• nano diagnostics
• nanomaterial
• prostate cancer (PCa)
• urinary biomarker
• urinary liquid biopsy

• Biofluids
• PSA
• Prostate cancer
• Raman spectroscopy
• SERS
• Spectro-analytical methods

• Dosimetry
• IBCL
• Loose seeds
• Meta-analysis
• Migration
• Stranded seeds
• bNED

• Active surveillance
• Androgen receptor
• Chemotherapy
• Prostate cancer
• Radiation therapy
• Radical prostatectomy
• Robotic surgery
• Survivorship

• Extracapsular extension
• Magnetic resonance imaging
• Prostatectomy
• Prostatic neoplasms
• Radiomics

• 12-core prostate biopsy scheme
• Clinically insignificant prostate cancer
• Epstein criteria
• Low-risk and intermediate-risk prostate cancer
• Prostate cancer
• Radical prostatectomy

• Gleason score
• Multiparametric MRI
• Prostate cancer
• Prostate specific antigen

• Brachytherapy
• Brachytherapy boost
• Cancer de la prostate
• Cancer de la prostate à haut risque
• Curiethérapie
• High-risk prostate cancer
• Prostate cancer
• Radiothérapie corporelle stéréotaxique
• Stereotactic body radiation therapy
• Stereotactic body radiation therapy boost
• Stimulation de la curiethérapie
• Stimulation de la radiothérapie corporelle stéréotaxique

• active surveillance
• decision aids
• national survey
• prostate cancer
• shared decision-making

The important part of radical prostatectomy (RP) for high risk (HR) is extended pelvic lymph node dissection (ePLND). This method consists of two stages of surgery usually performed at the compartment (pre- or transperineally).

We present our new combined technique of RP using two different approaches: a pre-peritoneal approach for laparoscopic radical prostatectomy (LRP) and a transperitoneal approach for ePLND.

This study included 30 patients aged 53 to 75 years (mean age: 64 years) with prostate cancer who underwent LRP and ePLND using a combined technique. After the pre-peritoneal LRP, transposition of the trocars into the peritoneal cavity was performed without changing their location, except the extreme left trocar, which was inserted through a new approach.

The total duration of surgery was 155 to 290 min (mean: 215 min); ePLND lasted from 35 to 85 min (mean: 56 min). The movement of trocars into the peritoneal cavity was a very simple maneuver, taking up to 1 min without any complications. The number of removed lymph nodes (LNs) ranged from 13 to 28 (mean: 16.8). A positive margin was found in 5 (16%) patients. We recognized positive nodes in 9 (30%) patients.

The combined technique is both feasible and safe. Performing the most difficult maneuver, removal of the prostate, in the first stage appears to be more comfortable for the operator. The timing of the PLND stage in the combined technique and the number of removed LNs do not differ from the standard lenticular access.

• laparoscopy
• lymph node dissection
• prostate cancer

Data on prostate cancer (PCa) treatment in Africa remains under-reported. We present a review of the management of PCa at the cancer center of the largest tertiary referral facility in Ghana, with emphasis on curative treatment.

We retrospectively reviewed data on 1,074 patients seen at the National Center for Radiotherapy and Nuclear Medicine from 2003 to 2016. Patient and disease characteristics at presentation are presented using descriptive statistics. The χ² and Fisher’s exact tests and Mann-Whitney U test were used to analyze differences between categorical and continuous variables, respectively. Methods of survival analysis were used to evaluate the relative risk of biochemical disease-free survival (bDFS).

Seventy percent of the study population presented with localized disease. High-risk disease presentation accounted for 64.4% of these patients. Only 57.6% of patients with localized disease received curative radiotherapy. The 5-year overall survival for the curative cohort was 96% (interquartile range, 93% to 98%). The 5-year bDFS rates for low-, intermediate-, and high-risk groups were 95%, 70%, and 48%, respectively. Both Gleason score and pretreatment prostate-specific antigen were significant predictors for bDFS in multivariable analysis.

We show that the majority of patients with PCa have locally advanced disease at the time of presentation for radiotherapy. bDFS was significantly better for low- and intermediate-risk than for high-risk disease. These data emphasize the dire need to re-evaluate screening and patient education of PCa in regions of the world with high incidence and mortality as well as the need for improved access to care and treatment delivery.

