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Cancers
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Prostate Cancer and Radical Prostatectomy; Controversies in Anatomy, Surgical Techniques...
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Prostate Cancer and Radical Prostatectomy; Controversies in Anatomy, Surgical Techniques and Outcome

A special issue of Cancers (ISSN 2072-6694).

Deadline for manuscript submissions: closed (15 June 2022) | Viewed by 25774

Special Issue Editor

Prof. Konstantinos Gyftopoulos

E-Mail Website
Guest Editor
1. Department of Anatomy, School of Medicine, University of Patras, Patras, Greece
2. Olympion Hospital, Patras, Greece
Interests: prostate cancer; pelvic floor anatomy; congenital urogenital malformations

Special Issue Information

Dear Colleagues

The incidence of prostate cancer is rising worldwide, especially in younger men. Although the contributing factors underlying this trend are still elusive, it is possible that increased PSA screening is playing a central role. Irrespectively of the aetiology however, the fact is that more men, especially at a younger age, will be diagnosed with prostate cancer and will eventually be treated for localized disease with radical prostatectomy. Although major advances in the anatomical knowledge of the pelvic region and the advent of new techniques have changed the efficacy and the complication rate of this procedure, several controversies still exist regarding the detailed anatomy of the prostate gland and the adjacent anatomical structures in the pelvic region, the optimal surgical approach and the factors that may affect the oncological and functional outcome. This special issue of Cancers is dedicated to original articles and timely reviews that may shed light to long-standing debates regarding radical prostatectomy: a standard, widely used but still challenging surgical procedure.

Prof. Konstantinos Gyftopoulos
Guest Editor

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Keywords

  • prostate carcinoma
  • male pelvis
  • anatomy
  • embryology
  • radical prostatectomy
  • surgical technique
  • complications

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Published Papers (7 papers)

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Editorial

Jump to: Research, Review, Other

5 pages, 2632 KiB  
Editorial
Radical Prostatectomy and Anatomical Controversies: The Urethral Sphincter and the Elusive Continence Mechanisms
by Kostis Gyftopoulos
Cancers 2023, 15(13), 3410; https://doi.org/10.3390/cancers15133410 - 29 Jun 2023
Viewed by 965
Abstract
Prostate cancer incidence is rising [...] Full article
(This article belongs to the Special Issue Prostate Cancer and Radical Prostatectomy; Controversies in Anatomy, Surgical Techniques and Outcome)
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Research

Jump to: Editorial, Review, Other

15 pages, 2073 KiB  
Article
Prediction of Incontinence after Robot-Assisted Radical Prostatectomy: Development and Validation of a 24-Month Incontinence Nomogram
by Ruben M. Pinkhasov, Timothy Lee, Rogerio Huang, Bonnie Berkley, Alexandr M. Pinkhasov, Nicole Dodge, Matthew S. Loecher, Gaybrielle James, Elena Pop, Kristopher Attwood and James L. Mohler
Cancers 2022, 14(7), 1644; https://doi.org/10.3390/cancers14071644 - 24 Mar 2022
Cited by 13 | Viewed by 2571
Abstract
Incontinence after robot-assisted radical prostatectomy (RARP) is feared by most patients with prostate cancer. Many risk factors for incontinence after RARP are known, but a paucity of data integrates them. Prospectively acquired data from 680 men who underwent RARP January 2008–December 2015 and [...] Read more.
Incontinence after robot-assisted radical prostatectomy (RARP) is feared by most patients with prostate cancer. Many risk factors for incontinence after RARP are known, but a paucity of data integrates them. Prospectively acquired data from 680 men who underwent RARP January 2008–December 2015 and met inclusion/exclusion criteria were queried retrospectively and then divided into model development (80%) and validation (20%) cohorts. The UCLA-PCI-Short Form-v2 Urinary Function questionnaire was used to categorize perfect continence (0 pads), social continence (1–2 pads), or incontinence (≥3 pads). The observed incontinence rates were 26% at 6 months, 7% at 12 months, and 3% at 24 months. Logistic regression was used for model development, with variables identified using a backward selection process. Variables found predictive included age, race, body mass index, and preoperative erectile function. Internal validation and calibration were performed using standard bootstrap methodology. Calibration plots and receiver operating curves were used to evaluate model performance. The initial model had 6-, 12-, and 24-month areas under the curves (AUCs) of 0.64, 0.66, and 0.80, respectively. The recalibrated model had 6-, 12-, and 24-month AUCs of 0.52, 0.52, and 0.76, respectively. The final model was superior to any single clinical variable for predicting the risk of incontinence after RARP. Full article
(This article belongs to the Special Issue Prostate Cancer and Radical Prostatectomy; Controversies in Anatomy, Surgical Techniques and Outcome)
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Review

