Objective:Caudal block provides satisfactory postoperative pain relief in lower abdominal operations.This pilot study explores its safety and effect on postoperative pain control in patients who underwent robot-assist...Objective:Caudal block provides satisfactory postoperative pain relief in lower abdominal operations.This pilot study explores its safety and effect on postoperative pain control in patients who underwent robot-assisted laparoscopic radical prostatectomy(RARP).Methods:From 2013 to 2014,40 consecutive patients were randomized into two groups d one received caudal block using ropivacaine immediately after operation,the other received standard analgesia.Primary outcome measure was pain score based on 11-point Likert scale(0e10)recorded at recovery room,and at 6,12,24,48,and 72 h after operation.All analgesic requirements,opioid-related adverse events and time to passage of flatus were examined.Results:Mean age of the two groups was similar(60.4 vs.62.3 years,p Z 0.33),as was American Society of Anaesthesiologists(ASA)class,body mass index(BMI)and operation times.No significant difference in median pain scores was reported in recovery room(2 vs.3,p Z 0.34),and at 6 h(2 vs.2,p Z 0.94),12 h(0 vs.0,p Z 0.62),24 h(1 vs.0,p Z 0.58),48 h(1 vs.0,p Z 0.36)and 72 h(0 vs.0,p Z 0.78)postoperatively between control and caudal block groups,respectively.There was a higher mean opioid usage in the caudal block group which was not statistically significant.Although this was statistically insignificant while no significant difference in mean paracetamol usage was observed postoperatively.Median time to passage of flatus was similar(2.0 vs.2.0 days,p Z 0.97).There was one case of superficial wound infection and no opioid-related adverse events observed.Hospital stay was similar in both groups(2.5 vs.2.5 days,p Z 0.96).展开更多
Objective:Active surveillance(AS)offers a strategy to reduce overtreatment and now is a widely accepted treatment option for low-risk prostate cancer.An ideal tool for risk-stratification would detect aggressive cance...Objective:Active surveillance(AS)offers a strategy to reduce overtreatment and now is a widely accepted treatment option for low-risk prostate cancer.An ideal tool for risk-stratification would detect aggressive cancers and exclude such men from taking up AS in the first place.We evaluate if a combination of transperineal template biopsy with magnetic resonance imaging(MRI)-targeted biopsy identifies significant prostate cancer amongst men initially diagnosed with low-risk prostate cancer.Methods:This prospective,single-blinded study included men with low-risk prostate cancer(D’Amico’s Criteria)diagnosed on conventional transrectal ultrasound-guided biopsy.Patients first underwent multiparametric MRI of the prostate6 weeks after initial biopsy.Each suspicious lesion is mapped and assigned a Prostate Imaging Reporting and Data System(PIRADS)score.Template biopsy is first performed with the surgeon blinded to MRI findings followed by MRI-targeted biopsy using a robotic transperineal biopsy platform.Results:The age of the 19 men included is 65.4±4.9 years(mean±SD).Prostate specific antigen(PSA)at diagnosis and at the time of transperineal biopsy were comparable(7.3±1.7 ng/mL and 7.0±1.8 ng/mL,p Z 0.67),so were prostate volumes(34.2±8.9 mL and 32.1±13.4 mL,p Z 0.28).MRI-targeted biopsy had a higher percentage of cancer detection per core compared to template biopsy(11.7%vs.6.5%,p Z 0.02),this was more than 3 times superior for Gleason 7 disease(5.9%vs.1.6%,p<0.01).Four of 18(22.2%)patients with MRI lesions had significant disease with MRI-targeted biopsy alone.Three of 19 patients(15.8%)had significant disease with template biopsy alone.In combination,both techniques upclassified five patients(26.3%),all of whom underwent radical prostatectomy.Whole mount histology confirmed tumour location and grade.All six patients with PIRADS 5 lesions had cancer detected(66.6%significant disease).Conclusion:A combination of MRI-targeted and template biopsy may optimally risk-classify“low-risk”patients diagnosed on initial conventional transrectal ultrasonography(TRUS)prostate biopsy.展开更多
