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Background: Studies for 3D-laparoscopic prostatectomy (3D-LRP) learning curve and surgical results are lacking. Combining 3D vision to LRP attenuates differences compared to Robotic assisted laparoscopic prostatectomy (RALP) with similar mini-invasiveness but lower costs. Materials and methods: Two hundred consecutive men with localized prostate cancer underwent 3D-LRP at Seinäjoki central hospital between 2013 and 2018. Oncological and functional results were documented. Long-term functional evaluation was done using EPIC-26 survey. Clavien-Dindo classification was used to assess complications during first 3 months. All operations were performed by a single surgeon (M.R.) with no experience of LRP or 3D-LRP. The learning curve was assessed by evaluating urethral anastomosis- and total operative time. Perioperative and postoperative data was collected prospectively during surgery and at subsequent control visits up to minimum of 1 year. Results: A plateau in anastomosis time was reached after 30 cases and in operative time after 60 cases. Median operative time was 114 min (78–258 min) and median time for anastomosis was 25 min (11–90 min). Median blood loss was 150 ml (10–800 ml); 93.5% of the patients were discharged within the first 3 days. Clavien-Dindo ≥3a complications occurred in 6.5%. Positive surgical margins occurred in 23%. One-year after the operation, 93.3% had PSA ≤ 0.1; 91.9% of the patients were dry or used one daytime pad. EPIC-26 scores were as follows: Urinary incontinence 79.25 (14.5–100), urinary irritative/obstructive 93.75 (31.25–100), bowel 100 (33.33–100), sexual 36.17 (0–100) and hormonal 95 (37.5–100). Conclusion: The learning curve for 3D laparoscopic prostatectomy is comparable to RALP, which makes it a cost-effective alternative with comparable oncological and functional results. publishedVersion

Background: To analyse the association between antihypertensive (anti-HT) drug use and risk of urothelial cancer (UC) death. UC occurs as bladder cancer (BCa) and upper tract urothelial carcinomas (UTUCs). Hypertension is a suggested risk factor for BCa and may impair disease prognosis. However, it’s unclear if use of anti-HT drugs could improve the prognosis of UC. Materials and methods: This study evaluated the association between use of anti-HT drugs and UC survival among 14,065 participants diagnosed with BCa and 1080 with UTUC during 1995–2012 in Finland. It analyzed data using the multivariable adjusted conditional Cox regression model. Results: Angiotensin-receptor (ATR) blocker use before BCa diagnosis was associated with slightly decreased risk of BCa death (HR = .81, CI = .71–0.93). The association was dose-dependent and it decreased in association with elevated intensity of ATR-blocker use. Post-diagnostic use of ATR-blockers was similarly associated with better survival compared to non-users (HR = .81, CI = .71–0.92. Interestingly, use of calcium-channel blockers also associated with better survival and the risk of BCa death decreased with increasing intensity of use (HR = .67, CI = .52–0.86 for highest intensity). Conclusions: This large population-based cohort suggests decreased risk of BCa death among ATR-blocker and calcium-channel blocker users. The risk association among ATR-blockers and calcium-channel blockers was dose-dependent suggesting a causal explanation. Similar risk associations are not observed for other anti-HT drug users, which may suggest a direct effect of ATR blocker or calcium-channel blocker use. Further studies are needed to elucidate the potential anticancer mechanism.

The etiology of prostate cancer (PCa) involves environmental and genetic factors. Understanding the role of medication use on PCa risk may clarify the pathophysiological changes and mechanisms in development of cancer.This study investigated PCa risk in relation to overall use of anti-hypertensive drugs and those with specific mechanisms of action. The study cohort (78,615 men) was linked to the prescription database to obtain information on medication use during 20-year follow-up. Information was obtained on PCa diagnoses, causes of deaths, and for a sub-set on B.M.I. and use of non-prescription drugs. Time-dependent drug use variables hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Cox regression analyses.Use of antihypertensive drugs slightly increased PCa risk (HR = 1.16, 95% CI = 1.11-1.22). The risk increase was clearest for metastatic PCa (HR = 1.36, 95% CI = 1.14-1.62). ACE inhibitors, beta-blockers, and diuretics were all separately associated with a small excess risk (HR = 1.10, 95% CI = 1.01-1.19, HR = 1.14, 95% CI = 1.06-1.21, and HR = 1.16, 95% CI = 1.07-1.27, respectively). None of the other groups showed a clear association with PCa risk.The use of antihypertensive drugs was associated with increased prostate cancer risk. Similar risk association for multiple drug groups suggests that the findings may not reflect a direct medication effect, but may be due to underlying hypertension.

The effects of blood cholesterol levels on prostate cancer (PCa) prognosis are unclear. This study explored the associations between blood cholesterol levels and PCa clinical characteristics, including Gleason score and tumor, node, metastasis stage, as well as risk of PCa recurrence and death after radical prostatectomy. The association between statin-induced cholesterol decline and PCa prognosis was also studied.The study cohort consisted of 1314 PCa patients who underwent radical prostatectomy as primary management at the Tampere University Hospital between 1995 and 2009. The follow-up continued until the end of 2016.No associations between cholesterol and PCa severity were found. High-density lipoprotein (HDL) 1 mmol/l and low-density lipoprotein (LDL) 3 mmol/l were associated with reduced risk of all-cause death in time-dependent analysis. However, the risk association was short term as neither HDL or LDL measured 3 years earlier had an effect on PCa prognosis. Modest statin-induced cholesterol decline lowered the risk of PCa recurrence. Hazard ratios (95% confidence intervals) by modest total cholesterol and LDL declines were 0.24 (0.09-0.60) and 0.31 (0.11-0.88), respectively.The findings do not support cholesterol as a risk factor for PCa severity or prognosis after prostatectomy. Cholesterol decline by statin treatment was associated with improved recurrence-free survival compared to statin users whose cholesterol did not decline, which supports the importance of controlling for compliance with statin use when estimating the effects of statins in PCa.

This study analyzes risk associations between metabolic syndrome (MetS) components and the extent and prognosis of renal cell cancer (RCC). The independent effect of each MetS component is unclear, but they may affect RCC prognosis.The study included 13,873 RCC patients (7720 men, 6153 women) diagnosed in Finland in 1995-2012. Data on MetS components (hypertension, dyslipidemia, diabetes and obesity) were obtained as recorded diagnoses or drug purchases related to these conditions. Risk of advanced RCC at diagnosis was estimated by logistic regression. Cox proportional hazard regression was used to evaluate risk associations for RCC death by MetS components after diagnosis. Components were analyzed as time-dependent variables, and included in analyses simultaneously to evaluate their independent effects.During follow-up (median 1.92, SD 4.35 years) 5179 participants died of RCC. Risk of advanced RCC at diagnosis was associated with hypertension [odds ratio (OR) 0.82, 95% confidence interval (CI) 0.74-90] and dyslipidemia (OR 0.52, 95% CI 0.48-0.57). After adjustment for tumor extent, hypertension remained associated with increased risk of RCC death (hazard ratio 1.44, 95% CI 1.35-1.54]. Other MetS components were not independently associated with RCC death when taking hypertension into account. Study limitations include the non-randomized design and lack of smoking status.The lower risk of advanced disease among hypertensive participants may reflect the higher proportion of incidental renal tumors found through more frequent physician contacts. Nevertheless, hypertension was independently associated with worse RCC survival, whereas other MetS components had no clear prognostic role.