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Prostate Cancer Treatment Options and Its Complications
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Prostate Cancer Treatment Options and Its Complications

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: closed (30 December 2023) | Viewed by 7587

Special Issue Editor

Dr. Javier C. Angulo

E-Mail Website
Guest Editor
Department of Urology, Hospital Universitario de Getafe, Universidad Europea de Madrid, 28093 Madrid, Spain
Interests: urology; urethral reconstruction; stress urinary incontinence

Special Issue Information

Dear Colleagues,

Prostate cancer is the most common malignancy in males. Prostate cancer treatment has evolved in recent decades with the widespread use of different minimally invasive options and also new strategies, such as focal therapies and active surveillance, with the use of delayed rescue treatment options increasing to avoid sequelae and preserve quality of life. From a technological perspective, surgery has progressed with laparoscopic and robotic prostatectomy to achieve free-of-recurrence status and minimize postoperative complications. Radiation therapy has also evolved to reduce toxicities and has become a first-line treatment option for patients at increased age at the time of diagnosis and for patients considered unfit for surgery. Still, the risk to suffer male stress incontinence and/or erectile dysfunction after prostate cancer treatment remains high. The good news is that complications from prostate cancer treatment can also be effectively treated both medically and surgically. Post-prostatectomy incontinence can be effectively managed in many cases using pelvic floor rehabilitation and prosthetic surgery using male fixed and adjustable slings as well as artificial urinary sphincters. Erectile dysfunction can be avoided using a nerve-sparing approach and safely treated with vasoactive agents and phosphodiesterase-inhibitors. Other options such as low-energy shockwave therapy to ameliorate erectile dysfunction are more controversial. This Special Issue on prostate cancer treatment and its complications is intended to provide a collection of new and updated techniques presenting state-of-the-art guidance to a safer and more effective treatment of prostate cancer.

Dr. Javier C. Angulo
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • prostate cancer
  • treatment
  • post-prostatectomy incontinence
  • complications
  • stress incontinence
  • erectile dysfunction

Published Papers (6 papers)

