Richardsroman3652

We conclude that patients on active surveillance can be monitored with MRI scans over time and that biopsies could be used only when there are changes on MRI or a rising prostate-specific antigen (PSA) not explained by an increase in prostate size.

In this report we looked at the role of magnetic resonance imaging (MRI) scans in avoiding unnecessary prostate biopsies for patients being monitored for low- or intermediate-risk prostate cancer. We conclude that patients on active surveillance can be monitored with MRI scans over time and that biopsies could be used only when there are changes on MRI or a rising prostate-specific antigen (PSA) not explained by an increase in prostate size.

Although the Decipher genomic classifier has been validated as a prognostic tool for several prostate cancer endpoints, little is known about its role in assessing the risk of biopsy reclassification for patients on active surveillance, a key event that often triggers treatment.

To evaluate the association between Decipher genomic classifier scores and biopsy Gleason upgrading among patients on active surveillance.

This was a retrospective cohort study among patients with low- and favorable intermediate-risk prostate cancer on active surveillance who underwent biopsy-based Decipher testing as part of their clinical care.

We evaluated the association between the Decipher score and any increase in biopsy Gleason grade group (GG) using univariable and multivariable logistic regression. We compared the area under the receiver operating characteristic curve (AUC) for models comprising baseline clinical variables with or without the Decipher score.

We identified 133 patients for inclusion with a median agght be useful for guiding the intensity of monitoring during active surveillance, such as more frequent biopsy for patients with higher scores.

The results from this study indicate that among patients with prostate cancer undergoing active surveillance, those with higher Decipher scores were more likely to have higher-grade disease found over time. These findings indicate that the Decipher test might be useful for guiding the intensity of monitoring during active surveillance, such as more frequent biopsy for patients with higher scores.

Recent reports with a small number of patients showed an association of red blood cell distribution width (RDW) with prostate cancer (PCa) progression.

To investigate whether preoperative RDW can serve as a prognostic marker in patients with PCa undergoing radical prostatectomy (RP) in a large, equal access, and diverse patient cohort.

Data were retrospectively collected on 4756 men treated with RP at eight Veteran Affairs medical centers within the Shared Equal Access Regional Cancer Hospital (SEARCH) database from 1999 through 2017.

Biochemical recurrence (BCR) was the primary outcome, while metastasis, all-cause mortality (ACM), and prostate cancer-specific mortality (PCSM) were secondary outcomes.

The mean (standard deviation) age was 62 yr (6.1), and 1589 (33%) men were black. The median (interquartile range) follow-up was 82 mo (46-127). Preoperative RDW either as a continuous variable or when stratified by quartiles was not associated with BCR. Likewise, preoperative RDW was not associated wicancer includes a wide spectrum of diseases with different genetic, pathological, and oncological behaviors. Red blood cell distribution width is helpful in predicting the overall survival for a localized prostate cancer patient, and hence, it can help inform personalized treatment decisions and operative care.

Some health care systems have set up referral trauma centers to centralize expertise to improve trauma management. There is scant and controversial evidence regarding the impact of provider's volume on the outcomes of trauma management.

To evaluate the impact of hospital volume on the outcomes of renal trauma management in a European health care system.

A retrospective multicenter study, including all patients admitted for renal trauma in 17 French hospitals between 2005 and 2015, was conducted.

Nephrectomy, angioembolization, or nonoperative management.

Four quartiles according to the caseload per year low volume (eight or fewer per year), moderate volume (nine to 13 per year), high volume (14-25/yr), and very high volume (≥26/yr). The primary endpoint was failure of nonoperative management defined as any interventional radiology or surgical procedure needed within the first 30 d after admission.

Of 1771 patients with renal trauma, 1704 were included. Nonoperative management was more prevalent inrauma varied according to hospital volume. Very-high-volume centers had lower rates of nephrectomy and failure of nonoperative management.

In this study, management of renal trauma varied according to hospital volume. buy WZ4003 Very-high-volume centers had lower rates of nephrectomy and failure of nonoperative management.

The AnTIC trial linked continuous low-dose antibiotic prophylaxis treatments to a lower incidence of symptomatic urinary tract infections (UTIs) among individuals performing clean intermittent self-catheterisation (CISC).

To explore potential mechanisms underlying the protective effects of low-dose antibiotic prophylaxis treatments, blood and urine samples and uro-associated

isolates from AnTIC participants were analysed.

Blood samples (

= 204) were analysed for

gene polymorphisms associated with UTI susceptibility and multiple urine samples (

= 558) were analysed for host urogenital responses.

sequence data for 45 temporal isolates recovered from the urine samples of 16 trial participants in the prophylaxis (

= 9) and no-prophylaxis (

= 7) study arms, and characterised by multidrug resistance (MDR), were used to classify individual strains.

polymorphism data were analysed using Poisson regression. Concentrations of urine host defence markers were analysed using linear mixed-effects -catheterisation (CISC) users were not impacted by antibiotic treatments. For some CISC users, prophylaxis with low-dose antibiotics selected for a stable, predominantly,

rich uromicrobiota.

