ORCID Profile
0000-0001-8553-5618
Current Organisations
Peter MacCallum Cancer Centre
,
University of Melbourne
,
Epworth Hospital
,
Royal Melbourne Hospital Royal Park Campus
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Publisher: Wiley
Date: 19-07-2023
DOI: 10.1111/BJU.16135
Publisher: Elsevier BV
Date: 10-2009
DOI: 10.1016/J.UROLOGY.2009.01.071
Abstract: To reduce the complications associated with placenta percreta (PP) by adequate preoperative planning with a multidisciplinary team. PP is a rare and potentially morbid condition of pregnancy, particularly if the urinary tract is involved. Cesarean delivery and hysterectomy are typically required to reduce the pelvic hemorrhage, placing the urinary tract at risk. We reviewed our urologic consultations and experience with PP in the past year. Maternal factors, surgical timing, blood loss, surgical complications, and outcomes were recorded. The timing of the urologic assessment was ided into preoperative and perioperative. Five cases of PP were available. Of the 5 cases, 4 had been successfully diagnosed by prenatal ultrasonography, with 2 also requiring magnetic resonance imaging. All patients underwent cesarean delivery and hysterectomy, with significant blood loss (median 12 U transfused). A preoperative urologic assessment was done in 2 of the 5 patients, with no urinary complications found in this group. Both patients had undergone cystoscopy with placement of temporary ureteral catheters, even though the cases were emergent. In contrast, 3 patients underwent urologic consultation during or immediately after surgery. All 3 had bladder injuries, with 1 ureteral injury and delayed convalescence in this group of patients. PP remains a technically challenging and high-risk obstetric condition. In the setting of urinary tract involvement, adequate imaging, surgical planning, and preoperative urologic assessment with placement of temporary ureteral catheters were associated with a lower incidence of urologic complications in our series. Adequate preoperative planning with a multidisciplinary team is recommended to reduce the complications associated with PP.
Publisher: Wiley
Date: 11-2011
Publisher: Springer Science and Business Media LLC
Date: 04-06-2021
Publisher: Springer Science and Business Media LLC
Date: 08-02-2013
DOI: 10.1007/S11934-013-0308-Y
Abstract: Imaging for urothelial cancer, particularly that located in the bladder, has generally been based on computed tomography (CT). However in more recent times the role of positron emission tomography-CT (PET-CT) has emerged and increasingly magnetic resonance (MR) imaging has become utilised. This concise review will outline the role of these modalities when dealing with muscle-invasive bladder cancer (MIBC).
Publisher: Elsevier BV
Date: 11-2009
DOI: 10.1016/J.UROLOGY.2009.05.091
Abstract: To compare the quality of uro-oncological Web sites, to assess for language or disease differences across Western languages, and to perform a longitudinal comparison between 2004 and 2009. Uro-oncological Internet information quality is considered variable but no comprehensive analysis exists. Health on the Net (HON) principles may be applied to Web sites using an automated toolbar function. Using the Google search engine (www.Google.com), in 2004 and 2009, 2400 Web sites were assessed using the keywords prostate, bladder, kidney, and testicular cancer in English, French, German, and Spanish. The first 150 Web sites in each language had HON principles measured-a comparison between 2004 and 2009 was done. A further analysis of site sponsorship was undertaken. Regardless of language or cancer type, most sites are not HON accredited. English has consistently more than English, French, Spanish, or German. For the respective languages in 2009, prostate has the most (29, 14%, 16%, 12%), followed by bladder (29%, 22%, 14%, 13%), kidney (25%, 15%, 10%, 13%), and testis (26%, 19%, 7.11%). Significant differences were found comparing language and organ groups. The quality improved from 2004 to 2009. Nonprofit organizations (51%), government and/or educational (39%), commercial (20%), with urologists last (14%) were accredited. A lack of validation of most uro-oncological sites should be appreciated by urologists. Additionally, there is a discrepancy in quality and number of Web sites across uro-oncological diseases and major Western European languages, but with some improvement seen recently. We need to encourage informative, ethical, and reliable complimentary health Web sites on the Internet and direct patients to them.
Publisher: Wiley
Date: 15-06-2022
DOI: 10.1002/BCO2.173
Abstract: The aim of this study is to gain experienced nursing perspective on current and future complication reporting and grading in Urology, establish the CAMUS CCI and quality control the use of the Clavien‐Dindo Classification (CDC) in nursing staff. The 12‐part REDCap‐based Delphi survey was developed in conjunction with expert nurse, urologist and methodologist input. Certified local and international inpatient and outpatient nurses specialised in urology, perioperative nurses and urology‐specific advanced practice nurses/nurse practitioners will be included. A minimum s le size of 250 participants is targeted. The survey assesses participant demographics, nursing experience and opinion on complication reporting and the proposed CAMUS reporting recommendations grading of intervention events using the existing CDC and the proposed CAMUS Classification and rating various clinical scenarios. Consensus will be defined as ≥75% agreement. If consensus is not reached, subsequent Delphi rounds will be performed under Steering Committee guidance. Twenty participants completed the pilot survey. Median survey completion time was 58 min (IQR 40–67). The survey revealed that 85% of nursing participants believe nurses should be involved in future complication reporting and grading but currently have poor confidence and inadequate relevant background education. Overall, 100% of participants recognise the universal demand for reporting consensus and 75% hold a preference towards the CAMUS System. Limitations include variability in nursing experience, complexity of supplemental grades and survey duration. The integration of experienced nursing opinion and participation in complication reporting and grading systems in a modern and evolving hospital infrastructure may facilitate the assimilation of otherwise overlooked safety data. Incorporation of focused teaching into routine nursing education will be essential to ensure quality control and stimulate awareness of complication‐related burden. This, in turn, has the potential to improve patient counselling and quality of care.
Publisher: Wiley
Date: 10-04-2018
DOI: 10.1111/BJU.14192
Abstract: To report on the dosimetric benefits and late toxicity outcomes after injection of hydrogel spacer (HS) between the prostate and rectum for patients treated with prostate radiotherapy (RT). In all, 76 patients with a clinical stage of T1-T3a prostate cancer underwent general anaesthesia for fiducial marker insertion plus injection of the HS into the perirectal space before intensity-modulated RT (IMRT) or volumetric-modulated arc RT (VMAT). HS safety, dosimetric benefits, and the immediate- to long-term effects of gastrointestinal (GI) toxicity were assessed. There were no postoperative complications reported. The mean (range) prostate size was 66.0 (25.0-187.0) mm. Rectal dose volume parameters were observed and the volume of rectum receiving 70 Gy (rV Injection of HS resulted in a reduction of irradiated rectal dose volumes along with minimal GI toxicities, irrespective of prostate size.
Publisher: Hindawi Limited
Date: 2009
DOI: 10.1100/TSW.2009.45
Abstract: Testosterone replacement has undergone somewhat of a revolution in the past decade with the introduction of topical administration techniques, including patches and gels, as well as an increasing interest in the treatment of older men with low testosterone levels for what is now termed andropause. Increasingly, testosterone replacement therapy is being in idually tailored. Side effects to skin patches have been reported with irritant contact dermatitis being the most common. However, ulceration has previously not been reported. Herein, we present a case that highlights testosterone transdermal therapies, their potential side effects and management strategies, and broadens our knowledge as we approach an era where these types of treatments are likely to be more common.
Publisher: JMIR Publications Inc.
Date: 18-09-2015
DOI: 10.2196/JMIR.4786
Publisher: Wiley
Date: 11-08-2005
Publisher: AMPCo
Date: 12-2013
DOI: 10.5694/MJA13.10779
Publisher: Elsevier BV
Date: 10-2010
DOI: 10.1016/J.UROLOGY.2009.12.050
Abstract: The spread of urological malignancies to bone is a poor prognostic factor. Early detection of metastatic bony lesions assists with tailoring patient management and potentially improving quality of life. Newer therapies such as zolderonic acid for prostate cancer have reinvigorated the importance of clinicians treating bony disease. An array of biochemical and imaging options are available and the order, sensitivity and cost of such investigations need to be understood to maximise clinical benefit. Furthermore, the ideal time to investigate for bony metastases has often been controversial. Although simple history and examination, serum calcium and alkaline phosphatase and plain radiography with bone scintigraphy remain at the forefront of diagnosing bony disease, evolving diagnostic modalities, such as positron emission tomography and newer bone markers need to be considered. The aim of this review is to clarify the role of various investigations and to give clinicians a current analysis of the timing of such investigations in the context of evolving diagnostic modalities and accepted guidelines for urological malignancy.
Publisher: Wiley
Date: 07-08-2023
DOI: 10.1111/BJU.16139
Publisher: Wiley
Date: 28-11-2019
DOI: 10.1111/BJU.14516
Abstract: Haemorrhage is a frequent complication of radiation cystitis leading to emergency presentations in patients with prior pelvic radiation therapy. Standard initial patient management strategies involve resuscitation, bladder washout with clot evacuation and continuous bladder irrigation. Beyond this, definitive surgical treatment is associated with significant morbidity and mortality. Alternative less invasive management options for non-emergent haemorrhagic cystitis include systemic medical therapies, hyperbaric oxygen (HBO), intravesical therapies and laser ablation. However, evidence to support and compare treatment for haemorrhagic radiation cystitis is limited. Herein, a literature search pertaining to the current management of haemorrhagic cystitis was conducted. In total, 23 studies were included in this review with 2 studies reviewing systemic therapy, 7 studies evaluating HBO therapy, 10 studies investigating a variety of intravesical therapies and the remaining 4 were relating to ablative therapies. Across these studies, the patient groups were heterogenous with small numbers and variable follow up periods. With evaluation of existing literature, this narrative review also provides a stepwise clinical algorithm to aid the urologist in treating patients presenting with complications associated with radiation cystitis.
Publisher: Wiley
Date: 12-02-2020
DOI: 10.1111/BJU.14999
Abstract: Primary objectives: To determine the additive value of gallium‐68 prostate‐specific membrane antigen (PSMA) positron emission topography (PET)/computed tomography (CT) when combined with multiparametric magnetic resonance imaging (mpMRI) detecting clinically significant prostate cancer (csPCa) in men undergoing initial biopsy for suspicion of PCa, and to determine the proportion of men who could have avoided prostate biopsy with positive mpMRI (PI‐RADS ≥3) but negative PSMA‐PET/CT. Secondary objectives: To determine the proportion of men who had csPCa detected only by PSMA‐PET/CT or only by systematic prostate biopsy to compare index lesions by template biopsies vs targeted lesions identified on mpMRI or PSMA‐PET/CT to assess whether there may be health economic benefit or harm if PSMA‐PET/CT is incorporated into the diagnostic algorithm and to develop a nomogram which combines clinical, imaging and biomarker data to predict the likelihood of csPCa. The PRIMARY trial is a multicentre, prospective, cross‐sectional study that meets the criteria for level 1 evidence in diagnostic test evaluation. PRIMARY will investigate if a limited (pelvic‐only) PSMA‐PET/CT in combination with routine mpMRI can reliably discriminate men with csPCa from those without csPCa. We conducted a power calculation based on pilot data and will recruit up to 600 men who will undergo PSMA‐PET/CT (the index test), mpMRI (standard test) and transperineal template + targeted (PSMA‐PET/CT and/or mpMRI) biopsies (reference test). The conduct and reporting of the mpMRI and PSMA‐PET/CT will be blinded to each other. The PRIMARY trial will measure and compare sensitivity, specificity, positive predictive value and negative predictive value of both mpMRI and PSMA‐PET/CT vs targeted prostrate biopsy. The results will be used to determine the proportion of men who could safely avoid biopsy without compromising detection of csPCa. Furthermore, we will assess whether there is a health economic benefit in incorporating PSMA‐PET/CT into the diagnostic algorithm. This trial will provide robust prospective data to determine the diagnostic ability of PSMA‐PET/CT used in addition to mpMRI. It will establish if certain patients can avoid biopsy in the investigation of PCa.
Publisher: Wiley
Date: 29-03-2022
DOI: 10.1111/BJU.15722
Publisher: Wiley
Date: 19-02-2014
DOI: 10.1111/BJU.12458
Abstract: To evaluate the accuracy of various prostate tumour volume (TV) estimation methods. To determine the most appropriate estimation method for current clinical practice. Radical prostatectomy (RP) specimens from multiple institutions were analysed by a single uro-pathologist between September 2009 and May 2011. Tumour properties including thickness, width and length were collected and TV was established using computer-assisted image analysis (CAIA). TV estimation methods including square, cuboidal and ellipsoidal estimations were calculated using previously reported formulae. The estimation methods were compared against the 'gold-standard' and the accuracy of identifying clinically significant tumours of TV ≥0.5 cc was determined. In all, 299 consecutive specimens were analysed by a single uropathologist. The median index TV on CAIA was 1.42 cc. Of the four estimation methods, the ellipsoid methods produced the closest correlation with the gold-standard (r(2) 0.91, P = 0.71). This correlation lost accuracy when larger tumours (TV >4 cc) were excluded from the analysis (r(2) = 0.73, P = 0.003). Sensitivity and specificity for identifying clinically significant tumours was 94% and 92% respectively, when using the ellipsoid estimation. In current uro-pathology, the ellipsoidal estimation method appears to be the most suitable for estimating TV in prostate cancers. This method is cheap, reproducible and sensitive and can be safely used as a surrogate for CAIA volumes when such technology is not available.
Publisher: Elsevier BV
Date: 11-2009
Publisher: Wiley
Date: 04-2013
DOI: 10.1111/ANS.12082
Publisher: Mary Ann Liebert Inc
Date: 02-2006
Abstract: To demonstrate the construction of a simple training model from reconfigured chicken skin to simulate open and laparoscopic reconstructive pyeloplasty. Reconfiguring and suturing chicken skin dissected off its muscle creates a model of the ureteropelvic junction. Dismembered pyeloplasty techniques may be practiced with open or laparoscopic equipment. Students with prior training in suturing and knot-tying only used the open pyeloplasty model on three occasions. Urology trainees experienced in surgery but not laparoscopic pyeloplasty used the model laparoscopically. Students demonstrated a significant improvement (P < 0.05) between their first (17.00 +/- 4.44 minutes mean +/- 95% CI) and third (11.33 +/- 2.40 minutes) attempts using the open model. Urology trainees improved their mean times from the first (18.0 minutes) to third (11.8 minutes) attempts using the laparoscopic model. This cheap and readily available model is reproducible and applicable to training in both open and laparoscopic pyeloplasty.
Publisher: FapUNIFESP (SciELO)
Date: 10-2010
Publisher: JMIR Publications Inc.
Date: 12-05-2017
DOI: 10.2196/IJMR.6732
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2010
DOI: 10.1016/J.JURO.2009.12.097
Abstract: Complementary and alternative medicine, including phytotherapeutic agents, or those derived from plant or herb extracts to treat symptoms, is widely accepted in the community. Men with bothersome lower urinary tract symptoms due to benign prostatic hyperplasia increasingly use such preparations. Phytotherapeutic agent quality is unregulated and in most instances the contents are unknown while erectile dysfunction and prostate cancer treatments have shown contamination with standard pharmaceuticals. Since trial results for benign prostatic hyperplasia phytotherapeutic agents are inconsistent, they may also be contaminated. Thus, we determined whether pharmacological doses of alpha-blockers and/or 5alpha-reductase inhibitors were present in a s le of phytotherapeutic agents for benign prostatic hyperplasia. We analyzed 15 phytotherapeutic products marketed for benign prostatic hyperplasia. Only oral tablets or capsules were considered with teas, tonics and foods excluded from study. We made random purchases from shop front health stores and Internet retailers. All batches of commercial phytotherapy were analyzed by high performance liquid chromatography. Analysis was semiquantitative using extracts from alfuzosin, doxazosin, terazosin, tamsulosin, dutasteride and finasteride. In the 15 batches of different phytotherapeutic agents tested no interference secondary to contamination with alpha-blockers or 5alpha-reductase inhibitors was observed. All phytotherapeutic agents for benign prostatic hyperplasia in this study tested negative for alpha-blockers and 5alpha-reductase inhibitors. Inconsistent results in trials using phytotherapeutic agents are probably not explained by the presence of standard pharmaceuticals.
Publisher: Canadian Urological Association Journal
Date: 12-2011
DOI: 10.5489/CUAJ.11281
Publisher: Springer Science and Business Media LLC
Date: 13-05-2010
DOI: 10.1007/S11255-010-9750-7
Abstract: Complex statistical models utilizing multiple inputs to derive a risk assessment may benefit prostate cancer (PC) detection where focus has been on prostate-specific antigen (PSA). This study develops a polychotomous logistic regression (PR) model and an artificial neural network (ANN) for predicting biopsy results, particularly for clinically significant PC. There were 3,025 men undergoing TRUS-guided biopsy (BX) with PSA <10 ng/ml selected. BX outcome classified as benign, atypical small acinar proliferation or high-grade prostatic intraepithelial neoplasia (ASAP/PIN), non-significant (NSPC) or clinically significant PC (CSPC). PR and ANN models were developed to distinguish between BX categories. Predictors were age, PSA, abnormal digital rectal examination (DRE), positive transrectal ultrasound (TRUS) and prostate volume. Among the BXs, 44% were benign, 14% ASAP/PIN, 16% NSPC and 25% CSPC. Median age, PSA and volume were 64 years, 5.7 ng/ml and 50 cc. TRUS lesion was present in 47%, and DRE was abnormal in 39%. PR and ANN models did not differ on percentage BX outcomes correctly predicted (55, 57%, respectively) and were equally poor for both ASAP/PIN (0%) and NSPC (2%). For PR and ANN, 74-78% ASAP/PIN predicted benign, 2% NSPC and 20-24% CSPC. For NSPC, 69-71% predicted benign, 27-29% CSPC. Benign outcomes were well identified (86-88%), although 12-13% classified CSPC. CSPC was correctly identified in 65-66% with misclassifications largely benign (33% for PR and ANN). Neither PR nor ANN was able to distinguish between the four biopsy outcomes: ASAP/PIN and NSPC were not distinguished from benign or CSPC. ANN did not perform better than PR. Inclusion of additional predictors may increase the performance of statistical models in predicting BX outcome.
Publisher: Wiley
Date: 07-04-2020
DOI: 10.1111/BJU.15055
Publisher: Springer Science and Business Media LLC
Date: 26-02-2009
Publisher: Springer Science and Business Media LLC
Date: 26-04-2011
Abstract: Active surveillance is now an accepted management strategy for men with low-risk localized prostate cancer, in recognition of the knowledge that the majority of men with such cancers are likely to die from other causes. The most obvious benefit of active surveillance is the reduction of morbidity associated with surgery by delaying or avoiding radical gland therapy. Other advantages include lower overall costs to the health-care system and potentially a better quality of life. These advantages should be balanced against the risks of delayed therapy, the most considerable of which being development of more-aggressive disease. Appropriate selection criteria and the definition of triggers for intervention with radical therapy are critical components of an active surveillance protocol. The ability to accurately identify and cure the men whose cancers will progress using clinical, biopsy and imaging data is yet to be resolved, as is the psychological burden of living with an untreated cancer. The benefit of 5α-reductase inhibitors as secondary chemoprevention in men on active surveillance is a new avenue of research. Focal therapy, which has the similar aim of reducing morbidity while maintaining oncological control, is an emerging competitor for active surveillance. Nevertheless, active surveillance is an appealing management option for selected men with prostate cancer.
Publisher: MDPI AG
Date: 13-12-2022
Abstract: PSMA PET-CT scans are now recommended in international urological guidelines for primary staging and re-staging of prostate cancer. However, there is little published literature on the clinical outcomes for patients after treatment decisions made using PSMA PET-CT results. This is a multisite, prospective cohort study investigating the clinical outcomes of men who received treatment plans based on PSMA PET-CT results for primary staging. Men with biopsy proven prostate cancer received a PSMA PET-CT scan for primary staging. Treatment plans were recommended by multidisciplinary teams (MDT). After treatment, these men were followed with 6 monthly PSA tests and imaging or biopsies if recommended by MDT. The primary outcome was treatment progression defined as the addition or change of any treatment modalities such as androgen deprivation therapy, radiation therapy or chemotherapy. In total, 80% of men did not have any treatment progression after enactment of treatment based on PSMA PET-CT primary staging results at 29 months of follow up. Men who had distant nodes seen on PSMA PET-CT had a 5 times increased risk of treatment progression. Larger studies with longer follow up are needed to validate our results and optimise the way clinicians use PSMA PET-CT results to guide management.
Publisher: Canadian Urological Association Journal
Date: 17-10-2012
DOI: 10.5489/CUAJ.10070
Publisher: JMIR Publications Inc.