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Research

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14 pages, 2341 KiB  
Article
Results of Adjustable Trans-Obturator Male System in Patients with Prostate Cancer Treated with Prostatectomy and Radiotherapy: A Multicenter Study
by Javier C. Angulo, Carlos Téllez, Alessandro Giammò, Carmen González-Enguita, Sandra Schoenburg, Fabian Queissert, Juliusz Szczesniewski, Raquel González, Antonio Romero, Andreas Gonsior, Francisco E. Martins, Tiago Antunes-Lopes, Francisco Cruz and Keith Rourke
J. Clin. Med. 2023, 12(14), 4721; https://doi.org/10.3390/jcm12144721 - 17 Jul 2023
Cited by 1 | Viewed by 970
Abstract
(1) Background: Treatment of male stress incontinence in patients with prostate cancer treated with radical prostatectomy and adjuvant pelvic radiation is a therapeutic challenge. The efficacy and safety of the adjustable trans-obturator male system (ATOMS) in these patients is not well established, despite [...] Read more.
(1) Background: Treatment of male stress incontinence in patients with prostate cancer treated with radical prostatectomy and adjuvant pelvic radiation is a therapeutic challenge. The efficacy and safety of the adjustable trans-obturator male system (ATOMS) in these patients is not well established, despite the general belief that outcomes are worse than in patients without radiation. (2) Methods: Retrospective multicenter study evaluating patients treated with silicone-covered scrotal port (SSP) ATOMS implant after radical prostatectomy and radiotherapy in nine different institutions between 2016 and 2022. The primary endpoint was dry patient rate, defined as pad-test ≤ 20 mL/day. The secondary endpoints were complication rate (defined using Clavien–Dindo classification), device removal and self-perceived satisfaction using the Patient Global Impression of Improvement (PGI-I) scale. Wilcoxon rank-sum test, Fisher’s exact test and logistic regression were performed using stepwise method with a 0.15 entry and 0.1 stay criteria. (3) Results: 223 patients fulfilled the criteria for inclusion and 12 (5.4%) received salvage prostatectomy after radiation and 27 (12.1%) previous devices for stress incontinence. After ATOMS adjustment, 95 patients (42.6%) were dry and 36 (16.1%) had complications of any grade (grade I, n = 20; grade II, n = 11; grade III, n = 5) during the first 3 months postoperatively. At a mean of 36 ± 21 months follow-up, the device was explanted in 26 (11.7%) patients. Regarding self-perceived satisfaction with the implant, 105 of 125 patients (84%) considered themselves satisfied (PGI-I 1 to 3). In the univariate analysis, dryness was associated to younger age (p = 0.06), primary prostatectomy (p = 0.08), no previous incontinence surgery (p = 0.02), absence of overactive bladder symptoms (p = 0.04), absence of bladder neck stricture (p = 0.001), no need of surgical revision (p = 0.008) and lower baseline incontinence severity (p = 0.0003). Multivariate analysis identified absence of surgical revision (p = 0.018), absence of bladder neck stricture (p = 0.05), primary prostatectomy (p = 0.07) and lower baseline incontinence severity (p < 0.0001) were independent predictors of dryness. A logistic regression model was proposed and internally validated. (4) Conclusions: ATOMS is an efficacious and safe alternative to treat male incontinence after radical prostatectomy and adjuvant radiotherapy. Factors predictive of dryness are identified in this complex scenario to allow for better patient selection. Full article
(This article belongs to the Special Issue Prostate Cancer Treatment Options and Its Complications)
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12 pages, 7234 KiB  
Article
A New Proximal Adjustable Sling ATOMS SSP® Implantation Technique with Focus on the Urethral Bulb: Lessons Learned from Revision Surgery
by Fabian Queissert, Benedict Bruecher and Andres J. Schrader
J. Clin. Med. 2023, 12(13), 4409; https://doi.org/10.3390/jcm12134409 - 30 Jun 2023
Viewed by 771
Abstract
Background: Adjustable sling ATOMS-SSP results in ventral compression of the urethra with favorable results in the treatment of men with mild to moderate stress incontinence. However, with transobturator tunneling and mesh fixation, the surgeon has a range of options, which leads to different [...] Read more.
Background: Adjustable sling ATOMS-SSP results in ventral compression of the urethra with favorable results in the treatment of men with mild to moderate stress incontinence. However, with transobturator tunneling and mesh fixation, the surgeon has a range of options, which leads to different results and sometimes unfavorable positioning of the silicone cushion. Using retrograde urethrography (RUG), we identified ATOMS patients with considerable misplacement. We then modified the implantation technique when we performed the revision, and now present here our first experiences with this new surgical technique. Methods: Patients after ATOMS-SSP implantation at our clinic were systematically subjected to a RUG if incontinence persisted after adjustments. In case of unfavorable positioning, a revision was performed with the aim of achieving an idealized urethroproximal position of the silicone pad. During follow-up, a repeat RUG was performed, and both subjective and objective outcome parameters were recorded. Results: Four men met the above criteria and underwent revision with reimplantation using our new technique. All patients postoperatively experienced significantly improved continence. RUGs demonstrated an ideal ATOMS position immediately below the proximal bulbar urethra. Conclusions: Our proximal implantation technique, presented here for the first time, allows optimal positioning of the ATOMS SSP, which is reflected in the objective parameters and RUG. Its use in primary implantation should also be considered and an expansion to the indication of severe stress incontinence seems possible, but this should only be done in studies. Full article
(This article belongs to the Special Issue Prostate Cancer Treatment Options and Its Complications)
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9 pages, 892 KiB  
Article
Is the Standard Artificial Urinary Sphincter AMS 800 Still a Treatment Option for the Irradiated Male Patient Presenting with a Devastated Bladder Outlet?
by Fabian Queissert, Tanja Huesch, Alexander Kretschmer, Ruth Kirschner-Hermanns, Tobias Pottek, Roberto Olianas, Alexander Friedl, Roland Homberg, Jesco Pfitzenmaier, Carsten M. Naumann, Joanne Nyarangi-Dix, Torben Hofmann, Achim Rose, Christian Weidemann, Carola Wotzka, Wilhelm Hübner, Hagen Loertzer, Rudi Abdunnur, Markus Grabbert, Ralf Anding, Ricarda M. Bauer, Axel Haferkamp and Andres J. Schraderadd Show full author list remove Hide full author list
J. Clin. Med. 2023, 12(12), 4002; https://doi.org/10.3390/jcm12124002 - 12 Jun 2023
Cited by 1 | Viewed by 884
Abstract
Background: Circular urethral compression with an artificial sphincter allows control of voiding, even in patients with severe stress urinary incontinence, but it heightens the risk of urethral atrophy and erosion. This study of one of the largest populations of patients treated with radiotherapy [...] Read more.
