Publications by authors named "Kesch C"
Introduction And Aim Of The Study: The impact of surgical therapy in selected patients with limited metastatic/recurrence burden have not yet been well studied. We investigated the outcome of surgical resection for patients with local recurrence only or oligometastatic UC of the bladder.
Patients And Methods: We identified patients with oligometastatic UC or local recurrence only after radical cystectomy (RC) who underwent surgical resection with curative intent between 2003 and 2022 at our center.
Background: eHealth can help replicate the benefits of conventional surgical prehabilitation programs and overcome organizational constraints related to human resources and health care-related costs.
Objective: We aimed to assess the impact of an optimized perioperative program using a personalized mobile app designed for preparation and recovery after radical prostatectomy (RP).
Methods: We report on a series of 122 consecutive robot-assisted RP before and after the implementation of the betty.
Background And Objective: The role of prostate-specific membrane antigen (PSMA)-based positron emission tomography (PET)/computed tomography (CT) in addition to magnetic resonance imaging (MRI) for local staging of prostate cancer (PC) has been poorly addressed so far. Our aim was to assess the diagnostic accuracy of PSMA PET/CT and MRI, alone and combined, for detection of extraprostatic extension (EPE) and seminal vesicle invasion (SVI) in PC.
Methods: We conducted a multicenter retrospective study evaluating patients undergoing PSMA PET/CT and MRI before radical prostatectomy.
Article Synopsis
- Conversions from robot-assisted partial nephrectomy to more invasive surgeries happen in about 1-5% of cases, and this study looks at what could predict these conversions.
- The research analyzed 2,549 patients operated on by 25 surgeons, finding a 3.5% conversion rate linked to factors like older age, higher BMI, tumor size, and the surgeon’s experience.
- The study concludes that both patient characteristics and surgical expertise significantly impact the likelihood of conversion, suggesting that better training could enhance outcomes and allow for more kidney-sparing procedures.
Article Synopsis
- This study validated a risk model that integrates clinical and multiparametric MRI parameters to predict extraprostatic extension (EPE) of prostate cancer before radical prostatectomy.
- The research analyzed data from 205 patients across two German hospitals, using techniques like receiver operating characteristic analysis to assess the model's effectiveness against ESUR criteria.
- Results showed the risk model had strong predictive performance (AUC = 0.86) for EPE, similar to the ESUR classification (AUC = 0.87), although its applicability may be limited to populations with a high prevalence of EPE.
Purpose: In metastatic castration-resistant prostate cancer (mCRPC), some patients show low/absent PSMA expression in tumour lesions on positron emission tomography (PET) scans, indicating heterogeneity and heightened risk of non-response to PSMA-RLT (radioligand therapy). Imaging cancer-associated fibroblasts and glucose uptake may further characterise tumour heterogeneity in mCRPC patients. Here, we aimed to evaluate tumour heterogeneity and its potential implications for management in mCRPC patients assessed for PSMA-RLT using [Ga]Ga-FAPI-46, 2-[F]FDG and [Ga]Ga-/[F]F-PSMA-11/-1007 PET.
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- PSMA-PET, introduced in 2012, has significantly improved prostate cancer staging, leading to the development of the PROMISE criteria for standardized imaging reports.
- This study analyzed data from a large cohort of prostate cancer patients across multiple German hospitals to assess the prognostic value of PROMISE staging in comparison to existing clinical risk assessment models.
- The findings from 2,414 patients revealed that PPP staging had performance metrics comparable to established clinical risk scores, thus highlighting its potential usefulness in predicting overall survival outcomes.
Purpose: To assess if PSMA PET quantitative parameters are associated with pathologic ISUP grade group (GG) and upgrading/downgrading.
Methods: PCa patients undergoing radical prostatectomy with or without pelvic lymph node dissection staged with preoperative PSMA PET at seven referral centres worldwide were evaluated. PSMA PET parameters which included SUV, PSMA, and total PSMA accumulation (PSMA) were collected.
Background: It is controversial whether the use of a double-J stent (DJ) in patients with bladder cancer before radical cystectomy (RC) increases the risk of tumour seeding in the upper tract and thus the risk of metachronous upper tract urothelial carcinoma (UTUC). The aim of our study is to investigate the risk of upper tract recurrence after RC in patients previously managed with a DJ stent.
Methods: A total of 699 patients who had undergone RC between January 2003 and March 2022 with complete perioperative data and pathological outcome were included in our study.
Article Synopsis
- The review examines targeted biopsy (TBx) techniques for better detection of clinically significant prostate cancer (csPCa), addressing the unclear optimal number of MRI-targeted biopsy cores needed for effective diagnosis.
- Two cores identify csPCa in 55-65% of cases, but increasing the number to 5 or more can raise detection rates to around 90%, although this may also increase the risk of overdiagnosing indolent tumors.
- While adding cores can escalate complications and patient discomfort, these effects are generally within acceptable limits, suggesting a need for careful consideration in determining the ideal core number during biopsies.
Aim Of The Study: The aim of our study is to evaluate the difference in stricture rate between matched groups of Bricker and Wallace techniques for ureteroileal anastomosis.
Patients And Methods: A retrospective analysis of patients undergoing urinary diversion (UD) with Bricker and Wallace ureteroileal anastomosis at two university hospitals. Two groups of Bricker and Wallace patients were matched in a 1:1 ratio based on the age, sex, body mass index (BMI), Charlson comorbidity index (CCI), preoperative hydronephrosis, prior radiation therapy or abdominal surgery, pathologic T and N stages and 30-days-Clavien grade complications≥III.
