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Einleitung: Es sollte untersucht werden, wie sich die Implementierung eines standardmäßigen Erhalt des funktionellen Harnröhrenschließmuskels in voller Länge (FFLU) und der Erhalt des neurovaskulären Bündels (NVBP) mit intraoperativer Schnellschnitttechnik (IFT) auf [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund: Es wurden die Auswirkungen von Diabetes mellitus (DM) auf die frühe Harnkontinenz bei Patienten untersucht, die sich einer radikalen Prostatektomie (RP) unterziehen. Methoden: Es erfolgte die Identifizierung der Patienten aus der Datenbank des Universitätsklinikums Frankfurt, [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund: Es erfolgt die Untersuchung der Auswirkungen der Länge des Harnröhrenschließmuskels und der anatomischen Varianten des Apex der Prostata (Lee-Typ-Klassifikation) in der präoperativen multiparametrischen Magnetresonanztomographie (mpMRT) auf die mittelfristige Harnkontinenz [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Einleitung: Sehr niedrige PSA-Werte bei Patienten mit high-risk Prostatakrebs (PCa) k��nnen ein Zeichen f��r Dedifferenzierung und konsekutiv vergesellschaftet mit schlechter Prognose sein. Methoden: Retrospektive Analyse von 3.010 Patienten mit neu diagnostiziertem high-risk PCa (Gleason [zum vollst��ndigen Text gelangen Sie ��ber die oben angegebene URL]

Radioligand therapy with Lutetium-177 (177Lu)-Prostate-specific membrane antigen (PSMA) has shown to prolong survival in metastatic castration resistant prostate cancer (mCRPC). One of the major challenges for clinicians in the future is to select those patients who would benefit most from this therapy to position it in the treatment landscape of mCRPC. This, in turn, will lead to the delivery of personalized therapies. In this narrative review article we summarize recent studies investigating both predictive and prognostic clinical, imaging-based, and molecular biomarkers to predict treatment response to 177Lu-PSMA-617 radioligand therapy with the aim of identifying men who should be considered for this approach. Of note, the evidence on the role of biomarkers currently relies on small retrospective trials and their validation in larger prospective cohorts is necessary before these results can be translated in the clinical practice.

With the therapeutic landscape of advanced prostate cancer rapidly evolving and oncological benefits being shown for a plethora of new agents and indications, health-related quality of life (HRQOL)-associated evidence is still subpar. In the current comprehensive review, we discuss the importance of HRQOL for patients with advanced PC (metastatic hormone-sensitive prostate cancer (mHSPC), metastatic castration-resistant prostate cancer (mCRPC) and non-metastatic castration-resistant prostate cancer (nmCRPC)), and present the most frequently used tools to evaluate HRQOL in recent randomized trials. Furthermore, we discuss the ease of use of these validated questionnaires for clinicians and try to focus on the suggested appropriate use in clinical practice, as well as potential strategies for improvement of HRQOL evaluation in these clinical scenarios of advanced prostate cancer.

Hintergrund: Der Einfluss der Zeit bis zur Kastrationsresistenz (TTCR) bei Patienten mit metastasiertem hormonsensitivem Prostatakarzinom (mHSPC) auf das Gesamtüberleben (OS) in der Ära der Kombinationstherapien für mHSPC wurde untersucht. Material und Methoden: Von 213 mHSPC Patienten,[zum vollständigen Text gelangen Sie über die oben angegebene URL], 61. Jahrestagung der Südwestdeutschen Gesellschaft für Urologie e.V.

Einleitung: Die robotisch-assistierte laparoskopische radikale Prostatektomie (RALP) stellt eines der chirurgischen Standardverfahren beim Prostatakarzinom (PCa) dar. Eine suffiziente urethrovesikale Anastomose (uA) erlaubt eine frühe Entfernung des transurethralen Katheters. Methode: Im [zum vollständigen Text gelangen Sie über die oben angegebene URL], 61. Jahrestagung der Südwestdeutschen Gesellschaft für Urologie e.V.

