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Aksoy C, Reimold P, Karschuck P, Groeben C, Koch R, Eisenmenger N, Thoduka S, Zacharis A, Schmelz H, Huber J, Flegar L. Trends in the use of testicular prostheses in Germany: a total population analysis from 2006-2021. Andrology 2024; 12:1209-1214. [PMID: 38228573 DOI: 10.1111/andr.13598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/25/2023] [Accepted: 12/28/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Testicular tumors are the most common malignancies in young adults and their incidence is growing. The implantation of a testicular prosthesis, for example, during orchiectomy is a standard procedure but its frequency in Germany is unknown. This study aims to analyze trends of testicular prosthesis implantation in recent years in Germany. MATERIAL AND METHODS The nationwide German hospital billing database and the German hospital quality reports from 2006 to 2021 were studied. RESULTS A total of 12,753 surgical procedures with implantation of testicular prosthesis and 1,244 procedures with testicular prosthesis explantation were included. Testicular prosthesis implantation increased in total from 699 cases in 2006 to 870 cases in 2020 (+11.4 cases/year; p < 0.001). The share of implantation of testicular prosthesis due to testicular tumor decreased from 72.6% in 2006 to 67.5% in 2020 (p < 0.001). The share of implantation due to gender affirming surgery increased from 6.8% in 2006 to 23.3% in 2020 (p < 0.001). The share of implantation due to testicular atrophy decreased from 11.4% in 2006 to 3.4% in 2020 (p < 0.001). Simultaneous implantation of testicular prosthesis during orchiectomy for testicular cancer increased from 7.8% in 2006 to 11.4% in 2020 (p < 0.001). In 2006, 146 hospitals (85%) performed < 5 testicular prosthesis implantation, while 20 hospitals (12%) performed 5-15 implantation procedures and 6 hospitals (3%) performed > 15 testicular implantation surgeries. In 2021, 115 hospitals (72%) performed < 5 testicular prosthesis implantation, while 39 hospitals (25%) performed 5-15 implantation procedures and 5 hospitals (3%) performed > 15 testicular implantation surgeries. CONCLUSION This study shows that implantation of testicular prostheses is steadily increasing. Explantation rates are low. Besides testicular cancer transgender surgeries were the main driver for increasing case numbers in recent years.
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Affiliation(s)
- Cem Aksoy
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Philipp Reimold
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Philipp Karschuck
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Christer Groeben
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Rainer Koch
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | | | - Smita Thoduka
- Department of Nuclear Medicine, Philipps-University Marburg, Marburg, Germany
| | | | - Hans Schmelz
- Department of Urology, German Federal Armed Forces Hospital Koblenz, Koblenz, Germany
| | - Johannes Huber
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Luka Flegar
- Department of Urology, Philipps-University Marburg, Marburg, Germany
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McKone EL, Sutton EA, Johnson GB, Phillips RM. Application of Advanced Imaging to Prostate Cancer Diagnosis and Management: A Narrative Review of Current Practice and Unanswered Questions. J Clin Med 2024; 13:446. [PMID: 38256579 PMCID: PMC10816977 DOI: 10.3390/jcm13020446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/06/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Major advances in prostate cancer diagnosis, staging, and management have occurred over the past decade, largely due to our improved understanding of the technical aspects and clinical applications of advanced imaging, specifically magnetic resonance imaging (MRI) and prostate-cancer-specific positron emission tomography (PET). Herein, we review the established utility of these important and exciting technologies, as well as areas of controversy and uncertainty that remain important areas for future study. There is strong evidence supporting the utility of MRI in guiding initial biopsy and assessing local disease. There is debate, however, regarding how to best use the imaging modality in risk stratification, treatment planning, and assessment of biochemical failure. Prostate-cancer-specific PET is a relatively new technology that provides great value to the evaluation of newly diagnosed, treated, and recurrent prostate cancer. However, its ideal use in treatment decision making, staging, recurrence detection, and surveillance necessitates further research. Continued study of both imaging modalities will allow for an improved understanding of their best utilization in improving cancer care.
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Affiliation(s)
| | - Elsa A. Sutton
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Geoffrey B. Johnson
- Department of Radiology, Nuclear Medicine Division, Mayo Clinic, Rochester, MN 55905, USA
| | - Ryan M. Phillips
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
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Henriksen NA, Jensen KK. Trends in Use of Laparoscopic Intraperitoneal Onlay Mesh for Ventral Hernia Repair. JAMA Surg 2024; 159:109-111. [PMID: 37938823 PMCID: PMC10633413 DOI: 10.1001/jamasurg.2023.5623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/26/2023] [Indexed: 11/10/2023]
Abstract
This cohort study examines changes in the proportion of laparoscopic intraperitoneal onlay mesh procedures performed for hernia repair in Denmark since initial description of the procedure.
