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Dinneen E, Kasivisvanathan V, Giganti F, Allen C, Shaw G, Punwani S. Re: Multiparametric MRI is not sufficient for prostate cancer staging: A single institutional experience validated by a multi-institutional regional collaborative. Thenappan Chandrasekar, Andrew Denisenko, Vasil Mico and Colleagues. Urological Oncology: Seminars and Original Investigations 41 (2023) 355.e1-355.e8. Urol Oncol 2024; 42:18-19. [PMID: 37968168 DOI: 10.1016/j.urolonc.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 08/26/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Eoin Dinneen
- Division of Surgery & Interventional Science, University College London, London, W1W 7TS, UK; Department of Urology, University College Hospital London, London, W1G 8PH, UK.
| | - Veeru Kasivisvanathan
- Division of Surgery & Interventional Science, University College London, London, W1W 7TS, UK; Department of Urology, University College Hospital London, London, W1G 8PH, UK
| | - Francesco Giganti
- Division of Surgery & Interventional Science, University College London, London, W1W 7TS, UK; Department of Radiology, University College London Hospitals, London, NW1 2BU, UK
| | - Clare Allen
- Department of Radiology, University College London Hospitals, London, NW1 2BU, UK
| | - Greg Shaw
- Division of Surgery & Interventional Science, University College London, London, W1W 7TS, UK; Department of Urology, University College Hospital London, London, W1G 8PH, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospitals, London, NW1 2BU, UK; Centre for Medical Imaging, University College London, London, W1W 7TS, UK
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Au M, Almeida-Magana R, Al-Hammouri T, Haider A, Shaw G. Accuracy of Ex-vivo Fluorescence Confocal Microscopy in Margin Assessment of Solid Tumors: A Systematic Review. J Histochem Cytochem 2023; 71:661-674. [PMID: 37968920 PMCID: PMC10691410 DOI: 10.1369/00221554231212948] [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: 08/07/2023] [Accepted: 10/20/2023] [Indexed: 11/17/2023] Open
Abstract
Fluorescence confocal microscopy (FCM) is a novel technology that enables rapid high-resolution digital imaging of non-formalin-fixed tissue specimens and offers real-time positive surgical margin identification. In this systematic review, we evaluated the accuracy metrics of ex vivo FCM for intraoperative margin assessment of different tumor types. A systematic search of MEDLINE via PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus was performed for relevant papers (PROSPERO ID: CRD42022372558). We included 14 studies evaluating four types of microscopes in six different tumor types, including breast, prostate, central nervous system, kidney, bladder, and conjunctival tumors. Using the Quality Assessment of Diagnostic Accuracy Studies tool, we identified a high risk of bias in patient selection (21%) and index test (36%) of the included studies. Overall, we found that FCM has good accuracy metrics in all tumor types, with high sensitivity and specificity (>80%) and almost perfect concordance (>90%) against final pathology results. Despite these promising findings, the quality of the available evidence and bias concerns highlight the need for adequately designed studies to further define the role of ex vivo FCM in replacing the frozen section as the tool of choice for intraoperative margin assessment.
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Affiliation(s)
- Matthew Au
- Department of Targeted Intervention, University College London, London, United Kingdom, University College London Hospitals, London, United Kingdom
| | - Ricardo Almeida-Magana
- Department of Targeted Intervention, University College London, London, United Kingdom, University College London Hospitals, London, United Kingdom
| | - Tarek Al-Hammouri
- Department of Urology, University College London Hospitals, London, United Kingdom
| | - Aiman Haider
- Department of Pathology, University College London Hospitals, London, United Kingdom
| | - Greg Shaw
- Department of Targeted Intervention, University College London, London, United Kingdom, University College London Hospitals, London, United Kingdom
- Department of Urology, University College London Hospitals, London, United Kingdom
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Almeida-Magana R, Au M, Al-Hammouri T, Dinneen K, Haider A, Freeman A, Shaw G. Improving fluorescence confocal microscopy for margin assessment during RARP: The LaserSAFE technique. BJU Int 2023. [PMID: 38009389 DOI: 10.1111/bju.16239] [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: 11/28/2023]
Affiliation(s)
- Ricardo Almeida-Magana
- Division of Surgery and Interventional Sciences, University College London, London, United Kingdom
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Matthew Au
- Division of Surgery and Interventional Sciences, University College London, London, United Kingdom
| | - Tarek Al-Hammouri
- Division of Surgery and Interventional Sciences, University College London, London, United Kingdom
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kate Dinneen
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Aiman Haider
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alex Freeman
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Greg Shaw
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
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4
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Al-Hammouri T, Almeida-Magana R, Lawrence R, Duffy T, White L, Burke E, Kudahetti S, Collins J, Rajan P, Berney D, Gabe R, Shaw G, Lu YJ. Protocol for a prospective study evaluating circulating tumour cells status to predict radical prostatectomy treatment failure in localised prostate cancer patients (C-ProMeta-1). BMC Cancer 2023; 23:581. [PMID: 37353740 DOI: 10.1186/s12885-023-11081-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Treatment decisions in prostate cancer (PCa) rely on disease stratification between localised and metastatic stages, but current imaging staging technologies are not sensitive to micro-metastatic disease. Circulating tumour cells (CTCs) status is a promising tool in this regard. The Parsortix® CTC isolation system employs an epitope-independent approach based on cell size and deformability to increase the capture rate of CTCs. Here, we present a protocol for prospective evaluation of this method to predict post radical prostatectomy (RP) PCa cancer recurrence. METHODS We plan to recruit 294 patients diagnosed with unfavourable intermediate, to high and very high-risk localised PCa. Exclusion criteria include synchronous cancer diagnosis or prior PCa treatment, including hormone therapy. RP is performed according to the standard of care. Two blood samples (20 ml) are collected before and again 3-months after RP. The clinical team are blinded to CTC results and the laboratory researchers are blinded to clinical information. Treatment failure is defined as a PSA ≥ 0.2 mg/ml, start of salvage treatment or imaging-proven metastatic lesions. The CTC analysis entails enumeration and RNA analysis of gene expression in captured CTCs. The primary outcome is the accuracy of CTC status to predict post-RP treatment failure at 4.5 years. Observed sensitivity, positive and negative predictive values will be reported. Specificity will be presented over time. DISCUSSION CTC status may reflect the true potential for PCa metastasis and may predict clinical outcomes better than the current PCa progression risk grading systems. Therefore establishing a robust biomarker for predicting treatment failure in localized high-risk PCa would significantly enhance guidance in treatment decision-making, optimizing cure rates while minimizing unnecessary harm from overtreatment. TRIAL REGISTRATION ISRCTN17332543.
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Affiliation(s)
- Tarek Al-Hammouri
- Dept. of Urology, University College London Hospitals, London, UK
- Queen Mary University of London, Barts Cancer Institute, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Ricardo Almeida-Magana
- Dept. of Urology, University College London Hospitals, London, UK
- Queen Mary University of London, Barts Cancer Institute, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Rachel Lawrence
- Queen Mary University of London, Barts Cancer Institute, London, UK
| | - Tom Duffy
- Queen Mary University of London, Wolfson Institute of Population Health, London, UK
| | - Laura White
- Queen Mary University of London, Wolfson Institute of Population Health, London, UK
| | - Edwina Burke
- Queen Mary University of London, Barts Cancer Institute, London, UK
| | | | - Justin Collins
- Dept. of Urology, University College London Hospitals, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Prabhakar Rajan
- Dept. of Urology, University College London Hospitals, London, UK
- Queen Mary University of London, Barts Cancer Institute, London, UK
| | - Daniel Berney
- Queen Mary University of London, Barts Cancer Institute, London, UK
| | - Rhian Gabe
- Queen Mary University of London, Wolfson Institute of Population Health, London, UK.
| | - Greg Shaw
- Dept. of Urology, University College London Hospitals, London, UK.
- Queen Mary University of London, Barts Cancer Institute, London, UK.
- Division of Surgery and Interventional Science, University College London, London, UK.
| | - Yong-Jie Lu
- Queen Mary University of London, Barts Cancer Institute, London, UK.
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Au M, Almeida-Magana R, Al-Hammouri T, Haider A, Miskovic D, Shaw G. Rare primary prostate cancer presenting with testicular and hip pain. Lancet Oncol 2023; 24:e186. [PMID: 36990616 DOI: 10.1016/s1470-2045(23)00002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/28/2022] [Accepted: 01/04/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Matthew Au
- Department of Targeted Intervention, University College London, London, UK
| | | | - Tarek Al-Hammouri
- Department of Urology, University College London Hospitals, London, UK
| | - Aiman Haider
- Department of Histopathology, University College London Hospitals, London, UK
| | - Danilo Miskovic
- Colorectal and Robotic Surgery Centre, St Marks Hospital, London, UK
| | - Greg Shaw
- Department of Targeted Intervention, University College London, London, UK; Department of Urology, University College London Hospitals, London, UK.
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Samra G, Mahabir S, Madgula A, Kanwar M, Trombetta M, Seungjong O, Cherian T, Silverstein J, Belden W, Friehling M, Liu E, Thosani A, Shaw G. Stereotactic Arrhythmia Radioablation (STAR) as Treatment for Recurrent Ventricular Tachycardia (VT) in Two Patients with Left Ventricle Assist Devices (LVAD). J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.837] [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: 04/05/2023] Open
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Zhao L, Akdim O, Huang X, Wang K, Douthwaite M, Pattisson S, Lewis RJ, Lin R, Yao B, Morgan DJ, Shaw G, He Q, Bethell D, McIntosh S, Kiely CJ, Hutchings GJ. Insights into the Effect of Metal Ratio on Cooperative Redox Enhancement Effects over Au- and Pd-Mediated Alcohol Oxidation. ACS Catal 2023; 13:2892-2903. [PMID: 36910870 PMCID: PMC9990151 DOI: 10.1021/acscatal.2c06284] [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: 12/21/2022] [Revised: 01/30/2023] [Indexed: 02/12/2023]
Abstract
The aerobic oxidation of alcohols and aldehydes over supported heterogeneous catalysts can be considered as comprising two complementary and linked processes: dehydrogenation and oxygen reduction. Significant rate enhancements can be observed when these processes are catalyzed by independent active sites, coupled by electron transport between the two catalysts. This effect, termed cooperative redox enhancement (CORE), could significantly influence how researchers approach catalyst design, but a greater understanding of the factors which influence it is required. Herein, we demonstrate that the Au/Pd ratio used in physical mixtures of monometallic catalysts and phase-separated Au and Pd bimetallic catalysts dramatically influences the degree to which CORE effects can promote alcohol oxidation. Perhaps more interestingly, the roles of Au and Pd in this coupled system are determined to be interchangeable. Preliminarily, we hypothesize that this is attributed to the relative rates of the coupled reactions and demonstrate how physical properties can influence this. This deeper understanding of the factors which influence CORE is an important development in bimetallic catalysis.
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Affiliation(s)
- Liang Zhao
- Max Planck- Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Cardiff CF10 3AT, U.K
| | - Ouardia Akdim
- Max Planck- Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Cardiff CF10 3AT, U.K
| | - Xiaoyang Huang
- Max Planck- Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Cardiff CF10 3AT, U.K
| | - Kai Wang
- Max Planck- Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Cardiff CF10 3AT, U.K
| | - Mark Douthwaite
- Max Planck- Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Cardiff CF10 3AT, U.K
| | - Samuel Pattisson
- Max Planck- Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Cardiff CF10 3AT, U.K
| | - Richard J Lewis
- Max Planck- Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Cardiff CF10 3AT, U.K
| | - Runjia Lin
- Max Planck- Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Cardiff CF10 3AT, U.K
| | - Bingqing Yao
- Department of Materials Science and Engineering, Faculty of Engineering, National University of Singapore, 119077 Singapore
| | - David J Morgan
- Max Planck- Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Cardiff CF10 3AT, U.K
| | - Greg Shaw
- Max Planck- Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Cardiff CF10 3AT, U.K
| | - Qian He
- Department of Materials Science and Engineering, Faculty of Engineering, National University of Singapore, 119077 Singapore
| | - Donald Bethell
- Max Planck- Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Cardiff CF10 3AT, U.K
| | - Steven McIntosh
- Department of Chemical and Biomolecular Engineering, Lehigh University, Bethlehem, Pennsylvania 18015, United States
| | - Christopher J Kiely
- Department of Chemical and Biomolecular Engineering, Lehigh University, Bethlehem, Pennsylvania 18015, United States.,Department of Materials Science and Engineering, Lehigh University, Bethlehem, Pennsylvania 18015, United States
| | - Graham J Hutchings
- Max Planck- Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Cardiff CF10 3AT, U.K
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Christodoulou P, Tipples K, Shaw G. Management Outcomes of Ductal Adenocarcinoma of the Prostate: a Single Centre Retrospective Study. Clin Oncol (R Coll Radiol) 2023. [DOI: 10.1016/j.clon.2022.11.026] [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: 01/13/2023]
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Al-Hammouri T, Almeida-Magana R, Lawrence R, Duffy T, Kudahetti S, Berney D, Gabe R, Shaw G, Lu Y. Predicting treatment failure after radical prostatectomy by circulating tumour cells status (C-ProMeta-1). A single site prospective cohort: A study protocol. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00576-6] [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: 02/12/2023]
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Al-Hammouri T, Almeida-Magana R, Tandogdu Z, Shaw G. Beyond bladder neck sparing: Complete Urethral Preservation (CUP) during RARP. Video description of surgical technique and reported continence outcomes. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01461-6] [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: 02/12/2023]
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Almeida-Magana R, Al-Hammouri T, Au M, Haider A, Freeman A, Ta A, Shaw G. Optimizing fluorescence confocal microscopy margin assessment during RARP, the LaserSAFE technique. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01373-8] [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: 02/12/2023]
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Davies CR, Guo T, Burke E, Stankiewicz E, Xu L, Mao X, Scandura G, Rajan P, Tipples K, Alifrangis C, Wimalasingham AG, Galazi M, Crusz S, Powles T, Grey A, Oliver T, Kudahetti S, Shaw G, Berney D, Shamash J, Lu YJ. The potential of using circulating tumour cells and their gene expression to predict docetaxel response in metastatic prostate cancer. Front Oncol 2023; 12:1060864. [PMID: 36727071 PMCID: PMC9885040 DOI: 10.3389/fonc.2022.1060864] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 10/03/2022] [Accepted: 12/14/2022] [Indexed: 01/18/2023] Open
Abstract
Background Docetaxel improves overall survival (OS) in castration-resistant prostate cancer (PCa) (CRPC) and metastatic hormone-sensitive PCa (mHSPC). However, not all patients respond due to inherent and/or acquired resistance. There remains an unmet clinical need for a robust predictive test to stratify patients for treatment. Liquid biopsy of circulating tumour cell (CTCs) is minimally invasive, can provide real-time information of the heterogeneous tumour and therefore may be a potentially ideal docetaxel response prediction biomarker. Objective In this study we investigate the potential of using CTCs and their gene expression to predict post-docetaxel tumour response, OS and progression free survival (PFS). Methods Peripheral blood was sampled from 18 mCRPC and 43 mHSPC patients, pre-docetaxel treatment, for CTC investigation. CTCs were isolated using the epitope independent Parsortix® system and gene expression was determined by multiplex RT-qPCR. We evaluated CTC measurements for post-docetaxel outcome prediction using receiver operating characteristics and Kaplan Meier analysis. Results Detection of CTCs pre-docetaxel was associated with poor patient outcome post-docetaxel treatment. Combining total-CTC number with PSA and ALP predicted lack of partial response (PR) with an AUC of 0.90, p= 0.037 in mCRPC. A significantly shorter median OS was seen in mCRPC patients with positive CTC-score (12.80 vs. 37.33 months, HR= 5.08, p= 0.0005), ≥3 total-CTCs/7.5mL (12.80 vs. 37.33 months, HR= 3.84, p= 0.0053), ≥1 epithelial-CTCs/7.5mL (14.30 vs. 37.33 months, HR= 3.89, p= 0.0041) or epithelial to mesenchymal transitioning (EMTing)-CTCs/7.5mL (11.32 vs. 32.37 months, HR= 6.73, p= 0.0001). Significantly shorter PFS was observed in patients with ≥2 epithelial-CTCs/7.5mL (7.52 vs. 18.83 months, HR= 3.93, p= 0.0058). mHSPC patients with ≥5 CTCs/7.5mL had significantly shorter median OS (24.57 vs undefined months, HR= 4.14, p= 0.0097). In mHSPC patients, expression of KLK2, KLK4, ADAMTS1, ZEB1 and SNAI1 was significantly associated with shorter OS and/or PFS. Importantly, combining CTC measurements with clinical biomarkers increased sensitivity and specificity for prediction of patient outcome. Conclusion While it is clear that CTC numbers and gene expression were prognostic for PCa post-docetaxel treatment, and CTC subtype analysis may have additional value, their potential predictive value for docetaxel chemotherapy response needs to be further investigated in large patient cohorts.
