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Exercise testing in breast and prostate cancer
Published in R. C. Richard Davison, Paul M. Smith, James Hopker, Michael J. Price, Florentina Hettinga, Garry Tew, Lindsay Bottoms, Sport and Exercise Physiology Testing Guidelines: Volume II – Exercise and Clinical Testing, 2022
Although minimally invasive robot-assisted radical prostatectomy is widely available and is associated with fewer intra-operative and post-operative complications (Trinh et al., 2012), there can still be considerable long-term morbidity (Barry et al., 2012; Capogrosso et al., 2019). Recovery of physical functioning and quality of life after radical prostatectomy often has a protracted time-course, with only 23–38% of patients recovered to baseline levels of physical, mental and social functioning by three months post surgery, increasing to 71–82% at six months post surgery (Litwin et al., 1999). However, 66–73% of men still report experiencing sexual and urinary functional impairments six months after surgery (Litwin et al., 1999). Recent cross-sectional data suggest that a substantial proportion of men treated with radical prostatectomy (an average of 11.7 months previously) were at increased risk of suffering a cardiovascular-related event within the next 10–15 years (Ashton et al., 2019). A recent small-scale study reported a reduction in upper- and lower-limb strength, accompanied by decreases in lean body mass, following radical prostatectomy (Singh et al., 2017).
A builder with back pain
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
There is no best treatment. The type of treatment depends on the stage of the cancer. Possible treatments are: open or laparoscopic radical prostatectomy, radical radiotherapy, brachytherapy, hormone manipulation (probably in combination with one of the other treatments), and ‘watchful waiting’ (i.e. no immediate active treatment). So you can legitimately argue that the one the patient chooses after discussion with the urologist is the ‘best’ treatment. The point is that there are no properly conducted (controlled) trials that have established the best treatment.
Prostate Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Malcolm Mason, Howard Kynaston
Open radical prostatectomy involves the removal of the prostate, seminal vesicles, and pelvic lymph nodes. The bladder neck is then re-anastomosed to the urethra, and a catheter is placed in situ for around 10 days. In experienced hands, blood loss is usually below the threshold for transfusion, and the length of hospital stay, particularly with robotic-assisted laparoscopic prostatectomy (RALP), is on average 1 day. Postoperative mortality is exceedingly low. There is undoubtedly a “learning curve,” the best results depending on experience and also on the numbers of patients treated by the center. The main risks following radical prostatectomy are incontinence and erectile dysfunction. Following a classical open radical prostatectomy, the incidence of erectile failure is between 90% and 100%, but in recent years, it has been possible to perform a nerve-sparing procedure on appropriately selected patients, which is said to preserve potency in up to 80% of patients. Significant incontinence rates are usually of the order of around 1%–2%, but more minor degrees of leakage might occur in around 9% of men, particularly in the first year after surgery.
Biochemical recurrence after radical prostatectomy – a large, comprehensive, population-based study with long follow-up
Published in Scandinavian Journal of Urology, 2022
Elin Axén, Johan Stranne, Marianne Månsson, Erik Holmberg, Rebecka Arnsrud Godtman
The aim of radical prostatectomy is to achieve cure from prostate cancer. In this large, population-based study, we demonstrate a continued risk for BCR throughout the study period of up to twenty years. The risk was highest within the first two years after surgery, after which it declined slightly. After five years, the risk did no longer decrease but remained the same up to 15 years. For patients alive 10 years after surgery, the risk for BCR is still substantial. Median age at radical prostatectomy in Sweden in 2016 was 65 years (interquartile range [IQR] 60–69 years) and 67 years (IQR 62–70 years), for robot assisted and open radical prostatectomy, respectively [18]; life expectancy at age 65 was 19 years the same year [19]. Hence, the risk for long-term BCR is relevant for a large group of patients. Patients with BCR within two years of surgery had the most unfavourable prognosis; for patients with BCR after more than two years, the risk for failure was still substantial. Even though the majority of patients with salvage hormonal treatment neither developed distant metastasis nor died from prostate cancer during follow-up, we consider such treatment as failure. Adverse effects of ADT are potentially severe, showing a wide range of manifestations including secondary morbidity and reduced quality of life [20]. While side-effects of antiandrogen monotherapy are less pronounced, with exception for gynecomastia [21], hormonal treatment of any kind is not consistent with cure.
The safety and feasibility of simultaneous robotic repair of an inguinal hernia during robotic-assisted laparoscopic prostatectomy: a systematic review and meta-analysis
Published in Scandinavian Journal of Urology, 2022
Motaz Melhem, Javid Burki, Omar Algurabi, Sayed Gilani, Faisal Ghumman, Matin Sheriff, Mudassir Wani, Ra’ed Haddad, Sanjeev Madaan
Prostate cancer is the second most common cancer in men [1]. Surgery in the form of radical prostatectomy is one of the primary forms of localised prostate cancer treatment. Presently, in most developed countries, radical prostatectomy is performed through robotic approach [2]. Both clinical and subclinical inguinal hernias are common in the age group of men diagnosed with prostate cancer. During robotic-assisted laparoscopic prostatectomy (RALP) achieving pneumoperitoneum would increase intraabdominal pressure; hence, unrecognised inguinal hernias may become recognised. Facing an inguinal hernia during RALP could be a challenge for the surgeon, whether to repair it or not. Conceptually, a foreign body(mesh) near the urethrovesical anastomosis can act as a nidus for infection and adhesions if the anastomosis leaks and repair would also increase the operative time. Nevertheless, if left untreated subclinical inguinal hernias may manifest themselves clinically within two years of radical prostatectomy [3]. Additionally, repairing at this stage will be associated with longer operative times and increased morbidity due to significant scarring of the pre-peritoneal space from previous RALP. Also, untreated Inguinal hernias may lead to bowel obstruction and/or strangulation, requiring emergency open surgery [4]. The aim of this systematic review is to evaluate the safety and feasibility of simultaneous RALP and robotic inguinal hernia repair (RIHR).
Quality of life assessment using EORTC QLQ questionnaires in the prostate cancer population treated with radical prostatectomy: a systematic review
Published in Scandinavian Journal of Urology, 2021
Care for patients suffering from prostate cancer is multidisciplinary in approach and involves various treatment methods including radical prostatectomy, for which surgical techniques have seen considerable evolution in recent years [23]. The selection of optimal treatment methods or surgical techniques is a complex process both for healthcare professionals and for patients themselves. It is for this reason that in recent years, research on quality of life has become an endpoint of clinical research conducted among patients suffering from prostate cancer [6]. This allows for better understanding of the possible after-effects (physical, psychological, emotional, and social) of different treatment methods and surgical techniques. Moreover, quality of life can also be an early indicator of progression of disease and therefore may assist healthcare professionals in daily clinical practice [4,24].