Salvage brachytherapy for prostate bed recurrence following radical prostatectomy.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 218-218
Author(s):  
Kristin Smith ◽  
Jay P. Ciezki ◽  
Kevin L. Stephans ◽  
Chandana A. Reddy ◽  
Eric A. Klein
Keyword(s):  
Radical Prostatectomy ◽  
Gleason Score ◽  
Case Series ◽  
Distant Metastases ◽  
Prostate Bed ◽  
Salvage Brachytherapy ◽  
Psa Velocity ◽  
The One ◽  
Median Interval

218 Background: Approximately 10% of patients who undergo a radical prostatectomy (RP) for localized prostate cancer subsequently experience a local recurrence. A small percentage of these patients present with prostate bed nodules (PBN). We present here, a case series of 12 patients treated with low dose rate brachytherapy (BT) for a PBN post RP. Methods: All 12 patients had biopsy confirmed cases of recurrent adenocarcinoma in the prostatic bed. At the time of PBN diagnosis, 2 patients had received EBRT, 2 patients had received ADT, and 1 patient had undergone HIFU. Patients were confirmed to have a negative CT and bone scan prior to salvage BT. All patients received salvage BT with I-125 prescribed to 144 Gray. Results: The median interval between RP and BT was 8 years (range 0.5- 17.9), median PSA prior to BT was 4.53 ng/ml (range 0.55-15.2), and the median age was 69 (range 59-86). Forty-two percent of patients had a PBN Gleason score of 8, 33% had a score of 7, and a score was not reported for 25% of patients due to prior EBRT or ADT use. The median follow up for this series is 26.5 months (range 1-69). At the time of this analysis, 10 patients were evaluable for biochemical failure (bF) (nadir+2) and distant metastases (DM). The one and two year rates of bF were 0% and 52%. There was no association between pre-BT PSA and bF, nor between pre-BT Gleason score and bF. Two patients subsequently developed DM at 17 months and 55 months after BT. The pelvic lymph nodes were the site of DM for both patients. The median PSA velocity post BT was -0.120 ng/ml/yr (range -1.404- 9.096). Five patients had a negative PSA velocity at last follow-up, while 4 had an increasing PSA velocity. Velocity could not be defined for 3 patients (insufficient PSA n=2, ADT n=1). To date, no gastrointestinal or urinary toxicities have been noted. Conclusions: Brachytherapy as a salvage treatment for a PBN appears to be well tolerated. The rates of bF and DM following salvage BT are comparable to those of salvage EBRT for this patient population. Intermediate-term biochemical control was attained in a sub-set of patients with declining PSA at last follow-up.

scholarly journals Acute bilateral foot drop with or without cauda equina syndrome—a case series

2021 ◽  
Vol 163 (4) ◽  
pp. 1191-1198
Author(s):  
Andreas K. Demetriades ◽  
Marco Mancuso-Marcello ◽  
Asfand Baig Mirza ◽  
Joseph Frantzias ◽  
David A. Bell ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Case Series ◽  
Foot Drop ◽  
Spinal Disease ◽  
Full Resolution ◽  
Degenerative Spinal Disease ◽  
The Mean ◽  
The One

Abstract Introduction Isolated acute bilateral foot drop due to degenerative spine disease is an extremely rare neurosurgical presentation, whilst the literature is rich with accounts of chronic bilateral foot drop occurring as a sequela of systemic illnesses. We present, to our knowledge, the largest case series of acute bilateral foot drop, with trauma and relevant systemic illness excluded. Methods Data from three different centres had been collected at the time of historic treatment, and records were subsequently reviewed retrospectively, documenting the clinical presentation, radiological level of compression, timing of surgery, and degree of neurological recovery. Results Seven patients are presented. The mean age at presentation was 52.1 years (range 41–66). All patients but one were male. All had a painful radiculopathic presentation. Relevant discopathy was observed from L2/3 to L5/S1, the commonest level being L3/4. Five were treated within 24 h of presentation, and two within 48 h. Three had concomitant cauda equina syndrome; of these, the first two made a full motor recovery, one by 6 weeks follow-up and the second on the same-day post-op evaluation. Overall, five out of seven cases had full resolution of their ankle dorsiflexion pareses. One patient with 1/5 power has not improved. Another with 1/5 weakness improved to normal on the one side and to 3/5 on the other. Conclusion When bilateral foot drop occurs acutely, we encourage the consideration of degenerative spinal disease. Relevant discopathy was observed from L2/3 to L5/S1; aberrant innervation may be at play. Cauda equina syndrome is not necessarily associated with acute bilateral foot drop. The prognosis seems to be pretty good with respect to recovery of the foot drop, especially if partial at presentation and if treated within 48 h.