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Affiliation(s)
- Caitlin R. Davies
- Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Tianyu Guo
- Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom,Department of Cell Biology and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Edwina Burke
- Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Elzbieta Stankiewicz
- Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom,Central Biobank, Medical University of Gdansk, Gdansk, Poland
| | - Lei Xu
- Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom,Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xueying Mao
- Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Glenda Scandura
- Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Prabhakar Rajan
- Centre for Cancer Cell and Molecular Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom,Department of Urology, Barts Health National Health Service Trust (NHS), London, United Kingdom,Division of Surgery and Interventional Sciences, University College London, London, United Kingdom,University College London Hospitals, National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Karen Tipples
- Department of Urology, Barts Health National Health Service Trust (NHS), London, United Kingdom
| | - Constantine Alifrangis
- University College London Hospitals, National Health Service (NHS) Foundation Trust, London, United Kingdom,Department of Medical Oncology, Barts Health National Health Service (NHS) Trust, London, United Kingdom
| | | | - Myria Galazi
- Department of Medical Oncology, Barts Health National Health Service (NHS) Trust, London, United Kingdom
| | - Shanthini Crusz
- Department of Medical Oncology, Barts Health National Health Service (NHS) Trust, London, United Kingdom
| | - Thomas Powles
- Department of Urology, Barts Health National Health Service Trust (NHS), London, United Kingdom,Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Alistair Grey
- Department of Urology, Barts Health National Health Service Trust (NHS), London, United Kingdom,Division of Surgery and Interventional Sciences, University College London, London, United Kingdom,University College London Hospitals, National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Tim Oliver
- Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Sakunthala Kudahetti
- Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Greg Shaw
- Department of Urology, Barts Health National Health Service Trust (NHS), London, United Kingdom,Division of Surgery and Interventional Sciences, University College London, London, United Kingdom,University College London Hospitals, National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Daniel Berney
- Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Jonathan Shamash
- Department of Medical Oncology, Barts Health National Health Service (NHS) Trust, London, United Kingdom
| | - Yong-Jie Lu
- Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom,*Correspondence: Yong-Jie Lu,
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Shaw G, Lieblich A. BJUI Knowledge: urology online learning resource. Trends Urol & Men's Health 2022. [DOI: 10.1002/tre.891] [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] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Greg Shaw
- University College London Hospitals NHS Foundation Trust UK
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Singh S, Rogers H, Kanber B, Clemente J, Pye H, Johnston EW, Parry T, Grey A, Dinneen E, Shaw G, Heavey S, Stopka-Farooqui U, Haider A, Freeman A, Giganti F, Atkinson D, Moore CM, Whitaker HC, Alexander DC, Panagiotaki E, Punwani S. Avoiding Unnecessary Biopsy after Multiparametric Prostate MRI with VERDICT Analysis: The INNOVATE Study. Radiology 2022; 305:623-630. [PMID: 35916679 DOI: 10.1148/radiol.212536] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background In men suspected of having prostate cancer (PCa), up to 50% of men with positive multiparametric MRI (mpMRI) findings (Prostate Imaging Reporting and Data System [PI-RADS] or Likert score of 3 or higher) have no clinically significant (Gleason score ≤3+3, benign) biopsy findings. Vascular, Extracellular, and Restricted Diffusion for Cytometry in Tumor (VERDICT) MRI analysis could improve the stratification of positive mpMRI findings. Purpose To evaluate VERDICT MRI, mpMRI-derived apparent diffusion coefficient (ADC), and prostate-specific antigen density (PSAD) as determinants of clinically significant PCa (csPCa). Materials and Methods Between April 2016 and December 2019, men suspected of having PCa were prospectively recruited from two centers and underwent VERDICT MRI and mpMRI at one center before undergoing targeted biopsy. Biopsied lesion ADC, lesion-derived fractional intracellular volume (FIC), and PSAD were compared between men with csPCa and those without csPCa, using nonparametric tests subdivided by Likert scores. Area under the receiver operating characteristic curve (AUC) was calculated to test diagnostic performance. Results Among 303 biopsy-naive men, 165 study participants (mean age, 65 years ± 7 [SD]) underwent targeted biopsy; of these, 73 had csPCa. Median lesion FIC was higher in men with csPCa (FIC, 0.53) than in those without csPCa (FIC, 0.18) for Likert 3 (P = .002) and Likert 4 (0.60 vs 0.28, P < .001) lesions. Median lesion ADC was lower for Likert 4 lesions with csPCa (0.86 × 10-3 mm2/sec) compared with lesions without csPCa (1.12 × 10-3 mm2/sec, P = .03), but there was no evidence of a difference for Likert 3 lesions (0.97 × 10-3 mm2/sec vs 1.20 × 10-3 mm2/sec, P = .09). PSAD also showed no difference for Likert 3 (0.17 ng/mL2 vs 0.12 ng/mL2, P = .07) or Likert 4 (0.14 ng/mL2 vs 0.12 ng/mL2, P = .47) lesions. The diagnostic performance of FIC (AUC, 0.96; 95% CI: 0.93, 1.00) was higher (P = .02) than that of ADC (AUC, 0.85; 95% CI: 0.79, 0.91) and PSAD (AUC, 0.74; 95% CI: 0.66, 0.82) for the presence of csPCa in biopsied lesions. Conclusion Lesion fractional intracellular volume enabled better classification of clinically significant prostate cancer than did apparent diffusion coefficient and prostate-specific antigen density. Clinical trial registration no. NCT02689271 © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Saurabh Singh
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Harriet Rogers
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Baris Kanber
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Joey Clemente
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Hayley Pye
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Edward W Johnston
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Tom Parry
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Alistair Grey
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Eoin Dinneen
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Greg Shaw
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Susan Heavey
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Urszula Stopka-Farooqui
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Aiman Haider
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Alex Freeman
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Francesco Giganti
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - David Atkinson
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Caroline M Moore
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Hayley C Whitaker
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Daniel C Alexander
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Eleftheria Panagiotaki
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Shonit Punwani
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
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Britton S, Lee K, Azizova L, Shaw G, Ayre WN, Mansell JP. Immobilised teicoplanin does not demonstrate antimicrobial activity against Staphylococcus aureus. Sci Rep 2022; 12:16661. [PMID: 36198734 PMCID: PMC9534865 DOI: 10.1038/s41598-022-20310-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/12/2022] [Indexed: 11/09/2022] Open
Abstract
Antibacterial bone biomaterial coatings appeal to orthopaedics, dentistry and veterinary medicine. Achieving the successful, stable conjugation of suitable compounds to biomaterial surfaces is a major challenge. A pragmatic starting point is to make use of existing, approved antibiotics which are known to remain functional in a stationary, immobilised state. This includes the macrocyclic glycopeptide, teicoplanin, following the discovery, in the 1990's, that it could be used as a chiral selector in chromatographic enantiomeric separations. Importantly teicoplanin works at the level of the bacterial cell wall making it a potential candidate for biomaterial functionalisations. We initially sought to functionalise titanium (Ti) with polydopamine and use this platform to capture teicoplanin, however we were unable to avoid the natural affinity of the antibiotic to the oxide surface of the metal. Whilst the interaction between teicoplanin and Ti was robust, we found that phosphate resulted in antibiotic loss. Before contemplating the covalent attachment of teicoplanin to Ti we examined whether a commercial teicoplanin stationary phase could kill staphylococci. Whilst this commercially available material could bind N-Acetyl-L-Lys-D-Ala-D-Ala it was unable to kill bacteria. We therefore strongly discourage attempts at covalently immobilising teicoplanin and/or other glycopeptide antibiotics in the pursuit of novel antibacterial bone biomaterials.
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Affiliation(s)
- S Britton
- Department of Applied Sciences, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK
| | - K Lee
- Department of Chemistry, Green-Nano Materials Research Center, Kyungpook National University, Daegu, 41566, South Korea
| | - L Azizova
- School of Dentistry, Cardiff University, Cardiff, CF14 4XY, UK
| | - G Shaw
- School of Dentistry, Cardiff University, Cardiff, CF14 4XY, UK
| | - W Nishio Ayre
- School of Dentistry, Cardiff University, Cardiff, CF14 4XY, UK
| | - J P Mansell
- Department of Applied Sciences, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK.
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Thavarajah V, Akman G, Carmona Echeverria L, Griffin J, Freeman A, Haider A, Shaw G, Narashima Sridhar A, Kelly J, Pye H, Crompton J, Enica A, Whitaker H, Okoli U, Cheema U, Heavey S. 120P The compartment-specific spatial transcriptomic landscape of 3D cultured Gleason 7 prostate cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.09.121] [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: 11/01/2022] Open
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Okoli U, Akman G, Thavarajah V, Carmona Echeverria L, Griffin J, Ohayi R, Freeman A, Haider A, Shaw G, Sridhar A, Kelly J, Simpson B, Pye H, Crompton J, Whitaker H, Cheema U, Heavey S. 99P The transcriptional atlas of co-targeted PIM/PI3K/mTOR ex-vivo patient-derived prostate cancer as revealed by spatial transcriptomics. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.09.100] [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: 11/01/2022] Open
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Dinneen E, Grierson J, Almeida-Magana R, Clow R, Haider A, Allen C, Heffernan-Ho D, Freeman A, Briggs T, Nathan S, Mallett S, Brew-Graves C, Muirhead N, Williams NR, Pizzo E, Persad R, Aning J, Johnson L, Oxley J, Oakley N, Morgan S, Tahir F, Ahmad I, Dutto L, Salmond JM, Kelkar A, Kelly J, Shaw G. NeuroSAFE PROOF: study protocol for a single-blinded, IDEAL stage 3, multi-centre, randomised controlled trial of NeuroSAFE robotic-assisted radical prostatectomy versus standard robotic-assisted radical prostatectomy in men with localized prostate cancer. Trials 2022; 23:584. [PMID: 35869497 PMCID: PMC9306247 DOI: 10.1186/s13063-022-06421-7] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Robotic radical prostatectomy (RARP) is a first-line curative treatment option for localized prostate cancer. Postoperative erectile dysfunction and urinary incontinence are common associated adverse side effects that can negatively impact patients' quality of life. Preserving the lateral neurovascular bundles (NS) during RARP improves functional outcomes. However, selecting men for NS may be difficult when there is concern about incurring in positive surgical margin (PSM) which in turn risks adverse oncological outcomes. The NeuroSAFE technique (intra-operative frozen section examination of the neurovascular structure adjacent prostate margin) can provide real-time pathological consult to promote optimal NS whilst avoiding PSM. METHODS NeuroSAFE PROOF is a single-blinded, multi-centre, randomised controlled trial (RCT) in which men are randomly allocated 1:1 to either NeuroSAFE RARP or standard RARP. Men electing for RARP as primary treatment, who are continent and have good baseline erectile function (EF), defined by International Index of Erectile Function (IIEF-5) score > 21, are eligible. NS in the intervention arm is guided by the NeuroSAFE technique. NS in the standard arm is based on standard of care, i.e. a pre-operative image-based planning meeting, patient-specific clinical information, and digital rectal examination. The primary outcome is assessment of EF at 12 months. The primary endpoint is the proportion of men who achieve IIEF-5 score ≥ 21. A sample size of 404 was calculated to give a power of 90% to detect a difference of 14% between groups based on a feasibility study. Oncological outcomes are continuously monitored by an independent Data Monitoring Committee. Key secondary outcomes include urinary continence at 3 months assessed by the international consultation on incontinence questionnaire, rate of biochemical recurrence, EF recovery at 24 months, and difference in quality of life. DISCUSSION NeuroSAFE PROOF is the first RCT of intra-operative frozen section during radical prostatectomy in the world. It is properly powered to evaluate a difference in the recovery of EF for men undergoing RARP assessed by patient-reported outcome measures. It will provide evidence to guide the use of the NeuroSAFE technique around the world. TRIAL REGISTRATION NCT03317990 (23 October 2017). Regional Ethics Committee; reference 17/LO/1978.
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Affiliation(s)
- Eoin Dinneen
- Division of Surgery & Interventional Science, University College London, London, UK.
