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Re: Cesare Cozzarini, Claudio Fiorino, Chiara Deantoni, et al. Higher-than-expected Severe (Grade 3–4) Late Urinary Toxicity After Postprostatectomy Hypofractionated Radiotherapy: A Single-institution Analysis of 1176 Patients. Eur Urol. In press. http://

Refers to article:

Higher-than-expected Severe (Grade 3–4) Late Urinary Toxicity After Postprostatectomy Hypofractionated Radiotherapy: A Single-institution Analysis of 1176 Patients

Cesare Cozzarini, Claudio Fiorino, Chiara Deantoni, Alberto Briganti, Andrei Fodor, Mariangela La Macchia, Barbara Noris Chiorda, Paola Maria Vittoria Rancoita, Nazareno Suardi, Flavia Zerbetto, Riccardo Calandrino, Francesco Montorsi and Nadia Di Muzio

Accepted 6 June 2014

Footnotes

a Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland

b Radiation Oncology, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy

c Radiation Oncology, S. Camillo – Forlanini Hospital, Rome, Italy

Corresponding author. Centre hospitalier universitaire vaudois (CHUV), Service de radio-oncologie, Bâtiment hospitalier, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland. Tel. +41 (0)21 314 46 00; Fax: +41 (0)21 314 46 01.

Article information

PII: S0302-2838(14)00802-1
DOI: 10.1016/j.eururo.2014.08.049
© 2014 Published by Elsevier B.V.

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Discordance between patient and provider in discussions about kidney transplantation

MedicalNewsToday - Mon, 2014-09-01 02:00
In a study of dialysis patients, those who reported that they had discussed the option of transplantation with clinicians were more likely to be put on the transplant waiting list; however...
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Kidney stones may increase the risk of heart disease, stroke

MedicalNewsToday - Mon, 2014-09-01 02:00
A new study finds that kidney stones - a condition that affects around 1 in 10 Americans - may increase the risk of coronary heart disease and stroke.
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Reply to Marc Bjurlin, Elena Elkin, and William Huang's Letter to the Editor re: Maxine Sun, Andreas Becker, Zhe Tian, et al. Management of Localized Kidney Cancer: Calculating Cancer-specific Mortality and Competing Risks of Death for Surgery and Nonsurg

Refers to article:

Re: Maxine Sun, Andreas Becker, Zhe Tian, et al. Management of Localized Kidney Cancer: Calculating Cancer-specific Mortality and Competing Risks of Death for Surgery and Nonsurgical Management. Eur Urol 2014;65:235–41

Marc Bjurlin, Elena B. Elkin and William C. Huang

Accepted 21 July 2014

Refers to article:

Management of Localized Kidney Cancer: Calculating Cancer-specific Mortality and Competing Risks of Death for Surgery and Nonsurgical Management

Maxine Sun, Andreas Becker, Zhe Tian, Florian Roghmann, Firas Abdollah, Alexandre Larouche, Pierre I. Karakiewicz and Quoc-Dien Trinh

Accepted 15 March 2013

January 2014 (Vol. 65, Issue 1, pages 235 - 241)

Footnotes

a Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada

b Department of Urology, University of Montreal Health Centre, Montreal, Canada

Corresponding author. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec H2X 1P1, Canada. Tel. +1 514 890 8000 ext. 35335.

Article information

PII: S0302-2838(14)00675-7
DOI: 10.1016/j.eururo.2014.07.023
© 2014 European Association of Urology, Published by Elsevier B.V.

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Re: Maxine Sun, Andreas Becker, Zhe Tian, et al. Management of Localized Kidney Cancer: Calculating Cancer-specific Mortality and Competing Risks of Death for Surgery and Nonsurgical Management. Eur Urol 2014;65:235–41

Refers to article:

Management of Localized Kidney Cancer: Calculating Cancer-specific Mortality and Competing Risks of Death for Surgery and Nonsurgical Management

Maxine Sun, Andreas Becker, Zhe Tian, Florian Roghmann, Firas Abdollah, Alexandre Larouche, Pierre I. Karakiewicz and Quoc-Dien Trinh

Accepted 15 March 2013

January 2014 (Vol. 65, Issue 1, pages 235 - 241)

Footnotes

a Department of Urology, New York, NY, USA

b Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

Corresponding author. Department of Urology, New York University, 150 East 32nd Street, 2nd Floor, New York, NY 10016, USA. Tel. +1 646 744 1503.

