283 results found
Miah S, Eldred-Evans D, Simmons LAM, et al., 2018, Patient Reported Outcome Measures for Transperineal Template Prostate Mapping Biopsies in the PICTURE Study, JOURNAL OF UROLOGY, Vol: 200, Pages: 1235-1240, ISSN: 0022-5347
Simmons LAM, Kanthabalan A, Arya M, et al., 2018, Accuracy of Transperineal Targeted Prostate Biopsies, Visual Estimation and Image Fusion in Men Needing Repeat Biopsy in the PICTURE Trial, JOURNAL OF UROLOGY, Vol: 200, Pages: 1227-1233, ISSN: 0022-5347
Olivier J, Stavrinides V, Kay J, et al., 2018, Immunohistochemical biomarker validation in highly selective needle biopsy microarrays derived from mpMRI-characterized prostates, PROSTATE, Vol: 78, Pages: 1229-1237, ISSN: 0270-4137
Elliott D, Hamdy FC, Leslie TA, et al., 2018, Overcoming difficulties with equipoise to enable recruitment to a randomised controlled trial of partial ablation vs radical prostatectomy for unilateral localised prostate cancer., BJU Int, Vol: 122, Pages: 970-977
OBJECTIVE: To describe how clinicians conceptualised equipoise in the PART (Partial prostate Ablation vs Radical prosTatectomy in intermediate-risk unilateral clinically localised prostate cancer) feasibility study and how this affected recruitment. SUBJECTS AND METHODS: PART included a QuinteT Recruitment Intervention (QRI) to optimise recruitment. Phase I aimed to understand recruitment, and included: scrutinising recruitment data, interviewing the trial management group and recruiters (n = 13), and audio-recording recruitment consultations (n = 64). Data were analysed using qualitative content and thematic analysis methods. In Phase II, strategies to improve recruitment were developed and delivered. RESULTS: Initially many recruiters found it difficult to maintain a position of equipoise and held preconceptions about which treatment was best for particular patients. They did not feel comfortable about approaching all eligible patients, and when the study was discussed, biases were conveyed through the use of terminology, poorly balanced information, and direct treatment recommendations. Individual and group feedback led to presentations to patients becoming clearer and enabled recruiters to reconsider their sense of equipoise. Although the precise impact of the QRI alone cannot be determined, recruitment increased (from a mean [range] of 1.4 [0-4] to 4.5 [0-12] patients/month) and the feasibility study reached its recruitment target. CONCLUSION: Although clinicians find it challenging to recruit patients to a trial comparing different contemporary treatments for prostate cancer, training and support can enable recruiters to become more comfortable with conveying equipoise and providing clearer information to patients.
Hamid S, Donaldson IA, Hu Y, et al., 2018, The SmartTarget Biopsy Trial: A Prospective, Within-person Randomised, Blinded Trial Comparing the Accuracy of Visual-registration and Magnetic Resonance Imaging/Ultrasound Image-fusion Targeted Biopsies for Prostate Cancer Risk Stratification., Eur Urol
BACKGROUND: Multiparametric magnetic resonance imaging (mpMRI)-targeted prostate biopsies can improve detection of clinically significant prostate cancer and decrease the overdetection of insignificant cancers. It is unknown whether visual-registration targeting is sufficient or augmentation with image-fusion software is needed. OBJECTIVE: To assess concordance between the two methods. DESIGN, SETTING, AND PARTICIPANTS: We conducted a blinded, within-person randomised, paired validating clinical trial. From 2014 to 2016, 141 men who had undergone a prior (positive or negative) transrectal ultrasound biopsy and had a discrete lesion on mpMRI (score 3-5) requiring targeted transperineal biopsy were enrolled at a UK academic hospital; 129 underwent both biopsy strategies and completed the study. INTERVENTION: The order of performing biopsies using visual registration and a computer-assisted MRI/ultrasound image-fusion system (SmartTarget) on each patient was randomised. The equipment was reset between biopsy strategies to mitigate incorporation bias. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The proportion of clinically significant prostate cancer (primary outcome: Gleason pattern ≥3+4=7, maximum cancer core length ≥4mm; secondary outcome: Gleason pattern ≥4+3=7, maximum cancer core length ≥6mm) detected by each method was compared using McNemar's test of paired proportions. RESULTS AND LIMITATIONS: The two strategies combined detected 93 clinically significant prostate cancers (72% of the cohort). Each strategy detected 80/93 (86%) of these cancers; each strategy identified 13 cases missed by the other. Three patients experienced adverse events related to biopsy (urinary retention, urinary tract infection, nausea, and vomiting). No difference in urinary symptoms, erectile function, or quality of life between baseline and follow-up (median 10.5 wk) was observed. The key limitations were lack of parallel-group randomisation and a limit on the number of