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Affiliation(s)
- Nadia A. Henriksen
- Department of Gastrointestinal and Hepatic Diseases, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Kristian K. Jensen
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen, Denmark
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Lucarelli NM, Villanova I, Maggialetti N, Greco S, Tarantino F, Russo R, Trabucco SMR, Stabile Ianora AA, Scardapane A. Quantitative ADC: An Additional Tool in the Evaluation of Prostate Cancer? J Pers Med 2023; 13:1378. [PMID: 37763146 PMCID: PMC10533005 DOI: 10.3390/jpm13091378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Prostate cancer is one of the most common tumors among the male population. Magnetic resonance imaging (MRI), standardized by the PI-RADS version 2.1 scoring system, has a fundamental role in detecting prostate cancer and evaluating its aggressiveness. Diffusion-weighted imaging sequences and apparent diffusion coefficient values, in particular, are considered fundamental for the detection and characterization of lesions. In 2016 the International Society of Urological Pathology introduced a new anatomopathological 5-grade scoring system for prostate cancer. The aim of this study is to evaluate the correlation between quantitative apparent diffusion coefficient values (ADC) derived from diffusion-weighted imaging (DWI) sequences and the International Society of Urological Pathology (ISUP) and PI-RADS groups. Our retrospective study included 143 patients with 154 suspicious lesions, observed on prostate magnetic resonance imaging and compared with the histological results of the biopsy. We observed that ADC values can aid in discriminating between not clinically significant (ISUP 1) and clinically significant (ISUP 2-5) prostate cancers. In fact, ADC values were lower in ISUP 5 lesions than in negative lesions. We also found a correlation between ADC values and PI-RADS groups; we noted lower ADC values in the PI-RADS 5 and PI-RADS 4 groups than in the PI-RADS 3 group. In conclusion, quantitative apparent diffusion coefficient values can be useful to assess the aggressiveness of prostate cancer.
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Affiliation(s)
- Nicola Maria Lucarelli
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (N.M.L.); (I.V.); (N.M.); (S.G.); (R.R.); (A.A.S.I.); (A.S.)
| | - Ilaria Villanova
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (N.M.L.); (I.V.); (N.M.); (S.G.); (R.R.); (A.A.S.I.); (A.S.)
| | - Nicola Maggialetti
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (N.M.L.); (I.V.); (N.M.); (S.G.); (R.R.); (A.A.S.I.); (A.S.)
| | - Sara Greco
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (N.M.L.); (I.V.); (N.M.); (S.G.); (R.R.); (A.A.S.I.); (A.S.)
| | - Francesca Tarantino
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (N.M.L.); (I.V.); (N.M.); (S.G.); (R.R.); (A.A.S.I.); (A.S.)
| | - Roberto Russo
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (N.M.L.); (I.V.); (N.M.); (S.G.); (R.R.); (A.A.S.I.); (A.S.)
| | - Senia Maria Rosaria Trabucco
- Section of Molecular Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Amato Antonio Stabile Ianora
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (N.M.L.); (I.V.); (N.M.); (S.G.); (R.R.); (A.A.S.I.); (A.S.)
| | - Arnaldo Scardapane
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (N.M.L.); (I.V.); (N.M.); (S.G.); (R.R.); (A.A.S.I.); (A.S.)
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Flegar L, Thoduka SG, Librizzi D, Luster M, Zacharis A, Heers H, Eisenmenger N, Ahmadzadehfar H, Eiber M, Weber W, Groeben C, Huber J. Adoption of Lutetium- 177 PSMA radioligand therapy for metastatic castration resistant prostate cancer: a total population analysis in Germany from 2016 to 2020. Eur J Nucl Med Mol Imaging 2023; 50:2188-2195. [PMID: 36826478 PMCID: PMC10199877 DOI: 10.1007/s00259-023-06139-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE This study is to investigate the adoption and current trends of Lutetium-177 PSMA RLT for mCRPC in Germany. METHODS We analyzed data from the reimbursement.INFO tool based on German hospitals' quality reports for Lutetium-177 PSMA RLT from 2016 to 2020 and from the nationwide German hospital billing database (Destatis) for general therapy with open radionuclides in combination with prostate cancer from 2006 to 2020. For validation of these billing data, we included the 177Lu-PSMA RLT cycles from two participating institutions from 2016 to 2020. For detection of trends over time we applied linear regression models. RESULTS General therapy with open radionuclides increased from 2006 to 2020. We identified a total of 12,553 177Lu-PSMA RLT cycles. The number of 177Lu-PSMA RLTs steadily increased from a total of 1026 therapies in 2016 to 3328 therapies in 2020 (+ 576 RLT/year; p < 0.005). In 2016, 25 departments of nuclear medicine offered this treatment, which increased to 44 nuclear medicine departments in 2020. In 2016, 16% of nuclear medicine departments (4/25) performed more than 100 177Lu-PSMA RLTs, which increased to 36% (16/44) in 2020 (p < 0.005). In 2016, 88% (22/25) of 177Lu-PSMA RLTs were performed at a university hospital, which decreased to 70% (31/44) in 2020. The proportion of patients older than 65 years receiving 177Lu-PSMA RLT increased from 78% in 2016 to 81% in 2020. CONCLUSION Treatment of mCRPC with 177Lu-PSMA RLT has been rapidly increasing in Germany in the recent years providing an additional therapy option. This development is remarkable, because of outstanding formal EMA approval.
