1,721,007 research outputs found
Reply to Ian Beckley and Masood A. Khan's letter to the editor Re: Felix K.-H. Chun, Thomas Steuber, Andreas Erbersdobler, et al. development and internal validation of a nomogram predicting the probability of prostate cancer gleason sum upgrading between biopsy and radical prostatectomy pathology. Eur Urol 2006;49 : 820-26
No full textCritical assessment of tools to predict clinically insignificant prostate cancer at radical prostatectomy in contemporary men
No full textBACKGROUND. Overtreatment of prostate cancer (PCa) is a concern, especial;u patients who might quality for the diagnosis of insignificant prostate cancer (IPCa). The ability to identify IPCa prior to definitive therapy was tested. METHODS. In a cohort of 1132 men a nomogram was developed to predict the probability of IPCa. Predictors consisted of prostate-specific antigen (PSA), clinical stage, biopsy Gleason sum, core cancer length and percentage of positive biopsy cores (percent positive cores). IPCa was defined as organ-confined PCa (OC) With tumor volume (TV) < 0.5 cc and without Gleason 4 or 5 patterns. Finally, an external validation of the most accurate IPCa nomogram was performed in the same group. RESULTS. IPCa was pathologically confirmed in 65 (5.7%) trien. The 200 bootstrap-corrected predictive accuracy of the new nomogram Was 90% versus 81% for the older nomogram. However, in cutoff-based analyses of patients who were qualified by our and the older nomgrams as high probability for IPCa, respectively 63% and 45% harbored aggressive PCa variants at radical prostatectomy (Gleason score 7-10, ECE, SVI, and/or LNI). CONCLUSIONS. Despite a high accuracy, currently available models for prediction of IPCa are incorrect in 10% to 20% of predictions. The rate of misclassification is even further inflated when specific Cutoffs are used. As a CONCLUSIONS. extreme caution is advised when statistical tools are Used to assign the diagnosis of IPCa
GLEASON SCORE UPGRADING AT TIME OF PATHOLOGICAL GLEASON SCORE OCCURS MORE FREQUENTLY IN EXTERNAL BASED BIOPSIES THAN IN UNIVERSITY-BASED BIOPSIES
No full textA comparative review of apomorphine formulations for erectile dysfunction - Recommendations for use in the elderly
No full textErectile dysfunction (ED) is a common medical condition that affects the sexual life of millions of men worldwide. First-line oral therapy for ED includes the use of phosphodiesterase type 5 inhibitors (sildenafil, tadalafil and vardenafil) and sublingual apomorphine. Apomorphine is a dopamine D-1 and D-2 receptor agonist that has been approved for marketing in Europe. Different apomorphine formulations have been tested, such as sublingual, subcutaneous and intranasal. However, the sublingual formulation has shown the best results in terms of efficacy, safety and tolerability, especially the 2mg and 3mg doses. Although clinical studies of the efficacy and tolerability of apomorphine sublingual (SL) have included older patients, who are more likely to have ED, no study has specifically assessed the efficacy and tolerability of different doses of apomorphine SL in aging men. Therefore, a MEDLINE search was conducted from January 1987 to November 2005 to identify studies of the efficacy, safety (in particular cardiovascular safety) and tolerability of different apomorphine formulations and doses as treatments for ED in the subcohort of aging men. On the basis of the most recent peer-reviewed publications, the first part of this article critically evaluates data regarding the epidemiology of ED in the aging population. The second part of the article focuses on the mechanism of action and pharmacokinetics of apomorphine both in the general and the elderly population. Finally, a critical analysis of the efficacy and safety of different apomorphine formulations and doses for the treatment of ED is reported. Apomorphine represents a first-line oral treatment for ED. Available formulations include only sublingual administration. Few studies have assessed the efficacy and safety of apomorphine in the elderly population. However, in clinical practice, older patients with multiple vascular risk factors and systematic vascular damage show poor overall response to apomorphine SL for the treatment of ED
Validation of a nomogram predicting the probability of lymph node invasion among patients undergoing radical prostatectomy and an extended pelvic lymphadenectomy