Our findings show that the natural urogenital defences of clean intermittent self-catheterisation (CISC) users were not impacted by antibiotic treatments. For some CISC users, prophylaxis with low-dose antibiotics selected for a stable, predominantly, Esherichia coli rich uromicrobiota.

Elderly patients diagnosed with high-risk prostate cancer (PCa) present a therapeutic dilemma of balancing treatment of a potentially lethal malignancy with overtreatment of a cancer that may not threaten life expectancy.

To investigate treatment patterns and overall survival outcomes in this group of patients.

A retrospective cohort study was conducted. We queried the National Cancer Database for high-risk PCa in patients aged 80 yr or older diagnosed during 2004-2016.

Eligible patients underwent no treatment following biopsy (ie, observation), androgen deprivation therapy (ADT) alone, radiation therapy (RT) alone, RT+ADT, or surgery.

Kaplan-Meier, log rank, and multivariate Cox proportional hazard regression was performed to compare overall survival (OS).

A total of 19 920 men were eligible for analysis, and the most common treatment approach was RT+ADT (7401 patients; 37.2%). Observation and ADT alone declined over time (59.3% in 2004 vs 47.5% in 2016). There was no observed difference in OS ber, definitive local therapy, including surgery or radiation therapy and/or androgen deprivation therapy, is associated with a 50% reduction in overall mortality compared with observation or androgen deprivation therapy alone. We therefore recommend that life expectancy (ie, physiologic age) be taken into account, over chronologic age, and that elderly men with good life expectancy (eg, >5 yr; minimal comorbidity) should be offered definitive, life-prolonging therapy.

5 yr; minimal comorbidity) should be offered definitive, life-prolonging therapy.

Transperineal prostate biopsy is associated with a significantly lower risk of infectious complications than the transrectal approach. In fact, the risk of infectious complications with transperineal prostate biopsy is so low that the utility of administering periprocedural antibiotics with this procedure has come under question.

To perform a systematic review and meta-analysis to assess for differences in the rates of infectious complications (septic, nonseptic, and overall) after performing transperineal prostate biopsy with and without the administration of periprocedural antibiotic prophylaxis.

Three electronic databases (PubMed, Embase, and MEDLINE) were searched, and studies were included if they included patients who underwent transperineal prostate biopsy, were published after January 2000, included information on periprocedural antibiotic administration, and reported postbiopsy complications. Preferred Reporting Items for Systematic Reviews and Meta-analyses and Agency for Healthcare Research aenefit in terms of preventing less serious infections.The aim of this study was to externally validate a nomogram for side-specific extraprostatic extension (EPE) of prostate cancer (PCa) at robot-assisted radical prostatectomy (RARP). A prospectively maintained cohort of 1170 consecutive patients with PCa who underwent RARP at two high-volume RARP centres between 2018 and 2021 was retrospectively evaluated. Biopsies and magnetic resonance imaging (MRI) scans were centrally reviewed. The side-specific probability of EPE was calculated for each prostate side using prostate-specific antigen density, ipsilateral highest biopsy Gleason score, and ipsilateral MRI tumour stage. Model discrimination and calibration were analysed using the area under the receiver operating characteristic curve (AUC), calibration in the large, and calibration curves. The rate of side-specific EPE was 30% among 2254 prostate sides; the mean predicted rate was also 30%. The discriminatory value of the model was good, with an AUC of 80.4% (interquartile range 78.4-82.3%). The predicted probabilities matched the observed probabilities well (intercept -0.02, slope 1.053). There was slight underestimation of the observed probabilities from 70% upwards. In conclusion, an easy-to-use nomogram for side-specific EPE at RARP was externally validated and can be applied to virtually all PCa patients.

A prediction model used to decide whether to spare the neurovascular bundles during removal of the prostate can be applied to virtually all prostate cancer patients.

A prediction model used to decide whether to spare the neurovascular bundles during removal of the prostate can be applied to virtually all prostate cancer patients.

Mini percutaneous nephrolithotomy (MPCNL) is a newer surgical procedure that has changed the management of paediatric renal stones.

To evaluate MPCNL morbidity and success rates for renal stones as a function of patient age in a paediatric cohort.

This was a retrospective case series that included 143 consecutive patients younger than 17 yr who underwent MPCNL at our institution between January 2016 and November 2020. The patients were categorised into three different age groups <6 yr (

= 71, 49.7%), 6-11 yr (

= 44, 30.8%), and 12-17 yr (

= 28, 19.6%). MPCNL was performed in all patients through 16-20Fr tracts.

The stone-free rate, perioperative complications, tract number, operative time, postoperative haemoglobin change, and hospitalisation time were evaluated for each age group.

MPCNL was performed in 143 paediatric patients (88 boys and 55 girls; mean age 6.53 yr). The mean stone burden (± standard deviation) was 2.096 ± 1.01 cm in group one, 2.05 ± 1.05 cm in group two, and 3.46 ± 19.94 cm in group three; group three was significantly larger (

= 0.