Can J Urol
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Review Comparative Study
Radical prostatectomy: a comparison of open, laparoscopic and robot-assisted laparoscopic techniques.
Surgical approaches to prostate cancer continue to evolve and patient demand for prostatectomy continues to increase. Technical modifications have expanded beyond open surgical approaches to include laparoscopy and more recently robotics. It is important that the enthusiasm that accompanies the introduction of new technology to surgery be accompanied by tangible benefits in terms of comparable oncological or functional outcomes and treatment morbidity. ⋯ Early data from LRP and RALP series are comparable to RRP in terms of margin-positivity and functional outcomes. Blood loss and transfusion rates appear to be lower for LRP and RALP compared to RRP, while financial costs remain higher than RRP. Long-term oncological results are keenly awaited. Ideally direct comparison between equally experienced surgeons in similar population groups will be required to demonstrate any inherent advantages or disadvantages of individual surgical approaches.
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Review Comparative Study
Detection of prostate cancer: the impact of the European Randomized Study of Screening for Prostate Cancer (ERSPC).
The European Randomized Study of Screening for Prostate Cancer (ERSPC) is a large, randomized controlled trial of screening versus control, conducted in eight European countries (Belgium, Finland, France, Italy, the Netherlands, Spain, Sweden, and Switzerland). This article focuses on important aspects relating to recent findings from the ERSPC about two topics: first, leadtime and overdiagnosis, and second, prostate-specific antigen (PSA) as a test for repeated screening. The ERSPC together with the prostate cancer arm of the Prostate, Lung, Colon and Ovary (PLCO) screening trial of the National Cancer Institute in the United States are set to show or exclude an effect of screening on prostate cancer mortality. ⋯ This may be compatible with the observation that tumor volumes in second round screening are smaller, and larger tumors are harvested. Tumor volume becomes a negative predictor in round 2, indicating that a large proportion of elevated PSA values are caused by benign prostatic hyperplasia (BPH) rather than by prostate cancer. While the outcome of the ongoing randomized studies is uncertain, screening tests cannot be refused to men who are well-informed and accept to take the risk of experiencing more harm than benefit as a result of a positive screening test result.
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Biochemical parameters and pathological features as well as biopsy related morbidity of prostate cancer detected on second, third and fourth repeat prostate biopsy in men with a serum total PSA level between 4 ng/mL and 10 ng/mL were evaluated and compared to those cancers detected on initial prostate biopsy. In a prospective European Prostate Cancer Detection study, 1051 men with a total PSA level between 4 ng/mL and 10 ng/mL underwent transrectal ultrasound (TRUS)-guided sextant biopsy and two additional transition zone biopsies. All subjects whose biopsy samples were negative for prostate cancer (CaP) underwent a first repeat biopsy after 6 weeks. ⋯ Hence, a second prostate biopsy in all cases of a negative finding on initial biopsy appears justified. Third and fourth repeat biopsies however, should only be obtained in very selected patients with high suspicion of cancer and/or poor prognostic factors on the first or second biopsy. Power Doppler TRUS will further enhance prostate cancer detection as will artificial neural networks as patient selecting tools.
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Clinical Trial
Success of sildenafil for erectile dysfunction in men treated with brachytherapy or external beam radiation for prostate cancer.
We undertook to determine if any significant differences in the efficacy of sildenafil citrate for erectile dysfunction (ED) exists between patients who have received external beam radiation or brachytherapy for prostate cancer. ⋯ Sildenafil citrate improved ED in a significantly greater number of patients who had undergone brachytherapy over those who had received external beam radiation. However, the patients who had received external beam radiation were both older and experienced a longer lapse of time between completion of radiotherapy and administration of sildenafil citrate than the brachytherapy patient group. This may explain the poorer success in the external beam radiation patients. The success of sildenafil in both groups of patients was lower than has previously been reported.
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To determine whether men who relapse after neoadjuvant androgen ablation (NAA) and high-dose radiation therapy (RT) have faster PSA doubling times(PSAdt) than those who are treated with RT alone. ⋯ The use of prolonged NAA in men treated with RT does not itself cause a more rapid PSAdt when relapse occurs. Faster relapse observed in these men is due to intrinsically more aggressive tumors prior to treatment.