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Christodouleas J, Baumann B, Bosch W, Bahl A, Birtle A, Breau R, Challapalli A, Chang A, Choudhury A, Daneshmand S, Feldman A, Guzzo T, Hilman S, Jani A, Malkowicz B, Master V, Mitra A, Porten S, Efstathiou J, Eapen L. Development and Validation of Contouring Guidelines for Postcystectomy Adjuvant Radiation of Bladder Cancer. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bahl A, Brown JM, Wright EM, Kolesik M. Assessment of the metastable electronic state approach as a microscopically self-consistent description for the nonlinear response of atoms. OPTICS LETTERS 2015; 40:4987-4990. [PMID: 26512500 DOI: 10.1364/ol.40.004987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This Letter presents the first quantitative assessment of the recently proposed metastable electronic state approach (MESA) for calculation of the nonlinear optical response of noble gas atoms. Based on the single active electron potentials for several atomic species, Stark resonant states are used to extract the nonlinear polarization and ionization rates free of any additional fitting parameters. It is shown that even the simplest version of the method provides a viable, first-principle-based, and self-consistent alternative to the standard model commonly used for simulations in the field of extreme nonlinear optics.
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Hallam S, Govindarajulu S, Bahl A. BRCA1/2 mutation associated breast cancer, wide local excision and radiotherapy or unilateral mastectomy: A systematic review. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wagstaff J, Jones R, Hawkins R, Porfiri E, Pickering L, Bahl A, Brown J, Buchan S. Treatment patterns and clinical outcomes in patients with renal cell carcinoma in the UK: insights from the RECCORD registry. Ann Oncol 2015; 27:159-65. [PMID: 26489444 PMCID: PMC4684158 DOI: 10.1093/annonc/mdv504] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 10/11/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aim of the RECCORD registry was to gather real-world UK data on the use of targeted therapies in renal cell carcinoma (RCC) and assess clinical outcomes. Here, demographic and outcome data are presented with the treatment patterns and demographic profile of patients on the registry. PATIENTS AND METHODS Patients were retrospectively identified at seven UK hospitals with large cancer centres in England (5), Scotland (1) and Wales (1). Anonymised data were collected through an online registry covering demographics, treatments and outcomes. Five hundred and fourteen UK adult patients with metastatic RCC were included in the study for analysis. Patients were included if they were treated for metastatic RCC at one of the seven centres, and started systemic anti-cancer treatment from March 2009 to November 2012 inclusive. In addition to demographic factors, the principal outcome measures were overall survival (OS), time to disease progression and toxicity. RESULTS The majority of first-line treatment was with sunitinib; first-line use of pazopanib increased as the study progressed. 15.8% of patients received second-line treatment, half of whom were prescribed everolimus. Median OS (from initiation of first-line treatment) was 23.9 months (95% confidence interval [CI] 18.6-29.1 months), similar to that reported for clinical trials of targeted RCC therapies [Ljungberg B, Campbell SC, Choi HY et al. The epidemiology of renal cell carcinoma. Eur Urol 2011; 60: 615-621; Abe H, Kamai T. Recent advances in the treatment of metastatic renal cell carcinoma. Int J Urol 2013; 20: 944-955; Motzer RJ, Hutson TE, Tomczak P et al. Overall survival and updated results for sunitinib compared with interferon alfa in patients with metastatic renal cell carcinoma. J Clin Oncol 2009; 27: 3584-3590]. OS was significantly longer for those who received second-line treatment after disease progression (33.0 months; 95% CI 30.8-35.2 months) than those who did not (20.9 months; 95% CI 16.4-25.3 months; P = 0.008). CONCLUSIONS RECCORD is a large 'real-world' database assessing metastatic RCC treatment patterns and outcomes. Treatment patterns changed over time as targeted therapies were approved and became widely available; survival data in RECCORD are consistent with those reported for systemic treatments in clinical trials. Kaplan-Meier analysis of results demonstrated that receiving second-line therapy was a major prognostic factor for longer OS.