Objective:Focal therapy(FT)is a potential treatment option for limited-volume clinically-significant prostate cancer(csPCa).However,despite rigorous selection,approximately 20%of patients experience early failure.We i...Objective:Focal therapy(FT)is a potential treatment option for limited-volume clinically-significant prostate cancer(csPCa).However,despite rigorous selection,approximately 20%of patients experience early failure.We investigated the association of transcriptomic profiles and csPCa recurrence post-FT.Methods:52 men from a phase II trial(NCT04138914)and a prospective observational cohort underwent focal cryotherapy for csPCa.Patients underwent multiparametric magnetic resonance imaging,and targeted and systematic-saturation biopsy before-and 1-year post-FT.Recurrence was defined as grade-group(GG)≥2 cancer in the 1-year post-FT biopsy.Pre-treatment lesions were profiled using the Decipher genomic classifier(GC).GC scores,luminal-basal status,tumor microenvironment and cancer hallmark pathways were correlated with csPCa recurrence.Results:Median PSA was 7.0 ng/dl;37/52(71.1%)men had GG2,12/52(23.1%)GG3,and 3/52(5.8%)GG4 cancer.Recurrence was observed in 9/52(17.3%)men.Median GC score was higher in patients with recurrence(0.60 vs 0.38,P=0.014)and remained significantly associated with recurrence after adjustment for GG(adjusted OR:1.37[95%CI:1.01-1.93],P=0.04).Luminal-proliferative tumors based on the prostate cancer-specific subtyping classifier(PSC)had more csPCa recurrence compared with luminal-differentiated(LD)and basal subtypes(30.4%vs 0%[LD]vs 15.4%[basal-neuroendocrine]and 14.3%[basal-immune],P=0.027).Higher expression of DNA repair pathway was also associated with recurrence(OR:2.12[95%CI:1.09-4.57],P=0.025).Conclusions:Higher GC score is associated with risk of csPCa recurrence post-FT.Patients with GC low-risk and PSC-LD csPCa may represent the ideal subgroup for FT.Prospective validation in a large cohort is warranted.展开更多
文摘Objective:Caudal block provides satisfactory postoperative pain relief in lower abdominal operations.This pilot study explores its safety and effect on postoperative pain control in patients who underwent robot-assisted laparoscopic radical prostatectomy(RARP).Methods:From 2013 to 2014,40 consecutive patients were randomized into two groups d one received caudal block using ropivacaine immediately after operation,the other received standard analgesia.Primary outcome measure was pain score based on 11-point Likert scale(0e10)recorded at recovery room,and at 6,12,24,48,and 72 h after operation.All analgesic requirements,opioid-related adverse events and time to passage of flatus were examined.Results:Mean age of the two groups was similar(60.4 vs.62.3 years,p Z 0.33),as was American Society of Anaesthesiologists(ASA)class,body mass index(BMI)and operation times.No significant difference in median pain scores was reported in recovery room(2 vs.3,p Z 0.34),and at 6 h(2 vs.2,p Z 0.94),12 h(0 vs.0,p Z 0.62),24 h(1 vs.0,p Z 0.58),48 h(1 vs.0,p Z 0.36)and 72 h(0 vs.0,p Z 0.78)postoperatively between control and caudal block groups,respectively.There was a higher mean opioid usage in the caudal block group which was not statistically significant.Although this was statistically insignificant while no significant difference in mean paracetamol usage was observed postoperatively.Median time to passage of flatus was similar(2.0 vs.2.0 days,p Z 0.97).There was one case of superficial wound infection and no opioid-related adverse events observed.Hospital stay was similar in both groups(2.5 vs.2.5 days,p Z 0.96).
