Epworth Collection:

Guideline of guidelines: pelvic lymph node dissection at time of radical prostatectomy.

2026-05-08T11:02:17Z

Title: Guideline of guidelines: pelvic lymph node dissection at time of radical prostatectomy. Epworth Authors: Carll, Jonathon; Lawrentschuk, Nathan Abstract: Objective: To provide a comprehensive review, analysis and critique of guidelines from various oncological and urological organisations regarding the use pelvic lymph node dissection (PLND) in men undergoing radical prostatectomy (RP) for primary treatment of prostate cancer (PCa). Methods: PubMed, Google Scholar and the official webpages of major urological and oncological societies were searched for PCa guidelines. Guidelines were assessed for recommendations and opinions regarding the use of PLND. A total of 15 guidelines were identified and included for this review. Results: There is consensus amongst guidelines that an extended template (ePLND), is the preferred templated when PLND is to be undertaken. The majority of guidelines acknowledge the lack of proven oncological benefit from PLND, and that the largest benefit is from improved staging information. However, there is significant divergence between the guidelines about which patients should undergo PLND. Some guidelines advocate for the abandonment of PLND altogether, whilst others adopt a risk-stratified approach, suggesting that patients should be offered PLND based on nomograms or clinical risk stratification. Conclusion: Whilst ePLND is recommended by some guidelines for select patients undergoing RP, it remains a contentious topic with significant discordance between guidelines regarding patient selection. Given the lack of proven oncological benefit and significant morbidity from the procedure, careful selection is required. It is uncertain as to how pathological findings on PLND will change management given recent trends towards salvage rather than adjuvant radiotherapy, and improved preoperative staging with prostate-specific membrane antigen-positron emission tomography/computed tomography.

A prospective cohort study of men receiving irreversible electroporation (NanoKnife) for prostate cancer.

2025-08-22T11:03:11Z

Title: A prospective cohort study of men receiving irreversible electroporation (NanoKnife) for prostate cancer. Epworth Authors: Carll, Jonathon; Lawrentschuk, Nathan; Chengodu, Thili Abstract: Irreversible Electroporation (IRE) also known as Nanoknife, is an emerging focal therapy used in the treatment of localised prostate cancer. It remains an investigational, technique with long-term oncological outcomes not yet well-established. This study assesses the initial experience from a prospectively collected database at a single institution.

Comparison of perioperative outcomes following transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: a propensity-matched analysis of VCQI database.

2023-07-31T04:55:04Z

Title: Comparison of perioperative outcomes following transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: a propensity-matched analysis of VCQI database. Epworth Authors: Moon, Daniel Abstract: Objective: To compare perioperative outcomes following retroperitoneal (RPRAPN) and transperitoneal robot-assisted partial nephrectomy (TPRAPN). Methods: With this Vattikuti Collective Quality Initiative (VCQI) database, study propensity scores were calculated according to the surgical access (TPRAPN and RPRAPN) for the following independent variables, i.e., age, sex, side of the surgery, RENAL nephrometry scores (RNS), estimated glomerular filtration rate (eGFR) and serum creatinine. The study's primary outcome was the comparison of trifecta between the two groups. Results: In this study, 309 patients who underwent RPRAPN were matched with 309 patients who underwent TPRAPN. The two groups matched well for age, sex, tumor side, polar location of the tumor, RNS, preoperative creatinine and eGFR. Operative time and warm ischemia time were significantly shorter with RPRAPN. Intraoperative blood loss and need for blood transfusion were lower with RPRAPN. There was a significantly higher number of intraoperative complications with RPRAPN. However, there was no difference in the two groups for postoperative complications. Trifecta outcomes were better with RPRAPN (70.2% vs. 53%, p < 0.0001) compared to TPRAPN. We noted no significant change in overall results when controlled for tumor location (anteriorly or posteriorly). The surgical approach, tumor size and RNS were identified as independent predictors of trifecta on multivariate analysis. Conclusion: RPRAPN is associated with superior perioperative outcomes in well-selected patients compared to TPRAPN. However, the data for the retroperitoneal approach were contributed by a few centers with greater experience with this technique, thus limiting the generalizability of the results of this study.

Tumor immune microenvironment of primary prostate cancer with and without germline mutations in homologous recombination repair genes.

2022-07-05T11:02:27Z

Title: Tumor immune microenvironment of primary prostate cancer with and without germline mutations in homologous recombination repair genes. Epworth Authors: Moon, Daniel; Murphy, Declan; Lawrentschuk, Nathan; Bolton, Damian Abstract: Background: Aberrations in homologous recombination repair (HRR) genes are emerging as important biomarkers for personalized treatment in prostate cancer (PCa). HRR deficiency (HRD) could affect the tumor immune microenvironment (TIME), potentially contributing to differential responses to poly ADP-ribose polymerase (PARP) inhibitors and immune checkpoint inhibitors. Spatial distribution of immune cells in a range of cancers identifies novel disease subtypes and is related to prognosis. In this study we aimed to determine the differences in the TIME of PCa with and without germline (g) HRR mutations. Methods: We performed gene expression analysis, multiplex immunohistochemistry of T and B cells and quantitative spatial analysis of PCa samples from 36 patients with gHRD and 26 patients with sporadic PCa. Samples were archival tumor tissue from radical prostatectomies with the exception of one biopsy. Results were validated in several independent cohorts. Results: Although the composition of the T cell and B cells was similar in the tumor areas of gHRD-mutated and sporadic tumors, the spatial profiles differed between these cohorts. We describe two T-cell spatial profiles across primary PCa, a clustered immune spatial (CIS) profile characterized by dense clusters of CD4+ T cells closely interacting with PD-L1+ cells, and a free immune spatial (FIS) profile of CD8+ cells in close proximity to tumor cells. gHRD tumors had a more T-cell inflamed microenvironment than sporadic tumors. The CIS profile was mainly observed in sporadic tumors, whereas a FIS profile was enriched in gHRD tumors. A FIS profile was associated with lower Gleason scores, smaller tumors and longer time to biochemical recurrence and metastasis. Conclusions: gHRD-mutated tumors have a distinct immune microenvironment compared with sporadic tumors. Spatial profiling of T-cells provides additional information beyond T-cell density and is associated with time to biochemical recurrence, time to metastasis, tumor size and Gleason scores.