• Cancer de la prostate
• Classification de D’Amico
• Curage ganglionnaire
• D’Amico class system
• Guidelines
• Lymph node dissection
• Prostate cancer
• Prostatectomie radicale
• Radical prostatectomy
• Recommandations

• Prostate Cancer
• Prostatectomy
• Recurrence
• Survival

• Aged
• Disease-Free Survival
• Humans
• Lymph Nodes/pathology
• Lymphatic Metastasis/pathology
• Male
• Middle Aged
• Neoplasm Grading
• Neoplasm Recurrence, Local/mortality
• Prostate/pathology
• Prostate-Specific Antigen/blood
• Prostatectomy
• Prostatic Neoplasms/blood
• Prostatic Neoplasms/pathology
• Prostatic Neoplasms/surgery
• Retrospective Studies
• Robotic Surgical Procedures
• Survival Rate
• Tertiary Care Centers

• National Research Foundation of Korea

• Age Factors
• Aged
• Comorbidity
• Databases, Factual
• Humans
• Male
• Prognosis
• Prostatectomy/methods
• Prostatectomy/mortality
• Prostatic Neoplasms/etiology
• Prostatic Neoplasms/mortality
• Prostatic Neoplasms/surgery
• Registries
• Regression Analysis
• Republic of Korea
• Retrospective Studies
• Risk Assessment/statistics & numerical data
• Risk Factors
• Survival Analysis

Prostate cancer (PCa) is the second most common cancer in men worldwide with an incidence of 14.8% and a mortality of 6.6%. Shortcomings in comprehensive medical check-ups in low- and middle-income countries lead to delayed detection of PCa and are causative of high numbers of advanced PCa cases at first diagnosis. The performance of available biomarkers is still insufficient and limited applicability, including logistical and financial burdens, impedes comprehensive implementation into health care systems. There is broad agreement on the need of new biomarkers to improve (i) early detection of PCa, (ii) risk stratification, (iii) prognosis, and (iv) treatment monitoring. This review focuses on liquid biopsy tests distinguishing high-grade significant (Gleason score (GS) ≥ 7) from low-grade indolent PCa. Available biomarkers still lack performance in risk stratification of biopsy naïve patients. However, biomarkers with highly negative predictive values may help to reduce unnecessary biopsies. Risk calculators using integrative scoring systems clearly improve decision-making for invasive prostate biopsy. Emerging biomarkers have the potential to substitute PSA and improve the overall performance of risk calculators. Until then, PSA should be used and may be replaced whenever enough evidence has accumulated for better performance of a new biomarker.

• biomarkers
• diagnosis high-grade PCa
• liquid biopsy
• prostate cancer (PCa)
• risk calculators
• risk stratification

• high-risk prostate cancer
• laparoscopy
• radical prostatectomy

• Digital rectal exam
• Family history
• High-grade disease
• Prostate cancer
• Prostate-specific antigen
• Risk prediction

• Neoadjuvant therapy
• Prostatectomy
• Prostatic neoplasms
• Risk assessment lymph nodes

• Artificial urinary sphincter (AUS)
• Explantation
• Post-prostatectomy incontinence
• Radiation
• Revision
• Timing

• Extended pelvic lymphadenectomy
• external beam radiotherapy
• lymph-node metastasis
• prostate cancer
• survival

• outcomes
• prostate cancer
• quality
• radiation therapy
• treatment interruption

• Active surveillance
• Primary androgen deprivation therapy
• Primary therapy
• Radiation therapy
• Radical prostatectomy
• Risk classification

• End of life
• Palliative care
• Shared decision-making

• local
• mortality
• neoplasm recurrence
• neoplasm grading
• prostatectomy
• prostatic neoplasms

• Multi-parametric magnetic resonance imaging (mpMRI)
• prostate cancer (PCa)
• treatment decisions

• cribriform pattern
• glomeruloid glands
• prostatic adenocarcinoma

• Gene Expression Regulation, Neoplastic
• Humans
• Internationality
• Male
• Neoplasm Grading/methods
• Neoplasm Grading/standards
• Prostatic Neoplasms/genetics
• Prostatic Neoplasms/metabolism
• Prostatic Neoplasms/pathology
• Societies, Medical/standards
• Suppressor of Cytokine Signaling 3 Protein/biosynthesis
• Suppressor of Cytokine Signaling 3 Protein/genetics
• Urologic Diseases/genetics
• Urologic Diseases/metabolism
• Urologic Diseases/pathology

Recent data suggest that intensity-modulated radiation therapy (IMRT) plus brachytherapy boost for unfavorable prostate cancer provides improved biochemical relapse-free survival over IMRT alone. Stereotactic body radiation therapy (SBRT) may be a less invasive alternative to brachytherapy boost. Here, we report the 3-year gastrointestinal (GI) and genitourinary (GU) toxicities of IMRT plus SBRT boost.

