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Postoperative Ileus After Radical Cystectomy: Looking for Answers to an Age-old Problem

Refers to article:

Alvimopan Accelerates Gastrointestinal Recovery After Radical Cystectomy: A Multicenter Randomized Placebo-Controlled Trial

Cheryl T. Lee, Sam S. Chang, Ashish M. Kamat, Gilad Amiel, Timothy L. Beard, Amr Fergany, R. Jeffrey Karnes, Andrea Kurz, Venu Menon, Wade J. Sexton, Joel W. Slaton, Robert S. Svatek, Shandra S. Wilson, Lee Techner, Richard Bihrle, Gary D. Steinberg and Michael Koch

Accepted 13 February 2014

Footnotes

Department of Urology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

Corresponding author. University of North Carolina, Surgery/Urology, 2140 Bioinformatics Bldg., CB # 7235, Chapel Hill, NC 27599, USA. Tel. +1 919 966 2571; Fax: +1 919 966 0098.

Article information

PII: S0302-2838(14)00307-8
DOI: 10.1016/j.eururo.2014.03.041
© 2014 Published by Elsevier B.V.

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Assessment of the Impact of Targeted Therapy on Metastatic Bone Disease in Renal Cancer

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Prognostic Significance of Bone Metastases and Bisphosphonate Therapy in Patients with Renal Cell Carcinoma

Rana R. McKay, Xun Lin, Julia J. Perkins, Daniel Y.C. Heng, Ronit Simantov and Toni K. Choueiri

Accepted 17 February 2014

Footnotes

a Academic Unit of Clinical Oncology, University of Sheffield, Weston Park Hospital, Sheffield, UK

b Cancer Research UK Manchester Institute, The University of Manchester, Withington, Manchester, UK

Corresponding author. Academic Unit of Clinical Oncology, University of Sheffield, Weston Park Hospital, Witham Road, Sheffield S10 2SJ, UK. Tel. +44 114 2265235; Fax: +44 114 2265364.

Article information

PII: S0302-2838(14)00308-X
DOI: 10.1016/j.eururo.2014.03.042
© 2014 European Association of Urology, Published by Elsevier B.V.

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Reply to E. David Crawford and Bo-Eric Persson's Letter to the Editor re: Giorgio Gandaglia, Maxine Sun, Jim C. Hu, et al. Gonadotropin-releasing Hormone Agonists and Acute Kidney Injury in Patients with Prostate Cancer. Eur Urol. In press. http://dx.doi.

Refers to article:

Re: Giorgio Gandaglia, Maxine Sun, Jim C. Hu, et al. Gonadotropin-releasing Hormone Agonists and Acute Kidney Injury in Patients with Prostate Cancer. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2014.01.026

E. David Crawford and Bo-Eric Persson

Accepted 29 March 2014

Refers to article:

Gonadotropin-releasing Hormone Agonists and Acute Kidney Injury in Patients with Prostate Cancer

Giorgio Gandaglia, Maxine Sun, Jim C. Hu, Giacomo Novara, Toni K. Choueiri, Paul L. Nguyen, Jonas Schiffmann, Markus Graefen, Shahrokh F. Shariat, Firas Abdollah, Alberto Briganti, Francesco Montorsi, Quoc-Dien Trinh and Pierre I. Karakiewicz

Accepted 19 January 2014

Footnotes

a Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy

b Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada

Corresponding author. Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy. Tel. +39 02 2643 5663; Fax: +39 02 2643 7286.

Article information

PII: S0302-2838(14)00309-1
DOI: 10.1016/j.eururo.2014.03.043
© 2014 European Association of Urology, Published by Elsevier B.V.

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Racial Variation in Prostate Cancer Upgrading and Upstaging Among Men with Low-risk Clinical Characteristics

Abstract Background

African American (AA) men suffer a higher prostate cancer (PCa) burden than other groups.

Objective

We aim to determine the impact of race on the risk of upgrading, upstaging, and positive surgical margins (PSM) at radical prostatectomy (RP) among men eligible for active surveillance.

Design, setting, and participants

We studied men with low-risk PCa treated with RP at two centers. Low clinical risk was defined by National Comprehensive Cancer Network criteria. Outcome variables were upgrading, upstaging, and PSMs at surgery. Associations between race and the outcomes were evaluated with logistic regression adjusted for age, relationship status, diagnostic prostate-specific antigen level, percentage of positive biopsy cores, surgical approach, year of diagnosis, and clinical site.

Results and limitations

Of 9304 men diagnosed with PCa, 4231 were low risk and underwent RP within 1 yr. Men were categorized as AA (n = 273; 6.5%), Caucasian (n = 3771; 89.1%), or other racial/ethnic group (Other; n = 187; 4.4%). AA men had a significantly younger mean age (58.7 yr; standard deviation: ±7.06), and fewer (85%) were married or had a partner. Upgrading (34%) and upstaging (13%) rates did not significantly differ among the groups. The PSM rate was significantly higher in AA men (31%) than in the Caucasian (21%) and Other (20%) groups (p < 0.01). We found an association between race group and PSM rate (p < 0.03), with higher odds of PSMs in AA men versus Caucasian men (odds ratio [OR]: 1.64; 95% confidence interval [CI], 1.08–2.47). No statistically significant associations between race and rates of upgrading and upstaging were found. This study was limited by the relatively low proportion of AA men in the cohort.

Conclusions

Among clinically low-risk men who underwent RP, AA men had a higher likelihood of PSMs compared with Caucasian men. We did not find statistically significantly different rates of upgrading and upstaging between the race groups.

Patient summary

We analyzed two large groups of men with what appeared to be low-risk prostate cancer based on the initial biopsy findings. The likelihood of finding worse disease (higher grade or stage) at the time of surgery was similar across different racial groups.