- University College Hospital London, Department of Urology, Westmoreland Street Hospital, 6-18 Westmoreland Street, W1G 8PH, London, UK.
| | - Jack Grierson
- Division of Surgery & Interventional Science, University College London, London, UK
- University College Hospital London, Department of Urology, Westmoreland Street Hospital, 6-18 Westmoreland Street, W1G 8PH, London, UK
| | | | - Rosie Clow
- Division of Surgery & Interventional Science, University College London, London, UK
- University College Hospital London, Department of Urology, Westmoreland Street Hospital, 6-18 Westmoreland Street, W1G 8PH, London, UK
| | - Aiman Haider
- University College Hospital London, Department of Histopathology, 235 Euston Road, Bristol, NW1 2BU, UK
| | - Clare Allen
- University College Hospital London, Department of Urology, Westmoreland Street Hospital, 6-18 Westmoreland Street, W1G 8PH, London, UK
| | - Daniel Heffernan-Ho
- University College Hospital London, Department of Urology, Westmoreland Street Hospital, 6-18 Westmoreland Street, W1G 8PH, London, UK
| | - Alex Freeman
- University College Hospital London, Department of Histopathology, 235 Euston Road, Bristol, NW1 2BU, UK
| | - Tim Briggs
- University College Hospital London, Department of Urology, Westmoreland Street Hospital, 6-18 Westmoreland Street, W1G 8PH, London, UK
| | - Senthil Nathan
- University College Hospital London, Department of Urology, Westmoreland Street Hospital, 6-18 Westmoreland Street, W1G 8PH, London, UK
| | - Susan Mallett
- Division of Medicine, University College London, Charles Bell House, 43-45 Foley Street, Sheffield, W1W 7JN, UK
| | - Chris Brew-Graves
- Division of Medicine, University College London, Charles Bell House, 43-45 Foley Street, Sheffield, W1W 7JN, UK
| | - Nicola Muirhead
- Division of Medicine, University College London, Charles Bell House, 43-45 Foley Street, Sheffield, W1W 7JN, UK
| | - Norman R Williams
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Elena Pizzo
- Department of Applied Health Research, University College London, 1-19 Torrington Place, Glasgow, WC1E 7HB, UK
| | - Raj Persad
- North Bristol Hospitals Trust, Department of Urology, Southmead Hospital, Southmead Lane, Westbury-on-Trym, Bristol, BS10 5NB, UK
| | - Jon Aning
- North Bristol Hospitals Trust, Department of Urology, Southmead Hospital, Southmead Lane, Westbury-on-Trym, Bristol, BS10 5NB, UK
| | - Lyndsey Johnson
- North Bristol Hospitals Trust, Department of Urology, Southmead Hospital, Southmead Lane, Westbury-on-Trym, Bristol, BS10 5NB, UK
| | - Jon Oxley
- North Bristol Hospitals Trust, Department of Histopathology, Southmead Hospital, Southmead Lane, Westbury-on-Trym, BS10 5NB, Bristol, UK
| | - Neil Oakley
- Sheffield Teaching Hospitals NHS Trust, Department of Urology, Royal Hallamshire Hospital, Glossop Road, S10 2JF, UK
| | - Susan Morgan
- Sheffield Teaching Hospitals NHS Trust, Department of Histopathology, Royal Hallamshire Hospital, Glossop Road, S10 2JF, UK
| | - Fawzia Tahir
- Sheffield Teaching Hospitals NHS Trust, Department of Histopathology, Royal Hallamshire Hospital, Glossop Road, S10 2JF, UK
| | - Imran Ahmad
- Glasgow & Clyde NHS Trust, Department of Urology, Queen Elizabeth Hospital, 1345 Govan Road, Glasgow, UK
| | - Lorenzo Dutto
- Glasgow & Clyde NHS Trust, Department of Urology, Queen Elizabeth Hospital, 1345 Govan Road, Glasgow, UK
| | - Jonathan M Salmond
- Glasgow & Clude NHS Trust, Department of Histopathology, Queen Elizabeth Hospital, 1345 Govan Road, Glasgow, UK
| | - Anand Kelkar
- University College Hospital London, Department of Urology, Westmoreland Street Hospital, 6-18 Westmoreland Street, W1G 8PH, London, UK
- Barking Havering & Redbridge University Hospitals Trust, Rom Valley Way, Romford, RM7 0AG, UK
| | - John Kelly
- Division of Surgery & Interventional Science, University College London, London, UK
- University College Hospital London, Department of Urology, Westmoreland Street Hospital, 6-18 Westmoreland Street, W1G 8PH, London, UK
| | - Greg Shaw
- Division of Surgery & Interventional Science, University College London, London, UK
- University College Hospital London, Department of Urology, Westmoreland Street Hospital, 6-18 Westmoreland Street, W1G 8PH, London, UK
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19
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Almeida-Magana R, Maroof H, Grierson J, Clow R, Dinneen E, Al-Hammouri T, Muirhead N, Brew-Graves C, Kelly J, Shaw G. E-Consent-a guide to maintain recruitment in clinical trials during the COVID-19 pandemic. Trials 2022; 23:388. [PMID: 35550639 PMCID: PMC9096749 DOI: 10.1186/s13063-022-06333-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/23/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has posed daunting challenges when conducting clinical research. Adopting new technologies such as remote electronic consent (e-Consent) can help overcome them. However, guidelines for e-Consent implementation in ongoing clinical trials are currently lacking. The NeuroSAFE PROOF trial is a randomized clinical trial evaluating the role of frozen section analysis during RARP for prostate cancer. In response to the COVID-19 crisis, recruitment was halted, and a remote e-Consent solution was designed. The aim of this paper is to describe the process of implementation, impact on recruitment rate, and patients' experience using e-Consent. METHODS A substantial amendment of the protocol granted the creation of a remote e-Consent framework based on the REDCap environment, following the structure and content of the already approved paper consent form. Although e-Consent obviated the need for in-person meeting, there was nonetheless counselling sessions performed interactively online. This new pathway offered continuous support to patients through remote consultations. The whole process was judged to be compliant with regulatory requirements before implementation. RESULTS Before the first recruitment suspension, NeuroSAFE PROOF was recruiting an average of 9 patients per month. After e-Consent implementation, 63 new patients (4/month) have been enrolled despite a second lockdown, none of whom would have been recruited using the old methods given restrictions on face-to-face consultations. Patients have given positive feedback on the use of the platform. Limited troubleshooting has been required after implementation. CONCLUSION Remote e-Consent-based recruitment was critical for the continuation of the NeuroSAFE PROOF trial during the COVID-19 pandemic. The described pathway complies with ethical and regulatory guidelines for informed consent, while minimizing face-to-face interactions that increase the risk of COVID-19 transmission. This guide will help researchers integrate e-Consent to ongoing or planned clinical trials while uncertainty about the course of the pandemic continues. TRIAL REGISTRATION NeuroSAFE PROOF trial NCT03317990 . Registered on 23 October 2017. Regional Ethics Committee reference 17/LO/1978.
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Affiliation(s)
- Ricardo Almeida-Magana
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London, W1W 7TY, UK.
| | - Hanna Maroof
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Jack Grierson
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London, W1W 7TY, UK
| | - Rosie Clow
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London, W1W 7TY, UK
| | - Eoin Dinneen
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Tarek Al-Hammouri
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Nicola Muirhead
- NCITA Clinical Trials Unit, Division of Medicine, University College London, Charles Bell House, 2nd Floor, 43-45 Foley Street, London, W1W 7TY, UK
| | - Chris Brew-Graves
- NCITA Clinical Trials Unit, Division of Medicine, University College London, Charles Bell House, 2nd Floor, 43-45 Foley Street, London, W1W 7TY, UK
| | - John Kelly
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London, W1W 7TY, UK
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Greg Shaw
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
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Dinneen E, Allen C, Strange T, Heffernan-Ho D, Banjeglav J, Lindsay J, Mulligan JP, Briggs T, Nathan S, Sridhar A, Grierson J, Haider A, Panayi C, Patel D, Freeman A, Aning J, Persad R, Ahmad I, Dutto L, Oakley N, Ambrosi A, Parry T, Kasivisvanathan V, Giganti F, Shaw G, Punwani S. Negative mpMRI Rules Out Extra-Prostatic Extension in Prostate Cancer before Robot-Assisted Radical Prostatectomy. Diagnostics (Basel) 2022; 12:1057. [PMID: 35626214 PMCID: PMC9139507 DOI: 10.3390/diagnostics12051057] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background: The accuracy of multi-parametric MRI (mpMRI) in the pre-operative staging of prostate cancer (PCa) remains controversial. Objective: The purpose of this study was to evaluate the ability of mpMRI to accurately predict PCa extra-prostatic extension (EPE) on a side-specific basis using a risk-stratified 5-point Likert scale. This study also aimed to assess the influence of mpMRI scan quality on diagnostic accuracy. Patients and Methods: We included 124 men who underwent robot-assisted RP (RARP) as part of the NeuroSAFE PROOF study at our centre. Three radiologists retrospectively reviewed mpMRI blinded to RP pathology and assigned a Likert score (1-5) for EPE on each side of the prostate. Each scan was also ascribed a Prostate Imaging Quality (PI-QUAL) score for assessing the quality of the mpMRI scan, where 1 represents the poorest and 5 represents the best diagnostic quality. Outcome measurements and statistical analyses: Diagnostic performance is presented for the binary classification of EPE, including 95% confidence intervals and the area under the receiver operating characteristic curve (AUC). Results: A total of 231 lobes from 121 men (mean age 56.9 years) were evaluated. Of these, 39 men (32.2%), or 43 lobes (18.6%), had EPE. A Likert score ≥3 had a sensitivity (SE), specificity (SP), NPV, and PPV of 90.4%, 52.3%, 96%, and 29.9%, respectively, and the AUC was 0.82 (95% CI: 0.77-0.86). The AUC was 0.76 (95% CI: 0.64-0.88), 0.78 (0.72-0.84), and 0.92 (0.88-0.96) for biparametric scans, PI-QUAL 1-3, and PI-QUAL 4-5 scans, respectively. Conclusions: MRI can be used effectively by genitourinary radiologists to rule out EPE and help inform surgical planning for men undergoing RARP. EPE prediction was more reliable when the MRI scan was (a) multi-parametric and (b) of a higher image quality according to the PI-QUAL scoring system.
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Affiliation(s)
- Eoin Dinneen
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London W1W 7TS, UK; (J.G.); (V.K.); (F.G.); (G.S.)
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - Clare Allen
- Department of Radiology, University College London Hospitals, 235 Euston Road, London NW1 2BU, UK; (C.A.); (T.S.); (D.H.-H.); (S.P.)
| | - Tom Strange
- Department of Radiology, University College London Hospitals, 235 Euston Road, London NW1 2BU, UK; (C.A.); (T.S.); (D.H.-H.); (S.P.)
| | - Daniel Heffernan-Ho
- Department of Radiology, University College London Hospitals, 235 Euston Road, London NW1 2BU, UK; (C.A.); (T.S.); (D.H.-H.); (S.P.)
| | - Jelena Banjeglav
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - Jamie Lindsay
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - John-Patrick Mulligan
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - Tim Briggs
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - Senthil Nathan
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - Ashwin Sridhar
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - Jack Grierson
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London W1W 7TS, UK; (J.G.); (V.K.); (F.G.); (G.S.)
- Department of Histopathology, University College Hospital London, 235 Euston Road, London NW1 2BU, UK; (A.H.); (C.P.); (D.P.); (A.F.)
| | - Aiman Haider
- Department of Histopathology, University College Hospital London, 235 Euston Road, London NW1 2BU, UK; (A.H.); (C.P.); (D.P.); (A.F.)
| | - Christos Panayi
- Department of Histopathology, University College Hospital London, 235 Euston Road, London NW1 2BU, UK; (A.H.); (C.P.); (D.P.); (A.F.)
| | - Dominic Patel
- Department of Histopathology, University College Hospital London, 235 Euston Road, London NW1 2BU, UK; (A.H.); (C.P.); (D.P.); (A.F.)
| | - Alex Freeman
- Department of Histopathology, University College Hospital London, 235 Euston Road, London NW1 2BU, UK; (A.H.); (C.P.); (D.P.); (A.F.)
| | - Jonathan Aning
- North Bristol Hospitals Trust, Department of Urology, Southmead Hospital, Southmead Lane, Westbury-on-Trym, Bristol BS10 5NB, UK; (J.A.); (R.P.)
| | - Raj Persad
- North Bristol Hospitals Trust, Department of Urology, Southmead Hospital, Southmead Lane, Westbury-on-Trym, Bristol BS10 5NB, UK; (J.A.); (R.P.)
| | - Imran Ahmad
- Department of Urology, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, 1345 Govan Road, Glasgow G51 4TF, UK; (I.A.); (L.D.)
| | - Lorenzo Dutto
- Department of Urology, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, 1345 Govan Road, Glasgow G51 4TF, UK; (I.A.); (L.D.)
| | - Neil Oakley
- Department of Urology, Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK;
| | - Alessandro Ambrosi
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milano, Italy;
| | - Tom Parry
- Centre for Medical Imaging, University College London, Charles Bell House, 2nd Floor, 43-45 Foley Street, London W1W 7TS, UK;
| | - Veeru Kasivisvanathan
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London W1W 7TS, UK; (J.G.); (V.K.); (F.G.); (G.S.)
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - Francesco Giganti
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London W1W 7TS, UK; (J.G.); (V.K.); (F.G.); (G.S.)
- Department of Radiology, University College London Hospitals, 235 Euston Road, London NW1 2BU, UK; (C.A.); (T.S.); (D.H.-H.); (S.P.)
| | - Greg Shaw
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London W1W 7TS, UK; (J.G.); (V.K.); (F.G.); (G.S.)
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - Shonit Punwani
- Department of Radiology, University College London Hospitals, 235 Euston Road, London NW1 2BU, UK; (C.A.); (T.S.); (D.H.-H.); (S.P.)