Date: 28-10-2022
DOI: 10.2196/39725
Abstract: Distress is common immediately after diagnosis of testicular cancer. It has historically been difficult to engage people in care models to alleviate distress because of complex factors, including differential coping strategies and influences of social gender norms. Existing support specifically focuses on long-term survivors of testicular cancer, leaving an unmet need for age-appropriate and sex-sensitized support for in iduals with distress shortly after diagnosis. We evaluated a web-based intervention, Nuts & Bolts, designed to provide support and alleviate distress after diagnosis of testicular cancer. Using a mixed methods design to evaluate the acceptability, feasibility, and impact of Nuts & Bolts on distress, we randomly assigned participants with recently diagnosed testicular cancer (1:1) access to Nuts & Bolts at the time of consent (early) or alternatively, 1 week later (day 8 delayed). Participants completed serial questionnaires across a 4- to 5-week period to evaluate levels of distress (measured by the National Comprehensive Cancer Network Distress Thermometer [DT] scored 0-10), anxiety, and depression (Hospital Anxiety and Depression Score [HADS]–Anxiety and HADS-Depression each scored 0-21). The primary end point was change in distress between consent and day 8. Secondary end points of distress, anxiety, and depression were assessed at defined intervals during follow-up. Optional, semistructured interviews occurring after completion of quantitative assessments were thematically analyzed. Overall, 39 participants were enrolled in this study. The median time from orchidectomy to study consent was 14.8 (range 3-62) days. Moderate or high levels of distress evaluated using DT were reported in 58% (23/39) of participants at consent and reduced to 13% (5/38) after 1 week of observation. Early intervention with Nuts & Bolts did not significantly decrease the mean DT score by day 8 compared with delayed intervention (early: 4.56-2.74 vs delayed: 4.47-2.74 P=.85), who did not yet have access to the website. A higher baseline DT score was significantly predictive of reduction in DT score during this period (P .001). Median DT, HADS-Anxiety, and HADS-Depression scores reduced between orchidectomy and 3 weeks postoperatively and then remained stable throughout the observation period. Thematic analysis of 16 semistructured interviews revealed 4 key themes, “Nuts & Bolts is a helpful tool,” “Maximizing benefits of the website,” “Whirlwind of diagnosis and readiness for treatment,” and “Primary stressors and worries,” as well as multiple subthemes. Distress is common following the diagnosis of testicular cancer however, it decreases over time. Nuts & Bolts was considered useful, acceptable, and relevant by in iduals diagnosed with testicular cancer, with strong support for the intervention rendered by thematic analyses of semistructured interviews. The best time to introduce support, such as Nuts & Bolts, is yet to be determined however, it may be most beneficial as soon as testicular cancer is strongly suspected or diagnosed.
Publisher: Springer Science and Business Media LLC
Date: 22-12-2005
DOI: 10.1007/S00534-005-1011-2
Abstract: Spleen-preserving distal pancreatectomy, although rarely performed, has become an option for treatment of distal pancreatic neoplasms. However, the spleen, once mobilised, is often free to tort. A reliable method of fixing the spleen would be a useful adjunct to this procedure. We describe the use of a new technique to fix the spleen using a peritoneal "pillowcase" to envelop the spleen, thus preventing its torsion. This patient has done well, with no problems encountered intraoperatively or postoperatively, using this new technique of spleen fixation. The use of a peritoneal "pillowcase" to envelope the spleen following distal pancreatectomy has proven a useful adjunct to this somewhat difficult surgical procedure. It may be applied in other cases where spleen fixation is necessary.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2007
Publisher: Springer Science and Business Media LLC
Date: 11-06-2009
DOI: 10.1007/S00345-009-0430-0
Abstract: We believe that active surveillance is the optimal choice for compliant men who are able to handle the mental burden of not receiving adjuvant treatment. This takes into consideration the fact that a small number of men with clinical stage I (CSI) seminoma on surveillance will recur but are salvageable with equivalent outcome compared to those having adjuvant treatment which exposes eight in ten men to unnecessary short- and long-term risks with still the possibility of recurrence requiring salvation. This review will focus on CSI seminoma and the controversies surrounding its treatment and based upon current available evidence will outline the case for surveillance.
Publisher: Wiley
Date: 11-09-2019
DOI: 10.1111/BJU.14886
Abstract: To report the outcomes of stereotactic ablative body radiotherapy (SABR) in men with oligometastatic prostate cancer (PCa) diagnosed on prostate-specific membrane antigen (PSMA)-positron emission tomography/computed tomography (PET/CT), based on a single-institution experience and the published literature. This was a retrospective cohort study of the first 20 consecutive men with oligometastatic PCa, treated with SABR in a single institution, who had biochemical recurrence after previous curative treatment (surgery/radiotherapy), had no evidence of local recurrence, were not on palliative androgen deprivation therapy (ADT), and had PSMA-PET/CT-confirmed oligometastatic disease (≤3 lesions). These men were treated with SABR to a dose of 30 Gy in three fractions for bone metastases, and 35-40 Gy in five fractions for nodal metastases. The outcomes of interest were: PSA response local progression-free survival (LPFS) distant progression-free survival (DPFS) and ADT-free survival (ADTFS). A literature review was performed to identify published studies reporting on outcomes of PSMA-PET/CT-guided SABR. In our institutional cohort, 12 men (60%) had a decline in PSA post-SABR. One man had local progression 9.6 months post-SABR, with 12-month LPFS of 93%. Ten men had distant progression outside of their SABR treatment field, confirmed on PSMA-PET/CT, with 12-month DPFS of 62%, of whom four were treated with palliative ADT, two received prostate bed radiotherapy for prostate bed progression (confirmed on magnetic resonance imaging), and four received a further course of SABR (of whom one had further progression and was treated with palliative ADT). At last follow-up, six men (one with local progression and five with distant progression) had received palliative ADT. The 12-month ADTFS was 70%. Men with longer intervals between local curative treatment and SABR had better DPFS (P = 0.03) and ADTFS (P = 0.005). Four additional studies reporting on PSMA-PET/CT-guided SABR for oligometastatic PCa were identified and included in the review, giving a total of 346 patients. PSA decline was reported in 60-70% of men post-SABR. The 2-year LPFS, DPFS and ADTFS rates were 76-100%, 27-52%, and 58-62%, respectively. Our results showed that PSMA-PET/CT could have an important role in identifying men with true oligometastatic PCa who would benefit the most from metastases-directed therapy with SABR.
Publisher: American Geophysical Union (AGU)
Date: 04-2018
DOI: 10.1002/2017JB015114
Publisher: Wiley
Date: 07-02-2023
DOI: 10.1111/BJU.15974
Abstract: To perform a systematic review of all cases of spontaneous rupture of the urinary bladder (SRUB) and to describe the demographic data, associated comorbidities, clinical presentation, diagnosis, relevant laboratory findings, associated factors, management, morbidity and mortality associated with the presentation of SRUB. The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). A search was carried out across the following electronic databases: PubMed, Web of Science, Scopus, Google Scholar and the Cochrane Database of Systematic Reviews. Full texts of selected studies were analysed, and data extracted. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA). A total of 278 articles comprising 240 case reports and 38 case series, with a total of 351 patients were included. The median (interquartile range [IQR]) age of all included patients was 47.5 (33–65) years. The median (IQR) time to presentation was 48 (24–96) h, with the major presenting symptom being abdominal pain (76%). In patients in whom the diagnosis was made prior to any intervention, the condition was misdiagnosed in 64% of cases. The diagnosis was confirmed during explorative open surgery in 42% of cases. Pelvic radiation (13%) and alcohol intoxication (11%) were the most common associated factors. Intraperitoneal rupture (89%) was much more common, with the dome of the bladder being most frequently involved (55%). The overall mortality was 15%. This review identified a number of key factors that appear to be associated with an increased incidence of SRUB. It also emphasized the high rate of misdiagnosis and challenge in confirming the diagnosis. Overall, it highlighted the importance of the need for increased awareness and maintaining a high index of suspicion for this condition.
Publisher: Wiley
Date: 08-10-2021
DOI: 10.1002/PON.5833
Abstract: Feeling depressed and lethargic are common side effects of prostate cancer (PCa) and its treatments. We examined the incidence and severity of feeling depressed and lack of energy in patients in a population based PCa registry. We included men diagnosed with PCa between 2015 and 2019 in Victoria, Australia, and enrolled in the Prostate Cancer Outcomes Registry. The primary outcome measures were responses to two questions on the Expanded Prostate Cancer Index Composite (EPIC‐26) patient reported instrument: problems with feeling depressed and problems with lack of energy 12 months following treatment. We evaluated associations between these and age, cancer risk category, treatment type, and urinary, bowel, and sexual function. Both outcome questions were answered by 9712 out of 12,628 (77%) men. 981 patients (10%) reported at least moderate problems with feeling depressed 1563 (16%) had at least moderate problems with lack of energy and 586 (6.0%) with both. Younger men reported feeling depressed more frequently than older men. Lack of energy was more common for treatments that included androgen deprivation therapy than not (moderate/big problems: 31% vs. 13%), irrespective of disease risk category. Both outcomes were associated with poorer urinary, bowel, and sexual functional domain scores. Self‐reported depressive feelings and lack of energy were frequent in this population‐based registry. Problems with feeling depressed were more common in younger men and lack of energy more common in men having hormonal treatment. Clinicians should be aware of the incidence of these symptoms in these at‐risk groups and be able to screen for them.
Publisher: Elsevier BV
Date: 03-2010
DOI: 10.1016/J.UROLONC.2009.08.015
Abstract: Prostate cancer remains a challenge due to its incidence and radical prostatectomy continues to be a major treatment option for men with potentially curable disease who have a life expectancy over a decade. This article will address the common problem of positive surgical margins and the impact of them on patient outcome. Through these we can examine relevant clinical trials that have attempted to address this issue and offer some guided to therapy among men with this clinical problem. Close margins are probably of no significance and will not be addressed. Our recommendations take into account the current level of medical evidence, and are balanced with anticipated adverse effects of treatment. They may change over time once definitive clinical trials are completed. In brief we believe those with positive margins and PT2 we advocate close observation with the aim of early salvage radiotherapy if necessary. Those with PT3a and focally positive margins with low/intermediate grade tumors are at moderate risk of biochemical failure so should be managed like PT2 patients. However those with high-grade disease should be offered adjuvant radiotherapy. Similarly those with PT3a margin positive extensive or multiple site disease should have adjuvant radiotherapy. PT3B margin positive patients should be offered radiotherapy. PT4 with bladder neck only margin positive can probably be observed.
Publisher: Wiley
Date: 26-04-2023
DOI: 10.1111/BJU.15980
Abstract: To assess changes in diagnosis prostate cancer (PCa) grade, biopsy and treatment approach over a decade (2011–2020) at a population level within a clinical quality cancer registry. Patients diagnosed by prostate biopsy between 2011 and 2020 were retrieved from the Victorian Prostate Cancer Outcomes Registry, a prospective, state‐wide clinical quality registry in Australia. Distributions of each grade group (GG) proportion over time were modelled with restricted cubic splines, separately by biopsy technique, age group and subsequent treatment method. From 2011 to 2020, 24 308 men were diagnosed with PCa in the registry. The proportion of GG 1 disease declined from 36–23%, with commensurate rises in GG 2 (31–36%), GG 3 (14–17%) and GG 5 (9.3–14%) disease. This pattern was similar for men diagnosed by transrectal ultrasonography or transperineal biopsy. Patients aged years had the largest absolute reduction in GG 1 PCa, from 56–35%, compared to patients aged 55–64 (41–31%), 65–74 (31–21%), and ≥75 years (12–10%). The proportion of prostatectomies performed for patients with GG 1 disease fell from 28% to 7.1% and, for primary radiation therapy, the proportion fell from 22% to 3.5%. From 2011 to 2020, there has been a substantial decrease in the proportion of GG 1 PCa diagnosed, particularly in younger men. The percentage of interventional management performed in GG 1 disease has fallen to very low levels. These results reflect the implementation of major changes to diagnostic and treatment guidelines and inform the future allocation of treatment methods.
Publisher: Wiley
Date: 02-08-2022
DOI: 10.1111/BJU.15860
Publisher: Elsevier BV
Date: 04-2011
DOI: 10.1016/J.EURURO.2010.12.018
Abstract: In two large randomized controlled trials, 5α-reductase inhibitors (5-ARIs) were shown to prevent prostate cancer. No prior work had shown the effect of 5-ARIs on those already diagnosed with low-risk prostate cancer. Our aim was to determine the effect of 5-ARIs on pathologic progression in men on active surveillance. We conducted a single-institution retrospective cohort study comparing men taking a 5-ARI versus no 5-ARI while on active surveillance for prostate cancer. Pathologic progression was evaluated and defined as Gleason score >6, maximum core involvement >50%, or more than three cores positive on a follow-up prostate biopsy. Kaplan-Meier analyses were conducted along with multivariable Cox proportional hazard regression modeling for predictors of pathologic progression. A total of 288 men on active surveillance met the inclusion criteria. The median follow-up was 38.5 mo (interquartile range: 23.6-59.4) with 93 men (32%) experiencing pathologic progression and 96 men (33%) abandoning active surveillance. Men taking a 5-ARI experienced a lower rate of pathologic progression (18.6% vs 36.7% p=0.004) and were less likely to abandon active surveillance (20% vs 37.6% p=0.006). On multivariable Cox proportional hazards analysis, lack of 5-ARI use was most strongly associated with pathologic progression (hazard ratio: 2.91 95% confidence interval, 1.5-5.6). The main study limitation was the retrospective design and variable duration of 5-ARI therapy. The 5-ARIs were associated with a significantly lower rate of pathologic progression and abandonment of active surveillance.
Publisher: Springer Science and Business Media LLC
Date: 12-02-2019
DOI: 10.1007/S00345-019-02670-5
Abstract: Men's health research covers a broad range of topics. Men and women face different barriers to health, with men almost universally having a lower life expectancy than women. Access to high-quality information on men's health topics is potentially an important part of engaging men with medical services. We aim to assess the quality of men's health resources available on the internet across 4 developed countries using a tier-based rating system as well as the World Health Organisation Health on the Net (HON) standards. The Google search engine imbedded with the Health on the Net toolbar was used to assess 357 websites across Australia, Canada, America and United Kingdom using the search term 'men's health'. The websites were further sub ided into 3 tiers by 2 independent investigators, with tier 1 websites defined as government or health organisation sponsored, tier 2 websites defined as being sponsored by health services such as private clinics and insurance providers, and tier 3 websites being websites that did not meet criteria for the first 2 tiers. Overall, 28% of websites were rated as tier 1, 26% as tier 2 and 46% as tier 3. The HONcode accreditation was overall 39% of tier 1 websites. The majority of websites reviewed were in the tier 3 category, and 35% of overall websites being non-health or non-medically related. The lack of 'relevant' and HONcode-accredited websites relating to men's health should be appreciated by health care professionals.
Publisher: Wiley
Date: 22-07-2017
DOI: 10.1111/BJU.13562
Publisher: Wiley
Date: 30-07-0088
DOI: 10.1111/BJU.16154
Publisher: Canadian Urological Association Journal
Date: 06-2011
DOI: 10.5489/CUAJ.10085
Publisher: MDPI AG
Date: 20-03-2023
Abstract: Epigenetics is a growing field and in bladder cancer, it is of particular interest in advanced or metastatic disease. As opposed to genetic mutations in which the nucleotide sequence itself is altered, epigenetic alterations refer to changes to the genome that do not involve nucleotides. This is of great interest in cancer research because epigenetic alterations are reversible, making them a promising target for pharmacological agents. While chemoimmunotherapy is the mainstay for metastatic disease, there are few alternatives for patients who have progressed on first- or second-line treatment. By targeting reversible epigenetic alterations, novel epigenetic therapies are important potential treatment options for these patients. A search of clinical registries was performed in order to identify and collate epigenetic therapies currently in human trials. A literature search was also performed to identify therapies that are currently in preclinical stages, whether this be in vivo or in vitro models. Twenty-five clinical trials were identified that investigated the use of epigenetic inhibitors in patients with bladder cancer, often in combination with another agent, such as platinum-based chemotherapy or pembrolizumab. The main classes of epigenetic inhibitors studied include DNA-methyltransferase (DNMT) inhibitors, histone deacetylase (HDAC) inhibitors, and histone methyltransferase (HMT) inhibitors. At present, no phase 3 clinical trials have been registered. Few trials have published results, though DNMT inhibitors have shown the most promise thus far. Many patients with advanced or metastatic bladder cancer have limited treatment options, particularly when first- or second-line chemoimmunotherapy fails. Epigenetic alterations, which are common in bladder cancer, are potential targets for drug therapies, and these epigenetic agents are already in use for many cancers. While they have shown promise in pre-clinical trials for bladder cancer, more research is needed to assess their benefit in clinical settings.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2023
Publisher: Hindawi Limited
Date: 2009
DOI: 10.1100/TSW.2009.24
Abstract: This is the first report of a radical retropubic prostatectomy (RRP) in an achondroplastic dwarf. We highlight the pelvic anatomy, precluding laparoscopic or robotic prostatectomy, and making open surgery extremely difficult. We review relevant literature regarding general, urological, and orthopedic abnormalities of achondroplasia (ACH) and present a clinical case. No reports of RRP in achondroplastic dwarfs exist, with only one case of an abandoned RRP due to similar pelvic anatomy in a patient with osteogenesis imperfecta. Significant lumbar lordosis found in ACH results in a short anteroposterior dimension, severely limiting access to the prostate. We present a case of a 62-year-old achondroplastic dwarf who had Gleason 3+4 disease on transrectal ultrasound-guided biopsy in four from 12 cores. Surgery was difficult due to narrow anteroposterior pelvic dimension, but achievable. Histological analysis revealed multifocal prostate cancer, with negative surgical margins and no extraprostatic extension. RRP in ACH patients, although possible, should be approached with caution due to the abnormal pelvic dimensions, and discussions regarding potential abandonment of surgery should be included during informed consent. This case highlights the preoperative use of computed tomography to assist in the surgical planning for patients with difficult pelvic anatomy.
Publisher: Springer Science and Business Media LLC
Date: 07-12-2012
DOI: 10.1245/S10434-011-2137-X
Abstract: Oncologic Internet information quality is considered variable, but no comprehensive analysis exists to support this. We compared the quality of common malignancy Web sites to assess them for language or disease differences and to perform a quality comparison between medical and layperson terminology. World Health Organization Health on the Net (HON) principles may be applied to Web sites by using an automated toolbar function. We used the Google search engine ( www.google.com ) to assess 10,200 Web sites using the keywords "Breast," "Colorectal," "Stomach," "Liver," "Pancreas," "Bile Duct," "Melanoma," and "Thyroid," plus "cancer," in English, French, German, and Spanish. The searches were then repeated with alternative terms, such as "Bowel" and "Skin cancer." Less than a quarter of Web sites are HON accredited, with significant differences by malignancy type (P < 0.0001), language (P < 0.0001), and tertiles of the first 150 Web sites returned (P < 0.0001). French-language queries resulted in the most accredited Web sites returned. The use of alternative terms resulted in marked differences in accredited Web sites for hepatobiliary cancers. A lack of validation of most oncologic sites is present, with discrepancies in the quality and number of Web sites across diseases and languages, as well as medical and alternative terms. Physicians should encourage and participate in the development of informative, ethical, and reliable health Web sites on the Internet and direct patients to them.
Publisher: Wiley
Date: 09-10-2014
DOI: 10.1111/BJU.12915
Publisher: Wiley
Date: 19-01-2007
DOI: 10.1111/J.1442-2042.2006.01659.X
Abstract: Nuclear medicine techniques continue to be important non-invasive imaging tools assisting the diagnosis, monitoring and--in some cases--treatment of prostate cancer. Bone scintigraphy was the premier modality to have an extensive role in the staging of prostate cancer and has remained an integral tool for over three decades in the assessment of newly diagnosed disease or in follow-up staging. Therapeutic treatment and palliation of disseminated disease, particularly in the skeleton, has also been successful with several radioisotopes including strontium-89 chloride. Despite advances in nuclear medicine techniques and molecular imaging technology such as positron emission tomography and radioimmunoscintigraphy, bone scintigraphy still remains the gold standard in the assessment of osseous metastatic disease in prostate cancer. Thus, it is important to continually review the modalities that have remained important over time and not just to focus on newer technologies. This article summarizes the current diagnostic and therapeutic use of radioisotopes for bony disease in prostate cancer with particular reference to radionuclide bone scintigraphy and positron emission tomography.
Publisher: Springer Science and Business Media LLC
Date: 04-07-2013
DOI: 10.1007/S00345-013-1125-0
Abstract: To evaluate the temporal relationship between interval to biochemical recurrence (BCR) following radical prostatectomy (RP) and prostate cancer-specific mortality (PCSM). The study comprised of 2,116 men from the Victorian Radical Prostatectomy Register, a whole-of-population database of all RPs performed between 1995 and 2000 in Victoria, Australia. Follow-up prostate-specific antigen and death data were obtained via record linkage to pathology laboratories and the Victorian Registry of Births, Deaths and Marriages. Poisson regression models with PCSM as the outcome were fit to the data. Models included age at surgery, Gleason score and tumour stage as covariates. Median post-surgery and post-BCR follow-up was 10.3 and 7.5 years, respectively. 695 men (33 %) experienced BCR during follow-up, of which 82 % occurred within 5 years of RP 66 men died from prostate cancer. Men with combined high Gleason sum (≥4 + 3) and extra-prostatic (≥pT3a) disease had substantially increased mortality rate with early BCR, while those experiencing BCR after a longer interval had significantly lower mortality. Men with combined low Gleason sum (≤3 + 4) and organ-confined disease (≤pT2c) risk disease were not at any substantial risk of death in this time frame regardless of timing of BCR following RP. This study evaluates the temporal relationship between BCR and PCSM using a whole-of-population cohort of men treated with RP. Men with low-risk features of prostate cancer at time of RP have low mortality even if they experience early BCR. This subgroup may be counselled regarding their favourable long-term prognosis.