scholarly journals One-Time Cortical Lamina: A New Technique for Horizontal Ridge Augmentation. A Case Series

2021 ◽  
Vol 8 (6) ◽  
pp. 22-30
Author(s):  
Vincenzo Foti ◽  
Davide Savio ◽  
Roberto Rossi
Keyword(s):  
Fibrin Sealant ◽  
Case Series ◽  
X Rays ◽  
Marginal Bone Loss ◽  
Ridge Augmentation ◽  
Keratinized Tissue ◽  
A New Technique ◽  
The One ◽  
Hard Consistency

The aim of this case series is to introduce the One-Time Cortical Lamina Technique, a simplification of the F.I.R.S.T. (Fibrinogen-Induced Regeneration Sealing Technique) in cases where only horizontal augmentation is needed. The indications for this technique are ASA2 and ASA1 anxious patients. Pre-requisites for this surgical technique are: a good amount of keratinized tissue, sufficient alveolar ridge width for placement of implants, thickness of vestibular bone at CBCT planning less than 1 mm with risk of threads exposure. Five patients with horizontal deficiencies were selected to test the efficacy of this approach. The defects were augmented using a porcine cortical bone lamina in combination with collagenated porcine bone mixed with fibrin sealant. The cortical lamina was placed only buccal to the implants and stabilized with fibrin sealant, without pins or screws. Upon completion of the implant surgery, healing abutments were connected to the implants and the soft tissue sutured around them. The healing was uneventful in all cases. Six months after surgery impressions for final restorations were taken and screwed crowns delivered. The new volume had hard consistency and the follow-up CBCT measured an average of 4.17 mm of horizontal bone augmentation. One to three years of follow up demonstrated the maintenance of vestibular volume, hard consistency and clinical stability. Intraoral X-rays showed no marginal bone loss. An advantage of this technique could be the one stage surgery that creates a stable environment for regeneration from day one.

scholarly journals Factors Related to Biochemical Relapse in Patients Undergoing Radical Prostatectomy with Lymphadenectomy.

2019 ◽  
Vol 2 (1) ◽  
pp. 01-04
Author(s):  
Grimar de Oliveira Paula ◽  
João Emerson de Alencar Santos ◽  
Luiz Carlos de Araújo Souza
Keyword(s):  
Radical Prostatectomy ◽  
Gleason Score ◽  
Clinical Stage ◽  
Surgical Specimen ◽  
Pathological Staging ◽  
Bcr Method ◽  
Transrectal Prostate Biopsy ◽  
Age Range

Objectives - Analyze the prevalence of biochemical recurrence (BCR) in patients submitted to radical prostatectomy with lymphadenectomy (RP-LD) the most prevalent clinical and pathological staging in the BCR and to correlate the sum of the Gleason score (GS) in the surgical specimen in patients who presented BCR. Method - Analysis of 100 patients diagnosed with prostate adenocarcinoma who performed RP-LD between 2013 to 2017. All subjects underwent transrectal prostate biopsy due to PSA or rectal examination and RP-LD. The lymphadenectomy considered in the study was the iliac-obturator, and the surgical pieces were analyzed to determine the pathological staging and its descriptors. All patients who had two or more PSA measurements >0.2 ng/ml and who had undergone RP-LD were considered postoperative. Results -About 22% of the patients submitted to RP-LD presented BCR. Patients with BCR had a 59-76 age range, mean age of 66.27 years, and median age of 63.50 years. The most prevalent preoperative PSA in patients with BCR was between 10-20 ng/ml (40.90%) and the most prevalent clinical stage was cT2 (59.10%). Regarding the Gleason score, the BCR patients had the most prevalent 6 (36.37%) score in the biopsy and score 7 (4 + 3) (36.37%) in the surgical specimen. All patients (100%) with BCR presented perineural invasion, with pT3 staging (81.81%) and pN0 (77.28%) being the most prevalent in patients with BCR. Patients with BCR presented a correlation (p<0.05) between the increase in the sum of pathological GS and the increase in pTN staging. Conclusion - All these variables were important in the determination of BCR in patients submitted to RP-LD, thus demonstrating the importance of this information in the analysis of the prognosis and in the follow-up of these patients.

