BJMO - volume 19, issue 7, november 2025
E. Smet , A. Peeters , C. Van Praet MD, PhD, K. Decaestecker PhD, C. Berquin MD, B. De Troyer MD, N. Lumen MD, PhD
Background: Robot-assisted radical prostatectomy (RARP) has become the standard surgical treatment for patients with localised and locally advanced prostate cancer (PC). While its perioperative advantages are well established, there remains a need for long-term data on functional and oncological outcomes, as well as a better understanding of the factors that influence these outcomes. Objective: To evaluate long-term functional and oncological outcomes after RARP and identify patient- and surgery-related predictors of these outcomes in a cohort of 941 men with non-metastatic PC who underwent RARP between 2013 and 2024. Factors to be examined are age, mode of radical prostatectomy (RP) (Vattikuti vs. Bocciardi), previous benign prostatic hyperplasia (BPH) surgery, nerve-sparing (NS) technique, collar technique and EAU risk group. Results: At twelve months, 86.1% of patients regained functional continence, 59.7% full continence and 26.3% spontaneous erectile function. Younger age, NS and the Bocciardi technique were associated with better functional outcomes. Positive surgical margins (PSM) occurred in 31.9%. Five-year biochemical recurrence-free survival (BCRFS), metastasis-free survival (MFS) and overall survival (OS) were 71.5%, 93.2% and 96.4%, respectively. Biochemical recurrence (BCR) rates were higher in patients with prior BPH surgery and EAU risk group stratification was a strong prognostic factor for all oncological outcomes. Conclusion: This study identified key predictors of functional and oncological outcomes following RARP, including age, mode of RP, prior BPH surgery and EAU risk group. These findings may inform preoperative counselling and support future AI-based models for personalised surgical planning. Patient summary: This study investigated outcomes in patients who underwent robot-assisted prostate surgery for cancer. Most patients regained urinary continence and remained recurrence-free after several years. Factors such as age and surgical technique influenced recovery, whereas cancer recurrence was primarily determined by cancer stage. These findings support more individualised surgical planning and patient counselling.
(BELG J MED ONCOL 2025;19(7):313–320)
Read moreBJMO - volume 19, issue 2, march 2025
E. Donck MD, P. de Visschere MD, PhD, C. Van Praet MD, PhD, S. Verbeke MD, PhD, S. Hendrickx MD, C. Berquin MD, S. Rottey MD, PhD, W. Verla MD, PhD, N. Lumen MD, PhD
Background: Magnetic Resonance Imaging (MRI) is advised for the diagnosis of prostate cancer (PC), and PSMA PET/CT is used for distant staging of PC. Local staging of the primary tumour with PSMA PET/CT is currently not recommended, although the primary lesion can be visualised as well. Recently, two new tumour-assessing scores were developed to optimise the diagnostic accuracy of PSMA PET/CT for the primary tumour: the PSMA-expression score and the PRIMARY score.
Objective: To evaluate the performance of PSMA PET/CT and its PRIMARY and PSMA-expression scores in the assessment of intraprostatic lesions in patients with PC. Patients and methods: This is a retrospective analysis of patients treated with radical prostatectomy for PC in a single tertiary centre between 2019 and 2022. All patients underwent preoperative prostate MRI and 18F- or 68Ga-PSMA-11 PET/CT. The medical images were pseudonymized and retrospectively assessed by two radiologists and a nuclear medicine specialist. The PSMA PET/CTs were scored according to the PSMA-expression score (PROMISE V2 framework) and the PRIMARY score. The MRIs were scored using the PI-RADS system. The accuracy of the three different scores for diagnosing high-grade PC (ISUP grade ≥3) was evaluated.
Results: The PSMA-expression score demonstrated the highest accuracy for detecting high-grade PC, with an AUC of 0.76, outperforming the PI-RADS scores from reader 1 (AUC of 0.59) and reader 2 (AUC of 0.68) and the PRIMARY score (AUC of 0.69). It had a sensitivity of 72%, a specificity of 70%, a positive predictive value of 85%, and a negative predictive value of 51%.
Conclusion: PSMA PET/CT has a promising diagnostic accuracy to detect intraprostatic lesions of high grade in patients with PC. Further validation of the PSMA PET scoring systems is warranted.
Patient summary: In this study, the performance of PSMA PET/CT (the PRIMARY and PSMA-expression scores) to detect malignant lesions in the prostate was evaluated. PSMA PET/CT and these scoring systems seem promising to detect PC and could be of interest in cases where MRI is ambiguous.
(BELG J MED ONCOL 2025;19(2):46–53)
Read moreBJMO - volume 7, issue 4, september 2013
C. Van Praet MD, PhD, D. De Maeseneer MD, N. Lumen MD, PhD, S. Rottey MD, PhD
Since the 1940’s the androgen receptor has been the main target for systemic therapy in prostate cancer. Classic hormonal therapy aims at lowering serum testosterone levels or block the androgen receptor ligand-binding domain. Despite disease progression, castration-resistant prostate cancer remains predominantly androgen-driven as novel secondary hormonal therapy with abiraterone acetate or enzalutamide has demonstrated increased overall survival. Promising androgen synthesis inhibitors (orteronel, galeterone), androgen receptor inhibitors (ARN-509, EPI-001, AZD3514) and heat-shock protein modulators are under investigation. Given the upcoming arsenal of systemic therapies and the molecular heterogeneity of castration-resistant prostate cancer, patient-tailored therapy strategies are being explored.
(BELG J MED ONCOL 2013;7(3):111–8)
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