Optimizing surgical outcomes in bladder cancer patients undergoing radical cystectomy.

Purpose: To evaluate predictors of high-quality surgery and their effect on surgical outcomes in patients with bladder cancer undergoing radical cystectomy. Evidence acquisition: A systematic and thorough review was performed to identify the most recent literature on current optimal management and predictors of high-quality surgery for patients undergoing radical cystectomy. Conclusions: Muscle-invasive bladder cancer is an aggressive cancer requiring efficient and high-quality surgery in order to achieve the best oncological outcomes. Negative surgical margins, number of lymph nodes resected, lymph node dissection template, and surgical volume have been associated with improved oncologic outcomes. Robotic radical cystectomy continues to evolve and recent randomized controlled trials have shown that oncological outcomes are non-inferior when compared to the open technique. Regardless of approach, surgical technique should continually be evaluated and refined to optimize outcomes in patients undergoing radical cystectomy.

Clinical outcomes of abiraterone acetate and predictors of its treatment duration in metastatic castration-resistant prostate cancer: Real-world experience in the Southeast Asian cohort.

It is of much interest to understand the efficacy of abiraterone acetate (AA) in routine clinical practice. We assessed the clinical outcome of AA in patients with metastatic castration-resistant prostate cancer (mCRPC) and determined clinical factors associated with AA treatment duration in real-world setting. This real-world cohort consisted of 93 patients with mCRPC treated with AA in Thailand (58.1%) and Malaysia (41.9%). Primary endpoints were overall survival (OS) and biochemical progression-free survival (bPFS). Secondary endpoints were predictors associated with AA treatment duration evaluated with Cox proportional hazards regression. Around 74% were chemotherapy-naïve. The median AA treatment duration was 10 months (IQR 5.6-17.1). Malaysians had a relatively lower median OS and bPFS (OS 17.8 months; 95% CI 6.4-29.1, bPFS 10.4 months; 95% CI 8.8-12.0) compared to Thais (OS 27.0 months; 95% CI 11.3-42.7, bPFS 14.0 months; 95% CI 5.8-22.2), although it did not achieve statistical significance (P > .05). Patients with longer AA treatment duration (>10 months) had lower risk of death and longer bPFS, compared to those with shorter AA treatment duration (≤10 months) (hazard ratio [HR] 0.10, 95% CI 0.05-0.22 and HR 0.13, 95% CI 0.06-0.25, respectively). Multivariable analysis showed that PSA at AA initiation, presence of PSA response and chemotherapy-naive were independently associated with AA duration (P < .05). Abiraterone acetate is well-tolerated in the Southeast Asian cohort with comparable survival benefits to other Asian populations in real-world setting. Lower PSA levels at AA initiation, presence of PSA response, and chemotherapy-naive were significant in determining AA treatment duration.

Prospective performance of the Prostate Health Index in prostate cancer detection in the first prostate biopsy of men with a total prostatic specific antigen of 4-10 ng/mL and negative digital rectal examination.

BACKGROUND: The disadvantage of using total serum prostatic specific antigen (PSA) test for detection of prostate cancer is that it has a low specificity. The low specificity of total PSA (tPSA) test leads to unnecessary prostate biopsies. In this prospective study, we assessed the serum tPSA, free PSA, p2PSA, and the Prostate Health Index (PHI) in the detection of prostate cancer in men with a tPSA of 4-10 ng/mL and a negative digital rectal examination (DRE). MATERIALS AND METHODS: 101 male outpatients with a serum PSA of 4-10 ng/mL and nonsuspicious DRE for prostate cancer who underwent first transrectal ultrasound with a prostate biopsy were recruited. A blood sample to enable tPSA, free PSA, and p2PSA levels to be calculated was drawn before the prostate biopsy. The diagnosis and detection of high-grade cancer are correlated with the blood sample. RESULTS: Sixteen patients were positive for prostate cancer. All had significantly higher serum 2pPSA and PHI levels than patients with no cancer. A PHI level at 90% sensitivity (cutoff of 34.14) demonstrated a higher area under the receiver operating characteristic curve and more specificity in diagnosis and detection of high-grade prostate cancer than other tests. CONCLUSIONS: The PHI in men with a PSA level of 4-10 ng/mL with negative DRE increased specificity in the detection of prostate cancer. This test is useful in discriminating between patients with or without cancer and also enables the detection of high-grade cancer avoiding unnecessary biopsies.

Management of metastatic castration-resistant prostate cancer: Insights from urology experts in Thailand.

Treatment options for castration-resistant prostate cancer (CRPC) are available, but clear instructions for the selection of appropriate treatment are lacking. A meeting of urology experts based in Thailand was convened with the following objectives: (1) to reach a consensus and share real-life experiences about how to identify CRPC; (2) to choose the appropriate treatment for CRPC patients; (3) to evaluate disease progression using novel inhibitors of the androgen receptor pathway; (4) to identify the frequency of monitoring disease; and (5) to promote rational use of corticosteroids in CRPC patients. This consensus document can provide guidance to other urologists in Thailand to provide appropriate treatment to metastatic CRPC patients in a timely manner.

The resolution of detrusor over activity after medical and surgical treatment in patients with bladder outlet obstruction.

OBJECTIVE: This study was design to evaluate the efficacy of transurethral resection of prostate (TURP) compared to alpha-adrenoceptor antagonists (Alfuzosin SR) for the treatment of patients with benign prostatic hyperplasia BPH concomitant with detrusor overactivity (DO). MATERIAL AND METHOD: The patients presenting with lower urinary tract symptoms (LUTS), due to benign prostatic enlargement were invited into the present study. These patients completed the International Prostatic Symptom Score (IPSS), the Quality of Life score (QoL), and underwent urodynamic investigation. Twenty-five patients with urodynamics proving bladder outlet obstruction and concomitant detrusor overactivity were allocated into two groups. Group I was treated by TURP (surgical treatment group) and group 2 was treated with Alfuzosin SR (medical treatment group). Twelve patients were allocated to group 1 and the remainder 13 to group 2. Reassessment was performed after three months when the patients completed the International Prostatic Symptom Score (IPSS), Quality of Life score (QoL), and urodynamics study. RESULTS: Mean patient age was compared for both groups (70 +/- 2.5 years in group I and 70.7 +/- 1.8 in group 2, p = 0.84). There were no statistically significant differences between baseline clinical and urodynamic characteristics of patients in the different treatment groups. IPSS and QoL scores improved significantly after treatment in each group. A statistically significant difference after treatment was noted in group I for the obstruction urodynamic parameters (Qmax, PdetQmax, Bladder outlet obstruction index). In group 2, a significant improvement was found in PdetQmax and Bladder outlet obstruction index, but not in Qmax. Detrusor overactivity persisted in three patients of group 1 (75% resolution), while two patients in group 2 were free from detrusor overactivity (15% resolution) (Chi-square = 0.001). CONCLUSION: Surgical treatment of benign prostatic hyperplasia, particularly TURP, significantly reduces the incidence of detrusor overactivity concurrent with bladder outlet obstruction, when compared with the use of alpha-adrenoceptor antagonists alone.