Background: Circular urethral compression with an artificial sphincter allows control of voiding, even in patients with severe stress urinary incontinence, but it heightens the risk of urethral atrophy and erosion. This study of one of the largest populations of patients treated with radiotherapy investigates the additive effect of the post-radiogenic stricture of the membranous urethra/bladder neck on AMS 800 artificial urinary sphincter outcomes. Methods: In a retrospective multicenter cohort study, we analyzed patients fitted with an AMS 800, comparing those who had received radiotherapy with patients presenting a devastated bladder outlet (stricture of the membranous urethra/bladder neck). We determined the correlation between these groups of patients using both univariate and stepwise adjusted multivariate regression. The revision-free interval was estimated by a Kaplan–Meier plot and compared by applying the log-rank test. A p value below 0.05 was considered statistically significant. Results: Of the 123 irradiated patients we identified, 62 (50.4%) had undergone at least one prior desobstruction for bladder-neck/urethra stenosis. After a mean follow-up of 21 months, the latter tended to achieve social continence less frequently (25.7% vs. 35%; p = 0.08). Revision was required significantly more often for this group (43.1% vs. 26.3%; p = 0.05) due to urethral erosion in 18 of 25 cases. A stenosis recurred in five cases; desobstruction was performed in two cases, leading to erosion in both. Multivariate analysis revealed a significantly higher risk of revision when recurrent stenosis necessitated at least two prior desobstructions (HR 2.8; p = 0.003). Conclusions: A devastated bladder outlet is associated with a lower proportion of men with social continence and a significantly higher need for revision compared with irradiated patients without a history of urethral stenosis. Alternative surgical procedures should be discussed beforehand, especially in cases of recurrent urethral stenosis. Full article
(This article belongs to the Special Issue Prostate Cancer Treatment Options and Its Complications)
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10 pages, 251 KiB  
Article
BMI Impact on Readmissions for Patients Undergoing Robot-Assisted Radical Prostatectomy: A Monocentric, Single-Surgeon Serial Analysis of 500 Cases
by Mahmoud Farzat, Ismail Sharabaty, Christian Tanislav, Yaman Alsaid and Florian M. Wagenlehner
J. Clin. Med. 2023, 12(12), 3908; https://doi.org/10.3390/jcm12123908 - 7 Jun 2023
Cited by 1 | Viewed by 915
Abstract
Due to more difficult intraoperative courses, elevated rates of case abortion and unfavored postoperative outcomes in obese patients, urologists tend to consider other therapeutic modalities than prostate removal in very obese patients. With the surge in robotic surgery in the last two decades, [...] Read more.
Due to more difficult intraoperative courses, elevated rates of case abortion and unfavored postoperative outcomes in obese patients, urologists tend to consider other therapeutic modalities than prostate removal in very obese patients. With the surge in robotic surgery in the last two decades, more obese patients have undergone robot-assisted radical prostatectomy (RARP). Objective: This current, monocentric, retrospective serial study investigates primarily the impact of obesity on readmissions and secondarily the major complications of RARP. Methods: Five hundred patients from one referral center who underwent RARP between April 2019 and August 2022 were included in this retrospective study. To investigate the impact of patient BMI on postoperative outcomes, we divided our cohort into two groups with a cut-off of 30 kg/m2 (according to the WHO definition). Demographic and perioperative data were analyzed. Postoperative complications and readmission rates were compared between standard, normal patients (NOBMI—BMI under 30; n = 336, 67.2%) and overweight patients (OBMI—BMI equal to/more than 30; n = 164, 32.8%). Results: OBMI patients had bigger prostates on TRUS, more comorbidities and worse baseline erectile function scores. They also received fewer nerve-sparing procedures than their counterparts (p = 0.005). Analysis showed no statistically significant differences in readmission rates or in minor or major complications (p = 0.336, 0.464 and 0.316, respectively). In a univariate analysis, BMI could predict positive surgical margins (p = 0.021). Conclusion: Performing RARP in obese patients seems to be safe and feasible, without major adverse events or elevated readmission rates. Obese patients should be informed preoperatively about the elevated risk of higher PSMs and technically more difficult nerve-sparing procedures. Full article
(This article belongs to the Special Issue Prostate Cancer Treatment Options and Its Complications)
7 pages, 986 KiB  
Article
Long-Term Survival Rate of ATOMS Implant for Male Stress Urinary Incontinence and Management of Late Complications
by Alessandro Giammò and Enrico Ammirati
J. Clin. Med. 2023, 12(6), 2296; https://doi.org/10.3390/jcm12062296 - 15 Mar 2023
Cited by 5 | Viewed by 1349
Abstract
Background: stress urinary incontinence (SUI) still represents a major drawback of prostate surgery. The aim of this study is to evaluate long term efficacy, safety and survival of ATOMS system implant in a single center. Methods: we retrospectively included al consecutive patients treated [...] Read more.
Background: stress urinary incontinence (SUI) still represents a major drawback of prostate surgery. The aim of this study is to evaluate long term efficacy, safety and survival of ATOMS system implant in a single center. Methods: we retrospectively included al consecutive patients treated with ATOMS implant for SUI from October 2014 to July 2019. Patients received anamnesis, urodynamic evaluation, pre- and postoperative 24 h pad test and count. Patients were considered “continent” when dry or when wearing a security pad (social continence). Results: we treated99 patientswith median age 77.98 years (IQR 72.7–82.52). Most of the patients had undergone radical prostatectomy. Median follow-up was 62.9 months (IQR 47.5–75.9). At last follow-up 74 (74.7%) patients reported continence. We had 21 early (<30 days) postoperative complications, all Clavien-Dindo (CD) grade 1 [11 temporary perineal pain, 4 urinary retention, 3 scrotal edema, 2 superficial wound dehiscence, 1 dysuria]. We had late postoperative complications in 28 patients [7 port dislocations requiring surgical repositioning (CD 3a), 6 device removals (CD 3a) due to port erosion (2), inefficacy (2), cushion leakage (1), mesh detachment (1), perineal pain (5), 2 cases of port extrusion solved with port removal leaving the device in place (CD 3a), 2 superficial wound dehiscence (CD 1), 2 UTI (CD 1), 1 scrotal edema (CD 1), 1 cushion deflate (CD 1), 1 dysuria (CD 1), 1 perineal pain (CD 1)]. The survival of the device was 97% at 12 months, 93% at 24 months, 91% at 36 months, 90% at 48 months and 87.9% at 60 months. Conclusions: This study demonstrates the good safety and efficacy of ATOMS implant for the treatment of SUI. Full article
(This article belongs to the Special Issue Prostate Cancer Treatment Options and Its Complications)
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Review

