154 research outputs found
Biochemical Recurrence and Risk of Mortality Following Radiotherapy or Radical Prostatectomy
No full textImportance: Stratifying patients with biochemical recurrence (BCR) after primary treatment for prostate cancer based on the risk of prostate cancer-specific mortality (PCSM) is essential for determining the need for further testing and treatments. Objective: To evaluate the association of BCR after radical prostatectomy or radiotherapy and its current risk stratification with PCSM. Design, Setting, and Participants: This population-based cohort study included a total of 16 311 male patients with 10 364 (64%) undergoing radical prostatectomy and 5947 (36%) undergoing radiotherapy with curative intent (cT1-3, cM0) and PSA follow-up in Stockholm, Sweden, between 2003 and 2019. Follow-up for all patients was until death, emigration, or end of the study (ie, December 31, 2018). Data were analyzed between September 2022 and March 2023. Main Outcomes and Measures: Primary outcomes of the study were the cumulative incidence of BCR and PCSM. Patients with BCR were stratified in low- and high-risk according to European Association of Urology (EAU) criteria. Exposures: Radical prostatectomy or radiotherapy. Results: A total of 16 311 patients were included. Median (IQR) age was 64 (59-68) years in the radical prostatectomy cohort (10 364 patients) and 69 (64-73) years in the radiotherapy cohort (5947 patients). Median (IQR) follow-up for survivors was 88 (55-138) months and 89 (53-134) months, respectively. Following radical prostatectomy, the 15-year cumulative incidences of BCR were 16% (95% CI, 15%-18%) for the 4024 patients in the low D'Amico risk group, 30% (95% CI, 27%-32%) for the 5239 patients in the intermediate D'Amico risk group, and 46% (95% CI, 42%-51%) for 1101 patients in the high D'Amico risk group. Following radiotherapy, the 15-year cumulative incidences of BCR were 18% (95% CI, 15%-21%) for the 1230 patients in the low-risk group, 24% (95% CI, 21%-26%) for the 2355 patients in the intermediate-risk group, and 36% (95% CI, 33%-39%) for the 2362 patients in the high-risk group. The 10-year cumulative incidences of PCSM after radical prostatectomy were 4% (95% CI, 2%-6%) for the 1101 patients who developed low-risk EAU-BCR and 9% (95% CI, 5%-13%) for 649 patients who developed high-risk EAU-BCR. After radiotherapy, the 10-year PCSM cumulative incidences were 24% (95% CI, 19%-29%) for the 591 patients in the low-risk EAU-BCR category and 46% (95% CI, 40%-51%) for the 600 patients in the high-risk EAU-BCR category. Conclusions and Relevance: These findings suggest the validity of EAU-BCR stratification system. However, while the risk of dying from prostate cancer in low-risk EAU-BCR after radical prostatectomy was very low, patients who developed low-risk EAU-BCR after radiotherapy had a nonnegligible risk of prostate cancer mortality. Improving risk stratification of patients with BCR is pivotal to guide salvage treatment decisions, reduce overtreatment, and limit the number of staging tests in the event of PSA elevations after primary treatment.</p
Reply to Borivoj Golijanin, Anthony Mega, and Dragan Golijanin's Letter to the Editor re:Ivo I. de Vos, Sebastiaan Remmers, Renée Hogenhout, Monique J. Roobol, ERSPC Rotterdam Study Group. Prostate Cancer Mortality Among Elderly Men After Discontinuing Organised Screening: Long-term Results from the European Randomized Study of Screening for Prostate Cancer Rotterdam. Eur Urol 2024;85:74–81
No full textPersonalized strategies in population screening for prostate cancer
No full textThis review discusses evidence for population-based screening with contemporary screening tools. In Europe, prostate-specific antigen (PSA)-based screening led to a relative reduction of prostate cancer (PCa) mortality, but also to a substantial amount of overdiagnosis and unnecessarily biopsies. Risk stratification based on a single variable (a clinical variable or based on the presence of a lesion on prostate imaging) or based on multivariable approaches can aid in reducing unnecessary prostate biopsies and overdiagnosis by selecting men who can benefit from further clinical assessment. Multivariable approaches include clinical variables, and biomarkers, often combined in risk calculators or nomograms. These risk calculators can also