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Localized Prostate Cancer

Artificial Intelligence and Prostate Cancer: Diagnosis and Grading, mpMRI, and Active Surveillance

Across all aspects of daily life, artificial intelligence more than ever is harnessing the power of machine learning to automate and improve the efficiency of tasks. This is also true in medicine and, in particular, in the field of prostate cancer. The concept of artificial intelligence began in the 1950s with the prime objective of emulating the cognitive capabilities of human beings in machines. More specifically, artificial intelligence is the ability of a machine to independently replicate intellectual processes typical of human cognition. Machine learning comprises algorithms that parse data, learn from that data, and then apply what they have learned to make informed decisions. Deep learning is a form of machine learning that is inspired by the structure of the human brain and is particularly effective in feature detection:1

The Impact of Surgeon Experience and Volume on Patient Outcomes in Radical Prostatectomy Patients

Introduction

The last decade has seen an increased uptake of the robotic-assisted laparoscopic approach for radical prostatectomies. Despite the negative results of the only published phase III randomized clinical trial comparing robotic-assisted laparoscopic to open radical prostatectomy, which demonstrated no significant differences in short- and medium-term functional outcomes between the two approaches,1 it is currently estimated that more than 70% of radical prostatectomy surgeries performed since 2012 in the United States have been with robotic assistance.2 In 2018, it was estimated that 92.6% of all radical prostatectomies in England were performed using this minimally invasive technique.3
  • Written by: Rashid K. Sayyid, MD MSc and Zachary Klaassen, MD,MSc
  • References:
    1. Coughlin GD, Yaxley JW, Chambers SK, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24-month outcomes from a randomised controlled study. Lancet Oncol 2018;19(8):1051-1060.
    2. Schroeck FR, Jacobs BL, Bhayani  SB, et al.  J.  Cost of new technologies in prostate cancer treatment: systematic review of costs and cost effectiveness of robotic-assisted laparoscopic prostatectomy, intensity-modulated radiotherapy, and proton beam therapy. Eur Urol 2017;72(5):712-735.
    3. Gray WK, Day J, Briggs TWR, Harrison S. An observational study of volume–outcome effects for robot-assisted radical prostatectomy in England. BJU International 2021;12(1):93-103.
    4. Begg CB, Riedel ER, Bach PB, et al. Variations in Morbidity after Radical Prostatectomy. N Engl J Med 2002;346:1138-1144.
    5. Hu JC, Gold KF, Pashos CL, et al. Role of surgeon volume in radical prostatectomy outcomes. J Clin Oncol 2003;21(3):401-405.
    6. Almatar A, Wallis CJD, Hrrschorn S, et al. Effect of radical prostatectomy surgeon volume on complication rates from a large population-based cohort. Can Urol Assoc J 2016;10(1-2):45-49.
    7. Godtman RA, Persson E, Cazzaniga W, et al. Association of surgeon and hospital volume with short-term outcomes after robot-assisted radical prostatectomy: Nationwide, population-based study. PLoS One 2021;16(6):e0253081.
    8. Gray WK, Day J, Briggs TWR, Harrison S. An observational study of volume–outcome effects for robot-assisted radical prostatectomy in England. BJU International 2021;129(1):93-103.
    9. Van den Broeck T, Oprea-Lager D, Moris L, et al. A Systematic Review of the Impact of Surgeon and Hospital Caseload Volume on Oncological and Nononcological Outcomes After Radical Prostatectomy for Nonmetastatic Prostate Cancer. Eur Urol 2021;80(5):531-545.
    10. Porcaro AB, Tafuri A, Sebben M, et al. Linear extent of positive surgical margin impacts biochemical recurrence after robotassisted radical prostatectomy in a high-volume centre. J Robot Surg 2020;14:663–675.
    11. Steinsvik EAS, Axcrona K, Angelsen A, et al. Does a surgeon’s annual radical prostatectomy volume predict the risk of positive surgical margins and urinary incontinence at one-year follow-up?—Findings from a prospective national study. Scand J Urol 2013;47:92–100.
