Alon Lazarovich, Tanya W Kristof, Shavano Steadman, Aaron S Dahmen, Michelle A Josephson, Rolf Barth, Todd M Morgan, Marc-Olivier Timsit, Scott Eggener
Objective: To analyse the management and outcomes of individuals diagnosed with prostate cancer either before or after organ transplantation, as the impact of organ transplantation and associated immunosuppression on the incidence, progression, and mortality of prostate cancer remains an area of substantial clinical interest and uncertainty.
Patients and methods: We conducted a retrospective analysis of patients from two tertiary care centres who had solid organ transplantation and were diagnosed with prostate cancer before or after organ transplantation. Data collected included demographics and clinical information.
Results: The cohort consisted of 110 patients with a median (interquartile range [IQR]) age at prostate cancer diagnosis of 62 (56.6-67.2) years and a median (IQR) age at transplantation of 58.6 (52.7-65.3) years. Renal transplantation was the most common (54%). The median (IQR) prostate-specific antigen concentration at prostate cancer diagnosis was 6.2 (4.5-10) ng/mL, and the distribution of American Urological Association risk groups was: low risk, 36%; intermediate risk, 50%; and high risk, 14%. In all, 45 (41%) patients were diagnosed with prostate cancer prior to transplantation. Management included radical prostatectomy (RP; 62%), prostate radiotherapy (RT; 13%), and active surveillance (AS; 18%). During a median (IQR) follow-up of 5.8 (2.5-10) years from prostate cancer diagnosis, one (2%) patient developed metastatic disease. In all, 65 (59%) patients were diagnosed with prostate cancer subsequent to organ transplantation. Management included AS (29%), RT (45%), and RP (15%). During a median (IQR) follow-up of 5.3 (1-8.4) years, three patients (5%) developed metastatic disease. There were no deaths from prostate cancer.
Conclusion: A diagnosis of localised prostate cancer should not preclude solid organ transplantation, and the presence of a transplant does not appear to substantially impact risk of prostate cancer progression.
{"title":"Prostate cancer and solid organ transplantation: patient management and outcomes.","authors":"Alon Lazarovich, Tanya W Kristof, Shavano Steadman, Aaron S Dahmen, Michelle A Josephson, Rolf Barth, Todd M Morgan, Marc-Olivier Timsit, Scott Eggener","doi":"10.1111/bju.16558","DOIUrl":"https://doi.org/10.1111/bju.16558","url":null,"abstract":"<p><strong>Objective: </strong>To analyse the management and outcomes of individuals diagnosed with prostate cancer either before or after organ transplantation, as the impact of organ transplantation and associated immunosuppression on the incidence, progression, and mortality of prostate cancer remains an area of substantial clinical interest and uncertainty.</p><p><strong>Patients and methods: </strong>We conducted a retrospective analysis of patients from two tertiary care centres who had solid organ transplantation and were diagnosed with prostate cancer before or after organ transplantation. Data collected included demographics and clinical information.</p><p><strong>Results: </strong>The cohort consisted of 110 patients with a median (interquartile range [IQR]) age at prostate cancer diagnosis of 62 (56.6-67.2) years and a median (IQR) age at transplantation of 58.6 (52.7-65.3) years. Renal transplantation was the most common (54%). The median (IQR) prostate-specific antigen concentration at prostate cancer diagnosis was 6.2 (4.5-10) ng/mL, and the distribution of American Urological Association risk groups was: low risk, 36%; intermediate risk, 50%; and high risk, 14%. In all, 45 (41%) patients were diagnosed with prostate cancer prior to transplantation. Management included radical prostatectomy (RP; 62%), prostate radiotherapy (RT; 13%), and active surveillance (AS; 18%). During a median (IQR) follow-up of 5.8 (2.5-10) years from prostate cancer diagnosis, one (2%) patient developed metastatic disease. In all, 65 (59%) patients were diagnosed with prostate cancer subsequent to organ transplantation. Management included AS (29%), RT (45%), and RP (15%). During a median (IQR) follow-up of 5.3 (1-8.4) years, three patients (5%) developed metastatic disease. There were no deaths from prostate cancer.</p><p><strong>Conclusion: </strong>A diagnosis of localised prostate cancer should not preclude solid organ transplantation, and the presence of a transplant does not appear to substantially impact risk of prostate cancer progression.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kevin G. Byrnes, Cameron Alexander, Mariam Lami, Marie Edison, Aqua Asif, Alexander Ng, Quentin Mak, Bing Jie Chow, Mathew Smith, Kevin Keane, Kevin Gallagher, Arjun S. Nathan, Sinan Khadhouri, Nikita R. Bhatt, Veeru Kasivisvanathan
