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Gurayah AA, Blachman‐Braun R, Machado CJ, Mason MM, Hougen HY, Mouzannar A, Gonzalgo ML, Nahar B, Punnen S, Parekh DJ, Ritch CR. Clinical variables associated with major adverse cardiac events following radical cystectomy. BJUI Compass 2024; 5:480-488. [PMID: 38633835 PMCID: PMC11019239 DOI: 10.1002/bco2.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/08/2023] [Accepted: 11/10/2023] [Indexed: 04/19/2024] Open
Abstract
Objectives The objective of this study is to investigate the association between major adverse cardiac events (MACE) and clinical factors of patients undergoing radical cystectomy (RC) for bladder cancer. Materials and Methods A retrospective analysis using the 2015-2020 National Surgical Quality Improvement Program database was performed on patients who underwent RC for bladder cancer. MACE was defined as any report of cerebrovascular accident, myocardial infarction, or thromboembolic events (pulmonary embolism or deep vein thrombosis). A multivariable-adjusted logistic regression was conducted to identify clinical predictors of postoperative MACE. Results A total of 10 308 (84.2%) patients underwent RC with incontinent urinary diversion (iUD), and 1938 (15.8%) underwent RC with continent urinary diversion (cUD). A total of 629 (5.1%) patients recorded a MACE, and on the multivariable-adjusted logistic regression, it was shown that MACE was significantly associated with increased age (OR = 1.035, 95% CI: 1.024-1.046, p < 0.001), obesity (OR = 1.583, 95% CI: 1.266-1.978, p < 0.001), current smokers (OR = 1.386, 95% CI: 1.130-1.700, p = 0.002), congestive heart failure before surgery (OR = 1.991, 95% CI: 1.016-3.900; p = 0.045), hypertension (OR = 1.209, 95% CI: 1.016-1.453, p = 0.043), and increase the surgical time (per 10 min increase, OR = 1.010, 95% CI: 1.003-1.017, p = 0.009). We also report that increased age, obesity, and patients undergoing cUD (OR = 1.368, 95% CI: 1.040-1.798; p = 0.025) are associated with thromboembolic events. Conclusion By considering the preoperative characteristics of patients, including age, obesity, smoking, congestive heart failure, and hypertension status, urologists may be able to decrease the incidence of MACE in patients undergoing RC. Urologists should aim for lower operative times as this was associated with a decreased risk of thromboembolic events.
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Affiliation(s)
| | - Ruben Blachman‐Braun
- Desai Sethi Urology InstituteUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | | | | | - Helen Y. Hougen
- Desai Sethi Urology InstituteUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Ali Mouzannar
- Desai Sethi Urology InstituteUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Mark L. Gonzalgo
- Desai Sethi Urology InstituteUniversity of Miami Miller School of MedicineMiamiFloridaUSA
- Sylvester Comprehensive Cancer CenterMiamiFloridaUSA
| | - Bruno Nahar
- Desai Sethi Urology InstituteUniversity of Miami Miller School of MedicineMiamiFloridaUSA
- Sylvester Comprehensive Cancer CenterMiamiFloridaUSA
| | - Sanoj Punnen
- Desai Sethi Urology InstituteUniversity of Miami Miller School of MedicineMiamiFloridaUSA
- Sylvester Comprehensive Cancer CenterMiamiFloridaUSA
| | - Dipen J. Parekh
- Desai Sethi Urology InstituteUniversity of Miami Miller School of MedicineMiamiFloridaUSA
- Sylvester Comprehensive Cancer CenterMiamiFloridaUSA
| | - Chad R. Ritch
- Desai Sethi Urology InstituteUniversity of Miami Miller School of MedicineMiamiFloridaUSA
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Mouzannar A, Delgado J, Kwon D, Atluri VS, Mason MM, Prakash NS, Zhao W, Nahar B, Swain S, Punnen S, Gonzalgo ML, Parekh DJ, Deane LA, Ritch CR. Racial disparity in the utilization of immunotherapy for advanced prostate cancer. J Natl Med Assoc 2023; 115:566-576. [PMID: 37903694 DOI: 10.1016/j.jnma.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/16/2023] [Accepted: 09/26/2023] [Indexed: 11/01/2023]
Abstract
PURPOSE To identify whether there was a disparity in the utilization of immunotherapy in the treatment of black patients with metastatic castration resistant prostate cancer (mCRPC). METHODS Using the National Cancer Database, we identified patients between 2010- 2015 with likely minimally/asymptomatic mCRPC. We analyzed annual trends for chemotherapy and immunotherapy use and compared utilization by demographic and clinical features. Multivariable analysis was performed to determine predictors of receiving immunotherapy vs chemotherapy. RESULTS We identified 1301 patients with likely mCRPC. The majority were non Hispanic White (NHW - 63 %) and 23 % were non-Hispanic Black (NHB). Overall, there was increased utilization of immunotherapy in mCRPC from 2010 onwards, with the peak occurring in 2014 (4.6 %). Chemotherapy use increased significantly, peaking in 2014 to 26.1 %. However, the increased utilization of immunotherapy in the mCRPC was mainly seen in White patients: from 50 % to 74.2 % of the cohort. Conversely, there was a decrease in utilization of immunotherapy among Black mCPRC patients: from 50 % to 25.8 %. On multivariable analysis, there was no statistically significant difference between treatment types by race. CONCLUSION FDA approval of Sipuleucel-T for mCRPC led to increased utilization of immunotherapy shortly thereafter, but this was mainly noted in white patients. Black patients comparatively did not exhibit increased utilization of this novel agent after 2010. Further studies are necessary to help understand barriers to access to new treatment in mCRPC and eliminate the burden of disease in minority populations."
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Affiliation(s)
| | | | - Deukwoo Kwon
- Biostatistics, University of Miami, Miller School of Medicine, 1120 NW 14th Street, 15th Floor, Miami, FL 33136, USA; Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL 33136, USA
| | | | | | | | - Wei Zhao
- Biostatistics, University of Miami, Miller School of Medicine, 1120 NW 14th Street, 15th Floor, Miami, FL 33136, USA
| | - Bruno Nahar
- Department of Urology, USA; Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL 33136, USA
| | - Sanjaya Swain
- Department of Urology, USA; Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL 33136, USA
| | - Sanoj Punnen
- Department of Urology, USA; Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL 33136, USA
| | - Mark L Gonzalgo
- Department of Urology, USA; Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL 33136, USA
| | - Dipen J Parekh
- Department of Urology, USA; Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL 33136, USA
| | | | - Chad R Ritch
- Department of Urology, USA; Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL 33136, USA
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3
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Blachman-Braun R, Gurayah AA, Mason MM, Hougen HY, Gonzalgo ML, Nahar B, Punnen S, Parekh DJ, Ritch CR. Incidence and predictors of deep incisional and organ/space surgical site infection following radical cystectomy. Urol Oncol 2023; 41:455.e17-455.e24. [PMID: 37524577 DOI: 10.1016/j.urolonc.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/01/2023] [Accepted: 06/26/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE To investigate clinical risk factors associated with postoperative deep incisional or organ/space surgical site infections (SSI) following radical cystectomy (RC) in a well characterized and large contemporary cohort. METHODS We used the American College of Surgeons National Surgical Quality Improvement Program database to identify adult patients who underwent RC for bladder cancer between 2015 and 2020 (n = 13,081). We conducted multivariable-adjusted logistic regression and Cox adjusted proportional hazards regression analysis to identify clinical predictors of deep incisional or organ/space SSI in the 30-day postoperative-period following RC. RESULTS Deep incisional or organ/space SSI risk increased with continent urinary diversion (HR = 1.61, 95% CI: 1.38-1.88; P < 0.001), obesity (HR = 1.60, 95% CI: 1.35-1.90; P < 0.001), diabetes mellitus (HR = 1.30, 95% CI: 1.13-1.51; P < 0.001), and being functionally dependent before surgery (HR = 2.09, 95% CI: 1.44-3.03; P < 0.001). CONCLUSIONS Postoperative deep incisional or organ/space SSIs following RC occur more frequently in patients who were obese, diabetic, functionally dependent before surgery, and those who underwent continent urinary diversion. These findings may assist urologists in preoperative counseling, medical optimization, and choice of urinary diversion approach, as well as improved patient monitoring and identification of candidates for intervention postoperatively.
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Affiliation(s)
- Ruben Blachman-Braun
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL.
| | | | | | - Helen Y Hougen
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Mark L Gonzalgo
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Miami, FL
| | - Bruno Nahar
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Miami, FL
| | - Sanoj Punnen
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Miami, FL
| | - Dipen J Parekh
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Miami, FL
| | - Chad R Ritch
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Miami, FL
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Porto JG, Arbelaez MCS, Pena B, Khandekar A, Malpani A, Nahar B, Punnen S, Ritch CR, Gonzalgo ML, Parekh DJ, Marcovich R, Shah HN. The Influence of the Microbiome on Urological Malignancies: A Systematic Review. Cancers (Basel) 2023; 15:4984. [PMID: 37894351 PMCID: PMC10605095 DOI: 10.3390/cancers15204984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
The microbiome, once considered peripheral, is emerging as a relevant player in the intricate web of factors contributing to cancer development and progression. These often overlooked microorganisms, in the context of urological malignancies, have been investigated primarily focusing on the gut microbiome, while exploration of urogenital microorganisms remains limited. Considering this, our systematic review delves into the complex role of these understudied actors in various neoplastic conditions, including prostate, bladder, kidney, penile, and testicular cancers. Our analysis found a total of 37 studies (prostate cancer 12, bladder cancer 20, kidney cancer 4, penile/testicular cancer 1), revealing distinct associations specific to each condition and hinting at potential therapeutic avenues and future biomarker discoveries. It becomes evident that further research is imperative to unravel the complexities of this domain and provide a more comprehensive understanding.