Background: The extent of pelvic lymphadenectomy (PLND) as part of radical cystectomy (RC) for bladder cancer (BC) remains unclear. Sentinel-based and lymphangiographic approaches could lead to reduced morbidity without sacrificing oncologic safety.
Objective: To evaluate the feasibility and diagnostic value of fluorescence-guided template sentinel region dissection (FTD) using a handheld near-infrared fluorescence (NIRF) camera in open radical cystectomy.
Background And Objective: The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations standardise the reporting of prostate magnetic resonance imaging (MRI) in patients on active surveillance (AS) for prostate cancer. An international consensus group recently updated these recommendations and identified the areas of uncertainty.
Methods: A panel of 38 experts used the formal RAND/UCLA Appropriateness Method consensus methodology.
Purpose Of Review: Oligometastatic (om) cancer is considered as a transitional state in between locally confined disease and widespread metastases, accessible to a multimodal treatment, combining systemic and local therapy. In urothelial bladder cancer (BCa), the definitions and the approaches to this condition are poorly standardised and mainly based on retrospective data. We aim to portray the framework for uro-oncologic terminology in omBCa and go through the latest evidence and the future perspectives.
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- The study compared the diagnostic accuracy of Ga-labeled fibroblast activation protein inhibitor (FAPI) and F-labeled FDG PET imaging in detecting various tumors across 115 patients with 8 different tumor types.
- Ga-FAPI PET showed higher accuracy than F-FDG PET for detecting colorectal and prostate cancers, while both methods had similar accuracy for breast and head and neck cancers.
- However, F-FDG PET outperformed Ga-FAPI PET in bladder, kidney, lymphoma, and myeloma cancers.
- Ongoing research aims to further evaluate the accuracy and impact on patient management.
Introduction: Ureteroenteric stricture (UES) is the leading cause of renal function deterioration after radical cystectomy (RC) and urinary diversion (UD). The aim of the present review is to summarize studies that discussed the risk factors associated with UES development. Identifying the responsible factors is of importance to help surgeons to modify their treatment or follow-up strategies to reduce this serious complication.
View Article and Find Full Text PDFAn updated model for predicting side-specific extraprostatic extension in the era of MRI-targeted biopsy.
Prostate Cancer Prostatic Dis
September 2024
Purpose: Accurate prediction of extraprostatic extension (EPE) is pivotal for surgical planning. Herein, we aimed to provide an updated model for predicting EPE among patients diagnosed with MRI-targeted biopsy.
Materials And Methods: We analyzed a multi-institutional dataset of men with clinically localized prostate cancer diagnosed by MRI-targeted biopsy and subsequently underwent prostatectomy.
External validation of nomograms including MRI features for the prediction of side-specific extraprostatic extension.
Prostate Cancer Prostatic Dis
September 2024
Background: Prediction of side-specific extraprostatic extension (EPE) is crucial in selecting patients for nerve-sparing radical prostatectomy (RP). Multiple nomograms, which include magnetic resonance imaging (MRI) information, are available predict side-specific EPE. It is crucial that the accuracy of these nomograms is assessed with external validation to ensure they can be used in clinical practice to support medical decision-making.
View Article and Find Full Text PDFPrehabilitation programs play a key role in optimizing patient experiences and outcomes after surgery. However, there are few data on robot-assisted radical prostatectomy, and prehabilitation programs may be challenging to launch and maintain over time for every patient. Here we report our 5-yr experience of an on-site prehabilitation program and its impact on patient and hospital outcomes.
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- Lu-PSMA therapy is a promising treatment for advanced prostate cancer but has a 30% non-responder rate, leading to investigation of combining it with PD-L1 inhibition to enhance effectiveness.
- A study conducted from March 2018 to December 2021 analyzed 168 patients, focusing on the immune-related signatures in a subset with RNA analysis, revealing that PD-L1 did not significantly impact overall survival (OS), whereas PD-L2 was positively associated with longer OS and better PSA response.
- The findings suggest that a higher PD-L2 signature may improve outcomes with Lu-PSMA therapy, indicating the need for further research into its potential benefits alongside immunotherapy approaches.
Background: High-risk prostate cancer (PCa) patients frequently experience recurrence and progression after radical prostatectomy (RP). Neoadjuvant androgen deprivation therapy (ADT) has not demonstrated a clear oncological benefit and is not currently recommended.
Objective: The SUGAR trial is the first phase 2, randomised, controlled, multicentre, noncommercial, open-label study investigating single-agent perioperative darolutamide compared with the standard of care (ie, upfront RP, without neoadjuvant ADT).
Background: The role of local therapies including radical prostatectomy (RP) in prostate cancer (PCa) patients with clinical lymphadenopathies on prostate-specific membrane antigen (PSMA) positron emission tomography/computerized tomography (PET/CT) has scarcely been explored. Limited data are available to identify men who would benefit from RP; on the contrary, those more likely to benefit already have systemic disease.
Objective: We aimed to assess the predictors of prostate-specific antigen (PSA) persistence in surgically managed PCa patients with lymphadenopathies on a PSMA PET/CT scan by integrating clinical, magnetic resonance imaging (MRI), and PSMA PET/CT parameters.