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Buckley Bennetsen posted an update 6 months, 2 weeks ago
To externally validate a Genomic Classifier (GC) based risk-stratification nomogram identifying candidates who would benefit from adjuvant radiation (aRT) therapy after radical prostatectomy (RP).
We identified 350 patients who underwent RP, between 2013 and 2018, and had adverse pathological features (positive margin, and/or pT3a or higher) on final pathology. Genomic profile was available for all these men. The clinical recurrence-free survival was estimated using the Kaplan-Meier method. The external validity of the nomogram was tested using the concordance index (c-index), calibration plot, and decision curve analysis.
The median follow-up of the cohort was 26.5months. Overall, 14% of the patients received aRT. During the follow-up period, 3.4% of the patients developed metastasis. Overall 3-year metastasis-free survival was 95% (95% CI 0.92-0.98). The c-index of the nomogram was 0.84. The calibration of the model was favorable. Decision-curve analysis showed a positive net benefit for probabilities ranging between 0.01 and 0.09, with the highest difference at threshold probability around 0.05. At that threshold, the net benefit is 0.06 for the model and 0 for treating all the patients.
Our report is the first to confirm the validity of this genomic-based risk-stratification tool in identifying men who might benefit from aRT after RP. As such, it can be a useful instrument to be incorporated in shared decision making on whether administration of aRT will lead to a clinically meaningful benefit. Such a model can also be useful for patients’ classification in future clinical trials.
Our report is the first to confirm the validity of this genomic-based risk-stratification tool in identifying men who might benefit from aRT after RP. As such, it can be a useful instrument to be incorporated in shared decision making on whether administration of aRT will lead to a clinically meaningful benefit. Such a model can also be useful for patients’ classification in future clinical trials.
The objective of this paper was to discuss the psychological impact of active surveillance (AS) for prostate cancer (PCa) and the resulting implications of psychological wellbeing for treatment decision making and acceptance of AS protocols.
Qualitative and quantitative research in the area of anxiety, depression, and distress is discussed drawing from PCa literature as well other health conditions from which parallels can be drawn.
Attention is given to the role of the clinician in treatment decision making, including the value of information provision, and perceived trust in the AS as a management approach.
Given that research is conflicted regarding the psychological impact of AS for PCa, it is suggested that focus shifts away from debate of the ‘true’ experience of AS rather researchers and clinicians should seek to identify the factors associated with positive and negative psychological response to diagnosis and AS to improve psychological and physical outcomes. Recommendations for clinical practice are discussed.
Given that research is conflicted regarding the psychological impact of AS for PCa, it is suggested that focus shifts away from debate of the ‘true’ experience of AS rather researchers and clinicians should seek to identify the factors associated with positive and negative psychological response to diagnosis and AS to improve psychological and physical outcomes. Recommendations for clinical practice are discussed.
Previous analyses ofthe impact of median lobe presence on Greenlight photoselective vaporization of the prostate (PVP) outcomes were limited by their small sample size and the ability to adjust for important confounders. As such, we sought to investigate the impact of prostate median lobe presence on the operative outcomes of 180W XPS GreenLight PVP using a large international database.
Data were obtained from the Global GreenLight Group (GGG) database whichpools data of eight high-volume, experienced surgeons, from a total of seven international centers. All men with established benign prostatic hyperplasia who underwent GreenLight PVP using the XPS-180W system between 2011 and 2019 were eligible for the study. Patients were assigned to two groups based on presence or absence of median lobes. Analyses were adjusted for patient age, prostate volume, body mass index, and American Society of Anesthesia (ASA) score.
A total of 1650 men met the inclusion criteria. A median lobe was identified in 621 (37.6%)al or postoperative outcomes for patients undergoing Greenlight PVP using the XPS-180 W system.
To report our experience with excision and primary anastomosis (EPA) for bulbar urethral stricture.
Patients who underwent EPA for bulbar stricture between 2012 and 2019 were retrospectively analyzed (n = 308). Successful urethroplasty was defined as the absence of the need for additional treatment. For follow-up, uroflowmetry was performed and the patients completed the validated Urethral Stricture Surgery Patient-reported Outcome Measure and Sexual Health Inventory for Men (SHIM) questionnaires before (baseline) and 6months after EPA. Overall patient satisfaction after urethroplasty was also evaluated.
Urethroplasty was successful in 97.1% of patients (n = 299) with a median follow-up of 37months. A total of 215 patients (69.8%) completed the questionnaires at 6months postoperatively. The mean maximum flow rate, lower urinary tract symptom (LUTS)-total score, Peeling’s picture score, LUTS-specific quality of life, and EuroQol-visual analog scale scores improved significantly from 7.7ml/s, 11.6, 3.3, 2.4, and 58.0 at baseline to 24.1ml/s, 2.7, 1.9, 0.4, and 82.1 postoperatively (p < 0.0001 for all comparisons). However, five-point or greater deterioration in the SHIM score was found in 41 patients (19.1%). VT107 price Regarding patient satisfaction, 98.6% of patients (212/215) were “satisfied” (32.6%) or “very satisfied” (66.0%) with the outcome. A low postoperative LUTS-total score and Peeling’s picture score were independent predictors of a “very satisfied” patient (p = 0.001 and p = 0.01, respectively).
EPA had a high success rate and was associated with significant benefits in both subjective and objective outcomes. Contrarily, a high incidence of postoperative erectile dysfunction was observed.
EPA had a high success rate and was associated with significant benefits in both subjective and objective outcomes. Contrarily, a high incidence of postoperative erectile dysfunction was observed.