Publisher: Wiley
Date: 09-10-2014
DOI: 10.1111/BJU.12916
Publisher: Wiley
Date: 22-12-2023
DOI: 10.1111/BJU.15867
Publisher: Wiley
Date: 10-11-2011
Publisher: Wiley
Date: 31-10-2014
DOI: 10.1111/BJU.12354
Abstract: To analyse the trends in opportunistic PSA screening in Australia, focusing on younger men (<55 years of age), to examine the effects of this screening on transrectal ultrasonography (TRUS)-guided biopsy rates and to determine the nature of prostate cancers (PCas) being detected. All men who received an opportunistic screening PSA test and TRUS-guided biopsy between 2001 and 2008 in Australia were analysed using data from the Australian Cancer registry (Australian Institute of Health and Welfare) and Medicare databases. The Victorian cancer registry was used to obtain Gleason scores. Age-standardized and age-specific rates were calculated, along with the incidence of PCa, and correlated with Gleason scores. A total 5 174 031 PSA tests detected 128 167 PCas in the period 2001-2008. During this period, PSA testing increased by 146% (a mean of 4629 tests per 100 000 men annually), with 80 and 59% increases in the rates of TRUS-guided biopsy and incidence of PCa, respectively. The highest increases in PSA screening occurred in men <55 years old and up to 1101 men had to be screened to detect one incident case of PCa (0.01%). Screening resulted in two thirds of men aged 7 tumours in patients aged <55 years. Despite the ongoing controversy about the merits of PCa screening, there was an increase in PSA testing, especially in men <55 years old, leading to a modestly higher incidence of PCa in Australia. Overall, PSA screening was associated with high rates of negative TRUS-biopsy and the detection of low/intermediate grade PCa among younger patients.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2012
DOI: 10.1016/J.JURO.2011.11.112
Abstract: We report magnetic resonance imaging findings among unselected men with low risk prostate cancer before active surveillance. We prospectively enrolled men with low grade, low risk, localized prostate cancer. All patients underwent multiparametric endorectal coil magnetic resonance imaging and were offered confirmatory biopsy within 1 year of imaging. The primary outcome was the impact of magnetic resonance imaging on identifying patients who were reclassified by confirmatory biopsy as no longer fulfilling active surveillance criteria. We further identified clinical parameters associated with reclassification. The cohort was stratified as patients with 1) normal magnetic resonance imaging, 2) cancer on magnetic resonance imaging concordant with initial biopsy (less than 1 cm) and 3) cancer on magnetic resonance imaging larger than 1 cm. We performed univariate analysis to assess differences in clinical parameters among the groups. Magnetic resonance imaging did not detect cancer in 23 cases (38%) while magnetic resonance imaging and initial biopsy were concordant in 24 (40%). Magnetic resonance imaging detected a 1 cm or larger lesion in 13 patients (22%). Of the cases 18 (32.14%) were reclassified. When no cancer was identified on magnetic resonance imaging, only 2 cases (3.5%) were reclassified. The positive and negative predictive values for magnetic resonance imaging predicting reclassification were 83% (95% CI 73-93) and 81% (95% CI 71-91), respectively. Prostate specific antigen density was increased in patients with lesions larger than 1 cm on magnetic resonance imaging compared to those with no cancer on imaging (median 0.15 vs 0.07 ng/ml/cc, p=0.016). Magnetic resonance imaging appears to have a high yield for predicting reclassification among men who elect active surveillance. Upon confirmation of our results magnetic resonance imaging may be used to better select and guide patients before active surveillance.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2010
Publisher: Wiley
Date: 05-2003
DOI: 10.1046/J.1445-2197.2003.T01-1-02617.X
Abstract: Testicular microlithiasis (TM) is a rare condition in which men have innumerable testicular calcifications. It is increasingly being reported on ultrasound. The published literature has reported an association between confirmed testicular malignancy and testicular microlithiasis. The relationship between TM and the risk of developing malignancy is unclear. The present paper reports a patient with a previously normal scrotal ultrasound except for bilateral sonographically detected TM who developed a testicular tumour. It also discusses the appropriate management of TM after reviewing the published literature.
Publisher: Wiley
Date: 07-04-2009
Publisher: Elsevier BV
Date: 02-2005
Publisher: Springer Science and Business Media LLC
Date: 20-03-2019
DOI: 10.1007/S00345-019-02727-5
Abstract: Data assessing the effectiveness of intracavernosal injections (ICIs) for the treatment of erectile dysfunction (ED) are limited. This study evaluates intracavernosal injectable therapies for ED and reviews available guidelines that inform clinical practice. A systematic search using electronic databases (Medline, Pubmed) was performed for studies investigating injectable management strategies for ED published after 1990. Primary outcome measures were to comparatively evaluate clinical efficacy, continuation rates and adverse event profiles of each injectable agent as monotherapy or in combination. The secondary outcome measurement was to discuss available guidelines that inform clinical practice for injectable agents. ICIs demonstrate clinical efficacy in 54-100% of patients, early discontinuation rates of ≤ 38% and adverse events in ≤ 26%. Discontinuation rates are typically greatest within 3-6 months of commencement. Anxiety related to the initial injection occurs in approximately 65% and anxiety levels can remain high for 4 months. Approval of intracavernosal injection agents is mainly limited to alprostadil with the recent addition of aviptadil hentolamine combination therapy in a select few geographical regions. Although combination therapies are attractive alternative options, their formulations are variable and should be standardised before widespread acceptance is achieved. ICIs are associated with good clinical efficacy rates, high discontinuation rates and a moderate side-effect profile. They represent an important tool in the urological armamentarium for treating ED in patients that cannot tolerate or are refractory to oral therapies.
Publisher: Springer Science and Business Media LLC
Date: 31-08-2017
DOI: 10.1038/S41598-017-07861-X
Abstract: Lower urinary tract symptoms (LUTS) due to Benign Prostatic Hyperplasia (BPH) are highly prevalent in older men, having a profound impact on patient quality of life. Current therapeutics for BPH/LUTS target neurogenic smooth muscle tone, but response is unpredictable and many patients fail to respond. Spontaneous myogenic tone is another component of smooth muscle contractility that is uncharacterized in human prostate. To better understand and improve the predictability of patient response, we defined myogenic contractility using human prostate specimens and examined the effect of existing therapeutics. We show that myogenic activity is present in the human prostate with the frequency of contractions in transition zone (TZ) specimens from BPH diagnosed patients approximately 160% greater than matched controls. α1-adrenoreceptor antagonists (Tamsulosin) and PDE5 inhibitors (Sildenafil) both significantly reduced myogenic contractile parameters, including frequency, with notable interpatient variability. Tamsulosin was more effective in older patients (R 2 = 0.36, p 0.01) and men with larger prostate volumes (R 2 = 0.41, p 0.05), while Sildenafil was more effective in younger men (R 2 = 0.45, p 0.05). As myogenic tone is significantly increased in BPH, therapeutics targeting this mechanism used with reference to patient characteristics could improve clinical outcomes and better predict patient response.
Publisher: Wiley
Date: 04-2011
Publisher: Elsevier BV
Date: 11-2003
DOI: 10.1016/S0090-4295(03)00684-8
Abstract: Suprapubic catheters have gained wide acceptance in urology. Although many regard their insertion a simple procedure, morbidity is significant and is probably underreported. We describe a percutaneous technique using intraoperative ultrasonography combined with flexible cystoscopy to ensure safe insertion, minimizing the risk to adjacent viscera.
Publisher: Oxford University Press (OUP)
Date: 12-01-2021
DOI: 10.1093/GJI/GGAB005
Abstract: We present PRISM3D, a 3-D reference seismic model of P- and S-wave velocities for Iberia and adjacent areas. PRISM3D results from the combination of the most up-to-date earth models available for the region. It extends horizontally from 15°W to 5°E in longitude, 34°N to 46°N in latitude and vertically from 3.5 km above to 200 km below sea level, and is modelled on a regular grid with 10 and 0.5 km of grid node spacing in the horizontal and vertical directions, respectively. It was designed using models inferred from local and teleseismic body-wave tomography, earthquake and ambient noise surface wave tomography, receiver function analysis and active source experiments. It includes two interfaces, namely the topography/bathymetry and the Mohorovičić (Moho) discontinuity. The Moho was modelled from previously published receiver function analysis and deep seismic sounding results. To that end we used a probabilistic surface reconstruction algorithm that allowed to extract the mean of the Moho depth surface along with its associated standard deviation, which provides a depth uncertainty estimate. The Moho depth model is in good agreement with previously published models, although it presents slightly sharper gardients in orogenic areas such as the Pyrenees or the Betic-Rif system. Crustal and mantle P- and S-wave wave speed grids were built separately on each side of the Moho depth surface by weighted average of existing models, thus allowing to realistically render the speed gradients across that interface. The associated weighted standard deviation was also calculated, which provides an uncertainty estimation on the average wave speed values at any point of the grid. At shallow depths (& km), low P and S wave speeds and high VP/VS are observed in offshore basins, while the Iberian Massif, which covers a large part of western Iberia, appears characterized by a rather flat Moho, higher than average VP and VS and low VP/VS. Conversely, the Betic-Rif system seems to be associated with low VP and VS, combined with high VP/VS in comparison to the rest of the study area. The most prominent feature of the mantle is the well known high wave speed anomaly related to the Alboran slab imaged in various mantle tomography studies. The consistency of PRISM3D with previous work is verified by comparing it with two recent studies, with which it shows a good general agreement.The impact of the new 3-D model is illustrated through a simple synthetic experiment, which shows that the lateral variations of the wave speed can produce traveltime differences ranging from –1.5 and 1.5 s for P waves and from –2.5 and 2.5 s for S waves at local to regional distances. Such values are far larger than phase picking uncertainties and would likely affect earthquake hypocentral parameter estimations. The new 3-D model thus provides a basis for regional studies including earthquake source studies, Earth structure investigations and geodynamic modelling of Iberia and its surroundings.
Publisher: Wiley
Date: 30-10-2023
DOI: 10.1111/BJU.16214
Publisher: Wiley
Date: 06-12-2006
Publisher: Springer Science and Business Media LLC
Date: 16-08-2011
Abstract: Transurethral resection of the prostate (TURP) is the most common surgical treatment for benign prostatic hyperplasia (BPH) worldwide, but despite its minimally invasive nature, perioperative bleeding remains a common morbidity. Anticoagulant and antiplatelet medications are increasingly common in this patient population and further contribute to the risk of bleeding and extended hospital stay. Preoperative cessation of anticoagulant and antiplatelet drugs is recommended but requires risk assessment of thrombotic complications. Pharmacologic maneuvers to reduce hemorrhage include perioperative administration of 5α-reductase inhibitors. Technical considerations include the use of hemostatic energy sources such as laser and bipolar technologies. Ultimately, no surgical technique is devoid of bleeding risks, and urologists should be aware of how best to prevent and treat TURP-related hemorrhage.
Publisher: Elsevier BV
Date: 10-2023
Publisher: Springer Science and Business Media LLC
Date: 02-2006
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2008
Publisher: Wiley
Date: 04-2011
Publisher: Mary Ann Liebert Inc
Date: 07-2009
Publisher: Wiley
Date: 04-2004
Publisher: Public Library of Science (PLoS)
Date: 18-10-2018
Publisher: Elsevier BV
Date: 08-2013
DOI: 10.1016/J.UROLOGY.2013.03.057
Abstract: To investigate if prostate biopsy templates with fewer cores can be used during active surveillance (AS) for prostate cancer. At present, we use an AS protocol template (ASPT) consisting of 13-17 cores. We hypothesize in the setting of known cancer, sextant (6 cores) or standard extended (10-12 cores) templates, could be used with similar effect. We identified patients in our referral institution database (1997-2009) with entry prostate-specific antigen <10 ng/mL, stage ≤cT2, Gleason sum ≤6, ≤3 cores positive for cancer, <50% of single core involved, and age ≤75 years (N = 272). Patients fulfilling standard criteria for pathologic reclassification (N = 94) at any follow-up biopsy were selected for evaluation. By mapping tumor location on the pathologic reclassification determining biopsy, hypothetical scenarios of sextant or standard extended templates (SET) were compared with our ASPT and examined for frequency of cancer detection and pathologic reclassification. For the 94 patients analyzed, the median number of cores taken was 9.7 (6-22) at baseline and 15 (14-17) for the reclassification biopsy. The median time between baseline and the pathologic reclassification determining biopsy was 15.4 months. Analysis of subgroupings showed that sextant template would identify 84% of cancers and 47.9% of the reclassification events, whereas SET detected 99% of cancers and 81.9% of patients who pathologically reclassified. When only considering Gleason sum ≥7 related progression events, SET found 16.2% less (n = 57) compared with ASPT (n = 68). When monitoring patients on AS, a 13-17 core template detects more pathologic reclassification than standard sextant (18.1%) or extended (52.1%) biopsy templates.
Publisher: Wiley
Date: 12-2004
DOI: 10.1111/J.1445-1433.2004.03250.X
Abstract: Polyorchidism is defined as the presence of two or more testes. It is a rare anomaly with approximately 77 cases reported in the literature. Polyorchidism is frequently associated with additional urological pathologies such as undescended testis, inguinal hernia, testicular torsion, hydrocoele, malignancy and infertility. Differential diagnosis includes spermatocoele, hydrocoele, epididymal cysts or aberrant epididymis. We report on an interesting case of polyorchidism in a 15-year-old man diagnosed on ultrasound and we review the literature and current management of polyorchidism.
Publisher: Wiley
Date: 05-12-2022
DOI: 10.1111/BJU.15929
Abstract: To identify whether synchronous reading of multiparametric magnetic resonance imaging (mpMRI) and 68 Ga‐PSMA‐11 positron emission tomography (PET)/computed tomography (prostate‐specific membrane antigen [PSMA‐PET]) images can improve diagnostic performance and certainty compared with mpMRI/PSMA‐PET reported independently and synthesized, while also assessing concordance between imaging modalities and agreement with histopathology. This was a retrospective analysis of 100 patients randomly selected from the PRIMARY trial, a prospective Phase II multicentre imaging trial. Three dual‐trained radiologist/nuclear medicine physicians re‐reported the mpMRI and PSMA‐PET both independently and synchronously for the same patients in random order, blinded to previous results. Diagnostic performance was assessed for mpMRI/PSMA‐PET images read synchronously or independently and then synthesized. Agreement between imaging results and histopathology was examined. ‘Concordance’ between imaging modalities was defined as overlapping lesions. Reporting certainty was evaluated by the in idual reporters for each modality. International Society of Urological Pathology Grade Group ≥2 cancer was present in 60% of patients on biopsy. Synchronous reading of mpMRI/PSMA‐PET increased sensitivity compared to mpMRI or PSMA‐PET alone (93% vs 80% vs 88%, respectively), although specificity was not improved (63% vs 58% vs 78%, respectively). No significant difference in diagnostic performance was noted between mpMRI/PSMA‐PET read synchronously and mpMRI or PSMA‐PET reported independently and then synthesized. Most patients had concordant imaging (60%), while others had discordant lesions only (28%) or a mixture (concordant and discordant lesions 12%). When mpMRI/PSMA‐PET findings were concordant and positive, 95% of patients had clinically significant prostate cancer (csPCa). When PSMA‐PET alone was compared to synchronous PSMA‐PET/MRI reads, there was an improvement in reader certainty in 20% of scans. Synchronous mpMRI/PSMA‐PET reading improves reader certainty and sensitivity for csPCa compared to mpMRI or PSMA‐PET alone. However, synthesizing the results of independently read PSMA‐PET and mpMRI reports provided similar diagnostic performance to synchronous PSMA‐PET/MRI reads. This may provide greater flexibility for urologists in terms of referral patterns, reducing healthcare system costs and improving efficiencies in prostate cancer diagnosis.
Publisher: Wiley
Date: 05-12-2020
DOI: 10.1111/BJU.14951
Abstract: Whilst whole-gland radical treatment is highly effective for prostate cancer control, it has significant impact on quality of life and is unnecessary 'over-treatment' in many men with screening-detected prostate cancer. Improvements in prostate biopsy and imaging have led to increased interest in partial gland ablation to reduce treatment-related morbidity. Several energies for focal ablation have been trialled. Irreversible electroporation (IRE) is a novel technology that ablates tissue by delivering direct current between electrodes. This narrative review documents the history of electroporation including its scientific basis, early data from pre-clinical animal studies, and contemporary clinical outcomes from the use of IRE in prostate cancer. A literature search using the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE), PubMed and Google Scholar was undertaken to identify historical perspectives and current clinical data relating to IRE for prostate cancer. The history of electroporation and its implementation as a prostate cancer treatment was following the basic scientific principles, in vitro data, then animal studies, and now short- to medium-term clinical cohorts in humans. The results of IRE on >283 patients have been published in several papers, with preserved rates of (pad-free) continence in 91-100% of men and preserved erectile function in 79-100% of men. In-field recurrence rates range from 0% to 33%. The current state of evidence for IRE for the treatment of primary and salvage prostate cancer is considered as Idea, Development, Exploration, Assessment, Long-term follow-up (IDEAL) stage 2B. IRE is a new focal ablative technology for the treatment of localised prostate cancer in carefully selected men. Published cohorts report encouraging short-term oncological and functional outcomes however, longer-term data are needed to validate this treatment before it can be recommended for widespread clinical use.
Publisher: Wiley
Date: 19-02-2014
DOI: 10.1111/BJU.12536
Abstract: To determine the rate of hospital re-admission for sepsis after transperineal (TP) biopsy using both local data and worldwide literature, as there is growing interest in TP biopsy as an alternative to transrectal ultrasonography (TRUS)-guided biopsy for patients undergoing repeat prostate biopsy. Pooled prospective databases on TP biopsy from multiple centres in Melbourne were queried for rates of re-admission for infection. A literature review of PubMed and Embase was also conducted using the search terms: 'prostate biopsy, fever, infection, sepsis, septicaemia and complications'. In all, 245 TP biopsies were performed (111 at Alfred Health, 92 at Epworth Healthcare, 38 at Peter MacCallum Cancer Centre, and four at other institutions). The rate of hospital re-admission for infection was zero. The literature review showed that the rate of sepsis after TRUS biopsy appears to be rising with increasing rates of multi-resistant bacteria found in rectal flora, and is as high as 5%. However, the rate of sepsis from published series of TP biopsy approached zero. Both local and international data suggest a negligible rate of sepsis with TP biopsy. This compares to a concerning rise in the rate of sepsis after TRUS biopsy due to the increasing prevalence of multi-resistant bacteria in rectal flora. Although TRUS biopsy is convenient, cheap and quick to perform, we think that TP biopsy should now be offered as an option, not only to patients undergoing repeat prostate biopsy, but to all patients in whom a prostate biopsy is indicated.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2010
DOI: 10.1016/J.JURO.2010.01.017
Abstract: Digital image analysis software to review histopathology specimens is advancing uropathology by objectivity and reproducibility. Subjective pathologist assessed prostate tumor volume calculations correlate with known prognostic factors at radical prostatectomy. We ascertained whether image analysis software calculations of prostate tumor volume correlate with such prognostic factors, particularly positive surgical margins. Prostate tumor volume was calculated using digital image analysis software in 851 sequential radical prostatectomy specimens. Results were correlated with clinicopathological data by logistic regression. Median prostate tumor volume was 2.2 cc (IQR 0.9-3.8). Median peripheral and transition zone tumor volume was 1.9 and 0.6 cc, respectively. Transition zone tumors were noted in 236 specimens (27.8%) and positive surgical margins occurred in 244 (28.7%). Tumors with extensive positive surgical margins had larger image analysis software assessed prostate tumor volume (p = 0.029) and peripheral zone volume (p = 0.007) than those with only focal positive surgical margins. On univariate analysis positive surgical margin tumors were larger and had seminal vesicle invasion, extraprostatic extension, perineural invasion and higher preoperative prostate specific antigen than those without positive surgical margins (each p <0.001). A linear relationship existed between image analysis software determined prostate tumor volume, and increasing tumor stage, Gleason score and prostate specific antigen (p for trend <0.001). On multivariate analysis tumor volume and tumor volume as a percent of prostate volume predicted positive surgical margins. Prostate tumor volume determined objectively by image analysis software correlates with positive surgical margins, as do prognostic variables such as extraprostatic extension, seminal vesicle invasion, perineural invasion, peripheral zone volume and Gleason score greater than 7. Objective digital image analysis software assessment appears to be a valid form to determine prostate tumor volume at radical prostatectomy. It is a useful adjunct to other histopathological analyses.
