scholarly journals Can We Consider the Possibility of Transurethral Resection of the Prostate (TURP) Becoming Another Gateway to the Focal Therapy of Localized Prostate Cancer?

2020 ◽  
Vol 3 (2) ◽  
pp. e22-e30
Author(s):  
Masaru Morita ◽  
Akira Morita ◽  
Takeshi Matsuura
Keyword(s):  
Prostate Cancer ◽  
Transurethral Resection ◽  
Risk Group ◽  
Radical Resection ◽  
Focal Therapy ◽  
Localized Prostate Cancer ◽  
Transurethral Resection Of Prostate ◽  
Low Grade ◽  
Psa Testing ◽  
Number Of Patients

Background and ObjectivesMinimally invasive methods are expected to avoid the risk of overtreatment and overtreatment of radical therapy to manage the increased number of patients with low-volume, low-grade localized prostate cancer. Based on our experience of radical transurethral resection of prostate cancer (TURPCa) as a radical treatment, we studied the efficacy and safety of focal TURPCa as a focal therapy for patients with localized prostate cancer. Materials and MethodsWe performed focal TURPCa in 49 patients during the period from July 2007 to August 2016 and followed them with prostate-specific antigen (PSA) testing for the mean period of 68.0 months. We selected the patient as a candidate for the study if the biopsy revealed that cancer foci were limited in one lobe, or the foci were several or less even found in both lobes. Standard TURP was followed by further resection and fulguration of the peripheral zone where cancer was considered to exist. We selected one of our three methods of focal TURPCa as follows: one lobe radical TURPCa, radical resection of the affected lobe with unaffected lobe being resected less vigorously; nerve-sparing radical TURPCa, radical resection of both lobes except for the posterolateral part of the prostate; target radical TURPCa, radical resection of the cancer focus and the surrounding prostate when the target is suggested single. ResultsTwelve patients were in the low-risk group (D’Amico), 29 in the intermediate-risk group, and 8 in the high-risk group. Pathological stages were as follows: pT0, three cases; pT2a-b, 17 cases; pT2c, 29 cases. The preoperative PSA of 6.15±2.73 ng/mL (mean±SD) dropped to 0.172±0.283 ng/mL postoperatively. PSA failure occurred in only two patients (4.1%). Incontinence did not develop and erectile function was preserved in eight (44.4%) of the 18 potent patients. The most frequent complication was bladder neck contracture (20.4%). Other complications included acute epididymitis (8.1%), bladder tamponade (2.0%). No patients died of prostate cancer. ConclusionsThough the final assessment of efficacy will require long-term follow-up results with more cases, we may think focal TURPCa can be another treatment option as a focal therapy for localized prostate cancer.

scholarly journals Effect of subtotal transurethral resection of prostate performed prior to high-intensity focused ultrasound on risk of urological complications in patients with localized prostate cancer

2014 ◽  
Vol 95 (2) ◽  
pp. 216-219
Author(s):  
M B Pryanichnikova ◽  
R S Nizamova ◽  
E S Gubanov ◽  
A A Zimichev ◽  
E A Boryaev
Keyword(s):  
Prostate Cancer ◽  
Urinary Incontinence ◽  
Urethral Stricture ◽  
Transurethral Resection ◽  
High Intensity ◽  
Focused Ultrasound ◽  
High Intensity Focused Ultrasound ◽  
Localized Prostate Cancer ◽  
Transurethral Resection Of Prostate ◽  
Urological Complications

Aim. To assess the rate and reasons for urological complications of subtotal transurethral resection of prostate performed prior to high-intensity focused ultrasound. Methods. The study included 101 patients with localized prostate cancer treated by high-intensity focused ultrasound. Two groups of patients were allocated. Patients, who did not undergo transurethral resection of prostate prior to high-intensity focused ultrasound, were included in group 1 (21 patients). Second group included patients in whom subtotal transurethral resection of prostate was performed prior to high-intensity focused ultrasound to decrease anteroposterior diameter of the prostate and urethral canal compression. The impact of treatment tactics on complications rate was defined by factor analysis. Results. Early post-surgical complications were rare, complications mostly occurred at late period. The most frequent, severe and poorly controlled complications included urinary incontinence [58 (57.8%) patients] and urethral stricture [30 (29.7%) patients]. Most of complications were registered in second group of patients compared to the first: first group - in 10 (12.5%) of cases, second group - in 77 (95.0%) of cases. Urinary incontinence was observed in 7 (33.3%) patients and urethral stricture - in 4 (19%) of patients in the first group; in 51 (63.7%) and 26 (32.5%) patients in the second group respectively; the difference was statistically significant. Conclusion. Comparative analysis of different approaches to treatment of localized prostate cancer using high-intensity focused ultrasound revealed that subtotal transurethral resection of prostate performed prior to high-intensity focused ultrasound significantly increases the risk for developing urinary incontinence and urethral strictures.

