Objective:To evaluate the use of Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography(^(68)Ga-PSMA PET/CT),compared with conventional CT abdomen/pelvis(CTAP)and whole body sin...Objective:To evaluate the use of Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography(^(68)Ga-PSMA PET/CT),compared with conventional CT abdomen/pelvis(CTAP)and whole body single photon emission CT bone scan(BS),for detection of local or distant metastasis following biochemical failure/recurrence in post-prostatectomy patients.Methods:We conducted a review of our prospectively maintained,institutional database to identify 384 patients with post-prostatectomy biochemical failure/recurrence who underwent PSMA PET/CT,CTAP and BS from February 2015 to August 2017 in Nepean Hospital,tertiary referral centre.The results of the three imaging modalities were analysed for their ability to detect local recurrence and distant metastases.PSMA PET/CT and CTAP imaging were separately performed on the same day and the BS was performed within several days(mostly in 24 h).Difference in detection rates was determined between the modalities and the Chi square test was used to determine significance.Results:A total of 384 patients were identified with a median prostate-specific antigen(PSA)of 0.465 ng/mL(interquartile range =0.19-2.00 ng/mL).Overall,PSMA PET/CT was positive for 245(63.8%)patients whereas CTAP and BS were positive in 174 patients(45.3%).A total of 98 patients(25.5%)had local or distant metastasis detected on PSMA only,while 20 patients(5.2%)had recurrences detected on CTAP but not on PSMA PET/CT.Conclusion:The use of PSMA PET/CT has a higher detection rate of predicted local or distant metastasis compared to CTAP and BS in the staging of patients with biochemical recurrences after radical prostatectomy.展开更多
Objectives:To describe the surgical approach and perioperative outcomes of a multicenter series evaluating a robotic-assisted approach to radical cystectomy with total intracorporeal urinary diversion in the setting o...Objectives:To describe the surgical approach and perioperative outcomes of a multicenter series evaluating a robotic-assisted approach to radical cystectomy with total intracorporeal urinary diversion in the setting of prior pelvic radiotherapy.Materials and methods:We analyzed our prospective cystectomy database for patients who underwent robotic-assisted radical cystectomy for bladder cancer after radiotherapy between 2018 and 2022.Demographic information and data regarding preoperative factors including stage of disease,preoperative hydronephrosis,and history of pelvic radiotherapy were collected via reviewof electronic medical records.All operations were performed by 1 of 2 experienced urologists using the da Vinci X,Xi,or Si surgical platforms.Results:Ten patients were identified for this study.The median age of participants was 73.5 years(range,41-84 years).The median American Society of Anesthesiologists classification score was 3(range,3-4).The median Charlson Comorbidity Index was 6(range,2-12).Among the patients,4 out of 10 patients(40%)had muscle invasive bladder cancer before salvage surgery.Intracorporeal ileal conduit urinary diversion was performed in 8 patients,whereas 2 patients underwent intracorporeal neobladder formation.Median intraoperative blood loss was 250 mL(range,150-600 mL),and median operative duration was 390 minutes(range,195-450 minutes).The overall 30-day complication rate was 60%with a Clavien-Dindo grade≥3 complication rate of 15%.Perioperativemortalitywas 0%.Median duration of follow-up was 210 days(range,60-1580 days).Conclusions:This series describing the outcomes of salvage robotic-assisted radical cystectomy using total intracorporeal urinary diversion demonstrates the safety of this technique.Further studies with long-term follow-up,including oncological outcomes,are required to support the widespread adoption of this procedure.展开更多
文摘Objective:To evaluate the use of Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography(^(68)Ga-PSMA PET/CT),compared with conventional CT abdomen/pelvis(CTAP)and whole body single photon emission CT bone scan(BS),for detection of local or distant metastasis following biochemical failure/recurrence in post-prostatectomy patients.Methods:We conducted a review of our prospectively maintained,institutional database to identify 384 patients with post-prostatectomy biochemical failure/recurrence who underwent PSMA PET/CT,CTAP and BS from February 2015 to August 2017 in Nepean Hospital,tertiary referral centre.The results of the three imaging modalities were analysed for their ability to detect local recurrence and distant metastases.PSMA PET/CT and CTAP imaging were separately performed on the same day and the BS was performed within several days(mostly in 24 h).Difference in detection rates was determined between the modalities and the Chi square test was used to determine significance.Results:A total of 384 patients were identified with a median prostate-specific antigen(PSA)of 0.465 ng/mL(interquartile range =0.19-2.00 ng/mL).Overall,PSMA PET/CT was positive for 245(63.8%)patients whereas CTAP and BS were positive in 174 patients(45.3%).A total of 98 patients(25.5%)had local or distant metastasis detected on PSMA only,while 20 patients(5.2%)had recurrences detected on CTAP but not on PSMA PET/CT.Conclusion:The use of PSMA PET/CT has a higher detection rate of predicted local or distant metastasis compared to CTAP and BS in the staging of patients with biochemical recurrences after radical prostatectomy.
文摘Objectives:To describe the surgical approach and perioperative outcomes of a multicenter series evaluating a robotic-assisted approach to radical cystectomy with total intracorporeal urinary diversion in the setting of prior pelvic radiotherapy.Materials and methods:We analyzed our prospective cystectomy database for patients who underwent robotic-assisted radical cystectomy for bladder cancer after radiotherapy between 2018 and 2022.Demographic information and data regarding preoperative factors including stage of disease,preoperative hydronephrosis,and history of pelvic radiotherapy were collected via reviewof electronic medical records.All operations were performed by 1 of 2 experienced urologists using the da Vinci X,Xi,or Si surgical platforms.Results:Ten patients were identified for this study.The median age of participants was 73.5 years(range,41-84 years).The median American Society of Anesthesiologists classification score was 3(range,3-4).The median Charlson Comorbidity Index was 6(range,2-12).Among the patients,4 out of 10 patients(40%)had muscle invasive bladder cancer before salvage surgery.Intracorporeal ileal conduit urinary diversion was performed in 8 patients,whereas 2 patients underwent intracorporeal neobladder formation.Median intraoperative blood loss was 250 mL(range,150-600 mL),and median operative duration was 390 minutes(range,195-450 minutes).The overall 30-day complication rate was 60%with a Clavien-Dindo grade≥3 complication rate of 15%.Perioperativemortalitywas 0%.Median duration of follow-up was 210 days(range,60-1580 days).Conclusions:This series describing the outcomes of salvage robotic-assisted radical cystectomy using total intracorporeal urinary diversion demonstrates the safety of this technique.Further studies with long-term follow-up,including oncological outcomes,are required to support the widespread adoption of this procedure.
