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Souto-Ribeiro I, Woods L, Maund E, Alexander Scott D, Lord J, Picot J, Shepherd J. Transperineal biopsy devices in people with suspected prostate cancer - a systematic review and economic evaluation. Health Technol Assess 2024; 28:1-213. [PMID: 39364806 DOI: 10.3310/zktw8214] [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] [Indexed: 10/05/2024] Open
Abstract
Background People with suspected prostate cancer are usually offered either a local anaesthetic transrectal ultrasound-guided prostate biopsy or a general anaesthetic transperineal prostate biopsy. Transperineal prostate biopsy is often carried out under general anaesthetic due to pain caused by the procedure. However, recent studies suggest that performing local anaesthetic transperineal prostate biopsy may better identify cancer in particular regions of the prostate and reduce infection rates, while being carried out in an outpatient setting. Devices to assist with freehand methods of local anaesthetic transperineal prostate may also help practitioners performing prostate biopsies. Objectives To evaluate the clinical effectiveness and cost-effectiveness of local anaesthetic transperineal prostate compared to local anaesthetic transrectal ultrasound-guided prostate and general anaesthetic transperineal prostate biopsy for people with suspected prostate cancer, and local anaesthetic transperineal prostate with specific freehand devices in comparison with local anaesthetic transrectal ultrasound-guided prostate and transperineal prostate biopsy conducted with a grid and stepping device conducted under local or general anaesthetic. Data sources and methods We conducted a systematic review of studies comparing the diagnostic yield and clinical effectiveness of different methods for performing prostate biopsies. We used pairwise and network meta-analyses to pool evidence on cancer detection rates and structured narrative synthesis for other outcomes. For the economic evaluation, we reviewed published and submitted evidence and developed a model to assess the cost-effectiveness of the different biopsy methods. Results We included 19 comparative studies (6 randomised controlled trials and 13 observational comparative studies) and 4 single-arm studies of freehand devices. There were no statistically significant differences in cancer detection rates for local anaesthetic transperineal prostate (any method) compared to local anaesthetic transrectal ultrasound-guided prostate (relative risk 1.00, 95% confidence interval 0.85 to 1.18) (n = 5 randomised controlled trials), as was the case for local anaesthetic transperineal prostate with a freehand device compared to local anaesthetic transrectal ultrasound-guided prostate (relative risk 1.40, 95% confidence interval 0.96 to 2.04) (n = 1 randomised controlled trial). Results of meta-analyses of observational studies were similar. The economic analysis indicated that local anaesthetic transperineal prostate is likely to be cost-effective compared with local anaesthetic transrectal ultrasound-guided prostate (incremental cost below £20,000 per quality-adjusted life-year gained) and less costly and no less effective than general anaesthetic transperineal prostate. local anaesthetic transperineal prostate with a freehand device is likely to be the most cost-effective strategy: incremental cost versus local anaesthetic transrectal ultrasound-guided prostate of £743 per quality-adjusted life-year for people with magnetic resonance imaging Likert score of 3 or more at first biopsy. Limitations There is limited evidence for efficacy in detecting clinically significant prostate cancer. There is comparative evidence for the PrecisionPoint™ Transperineal Access System (BXTAccelyon Ltd, Burnham, UK) but limited or no evidence for the other freehand devices. Evidence for other outcomes is sparse. The cost-effectiveness results are sensitive to uncertainty over cancer detection rates, complication rates and the numbers of core samples taken with the different biopsy methods and the costs of processing them. Conclusions Transperineal prostate biopsy under local anaesthetic is equally efficient at detecting prostate cancer as transrectal ultrasound-guided prostate biopsy under local anaesthetic but it may be better with a freehand device. local anaesthetic transperineal prostate is associated with urinary retention type complications, whereas local anaesthetic transrectal ultrasound-guided prostate has a higher infection rate. local anaesthetic transperineal prostate biopsy with a freehand device appears to meet conventional levels of costeffectiveness compared with local anaesthetic transrectal ultrasound-guided prostate. Study registration This study is registered as PROSPERO CRD42021266443. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Evidence Synthesis programme (NIHR award ref: NIHR134220) and is published in full in Health Technology Assessment Vol. 28, No. 60. See the NIHR Funding and Awards website for further award information.
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Hogenhout R, Remmers S, van Slooten-Midderigh ME, de Vos II, Roobol MJ. From Screening to Mortality Reduction: An Overview of Empirical Data on the Patient Journey in European Randomized Study of Screening for Prostate Cancer Rotterdam After 21 Years of Follow-up and a Reflection on Quality of Life. Eur Urol Oncol 2024; 7:713-720. [PMID: 37690917 DOI: 10.1016/j.euo.2023.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/13/2023] [Accepted: 08/23/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Previous research quantified the effect of prostate-specific antigen (PSA)-based prostate cancer (PCa) screening on quality-adjusted life years using 11-yr follow-up data from the European Randomized Study of Screening for Prostate Cancer (ERSPC) extrapolated by the Microsimulation Screening Analysis (MISCAN). ERSPC data now matured to 21 yr of follow-up. OBJECTIVE To provide an overview of the effect of PSA-based screening on tumour characteristics and PCa treatment using long-term, detailed, empirical ERSPC data. DESIGN, SETTING, AND PARTICIPANTS Men were included from the ERSPC Rotterdam who were randomised to a PSA-based screening (S) or control (C) arm. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We assessed the effects of PSA-based screening on the number of PCa diagnoses, tumour characteristics, treatments, and cumulative incidence of disease progression. We also evaluated the changes in tumour characteristics and treatments over time for both study arms. RESULTS AND LIMITATIONS Among PCa patients in the S-arm, fewer patients were diagnosed with advanced tumour stages (T3/T4: 12% vs 23%; relative risk [RR] = 0.50; 95% confidence interval [CI] 0.44-0.57), less disease progression was observed, and less secondary treatment (30% vs 48%; RR = 0.61; 95% CI 0.57-0.66; p < 0.001) and less palliative treatment were needed (21% vs 55%; RR = 0.38; 95% CI 0.35-0.42) than among those in the C-arm. This was at the cost of overdiagnosis and increased local treatments (eg, radical prostatectomy: 32% vs 14%; RR = 2.18; 95% CI 1.92-2.48). Over time, the number of local treatments decreased, whereas expectant management strategies increased. The RRs of treatments were slightly different from those of the MISCAN. CONCLUSIONS After 21 yr of follow-up, empirical data of the ERSPC showed that PSA-based screening reduces advanced PCa stages, disease progression, and extensive treatments at the cost of more overdiagnosis and probably more overtreatment. Our data showed reduced local treatments and increased expectant management strategies over time. PATIENT SUMMARY Prostate-specific antigen-based screening reduces the number of invasive prostate cancer treatments needed, however, at the cost of more overdiagnosis and probably more overtreatment. Limiting these costs remains crucial to benefit optimally from prostate cancer screening.