Publisher: Elsevier BV
Date: 05-2007
DOI: 10.1016/J.AJOG.2006.10.864
Abstract: Pregnancy may be associated with urological complications but gross hematuria is rare. Mechanical obstruction of venous return with pregnancy-associated smooth muscle dilatation and vasodilatation causes venous congestion, predisposing to varicose veins. We present a case of bladder submucosal venous hemorrhage secondary to such varices and describe mechanisms underlying cystovarix formation.
Publisher: Elsevier BV
Date: 03-2019
Publisher: Wiley
Date: 20-04-2011
Publisher: Elsevier BV
Date: 07-2004
Publisher: Neoplasia Research
Date: 28-01-2012
DOI: 10.6000/1927-7229.2012.01.01.14
Abstract: Partial nephrectomy has become the 'gold standard" for treatment of suspicious renal masses when surgery is required. The advantages in terms of renal preservation without compromising cancer control are well accepted provided lesions are carefully selected. The challenge now is to improve upon patient selection for partial nephrectomy, optimising the surgical technique and also considering how to reduce ischaemic time to the kidney that will remain. This article explores such issues and summarises the current status of partial nephrectomy.
Publisher: Wiley
Date: 10-2016
DOI: 10.1111/BJU.13633
Abstract: To examine the current literature and identify key consensus findings from the available studies to better educate urologists and medical oncologists on agents used in the treatment of metastatic prostate cancer (mPC). Following PRISMA guidelines, we conducted a systematic review of the available literature on reported trials of systemic therapies for mPC. Two search terms were used: 'metastatic prostate cancer' and 'treatment'. A variety of agents have demonstrated improved overall survival in patients with mPC. Twenty recently documented trials were reported in the literature with a focus on enzalutamide, abiraterone acetate, docetaxel and other newer agents. These studies were grouped based on patient populations. The increasing number of high-quality clinical trials, with overlapping patient populations has made defining the correct therapy for men with mPC challenging for urologists and medical oncologists. The data suggests that the optimal sequence of drugs is not only unknown but also not necessarily the same for each patient. As such, we suggest a more in idualized approach to the treatment of prostate cancer depending on patient and disease factors.
Publisher: Wiley
Date: 10-2004
DOI: 10.1111/J.1442-2042.2004.00905.X
Abstract: Foreign bodies placed into the ureter are uncommon. Unintentionally placed sutures may cause obstruction and stone formation. If not recognized, the patient may become symptomatic. A diagnosis of a suture in the ureter is best made and subsequently dealt with endoscopically. We report on laser ablation of the suture as a safe technique for its removal.
Publisher: Springer Science and Business Media LLC
Date: 02-2006
DOI: 10.1007/S11255-005-8572-5
Abstract: Primary sclerosing lipogranuloma is an unusual benign condition of the genitalia typically presenting as a painless mass affecting the penis and scrotum. Its importance lies in differentiating it from malignancy to avoid extensive surgery. It is normally treated with total or partial excision. This is the first reported case where oral corticosteroids have been used to treat this condition whereby a six-week course resulted in the mass disappearing. In conclusion, if sclerosing lipogranuloma is suspected biopsy should be undertaken to exclude sarcoma. We believe surgery should be reserved for recurrent or refractory cases when steroids have failed as first-line treatment.
Publisher: Hindawi Limited
Date: 2006
DOI: 10.1100/TSW.2006.361
Abstract: Penile lesions are encountered in a variety of fields from family medicine practice through urology, to sexual health specialists. It is important that practitioners consider and recognize fixed drug eruptions of the penis while being able to initiate appropriate treatment in order to avoid misdiagnosis and avoidable stress. In summary, withdrawal of the offending medication and initiation of corticosteroid therapy remain the cornerstones of treatment of fixed drug eruptions of the penis.
Publisher: Elsevier BV
Date: 03-2005
Publisher: Elsevier BV
Date: 12-2005
DOI: 10.1016/J.UROLOGY.2005.06.118
Abstract: Flexible cystourethroscopy is an accepted routine procedure in urology. The sterilization of instruments is time consuming and may damage flexible instruments. However, it must be performed to prevent contamination of the endoscopes. This study is the first to document experience using a flexible cystoscope with a disposable sheath in a urologic setting.
Publisher: Wiley
Date: 09-01-2023
DOI: 10.1111/BJU.15947
Abstract: To prospectively assess the safety, functional‐ and oncological‐outcomes of irreversible electroporation (IRE) as salvage therapy for radio‐recurrent focal prostate cancer in a multicenter setting. Men with focal recurrent PCa after external beam radiation or brachytherapy without metastatic disease on staging imaging and co‐registration between mpMRI and biopsies were prospectively included in this multicenter trial. Adverse events were reported following the Clavien‐Dindo classification. Validated questionnaires were used for patient‐reported functional outcomes. Follow‐up consisted of 3 monthly prostate specific antigen (PSA) levels, a 6‐month mpMRI and standardised transperineal template mapping biopsies at 12‐months. Thereafter follow‐up was guided by MRI and/or PSMA‐PET/CT and PSA. Local recurrence was defined as any ISUP score ≥2 on biopsies. 37 patients were analysed with a median (interquartile range (IQR)) follow up of 29 (22–43) months. Median age was 71 (53–83), median PSA was 3.5 ng/mL (2.7–6.1). 28 (75.5%) patients harboured intermediate risk and 9 patients (24.5%) high risk PCa. Seven patients (19%) reported self‐limiting urgency, frequency, or hematuria (grade 1–2). Seven patients (19%) developed a grade 3 AE urethral sludge requiring transurethral resection. At 12 months post treatment 93% of patients remained continent and erectile function sufficient for intercourse deteriorated from 35% to 15% (4/27). Local control was achieved in 29 patients (78%) and 27 patients (73%) were clear of local and systemic disease. Four (11%) patients had local recurrence only. Six (16%) patients developed metastatic disease with a median time to metastasis of 8 months. The FIRE trial shows that salvage IRE after failed radiation therapy for localised PCa is safe with minimal toxicity, and promising functional and oncological outcomes. Salvage IRE can offer a possible solution for notoriously difficult to manage radio recurrent prostate tumours.
Publisher: Wiley
Date: 07-2020
DOI: 10.1111/BJU.14858
Abstract: To compare the accuracy of 68 gallium prostate‐specific membrane antigen positron emission tomography/computed tomography ( 68 Ga‐PSMA PET/CT) with multiparametric MRI (mpMRI) in detecting and localising primary prostate cancer when compared with radical prostatectomy (RP) specimen pathology. Retrospective review of men who underwent 68 Ga‐PSMA PET/CT and mpMRI for primary prostate cancer before RP across four centres between 2015 and 2018. Patients undergoing imaging for recurrent disease or before non‐surgical treatment were excluded. We defined pathological index tumour as the lesion with highest International Society of Urological Pathology Grade Group (GG) on RP specimen pathology. Our primary outcomes were rates of accurate detection and localisation of RP specimen pathology index tumour using 68 Ga‐PSMA PET/CT or mpMRI. We defined tumour detection as imaging lesion corresponding with RP specimen tumour on any imaging plane, and localisation as imaging lesion matching RP specimen index tumour in all sagittal, axial, and coronal planes. Secondary outcomes included localisation of clinically significant and transition zone (TZ) index tumours. We defined clinically significant disease as GG 3–5. We used descriptive statistics and the Mann–Whitney U ‐test to define and compare demographic and pathological characteristics between detected, missed and localised tumours using either imaging modality. We used the McNemar test to compare detection and localisation rates using 68 Ga‐PSMA PET/CT and mpMRI. In all, 205 men were included in our analysis, including 133 with clinically significant disease. There was no significant difference between 68 Ga‐PSMA PET/CT and mpMRI in the detection of any tumour (94% vs 95%, P 0.9). There was also no significant difference between localisation of all index tumours (91% vs 89%, P = 0.47), clinically significant index tumours (96% vs 91%, P = 0.15) or TZ tumours (85% vs 80%, P 0.9) using 68 Ga‐PSMA PET/CT and mpMRI. Limitations include retrospective study design and non‐central review of imaging and pathology. We found no significant difference in the detection or localisation of primary prostate cancer between 68 Ga‐PSMA PET/CT and mpMRI. Further prospective studies are required to evaluate a combined PET/MRI model in minimising tumours missed by either modality.
Publisher: Wiley
Date: 15-11-2018
DOI: 10.1111/BJU.14065
Publisher: MDPI AG
Date: 27-05-2021
DOI: 10.3390/LIFE11060490
Abstract: Although it can be lethal in its advanced stage, prostate cancer can be effectively treated when it is localised. Traditionally, radical prostatectomy (RP) or radiotherapy (RT) were used to treat all men with localised prostate cancer however, this has significant risks of post-treatment side effects. Focal therapy has emerged as a potential form of treatment that can achieve similar oncological outcomes to radical treatment while preserving functional outcomes and decreasing rates of adverse effects. Irreversible electroporation (IRE) is one such form of focal therapy which utilises pulsatile electrical currents to ablate tissue. This modality of treatment is still in an early research phase, with studies showing that IRE is a safe procedure that can offer good short-term oncological outcomes whilst carrying a lower risk of poor functional outcomes. We believe that based on these results, future well-designed clinical trials are warranted to truly assess its efficacy in treating men with localised prostate cancer.
Publisher: Medknow
Date: 2015
Publisher: Elsevier BV
Date: 10-2018
Publisher: Wiley
Date: 04-2006
DOI: 10.1111/J.1442-2042.2006.01316.X
Abstract: To investigate if women with recurrent urinary tract infection (UTI) warrant cystoscopy to exclude an abnormality of the lower urinary tract. This is particularly relevant given that non-invasive imaging has often been performed to exclude abnormality. Our further aims were to correlate imaging and risk factors with cystoscopic findings to determine their predictive value in finding pathology. A database of women undergoing cystoscopy with recurrent UTI has been maintained at our institution for 10 years. We retrospectively examined this and patient records for patient demographics, and investigative and operative data. A total of 118 patients (mean 55 years) having recurrent UTI (mean 4.7 infections/year) were available. There were nine patients (8%) with significant abnormalities at cystoscopy: urethral stricture (six), bladder calculus (one), bladder erticulum (one) and colovesical fistula (one). The negative predictive value (NPV) of imaging was 99% and significant (P 0.05). The positive predictive value was low for imaging and risk factors in predicting cystoscopy findings. In our study, 8% of women had significant abnormalities detected during cystoscopy with most over 50 years. Women without risk factors for recurrent UTI and with normal imaging could have a cystoscopy omitted. Younger women are less likely to have pathology and this must be factored into decisions to perform cystoscopy.
Publisher: Wiley
Date: 04-08-2020
DOI: 10.1111/BJU.15151
Publisher: Springer Science and Business Media LLC
Date: 06-07-2013
Publisher: American Society of Clinical Oncology (ASCO)
Date: 10-09-2013
Publisher: Elsevier BV
Date: 04-2003
Publisher: The Korean Urological Association
Date: 2010
Publisher: Bentham Science Publishers Ltd.
Date: 02-2007
Publisher: Wiley
Date: 24-07-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2010
Publisher: The Korean Urological Association
Date: 2013
Publisher: Elsevier BV
Date: 2020
Publisher: Wiley
Date: 10-2004
DOI: 10.1111/J.1442-2042.2004.00921.X
Abstract: Transrectal ultrasound-guided biopsy of the prostate is an integral step in the investigation of patients at risk of prostate adenocarcinoma. With an increasing number of biopsies being performed, uncommon forms of prostatic pathology will be identified more frequently. Amyloidosis of the prostate and/or the seminal vesicles may be noted on transrectal ultrasound-guided biopsy of the prostate and the implications of this histological diagnosis must be understood. We present our experience of two such cases of amyloidosis and review the literature regarding their management.
Publisher: Wiley
Date: 10-04-2013
DOI: 10.1111/BJU.12052
Abstract: To investigate the incidence of carcinoma in situ (CIS) in Australia and examine implications for its diagnosis and management, as CIS of the urinary bladder is a non-reportable disease in Australia. Analysis of annual hospitalisation data using Australian Institute of Health and Welfare (AIHW) datasets showed an increase in CIS from 2001 onwards. To determine whether the increase seen with AIHW data represented a true increase in the rates offices, patient level data was examined using the Centre for Health record linkage (CHeReL) datasets. CHeReL linked data of 13,790 males and 5902 females, calculated the average incidence of CIS to be 20.9 per 100,000 and 6.5 per 100,000 respectively in those aged > 50 years, showing a rapid increase in the rates of CIS from 2001. There was an 11% (P = 0.04) and 14% (P = 0.02) annual increase in incidence of CIS in men and women and these rates increased with age. National data (AIHW) substantially underestimate the incidence of CIS in the Australian population. Patient level data suggest CIS rates are rapidly increasing in Australia despite high treatment rates. Closer surveillance and awareness of these high rates warrants further study and we recommend that CIS be considered a reportable disease.
Publisher: Wiley
Date: 05-01-2021
DOI: 10.1111/BJU.15321
Abstract: To describe the Agarwal loop‐ligation technique for the management of the distal ureter during laparoscopic radical nephroureterectomy (LRNU) for upper tract urothelial carcinoma (UTUC) and report on long‐term oncological outcomes. In the Agarwal loop‐ligation technique, the distal ureteric stump is controlled using endoscopic Endoloop ® or PolyLoop ® ligation to ensure en bloc excision of the bladder cuff and prevent spillage of upper tract urine into the perivesical space. A retrospective review of the medical records of 76 patients who underwent the Agarwal loop‐ligation technique for UTUC at participating centres from July 2004 to December 2017 was performed. Data collected included demographics, perioperative, and long‐term oncological outcomes. Survival was calculated using Kaplan–Meier survival analyses. A total of 76 patients were included. The median age was 71.5 years and median operative time was 4.3 h. The intramural ureter and bladder cuff were completely excised in all patients. Distal surgical margins were clear in all, with only two patients found to have tumour extending to the circumferential surgical margin. There were no cases of perivesical recurrence or port‐site metastasis. The 5‐year bladder, local, and contralateral recurrence‐free survival was 59.6%, 89.0% and 93.5%, respectively. Metastasis‐free survival at 5‐years was 73.5%. The 5‐year overall survival and cancer‐specific survival rates were 70.3% and 84.7%, respectively. We have described the Agarwal loop‐ligation technique for the management of the distal ureter in LRNU. This technique complies with oncological principles outlined in the European Association of Urology guidelines, which minimises tumour spillage. Long‐term oncological outcomes are satisfactory, with no cases of perivesical recurrence detected in this series.
Publisher: Wiley
Date: 10-11-2009
Publisher: Elsevier BV
Date: 10-2014
Publisher: Wiley
Date: 15-11-2010
Publisher: Springer Science and Business Media LLC
Date: 02-0001
Abstract: Organ-sparing approaches are currently practiced in urology for many malignancies. Partial orchiectomy of germ cell tumors (GCT) provides potential benefits over radical surgery by reducing the need for androgen substitution, lessening psychological stress, and preserving fertility, with a durable cure rate. Furthermore, many testicular lesions detected clinically or by ultrasonography will be benign, in which case radical orchiectomy represents overtreatment. Partial orchiectomy for benign lesions allows preservation of endocrine and exocrine function, and reduced risk of local recurrence. However, selection criteria are not clear and one must always be suspicious that a GCT might exist. Carcinoma in situ that remains in the salvaged testicle is a challenge to treat. Radiation therapy is an option, although there is a high chance that patients will subsequently require hormonal replacement. Partial orchiectomy should be undertaken only in selected patients--men with bilateral testicular cancer or GCT in a solitary testis--if the size and location of the mass are amenable to surgery. Informed patient consent discussing radical orchiectomy as the gold standard is mandatory, and discussion of the risks associated with CIS and its treatment, as well as the need for androgen supplementation are paramount. Alternative strategies of organ preservation, such as radiotherapy, HIFU and chemotherapy, might be appropriate treatment options in the future. However, the safety and efficacy of these procedures needs to be demonstrated in comparison with partial orchiectomy in larger and prospective studies with longer follow-up.
Publisher: Wiley
Date: 08-01-2016
DOI: 10.1111/BJU.13384
Abstract: The purpose of this article was to review and compare the international guidelines and surveillance protocols for post-nephrectomy renal cell carcinoma (RCC). PubMed database searches were conducted, according to the PRISMA statement for reporting systematic reviews, to identify current international surveillance guidelines and surveillance protocols for surgically treated and clinically localized RCC. A total of 17 articles were reviewed. These included three articles on urological guidelines, three on oncological guidelines and 11 on proposed strategies. Guidelines and strategies varied significantly in relation to follow-up, specifically with regard to the frequency and timing of radiological imaging. Although there is currently no consensus within the literature regarding surveillance protocols, various guidelines and strategies have been developed using both patient and tumour characteristics.
Publisher: Wiley
Date: 22-07-2010
DOI: 10.1111/J.1442-2042.2010.02570.X
Abstract: Obesity has been proposed as a risk factor for reduced disease-specific survival, increased positive surgical margin (PSM) and biochemical recurrence (BCR) after radical prostatectomy (RP) in patients with prostate cancer. The aim of this study was to clarify the relationship between obesity and surgical outcomes in patients undergoing RP. Medical records of 491 patients who underwent RP from 2004 to 2007 were retrieved from our institutional database. Patients were ided into three groups based on their body mass index (BMI): 30 kg/m (obese). Outcomes after RP were compared between the groups in terms of length of stay, perioperative complications, BCR, PSM and Gleason scores. Age, stage and preoperative prostate-specific antigen were similar between BMI categories. Operating time was prolonged in obese patients (146 vs 135 min, P = 0.01) and blood loss was greater (mean estimated blood loss 640 vs 504 mL, P = 0.02), but did not translate into higher transfusion rates. Early complication rates, PSM rates and Gleason scores were not statistically different between the groups. Significant differences in late outcomes, such as the need for adjunct procedures or BCR (hazard ratio 0.44, 95% CI 0.18-1.09), were not shown. As surgical experience with high BMI patients has developed, RP appears to be a well tolerated procedure in contemporary series, irrespective of BMI. In particular, early outcome parameters, such as PSM and BCR rates, are similar.
Publisher: Hindawi Limited
Date: 2012
DOI: 10.1100/2012/476759
Abstract: Objective . To investigate the effects of height, external pressure, and bladder fullness on the flow rate in continuous, non-continuous cystoscopy and the automated irrigation fluid pumping system (AIFPS). Materials . Each experiment had two 2-litre 0.9% saline bags connected to a continuous, non-continuous cystoscope or AIFPS via irrigation tubing. Other equipment included height-adjustable drip poles, uroflowmetry devices, and model bladders. Methods . In Experiment 1, saline bags were elevated to measure the increment in flow rate. In Experiment 2, saline bags were placed under external pressures to evaluate the effect on flow rate. In Experiment 3, flow rate changes in response to variable bladder fullness were measured. Results . Elevating saline bags caused an increase in flow rates, however the increment slowed down beyond a height of 80 cm. Increase in external pressure on saline bags elevated flow rates, but inconsistently. A fuller bladder led to a decrease in flow rates. In all experiments, the AIFPS posted consistent flow rates. Conclusions . Traditional irrigation systems were susceptible to changes in height of irrigation solution, external pressure application, and bladder fullness thus creating inconsistent flow rates. The AIFPS produced consistent flow rates and was not affected by any of the factors investigated in the study.
Publisher: Elsevier BV
Date: 03-2018
Publisher: Mary Ann Liebert Inc
Date: 05-2010
Abstract: Throughout history, medicine has witnessed paradigm shifts that significantly change patient treatment. In surgical oncology, the introduction of lumpectomy revolutionized breast cancer treatment while partial nephrectomy has altered the management of kidney cancer. In both cases, organ preservation is combined with efficacious management of the cancer via a less invasive approach. Within urology, prostate cancer (PCa) may be the next to benefit from such a treatment paradigm. Current management of PCa involves either whole organ treatment, with the inherent side effects, while selected patients are eligible for active surveillance. Focal therapy offers a middle ground for low-risk patients with PCa, again using the principles of a minimally invasive treatment of the cancer, in this case using an energy source with few side effects, combined with maximal organ preservation. Because focal therapy for PCa is still in evolution, there is no consensus on the ideal energy source that should be used to ablate the PCa, imaging to monitor the tissue destruction in real time, how many treatments may be offered, and the ideal follow-up regimen. Long-term follow-up of patients is needed before it is recommended as a first-line treatment. Nevertheless, evidence is accumulating that radically treating PCa holds survival benefit for patients however, the number of men needed to treat is considerable, with significant side effects thus, more centers are investigating focal therapy as an option. This review focuses on the use of the laser as the energy source for focal ablation, while bringing historically relevant information regarding laser energy and highlighting the perceived advantageous of focal laser ablation.
