OBJECTIVE: Since its introduction in the Philippines in 2001, low dose rate brachytherapy (permanent I-125 prostate seed implant) has become one of the widely utilized modality for the treatment of localized prostate cancer. This study aimed to evaluate the long-term clinical outcomes of low dose rate prostate brachytherapy (Permanent I-125 Prostate Seed Implant) in terms of overall survival (OS), disease specific survival (DSS), biochemical no evidence of disease (BNED), complications and mortality.

MATERIALS AND METHODS: Two hundred and two consecutive patients who underwent permanent I-125 prostate seed implant from April 2002 to December 2012 were included in this study. The details of all patients were derived from the database of a single urologist. The median follow up is 6.3 years. Kaplan-Meier curves were used to evaluate overall survival, prostate cancer specific survival and biochemical no evidence of disease (defined by the ASTRO criteria) across all disease risks. Treatment-related complications and causes of mortality were also reviewed.

RESULTS: The 11-year overall survival and disease-specific survival rates were 89.1% and 98%, respectively. The biochemical no evidence of disease was 82.7%. Log rank testing showed that survival in terms of OS, DSS, and BNED did not differ significantly regardless of risk stratification into low, moderate and high risk groups. The treatment-related morbidity rate for this series was 5.4%.

CONCLUSION: Brachytherapy is an effective treatment for localized prostate cancer with favorable long term survival results, durable biochemical outcomes, and minimal toxicity.

Human ; Male ; Aged 80 and over ; Aged ; Middle Aged ; Adult ; Neoplasms ; Prostatic Neoplasms ; Brachytherapy ; Prosthesis Implantation

OBJECTIVE: Radical prostatectomy (RP), brachytherapy, cryosurgical ablation and intensity-modulated radiotherapy (IMRT) are accepted treatment options for localized prostate cancer. The objectives of this study were to determine the overall survival (OS), disease specific survival (DSS) and biochemical no evidence of disease (BNED) rates of the patients who underwent these different treatment modalities.

MATERIALS AND METHODS: A total of 485 patients with localized prostate cancer treated with RP (n=235), brachytherapy (n=202), cryosurgical ablation (n=33), and IMRT (n=15) were identified from the database of a single urological practice. Analysis of variance (ANOVA) was used to compare means of patients. Chi-square test was used to compare percentages. Kaplan-Meier survival analysis was used to determine if the outcome parameters significantly differed according to the methods. P-values less than 0.05 indicate significant difference. All the statistical tests were performed using SPSS 20.0.

RESULTS: The OS rate after RP, brachytherapy, cryosurgical ablation and IMRT were 97.9%, 89.1%, 93.9% and 93.3%, respectively. The DSS rate was 99.6%, 98.0% and 97.0%. respectively. No mortality from prostatic cause was reported from IMRT. The BNED rate was 90.6%, 88.1%, 78.8% and 93.3%, respectively.

CONCLUSION: The overall and disease specific survival were comparable among all treatment modalities. Although radical prostatectomy and IMRT showed an overall better BNED outcomes, this advantage disappeared when the patients were analyzed according to their respective risk stratification into low, moderate and high risk group.

Human ; Male ; Aged 80 and over ; Aged ; Middle Aged ; Adult ; Neoplasms ; Prostatic Neoplasms-therapeutics, therapy ; Survival