The role and timing of radiotherapy (RT) in prostate cancer (PCa) patients treated with radical prostatectomy (RP) remains controversial. While recent trials support the oncological safety of early salvage RT (SRT) compared to adjuvant RT (ART) in selected patients, previous randomized studies demonstrated that ART might improve recurrence-free survival in patients at high risk for local recurrence based on adverse pathology. Although ART might improve survival, this approach is characterized by a risk of overtreatment in up to 40% of cases. SRT is defined as the administration of RT to the prostatic bed and to the surrounding tissues in the patient with PSA recurrence after surgery but no evidence of distant metastatic disease. The delivery of salvage therapies exclusively in men who experience biochemical recurrence (BCR) has the potential advantage of reducing the risk of side effects without theoretically compromising outcomes. However, how to select patients at risk of progression who are more likely to benefit from a more aggressive treatment after RP, the exact timing of RT after RP, and the use of hormone therapy and its duration at the time of RT are still open issues. Moreover, what the role of novel imaging techniques and genomic classifiers are in identifying the most optimal post-operative management of PCa patients treated with RP is yet to be clarified. This narrative review summarizes most relevant published data to guide a multidisciplinary team in selecting appropriate candidates for post-prostatectomy radiation therapy.

Objective: Radical prostatectomy (RP) is a frequent treatment for men suffering from localized prostate cancer (PCa). Whilst offering a high chance for cure, it does not come without a significant impact on health-related quality of life. Herein we review the common adverse effects RP may have over the course of time. Methods: A collaborative narrative review was performed with the identification of the principal studies on the topic. The search was executed by a relevant term search on PubMed from 2010 to February 2021. Results: Rates of major complications in patients undergoing RP are generally low. The main adverse effects are erectile dysfunction varying from 11 to 87% and urinary incontinence varying from 0 to 87% with a peak in functional decline shortly after surgery, and dependent on definitions. Different less frequent side effects also need to be taken into account. The highest rate of recovery is seen within the first year after RP, but even long-term improvements are possible. Nevertheless, for some men these adverse effects are long lasting and different, less frequent side effects also need to be taken into account. Despite many technical advances over the last two decades no surgical approach can be clearly favored when looking at long-term outcome, as surgical volume and experience as well as individual patient characteristics are still the most influential variables. Conclusions: The frequency of erectile function and urinary continence side effects after RP, and the trajectory of recovery, need to be taken into account when counseling patients about their treatment options for prostate cancer.

Focal therapy is a modern alternative to selectively treat a specific part of the prostate harboring clinically significant disease while preserving the rest of the gland. The aim of this therapeutic approach is to retain the oncological benefit of active treatment and to minimize the side-effects of common radical treatments. The oncological effectiveness of focal therapy is yet to be proven in long-term robust trials. In contrast, the toxicity profile is well-established in randomized controlled trials and multiple robust prospective cohort studies. This narrative review summarizes the relevant evidence on complications and their management after focal therapy. When compared to whole gland treatments, focal therapy provides a substantial benefit in terms of adverse events reduction and preservation of genito-urinary function. The most common complications occur in the peri-operative period. Urinary tract infection and acute urinary retention can occur in up to 17% of patients, while dysuria and haematuria are more common. Urinary incontinence following focal therapy is very rare (0-5%), and the vast majority of patients recover in few weeks. Erectile dysfunction can occur after focal therapy in 0-46%: the baseline function and the ablation template are the most important factors predicting post-operative erectile dysfunction. Focal therapy in the salvage setting after external beam radiotherapy has a significantly higher rate of complications. Up to one man in 10 will present a severe complication.