Article information

PII: S0302-2838(14)00676-9
DOI: 10.1016/j.eururo.2014.07.024
© 2014 European Association of Urology, Published by Elsevier B.V.

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The Evolution of Self-Reported Urinary and Sexual Dysfunction over the Last Two Decades: Implications for Comparative Effectiveness Research

Abstract Background

Despite the paramount importance of patient-reported outcomes, little is known about the evolution of patient-reported urinary and sexual function over time.

Objective

To evaluate differences in pretreatment urinary and sexual function in two population-based cohorts of men with prostate cancer enrolled nearly 20 yr apart.

Design, setting, and participants

Patients were enrolled in the Prostate Cancer Outcomes Study (PCOS) or the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study, two population-based cohorts that enrolled patients with incident prostate cancer from 1994 to 1995 and from 2011 to 2012, respectively. Participants completed surveys at baseline and various time points thereafter.

Outcome measurements and statistical analysis

We performed multivariable logistic and linear regression analysis to investigate differences in pretreatment function between studies.

Results and limitations

The study comprised 5469 men of whom 2334 (43%) were enrolled in PCOS and 3135 (57%) were enrolled in CEASAR. Self-reported urinary incontinence was higher in CEASAR compared with PCOS (7.7% vs 4.7%; adjusted odds ratio [OR]: 1.83; 95% confidence interval [CI], 1.39–2.43). Similarly, self-reported erectile dysfunction was more common among CEASAR participants (44.7% vs 24.0%) with an adjusted OR of 3.12 (95% CI, 2.68–3.64). Multivariable linear regression models revealed less favorable self-reported baseline function among CEASAR participants in the urinary incontinence and sexual function domains. The study is limited by its observational design and possibility of unmeasured confounding.

Conclusions

Reporting of pretreatment urinary incontinence and erectile dysfunction has increased over the past two decades. These findings may reflect sociological changes including heightened media attention and direct-to-consumer marketing, among other potential explanations.

Patient summary

Patient reporting of urinary and sexual function has evolved and is likely contingent on continually changing societal norms. Recognizing the evolving nature of patient reporting is essential in efforts to conduct high-quality, impactful comparative effectiveness research.

Take Home Message

Reporting of pretreatment urinary incontinence and erectile dysfunction has increased over the past two decades. These data suggest that patient reporting of urinary and sexual function is dynamic and likely is contingent on continually changing societal norms.

Keywords: Prostate cancer, Quality of life, Urinary function, Sexual function, Patient-reported outcomes.

Footnotes

a Department of Urologic Surgery, Vanderbilt University, Nashville, TN, USA

b Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA

c Department of Medicine, Vanderbilt University, Nashville, TN, USA

d Department of Biostatistics, Vanderbilt University, Nashville, TN, USA

e Division of Urology, University of Connecticut Health Center, Farmington, CT, USA

f Department of Urology, University of California San Francisco, San Francisco, CA, USA

g Department of Epidemiology, Emory University, Atlanta, GA, USA

h Department of Medicine, University of California, Irvine, Irvine, CA, USA

i Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA

j Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

k Department of Medicine, University of New Mexico, Albuquerque, NM, USA

l Eskind Biomedical Library, Vanderbilt University, Nashville, TN, USA

m New Jersey State Cancer Registry, Trenton, NJ, USA

n Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

o Louisiana State University Health Sciences Center, New Orleans, LA, USA

Corresponding author. Department of Urologic Surgery, Vanderbilt University, A-1302 Medical Center North, Nashville, TN 37232, USA. Tel. +1 615 322 2101; Fax: +1 615 322 8990.

Article information

PII: S0302-2838(14)00788-X
DOI: 10.1016/j.eururo.2014.08.035
© 2014 Published by Elsevier B.V.