OBJECTIVE: This study aims to determine the tumor location of prostate adenocarcinoma in patientswho underwent Robotic Radical Prostatectomy (RRP) for localized and locally-advanced prostatecancer and the correlation of the tumor location with the incidence of biochemical recurrence. PATIENTS AND METHODS: The authors reviewed the patient database of a single Urological Oncologistfrom January 2015 to April 2017 for patients who underwent RRP for localized or locally-advancedprostate cancer. They also reviewed the histopathologic report of the prostatectomy specimens todetermine pathologic T-stage, prostate volume, and post-operative Gleason score. The histopathologicexamination of specimens was interpreted by a single Urological Pathologist based on the 2014International Society of Urological Pathology Gleason Scoring System. Eligible patients were thendivided into three groups: those with pure anterior tumor location, pure posterior tumor location,and mixed tumor location. Presence of positive surgical margins, mean follow-up period, andbiochemical recurrence were determined for these groups. Patient demographic data were analyzedusing test of proportions. Correlation of tumor location with biochemical recurrence was derivedusing Pearson chi-square test. RESULTS: Of the 113 patients included in the study, 63 (55.8%) were clinically-staged T2 patients while27 (23.9%) and 23 (20.3%) were clinical stage T1 and T3, respectively. On pre-operative prostatebiopsy, 27 (23.9%) patients had a Gleason score of 8-10. Thirty-eight (33.6%) and 30 (26.6%) had aGleason score of 6 (3+3) or 7 (3+4), respectively Average prostate volume was 42.8 grams. Ninety-five (84.1%) of the patients had mixed tumor location, 11 (11.6%) had pure posterior tumor location,and only 7 (6.2%) had pure anterior tumor location. In those with pure anterior or posterior tumorlocations, majority were low-grade prostate cancers (Gleason 6(3+3) and Gleason 7(3+4)) whilethose with mixed tumor location had low to high-grade prostate cancers (Gleason 7 (3+4) and Gleason7 (4+3.)) Majority of the patients had pathologic T2c and T3a tumors across all groups. Positivesurgical margins were present in 31% of those with mixed tumor location and only 0.9% in those withpure anterior or posterior tumor location, respectively. Only 10 patients from the population hadbiochemical recurrence, 9 of which had mixed tumor location while 1 had pure posterior tumorlocation. Pearson chi-square test shows no significant relationship between tumor location andbiochemical recurrence at 95% CI (p= regional involvement 0.695.) Furthermore, there is a very weak positive correlation (R=0.069) between tumor location and biochemical recurrence. CONCLUSION Majority of patients who underwent RRP have mixed tumor location. There is poorcorrelation between prostate cancer tumor location and biochemical recurrence.

OBJECTIVE: The detection rate of the current standard systematic 12 core transrectal ultrasound (TRUS)guided prostate biopsy remains low despite numerous modifications of the technique. This non-randomized experimental study evaluated the accuracy of standard TRUS-guided systematic prostatebiopsy as performed by selected urologists in obtaining samples representative of the peripheral zoneof the prostate, by analyzing virtual biopsies performed on a prostate phantom model. MATERIALS AND METHODS: Thirty (30) urologists (26 consultants and 4 senior residents) were invited toperform two consecutive simulation TRUS guided 12-core biopsies on a phantom prostate model.The task was to hit twelve equal sized spherical targets which would correspond to the lateral andextreme lateral areas of the base, mid gland and apex of the peripheral zone of the phantom prostate,which would represent the usual biopsy technique. Degree of agreement (kappa) was computed.Eight (8) operators had below satisfactory kappa values and were excluded from the succeedinganalysis. Accuracy was calculated by dividing the number of accurately hit targets by the number ofvirtual cores (12). Data were encoded in MS Excel and Stata MP v.14 was used for data analysis. RESULTS: Overall, the mean accuracy was 63.17% and median accuracy was 60% (95% CI: 49.2-65.15)for the 22 operators included in the study. The lateral regions, particularly the midgland (95.8%-100% accuracy) were the most frequently biopsied areas and were often resampled. The targets at theprostatic base were missed by most operators (36.05% accuracy). CONCLUSION Systematic TRUS guided prostate biopsy, in the manner that it is performed, has itsinherent flaws, compounded by limitations in imaging capability and intra-operator variabilityresulting in low accuracy rates. A shift to newer prostate biopsy technique and methodologies withsignificantly higher accuracy rates is recommended.