Dikaios N, Giganti F, Sidhu HS, et al., 2018, Multi-parametric MRI zone-specific diagnostic model performance compared with experienced radiologists for detection of prostate cancer., Eur Radiol
OBJECTIVES: Compare the performance of zone-specific multi-parametric-MRI (mp-MRI) diagnostic models in prostate cancer detection with experienced radiologists. METHODS: A single-centre, IRB approved, prospective STARD compliant 3 T MRI test dataset of 203 patients was generated to test validity and generalisability of previously reported 1.5 T mp-MRI diagnostic models. All patients included within the test dataset underwent 3 T mp-MRI, comprising T2, diffusion-weighted and dynamic contrast-enhanced imaging followed by transperineal template ± targeted index lesion biopsy. Separate diagnostic models (transition zone (TZ) and peripheral zone (PZ)) were applied to respective zones. Sensitivity/specificity and the area under the receiver operating characteristic curve (ROC-AUC) were calculated for the two zone-specific models. Two radiologists (A and B) independently Likert scored test 3 T mp-MRI dataset, allowing ROC analysis for each radiologist for each prostate zone. RESULTS: Diagnostic models applied to the test dataset demonstrated a ROC-AUC = 0.74 (95% CI 0.67-0.81) in the PZ and 0.68 (95% CI 0.61-0.75) in the TZ. Radiologist A/B had a ROC-AUC = 0.78/0.74 in the PZ and 0.69/0.69 in the TZ. Radiologists A and B each scored 51 patients in the PZ and 41 and 45 patients respectively in the TZ as Likert 3. The PZ model demonstrated a ROC-AUC = 0.65/0.67 for the patients Likert scored as indeterminate by radiologist A/B respectively, whereas the TZ model demonstrated a ROC-AUC = 0.74/0.69. CONCLUSION: Zone-specific mp-MRI diagnostic models demonstrate generalisability between 1.5 and 3 T mp-MRI protocols and show similar classification performance to experienced radiologists for prostate cancer detection. Results also indicate the ability of diagnostic models to classify cases with an indeterminate radiologist score. KEY POINTS: • MRI diagnostic models had similar performance
Bass EJ, Freeman A, Jameson C, et al., 2018, Prostate cancer diagnostic pathway: Is a one-stop cognitive MRI targeted biopsy service a realistic goal in everyday practice? A pilot cohort in a tertiary referral centre in the UK., BMJ Open, Vol: 8
OBJECTIVES: To evaluate the feasibility of a novel multiparametric MRI (mpMRI) and cognitive fusion transperineal targeted biopsy (MRTB) led prostate cancer (PCa) diagnostic service with regard to cancer detection and reducing time to diagnosis and treatment. DESIGN: Consecutive men being investigated for possible PCa under the UK 2-week wait guidelines. SETTING: Tertiary referral centre for PCa in the UK. PARTICIPANTS: Men referred with a raised prostate-specific antigen (PSA) or abnormal digital rectal examination between February 2015 and March 2016 under the UK 2-week rule guideline. INTERVENTIONS: An mpMRI was performed prior to patients attending clinic, on the same day. If required, MRTB was offered. Results were available within 48 hours and discussed at a specialist multidisciplinary team meeting. Patients returned for counselling within 7 days PRIMARY AND SECONDARY OUTCOME MEASURES: Outcome measures in this regard included the time to diagnosis and treatment of patients referred with a suspicion of PCa. Quality control outcome measures included clinically significant and total cancer detection rates. RESULTS: 112 men were referred to the service. 111 (99.1%) underwent mpMRI. Median PSA was 9.4 ng/mL (IQR 5.6-21.0). 87 patients had a target on mpMRI with 25 scoring Likert 3/5 for likelihood of disease, 26 4/5 and 36 5/5.57 (51%) patients received a local anaesthetic, Magnetic resonance imaging targeted biopsy (MRTB). Cancer was detected in 45 (79%). 43 (96%) had University College London definition 2 disease or greater. The times to diagnosis and treatment were a median of 8 and 20 days, respectively. CONCLUSIONS: This approach greatly reduces the time to diagnosis and treatment. Detection rates of significant cancer are high. Similar services may be valuable to patients with a potential diagnosis of PCa.