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Affiliation(s)
- Joao G. Porto
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | | | - Brandon Pena
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
- Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Archan Khandekar
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Ankur Malpani
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Bruno Nahar
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Sanoj Punnen
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Chad R. Ritch
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Mark L. Gonzalgo
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Dipen J. Parekh
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Robert Marcovich
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Hemendra N. Shah
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
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5
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Aihie NS, Hougen HY, Kwon D, Punnen S, Nahar B, Parekh DJ, Gonzalgo ML, Ritch CR. Predictors of discharge to home following major surgery for urologic malignancies: Results from the national surgical quality improvement program. Urol Oncol 2023; 41:392.e19-392.e25. [PMID: 37495474 DOI: 10.1016/j.urolonc.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 06/16/2023] [Accepted: 07/03/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVES To identify patient risk factors that predict nonhome discharge after surgery for urologic malignancies as well as determine whether discharge status had an impact on readmission rates in patients undergoing surgery for urologic malignancies. METHODS We identified patients who had undergone surgery for urologic malignancies including prostate, bladder, kidney, or upper tract urothelial cancer from 2011 to 2019 in the American College of Surgeon National Surgical Quality Improvement Program (ACS-NSQIP) database. Multivariable logistic regression analyses were performed to identify patient characteristics that were associated with nonhome discharges and 30-day postoperative readmission. RESULTS Nonhome discharge occurred in 2.8% of our study population. Women were less likely to be discharged to home (OR 0.60 p < 0.0001). Nonhome discharge was more common in patients who underwent cystectomy when compared to nephrectomy (OR 1.41 p < 0.0001) or prostatectomy (OR 4.16 p < 0.0001). Those with elevated BMI were less likely to experience non-home discharge (OR 0.86 p=0.0095) while patients who were identified as underweight and those with unexpected weight loss prior to surgery were more likely to have nonhome discharges (OR 1.76 p = 0.0002, OR 1.67, p < 0.0001). Comorbidities and presence of postoperative complications were also found to be significant independent predictors of nonhome discharges. Thirty-day postoperative readmission occurred in 6.9% of our study population. Of the patients who were readmitted 93.1% were initially discharged home, and 6.9% had nonhome discharges. Higher risk of readmission was seen in elderly patients and those with significant comorbidities. When controlling for predictors of readmission, on multivariate analysis, non-home discharge was associated with a decreased likelihood of readmission (OR 0.79, p = 0.0004). CONCLUSIONS Patient factors including age, gender, weight, comorbidities, postoperative complications, and site of procedure were found to be independent predictors of non-home discharge following surgery for urologic malignancies. Patients with these risk factors should be counseled preoperatively on the likelihood of requiring a non-home discharge to help manage expectations and create a standardized transition of care pathway following surgery.
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Affiliation(s)
- Nehizena S Aihie
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Helen Y Hougen
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deukwoo Kwon
- Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sanoj Punnen
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester ComprehensiveCancerCenter, Miami, FL, USA
| | - Bruno Nahar
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester ComprehensiveCancerCenter, Miami, FL, USA
| | - Dipen J Parekh
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester ComprehensiveCancerCenter, Miami, FL, USA
| | - Mark L Gonzalgo
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester ComprehensiveCancerCenter, Miami, FL, USA
| | - Chad R Ritch
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester ComprehensiveCancerCenter, Miami, FL, USA.
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6
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Hougen HY, Iakymenko OA, Punnen S, Ritch CR, Nahar B, Parekh DJ, Kryvenko ON, Gonzalgo ML. Prostate cancer upgrading and adverse pathology in Hispanic men undergoing radical prostatectomy. World J Urol 2022; 40:2017-2023. [PMID: 35689106 DOI: 10.1007/s00345-022-04065-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/19/2022] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Radical prostatectomy (RP) outcomes in Hispanic men with prostate cancer are not well-described. Prior studies showed varying results regarding the rate of upgrading and upstaging, and these studies included limited pathologic data and lack of central pathology review. We characterized the rate of upgrading, adverse pathology, and oncologic outcomes in Hispanics after prostatectomy using a large institutional database. METHODS We included Hispanic white (HW), non-Hispanic white (NHW), and black men who underwent (RP) between 2010 and 2021 at a single institution. We recorded differences in grade group between biopsy and prostatectomy and performed multivariable analyses for odds of upgrading and adverse pathologic findings. The primary outcome was rate of upgrading in HWs. Using a sub-cohort with follow-up data, we assessed race/ethnicity and upgrading as a predictor of biochemical recurrence (BCR)-free survival. RESULTS Our cohort included 1877 men: 36.7% were NHW, 40.6% were HW, and 22.7% were black. Rates of upgrading were not different between NHW, NHW, and black men at 34.0, 33.8, and 37.3%, respectively (p = 0.4). In the multivariable analysis for upgrading, significant predictors for upgrading were older age (p = 0.002), higher PSA (p < 0.001), and lower prostate weight (p = 0.02), but race/ethnicity did not predict upgrading. In patients with available follow-up (1083, 58%), upgrading predicted worse BCR-free survival (HR 2.17, CI 1.46-3.22, p < 0.0001) but race/ethnicity did not. CONCLUSIONS HW men undergoing RP had similar rates of upgrading and adverse pathologic outcomes as NHW men. Race/ethnicity does not independently predict upgrading or worse oncologic outcomes after RP.
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Affiliation(s)
- Helen Y Hougen
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.
| | - Oleksii A Iakymenko
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sanoj Punnen
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chad R Ritch
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bruno Nahar
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dipen J Parekh
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Oleksandr N Kryvenko
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mark L Gonzalgo
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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7
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Merhe A, Horodyski L, Ritch CR, Kryvenko ON, Gonzalgo ML. Robotic partial nephrectomy with inferior vena cava thrombectomy. Urology Video Journal 2022. [DOI: 10.1016/j.urolvj.2021.100108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kryvenko ON, Iakymenko OA, De Lima Guido LP, Bhattu AS, Merhe A, Mouzannar A, Briski LM, Oymagil I, Lugo I, Nemov I, Ritch CR, Kava BR, Punnen S, Jorda M, Parekh DJ, Gonzalgo ML. Prostatic Ductal Adenocarcinoma Controlled for Tumor Grade, Stage, and Margin Status Does Not Independently Influence the Likelihood of Biochemical Recurrence in Localized Prostate Cancer After Radical Prostatectomy. Arch Pathol Lab Med 2021; 146:1012-1017. [PMID: 34739539 DOI: 10.5858/arpa.2021-0048-oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Prostatic ductal adenocarcinoma (PDA) has historically been considered to be an aggressive subtype of prostate cancer. OBJECTIVE.— To investigate if PDA is independently associated with worse biochemical recurrence (BCR)-free survival after radical prostatectomy. DESIGN.— A review of 1584 radical prostatectomies was performed to grade, stage, and assess margin status in each tumor nodule. Radical prostatectomies with localized PDA (ie, those lacking metastasis) in the tumor nodule with the highest grade and stage and worst margin status were matched with prostatic acinar adenocarcinoma according to grade, stage, and margin status. The effect of PDA on BCR was assessed by multivariable Cox regression and Kaplan-Meier analyses. RESULTS.— Prostatic ductal adenocarcinoma was present in 171 cases. We excluded 24 cases because of lymph node metastasis (n = 13), PDA not in the highest-grade tumor nodule (n = 9), and positive surgical margin in a lower-grade tumor nodule (n = 2). The remaining 147 cases included 26 Grade Group (GG) 2, 44 GG3, 6 GG4, and 71 GG5 cancers. Seventy-six cases had extraprostatic extension, 33 had seminal vesicle invasion, and 65 had positive margins. Follow-up was available for 113 PDA and 109 prostatic acinar adenocarcinoma cases. Prostate-specific antigen density (odds ratio, 3.7; P = .001), cancer grade (odds ratio, 3.3-4.3; P = .02), positive surgical margin (odds ratio, 1.7; P = .02), and tumor volume (odds ratio, 1.3; P = .02) were associated with BCR in multivariable analysis. Prostatic ductal adenocarcinoma, its percentage, intraductal carcinoma, and cribriform Gleason pattern 4 were not significant independent predictors of BCR. CONCLUSIONS.— Advanced locoregional stage, higher tumor grade, and positive surgical margin status rather than the mere presence of PDA are more predictive of worse BCR-free survival outcomes following radical prostatectomy in men with a component of PDA.
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Affiliation(s)
- Oleksandr N Kryvenko
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida.,Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Oleksii A Iakymenko
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida
| | - Luiz P De Lima Guido
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida
| | - Amit S Bhattu
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Ali Merhe
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Ali Mouzannar
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Laurence M Briski
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Irfan Oymagil
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Isabella Lugo
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida
| | - Ivan Nemov
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida
| | - Chad R Ritch
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Bruce R Kava
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Sanoj Punnen
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Merce Jorda
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida.,Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Dipen J Parekh
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Mark L Gonzalgo
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
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9
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Hayee A, Lugo I, Iakymenko OA, Kwon D, Briski LM, Zhao W, Nemov I, Punnen S, Ritch CR, Pollack A, Jorda M, Stoyanova R, Parekh DJ, Gonzalgo ML, Kryvenko ON. Anterior or Posterior Prostate Cancer Tumor Nodule Location Predicts Likelihood of Certain Adverse Outcomes at Radical Prostatectomy. Arch Pathol Lab Med 2021; 146:833-839. [PMID: 34669939 DOI: 10.5858/arpa.2021-0104-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Effect of tumor nodule (TN) location in the prostate on adverse radical prostatectomy (RP) outcomes is not well studied in contemporary cohort. OBJECTIVE.— To investigate the significance of TN location with respect to extraprostatic extension (EPE), seminal vesicle invasion (SV+), and positive margin status (SM+) in 1388 RPs. DESIGN.— Each TN at RP was independently graded, staged, and volumetrically assessed. TNs with at least 80% of their volume occupying either the anterior or posterior part of the prostate were categorized accordingly and included in our study, while all other TNs were excluded. RESULTS.— A total of 3570 separate TNs (median = 3 per RP; range = 1-7 per RP) were scored. There were 1320 of 3570 (37%) anterior TNs and 2250 of 3570 (63%) posterior TNs. Posterior TNs were more likely to be higher grade, and exhibit EPE (18% versus 9.4%) and SV+ (4% versus 0.15%), all P < .001. Anterior TNs with EPE were more likely to exhibit SM+ than posterior TNs with EPE (62% versus 30.8%, P < .001). TN location, grade, and volume were significant factors associated with adverse RP outcomes in our univariable analysis. When we controlled for grade and tumor volume in a multivariable analysis using anterior TN location as a reference, posterior TN location was an independent predictor of EPE and SV+ and was less likely to be associated with SM+ (odds ratio = 3.1, 81.5, and 0.7, respectively). CONCLUSIONS.— These associations may be useful in preoperative surgical planning, particularly with respect to improving radiographic analysis of prostate cancer.