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Biswas B, Sharma A, Makharia GK, Thulkar S, Arava S, Bahl A, Chaudhary S. Immunoproliferative small intestinal disease: a report of 6 cases. ACTA ACUST UNITED AC 2015; 35:269-72. [PMID: 26349179 DOI: 10.7869/tg.233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jamali A, Ramesh G, Sharafi M, Ditkoff J, Bahl A. 22 Impact of Early Urine Specimen Collection on Emergency Department Time to Disposition. Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bagan M, Bahl A. 379 Comparison of Nurse-Performed Ultrasound-Guided versus Standard of Care Intravenous Access in Emergency Department Patients With Difficult Access. Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.07.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pan S, Bahl A, Gee A, Butt M, Malik Z, Dew R, Birtle A. 2552 Real Life treatment sequences and survival of men with metastatic castrate-resistant prostate cancer (mCRPC) receiving cabazitaxel in UK clinical practice. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31371-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Eylert MF, Bahl A, Hounsome L, Verne J, Jefferies ER, Persad RA. The impact of socio-economic deprivation on incidence, treatment and mortality from prostate cancer in England, 1990–2010. JOURNAL OF CLINICAL UROLOGY 2015. [DOI: 10.1177/2051415815594976] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To explore any association between socio-economic deprivation and prostate cancer diagnosis and/or treatment. Patients and methods: Data was extracted as follows: We gained the incident cases and staging from the National Cancer Data Repository, survival from the Cancer Information System, mortality from the Office for National Statistics, treatment data from Hospital Episode Statistics and National Clinical Analysis and Specialised Applications Team. Our analysis regarding socio-economic deprivation was controlled for age distribution. Results: We recorded 518,453 diagnoses of prostate cancer; 174,579 prostate cancer deaths; 33,889 prostatectomies and 21,351 radiotherapy treatments. Incidence is increasing in all groups, but the highest is amongst the least deprived. Mortality is decreasing, with survival consistently better in the least deprived. Prostatectomies are more frequent in the least deprived; however, this gap is narrowing. Conclusions: Prostate cancer incidence, survival and treatment are associated with socio-economic deprivation. Prostatectomy rates show a decrease in the gap of inequality. Multiple potential confounding factors, such as rates of prostate specific antigen (PSA) testing and access to health care are associated with socio-economic deprivation. The unifying influences of Improving Outcomes Guidance and the National Treatment Guidelines are intended to counteract the above inequalities. Particularly in prostate cancer, where long-term gain depends on multiple factors, individualised treatment decisions are paramount.
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Hallam S, Govindarajulu S, Huckett B, Bahl A. BRCA1/2 Mutation-associated Breast Cancer, Wide Local Excision and Radiotherapy or Unilateral Mastectomy: A Systematic Review. Clin Oncol (R Coll Radiol) 2015; 27:527-35. [PMID: 26113392 DOI: 10.1016/j.clon.2015.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 05/21/2015] [Accepted: 06/02/2015] [Indexed: 01/13/2023]
Abstract
AIMS BRCA1/2 mutation carriers show reduced apoptotic response to ionising radiation leading to recent debate about the safety of wide local excision and radiotherapy. The aim of the current study was to determine if BRCA1/2 mutation carriers with breast cancer undergoing wide local excision and radiotherapy show increased ipsilateral and contralateral breast tumour recurrence and reduced survival compared with unilateral mastectomy. MATERIALS AND METHODS Following a detailed literature search, the methodology, populations, biases and outcomes of ipsilateral breast tumour recurrence, contralateral breast tumour recurrence and survival were evaluated for 25 articles. RESULTS No differences in outcomes were found between wide local excision and mastectomy. BRCA1/2 mutation status was predictive of contralateral breast cancer only. Radiotherapy reduces the risk of ipsilateral recurrence and confers no increase in contralateral recurrence. CONCLUSION BRCA1/2 mutation status does not preclude treatment with wide local excision and radiotherapy. Given the retrospective studies with inherent flaws and small patient numbers, further large prospective trials are required.
