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Prostate-specific antigen (PSA) testing has dramatically changed the composition of prostate cancer (PCa), making it difficult to interpret incidence trends. New methods are needed to examine temporal trends in the incidence of clinically significant PCa and whether trends vary by race.Objective
To conduct an in-depth analysis of incidence trends in clinically significant PCa, defined as cases in which PCa was the underlying cause of death within 10 yr of diagnosis.Design, setting, and participants
We extracted incident PCa cases during the period 1975–2002 and associated causes of death and survival through 2012 from nine cancer registries in the population-based Surveillance Epidemiology and End Results program database.Outcome measurements and statistical analysis
We applied joinpoint regression analysis to identify when significant changes in trends occurred and age–period–cohort models to examine longitudinal and cross-sectional trends in the incidence of fatal PCa.Results and limitations
Among 51 680 fatal PCa cases, incidence increased 1% per year prior to 1992, declined 15% per year from 1992 to 1995, and further declined by 5% per year through 2002. Age-specific incidence rates of fatal disease decreased >2% per year among men aged ≥60 yr, yet rates remained relatively stable among men aged ≤55 yr. Fatal disease rates were >2-fold higher in black men compared with white men, a racial disparity that increased to 4.2-fold among younger men.Conclusions
The incidence of fatal PCa substantially declined after widespread PSA screening and treatment advances. Nevertheless, rates of fatal disease among younger men have remained relatively stable, suggesting the need for additional attention to early onset PCa, especially among black men. The persistent black-to-white racial disparity observed in fatal PCa underscores the need for greater understanding of the causes of this difference so that strategies can be implemented to eliminate racial disparities.Patient summary
We assessed how the incidence of ultimately fatal prostate cancer (PCa) changed over time. We found that the incidence of fatal PCa declined by >50% since the introduction of prostate-specific antigen testing and advances in treatment options; however, incidence rates among younger men remained relatively stable, and younger black men exhibited a 4.2-fold higher risk for fatal disease compared with white men.Take Home Message
The incidence of clinically significant prostate cancer (PCa) declined substantially after widespread prostate-specific antigen testing and treatment advances. Nevertheless, among younger men, the stable rates and the large black-to-white racial disparity underscore the need for additional attention to early onset PCa.
Keywords: Cancer trends, Cause-specific mortality, Disease progression, Prostate cancer, Prostate-specific antigen.Footnotes
a Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
b Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
Corresponding author. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Room 7E-106, MSC 9774, Bethesda MD 20892, USA. Tel. +1 240 276 7298; Fax: +1 240 276 7838.
© 2016 Published by Elsevier B.V.
Use of the UPOINT Classification in Turkish Chronic Prostatitis/Chronic Pelvic Pain Syndrome Patients
Design and Methodological Considerations of the National Spina Bifida Patient Registry Urologic and Renal Protocol for the Newborn and Young Child
Use of EPIC for Clinical Practice (EPIC-CP) to Assess Patient-Reported Prostate Cancer Quality-of-Life Following Robot-Assisted Radical Prostatectomy
Optical Coherence Tomography as a Tool for in Vivo Staging and Grading of Upper Urinary Tract Urothelial Carcinoma: A Study for Diagnostic Accuracy
Outcomes following complete surgical metastasectomy for patients with metastatic renal cell carcinoma: a systematic review and meta-analysis
Correlation of ASA Grade and the Charlson Comorbidity Index with Complications in Patients after Transurethral Resection of Prostate
Complete AZFb Deletion of Y Chromosome in an Infertile Male with Severe Oligoasthenozoospermia: Case Report and Literature Review
Robot-assisted Surgery for Benign Ureteral Strictures: Experience and Outcomes from Four Tertiary Care Institutions
Minimally invasive treatment of benign ureteral strictures is still challenging because of its technical complexity. In this context, robot-assisted surgery may overcome the limits of the laparoscopic approach.Objective
To evaluate outcomes for robotic ureteral repair in a multi-institutional cohort of patients treated for ureteropelvic junction obstruction and ureteral stricture (US) at four tertiary referral centres.Design, setting, and participants
This retrospective study reports data for 183 patients treated with standard robot-assisted pyeloplasty (PYP) and robotic uretero-ureterostomy (UUY) at four high-volume centres from January 2006 to September 2014.Surgical procedure
Robotic PYP and robot-assisted UUY were performed according to previously reported surgical techniques.Outcome measurements and statistical analysis
Preoperative, intraoperative, and postoperative variables and outcomes were assessed. A descriptive statistical analysis was performed.Results and limitations
No robot-assisted UUY cases required surgical conversion, while 2.8% of PYP cases were not completed robotically. The median operative time was 120 and 150 min for robot-assisted PYP and robot-assisted UUY, respectively. No intraoperative complications were reported. The overall complication rate for all procedures was 11% (n = 20) and complications were mostly of low grade. The high-grade complication rate was 2.2% (n = 4). At median follow-up of 24 mo, the overall success rate was >90% for both procedures. The study limitations include its retrospective nature and the heterogeneity of the study population.Conclusions
Robotic surgery for benign US is safe and effective, with limited risk of high-grade complications and good intermediate-term results.Patient summary
In this study we review the use of robotic surgery at four different tertiary care centres in the treatment of patients affected by benign ureteral strictures. Our results demonstrate that robotic surgery is a safe alternative to the standard open approach in the treatment of ureteral strictures.Take Home Message
The results of the current study confirm the feasibility, safety, and efficacy of robotic surgery as a minimally invasive alternative to open surgery for the treatment of benign ureteral strictures.