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European Urology: Serving Our Readership Through Systematic Peer Review, Use of Reporting Standards, and Encouragement of Postpublication Review

Refers to article:

European Association of Urology (@Uroweb) Recommendations on the Appropriate Use of Social Media

Morgan Rouprêt, Todd M. Morgan, Peter J. Bostrom, Matthew R. Cooperberg, Alexander Kutikov, Kate D. Linton, Joan Palou, Luis Martínez-Piñeiro, Henk van der Poel, Carl Wijburg, Andrew Winterbottom, Henry H. Woo, Manfred P. Wirth and James W.F. Catto

Accepted 27 June 2014

Footnotes

a Academic Urology Unit, University of Sheffield, Sheffield, UK

b Departments of Urology and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA

c Department of Urology, Tenon Hospital, Paris, France

d Department of Urology, University Hospital Munich, Munich, Germany

e Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy

f Department of Urology and Comprehensive Cancer Centre, Vienna General Hospital, Medical University of Vienna, Vienna, Austria

g Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

Corresponding author. Sheffield University, Academic Urology Unit, G Floor, Institute for Cancer Studies, The Medical School, Beech Hill Road, Sheffield, South Yorks S102RX, UK. Tel. +44 1142712163; Fax: +44 1142712268.

Article information

PII: S0302-2838(14)00770-2
DOI: 10.1016/j.eururo.2014.08.017
© 2014 Published by Elsevier B.V.

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A Systematic Review of Hypofractionation for Primary Management of Prostate Cancer

Abstract Context

Technological advances in radiation therapy delivery have permitted the use of high-dose-per-fraction radiation therapy (RT) for early-stage prostate cancer (PCa). Level 1 evidence supporting the safety and efficacy of hypofractionated RT is evolving as this modality becomes more widely utilized and refined.

Objective

To perform a systematic review of the current evidence on the safety and efficacy of hypofractionated RT for early-stage PCa and to provide in-context recommendations for current application of this technology.

Evidence acquisition

Embase, PubMed, and Scopus electronic databases were queried for English-language articles from January 1990 through June 2014. Prospective studies with a minimum of 50 patients were included. Separate consideration was made for studies involving moderate hypofractionation (doses of 2.5–4 Gy per fraction) and extreme hypofractionation (5–10 Gy in 4–7 fractions).

Evidence synthesis

Six relatively small superiority designed randomized trials of standard fractionation versus moderate hypofractionation in predominantly low- and intermediate-risk PCa have been published with follow-up ranging from 4 to 8 yr, noting similar biochemical control (5-yr freedom from biochemical failure in modern studies is >80% for low-risk and intermediate-risk patients) and late grade ≥2 genitourinary and gastrointestinal toxicities (between 2% and 20%). Noninferiority studies are pending. In prospective phase 2 studies, extreme hypofractionation has promising 2- to 5-yr biochemical control rates of >90% for low-risk patients. Results from a randomized trial are expected in 2015.

Conclusions

Moderate hypofractionation has 5-yr data to date establishing safety compared with standard fractionation, but 10-yr outcomes and longer follow-up are needed to establish noninferiority for clinical effectiveness. Extreme hypofractionation is promising but as yet requires reporting of randomized data prior to application outside of a clinical protocol.

Patient summary

Hypofractionation for prostate cancer delivers relatively high doses of radiation per treatment. Prospective studies support the safety of moderate hypofractionation, while extreme fractionation may have greater toxicity. Both show promising cancer control but long-term results of noninferiority studies of both methods are required before use in routine treatment outside of clinical protocols.

Take Home Message

With intermediate follow-up, moderate hypofractionation appears safe. Extreme hypofractionation has high short-term biochemical control but possibly greater toxicity. Long-term results of noninferiority studies of both methods are required before use in routine treatment outside of clinical protocols.

Keywords: Prostate cancer, Stereotactic radiation therapy, Hypofractionation, Prostate-specific antigen, Randomized trials, Genitourinary toxicity, Gastrointestinal toxicity.

Footnotes

a Department of Radiation Oncology, Duke Cancer Institute, Durham, NC, USA

b Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France

c Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy

d Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany

e Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA

Corresponding author. Department of Radiation Oncology, Duke Cancer Institute, Box 3085, Durham, NC 27707, USA. Tel. +1 919 668 5213; Fax: +1 919 668 7345.

Article information

PII: S0302-2838(14)00751-9
DOI: 10.1016/j.eururo.2014.08.009
© 2014 European Association of Urology, Published by Elsevier B.V.

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EAU Standardised Medical Terminology for Urologic Imaging: A Taxonomic Approach

Abstract Background

The terminology and abbreviations used in urologic imaging have generally been adopted on an ad hoc basis by different speciality groups; however, there is a need for shared nomenclature to facilitate clinical communication and collaborative research.

Objective

This work reviews the current nomenclature for urologic imaging used in clinical practice and proposes a taxonomy and terminology for urologic imaging studies.

