Abstract Objective Transrectal (TR) prostate biopsy is being increasingly abandoned in favour of a transperineal (TP) approach as well as a targeted biopsy only of the index lesion(s). It remains underreported how these changes could impact concordance at final pathology. We aimed to evaluate the impact of transitioning from standard transrectal (sTR) to cognitive targeted transperineal (cog‐tTP) biopsy on final pathology including concordance and upgrading. Material and methods Analysis of consecutive patients undergoing prostate biopsy and prostatectomy (RP) between January 2018 and May 2022 at a tertiary centre in Western Norway. Results There were 210 and 239 patients in the sTR and cog‐tTP groups, respectively. The mean [IQR] number of biopsies decreased from 12 [4–12] to 3 [3–4] ( p < 0.001). The overall rate of concordance between biopsy and final pathology was 64% in both groups (Table 3, Figure 1). 24% Twenty‐four per cent (cog‐tTP) versus 19% (sTR) had grade group (GG) upgrading, while 12% versus 17% were downgraded ( p = 0.2). Regarding positive surgical margins (PSMs) that were >3 mm in extension, there were only 3.3% and 2.1% in the sTR and cog‐tTP groups, respectively ( p = 0.4). For surgical outcomes associated with RP, no differences in terms of postoperative complications between the groups were found (cog‐tTP:10% vs. sTR:6%, p = 0.10). Conclusion Transitioning from sTR biopsy to targeted cog‐tTP biopsy does not compromise concordance at final pathology nor does it increase the risk of tumour upgrading.
Bladder neck contracture is a recognised complication associated with radical prostatectomy.The management can be challenging, especially when refractory to initial intervention strategies.For the patient, the burden of disease is high and continence status cannot be overlooked.This review serves to provide an overview of the management of this recognised clinical pathology.Consideration needs to be given to minimally invasive approaches such as endoscopic incision, injectables, implantable devices as well as major reconstructive surgery where the condition persists.For the latter, this can involve open and robotic surgery as well as use of grafts and artificial sphincter surgery.These elements underline the need for a tailored and a patient centred approach.
There are no well-established re-treatment options for local recurrence after primary curative radiation therapy for prostate cancer (PCa), as prospective studies with long-term follow-up are lacking. Here, we present results from a prospective study on focal salvage reirradiation with external-beam radiation therapy with a median follow-up of 7.2 years.
Abstract Metastatic castration-resistant prostate cancer (mCRPC) is an immunologically cold disease with dismal outcomes. Cryoablation destroys cancer tissue, releases tumor-associated antigens and creates a pro-inflammatory microenvironment, while dendritic cells (DCs) activate immune responses through processing of antigens. Immunotherapy combinations could enhance the anti-tumor efficacy. This open-label, single-arm, single-center phase I trial determined the safety and tolerability of combining cryoablation and autologous immature DC, without and with checkpoint inhibitors. Immune responses and clinical outcomes were evaluated. Patients with mCRPC, confirmed metastases and intact prostate gland were included. The first participants underwent prostate cryoablation with intratumoral injection of autologous DCs in a 3 + 3 design. In the second part, patients received cryoablation, the highest acceptable DC dose, and checkpoint inhibition with either ipilimumab or pembrolizumab. Sequentially collected information on adverse events, quality of life, blood values and images were analyzed by standard descriptive statistics. Neither dose-limiting toxicities nor adverse events > grade 3 were observed in the 18 participants. Results indicate antitumor activity through altered T cell receptor repertoires, and 33% durable (> 46 weeks) clinical benefit with median 40.7 months overall survival. Post-treatment pain and fatigue were associated with circulating tumor cell (CTC) presence at inclusion, while CTC responses correlated with clinical outcomes. This trial demonstrates that cryoimmunotherapy in mCRPC is safe and well tolerated, also for the highest DC dose (2.0 × 10 8 ) combined with checkpoint inhibitors. Further studies focusing on the biologic indications of antitumor activity and immune system activation could be considered through a phase II trial focusing on treatment responses and immunologic biomarkers.
Objectives To report a single‐centre experience of a complete transition from transrectal (TR) to transperineal (TP) prostate biopsy under local anaesthesia using a freehand cognitive coaxial approach and without use of antibiotic prophylaxis. Patients and Methods Analysis was performed of a prospective database of patients undergoing prostate biopsy performed by four surgeons between 1 June 2018 and 31 May 2022. Outcomes of interest were complications, cancer detection rate, inter‐operator reliability, and tolerability. Results Overall, 1915 patients underwent 2337 separate prostate biopsy sessions. Only 2.4% patients in the TP group received antibiotic prophylaxis, while 100% received antibiotics in the TR group. The complication rate was significantly lower in the TP group compared to the TR group (0.3% vs 5.0%, P < 0.001). In contrast to the TR group, there were no cases of urosepsis or admissions to intensive care in the TP group. The total cancer detection rate by TP biopsy was 70% and the overall pathology detection rate was 88.4%. There was no difference in cancer or pathology detection between operators. A stable level of cancer detection was reached early on for both Prostate Imaging‐Reporting and Data System 4 and 5 lesions. All cases performed were performed successfully without need for early termination. Conclusion Implementing a complete transition from TR to TP biopsy can result in a significant reduction in complications and hospital re‐admissions. A cognitive freehand coaxial technique is well tolerated by patients and achieves a high cancer detection rate.