scholarly journals Effectiveness and safety of endoscopic radial incision and cutting for severe benign anastomotic stenosis after surgery for colorectal carcinoma: a three-case series

2018 ◽  
Vol 06 (03) ◽  
pp. E335-E339 ◽  
Author(s):  
Naoki Asayama ◽  
Shinji Nagata ◽  
Kenjiro Shigita ◽  
Taiki Aoyama ◽  
Akira Fukumoto ◽  
...  
Keyword(s):  
Colorectal Carcinoma ◽  
Surgical Resection ◽  
Case Series ◽  
Anastomotic Stenosis ◽  
Endoscopic Dilation ◽  
Limited Data ◽  
Radial Incision ◽  
Hiroshima City ◽  
Median Interval

AbstractBenign colonic anastomotic stenosis sometimes occurs after surgical resection and usually requires surgical or endoscopic dilation. Limited data are available on the effectiveness and safety of the endoscopic radial incision and cutting (RIC) method at sites other than the esophagus. The aim of this retrospective study was to investigate the effectiveness and safety of RIC dilation for severe benign anastomotic colonic stenosis. Subjects were 3 men (median age 72 years, range 65 – 76 years) who developed severe benign anastomotic stenosis after surgical resection for colorectal carcinoma and were subsequently treated by RIC dilation at Hiroshima City Asa Citizens Hospital between May 2014 and December 2016. Severe anastomotic stenosis was defined as a narrowed anastomosis through which a standard colonoscope could not be passed. The median interval from surgery to RIC was 21 months (range 9 – 29 months). RIC was successful in all 3 patients and reduced the severity of dyschezia postoperatively; 2 patients experienced improvement after a single RIC session and the other after 6 RIC sessions. No treatment-related adverse events or re-stenosis requiring repeat dilation was noted during a median follow-up of 27 months (range 8 – 37 months). Our findings indicate that the RIC technique can be applied safely and effectively to various sites in the colon, avoiding the need for reoperation.

scholarly journals Neurofibrosarcoma: case series in south-south Nigeria

2017 ◽  
Vol 5 (1) ◽  
pp. 79
Author(s):  
Maurice Asuquo ◽  
Victor Nwagbara ◽  
Martin Nnoli ◽  
John Ashindoitiang ◽  
Theophilus Ugbem ◽  
...  
Keyword(s):  
Case Series ◽  
Late Presentation ◽  
Histologic Diagnosis ◽  
Adequate Treatment ◽  
Improve Outcome ◽  
Long Term Follow Up ◽  
The One ◽  
The University

Neurofibrosarcoma is a malignancy that occurs more frequently in patients with neurofibromatosis- 1 (NF- 1) and rarely may arise independently. This is a presentation of 3 consecutive patients with histologic diagnosis of neurofibrosarcoma who presented to the University of Calabar Teaching Hospital, Calabar from 2011-2013. Two patients presented were associated with NF-1 and were a decade younger than the one without NF-1. Late presentation and poor follow up were notable underlying factors. Long term follow up of patients with NF -1 for early diagnosis and adequate treatment will improve outcome.

Evaluation of length, maximum Gleason score, and extension of disease at positive surgical margins during radical prostatectomy.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 98-98
Author(s):  
Hooman Djaladat ◽  
Mehrdad Alemozaffar ◽  
Christina Day ◽  
Manju Aron ◽  
Jie Cai ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Gleason Score ◽  
Cox Regression ◽  
Surgical Margin ◽  
Oncologic Outcomes ◽  
Positive Surgical Margin ◽  
Extracapsular Extension ◽  
Clinical Recurrence ◽  
The Impact