Design, setting, and participants

A list of terms used in urologic imaging were compiled from guidelines published by the European Association of Urology and the American Urological Association and from the American College of Radiology Appropriateness Criteria.

Outcome measurements and statistical analysis

Terms searched were grouped into broad categories based on technology, and imaging terms were further stratified based on the anatomic extent, contrast or phases, technique or modifiers, and combinations or fusions. Terms that had a high degree of utilisation were classified as accepted.

Results and limitations

We propose a new taxonomy to define a more useful and acceptable nomenclature model acceptable to all health professionals involved in urology. The major advantage of a taxonomic approach to the classification of urologic imaging studies is that it provides a flexible framework for classifying the modifications of current imaging modalities and allows the incorporation of new imaging modalities. The adoption of this hierarchical classification model ranging from the most general to the most detailed descriptions should facilitate hierarchical searches of the medical literature using both general and specific terms. This work is limited in its scope, as it is not currently all-inclusive. This will hopefully be addressed by future modification as others embrace the concept and work towards uniformity in nomenclature.

Conclusions

This paper provides a noncomprehensive list of the most widely used terms across different specialties. This list can be used as the basis for further discussion, development, and enhancement.

Patient summary

In this paper we describe a classification system for urologic imaging terms with the aim of aiding health professionals and ensuring that the terms used are more consistent.

Take Home Message

Urologic imaging terminology varies greatly, and there is a need for shared nomenclature to facilitate clinical communication and collaborative research. This work reviews current urologic imaging nomenclature and proposes a new taxonomy to define a more consistent nomenclature.

Keywords: Computed tomography, EAU guidelines, Magnetic resonance imaging, Positron emission tomography, Radiographs, Taxonomy, Terminology, Ultrasound, Urologic imaging.

Footnotes

a Klinik für Urologie, Diakonissenkrankenhaus Flensburg, Lehrkrankenhaus der Christian-Albrechts-Universität, Flensburg, Germany

b St. James Institute of Oncology, Leeds, UK

c Department of Urology, Institute Paoli-Calmettes Cancer Centre, Marseille, France

d Department of Urology, Texas Health Presbyterian Hospital Dallas, Dallas TX, USA

Corresponding author. Klinik für Urologie, Diakonissenkrankenhaus Flensburg, Knuthstrasse 1, 24939 Flensburg, Germany. Tel. +49 461 812 1401; Fax: +49 461 812 1402.

Article information

PII: S0302-2838(14)00767-2
DOI: 10.1016/j.eururo.2014.08.014
© 2014 European Association of Urology, Published by Elsevier B.V.

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Efficacy Outcomes by Baseline Prostate-specific Antigen Quartile in the AFFIRM Trial

Abstract Background

Enzalutamide significantly prolonged the survival of men with metastatic castration-resistant prostate cancer (PCa) after docetaxel in the randomised, phase 3, double-blind, placebo-controlled, multinational Patients with Progressive Castration-Resistant Prostate Cancer Previously Treated with Docetaxel-Based Chemotherapy (AFFIRM) trial ( NCT00974311 ). Prostate-specific antigen (PSA) is commonly used as a marker of PCa disease burden, and the relationship of baseline PSA level to consequent treatment effect is of clinical interest.

Objective

Exploratory analysis to evaluate any differences in patient characteristics and efficacy outcomes by baseline PSA level in the AFFIRM trial.

Design, setting, and participants

Post hoc subanalysis of all randomised patients (n = 1199) from the AFFIRM trial.

Intervention

Participants were randomly assigned in a two-to-one ratio to receive oral enzalutamide 160 mg/d or placebo.

Outcome measurements and statistical analysis

The major clinical efficacy end points were overall survival (OS), radiographic progression-free survival (rPFS), and time to PSA progression (TTPP) versus placebo; baseline characteristics, treatment duration, and subsequent antineoplastic therapy were compared by baseline PSA quartile.

Results and limitations

Baseline PSA quartiles corresponded to the following PSA groups: <40 ng/ml (n = 299), 40 to <111 ng/ml (n = 300), 111 to <406 ng/ml (n = 300), and ≥406 ng/ml (n = 300). Enzalutamide consistently improved OS, rPFS, and TTPP compared with placebo across all subgroups, regardless of baseline PSA level. Hazard ratios for improvements in OS were 0.55 (95% confidence interval [CI], 0.36−0.85), 0.69 (95% CI, 0.47−1.02), 0.73 (95% CI, 0.53−1.01), and 0.53 (95% CI, 0.39−0.73) for PSA groups 1–4, respectively. The post hoc design of this analysis was not statistically powered to assess the relationship between baseline PSA and clinical efficacy outcomes.