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Kapoor R, Khosla D, Gupta R, Bahl A, Shukla AK, Sharma SC. Role of neoadjuvant concurrent chemoradiation in locally advanced unresectable pancreatic cancer: a feasibility study at tertiary care centre. Indian J Cancer 2015; 51:176-9. [PMID: 25104204 DOI: 10.4103/0019-509x.138295] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Pancreatic cancer has an extremely poor prognosis and prolonged survival is achieved only by resection with macroscopic tumor clearance. There is a strong rationale for a neoadjuvant approach, since a relevant percentage of pancreatic cancer patients present with non-metastatic but locally advanced disease. The objective of the present study was to assess the effect of neoadjuvant chemoradiation therapy (NACRT) on tumor response, down staging and resection, toxicity and any survival advantage. MATERIALS AND METHODS A prospective pilot study was carried out from January 2009 to June 2011 in which 15 patients of locally advanced unresectable pancreatic cancer were included. All patients were treated with NACRT protocol with oral Capecitabine and 3D conformal radiotherapy (3DCRT) of 30 Gy in 10 fractions. The patients were restaged 3 to 4 weeks after the completion of NACRT and explored for resection. RESULTS Out of 15 patients, fourteen were evaluable. Four patients underwent surgery, 5 had partial response but remained unresectable, 2 patients had stable disease and 3 had progressive disease. Most of the toxicities were slight and were in grade 1 to 2. None of the patients developed grade 3 or 4 gastrointestinal or hematological toxicity. The median survival was 15 months for resected patients and 8.6 months for unresected patients, respectively. The 2 year actuarial overall survival was 34.6%. CONCLUSION All patients with locally unresectable pancreatic cancer should be offered chemoradiation therapy, in hopes of down staging the tumor for possible resection and achieving higher survival.
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Bahl A, Sharma A, Raina V, Kumar L, Bakhshi S, Gupta R, Kumar R. Long-term outcomes for patients with acute myeloid leukemia: a single-center experience from AIIMS, India. Asia Pac J Clin Oncol 2015; 11:242-52. [PMID: 25639656 DOI: 10.1111/ajco.12333] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2014] [Indexed: 11/29/2022]
Abstract
AIM To analyze clinicopathological characteristics of acute myeloid leukemia (AML) patients and to evaluate long-term outcome of these patients presented to single tertiary care center in India. METHODS We evaluated outcomes of 480 patients (age 8-60 years), classified into good, intermediate and poor risk according to cytogenetic results. Standard "3 + 7" induction therapy with dose of daunorubicin ranging from 45 to 90 mg/m(2) followed by two to three courses of high-dose cytarabine (12-18 g/m(2) ) as consolidation therapy was given to majority. RESULTS The complete remission rate of the treated population (407 patients) was 70% with 84.8% in good risk, 67.9% in intermediate risk and 54.2% in poor risk (P = 0.0001). Induction mortality was 18.4%. One hundred twenty-nine patients relapsed with median treatment free interval of 10.4 months. At a median follow-up of 34.5 months, the median overall survival (OS) was 20.6 months with an estimated 5-year survival rate of 35.5%. No difference was found in OS between the three risk groups; however, patients with intermediate risk had a better leukemia-free survival (LFS) in comparison to good risk. Multivariate analysis showed age, performance status, treatment completion and hematopoietic stem cell transplant affecting OS, while only treatment completion affected LFS. CONCLUSION This is one of the largest single-center studies reflecting more accurately the outcome of AML in India. These results are likely due to uniform treatment protocols, intensification of induction and post-remission treatments with comprehensive supportive care.