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Affiliation(s)
- Amin Hayee
- From the Department of Pathology and Laboratory Medicine (Hayee, Lugo, Iakymenko, Briski, Nemov, Jorda, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Isabella Lugo
- From the Department of Pathology and Laboratory Medicine (Hayee, Lugo, Iakymenko, Briski, Nemov, Jorda, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Oleksii A Iakymenko
- From the Department of Pathology and Laboratory Medicine (Hayee, Lugo, Iakymenko, Briski, Nemov, Jorda, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Deukwoo Kwon
- Department of Public Health Sciences (Kwon), at the University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Laurence M Briski
- From the Department of Pathology and Laboratory Medicine (Hayee, Lugo, Iakymenko, Briski, Nemov, Jorda, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Wei Zhao
- Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Ivan Nemov
- From the Department of Pathology and Laboratory Medicine (Hayee, Lugo, Iakymenko, Briski, Nemov, Jorda, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Sanoj Punnen
- Department of Urology (Punnen, Ritch, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Chad R Ritch
- Department of Urology (Punnen, Ritch, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Alan Pollack
- Radiation Oncology (Pollack, Stoyanova), at the University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Merce Jorda
- From the Department of Pathology and Laboratory Medicine (Hayee, Lugo, Iakymenko, Briski, Nemov, Jorda, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida.,Department of Urology (Punnen, Ritch, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Radka Stoyanova
- Radiation Oncology (Pollack, Stoyanova), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Dipen J Parekh
- Department of Urology (Punnen, Ritch, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Mark L Gonzalgo
- Department of Urology (Punnen, Ritch, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Oleksandr N Kryvenko
- From the Department of Pathology and Laboratory Medicine (Hayee, Lugo, Iakymenko, Briski, Nemov, Jorda, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida.,Department of Urology (Punnen, Ritch, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
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10
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Bhattu AS, Ritch CR, Jahromi M, Banerjee I, Gonzalgo ML. Robotic intracorporeal orthotopic neobladder in the supine Trendelenburg position: a stepwise approach. Can J Urol 2021; 28:10794-10798. [PMID: 34378518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Robotic radical cystectomy with urinary diversion has become increasingly utilized for the surgical management of bladder cancer. Orthotopic neobladder reconstruction is still performed worldwide primarily via an extracorporeal approach because of the difficulty associated with robotic intracorporeal reconstruction. The objective of this article is to demonstrate a stepwise approach for robotic intracorporeal neobladder in a standardized manner that adheres to the principles of open surgery.
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Affiliation(s)
- Amit S Bhattu
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
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11
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Horodyski L, Ball B, Emile C, Rhodes A, Miao F, Reis IM, Carrasquillo MZ, Livingstone J, Matadial C, Ritch CR, Deane LA. Safe transition to opioid-free pathway after robotic-assisted laparoscopic prostatectomy. J Robot Surg 2021; 16:307-314. [PMID: 33855681 DOI: 10.1007/s11701-021-01237-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/03/2021] [Indexed: 11/27/2022]
Abstract
To determine whether local anesthetic infiltration and non-narcotic pain medications can safely reduce or eliminate opioid use following robotic-assisted laparoscopic prostatectomy while maintaining adequate pain control. After initiation of this quality-improvement project, patients undergoing robotic-assisted laparoscopic prostatectomy had surgeon-administered local anesthesia around all incisions into each successive layer from peritoneum to skin, with the majority infiltrated into the transversus abdominis muscle plane and posterior rectus sheath of the midline extraction incision. Post-operatively patients received scheduled acetaminophen plus ketorolac, renal function permitting. A retrospective review was performed for all cases over 19 months, spanning project implementation. 157 cases (76 in opioid-free pathway, 81 in standard pathway) were included. Five patients (6.6%) in the opioid-free pathway required post-operative opioids while inpatient, versus 61 (75.3%) in the standard pathway, p < .001. Mean patient-reported pain score on each post-operative day was lower in the opioid-free pathway compared to the standard pathway [day 0: 2.4 (SD 2.6) vs. 3.9 (SD 2.7), p < .001; day 1: 1.4 [SD 1.6] vs. 3.3 (SD 2.2), p < .001; day 2 0.9 (SD 1.5) vs. 2.6 (SD 1.9), p < .001]. Fewer post-operative complications were seen in the opioid-free pathway versus standard [0 vs. 5 (6.2%), p = 0.028], and there was no statistically significant difference in number of emergency room visits or readmissions within 3 weeks of surgery. The use of surgeon-administered local anesthetic plus scheduled non-narcotic analgesics can safely and significantly reduce opioid use after robotic-assisted laparoscopic prostatectomy while improving pain control.
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Affiliation(s)
- Laura Horodyski
- University of Miami, 1120 NW 14th Street Suite 1551C, Miami, FL, USA.
| | - Brittany Ball
- Miami Veteran's Affairs Medical Center, Miami, FL, USA
| | - Clarence Emile
- University of Miami, 1120 NW 14th Street Suite 1551C, Miami, FL, USA
| | | | - Feng Miao
- University of Miami, 1120 NW 14th Street Suite 1551C, Miami, FL, USA
| | - Isildinha M Reis
- University of Miami, 1120 NW 14th Street Suite 1551C, Miami, FL, USA
| | | | - Joshua Livingstone
- University of Miami, 1120 NW 14th Street Suite 1551C, Miami, FL, USA
- Miami Veteran's Affairs Medical Center, Miami, FL, USA
| | - Christina Matadial
- University of Miami, 1120 NW 14th Street Suite 1551C, Miami, FL, USA
- Miami Veteran's Affairs Medical Center, Miami, FL, USA
| | - Chad R Ritch
- University of Miami, 1120 NW 14th Street Suite 1551C, Miami, FL, USA
- Miami Veteran's Affairs Medical Center, Miami, FL, USA
| | - Leslie A Deane
- University of Miami, 1120 NW 14th Street Suite 1551C, Miami, FL, USA
- Miami Veteran's Affairs Medical Center, Miami, FL, USA
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12
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Punnen S, Stoyanova R, Kwon D, Reis IM, Soodana-Prakash N, Ritch CR, Nahar B, Gonzalgo ML, Kava B, Liu Y, Arora H, Gaston SM, Castillo Acosta RP, Pra AD, Abramowitz M, Kryvenko ON, Davicioni E, Pollack A, Parekh DJ. Heterogeneity in Genomic Risk Assessment from Tissue Based Prognostic Signatures Used in the Biopsy Setting and the Impact of Magnetic Resonance Imaging Targeted Biopsy. J Urol 2020; 205:1344-1351. [PMID: 33356482 DOI: 10.1097/ju.0000000000001559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Genomic prognostic signatures are used on prostate biopsy tissue for cancer risk assessment, but tumor heterogeneity and multifocality may be an issue. We evaluated the variability in genomic risk assessment from different biopsy cores within the prostate using 3 prognostic signatures (Decipher, CCP, GPS). MATERIALS AND METHODS Men in this study came from 2 prospective prostate cancer trials of patients undergoing multiparametric magnetic resonance imaging and magnetic resonance imaging targeted biopsy with genomic profiling of positive biopsy cores. We explored the relationship among tumor grade, magnetic resonance imaging risk and genomic risk for each signature. We evaluated the variability in genomic risk assessment between different biopsy cores and assessed how often magnetic resonance imaging targeted biopsy or the current standard of care (profiling the core with the highest grade) resulted in the highest genomic risk level. RESULTS In all, 224 positive biopsy cores from 78 men with prostate cancer were profiled. For each signature, higher biopsy grade (p <0.001) and magnetic resonance imaging risk level (p <0.001) were associated with higher genomic scores. Genomic scores from different biopsy cores varied with risk categories changing by 21% to 62% depending on which core or signature was used. Magnetic resonance imaging targeted biopsy and profiling the core with the highest grade resulted in the highest genomic risk level in 72% to 84% and 75% to 87% of cases, respectively, depending on the signature used. CONCLUSIONS There is variation in genomic risk assessment from different biopsy cores regardless of the signature used. Magnetic resonance imaging directed biopsy or profiling the highest grade core resulted in the highest genomic risk level in most cases.
