This video tells the story of Matt, who was diagnosed with advanced prostate cancer and told he only had two years to live. Nine years after he was diagnosed, Matt and his family share their experience of living with prostate cancer and how the diagnosis affected their lives.
Every Month Matters is a disease awareness campaign funded by Astellas Pharma Europe Ltd.
Primary treatments for clinically localised prostate cancer: a comprehensive lifetime cost-utility analysis
Matthew R. Cooperberg, Naren R. Ramakrishna†, Steven B. Duff*, Kathleen E. Hughes‡, Sara Sadownik‡, Joseph A. Smith§ and Ashutosh K. Tewari¶
Departments of Urology and Epidemiology and Biostatistics, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, *Veritas Health Economics Consulting, Inc., Carlsbad, CA, †Department of Radiation Oncology, MD Anderson Cancer Center, Orlando, FL, ‡Avalere Health LLC, Washington, DC, §Department of Urologic Surgery, Vanderbilt University, Nashville, TN, and ¶Department of Urology, Cornell University, New York, NY, USA
• To characterise the costs and outcomes associated with radical prostatectomy (open, laparoscopic, or robot-assisted) and radiation therapy (RT: dose-escalated three-dimensional conformal RT, intensity-modulated RT, brachytherapy, or combination), using a comprehensive, lifetime decision analytical model.
PATIENTS AND METHODS
• A Markov model was constructed to follow hypothetical men with low-, intermediate-, and high-risk prostate cancer over their lifetimes after primary treatment; probabilities of outcomes were based on an exhaustive literature search yielding 232 unique publications.
• In each Markov cycle, patients could have remission, recurrence, salvage treatment, metastasis, death from prostate cancer, and death from other causes.
• Utilities for each health state were determined, and disutilities were applied for complications and toxicities of treatment.
• Costs were determined from the USA payer perspective, with incorporation of patient costs in a sensitivity analysis.
• Differences across treatments in quality-adjusted life years across methods were modest, ranging from 10.3 to 11.3 for low-risk patients, 9.6–10.5 for intermediate-risk patients and 7.8–9.3 for high-risk patients.
• There were no statistically significant differences among surgical methods, which tended to be more effective than RT methods, with the exception of combined external beam + brachytherapy for high-risk disease.
• RT methods were consistently more expensive than surgical methods; costs ranged from $19 901 (robot-assisted prostatectomy for low-risk disease) to $50 276 (combined RT for high-risk disease).
• These findings were robust to an extensive set of sensitivity analyses.
• Our analysis found small differences in outcomes and substantial differences in payer and patient costs across treatment alternatives.
• These findings may inform future policy discussions about strategies to improve efficiency of treatment selection for localised prostate cancer.
A prospective comparison of surgical and pathological outcomes obtained after robot-assisted or pure laparoscopic partial nephrectomy in moderate to complex renal tumours: results from a French multicentre collaborative study
Alexandra Masson-Lecomte1,2,3, Karim Bensalah5,6, Elise Seringe2,3, Christophe Vaessen1,2, Alexandre de la Taille4,7, Nicolas Doumerc8,9, Pascal Rischmann8,9, Franck Bruyère10,11, Laurent Soustelle12,13, Stéphane Droupy12,13 and Morgan Rouprêt1,2
1Department of Urology, Pitié Salpétrière, Assistance Publique – Hôpitaux de Paris, Paris, 2Université Paris 6, Paris, 3Department of Statistics, Pitié Salpétrière, Assistance Publique – Hôpitaux de Paris, Paris, 4Department of Urology, Henri Mondor, Assistance Publique – Hôpitaux de Paris, Paris, 5Department of Urology, CHU de Reims, Reims, 6Université de Reims Champagnes-Ardenne, Marne, 7Université Paris-Est Creteil, Marne, 8Department of Urology, CHU Rangueil, Toulouse, 9Université Toulouse 3, Toulouse, 10Department of Urology, CHU Bretonneau, Tours, 11Université François-Rabelais, Tours, 12Department of Urology, CHU Caremeau, Nimes, 13Université Montpellier 1, Montpellier, France
• To prospectively compare the surgical and pathological outcomes obtained with robot-assisted laparoscopic partial nephrectomy (RAPN) or laparoscopic PN (LPN) for renal cell carcinoma in a multicentre cohort.