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Mishra B, Sharma M, Sarkar S, Bahl A, Saikia UN, Ratho RK. Tumour necrosis factor-alpha promoter polymorphism and its association with viral dilated cardiomyopathy in Indian population: A pilot study. Indian J Med Microbiol 2015; 33:16-20. [DOI: 10.4103/0255-0857.148370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Goonewardene S, Bahl A, Persad R. Re: Defining the Potential of Neoadjuvant Chemotherapy Use as a Quality Indicator for Bladder Cancer Care. J Urol 2015; 193:370-1. [DOI: 10.1016/j.juro.2014.07.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 11/27/2022]
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Lorente D, Mateo J, Templeton AJ, Zafeiriou Z, Bianchini D, Ferraldeschi R, Bahl A, Shen L, Su Z, Sartor O, de Bono JS. Baseline neutrophil-lymphocyte ratio (NLR) is associated with survival and response to treatment with second-line chemotherapy for advanced prostate cancer independent of baseline steroid use. Ann Oncol 2014; 26:750-755. [PMID: 25538172 DOI: 10.1093/annonc/mdu587] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The neutrophil-lymphocyte ratio (NLR), proposed as an indicator of cancer-related inflammation, has known prognostic value in prostate cancer. We examine its association with survival (OS) and response in patients treated with second-line chemotherapy. METHODS We analysed patients with metastatic castration-resistant prostate cancer (mCRPC) treated in the TROPIC trial, evaluating cabazitaxel versus mitoxantrone. Cox regression models were used to investigate the association of baseline NLR (BLNLR) with OS and the significance of a change in NLR count with treatment. Logistic regression models were used to determine the association of BLNLR counts with prostate specific antigen (PSA) and RECIST responses. The optimal NLR cut-off was established based on the concordance index of different values. RESULTS Data from 755, 654 and 405 patients was available for OS, PSA and RECIST response analysis respectively. Median OS was 14.0 months [95% confidence interval (CI) 13.2-14.8]. Median NLR was 2.9 (IQR: 1.9-5.1). BLNLR was associated with survival (HR 1.5, 95% CI 1.1-2.1, P = 0.011) in multivariable analysis (MVA) independently of variables included in the Halabi nomogram, treatment arm and corticosteroid use. The optimal cut-off for a dichotomous NLR was selected at 3.0 based on its higher c-index related to survival. BLNLR ≥3.0 was associated with lower PSA response (40.1% versus 59.9%; P < 0.001) and RECIST response (7.7% versus 15.6%, P = 0.022) in MVA. Conversion from high (≥3) to low (<3) NLR was associated with improved survival (HR 0.66; 95% CI 0.51-0.85; P = 0.001) and higher PSA response rates (66.4% versus 33.6%; P = 0.000). Use of corticosteroids at baseline did not modify the association between NLR and survival. CONCLUSIONS NLR is a valid prognostic biomarker in CRPC and is associated with survival, PSA and RECIST responses in patients treated with second-line chemotherapy. Changes in NLR counts with treatment may indicate benefit. NLR prognostic value is independent of prior use of corticosteroids. CLINICALTRIALSGOV NCT00417079.
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Andreasen J, Bahl A, Kolesik M. Spatial effects in supercontinuum generation in waveguides. OPTICS EXPRESS 2014; 22:25756-25767. [PMID: 25401609 DOI: 10.1364/oe.22.025756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
An economic, space- and time-resolved method to model ultra-short, intense pulse propagation in waveguides is described. Simulations of supercontinuum generation on a chip demonstrate the utility of the approach. Comparisons with the generalized nonlinear Schrödinger equation elucidate spatial effects, which influence pulse dynamics and the generation of new spectral components.
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Dang V, Bahl A. 324 A Retrospective Review of Variables Impacting Patient Care in the Emergency Department With the Annual Change in Resident Staffing. Ann Emerg Med 2014. [DOI: 10.1016/j.annemergmed.2014.07.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Powles T, Hawkins R, Ralph C, Larkin J, Jones R, Chowdhury S, Boleti E, Fife K, Bahl A, Crabb S, Webb A, Din O, Dunlop J, Hill R, Geldart T, McLaren D, Nathan P. A Randomised Phase Ii Study of Cediranib with or Without Src Inhibition (Saracatinib) in Metastatic Clear Cell Renal Cancer (Rcc) Patients Resistant to Vegf Targeted Therapy. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu438.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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69
