High-Dose-Rate Brachytherapy as an Organ-Sparing Treatment for Early Penile Cancer.

BACKGROUND: Low-dose-rate brachytherapy is an effective organ-sparing treatment for patients with early-stage penile cancer. However, only limited data are available on the role of high-dose-rate brachytherapy (HDR-BT) in this clinical setting. METHODS: Between 2002 and 2020, 31 patients with early penile cancer were treated at our center with interstitial HDR BT at a dose of 18 × 3 Gy twice daily. A breast brachytherapy template was used for the fixation of stainless hollow needles. RESULTS: The median follow-up was 117.5 months (range, 5-210). Eight patients (25.8%) developed a recurrence; of these, seven were salvaged by partial amputation. Six patients died of internal comorbidities or a second cancer. The probability of local control at 5 and 10 years was 80.7% (95% CI: 63.7-97.7%) and 68.3% (95% CI: 44.0-92.6%), respectively. Cause-specific survival was 100%. Only one case of radiation-induced necrosis was observed. The probability of penile sparing at 5 and 10 years was 80.6% (95% CI: 63.45-97.7%) and 62.1% (95% CI: 34.8-89.4%), respectively. CONCLUSIONS: These results show that HDR-BT for penile cancer can achieve results comparable to LDR-BT with organ sparing. Despite the relatively large patient cohort-the second largest reported to date in this clinical setting-prospective data from larger samples are needed to confirm the role of HDR-BT in penile cancer.

Urological surgery in elderly patients: results and complications.

PURPOSE: Owing to the large aging population, a growing number of elderly patients are undergoing surgical treatment. Surgical procedures in elderly patients are associated with a higher risk of complications. The aim of this study was to evaluate the efficacy and safety of urological surgeries in old patients. METHODS: The authors carried out a retrospective study, evaluating results and early postoperative complications in patients aged 75 years and older. The cohort of patients included 221 patients who underwent surgical procedures in the department of urology between January 2011 and December 2012. The average age of patients was 78. The results and complications were categorized based on the type of surgery performed, and the Dindo-Clavien scale. RESULTS: The median follow-up was 18 months. All surgeries for malignant tumors were performed successfully with no residual disease. Totally, 48 (22%) complications were recorded. The most serious were as follows: one patient (<0.5%) died; and four (<2%) patients underwent reoperation. The most common complications involved infection, mainly sepsis and surgical site infections. Other complications included mild respiratory insufficiency, delirium, bleeding, etc. CONCLUSION: Surgeries in elderly patients were effective and safe. The cornerstone of safety is careful preparation and treatment of comorbidities. Complications occurred mainly as a result of emergency procedures during emergency procedures and in major surgeries such as cystectomy and nephrectomy. The standard use of low molecular-weight heparin caused no incidence of thromboembolic disease.

Radical prostatectomy in high-grade prostate cancer, salvage and adjuvant radiotherapy.

INTRODUCTION: Prostate cancer with a Gleason score (GS) of 8-10 is linked to a higher risk of recurrence and progression. The aim of this paper is to evaluate treatment results of our high-risk patient cohort. PATIENTS AND METHODS: The cohort of 42 patients with radical prostatectomy (RP) specimen histology GS 8-10 was assessed. The patients were followed up after RP and radiotherapy (RT) was delivered in case of a biochemical relapse. Adjuvant radiotherapy (aRT) was delivered only in case of a positive surgical margin (PSM). The following parameters were evaluated: biochemical progression-free survival (BPFS), overall survival (OS) and cancer-specific survival (CSS). The second objective was to evaluate adverse effects of RP and RT. RESULTS: The median follow-up time was 88 months (18-168). RP led to BPFS in 16 patients (38%). Five patients with PSM underwent aRT and 20 underwent salvage radiotherapy (sRT). One patient died of myocardial infarction and 1 patient died of metastatic disease. Skeletal metastases were recorded in 2 patients. The BPFS in RP combinations with sRT or aRT was reached in 29 patients (69%). The OS and CSS in our cohort reached 95 and 98%, respectively. CONCLUSION: Management with aRT only in PSM was very effective, according to our retrospective study.

Bipolar transurethral resection of anastomotic strictures after radical prostatectomy.

PURPOSE: The efficacy of the bipolar endoscopic resection for anastomotic stricture was assessed and compared with holmium laser treatment. PATIENTS AND METHODS: We studied a cohort of 39 patients with anastomotic strictures in years 1999 to 2007. Twenty-two patients had undergone bipolar resection, and 17 patients had undergone holmium laser treatment. The mean age of the bipolar cohort was 63.8 years; initial prostate-specific antigen (PSA) level was 10.7 ng/mL. The mean age of the laser cohort was 64 years; initial PSA level was 7.8 ng/mL. The results were evaluated by measurement of the maximum urinary flow (Qmax) and the postvoid residual volume of urine (PVR) before surgery, and at 6 weeks and 6 months after surgery. The Wilcoxon rank-sum test was used for statistical analysis, and a P value <0.05 was considered significant. RESULTS: The mean follow-up period was 42 (14-74) months. Improvements in Qmax and PVR were recorded in the two cohorts. In the bipolar cohort, the mean values of Qmax were 3.9 mL/s, 14 mL/s, and 13 ml/s, while PVR values were 46 mL, 10 mL, and 11 mL. The mean values of Qmax in the laser cohort were 3.7 mL/s, 11 mL/s and 6.1 mL/s; PVR were 25 mL, 16 mL, and 19 mL. Statistically significantly better results of Qmax over 6 months were in the bipolar cohort (P < 0.001). No perioperative complications and no deterioration of urinary continence were recorded. CONCLUSION: The bipolar resection of an anastomotic stricture is a highly effective method that produces better long-term results than the holmium laser treatment.