Keywords: Ureter, Ureteral strictures, Robot-assisted surgery, Surgical technique, Outcomes, Ureteral surgery, Reimplantation.Footnotes
a Department of Urology, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
b Department of Urology, Humanitas Mater Domini, Castellanza, Varese, Italy
c San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
d Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
e Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium
f OLV Vattikuti Robotic Surgery Institute, Melle, Belgium
Corresponding author. Department of Urology, Humanitas Clinical and Research Center, Via Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy. Tel. +39 347 5381313; Fax: +39 028 2245721.
© 2016 Published by Elsevier B.V.
Expression of AR-V7 in Circulating Tumour Cells Does Not Preclude Response to Next Generation Androgen Deprivation Therapy in Patients with Castration Resistant Prostate Cancer
The androgen receptor splice variant AR-V7 has recently been discussed as a predictive biomarker for nonresponse to next-generation androgen deprivation therapy (ADT) in patients with castration-resistant prostate cancer. However, we recently identified one patient showing a response from abiraterone despite expression of AR-V7 in his circulating tumour cells (CTC).
Therefore, we precisely assessed the response in a cohort of 21 AR-V7 positive castration-resistant prostate cancer patients who had received therapy with abiraterone or enzalutamide. We detected a subgroup of six AR-V7 positive patients showing benefit from either abiraterone or enzalutamide. Their progression free survival was 26 d (censored) to 188 d. Four patients displayed a prostate-specific antigen decrease of >50%. When analysing prior therapies, we noticed that only one of the six patients had received next-generation ADT prior to CTC collection.
As a result, we conclude that AR-V7 status in CTC cannot entirely predict nonresponse to next generation ADT and AR-V7-positive patients should not be systematically denied abiraterone or enzalutamide treatment, especially as effective alternative treatment options are still limited.Patient summary
A subgroup of patients can benefit from abiraterone and/or enzalutamide despite detection of AR-V7 splice variants in their circulating tumour cells.Take Home Message
Androgen receptor splice variant-7 expression in circulating tumour cells from patients with castration-resistant prostate cancer cannot entirely predict nonresponse to next-generation androgen deprivation therapy. Therefore, androgen receptor splice variant-7-positive patients should not be denied abiraterone or enzalutamide treatment systematically, especially as effective alternative treatment options are still limited.
Keywords: Abiraterone, Enzalutamide, Androgen receptor splice variant, AR-V7, Castration resistant prostate cancer.Footnotes
a Clinic of Urology, University Hospital Muenster, Muenster, Germany
b Clinic of Urology, University Hospital Ulm, Ulm, Germany
c Gerhard-Domagk-Institute of Pathology, University Hospital Muenster, Muenster, Germany
Corresponding author. Department of Urology, Muenster University Medical Centre, Albert-Schweitzer-Campus 1, Building A 1, Muenster D-48149, Germany. Tel. +49 (0) 2 51/83-44609; Fax: +49 (0) 2 51/83-44619.
© 2016 European Association of Urology, Published by Elsevier B.V.
Reply to Lu Yang, Shi Qiu and Qiang Wei's Letter to the Editor re: Christopher E. Bayne, Stephen B. Williams, Matthew R. Cooperberg, et al. Treatment of the Primary Tumor in Metastatic Prostate Cancer: Current Concepts and Future Perspectives. Eur Urol...
Refers to article:Re: Christopher E. Bayne, Stephen B. Williams, Matthew R. Cooperberg, et al. Treatment of the Primary Tumor in Metastatic Prostate Cancer: Current Concepts and Future Perspectives. Eur Urol 2016;69:775–87
Accepted 12 July 2016
Refers to article:Treatment of the Primary Tumor in Metastatic Prostate Cancer: Current Concepts and Future Perspectives
Accepted 22 April 2015
May 2016 (Vol. 69, Issue 5, pages 775 - 787)Footnotes
a Department of Urology, The George Washington University, Washington, DC, USA
b Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
c Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Corresponding author. The University of Texas, M.D. Anderson Cancer Center, Department of Urology, 1515 Holcombe Blvd, Unit 1373, Houston, TX 77030, USA.
© 2016 European Association of Urology, Published by Elsevier B.V.