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Video: Update on the guideline of guidelines: non‐muscle‐invasive bladder cancer

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Update on the guideline of guidelines: non‐muscle‐invasive bladder cancer

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Abstract

Non‐muscle‐invasive bladder cancer (NMIBC) is the most common form of bladder cancer, with frequent recurrences and risk of progression. Risk‐stratified treatment and surveillance protocols are often used to guide management. In 2017, BJUI reviewed guidelines on NMIBC from four major organizations: the American Urological Association/Society of Urological Oncology, the European Association of Urology, the National Comprehensive Cancer Network, and the National Institute for Health and Care Excellence. The present update will review major changes in the guidelines and broadly summarize new recommendations for treatment of NMIBC in an era of bacillus Calmette‐Guérin shortage and immense novel therapy development.

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Residents’ podcast: Exercise-induced attenuation of treatment side effects in newly diagnosed PCa patients beginning androgen-deprivation therapy

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Maria Uloko is a Urology Resident at the University of Minnesota Hospital. In this podcast she discusses a recent Article of the month:

Exercise‐induced attenuation of treatment side‐effects in patients with newly diagnosed prostate cancer beginning androgen‐deprivation therapy: a randomised controlled trial

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Abstract

Objectives

(i) To assess whether exercise training attenuates the adverse effects of treatment in patients with newly diagnosed prostate cancer beginning androgen‐deprivation therapy (ADT), and (ii) to examine whether exercise‐induced improvements are sustained after the withdrawal of supervised exercise.

Patients and Methods

In all, 50 patients with prostate cancer scheduled for ADT were randomised to an exercise group (n = 24) or a control group (n = 26). The exercise group completed 3 months of supervised aerobic and resistance exercise training (twice a week for 60 min), followed by 3 months of self‐directed exercise. Outcomes were assessed at baseline, 3‐ and 6‐months. The primary outcome was difference in fat mass at 3‐months. Secondary outcomes included: fat‐free mass, cardiopulmonary exercise testing variables, QRISK®2 (ClinRisk Ltd, Leeds, UK) score, anthropometry, blood‐borne biomarkers, fatigue, and quality of life (QoL). HealthEd Academy can provide an extensive guides about bodybuilding, the best SARMs, Anadrole reviews and much more, take a look!

Results

At 3‐months, exercise training prevented adverse changes in peak O2 uptake (1.9 mL/kg/min, P = 0.038), ventilatory threshold (1.7 mL/kg/min, P = 0.013), O2 uptake efficiency slope (0.21, P = 0.005), and fatigue (between‐group difference in Functional Assessment of Chronic Illness Therapy‐Fatigue score of 4.5 points, P = 0.024) compared with controls. After the supervised exercise was withdrawn, the differences in cardiopulmonary fitness and fatigue were not sustained, but the exercise group showed significantly better QoL (Functional Assessment of Cancer Therapy‐Prostate difference of 8.5 points, P = 0.034) and a reduced QRISK2 score (−2.9%, P = 0.041) compared to controls.

Conclusion

A short‐term programme of supervised exercise in patients with prostate cancer beginning ADT results in sustained improvements in QoL and cardiovascular events risk profile.

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BJUI Podcasts are available on iTunes: https://itunes.apple.com/gb/podcast/bju-international/id1309570262

Visual abstract: Clinical, fiscal and environmental benefits of a specialist‐led virtual ureteric colic clinic: a prospective study

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Video: Cost–utility analysis of focal HIFU vs AS for low‐ to intermediate‐risk prostate cancer using a Markov multi‐state model

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Cost–utility analysis of focal high‐intensity focussed ultrasound vs active surveillance for low‐ to intermediate‐risk prostate cancer using a Markov multi‐state model

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Abstract

Objectives

To estimate the relative cost‐effectiveness of focal high‐intensity focussed ultrasound (F‐HIFU) compared to active surveillance (AS) in patients with low‐ to intermediate‐risk prostate cancer, in France.