Publisher: Wiley
Date: 09-03-2006
Publisher: Elsevier BV
Date: 07-2012
DOI: 10.1053/J.SEMNUCLMED.2012.03.002
Abstract: (18)F-fluorodeoxyglucose (FDG) is the most common positron emission tomography (PET) radiotracer used in prostate and bladder cancer evaluation, but its role is h ered by a generally low glucose metabolic rate in primary prostate carcinoma, and physiological excretion of FDG through the urinary system masking FDG uptake in primary bladder and prostate carcinoma. FDG-PET may have a role in selected patients for staging and restaging advanced prostate cancer, particularly in patients with an increasing prostatic-specific antigen (PSA) level. The use of diuresis strategies facilitates the identification of primary bladder cancer, and may be useful in staging extravesical spread of disease. FDG-PET may also be useful in patients with ureteric and urethral cancers. New PET tracers are showing promise in the staging and biological characterization of prostate cancer, which can assist with therapeutic decision making in patients undergoing radiotherapy of primary disease, and in the assessment of metastatic disease.
Publisher: Wiley
Date: 13-08-2020
DOI: 10.1002/BCO2.33
Publisher: Wiley
Date: 06-04-2006
Publisher: Informa UK Limited
Date: 10-2013
DOI: 10.2147/RRU.S49219
Publisher: Wiley
Date: 29-10-2003
DOI: 10.1046/J.1445-2197.2003.02826.X
Abstract: The aim of the present study was to assess the impact of surgical waiting times on patients scheduled for elective laparoscopic cholecystectomy (LC), with emphasis on morbidity and costs incurred. A retrospective review of all patients who underwent cholecystectomy at the Launceston General Hospital between 1 January 1999 and 31 December 2001 was performed. A total of 322 LCs was performed during the study period. Median time on the waiting list was 130 (1-1481) days. While awaiting surgery, 44/322 patients (14%) re-presented to the emergency department with biliary symptoms (89 separate presentations) 21 patients (6%) were admitted (28 admissions), of whom 18 (86%) were on the waiting list for biliary colic symptoms only. Reasons for emergency admission included pancreatitis (1), cholangitis (3), choledocholithiasis (7), cholecystitis (7), and exacerbation of symptoms (10). Median hospital stay was 4 days (1-14 days) (total cost of 124 hospital days, excluding subsequent admission for cholecystectomy, $A128 712 according to average bed day costs), and 11 patients required endoscopic retrograde cholangiopancreatography (13 procedures). Mean (median) time on the surgical waiting list for patients who developed complications was 238 (203) days versus 185 (126) days for patients who had LC without interval complications. A total of 198 cancellations occurred in 124/322 patients (39%) before surgery. Prolonged waiting times for elective LC are associated with morbidity in 14% of patients at the Launceston General Hospital. This, combined with frequent cancellation of elective surgery, may result in significant costs to the health-care sector.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2011
Publisher: Wiley
Date: 06-2005
DOI: 10.1111/J.1445-2197.2005.03404.X
Abstract: Suspected spinal cord or cauda equina pathology is an emergency that must be dealt with swiftly, with appropriate referral and investigations. Constipation is a clinical diagnosis of exclusion, but should not be forgotten as a cause of major morbidity when severe in nature. It can mimic an acute abdomen, sepsis and even spinal cord pathology. We describe a case of cauda equina syndrome in a young man. The pathology responsible was found to be constipation with faecal impaction, once nerve and bony pathology were excluded. When treated, there was almost immediate resolution of the neurologic signs and urinary retention.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2009
DOI: 10.1016/J.JURO.2008.10.004
Abstract: External sphincterotomy is an accepted option for treating patients with detrusor-sphincter dyssynergia. However, long-term outcome data are limited. We ascertained the outcome of treatment results for this procedure. A database was reviewed for patients undergoing external sphincterotomy at a large tertiary referral spinal injuries center. For 84 primary sphincterotomies the mean duration of successful outcome was 81 months. A second procedure was required in 30 patients and mean duration of success thereafter was 80 months. Recurrent symptomatic episodes of urinary tract infection, recurrent detrusor-sphincter dyssynergia or upper tract dilatation eventually ensued in 57 of 84 patients (68%). Renal failure did not develop in any patients. External sphincterotomy protects the upper renal tracts and provides extended periods of satisfactory bladder emptying. However, it may require ongoing revision and should potentially be regarded as a staged intervention.
Publisher: S. Karger AG
Date: 2006
DOI: 10.1159/000094093
Abstract: i Introduction: /i The growth of human tumours under the renal capsule in animal models has been performed in the past. However, the use of modern surgical equipment has not always been translated into the laboratory. We report on a novel method for human renal tumour transplants using an automated biopsy gun to obtain tumour tissue and an epidural needle with introducer to easily deploy the grafts under the renal capsule. i Methods: /i Nude mice had human xenografted tumours grown subcutaneously after implantation of cells from culture. Tumours were then biopsied using a 16-gauge automated biopsy gun. Digital calipers were used to measure a 2-mm segment of the biopsy core that was cut and placed inside a hollow needle (epidural needle). The needle was placed under the renal capsule and the trocar introduced to deploy the graft beneath the capsule with minimal trauma. Further groups had tumour harvested similarly by automated biopsy gun but had the implants placed subcutaneously for comparison. i Results: /i Tumour grafts were established in 90% of grafted kidneys in this renal subcapsular model (229.68 ± 118.32 mm sup /sup mean ± 95% CI) which compared favourably to the subcutaneous model (163.81 ± 43.3 mm sup /sup ). Grafts were confirmed by direct observation and histology. i Conclusion: /i Modern surgical equipment may be utilised to allow tumour transplantation to be precise, with an identifiable and reproducible tumour volume deployed. Surgical researchers and laboratory-based scientists need to embrace new techniques and utilise them to improve models. This model may be adapted to many situations in oncologic research involving xenografting.
Publisher: Wiley
Date: 24-07-2005
Publisher: Wiley
Date: 15-06-2017
DOI: 10.1111/BJU.13838
Publisher: The Korean Urological Association
Date: 2013
Publisher: Faculty Opinions Ltd
Date: 08-12-2010
DOI: 10.3410/M2-86
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2012
Publisher: Wiley
Date: 19-02-2014
DOI: 10.1111/BJU.12624
Abstract: To review the use of fiducial markers and spacers in prostate radiotherapy (RT). We reviewed the literature on the use of fiducial markers to improve accuracy in delivery of RT for prostate cancer. We discuss the rationale for fiducials, the types available, the procedures and complications. We also reviewed the current literature on the novel use of spacers to reduce rectal toxicity during prostate irradiation. Prostate motion is a significant problem both during and between RT treatments. Intraprostatic fiducials allow accurate prostate localisation ensuring RT treatment accuracy. Insertion of gold fiducials are a cost-effective marker that can be easily and quickly implanted and at least three fiducials are recommended. Severe complications from fiducial implantation are uncommon and marker migration is very rarely clinically significant. Spacers are a novel method to distance the rectum from the prostate during RT, reducing acute rectal toxicity, and have no detrimental impact on health-related quality of life. Intraprostatic fiducials are now standard of care when delivering prostate RT and early data shows benefit of spacers in reducing RT rectal toxicity.
Publisher: Wiley
Date: 23-02-2009
Publisher: Wiley
Date: 21-02-2022
DOI: 10.1111/BJU.15698
Publisher: Wiley
Date: 19-02-2014
DOI: 10.1111/BJU.12622
Publisher: Hindawi Limited
Date: 2011
DOI: 10.1155/2011/383571
Abstract: Penile squamous cell carcinoma (SCC) is an uncommon condition in Western countries. Inguinal lymph nodes dissection can be curative in 20%–60% of node positive patients. However, there is a high complication rates from the dissection, thus accurate diagnosis of inguinal lymph nodes metastasis is required. Current non invasive methods to detect lymph nodes metastasis are unreliable. Dynamic Sentinel Node Biopsy (DNSB), ultrasonography (US), and fine needle aspiration (FNA) cytology were proposed to in an attempt to detect sentinel lymph node (SLN). Despite the initial high rate of false negative results, recent DSNB showed improved survival compared to wait and see policy as well as reduced mortality compared to prophylactic inguinal lymphadenectomy. In addition, the US guided FNA shown 100% of specificity in detecting clinically occult lymph nodes metastasis. We proposed an algorithm for management of lymph nodes in penile cancer and suggest that FNA with US guidance should be performed in all high risk patients and that therapeutic dissection should be performed if findings are positive.
Publisher: Wiley
Date: 10-06-2019
DOI: 10.1111/BJU.14373
Abstract: To evaluate systematically the safety and efficacy of intra-operative cell salvage (ICS) in urology. A search of Medline, Embase and Cochrane Library to August 2017 was performed using methods pre-published on PROSPERO. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Eligible titles were comparative studies published in English that used ICS in urology. Primary outcomes were allogeneic transfusion rates (ATRs) and tumour recurrence. Secondary outcomes were complications and cost. Fourteen observational studies were identified, with a total of 4 536 patients. ICS was compared with no the blood conservation technique (seven studies), preoperative autologous donation (PAD five studies) or both (two studies). Cohorts underwent open prostatectomy (11 studies), open cystectomy (two studies) or open partial nephrectomy (one study). Meta-analysis was possible only for ATRs within prostatectomy studies. In this setting, ICS reduced ATR compared with no the blood conservation technique (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.15-0.76) but not PAD (OR 0.76, 95% CI 0.39-1.31). In the non-prostatectomy setting, ATRs amongst patients who underwent ICS were significantly higher or similar in one and two studies, respectively. Tumour recurrence was found to be significantly less common (two studies), similar (eight studies) or not measured (four studies). All six studies reporting complications found no difference in their ICS cohorts. Regarding cost, one study from 1995 found ICS more expensive than PAD, while two more recent studies found ICS to be cheaper than no blood conservation technique. As a result of inter-study heterogeneity, meta-analyses were not possible for recurrence, complications or cost. Low-level evidence exists that, compared with other blood conservation techniques, ICS reduces ATR and cost while not affecting complications. It does not appear to increase tumour recurrence post-prostatectomy, although follow-up durations were short. Small study sizes and short follow-ups mean conclusions cannot be drawn with regard to recurrence after nephrectomy or cystectomy. Randomized trials with long-term follow-up evaluating ICS in urology are required.
Publisher: Elsevier BV
Date: 07-2011
DOI: 10.1016/J.UROLONC.2009.03.028
Abstract: In tumors, hypoxia stimulates angiogenesis and correlates with treatment resistance and poor prognosis. We have previously demonstrated hypoxia in human renal cell carcinoma (RCC) via direct oxygen probe measurements. Carbonic anhydrase IX (CA IX) is a protein stimulated by hypoxia and involved in angiogenesis, and is a potential tumor target for imaging and therapies using cG250, a monoclonal antibody that recognizes CAIX. Our objectives were to characterize intratumoral hypoxia in a human RCC xenograft model using oxygen probe measurements investigate if (124)I-cG250 targets RCC correlating uptake on noninvasive positron emission tomography-computerized tomography (PET-CT) against traditional biodistribution studies, and investigate CAIX expression in this RCC model. BALB/c nude mice had human RCC (SK-RC-52) subcutaneously xenografted with oxygen levels measured by probe. Positron emission tomography (PET/CT) and biodistribution studies ((124)I-cG250) were correlated with oxygen measurements. Immunohistochemistry and autoradiography were performed on selected tumors to confirm CAIX expression. Oxygen tension in normal tissue (muscle) was 35.08 ± 2.41 mmHg (mean ± 95% CI), significantly greater compared to xenograft SK-RC-52 tumors at 5.02 ± 1.12 mmHg. Biodistribution studies of (124)I-cG250 demonstrated isotope uptake in SK-RC-52 xenografts peaking at 23.45 ± 5.07% ID/g (mean ± SD) 48 hours after antibody injection, which was maintained for a further 2 days (19.43 ± 4.31 and 10.64 ± 5.64 % ID/g, respectively). PET studies demonstrated excellent localization of (124)I-cG250 in tumor, and a significant correlation between SUVmean, SUVmax, and %/ID (124)I-cG250. CAIX expression was present in all groups studied but there was no significant correlation between it and any oxygen parameter studied. Intratumoral hypoxia does exist within a human RCC xenograft model using invasive oxygen probe measurements. (124)I-cG250 targets RCC with correlation between uptake on noninvasive PET-CT studies and traditional biodistribution studies opening the possibility of using PET/CT in future studies. Finally, CAIX expression was not related to hypoxia in this model, supporting the hypothesis that cell lines may subvert known hypoxia mechanisms in hypoxic environments.
Publisher: Wiley
Date: 03-06-2018
DOI: 10.1111/BJU.14374
Abstract: Accurate staging of patients with prostate cancer (PCa) is important for therapeutic decision-making. Relapse after surgery or radiotherapy of curative intent is not uncommon and, in part, represents a failure of staging with current diagnostic imaging techniques to detect disease spread. Prostate-specific membrane antigen (PSMA) positron-emission tomography (PET)/computed tomography (CT) is a new whole-body scanning technique that enables visualization of PCa with high contrast. The hypotheses of this study are that: (i) PSMA-PET/CT has improved diagnostic performance compared with conventional imaging (ii) PSMA-PET/CT should be used as a first-line diagnostic test for staging (iii) the improved diagnostic performance of PSMA-PET/CT will result in significant management impact and (iv) there are economic benefits if PSMA-PET/CT is incorporated into the management algorithm. The proPSMA trial is a prospective, multicentre study in which patients with untreated high-risk PCa will be randomized to gallium-68-PSMA-11 PET/CT or conventional imaging, consisting of CT of the abdomen elvis and bone scintigraphy with single-photon emission CT/CT. Patients eligible for inclusion are those with newly diagnosed PCa with select high-risk features, defined as International Society of Urological Pathology grade group ≥3 (primary Gleason grade 4, or any Gleason grade 5), prostate-specific antigen level ≥20 ng/mL or clinical stage ≥T3. Patients with negative, equivocal or oligometastatic disease on first line-imaging will cross over to receive the other imaging arm. The primary objective is to compare the accuracy of PSMA-PET/CT with that of conventional imaging for detecting nodal or distant metastatic disease. Histopathological, imaging and clinical follow-up at 6 months will define the primary endpoint according to a predefined scoring system. Secondary objectives include comparing management impact, the number of equivocal studies, the incremental value of second-line imaging in patients who cross over, the cost of each imaging strategy, radiation exposure, inter-observer agreement and safety of PSMA-PET/CT. Longer-term follow-up will also assess the prognostic value of a negative PSMA-PET/CT. This trial will provide data to establish whether PSMA-PET/CT should replace conventional imaging in the primary staging of select high-risk localized PCa, or whether it should be used to provide incremental diagnostic information in selected cases.
Publisher: Royal Society of Chemistry (RSC)
Date: 2019
DOI: 10.1039/C8DT04814B
Abstract: A {Eu III Cu 5 } metallacrown displays field-induced slow magnetic relaxation, in which the Eu III with diamagnetic ground state enhances the relaxation rates.
Publisher: Oxford University Press (OUP)
Date: 28-10-2013
DOI: 10.1093/CID/CIT704
Abstract: Multidrug-resistant gram-negative bacterial (MDR-GNB) infections of the prostate are an increasing problem worldwide, particularly complicating transrectal ultrasound (TRUS)-guided prostate biopsy. Fluoroquinolone-based regimens, once the mainstay of many protocols, are increasingly ineffective. Fosfomycin has reasonable in vitro and urinary activity (minimum inhibitory concentration breakpoint ≤64 µg/mL) against MDR-GNB, but its prostatic penetration has been uncertain, so it has not been widely recommended for the prophylaxis or treatment of MDR-GNB prostatitis. In a prospective study of healthy men undergoing a transurethral resection of the prostate for benign prostatic hyperplasia, we assessed serum, urine, and prostatic tissue (transition zone [TZ] and peripheral zone [PZ]) fosfomycin concentrations using liquid chromatography-tandem mass spectrometry, following a single 3-g oral fosfomycin dose within 17 hours of surgery. Among the 26 participants, mean plasma and urinary fosfomycin levels were 11.4 ± 7.6 µg/mL and 571 ± 418 µg/mL, 565 ± 149 minutes and 581 ± 150 minutes postdose, respectively. Mean overall prostate fosfomycin levels were 6.5 ± 4.9 µg/g (range, 0.7-22.1 µg/g), with therapeutic concentrations detectable up to 17 hours following the dose. The mean prostate to plasma ratio was 0.67 ± 0.57. Mean concentrations within the TZ vs PZ prostate regions varied significantly (TZ, 8.3 ± 6.6 vs PZ, 4.4 ± 4.1 µg/g P = .001). Only 1 patient had a mean prostatic fosfomycin concentration of <1 µg/g, whereas the majority (70%) had concentrations ≥4 µg/g. Fosfomycin appears to achieve reasonable intraprostatic concentrations in uninflamed prostate following a single 3-g oral dose, such that it may be a potential option for prophylaxis pre-TRUS prostate biopsy and possibly for the treatment of MDR-GNB prostatitis. Formal clinical studies are now required.
Publisher: Elsevier BV
Date: 09-2016
Publisher: Springer Science and Business Media LLC
Date: 21-10-2010
DOI: 10.1007/S00345-010-0604-9
Abstract: Focal therapy is an appealing strategy for any tumor and in time may prove to be a valuable treatment option for low-risk, carefully selected prostate cancer (PCa) patients. In an era where active surveillance is now considered a viable option for low-risk PCa patients, it is conceivable that organ-sparing treatments could also become an established option. The aim of focal therapy is to achieve long-term cancer control with minimal morbidity yet without the side effects of radical therapy. Although lacking in evidence, it remains intuitive that if we treat the smallest possible region of the prostate where to ensure cancer control by ablation (laser, cryotherapy or another ablative source), then there is less potential for untoward side effects. Thus, we believe the ultimate goal in focal therapy is to target specifically the cancerous site while ablating it and the smallest zone of normal prostate tissue around it to obtain cancer control. To achieve this goal, one is dependent on high-quality imaging to: locate the cancerous lesion and have it assist in guiding the ablative modality toward the lesion monitor the ablation in real time accurately assess the extent and totality of the ablation post-treatment and finally be used to follow-up and monitor the prostate in search of a recurrence of cancer in the treated area or the development ion new zones. This review seeks to discuss such issues focusing on imaging modalities as they relate to focal therapy of PCa.
Publisher: BMJ
Date: 06-2012
DOI: 10.1136/JCLINPATH-2011-200460
Abstract: High intensity focused ultrasound (HIFU) is currently offered as primary treatment for patients with clinically localised prostate cancer. Data on histopathological features of post-treatment biopsies are limited. Pretreatment biopsies were identified in 45 men (age range 41-85) who received primary HIFU therapy. Post-HIFU biopsies were performed in 30 of these patients (67%) at mean 14.1 months (95% CI 11.7 to 16.5) follow-up, 22 due to rising PSA and eight as part of routine follow-up. Biopsies were examined for presence, distribution and extent of adenocarcinoma, Gleason scores, use of standard immunohistochemistry and ablative tissue changes were attributable to HIFU. In post-HIFU biopsies performed for biochemical failure, 17/22 (77%) contained adenocarcinoma 4/22 (18%) had higher post-HIFU Gleason score 3/22 (14%) had newly recognised bilateral involvement and 4/22 (18%) had higher percentage tissue involvement compared with pre-HIFU biopsies. Of cases without rising post-HIFU PSA, 2/8 (25%) routine follow-up biopsies contained adenocarcinoma. Stromal fibrosis was the commonest finding in non-tumour post-HIFU biopsy tissue (17/30, 57%) with coagulative necrosis occurring in fewer cases (4/30, 13%) and over a shorter follow-up interval than cases showing fibrosis (8.5 (0.2-16.8) vs 15.3 (11.5-19.1) months). Treatment effects in tumour cells precluding the assignment of Gleason scores or use of immunohistochemistry in post-HIFU biopsies were not identified. Post-HIFU biopsies are positive in more than 75% of patients with elevated or rising PSA. Stromal fibrosis is common but the tissue effects of this modality do not appear to impair pathologists' ability to detect and grade adenocarcinoma in follow-up biopsies.
Publisher: Wiley
Date: 16-01-2017
DOI: 10.1111/BJU.13600
Publisher: Wiley
Date: 27-04-2009
Publisher: Elsevier BV
Date: 2009
DOI: 10.1016/J.AJOG.2008.09.024
Abstract: Vulvar hematomas occur rarely outside the obstetric population but may present after other trauma to the pelvis or perineum. Spontaneous rupture of the internal iliac artery is described mostly in the presence of an aneurysm, with atherosclerosis, connective tissue disease, infection, and trauma as causative factors. It most often presents with abdominal pain and neurologic or urologic symptoms. We present an unusual case of a spontaneous rupture of the internal iliac artery that presented as a vulvar hematoma in a nulliparous woman that was successfully treated with selective arterial embolization and surgical evacuation. The literature is reviewed and management options discussed.