Marra G, Ploussard G, Ost P, et al., 2018, Focal therapy in localised prostate cancer: Real-world urological perspective explored in a cross-sectional European survey., Urol Oncol
INTRODUCTION: The urological community's opinion over focal therapy (FT) for prostate cancer (PCa) has never been assessed. Our aim was to investigate the current opinion on FT in the European urological community. METHODS: A 25-item questionnaire was devised according to the Cherries checklist and distributed through SurveyMonkey using a web link from November 2016 to October 2017. After a pilot validation (n = 40 urologists), the survey was sent through EAU and 9 other national European urological societies mailing list. Twitter was also used. RESULTS: We received 484 replies from 51 countries. Almost half (44.8%, n = 217) stated FT would represent a step forward, and 52.0% (n = 252) would suggest FT to a patient. Almost three-quarters (70.8%, n = 343) agreed FT will become a standard option after improvements in patient selection (n = 66) or when its effectiveness will be proven (n = 78), or both (n = 199). Most frequently used definition of FT was treatment of all significant (life-threatening) cancer foci whilst leaving untreated the rest of the gland (39.3%, n = 190). FT use was considered as an alternative to whole-gland treatments by 29.7% (n = 144), and to AS by 25.0% (n = 121). On multivariate analysis, FT availability and publications were associated with a positive opinion on FT. Conversely, attending International congresses, treating high PCa volumes and high percentages of high-risk PCa was associated with a negative opinion. CONCLUSIONS: FT is considered as an attractive option for PCa treatment by the European urological community sampled by our survey. FT availability positively influences these thoughts. The present survey suggests whilst some early adopters already embraced FT, the relative majority of the urological community is prone to embrace FT in the near future, once current areas of debate are solved.
Miah S, Dunford C, Edison M, et al., 2018, A prospective clinical, cost and environmental analysis of a clinician-led virtual urology clinic., Ann R Coll Surg Engl, Pages: 1-5
INTRODUCTION: Minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism is dependent upon accurate prediction of single-gland disease on the basis of preoperative imaging and biochemistry. The aims of this study were to validate currently available predictive models of single-gland disease in two UK cohorts and to determine if these models can facilitate MIP. MATERIAL AND METHODS: We collected data prospectively from our weekly follow-up virtual clinic over a continuous four-month period between July and September 2017. RESULTS: In total, we reviewed 409 patients. Following virtual clinic consultation, 68.5% of our patients were discharged from further follow-up. The majority of our patients (male 57.7%, female 55.5%) were of working age. The satisfaction scores were high, at 90.1%, and there were no reported adverse events as a result of using the virtual clinic. Our calculated cost savings were £18,744, with a predicted 12-month cost saving of £56,232. The creation of additional face-to-face clinic capacity has created an estimated 12-month increase in tariff generation for our unit of £72,072. In total, 4623 travel miles were avoided by patients using the virtual clinic, with an estimated avoided carbon footprint of 0.35-1.45 metric tonnes of CO2e, depending on mode of transport. Our predicted 12-month avoided carbon footprint is 1.04-4.04 metric tonnes of CO2e. CONCLUSIONS: Our virtual clinic model has demonstrated a trifecta of positive outcomes, namely, clinical, financial and environmental benefits. The environmental importance and benefits of a virtual clinic should be promoted as a social enterprise value when engaging stakeholders in setting up such a urological service. We propose the adoption of our virtual clinic model in those urological units considering this method of telemedicine.