scholarly journals Management of Localized Prostate Cancer by Focal Transurethral Resection of Prostate Cancer: An Application of Radical TUR-PCa to Focal Therapy

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Masaru Morita ◽  
Takeshi Matsuura
Keyword(s):  
Prostate Cancer ◽  
Bladder Neck ◽  
Peripheral Zone ◽  
Focal Therapy ◽  
Localized Prostate Cancer ◽  
Transurethral Resection Of Prostate ◽  
Bladder Neck Contracture ◽  
Psa Failure ◽  
The Mean

Background. We analyzed radical TUR-PCa against localized prostate cancer.Patients and Methods. Seventy-nine out of 209 patients with prostate cancer in one lobe were studied. Patients’ age ranged from 58 to 91 years and preoperative PSA, 0.70 to 17.30 ng/mL. In other 16 additional patients we performed focal TUR-PCa. Patients’ age ranged from 51 to 87 years and preoperative PSA, 1.51 to 25.74 ng/mL.Results. PSA failure in radical TUR-PCa was 5.1% during the mean follow-up period of 58.9 months. The actuarial biochemical non-recurrence rate was 98.2% for pT2a and 90.5% for pT2b. Bladder neck contracture occurred in 28 patients (35.4%). In 209 patients, pathological study revealed prostate cancer of the peripheral zone near the neurovascular bundle bilaterally in 25%, unilaterally in 39% and no cancer bilaterally in 35%, suggesting the possibility of focal TUR-PCa. Postoperative PSA of 16 patients treated by focal TUR-PCa was stable between 0.007 and 0.406 ng/mL at 24.2 months’ follow-up. No patients suffered from urinary incontinence. Bladder neck contracture developed in only 1 patient and all 5 patients underwent nerve-preserving TUR-PCa did not show erectile dysfunction.Conclusion. Focal TUR-PCa was considered to be a promising option among focal therapies against localized prostate cancer.

scholarly journals Magnetic Resonance–Guided Prostate Ablation

2019 ◽  
Vol 36 (05) ◽  
pp. 351-366
Author(s):  
David A. Woodrum ◽  
Akira Kawashima ◽  
Krzysztof R. Gorny ◽  
Lance A. Mynderse
Keyword(s):  
Prostate Cancer ◽  
Prediction Models ◽  
Focal Therapy ◽  
The United States ◽  
Management Approach ◽  
Low Grade ◽  
Intermediate Risk ◽  
Screening Programs ◽  
Risk Prostate Cancer ◽  
Prostate Cancers

AbstractIn 2019, the American Cancer Society (ACS) estimates that 174,650 new cases of prostate cancer will be diagnosed and 31,620 will die due to the prostate cancer in the United States. Prostate cancer is often managed with aggressive curative intent standard therapies including radiotherapy or surgery. Regardless of how expertly done, these standard therapies often bring significant risk and morbidity to the patient's quality of life with potential impact on sexual, urinary, and bowel functions. Additionally, improved screening programs, using prostatic-specific antigen and transrectal ultrasound-guided systematic biopsy, have identified increasing numbers of low-risk, low-grade “localized” prostate cancer. The potential, localized, and indolent nature of many prostate cancers presents a difficult decision of when to intervene, especially within the context of the possible comorbidities of aggressive standard treatments. Active surveillance has been increasingly instituted to balance cancer control versus treatment side effects; however, many patients are not comfortable with this option. Although active debate continues on the suitability of either focal or regional therapy for the low- or intermediate-risk prostate cancer patients, no large consensus has been achieved on the adequate management approach. Some of the largest unresolved issues are prostate cancer multifocality, limitations of current biopsy strategies, suboptimal staging by accepted imaging modalities, less than robust prediction models for indolent prostate cancers, and safety and efficiency of the established curative therapies following focal therapy for prostate cancer. In spite of these restrictions, focal therapy continues to confront the current paradigm of therapy for low- and even intermediate-risk disease. It has been proposed that early detection and proper characterization may play a role in preventing the development of metastatic disease. There is level-1 evidence supporting detection and subsequent aggressive treatment of intermediate- and high-risk prostate cancer. Therefore, accurate assessment of cancer risk (i.e., grade and stage) using imaging and targeted biopsy is critical. Advances in prostate imaging with MRI and PET are changing the workup for these patients, and advances in MR-guided biopsy and therapy are propelling prostate treatment solutions forward faster than ever.