PATIENTS AND METHODS
• Between 2007 and 2011, 265 nephron-sparing surgeries were performed at six French urology departments. The patients underwent either RAPN (n = 220) or LPN (n = 45) procedures.
• The operative data included operative duration, warm ischaemia time (WIT) and estimated blood loss (EBL). The postoperative outcomes included length of stay (LOS), creatinine variation (Modiﬁcation of Diet in Renal Disease group), Clavien complications and pathological results.
• The complexity of the renal tumour was classiﬁed using the R.E.N.A.L. nephrometry scoring system. Student’s t-test and chi-squared tests were used to compare variables.
• The median follow-ups for the RAPN and LPN groups were 7 and 18 months, respectively (P < 0.001).
• Age and American Society of Anesthesiology score were signiﬁcantly higher in the LPN group (P = 0.02 and P = 0.004, respectively).
• These variables were lower in the RAPN group: WIT [mean (SD) 20.4 (9.7) vs 24.3 (15.2) min; P = 0.03], operative duration [mean (SD) 168.1 (55.5) vs 199.7 (51.2) min; P < 0.001], operating room occupation time [mean (SD) 248.3 (66.7) vs 278.2 (71.3) min; P = 0.008], EBL [mean (SD) 244.8 (365.4) vs 268.3 (244.9) mL; P = 0.01], use of haemostatic agents [used in 78% of RAPNs and 100% of LPNs; P < 0.001] and LOS [mean (SD) 5.5 (4.3) vs 6.8 (3.2) days; P = 0.05).
• There were no signiﬁcant diﬀerences between pre- and postoperative creatinine levels, pathology report or complication rates between the groups. The main limitation was due to the study’s non-randomised design.
• RAPN is not inferior to pure LPN for perioperative outcomes (i.e. EBL, operative duration, WIT, LOS). Only a randomised study with a longer follow-up can now provide further insight into oncological outcomes.
The Patagonia trans-Andes Challenge was the fourth in the series of cycle rides that have taken us to Sicily, Malawi and Madagascar to raise funds for The Urology Foundation (TUF) a charity that supports research and training into all urological diseases. It brings 14 urologists, including the indefatigable Roland Morley, Neil Barber and Richard Hindley, not forgetting the incredibly plucky Jo Cresswell, together with patients and other enthusiastic supporters.
The TUF team gathered in Bariloche, a town in the foothills of the Andes and on the shore of the incredibly beautiful Lake Nahuelhuapi. We were so lucky with the weather: although we were greeted by a torrential downpour when we arrived, we awoke to a perfect day and collected our almost new Wisper bikes which were sturdy enough to get us over and across the Andes to Chile, on and off road!
We set off in convoy, 47 cyclists, plus our handsome Argentinian guide, Roderigo as well as our leader Miriam, who has guided all our cycling adventures for TUF in Sicily, Malawi and Madagascar. On day one, Lesley Hawker, a bladder cancer survivor, is unceremoniously jettisoned from her saddle by an Argentinian driver who fails to give her a wide enough berth and clips her from behind with a wing mirror. Luckily Lesley suffers nothing worse than a few scratches and bruises, but it was a near miss! Later, Abhay Rane manages to outdo her with a more spectacular fall, flying gracefully over his handlebars, but like her, emerges bloodied, but unbowed.
The scenery in Patagonia is unbelievably spectacular: dramatic desert-like landscapes, then forests and mountains on the approach to the Villa La Angostura, a colonial type hotel, beside a stunning lake where we spend the night. The pre-trip information stressed the need for fitness preparation, but didn’t mention the need to induce liver enzymes to cope with vast quantities of Argentinian and Chilean wine consumed in the evenings!
The next morning we were back on our mountain bikes, notwithstanding sore heads and even more uncomfortable perineal parts, the legacy of the previous day’s cycling. A 90 Km ride with three seemingly endless climbs takes us to Aguas Calientes, where our weary legs benefit from alternate immersion in hot springs and submersion in freezing river water formed by glacial melt-water.
An Andean vulture circles ominously overhead as the last weary cyclists toil to the top of the Puyehue Pass in Argentina. A gruelling 27 Km uphill ride has brought 47 sweating participants to the border with Chile. Here, at the highest point that we reach on this Challenge, we hold a minute’s silence to remember friends, relations and patients who are sadly no longer with us.