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Affiliation(s)
- Sanoj Punnen
- Department of Urology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Radka Stoyanova
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Deukwoo Kwon
- Biostatistics and Bioinformatics Shared Resource and Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Isildinha M Reis
- Biostatistics and Bioinformatics Shared Resource and Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Nachiketh Soodana-Prakash
- Department of Urology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Chad R Ritch
- Department of Urology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Bruno Nahar
- Department of Urology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Mark L Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Bruce Kava
- Department of Urology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Yang Liu
- Research and Development, Decipher Biosciences, San Diego, California
| | - Himanshu Arora
- Department of Urology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Sandra M Gaston
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
| | | | - Alan Dal Pra
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Matthew Abramowitz
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Oleksandr N Kryvenko
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Elai Davicioni
- Research and Development, Decipher Biosciences, San Diego, California
| | - Alan Pollack
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Dipen J Parekh
- Department of Urology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
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13
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Becerra MF, Alameddine M, Zucker I, Tamariz L, Palacio A, Nemeth Z, Velasquez MC, Savio LF, Panizzutti M, Jue JS, Soodana-Prakash N, Ritch CR, Gonzalgo ML, Parekh DJ, Punnen S. Performance of Multiparametric MRI of the Prostate in Biopsy Naïve Men: A Meta-analysis of Prospective Studies. Urology 2020; 146:189-195. [DOI: 10.1016/j.urology.2020.06.102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 11/29/2022]
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14
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Jue JS, Koru-Sengul T, Miao F, Velásquez MC, Sávio LF, Alameddine M, Kroeger ZA, Punnen S, Parekh DJ, Ritch CR, Gonzalgo ML. Neoadjuvant versus adjuvant chemotherapy for muscle-invasive bladder cancer: a propensity matched analysis. Minerva Urol Nephrol 2020; 73:572-580. [PMID: 32026665 DOI: 10.23736/s2724-6051.19.03657-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We compared survival outcomes among patients who received either NAC or AC and RC. METHODS We identified patients in the National Cancer Data Base (NCDB) diagnosed with clinical T2-T4, N0, M0 urothelial carcinoma who underwent RC. Patients who received NAC were propensity matched by age, race, ethnicity, sex, insurance type, academic/research program, comorbidity, and clinical stage to patients receiving AC within 90 days of RC. Median survival was calculated using Kaplan-Meier analysis. Adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) were calculated from multivariable Cox regression models to compare overall survival (OS), downstaging to non-MIBC (NMIBC), and N upstaging. RESULTS A total of 417 patients treated with NAC and 272 patients treated with AC were identified from 2004-2013. Patients who received NAC had better 5-year OS (46.2%, 95% CI: 39.2-53.0%) compared to patients who received AC (37.6%, 95% CI: 31.5-43.7%). NAC was a significant predictor of decreased mortality, decreased progression to node positivity, and downstaging to NMIBC (0.76, 0.60-0.96, P=0.023; 0.19, 0.13-0.28, P<0.001; 23.96, 8.91-64.42, P<0.001). CONCLUSIONS The use of NAC+RC was associated with improved OS compared to RC+AC for patients diagnosed with T2-T4, N0, M0 bladder cancer. The increased survival benefit associated with NAC compared to AC among patients undergoing RC may be due to decreased progression to node positivity and pathological downstaging.
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Affiliation(s)
- Joshua S Jue
- Miller School of Medicine, Department of Urology, University of Miami, Miami, FL, USA -
| | - Tulay Koru-Sengul
- Miller School of Medicine, Department of Public Health Sciences, University of Miami, Miami, FL, USA.,Miller School of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Feng Miao
- Miller School of Medicine, Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - María C Velásquez
- Miller School of Medicine, Department of Urology, University of Miami, Miami, FL, USA
| | - Luís F Sávio
- Miller School of Medicine, Department of Urology, University of Miami, Miami, FL, USA
| | - Mahmoud Alameddine
- Miller School of Medicine, Department of Urology, University of Miami, Miami, FL, USA
| | - Zachary A Kroeger
- Miller School of Medicine, Department of Urology, University of Miami, Miami, FL, USA
| | - Sanoj Punnen
- Miller School of Medicine, Department of Urology, University of Miami, Miami, FL, USA
| | - Dipen J Parekh
- Miller School of Medicine, Department of Urology, University of Miami, Miami, FL, USA.,Miller School of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Chad R Ritch
- Miller School of Medicine, Department of Urology, University of Miami, Miami, FL, USA
| | - Mark L Gonzalgo
- Miller School of Medicine, Department of Urology, University of Miami, Miami, FL, USA.,Miller School of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
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15
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Jue JS, Koru-Sengul T, Miao F, Velásquez MC, Sávio LF, Alameddine M, Kroeger ZA, Punnen S, Parekh DJ, Ritch CR, Gonzalgo ML. Neoadjuvant vs adjuvant chemotherapy for muscle-invasive bladder cancer: a propensity matched analysis. Minerva Urol Nefrol 2020. [PMID: 32026665 DOI: 10.23736/s0393-2249.19.03657-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We compared survival outcomes among patients who received either NAC or AC and RC. METHODS We identified patients in the National Cancer Data Base (NCDB) diagnosed with clinical T2-T4, N0, M0 urothelial carcinoma who underwent RC. Patients who received NAC were propensity matched by age, race, ethnicity, sex, insurance type, academic/research program, comorbidity, and clinical stage to patients receiving AC within 90 days of RC. Median survival was calculated using Kaplan-Meier analysis. Adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) were calculated from multivariable Cox regression models to compare overall survival (OS), downstaging to non-MIBC (NMIBC), and N upstaging. RESULTS A total of 417 patients treated with NAC and 272 patients treated with AC were identified from 2004-2013. Patients who received NAC had better 5 year OS (46.2%, 95% CI: 39.2%-53.0%) compared to patients who received AC (37.6%, 95% CI: 31.5%-43.7%). NAC was a significant predictor of decreased mortality, decreased progression to node positivity, and downstaging to NMIBC (0.76, 0.60-0.96, p=0.023; 0.19, 0.13-0.28, p<0.001; 23.96, 8.91-64.42, p<0.001). CONCLUSIONS The use of NAC+RC was associated with improved OS compared to RC+AC for patients diagnosed with T2-T4, N0, M0 bladder cancer. The increased survival benefit associated with NAC compared to AC among patients undergoing RC may be due to decreased progression to node positivity and pathological downstaging.
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Affiliation(s)
- Joshua S Jue
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA -
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Feng Miao
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - María C Velásquez
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Luís F Sávio
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mahmoud Alameddine
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Zachary A Kroeger
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sanoj Punnen
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dipen J Parekh
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chad R Ritch
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mark L Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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16
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Jue JS, Koru-Sengul T, Miao F, Kroeger ZA, Moore KJ, Alameddine M, Punnen S, Parekh DJ, Ritch CR, Gonzalgo ML. Timing of adjuvant chemotherapy and overall survival following radical cystectomy. Urol Oncol 2019; 38:75.e15-75.e22. [PMID: 31864939 DOI: 10.1016/j.urolonc.2019.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 10/02/2019] [Accepted: 11/04/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND We investigated the relationship between timing of adjuvant chemotherapy on overall survival following radical cystectomy. METHODS We retrospectively reviewed the National Cancer Data Base for patients with newly diagnosed pT2-T4, N0, M0 urothelial cell carcinoma who received no treatment prior to radical cystectomy. Patients who received no adjuvant chemotherapy or who received adjuvant chemotherapy more than 45 days after radical cystectomy were propensity matched to patients receiving adjuvant chemotherapy within 45 days of radical cystectomy. Selection bias was assessed by comparing the length of stay, readmission rate, and surgical approach between groups. Median survival was calculated using Kaplan-Meier analysis. Adjusted hazard ratios and 95% confidence intervals were calculated from a multivariable Cox regression model to examine factors affecting overall survival. RESULTS From 2004 to 2014, 284 patients with muscle-invasive bladder cancer met inclusion criteria. Patients receiving chemotherapy within 45 days had the best 5-year overall survival (47.0%, 95%CI: 40.6%-53.2%) compared to those receiving chemotherapy after 45 days (37.5%, 95%CI: 31.4%-43.7%). Chemotherapy after 45 days and no adjuvant chemotherapy were significant predictors of worse overall survival compared to chemotherapy within 45 days (1.27, 1.02-1.59, P = 0.033 and 1.41, 1.12-1.78, P = 0.003). Receiving no adjuvant chemotherapy was not significantly different than chemotherapy after 45 days (1.11, 0.89-1.38, P = 0.348). Significant predictors of poorer overall survival were female sex (1.37, 1.04-1.81, P = 0.028), Medicare (1.37, 1.06-1.76, P = 0.016), pT3 stage (1.79, 1.35-2.38, P < 0.001), and pT4 stage (3.00, 2.20-4.01, P < 0.001). Significantly more patients with length of stay ≤7 days following RC received chemotherapy within 45 days (53.2%) compared to those who received adjuvant chemotherapy after 45 days after RC (44.0%) or no adjuvant chemotherapy (43.0%; P = 0.0369). CONCLUSIONS Initiation of adjuvant chemotherapy within 45 days of radical cystectomy for patients with pT2-4 bladder cancer was associated with an overall survival benefit compared to patients who received adjuvant chemotherapy after 45 days or no adjuvant chemotherapy.
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Affiliation(s)
- Joshua S Jue
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL.