Conclusions

This post hoc analysis of the AFFIRM trial demonstrates consistent benefits in OS, rPFS, and TTPP with enzalutamide regardless of baseline disease severity, as assessed by PSA.

Patient summary

Exploratory post hoc analysis of the AFFIRM trial showed that enzalutamide improves overall survival, radiographic progression-free survival, and time to prostate-specific antigen progression compared with placebo regardless of baseline disease severity, as assessed by prostate-specific antigen.

Trial registration

ClinicalTrials.gov identifier NCT00974311 .

Take Home Message

Post hoc analysis of the AFFIRM trial showed that enzalutamide consistently improved outcomes regardless of disease severity, as assessed by baseline prostate-specific antigen levels.

Keywords: Androgen receptor inhibitor, Enzalutamide, Metastatic castration-resistant prostate cancer, Prostate-specific antigen, AFFIRM trial.

Footnotes

a University of Montreal Hospital Centre, Montreal, QC, Canada

b Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK

c Carolina Urologic Research Center, Myrtle Beach, SC, USA

d Gustave Roussy, Cancer Campus Grand Paris, University of Paris Sud, Villejuif, France

e Medivation, Inc., San Francisco, CA, USA

f Astellas Global Medical Affairs, Inc., Northbrook, IL, USA

g Memorial Sloan-Kettering Cancer Center, New York, NY, USA

Corresponding author. University of Montreal Health Centre, Montreal, Quebec, H2W 1T7, Canada. Tel. +1 514 890 8000 ext. 27466; Fax: +1 514 412 7620.

Article information

PII: S0302-2838(14)00778-7
DOI: 10.1016/j.eururo.2014.08.025
© 2014 European Association of Urology, Published by Elsevier B.V.

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A Randomized Comparison of a Single-incision Midurethral Sling and a Transobturator Midurethral Sling in Women with Stress Urinary Incontinence: Results of 12-mo Follow-up

Abstract Background

Midurethral sling procedures have become the prime surgical treatment for women with stress urinary incontinence (SUI). Single-incision mini-slings (SIMS) potentially offer similar efficacy with reduced morbidity. This international multicenter trial compared the efficacy and morbidity of a SIMS (MiniArc) and a transobturator standard midurethral sling (SMUS) (Monarc).

Objective

To compare subjective and objective cure, morbidity, and surgery-related discomfort following SIMS and transobturator SMUS.

Design, setting, and participants

Prospective randomized controlled trial with an initial follow-up period of 12 mo. Women with symptomatic SUI were eligible.

Outcome measurements and statistical analysis

Primary outcome was subjective cure, defined as an improvement on the Patient Global Impression of Improvement (PGI-I). Coprimary outcome was the mean visual analog scale (VAS) pain score (0–100) during 3 d after surgery. Secondary outcomes were objective cure based on the cough stress test (CST), disease-specific quality of life determined by the Urogenital Distress Inventory (UDI-6) score, surgical parameters, and physical performance during recovery. Analysis was by intent to treat. Differences between the MiniArc and Monarc groups on dichotomous variables were chi-square tested and presented as relative risks (RR) with corresponding 95% confidence intervals. We hypothesized that MiniArc was noninferior to Monarc concerning subjective cure and superior concerning postoperative pain.

Results and limitations

We randomized 97 women to MiniArc and 96 to Monarc. At 12-mo follow-up, subjective cure was 83% following MiniArc and 86% following Monarc (p = 0.46). Objective cure was 89% following MiniArc and 91% following Monarc (p = 0.65). The mean pain VAS score during the first three postoperative days was 9 following MiniArc and 22 following Monarc (Mann-Whitney U test, p < 0.01).

Conclusions

At 1-yr follow-up, MiniArc was noninferior to Monarc with respect to subjective and objective cure and superior with respect to postoperative pain.

Patient summary

This 1-yr randomized clinical trial showed that MiniArc, a single-incision midurethral sling, is noninferior to Monarc, a transobturator sling, with respect to cure and superior with respect to pain and recovery.

Take Home Message

At 1-yr follow-up, MiniArc was noninferior to Monarc regarding subjective and objective cure rates and superior with respect to postoperative pain.