98 Background: Positive surgical margin (PSM) found following radical prostatectomy (RP) is known to affect subsequent recurrence and survival. The extent of PSM has been shown to impact clinical outcomes. We examined the effect of length of PSM, extent of disease at PSM and maximum Gleason score at PSM on oncologic outcomes. Methods: A retrospective review of 3971 patients undergoing RP for prostate cancer at our institution between1978-2009 revealed 1053 patients with PSM, out of whom 814 received no hormone therapy. The initial 175 patients were selected to maximize available follow-up, and their slides were re-reviewed for following parameters: length of PSM (mm), maximum Gleason score at PSM, and maximal extension of PSM (intraprostatic incision vs. extracapsular extension). Data was available in 107 patients who are the subject of this study. Multivariable Cox regression models were used to evaluate the impact of above features as well as age, preoperative PSA, pathologic Gleason score, stage and adjuvant radiotherapy on biochemical and clinical recurrence-free survival (RFS), and overall survival (OS). Results: Median follow-up was 17.6 years. Maximum extension of PSM was limited to intraprostatic incision in 63 (58.9%) and extracapsular in 44(41.1%) patients. Median length of PSM was 4 mm (range 1-55 mm); 41 (38.3%) with <3mm and 66 (61.7%) with >4mm. Maximum Gleason score at PSM was <6 in 70 (66.0%) and >7 in 36 (34%) patients. 10-yr PSA RFS, clinical RFS, and OS were 60.2%, 80.7%, and 60.2%, respectively. Multivariable Cox regression modeling showed the length of PSM >4mm and extracapsular extension as independent predictors of PSA RFS and clinical RFS. Age and extracapsular extension were independent predictors of OS. Conclusions: PSM >4mm and extracapsular extension have a higher risk of PSA and clinical recurrence after RP. These findings can help decision-making regarding adjuvant therapy in patients with PSM and should be reported by pathologists in addition to the presence of PSM. [Table: see text]

401 UTILITY OF PSA VELOCITY FOR PREDICTION OF GLEASON SCORE UPGRADING BETWEEN BIOPSY AND RADICAL PROSTATECTOMY

2010 ◽  
Vol 183 (4S) ◽  
Author(s):  
Mark W. Ball ◽  
Stacy Loeb ◽  
Ahmed Magheli ◽  
H. Ballentine Carter ◽  
Alan W. Partin ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Gleason Score ◽  
Psa Velocity

Contemporary Update of a Multi-Institutional Predictive Nomogram for Salvage Radiotherapy After Radical Prostatectomy

2016 ◽  
Vol 34 (30) ◽  
pp. 3648-3654 ◽  
Author(s):  
Rahul D. Tendulkar ◽  
Shree Agrawal ◽  
Tianming Gao ◽  
Jason A. Efstathiou ◽  
Thomas M. Pisansky ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Multivariable Analysis ◽  
Specific Antigen ◽  
Distant Metastases ◽  
Salvage Radiotherapy ◽  
Surgical Margins ◽  
Node Negative ◽  
Modern Era ◽  
Extraprostatic Extension

Purpose We aimed to update a previously published, multi-institutional nomogram of outcomes for salvage radiotherapy (SRT) following radical prostatectomy (RP) for prostate cancer, including patients treated in the contemporary era. Methods Individual data from node-negative patients with a detectable post-RP prostate-specific antigen (PSA) treated with SRT with or without concurrent androgen-deprivation therapy (ADT) were obtained from 10 academic institutions. Freedom from biochemical failure (FFBF) and distant metastases (DM) rates were estimated, and predictive nomograms were generated. Results Overall, 2,460 patients with a median follow-up of 5 years were included; 599 patients (24%) had a Gleason score (GS) ≤ 6, 1,387 (56%) had a GS of 7, 244 (10%) had a GS of 8, and 230 (9%) had a GS of 9 to 10. There were 1,370 patients (56%) with extraprostatic extension (EPE), 452 (18%) with seminal vesicle invasion (SVI), 1,434 (58%) with positive surgical margins, and 390 (16%) who received ADT (median, 6 months). The median pre-SRT PSA was 0.5 ng/mL (interquartile range, 0.3 to 1.1). The 5-yr FFBF rate was 56% overall, 71% for those with a pre-SRT PSA level of 0.01 to 0.2 ng/mL (n = 441), 63% for those with a PSA of 0.21 to 0.50 ng/mL (n = 822), 54% for those with a PSA of 0.51 to 1.0 ng/mL (n = 533), 43% for those with a PSA of 1.01 to 2.0 ng/mL (n = 341), and 37% for those with a PSA > 2.0 ng/mL (n = 323); P < .001. On multivariable analysis, pre-SRT PSA, GS, EPE, SVI, surgical margins, ADT use, and SRT dose were associated with FFBF. Pre-SRT PSA, GS, SVI, surgical margins, and ADT use were associated with DM, whereas EPE and SRT dose were not. The nomogram concordance indices were 0.68 (FFBF) and 0.74 (DM). Conclusion Early SRT at low PSA levels after RP is associated with improved FFBF and DM rates. Contemporary nomograms can estimate individual patient outcomes after SRT in the modern era.

