Extended versus standard lymph node dissection for urothelial carcinoma of the bladder in patients undergoing radical cystectomy

We acknowledge the support received from the author of the in-cluded study, Jürgen E. Gschwend who provided information onthe method of blinding. We are very grateful to Annemarie Uhlig, Guillaume Ploussard,Wassim Kassouf, Caroline Raw and Martin Burton for havingserved as peer reviewers. We thank Cochrane Urology, ManagingEditor Robert Lane and Cochrane Fast-Track Service, ManagingEditor Helen Wakeford, for the support we received.Peer reviewedPublisher PD

Same day discharge for robot-assisted radical prostatectomy: a prospective cohort study documenting an Australian approach.

BACKGROUND The introduction of robotic surgical systems has significantly impacted urological surgery, arguably more so than other surgical disciplines. The focus of our study was length of hospital stay - patients have traditionally been discharged day 1 post-robot-assisted radical prostatectomy (RARP), however, during the ongoing COVID-19 pandemic and consequential resource limitations, our centre has facilitated a cohort of same-day discharges with initial success. METHODS We conducted a prospective tertiary single-centre cohort study of a series of all patients (n = 28) - undergoing RARP between January and April 2021. All patients were considered for a day zero discharge pathway which consisted of strict inclusion criteria. At follow-up, each patient's perspective on their experience was assessed using a validated post-operative satisfaction questionnaire. Data were reviewed retrospectively for all those undergoing RARP over the study period, with day zero patients compared to overnight patients. RESULTS Overall, 28 patients 20 (71%) fulfilled the objective criteria for day zero discharge. Eleven patients (55%) agreed pre-operatively to day zero discharge and all were successfully discharged on the same day as their procedure. There was no statistically significant difference in age, BMI, ASA, Charlson score or disease volume. All patients indicated a high level of satisfaction with their procedure. Median time from completion of surgery to discharge was 426 min (7.1 h) in the day zero discharge cohort. CONCLUSION Day zero discharge for RARP appears to deliver high satisfaction, oncological and safety outcomes. Therefore, our study demonstrates early success with unsupported same-day discharge in carefully selected and pre-counselled patients

Lymphovascular Invasion at the Time of Radical Prostatectomy Adversely Impacts Oncological Outcomes.

Lymphovascular invasion, whereby tumour cells or cell clusters are identified in the lumen of lymphatic or blood vessels, is thought to be an essential step in disease dissemination. It has been established as an independent negative prognostic indicator in a range of cancers. We therefore aimed to assess the impact of lymphovascular invasion at the time of prostatectomy on oncological outcomes. We performed a multicentre, retrospective cohort study of 3495 men who underwent radical prostatectomy for localised prostate cancer. Only men with negative preoperative staging were included. We assessed the relationship between lymphovascular invasion and adverse pathological features using multivariable logistic regression models. Kaplan-Meier curves and Cox proportional hazard models were created to evaluate the impact of lymphovascular invasion on oncological outcomes. Lymphovascular invasion was identified in 19% (n = 653) of men undergoing prostatectomy. There was an increased incidence of lymphovascular invasion-positive disease in men with high International Society of Urological Pathology (ISUP) grade and non-organ-confined disease (p < 0.01). The presence of lymphovascular invasion significantly increased the likelihood of pathological node-positive disease on multivariable logistic regression analysis (OR 15, 95%CI 9.7-23.6). The presence of lymphovascular invasion at radical prostatectomy significantly increased the risk of biochemical recurrence (HR 2.0, 95%CI 1.6-2.4). Furthermore, lymphovascular invasion significantly increased the risk of metastasis in the whole cohort (HR 2.2, 95%CI 1.6-3.0). The same relationship was seen across D'Amico risk groups. The presence of lymphovascular invasion at the time of radical prostatectomy is associated with aggressive prostate cancer disease features and is an indicator of poor oncological prognosis

The Use of Magnetic Resonance Imaging in the Prostate Cancer Primary Diagnostic Pathway: Is It Ready for Primetime?