Keywords: Stress urinary incontinence, Midurethral slings, Surgery, Randomized controlled trial, Disease-specific quality of life.

Footnotes

a Department of Obstetrics and Gynecology, Kennemer Gasthuis, Haarlem, The Netherlands

b Department of Obstetrics and Gynecology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands

c Department of Urology, University Hospitals Leuven, Leuven, Belgium

d Department of Obstetrics and Gynecology, Jeanne de Flandre Hôpital, Lille Cedex, France

e Department of Urology, General Hospital Sint Lucas, Bruges, Belgium

f Clinical Research Unit, Academic Medical Center Amsterdam, Amsterdam, The Netherlands

Corresponding author. Department of Obstetrics and Gynecology, Kennemer Gasthuis, Boerhaavelaan 22, 2035 RC Haarlem, The Netherlands. Tel. +31 23 5453545.

Article information

PII: S0302-2838(14)00679-4
DOI: 10.1016/j.eururo.2014.07.027
© 2014 European Association of Urology, Published by Elsevier B.V.

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Focal Therapy for Treatment of the Small Renal Mass: Dealer's Choice or a Therapeutic Gamble?

Refers to article:

Comparison of Partial Nephrectomy and Percutaneous Ablation for cT1 Renal Masses

R. Houston Thompson, Tom Atwell, Grant Schmit, Christine M. Lohse, A. Nicholas Kurup, Adam Weisbrod, Sarah P. Psutka, Suzanne B. Stewart, Matthew R. Callstrom, John C. Cheville, Stephen A. Boorjian and Bradley C. Leibovich

Accepted 23 July 2014

Footnotes

Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA

Corresponding author. Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA. Tel. +1 215 728 5342; Fax: +1 215 214 1734.

Article information

PII: S0302-2838(14)00787-8
DOI: 10.1016/j.eururo.2014.08.034
© 2014 European Association of Urology, Published by Elsevier B.V.

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The Added Value of Percentage of Free to Total Prostate-specific Antigen, PCA3, and a Kallikrein Panel to the ERSPC Risk Calculator for Prostate Cancer in Prescreened Men

Abstract Background

Prostate-specific antigen (PSA) testing has limited accuracy for the early detection of prostate cancer (PCa).

Objective

To assess the value added by percentage of free to total PSA (%fPSA), prostate cancer antigen 3 (PCA3), and a kallikrein panel (4k-panel) to the European Randomised Study of Screening for Prostate Cancer (ERSPC) multivariable prediction models: risk calculator (RC) 4, including transrectal ultrasound, and RC 4 plus digital rectal examination (4+DRE) for prescreened men.

Design, setting, and participants

Participants were invited for rescreening between October 2007 and February 2009 within the Dutch part of the ERSPC study. Biopsies were taken in men with a PSA level ≥3.0 ng/ml or a PCA3 score ≥10. Additional analyses of the 4k-panel were done on serum samples.

Outcome measurements and statistical analysis

Outcome was defined as PCa detectable by sextant biopsy. Receiver operating characteristic curve and decision curve analyses were performed to compare the predictive capabilities of %fPSA, PCA3, 4k-panel, the ERSPC RCs, and their combinations in logistic regression models.

Results and limitations

PCa was detected in 119 of 708 men. The %fPSA did not perform better univariately or added to the RCs compared with the RCs alone. In 202 men with an elevated PSA, the 4k-panel discriminated better than PCA3 when modelled univariately (area under the curve [AUC]: 0.78 vs 0.62; p = 0.01). The multivariable models with PCA3 or the 4k-panel were equivalent (AUC: 0.80 for RC 4+DRE). In the total population, PCA3 discriminated better than the 4k-panel (univariate AUC: 0.63 vs 0.56; p = 0.05). There was no statistically significant difference between the multivariable model with PCA3 (AUC: 0.73) versus the model with the 4k-panel (AUC: 0.71; p = 0.18). The multivariable model with PCA3 performed better than the reference model (0.73 vs 0.70; p = 0.02). Decision curves confirmed these patterns, although numbers were small.

Conclusions

Both PCA3 and, to a lesser extent, a 4k-panel have added value to the DRE-based ERSPC RC in detecting PCa in prescreened men.

Patient summary

We studied the added value of novel biomarkers to previously developed risk prediction models for prostate cancer. We found that inclusion of these biomarkers resulted in an increase in predictive ability.