{"title":"The LANDMARK project: providing summaries of key papers that have shaped urological practice","authors":"Kevin G. Byrnes, Cameron Alexander, Mariam Lami, Marie Edison, Aqua Asif, Alexander Ng, Quentin Mak, Bing Jie Chow, Mathew Smith, Kevin Keane, Kevin Gallagher, Arjun S. Nathan, Sinan Khadhouri, Nikita R. Bhatt, Veeru Kasivisvanathan","doi":"10.1111/bju.16548","DOIUrl":"10.1111/bju.16548","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"134 6","pages":"919-921"},"PeriodicalIF":3.7,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bju.16548","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patrick Gordon, Daryl Thompson, Oneel Patel, Ronald Ma, Damien Bolton, Joseph Ischia
Objective: To evaluate the safety, efficacy, tolerability, and cost-effectiveness of bedside or office-based ureteric stent insertion.
Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocols (PRISMA-P) and A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 guidelines, we searched PubMed/the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE), Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and Dimensions for English-language studies from 1978 to April 2023. Inclusion criteria focused on primary ureteric stent placements outside of the operating theatre (OT).
Results: A total of 15 studies involving 2072 stents were included. Success rates for correctly positioned stents in bedside or office-based insertions ranged from 60% to 95.8%, with most studies reporting ≥80% success rates. Common failure reasons included impacted stones and difficulty identifying the ureteric orifice. Pain and tolerability were assessed using various methods, with validated tools indicating moderate pain levels, but most patients would undergo the procedure again under local anaesthesia. Complication rates were generally low, with minor complications such as haematuria or postoperative fever being the most common. Procedural costs were significantly lower in non-OT settings, with estimates indicating savings of up to four-fold.
Conclusion: Bedside or office-based ureteric stent insertion is a viable alternative to OT procedures, offering high success rates, manageable pain levels, low complication rates, and substantial cost savings. This approach is particularly advantageous in settings with limited OT access, highlighting its potential for broader adoption in urological practice. Future research should focus on standardising pain assessment methods and randomised studies.
{"title":"Ureteric stenting outside of the operation theatre: challenges and opportunities.","authors":"Patrick Gordon, Daryl Thompson, Oneel Patel, Ronald Ma, Damien Bolton, Joseph Ischia","doi":"10.1111/bju.16533","DOIUrl":"https://doi.org/10.1111/bju.16533","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the safety, efficacy, tolerability, and cost-effectiveness of bedside or office-based ureteric stent insertion.</p><p><strong>Methods: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocols (PRISMA-P) and A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 guidelines, we searched PubMed/the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE), Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and Dimensions for English-language studies from 1978 to April 2023. Inclusion criteria focused on primary ureteric stent placements outside of the operating theatre (OT).</p><p><strong>Results: </strong>A total of 15 studies involving 2072 stents were included. Success rates for correctly positioned stents in bedside or office-based insertions ranged from 60% to 95.8%, with most studies reporting ≥80% success rates. Common failure reasons included impacted stones and difficulty identifying the ureteric orifice. Pain and tolerability were assessed using various methods, with validated tools indicating moderate pain levels, but most patients would undergo the procedure again under local anaesthesia. Complication rates were generally low, with minor complications such as haematuria or postoperative fever being the most common. Procedural costs were significantly lower in non-OT settings, with estimates indicating savings of up to four-fold.