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Affiliation(s)
- Renée Hogenhout
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Ivo I de Vos
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Alberti A, Nicoletti R, Castellani D, Yuan Y, Maggi M, Dibilio E, Resta GR, Makrides P, Sessa F, Sebastianelli A, Serni S, Gacci M, De Nunzio C, Teoh JYC, Campi R. Patient-reported Outcome Measures and Experience Measures After Active Surveillance Versus Radiation Therapy Versus Radical Prostatectomy for Prostate Cancer: A Systematic Review of Prospective Comparative Studies. Eur Urol Oncol 2024:S2588-9311(24)00138-X. [PMID: 38816298 DOI: 10.1016/j.euo.2024.05.008] [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: 03/21/2024] [Revised: 05/02/2024] [Accepted: 05/14/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND AND OBJECTIVE Current management options for localized prostate cancer (PCa) include radical prostatectomy (RP), radiotherapy (RT), and active surveillance (AS). Despite comparable oncological outcomes, there is still lack of evidence on their comparative effectiveness in terms of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). We conducted a systematic review of studies comparing PROMs and PREMs after all recommended management options for localized PCa (RP, RT, AS). METHODS A literature search was performed in the MEDLINE, EMBASE, and Cochrane CENTRAL databases in accordance with recommendations from the European Association of Urology Guidelines Office and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. All prospective clinical trials reporting PROMs and/or PREMs for comparisons of RP versus RT versus AS were included. A narrative synthesis was used to summarize the review findings. No quantitative synthesis was performed because of the heterogeneity and limitations of the studies available. KEY FINDINGS AND LIMITATIONS Our findings reveal that RP mostly affects urinary continence and sexual function, with better results for voiding symptoms in comparison to other treatments. RT was associated with greater impairment of bowel function and voiding symptoms. None of the treatments had a significant impact on mental or physical quality of life. Only a few studies reported PREMs, with a high rate of decision regret for all modalities (up to 23%). CONCLUSIONS AND CLINICAL IMPLICATIONS All recommended treatments for localized PCa have an impact on PROMs and PREMs, but for different domains and with differing severity. We found significant heterogeneity in PROM collection, so standardization in real-world practice and clinical trials is warranted. Only a few studies have reported PREMs, highlighting an unmet need that should be explored in future studies. PATIENT SUMMARY We reviewed differences in patient reports of their outcomes and experiences after surgical prostate removal, radiotherapy, or active surveillance for prostate cancer. We found differences in the effects on urinary, bowel, and sexual functions among the treatments, but no difference for mental or physical quality of life. Our results can help doctors and prostate cancer patients in shared decision-making.
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Affiliation(s)
- Andrea Alberti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Rossella Nicoletti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Yuhong Yuan
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Martina Maggi
- Department of Urology, Sapienza Rome University, Rome, Italy
| | - Edoardo Dibilio
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Giulio Raffaele Resta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Pantelis Makrides
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Francesco Sessa
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Arcangelo Sebastianelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Sergio Serni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Mauro Gacci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, La Sapienza University, Rome, Italy
| | - Jeremy Y C Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Riccardo Campi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.
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Tessema ZT, Tesema GA, Wah W, Ahern S, Papa N, Millar JL, Earnest A. Bayesian Spatio-Temporal Multilevel Modelling of Patient-Reported Quality of Life following Prostate Cancer Surgery. Healthcare (Basel) 2024; 12:1093. [PMID: 38891168 PMCID: PMC11171974 DOI: 10.3390/healthcare12111093] [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: 03/15/2024] [Revised: 05/10/2024] [Accepted: 05/18/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Globally, prostate cancer is the second leading cause of cancer deaths among males. It is the most commonly diagnosed cancer in Australia. The quality of life of prostate cancer patients is poorer when compared to the general population due to the disease itself and its related complications. However, there is limited research on the geographic pattern of quality of life and its risk factors in Victoria. Therefore, an examination of the spatio-temporal pattern and risk factors of poor quality of life, along with the impact of spatial weight matrices on estimates and model performance, was conducted. METHOD A retrospective study was undertaken based on the Prostate Cancer Outcome Registry-Victoria data. Patient data (n = 5238) were extracted from the Prostate Cancer Outcome Registry, a population-based clinical quality outcome assessment from 2015 to 2021. A Bayesian spatio-temporal multilevel model was fitted to identify risk factors for poor quality of life. This study also evaluated the impact of distance- and adjacency-based spatial weight matrices. Model convergence was assessed using Gelman-Rubin statistical plots, and model comparison was based on the Watanabe-Akaike Information Criterion. RESULTS A total of 1906 (36.38%) prostate cancer patients who had undergone surgery experienced poor quality of life in our study. Belonging to the age group between 76 and 85 years (adjusted odds ratio (AOR) = 2.90, 95% credible interval (CrI): 1.39, 2.08), having a prostate-specific antigen level between 10.1 and 20.0 (AOR = 1.33, 95% CrI: 1.12, 1.58), and being treated in a public hospital (AOR = 1.35, 95% CrI: 1.17, 1.53) were significantly associated with higher odds of poor quality of life. Conversely, residing in highly accessible areas (AOR = 0.60, 95% CrI: 0.38, 0.94) was significantly associated with lower odds of poor prostate-specific antigen levels. Variations in estimates and model performance were observed depending on the choice of spatial weight matrices. CONCLUSION Belonging to an older age group, having a high prostate-specific antigen level, receiving treatment in public hospitals, and remoteness were statistically significant factors linked to poor quality of life. Substantial spatio-temporal variations in poor quality of life were observed in Victoria across local government areas. The distance-based weight matrix performed better than the adjacency-based matrix. This research finding highlights the need to reduce geographical disparities in quality of life. The statistical methods developed in this study may also be useful to apply to other population-based clinical registry settings.