No full textIntroduction: Our goal was to develop and internally validate a nomogram for prediction of lymph node invasion (LNI) in patients with clinically localized prostate cancer undergoing extended pelvic lymphadenectomy (ePLND). Methods: 602 consecutive patients (mean age 65.8 years) underwent an ePLND, where 10 or more nodes were removed. PSA was 1.1-49.9 (median 7.2). Clinical stages were: T1c in 55.6%, T2 in 41.4% and T3 in 3%. Biopsy Gleason sums were: 6 or less in 66%, 7 in 25.4%, 8-10 in 8.6%. Multivariate logistic regression models tested the association between all of the above predictors and LNI. Regression-based coefficients were used to develop a nomogram predicting LNI and 200 bootstrap resamples were used for internal validation. Results: Mean number of lymph nodes removed was 17.1 (range 10-40). LNI was detected in 66 patients (11.0%). Univariate predictive accuracy for total PSA, clinical stage and biopsy Gleason sum was 63%, 58% and 73%, respectively. A nomogram based on clinical stage, PSA and Biopsy Gleason sum demonstrated bootstrap-corrected predictive accuracy of 76%. Conclusions: A nomogram based on pre-treatment PSA, clinical stage and biopsy Gleason sum can highly accurately predict LNI at ePLND. (c) 2006 Elsevier B.V. All rights reserved
Critical assessment of ideal nodal yield at pelvic lymphadenectomy to accurately diagnose prostate cancer nodal metastasis in patients undergoing radical retropubic prostatectomy
No full textOBJECTIVES To study the relation between the number of removed and examined lymph nodes at pelvic lymph node dissection and the rate of lymph node invasion (LNI). METHODS A total of 858 patients aged 45 to 85 years were predominantly treated with extended pelvic lymph node dissection before radical retropubic prostatectomy. The pretreatment prostate-specific antigen level was 0.24 to 49.9 ng/mL (median 5.8). Most lesions were Stage Tlc (55.2%) or T2 (40.7%), with a biopsy Gleason SLIM of 6 or less (62.2%) or 7 (25.1%). Receiver operating characteristic curve coordinates were used to determine the probability of finding LNI according to the number of removed and examined lymph nodes. Moreover, the association between the number of removed lymph nodes and LNI was tested in univariate and multivariate logistic regression models. RESULTS From 2 to 40 nodes (mean 15, median 14) were removed and examined, and 88 patients (10.3%) had LNI. The LNI rate increased with the number of removed nodes (P < 0.001): 2 to 10 nodes rernoved, 5.6% LNI rate; 10 to 14 nodes removed, 8.6% LNI rate; 15 to 19 removed, 10.2% LNI rate; and 20 to 40 removed, 17.6% LNI rate. On multivariate analysis, the number of examined nodes predicted for LNI (P < 0.001), after accounting for prostate-specific antigen level, clinical stage, and biopsy Gleason sum. The receiver operating characteristic coordinate plot indicated that the removal of 28 nodes yielded a 90% ability to detect LNI. Conversely, the assessment of 10 or fewer nodes was associated with a virtually zero probability of finding LNI. CONCLUSIONS We have provided a critical assessment of the concept that the nodal yield at pelvic lymph node dissection is closely associated with the rate of LNI.OBJECTIVES To study the relation between the number of removed and examined lymph nodes at pelvic lymph node dissection and the rate of lymph node invasion (LNI). METHODS A total of 858 patients aged 45 to 85 years were predominantly treated with extended pelvic lymph node dissection before radical retropubic prostatectomy. The pretreatment prostate-specific antigen level was 0.24 to 49.9 ng/mL (median 5.8). Most lesions were Stage Tlc (55.2%) or T2 (40.7%), with a biopsy Gleason SLIM of 6 or less (62.2%) or 7 (25.1%). Receiver operating characteristic curve coordinates were used to determine the probability of finding LNI according to the number of removed and examined lymph nodes. Moreover, the association between the number of removed lymph nodes and LNI was tested in univariate and multivariate logistic regression models. RESULTS From 2 to 40 nodes (mean 15, median 14) were removed and examined, and 88 patients (10.3%) had LNI. The LNI rate increased with the number of removed nodes (P < 0.001): 2 to 10 nodes rernoved, 5.6% LNI rate; 10 to 14 nodes removed, 8.6% LNI rate; 15 to 19 removed, 10.2% LNI rate; and 20 to 40 removed, 17.6% LNI rate. On multivariate analysis, the number of examined nodes predicted for LNI (P < 0.001), after accounting for prostate-specific antigen level, clinical stage, and biopsy Gleason sum. The receiver operating characteristic coordinate plot indicated that the removal of 28 nodes yielded a 90% ability to detect LNI. Conversely, the assessment of 10 or fewer nodes was associated with a virtually zero probability of finding LNI. CONCLUSIONS We have provided a critical assessment of the concept that the nodal yield at pelvic lymph node dissection is closely associated with the rate of LNI