After toiling up the Argentinian side of the Andes, we hurtled down the Chilean slopes where we encountered snow-capped volcanoes, turquoise lakes and spectacular waterfalls rushing between the rock formations of the beautiful Osorno volcano. The laughter and team camaraderie continued to build as the four sporty Belgians who cycle all in black are integrated seamlessly into the group. We dubbed them “L’Equipe Noir”
Luckily for us the good weather held for the week and although there were a few more plummets from the bikes, there were no serious injuries. We cycled 462 Km and climbed in all 16,454 feet. We held a celebratory dinner in Puerto Varas, by Lake LLanquihue, in Chile, with an Awards Ceremony, which includes the sought-after prize for the “best female bum”, proudly won by Georgina Stewart. The really great news is that we have raised more than £287,000 for TUF. The money will be targeted on research into urological cancers, as well as training urologists in new surgical technologies, utilizing robotics and laparoscopy. We will also deploy funds to develop our personal development programmes for trainees and younger consultants, including “SpRUCE ” interview training and “Thriving and Surviving as a First Year Consultant.” To do these important things we need your support. Why not join us on our next cycle Challenge for TUF in South Africa in November 2013? For more information check out www.theurologyfoundation.org or www.actionforcharity.co.uk . Come on guys and gals, get on yer bikes!
Bike Accident Common Causes
When a bicycle crash involving a motor vehicle results in injuries, there is a common misconception that it is the cyclist who is probably to blame. However, statistics show motorists are more often at-fault.
The City of Boston reported that in 55 percent of bicycle vs. vehicle accidents locally, it’s the motor vehicle operator who is cited.
If you get involved on any kind of traffic accident with injuries result from carelessness or recklessness of a driver, appeal law and order to pursue a claim for compensation.
Bicycle accident fatalities account for 2 percent of all traffic-related deaths, according to the National Highway Traffic Safety Administration (NHTSA). However, hospital data shows only a fraction of bicycle accidents that result in injury are recorded by police. Even among recorded cycling accidents, the National Safety Council reports a 9 percent increase between 2001 and 2011. There was also a 9 percent increase in bicyclist deaths between 2011 and 2013.
For insurance purposes, collisions between bicyclists and vehicle drivers are considered “auto accidents,” and injured cyclists are entitled to collect damages to cover hospital bills, lost wages and other costs. In hit-and-run accidents or those in which the driver lacks or has limited insurance, the cyclist can also use his or her own uninsured/ underinsured auto coverage.
Matthew Bultitude, BJUI Associate Editor, discusses the direction the Journal has taken towards the web. The video includes an explanation of the key features that can be found on the BJUI website, including the Article of the Week, Picture Quizzes, Polls, Blogs and Videos.
A case-mix-adjusted comparison of early oncological outcomes of open and robotic prostatectomy performed by experienced high volume surgeons
Jonathan L. Silberstein*, Daniel Su*, Leonard Glickman*, Matthew Kent†, Gal Keren-Paz*, Andrew J. Vickers†, Jonathan A. Coleman*‡, James A. Eastham*‡, Peter T. Scardino*‡ and Vincent P. Laudone*‡
*Department of Surgery, Urology Service, and †Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, and ‡Department of Urology,Weill Cornell Medical Center, New York, NY, USA
• To compare early oncological outcomes of robot assisted laparoscopic prostatectomy (RALP) and open radical prostatectomy (ORP) performed by high volume surgeons in a contemporary cohort.
• We reviewed patients who underwent radical prostatectomy for prostate cancer by high volume surgeons performing RALP or ORP.
• Biochemical recurrence (BCR) was defined as PSA 0.1 ng/mL or PSA 0.05 ng/mL with receipt of additional therapy.
• A Cox regression model was used to evaluate the association between surgical approach and BCR using a predictive model (nomogram) based on preoperative stage, grade, volume of disease and PSA.
• To explore the impact of differences between surgeons, multivariable analyses were repeated using surgeon in place of approach.
• Of 1454 patients included, 961 (66%) underwent ORP and 493 (34%) RALP and there were no important differences in cancer characteristics by group.