- Centre for Medical Imaging, University College London, Charles Bell House, 2nd Floor, 43-45 Foley Street, London W1W 7TS, UK;
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21
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Singh S, Mathew M, Mertzanidou T, Suman S, Clemente J, Retter A, Papoutsaki MV, Smith L, Grussu F, Kasivisvanathan V, Grey A, Dinneen E, Shaw G, Carter M, Patel D, Moore CM, Atkinson D, Panagiotaki E, Haider A, Freeman A, Alexander D, Punwani S. Histo-MRI map study protocol: a prospective cohort study mapping MRI to histology for biomarker validation and prediction of prostate cancer. BMJ Open 2022; 12:e059847. [PMID: 35396316 PMCID: PMC8995953 DOI: 10.1136/bmjopen-2021-059847] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Multiparametric MRI (mpMRI) is now widely used to risk stratify men with a suspicion of prostate cancer and identify suspicious regions for biopsy. However, the technique has modest specificity and a high false-positive rate, especially in men with mpMRI scored as indeterminate (3/5) or likely (4/5) to have clinically significant cancer (csPCa) (Gleason ≥3+4). Advanced MRI techniques have emerged which seek to improve this characterisation and could predict biopsy results non-invasively. Before these techniques are translated clinically, robust histological and clinical validation is required. METHODS AND ANALYSIS This study aims to clinically validate two advanced MRI techniques in a prospectively recruited cohort of men suspected of prostate cancer. Histological analysis of men undergoing biopsy or prostatectomy will be used for biological validation of biomarkers derived from Vascular and Extracellular Restricted Diffusion for Cytometry in Tumours and Luminal Water imaging. In particular, prostatectomy specimens will be processed using three-dimension printed patient-specific moulds to allow for accurate MRI and histology mapping. The index tests will be compared with the histological reference standard to derive false positive rate and true positive rate for men with mpMRI scores which are indeterminate (3/5) or likely (4/5) to have clinically significant prostate cancer (csPCa). Histopathological validation from both biopsy and prostatectomy samples will provide the best ground truth in validating promising MRI techniques which could predict biopsy results and help avoid unnecessary biopsies in men suspected of prostate cancer. ETHICS AND DISSEMINATION Ethical approval was granted by the London-Queen Square Research Ethics Committee (19/LO/1803) on 23 January 2020. Results from the study will be presented at conferences and submitted to peer-reviewed journals for publication. Results will also be available on ClinicalTrials.gov. TRIAL REGISTRATION NUMBER NCT04792138.
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Affiliation(s)
- Saurabh Singh
- Centre for Medical Imaging, University College London, London, UK
| | - Manju Mathew
- Centre for Medical Imaging, University College London, London, UK
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Thomy Mertzanidou
- Centre for Medical Imaging Computing, Department of Computer Science, University College London, London, UK
| | - Shipra Suman
- Centre for Medical Imaging, University College London, London, UK
- Centre for Medical Imaging Computing, Department of Computer Science, University College London, London, UK
| | - Joey Clemente
- Centre for Medical Imaging, University College London, London, UK
| | - Adam Retter
- Centre for Medical Imaging, University College London, London, UK
| | | | - Lorna Smith
- Centre for Medical Imaging, University College London, London, UK
| | - Francesco Grussu
- Centre for Medical Imaging Computing, Department of Computer Science, University College London, London, UK
- Radiomics Group, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Veeru Kasivisvanathan
- Division Of Surgery and Interventional Sciences, University College London, London, UK
| | - Alistair Grey
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Urology, Barts Health NHS Trust, London, UK
| | - Eoin Dinneen
- Division Of Surgery and Interventional Sciences, University College London, London, UK
| | - Greg Shaw
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Urology, Barts Health NHS Trust, London, UK
| | - Martyn Carter
- Faculty of the Built Environment, University College London, London, UK
| | - Dominic Patel
- Department of Pathology, University College London Cancer Institute, London, UK
| | - Caroline M Moore
- Division Of Surgery and Interventional Sciences, University College London, London, UK
| | - David Atkinson
- Centre for Medical Imaging, University College London, London, UK
| | - Eleftheria Panagiotaki
- Centre for Medical Imaging Computing, Department of Computer Science, University College London, London, UK
| | - Aiman Haider
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Daniel Alexander
- Centre for Medical Imaging Computing, Department of Computer Science, University College London, London, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, London, UK
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22
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Nathan A, Ng A, Mitra A, Davda R, Sooriakumaran P, Patel S, Fricker M, Kelly J, Shaw G, Rajan P, Sridhar A, Nathan S, Payne H,. Comparative effectiveness analysis of oncological and functional outcomes after salvage radical treatment with surgery or radiotherapy following primary focal or whole-gland ablative therapy for localised prostate cancer. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01040-5] [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: 11/04/2022]
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23
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Sun S, Dummer NF, Bere T, Barnes AJ, Shaw G, Douthwaite M, Pattisson S, Lewis RJ, Richards N, Morgan DJ, Hutchings GJ. Selective oxidation of methane to methanol and methyl hydroperoxide over palladium modified MoO 3 photocatalyst under ambient conditions. Catal Sci Technol 2022. [DOI: 10.1039/d2cy00240j] [Citation(s) in RCA: 1] [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: 01/14/2023]
Abstract
In situ generated H2O2 from water on Pd–MoO3 catalyst can oxide methane into methanol and methyl hydroperoxide with high selectivity under simulated solar light irradiation.
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Affiliation(s)
- Songmei Sun
- Max Planck-Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff, CF10 3AT, UK
- Donghua University, College of Environmental Science and Engineering, Shanghai 201620, P.R. China
- Shanghai Institute of Pollution Control and Ecological Security, Shanghai 200092, P.R. China
| | - Nicholas F. Dummer
- Max Planck-Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff, CF10 3AT, UK
| | - Takudzwa Bere
- Max Planck-Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff, CF10 3AT, UK
| | - Alexandra J. Barnes
- Max Planck-Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff, CF10 3AT, UK
| | - Greg Shaw
- Max Planck-Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff, CF10 3AT, UK
| | - Mark Douthwaite
- Max Planck-Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff, CF10 3AT, UK
| | - Samuel Pattisson
- Max Planck-Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff, CF10 3AT, UK
| | - Richard J. Lewis
- Max Planck-Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff, CF10 3AT, UK
| | - Nia Richards
- Max Planck-Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff, CF10 3AT, UK
| | - David J. Morgan
- Max Planck-Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff, CF10 3AT, UK
| | - Graham J. Hutchings
- Max Planck-Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff, CF10 3AT, UK
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24
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Nathan A, Ng A, Mitra A, Sooriakumaran P, Davda R, Patel S, Fricker M, Kelly J, Shaw G, Rajan P, Sridhar A, Nathan S, Payne H. Comparative Effectiveness Analyses of Salvage Prostatectomy and Salvage Radiotherapy Outcomes Following Focal or Whole-Gland Ablative Therapy (High-Intensity Focused Ultrasound, Cryotherapy or Electroporation) for Localised Prostate Cancer. Clin Oncol (R Coll Radiol) 2021; 34:e69-e78. [PMID: 34740477 DOI: 10.1016/j.clon.2021.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 08/23/2021] [Revised: 09/27/2021] [Accepted: 10/20/2021] [Indexed: 11/25/2022]
Abstract
AIMS Ablative therapy, such as focal therapy, cryotherapy or electroporation, aims to treat clinically significant prostate cancer with reduced treatment-related toxicity. Up to a third of patients may require further local salvage treatment after ablative therapy failure. Limited descriptive, but no comparative, evidence exists between different salvage treatment outcomes. The aim of this study was to compare oncological and functional outcomes after salvage robot-assisted radical prostatectomy (SRARP) and salvage radiotherapy (SRT). MATERIALS AND METHODS Data were collected prospectively and retrospectively on 100 consecutive SRARP cases and 100 consecutive SRT cases after ablative therapy failure in a high-volume tertiary centre. RESULTS High-risk patients were over-represented in the SRARP group (66.0%) compared with the SRT group (48.0%) (P = 0.013). The median (interquartile range) follow-up after SRARP was 16.5 (10.0-30.0) months and 37.0 (18.5-64.0) months after SRT. SRT appeared to confer greater biochemical recurrence-free survival at 1, 2 and 3 years compared with SRARP in high-risk patients (year 3: 86.3% versus 66.0%), but biochemical recurrence-free survival was similar for intermediate-risk patients (year 3: 90.0% versus 75.6%). There was no statistical difference in pad-free continence at 12 and 24 months between SRARP (77.2 and 84.7%) and SRT (75.0 and 74.0%) (P = 0.724, 0.114). Erectile function was more likely to be preserved in men who underwent SRT. After SRT, cumulative bowel and urinary Radiation Therapy Oncology Group toxicity grade I were 25.0 and 45.0%, grade II were 11.0 and 11.0% and grade III or IV complications were 4.0 and 5.0%, respectively. CONCLUSION We report the first comparative analyses of salvage prostatectomy and radiotherapy following ablative therapy. Men with high-risk disease appear to have superior oncological outcomes after SRT; however, treatment allocation does not appear to influence oncological outcomes for men with intermediate-risk disease. Treatment allocation was associated with a different spectrum of toxicity profile. Our data may inform shared decision-making when considering salvage treatment following focal or whole-gland ablative therapy.
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Affiliation(s)
- A Nathan
- University College London, London, UK; University College London Hospitals NHS Trust, London, UK; The Royal College of Surgeons of England, London, UK.
| | - A Ng
- University College London, London, UK
| | - A Mitra
- University College London Hospitals NHS Trust, London, UK
| | - P Sooriakumaran
- University College London Hospitals NHS Trust, London, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - R Davda
- University College London Hospitals NHS Trust, London, UK
| | - S Patel
- University College London, London, UK
| | | | - J Kelly
- University College London, London, UK; University College London Hospitals NHS Trust, London, UK
| | - G Shaw
- University College London, London, UK; University College London Hospitals NHS Trust, London, UK
| | - P Rajan
- University College London Hospitals NHS Trust, London, UK
| | - A Sridhar
- University College London, London, UK; University College London Hospitals NHS Trust, London, UK
| | - S Nathan
- University College London, London, UK; University College London Hospitals NHS Trust, London, UK
| | - H Payne
- University College London, London, UK; University College London Hospitals NHS Trust, London, UK
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25
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Nathan A, Hanna N, Rashid A, Patel S, Phuah Y, Flora K, Fricker M, Cleaveland P, Kasivisvanathan V, Williams N, Miah S, Shah N, Hines J, Collins J, Sridhar A, Kelkar A, Briggs T, Kelly J, Shaw G, Sooriakumaran P, Rajan P, Lamb B, Nathan S. 141 New Guidelines to Reduce Unnecessary Blood Tests, Delayed Discharge and Costs Following Robot Assisted Radical Prostatectomy. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1070] [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] [Indexed: 11/14/2022]
Abstract
Abstract
Objectives
Routine postoperative blood tests (POBT) following robot assisted radical prostatectomy (RARP) are used to evaluate the impact of surgery on pre-existing co-morbidities and to detect early complications. This practice dates back to an era of open surgery, when blood loss and complication rates were higher. We propose new guidelines to improve the specificity of POBT.
Method
The cases of 1040 consecutive patients who underwent a primary or salvage RARP at two large tertiary urology centres in the United Kingdom were retrospectively reviewed to form new guidelines. The new guidelines were prospectively validated in a sample of 300 patients.
Results
Derivation Dataset: 3% and 5% had intra- and post-operative Clavien-Dindo complications, respectively. 15% had clinical concerns postoperatively. 0.9% required perioperative transfusion. 78% had routine blood tests without clinical concerns, none of whom developed a complication. 98% of complications were suspected by clinical judgement. 6% of patients had a discharge delay of ≥ 1 day due to delayed or incomplete blood tests. Validation Dataset: No significant difference existed in complication, clinical concern or transfusion rates between the derivation and validation datasets. Number of POBT requested reduced by 73% (p < 0.001). The new guidelines improved POBT sensitivity for complications from 98% to 100% and specificity from 0% to 74%. Discharge delays reduced from 6% to 0% (p = 0.008). Cost savings were £178 per patient.
Conclusions
Postoperative complications and transfusion following RARP are rare. Routine POBT without clinical indication are unnecessary and inefficient. A guideline-based approach to POBT can reduce costs and optimise discharge without compromising patient safety or care.
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Affiliation(s)
- A Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
| | - N Hanna
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- University of Cambridge, Cambridge, United Kingdom
| | - A Rashid
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- University of Cambridge, Cambridge, United Kingdom
| | - S Patel
- University College London, London, United Kingdom
| | - Y Phuah
- University College London, London, United Kingdom
| | - K Flora
- University College London, London, United Kingdom
| | - M Fricker
- Newcastle University, Newcastle, United Kingdom
| | - P Cleaveland
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - V Kasivisvanathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - N Williams
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - S Miah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - N Shah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - J Hines
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - J Collins
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - A Sridhar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - A Kelkar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - T Briggs
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - J Kelly
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - G Shaw
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - P Sooriakumaran
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - P Rajan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Barts Cancer Institute, CR-UK Barts Centre, Queen Mary University of London, London, United Kingdom
| | - B Lamb
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - S Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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26
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Nathan A, Fricker M, De Groote R, Arora A, Phuah Y, Flora K, Patel S, Kasivisvanathan V, Sridhar A, Shaw G, Kelly J, Briggs T, Rajan P, Sooriakumaran P, Nathan S. 283 Salvage Versus Primary Robot-Assisted Radical Prostatectomy: A Propensity-Matched Comparative Effectiveness Study from A High-Volume Tertiary Centre. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1075] [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] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
Salvage Robot-Assisted Radical Prostatectomy (sRARP) is a potential treatment option for locally recurrent Prostate Cancer after non-surgical primary treatment. There are minimal data comparing outcomes between propensity-matched salvage and primary Robot-Assisted Radical Prostatectomy (RARP). We compare perioperative, oncological, and functional outcomes of sRARP with primary RARP and between sRARP post-whole and focal gland therapy.
Method
1:1 propensity-matched comparison of 146 sRARP with primary RARP from a cohort of 3,852 consecutive patients from a high-volume tertiary centre.
Results
There were no significant differences in patient characteristics between the salvage and primary RARP groups. Grade III-V Clavien-Dindo complication rates were 1.3% and 0% in the salvage and primary groups, respectively (p = 0.310). Median (IQR) follow-up was 16 (10,30) and 21 (13,33) months in the salvage and primary groups, respectively. BCR rates were 30.8% and 13.7% in the salvage and primary groups, respectively (p < 0.001). Pad-free continence rates were 79.1% and 85.4% at two years in the salvage and primary groups, respectively (p = 0.160). ED rates were 95.2% and 77.4% in the salvage and primary groups, respectively (p < 0.001). Comparing the whole gland and focal gland groups, BCR rates were 33.3% and 29.1%, respectively (p = 0.687), pad-free continence rates were 66% and 89.3%, respectively (p = 0.001), and ED rates were 98.3% and 93%, respectively (p = 0.145).