Multiparametric magnetic resonance imaging (mpMRI) has been increasingly utilized in the prostate cancer diagnostic landscape over the last five years. The majority of the literature has focused on its use in men with a previous negative biopsy. However, over time, clinicians have begun using mpMRI in the work-up of men being considered for primary biopsy and subsequently data characterizing its diagnostic performance in this setting is emerging. This review comprehensively assesses the utility of mpMRI in the primary biopsy setting

Primary follicular lymphoma of an extraordinarily large prostate: A case report and review of the literature

Primary follicular lymphoma of the prostate is rare. This case report and literature review literature describes a 74-year old male patient who presented with worsening urinary symptoms, and imaging showing prostatomegaly compressing and displacing the rectum. He ultimately underwent a Millen retropubic prostatectomy for a prostate of 692 cc. The histology and immunohistochemistry confirmed the diagnosis as follicular lymphoma. His lymphoma underwent high-grade transformation with leptomeningeal involvement

Functional Impact of Neuro-Vascular Bundle Preservation in High Risk Prostate Cancer without Compromising Oncological Outcomes: A Propensity-Modelled Analysis.

Nerve sparing (NS) is a surgical technique to optimize functional outcomes of radical prostatectomy (RP). However, it is not recommended in high risk (HR) cases because of the risk of a positive surgical margin that may increase the risk of cancer recurrence. In the last two decades there has been a change of perspective to the effect that in well-selected cases NS could be an oncologically safe option with better functional outcomes. Therefore, we aim to compare the functional outcomes and oncological safety of NS during RP in men with HR disease. A total of 1340 patients were included in this analysis, of which 12% (n = 158) underwent non-NSRP and 39% (n = 516) and 50% (n = 666) uni- and bilateral NSRP, respectively. We calculated a propensity score and used inverse probability of treatment weighting (IPTW) to balance the baseline characteristics of Pca patients undergoing non-NSRP and those having uni- and bilateral NSRP, respectively. NS improved functional outcomes; after IPTW, only 3% of patients having non-NSRP reached complete erectile function recovery (without erectile aid) at 24 months, whereas 22% reached erectile function recovery (with erectile aid), while 87% were continent. Unilateral NS increased the probability of functional recovery in all outcomes (OR 1.1 or 1.2, respectively), bilateral NS slightly more so (OR 1.1 to 1.4). NSRP did not impact the risk of any recurrence (HR 0.99, 95%CI 0.73-1.34, p = 0.09), and there was no difference in survival for men who underwent NSRP (HR 0.65, 95%CI 0.39-1.08). There was no difference in cancer-specific survival (0.56, 95%CI 0.29-1.11). Our study found that NSRP significantly improved functional outcomes and can be safely performed in carefully selected patients with HR-PCa without compromising long term oncological outcomes

Comparing the Diagnostic Performance of Micro- Ultrasound-Guided Biopsy Versus Multiparametric Magnetic Resonance Imaging-Targeted Biopsy in the Detection of Clinically Significant Prostate Cancer: A Systematic Review and Meta-Analysis

BackgroundMicro-ultrasound is a novel, high-resolution imaging modality that aims to improve the accuracy of prostate cancer diagnosis compared with TRUS-guided biopsy. While traditional ultrasound systems operate at 8 to 12 MHz, micro-ultrasound operates at 29 MHz, allowing enhanced recognition of microstructures with 300% higher resolution. Micro-ultrasound can potentially identify and target in real-time suspicious lesions, improving sensitivity and the negative predictive value for clinically significant prostate cancer. It may be a low-cost alternative to multiparametric magnetic resonance imaging (mpMRI) in the detection of prostate cancer. MethodsA systematic review and meta-analysis was performed comparing the diagnostic performance of micro-ultrasound-guided prostate biopsies with mpMRI-targeted prostate biopsies in the detection of clinically significant prostate cancer. PubMed, EMBASE, SCOPUS, and Cochrane CENTRAL databases were searched to identify relevant studies published up to July 2022. ResultsA total of 15 studies were included for the systematic review, with 12 of those studies being included for the meta-analysis. The pooled sensitivity and specificity for micro-ultrasound-guided biopsies detecting clinically significant prostate cancer were 89% (95% CI 83 to 93) and 31% (95% CI 23 to 40) respectively (I2 = 0%). In comparison, the pooled sensitivity and specificity for mpMRI-targeted biopsies detecting clinically significant prostate cancer were 86% (95% CI 73 to 93) and 32% (95% CI 18 to 50) respectively (I2 = 16%). There was no statistically significant difference in the sensitivity or specificity between micro-ultrasound and mpMRI. Subgroup analysis found no difference in MRI subgroups based on blinding (P = 0. 383). ConclusionMicro-ultrasound-guided biopsies are comparable to mpMRI targeted biopsies with no difference in the detection of clinically significant prostate cancer between the 2 modalities. Large, multicentre, prospective studies are required to further substantiate the use of micro-ultrasound as an alternative to or in conjunction with mpMRI in the detection of prostate cancer