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Affiliation(s)
- Zemenu Tadesse Tessema
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Getayeneh Antehunegn Tesema
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Win Wah
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Nathan Papa
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia
| | - Jeremy Laurence Millar
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Department of Radiation Oncology, Alfred Health, Melbourne, VIC 3004, Australia
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
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Duwe G, Boehm K, Becker G, Ruckes C, Sparwasser P, Haack M, Dotzauer R, Thomas A, Mager R, Tsaur I, Neumann CCM, Feick G, Carl G, Brandt MP, Haferkamp A, Höfner T. Individualized center-based analysis of urinary and sexual functional outcome after radical prostatectomy based on the prostate cancer outcome study: a post hoc pathway to patient outcome measurement analysis for quality improvement. World J Urol 2024; 42:236. [PMID: 38619659 DOI: 10.1007/s00345-024-04950-1] [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: 06/18/2023] [Accepted: 02/08/2024] [Indexed: 04/16/2024] Open
Abstract
PURPOSE We evaluate differences of patient-reported outcome measurements (PROM) based urinary continence and sexual function 12 months after radical prostatectomy (RPE) based on perioperative, surgical, and patient-specific characteristics in a large European academic urology center. MATERIALS AND METHODS All men enrolled in the Prostate Cancer Outcome Study (PCO) study who were treated with RPE between 2017 and 2021 completed EPIC-26 information surveys before and 12 months after RPE. Survey data were linked to clinical data of our institution. Logistic regression analyses were performed to examine the correlation between individual surgeons, patient characteristics, patient clinical data, and their urinary continence and sexual function. RESULTS In total, data of 429 men were analyzed: unstratified mean (SD) EPIC-26 domain score for urinary function decreased from 93.3 (0.7) to 60.4 (1.5) one year after RPE, respectively for sexual function from 64.95 (1.6) to 23.24 (1.1). Patients with preoperative adequate urinary function (EPIC-26 score > 80) reported significantly different mean urinary function scores between 53.35 (28.88) and 66.25 (25.15), p= 0.001, stratified by surgeons experience. On binary logistic regression analyses, only nerve sparing techniques (OR: 1,83, 95% CI: 1.01;3.21; p = 0.045) and low body mass index (OR: 0.91, CI: 0.85;0.99, p= 0.032) predicted adequate postoperative urinary function. CONCLUSIONS The results show how using provider-specific data from a larger cohort study enables to develop institution-specific analysis for functional outcomes after RPE. These models can be used for internal quality improvement as well as enhanced and provider-specific patient communication and shared decision making.
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Affiliation(s)
- Gregor Duwe
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
| | - Katharina Boehm
- Department of Urology, University Hospital Carl Gustav-Carus, TU Dresden, 01307, Dresden, Germany
| | - Gerrit Becker
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Christian Ruckes
- Interdisciplinary Center for Clinical Trials Mainz, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Peter Sparwasser
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Maximilian Haack
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Robert Dotzauer
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Anita Thomas
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Rene Mager
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Christopher C M Neumann
- Department of Hematology, Oncology and Tumor Immunology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10117, Berlin, Germany
| | - Günther Feick
- Federal Association of German Prostate Cancer Patient Support Groups, Thomas-Mann Strasse 40, 55311, Bonn, Germany
| | - Günter Carl
- Federal Association of German Prostate Cancer Patient Support Groups, Thomas-Mann Strasse 40, 55311, Bonn, Germany
| | - Maximilian Peter Brandt
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Thomas Höfner
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
- Department of Urology, Ordensklinikum Linz Elisabethinen, Fadingerstrasse 1, 4020, Linz, Austria
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Roberts NA, Esler R, Pearce A, Wyld D, Smith M, Woollett K, Mazariego C, Roberts MJ. Exploring Unmet Needs in Prostate Cancer Care: A Cross-sectional Descriptive Study. EUR UROL SUPPL 2024; 62:36-42. [PMID: 38585211 PMCID: PMC10998272 DOI: 10.1016/j.euros.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 04/09/2024] Open
Abstract
Background and objective Prostate cancer, the most common cancer among men worldwide, has significant impact on quality of life. Supportive care needs for those affected by prostate cancer are not well understood. This study aims to describe patient-reported unmet needs and explore supportive care priorities of men treated for prostate cancer. Methods A cross-sectional survey was distributed to all men who had accessed prostate cancer services (including surgical, radiation, and medical oncology treatment modalities) at a tertiary hospital. The survey included qualitative questions exploring patient experience and a validated patient-reported outcome measure (Supportive Care Needs Survey Short Form 34). Clinical information was collected. Analyses included, descriptive statistics, multivariate logistic regression models and qualitative analyses using a framework method. Key findings and limitations A total of 162 participants provided survey data. Domains about information, self-management, and sexual function were the highest ranked items with unmet needs. A qualitative analysis also identified "relationships", "information", and "the value of hindsight" constructs. Participants who identified three or more unmet needs expressed treatment regret (odds ratio 5.92, 1.98-22.23, p = 0.01). Conclusions and clinical implications Understanding the unmet needs of patients may better inform supportive care interventions that address what is important to patients. Importantly, participants valued relationships. There may be opportunities to better meet the needs of patients by improving access to information and self-management resources, particularly around sexuality. Further research is warranted. Patient summary Prostate cancer and its treatment impacts are not well understood. Prioritisation of relationships and improving access to information and self-management resources are important. Further attention to prostate cancer supportive care in clinical practice is needed.