Simmons LAM, Kanthabalan A, Arya M, et al., 2018, Prostate Imaging Compared to Transperineal Ultrasound-guided biopsy for significant prostate cancer Risk Evaluation (PICTURE): a prospective cohort validating study assessing Prostate HistoScanning., Prostate Cancer Prostatic Dis
BACKGROUND: Men with negative prostate biopsies or those diagnosed with low-risk or low-volume intermediate-risk prostate cancers often require a second prostate biopsy prior to a treatment decision. Prostate HistoScanning (PHS) is an ultrasound imaging test that might inform prostate biopsy in such men. METHODS: PICTURE was a prospective, paired-cohort validating trial to assess the diagnostic accuracy of imaging in men requiring a further biopsy (clinicaltrials.gov, NCT01492270) (11 January 2012-29 January 2014). We enrolled 330 men who had undergone a prior TRUS biopsy but where diagnostic uncertainty remained. All eligible men underwent PHS and transperineal template prostate mapping (TTPM) biopsy (reference standard). Men were blinded to the imaging results until after undergoing TTPM biopsies. We primarily assessed the ability of PHS to rule out clinically significant prostate (negative predictive value [NPV] and sensitivity) for a target histological condition of Gleason ≥4+3 and/or a cancer core length (MCCL) ≥6 mm. We also assessed the role of visually estimated PHS-targeted biopsies. RESULTS: Of the 330 men enrolled, 249 underwent both PHS and TTPM biopsy. Mean (SD) age was 62 (7) years, median (IQR) PSA 6.8 (4.98-9.50) ng/ml, median (IQR) number of previous biopsies 1 (1-2) and mean (SD) gland size 37 (15.5) ml. One hundred and forty six (59%) had no clinically significant cancer. PHS classified 174 (70%) as suspicious. Sensitivity was 70.3% (95% CI 59.8-79.5) and NPV 41.3% (95% CI 27.0-56.8). Specificity and positive predictive value (PPV) were 14.7% (95% CI 9.1-22.0) and 36.8% (95% CI 29.6-44.4), respectively. In all, 213/220 had PHS suspicious areas targeted with targeting sensitivity 13.6% (95% CI 7.3-22.6), specificity 97.6% (95% CI 93.1-99.5), NPV 61.6% (95% CI 54.5-68.4) and PPV 80.0% (95% CI 51.9-95.7). CONCLUSIONS: PHS is not a useful test in men seeking risk stratification following initial prostate biopsy.
Guillaumier S, Peters M, Arya M, et al., 2018, A Multicentre Study of 5-year Outcomes Following Focal Therapy in Treating Clinically Significant Nonmetastatic Prostate Cancer, EUROPEAN UROLOGY, Vol: 74, Pages: 422-429, ISSN: 0302-2838
Miah S, Winkler M, Ahmed HU, 2018, Re: Predictors of Infectious Complications After Targeted Prophylaxis for Prostate Needle Biopsy, EUROPEAN UROLOGY, Vol: 74, Pages: 523-524, ISSN: 0302-2838
Valerio M, Emberton M, Ahmed HU, 2018, Re: Henk G. van der Poel, Roderick C.N. van den Bergh, Erik Briers, et al. Focal Therapy in Primary Localised Prostate Cancer: The European Association of Urology Position in 2018. Eur Urol 2018;74:84-91., Eur Urol
Lovegrove CE, Matanhelia M, Randeva J, et al., 2018, Prostate imaging features that indicate benign or malignant pathology on biopsy, TRANSLATIONAL ANDROLOGY AND UROLOGY, Vol: 7, Pages: S420-S435, ISSN: 2223-4683
Hamdy FC, Elliott D, le Conte S, et al., 2018, Partial ablation versus radical prostatectomy in intermediate-risk prostate cancer: the PART feasibility RCT, HEALTH TECHNOLOGY ASSESSMENT, Vol: 22, Pages: 1-+, ISSN: 1366-5278
Chandak P, Byrne N, Lynch H, et al., 2018, Three-dimensional printing in robot-assisted radical prostatectomy - an Idea, Development, Exploration, Assessment, Long-term follow-up (IDEAL) Phase 2a study, BJU INTERNATIONAL, Vol: 122, Pages: 360-361, ISSN: 1464-4096
