate cancer can be performed with reasonable oncological results. The PSA nadir levels, and rates of biochemical failure and postoperative complications, including incontinence, were comparable with the published results for other procedures. TURPC is also inexpensive and non-invasive, and requires short hospitalization and a short surgical time without vesicourethral anastomosis.

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Section: Discussionsupporting

confidence: 92%

Continence Rate and Oncological Feasibility after Total Transurethral Resection of the Prostate as an Alternative Therapy for the Treatment of Prostate Cancer: A Pilot Study

Jeong

Kwon

2011

Int Neurourol J

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“…Thus, if resection of the tip of the SV is not oncologically necessary, it would seem wise to spare it. However, the benefits and the risks of SV tip preservation are subject to considerable uncertainty [30][31][32][33][34][35]. There are no good estimates of the degree to which SV sparing improves function and similarly we have no good estimates of the degree to which SV preservation increases the risk of recurrence.…”

Section: Discussionmentioning

confidence: 99%

Radical Prostatectomy, Sparing of the Seminal Vesicles, and Painful Orgasm

Mogorovich

Nilsson

Tyritzis

et al. 2013

The Journal of Sexual Medicine

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Introduction Erectile dysfunction has been widely investigated as the major factor responsible for sexual bother in patients after radical prostatectomy (RP); painful orgasm (PO) is one element of this bother, but little is known about its prevalence and its effects on sexual health. Aim This study aims to investigate the prevalence of PO and to identify potential risk factors. Main Outcome Measures A total of 1,411 consecutive patients underwent open (radical retropubic prostatectomy) or robot-assisted laparoscopic RP between 2002 and 2006. The patients were asked to complete a study-specific questionnaire. Methods Of a total of 145 questions, 5 dealt with the orgasmic characteristics. The questionnaire was also administered to a comparison group of 442 persons, matched for age and area of residency. Results The response rate was 91% (1,288 patients). A total of 143 (11%) patients reported PO. Among the 834 men being able to have an orgasm, the prevalence was 18% vs. 6% in the comparison group (relative risk [RR] 2.8, 95% confidence interval [CI] 1.7–4.5). When analyzed as independent variables, bilateral seminal vesicle (SV)-sparing approach (RR 2.33, 95% CI 1.0–5.3, P = 0.045) and age <60 years were significantly related to the presence of PO (95% CI 0.5–0.9, P = 0.019). After adjustment for age, bilateral SV-sparing still remained a significant predictor for occurrence of PO. Conclusions We found that PO occurs significantly more often in patients undergoing bilateral SV-sparing RP when compared with age-matched comparison population.

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“…First proposed in 2006, decision curves have been used in cancer research [2][3][4][5][6] and many other fields. 7-11 For example, decision curves have evaluated models that predict lung cancer in high-risk populations which can then be used as tools for recommending computed tomography (CT) screening.…”

Section: Decision Curvesmentioning

confidence: 99%

Assessing the Clinical Impact of Risk Prediction Models With Decision Curves: Guidance for Correct Interpretation and Appropriate Use

Kerr

Brown

Zhu

et al. 2016

JCO

445

357

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The decision curve is a graphical summary recently proposed for assessing the potential clinical impact of risk prediction biomarkers or risk models for recommending treatment or intervention. It was applied recently in an article in Journal of Clinical Oncology to measure the impact of using a genomic risk model for deciding on adjuvant radiation therapy for prostate cancer treated with radical prostatectomy. We illustrate the use of decision curves for evaluating clinical- and biomarker-based models for predicting a man’s risk of prostate cancer, which could be used to guide the decision to biopsy. Decision curves are grounded in a decision-theoretical framework that accounts for both the benefits of intervention and the costs of intervention to a patient who cannot benefit. Decision curves are thus an improvement over purely mathematical measures of performance such as the area under the receiver operating characteristic curve. However, there are challenges in using and interpreting decision curves appropriately. We caution that decision curves cannot be used to identify the optimal risk threshold for recommending intervention. We discuss the use of decision curves for miscalibrated risk models. Finally, we emphasize that a decision curve shows the performance of a risk model in a population in which every patient has the same expected benefit and cost of intervention. If every patient has a personal benefit and cost, then the curves are not useful. If subpopulations have different benefits and costs, subpopulation-specific decision curves should be used. As a companion to this article, we released an R software package called DecisionCurve for making decision curves and related graphics.

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Is it Necessary to Remove the Seminal Vesicles Completely at Radical Prostatectomy? Decision Curve Analysis of European Society of Urologic Oncology Criteria

Cited by 20 publications

References 18 publications

Continence Rate and Oncological Feasibility after Total Transurethral Resection of the Prostate as an Alternative Therapy for the Treatment of Prostate Cancer: A Pilot Study

Continence Rate and Oncological Feasibility after Total Transurethral Resection of the Prostate as an Alternative Therapy for the Treatment of Prostate Cancer: A Pilot Study

Radical Prostatectomy, Sparing of the Seminal Vesicles, and Painful Orgasm

Assessing the Clinical Impact of Risk Prediction Models With Decision Curves: Guidance for Correct Interpretation and Appropriate Use

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