Conclusions
SRARP has similar perioperative but inferior oncological outcomes to primary RARP. Continence rates are similar to primary RARP, but potency is worse. Perioperative and oncological outcomes of sRARP after focal gland therapy are similar but continence outcomes are superior compared to sRARP after whole gland therapy.
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Affiliation(s)
- A Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
| | - M Fricker
- University of Newcastle, Newcastle, United Kingdom
| | - R De Groote
- Department of Urology, Onze Lieve Vrouw Hospital Aalst, Aalst, Belgium
| | - A Arora
- Department of Urology, Tata Memorial Hospital, Mumbai, India
| | - Y Phuah
- University College London, London, United Kingdom
| | - K Flora
- University College London, London, United Kingdom
| | - S Patel
- University College London, London, United Kingdom
| | - V Kasivisvanathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
| | - A Sridhar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - G Shaw
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - J Kelly
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - T Briggs
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - P Rajan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Barts Cancer Institute, CR-UK Barts Centre, Queen Mary University of London, London, United Kingdom
| | - P Sooriakumaran
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - S Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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27
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Dinneen E, Oxley J, Shaw G. Re: Bernardo Rocco, Luca Sarchi, Simone Assumma, et al. Digital Frozen Sections with Fluorescence Confocal Microscopy During Robot-assisted Radical Prostatectomy: Surgical Technique. Eur Urol. In press. https://doi.org/10.1016/j.eururo.2021.03.021. Eur Urol 2021; 80:e120-e121. [PMID: 34489141 DOI: 10.1016/j.eururo.2021.08.015] [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] [Received: 07/12/2021] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Eoin Dinneen
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College Hospital London, London, UK.
| | - Jon Oxley
- Department of Histopathology, Southmead Hospital, North Bristol Hospitals Trust, Bristol, UK
| | - Greg Shaw
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College Hospital London, London, UK
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28
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Fricker M, Nathan A, Hannah N, Rashid A, Patel S, Phuah Y, Flora K, Cleaveland P, Kasivisvanathan V, Williams N, Miah S, Shah N, Hines J, Collins J, Sridhar A, Kelkar A, Briggs T, Kelly J, Shaw G, Sooriakumaran P, Rajan P, Lamb B, Nathan S. O50 New guidelines to reduce unnecessary blood tests, delayed discharge and costs following robot assisted radical prostatectomy. Br J Surg 2021. [DOI: 10.1093/bjs/znab282.055] [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] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Routine postoperative blood tests (POBT) are used to evaluate the impact of surgery on pre-existing co-morbidities and to detect early complications. This practice dates back to an era of open surgery, when blood loss and complication rates were higher. We propose new guidelines to improve the specificity of POBT.
Method
The cases of 1040 consecutive patients who underwent a primary or salvage RARP at two large tertiary urology centres in the United Kingdom were retrospectively reviewed, and new guidelines were designed. The guidelines were prospectively validated in a cohort of 300 patients.
Result
Derivation Dataset 3% and 5% had intra- and post-operative Clavien-Dindo complications, respectively. 15% had clinical concerns postoperatively. 0.9% required perioperative transfusion. 78% had routine blood tests without clinical concerns, none of whom developed a complication. 98% of complications were suspected by clinical judgement. 6% of patients had a discharge delay of ≥ 1 days due to delayed or incomplete blood tests.
Validation Dataset No significant difference existed in complication, clinical concern or transfusion rates between the derivation and validation datasets. New guidelines improved sensitivity for complications from 98% to 100% and specificity from 0% to 74%. The number of blood tests requested reduced by 73% (P < 0.001). Discharge delays reduced from 6% to 0% (P = 0.008). Cost savings were £178 per patient.
Conclusion
Postoperative complications and transfusion following RARP are rare. Routine POBT without clinical indication are unnecessary and inefficient. A guideline-based approach to POBT can reduce costs and optimise discharge without compromising patient safety or care.
Take-home Message
Routine postoperative blood tests following robot assisted radical prostatectomy are often unnecessary. A guideline-based approach can reduce costs and optimise patient care.
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Affiliation(s)
| | - A Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
- University College London
| | - N Hannah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
- University of Cambridge
| | - A Rashid
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
- University of Cambridge
| | | | | | | | - P Cleaveland
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - V Kasivisvanathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - N Williams
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - S Miah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
| | - N Shah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
| | - J Hines
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - J Collins
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - A Sridhar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - A Kelkar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - T Briggs
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - J Kelly
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - G Shaw
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - P Sooriakumaran
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
- Nuffield Department of Surgical Sciences, University of Oxford
| | - P Rajan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
- Barts Cancer Institute, CR-UK Barts Centre, Queen Mary University of London
| | - B Lamb
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
| | - S Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
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29
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Giganti F, Dinneen E, Kasivisvanathan V, Haider A, Freeman A, Kirkham A, Punwani S, Emberton M, Shaw G, Moore CM, Allen C. Inter-reader agreement of the PI-QUAL score for prostate MRI quality in the NeuroSAFE PROOF trial. Eur Radiol 2021; 32:879-889. [PMID: 34327583 PMCID: PMC8794934 DOI: 10.1007/s00330-021-08169-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/20/2021] [Accepted: 06/25/2021] [Indexed: 02/03/2023]
Abstract
Objectives The Prostate Imaging Quality (PI-QUAL) score assesses the quality of multiparametric MRI (mpMRI). A score of 1 means all sequences are below the minimum standard of diagnostic quality, 3 implies that the scan is of sufficient diagnostic quality, and 5 means that all three sequences are of optimal diagnostic quality. We investigated the inter-reader reproducibility of the PI-QUAL score in patients enrolled in the NeuroSAFE PROOF trial. Methods We analysed the scans of 103 patients on different MR systems and vendors from 12 different hospitals. Two dedicated radiologists highly experienced in prostate mpMRI independently assessed the PI-QUAL score for each scan. Interobserver agreement was assessed using Cohen’s kappa with standard quadratic weighting (κw) and percent agreement. Results The agreement for each single PI-QUAL score was strong (κw = 0.85 and percent agreement = 84%). A similar agreement (κw = 0.82 and percent agreement = 84%) was observed when the scans were clustered into three groups (PI-QUAL 1–2 vs PI-QUAL 3 vs PI-QUAL 4–5). The agreement in terms of diagnostic quality for each single sequence was highest for T2-weighted imaging (92/103 scans; 89%), followed by dynamic contrast-enhanced sequences (91/103; 88%) and diffusion-weighted imaging (80/103; 78%). Conclusion We observed strong reproducibility in the assessment of PI-QUAL between two radiologists with high expertise in prostate mpMRI. At present, PI-QUAL offers clinicians the only available tool for evaluating and reporting the quality of prostate mpMRI in a systematic manner but further refinements of this scoring system are warranted. Key Points • Inter-reader agreement for each single Prostate Imaging Quality (PI-QUAL) score (i.e., PI-QUAL 1 to PI-QUAL 5) was strong, with weighted kappa = 0.85 (95% confidence intervals: 0.51 – 1) and percent agreement = 84%. • Interobserver agreement was strong when the scans were clustered into three groups according to the ability (or not) to rule in and to rule out clinically significant prostate cancer (i.e., PI-QUAL 1-2 vs PI-QUAL 3 vs PI-QUAL 4–5), with weighted kappa = 0.82 (95% confidence intervals: 0.68 – 0.96) and percent agreement = 84%. • T2-weighted acquisitions were the most compliant with the Prostate Imaging Reporting and Data System (PI-RADS) v. 2.0 technical recommendations and were the sequences of highest diagnostic quality for both readers in 95/103 (92%) scans, followed by dynamic contrast enhanced acquisition with 81/103 (79%) scans and lastly by diffusion-weighted imaging with 79/103 (77%) scans. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08169-1.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St, London, W1W 7TS, UK.
| | - Eoin Dinneen
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St, London, W1W 7TS, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Veeru Kasivisvanathan
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St, London, W1W 7TS, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Aiman Haider
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Centre for Medical Imaging, University College London, London, UK
| | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St, London, W1W 7TS, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Greg Shaw
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St, London, W1W 7TS, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St, London, W1W 7TS, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
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30
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Nathan A, Hanna N, Rashid A, Patel S, Phuah Y, Flora K, Fricker M, Cleaveland P, Kasivisvanathan V, Williams N, Miah S, Collins J, Kelkar A, Sridhar A, Hines J, Briggs T, Kelly J, Shah N, Shaw G, Sooriakumaran P, Rajan P, Lamb BW, Nathan S. New recommendations to reduce unnecessary blood tests after robot-assisted radical prostatectomy. BJU Int 2021; 128:681-684. [PMID: 34110673 DOI: 10.1111/bju.15511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Arjun Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Nancy Hanna
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,University of Cambridge, Cambridge, UK
| | - Amir Rashid
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,University of Cambridge, Cambridge, UK
| | | | | | | | | | - Paul Cleaveland
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Veeru Kasivisvanathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Norman Williams
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Saiful Miah
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Justin Collins
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Anand Kelkar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ashwin Sridhar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - John Hines
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tim Briggs
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - John Kelly
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Nimish Shah
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Greg Shaw
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Prasanna Sooriakumaran
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Prabhakar Rajan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK.,Barts Cancer Institute, CR-UK Barts Centre, Queen Mary University of London, London, UK
| | - Benjamin W Lamb
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Senthil Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
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Dinneen E, Haider A, Grierson J, Freeman A, Oxley J, Briggs T, Nathan S, Williams NR, Brew-Graves C, Persad R, Aning J, Jameson C, Ratynska M, Ben-Salha I, Ball R, Clow R, Allen C, Heffernan-Ho D, Kelly J, Shaw G. NeuroSAFE frozen section during robot-assisted radical prostatectomy: peri-operative and histopathological outcomes from the NeuroSAFE PROOF feasibility randomized controlled trial. BJU Int 2021; 127:676-686. [PMID: 32985121 DOI: 10.1111/bju.15256] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 01/05/2023]
Abstract
OBJECTIVES To report on the methods, peri-operative outcomes and histopathological concordance between frozen and final section from the NeuroSAFE PROOF feasibility study (NCT03317990). PATIENTS AND METHODS Between May 2018 and March 2019, 49 patients at two UK centres underwent robot-assisted radical prostatectomy (RARP). Twenty-five patient were randomized to NeuroSAFE RARP (intervention arm) and 24 to standard RARP (control arm). Frozen section was compared to final paraffin section margin assessment in the 25 patients in the NeuroSAFE arm. Operation timings and complications were collected prospectively in both arms. RESULTS Fifty neurovascular bundles (NVBs) from 25 patients in the NeuroSAFE arm were analysed. When analysed by each pathological section (n = 250, average five per side), we noted a sensitivity of 100%, a specificity of 99.2%, and an area under the curve (AUC) of 0.994 (95% confidence interval [CI] 0.985 to 1; P ≤0.001). On an NVB basis (n = 50), sensitivity was 100%, specificity was 92.7%, and the AUC was 0.963 (95% CI 0.914 to 1; P ≤0.001). NeuroSAFE RARP lasted a mean of 3 h 16 min (knife to skin to off table, 95% CI 3 h 2 min-3 h 30 min) compared to 2 h 4 min (95% CI 2 h 2 min-2 h 25 min; P ≤0.001) for standard RARP. There was no morbidity associated with the additional length of operating time on in the NeuroSAFE arm. CONCLUSION This feasibility study demonstrates the safety, reproducibility and excellent histopathological concordance of the NeuroSAFE technique in the NeuroSAFE PROOF trial. Although the technique increases the duration of RARP, this does not cause short-term harm. Confirmation of feasibility has led to the opening of the fully powered NeuroSAFE PROOF randomized controlled trial, which is currently under way at four sites in the UK.
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Affiliation(s)
- Eoin Dinneen
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| | - Aiman Haider
- Department of Histopathology, University College Hospital London, London, UK
| | - Jack Grierson
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Alex Freeman
- Department of Histopathology, University College Hospital London, London, UK
| | - Jon Oxley
- Department of Histopathology, North Bristol Hospitals Trust, Southmead Hospital, Bristol, UK
| | - Tim Briggs
- Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| | - Senthil Nathan
- Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| | - Norman R Williams
- Division of Surgery and Interventional Science, University College London, London, UK
| | | | - Raj Persad
- Department of Urology, North Bristol Hospitals Trust, Southmead Hospital, Bristol, UK
| | - Jon Aning
- Department of Urology, North Bristol Hospitals Trust, Southmead Hospital, Bristol, UK
| | - Charles Jameson
- Department of Histopathology, University College Hospital London, London, UK
| | - Marzena Ratynska
- Department of Histopathology, University College Hospital London, London, UK
| | - Imen Ben-Salha
- Department of Histopathology, University College Hospital London, London, UK
| | - Rhys Ball
- Department of Histopathology, University College Hospital London, London, UK
| | - Rosie Clow
- Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| | - Clare Allen
- Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| | - Daniel Heffernan-Ho
- Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| | - John Kelly
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| | - Greg Shaw
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
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Dinneen E, Grierson J, Haider A, Allen C, Heffernan-Ho D, Clow R, Freeman A, Briggs T, Nathan S, Brew-Graves C, Mallett S, Williams N, Persad R, Aning J, Oxley J, Oakley N, Morgan S, Tahir F, Ahmad I, Dutto L, Salmond J, Marzena R, Ben-Salha I, Kelly J, Shaw G. NeuroSAFE PROOF. Update on a multi-centre, pragmatic, RCT for men undergoing robot-assisted radical prostatectomy: Trial in progress. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01245-8] [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: 10/20/2022]
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Giganti F, Dinneen E, Kasivisvanathan V, Haider A, Freeman A, Emberton M, Shaw G, Moore C, Allen C. Interobserver reproducibility of the Prostate Imaging Quality (PI-QUAL) score for prostate MRI quality. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01289-6] [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: 10/20/2022]
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Nathan A, Fricker M, De Groote R, Arora A, Phuah Y, Flora K, Pavan N, Kasivisvanathan V, Collins J, Kelkar A, Sridhar A, Shaw G, Rajan P, Kelly J, Briggs T, Sooriakumaran P, Nathan S. Salvage versus primary robot-assisted radical prostatectomy: A propensity-matched comparative effectiveness study from a high-volume tertiary center. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01569-4] [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: 11/26/2022]
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35
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Nathan A, Hanna N, Rashid A, Patel S, Phuah Y, Flora K, Sharma A, Cleaveland P, Kasivisvanatha V, William N, Mia S, Collin J, Sridha A, Kelka A, Sha N, Kell J, Briggs T, Shaw G, Sooriakumaran P, Rajan P, Lamb B, Nathan S. 236 Novel Guidelines to Avoid Routine Blood Tests After Robotic Assisted Radical Prostatectomy (RARP). Br J Surg 2021. [DOI: 10.1093/bjs/znab134.388] [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] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Patients undergoing RARP commonly require routine post-operative blood tests. This practice dates from an era of open surgery, with increased blood loss and complications. We aim to improve specificity of blood test requests with novel guidelines.