Take Home Message

Both prostate cancer antigen 3 and a kallikrein panel have some added value to the European Randomised study of Screening for Prostate Cancer digital rectal examination–based risk calculator for detecting prostate cancer in prescreened men. Further research should focus on men with a previous negative biopsy, for whom markers may especially be useful.

Keywords: Percentage of free to total PSA, Kallikrein panel (4k-panel), Prostate biopsy, Prostate cancer, Prostate cancer antigen 3 (PCA3), Prostate cancer risk calculator, Validation.

Footnotes

a Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands

b Departments of Surgery (Urology), Laboratory Medicine, and Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

c Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK

d Department of Laboratory Medicine and Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden

e Institute of Biomedical Technology, University of Tampere, Tampere, Finland

f Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

g Department of Pathology, Erasmus Medical Centre, Rotterdam, The Netherlands

h Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands

Corresponding author. Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Tel. +31 10 704 3732; Fax: +31 10 703 8475.

Article information

PII: S0302-2838(14)00753-2
DOI: 10.1016/j.eururo.2014.08.011
© 2014 Published by Elsevier B.V.

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Reply from Authors re: Christian Stief. Mere Extension of the Field of Resection Cannot Be the Answer to Surgery for Metastatic Spread: We Need Individualized Approaches Based on Modern Imaging Techniques. Eur Urol. In press. http://dx.doi.org/10.1016/j.e

Refers to article:

More Extensive Pelvic Lymph Node Dissection Improves Survival in Patients with Node-positive Prostate Cancer

Firas Abdollah, Giorgio Gandaglia, Nazareno Suardi, Umberto Capitanio, Andrea Salonia, Alessandro Nini, Marco Moschini, Maxine Sun, Pierre I. Karakiewicz, Sharhokh F. Shariat, Francesco Montorsi and Alberto Briganti

Accepted 15 May 2014

Refers to article:

Mere Extension of the Field of Resection Cannot Be the Answer to Surgery for Metastatic Spread: We Need Individualized Approaches Based on Modern Imaging Techniques

Christian Stief

Footnotes

a Vattikuti Urology Institute (VUI) and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA

b Department of Urology, Scientific Institute Hospital San Raffaele, Milan, Italy

Corresponding author. Vattikuti Urology Institute and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, 2799 W. Grand Blvd., Detroit, MI 48202-2689, USA. Tel. +1 313 916 9923.

Article information

PII: S0302-2838(14)00779-9
DOI: 10.1016/j.eururo.2014.08.026
© 2014 European Association of Urology, Published by Elsevier B.V.

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Androgen Deprivation Therapy in Prostate Cancer: Looking Beyond Prostate-specific Antigen and Testosterone Levels

Refers to article:

Adverse Effects of Androgen Deprivation Therapy and Strategies to Mitigate Them

Paul L. Nguyen, Shabbir M.H. Alibhai, Shehzad Basaria, Anthony V. D’Amico, Philip W. Kantoff, Nancy L. Keating, David F. Penson, Derek J. Rosario, Bertrand Tombal and Matthew R. Smith

Accepted 11 July 2014

Footnotes

University of Montreal Hospital Center, Montreal, Quebec, Canada

University of Montreal Health Center, 1560 Sherbrooke East, Montreal, Quebec H2L 4M1, Canada.

Article information

PII: S0302-2838(14)00786-6
DOI: 10.1016/j.eururo.2014.08.033
© 2014 European Association of Urology, Published by Elsevier B.V.

Categories: Urology News Feeds

Banishing stigma and educating providers on postmenopausal problems

MedicalNewsToday - Tue, 2014-08-26 03:00
Talking about genital, sexual, and urinary problems can be uncomfortable for postmenopausal women and their doctors.
Categories: Urology News Feeds

Catheter-associated urinary tract infections significantly reduced by electronic alerts

MedicalNewsToday - Tue, 2014-08-26 02:00
A Penn Medicine team has found that targeted automated alerts in electronic health records significantly reduce urinary tract infections in hospital patients with urinary catheters.
Categories: Urology News Feeds

Anti-inflammatory nanomolecules enable tissue regeneration

MedicalNewsToday - Tue, 2014-08-26 02:00
Anyone who has suffered an injury can probably remember the after-effects, including pain, swelling or redness. These are signs that the body is fighting back against the injury.
Categories: Urology News Feeds
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