Patients and Methods

A Markov multi‐state model was elaborated for this purpose. Our analyses were conducted from the French National Health Insurance perspective, with a time horizon of 10 years and a 4% discount rate for cost and effectiveness. A secondary analysis used a 30‐year time horizon. Costs are presented in 2016 Euros (€), and effectiveness is expressed as quality‐adjusted life years (QALYs). Model parameters’ value (probabilities for transitions between health states, and cost and utility of health states) is supported by systematic literature reviews (PubMed) and random effect meta‐analyses. The cost of F‐HIFU in our model was the temporary tariff attributed by the French Ministry of Health to the overall treatment of prostate cancer by HIFU (€6047).

Our model was analysed using Microsoft Excel 2010 (Microsoft Corp., Redmond, WA, USA). Uncertainty about the value of the model parameters was handled through probabilistic analyses.

Results

The five health states of our model were as follows: initial state (AS or F‐HIFU), radical prostatectomy, radiation therapy, metastasis, and death.

Transition probabilities from the initial F‐HIFU state relied on four articles eligible for our meta‐analyses. All were non‐comparative studies. Utilities relied on a single cohort in San Diego, CA, USA.

For a fictive cohort of 1000 individuals followed for 10 years, F‐HIFU would be €207 520 more costly and would yield 382 less QALYs than AS, which means that AS is cost‐effective when compared to F‐HIFU. For a threshold value varying from €0 to 100 000/QALY, the probability of AS being cost‐effective compared to F‐HIFU varied from 56.5% to 60%. This level of uncertainty was in the same range with a 30‐year time horizon.

Conclusion

Given existing published data, our results suggest that AS is cost‐effective compared to F‐HIFU in patients with low‐ and intermediate‐risk prostate cancer, but with high uncertainty. This uncertainty must be scaled down by continuing to supply the model with new published data and ideally through a randomised clinical trial that includes cost‐effectiveness analyses.

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Article of the week: mpMRI and fusion‐guided biopsies to select and follow African‐American men on active surveillance

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Every week, the Editor-in-Chief selects an Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

In addition to the article itself, there is an editorial written by a prominent member of the urological community and a video prepared by the authors. These are intended to provoke comment and discussion and we invite you to use the comment tools at the bottom of each post to join the conversation. 

If you only have time to read one article this week, it should be this one.

Use of multiparametric magnetic resonance imaging and fusion‐guided biopsies to properly select and follow African‐American men on active surveillance

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Jonathan B. Bloom*, Amir H. Lebastchi*, Samuel A. Gold*, Graham R. Hale*, Thomas Sanford*†, Sherif Mehralivand*†‡, Michael Ahdoot*, Kareem N. Rayn*, Marcin Czarniecki†, Clayton Smith†, Vladimir Valera*, Bradford J. Wood§, Maria J. Merino, Peter L. Choyke†, Howard L. Parnes**, Baris Turkbey† and Peter A. Pinto*§

*Urologic Oncology Branch, †Molecular Imaging Program, NCI, NIH, Bethesda, MD, USA, ‡Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany, §Center for Interventional Oncology, Laboratory of Pathology, and **Division of Cancer Prevention, NCI, NIH, Bethesda, MD, USA

Abstract

Objectives

To determine the rate of Gleason Grade Group (GGG) upgrading in African‐American (AA) men with a prior diagnosis of low‐grade prostate cancer (GGG 1 or GGG 2) on 12‐core systematic biopsy (SB) after multiparametric magnetic resonance imaging (mpMRI) and fusion biopsy (FB); and whether AA men who continued active surveillance (AS) after mpMRI and FB fared differently than a predominantly Caucasian (non‐AA) population.

Patients and methods

A database of men who had undergone mpMRI and FB was queried to determine rates of upgrading by FB amongst men deemed to be AS candidates based on SB prior to referral. After FB, Kaplan–Meier curves were generated for AA men and non‐AA men who then elected AS. The time to GGG upgrading and time continuing AS were compared using the log‐rank test.