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17 pages, 1030 KiB  
Review
Complications after Prostate Cancer Treatment: Pathophysiology and Repair of Post-Radiation Urethral Stricture Disease
by Joshua Sterling, Syed N. Rahman, Ajin Varghese, Javier C. Angulo and Dmitriy Nikolavsky
J. Clin. Med. 2023, 12(12), 3950; https://doi.org/10.3390/jcm12123950 - 9 Jun 2023
Cited by 3 | Viewed by 2056
Abstract
Radiation therapy (RT) in the management of pelvic cancers remains a clinical challenge to urologists given the sequelae of urethral stricture disease secondary to fibrosis and vascular insults. The objective of this review is to understand the physiology of radiation-induced stricture disease and [...] Read more.
Radiation therapy (RT) in the management of pelvic cancers remains a clinical challenge to urologists given the sequelae of urethral stricture disease secondary to fibrosis and vascular insults. The objective of this review is to understand the physiology of radiation-induced stricture disease and to educate urologists in clinical practice regarding future prospective options clinicians have to deal with this condition. The management of post-radiation urethral stricture consists of conservative, endoscopic, and primary reconstructive options. Endoscopic approaches remain an option, but with limited long-term success. Despite concerns with graft take, reconstructive options such as urethroplasties in this population with buccal grafts have shown long-term success rates ranging from 70 to 100%. Robotic reconstruction is augmenting previous options with faster recovery times. Radiation-induced stricture disease is challenging with multiple interventions available, but with successful outcomes demonstrated in various cohorts including urethroplasties with buccal grafts and robotic reconstruction. Full article
(This article belongs to the Special Issue Prostate Cancer Treatment Options and Its Complications)
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