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Feng Miao
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Zachary A Kroeger
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL
| | - Kevin J Moore
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Mahmoud Alameddine
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL
| | - Sanoj Punnen
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Dipen J Parekh
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Chad R Ritch
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Mark L Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
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Owyong M, Koru-Sengul T, Miao F, Razdan S, Moore KJ, Alameddine M, Punnen S, Parekh DJ, Ritch CR, Gonzalgo ML. Impact of Surgical Technique on Surgical Margin Status Following Partial Cystectomy. Urol Oncol 2019; 37:870-876. [PMID: 31445895 PMCID: PMC7696003 DOI: 10.1016/j.urolonc.2019.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/15/2019] [Accepted: 07/25/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION We assessed the impact of open or minimally-invasive partial cystectomy on surgical margin status in a nationwide hospital-based cohort. MATERIALS AND METHODS Patients who underwent partial cystectomy from 2010 to 2014 were identified in the National Cancer Data Base. The primary outcome was surgical margin status. A multivariable logistic regression model was fitted to identify patient, hospital, and surgical factors associated with positive surgical margins (PSMs). RESULTS Partial cystectomy was performed in 1,118 patients via open (n = 715, 64%), laparoscopic (n = 209, 19%), and robotic (n = 194, 17%) approaches. Overall, 220 (19.7%) patients had PSMs. The PSM rate by surgical approach was 19.6% for open, 18.2% for laparoscopic, and 21.6% for robotic (P = 0.678). Compared to open partial cystectomy, the laparoscopic (aOR 1.06, 95%CI 0.70-1.60, P = 0.782), and robotic (aOR 1.28, 95%CI 0.85-1.91, P = 0.235) approaches were not significantly different in terms of PSM rate. There were higher odds of PSMs in non-Hispanic blacks (aOR 1.93, 95%CI 1.09-3.39, P = 0.023) compared to non-Hispanic whites, and in patients with muscle invasive bladder cancer (aOR 3.28, 95%CI 2.00-5.37, P < 0.001) or tumor size ≥ 3 cm (aOR 1.67, 95%CI 1.21-2.30, P = 0.002). Tumors in a dome/urachal location had lower odds of a PSM compared to tumors in a nondome/urachal location (aOR 0.67, 95%CI 0.47-0.94, P = 0.022). CONCLUSIONS Our results suggest that partial cystectomy using a laparoscopic or robotic-assisted approach is not associated with an increased risk of PSMs compared to open partial cystectomy.
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Affiliation(s)
- Michael Owyong
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Feng Miao
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Shirin Razdan
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL
| | - Kevin J Moore
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Mahmoud Alameddine
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL
| | - Sanoj Punnen
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Dipen J Parekh
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Chad R Ritch
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Mark L Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL.
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18
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Iakymenko OA, Lugo I, Kwon D, Zhao W, Hayee A, Punnen S, Parekh DJ, Pollack A, Ritch CR, Gonzalgo ML, Stoyanova R, Jorda M, Kryvenko ON. Prostatic Ductal Adenocarcinoma Controlled for Cancer Grade and Tumor Volume Does Not Have an Independent Effect on Adverse Radical Prostatectomy Outcomes Compared to Usual Acinar Prostatic Adenocarcinoma. Urology 2019; 137:108-114. [PMID: 31711982 DOI: 10.1016/j.urology.2019.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 10/03/2019] [Accepted: 10/21/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To study if prostatic ductal adenocarcinoma (PDA) controlled by Grade Group (GG), PSA, and tumor volume (TV) is an independent predictor of adverse radical prostatectomy (RP) outcomes. MATERIALS One-hundred and twenty-eight PDA and 1141 acinar continuous RPs were studied. Each tumor nodule (TN) was individually graded, staged, and its TV measured. Univariate analysis (UVA) identified features associated with lymph node metastasis (LN+), extraprostatic extension (EPE), positive surgical margins (SM+), and seminal vesicle invasion (SV+). We then assessed PDA effect on RP outcomes in a multivariate analysis (MVA). RESULTS In 127 cases PDA was present in 1 TN and no TN was pure PDA. One-hundred and twenty-three cases had PDA in TNs with highest grade, stage, and TV. Patients with PDA were older (65 vs 63 years, P < 0.001), had higher GG (P < 0.001), and LN+ (6.3% vs 2.7%, P = 0.049). Controlling these variables by GG eliminated statistical significance. Overall, there were 3249 separate TNs (129 PDA and 3120 acinar). In UVA, PDA predicted EPE (92/124 vs 517/3045), SV+ (28/1129 vs 116/3,120), and SM+ (51/129 vs 296/3120), all P < 0.001. In MVA, PDA lost its effect on EPE (OR = 0.88, P = 0.64), SM+ (OR = 0.86, P = 0.5), and SV+ (OR = 0.99, P = 0.98). CONCLUSION Controlled for grade and TV, PDA was not an independent predictor of adverse RP outcomes, but former 2 were. Hence, higher GG and TV associated with PDA TNs may be predictive of adverse RP outcomes rather than PDA by itself. These conclusions may be used in preoperative risk stratification and definitive therapy planning when PDA is identified on needle biopsy.
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Affiliation(s)
- Oleksii A Iakymenko
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Isabella Lugo
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Deukwoo Kwon
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Wei Zhao
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Amin Hayee
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Sanoj Punnen
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Dipen J Parekh
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Alan Pollack
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Chad R Ritch
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Mark L Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Radka Stoyanova
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Merce Jorda
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL; Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Oleksandr N Kryvenko
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL; Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL.
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19
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Wu SC, Kwon D, Jue JS, Chen FV, Velasquez Escobar MC, Punnen S, Parekh DJ, Ritch CR, Gonzalgo ML. Androgen Suppression Therapy Is Associated with Lower Recurrence of Non-muscle-invasive Bladder Cancer. Eur Urol Focus 2019; 7:142-147. [PMID: 31103602 DOI: 10.1016/j.euf.2019.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/21/2019] [Accepted: 04/30/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND The challenge of managing non-muscle-invasive bladder cancer (NMIBC) is its high recurrence rate. Clinical investigations have begun to explore the role of androgen suppression as an adjunct to bladder cancer (BC) treatment. OBJECTIVE To examine the effect of androgen suppression therapy (AST) on recurrence and progression rate of risk-stratified NMIBC. DESIGN, SETTING, AND PARTICIPANTS Male patients with NMIBC were identified retrospectively from a US institutional database between 2001 and 2017. AST included 5α-reductase inhibitor, gonadotropin-releasing hormone agonist, and antiandrogen. Patients who were exposed to AST prior to documented recurrence/progression were included in the treatment arm. BC was risk stratified to investigate the differential response to AST. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Hazard ratios (HRs) for NMIBC recurrence and progression were estimated using Cox proportional hazards multivariate regression models with stepwise method. Recurrence-free survival (RFS) and progression-free survival (PFS) were compared between groups with and without AST. RESULTS AND LIMITATIONS We identified a total of 274 males with a median follow-up period of 3.1 yr (interquartile range [IQR] 1.5-5.2). Thirty-six patients were exposed to AST with a median duration of 1.7 yr (IQR 0.7-2.6). AST was associated with a lower risk of recurrence (HR 0.53, 95% confidence interval 0.30-0.88) as well as improved RFS (p = 0.014). However, no significant reduction of progression or improvement of PFS (p = 0.23) was found with AST. After risk stratification, all five patients who progressed in the AST cohort had high-risk disease on initial transurethral resection (TUR), whereas no patients with low/intermediate-risk disease progressed on AST. Limitations of the study include nonstandardized initiation of AST in relation to initial TUR, lack of androgen level quantification, and small sample size in the treatment arm. CONCLUSIONS In this retrospective, single-institution study, AST was associated with a lower risk of recurrence in NMIBC. No significant association between AST and progression was found. Further investigation is warranted to define the role of AST as an adjunctive therapy for NMIBC. PATIENT SUMMARY Non-muscle-invasive bladder cancer is a highly recurrent disease that often requires patients to undergo repeated surgical treatments. This single-institution report suggests that medical suppression of androgen may be a potential preventive therapy to reduce recurrence in certain patients.
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Affiliation(s)
- Shuo-Chieh Wu
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deukwoo Kwon
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua S Jue
- Department of Urology, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Felix V Chen
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Sanoj Punnen
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dipen J Parekh
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chad R Ritch
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mark L Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
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Ritch CR, Cookson MS, Clark PE, Chang SS, Fakhoury K, Ralls V, Thu MH, Penson DF, Smith JA, Silver HJ. Perioperative Oral Nutrition Supplementation Reduces Prevalence of Sarcopenia following Radical Cystectomy: Results of a Prospective Randomized Controlled Trial. J Urol 2019; 201:470-477. [DOI: 10.1016/j.juro.2018.10.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Chad R. Ritch
- Departments of Urology, University of Miami, Miller School of Medicine, Miami, Florida
- Department of Urologic Surgery, Vanderbilt University Medical Center, Tennessee
| | | | - Peter E. Clark
- Levine Cancer Center at Atrium Health, Charlotte, North Carolina
| | - Sam S. Chang
- Department of Urologic Surgery, Vanderbilt University Medical Center, Tennessee
| | - Kareem Fakhoury
- Department of Medicine, Vanderbilt University Medical Center, Tennessee
| | - Veronica Ralls
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Muang H. Thu
- Department of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - David F. Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Tennessee
| | - Joseph A. Smith
- Department of Urologic Surgery, Vanderbilt University Medical Center, Tennessee
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21
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Soodana-Prakash N, Koru-Sengul T, Miao F, Lopategui DM, Savio LF, Moore KJ, Johnson TA, Alameddine M, Barboza MP, Parekh DJ, Punnen S, Gonzalgo ML, Ritch CR. Lymph node yield as a predictor of overall survival following inguinal lymphadenectomy for penile cancer. Urol Oncol 2018; 36:471.e19-471.e27. [DOI: 10.1016/j.urolonc.2018.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/27/2018] [Accepted: 07/17/2018] [Indexed: 12/23/2022]
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22
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Lotan Y, Black PC, Caba L, Chang SS, Cookson MS, Daneshmand S, Kamat AM, McKiernan JM, Pruthi RS, Ritch CR, Steinberg GD, Svatek RS, Zwarthoff EC. Optimal Trial Design for Studying Urinary Markers in Bladder Cancer: A Collaborative Review. Eur Urol Oncol 2018; 1:223-230. [DOI: 10.1016/j.euo.2018.04.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/03/2018] [Accepted: 04/17/2018] [Indexed: 12/31/2022]
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23
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Velasquez MC, Chinea FM, Kwon D, Prakash NS, Barboza MP, Gonzalgo ML, Ritch CR, Pollack A, Parekh DJ, Punnen S. The Influence of Ethnic Heterogeneity on Prostate Cancer Mortality After Radical Prostatectomy in Hispanic or Latino Men: A Population-based Analysis. Urology 2018; 117:108-114. [PMID: 29630954 PMCID: PMC6062850 DOI: 10.1016/j.urology.2018.03.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/15/2018] [Accepted: 03/22/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To determine if recently found disparities in prostate cancer-specific mortality (PCSM) among Mexican and Puerto Rican men remained true in patients undergoing radical prostatectomy (RP), where the true grade and extent of cancer are known and can be accounted for. MATERIALS AND METHODS Men diagnosed with localized-regional prostate cancer who had undergone RP as primary treatment were identified (N = 180,794). Patients were divided into the following racial and ethnic groups: non-Hispanic white (NHW) (n = 135,358), non-Hispanic black (NHB) (n = 21,882), Hispanic or Latino (n = 15,559), and Asian American or Pacific Islander (n = 7995). Hispanic or Latino men were further categorized into the following subgroups: Mexican (n = 3323) and South or Central American, excluding Brazilian (n = 1296), Puerto Rican (n = 409), and Cuban (n = 218). A multivariable analysis was conducted using competing risk regression in the prediction of PCSM. RESULTS This analysis revealed hidden disparities in surgical outcomes for prostate cancer. In the multivariable analysis, Hispanic or Latino men (hazard ratio [HR] = 0.88, P = .207) did not show a significant difference in PCSM compared with NHW men. When breaking Hispanic or Latino men into their country of origin or ancestry, Puerto Rican men were found to have significantly worse PCSM than NHW men (HR = 2.55, P = .004) and NHB men (HR = 2.33, P = .016). CONCLUSION Our findings reveal higher rates of PCSM for Puerto Rican men after RP than for both NHW and NHB men. At a minimum, these findings need further validation and should be considered in the screening and management of these men.