17 Morbidity of focal therapy in the treatment of localized prostate cancer

2012 ◽  
Vol 11 (1) ◽  
pp. e17-e17a
Author(s):  
E. Barret ◽  
R.E Sanchez-Salas ◽  
A. Ouzzane ◽  
R. Valero ◽  
Encinas M. Sanchez ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Focal Therapy ◽  
Localized Prostate Cancer

358 Focal therapy with HIFU for localized prostate cancer: A prospective multicentric study

2014 ◽  
Vol 13 (1) ◽  
pp. e358 ◽  
Author(s):  
P. Rischmann ◽  
L. Hoquetis ◽  
S. Crouzet ◽  
G. Pasticier ◽  
A. Villers ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Focal Therapy ◽  
Localized Prostate Cancer ◽  
Multicentric Study

scholarly journals HISTOPATHOLOGICALANALYSIS OF INCIDENTAL PROSTATE CARCINOMA IN TRANSURETHRAL RESECTION OF PROSTATE SPECIMENS: A FIVE-YEAR RETROSPECTIVE STUDY

2020 ◽  
pp. 79-80
Author(s):  
Alfy Ann George ◽  
Anitha Das P.H ◽  
I. Praseeda ◽  
Baby Mathew
Keyword(s):  
Prostate Cancer ◽  
Retrospective Study ◽  
Prostate Carcinoma ◽  
Transurethral Resection ◽  
Retrospective Review ◽  
Transurethral Resection Of Prostate ◽  
Incidental Prostate Cancer ◽  
Poorly Differentiated Adenocarcinoma ◽  
Detailed Review ◽  
Poorly Differentiated

Aim: To identify the rate of incidental prostate cancer in patients undergone Transurethral resection of prostate(TURP) over a period of 5 years in our center. Methods: A Retrospective review was conducted using Histopathological department database on all TURP specimens over a period of 5 years from January 2015 to December 2019. Results: Out of 570 cases of TURP during our study period, 1.9% had incidental prostate cancer. Most of these positive cases had a Gleasons score of 10, which represent poorly differentiated Adenocarcinoma. Conclusion: The value of pathologic review of TURP specimens is limited but a detailed review helps to reduce under detection of prostate cancer.

Overdiagnosis and Overtreatment of Prostate Cancer

2012 ◽  
pp. e35-e39 ◽  
Author(s):  
Ian M. Thompson
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Specific Antigen ◽  
The United States ◽  
Assessment Tools ◽  
Low Grade ◽  
High Grade ◽  
Surveillance Strategy ◽  
Psa Testing ◽  
Prostate Cancer Prevention

Overview: Prostate cancer is a ubiquitous disease, affecting as many as two-thirds of men in their 60s. Through widespread prostate-specific antigen (PSA) testing, increasing rates of prostate biopsy, and increased sampling of the prostate, a larger fraction of low-grade, low-volume tumors have been detected, consistent with tumors often found at autopsy. These tumors have historically been treated in a manner similar to that used for higher-grade tumors but, more recently, it has become evident that with a plan of active surveillance that reserves treatment for only those patients whose tumors show evidence of progression, very high disease-specific survival can be achieved. Unfortunately, the frequency of recommendation of an active surveillance strategy in the United States is low. An alternative strategy to improve prostate cancer detection is through selected biopsy of those men who are at greater risk of harboring high-grade, potentially lethal cancer. This strategy is currently possible through the use of risk assessment tools such as the Prostate Cancer Prevention Trial Risk Calculator ( www.prostate.cancer.risk.calculator.com ) as well as others. These tools can predict with considerable accuracy a man's risk of low-grade and high-grade cancer, allowing informed decision making for the patient with a goal of detection of high-risk disease. Ultimately, other biomarkers including PCA3, TMPRSS2:ERG, and [-2]proPSA will likely aid in discriminating these two types of cancer before biopsy.

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