Adverse Short-Term Postoperative Outcomes in Patients Treated with Radical Prostatectomy Predicted by Preoperative Frailty - Editorial

The majority of urologists performing radical prostatectomy in developed populations are doing so with robotic platforms. Since adopting this approach, many of us have observed that our patients appear to have less pain and recover more rapidly. If we are brutally honest with ourselves, we have all probably lowered our bar for accepting patients for surgery on the basis of overall health because they seem to handle robotic-assisted surgery better than open surgery. In my own practice, for patients not willing to consider radiotherapy and were frail by my own subjective assessment, I would routinely send these patients for a review by one of my internal medicine colleagues who is by training a geriatrician and has developed a special interest in perioperative medicine. Almost always, these patients were then being cleared for surgery and gradually I have found that I am operating on more of these types of patients apart from just older patients.


stephen j freedland

Stephen J. Freedland, MD

Stephen J. Freedland, MD, is director of the Center for Integrated Research in Cancer and Lifestyle and co-director of the Cancer Genetics and Prevention Program and Associate Director for Faculty Development at the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute. He is also a faculty physician in the Division of Urology within the Department of Surgery at Cedars-Sinai. He has served on numerous American Urological Association guideline panels for prostate cancer and co-chaired a prostate cancer guideline panel for the American Society of Clinical Oncology.

Dr. Freedland's clinical area of expertise focuses on urological diseases, particularly benign prostatic hyperplasia and prostate cancer. His approach toward cancer prevention and awareness focuses on treating the whole patient, not just the disease, by combining traditional Western medicine with complementary holistic interventions. His research interests include investigations on urological diseases and the role of diet, lifestyle and obesity in prostate cancer development and progression, as well as prostate cancer among racial groups and risk stratification for men with prostate cancer.

PCAN: January 2021

Preoperative Frailty Predicts Adverse Short-Term Postoperative Outcomes in Patients Treated with Radical Prostatectomy - Full-Text Article

Background - To investigate the effect of frailty on short-term postoperative outcomes in patients with prostate cancer treated with radical prostatectomy (RP).

Methods - Within the National Inpatient Sample database, we identified 91,618 RP patients treated between 2008 and 2015. The Johns Hopkins Adjusted Clinical Groups frailty-defining indicator was applied, and we examined the rates of frailty over time, as well as its effect on overall complications, major complications, nonhome-based discharge, length of stay (LOS), and total hospital charges (THCs). Time trends and multivariable logistic, Poisson and linear regression models were applied.
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PCAN: December 2020

3-Year Results Following Treatment with the Second Generation of the Temporary Implantable Nitinol Device in Men with LUTS Secondary to Benign Prostatic Obstruction - Full-Text Article

Background - To report the 3-year results of a prospective, single arm, multicenter, international clinical study with the second generation of the temporary implantable nitinol device (iTIND; Medi-Tate Ltd®, Israel) on men suffering lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO).
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PCAN: November 2020

Abiraterone and Enzalutamide Had Different Adverse Effects on the Cardiovascular System: A Systematic Review with Pairwise and Network Meta-Analyses - Full Text Article

Background Abiraterone and enzalutamide may increase the risk of cardiovascular events in patients with castration-resistant prostate cancer (CRPC).

Methods A comprehensive literature search was performed using a combination of keywords related to “abiraterone,” “enzalutamide,” “prostate cancer,” and “adverse events.” Phase II–IV randomized controlled trials (RCTs) on abiraterone
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PCAN: October 2020

Immunohistochemistry-Based Assessment of Androgen Receptor Status and the AR-Null Phenotype in Metastatic Castrate Resistant Prostate Cancer - Full Text Article

Background Molecular and immunohistochemistry-based profiling of prostatic adenocarcinoma has revealed frequent Androgen Receptor (AR) gene and protein alterations in metastatic disease. This includes an AR-null non-neuroendocrine phenotype of metastatic castrate-resistant prostate cancer which may be less sensitive to androgen receptor signaling inhibitors. This AR-null non-neuroendocrine phenotype is thought to be associated with TP53 and RB1 alterations. Herein, we have correlated molecular profiling of metastatic castrate-resistant prostate cancer with AR/P53/RB immunohistochemistry and relevant clinical correlates.
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PCAN: September 2020

Diagnostic Performance of 18F-PSMA-1007 PET/CT in Biochemically Relapsed Patients with Prostate Cancer with PSA Levels ≤ 2.0 Ng/ml - Full Text Article

Background: The aim of the study was to prospectively evaluate the diagnostic performance of 18F-PSMA-1007 PET/CT in patients with prostate cancer (PCa) after radical treatment and low but rising prostate-specific antigen (PSA) levels.

Methods: We prospectively enrolled 40 consecutive patients after radical treatment (80%—radical prostatectomy, 20%— radiation beam therapy) of PCa and low (0.008 to ≤2.0 ng/ml), rising PSA. Skull to mid-thigh PET/CT imaging was performed 95 (±12) min after injection of 295.5 (±14.1) MBq 18F-PSMA-1007. Detection rate was correlated with PSA levels,
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PCAN: August 2020

Testosterone Therapy does not Increase the Risks of Prostate Cancer Recurrence or Death after Definitive Treatment for Localized Disease - Full Text Article

Background: The safety of testosterone therapy (TT) after definitive treatment for localized prostate cancer remains undefined. We analyzed the risks of biochemical recurrence and mortality in men receiving TT after treatment for localized prostate cancer.

Methods: Cohort analysis using the national US Veterans Affairs Informatics and Computing Infrastructure. We identified 69,984 patients with localized prostate cancer diagnosed from 2001 to 2015 treated with surgery or radiation. We coded receipt of TT after treatment as a time-dependent covariate; used the National Death Index to identify cause of death; and defined biochemical recurrence as PSA > 0.2 ng/mL after surgery and nadir + 2 ng/mL after radiation. We analyzed recurrence and mortality using cumulative incidence curves, Fine–Gray competing risk regression, and Cox regression.
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