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Affiliation(s)
| | - Felix M Chinea
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL; Department of Radiation Oncology, University of Miami, Miami, FL
| | - Deukwoo Kwon
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | | | | | - Mark L Gonzalgo
- Department of Urology, University of Miami, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Chad R Ritch
- Department of Urology, University of Miami, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Alan Pollack
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL; Department of Radiation Oncology, University of Miami, Miami, FL
| | - Dipen J Parekh
- Department of Urology, University of Miami, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Sanoj Punnen
- Department of Urology, University of Miami, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL.
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24
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Velasquez MC, Kwon D, Soodana Prakash N, Barboza MP, Savio LF, Kineish O, Alameddine M, Punnen S, Gonzalgo M, Parekh DJ, Ritch CR, Ritch CR. MP06-20 APPLICATION OF AUA RISK STRATIFICATION FOR NON-MUSCLE INVASIVE BLADDER CANCER: LONG-TERM RESULTS IN A CONTEMPORARY SINGLE INSTITUTION COHORT. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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25
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Sávio LF, Panizzutti Barboza M, Alameddine M, Ahdoot M, Alonzo D, Ritch CR. Combined Partial Penectomy With Bilateral Robotic Inguinal Lymphadenectomy Using Near-infrared Fluorescence Guidance. Urology 2018; 113:251. [DOI: 10.1016/j.urology.2017.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/12/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
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26
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Ritch CR, Balise R, Prakash NS, Alonzo D, Almengo K, Alameddine M, Venkatramani V, Punnen S, Parekh DJ, Gonzalgo ML. Propensity matched comparative analysis of survival following chemoradiation or radical cystectomy for muscle-invasive bladder cancer. BJU Int 2018; 121:745-751. [DOI: 10.1111/bju.14109] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Chad R. Ritch
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Raymond Balise
- Division of Biostatistics; Department of Public Health Sciences; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | | | - David Alonzo
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Katherine Almengo
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Mahmoud Alameddine
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Vivek Venkatramani
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Sanoj Punnen
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Dipen J. Parekh
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Mark L. Gonzalgo
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
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27
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Ritch CR, Soodana-Prakash N, Pavan N, Balise RR, Velasquez MC, Alameddine M, Adamu DY, Punnen S, Parekh DJ, Gonzalgo ML. Racial disparity and survival outcomes between African-American and Caucasian American men with penile cancer. BJU Int 2018; 121:758-763. [DOI: 10.1111/bju.14110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Chad R. Ritch
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | | | - Nicola Pavan
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Raymond R. Balise
- Division of Biostatistics; Department of Public Health Sciences; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Maria Camila Velasquez
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Mahmoud Alameddine
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Desmond Y. Adamu
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Sanoj Punnen
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Dipen J. Parekh
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Mark L. Gonzalgo
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
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28
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Alameddine M, Koru-Sengul T, Moore KJ, Miao F, Sávio LF, Nahar B, Prakash NS, Venkatramani V, Jue JS, Punnen S, Parekh DJ, Ritch CR, Gonzalgo ML. Trends in Utilization of Robotic and Open Partial Nephrectomy for Management of cT1 Renal Masses. Eur Urol Focus 2018; 5:482-487. [PMID: 29325761 DOI: 10.1016/j.euf.2017.12.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/27/2017] [Accepted: 12/18/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Partial nephrectomy is widely used for surgical management of small renal masses. Use of robotic (RPN) versus open partial nephrectomy (OPN) among various populations is not well characterized. OBJECTIVE To analyze trends in utilization of RPN and disparities that may be associated with this procedure for management of cT1 renal masses in the USA. DESIGN, SETTING, AND PARTICIPANTS Patients who underwent RPN or OPN for clinical stage T1N0M0 renal masses in the USA from 2010 to 2013 were identified in the National Cancer Data Base. A total of 23 154 patients fulfilled the inclusion criteria. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Univariable and multivariable logistic regression analyses were performed to evaluate differences in receiving RPN or OPN across various patient groups. RESULTS AND LIMITATIONS Utilization of RPN increased from 41% in 2010 to 63% in 2013. Black patients (adjusted odds ratio [aOR] 0.91, 95% confidence interval [CI] 0.84-0.98) and Hispanic patients (aOR 0.85, 95% CI 0.77-0.95) were less likely to undergo RPN. RPN was less likely to be performed in rural counties (aOR 0.80, 95% CI 0.66-0.98) and in patients with no insurance (aOR 0.52, 95% CI 0.44-0.61) or patients covered by Medicaid (aOR 0.81, 95% CI 0.73-0.90). There was no significant difference in RPN utilization between academic and non-academic facilities. Patients with higher clinical stage (aOR 0.58, 95% CI 0.55-0.62) and comorbidities (aOR 0.79, 95% CI 0.71-0.88) were also less likely to undergo RPN. CONCLUSIONS Utilization of RPN has continued to increase over time; however, there are significant disparities in its utilization according to race and socioeconomic status. Black and Hispanic patients and patients in rural communities and with limited insurance were more likely to be treated with OPN instead of RPN. PATIENT SUMMARY The use of robotic surgery in partial nephrectomy for management of small renal masses has increased over time. We found a significant disparity across different racial and socioeconomic groups in use of robotic partial nephrectomy compared to open surgery. Patients living in rural areas, with limited insurance, and multiple medical comorbidities were more likely to undergo open than robotic partial nephrectomy.
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Affiliation(s)
- Mahmoud Alameddine
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kevin J Moore
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Feng Miao
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Luís Felipe Sávio
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bruno Nahar
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Vivek Venkatramani
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua S Jue
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sanoj Punnen
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dipen J Parekh
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chad R Ritch
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mark L Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
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Nahar B, Katims A, Barboza MP, Soodana Prakash N, Venkatramani V, Kava B, Satyanarayana R, Gonzalgo ML, Ritch CR, Parekh DJ, Punnen S. Reclassification Rates of Patients Eligible for Active Surveillance After the Addition of Magnetic Resonance Imaging-Ultrasound Fusion Biopsy: An Analysis of 7 Widely Used Eligibility Criteria. Urology 2017; 110:134-139. [PMID: 28842208 DOI: 10.1016/j.urology.2017.08.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/17/2017] [Accepted: 08/09/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the impact of adding magnetic resonance imaging-ultrasound (MRI-US) fusion biopsy cores to standard 12-core biopsy in selecting men for active surveillance (AS). MATERIALS AND METHODS Among men undergoing a fusion biopsy for evaluation of prostate cancer, we selected men who were eligible for at least 1 of 7 different AS criteria based on the standard biopsy alone. We assessed each patient's eligibility for each AS criterion with and without the inclusion of fusion biopsy cores. The primary end point was the proportion of men who were initially eligible for AS but became ineligible after addition of the fusion biopsy cores. RESULTS A total of 100 men were eligible for at least 1 AS criterion. After addition of fusion biopsy cores, the proportion of men who became ineligible for AS varied from 10.3% to 40.7%. Criteria that incorporated an absolute maximum number of cores positive had the highest rates of ineligibility. Using a percentage of cores positive helped to reduce the number of patients who would have been excluded. Combining the targeted biopsy cores into one, or taking the single core with the highest grade or volume did not appear to reduce the proportion of men who became ineligible. CONCLUSIONS The addition of fusion biopsy to standard 12-core biopsy significantly increased the number of men who became ineligible for AS. Using the percent of cores positive, instead of an absolute number, allowed fewer exclusions. AS criteria may need to be updated to prevent the unnecessary exclusion of men due to an oversampling of low-risk disease.
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Affiliation(s)
- Bruno Nahar
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Andrew Katims
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Marcelo Panizzutti Barboza
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Nachiketh Soodana Prakash
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Vivek Venkatramani
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Bruce Kava
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Ramgopal Satyanarayana
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Mark L Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Chad R Ritch
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Dipen J Parekh
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Sanoj Punnen
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL.