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Affiliation(s)
- Natasha A. Roberts
- Centre for Clinical Research, Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Herston, QLD, Australia
| | - Rachel Esler
- Department of Urology, Cancer Care Services, Surgery and Peri-operative Services, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - Adam Pearce
- Department of Urology, Cancer Care Services, Surgery and Peri-operative Services, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - David Wyld
- Centre for Clinical Research, Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Urology, Cancer Care Services, Surgery and Peri-operative Services, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - Michael Smith
- Department of Urology, Cancer Care Services, Surgery and Peri-operative Services, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Kaylene Woollett
- Department of Urology, Cancer Care Services, Surgery and Peri-operative Services, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - Carolyn Mazariego
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Kings Cross, NSW, Australia
| | - Matthew J. Roberts
- Centre for Clinical Research, Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Urology, Cancer Care Services, Surgery and Peri-operative Services, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
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MacAskill F, Shabbir M, Sahai A. Survivorship in prostate cancer following robotic assisted radical prostatectomy-the time to act is now! Prostate Cancer Prostatic Dis 2024; 27:46-47. [PMID: 36065059 PMCID: PMC10876470 DOI: 10.1038/s41391-022-00589-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/10/2022] [Accepted: 08/18/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Findlay MacAskill
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
- King's College London, London, UK.
| | - Majed Shabbir
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Arun Sahai
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
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Karaihira W, Karimi PN, Weru IW. Management and health-related quality of life among patients with prostate cancer in a Kenyan tertiary health facility. J Oncol Pharm Pract 2023:10781552231221110. [PMID: 38105481 DOI: 10.1177/10781552231221110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Advances made in the screening, diagnosis and management of prostate cancer have improved the survival rates of the patients. However, many of these treatments including surgery, radiotherapy, and pharmacotherapy, have an impact on the subsequent health-related quality of life (HRQoL) of these patients. Since it is an important prognostic factor of survival, failure to evaluate the HRQoL and its predictors in these patients typically results in long-term deficits in their overall well-being, that is, their physical, social, emotional, and mental health. The objective of this study was to evaluate the management and HRQoL among patients with prostate cancer at Kenyatta National Hospital. METHODS This was a descriptive cross-sectional study. The sample size of 62 patients who met the eligibility criteria was selected through simple random sampling on the respective clinic days of the cancer treatment centre and urology clinic. Data was collected through a pre-tested structured questionnaire and HRQoL tools which are EORTC-QLQ-C30 and EORTC-QLQ-PR25 and analysed using STATA version 13 software. Descriptive analysis was used to summarise the continuous and categorical variables. Spearman's rho (rs) correlation was used to determine the predictors of HRQoL based on the strength and significance of association at 0.05 level of significance. RESULTS The mean age of the participants was 70.5 (±7.35) years. The majority (52, 83.9%) of the patients had a prostate specific antigen (PSA) above 20 ng/ml. Twenty-one (33.9%) were graded as Gleason group 5 and 41 (66.1%) had stage IV disease at diagnosis. Fifty (80.9%) participants were on hormonal therapy, with most of them being on combined androgen blockade. The overall HRQoL was 65.1. Fatigue, one of the major complaints among these patients, was negatively associated with physical functioning (p = 0.0005), role functioning (p = 0.0026), social functioning (p = 0.0001), financial difficulties (p = 0.0077) and quality of life (p = 0.0050). CONCLUSION Fatigue was the most common predictor of poor HRQoL in several scales of measurement. For those on management, frequent assessment of HRQoL should be carried out and interventions instituted immediately.
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Affiliation(s)
| | - Peter N Karimi
- Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, University of Nairobi, Nairobi, Kenya
| | - Irene W Weru
- Pharmacy Division, Kenyatta National Hospital, Nairobi, Kenya
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Venderbos LDF, Remmers S, Deschamps A, Dowling J, Carl EG, Pereira-Azevedo N, Roobol MJ. The Europa Uomo Patient Reported Outcome Study 2.0-Prostate Cancer Patient-reported Outcomes to Support Treatment Decision-making. Eur Urol Focus 2023; 9:1024-1036. [PMID: 37268512 DOI: 10.1016/j.euf.2023.05.006] [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: 03/02/2023] [Revised: 04/21/2023] [Accepted: 05/23/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND To further strengthen the voice of patients, Europa Uomo initiated the Europa Uomo Patient Reported Outcome Study 2.0 (EUPROMS 2.0) in October 2021. OBJECTIVE To collect the self-reported perspective of prostate cancer (PCa) patients on physical and mental well-being after PCa treatment outside a clinical trial setting to inform future fellow patients about the impact of PCa treatment. DESIGN, SETTING, AND PARTICIPANTS Europa Uomo invited PCa patients to complete a cross-sectional survey including the validated EQ-5D-5L, EORTC-QLQ-C30, and the EPIC-26 questionnaires. Furthermore, the nine-item Shared Decision Making Questionnaire (SDM-Q-9) and diagnostic clinical scenarios were included. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Descriptive statistics was used to assess the demographic and clinical characteristics and to analyze the patient-reported outcome data. RESULTS AND LIMITATIONS Between October 25, 2021 and January 17, 2022, 3571 men from 30 countries completed the EUPROMS 2.0 survey. The median age of respondents was 70 yr (interquartile range 65-75 yr). Half of the respondents underwent one treatment, most often radical prostatectomy. Men who are treated actively experience lower health-related quality of life than men on active surveillance, mainly regarding sexual function, fatigue, and insomnia. Lower urinary incontinence levels were seen for men who underwent radical prostatectomy (single treatment or in combination with other treatments). Of the respondents, 42% indicated that the determination of the prostate-specific antigen (PSA) value was part of a routine blood test; 25% wanted to undergo screening/early detection for PCa, and 20% indicated that the determination of the PSA value had a clinical reason. CONCLUSIONS A large sample of 3571 international patients has contributed patient experience after PCa treatment in the EUPROMS 2.0 study, confirming that treatment for PCa mainly affects urinary incontinence, sexual function, fatigue, and insomnia. Such information can be used to direct toward a better patient-doctor relationship, to offer patients ready access to responsible information and a better understanding of their disease and treatment. PATIENT SUMMARY Through the EUPROMS 2.0 survey, Europa Uomo has strengthened the voice of the patient. Such information can be used to inform future prostate cancer (PCa) patients about the impact of PCa treatment and to engage them in informed and shared decision-making.