Between March 2008 and September 2012, patients with prostate cancer were treated with robotic SBRT (19.5 Gy in three fractions) followed by fiducial-guided IMRT (45–50.4 Gy) on an institutional protocol. Toxicity was prospectively graded using the common terminology criteria for adverse events version 4.0 (CTCAEv.4) at the start of and at 1- to 6-month intervals after therapy. Rectal telangiectasias were graded using the Vienna Rectoscopy Score (VRS).

At a median follow-up of 4.2 years (2.4–7.5), 108 patients (4 low-, 45 intermediate-, and 59 high-risk) with a median age of 74 years (55–92) were treated with SBRT plus IMRT, with 8% on anticoagulation and an additional 48% on antiplatelet therapy at the start of therapy. The cumulative incidence of late ≥grade 2 GI toxicity was 12%. Of these, 7% were due to late rectal bleeding, with six patients requiring up to two coagulation procedures. One patient with rectal telangiectasias was treated with hyperbaric oxygen (grade 3 toxicity). No rectal fistulas or stenoses were observed. Ten patients had multiple non-confluent telangiectasias (VRS grade 2), and three patients had multiple confluent telangiectasias (VRS grade 3). The cumulative incidence of late grade 3 GU toxicity was 6%. Most late toxicities were due to hematuria requiring bladder fulguration. There were no late ≥grade 4 GU toxicities.

Rates of clinically significant GI and GU toxicities are modest following IMRT plus SBRT boost. Future studies should compare cancer control, quality of life, and toxicity with other treatment modalities for patients with high-risk prostate cancer.

• CyberKnife
• IMRT
• SBRT
• common terminology criteria
• prostate cancer

This study was designed to identify clinical predictors of favorable pathology and biochemical recurrence (BCR) in patients with intermediate-risk prostate cancer (IRPCa). Between 2006 and 2012, clinicopathological and oncological data from 203 consecutive men undergoing robot-assisted radical prostatectomy (RARP) for IRPCa were reviewed in a single-institutional retrospective study. Favorable pathology was defined as Gleason score ≤6 and organ-confined cancer as detected by surgical pathology. Logistic regression analysis was used to determine predictive variables of favorable pathology, and the Kaplan–Meier and multivariate Cox regression model were used to estimate BCR-free survival after RARP. Overall, 38 patients (18.7%) had favorable pathology after RARP. Lower quartile prostate-specific antigen density (PSAD) was associated with favorable pathology compared to the highest quartile PSAD after adjusting for preoperative PSA, clinical stage and biopsy Gleason score (odds ratio, 5.42; 95% confidence interval, 1.01–28.97; P = 0.048). During a median 37.8 (interquartile range, 24.6–60.2) months of follow-up, 66 patients experienced BCR. There were significant differences with regard to BCR free survival by PSAD quartiles (log rank, P = 0.003). Using a multivariable Cox proportion hazard model, PSAD was found to be an independent predictor of BCR in patients with IRPCa after RARP (hazard ratio, 4.641; 95% confidence interval, 1.109–19.417; P = 0.036). The incorporation of the PSAD into risk assessments might provide additional prognostic information and identify some patients in whom active surveillance would be appropriate in patients with IRPCa.

Extracapsular extension (ECE) of prostate cancer is a poor prognostic factor associated with progression, recurrence after treatment, and increased prostate cancer-related mortality. Accurate staging prior to radical prostatectomy is crucial in avoidance of positive margins and when planning nerve-sparing procedures. Multi-parametric magnetic resonance imaging (mpMRI) of the prostate has shown promise in this regard, but is hampered by poor sensitivity. We sought to identify additional clinical variables associated with pathologic ECE and determine our institutional accuracy in the detection of ECE amongst patients who went on to radical prostatectomy.

mpMRI studies performed between the years 2012 and 2014 were cross-referenced with radical prostatectomy specimens. Predictive properties of ECE as well as additional clinical and biochemical variables to identify pathology-proven prostate cancer ECE were analyzed.