Take Home Message

Among men in two large cohorts with low-risk prostate cancer and undergoing radical prostatectomy, rates of upgrading and upstaging were similar between African American and Caucasian men. African American men, however, had higher rates of positive surgical margins.

Keywords: Prostate cancer, African American, Grade, Stage, Risk assessment, Racial disparities, Radical prostatectomy.

Footnotes

University of California, San Francisco, San Francisco, CA, USA

Corresponding author. University of California, San Francisco, Box 1695, 1600 Divisadero Street, A-624, San Francisco, CA 94143-1695, USA; Tel. +1 415 885 3660; Fax: +1 415 885 7443.

Article information

PII: S0302-2838(14)00279-6
DOI: 10.1016/j.eururo.2014.03.026
© 2014 Published by Elsevier B.V.

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What Can Be Done to Maintain Men's Health: Perspectives from the EAU Young Academic Urologists Working Party Men's Health Group

Take Home Message

Men have a lower life expectancy than women in most countries around the world. Men need to be informed and educated about screening, prevention programs, and required lifestyle changes for a holistic approach to their health problems.

Footnotes

a Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey

b Department of Urology, Ludwig-Maximilians-University, Munich, Germany

c Department of Urology, University of Naples Federico II, Naples, Italy

Corresponding author. Department of Urology, University of Naples Federico II, Via S.Pansini, 5, Naples, 80131, Italy. Tel. +39 0817462520; Fax: +39 0815452959.

Article information

PII: S0302-2838(14)00315-7
DOI: 10.1016/j.eururo.2014.04.002
© 2014 Published by Elsevier B.V.

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A “PSA Pyramid” for Men with Initial Prostate-specific Antigen ≤3 ng/ml: A Plea for Individualized Prostate Cancer Screening

Abstract Background

In daily routine business, various prostate-specific antigen (PSA) retest strategies are being promoted.

Objective

To investigate rescreening intervals according to baseline PSA <3 ng/ml stratified by any and aggressive prostate cancer (PCa).

Design, setting, and participants

From 1998 to 2012, data from 4350 men aged 55–70 yr were analyzed from a population-based prospective screening study (median follow-up: 11.6 yr).

Outcome measurements and statistical analysis

The primary end point was detection of aggressive PCa (Gleason score 7–10). Cox regression analysis was used to examine the relationship between covariates.

Results and limitations

Baseline PSA of <1.0 ng/ml, 1–1.9 ng/ml, and 2–2.9 ng/ml was present in 2416 men (55.5%: group 1), 1371 men (31.6%: group 2), and 563 men (12.9%: group 3), respectively. Stratified according to these PSA groups, aggressive PCa was detected in 25 patients (1.0%), 80 patients (5.8%), and 34 patients (6.0%), respectively. During 4 yr, these numbers were 0.0%, 0.29%, and 1.8%, whereas during 8 yr, the numbers were 0.2%, 1.4%, and 2.5%, respectively. In multivariable Cox regression analysis, the only independent risk factor for aggressive PCa was baseline PSA (hazard ratio [HR]: 6.06; 95% confidence interval [CI], 3.82–9.61; p < 0.0001, group 2 vs group 1; and HR: 7.33; 95% CI, 4.29–12.52; p < 0.0001, group 3 vs group 1).

Conclusions

Baseline PSA was the only predictor regarding aggressive PCa. According to the low rate of potentially missed PCa in these groups, rescreening intervals can be safely adapted to baseline PSA values corresponding to a “PSA pyramid”: 6–8 yr if baseline PSA is <1.0 ng/ml, 3–4 yr if baseline PSA is 1–1.99 ng/ml, and yearly if baseline PSA is 2–2.99 ng/ml.

Patient summary

We observed men with a prostate-specific antigen (PSA) value ≤3 ng/ml during 12 yr and found that men can be retested according to their initial PSA value (“PSA pyramid”): PSA <1 (base), retest interval every 8 yr; PSA 1–2 (center), retest interval every 4 yr; and PSA 2–3 (top), retest yearly after risk stratification.

Take Home Message

Rescreening intervals among men with baseline prostate-specific antigen (PSA) values ≤3 ng/ml can be safely adapted to the baseline PSA values corresponding to a “PSA pyramid” with initial PSA <1.0 ng/ml at the base and 2–2.99 ng/ml at the top.

Keywords: Early detection, Prostate cancer, Screening, Screening interval, Survival.

Footnotes

a Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland

b Department of Laboratory Medicine, Cantonal Hospital Aarau, Aarau, Switzerland

c Department of Pathology, Cantonal Hospital Aarau, Aarau, Switzerland

d Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany

e Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

Corresponding author. Department of Urology, Kantonsspital Aarau, Aarau, CH-5000 Switzerland. Tel. +41 62 838 5929; Fax: +41 62 838 5929.

Article information

PII: S0302-2838(14)00318-2
DOI: 10.1016/j.eururo.2014.04.005
© 2014 Published by Elsevier B.V.

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Long-term Efficacy of the Transobturator and Retropubic Midurethral Slings for Stress Urinary Incontinence: Single-center Update from a Randomized Controlled Trial

Footnotes

a Department of Medical-Surgical Specialties and Public Health, Section of Urology and Andrology, University of Perugia, Perugia, Italy

b Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy

Corresponding author. Department of Medical-Surgical Specialties and Public Health, Section of Urology and Andrology, University of Perugia, Via Brunamonti 51; 06100 Perugia, Italy. Tel. +39 0755783743; Fax: +39 0755726123.

Article information

PII: S0302-2838(14)00317-0
DOI: 10.1016/j.eururo.2014.04.004
© 2014 Published by Elsevier B.V.

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