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Lorente D, Templeton A, Sartor O, Bahl A, Su Z, Devin J, de Bono J. Association of Neutrophil-To-Lymphocyte Ratio (Nlr) with Survival (Os) in Metastatic Castration-Resistant Prostate Cancer (Mcrpc) Patients Receiving Prednisone (P) Plus Cabazitaxel (Cbz) or Mitoxantrone (Mtx) in the Tropic Trial. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu336.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chi K, de Bono J, Bahl A, Oudard S, Tombal B, Özgüroğlu M, Hansen S, Kocak I, Gravis G, Shen L, Su Z, Sartor O. Analysis of Overall Survival (Os) for Patients (Pts) with Different Prognostic Risk Factors Treated with Cabazitaxel and Prednisone (Cbz + P) After Docetaxel (D) in the Tropic Trial. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu336.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sharma M, Mishra B, Saikia U, Bahl A, Ratho R. Association of enterovirus with dilated cardiomyopathy and an effective in-vitro therapeutic strategy against viral infection. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.1099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Chamberlain C, Collin SM, Stephens P, Donovan J, Bahl A, Hollingworth W. Does the cancer drugs fund lead to faster uptake of cost-effective drugs? A time-trend analysis comparing England and Wales. Br J Cancer 2014; 111:1693-702. [PMID: 24569469 PMCID: PMC4453744 DOI: 10.1038/bjc.2014.86] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 01/06/2014] [Accepted: 01/22/2014] [Indexed: 12/20/2022] Open
Abstract
Background: The Cancer Drugs Fund (CDF) provides £200 million annually in England for ‘anti-cancer' drugs. Methods: We used a controlled pre-/post-intervention design to compare IMS Health dispensing data for 15 cancer drugs (2007–2012) in England vs Wales, stratified by pre-CDF NICE drug approval status (rejected, mixed recommendations, recommended, not appraised). Results: The CDF was associated with increased prescribing in England for three of five drugs rejected or with mixed NICE recommendations. The prescribing volume ratios (PVR) ranged from 1.29 (95% CI 1.00, 1.67) for sorafenib to 3.28 (2.59, 4.14) for bevacizumab (NICE rejected) and 0.93 (0.81, 1.06) and 1.35 (1.21, 1.49) for sunitinib and imatinib respectively (mixed recommendations). Post CDF prescribing in England increased for both drugs awaiting NICE appraisal pre-CDF (lapatinib PVR=7.44 (5.81, 9.54), panitumumab PVR=5.40 (1.20, 24.42)) and subsequently rejected. The CDF was not associated with increased prescribing in England of NICE-recommended drugs. The three most recently launched, subsequently recommended drugs were adopted faster in Wales (from pazopanib PVR=0.51 (0.28, 0.96) to abiraterone PVR=0.78 (0.61–0.99)). Interpretation: These data indicate that the CDF is used to access drugs deemed not cost-effective by NICE. The CDF did not expedite access to new cost-effective cancer agents prior to NICE approval.
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Taylor H, Wain R, Cornes P, Beresford M, Bahl A, Thanvi N. Monitoring of Liver Function Tests in the First 12 Weeks of Abiraterone Acetate Treatment. Clin Oncol (R Coll Radiol) 2014. [DOI: 10.1016/j.clon.2013.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hoskin P, King P, Wylie J, Lydon A, Sreenivasan T, Bahl A, Henry A, Ahmed I, Elwell C, Heath C. OC-0068: Single dose HDR boost for prostate cancer: a multicentre prospectiveUK study. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30173-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hultin S, Hotston M, Day A, Taylor A, Goodall R, Thomas P, Bahl A, Persad R, Gjini A. Audit of PSA requesting practices in primary care compared to guidelines established by the Prostate Cancer Risk Management programme in the Avon region of the South West of England. JOURNAL OF CLINICAL UROLOGY 2014. [DOI: 10.1177/2051415813485945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background There is considerable challenge in transmitting the complicated information contained in the Prostate Cancer Risk Management (PCRM) programme in the primary care setting. 1 The practices surrounding requesting of PSA should be clearly understood by both GP and patient before requesting this investigation, and in order to further understand the needs and requirements of primary care practitioners in this regard we undertook an audit comparing practices in the Avon region of the Southwest of England compared to the guidelines of the PCRM programme. 1 Methods Our study identified a consistent year-on-year increase in PSA requests over the study period across all age categories and regions of the southwest of England. Results Questionnaire review of practices surrounding the PCRM programme revealed overall good practice but with space for improvement surrounding advice regarding the limitations of prostate biopsy and the relevance of testing in the elderly. Conclusions Despite requesting practices generally conforming to NICE guidelines, nearly half of all abnormal primary-care PSA tests are repeated. Requests in some cases may fall short of best practice.
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