Identification of Pathologically Favorable Disease in Intermediate-Risk Prostate Cancer Patients: Implications for Active Surveillance Candidates Selection
No full textBACKGROUND. Intermediate-risk prostate cancer (PCa) represents a heterogeneous disease, where a non-negligible proportion of patients harbor favorable pathologic characteristics and are potentially eligible for active surveillance (AS). We aimed at developing a model for the identification of pathologically favorable PCa at radical prostatectomy (RP) among intermediate-risk patients. METHODS. Overall, 3,821 intermediate-risk patients treated with RP at two centers between 2005 and 2013 were identified. Pathologically favorable PCa was defined as low-grade organ-confined disease. Age, biopsy Gleason, PSA density (PSAD), and the percentage of positive cores were included in multivariable logistic regression analyses predicting favorable PCa and formed the basis for a logistic regression-based risk calculator. The internally validated discrimination and calibration of the risk calculator were quantified using 200 bootstrap resamples. Decision curve analysis (DCA) provided an estimate of the net benefit obtained using this model versus treating no one and treating everyone. RESULTS. Overall, 10.0% of all intermediate risk patients had favorable disease. In multivariable analyses, patients with biopsy Gleason score <= 6 had higher probability of favorable disease compared to those with higher-grade disease (P <= 0.001). Similarly, age, PSAD, and percentage of positive cores were associated with the probability of favorable disease (all P <= 0.01). The risk calculator achieved a validated accuracy of 82.5%. The DCA showed that our prediction model is better than both treating no one and treating everyone. CONCLUSIONS. One out of ten intermediate-risk patients harbors favorable disease at RP. Our novel, pre-operative, validated risk calculator may help clinicians identifying patients who could be considered for conservative therapy approaches such as AS. (C) 2015 Wiley Periodicals, Inc
A HEAD TO HEAD COMPARISON OF NOMOGRAMS PREDICITNG THE PROBABILITY OF LYMPHNODE INVASION IN PATIENTS UNDERGOING EXTENDED PELVIC LYMPH NODE DISSECTION
No full textObesity does not increase the risk of lymph node metastases in patients with clinically localized prostate cancer undergoing radical prostatectomy and extended pelvic lymph node dissection
No full textObjectives: Several studies have shown that obesity is associated with more aggressive prostate cancer (PCa) variants. We hypothesized that obesity, quantified as body mass index (BMI), is associated with a higher risk of lymph node invasion (LNI) in patients undergoing extended pelvic lymph node dissection (ePLND). Methods: Clinical and pathological data were available for 994 consecutive men with PCa treated with radical prostatectomy (RP) and ePLND at a single European tertiary academic centre. Univariable and multivariable logistic regression analyses addressed the rate of LNI. Covariates consisted of pre-treatment prostate specific antigen (PSA), biopsy Gleason sum, clinical stage history of diabetes mellitus as well as BMI coded as either continuous or categorized (= 0.1). Moreover, inclusion of BMI with PSA, clinical stage, biopsy Gleason sum and presence of DM did not increase the ability of these variables to predict LNI (82.2% without BMI vs 82.5% and 82.9% with BMI coded as continuous and categorized variable, respectively; all P >= 0.4). Conclusions: In men undergoing RP and ePLND, increased BMI was not associated with increased risk of lymph node metastases. Therefore, routinely considering patient BMI in risk stratification schemes or prognostic LNI models may not be warranted
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