The prevalence of ECE was 32.4%, and the overall accuracy of mpMRI for ECE was 84.1%. Overall mpMRI sensitivity, specificity, positive predictive value, and negative predictive value for detection of ECE were 58.3%, 97.8%, 93.3%, and 81.5%, respectively. Specific mpMRI characteristics predictive of pathologic ECE included primary lesion size ((20.73 ± 9.09) mm, mean ± SD, p < 0.001), T2 PIRADS score (p = 0.009), overall primary lesion score (p < 0.001), overall study suspicion score (p = 0.003), and MRI evidence of seminal vesicle invasion (SVI) (p = 0.001).

While mpMRI is an accurate preoperative assessment tool for the detection of ECE, its overall sensitivity is poor, likely related to the low detection rate of standard protocol MRI for microscopic extraprostatic disease. The additional mpMRI findings described may also be considered in surgical margin planning prior to radical prostatectomy.

• Extracapsular extension
• Magnetic resonance imaging
• Prostate cancer
• Prostatectomy
• Staging

• Combination brachytherapy and external beam radiation
• High-risk prostate cancer
• Prostate cancer therapy

• diagnosis
• imaging
• urology/prostate

• Active surveillance
• Nomogram
• Prostate cancer
• Survival

There is significant variation in clinical outcome between patients diagnosed with prostate cancer (CaP). Although useful, statistical nomograms and risk stratification tools alone do not always accurately predict an individual’s need for and response to treatment. The factors that determine this variation are not fully elucidated. In particular, cellular response to androgen ablation and subsequent paracrine/autocrine adaptation is poorly understood and despite best therapies, median survival in castrate resistant patients is only approximately 35 mo. We propose that one way of understanding this is to look for correlates in other comparable malignancies, such as breast cancer, where markers of at least 4 distinct gene clusters coding for 4 different phenotypic subtypes have been identified. These subtypes have been shown to demonstrate prognostic significance and successfully guide appropriate treatment regimens. In this paper we assess and review the evidence demonstrating parallels in the biology and treatment approach between breast and CaP, and consider the feasibility of patients with CaP being stratified into different molecular classes that could be used to complement prostate specific antigen and histological grading for clinical decision making. We show that there are significant correlations between the molecular classification of breast and CaP and explain how techniques used successfully to predict response to treatment in breast cancer can be applied to the prostate. Molecular phenotyping is possible in CaP and identification of distinct subtypes may allow personalised risk stratification way beyond that currently available.

• Prostate cancer
• Molecular classification
• Biomarker
• Breast cancer
• Prognostic

• MRI
• Prostate cancer
• Risk stratification

Radiation therapy (RT) is one of the mainstay treatments for prostate cancer (PCa). The potentially curative approaches can provide satisfactory results for many patients with non-metastatic PCa; however, a considerable number of individuals may present disease recurrence and die from the disease. Exploiting the rich molecular biology of PCa will provide insights into how the most resistant tumor cells can be eradicated to improve treatment outcomes. Important for this biology-driven individualized treatment is a robust selection procedure. The development of predictive biomarkers for RT efficacy is therefore of utmost importance for a clinically exploitable strategy to achieve tumor-specific radiosensitization. This review highlights the current status and possible opportunities in the modulation of four key processes to enhance radiation response in PCa by targeting the: (1) androgen signaling pathway; (2) hypoxic tumor cells and regions; (3) DNA damage response (DDR) pathway; and (4) abnormal extra-/intracell signaling pathways. In addition, we discuss how and which patients should be selected for biomarker-based clinical trials exploiting and validating these targeted treatment strategies with precision RT to improve cure rates in non-indolent, localized PCa.

• biomarkers
• combined modality
• genomics
• molecular oncology
• prostate cancer
• radiotherapy
• targeted therapies

• Minimally Invasive Surgical Procedures
• Prostatic Neoplasms
• Radical Prostatectomy
• Risk Assessment
• Treatment Outcome

• Adult
• Aged
• Aged, 80 and over
• Disease-Free Survival
• Humans
• Laparoscopy/statistics & numerical data
• Male
• Middle Aged
• Minimally Invasive Surgical Procedures/statistics & numerical data
• Perineum/surgery
• Prevalence
• Prostatectomy/statistics & numerical data
• Prostatic Neoplasms/diagnosis
• Prostatic Neoplasms/epidemiology
• Prostatic Neoplasms/surgery
• Republic of Korea/epidemiology
• Retrospective Studies
• Risk Factors
• Treatment Outcome