    12. Williams SB, Gu X, Lipsitz SR, Nguyen PL, Choueiri TK, Hu JC. Utilization and expense of adjuvant cancer therapies following radical prostatectomy. Cancer 2011;117:4846–54.
    13. Hu JC, Wang Q, Pashos CL, Lipsitz SR, Keating NL. Utilization and outcomes of minimally invasive radical prostatectomy. J Clin Oncol 2008;26:2278–84.
    14. Bolton DM, Papa N, Ta AD, et al. Predictors of prostate cancer specific mortality after radical prostatectomy: 10 year oncologic outcomes from the Victorian Radical Prostatectomy Registry. BJU Int 2015;116:66–72.
    15. Schmitges J, Trinh QD, Sun M, et al. Annual prostatectomy volume is related to rectal laceration rate after radical prostatectomy. Urology 2012;79:796–803.
    16. Sharma V, Meeks JJ. Open conversion during minimally invasive radical prostatectomy: impact on perioperative complications and predictors from national data. J Urol 2014;192:1657–1662.
    17. Begg CB, Riedel ER, Bach PB, et al. Variations in morbidity after radical prostatectomy. N Engl J Med 2002;346:1138–1144.
    18. Leow JJ, Leong EK, Serrell EC, et al. Systematic Review of the Volume-Outcome Relationship for Radical Prostatectomy. Eur Urol Focus 2018;4(6):775-89.
    19. Bravi CA, Tin A, Vertosick E, et al. The Impact of Experience on the Risk of Surgical Margins and Biochemical Recurrence after Robot-Assisted Radical Prostatectomy: A Learning Curve Study. J Urol 2019;202(1):108-113.
    20. Klein EA, Bianco FJ, Serio AM, et al. Surgeon Experience is Strongly Associated with Biochemical Recurrence after Radical Prostatectomy for all Preoperative Risk Categories. J Urol 2008;179(6):2212-2216.
    21. Alemozaffar M, Duclos A, Hevelone ND, et al. Technical Refinement and Learning Curve for Attenuating Neurapraxia During Robotic-Assisted Radical Prostatectomy to Improve Sexual Function. Eur Urol 2012;61(6):1222-12228.
    22. Ju IE, Trieu D, Chang SB, et al. Surgeon Experience and Erectile Function After Radical Prostatectomy: A Systematic Review. Sex Med Rev 2021;9(4):650-658.
    23. Fossati N, Di Trapani E, Gandaglia G, et al. Assessing the Impact of Surgeon Experience on Urinary Continence Recovery After Robot-Assisted Radical Prostatectomy: Results of Four High-Volume Surgeons. J Endourol 2017;31(9):872-877.
    24. Matulewicz RS, Tosoian JT, Stimson CJ, et al. Implementation of a Surgeon-Level Comparative Quality Performance Review to Improve Positive Surgical Margin Rates during Radical Prostatectomy. J Urol 2017;197(5):1245-1250.
    25. Kumar RV, Fergusson DA, Lavallee, et al. Performance Feedback May Not Improve Radical Prostatectomy Outcomes: The Surgical Report Card (SuRep) Study. J Urol 2021;206(2):346-353.

Radiotherapy in Prostate Cancer: Utilization of Adjuvant and Salvage Radiotherapy

Introduction

While external beam radiotherapy is a standard treatment option as first-line therapy for men with localized prostate cancer, it is also an important component of care for patients following radical prostatectomy. For approximately two-thirds of patients undergoing radical prostatectomy for prostate cancer, surgery is curative, and patients remain disease-free (without biochemical or radiographic evidence of recurrence).1 However, patients with adverse pathologic findings (defined as seminal vesicle invasion, extraprostatic extension, and positive surgical margins (residual tumor at the surgical site) experience up to a 60% risk of recurrence at 10 years.2

The Importance of a Prostate Cancer Survivorship Program: A Multi-Disciplinary Approach

Despite prostate cancer being the second most common cause of cancer mortality among American men,1 there are over 3 million men in the United States living with prostate cancer. As such, there are many “prostate cancer survivors” that are either on active surveillance/watchful waiting or have undergone treatment for localized (ie. radiation therapy, radical prostatectomy, focal therapy, etc) or advanced disease (ie. androgen deprivation therapy, chemotherapy, novel hormonal therapy, immunotherapy, etc).