Method
1039 consecutive RARP patients at two tertiary urology centres in the UK were audited. Novel guidelines constructed based on risk stratified evidence from the initial audit were used to prospectively audit 133 patients.
Results
16% had clinical concerns post-operatively. 1% and 4% had an intra- and post-operative complication. Intra- or post-operative clinical judgement flagged post-operative complications in 99.9%. 80% had routine blood tests with no clinical concerns. 6% had delayed discharge due to delayed processing of blood tests. 0.9% received a peri-operative transfusion.
Re-Audit Novel guidelines reduced the number of blood tests requested from 100% to 36%. Specificity in diagnosing a complication improved from 0% to 67%. Discharge delays reduced from 6% to 0% and no post-operative complications were missed (sensitivity 100%).
Conclusions
Routine blood tests, without an indication, did not flag any additional post-operative complications. Blood transfusion is rare for RARP. Novel guidelines to request post-operative blood tests will reduce costs and discharge delays whilst maintaining appropriate patient safety and care.
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Affiliation(s)
- A Nathan
- University College London Hospitals, London, United Kingdom
| | - N Hanna
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - A Rashid
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - S Patel
- University College London Hospitals, London, United Kingdom
| | - Y Phuah
- University College London Hospitals, London, United Kingdom
| | - K Flora
- University College London Hospitals, London, United Kingdom
| | - A Sharma
- University College London Hospitals, London, United Kingdom
| | - P Cleaveland
- University College London Hospitals, London, United Kingdom
| | | | - N William
- University College London Hospitals, London, United Kingdom
| | - S Mia
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - J Collin
- University College London Hospitals, London, United Kingdom
| | - A Sridha
- University College London Hospitals, London, United Kingdom
| | - A Kelka
- University College London Hospitals, London, United Kingdom
| | - N Sha
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - J Kell
- University College London Hospitals, London, United Kingdom
| | - T Briggs
- University College London Hospitals, London, United Kingdom
| | - G Shaw
- University College London Hospitals, London, United Kingdom
| | | | - P Rajan
- University College London Hospitals, London, United Kingdom
| | - B Lamb
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - S Nathan
- University College London Hospitals, London, United Kingdom
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Nathan A, Fricker M, De Groote R, Arora A, Phuah Y, Flora K, Patel S, Kasivisvanathan V, Sridhar A, Shaw G, Kelly J, Briggs T, Rajan P, Sooriakumaran P, Nathan S. Salvage Versus Primary Robot-assisted Radical Prostatectomy: A Propensity-matched Comparative Effectiveness Study from a High-volume Tertiary Centre. EUR UROL SUPPL 2021; 27:43-52. [PMID: 33997823 PMCID: PMC8090976 DOI: 10.1016/j.euros.2021.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Salvage robot-assisted radical prostatectomy (sRARP) is a potential treatment option for locally recurrent prostate cancer (PCa) after nonsurgical primary treatment. There are minimal data comparing outcomes between propensity-matched sRARP and primary robot-assisted radical prostatectomy (RARP). Objective The primary objective is to compare perioperative, oncological, and functional outcomes of sRARP with primary RARP, and the secondary is to compare outcomes between sRARP after whole and focal gland therapy. Design, setting, and participants A 1:1 propensity-matched comparison was carried out of 135 sRARP cases with primary RARP cases from a cohort of 3852 consecutive patients from a high-volume tertiary centre. Outcome measurements and statistical analysis Perioperative, oncological, and functional outcomes including complication rates, positive surgical margins, biochemical recurrence (BCR), continence, and erectile dysfunction (ED) were retrospectively collected. Results and limitations There were no significant differences in patient characteristics between sRARP and primary RARP groups. In the salvage and primary groups, median (interquartile range) follow-up periods were 521 (304–951) and 638 (394–951) d, grade III–V Clavien-Dindo complication rates were 1.5% and 0% (p = 0.310), BCR rates were 31.9% and 14.1% (p < 0.001) at the last follow-up, pad-free continence rates were 78.8% and 84.3% at 2 yr (p = 0.337), and ED rates were 94.8% and 76.3% (p < 0.001), respectively. Comparing the whole and focal gland groups, BCR rates were 36.7% and 29.1% (p = 0.687) at follow-up, pad-free continence rates were 53.1% and 89.3% at 2 yr (p < 0.001), and ED rates were 98% and 93% (p = 0.214), respectively. Conclusions Salvage RARP has similar perioperative outcomes to primary RARP with inferior potency rates. Post–focal therapy sRARP has similar recurrence and continence rates to primary RARP. Post–whole gland therapy, complication, and recurrence rates are higher, and there is a higher risk of urinary incontinence. Patient summary We report the largest propensity-matched comparison of salvage robot-assisted radical prostatectomy (RARP) after focal and whole gland therapy. Salvage RARP is a feasible procedure for the treatment of locally recurrent prostate cancer in high-volume centres; however, patients should be counselled appropriately as to the different outcomes.
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Affiliation(s)
- Arjun Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | | | - Ruben De Groote
- Department of Urology, Onze Lieve Vrouw Hospital Aalst, Aalst, Belgium
| | - Amandeep Arora
- Department of Urology, Tata Memorial Hospital, Mumbai, India
| | | | | | | | - Veeru Kasivisvanathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Ashwin Sridhar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Greg Shaw
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - John Kelly
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tim Briggs
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Prabhakar Rajan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK.,Barts Cancer Institute, CR-UK Barts Centre, Queen Mary University of London, London, UK
| | - Prasanna Sooriakumaran
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Senthil Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
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Fitzgerald J, Shaw G, Jones D, Murphy M, Barry F. A novel xeno/serum-free medium to support the isolation and expansion of human adipose-derived mesenchymal stem cells. Cytotherapy 2021. [DOI: 10.1016/s1465324921003595] [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: 11/30/2022]
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38
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Pye H, Singh S, Norris JM, Carmona Echeverria LM, Stavrinides V, Grey A, Dinneen E, Pilavachi E, Clemente J, Heavey S, Stopka-Farooqui U, Simpson BS, Bonet-Carne E, Patel D, Barker P, Burling K, Stevens N, Ng T, Panagiotaki E, Hawkes D, Alexander DC, Rodriguez-Justo M, Haider A, Freeman A, Kirkham A, Atkinson D, Allen C, Shaw G, Beeston T, Brizmohun Appayya M, Latifoltojar A, Johnston EW, Emberton M, Moore CM, Ahmed HU, Punwani S, Whitaker HC. Evaluation of PSA and PSA Density in a Multiparametric Magnetic Resonance Imaging-Directed Diagnostic Pathway for Suspected Prostate Cancer: The INNOVATE Trial. Cancers (Basel) 2021; 13:1985. [PMID: 33924255 PMCID: PMC8074769 DOI: 10.3390/cancers13081985] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives: To assess the clinical outcomes of mpMRI before biopsy and evaluate the space remaining for novel biomarkers. Methods: The INNOVATE study was set up to evaluate the validity of novel fluidic biomarkers in men with suspected prostate cancer who undergo pre-biopsy mpMRI. We report the characteristics of this clinical cohort, the distribution of clinical serum biomarkers, PSA and PSA density (PSAD), and compare the mpMRI Likert scoring system to the Prostate Imaging-Reporting and Data System v2.1 (PI-RADS) in men undergoing biopsy. Results: 340 men underwent mpMRI to evaluate suspected prostate cancer. 193/340 (57%) men had subsequent MRI-targeted prostate biopsy. Clinically significant prostate cancer (csigPCa), i.e., overall Gleason ≥ 3 + 4 of any length OR maximum cancer core length (MCCL) ≥4 mm of any grade including any 3 + 3, was found in 96/195 (49%) of biopsied patients. Median PSA (and PSAD) was 4.7 (0.20), 8.0 (0.17), and 9.7 (0.31) ng/mL (ng/mL/mL) in mpMRI scored Likert 3,4,5 respectively for men with csigPCa on biopsy. The space for novel biomarkers was shown to be within the group of men with mpMRI scored Likert3 (178/340) and 4 (70/350), in whom an additional of 40% (70/178) men with mpMRI-scored Likert3, and 37% (26/70) Likert4 could have been spared biopsy. PSAD is already considered clinically in this cohort to risk stratify patients for biopsy, despite this 67% (55/82) of men with mpMRI-scored Likert3, and 55% (36/65) Likert4, who underwent prostate biopsy had a PSAD below a clinical threshold of 0.15 (or 0.12 for men aged <50 years). Different thresholds of PSA and PSAD were assessed in mpMRI-scored Likert4 to predict csigPCa on biopsy, to achieve false negative levels of ≤5% the proportion of patients whom who test as above the threshold were unsuitably high at 86 and 92% of patients for PSAD and PSA respectively. When PSA was re tested in a sub cohort of men repeated PSAD showed its poor reproducibility with 43% (41/95) of patients being reclassified. After PI-RADS rescoring of the biopsied lesions, 66% (54/82) of the Likert3 lesions received a different PI-RADS score. Conclusions: The addition of simple biochemical and radiological markers (Likert and PSAD) facilitate the streamlining of the mpMRI-diagnostic pathway for suspected prostate cancer but there remains scope for improvement, in the introduction of novel biomarkers for risk assessment in Likert3 and 4 patients, future application of novel biomarkers tested in a Likert cohort would also require re-optimization around Likert3/PI-RADS2, as well as reproducibility testing.
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Affiliation(s)
- Hayley Pye
- Division of Surgery & Interventional Science, University College London, London WC1E 6BT, UK; (J.M.N.); (L.M.C.E.); (V.S.); (S.H.); (U.S.-F.); (B.S.S.); (M.E.); (C.M.M.); (H.C.W.)
| | - Saurabh Singh
- Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.S.); (E.P.); (J.C.); (N.S.); (D.A.); (T.B.); (M.B.A.); (A.L.); (E.W.J.); (S.P.)
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.K.); (C.A.)
| | - Joseph M. Norris
- Division of Surgery & Interventional Science, University College London, London WC1E 6BT, UK; (J.M.N.); (L.M.C.E.); (V.S.); (S.H.); (U.S.-F.); (B.S.S.); (M.E.); (C.M.M.); (H.C.W.)
- Department of Urology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.G.); (E.D.); (G.S.)
| | - Lina M. Carmona Echeverria
- Division of Surgery & Interventional Science, University College London, London WC1E 6BT, UK; (J.M.N.); (L.M.C.E.); (V.S.); (S.H.); (U.S.-F.); (B.S.S.); (M.E.); (C.M.M.); (H.C.W.)
- Department of Urology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.G.); (E.D.); (G.S.)
| | - Vasilis Stavrinides
- Division of Surgery & Interventional Science, University College London, London WC1E 6BT, UK; (J.M.N.); (L.M.C.E.); (V.S.); (S.H.); (U.S.-F.); (B.S.S.); (M.E.); (C.M.M.); (H.C.W.)
- Department of Urology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.G.); (E.D.); (G.S.)
| | - Alistair Grey
- Department of Urology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.G.); (E.D.); (G.S.)
- Department of Urology, Barts Health, NHS Foundation Trust, London EC1A 7BE, UK
| | - Eoin Dinneen
- Department of Urology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.G.); (E.D.); (G.S.)
- Department of Urology, Barts Health, NHS Foundation Trust, London EC1A 7BE, UK
| | - Elly Pilavachi
- Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.S.); (E.P.); (J.C.); (N.S.); (D.A.); (T.B.); (M.B.A.); (A.L.); (E.W.J.); (S.P.)
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.K.); (C.A.)
| | - Joey Clemente
- Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.S.); (E.P.); (J.C.); (N.S.); (D.A.); (T.B.); (M.B.A.); (A.L.); (E.W.J.); (S.P.)
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.K.); (C.A.)
| | - Susan Heavey
- Division of Surgery & Interventional Science, University College London, London WC1E 6BT, UK; (J.M.N.); (L.M.C.E.); (V.S.); (S.H.); (U.S.-F.); (B.S.S.); (M.E.); (C.M.M.); (H.C.W.)
| | - Urszula Stopka-Farooqui
- Division of Surgery & Interventional Science, University College London, London WC1E 6BT, UK; (J.M.N.); (L.M.C.E.); (V.S.); (S.H.); (U.S.-F.); (B.S.S.); (M.E.); (C.M.M.); (H.C.W.)
| | - Benjamin S. Simpson
- Division of Surgery & Interventional Science, University College London, London WC1E 6BT, UK; (J.M.N.); (L.M.C.E.); (V.S.); (S.H.); (U.S.-F.); (B.S.S.); (M.E.); (C.M.M.); (H.C.W.)
| | - Elisenda Bonet-Carne
- Centre for Medical Image Computing, Department of Computer Science, University College London, London WC1E 6BT, UK; (E.B.-C.); (E.P.); (D.C.A.)
| | - Dominic Patel
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (D.P.); (M.R.-J.); (A.H.); (A.F.)
| | - Peter Barker
- Department of Clinical Biochemistry, Addenbrookes Hospital NHS Foundation Trust, Cambridge CB2 0QQ, UK; (P.B.); (K.B.)
| | - Keith Burling
- Department of Clinical Biochemistry, Addenbrookes Hospital NHS Foundation Trust, Cambridge CB2 0QQ, UK; (P.B.); (K.B.)
| | - Nicola Stevens
- Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.S.); (E.P.); (J.C.); (N.S.); (D.A.); (T.B.); (M.B.A.); (A.L.); (E.W.J.); (S.P.)
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.K.); (C.A.)
| | - Tony Ng
- Molecular Oncology Group, University College London, London WC1E 6BT, UK;
| | - Eleftheria Panagiotaki
- Centre for Medical Image Computing, Department of Computer Science, University College London, London WC1E 6BT, UK; (E.B.-C.); (E.P.); (D.C.A.)
| | - David Hawkes
- Department of Medical Physics and Bioengineering, University College London, London WC1E 6BT, UK;
| | - Daniel C. Alexander
- Centre for Medical Image Computing, Department of Computer Science, University College London, London WC1E 6BT, UK; (E.B.-C.); (E.P.); (D.C.A.)
| | - Manuel Rodriguez-Justo
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (D.P.); (M.R.-J.); (A.H.); (A.F.)
| | - Aiman Haider
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (D.P.); (M.R.-J.); (A.H.); (A.F.)