OBJECTIVE: To determine the proficiency of a single Urological Oncologist in performing RoboticRadical Prostatectomy (RRP) for localized prostate adenocarcinoma based on the following surgicaland functional outcomes: 1) operative time, 2) estimated blood loss, 3) positive surgical margin rate,4) postoperative complication rate, 5) open conversion rate, and 6) urinary continence rate. MATERIALS AND METHODS: The authors reviewed the records of a single Urological Oncologist fromJanuary 2010 to September 2017 for patients who underwent RRP for prostate adenocarcinoma.Patients were divided into 3 groups: Group 1 consisted of the first 30 cases done by the surgeon,Group 2 consisted of the next set of 30 cases, and Group 3 consisted of his cases done thereafter. Themean operative time, mean estimated blood loss, positive surgical margin rate, site of positive surgicalmargins (apex, midgland, or base), postoperative complication rate, open conversion rate, and urinarycontinence rate at 4, 8, and 12 weeks post-op were compared among the 3 groups. RESULTS: A total of 30 patients were included in Group 1, another 30 were included in Group 2, and 45patients were included in Group 3 for a total of 105. There is significant difference in the meanoperative times among the 3 groups with a Group 1 having a mean operative time of 302.1 minutes,170.3 minutes for Group 2, and 146.7 minutes for Group 3 (p<0.0001.) There is a statisticallysignificant difference in mean estimated blood loss among the 3 groups (706.9 mL, 528.2 mL and386.3 mL, respectively; p<0.0001.) No open conversion was performed in all 105 patients and only3 complications were noted in this study. There was no statistical significance with regards to positivesurgical margin rates among the 3 groups (5.7%, 11.4% and 15.2%, respectively.) with the apex beingthe most common site of positive margin in this study. There is a statistically significant difference in8-week urinary continence rate among the 3 groups (12.4%, 20% and 36.2%, respectively; p=0.005). CONCLUSION Robotic Radical Prostatectomy is quickly becoming a feasible and safe option in themanagement of localized and locally-advanced prostate cancer in the local setting. The learningcurve of 30 cases, based on the experiences of the Urological Oncologist, is sufficient in establishingproficiency in performing the said procedure.

OBJECTIVE: Vesicourethral anastomosis (VUA) is the most technically challenging part in open radical retropubic prostatectomy (ORRP). Traditionally, it is accomplished using interrupted anastomotic sutures. The objective of this study is to describe our surgical technique of continuous VUA and compare its outcomes with that of interrupted VUA as performed by a single surgeon.

MATERIALS AND METHODS: A total of 235 patients with clinically localized prostate cancer who underwent ORRP since February 2000 to June 2013 were included. They were divided into Group 1 (n=121) using interrupted VUA and Group 2 (n=114) using our technique of continuous VUA. Primary outcome measures to be evaluated include several operative parameters with respect to operative time, blood loss, anastomotic integrity, hospital stay, continence, potency and occurrence of VUA stenosis. Analysis was done using Welch's t-test and Fisher's exact test. All the statistical tests were performed using SPSS 20.0. P-values less than 0.05 indicate statistically significant difference.

RESULTS: Patients who underwent continuous VUA (Group 2) had significantly less operative time (210.05 ± 1.91 vs 251.37 ± 2.74 mins, P<0.001), anastomotic time (20.86 ± 0.49 vs 41.46 ± 0.58 mins, P<0.001), estimated blood loss (510.81 ±10.11 vs 623.89 ±26.60 ml, P<0.001), need for transfusion (7.89% vs 27.27%, P<0.001), number of days prior to drain removal (3.13 ± 0.05 vs 6.15 ± 0.11, P<0.001), number of days of hospital stay (3.44 ± 0.06 vs 6.36 ± 0.11, P<0.001), leakage per voiding cystourethrogram (0.88% vs 5.76%, P=0.035), number of days prior to urethral catheter removal (10.05 ± 0.12 vs 14.94 ± 0.2, P<0.001) and number of weeks to gain continence (7.05 ± 0.26 vs 12.46 ± 0.31, P<0.001). There were two cases of VUA stenosis for each of the two groups. There was no reported occurrence of pelvic infection, urinoma and acute urinary retention after catheter removal.

CONCLUSIONS: Our technique of continuous VUA for ORRP provides better outcome compared to standard interrupted VUA.