• Overall, 68% of patients met National Comprehensive Cancer Network (NCCN) criteria for intermediate or high risk disease and 9% had lymph node involvement. Positive margin rates were 15% for both open and robotic groups.
• Using NCCN risk group as the covariate in a Cox model gave similar results (hazard ratio 0.74; 95% CI 0.47–1.17; P = 0.2). The interaction term between NCCN risk and procedure type was also non-significant.
• Differences in BCR rates between techniques (4.1% vs 3.3% adjusted risk at 2 years) were smaller than those between surgeons (2.5% to 4.8% adjusted risk at 2 years).
• In this relatively high risk cohort of patients undergoing radical prostatectomy we found no evidence to suggest that ORP resulted in better early oncological outcomes then RALP.
• Oncological outcome after radical prostatectomy may be driven more by surgeon factors than surgical approach.
Effects of 12 weeks of tadalafil treatment on ejaculatory and orgasmic dysfunction and sexual satisfaction in patients with mild to severe erectile dysfunction: integrated analysis of 17 placebo-controlled studies
Darius A. Paduch*†, Alexander Bolyakov*†, Paula K. Polzer‡ and Steven D. Watts‡
*Department of Urology and Reproductive Medicine,Weill Cornell Medical College, New York, NY, †Consulting Research Services, Inc., Red Bank, NJ, and ‡Lilly Research Laboratories, Eli Lilly, Indianapolis, IN, USA
The idea of a joint fund-raising trek in support of Prostate Cancer UK (formerly Prostate Action) and Well-Being of Women (WoW) dates back to 2005, when almost 100 trekkers joined us to walk across the desert to Petra in Jordan to raise more than £600,000 for these two noble causes. Neither Marcus Setchell nor I thought then that subsequently we would go on to trek in Kenya, Sinai, Kerala, and most recently Morocco, to raise an eventual cumulative sum of £1.3 million.
The fifth and final Hike for Hope started inauspiciously with dark clouds and pouring rain, even though we were in Morocco in September, just a couple of hundred miles North of the Sahara desert. They told us it hadn’t rained for the whole year before we got there! Undaunted, but with little in the way of rain-gear, rather, an excess of redundant sunscreen products, we set off across the Ante-Atlas mountains in the direction of Marrakesh.
This time, there were 27 intrepid trekkers, including the redoubtable Andrew Etherington, Felicity Hoare and Rex Willoughby, veterans who had each accompanied us on all the previous four Hikes for Hope, as well as Rosemary Macaire. Unfortunately on day one the rain became steadily heavier, with the result that the beds of the mountain streams, usually dry, became minor torrents, which were more and more difficult to cross. We made the decision to abandon the last hour’s walking to the camp and instead managed to persuade some of the local people to let us shelter in two of their mountain huts for that night.
Days two and three were tough trekking, but in fine dry weather. We got to the very highest point of the mountain before holding a minute’s silence for those relatives and friends who had succumbed to prostate or pelvic cancer, the cures for which we were raising money. Perhaps as the result of our efforts, we are a little closer to that goal.
On day four the rain returned, this time with even greater intensity, and accompanied by a bitterly cold wind. With little in the way of protective clothing, hypothermia became an issue. Again the amazing hospitality of the local Berber goat herders came to our rescue. Cold, wet and shivering, packed in again like sardines, we managed to get some sleep, occasionally interrupted by a goat or two, who seemed justifiably irritated to be displaced from their usual place of nocturnal shelter! To the credit of the guides, the trek doctor and the trekkers themselves, morale and good humour were maintained.
On the final day the weather improved sufficiently for us to trek down the mountain to join the first road we had encountered for five days. A drive through the Atlas Mountains took us to the wonderful city of Marrakesh, where a well-deserved celebratory dinner and award ceremony took place. The trials and tribulations of our mountain trek had brought us all much closer together, so it was with a tinge of sadness that the Hikers for Hope disbanded and headed for home. The final sum of money raised and the camaraderie and bonding that occurred during the trek made the whole experience so very worthwhile.
Pain relief after ureteric stent removal: think NSAIDs
Nicholas N. Tadros, Lisa Bland, Edith Legg, Ali Olyaei and Michael J. Conlin*
Oregon Health & Science University and *Portland Veterans Administration Medical Center, Portland, OR, USA
• To determine the incidence of severe pain after ureteric stent removal.
