An-Najah Staff

Background
The aim of the study was to assess the morbidity and efficacy of repeat cryoablation (CA) in the treatment of localized prostate cancer.
Methods
Twenty-seven patients with median age of 71 years (range 48–80) who underwent repeat CA between April 2003 and April 2011 at a single institution were included. The median initial prostate-specific antigens (PSA) and Gleason values were 6.2 ng/ml (range 4–23.6) and 7 (range 6–9), respectively. Twenty-four patients underwent two CA treatments, and three patients underwent three CA treatments. Pre- and perioperative parameters and oncological and functional outcomes were evaluated.
Results
No intraoperative complications occurred. After the first CA, PSA was undetectable in 10 patients, and the median nadir PSA value was 0.65 ng/ml (range 0.1–4.9). After the second CA, 4 patients had undetectable PSA, and the median nadir PSA value was 1.25 ng/ml (range 0.2–7.9). For patients who underwent a third CA treatment, no patients had undetectable PSA, and the subsequent median nadir PSA value was 1.6 ng/ml (range 0.4–4.5). Two patients had incontinence (1 pad per day) following repeat CA. One patient had urinary retention after the third CA treatment, and one had urethral stricture. The mean hospitalization and follow-up periods were 1 day (range 0–2) and 51.5 months (range 11–96), respectively.
Conclusions
Repeat CA successfully reduced PSA levels, and complications were modest. We conclude that repeat CA is a feasible, safe, and effective treatment option for localized prostate cancer.

Since the first report on the efficacy of sextant biopsy under transrectal ultrasound guidance, there have been many modifications related to the total number of cores and the localization of biopsies to improve the prostate cancer (PCa) detection rate. The 2010 National Comprehensive Cancer Network Early PCa Detection Guidelines noted the 12-core biopsy scheme as the standard. However, this extended biopsy scheme still fails to detect 20% of high-grade PCa that can be detected by detailed pathological evaluation of radical prostatectomy; therefore, there is need for saturation biopsies. The existence of suspicions of PCa after previous negative biopsy or biopsies represents a valid indication for saturation biopsy. There has been no significant increment in morbidity or in insignificant PCa detection rates when a saturation biopsy scheme was used with an extended biopsy scheme. Along with the improvement in the PCa detection rate, accurate oncological mapping of PCa is another important consideration of saturation biopsies. The ideal number of cores and the diagnostic value of saturation biopsy after the failure of initial therapy are some of the issues that need to be addressed. Preliminary reports have shown that magnetic resonance imaging can improve the PCa detection rate, save patients from unnecessary biopsies, and decrease the need for a high number of cores; however, multiple limitations continue to exist

Purpose: We sought to evaluate the feasibility and safety of open or robotic radical prostatectomy (RP) after rectum, sigmoid or colon surgery.
Materials and Methods: Sixty-four patients, median age 65 years (range, 46-73) who underwent RP after prior pelvic surgery were included. Twenty-four (38%) underwent robotic and 40 patients (62%) underwent open RP. Bilateral lymph nodes dissection and nerve preservation were performed in 50 patients (78%) and 35 patients (55%) respectively. Variables evaluated included demographic characteristics, perioperative complications, functional and oncological outcomes. The median hospitalization and follow-up periods were 2 days (range, 1-12) and 21 months (range,1-108 months) respectively.
Results: No conversions from robotic to open surgery were performed and there were no intraoperative complications. Surgical margins were positive in 13 patients (20%), seminal vesicle involvement was detected in 6 patients (9%) and lymph nodes involvement was found in 2 patients (3%). Postoperative complications included; lymphocele in 1 patient, urethral stricture in 1 patient and bowel obstruction and persistent bladder leakage in 2 patients. Eighty eight percentages of patients were continent at 7 months and 80% of patients were able to achieve erection with or without medical aid.
Conclusion: Open or robotic RP can be done safely and effectively in patients who have previously undergone pelvic surgery. Although prior pelvic surgery of the large intestine was associated with increased morbidity, it shouldn't be contraindication for robotic or open RP.

Purpose
To evaluate the relationship between levels of total testosterone and total prostate-specific antigen (PSA) in healthy men with PSA<4 ng/mL.
Materials and Methods
The study comprised 179 men with a mean age of 59.19±12 years who visited Osmaniye State Hospital, Osmaniye, Turkey, between January 2006 and January 2007 for a routine checkup. The patients were divided into two subgroups: patients with PSA<2.5 mg/ml (group I, n=160 patients) and patients with PSA of 2.5 to 4 ng/mL (group II, n=19 patients). The relationship between PSA and testosterone levels was investigated in both groups and in patients aged <60 years. The mean testosterone level was calculated for patients aged <50 years and was compared with the mean value of patients aged ≥50 years.
Results
In all patients, the mean values for serum PSA and total testosterone were 1.27±0.88 ng/mL and 404.04±158.86 ng/mL, respectively. No correlation was detected between serum PSA and testosterone levels in either subgroup (group I, r=0.072, p=0.363; group II, r=0.031, p=0.900) or in patients aged <60 years (r=0.032, p=0.72). The mean values of testosterone in patients aged ≥50 years and in patients aged <50 years were 417.01±163.35 and 344.16±120.21 ng/dL, respectively (p=0.02).
Conclusions
No impact of testosterone was found on the PSA level in healthy men with PSA <4 ng/mL. Therefore, a high serum testosterone level may not mandate adjustment of PSA values. This serum sex hormone showed a significant increment after the age of 50 years. Further studies including a larger number of patients should be carried out to confirm these findings

Locally recurrent prostate cancer after radiation therapy, also known as radiorecurrent prostate cancer, has an unfavorable prognosis. Two-thirds of patients with radiorecurrent prostate cancer have an advanced pathological disease status by the time they undergo salvage therapy. Several salvage therapies for radiorecurrent prostate cancer are available. Salvage radical prostatectomy (SRP) and salvage cryoablation are the most feasible and effective therapies for radiorecurrent prostate cancer. Although SRP is technically more difficult and has a higher complication rate than do other salvage therapies, the procedure provides a long-term survival benefit. Preliminary studies of salvage robot-assisted radical prostatectomy (SRARP) suggest that SRARP may be similar to or at least as effective as SRP. The intermediate oncological efficacy and morbidity of salvage cryoablation are similar to those of SRP. Prognostic factors for successful salvage therapy include serum prostate-specific antigen level ≤10 ng/mL, Gleason score ≤8, and a clinical disease stage T1c or T2. Assessing the comparative oncological efficacy and complications of the available salvage therapies for radiorecurrent prostate cancer requires strict guidelines, including universal patient selection criteria and an intergrade definition of biochemical failure.