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Affiliation(s)
- Lionne D F Venderbos
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | | | - Nuno Pereira-Azevedo
- Department of Urology, Entre o Douro e Vouga Medical Center, Santa Maria da Feira, Portugal
| | - Monique J Roobol
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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de Vos II, Meertens A, Hogenhout R, Remmers S, Roobol MJ. A Detailed Evaluation of the Effect of Prostate-specific Antigen-based Screening on Morbidity and Mortality of Prostate Cancer: 21-year Follow-up Results of the Rotterdam Section of the European Randomised Study of Screening for Prostate Cancer. Eur Urol 2023; 84:426-434. [PMID: 37029074 DOI: 10.1016/j.eururo.2023.03.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/24/2023] [Accepted: 03/14/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Considering the long natural history of prostate cancer (PCa), long-term results of the European Randomised Study of Screening for PCa (ERSPC) are crucial. OBJECTIVE To provide an update on the effect of prostate-specific antigen (PSA)-based screening on PCa-specific mortality (PCSM), metastatic disease, and overdiagnosis in the Dutch arm of the ERSPC. DESIGN, SETTING, AND PARTICIPANTS Between 1993 and 2000, a total of 42376 men, aged 55-74 yr, were randomised to a screening or a control arm. The main analysis was performed with men aged 55-69 yr (n = 34831). Men in the screening arm were offered PSA-based screening with an interval of 4 yr. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Intention-to-screen analyses with Poisson regression were used to calculate rate ratios (RRs) of PCSM and metastatic PCa. RESULTS AND LIMITATIONS After a median follow-up of 21 yr, the RR of PCSM was 0.73 (95% confidence interval [CI]: 0.61-0.88) favouring screening. The numbers of men needed to invite (NNI) and needed to diagnose (NND) to prevent one PCa death were 246 and 14, respectively. For metastatic PCa, the RR was 0.67 (95% CI: 0.58-0.78) favouring screening. The NNI and NND to prevent one metastasis were 121 and 7, respectively. No statistical difference in PCSM (RR of 1.18 [95% CI: 0.87-1.62]) was observed in men aged ≥70 yr at the time of randomisation. In the screening arm, higher rates of PCSM and metastatic disease were observed in men who were screened only once and in a selected group of men above the screening age cut-off of 74 yr. CONCLUSIONS The current analysis illustrates that with a follow-up of 21 yr, both absolute metastasis and mortality reduction continue to increase, resulting in a more favourable harm-benefit ratio than demonstrated previously. These data do not support starting screening at the age of 70-74 yr and show that repeated screening is essential. PATIENT SUMMARY Prostate-specific antigen-based prostate cancer screening reduces metastasis and mortality. Longer follow-up shows fewer invitations and diagnoses needed to prevent one death, a positive note towards the issue of overdiagnosis.
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Affiliation(s)
- Ivo I de Vos
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Annick Meertens
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Renée Hogenhout
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sebastiaan Remmers
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Monique J Roobol
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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11
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Dickstein DR, Edwards CR, Lehrer EJ, Tarras ES, Gallitto M, Sfakianos J, Galsky MD, Stock R, Safer JD, Rosser BRS, Marshall DC. Sexual health and treatment-related sexual dysfunction in sexual and gender minorities with prostate cancer. Nat Rev Urol 2023; 20:332-355. [PMID: 37217695 PMCID: PMC10389287 DOI: 10.1038/s41585-023-00778-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 05/24/2023]
Abstract
Prostate cancer treatment has substantial effects on sexual health and function. Sexual function is a vital aspect of human health and a critical component of cancer survivorship, and understanding the potential effects of different treatment modalities on sexual health is crucial. Existing research has extensively described the effects of treatment on male erectile tissues necessary for heterosexual intercourse; however, evidence regarding their effects on sexual health and function in sexual and gender minority populations is minimal. These groups include sexual minority - gay and bisexual - men, and transgender women or trans feminine people in general. Such unique effects in these groups might include altered sexual function in relation to receptive anal and neovaginal intercourse and changes to patients' role-in-sex. Sexual dysfunctions following prostate cancer treatment affecting quality of life in sexual minority men include climacturia, anejaculation, decreased penile length, erectile dysfunction, and problematic receptive anal intercourse, including anodyspareunia and altered pleasurable sensation. Notably, clinical trials investigating sexual outcomes after prostate cancer treatment do not collect sexual orientation and gender identity demographic data or outcomes specific to members of these populations, which perpetuates the uncertainty regarding optimal management. Providing clinicians with a solid evidence base is essential to communicate recommendations and tailor interventions for sexual and gender minority patients with prostate cancer.
