This issue contains one Review Article, 10 Original Articles, one Short Communication and two Case Reports.
The Review Article was written by Wang and Lee (New Orleans, USA) on robot-assisted partial nephrectomy (RAPN). Recently, RAPN has been introduced as an alternative to laparoscopic partial nephrectomy, as more urologists gain experience from robot-assisted radical prostatectomy (RARP) with integration of the robot into clinical practice. In this review, the authors present their surgical steps as well as review the current status of RAPN. Current studies have shown that RAPN is a safe, minimally-invasive procedure with a short learning curve when carried out by an expert surgeon dealing with other robotic procedures, such as RARP. With this technique, the expansion of indications for RAPN has continued to hilar, endophytic and bilateral renal masses, as well as more complex masses. This review helps us to understand the procedures and advantages of RAPN.
Among the following Original Articles, five of them are related to prostate cancer (PC). The widespread introduction of prostate-specific antigen (PSA) screening has substantially increased the proportion of patients diagnosed with low-grade, organ-confined prostate cancer. Overdiagnosis and subsequent overtreatment are important side-effects of screening for, and early detection of, PC. Active surveillance (AS) is of growing interest as an alternative to radical treatment of low-risk PC. However, underdiagnosis on the initial biopsy is a concern to be resolved. Linder et al. (Rochester, USA) examined the ability of standard 12-core and extended saturation transrectal biopsy techniques to predict appropriate candidates for AS. In this study, the differences in diagnostic accuracy between two procedures were evaluated in patients (standard for 124 and saturation for 94) who underwent radical prostatectomy, but would have been candidates for AS. Upstaging was shown in two standard biopsy patients (1.6%) and no saturation biopsy patients (P = 0.62). The authors have concluded that these two techniques are equally predictive of candidates for active surveillance.
In the last couple of years, the number of patients who received RARP has dramatically increased in Japan. Hashimoto et al. (Tokyo, Japan) investigated preoperative factors for predicting positive surgical margin (PSM) in Japanese patients who underwent RARP carried out by a single surgeon. A total of 244 men underwent RARP between August 2006 and September 2011. In this study, PSA density and the learning curve have been highlighted as independent risk factors of PSM instead of the other parameters. Although the number of patients was relatively small compared with studies outside of Japan, the conclusion of this study is essentially the same as reported previously.
Another article on PC from Japan by Kimura et al. (Tsukuba, Japan) was carried out to evaluate and validate prognostic grouping in prostate cancer. The Union for International Cancer Control and American Joint Committee on Cancer developed prognostic grouping (PG) for PC in the TNM seventh edition by incorporating PSA and Gleason score into TNM stage grouping. In this study, the authors validated the PG of the TNM seventh edition using the Japan Study Group of Prostate Cancer database to clarify whether the PG could stratify the prognosis of PC patients. According to the data, there was considerable variation among the PG subgroups, although PG could stratify the prognosis of the PC patients. In this study, the authors also provided modified PG for patients who received primary androgen deprivation therapy, which might improve accuracy in predicting prognosis. It could be of worth to validate the modified PG using a large database of PC patients treated by other modalities.