incorporate the result of MRI imaging. In general, as compared to a purely PSA based approach, the combination of relevant prebiopsy information results in superior selection of men at higher risk of harboring clinically significant prostate cancer. Currently, it is not possible to draw any conclusions on the superiority of these multivariable risk-based approaches since head-to-head comparisons are virtually lacking. Recently initiated large population-based screening studies in Finland, Germany and Sweden, incorporating various multivariable risk stratification approaches will hopefully give more insight in whether the harm-benefit ratio can be improved, that is, maintain (or improving) the ability to reduce metastatic disease and prostate cancer mortality while reducing harm caused by unnecessary testing and overdiagnosis including related overtreatment
Studies on the natural history of prostate cancer and multivariable risk stratification in early detection and treatment
No full textStudies on the natural history of prostate cancer and multivariable risk stratification in early detection and treatment
No full textStudies on the natural history of prostate cancer and multivariable risk stratification in early detection and treatment
No full textHost genetic effects on HIV-1 replication in macrophages
No full textSebastiaan Bol ging op zoek naar humane eiwitten die hiv-vermenigvuldiging ondersteunen of remmen, met name in macrofagen. Deze cellen leven lang, gaan niet dood als gevolg van hiv-infectie en zijn - doordat ze zich veelal in weefsels bevinden - lastig bereikbaar voor hiv-remmers. Hierdoor vormen hiv-geïnfecteerde macrofagen één van de belangrijke barrières voor het genezen van mensen met hiv. Bol infecteerde macrofagen van honderden gezonde donoren met hiv en zocht naar verbanden tussen de mate waarin het virus zich vermenigvuldigde en variaties in het DNA (SNPs) van de betreffende proefpersonen. Hij identificeerde SNPs die coderen voor twee eiwitten die wellicht betrokken zijn bij hiv-replicatie in macrofagen. De SNP in één daarvan lijkt ook geassocieerd met ziektebeloop
Discontinuities in materials and structures: A unifying computational approach
No full textFailure mechanisms in materials and structures can be studied on different length scales. On a structural level, failure can be observed as the propagation of a single crack. However, when zooming into the apparent crack tip, it is revealed that the actual failure process is set by the nucleation and growth of multiple micro-cracks that together form the dominant crack. In crystalline materials, the nucleation of cracks can be traced back to even smaller levels of observation. The collective glide of dislocations in the atomistic structure of these materials appears to be the driving mechanism for the nucleation of micro-cracks near free edges. From a mathematical point of view the creation and propagation of cracks and the glide of dislocations can be considered as evolving discontinuities in the material. This thesis focuses on the numerical representation of these discontinuities on different length scales, varying from the simulation of delamination growth in fibre-metal laminates to a model that incorporates slip due to the motion of discrete dislocations.Aerospace Engineerin
Mode-jumping simulations using the new implicit time integrator in B2000
No full textAerospace Engineerin
Development of a constitutive model for self-healing materials
No full textThis report is the result of a pilot-study towards the numerical simulation of self-healing materials. At the moment this project is conducted the development of self-healing materials is in an early stage. At the chair of Engineering Mechanics of the faculty of Aerospace Engineering, Delft University of Technology, no numerical model has been developed yet for this new kind of materials. This project is a first exploration of the possibilities to simulate the behaviour of self-healing materials by numerical models. This exploration has been done by developing a constitutive law that adequately describes the mechanical behaviour of these materials. Subsequently this new constitutive law has been tested in a 1-dimensional test case and in a finite element setting.Aerospace Materials & ManufacturingAerospace Engineerin
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