Jump to: Editorial, Research, Other

22 pages, 2073 KiB  
Review
Emerging Role of Nuclear Medicine in Prostate Cancer: Current State and Future Perspectives
by Fabio Volpe, Carmela Nappi, Leandra Piscopo, Emilia Zampella, Ciro Gabriele Mainolfi, Andrea Ponsiglione, Massimo Imbriaco, Alberto Cuocolo and Michele Klain
Cancers 2023, 15(19), 4746; https://doi.org/10.3390/cancers15194746 - 27 Sep 2023
Cited by 5 | Viewed by 1966
Abstract
Prostate cancer is the most frequent epithelial neoplasia after skin cancer in men starting from 50 years and prostate-specific antigen (PSA) dosage can be used as an early screening tool. Prostate cancer imaging includes several radiological modalities, ranging from ultrasonography, computed tomography (CT), [...] Read more.
Prostate cancer is the most frequent epithelial neoplasia after skin cancer in men starting from 50 years and prostate-specific antigen (PSA) dosage can be used as an early screening tool. Prostate cancer imaging includes several radiological modalities, ranging from ultrasonography, computed tomography (CT), and magnetic resonance to nuclear medicine hybrid techniques such as single-photon emission computed tomography (SPECT)/CT and positron emission tomography (PET)/CT. Innovation in radiopharmaceutical compounds has introduced specific tracers with diagnostic and therapeutic indications, opening the horizons to targeted and very effective clinical care for patients with prostate cancer. The aim of the present review is to illustrate the current knowledge and future perspectives of nuclear medicine, including stand-alone diagnostic techniques and theragnostic approaches, in the clinical management of patients with prostate cancer from initial staging to advanced disease. Full article
(This article belongs to the Special Issue Prostate Cancer and Radical Prostatectomy; Controversies in Anatomy, Surgical Techniques and Outcome)
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16 pages, 2664 KiB  
Review
Different Nerve-Sparing Techniques during Radical Prostatectomy and Their Impact on Functional Outcomes
by Iason Kyriazis, Theodoros Spinos, Arman Tsaturyan, Panagiotis Kallidonis, Jens Uwe Stolzenburg and Evangelos Liatsikos
Cancers 2022, 14(7), 1601; https://doi.org/10.3390/cancers14071601 - 22 Mar 2022
Cited by 9 | Viewed by 7275
Abstract
The purpose of this narrative review is to describe the different nerve-sparing techniques applied during radical prostatectomy and document their functional impact on postoperative outcomes. We performed a PubMed search of the literature using the keywords “nerve-sparing”, “techniques”, “prostatectomy” and “outcomes”. Other potentially [...] Read more.
The purpose of this narrative review is to describe the different nerve-sparing techniques applied during radical prostatectomy and document their functional impact on postoperative outcomes. We performed a PubMed search of the literature using the keywords “nerve-sparing”, “techniques”, “prostatectomy” and “outcomes”. Other potentially eligible studies were retrieved using the reference list of the included studies. Nerve-sparing techniques can be distinguished based on the fascial planes of dissection (intrafascial, interfascial or extrafascial), the direction of dissection (retrograde or antegrade), the timing of the neurovascular bundle dissection off the prostate (early vs. late release), the use of cautery, the application of traction and the number of the neurovascular bundles which are preserved. Despite this rough categorisation, many techniques have been developed which cannot be integrated in one of the categories described above. Moreover, emerging technologies have entered the nerve-sparing field, making its future even more promising. Bilateral nerve-sparing of maximal extent, athermal dissection of the neurovascular bundles with avoidance of traction and utilization of the correct planes remain the basic principles for achieving optimum functional outcomes. Given that potency and continence outcomes after radical prostatectomy are multifactorial endpoints in addition to the difficulty in their postoperative assessment and the well-documented discrepancy existing in their definition, safe conclusions about the superiority of one technique over the other cannot be easily drawn. Further studies, comparing the different nerve-sparing techniques, are necessary. Full article
(This article belongs to the Special Issue Prostate Cancer and Radical Prostatectomy; Controversies in Anatomy, Surgical Techniques and Outcome)
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12 pages, 1360 KiB  
Review
Denonvilliers’ Fascia: The Prostate Border to the Outside World
by Lazaros Tzelves, Vassilis Protogerou and Ioannis Varkarakis
Cancers 2022, 14(3), 688; https://doi.org/10.3390/cancers14030688 - 29 Jan 2022
Cited by 4 | Viewed by 5678
Abstract
The fascial structure around the prostate has been a controversial issue for several decades, but its role in radical prostatectomy is crucial to achieving successful nerve-sparing surgery. One of the fasciae surrounding the prostate is Denonvilliers’ fascia, forming its posterior border with the [...] Read more.
The fascial structure around the prostate has been a controversial issue for several decades, but its role in radical prostatectomy is crucial to achieving successful nerve-sparing surgery. One of the fasciae surrounding the prostate is Denonvilliers’ fascia, forming its posterior border with the rectum and enclosing along its layers several fibers of the neurovascular bundle. This review focuses on embryological and anatomical points of Denonvilliers’ fascia, aiming to provide a summary for the operating general surgeons and urologists of this area. Full article
(This article belongs to the Special Issue Prostate Cancer and Radical Prostatectomy; Controversies in Anatomy, Surgical Techniques and Outcome)
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10 pages, 5658 KiB  
Review
Radical or Not-So-Radical Prostatectomy: Do Surgical Margins Matter?
by Ioanna Maria Grypari, Vasiliki Zolota and Vasiliki Tzelepi
Cancers 2022, 14(1), 13; https://doi.org/10.3390/cancers14010013 - 21 Dec 2021
Cited by 31 | Viewed by 3845
Abstract
Prostate cancer is the second most common malignancy in men, and prostatectomy is the treatment of choice for most patients with at least low risk of progression. The presence of positive margins in the radical prostatectomy specimen is considered an adverse pathologic feature, [...] Read more.
Prostate cancer is the second most common malignancy in men, and prostatectomy is the treatment of choice for most patients with at least low risk of progression. The presence of positive margins in the radical prostatectomy specimen is considered an adverse pathologic feature, and may prompt additional therapeutic intervention in the patients. The absence of a distinct capsule around the prostate and intraoperative manipulations that aim to minimize postoperative adverse effects, complicate its wide removal. Proper handling of the specimen during the gross processing is essential for accurate determination of the status of margins or resection. Positive margins, defined as the presence of neoplastic glands in the highlighted-with-ink margin of resection, range from 6–38%. The surgical technique, surgeon’s expertise and tumor (i.e., grade and stage) and patients’ (i.e., BMI) characteristics affect the rate of margin positivity. Extensive or multifocal and nonanterior/nonapical positive margins are linked with higher recurrence rates, especially in organ-confined disease, underscoring the need for treating these patients more aggressively. In summary, detailed description of the status of the margins should be performed in every pathology report to determine patients’ prognosis and the most appropriate therapeutic plan. Full article
(This article belongs to the Special Issue Prostate Cancer and Radical Prostatectomy; Controversies in Anatomy, Surgical Techniques and Outcome)
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Other