Are patients with Gleason 6 pathology safe from developing metastatic castration-resistant prostate cancer (mCRPC)?

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 110-110
Author(s):  
Christoph A. J. von Klot ◽  
Alena Boeker ◽  
Thomas R. W. Herrmann ◽  
Mario W. Kramer ◽  
Markus A. Kuczyk ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Initial Therapy ◽  
Castration Resistant Prostate Cancer ◽  
Prostate Biopsies ◽  
Castration Resistant ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

110 Background: Prostate cancer may remain clinical unapparent for decades, however at the stage of metastatic castration resistant prostate cancer (mCRPC), patients have only limited survival even with new therapeutic options. Recent evidence from histology studies regarding random prostate biopsies hint toward a relationship between higher biopsy Gleason score and the development of mCRPC. A few patients with initial low risk prostate cancer also seem to develop mCRPC. However, prostate biopsy underestimates final pathology in about one third of patients. We therefore evaluated the final whole gland pathology from radical prostatectomy to better assess the risk of progressing to mCRPC for patients with Gleason 6 prostate cancer in particular. Methods: Clinical data was assessed for patients with confirmed mCRPC between 3/2007 and 10/2014. Whole gland pathology workup was not available for patients with either metastatic disease on diagnosis, external radiation therapy or no curatively intended initial therapy. Results: Out of 605 screened patients we identified a total of 77 patients with confirmed mCRPC. Mean PSA at initial diagnosis was 29.5 ng/mL (range 1 - 58 ng/mL ). Mean PSA at the end of follow up was 34.1 ng/mL (range 1 - 71 ng/mL ). A total of 30 patients died during follow up. Distribution of Gleason scores for gleason 6, 7, 8, 9 and 10 were 2, 24, 28, 18, 5 patients respectively. Pathological evaluation obtained from laparoscopic or retropubic radical prostatectomy was available in 43 of 77 cases. cases. Interestingly, out of the only two patients with a documented gleason score of 6, one had radiation/I125 brachytherapy while the other had primary anti hormonal therapy. Therefore an understaging may be possible. Out of the confirmed final pathologies, non of the patients had a Gleason score below 7. Conclusions: Our observations suggest a non significant occurrence of mCRPC during the development of prostate cancer for patients with Gleason pathology of less than 7. Our results may potentially help better counseling for patients and need further validation in a larger series.

Utility of Prostate-Specific Antigen Kinetics in Addition to Clinical Factors in the Selection of Patients for Salvage Local Therapy

2005 ◽  
Vol 23 (32) ◽  
pp. 8192-8197 ◽  
Author(s):  
Andrew K. Lee ◽  
Anthony V. D'Amico
Keyword(s):  
Radical Prostatectomy ◽  
Gleason Score ◽  
Salvage Therapy ◽  
Doubling Time ◽  
Specific Antigen ◽  
Post Treatment ◽  
Clinical Factors ◽  
Psa Failure ◽  
Psa Velocity ◽  
T Category

A detectable and rising prostate-specific antigen (PSA) level after radical prostatectomy or a rising PSA above the nadir value after radiation therapy may represent a local failure, distant failure, or both. Determining the site or sites of failure is critical for selecting the appropriate salvage therapy. Nevertheless, although PSA failure precedes clinically evident failure by several years, determining the source of the biochemical failure is often not possible using currently available diagnostic studies. Selecting the optimal therapeutic approach may be guided by the initial clinical factors (eg, T-category, PSA, biopsy Gleason score). If the patient has had a radical prostatectomy, then the pathologic outcomes of the surgery (eg, pathologic T-category and prostatectomy Gleason score, nodal and margin status) may provide further information. Beyond pretreatment clinical and post-treatment pathologic factors, PSA kinetics, and specifically a pretreatment PSA velocity > 2 ng/mL/year, an interval to PSA failure < 3 years and a post-treatment PSA doubling time < 3 months place a man at increased risk for metastases and subsequent prostate cancer–specific mortality, making these men poor candidates for local-only salvage therapy. Therefore, the optimal candidate for local-only salvage therapy is a man whose pretreatment PSA velocity was 2 ng/mL/year or less, interval to PSA failure exceeds 3 years, and post-treatment PSA doubling time is at least 12 months, and who did not have biopsy or prostatectomy Gleason score of 8 to 10 or seminal vesicle or lymph node involvement.

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