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Affiliation(s)
- Daniel R Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Collin R Edwards
- Department of Radiology, Vagelos College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Eric J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elizabeth S Tarras
- Department of Pulmonology, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew Gallitto
- Department of Radiation Oncology, Vagelos College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - John Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew D Galsky
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Richard Stock
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua D Safer
- Center for Transgender Medicine and Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - B R Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health at University of Minnesota, Minneapolis, MN, USA
| | - Deborah C Marshall
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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12
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Remmers S, Nieboer D, Roobol MJ. The Patient Journey from Randomization to Detection of Prostate Cancer and Death: Results from ERSPC Rotterdam. EUR UROL SUPPL 2023; 51:1-6. [PMID: 37187725 PMCID: PMC10175721 DOI: 10.1016/j.euros.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 05/17/2023] Open
Abstract
Background The ERSPC study has demonstrated that prostate-specific antigen (PSA)-based screening results in a relative increase in diagnosis of (low-risk) prostate cancer (PCa) and a reduction in metastatic disease and PCa mortality. Objective To evaluate the burden of PCa among men randomized to active screening compared to those in the control arm in ERSPC Rotterdam. Design setting and participants We analyzed data for participants in the Dutch section of the ERSPC, including 21 169 men randomized to the screening arm and 21 136 randomized to the control arm. Men in the screening arm were invited for PSA-based screening every 4 yr, and transrectal ultrasound-guided prostate biopsy was recommended for those with PSA ≥3.0 ng/ml. Outcome measurements and statistical analysis We analyzed detailed follow-up and mortality data up to January 1, 2019, to a maximum of 21 yr, using multistate models. Results and limitations At 21 yr, 3046 men (14%) had been diagnosed with nonmetastatic PCa and 161 (0.76%) with metastatic PCa in the screening arm. In the control arm, 1698 men (8.0%) had been diagnosed with nonmetastatic PCa and 346 (1.6%) with metastatic PCa. In comparison to the control arm, men in the screening arm were diagnosed with PCa almost 1 yr earlier and if diagnosed with nonmetastatic PCa lived on average for almost 1 yr longer without disease progression. Among those who experienced biochemical recurrence (18-19% after nonmetastatic PCa), progression to metastatic disease or death was quicker in the control arm: men in the screening arm lived for 7.17 yr without progression, while the progression-free interval was only 1.59 yr for men in the control arm over a 10-yr time period. Among those who experienced metastatic disease, men in both study arms lived for 5 yr over a 10-yr time period. Conclusions PCa diagnosis was earlier after study entry for men in the PSA-based screening arm. However, disease progression was not as fast in the screening arm as in the control arm: once men in the control arm experienced biochemical recurrence, progression to metastatic disease or death was 5.6 yr faster than in the screening arm. Our results confirm the ability of early disease detection to reduce suffering and death from PCa at the cost of earlier (and more frequent) treatment-induced reductions in quality of life. Patient summary Our study shows that early detection of prostate cancer can reduce suffering and death from this disease. However, screening based on measurement of prostate-specific antigen (PSA) can also result in an earlier treatment-induced reduction in quality of life.
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Affiliation(s)
- Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
- Corresponding author. Department of Urology, Erasmus University Medical Center, P.O. Box 2040, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. Tel. +31 10 7032 239; Fax: +31 10 7035 315.
| | - Daan Nieboer
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Monique J. Roobol
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
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13
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Schubach K, Niyonsenga T, Turner M, Paterson C. Experiences of sexual well-being interventions in males affected by genitourinary cancers and their partners: an integrative systematic review. Support Care Cancer 2023; 31:265. [PMID: 37058163 PMCID: PMC10104925 DOI: 10.1007/s00520-023-07712-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/28/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE Sexual well-being has been identified as an unmet supportive care need among many individuals with genitourinary (GU) cancers. Little is known about the experiences of using sexual well-being interventions among men and their partners. METHODS This review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and followed a systematic review protocol. Data extraction and methodological quality appraisal were performed, and a narrative synthesis was conducted. RESULTS A total of 21 publications (reporting on 18 studies) were included: six randomised control trials, seven cross-sectional studies, three qualitative studies, and five mixed methods studies. Sexual well-being interventions comprised medical/pharmacological and psychological support, including counselling and group discussion facilitation. The interventions were delivered using various modes: face-to-face, web-based/online, or telephone. Several themes emerged and included broadly: (1) communication with patient/partner and healthcare professionals, (2) educational and informational needs, and (3) timing and/or delivery of the interventions. CONCLUSION Sexual well-being concerns for men and their partners were evident from diagnosis and into survivorship. Participants benefited from interventions but many articulated difficulties with initiating the topic due to embarrassment and limited access to interventions in cancer services. Noteworthy, all studies were only representative of men diagnosed with prostate cancer, underscoring a significant gap in other GU cancer patient groups where sexual dysfunction is a prominent consequence of treatment. IMPLICATIONS FOR CANCER SURVIVORS This systematic review provides valuable new insights to inform future models of sexual well-being recovery interventions for patients and partners with prostate cancer, but further research is urgently needed in other GU cancer populations.
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Affiliation(s)
- Kathryn Schubach
- Faculty of Health, University of Canberra, Bruce ACT, Australia.
- Rehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce ACT, Australia.
| | - Theo Niyonsenga
- Faculty of Health, University of Canberra, Bruce ACT, Australia
- Rehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce ACT, Australia
| | - Murray Turner
- Faculty of Health, University of Canberra, Bruce ACT, Australia
- Rehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce ACT, Australia
| | - Catherine Paterson
- Faculty of Health, University of Canberra, Bruce ACT, Australia
- Rehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce ACT, Australia
- Robert Gordon University, Aberdeen, Scotland, UK
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14
