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3 "Prostatic neoplasms"
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Initial experience with Retzius-sparing robot-assisted radical prostatectomy compared to the conventional method: is it a suitable option for robotic prostatectomy beginners?
Su Hwan Kang
Kosin Med J. 2023;38(4):267-273.   Published online November 9, 2023
DOI: https://doi.org/10.7180/kmj.23.143
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Abstract PDFPubReader   ePub   
Background
Retzius-sparing robot-assisted radical prostatectomy (rsRARP) is a surgical procedure that can minimize the resection of surrounding prostate tissue by enabling access through the anterior surface of the Douglas pouch. We reported our initial experiences with rsRARP compared to conventional robot-assisted radical prostatectomy (RARP).
Methods
Retrospective data were collected from March 2019 to June 2022, including 69 patients who underwent robotic radical prostatectomy for localized prostate cancer. The operations were performed at a single center, and we alternated between the two methods. Perioperative characteristics and oncologic and functional outcomes were analyzed.
Results
In total, 35 patients underwent RARP and 34 patients underwent rsRARP. The preoperative characteristics of the patients were similar. Oncologic and functional parameters were analyzed postoperatively. Except for early recovery of urinary incontinence (immediate, 1 month, 3 months, 6 months: p<0.001, p=0.002, p=0.004, and p=0.014, respectively), there were no significant differences between the two groups. We also analyzed trends in operation time and oncologic and functional outcomes according to the progression of rsRARP cases.
Conclusions
rsRARP has the major advantage of enabling an early recovery from urinary incontinence after surgery, and it is also a good surgical approach that shows oncologically similar results to the conventional approach. It is also highly reproducible and can be recommended to surgeons new to robotic radical prostatectomy.
The COVID-19 pandemic's impact on prostate cancer screening and diagnosis in Korea
Byeong Jin Kang, Kyung Hwan Kim, Hong Koo Ha
Kosin Med J. 2023;38(3):193-200.   Published online August 16, 2023
DOI: https://doi.org/10.7180/kmj.23.116
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Abstract PDFPubReader   ePub   
Background
The global coronavirus disease 2019 (COVID-19) pandemic, which started in early 2020, has had multiple impacts on cancer care. This study assessed how the COVID-19 pandemic influenced prostate cancer (PCa) screening and diagnosis in South Korea.
Methods
Patients who visited the outpatient clinic at a single institution for PCa evaluation were included in this study and divided into a pre-COVID-19 group and a COVID-19 pandemic group, based on the start of the COVID-19 pandemic and social distancing policies on March 1, 2020. The number of prostate-specific antigen (PSA) tests, patients with elevated PSA levels, and prostate biopsy results were analyzed.
Results
In total, 8,926 PSA tests were administered during the COVID-19 pandemic, compared to 15,654 before the pandemic (p<0.05). Of 2,132 patients with high PSA levels, 1,055 (49.5%) received prostate biopsies before the pandemic and 1,077 (50.5%) did so during the COVID-19 pandemic. The COVID-19 pandemic group had a higher detection rate of PC, and increased rates of Gleason scores (GS) 7 and 9–10, while the rate of GS 6 decreased compared to the pre-COVID-19 group (p<0.05). The rate of clinically significant PCa (csPCa) was also higher during the pandemic (p<0.05). In both magnetic resonance imaging-guided and standard biopsies, the GS 6 rate decreased, and the csPCa rate increased during the COVID-19 pandemic (each, p<0.05).
Conclusions
During the COVID-19 pandemic, the detection rate of prostate biopsies and the rate of csPCa increased significantly. Thus, PCa was diagnosed at a more advanced state in Korea during the COVID-19 pandemic.
Cribriform Pattern at the Surgical Margin is Highly Predictive of Biochemical Recurrence in Patients Undergoing Radical Prostatectomy
Kyung Hwan Kim, Ja Yoon Ku, Chan Ho Lee, Won Young Park, Hong Koo Ha
Kosin Med J. 2019;34(2):95-105.   Published online December 31, 2019
DOI: https://doi.org/10.7180/kmj.2019.34.2.95
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  • 4 Download
  • 1 Citations
Abstract PDFPubReader   ePub   
Objectives

We investigated the relationship between cribriform patterns and biochemical recurrence in patients with positive surgical margins after radical prostatectomy.

Methods

This study was based on radical prostatectomy specimens obtained from 817 patients (165 with margin-positive status) collected at a single center between 2010 and 2016. We retrospectively analyzed and compared body mass index, preoperative prostate-specific antigen, Gleason score, operative methods, postoperative Gleason score, pathological T-stage, tumor percentage involvement, lymphatic and perineural invasion, prostate-specific antigen nadir, location and length of the positive margin, cribriform pattern status, and Gleason grade at the surgical margin in terms of their association with biochemical recurrence. Risk factors for biochemical recurrence were also investigated.

Results

21% (31/146) of surgical margin-positive patients had a cribriform pattern. Nadir prostate-specific antigen, perineural invasion and biochemical recurrence rates were significantly higher in cribriform pattern present group than absent group (P = 0.031, 0.043 and 0.045, respectively). According to the Cox regression model, postoperative Gleason score, tumor percentage involvement, location and length of the positive margin, and the presence of a cribriform pattern at the surgical margin were significant predictive factors of biochemical recurrence (P = 0.022, < 0.001, 0.015, 0.001, and 0.022, respectively). Moreover, the biochemical recurrence risk was approximately 3-fold higher in patients with a cribriform pattern at the surgical margin than in those without (HR: 3.41, 95% CI 1.20-9.70, P = 0.022).

Conclusions

A cribriform pattern at the surgical margin is a significant predictor of biochemical recurrence in patients who undergo radical prostatectomy.

Citations

Citations to this article as recorded by  
  • Length of positive surgical margins after radical prostatectomy: Does size matter? – A systematic review and meta-analysis
    Athul John, Alicia Lim, Rick Catterwell, Luke Selth, Michael O’Callaghan
    Prostate Cancer and Prostatic Diseases.2023; 26(4): 673.     CrossRef

KMJ : Kosin Medical Journal