Quality of evidence to compare outcomes of open and robot-assisted laparoscopic prostatectomy.

Robot-assisted laparoscopic radical prostatectomy (RALP) has gained widespread acceptance in the treatment of prostate cancer. While it increasingly is becoming the surgical approach of choice in many centers, limited data exist directly comparing it to radical retropubic prostatectomy (RRP). This review examines the evidence comparing RALP to RRP.

The example of CaPSURE: lessons learned from a national disease registry.

Introduction: Although randomized controlled trials (RCTs) remain the gold standard for determining evidence-based clinical practices, large disease registries that enroll large numbers of patients have become paramount as a relatively cost-effective additional tool.

Methods: We highlight the advantages of disease registries focusing on the example of prostate cancer and the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE™) registry.

Results: CaPSURE collects approximately 1,000 clinical and patient-reported variables, in over 13,000 men that are enrolled.

Web-accessible interactive software of 3D anatomy representing pathophysiological conditions to enhance the patient-consent process for procedures.

Conveying to a patient the exact physical nature of a disease or procedure can be difficult. By establishing an access website, and using existing 3D viewer software along with our expanding set of anatomical models, we can provide an interface to manipulate realistic, 3D models of common anatomical ailments, chosen from a database frequently updated at the request of the medical community. Physicians will be able to show patients exactly what their condition looks like internally, and explain in better detail how a procedure will be performed.

Oncological and functional outcomes of radical cystectomy and orthotopic bladder replacement in women.

Objective: To report oncological and functional results in women undergoing radical cystectomy and orthotopic bladder replacement.

Materials And Methods: The charts of all women undergoing bladder replacement after radical cystectomy at UCSF through April 2008 were reviewed. Pathologic characteristics, survival (overall and disease-specific), and urinary functional outcomes are reported.

Complications rates of non-oncologic urologic procedures in population-based data: a comparison to published series.

Purpose: Published single institutional case series are often performed by one or more surgeons with considerable expertise in specific procedures. The reported incidence of complications in these series may not accurately reflect community-based practice. We sought to compare complication and mortality rates following urologic procedures derived from population-based data to those of published single-institutional case series.

Prostate cancer screening: issues and controversies.

Prostate cancer is the second leading cause of cancer death among men. Because it has been thought that identifying the disease earlier leads to better outcomes, there has been a great deal of interest in screening for the disease. Since the late 1980s, testing for elevated prostate-specific antigen (PSA) levels in blood has been the most prominent screening tool.

Surgical management after active surveillance for low-risk prostate cancer: pathological outcomes compared with men undergoing immediate treatment.

Unlabelled: Study Type--Therapy (case control) Level of Evidence 3b. What's known on the subject? and What does the study add? The risks of delayed radical prostatectomy for men who progress on active surveillance are largely unknown. Two series have reported that prostatectomy after active surveillance has similar results to immediate therapy.

Effect of a minimum lymph node policy in radical cystectomy and pelvic lymphadenectomy on lymph node yields, lymph node positivity rates, lymph node density, and survivorship in patients with bladder cancer.

Background: Extended pelvic lymphadenectomy (PLND) during radical cystectomy (RC) reportedly improves bladder cancer-specific survival. Lymph node counts are often a proxy for the extensiveness of a dissection. In the current study, the impact of an institutional policy requiring a minimum number of lymph nodes was assessed.

Effect of meeting Leapfrog volume thresholds on complication rates following complex surgical procedures.

Background: There is limited published data on the relationship between hospital volume and postoperative complications. The objectives of the current study are to examine the association between hospital volume and complications and also to examine the association between complications and in-hospital mortality following 5 complex surgical procedures.

Methods: The Nationwide Inpatient Sample for years 2000 to 2003 was used.

UroVysion testing can lead to early identification of intravesical therapy failure in patients with high risk non-muscle invasive bladder cancer.

Purpose: In this study, we investigated the ability of UroVysion to assess response to intravesical therapy in patients with high risk superficial bladder tumors.

Materials And Methods: We performed a retrospective review of patients undergoing intravesical therapy for high risk superficial bladder tumors. Urine specimens were collected for UroVysion analysis before and immediately after a course of intravesical therapy.

In vivo tumor grading of prostate cancer using quantitative 111In-capromab pendetide SPECT/CT.

Unlabelled: We have developed an in vivo method to quantify antibody uptake using (111)In-capromab pendetide SPECT combined with CT (SPECT/CT). Our goal was to evaluate this method for potential grading of prostate tumors.

Methods: Our phantom experiments focused on the robustness of an advanced iterative reconstruction algorithm that involves corrections for photon attenuation, scatter, and geometric blurring caused by radionuclide collimators.