文摘Objective:Active surveillance(AS)offers a strategy to reduce overtreatment and now is a widely accepted treatment option for low-risk prostate cancer.An ideal tool for risk-stratification would detect aggressive cancers and exclude such men from taking up AS in the first place.We evaluate if a combination of transperineal template biopsy with magnetic resonance imaging(MRI)-targeted biopsy identifies significant prostate cancer amongst men initially diagnosed with low-risk prostate cancer.Methods:This prospective,single-blinded study included men with low-risk prostate cancer(D’Amico’s Criteria)diagnosed on conventional transrectal ultrasound-guided biopsy.Patients first underwent multiparametric MRI of the prostate6 weeks after initial biopsy.Each suspicious lesion is mapped and assigned a Prostate Imaging Reporting and Data System(PIRADS)score.Template biopsy is first performed with the surgeon blinded to MRI findings followed by MRI-targeted biopsy using a robotic transperineal biopsy platform.Results:The age of the 19 men included is 65.4±4.9 years(mean±SD).Prostate specific antigen(PSA)at diagnosis and at the time of transperineal biopsy were comparable(7.3±1.7 ng/mL and 7.0±1.8 ng/mL,p Z 0.67),so were prostate volumes(34.2±8.9 mL and 32.1±13.4 mL,p Z 0.28).MRI-targeted biopsy had a higher percentage of cancer detection per core compared to template biopsy(11.7%vs.6.5%,p Z 0.02),this was more than 3 times superior for Gleason 7 disease(5.9%vs.1.6%,p<0.01).Four of 18(22.2%)patients with MRI lesions had significant disease with MRI-targeted biopsy alone.Three of 19 patients(15.8%)had significant disease with template biopsy alone.In combination,both techniques upclassified five patients(26.3%),all of whom underwent radical prostatectomy.Whole mount histology confirmed tumour location and grade.All six patients with PIRADS 5 lesions had cancer detected(66.6%significant disease).Conclusion:A combination of MRI-targeted and template biopsy may optimally risk-classify“low-risk”patients diagnosed on initial conventional transrectal ultrasonography(TRUS)prostate biopsy.
基金supported by National Medical Research Council Sin‐gapore,National Medical Research Council Singapore(grant numbers:TA20nov-0011,NMRC/CSA‐INV/0027/2018,CSAINV20nov‐0021)Duke‐NUS Oncology Academic Program+2 种基金Goh Foundation Proton Research ProgramNCCS Cancer FundKua Hong Pak Head and Neck Cancer Research Program.
文摘Objective:Focal therapy(FT)is a potential treatment option for limited-volume clinically-significant prostate cancer(csPCa).However,despite rigorous selection,approximately 20%of patients experience early failure.We investigated the association of transcriptomic profiles and csPCa recurrence post-FT.Methods:52 men from a phase II trial(NCT04138914)and a prospective observational cohort underwent focal cryotherapy for csPCa.Patients underwent multiparametric magnetic resonance imaging,and targeted and systematic-saturation biopsy before-and 1-year post-FT.Recurrence was defined as grade-group(GG)≥2 cancer in the 1-year post-FT biopsy.Pre-treatment lesions were profiled using the Decipher genomic classifier(GC).GC scores,luminal-basal status,tumor microenvironment and cancer hallmark pathways were correlated with csPCa recurrence.Results:Median PSA was 7.0 ng/dl;37/52(71.1%)men had GG2,12/52(23.1%)GG3,and 3/52(5.8%)GG4 cancer.Recurrence was observed in 9/52(17.3%)men.Median GC score was higher in patients with recurrence(0.60 vs 0.38,P=0.014)and remained significantly associated with recurrence after adjustment for GG(adjusted OR:1.37[95%CI:1.01-1.93],P=0.04).Luminal-proliferative tumors based on the prostate cancer-specific subtyping classifier(PSC)had more csPCa recurrence compared with luminal-differentiated(LD)and basal subtypes(30.4%vs 0%[LD]vs 15.4%[basal-neuroendocrine]and 14.3%[basal-immune],P=0.027).Higher expression of DNA repair pathway was also associated with recurrence(OR:2.12[95%CI:1.09-4.57],P=0.025).Conclusions:Higher GC score is associated with risk of csPCa recurrence post-FT.Patients with GC low-risk and PSC-LD csPCa may represent the ideal subgroup for FT.Prospective validation in a large cohort is warranted.