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Østergaard LD, Poulsen MH, Jensen ME, Lund L, Hildebrandt MG, Nørgaard B. Health‐related
quality of life the first year after a prostate cancer diagnosis a systematic review. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2023. [DOI: 10.1111/ijun.12340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Louise Dorner Østergaard
- Department of Urology Odense University Hospital Odense Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
| | - Mads Hvid Poulsen
- Department of Urology Odense University Hospital Odense Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
| | - Malene Eiberg Jensen
- The Psychiatric Research Unit at Mental Health Centre North Zealand Hillerød Denmark
- Department of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Lars Lund
- Department of Urology Odense University Hospital Odense Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
| | - Malene Grubbe Hildebrandt
- Department of Clinical Research University of Southern Denmark Odense Denmark
- Department of Nuclear Medicine Odense University Hospital Odense Denmark
| | - Birgitte Nørgaard
- Department of Public Health University of Southern Denmark Odense Denmark
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15
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Dordoni P, Remmers S, Valdagni R, Bellardita L, De Luca L, Badenchini F, Marenghi C, Roobol MJ, Venderbos LDF. Cross-cultural differences in men on active surveillance' anxiety: a longitudinal comparison between Italian and Dutch patients from the Prostate cancer Research International Active Surveillance study. BMC Urol 2022; 22:110. [PMID: 35850672 PMCID: PMC9295436 DOI: 10.1186/s12894-022-01062-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Men diagnosed with localized prostate cancer (PCa) on active surveillance (AS) have shown to cope with anxiety caused by living with an ‘untreated cancer’ and different factors can influence the tolerance level for anxiety in these patients. The present study analyzes Italian (Milan) and Dutch (Rotterdam) men prospectively included in the Prostate cancer International Active Surveillance (PRIAS) trial, aiming to explore whether socio-demographic factors (i.e. age, relationship status, education, nationality) may be relevant factors in conditioning the level of anxiety at AS entry and over time. Methods Italian and Dutch men participating in the IRB-approved PRIAS study, after signing an informed consent, filled in the Memorial Anxiety Scale for PCa (MAX-PC) at multiple time points after diagnosis. A linear mixed model was used to assess the relationship between the level of patient’s anxiety and time spent on AS, country of origin, the interaction between country and time on AS, patients’ relationship status and education, on PCa anxiety during AS. Results 823 MAX-PC questionnaires were available for Italian and 307 for Dutch men, respectively. Median age at diagnosis was 64 years (IQR 60–70 years) and did not differ between countries. On average, Dutch men had a higher total MAX-PC score than Italian men. However, the level of their anxiety decreased over time. Dutch men on average had a higher score on the PCa anxiety sub-domain, which did not decrease over time. Minimal differences were observed in the sub-domains PSA anxiety and fear of recurrence. Conclusion Significant differences in PCa anxiety between the Italian and Dutch cohorts were observed, the latter group of men showing higher overall levels of anxiety. These differences were not related to the socio-demographic factors we studied. Although both PRIAS-centers are dedicated AS-centers, differences in PCa-care organization (e.g. having a multidisciplinary team) may have contributed to the observed different level of anxiety at the start and during AS. Trial registration This study is registered in the Dutch Trial Registry (www.trialregister.nl) under NL1622 (registration date 11-03-2009), ‘PRIAS: Prostate cancer Research International: Active Surveillance—guideline and study for the expectant management of localized prostate cancer with curative intent’.
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Affiliation(s)
- Paola Dordoni
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sebastiaan Remmers
- Department of Urology, Erasmus Cancer Institute, Erasmus University Medical Center, Wytemaweg 80, kamer Na-1520, 3015 CN, Rotterdam, The Netherlands
| | - Riccardo Valdagni
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Lara Bellardita
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Letizia De Luca
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Fabio Badenchini
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Marenghi
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monique J Roobol
- Department of Urology, Erasmus Cancer Institute, Erasmus University Medical Center, Wytemaweg 80, kamer Na-1520, 3015 CN, Rotterdam, The Netherlands
| | - Lionne D F Venderbos
- Department of Urology, Erasmus Cancer Institute, Erasmus University Medical Center, Wytemaweg 80, kamer Na-1520, 3015 CN, Rotterdam, The Netherlands.
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16
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Koo K, Papa N, Evans M, Jefford M, IJzerman M, White V, Evans SM, Ristevski E, Emery J, Millar J. Mapping disadvantage: identifying inequities in functional outcomes for prostate cancer survivors based on geography. BMC Cancer 2022; 22:283. [PMID: 35296282 PMCID: PMC8928643 DOI: 10.1186/s12885-022-09389-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 03/04/2022] [Indexed: 11/30/2022] Open
Abstract
Background Prostate cancer is the most common internal malignancy in Australian men, and although most patients have good survival outcomes, treatment toxicities can impair function, leading to diminished quality of life for prostate cancer survivors. Socioeconomic disadvantage and geographical remoteness have been shown to be related to worse oncologic outcomes, and it is expected that they would similarly influence functional outcomes in prostate cancer. Methods Using data from the Victorian Prostate Cancer Outcomes Registry (n = 10,924), we investigated functional outcomes as measured by the Expanded Prostate Cancer Index Composite-26 (EPIC-26) following prostate cancer treatment, focusing on associations with socioeconomic status and geographical remoteness and controlling for clinicopathologic characteristics. A single composite score was developed from the five separate EPIC-26 domains for use in geo-mapping. Results A total of 7690 patients had complete EPIC-26 data, allowing mapping hotspots of poor function using our composite score. These hotspots were observed to relate to areas of socioeconomic disadvantage. Significant heterogeneity in outcomes was seen in urban areas, with hotspots of good and poor function. Both socioeconomic disadvantage and geographical remoteness were found to predict for worse functional outcomes, although only the former is significant on multivariate analysis. Conclusions Geo-mapping of functional outcomes in prostate cancer has the potential to guide health care service provision and planning. A nuanced policy approach is required so as not to miss disadvantaged patients who live in urban areas. We have demonstrated the potential of geo-mapping to visualise population-level outcomes, potentially allowing targeted interventions to address inequities in quality of care. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09389-4.
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Affiliation(s)
- Kendrick Koo
- Radiation Oncology, Alfred Health, Melbourne, Australia. .,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. .,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Melbourne, Australia. .,Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia.