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Affiliation(s)
- Chad R Ritch
- Department of Urology, University of Miami Leonard M Miller School of Medicine, Miami, FL, USA
| | - Sanoj Punnen
- Department of Urology, University of Miami Leonard M Miller School of Medicine, Miami, FL, USA
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Abstract
Docetaxel based chemotherapy showed survival benefit and emerged as the mainstay of treatment for castration resistant prostate cancer (CRPC) in 2004. However, therapeutic options have expanded rapidly since 2011. The spectrum of new agents is broad and includes drugs that target the androgen axis (enzalutamide, abiraterone), immunotherapy (sipuleucel-T), bone seeking radionuclides (radium-223), and second line chemotherapy (cabazitaxel). In addition, new agents have been developed to reduce skeletal related events (denosumab). Given that docetaxel was the standard first line treatment for metastatic CRPC, the newer oral agents that affect the androgen axis were initially approved in the post-docetaxel setting. However, subsequent randomized trials have led to their approval in the pre-chemotherapy setting as well. Patients with CRPC are clinically heterogeneous, ranging from patients who are asymptomatic and do not have metastases to those with substantial symptoms and both bony and visceral metastases. CRPC is a clinically challenging disease entity, therefore, with a wide array of treatment options and multiple possible sequencing combinations depending on the individual patient. This review will summarize the findings of the randomized trials that led to the approval of the therapies for CRPC. It will also discuss recent guidelines and provide suggestions for sequencing of drugs based on the best available evidence.
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Affiliation(s)
- Chad R Ritch
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Michael S Cookson
- Department of Urology, University of Oklahoma College of Medicine and Stephenson Cancer Center, Oklahoma City, OK, USA
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Affiliation(s)
- Chad R. Ritch
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
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Chang SS, Boorjian SA, Chou R, Clark PE, Daneshmand S, Konety BR, Pruthi R, Quale DZ, Ritch CR, Seigne JD, Skinner EC, Smith ND, McKiernan JM. Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Guideline. J Urol 2016; 196:1021-9. [PMID: 27317986 DOI: 10.1016/j.juro.2016.06.049] [Citation(s) in RCA: 816] [Impact Index Per Article: 102.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE Although associated with an overall favorable survival rate, the heterogeneity of non-muscle invasive bladder cancer (NMIBC) affects patients' rates of recurrence and progression. Risk stratification should influence evaluation, treatment and surveillance. This guideline attempts to provide a clinical framework for the management of NMIBC. MATERIALS AND METHODS A systematic review utilized research from the Agency for Healthcare Research and Quality (AHRQ) and additional supplementation by the authors and consultant methodologists. Evidence-based statements were based on body of evidence strength Grade A, B, or C and were designated as Strong, Moderate, and Conditional Recommendations with additional statements presented in the form of Clinical Principles or Expert Opinions.(1) RESULTS: A risk-stratified approach categorizes patients into broad groups of low-, intermediate-, and high-risk. Importantly, the evaluation and treatment algorithm takes into account tumor characteristics and uniquely considers a patient's response to therapy. The 38 statements vary in level of evidence, but none include Grade A evidence, and many were Grade C. CONCLUSION The intensity and scope of care for NMIBC should focus on patient, disease, and treatment response characteristics. This guideline attempts to improve a clinician's ability to evaluate and treat each patient, but higher quality evidence in future trials will be essential to improve level of care for these patients.
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Affiliation(s)
- Sam S Chang
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Stephen A Boorjian
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Roger Chou
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Peter E Clark
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Siamak Daneshmand
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Badrinath R Konety
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Raj Pruthi
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Diane Z Quale
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Chad R Ritch
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - John D Seigne
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Eila Curlee Skinner
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Norm D Smith
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - James M McKiernan
- American Urological Association Education and Research, Inc., Linthicum, Maryland
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Pavan N, Ray S, Soodana-Prakash N, Balise RR, Mir C, Nahar B, Marsicano F, Trombetta C, Ritch CR, Parekh DJ, Gonzalgo ML. MP69-07 IMPACT OF PELVIC LYMPH NODE DISSECTION DURING RADICAL PROSTATECTOMY ON 30-DAY POST OPERATIVE COMPLICATIONS: RESULTS FROM A LARGE NATIONAL DATABASE. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Pavan N, Mir C, Ritch CR, Ray S, Soodana-Prakash N, Balise RR, Trombetta C, Parekh DJ, Gonzalgo ML. MP08-09 NUTRITIONAL STATUS AND MAJOR ABDOMINAL SURGERIES: 30-DAY POSTOPERATIVE COMPLICATIONS. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bassett JC, Gore JL, Kwan L, Ritch CR, Barocas DA, Penson DF, McCarthy WJ, Saigal CS. Knowledge of the harms of tobacco use among patients with bladder cancer. Cancer 2014; 120:3914-22. [PMID: 25385059 DOI: 10.1002/cncr.28915] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 06/19/2014] [Accepted: 06/23/2014] [Indexed: 11/12/2022]
Abstract
BACKGROUND The objective of this study was to determine tobacco use knowledge and attribution of cause in patients with newly diagnosed bladder cancer. METHODS A stratified, random sample of bladder cancer survivors diagnosed between 2006 and 2009 was obtained from the California Cancer Registry. Respondents were surveyed about tobacco use, risk factors, and sources of information on the causes of bladder cancer. Contingency tables and logistic regression analyses were used to evaluate tobacco use knowledge and beliefs. RESULTS Of 1198 eligible participants, 790 (66%) completed the survey. Sixty-eight percent of the cohort had a history of tobacco use, and 19% were active smokers at diagnosis. Tobacco use was the most cited risk factor for bladder cancer, with active smokers more knowledgeable than former smokers or never smokers (90% vs 64% vs 61%, respectively; P<.001). Urologists were the predominant source of information and were cited most often by active smokers (82%). In multivariate analyses, active smokers had 6.37 times greater odds (95% confidence interval, 3.35-12.09) than never smokers of endorsing tobacco use as a risk factor for bladder cancer, and smokers who named the urologist as their information source had 2.80 times greater odds (95% confidence interval, 1.77-4.43) of believing tobacco use caused their cancer. CONCLUSIONS Patients' smoking status and primary source of information were associated with knowledge of the harms of tobacco use and, in smokers, acknowledgment that tobacco use increased the risk of their own disease. Urologists play a critical role in ensuring patients' knowledge of the connection between smoking and bladder cancer, particularly for active smokers who may be motivated to quit.
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Affiliation(s)
- Jeffrey C Bassett
- Department of Health Services, University of California-Los Angeles, Los Angeles, California; Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee; Department of Urology, Kaiser Permanente Southern California, Orange County
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Ritch CR, Cookson MS, Chang SS, Clark PE, Resnick MJ, Penson DF, Smith JA, May AT, Anderson CB, You C, Lee H, Barocas DA. Impact of Complications and Hospital-Free Days on Health Related Quality of Life 1 Year after Radical Cystectomy. J Urol 2014; 192:1360-4. [DOI: 10.1016/j.juro.2014.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Chad R. Ritch
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Sam S. Chang
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Peter E. Clark
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew J. Resnick
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David F. Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph A. Smith
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alex T. May
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Chaochen You
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Haerin Lee
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel A. Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Ritch CR, Graves AJ, Keegan KA, Ni S, Bassett JC, Chang SS, Resnick MJ, Penson DF, Barocas DA. Increasing use of observation among men at low risk for prostate cancer mortality. J Urol 2014; 193:801-6. [PMID: 25196658 DOI: 10.1016/j.juro.2014.08.102] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE There are growing concerns regarding the overtreatment of localized prostate cancer. It is also relatively unknown whether there has been increased uptake of observational strategies for disease management. We assessed the temporal trend in observation of clinically localized prostate cancer, particularly in men with low risk disease, who were young and healthy enough to undergo treatment. MATERIALS AND METHODS We performed a retrospective cohort study using the SEER-Medicare database in 66,499 men with localized prostate cancer between 2004 and 2009. The main study outcome was observation within 1 year after diagnosis. We performed multivariable analysis to develop a predictive model of observation adjusting for diagnosis year, age, risk and comorbidity. RESULTS Observation was performed in 12,007 men (18%) with a slight increase with time from 17% to 20%. However, there was marked increase in observation from 18% in 2004 to 29% in 2009 in men with low risk disease. Men 66 to 69 years old with low risk disease and no comorbidities had twice the odds of undergoing observation in 2009 vs 2004 (OR 2.12, 95% CI 1.73-2.59). Age, risk group, comorbidity and race were independent predictors of observation (each p <0.001), in addition to diagnosis year. CONCLUSIONS We identified increasing use of observation for low risk prostate cancer between 2004 and 2009 even in men young and healthy enough for treatment. This suggests growing acceptance of surveillance in this group of patients.