12 pages, 1711 KiB  
Systematic Review
Impact of Prostate Size on the Outcomes of Radical Prostatectomy: A Systematic Review and Meta-Analysis
by Omar Fahmy, Nabil A. Alhakamy, Osama A. A. Ahmed and Mohd Ghani Khairul-Asri
Cancers 2021, 13(23), 6130; https://doi.org/10.3390/cancers13236130 - 5 Dec 2021
Cited by 7 | Viewed by 2203
Abstract
Background: The impact of prostate size on the radical prostatectomy outcome is not clear. Several published reports have shown conflicting results. Objectives: To investigate the effect of prostate size on the surgical, functional and oncological results of radical prostatectomy. Methods: A systematic review [...] Read more.
Background: The impact of prostate size on the radical prostatectomy outcome is not clear. Several published reports have shown conflicting results. Objectives: To investigate the effect of prostate size on the surgical, functional and oncological results of radical prostatectomy. Methods: A systematic review and meta-analysis were carried out in accordance with the PRISMA criteria. Finally, we investigated the research that reported on the impact of prostate size on radical prostatectomy outcome. The Review Manager (RevMan) software version 5.4 was utilized for statistical analysis. Results: Eighteen studies including 12,242 patients were included. Estimated blood loss was significantly less with smaller prostates (Z = 3.01; p = 0.003). The complications rate was 17% with larger prostates, compared to 10% for smaller prostates (Z = 5.73; p < 0.00001). Seventy-three percent of patients with a smaller prostate were continent within one month, compared to 64% with a larger prostate (Z = 1.59; p = 0.11). The rate of positive surgical margins was significantly higher with smaller prostates (20.2% vs. 17.8%). (Z = 2.52; p = 0.01). The incidence of biochemical recurrence was higher with smaller prostates (7.8% vs. 4.9%) (Z = 1.87; p = 0.06). Conclusion: Larger prostate size is associated with more blood loss and a higher rate of complications. However, the oncological outcome is better, compared to that in patients with smaller prostates. The impact of the size on the functional outcome is not clear. Full article
(This article belongs to the Special Issue Prostate Cancer and Radical Prostatectomy; Controversies in Anatomy, Surgical Techniques and Outcome)
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