</p><p><strong>Conclusion: </strong>Bedside or office-based ureteric stent insertion is a viable alternative to OT procedures, offering high success rates, manageable pain levels, low complication rates, and substantial cost savings. This approach is particularly advantageous in settings with limited OT access, highlighting its potential for broader adoption in urological practice. Future research should focus on standardising pain assessment methods and randomised studies.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Response to letter 'Bladder-centric benign prostatic hyperplasia management post-laser enucleation of the prostate'.","authors":"Cristina Cano Garcia, Andreas Becker","doi":"10.1111/bju.16542","DOIUrl":"https://doi.org/10.1111/bju.16542","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alessandro Izzo, Gianluca Spena, Giovanni Grimaldi, Giuseppe Quarto, Luigi Castaldo, Raffaele Muscariello, Dario Franzese, Francesco Passaro, Riccardo Autorino, Antonio Tufano, Sisto Perdonà
{"title":"Single-port robot-assisted nephroureterectomy via a supine anterior approach: step-by-step technique.","authors":"Alessandro Izzo, Gianluca Spena, Giovanni Grimaldi, Giuseppe Quarto, Luigi Castaldo, Raffaele Muscariello, Dario Franzese, Francesco Passaro, Riccardo Autorino, Antonio Tufano, Sisto Perdonà","doi":"10.1111/bju.16537","DOIUrl":"https://doi.org/10.1111/bju.16537","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The ‘balls’ of an ideal man?","authors":"Farrokh Habibzadeh","doi":"10.1111/bju.16538","DOIUrl":"10.1111/bju.16538","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"134 6","pages":"918-919"},"PeriodicalIF":3.7,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142370919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Leilei Xia, J. Everett Knudsen, Daniel S. Roberson, Erika L. Wood, Anosh Dadabhoy, Sofia Romano, Thomas J. Guzzo, Trinity J. Bivalacqua, Siamak Daneshmand
{"title":"Residual cancer at radical cystectomy with or without neoadjuvant chemotherapy: a pathological stage‐matched comparison","authors":"Leilei Xia, J. Everett Knudsen, Daniel S. Roberson, Erika L. Wood, Anosh Dadabhoy, Sofia Romano, Thomas J. Guzzo, Trinity J. Bivalacqua, Siamak Daneshmand","doi":"10.1111/bju.16529","DOIUrl":"https://doi.org/10.1111/bju.16529","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"23 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142362896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Samantha Conroy,Ibrahim Jubber,Aidan P Noon,Derek J Rosario,Jon Griffin,Susan Morgan,Rachel Hubbard,Steve Kennish,Stephen Mitchell,Suresh Venugopal,Kate Linton,Ramanan Rajasundaram,Syed A Hussain,James W F Catto
OBJECTIVETo report real-world outcomes for high-risk non-muscle-invasive bladder cancer (HRNMIBC), including bacillus Calmette-Guérin (BCG) and radical cystectomy (RC), as randomised comparisons of these have not been possible.METHODSWe detail consecutive participants screened for the BRAVO randomised controlled trial comparing RC with BCG (International Standard Randomised Controlled Trial Number [ISRCTN]12509361). Patients were prospectively registered and case-note review used for outcomes. The primary outcome was overall survival. Secondary outcomes included recurrence, progression, metastasis, and bladder cancer-specific survival.RESULTS AND LIMITATIONSA total of 193 patients were screened, including 106 (54.9%) who received BCG, 43 (22.3%) primary RC, 37 (19.2%) 'other' treatment and seven (3.6%) hyperthermic intravesical mitomycin C. All-cause death occurred in 55 (28.5%) patients at median (interquartile range [IQR]) of 29.0 (19.5-42.0) months. In multivariable analysis, overall mortality was more common in older patients (hazard ratio [HR] 2.63, 95% confidence interval [CI] 1.35-5.13; Cox P = 0.004 for age >70 years), those recruited from district hospitals (HR 0.53, 95% CI 0.3-0.95; P = 0.032) and those who did not undergo RC as their first treatment (HR 2.16, 95% CI 1.17-3.99; P = 0.014). In all, 17 (8.8%) patients died from bladder cancer (BC) at median (IQR) of 22.5 (19-36.25) months. In multivariable analysis, BC-specific mortality was more common in older patients (HR 4.87, 95% CI 1.1-21.6; P = 0.037) and those with Tis/T1 disease (HR 2.26, 95% CI 1.23-4.16; P = 0.008) but did not vary with initial treatment.CONCLUSIONSPatients with HRNMIBC are at high-risk of mortality. Those choosing RC as their initial treatment have lower risks of mortality than others, although this may reflect fitness and selection.