Objective: To examine the incidence and time trends of secondary bladder cancer (BCa) and rectal cancer (RCa) after brachytherapy (BT) relative to radical prostatectomy (RP). Materials and Methods: Within the Surveillance, Epidemiology and End Results (SEER) database (1988–2015), we identified patients with localized PCa as an only or first primary cancer, who underwent BT or RP. Cumulative incidence plots and multivariable competing-risks regression (CRR) models were used. Sensitivity analyses focused on patients’ age and year of diagnosis intervals and tested the effect of an unmeasured confounder. Results: Of 318058 patients with localized prostate cancer (PCa), 55566 (18.4%) underwent BT. After propensity score-matching, 20-year secondary BCa incidence was 6.0% in patients who had undergone BT vs 2.4% in those who had undergone RP (P < 0.001) and the respective 20-year secondary RCa incidence was 1.1% vs 0.5% (P < 0.001). In multivariable CRR models, BT predicted higher secondary BCa (hazard ratio [HR] 1.58; P < 0.001) and RCa rates (HR 1.59; P < 0.001) vs RP. Sensitivity analyses replicated the same results after stratification according to age and showed HRs of decreasing magnitude for historical, intermediate and contemporary years of diagnosis. An unmeasured confounder with an HR of 2 would render the effect of BT statistically insignificant if it affected patients in the RP group with a ratio of 2 relative to those in the BT group. Finally, temporal trends showed a decrease of secondary 5-year BCa and RCa rates.>. Conclusions: Brachytherapy predominantly increases the risk of secondary BCa and, to a lesser extent, that of RCa. Follow-up of such patients is therefore required. It is encouraging that both secondary BCa, and RCa rates, in particular, have recently decreased, RCa.

Einleitung: Der Erhalt des Gefäß-Nervenbündels (NVB) und ein negativer chirurgisches Absetzungsrand (R0) sind die wichtigsten intraoperativen Faktoren, die das funktionelle und onkologische Ergebnis bei Patienten mit radikaler Prostatektomie (RP) beeinflussen. In der vorliegenden Studie[zum vollständigen Text gelangen Sie über die oben angegebene URL], 60. Jahrestagung der Südwestdeutschen Gesellschaft für Urologie e.V.

Zielsetzung: Zur Untersuchung der Prostatakarzinom-Detektionsraten der Magnetresonanztomographie(MRT)/Ultraschall Fusions-gestützten Targetbiopsie (TB) in Kombination mit einer systematischen Biopsie (SB) in der Detektion des Prostatakarzinoms (PCa). Patienten und Methoden: 222 konsekutive[zum vollständigen Text gelangen Sie über die oben angegebene URL], 60. Jahrestagung der Südwestdeutschen Gesellschaft für Urologie e.V.

Einleitung: Neben vielen Vorteilen der transrektalen Prostatastanzbiopsie wie die einfache und schnelle Durchführbarkeit und die fehlende Notwendigkeit einer Narkose im Vergleich zur perinealen Biopsie, wird als möglicher Nachteil oftmals ein erhöhtes Infektionsrisiko angeführt. [zum vollständigen Text gelangen Sie über die oben angegebene URL], 60. Jahrestagung der Südwestdeutschen Gesellschaft für Urologie e.V.

Thematik: Die MRT-gesteuerte Biopsie (TB) der Prostata erhöht die Gesamtdetektionsraten von Prostatakarzinomen (PCas) und reduziert die Detektionsrate klinisch nicht-relevanter Karzinome. Bestandteil aktueller Debatten ist der Einfluss der Biopsieverfahren in Hinblick auf die endgültige histologische[zum vollständigen Text gelangen Sie über die oben angegebene URL], 60. Jahrestagung der Südwestdeutschen Gesellschaft für Urologie e.V.

Einleitung: Der Erhalt der maximalen Harnröhrenlänge (full functional length of the urethral sphincter (FFLU) sowie eine nerverhaltende Operation haben einen positiven Einfluss auf die mittel- und langfristige postoperativen Kontinenz nach radikaler Prostatektomie (RP). Informationen über[zum vollständigen Text gelangen Sie über die oben angegebene URL], 60. Jahrestagung der Südwestdeutschen Gesellschaft für Urologie e.V.