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (D.P.); (M.R.-J.); (A.H.); (A.F.)
| | - Alex Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.K.); (C.A.)
| | - David Atkinson
- Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.S.); (E.P.); (J.C.); (N.S.); (D.A.); (T.B.); (M.B.A.); (A.L.); (E.W.J.); (S.P.)
| | - Clare Allen
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.K.); (C.A.)
| | - Greg Shaw
- Department of Urology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.G.); (E.D.); (G.S.)
- Department of Urology, Barts Health, NHS Foundation Trust, London EC1A 7BE, UK
| | - Teresita Beeston
- Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.S.); (E.P.); (J.C.); (N.S.); (D.A.); (T.B.); (M.B.A.); (A.L.); (E.W.J.); (S.P.)
| | - Mrishta Brizmohun Appayya
- Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.S.); (E.P.); (J.C.); (N.S.); (D.A.); (T.B.); (M.B.A.); (A.L.); (E.W.J.); (S.P.)
| | - Arash Latifoltojar
- Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.S.); (E.P.); (J.C.); (N.S.); (D.A.); (T.B.); (M.B.A.); (A.L.); (E.W.J.); (S.P.)
- Department of Radiology, Royal Marsden Hospital, London SW3 6JJ, UK
| | - Edward W. Johnston
- Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.S.); (E.P.); (J.C.); (N.S.); (D.A.); (T.B.); (M.B.A.); (A.L.); (E.W.J.); (S.P.)
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.K.); (C.A.)
| | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, London WC1E 6BT, UK; (J.M.N.); (L.M.C.E.); (V.S.); (S.H.); (U.S.-F.); (B.S.S.); (M.E.); (C.M.M.); (H.C.W.)
- Department of Urology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.G.); (E.D.); (G.S.)
| | - Caroline M. Moore
- Division of Surgery & Interventional Science, University College London, London WC1E 6BT, UK; (J.M.N.); (L.M.C.E.); (V.S.); (S.H.); (U.S.-F.); (B.S.S.); (M.E.); (C.M.M.); (H.C.W.)
- Department of Urology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.G.); (E.D.); (G.S.)
| | - Hashim U. Ahmed
- Imperial Urology, Imperial College Healthcare NHS Trust, London W2 1NY, UK;
- Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.S.); (E.P.); (J.C.); (N.S.); (D.A.); (T.B.); (M.B.A.); (A.L.); (E.W.J.); (S.P.)
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.K.); (C.A.)
| | - Hayley C. Whitaker
- Division of Surgery & Interventional Science, University College London, London WC1E 6BT, UK; (J.M.N.); (L.M.C.E.); (V.S.); (S.H.); (U.S.-F.); (B.S.S.); (M.E.); (C.M.M.); (H.C.W.)
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Tandogdu Z, Collins J, Shaw G, Rohn J, Koves B, Sachdeva A, Ghazi A, Haese A, Mottrie A, Kumar A, Sivaraman A, Tewari A, Challacombe B, Rocco B, Giedelman C, Wagner C, Rogers CG, Murphy DG, Pushkar D, Ogaya-Pinies G, Porter J, Seetharam KR, Graefen M, Orvieto MA, Moschovas MC, Schatloff O, Wiklund P, Coelho R, Valero R, de Reijke TM, Ahlering T, Rogers T, van der Poel HG, Patel V, Artibani W, Wagenlehner F, Maes K, Rha KH, Nathan S, Bjerklund Johansen TE, Hawkey P, Kelly J. Management of patients who opt for radical prostatectomy during the coronavirus disease 2019 (COVID-19) pandemic: an international accelerated consensus statement. BJU Int 2021; 127:729-741. [PMID: 33185026 DOI: 10.1111/bju.15299] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/15/2022]
Abstract
OBJECTIVE Coronavirus disease-19 (COVID-19) pandemic caused delays in definitive treatment of patients with prostate cancer. Beyond the immediate delay a backlog for future patients is expected. The objective of this work is to develop guidance on criteria for prioritisation of surgery and reconfiguring management pathways for patients with non-metastatic prostate cancer who opt for surgical treatment. A second aim was to identify the infection prevention and control (IPC) measures to achieve a low likelihood of coronavirus disease 2019 (COVID-19) hazard if radical prostatectomy (RP) was to be carried out during the outbreak and whilst the disease is endemic. METHODS We conducted an accelerated consensus process and systematic review of the evidence on COVID-19 and reviewed international guidance on prostate cancer. These were presented to an international prostate cancer expert panel (n = 34) through an online meeting. The consensus process underwent three rounds of survey in total. Additions to the second- and third-round surveys were formulated based on the answers and comments from the previous rounds. The Consensus opinion was defined as ≥80% agreement and this was used to reconfigure the prostate cancer pathways. RESULTS Evidence on the delayed management of patients with prostate cancer is scarce. There was 100% agreement that prostate cancer pathways should be reconfigured and measures developed to prevent nosocomial COVID-19 for patients treated surgically. Consensus was reached on prioritisation criteria of patients for surgery and management pathways for those who have delayed treatment. IPC measures to achieve a low likelihood of nosocomial COVID-19 were coined as 'COVID-19 cold' sites. CONCLUSION Reconfiguring management pathways for patients with prostate cancer is recommended if significant delay (>3-6 months) in surgical management is unavoidable. The mapped pathways provide guidance for such patients. The IPC processes proposed provide a framework for providing RP within an environment with low COVID-19 risk during the outbreak or when the disease remains endemic. The broader concepts could be adapted to other indications beyond prostate cancer surgery.
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Affiliation(s)
- Zafer Tandogdu
- Department of Urology, University College London Hospital, London, UK.,Medical School, University College London, London, UK
| | - Justin Collins
- Department of Urology, University College London Hospital, London, UK
| | - Greg Shaw
- Department of Urology, University College London Hospital, London, UK
| | - Jennifer Rohn
- Medical School, University College London, London, UK
| | - Bela Koves
- Department of Urology, Budapest Hospital, Budapest, Hungary
| | - Ashwin Sachdeva
- Department of Urology, NHS Foundation Trust, Freeman Hospital, Newcastle Upon-Tyne, UK
| | - Ahmed Ghazi
- Department of Urology, University of Rochester, Rochester, NY, USA
| | - Alexander Haese
- Leitender Arzt für Roboterassistierte Urologie, Martini-Klinik am UKE GmbH, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Alex Mottrie
- Department of Urology, OLV Hospital, Aalst, Belgium
| | - Anup Kumar
- Department Urology, Robotics and Renal Transplant, Safdarjang Hospital and VMMC, New Delhi, India
| | | | - Ashutosh Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Bernardo Rocco
- Department of Urology AOU di Mldena, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Christian Wagner
- Head of Robotic Urology, St. Antonius - Hospital Gronau, Gronau, Germany
| | - Craig G Rogers
- Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | | | | | | | | | - Markus Graefen
- Martini-Klinik, University-Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rafael Coelho
- University of São Paulo School of Medicine, São Paulo, Brazil
| | - Rair Valero
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Theo M de Reijke
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Travis Rogers
- Adventhealth Global Robotics Institute, Celebration, FL, USA
| | - Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Vipul Patel
- Adventhealth Global Robotics Institute, Celebration, FL, USA
| | | | - Florian Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany
| | | | - Koon H Rha
- Department of Urology, Institute of Urological Science, Yonsei University, Seoul, Korea
| | - Senthil Nathan
- Department of Urology, University College London Hospital, London, UK
| | | | - Peter Hawkey
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK.,Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - John Kelly
- Department of Urology, University College London Hospital, London, UK.,Medical School, University College London, London, UK
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40
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Dinneen E, Grierson J, Haider A, Freeman A, Aning J, Persad R, Oakley N, Ahmad I, Dutto L, Shaw G. A single-blinded, multicenter, randomized controlled trial to evaluate NeuroSAFE robotic-assisted radical prostatectomy (RARP) versus standard robotic-assisted radical prostatectomy (RARP) in men with localized prostate cancer: NeuroSAFE PROOF—Trial in progress. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.tps262] [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] [Indexed: 11/20/2022] Open
Abstract
TPS262 Background: Robot-assisted radical prostatectomy (RARP) offers cure for localised prostate cancer but is associated with considerable toxicity. Potency and urinary continence are improved when the neurovascular bundles (NVBs) are preserved during a nerve-sparing (NS) RARP. The NeuroSAFE (intra-operative frozen section examination of the neurovascular structure adjacent prostate margin) seeks to promote optimal NS to maximise the opportunity for functional recovery without jeopardising oncological safety. The NeuroSAFE technique in RP has never been evaluated against a standard of care in an randomised controlled trial. Methods: This is a pragmatic, multicentre, single-blinded randomised controlled trial (RCT) in which men are allocated in a 1:1 ratio to NeuroSAFE RARP or standard RARP. Men in the NeuroSAFE RARP arm will undergo RARP with NS guided by the NeuroSAFE technique. Men in the standard RARP arm will undergo RARP with NS guided by standard current practice (prostate cancer clinical characteristics, multi-parametric magnetic resonance imaging (mpMRI) recommendations and digital rectal examination (DRE)). Eligible men will have operable localised prostate cancer, will be opting for RARP as primary treatment and will have good baseline erectile function (EF) (as defined by an Internatinoal Index of Erectile Function (IIEF)-5 score >21). The primary outcome is the proportion of men who achieve EF recovery at 12-months according to the IIEF. Oncological safety will be ensured by the independent DMC who will routinely review proportions of men with treatment failure (adjuvant therapy or biochemical recurrence (BCR)) in each arm. A sample size of 404 is estimated required. NeuroSAFE PROOF will continue to follow participant recovery for 5 years following treatment. Key secondary outcomes include patient-reported urinary continence recovery, sexual satisfaction, quality of life, and economic analyses. NeuroSAFE PROOF will be the first RCT of frozen section in radical prostatectomy (RP) in the world. Ethics and dissemination: Ethical approval was obtained from the National Research Ethics Committee North London (17/LO/1978). Results of this study will be disseminated through national and international papers, and to study participants. Clinical trial information: NCT03317990.
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Affiliation(s)
- Eoin Dinneen
- University College London, London, United Kingdom
| | | | | | - Alex Freeman
- University College London Hospital, London, United Kingdom
| | | | | | - Neil Oakley
- Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - Imran Ahmad
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Lorenzo Dutto
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
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41
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Affiliation(s)
- Eoin Dinneen
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London, London, UK
| | - Greg Shaw
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London, London, UK
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42
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Joshi H, Sali G, Paramore L, Jones R, Lazarowicz H, Kujawa ML, Pandit A, David R, Wilson K, Bates C, Shergill I, Gan C, El-Husseiny T, Mukhtar B, Appanna T, Veeratterapillay R, Harding C, Crockett M, Dawson C, Simpson R, Zelhof B, Starmer B, Mukherjee R, Bourdoumis A, Jelski J, Hashim H, McCabe J, Shaw G, Chow K, Betts C. Current process and outcomes of the surgical management of LUTS due to benign prostatic enlargement: how consistent are we? - results from the multi-institutional audit of surgical management of BPE (AuSuM BPE) in the United Kingdom. Scott Med J 2021; 66:58-65. [PMID: 33459189 DOI: 10.1177/0036933020977295] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE In view of changing landscape of surgical treatment for LUTS secondary to BPE, this audit was undertaken to assess key aspects of the processes and outcomes of the current interventional treatments for BPE, across different units in the UK. MATERIALS AND METHOD A multi-institutional snapshot audit was conducted for patients undergoing interventions for LUTS/BPE over 8-week period. Using Delphi process two-part proforma was designed to capture data. RESULTS 529 patients were included across 20 NHS trusts in England and Wales. Median age was 73 years. Indications for surgery were acute retention (47%) and LUTS (45%). 80% of patients had prior medical therapy. TURP formed the commonest procedure. 27% patients had <23 hour hospital stay. Immediate (21%) and delayed (18%) complications were Clavien-Dindo <2 category. High proportion of patients reported residual symptoms. Type and indication of surgery were significant predictor of complications, length of stay and failure of TWOC outcomes, on multivariate analyses. There were variations in departmental processes, 50% centres used PROMs. CONCLUSION Monopolar TURP still remains the commonest intervention for BPE. Most departments are adopting newer technologies. The audit identified opportunities for development of consistent, effective and patient centric practices as well as need for large-scale focused studies.