Publisher: Wiley
Date: 22-08-2017
DOI: 10.1111/BJU.13602
Abstract: To assess the impact of the United States Preventive Services Task Force (USPTSTF) recommendations on prostate-specific antigen (PSA) testing, prostate biopsy, and prostatectomy in Australian men based on the available Medicare data. Events were identified using Medicare item numbers for PSA testing (66655, 66659), prostate biopsy (37219), prostatectomy (37210), and prostatectomy with lymph node dissection (37211). The occurrences of each procedure was queried per 100 000 capita for consecutive financial years over the period 2000-2015. For each item number, reports were also generated for all Australian States. For PSA testing the data was stratified into three age groups of 45-54, 55-64, and 65-74 years. For assessing the rate of prostatectomy the capita rate values for two item numbers of prostatectomy (37210) and prostatectomy with lymph node dissection (37211) were combined. Steady declines in per capita incidences of all five item numbers assessed were seen for the three consecutive financial years (2013-2015) since the publication of the USPTSTF recommendation statement. These declines were seen across all Australian States. When examining the rate of PSA testing for the three age brackets 45-54, 55-64, and 65-74 years, similar trends were identified. Since the introduction of the USPTSTF recommendation statement there has been a steady nationwide decline in per capita incidences of PSA testing, prostate biopsy, and prostatectomy based on the Australian Medicare data. Whether these declines are in the right direction toward reduction in over-diagnosis and overtreatment of clinically insignificant prostate cancer or stage migration toward more locally advanced disease due to lost opportunity in diagnosing and treating early clinically significant prostate cancer will remain to be seen.
Publisher: Springer Science and Business Media LLC
Date: 28-10-2014
Abstract: When Nature Reviews Urology launched in 2004, the field of urology was vastly different to that which we work in today, and the past 10 years have seen the field change immensely. As a specialty on the forefront of cutting-edge innovation, urologists are often the first to embrace new technologies and ideas. In this Viewpoint, members of the Nature Reviews Urology advisory board were asked what they thought was the most important change, issue or innovation in urology in the past 10 years, and what they expected to be the most important in the next decade. Here are their opinions.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2011
DOI: 10.1016/J.JURO.2010.10.080
Abstract: High intensity focused ultrasound for the treatment of primary prostate cancer is increasing in a subset of men seeking definitive treatment with reduced morbidity. We review outcomes in men undergoing salvage radical prostatectomy after failed whole gland high intensity focused ultrasound. Prospective data were collected for men presenting with an increasing prostate specific antigen and biopsy proven prostate cancer after high intensity focused ultrasound from 2007 to 2010 who underwent salvage open radical prostatectomy with a 22-month median followup, including prostate specific antigen, prostate volume, pathology results, continence and erectile function. Data for 15 men were available, including median age 64 years (IQR 55-69), Gleason score before high intensity focused ultrasound of 6 (8), Gleason score 7 (7), median cores positive 39% (IQR 17%-63%) and median prostate specific antigen 7 ng/ml (IQR 5-8). Whole gland high intensity focused ultrasound achieved median nadir prostate specific antigen 1.1 ng/ml (IQR 0.5-3.1). Biopsy after high intensity focused ultrasound demonstrated Gleason score 6 (in 3 patients), 7 (9) and 8/9 (3), and 42% (IQR 25%-50%) cores positive and a median time from high intensity focused ultrasound to radical prostatectomy of 22 months (IQR 7-26). Perioperative morbidity was limited to 1 transfusion in a patient with a rectal injury. Pathologically extensive periprostatic fibrosis was found with persistent prostate cancer, as pT3 disease (in 9 of 14), Gleason scores 6 (2), 7 (9) and 8 of 9 (4), with focally positive margins in 3 of 11 (pT3a). Postoperative prostate specific antigen was unrecordable in 14 of 15 patients with further treatment in 2. Postoperative continence (more than 12 months of followup) yielded no pad use in 6 of 10 men with universally poor erectile function. Radical prostatectomy as salvage is feasible for men in whom high intensity focused ultrasound failed, but with a higher morbidity than for primary surgery. Pathology results are alarming given the number of cases with extraprostatic extension yet early followup data suggest acceptable oncologic control. These results should be factored in when counseling men who wish to undergo primary high intensity focused ultrasound.
Publisher: American Geophysical Union (AGU)
Date: 29-06-2020
DOI: 10.1029/2019JB018873
Abstract: In typical subduction systems, plate convergence is subperpendicular to the trench. The Gibraltar Arc System is exceptional, with its narrow subduction arc oriented N‐S and laterally “squeezed” by the NNW‐SSE tectonic convergence between Nubia and Iberia. The extent to which the slab is still coupled to the surface and how it interacts actively with the surrounding mantle is a matter of ongoing debate. Here, we analyze new densely spaced GPS data, together with crustal and mantle observations, to better understand the slab kinematics, plate dynamics, and mantle flow. In light of previous and current research, we find that subduction below the Gibraltar Arc is currently in the middle of a disruption process, with parts of it already detached and others yet coupled to the surface. In particular, the slab seems to be detached to the north of the Gibraltar Strait, with a small portion still attached to the surface or in the process of detaching below the western Betics. South of Gibraltar, the slab is still coupled to the overriding plate, although the subduction seems to be very slow or stopped. Flow of mantle material around the detached portions of the slab causes most of the surface uplift and a positive residual topography anomaly. Our findings show that the interplay between slab dynamics, mantle flow, and plate convergence explains much of the observed residual topography, surface motion, seismicity, and mantle structure.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2009
DOI: 10.1016/J.JURO.2009.08.036
Abstract: We investigated whether interoperator differences exist in the setting of prostate cancer detection by transrectal ultrasound guided prostate biopsy. Our secondary aim was to investigate whether a learning curve exists for prostate cancer detection. A prospective database from 2000 to 2008 including 9,072 transrectal ultrasound guided prostate biopsies at our institution was limited to 4,724 done at initial presentation. Biopsies were performed by 4 uroradiologists. The OR for detecting cancer on transrectal ultrasound guided prostate biopsy was calculated for likely independent prognostic variables, including operator. We also examined the rate of biopsy positivity in increments, comparing the first and last cohorts. The senior radiologist (AT) with the most biopsies (75%) was considered the referent for prostate cancer detection. Univariate and multivariate logistic regression modeling was used to determine significant covariates with p <0.05 deemed relevant. Prostate cancer was detected in 2,331 men (49.3%). Operators performed a median of 514 transrectal ultrasound guided prostate biopsies (range 187 to 3,509) with a prostate cancer detection rate of 43.8% to 52.4% (p = 0.001). Other significant covariates were prostate specific antigen, suspicious lesions on ultrasound, nodule on digital rectal examination, smaller prostate volume and increasing patient age. Operator was a significant multivariate predictor of cancer detection (OR 0.67 to 0.89, p = 0.003). No learning curve was detected and biopsy rates were consistent throughout the series. Significant differences in prostate cancer detection exist among operators who perform transrectal ultrasound guided prostate biopsy even in the same setting. The volume of previously performed transrectal ultrasound guided prostate biopsies does not appear to influence the positive prostate cancer detection rate, nor could a learning curve be identified. Differences in prostate cancer detection among operators are likely related to unknown differences in expertise or technique. Further research is needed.
Publisher: Elsevier BV
Date: 09-2003
DOI: 10.1016/S0967-5868(03)00160-7
Abstract: The primary objective of this study was to evaluate the incidence of warfarin use in 156 consecutive patients presenting to a single tertiary referral centre with spontaneous intracerebral haemorrhage. Our study found that 11% of patients (16/159) presenting with spontaneous intracerebral haemorrhage were on warfarin for prophylactic anticoagulation at time of presentation. Comparison was made to other published Australian data with regard to the incidence of warfarin use in patients presenting with spontaneous intracerebral haemorrhage. Patient outcomes were also examined.
Publisher: Elsevier BV
Date: 2005
DOI: 10.1016/J.UROLOGY.2004.08.029
Abstract: A simple technique using a fenestrated urethral catheter to assist in drainage of pericatheter urethral exudates from the anastomosis of the urethra to the bladder neck in radical prostatectomy is described. It is applicable to open and laparoscopic techniques of radical prostatectomy.
Publisher: Wiley
Date: 15-04-2005
Publisher: Mary Ann Liebert Inc
Date: 06-2010
Abstract: Laparoscopic surgical procedures are becoming common across surgical specialties, including urology. Maintaining a clear field of vision is paramount in such procedures not only for safety by preventing inadvertent injury, but also to improve precision and reduce operative time. Laparoscopic lens fogging (LLF) is a major impediment to a clear visual field during laparoscopy and is caused by condensation as well as particulate debris, blood, and smoke accumulation on the scope lens. Despite many available techniques to improve vision during laparoscopy, available data on etiology and methods to improve vision have only sporadically been considered in the literature. The objective of this review was to summarize current literature on the etiology of LLF and other causes of poor vision during laparoscopy and also review the current approaches for minimizing or reducing such events. In summary, although the etiology of LLF is well understood, that is, temperature and humidity differences, the methods to reduce its occurrence lack significant data. Of those methods that are often espoused, most are not supported in the literature, such as warmed and humidified insufflation gas, or simply lack data, such as antifogging solutions.
Publisher: Wiley
Date: 25-05-2017
DOI: 10.1111/BJU.13859
Publisher: Elsevier BV
Date: 06-2010
DOI: 10.1016/J.EURURO.2010.02.024
Abstract: This review focuses on the prevention and management of complications following radical cystectomy (RC) for bladder cancer (BCa). We review the current literature and perform an analysis of the frequency, treatment, and prevention of complications related to RC for BCa. A Medline search was conducted to identify original articles, reviews, and editorials addressing the relationship between RC and short- and long-term complications. Series examined were published within the past decade. Large series reported on multiple occasions (Lee [1], Meyer [2], and Chang and Cookson [3]) with the same cohorts are recorded only once. Quality of life (QoL) and sexual function were excluded. The literature regarding prophylaxis, prevention, and treatment of complications of RC in general is retrospective, not standardised. In general, it is of poor quality when it comes to evidence and is thus difficult to synthesise. Progress has been made in reducing mortality and preventing complications of RC. Postoperative morbidity remains high, partly because of the complexity of the procedures. The issues of surgical volume and standardised prospective reporting of RC morbidity to create evidence-based guidelines are essential for further reducing morbidity and improving patients' QoL.
Publisher: Wiley
Date: 10-2002
DOI: 10.1046/J.1445-2197.2002.02529.X
Abstract: Wound blisters are formed in the epidermis adjacent to surgical incisions and are a significant cause of morbidity following hip surgery. This study was designed to compare two commonly used primary dressings, namely a nonadherent absorbable (NAA) dressing and paraffin tulle gras (PTG). Monitoring for the subsequent development of wound blisters in the epidermis adjacent to the surgical incision was then undertaken. The present study was performed in the setting of a prospective, randomised trial of 50 consecutive patients undergoing hip surgery. It was assumed there would be no difference in the development of blisters between the dressing groups. The alternative hypothesis was that PTG would, because of its properties, provide less friction in the epidermis and contribute to fewer wound blisters. A statistically significant difference (P = 0.0028) between the two dressing groups was observed with the NAA group developing blisters in 17 (64%) patients and the PTG group in only two (8%) of the patients. The present study would suggest that PTG produces fewer wound blisters following hip surgery when compared to the NAA type as a primary dressing.
Publisher: Medknow
Date: 2013
Publisher: Public Library of Science (PLoS)
Date: 04-03-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2013
Publisher: Informa UK Limited
Date: 06-2010
DOI: 10.1586/ERA.10.69
Publisher: Wiley
Date: 29-07-2014
DOI: 10.1111/BJU.12764
Abstract: To analyse the impact of the uro-oncology multidisciplinary meeting (MDM) at an Australian tertiary centre on patient management decisions, and to develop criteria for patient inclusion in MDMs. Over a 3-month period, all cases presented at our weekly uro-oncology MDM were prospectively assessed, by asking the presenting clinician to state their provisional management plans and comparing this with the subsequent consensus decision. The impact of the MDM was graded as high if there was a major change in the management plan or if a plan was developed where there was none. Over the study period, 120 discussions about 107 patients were recorded. Prostate, urothelial, kidney and testis cancer represented 46 (38.3%), 36 (30%), 26 (21.6%) and 12 (10%) of the discussions, respectively. The MDM made high impact changes to the original plan in 32 (26.7%) cases. High impact changes were nearly twice as likely to occur in patients with metastatic disease as in those without metastases (P < 0.05). Primary cross referral between disciplines occurred in 40 (33.3%) cases, including 66.7% of testicular and 42% of bladder cancers but only 26% of prostate and 19% of kidney cancers (P < 0.02). The uro-oncology MDM alters management plans in about one-quarter of cases. Additionally, MDMs also serve other purposes, such as cross-referral or consideration for clinical trials. Patients should be discussed in MDMs if multimodal therapy may be required, clinical trial eligibility is being considered or if metastasis or recurrence is noted.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2005
DOI: 10.1097/01.JU.0000161591.86721.E5
Abstract: To our knowledge this study represents the first analysis monitoring the efficacy of cyproterone acetate (CPA) monotherapy for achieving castrate testosterone levels prior to administering a luteinizing hormone-releasing analogue (LHRHA) for treating prostate cancer in the prostate specific antigen (PSA) era. Patients with untreated locally advanced or metastatic prostate cancer were recruited prospectively. Treatment involved a 28-day course of oral cyproterone acetate and LHRHA depot injection on day 14. Patients had serum PSA, luteinizing hormone and testosterone monitored at intervals during a 56-day period. A total of 15 patients with a mean age of 74 years completed the study. Near castrate serum testosterone was achieved on day 7 (mean +/- 95% CI 83.38 +/- 17.87 ng/dl). There was a significant testosterone increase after LHRHA administration on day 14 compared with the level of 160.23 +/- 36.60 ng/dl on day 16 (p <0.01). Serum luteinizing hormone mirrored testosterone, increasing from a mean of 4.93 +/- 0.61 to 15.4 +/- 6.12 nmol/l after LHRHA administration (p <0.01). Mean serum PSA demonstrated a decrease from 199.25 +/- 6.12 microg/l at day 0 to 43.77 +/- 33.08 microg/l by day 56. There was no increase in serum PSA after LHRHA administration. Two weeks of priming with CPA does not eliminate the surge in serum testosterone (testosterone flare) upon LHRHA administration but the testosterone increase does not exceed pretreatment levels. Furthermore, 2 weeks of CPA may not offer a benefit over 1 week in lowering serum testosterone. Finally, there is no increase in serum PSA when LHRHA is administered after priming with CPA.
Publisher: S. Karger AG
Date: 2008
DOI: 10.1159/000112616
Abstract: In the genitourinary tract, masses in the seminal vesicles, particularly primary tumors, are an unusual event. One must consider all diagnoses including Ewing’s sarcoma or its variant, peripheral primitive neuroectodermal tumor (PPNET). In this case report we describe a case of PPNET arising from the seminal vesicle. The prognosis of such tumors is generally poor and requires aggressive multimodal management if it is to be successful. It is essential that unusual tumors are considered when confronted by a seminal vesicle mass and that appropriate investigation and management are initiated.
Publisher: Wiley
Date: 04-01-2017
DOI: 10.1111/BJU.13734
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2004
Publisher: Wiley
Date: 10-2003
Publisher: Wiley
Date: 27-09-2023
DOI: 10.1111/BJU.15883
Abstract: To provide a summary and discussion of international guidelines, position statements and consensus statements in relation to focal therapy (FT) for prostate cancer (PCa). The European Association of Urology‐European Association of Nuclear Medicine‐European Society for Radiotherapy and Oncology‐European Society of Urogential Radiology‐International Society of Urological Pathology‐International Society of Geriatric Oncology and American Urological Association‐American Society for Radiation Oncology‐Society of Urologic Oncology guidelines were interrogated for recommendations for FT. PubMed and Ovid Medline were searched for consensus statements. Only studies in English since 2015 were included. Reference lists of the included articles were also interrogated and a manual search for studies was also performed. Our results showed a lack of long‐term randomised data for FT. International Urological guidelines emphasised the need for more high‐quality clinical trials with robust oncological and toxicity outcomes. Consensus and positions statements were heterogenous. A globally accepted guideline for FT planning, technique and follow‐up are still yet to be determined. Well‐designed studies with long‐term follow‐up and robust clinical and toxicity endpoints are needed to improve our understanding of FT and create uniform guidelines to streamline management and follow‐up.
Publisher: Springer Science and Business Media LLC
Date: 10-2010
Abstract: The role of imaging in treatment decision-making for patients with prostate cancer is to characterize the cancer already diagnosed on biopsy, to determine tumor location, to assess tumor volume, and to exclude more-extensive disease. MRI is currently the most established imaging modality for this purpose, with the highest sensitivity and specificity for detection and staging of prostate tumors. The development and wider adoption of active surveillance and focal treatment approaches would also benefit from accurate localization of cancer. As such, 3 T MRI and multiparametric approaches are being developed as tools for the localization and staging of prostate cancer. Men wishing to commence or remain on active surveillance might benefit by having larger cancers identified before embarking on this management strategy. MRI might have its greatest role in patients where there is a discrepancy between PSA and biopsy results suggesting a potential missed prostate tumor.
Publisher: Springer Science and Business Media LLC
Date: 14-09-2010
Abstract: Focal therapy is emerging as an alternative to active surveillance for the management of low-risk prostate cancer in carefully selected patients. The aim of focal therapy is long-term cancer control without the associated morbidity that plagues all radical therapies. Different energy modalities have been used to focally ablate cancer tissue, and available techniques include cryotherapy, laser ablation, high-intensity focused ultrasound and photodynamic therapy. The majority of evidence for focal therapy has come from case series and small phase I trials, and larger cohort studies with longer follow-up are only now being commenced. More data from large trials on the safety and efficacy of focal therapy are therefore required before this approach can be recommended in men with prostate cancer in particular, studies must confirm that no viable cells remain in the region of ablation. Focal therapy might eventually prove to be a 'middle ground' between active surveillance and radical treatment, combining minimal morbidity with cancer control and the potential for re-treatment.
Publisher: Wiley
Date: 04-10-2023
DOI: 10.1111/BJU.16175
Publisher: Wiley
Date: 27-09-2023
DOI: 10.1111/BJU.16176
Publisher: Future Medicine Ltd
Date: 09-2020
Publisher: Springer Science and Business Media LLC
Date: 24-09-2013
Abstract: Transperineal prostate biopsy is re-emerging after decades of being an underused alternative to transrectal biopsy guided by transrectal ultrasonography (TRUS). Factors driving this change include possible improved cancer detection rates, improved s ling of the anteroapical regions of the prostate, a reduced risk of false negative results and a reduced risk of underestimating disease volume and grade. The increasing incidence of antimicrobial resistance and patients with diabetes mellitus who are at high risk of sepsis also favours transperineal biopsy as a sterile alternative to standard TRUS-guided biopsy. Factors limiting its use include increased time, training and financial constraints as well as the need for high-grade anaesthesia. Furthermore, the necessary equipment for transperineal biopsy is not widely available. However, the expansion of transperineal biopsy has been propagated by the increase in multiparametric MRI-guided biopsies, which often use the transperineal approach. Used with MRI imaging, transperineal biopsy has led to improvements in cancer detection rates, more-accurate grading of cancer severity and reduced risk of diagnosing clinically insignificant disease. Targeted biopsy under MRI guidance can reduce the number of cores required, reducing the risk of complications from needle biopsy.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2010
DOI: 10.1016/J.JURO.2010.03.014
Abstract: We evaluated indications and outcomes of cystectomy in patients with spinal cord injury in a urology unit attached to a statewide spinal cord injury service. We performed a review of all patients with spinal cord injury in our database who underwent cystectomy between 1997 and 2008. Demographic, pathological and perioperative data were collected. Oncological outcomes were documented for those with malignant indications while patient satisfaction was recorded using the Patient Global Impression of Improvement scale for all patients. Of 2,569 acute spinal cord injury presentations there were 14 patients who underwent cystectomy. Mean patient age was 53 years (range 39 to 72). Of the 14 patients 9 had malignant disease and 5 had benign indications for cystectomy. Overall mean followup was 48 months (median 30.8). Cumulative survival in the malignant cohort was 66.7% with a 33.3% recurrence rate resulting in death. All survivors remained disease-free at a mean of 49 months (median 31). Mean Patient Global Impression of Improvement score was 3 (range 1-very much better to 7-very much worse). In the nonmalignant cohort mean followup was 75 months (median 77). The overall Patient Global Impression of Improvement score in this group was 2.4, suggesting overall positive patient satisfaction. In patients with spinal cord injury cystectomy is performed almost as often for nonmalignant as for malignant indications. Our data support a more aggressive presentation of cancer with a different pathological profile but not survival compared to normal populations. Centers treating patients with spinal cord injury should consider a lower threshold for the surgical management of bladder cancer where appropriate, especially considering that morbidity, satisfaction and outcome do not appear to be compromised in patients with spinal cord injury.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2011
DOI: 10.1016/J.JURO.2010.10.055
Abstract: Men with castrate resistant prostate cancer have limited treatment options. Although luteinizing hormone-releasing hormone agonists are in the same class, they are slightly different in their pharmacology. We determined whether rechallenging patients with prostate cancer, who were receiving a luteinizing hormone-releasing hormone analogue but had progression, with a different luteinizing hormone-releasing hormone analogue (goserelin or leuprolide acetate) would result in a prostate specific antigen response. Secondary objectives were to calculate the PSA response and determine whether sequence order impacted the response. We performed a retrospective, ethics approved review of the records of patients with prostate cancer at multiple institutions who received a luteinizing hormone-releasing hormone analogue (goserelin or leuprolide acetate), experienced progression, as measured by 2 consecutive prostate specific antigen increases, and were rechallenged with the other analogue (goserelin or leuprolide acetate). Prostate specific antigen and relevant clinical data were obtained and statistical analysis was done. Of 39 available men 27 (69%) had decreased prostate specific antigen after 3 months of switching regimens. The median change in prostate specific antigen was -1.5 (IQR -10.0, 0.8), indicating a statistically significant decrease (p=0.01). The median percent prostate specific antigen change for leuprolide acetate to goserelin was -69.3% (IQR -81.5, 26.2) and for goserelin to leuprolide acetate it was -6.4% (IQR -61.7, 21.8, p=0.05). Median time to a subsequent prostate specific antigen increase was 5.2 months (95% CI 3.5-17.4). Prostate specific antigen decreased after switching luteinizing hormone-releasing hormone therapies. This decrease appeared most significant in the group that switched from leuprolide acetate to goserelin. The duration of response after switching was approximately 5 months. The study is limited by its retrospective nature but should encourage prospective evaluation of this observation.