• To evaluate the efficacy of a single dose of a non-steroidal anti-inflammatory drug (NSAID) in preventing this complication.
PATIENTS AND METHODS
• A prospective, randomised, double-blind, placebo-controlled trial was performed at our institution.
• Adults with an indwelling ureteric stent after ureteroscopy were randomised to receive either a single dose of placebo or an NSAID (rofecoxib 50 mg) before ureteric stent removal.
• Pain was measured using a visual analogue scale (VAS) just before and 24 h after stent removal
• Pain medication use after ureteric stent removal was measured using morphine equivalents.
• In all, 22 patients were enrolled and randomised into the study before ending the study after interim analysis showed significant decrease in pain level in the NSAID group.
• The most common indication for ureteroscopy was urolithiasis (14 patients).
• The proportion of patients with severe pain (VAS score of ≥7) during the 24 h after ureteric stent removal was six of 11 (55%) in the placebo group and it was zero of 10 in the NSAID group (P < 0.01).
• There were no complications related to the use of rofecoxib.
• We found a 55% incidence of severe pain after ureteric stent removal.
• A single dose of a NSAID before stent removal prevents severe pain after ureteric stent removal.
Tadros NN, Bland L, Legg E, et al. A single dose of a non-steroidal anti-inflammatory drug (NSAID) prevents severe pain after ureteric stent removal: a prospective, randomised, double-blind, placebo-controlled trial. BJU Int 2013, 111: 101–105.
Natural orifice transluminal endoscopic surgery (NOTES): where are we going? A bibliometric assessment
Riccardo Autorino*†, Rachid Yakoubi*, Wesley M. White‡, Matthew Gettman§, Marco De Sio†, Carmelo Quattrone†, Carmine Di Palma†, Alessandro Izzo†, Jeorge Correia-Pinto¶, Jihad H. Kaouk* and Estevão Lima¶
*Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA, †Urology Unit, Second University of Naples, Naples, Italy, ‡Division of Urologic Surgery, University of Tennessee, Knoxville, TN, and §Department of Urology, Mayo Clinic, Rochester, MN, USA, and ¶Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
The aim of this study was to analyse natural oriﬁce transluminal endoscopic surgery (NOTES)-related publications over the last 5 years. A systematic literature search was done to retrieve publications related to NOTES from 2006 to 2011. The following variables were recorded: year of publication; article type; study design; setting; Journal Citation Reports® journal category; authors area of surgical speciality; geographic area of origin; surgical procedure; NOTES technique; NOTES access route; number of clinical cases. A time-trend analysis was performed by comparing early (2006–2008) and late (2009–2011) study periods. Overall, 644 publications were included in the analysis and most papers were found in general surgery journals (50.9%). Studies were most frequently clinical series (43.9%) and animal experimental (48%), with the articles focusing primarily on cholecystectomy, access creation and closure, and peritoneoscopy. Pure NOTES techniques were performed in most of the published reports (85%) with the remaining cases being hybrid NOTES (7.4%) and NOTES-assisted procedures (6.1%). The access routes included transgastric (52.5%), transcolonic (12.3%), transvesical (12.5%), transvaginal (10.5%), and combined (12.3%). From the early to the late period, there was a signiﬁcant increase in the number of randomised controlled trials (5.6% vs 7.2%) or non-randomised but comparative studies (5.6% vs 22.9%) (P < 0.001) and there was also a signiﬁcant increase in the number of colorectal procedures and nephrectomies (P = 0.002). Pure NOTES remained the most studied approach over the years but with increased investigation in the ﬁeld of NOTES-assisted techniques (P = 0.001). There was also a signiﬁcant increase in the adoption of transvesical access (7% vs 15.6%) (P = 0.007). NOTES is in a developmental stage and much work is still needed to reﬁne techniques, verify safety and document eﬃcacy. Since the ﬁrst description of the concept of NOTES, >2000 clinical cases, irrespective of specialty, have been reported. NOTES remains a ﬁeld of intense clinical and experimental research in various surgical specialities.
Autorino R, Yakoubi R, White WM, et al. Natural orifice transluminal endoscopic surgery (NOTES): where are we going? A bibliometric assessment. BJU Int 2013; 111: 11–16