18F-FDG PET/CT of transitional cell carcinoma.

Objective: The objective of this article is to provide a practical illustrated review of PET/CT in the imaging evaluation of transitional cell carcinoma.

Conclusion: Local evaluation of the primary tumor in patients with transitional cell carcinoma on PET is often limited by the obscuring effect of excreted FDG, but assessment of metabolic activity may still be possible through close correlation with CT images. PET/CT may also be helpful in the detection of disease outside the bladder at nodal or more distant sites and in the assessment of recurrent disease.

Phase I clinical trial of an adenovirus/prostate-specific antigen vaccine for prostate cancer: safety and immunologic results.

Purpose: We performed a phase I clinical trial of adenovirus/prostate-specific antigen (PSA) vaccine in men with measurable metastatic hormone-refractory disease.

Experimental Design: Men with measurable metastatic disease received one vaccine injection. Toxicity, immune responses, changes in PSA doubling times, and patient survival were assessed.

Association of age and response to androgen-deprivation therapy with or without radiotherapy for prostate cancer: data from CaPSURE.

Objective: To assess whether the response to primary androgen-deprivation therapy (PADT) and radiotherapy (RT) plus adjuvant ADT would be muted in older men, as their tumours might already be relatively androgen insensitive, because serum testosterone levels decline with increasing age.

Patients And Methods: Using the Cancer of the Prostate Strategic Urologic Research Endeavor database, we conducted an observational study evaluating two groups of men treated for prostate cancer from 1995 to 2006. One group of 1748 men was treated with PADT and the second group of 612 men was treated with RT (external beam RT or brachytherapy) with neoadjuvant and/or adjuvant ADT.

Estimating postoperative mortality and morbidity risk of radical cystectomy with continent diversion using predictor equations.

Purpose: The POSSUM (Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity) and Portsmouth POSSUM predictor equations are scoring systems validated in the general surgery literature that estimate postoperative morbidity and mortality risk. We tested the validity of POSSUM and Portsmouth POSSUM in patients undergoing radical cystectomy with continent diversion.

Materials And Methods: We retrospectively reviewed physiological parameters, operative parameters, and 30-day morbidity and mortality in 102 patients who underwent radical cystectomy with continent orthotopic diversion, as done by a single surgeon.

Candidate quality of care indicators for localized bladder cancer.

The surgical management of clinically localized bladder cancer is challenging, and the quality of care delivered to patients with bladder cancer is a subject of increasing interest. Multiple large studies have examined the association between surgical volume and outcomes after radical cystectomy. These studies generally find lower mortality and complication rates at high-volume centers, though interpretation of the data must be tempered by limitations of the datasets driving the studies.

Management of localized prostate cancer in men over 65 years.

Purpose Of Review: With the pervasive use of prostate-specific antigen-based screening, many men in the US are now diagnosed with prostate cancer in their 50s or earlier. However, the majority of tumors are still detected among men over 65-years-old. The appropriate management of localized disease among these older men is controversial.

Meta-analysis: does lidocaine gel before flexible cystoscopy provide pain relief?

Objective: To consolidate previous reports and conduct a meta-analysis to draw further conclusions on the efficacy of the instillation of lidocaine gel before flexible cystoscopy, as it has had varying efficacy in several randomized controlled studies.

Methods: We reviewed previous reports cited in PubMed, Biosis and the Cochrane Library, identified by a professional librarian searching for English language-only randomized controlled studies involving the keywords, lidocaine, cystoscopy, gel and pain, yielding 14 studies. Ten studies were excluded as they provided no comparison with appropriate control groups or contained insufficient data for analysis.

Sociodemographic predictors of prostate cancer risk category at diagnosis: unique patterns of significant and insignificant disease.

Purpose: We determined various sociodemographic predictors of prostate cancer risk category at presentation as assessed by serum prostate specific antigen, cancer grade and tumor stage.

Materials And Methods: We performed a retrospective cohort study of 5,939 patients enrolled in the CaPSURE national disease registry database between 1995 and 2007. Prostate cancer risk category was assigned as low, intermediate or high based on diagnostic prostate specific antigen, clinical grade and biopsy Gleason grade.

A multicolour fluorescence in situ hybridization test predicts recurrence in patients with high-risk superficial bladder tumours undergoing intravesical therapy.

Objective: To determine whether a multicolour fluorescence in situ hybridization test (UroVysion, Abbott Molecular Inc., Des Plaines, IL, USA) in patients with high-risk superficial bladder tumours maintains its predictive ability in a multivariate model for recurrence and progression, incorporating clinical and pathological predictors of outcome.

Patients And Methods: The charts of patients with superficial bladder cancer treated with induction or maintenance intravesical therapy (IVT) were reviewed retrospectively.