Publisher: The Korean Urological Association
Date: 2012
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1016/J.UROLOGY.2013.10.017
Abstract: To determine whether the method of specimen preparation after transrectal ultrasound-guided biopsy of the prostate affected core fragmentation, and secondly to determine whether such fragmentation was influenced by the presence of malignancy in the biopsy specimen. A prospective randomized study comparing 2 different mechanisms of specimen preparation, wash vs swipe of biopsy cores, with blinded assessment by a specific uropathologist was undertaken. For those cores in which prostate cancer was present, the wash method of specimen preparation resulted in fewer and longer core fragments (P = .005). Those patients in whom cancer was present on biopsy also had a greater degree of biopsy core fragmentation in those cores in which only benign tissue was identified (P = .017). Gleason score did not appear to influence the extent of fragmentation. The method of specimen preparation at prostate biopsy influences the degree of fragmentation seen at histologic evaluation. This has the potential to affect the interpretation of biopsy results, including suitability of patients for inclusion in active surveillance protocols. Core fragmentation might be minimized by modification of technique.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2010
DOI: 10.1016/J.JURO.2010.03.018
Abstract: Macroscopic hematuria is a common symptom and sign that is challenging to quantify and describe. The degree of hematuria communicated is variable due to health worker experience combined with lack of a reliable grading tool. We produced a reliable, standardized visual scale to describe hematuria severity. Our secondary aim was to validate a new laboratory test to quantify hemoglobin in hematuria specimens. Nurses were surveyed to ascertain current hematuria descriptions. Blood and urine were titrated at varying concentrations and digitally photographed in catheter bag tubing. Photos were processed and printed on transparency paper to create a prototype swatch or card showing light, medium, heavy and old hematuria. Using the swatch 60 s les were rated by nurses and laymen. Interobserver variability was reported using the generalized kappa coefficient of agreement. Specimens were analyzed for hemolysis by measuring optical density at oxyhemoglobin absorption peaks. Interobserver agreement between nurses and laymen was good (kappa = 0.51, p <0.001). Subgroup analysis showed substantial agreement for light hematuria (kappa = 0.71). Overall agreement improved when the moderate (kappa = 0.28) and heavy (kappa = 0.53) hematuria categories were combined (kappa = 0.70). Compared to known blood concentrations the assay of optical density at oxyhemoglobin absorption peaks showed a linear trend. A simple visual scale to grade and communicate hematuria with adequate interobserver agreement is feasible. The test for optical density at oxyhemoglobin absorption peaks is a new method, validated in our study, to quantify hemoglobin in a hematuria specimen.
Publisher: Future Medicine Ltd
Date: 06-2011
DOI: 10.2217/FON.11.51
Abstract: Organ-preserving therapies are widely accepted in many facets of medicine and, more recently, in oncology. For ex le, partial nephrectomy is now accepted as a preferred alternative over radical nephrectomy for small (up to 4 cm or T1) tumors. Focal therapy (FT) is another organ-preserving strategy applying energy (cryotherapy, laser ablation and/or high-intensity focused ultrasound) to destroy tumors while leaving the majority of the organ, surrounding tissue and structures unscathed and functional. Owing to the perceived multifocality of prostate cancer (PCa) technology limitations, in the past PCa was not considered suitable for FT. However, with the rise of active surveillance for the management of low-risk PCa in carefully selected patients, FT is emerging as an alternative. This is owing to technology improvements in imaging and energy-delivery systems to ablate tissue, as well as the realization that many men and clinicians still desire tumor control. With the postulated ability to ablate tumors with minimal morbidity, FT may have found a role in the management of PCa the aim of FT a being long-term cancer control without the morbidity associated with radical therapies. Data for FT in PCa have been derived from case series and small Phase I trials, with larger cohort studies with longer follow-up having only just commenced. More data from large trials on the safety and efficacy of FT are required before this approach can be recommended in men with PCa. Importantly, studies must confirm that no viable cancer cells remain in the region of ablation. FT might eventually prove to be a ‘middle ground’ between active surveillance and radical treatment, combining minimal morbidity with cancer control and the potential for retreatment.
Publisher: Wiley
Date: 05-2006
DOI: 10.1111/J.1442-2042.2006.01379.X
Abstract: Metastases to the penis are a rare event with most arising from pelvic organs, but occasionally the kidneys. Furthermore, very few cases exist where primary rectal carcinoma metastasising to the penis has been reported. We report on such a case and discuss the general management of penile metastases.
Publisher: Wiley
Date: 15-10-2013
DOI: 10.1111/BJU.12378
Abstract: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD? Urologists are often confronted with cystoscopic appearances that at times are abnormal but non-specific, may mimic urothelial carcinoma or in some instances are quite bizarre given the clinical scenarios in which they occur (e.g. changes associated with a catheter will be more obvious than a de-novo presentation of cystitis cystica). Metaplasias of the bladder urothelium make up the majority of such cases. Furthermore, when confronted with a pathological diagnosis of a metaplasia within the bladder- what are the implications for the patient and how should they be followed-up? This review provides a concise summary of the pathological features of the various metaplasias that occur in the bladder and briefly describes their current treatment and requirement for follow-up. Metaplasia of the bladder urothelium occurs commonly in response to local injury. Usually the changes are reversible, but some conditions may be premalignant. This review describes the different metaplastic entities and their clinical significance. Most importantly, keratinising squamous metaplasia is a precursor to the development of bladder cancer, and requires treatment and long term follow up. The role of intestinal metaplasia in the development of cancer is uncertain, and these patients require follow-up until further evidence is obtained on the outcome of this entity.
Publisher: Wiley
Date: 04-2003
DOI: 10.1046/J.1445-1433.2003.02576.X
Abstract: Pain is a personal, subjective experience. In the postoperative period, pain may be influenced by patient, pharmacological and environmental factors. In surgery the aim is to reduce pain in this period by educating patients and using adequate analgesia. The aim of the present study was to assess the effect of perceived wound size on pain, as indicated by wound dressing, in the immediate postoperative period. Patients undergoing appendicectomy were randomized into a group having a dressing the same size (SSD) as the surgical wound or double the size (DSD) of the wound. Patients' pain perception and analgesic requirements were then recorded and analysed to compare the two groups. Both groups had similar results when comparing pain perception. The median total pain score for the SSD and DSD groups at 12 and 24 h postoperatively revealed no statistically significant difference (P > 0.05). The data do not support the hypothesis that postoperative pain may be altered by perceived wound dressing size. Dressing size does not appear to be a variable that could easily be altered to reduce postoperative pain in surgical patients.
Publisher: Wiley
Date: 19-03-2010
Publisher: Future Medicine Ltd
Date: 12-2020
Publisher: Wiley
Date: 15-10-2013
DOI: 10.1111/BJU.12381
Abstract: The diagnosis of prostate cancer has long been plagued by the absence of an imaging tool that reliably detects and localises significant tumours. Recent evidence suggests that multi-parametric MRI could improve the accuracy of diagnostic assessment in prostate cancer. This review serves as a background to a recent USANZ position statement. It aims to provide an overview of MRI techniques and to critically review the published literature on the clinical application of MRI in prostate cancer. The combination of anatomical (T2-weighted) MRI with at least two of the three functional MRI parameters - which include diffusion-weighted imaging, dynamic contrast-enhanced imaging and spectroscopy - will detect greater than 90% of significant (moderate to high risk) tumours however MRI is less reliable at detecting tumours that are small (<0.5 cc), low grade (Gleason score 6) or in the transitional zone. The higher anatomical resolution provided by 3-Tesla magnets and endorectal coils may improve the accuracy, particularly in primary tumour staging. The use of mpMRI to determine which men with an elevated PSA should undergo biopsy is currently the subject of two large clinical trials in Australia. MRI should be used with caution in this setting and then only in centres with established uro-radiological expertise and quality control mechanisms in place. There is sufficient evidence to justify using MRI to determine the need for repeat biopsy and to guide areas in which to focus repeat biopsy. MRI-directed biopsy is an exciting concept supported by promising early results, but none of the three proposed techniques have so far been proven superior to standard biopsy protocols. Further evidence of superior accuracy and core-efficiency over standard biopsy is required, before their costs and complexities in use can be justified. When used for primary-tumour staging (T-staging), MRI has limited sensitivity for T3 disease, but its specificity of greater than 95% may be useful in men with intermediate-high risk disease to identify those with advanced T3 disease not suitable for nerve sparing or for surgery at all. MRI appears to be of value in planning dosimetry in men undergoing radiotherapy, and in guiding selection for and monitoring on active surveillance.
Publisher: Wiley
Date: 12-07-2022
DOI: 10.1111/BJU.15773
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.UROLONC.2018.08.012
Abstract: The advantages of Robot-assisted laparoscopic prostatectomy (RARP) over open radical prostatectomy (ORP) in Prostate cancer perioperatively are well-established, but quality of life is more contentious. Increasingly, patients are utilising online cancer support groups (OCSG) to express themselves. Currently there is no method of analysis of these sophisticated data sources. We have used the PRIME-2 (Patient Reported Information Multidimensional Exploration version 2) framework for automated identification and intelligent analysis of decision-making, functional and emotional outcomes in men undergoing ORP vs. RARP from OCSG discussions. The PRIME-2 framework was developed to retrospectively analyse in idualised patient-reported information from 5,157 patients undergoing RARP and 579 ORP. The decision factors, side effects, and emotions in 2 groups were analysed and compared using Chi-squared, t tests, and Pearson correlation. There were no differences in Gleason score, Prostate Specific Antigen (PSA), and age between the groups. Surgeon experience and preservation of erectile function (P < 0.01) were important factors in the decision making process. There were no significant differences in urinary, sexual, or bowel symptoms between ORP and RARP on a monthly basis during the initial 12 months. Emotions expressed by patients undergoing RARP were more consistent and positive while ORP expressed more negative emotions at the time of surgery and 3 months postsurgery (P < 0.05), due to pain and discomfort, and during ninth month due to fear and anxiety of pending PSA tests. ORP and RARP demonstrated similar side effect profiles for 12 months, but PRIME-2 enables identification of important quality of life features and emotions over time. It is timely for clinicians to accept OCSG as an adjunct to Prostate cancer care.
Publisher: Springer Science and Business Media LLC
Date: 05-2010
Abstract: The incidence of early and advanced-stage renal cell carcinoma (RCC) is increasing. Methods of diagnosing, staging and evaluating tumor burden that are more accurate and reliable than the currently available options are needed in order to identify RCC at a stage at which it is curable and to accurately determine the response to treatment. Functional imaging, particularly with combined PET-CT, might improve accuracy of detection and provide essential information that has been unavailable to date. This approach is against a background in which targeted therapies for metastatic RCC have entered clinical practice in the past few years, further highlighting the importance of accurate imaging for patient selection and for monitoring response to treatment. We outline the current clinical status of functional imaging in RCC using PET-CT, which allows simultaneous capture and co-registration of functional and anatomical data. New radiotracers and approaches-including radiolabeled monoclonal antibodies and imaging of tumor hypoxia-are touched on, and areas of future research discussed.
Publisher: Wiley
Date: 06-04-2006
Publisher: Wiley
Date: 03-10-2023
DOI: 10.1111/BJU.16188
Publisher: Canadian Urological Association Journal
Date: 15-06-2012
DOI: 10.5489/CUAJ.12053
Publisher: Elsevier BV
Date: 10-2014
Abstract: To present long-term survival data from the Victorian Radical Prostatectomy Register (VRPR), 1995-2000, and analyse the effect of rural residence on survival. Men who underwent open radical prostatectomy (RP) in Victoria from 1995 to 2000 were recorded in a population register co-ordinated by the Victorian Cancer Registry and Cancer Council Victoria. Baseline clinical, pathological and demographic information such as location were recorded and linked to mortality and recurrence data. Men who had neoadjuvant therapy or missing data for socioeconomic status (SES), tumour grade and stage were excluded leaving 1984 patients in the analyses (92.1% of total register). Follow-up concluded in 2009 with 238 deaths observed, of which 77 were prostate cancer (PCa) specific. Cox and competing risk regressions were used for analysis. Living in a rural area was associated with higher odds of PCa specific mortality after RP (trend p<0.001) and a higher hazard of PCa death, the discrepancy rising up to four-fold (SHR=4.09, p=0.004) with increasing remoteness of residence. This effect is apparent after adjustment for SES, age, private or public hospital treatment, PSA level and tumour-specific factors. Rural men in Victoria have a shorter time to PCa death following definitive treatment, even after adjustment for SES and adverse tumour characteristics. Rural men are faring worse than their urban counterparts following the same cancer treatment.
Publisher: Wiley
Date: 29-03-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2010
DOI: 10.1016/J.JURO.2010.03.001
Abstract: Focal therapy using lasers is emerging as an alternative strategy for prostate cancer treatment. However, to our knowledge no anatomically correct models are available to test imaging and ablation techniques. Animal models present ethical, anatomical and cost challenges. We designed and validated an inexpensive but anatomically correct prostate phantom incorporating tumor, rectum and urethra that can be used for simulated and experimental magnetic resonance guided focal intervention. Our secondary aim was to asses the phantom using other imaging modalities. The phantom, which was constructed of ballistic gel, includes an 80 gm prostate with urethra, tumor, perineum and rectum. Gadolinium was added to make the gel visible to magnetic resonance imaging. To recreate a tumor an irregularly shaped 5 cc volume of coagulable gel was inserted into the prostate phantom. The phantom was evaluated using magnetic resonance, computerized tomography and transrectal ultrasound. Thermal ablation was delivered via interstitial placement of laser fibers. Magnetic resonance thermometry was done to record real-time tissue temperatures during thermal ablation. With all modalities tested the phantom emulated human prostate anatomy. The coagulable gel tumor allowed us to generate focal thermal lesions. The phantom had magnetic resonance imaging properties comparable to in vivo properties, allowing ablative zones to be accurately assessed and magnetic resonance thermometry to be done. The phantom is a useful tool to test different aspects of thermal focal ablation for prostate cancer using multiple imaging modalities, particularly magnetic resonance. It is inexpensive and easily constructed, and may be considered a valuable model to train on and teach focal therapy.
Publisher: Elsevier BV
Date: 2012
Publisher: Wiley
Date: 09-04-2010
Publisher: The Korean Urological Association
Date: 2011
Publisher: The Korean Urological Association
Date: 2012
Publisher: American Geophysical Union (AGU)
Date: 02-2019
DOI: 10.1029/2018JB016531
Publisher: Springer Science and Business Media LLC
Date: 08-12-2010
Abstract: Nutraceuticals are 'natural' substances isolated or purified from food substances and used in a medicinal fashion. Several naturally derived food substances have been studied in prostate cancer in an attempt to identify natural preventative therapies for this disease. Vitamin E, selenium, vitamin D, green tea, soy, and lycopene have all been examined in human studies. Other potential nutraceuticals that lack human data, most notably pomegranate, might also have a preventative role in this disease. Unfortunately, most of the literature involving nutraceuticals in prostate cancer is epidemiological and retrospective. The paucity of randomized control trial evidence for the majority of these substances creates difficulty in making clinical recommendations particularly when most of the compounds have no evidence of toxicity and occur naturally. Despite these shortcomings, this area of prostate cancer prevention is still under intense investigation. We believe many of these 'natural' compounds have therapeutic potential and anticipate future studies will consist of well-designed clinical trials assessing combinations of compounds concurrently.
Publisher: Elsevier
Date: 2010
Publisher: FapUNIFESP (SciELO)
Date: 06-2014
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.EURURO.2018.10.055
Abstract: Active surveillance (AS) has become the recommended management strategy for men with low-risk prostate cancer. However, there is considerable uncertainty about the optimal follow-up schedule in terms of the tests to perform and their frequency. To assess the costs and benefits of different AS follow-up strategies compared to watchful waiting (WW) or immediate treatment. A state-transition Markov model was developed to simulate the natural history (ie, no testing or intervention) of prostate cancer for a hypothetical cohort of 50-yr-old men newly diagnosed with low-risk prostate cancer. Following diagnosis, men were hypothetically managed with immediate treatment, watchful waiting, or one of several AS strategies. AS follow-up was performed either with transrectal ultrasound-guided biopsy or magnetic resonance imaging (MRI) which was scheduled annually, biennially, every 3yrs, according to the PRIAS protocol (yrs 1, 4, 7, and 10, and then every 5yr) or every 5yr. Diagnosis of higher-grade or -stage disease while on AS resulted in curative treatment. We measured discounted quality-adjusted life years (QALYs), discounted lifetime medical costs (2017 US$), and incremental cost-effectiveness ratios (ICERs). Compared to WW, MRI-based surveillance performed every 5yr improved quality-adjusted survival by 4.47 quality-adjusted months and represented high-value health care at the Medicare reimbursement rate using standard cost-effectiveness metrics. Biopsy-based strategies were less effective and less costly than the corresponding MRI-based strategies for each testing interval. MRI-based surveillance at more frequent intervals had ICERs greater than $800000 per QALY and would not be considered cost-effective according to standard metrics. Our results were sensitive to the diagnostic accuracy and costs of both biopsy modes in detecting clinically significant cancer. Incorporation of MRI into surveillance protocols at Medicare reimbursement rates and decreasing the intensity of repeat testing may be cost-effective options for men opting for conservative management of low-risk prostate cancer. Our study modeled outcomes for men with low-risk prostate cancer undergoing watchful waiting, immediate treatment, or active surveillance with different follow-up schedules. We found that conservative management of low-risk disease optimizes health outcomes and costs. Furthermore, we showed that decreasing the intensity of active surveillance follow-up and incorporating magnetic resonance imaging (MRI) into surveillance protocols can be cost-effective, depending on the MRI costs.
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.UROLOGY.2013.10.032
Abstract: To investigate the association between extravesical (18)F-fluorodeoxyglucose (FDG) avid lesions on FDG-positron emission tomography/computed tomography (PET/CT) and mortality in patients with muscle-invasive bladder cancer. An international, bi-institutional cohort study of 211 patients with muscle-invasive bladder cancer who underwent staging CT and FDG-PET/CT imaging. On the basis of the presence of extravesical FDG-avid lesions suspicious for malignancy on PET/CT images, patients were ided into a PET/CT-positive and PET/CT-negative group. Data on staging and mortality were retrospectively analyzed from prospective databases. Kaplan-Meier analyses were performed to compare overall (OS) and disease-specific survival (DSS) between the groups. Multivariable Cox regression models were used to investigate the association between extravesical PET/CT lesions and mortality. Extravesical lesions suspicious for malignancy on conventional CT were included in the models. Of the 211 patients, 98 (46.4%) had 1 or more extravesical lesions on PET/CT, 113 (53.5%) had a negative PET/CT. Conventional CT revealed extravesical lesions in 51 patients (24.4%). Median follow-up was 18 months. Patients with a positive PET/CT had a significantly shorter OS and DSS (median OS: 14 vs 50 months, P = .001 DSS: 16 vs 50 months, P <.001). In multivariable analysis, the presence of extravesical lesions on PET/CT was an independent prognostic indicator of mortality (OS: hazard ratio = 3.0, confidence interval 95% 1.7-5.1). This association was not statistically significant for conventional CT (hazard ratio = 1.6 (95% confidence interval 0.9-2.7). On the basis of our results, the presence of extravesical FDG-avid lesions on PET/CT might be considered an independent indicator of mortality.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2009
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2006
Publisher: Wiley
Date: 21-04-2022
DOI: 10.1002/BCO2.151
Abstract: To determine whether any specific histologic subtype of prostate cancer was preferentially represented in pelvic lymph node metastases identified on 68 GA‐PSMA‐PET/CT. A consecutive series of 66 men with biochemical recurrent prostate cancer was evaluated with 68 GA‐PSMA‐PET/CT. Where disease was confined to pelvic lymph nodes, patients were offered salvage extended pelvic lymph node dissection. Twenty patients ultimately proceeded to extended bilateral template pelvic lymph node dissection. Lymph node positivity and the histologic subtype of apparent cancer were assessed, as was PSA response to this intervention. Mean PSA at time of PSMA scanning for patients undergoing lymphadenectomy was 2.49 ( n = 20, range 0.21–12.0). In 16 of 20 patients, there was evidence of metastatic cribriform pattern prostate cancer in excised nodes (100% cribriform pattern in 11/16). Only four of 20 patients had no evidence of this histologic subtype of disease. PSA response was not related to the presence or proportional amount of cribriform pattern disease identified. Cribriform pattern adenocarcinoma appears to be the histologic subtype preferentially identified in pelvic lymph nodes on 68 GA‐PSMA‐PET/CT. The use of PSMA‐PET may be particularly valuable in staging of primary or biochemically recurrent prostate cancer in patients with cribriform pattern disease detected on initial biopsy or radical prostatectomy. Further research is required to further confirm the observed association.
