Thirty-day hospital revisits after prostate brachytherapy: who is at risk?

Irradiation of localized prostate cancer in the elderly: A systematic literature review

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Oncological benefit for elderly patients with optimal treatment.

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Elderly patients often received inadequate treatment.

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Elderly comorbidities can influence oncological outcomes and treatment tolerance.

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Optimal curative treatment after oncogeriatric assessment.

Purpose

To analyze the literature that addresses radiation therapy for intermediate and high-risk prostate cancer (PC) in the elderly.

Patients and methods

A PubMed literature search was conducted including articles from 01/01/2000 to 30/06/21, with the following keywords: PC, radiotherapy/brachytherapy and elderly. The analysis mainly focused on the issue of under-treatment in the elderly and the benefit/risk balance of irradiation.

Results

Of the 176 references analyzed, 24 matched the selection criteria. The definition of “elderly patient” varied from 70 to 80 years. The analysis was impacted by the inhomogeneous primary end points used in each cohort. Age was often an obstacle to radical treatment, with a subsequent risk of under-treatment, particularly in patients with a poorer prognosis. However, comparable elderly oncological outcomes were compared to younger patients, both with external beam radiotherapy alone or combined with brachytherapy boost. Late toxicity rates are low and most often comparable to younger populations. However, a urinary over- toxicity was observed in the super-elderly (>80 years) after brachytherapy boost. The use of ADT should be considered in light of comorbidities, and may even be deleterious in some patients.

Conclusion

Due to the increase in life expectancy, the management of PC in the elderly is a challenge for patients, clinicians and health insurance payers. Except for unfit men, elderly patients remain candidates for optimal curative treatment (i.e. regardless of age) after oncogeriatric assessment. More solid data from prospective trials conducted specially in this population will provide better guidance in our daily clinical practice.

Relative Incidence of Emergency Department Visits After Treatment for Prostate Cancer with Radiation Therapy or Radical Prostatectomy

PURPOSE

Side effect profiles play an important role in treatment decisions for localized prostate cancer. Emergency department (ED) visits, which may be due to side effects from treatment, can be measured in real-world, structured, electronic health record (EHR) data. The goal of this study was to determine whether treatments for localized prostate cancer are associated with ED visits, as a measure of side effects, using EHR data.

METHODS AND MATERIALS

We used a self-controlled case series study (SCCS) design, including patients treated at an urban academic medical center with radiation therapy (RT) or radical prostatectomy (RP) for prostate cancer between 2011 and 2020 who had visits documented for ≥ 6 months before and after treatment and ≥1 ED visit. We estimated relative incidences (RI) of ED visits, comparing incidence in the exposed and unexposed periods, with the exposed period being between start of treatment and 1 month after completion, and the unexposed period consisting of all other documented time.

RESULTS

Among men who had at least one ED visit and after adjusting for age, there were higher rates of ED visits after RP (RI 20.4, 95% confidence interval [CI] 15.4-27.0, p<0.001), RT overall (RI 2.4, CI 1.7-3.4, p<0.001), intensity modulated radiation therapy with high dose-rate brachytherapy (HDR) (RI 3.4, CI 1.7-6.8, p<0.001) or stereotactic body radiation therapy boost (RI 7.1, CI 3.4-14.8, p < 0.001), and HDR alone (RI 16.3, CI 7.2-36.9, p<0.001), compared to unexposed time. The number needed to harm to result in an ED visit was less for RP (17, CI 13-23) than RT overall (43, CI 25-126), but varied by RT modality.

CONCLUSIONS

In summary, relative rates of ED visits vary by treatment type, suggesting differing severities of side effects. These data may aid in selecting treatments and demonstrate the feasibility of using the SCCS study design on ED visits in real-world, structured EHR data to better understand side effects of treatment.

Dhavileswarapu AVL, Naik N, Karimi H, Hegde P, Rai BP, Somani BK. Big Data Analytics in urology: the story so far and the road ahead

Artificial intelligence (AI) has a proven record of application in the field of medicine and is used in various urological conditions such as oncology, urolithiasis, paediatric urology, urogynaecology, infertility and reconstruction. Data is the driving force of AI and the past decades have undoubtedly witnessed an upsurge in healthcare data. Urology is a specialty that has always been at the forefront of innovation and research and has rapidly embraced technologies to improve patient outcomes and experience. Advancements made in Big Data Analytics raised the expectations about the future of urology. This review aims to investigate the role of big data and its blend with AI for trends and use in urology. We explore the different sources of big data in urology and explicate their current and future applications. A positive trend has been exhibited by the advent and implementation of AI in urology with data available from several databases. The extensive use of big data for the diagnosis and treatment of urological disorders is still in its early stage and under validation. In future however, big data will no doubt play a major role in the management of urological conditions.