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Affiliation(s)
- Chad R Ritch
- Department of Urology, University of Miami, Miami, Florida.
| | - Amy J Graves
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kirk A Keegan
- Division of Urology, San Antonio Military Medical Center, San Antonio, Texas
| | - Shenghua Ni
- Center for Surgical Quality and Outcomes Research, Nashville, Tennessee
| | | | - Sam S Chang
- Department of Urologic Surgery, Nashville, Tennessee
| | | | - David F Penson
- Vanderbilt University Medical Center, Nashville, Tennessee
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39
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Affiliation(s)
- Chad R. Ritch
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
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40
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Ritch CR, You C, May AT, Herrell SD, Clark PE, Penson DF, Chang SS, Cookson MS, Smith JA, Barocas DA. Biochemical Recurrence–free Survival After Robotic-assisted Laparoscopic vs Open Radical Prostatectomy for Intermediate- and High-risk Prostate Cancer. Urology 2014; 83:1309-15. [DOI: 10.1016/j.urology.2014.02.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 02/11/2014] [Accepted: 02/15/2014] [Indexed: 12/19/2022]
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Affiliation(s)
- Chad R Ritch
- Vanderbilt University Medical Center, Nashville, Tennessee
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42
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Abstract
The rate of clinical understaging in non-muscle invasive bladder cancer (NMIBC) after an initial transurethral resection (TUR) is significant, particularly for high-grade disease, and this has a major impact on prognosis. A repeat TUR, 2 to 6 weeks following the initial resection, is recommended in appropriately selected cases to avoid diagnostic inaccuracy and improve treatment allocation. This article summarizes the rationale and indications for performing a repeat TUR in NMIBC and also provides information regarding patient selection and technique.
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Affiliation(s)
- Chad R Ritch
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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Ritch CR, Morrison BF, Hruby G, Coard KC, Mayhew R, Aiken W, Benson MC, McKiernan JM. Pathological outcome and biochemical recurrence-free survival after radical prostatectomy in African-American, Afro-Caribbean (Jamaican) and Caucasian-American men: an international comparison. BJU Int 2012; 111:E186-90. [DOI: 10.1111/j.1464-410x.2012.11540.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ritch CR, Kearns JT, Mues AC, Hruby GW, Benson MC, McKiernan JM, Landman J. Comparison of Distal Ureteral Management Strategies During Laparoscopic Nephroureterectomy. J Endourol 2011; 25:1149-54. [DOI: 10.1089/end.2010.0542] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chad R. Ritch
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Jamie T. Kearns
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Adam C. Mues
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Gregory W. Hruby
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Mitchell C. Benson
- Department of Urology, Columbia University Medical Center, New York, New York
| | - James M. McKiernan
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Jaime Landman
- Department of Urology, Columbia University Medical Center, New York, New York
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Abstract
OBJECTIVE •To determine the relationship between statin use and biochemical recurrence (BCR) following radical prostatectomy (RP). PATIENTS AND METHODS •A retrospective analysis was performed on 3198 RP patients between 1990 and 2008. •Exclusion criteria were neo-adjuvant or adjuvant therapy, follow-up <2 years, and insufficient pathological or prostate-specific antigen (PSA) data. •Statin use was determined from the patient's record. Clinical and pathological variables were compared between statin users and non-users. •Kaplan-Meier and multivariate Cox regression analyses were performed to determine the effect of statin use on BCR. RESULTS •A total of 1261 patients fit criteria for analysis. There were 281 (22%) statin users. Mean age was 60 years and median follow-up was 36 months (mean 43 months). •Statin users had a lower median preoperative PSA (6.4) compared with non-users (7.1) (P < 0.05). In all, 80% of statin users had a pathological Gleason sum ≥7 compared with 67% of non-users (P < 0.05). •On multivariate analysis, statin use was an independent predictor of BCR (hazard ratio 1.54, P < 0.05). Statin users had a lower 5-year BCR-free survival compared with non-users (75% vs 84%, P < 0.05). CONCLUSIONS •Statin users are at an increased risk for BCR following RP. This finding may be due to the reduction in preoperative PSA potentially delaying diagnosis and/or masking aggressive disease. •Further studies are necessary to elucidate the impact of statin medications following prostate cancer therapy.
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Affiliation(s)
- Chad R Ritch
- Columbia University Medical Center/NY Presbyterian Hospital, Department of Urology, 161 Ft. Washington Ave, HIP 11, New York, NY 10032, USA.
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Abstract
OBJECTIVE • To describe our endoscopic management of adult women with vesicoureteral reflux (VUR) and associated outcomes. PATIENTS AND METHODS • We retrospectively identified 19 adult women who presented for the endoscopic treatment of VUR from November 2001 to January 2008. • Each patient was diagnosed with VUR by voiding cystourethrogram or nuclear cystourethrogram after an episode of pyelonephritis or recurrent urinary tract infections with renal scarring on ultrasound. • A dimercaptosuccinic acid renal scan was performed prior to treatment. All patients underwent endoscopic treatment with dextranomer/hyaluronic acid copolymer (Deflux). Patients with bilateral VUR received bilateral injections during the same procedure. • Follow-up imaging was obtained and success was strictly defined as no degree of VUR. Patients with residual VUR received repeat endoscopic treatment. RESULTS • Nineteen patients with a mean age of 22 years old (range 18-33 years old) underwent endoscopic treatment for VUR. A total of 79% (15/19) had pre-existing risk factors for VUR, including prior open anti-reflux surgery (26%), family history of VUR (26%) and childhood diagnosis of VUR (26%). • Imaging revealed that 47% (9/19) had renal scarring and 26% (5/19) had bilateral VUR. The success rate was 79% (19/24) after one treatment, 92% (22/24) after 5 patients received a second treatment, and 96% (23/24) after 2 patients received a third treatment. There were no perioperative complications. CONCLUSION • Endoscopic management of VUR is both safe and effective in adult women.
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Affiliation(s)
- Alana M Murphy
- Columbia University Medical Center, Department of Urology, New York, NY, USA
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Modi AP, Ritch CR, Arend D, Walsh RM, Ordonez M, Landman J, Gupta M, Knudsen BE. ACE2 and angiotensin 1-7 are increased in a human model of cardiovascular hyporeactivity: pathophysiological implications. J Endourol 2010; 24:1189-93. [PMID: 20575695 DOI: 10.1089/end.2010.0121] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND ACE and ACE2 produce angiotensin II (Ang II), a vasopressor that induces cardiovascular remodeling, and Ang 1-7, a vasodilator with an antiremodeling effect. While Ang 1-7 has antiarrhythmic properties, at higher concentration it may induce ventricular tachycardia and sudden death. ACE2, therefore, may play an essential role in blood pressure homeostasis, in the long-term complications of hypertension (cardiovascular remodeling), and in the induction of cardiac electric abnormalities. This study evaluated the levels of ACE2 and Ang 1-7 in Bartter's/Gitelman's patients (BS/GS) who have elevated Ang II and endogenous blockade of Ang II type 1 receptor signaling compared with healthy subjects (C) and essential hypertensives (EH). BS/ GS patients were also considered because of their predisposition to cardiac arrhythmias, which has yet to be completely clarified. METHODS Mononuclear cell ACE2 and Ang 1-7 were evaluated using western blot. RESULTS One-way ANOVA showed that ACE2 and Ang 1-7 levels were significantly different between the three groups (p=0.0074 and p=0.0001, respectively). Post-hoc analysis (Tukey's HSD) showed that both ACE2 (1.59+/-0.63) and Ang1-7 (2.26+/-1.18) were significantly elevated in BS/GS compared with either C (0.98+/-0.45; p=0.008; 1.12+/-0.48, p=0.002, respectively) or EH (1.06+/-0.24; p=0.043; 0.72+/-0.28; p=0.0001, respectively). ACE2 and Ang 1-7 directly correlated only in BS/GS (r=0.91, p<0.0003). CONCLUSIONS The elevated ACE2 and Ang 1-7 in BS/ GS patients mirror those in hypertensives and are in line with the clinical, hemodynamic and pathophysiological characteristics of BS/GS, likely contributing to them. In consideration of the clinical picture of these syndromes, the opposite of hypertension, the results of this study further strengthen the importance of the ACE2/Ang 1-7 system in the regulation of vascular tone and cardiovascular biology.
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Affiliation(s)
- Achal P Modi
- Department of Urology, The Ohio State University Medical Center, Columbus, Ohio, USA
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Ritch CR, Poon SA, Sulis ML, Schlussel RN. Cutaneous Vesicostomy for Palliative Management of Hemorrhagic Cystitis and Urinary Clot Retention. Urology 2010; 76:166-8. [DOI: 10.1016/j.urology.2010.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 01/08/2010] [Accepted: 02/06/2010] [Indexed: 11/16/2022]
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Ritch CR, Murphy AM, Woldu SL, Reiley EA, Hensle TW. Overnight urethral stenting after tubularized incised plate urethroplasty for distal hypospadias. Pediatr Surg Int 2010; 26:639-42. [PMID: 20419376 DOI: 10.1007/s00383-010-2605-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The duration of urethral stenting after tubularized incised plate (TIP) urethroplasty for hypospadias varies among surgeons. Typically the catheter is left for up to 7 days with the goal of minimizing post-operative complications. We describe our experience with overnight stenting for distal TIP hypospadias repair. MATERIALS AND METHODS A retrospective chart review was performed on patients who underwent TIP hypospadias repair from 2003 to 2008. Patients who had their urethral catheter overnight were included in this analysis. Outcomes analyzed were the rates of: urethrocutaneous fistula, meatal stenosis, urethral stricture and urinary tract infections. RESULTS A total of 64 patients underwent outpatient TIP hypospadias repair. Forty-nine patients had overnight urethral stenting with at least 12 months follow-up and were included in the analysis. Five of the 49 patients (10.2%) developed urethrocutaneous fistula. Of these five patients, two had undergone re-do hypospadias repair. The fistula rate in primary repairs was 3/45 (6.7%). There were no incidences of meatal stenosis, urinary tract infections or urethral strictures. CONCLUSION In our experience, overnight urethral stenting for TIP hypospadias repair does not significantly affect the rates of urethrocutaneous fistula, meatal stenosis and urinary tract infections. Patients who have had a primary TIP hypospadias repair may have their urethral catheter removed safely on post-operative day one.
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Affiliation(s)
- Chad R Ritch
- Division of Pediatric Urology, Department of Urology, Morgan Stanley Children's Hospital of New York, Presbyterian, Columbia University College of Physician and Surgeons, 3959 Broadway, New York, NY 10032, USA.
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