Publisher: The Korean Urological Association
Date: 2022
DOI: 10.4111/ICU.20210391
Publisher: MDPI AG
Date: 04-01-2023
Abstract: Prostate cancer is the second most frequent cancer in men, with increasing prevalence due to an ageing population. Advanced prostate cancer is diagnosed in up to 20% of patients, and, therefore, it is important to understand evolving mechanisms of progression. Significant morbidity and mortality can occur in advanced prostate cancer where treatment options are intrinsically related to lipid metabolism. Dysfunctional lipid metabolism has long been known to have a relationship to prostate cancer development however, only recently have studies attempted to elucidate the exact mechanism relating genetic abnormalities and lipid metabolic pathways. Contemporary research has established the pathways leading to prostate cancer development, including dysregulated lipid metabolism-associated de novo lipogenesis through steroid hormone biogenesis and β-oxidation of fatty acids. These pathways, in relation to treatment, have formed potential novel targets for management of advanced prostate cancer via androgen deprivation. We review basic lipid metabolism pathways and their relation to hypogonadism, and further explore prostate cancer development with a cellular emphasis.
Publisher: Elsevier BV
Date: 06-2010
DOI: 10.1016/J.EURURO.2010.03.008
Abstract: An increased incidence of low-risk prostate cancer (PCa) has led investigators to develop focal therapy as a management option for PCa. We evaluated the effects of focal laser ablation (FLA) on PCa tissue and the accuracy of magnetic resonance imaging (MRI) in determining ablated lesion volume by comparing the whole-mount histology and MRI in four patients that underwent FLA followed by radical prostatectomy. Ablated areas were characterized by homogeneous coagulation necrosis. The MRI-calculated ablated volume correlated well with histopathology. We found that FLA creates confluent ablation with no evidence of viable cells in treated regions. Postablation MRI is able to determine the ablation accurately.
Publisher: Wiley
Date: 13-08-2010
Publisher: Wiley
Date: 02-06-2011
Publisher: Wiley
Date: 23-12-2021
DOI: 10.1111/BJU.15667
Abstract: To determine the credibility of online urological information that medical students are likely to encounter, determine possible discrepancies between the credibility of information pertaining to different areas within urology (especially those less relevant to patients), and assess trends in the sponsorship of online urological educational material. Health on the Net (HON) principles were used as a validated benchmark to assess the reliability of websites that appeared in the first 150 results of a search using the Google search engine. A variety of urological search terms were used, grouped into three broad categories with varying relevance to patients and medical students. Further analysis focussed on the sponsorship of assessed websites. A total of 5400 websites were assessed for validation over a set of 36 search terms. Only 843/5400 (15.6%) of these were HONcode accredited, indicating a large proportion of unverified and potentially unreliable information. Search engine rankings usually favoured accredited websites ( P = 0.009), and accreditation peaked at 51.1% (184/360) in the first page of results, but sorting became weaker outside the highest search results. The percentage of accredited websites varied significantly between different subcategories of search terms such as conditions (18.3% [329/1800], P = 0.003) and procedures (13.5% [243/1800], P = 0.043). Governmental/educational and commercial sources supported the majority of websites assessed for sponsorship (21% [31/150] and 33% [49/150], respectively), and the former were more likely to rank highly in search results. Online urological information frequently lacks validation and is often of indeterminate credibility. There is a marked decrease in the proportion of accredited websites beyond the highest‐ranked results and when considering search categories more relevant to students and less relevant to patients. Students cannot necessarily rely on free online sources for accurate information and could benefit from the development of more rigorous novel tools and platforms.
Publisher: Elsevier BV
Date: 10-2004
Publisher: Wiley
Date: 09-05-2006
Publisher: Wiley
Date: 16-11-2019
DOI: 10.1111/BJU.14582
Publisher: Springer Science and Business Media LLC
Date: 18-05-2010
Abstract: The increased use of abdominal imaging techniques for a variety of indications has contributed to more-frequent detection of renal cell carcinoma (RCC). Ultrasonography has been used to characterize the solid versus cystic nature of renal masses. This modality has limitations, however, in further characterization of solid tumors and in staging of malignancy, although contrast-enhanced ultrasonography has shown promise. Cross-sectional imaging with multiplanar reconstruction capability via CT or MRI has become the standard-bearer in the diagnosis, staging and surveillance of renal cancers. The use of specific protocols and the exploitation of different imaging characteristics of RCC subtypes, including variations in contrast agent timing, MRI weighting and digital subtraction, have contributed to this diagnostic capability. Cystic renal masses are a special case, evaluation of which can require multiple imaging modalities. Rigorous evaluation of these lesions can provide information that is crucial to prediction of the likelihood of malignancy. Such imaging is not without risk, however, as radiation from frequent CT imaging has been implicated in the development of secondary malignancies, and contrast agents for CT and MRI can pose risks, particularly in patients with compromised renal function.
Publisher: Springer Science and Business Media LLC
Date: 14-11-2006
DOI: 10.1007/S00192-006-0250-3
Abstract: The key diagnosis and treating of vesicovaginal fistulae is accurate imaging. We illustrate the latest use of enhanced computed tomography for such cases.
Publisher: Elsevier BV
Date: 05-2009
DOI: 10.1016/J.UROLOGY.2009.02.022
Abstract: In many disease states, the use of biomarkers is a standard method of determining both the presence and the risk of the future development of disease. For several years, total prostate-specific antigen (PSA) levels have been the standard measure for the diagnosis of prostate cancer (PCa) and other prostatic diseases. However, recent data have indicated that PSA can also be used to determine the risk of developing PCa in the future. This evolving use of PSA is supported by clinical trial data from the Baltimore Longitudinal Study of Aging, the European Randomized Study of Screening for Prostate Cancer, and the Malmö Preventive Medicine Study. Data from the European Randomized Study of Screening for Prostate Cancer have demonstrated that men with a PSA level of > or =1.5 ng/mL are at a significantly elevated risk of developing PCa compared with patients with a PSA level <1.5 ng/mL. The Malmö study showed that the PSA level could independently the predict cancer risk as far as 25-30 years into the future. Secondary nonserum risk factors (eg, age, family history, ethnicity) can also offer predictive value for determining the risk of developing future disease. Furthermore, recent investigations of novel biomarkers have yielded promising PCa prognostic candidates, including the PCa gene 3 and early PCa antigen 2. However, PSA remains the most reliable measure in assessing the risk of developing PCa.
Publisher: Elsevier BV
Date: 09-2014
DOI: 10.1016/J.EURURO.2013.04.038
Abstract: Many men (21-52%) are reported to have no cancer on the second, also known as the confirmatory, biopsy (B2) for prostate cancer active surveillance (AS). If these men had a reduced risk of pathologic progression, particularly grade related, the intensity of their follow-up could be decreased. To investigate if men with no cancer on B2 are less likely to undergo subsequent pathologic progression. Men were identified from our tertiary care center AS prostate cancer database (1995-2012). Eligibility criteria were prostate-specific antigen (PSA) ≤ 10, cT2 or lower, no Gleason grade 4 or 5, three or fewer positive cores, and no core >50% involved. Only patients with three or more biopsies were selected and then dichotomized on cancer status (yes or no) at B2. Pathologic progression was defined as grade (advancement in Gleason score) and/or volume (more than three positive cores, >50% core involved). Progression-free survival was compared. Predictors of progression were investigated using a Cox proportional hazards model. Of the 286 patients remaining on AS after B2, 149 (52%) had no cancer and 137 (48%) had cancer. The median follow-up after B2 was 41 mo (interquartile range [IQR]: 26.5-61.9). Progression-free survival at 5 yr was 85.2% versus 67.3% for negative B2 versus cancer on B2, respectively (p = 0.002). Men with no cancer at B2 had a 53% reduction in risk of subsequent progression (hazard ratio [HR]: 0.47 95% confidence interval [CI], 0.29-0.77 p = 0.003). Subanalysis showed prognostic indicators of volume-related progression were absence of cancer (HR: 0.36 95% CI, 0.20-0.62 p = 0.0006) and PSA density (HR: 1.79 95% CI, 1.12-2.89 p = 0.01). The only predictor of grade-related progression was age (HR: 1.05 95% CI, 1.00-1.10 p = 0.04). Retrospective analysis was the major limitation of the study. Absence of cancer on B2 is associated with a significantly decreased risk of volume-related but not grade-related progression. This must be considered when counseling men on AS.
Publisher: Wiley
Date: 04-03-2010
Publisher: Wiley
Date: 09-06-2020
DOI: 10.1002/BCO2.20
Publisher: Royal Society of Chemistry (RSC)
Date: 2020
DOI: 10.1039/D0QI00655F
Abstract: A perfect triangular Dy 3 single-molecule magnet was reported. Each Dy( iii ) magnetic axis is oriented almost normal to the plane of Dy 3 , and the intramolecular magnetic dipole interaction gives rise to a virtually antiparallel Ising-like ground state.
Publisher: Future Medicine Ltd
Date: 11-2013
DOI: 10.2217/FON.13.173
Publisher: Wiley
Date: 14-07-2014
DOI: 10.1111/ANS.12772
Abstract: Lymph node dissection (LND) with radical cystectomy (RC) for surgical treatment of invasive urothelial carcinoma of the bladder can improve staging and has possible therapeutic benefit. The aim of this study was to assess utilization and extent of LND with RC at our institution and determine its impact on oncological outcomes. Using surgical databases and hospital coding, clinical and histopathological characteristics of 87 patients who underwent RC at Austin Health between 2004 and 2011 were retrospectively analysed. Associations of predictor variables with LND use and lymph node (LN) status were analysed using logistic regression. Survival analyses were undertaken using Cox proportional hazard models. Fifty-eight (65.9%) patients underwent LND, with a clear trend over time in the proportion of patients undergoing LND (three of seven in 2004 up to 10 of 10 in 2011, P < 0.001) and the median (range) of LN yield from five (2-19) in 2004 to 18 (7-35) in 2011 (P < 0.001). Year of treatment was the only significant predictor (univariately and multivariately) of a patient undergoing LND. Multivariately, a significant association with nodal metastases was found for cN stage and planned extent of LND preoperatively, and pT stage postoperatively. LN status was associated significantly with recurrence-free survival with best outcomes in patients who were node-negative on a pelvic LND. A similar trend was seen for cancer-specific survival (P = 0.053). Over the study period, there was an increase in the use of pelvic LND and LN numbers retrieved during RC. LN status appears to impact on recurrence-free survival, and possibly cancer-specific survival.
Publisher: Wiley
Date: 23-10-2015
DOI: 10.1111/BJU.12840
Abstract: To assess the emerging use of Twitter by urological journals. A search of the Journal of Citation Reports 2012 was performed to identify urological journals. These journals were then searched on Twitter.com. Each journal website was accessed for links to social media (SoMe). The number of 'tweets', followers and age of profile was determined. To evaluate the content, over a 6-month period (November 2013 to April 2014), all tweets were scrutinised on the journals Twitter profiles. To assess SoMe influence, the Klout score of each journal was also calculated. In all, 33 urological journals were identified. Eight (24.2%) had Twitter profiles. The mean (range) number of tweets and followers was 557 (19-1809) and 1845 (82-3692), respectively. The mean (range) age of the twitter profiles was 952 (314-1758) days with an average 0.88 tweets/day. A Twitter profile was associated with a higher mean impact factor of the journal (mean [sd] 3.588 [3.05] vs 1.78 [0.99], P = 0.013). Over a 6-month period, November 2013 to April 2014, the median (range) number of tweets per profile was 82 (2-415) and the median (range) number of articles linked to tweets was 73 (0-336). Of these 710 articles, 152 were Level 1 evidence-based articles, 101 Level 2, 278 Level 3 and 179 Level 4. The median (range) Klout score was 47 (19-58). The Klout scores of major journals did not exactly mirror their impact factors. SoMe is increasingly becoming an adjunct to traditional teaching methods, due to its convenient and user-friendly platform. Recently, many of the leading urological journals have used Twitter to highlight significant articles of interest to readers.
Publisher: MDPI AG
Date: 31-05-2022
Abstract: Prostate-specific membrane antigen (PSMA) positron emission tomography-computed tomography (PET-CT) is a novel imaging modality used to stage recurrent prostate cancer. It has the potential to improve prognostication and ultimately guide the timing of treatment for men with recurrent prostate cancer. This study aims to assess the clinical impact of PSMA PET-CT by analyzing its predictive value of treatment progression after 3 years of follow-up. In this prospective cohort study of 100 men, patients received a PSMA PET-CT for restaging of their disease which was used by a multi-disciplinary team to make a treatment decision. The primary endpoint was treatment progression. This was defined as the addition or change of any treatment modalities such as androgen deprivation therapy (ADT), radiation therapy or chemotherapy. The median follow-up time was 36 months (IQR 24–40 months). No treatment progression was found in 72 (75%) men and therefore 24 (25%) patients were found to have treatment progression. In men with a negative PSMA PET-CT result, 5/33 (15.1%) had treatment progression and 28/33 (84.8%) had no treatment progression. In conclusion, clinical decisions made with PSMA PET-CT results led to 75% of men having no treatment progression at 3 years of follow-up. In men with negative PSMA PET-CT results, this increased to 85% of men.
Publisher: Hindawi Limited
Date: 03-2005
Publisher: Wiley
Date: 30-03-2018
DOI: 10.1111/BJU.14226
Abstract: To determine patient satisfaction and experience after robot-assisted radical prostatectomy (RARP) for prostate cancer, using a convergent mixed-method qualitative analysis approach. 412 patients who underwent RARP between January 2014 and June 2016 were mailed questionnaires and invited to participate in focus groups. Qualitative data was thematically analysed using NVivo. Descriptive statistics were obtained from the questionnaire using SPSS. 214 patients responded (52% of s le size) of whom 97.6% were satisfied and 91.1% would likely recommend RARP. Key themes from the qualitative data highlighted the psychosocial impacts of the diagnosis and RARP process. The importance of early recovery, the benefits of pelvic floor exercises and educational resources were emphasised. Patients were overwhelmingly satisfied with RARP, largely due to relevance and timeliness of the information and support provided both before and after surgery. With an increased understanding of the factors and outcomes that are most important to patients regarding all aspects of hospital care, we can create more targeted care pathways. Key themes will help inform the implementation of an enhanced recovery after surgery (ERAS) protocol to further improve recovery and early return to function.
Publisher: Springer Science and Business Media LLC
Date: 12-06-2010
DOI: 10.1007/S11255-010-9772-1
Abstract: Recent data have suggested historical cutoff levels for prostate cancer (PC) screening using a prostate-specific antigen (PSA) level ≤ 4 ng/ml may no longer be appropriate with cancer detected at lower levels, particularly in younger men. Our aim was to conduct a contemporary survey of urologist's practice patterns toward PC detection, specifically focusing on factors determining the decision to recommend ultrasound-guided biopsy (TRUS-BX). Three hundred and sixty active urologists from the Canadian Urological Association were requested to complete an online questionnaire focusing on scenarios of varying age, family history, ethnicity and PSA. Urologists indicated when to TRUS-BX. Of 360 urologists, 125 (35%) completed the questionnaire. Sixty-seven percent indicated men should be screened for PC aged 50-60 with 27% preferring 40-50 years. Seventy-seven percent would continue screening >75. Considering a 65-year-old man with no risk factors and a normal digital rectal exam 56% would offer TRUS-BX at PSA 4.5 35% at 3.5 and 10% at 2.5 ng/ml. Considering a similar 45-year-old man, 94% would at PSA 4.5 77% at 3.5 and 33% at 2.5 ng/ml. On multivariate analysis, offering TRUS-BX appears driven significantly (P < 0.0001) more by younger age and higher PSA (OR 4.3-20.6 and 4.4-34.9, respectively) rather than family history or ethnicity (OR 3.3 and 1.8, respectively). Age and PSA appear the driving factors in obtaining TRUS-BX. Also, a significant proportion of urologists would still not offer TRUS-BX at the traditional PSA cutoff of 4 ng/ml for men with no risk factors. Further studies are required to ascertain whether this relates to a lack of dissemination of studies into practice.
Publisher: Wiley
Date: 03-01-2018
DOI: 10.1111/BJU.14103
Publisher: Wiley
Date: 17-08-2017
DOI: 10.1111/BJU.13813
Publisher: Elsevier BV
Date: 12-2004
DOI: 10.1016/J.UROLOGY.2004.07.024
Abstract: To evaluate the role of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) in the assessment of germ cell tumors after chemotherapy. We reviewed patients' records for the histologic findings and clinical outcome. 18F-FDG PET results were correlated with tissue histologic features where available and if not available, the correlation was with the clinical outcome. A total of 45 PET studies were performed on 38 patients (age range 19 to 64 years, median 31). All patients had received chemotherapy. In the nonseminomatous germ cell tumor (NSGCT) group, of the 31 patients with one scan, 18 PET scans were reported as positive, with only 2 not having active disease. Of the 12 negative scans, 6 showed teratoma, 1 tumor, and 5 did not show active disease. The equivocal scan revealed thyroid adenoma. In the seminoma group, the PET scans correlated well with the clinical and histologic outcomes. Four patients underwent salvage chemotherapy, and in this subgroup, the PET findings also correlated with the outcome. (18)F-FDG PET is a promising tool as an adjunct to current imaging techniques in detecting residual viable germ cell tumor after chemotherapy. In NSGCT, a positive PET scan was accurate in 16 of 18 patients, although negative PET studies did not exclude the presence of disease, mainly because of the presence of teratoma. In seminoma, a negative 18F-FDG PET study correlated with a favorable clinical outcome. PET was also predictive of the response to salvage chemotherapy and was highly specific for active tumor in both NSGCT and seminoma.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2011
DOI: 10.1016/J.JURO.2010.09.072
Abstract: Partial orchiectomy is becoming more accepted for indications such as a metachronous germ cell tumor due to reported oncological control, and minimal functional, physical and psychological morbidity. Most data originate from Europe. Thus, we reviewed our North American experience with such men who underwent partial orchiectomy for a presumed contralateral testicular malignancy. We identified demographic, clinical, pathological and outcome data on men in our institutional database who underwent partial orchiectomy for presumed testicular malignancy from 1994 to 2009 and had a prior germ cell tumor. Patients were followed with examination, markers and imaging. We identified 27 men, of whom 17 (63%) had malignancy, including seminoma in 9, teratoma in 3, embryonal lesion in 1, Leydig cell tumor in 3 and carcinoma in situ in 1, and 10 (37%) had benign lesions. Frozen section was accurate, no positive margins were reported and all tumors were stage 1. Carcinoma in situ was found in 9 patients (53%). No perioperative complications were recorded. Management after partial orchiectomy was observation in 12 of 17 cases. Two patients underwent completion orchiectomy for local recurrence of carcinoma in situ only, including chemotherapy in 1. A patient with seminoma elected radiation and 1 required retroperitoneal lymph node dissection for teratoma. The remaining 5 patients with carcinoma in situ were surveilled. Of the men 31% required testosterone substitution. All patients were disease free at a median 5.7-year followup with no local recurrences. Partial orchiectomy is an option to decrease morbidity in men with a metachronous germ cell tumor. Clearly a definite benefit of partial orchiectomy is that a significant proportion of patients with suspicious testicular lesions did not have malignancy and were definitively treated with an organ sparing approach. However, partial orchiectomy is potentially associated with the need for adjuvant treatment and androgen substitution, which should be discussed with all patients.
Location: Australia
Start Date: 2016
End Date: 2020
Funder: Fundação para a Ciência e a Tecnologia
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