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Affiliation(s)
- Luka Flegar
- Department of Urology, Philipps-University Marburg, Baldinger Street, 35043, Marburg, Germany.
| | - Smita George Thoduka
- Department of Nuclear Medicine, Philipps-University Marburg, Baldinger Street, 35043, Marburg, Germany
| | - Damiano Librizzi
- Department of Nuclear Medicine, Philipps-University Marburg, Baldinger Street, 35043, Marburg, Germany
| | - Markus Luster
- Department of Nuclear Medicine, Philipps-University Marburg, Baldinger Street, 35043, Marburg, Germany
| | - Aristeidis Zacharis
- Department of Urology, Philipps-University Marburg, Baldinger Street, 35043, Marburg, Germany
| | - Hendrik Heers
- Department of Urology, Philipps-University Marburg, Baldinger Street, 35043, Marburg, Germany
| | | | | | - Matthias Eiber
- Department of Nuclear Medicine, Technische Universität Munich, Munich, Germany
| | - Wolfgang Weber
- Department of Nuclear Medicine, Technische Universität Munich, Munich, Germany
| | - Christer Groeben
- Department of Urology, Philipps-University Marburg, Baldinger Street, 35043, Marburg, Germany
| | - Johannes Huber
- Department of Urology, Philipps-University Marburg, Baldinger Street, 35043, Marburg, Germany
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Kraywinkel K, Flegar L, Huber J, Groeben C. [Cancer registries in Germany: what does the future hold for urology?]. Aktuelle Urol 2023; 54:208-212. [PMID: 37019141 DOI: 10.1055/a-2041-3063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Cancer registries are defined as systematically collected information in the form of a database on tumour diseases. They can provide information about the quality of oncological care or progress in the treatment of individual cancers over time. Since 1995, all German federal states have been required by law to establish and maintain a cancer registry. The Center for Cancer Registry Data (ZfKD) at Robert Koch Institute has collected this nationwide data since 2009 and compiled it into an annually audited dataset available for research purposes. By virtue of the Cancer Early Detection and Registry Act (KFRG), which was passed in 2013, the cancer registries were given a new perspective. Since then, they have made a central contribution to the quality assurance of oncological care. The cancer registries are mainly financed by the health insurance funds. An upcoming expansion of the dataset including clinical variables and earlier provision by the ZfKD starting next year offers new opportunities for the scientific use of cancer registry data. In particular, the course of the disease will now be mapped in considerable detail. Apart from the cancer registries, there are not many useful supplemental datasets in Germany for the assessment of the nationwide healthcare situation and treatment reality on a national level. The DRG database (case-based hospital statistics) of the Federal Statistics Office records all billing data of all German hospitals with few exceptions. Another interesting supplement to the cancer registry data are the datasets of the structured quality reports, which have been mandatory for hospitals since 2003. In the future, the scientific role of cancer registries is to be further enhanced by the Act on the Pooling of Cancer Registry Data, which was passed in 2021.
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Affiliation(s)
- Klaus Kraywinkel
- Zentrum für Krebsregisterdaten, Robert Koch Institut, Berlin, Deutschland
| | - Luka Flegar
- Klinik für Urologie, Universitätsklinikum Gießen und Marburg - Standort Marburg, Marburg, Deutschland
| | - Johannes Huber
- Klinik für Urologie, Universitätsklinikum Gießen und Marburg - Standort Marburg, Marburg, Deutschland
| | - Christer Groeben
- Klinik für Urologie, Universitätsklinikum Gießen und Marburg - Standort Marburg, Marburg, Deutschland
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The Challenges of Patient Selection for Prostate Cancer Focal Therapy: A Retrospective Observational Multicentre Study. Curr Oncol 2022; 29:6826-6833. [PMID: 36290815 PMCID: PMC9600719 DOI: 10.3390/curroncol29100538] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 01/13/2023] Open
Abstract
Increased diagnoses of silent prostate cancer (PCa) have led to overtreatment and consequent functional side effects. Focal therapy (FT) applies energy to a prostatic index lesion treating only the clinically significant PCa focus. We analysed the potential predictive factors of FT failure. We collected data from patients who underwent robot-assisted radical prostatectomy (RARP) in two high-volume hospitals from January 2017 to January 2020. The inclusion criteria were: one MRI-detected lesion with a Gleason Score (GS) of ≤7, ≤cT2a, PSA of ≤10 ng/mL, and GS 6 on a random biopsy with ≤2 positive foci out of 12. Potential oncological safety of FT was defined as the respect of clinicopathological inclusion criteria on histology specimens, no extracapsular extension, and no biochemical, local, or metastatic recurrence within 12 months. To predict FT failure, we performed uni- and multivariate logistic regression. Sixty-seven patients were enrolled. The MRI index lesion median size was 11 mm; target lesions were ISUP grade 1 in 27 patients and ISUP grade 2 in 40. Potential FT failure occurred in 32 patients, and only the PSA value resulted as a predictive parameter (p < 0.05). The main issue for FT is patient selection, mainly because of multifocal csPCa foci. Nevertheless, FT could represent a therapeutic alternative for highly selected low-risk PCa patients.
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