目的报告高危非肌层浸润性膀胱癌(HRNMIBC)的实际治疗效果,包括卡介苗(BCG)和根治性膀胱切除术(RC),因为无法对这些治疗方法进行随机比较。方法我们详细记录了BRAVO随机对照试验(国际标准随机对照试验编号 [ISRCTN]12509361 )筛选出的连续参与者,对RC和BCG进行了比较。对患者进行了前瞻性登记,并采用病例记录回顾法对结果进行分析。主要结果是总生存期。共有 193 名患者接受了筛查,其中 106 人(54.9%)接受了卡介苗治疗,43 人(22.3%)接受了原发性膀胱癌治疗,37 人(22.3%)接受了膀胱癌治疗。55例(28.5%)患者在中位(四分位间距 [IQR])29.0(19.5-42.0)个月时因各种原因死亡。在多变量分析中,老年患者(危险比 [HR] 2.63,95% 置信区间 [CI] 1.35-5.13;年龄大于 70 岁,Cox P = 0.004)、从地区医院招募的患者(HR 0.53,95% CI 0.3-0.95;P = 0.032)和首次治疗未接受 RC 的患者(HR 2.16,95% CI 1.17-3.99;P = 0.014)的总死亡率更高。共有 17 名(8.8%)患者在中位(IQR)22.5(19-36.25)个月时死于膀胱癌(BC)。在多变量分析中,BC特异性死亡率更常见于年龄较大的患者(HR 4.87,95% CI 1.1-21.6;P = 0.037)和患有Tis/T1疾病的患者(HR 2.26,95% CI 1.23-4.16;P = 0.008),但与初始治疗方法无关。选择 RC 作为初始治疗方法的患者的死亡风险低于其他患者,尽管这可能反映了患者的体质和选择。
{"title":"Real-word outcomes for high-risk non-muscle-invasive bladder cancer: screened patients for the BRAVO trial.","authors":"Samantha Conroy,Ibrahim Jubber,Aidan P Noon,Derek J Rosario,Jon Griffin,Susan Morgan,Rachel Hubbard,Steve Kennish,Stephen Mitchell,Suresh Venugopal,Kate Linton,Ramanan Rajasundaram,Syed A Hussain,James W F Catto","doi":"10.1111/bju.16516","DOIUrl":"https://doi.org/10.1111/bju.16516","url":null,"abstract":"OBJECTIVETo report real-world outcomes for high-risk non-muscle-invasive bladder cancer (HRNMIBC), including bacillus Calmette-Guérin (BCG) and radical cystectomy (RC), as randomised comparisons of these have not been possible.METHODSWe detail consecutive participants screened for the BRAVO randomised controlled trial comparing RC with BCG (International Standard Randomised Controlled Trial Number [ISRCTN]12509361). Patients were prospectively registered and case-note review used for outcomes. The primary outcome was overall survival. Secondary outcomes included recurrence, progression, metastasis, and bladder cancer-specific survival.RESULTS AND LIMITATIONSA total of 193 patients were screened, including 106 (54.9%) who received BCG, 43 (22.3%) primary RC, 37 (19.2%) 'other' treatment and seven (3.6%) hyperthermic intravesical mitomycin C. All-cause death occurred in 55 (28.5%) patients at median (interquartile range [IQR]) of 29.0 (19.5-42.0) months. In multivariable analysis, overall mortality was more common in older patients (hazard ratio [HR] 2.63, 95% confidence interval [CI] 1.35-5.13; Cox P = 0.004 for age >70 years), those recruited from district hospitals (HR 0.53, 95% CI 0.3-0.95; P = 0.032) and those who did not undergo RC as their first treatment (HR 2.16, 95% CI 1.17-3.99; P = 0.014). In all, 17 (8.8%) patients died from bladder cancer (BC) at median (IQR) of 22.5 (19-36.25) months. In multivariable analysis, BC-specific mortality was more common in older patients (HR 4.87, 95% CI 1.1-21.6; P = 0.037) and those with Tis/T1 disease (HR 2.26, 95% CI 1.23-4.16; P = 0.008) but did not vary with initial treatment.CONCLUSIONSPatients with HRNMIBC are at high-risk of mortality. Those choosing RC as their initial treatment have lower risks of mortality than others, although this may reflect fitness and selection.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"120 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142324932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}