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Rödersheim-Gronau, Germany

Zugor V.,Prostate Center Northwest | Labanaris A.P.,Prostate Center Northwest | Bauer R.M.,Ludwig Maximilians University of Munich | Witt J.H.,Prostate Center Northwest
Anticancer Research | Year: 2012

Background: The objective of this study was to assess the surgical and oncological outcomes in patients with a preoperative prostate specific antigen (PSA) value <4 ng/ml undergoing robot-assisted radical prostatectomy (RARP) for prostate cancer. Patients and Methods: The records of 2000 men who underwent RARP from February 2006 to April 2010, were retrospectively reviewed. A total of 169 (8.4%) patients with a preoperative PSA value <4 ng/ml were identified. A comparison was performed between the overall patient cohort and the aforementioned patients. The analyzed parameters included: minor and major postoperative complications, postoperative Gleason score, pathological stage, positive margin status as well as presence of biochemical progression and of disease-specific mortality during the follow-up period. Results: The following results reflect the comparison of the overall cohort of patients vs. the cohort of patients who had a preoperative PSA value <4; ng/ml. A statistical difference of the analyzed parameters was observed in the median PSA value; 10.3 ng/ml (0.3-220 ng/ml) vs. 2.8 ng/ml (0.3-3.9 ng/ml) (p<0.001), in bilateral NVB; 65.7% vs. 85.2% (p<0.001), in Gleason score <7; 42.8% vs. 59.1% (p<0.05), in Gleason score 7; 47.7% vs. 36.6% (p<0.05) and in Gleason score >7 in 9.5% vs. 3.5% (p<0.001). Organ-confined disease was noted in 73.5% vs. 86.3% (p<0.05), extraprostatic extension in 25.2% vs. 13.7% (p<0.05). The percentage of cancer found in the prostate specimen was 16.1% (1-99%) vs. 7.3% (1-96%) (p<0.05) and a positive surgical margin status was encountered in 8.9% vs. 4.7% (p<0.05) of patients. Pelvic lymph node dissection was performed in 1623 patients (81.2%) of the overall cohort out of whom 64 cases (3.2%) were positive for metastasis. In the patient cohort of PSA value <4 ng/ml, pelvic lymph node dissection was performed in 114 patients (67.4%), out of which one case (0.5%) was positive for metastasis (p<0.05). After a median follow-up of 24.2 months (range 3-56 months), 162 patients (95.8%) were free of biochemical progression and no disease-specific mortality was evident. Conclusion: RARP in patients with a preoperative PSA value <4 ng/ml is a safe surgical procedure with limited complications and excellent oncological outcome. Source


Labanaris A.P.,Prostate Center Northwest | Labanaris A.P.,St Antonius Medical Center | Engelhard K.,Martha Maria Medical Center | Zugor V.,Prostate Center Northwest | And 2 more authors.
Urology | Year: 2011

Objectives To examine whether one could spare patients with a clinical suspicion of prostate cancer (PCa) but inapparent tumor on multimodality endorectal magnetic resonance imaging (e-MRI) of the prostate from undergoing prostate biopsy. Methods A total of 109 patients with a clinical suspicion of PCa underwent conventional and functional e-MRI of the prostate and subsequently prostate biopsy. The inclusion criteria were prostate-specific antigen level >4 ng/mL or a suspicious finding on digital rectal examination. The images were interpreted by a highly experienced radiologist and were considered negative for PCa in all cases. Regardless of the negative findings, all patients underwent an 18-core prostate biopsy. Functional e-MRI included contrast-enhanced e-MRI and diffusion-weighted imaging. The examinations were performed on a closed 1.0-T system combined with an endorectal body phased-array coil. The clinicopathologic parameters of the patients included age, prostate-specific antigen level, digital rectal examination findings, PCa detection rate, clinically significant PCa detection rate, high-grade PCa detection rate, and e-MRI specificity. Results The median age of the patients was 67.4 years, and the median prostate-specific antigen level was 12.9 ng/mL. The digital rectal examination findings were positive in 42 patients (38.5%) and negative in 67 patients (61.5%). Overall, PCa was detected in 19.2% of patients, with 47.6% cases defined as clinically significant and 38.1% as high grade. Overall, the e-MRI specificity was 80.8%. Conclusions The results of our study have shown that the absence of tumor on e-MRI scans of patients with a clinical suspicion of PCa does not rule out the probability of clinically significant and high-grade PCa, making prostate biopsy mandatory for these patients as well. © 2011 Elsevier Inc. Source


Zugor V.,Prostate Center Northwest | Labanaris A.P.,Prostate Center Northwest | Labanaris A.P.,Interbalkan Medical Center | Porres D.,RWTH Aachen | And 2 more authors.
Urologia Internationalis | Year: 2014