Appayya MB, Adshead J, Ahmed HU, et al., 2018, National implementation of multi-parametric magnetic resonance imaging for prostate cancer detection - recommendations from a UK consensus meeting, BJU INTERNATIONAL, Vol: 122, Pages: 13-25, ISSN: 1464-4096
Brown LC, Ahmed HU, Faria R, et al., 2018, Multiparametric MRI to improve detection of prostate cancer compared with transrectal ultrasound-guided prostate biopsy alone: the PROMIS study, HEALTH TECHNOLOGY ASSESSMENT, Vol: 22, Pages: 1-+, ISSN: 1366-5278
Shah TT, Valerio M, Ahmed HU, 2018, Re: Effect of Prior Focal Therapy on Perioperative, Oncologic and Functional Outcomes of Salvage Robotic Assisted Radical Prostatectomy, JOURNAL OF UROLOGY, Vol: 199, Pages: 1634-1635, ISSN: 0022-5347
Faria R, Soares MO, Spackman E, et al., 2018, Re: Jochen Walz. The "PROMIS" of Magnetic Resonance Imaging Cost Effectiveness in Prostate Cancer Diagnosis? Eur Urol 2018;73:31-2, EUROPEAN UROLOGY, Vol: 73, Pages: E151-E152, ISSN: 0302-2838
Ganzer R, Arthanareeswaran VKA, Ahmed HU, et al., 2018, Which technology to select for primary focal treatment of prostate cancer?-European Section of Urotechnology (ESUT) position statement, PROSTATE CANCER AND PROSTATIC DISEASES, Vol: 21, Pages: 175-186, ISSN: 1365-7852
Shah TT, Valerio M, Ahmed HU, 2018, Re: Effect of Prior Focal Therapy on Perioperative, Oncologic and Functional Outcomes of Salvage Robotic Assisted Radical Prostatectomy: I. Nunes-Silva, E. Barret, V. Srougi, M. Baghdadi, P. Capogrosso, S. Garcia-Barreras, S. Kanso, R. Tourinho-Barbosa, A. Carneiro, R. Sanchez-Salas, F. Rozet, M. Galiano and X. Cathelineau J Urol 2017;198:1069-1076., J Urol, Vol: 199, Pages: 1634-1635
Bonmati E, Hu Y, Villarini B, et al., 2018, Technical Note: Error metrics for estimating the accuracy of needle/instrument placement during transperineal magnetic resonance/ultrasound-guided prostate interventions, MEDICAL PHYSICS, Vol: 45, Pages: 1408-1414, ISSN: 0094-2405
Giancarlo M, Ploussard G, Ost P, et al., 2018, AN INTERNATIONAL SURVEY ABOUT FOCAL THERAPY FOR PROSTATE CANCER FROM THE YOUNG ACADEMIC UROLOGISTS (YAU): THE OPINION OF 484 PHYSICIANS, Publisher: INT INST ANTICANCER RESEARCH, Pages: 2567-2568, ISSN: 0250-7005
Shah TT, Peters M, Guillaumier S, et al., 2018, PREDICTORS OF POOR FUNCTIONAL OUTCOMES AFTER FOCAL HIGH INTENSITY FOCUSSED ULTRASOUND (HIFU), American-Urological-Association(AUA) Annual Meeting, Publisher: ELSEVIER SCIENCE INC, Pages: E378-E379, ISSN: 0022-5347
Ahmed HU, 2018, Opening Our Eyes to Multiparametric Magnetic Resonance Imaging Before Prostate Biopsy, EUROPEAN UROLOGY, Vol: 73, Pages: 361-362, ISSN: 0302-2838
Grey A, Scott R, Charman S, et al., 2018, The CADMUS trial - Multi-parametric ultrasound targeted biopsies compared to multi-parametric MRI targeted biopsies in the diagnosis of clinically significant prostate cancer, CONTEMPORARY CLINICAL TRIALS, Vol: 66, Pages: 86-92, ISSN: 1551-7144
Walker NAF, Norris JM, Shah TT, et al., 2018, A comparison of time taken to return to baseline erectile function following focal and whole gland ablative therapies for localized prostate cancer: A systematic review, UROLOGIC ONCOLOGY-SEMINARS AND ORIGINAL INVESTIGATIONS, Vol: 36, Pages: 67-76, ISSN: 1078-1439
Chau EM, Arya M, Petrides N, et al., 2018, Performance characteristics of multiparametric-MRI at a non-academic hospital using transperineal template mapping biopsy as a reference standard, INTERNATIONAL JOURNAL OF SURGERY OPEN, Vol: 10, Pages: 66-71, ISSN: 2405-8572
Kasivisvanathan V, Ahmed H, Cashman S, et al., 2018, The British Urology Researchers in Surgical Training (BURST) Research Collaborative: an alternative research model for carrying out large scale multi-centre urological studies, BJU INTERNATIONAL, Vol: 121, Pages: 6-9, ISSN: 1464-4096
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