Results

AA men referred with GGG 1 disease on previous SB were upgraded to GGG ≥3 by FB more often than non‐AA men, 22.2% vs 12.7% (P = 0.01). A total of 32 AA men and 258 non‐AA men then continued AS, with a median (interquartile range) follow‐up of 39.19 (24.24–56.41) months. The median time to progression was 59.7 and 60.5 months, respectively (P = 0.26). The median time continuing AS was 61.9 months and not reached, respectively (P = 0.80).

Conclusions

AA men were more likely to be upgraded from GGG 1 on SB to GGG ≥3 on initial FB; however, AA and non‐AA men on AS subsequently progressed at similar rates following mpMRI and FB. A greater tendency for SB to underestimate tumour grade in AA men may explain prior studies that have shown AA men to be at higher risk of progression during AS.

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BJUI Compass and open access

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There is no doubt that the publishing landscape is rapidly changing around us. The BJUI is a world leading surgical journal, serving 10 international organisations, with 90 years of history (1929–2019). So why are we launching, BJUI Compass an online, open access (OA) journal, now?

In September 2018, cOAlition S, a predominantly European consortium of research funders, launched Plan S. In its current form, this plan requires that from 2021, scientific publications from research funded by public grants through funders who have signed up to cOAlition S must be published in full OA journals or platforms. This is a model whereby publication of science is paid for by authors, or their funders, rather than by readers to whom access is free [1]. The Wellcome Trust, one of the largest funders of research in the UK, is a major supporter of Plan S and has its own OA policy for 2021 [2].

However, the practical implementation of Plan S continues to be a subject of debate. In other parts of the world, there is increasing interest in OA but the approach to implementation is likely to vary considerably. Our own publisher, Wiley, in readiness for Plan S, announced an agreement with Projekt DEAL, a representative of nearly 700 academic institutions in Germany [3]. Most academic institutions in Germany under this project can publish articles in OA or hybrid journals published by Wiley, including BJUI, a hybrid journal. These initiatives in OA are another factor in the increasing debate about scientific impact, bibliometrics beyond the impact factor, and translating research for public benefit rather than purely the career progression of academics [4].

Dr John W. Davis (@jdhdavis)

 

In keeping with our continued theme of the highest quality, clinically relevant papers, in this issue of the BJUI we present two MRI‐based prostate cancer papers, showing that while we could avoid biopsies in many men without missing significant disease [5], in African‐American men on active monitoring, the cancers can be upgraded more frequently and careful follow‐up is thus warranted [6].

by Prokar Dasgupta and John W. Davis

 

References

  1. cOAlition S. Plan S: Making full and immediate Open Access a reality. Available at: https://www.coalition-s.org/. Accessed October 2019
  2. Wellcome. Open access policy 2021. Available at: https://wellcome.ac.uk/funding/guidance/open-access-policy. Accessed October 2019
  3. Wiley. Wiley and Projekt DEAL partner to enhance the future of scholarly research and publishing in Germany. Available at: https://newsroom.wiley.com/press-release/all-corporate-news/wiley-and-projekt-deal-partner-enhance-future-scholarly-research-an. Accessed October 2019
  4. Hicks D, Wouters P, Waltman L, de Rijcke S, Rafols I. Bibliometrics: The Leiden Manifesto for research metrics. Nature 2015; 520: 429– 31
  5. Venderink W, van Luijtelaar A, van der Leest M et al. Multiparametric magnetic resonance imaging and follow‐up to avoid prostate biopsy in 4259 men. BJU Int 2019; 124: 775– 84
  6. Bloom JB, Lebastchi AH, Gold SA et al. Use of multiparametric magnetic resonance imaging and fusion‐guided biopsies to properly select and follow African‐American men on active surveillance. BJU Int 2019; 124: 768– 74

 

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