| | - Nathan Papa
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Melanie Evans
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michael Jefford
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia.,Department of Health Services Research, Peter MacCallum Cancer Centre, Victoria, Melbourne, Australia
| | - Maarten IJzerman
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia.,Centre for Cancer Research, Cancer Health Services Research, University of Melbourne, Victoria, Australia
| | - Victoria White
- School of Psychology, Deakin University, Victoria, Australia.,Cancer Council Victoria, Melbourne, Australia
| | - Sue M Evans
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Cancer Council Victoria, Melbourne, Australia
| | - Eli Ristevski
- Monash Rural Health - Warragul, Monash University, Victoria, Australia
| | - Jon Emery
- Centre for Cancer Research, Cancer Health Services Research, University of Melbourne, Victoria, Australia
| | - Jeremy Millar
- Radiation Oncology, Alfred Health, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Beyer K, Moris L, Lardas M, Omar MI, Healey J, Tripathee S, Gandaglia G, Venderbos LD, Vradi E, van den Broeck T, Willemse PP, Antunes-Lopes T, Pacheco-Figueiredo L, Monagas S, Esperto F, Flaherty S, Devecseri Z, Lam TB, Williamson PR, Heer R, Smith EJ, Asiimwe A, Huber J, Roobol MJ, Zong J, Mason M, Cornford P, Mottet N, MacLennan SJ, N'Dow J, Briganti A, MacLennan S, Van Hemelrijck M. Updating and Integrating Core Outcome Sets for Localised, Locally Advanced, Metastatic, and Nonmetastatic Castration-resistant Prostate Cancer: An Update from the PIONEER Consortium. Eur Urol 2022; 81:503-514. [DOI: 10.1016/j.eururo.2022.01.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/06/2022] [Accepted: 01/20/2022] [Indexed: 12/25/2022]
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18
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Radical prostatectomy - aftercare should not be an afterthought. Nat Rev Urol 2021; 18:703-704. [PMID: 34599300 DOI: 10.1038/s41585-021-00526-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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19
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Van Poppel H, Hogenhout R, Albers P, van den Bergh RCN, Barentsz JO, Roobol MJ. A European Model for an Organised Risk-stratified Early Detection Programme for Prostate Cancer. Eur Urol Oncol 2021; 4:731-739. [PMID: 34364829 DOI: 10.1016/j.euo.2021.06.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/10/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022]
Abstract
CONTEXT Overdiagnosis as the argument to stop prostate cancer (PCa) screening is less valid since the introduction of new technologies such as risk calculators (RCs) and magnetic resonance imaging (MRI). These new technologies result in fewer unnecessary biopsy procedures and fewer cases of both overdiagnosis and underdetection. Therefore, we can now adequately respond to the growing and urgent need for a structured risk assessment to detect PCa early. OBJECTIVE To provide expert discussion on the existing evidence for a previously published risk-stratified strategy regarding an organised population-based early detection programme for PCa. EVIDENCE ACQUISITION The proposed algorithm for early detection of PCa emerged from expert consensus by the authors based on available evidence derived from a nonsystematic review of the current literature using Medline/PubMed, Cochrane Library database, ClinicalTrials.gov, ISRCTN Registry, and the European Association of Urology guidelines on PCa. EVIDENCE SYNTHESIS Although not confirmed by the highest level of evidence, current literature and guidelines point towards an algorithm for early detection of PCa that starts with risk-based prostate-specific antigen (PSA) testing, followed by multivariable risk stratification with RCs. All men who are classified to be at intermediate and high risk are then offered prostate MRI. The combined data from RCs and MRI results can be used to select men for prostate biopsy. Low-risk men return to a risk-based safety net that includes individualised PSA-interval tests and, if necessary, repeated MRI. Depending on local availability, the use of the different risk stratification tools may be adapted. CONCLUSIONS We present a risk-stratified algorithm for an organised population-based early detection programme for clinically significant PCa. Although the proposed strategy has not yet been analysed prospectively, it exploits and may even improve the most important available benefits of "PSA-only" screening studies, while at the same time reduces unnecessary biopsies and overdiagnosis by using new risk stratification tools. PATIENT SUMMARY This paper presents a personalised strategy that enables selective early detection of prostate cancer by combining prostate-specific antigen (interval) testing' prediction models (risk calculators), and magnetic resonance imaging scans. This will likely lead to reduced prostate cancer-related morbidity and mortality, while reducing the need for prostate biopsy and limiting overdiagnosis.
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Affiliation(s)
- Hendrik Van Poppel
- Department of Development and Regeneration, University Hospital KU Leuven, Leuven, Belgium.
| | - Renée Hogenhout
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter Albers
- Department of Urology, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany; Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Jelle O Barentsz
- Department of Medical Imaging, Radboudumc, Nijmegen, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
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20
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Roobol MJ. Active surveillance for prostate cancer-will the discoveries of the last 5 years change the future? Transl Androl Urol 2021; 10:2828-2831. [PMID: 34295766 PMCID: PMC8261427 DOI: 10.21037/tau-20-1321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 01/01/2023] Open
Affiliation(s)
- Monique J Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
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21
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Validation of a German translation of the CARE questionnaire and its implementation as electronic PROM to assess patient-reported postoperative convalescence and recovery after major urological surgery. World J Urol 2021; 39:3979-3991. [PMID: 33963916 PMCID: PMC8519897 DOI: 10.1007/s00345-021-03713-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/21/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To validate a German translation of the convalescence and recovery evaluation (CARE) as an electronic patient-reported outcome measure (ePROM) and use it to assess recovery after major urological surgery. Methods The CARE questionnaire was provided to patients scheduled for major urological surgery preoperatively, at discharge and 6 weeks postoperatively, using an ePROM system. Cronbach’s alpha, inter-scale correlations and confirmatory factor analysis (CFA) were used to validate the translation. Mixed linear regression models were used to identify factors influencing CARE results, and a multivariable logistic regression analysis was done to determine the predictive value of CARE results on quality of life (QoL). Results A total of 283 patients undergoing prostatectomy (n = 146, 51%), partial/radical nephrectomy (n = 70, 25%) or cystectomy (n = 67, 24%) responded to the survey. Internal consistency was high (α = 0.649–0.920) and the CFA showed a factor loading > 0.5 in 17/27 items. Significant main effects were found for the time of survey and type of surgery, while a time by type interaction was only found for the gastrointestinal subscale (\documentclass[12pt]{minimal}
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\begin{document}$$\chi_{(4)}^{2}$$\end{document}χ(4)2 = 30.37, p < 0.0001) and the total CARE score (TCS) (\documentclass[12pt]{minimal}
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\begin{document}$$\chi_{(4)}^{2}$$\end{document}χ(4)2 = 13.47, p = 0.009) for cystectomy patients, meaning a greater score decrease at discharge and lower level of recovery at follow-up. Complications demonstrated a significant negative effect on the TCS (\documentclass[12pt]{minimal}
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\begin{document}$$\chi_{(2)}^{2}$$\end{document}χ(2)2 = 8.61, p = 0.014). A high TCS at discharge was an independent predictor of a high QLQ-C30 QoL score at follow-up (OR = 5.26, 95%-CI 1.42–19.37, p = 0.013). Conclusion This German translation of the CARE can serve as a valid ePROM to measure recovery and predict QoL after major urological surgery.
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