Human ; Male ; Aged ; Middle Aged ; Neoplasms ; Prostatic Neoplasms ; Anastomosis, Surgical ; Prostatectomy

OBJECTIVE: The purpose of this study was to compare voiding patterns of healthy infants and those with recurrent UTI aged 1-24 months.
METHODS: This was an analytical, cross sectional study of healthy infants and those with recurrent UTI, aged 1-24 months from March 1999 to March 2000 seen at University of Santo Tomas Hospital. The study included 100 subjects; Group I (50 subjects) healthy infants (neurologically intact with other anomalies ruled out by ultrasound and voiding cystourethrogram) Group 2 (50 subjects) are those with recurrent UTI. During the 24-hour period, all micturitions were recorded in terms of voiding frequency, volume and character of voiding. The observation was completed with three determination of residual urine volume using ultrasound by a single sonologist who did not know the diagnosis of each case. Voiding patterns in terms of mean voiding frequency, mean volume per voiding, mean functional bladder capacity and character of voiding were determined. Mean residual urine volume was also determined in milliliters. The two groups were compared using T test with a p value of 0.05 percent at 95 percent confidence interval.
RESULTS: The mean voiding frequency was 17.03 (SD +/- 7.5) in-group 1 and 13.5 (SD +/- 4.9) in-group 2 (p value of 0.009) The mean volume per voiding was 33.88 (SD +/- 15.2) on group 1 and 40.12 (SD +/- 37.4) in Group 2 (p value of 0.27). The mean bladder capacity was 44.02 (SD +/- 29.5) in group 1 and 66.48 (SD +/- 29.4) in group 2 (p value 0.00). In group 1 subjects, twenty eight percent showed interrupted voiding pattern compared to none in group 2 (p value 0.00). The mean residual urine volume for group 1 was 7.97 (SD +/- 7.5) and 6.06 (SD +/- 6.6) in group 2 (p value 0.183).
CONCLUSION: The voiding patterns of pediatric patients with recurrent UTI were significantly characterized by increased frequency, decreased functional bladder capacity, and interrupted voiding. Mean volume per voiding was also decreased in those with recurrent UTI but not to a significant degree. Determination of residual urine in those with recurrent UTI was not significantly different from healthy infants.

Human ; Male ; Female ; Infant ; Urination ; Urinary Bladder ; Cross-sectional Studies ; Confidence Intervals ; Urinary Tract Infections ; Urinary Retention ; Cystography ; Polyuria

OBJECTIVE: Image-guided targeted biopsy techniques have been proposed to address problems ofsystematic transrectal ultrasound guided prostate biopsies that lead to the suboptimal cancer detectionrate as well as inaccurate grading of the disease. This study aims to provide local data on the diagnosticaccuracy of multiparametric MRI (MP-MRI) and MP-MRI ultrasound cognitive fusion biopsy inidentifying areas of clinically significant malignancy of the prostate. MATERIALS AND METHODS: This is a validity study involving patients who underwent MP-MRI and MP-MRI ultrasound cognitive fusion biopsy, who eventually underwent robot-assisted laparoscopic radicalprostatectomy (RALRP). Outcome measures included sensitivity, specificity, positive and negativepredictive values of MP-MRI and MP-MRI ultrasound cognitive fusion biopsy. Reference standardused was the final histopathologic report obtained after RALRP. RESULTS: MP-MRI has a sensitivity of 35.5%, specificity of 95.2%, positive predictive value of 97.1%,and negative predictive value of 25%. MP-MRI ultrasound fusion biopsy had similar results, withsensitivity of 34.4%, specificity of 81.0%, positive predictive value of 88.9%, and negative predictivevalue of 21.8%. CONCLUSION The high specificity and positive predictive value of MP-MRI (95.2% and 97.1%respectively) indicates the necessity for a prostate biopsy and supports the utility of a targeted MP-MRI guided ultrasound cognitive fusion biopsy. However, the low sensitivity and negative predictivevalue (25% and 35% respectively) of 35.5% indicates that MP-MRI guidance does not limit thenumber of biopsy samples only to visible MP-MRI lesions, since negative areas on MP-MRI stillcontains tumors in 75% of cases.