Objective: The objective of this study was to assess the surgical, oncological and short-term functional outcomes in patients undergoing salvage robot-assisted radical prostatectomy (SRARP) for the treatment of radiation-resistant prostate cancer. Patients and Methods: The records of 3,500 men who underwent RARP from February 2006 to July 2011 were retrospectively reviewed. All peri- and postoperative data were recorded prospectively in our database. A total of 13 patients (0.37%) who had undergone SRARP for the treatment of radiation-resistant prostate cancer were identified. Results: The primary treatment was external beam radiotherapy in 7 patients (53.8%) and brachytherapy in 6 patients (46.2%). The interval from radiotherapy to biochemical recurrence (BCR) varied from 12 to 108 months (median 48.9). Neurovascular bundle preservation was performed in 3 patients (23.1%). No intraoperative or major complications were encountered. Minor complications were encountered in 4 patients (30.7%). At 12 months, 7 patients were continent (53.8%), 3 exhibited mild incontinence (23.1%) and 3 (23.1%) were incontinent. Regarding potency, none of the patients were potent at 6 months, but 3 patients (23.1%) were potent at 1 year. Regarding BCR, 3 of the patients (23.1%) never reached a prostate-specific antigen nadir of zero, and during the follow-up period only 3 patients (23.1%) exhibited BCR. No disease-specific mortality was evident during follow-up. Conclusions: Although early in its development, it appears that SRARP is technically feasible and offers satisfactory surgical, oncological and short-term functional outcomes. Copyright © 2013 S. Karger AG, Basel. Source


Labanaris A.P.,Prostate Center Northwest | Witt J.H.,Prostate Center Northwest | Zugor V.,Prostate Center Northwest
Anticancer Research | Year: 2012

Background: The aim of this study is to evaluate the surgical, the oncological and the functional outcomes in men ≥75 years of age undergoing robot-assisted radical prostatectomy (RARP). Patients and Methods: The records of N=2000 men who underwent RARP from February 2006 to April 2010 were retrospectively reviewed. A total of 45 patients who were ≥75 years of age were indentified. A comparison was performed between the overall patient cohort and the aforementioned patients. The analyzed parameters included: minor and major postoperative complications, postoperative Gleason score, pathological stage, positive-margin status, continence and potency in 12 months, disease-specific mortality and presence of biochemical progression at the follow-up period. Results: The following results reflect the comparison of the overall cohort of patients vs. the cohort of patients who were ≥75 years of age. A statistical difference of the analyzed parameters was observed only minor complications 11.4% vs. 15.5% (p<0.05), neurovascular bundle (NVB) preservation 65.7% vs. 51.1% (p<0.05) and potency after 12 months 66.2% vs. 39.6% (p<0.001). Major complications were noted in 1.3% vs. 2.2% of cases. A Gleason score <7 was noted in 42.8% vs. 37.3%, a Gleason score 7 in 47.7% vs. 51.1% and a Gleason score >7 in 9.5% vs. 11.6%. Organ-confined disease was noted in 73.5% vs. 68.8%, extraprostatic extension in 25.2% vs. 31.2% and positive surgical margin status was encountered in 8.9% vs. 11.1% of cases. At 12 months, 92.8% vs. 86.9% of patients were continent and 66.2% vs. 39.6% were potent. After a median follow-up of 17.2 months no disease-specific mortality was evident and 95.5% were free of biochemical progression in the cohort of patients who were ≥75 years of age. Conclusion: Our findings suggest that RARP in patients ≥75 years of age is a safe surgical procedure with limited complications, excellent oncologic and continence outcomes as well as acceptable potency outcomes. Nevertheless, RARP should be limited to a selected cohort of patients with a good overal health status and an individual life expectancy of more than 10 years in order for the oncological advantages of surgery to be achieved. Source


Labanaris A.P.,Prostate Center Northwest | Zugor V.,Prostate Center Northwest | Witt J.H.,Prostate Center Northwest
Urologia Internationalis | Year: 2013

Introduction: The objective of this study is to evaluate the surgical, oncological and short-term functional outcomes in patients with a pathologic prostate specimen weight ≥100 g versus patients with a pathologic prostate specimen weight ≤50 g undergoing robot-assisted radical prostatectomy (RARP). Patients and Methods: The records of 4,000 men who underwent RARP from February 2006 to April 2012 were reviewed retrospectively. A total of 185 men had a pathologic prostate specimen weight ≥100 g (group A). A matched pairs analysis was performed using our database to identify men with a pathologic prostate specimen weight ≤50 g but with equivalent clinicopathologic characteristics to serve as the control group (group B). Results: Our results indicated that although the intraoperative results were more than satisfying in patients with large glands, there is a significant increase in blood loss, operative time needed, increased need for bladder neck reconstruction as well as an increase in intraoperative complications. Nevertheless, patients with large glands exhibit less aggressive tumors, less positive surgical margins and a lower incidence of biochemical recurrence. Regarding functional outcomes, patients with larger glands had no difference regarding continence rates when compared to patients with smaller glands but exhibited significantly lower potency rates. Conclusions: Although RARP in patients with a pathologic prostate specimen weight ≥100 g is technically challenging, in experienced hands it can be considered a safe procedure with excellent surgical, oncological and functional outcomes. Nevertheless, this conclusion is limited, in that it is from a single institution with a large case volume and may not be reflective of outcomes at centers with smaller volumes and less experience. Copyright © 2012 S. Karger AG, Basel. Source

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