INTRODUCTION: Robot-assisted laparoscopic radical prostatectomy is now considered the gold standardtreatment of prostate adenocarcinoma in the modern world. There are two approaches to the precisedissection of seminal vesicles (anterior and posterior) during a laparoscopic radical prostatectomy,each of which with unique advantages and disadvantages. Primarily, the authors compared theintraoperative and oncological outcomes of these two approaches. Secondary objective included theestablishment of the minimum number of cases before a surgeon can enter the competent phase of thelearning curve. MATERIALS AND METHODS: Chart review was performed on 111 patients who underwent RALP from2014-2016 performed by 3 experienced robotic surgeons with interchangeability of role as consoleoperator. Two arms were developed based on the approach of seminal vesicle dissection, that is,anterior and posterior approach. Cumulative summation of the console time was performed to obtaina chart with a) negative slope-learning phase and b) positive slope-competent phase. Patients underthe competent phases were included for analysis. RESULTS: There were no significant differences in age, body mass index, prostate volume, preoperativeprostate specific antigen (PSA), gleason score and oncologic risk. Pathology was almost similar inmajority of cases under the anterior approach arm being gleason 7 (3+4) and posterior approach armbeing gleason 6 (3+3). With a p-value of <0.05, console time was significantly shorter in the posteriorapproach at 121±25.95 when compared to anterior approach at 148±30.25 minutes. The otherperioperative and postoperative outcomes were not significantly different between the groups. CONCLUSION Posterior approach has provided a shorter console time, while the overall oncologic andperioperative outcomes for both approaches were similar. The learning curve for the anterior approachis less steep than that of the posterior approach with only 14 versus 26 consecutive cases, respectively,to be able to competently perform RALP.

OBJECTIVE: To present the authors' experience on transperineal prostate sector biopsy (TPSB) in detecting prostate cancer, in identifying both low Gleason prostate cancers as well as clinically significant prostate cancer (Gleason 7 and higher), and in determining anatomical distributions of prostate cancer in both initial and repeat biopsy settings.
METHODS: All patients from June 2014 to September 2016 who underwent TPSB, as initial biopsy or repeat biopsy after previous negative transrectal ultrasound-guided biopsy (TRUSPNB) were included. Data for each patient were collected prospectively and subjected to statistical analysis. T test was used for continuous variables while Chi square test or Fisher exact test was used for categorical variables. Multiple logistic regression models were used to identify factors predictive of a positive result.
RESULTS: A total 130 patients were included in the study, 73 had TPSB as initial biopsy and 57 as repeat biopsy after previous negative TRUSPNB. The mean patient age of the Initial Biopsy Group (IBG) was 66 years while the mean age for the Repeat Biopsy Group (RBG) was 68 years. The IBG had a lower mean serum PSA level (9.07 ng/mL for IBG and 9.59ng/mL for RBG) and smaller prostate volumes (42.9 mL for the IBG and 44.3mL for the RBG). Prostate cancer was detected in 65.8% (48/73) of the IBG and 40.4% (23/57) of RBG, of which 77.1% (37/48) and 73.9% (17/23) respectively, were clinically significant, defined as a Gleason score of ?7. Of the cancers detected in IBG, 29.2% (14/48) exclusively involved the anterior sector (based on the Ginsburg Study Group's biopsy map), while 30.4% (7/23) were conned exclusively within the anterior sector for the RBG. Increasing PSA level and lower prostate volumes were predictive of cancer detection in RBG, while only increasing PSA level was predictive of a positive result in IBG.
CONCLUSION: Transperineal prostate sector biopsy demonstrated a high prostate cancer detection rate for both the initial and repeat biopsy settings. Likewise it provides for excellent sampling of the anterior region of the prostate, as it affords a more accurate sampling of the prostate gland based on a preplanned map and template to sample areas of interests. Similarly, it detects a high proportion of patients with clinically significant prostate cancer. This technique should therefore be highly considered as a first line option for all patients in whom a prostate biopsy is warranted.

Human ; Male ; Aged ; Chi-square Distribution ; Image-guided Biopsy ; Logistic Models ; Longitudinal Studies ; Neoplasm Grading ; Prostatic Neoplasms