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Affiliation(s)
- Hrishi Joshi
- Consultant Urological Surgeon and Honorary lecturer, Department of Urology, University Hospital of Wales, UK
| | - Gaurav Sali
- Clinical Fellow in Urology, Department of Urology, University Hospital of Wales, UK
| | - Louise Paramore
- Specialist Registrar in Urology, Department of Urology, University Hospital of Wales, UK
| | - Richard Jones
- Specialist Registrar in Urology, Department of Urology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
| | - Henry Lazarowicz
- Consultant Urological Surgeon, Department of Urology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
| | - Magda Lucia Kujawa
- Consultant Urological Surgeon, Department of Urology, Stepping Hill Hospital, UK
| | - Amol Pandit
- Consultant Urological Surgeon, Department of Urology, Morriston Hospital, UK
| | - Rotimi David
- Clinical Fellow in Urology , Department of Urology, Morriston Hospital, UK
| | - Katherine Wilson
- Specialist Registrar in Urology, Department of Urology, Royal Gwent Hospital, UK
| | - Christopher Bates
- Consultant Urological Surgeon, Department of Urology, Royal Gwent Hospital, UK
| | - I Shergill
- Consultant Urological Surgeon, Department of Urology, Wrexham Maelor Hospital, UK
| | - Christine Gan
- Consultant Urological Surgeon, Department of Urology, Charing Cross Hospital - Imperial College Healthcare NHS Trust, UK
| | - Tamer El-Husseiny
- Consultant Urological Surgeon, Department of Urology, Charing Cross Hospital - Imperial College Healthcare NHS Trust, UK
| | - Bashir Mukhtar
- Specialist Registrar in Urology, Department of Urology, Cwm Taf Morgannwg Health Board Royal Glamorgan Hospital, UK
| | - Timson Appanna
- Consultant Urological Surgeon, Department of Urology, Cwm Taf Morgannwg Health Board Royal Glamorgan Hospital, UK
| | - Rajan Veeratterapillay
- Consultant Urological Surgeon, Department of Urology, Freeman Hospital, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK
| | - Christopher Harding
- Consultant Urological Surgeon, Department of Urology, Freeman Hospital, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK
| | - Matthew Crockett
- Specialist Registrar in Urology, Department of Urology, Gloucestershire Hospitals NHS Foundation Trust, UK
| | - Christopher Dawson
- Consultant Urological Surgeon, Department of Urology, University Hospitals Birmingham NHS Foundation Trust, UK
| | - Richard Simpson
- Specialist Registrar in Urology, Department of Urology, Lancashire Teaching Hospitals NHS Foundation Trust, UK
| | - Bachar Zelhof
- Consultant Urological Surgeon, Department of Urology, Lancashire Teaching Hospitals NHS Foundation Trust, UK
| | - B Starmer
- Consultant Urological Surgeon, Department of Urology, Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust, UK
| | - Rono Mukherjee
- Consultant Urological Surgeon, Department of Urology, Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust, UK
| | - Andreas Bourdoumis
- Consultant Urological Surgeon, Department of Urology, Penine Acute Hospitals NHS Trust, The Royal Oldham Hospital, UK
| | - Joseph Jelski
- Specialist Registrar, Department of Urology, Southmead Hospital, North Bristol NHS Trust, UK
| | - H Hashim
- Specialist Registrar, Department of Urology, Southmead Hospital, North Bristol NHS Trust, UK
| | - John McCabe
- Consultant Urological Surgeon, Department of Urology, St Helens and Knowsley Teaching Hospitals NHS Trust, UK
| | - Greg Shaw
- Consultant Urological Surgeon, Department of Urology, University College London Hospitals NHS Foundation Trust, UK
| | - Karyee Chow
- Consultant Urological Surgeon, Department of Urology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, UK
| | - Christopher Betts
- Consultant Urological Surgeon, Department of Urology, Salford Royal NHS Foundation Trust, UK
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Guo T, Wang Y, Jia J, Mao X, Stankiewicz E, Scandura G, Burke E, Xu L, Marzec J, Davies CR, Lu JJ, Rajan P, Grey A, Tipples K, Hines J, Kudahetti S, Oliver T, Powles T, Alifrangis C, Kohli M, Shaw G, Wang W, Feng N, Shamash J, Berney D, Wang L, Lu YJ. The Identification of Plasma Exosomal miR-423-3p as a Potential Predictive Biomarker for Prostate Cancer Castration-Resistance Development by Plasma Exosomal miRNA Sequencing. Front Cell Dev Biol 2021; 8:602493. [PMID: 33490068 PMCID: PMC7817948 DOI: 10.3389/fcell.2020.602493] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/30/2020] [Indexed: 12/18/2022] Open
Abstract
Castration-resistant prostate cancer (CRPC) is the major cause of death from prostate cancer. Biomarkers to improve early detection and prediction of CRPC especially using non-invasive liquid biopsies could improve outcomes. Therefore, we investigated the plasma exosomal miRNAs associated with CRPC and their potential for development into non-invasive early detection biomarkers for resistance to treatment. RNA-sequencing, which generated approximately five million reads per patient, was performed to identify differentially expressed plasma exosomal miRNAs in 24 treatment-naive prostate cancer and 24 CRPC patients. RT-qPCR was used to confirm the differential expressions of six exosomal miRNAs, miR-423-3p, miR-320a, miR-99a-5p, miR-320d, miR-320b, and miR-150-5p (p = 7.3 × 10-8, 0.0020, 0.018, 0.0028, 0.0013, and 0.0058, respectively) firstly in a validation cohort of 108 treatment-naive prostate cancer and 42 CRPC patients. The most significant differentially expressed miRNA, miR-423-3p, was shown to be associated with CRPC with area under the ROC curve (AUC) = 0.784. Combining miR-423-3p with prostate-specific antigen (PSA) enhanced the prediction of CRPC (AUC = 0.908). A separate research center validation with 30 treatment-naive and 30 CRPC patients also confirmed the differential expression of miR-423-3p (p = 0.016). Finally, plasma exosomal miR-423-3p expression in CRPC patients was compared to 36 non-CRPC patients under androgen depletion therapy, which showed significantly higher expression in CRPC than treated non-CRPC patients (p < 0.0001) with AUC = 0.879 to predict CRPC with no difference between treatment-naive and treated non-CRPC patients. Therefore, our findings demonstrate that a number of plasma exosomal miRNAs are associated with CRPC and miR-423-3p may serve as a biomarker for early detection/prediction of castration-resistance.
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Affiliation(s)
- Tianyu Guo
- Centre for Cancer Biomarker and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom.,Department of Cell Biology, Zhejiang University School of Medicine, The Second Affiliated Hospital, Hangzhou, China
| | - Yang Wang
- Centre for Cancer Biomarker and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom.,Department of Urology, Affiliated Wuxi No. 2 Hospital of Nanjing Medical University, Wuxi, China
| | - Jing Jia
- Department of Tumor Biology, H. Lee Moffitt Cancer Center, Tampa, FL, United States
| | - Xueying Mao
- Centre for Cancer Biomarker and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Elzbieta Stankiewicz
- Centre for Cancer Biomarker and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Glenda Scandura
- Centre for Cancer Biomarker and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Edwina Burke
- Centre for Cancer Biomarker and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Lei Xu
- Centre for Cancer Biomarker and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom.,Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jacek Marzec
- Centre for Cancer Biomarker and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom.,Centre for Cancer Research, University of Melbourne, Melbourne, VIC, Australia
| | - Caitlin R Davies
- Centre for Cancer Biomarker and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Jiaying Jasmin Lu
- Centre for Cancer Biomarker and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Prabhakar Rajan
- Centre for Cancer Biomarker and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom.,Department of Urology, Barts Health NHS, London, United Kingdom.,Division of Surgery and Interventional Sciences, University College London, London, United Kingdom.,Department of Uro-oncology, University College London NHS Foundation Trust, London, United Kingdom
| | - Alistair Grey
- Department of Urology, Barts Health NHS, London, United Kingdom.,Division of Surgery and Interventional Sciences, University College London, London, United Kingdom
| | - Karen Tipples
- Department of Urology, Barts Health NHS, London, United Kingdom
| | - John Hines
- Department of Urology, Barts Health NHS, London, United Kingdom.,Department of Uro-oncology, University College London NHS Foundation Trust, London, United Kingdom
| | - Sakunthala Kudahetti
- Centre for Cancer Biomarker and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Tim Oliver
- Centre for Cancer Biomarker and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Thomas Powles
- Centre for Cancer Biomarker and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Constantine Alifrangis
- Department of Urology, Barts Health NHS, London, United Kingdom.,Department of Uro-oncology, University College London NHS Foundation Trust, London, United Kingdom
| | - Manish Kohli
- Department of Medicine, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, United States.,Department of Oncology, Mayo Clinic, Rochester, MN, United States
| | - Greg Shaw
- Department of Urology, Barts Health NHS, London, United Kingdom.,Division of Surgery and Interventional Sciences, University College London, London, United Kingdom.,Department of Uro-oncology, University College London NHS Foundation Trust, London, United Kingdom
| | - Wen Wang
- Division of Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, London, United Kingdom
| | - Ninghan Feng
- Department of Urology, Affiliated Wuxi No. 2 Hospital of Nanjing Medical University, Wuxi, China
| | - Jonathan Shamash
- Department of Medical Oncology, Barts Health NHS, London, United Kingdom
| | - Daniel Berney
- Centre for Cancer Biomarker and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Liang Wang
- Department of Tumor Biology, H. Lee Moffitt Cancer Center, Tampa, FL, United States
| | - Yong-Jie Lu
- Centre for Cancer Biomarker and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom.,Department of Urology, Affiliated Wuxi No. 2 Hospital of Nanjing Medical University, Wuxi, China
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Sun S, Barnes AJ, Gong X, Lewis RJ, Dummer NF, Bere T, Shaw G, Richards N, Morgan DJ, Hutchings GJ. Lanthanum modified Fe-ZSM-5 zeolites for selective methane oxidation with H 2O 2. Catal Sci Technol 2021. [DOI: 10.1039/d1cy01643a] [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] [Indexed: 12/12/2022]
Abstract
Lanthanum modified Fe-ZSM-5 catalyst can both increase selective methane oxidation performance and decrease H2O2 consumption.
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Affiliation(s)
- Songmei Sun
- Max Planck-Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff, CF10 3AT, UK
- College of Environmental Science and Engineering, Donghua University, Shanghai 201620, P.R. China
- Shanghai Institute of Pollution Control and Ecological Security, Shanghai 200092, P.R. China
| | - Alexandra J. Barnes
- Max Planck-Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff, CF10 3AT, UK
| | - Xiaoxiao Gong
- Max Planck-Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff, CF10 3AT, UK
- Research Institute of Petroleum Processing, SINOPEC, Beijing 100086, P.R. China
| | - Richard J. Lewis
- Max Planck-Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff, CF10 3AT, UK
| | - Nicholas F. Dummer
- Max Planck-Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff, CF10 3AT, UK
| | - Takudzwa Bere
- Max Planck-Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff, CF10 3AT, UK
| | - Greg Shaw
- Max Planck-Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff, CF10 3AT, UK
| | - Nia Richards
- Max Planck-Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff, CF10 3AT, UK
| | - David J. Morgan
- Max Planck-Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff, CF10 3AT, UK
| | - Graham J. Hutchings
- Max Planck-Cardiff Centre on the Fundamentals of Heterogeneous Catalysis FUNCAT, Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff, CF10 3AT, UK
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45
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Dinneen E, Haider A, Shaw G. NeuroSAFE technique-pathological considerations and practical implications for guiding nerve-sparing surgery in prostate cancer patients. Histopathology 2020; 77:536-538. [PMID: 32945017 DOI: 10.1111/his.14183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/11/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Eoin Dinneen
- Division of Surgery & Interventional Science, University College Hospital London, London, UK.,Department of Urology, University College Hospital London, London, UK
| | - Aiman Haider
- Department of Histopathology, University College Hospital London, London, UK
| | - Greg Shaw
- Division of Surgery & Interventional Science, University College Hospital London, London, UK.,Department of Urology, University College Hospital London, London, UK
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46
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Brennan PA, Shaw G, Davies RJ, Oeppen RS. Erratum to 'Personal black box' thinking to improve our communication, behaviour and interaction with others' [Br. J. Oral and Maxillofac. Surg. 58 (2020) 882-884]. Br J Oral Maxillofac Surg 2020; 59:143. [PMID: 33272703 DOI: 10.1016/j.bjoms.2020.11.006] [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: 11/26/2022]
Affiliation(s)
- P A Brennan
- Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK.
| | - G Shaw
- Critical Factors Ltd, 2, Melrose Avenue, Borehamwood, WB6 2BJ, UK
| | - R J Davies
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ UK
| | - R S Oeppen
- University Hospitals Southampton, Tremona Road, Southampton, SO16 6YD UK
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Richardson R, Donlon JP, Jayathirtha M, Forman JL, Shaw G, Gepner B, Kerrigan JR, Östling M, Mroz K, Pipkorn B. Kinematic and Injury Response of Reclined PMHS in Frontal Impacts. Stapp Car Crash J 2020; 64:83-153. [PMID: 33636004 DOI: 10.4271/2020-22-0004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Frontal impacts with reclined occupants are rare but severe, and they are anticipated to become more common with the introduction of vehicles with automated driving capabilities. Computational and physical human surrogates are needed to design and evaluate injury countermeasures for reclined occupants, but the validity of such surrogates in a reclined posture is unknown. Experiments with post-mortem human subjects (PMHS) in a recline posture are needed both to define biofidelity targets for other surrogates and to describe the biomechanical response of reclined occupants in restrained frontal impacts. The goal of this study was to evaluate the kinematic and injury response of reclined PMHS in 30 g, 50 km/h frontal sled tests. Five midsize adult male PMHS were tested. A simplified semi-rigid seat with an anti-submarining pan and a non-production threepoint seatbelt (pre-tensioned, force-limited, seat-integrated) were used. Global motions and local accelerations of the head, pelvis, and multiple vertebrae were measured. Seat and seatbelt forces were also measured. Injuries were assessed via post-test dissection. The initial reclined posture aligned body regions (pelvis, lumbar spine, and ribcage) in a way that reduced the likelihood of effective restraint by the seat and seatbelt: the occupant's pelvis was initially rotated posteriorly, priming the occupant for submarining, and the lumbar spine was loaded in combined compression and bending due to the inertia of the upper torso during forward excursion. Coupled with the high restraining forces of the seat and seatbelt, the unfavorable kinematics resulted in injuries of the sacrum/coccyx (four of five PMHS injured), iliac wing (two of five PMHS injured), lumbar spine (three of five PMHS injured), and ribcage (all five PMHS suffered sternal fractures, and three of five PMHS suffered seven or more rib fractures). The kinematic and injury outcomes strongly motivate the development of injury criteria for the lumbar spine and pelvis, the inclusion of intrinsic variability (e.g., abdomen depth and pelvis shape) in computational simulations of frontal impacts with reclined occupants, and the adaptation of comprehensive restraint paradigms to predicted variability of occupant posture.
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Affiliation(s)
| | | | | | | | - Greg Shaw
- University of Virginia Center for Applied Biomechanics
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Izquierdo M, Young SD, Bailey EH, Crout NMJ, Lofts S, Chenery SR, Shaw G. Kinetics of uranium(VI) lability and solubility in aerobic soils. Chemosphere 2020; 258:127246. [PMID: 32535442 DOI: 10.1016/j.chemosphere.2020.127246] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
Uranium may pose a hazard to ecosystems and human health due to its chemotoxic and radiotoxic properties. The long half-life of many U isotopes and their ability to migrate raise concerns over disposal of radioactive wastes. This work examines the long-term U bioavailability in aerobic soils following direct deposition or transport to the surface and addresses two questions: (i) to what extent do soil properties control the kinetics of U speciation changes in soils and (ii) over what experimental timescales must U reaction kinetics be measured to reliably predict long-term of impact in the terrestrial environment? Soil microcosms spiked with soluble uranyl were incubated for 1.7 years. Changes in UVI fractionation were periodically monitored by soil extractions and isotopic dilution techniques, shedding light on the binding strength of uranyl onto the solid phase. Uranyl sorption was rapid and strongly buffered by soil Fe oxides, but UVI remained reversibly held and geochemically reactive. The pool of uranyl species able to replenish the soil solution through several equilibrium reactions is substantially larger than might be anticipated from typical chemical extractions and remarkably similar across different soils despite contrasting soil properties. Modelled kinetic parameters indicate that labile UVI declines very slowly, suggesting that the processes and transformations transferring uranyl to an intractable sink progress at a slow rate regardless of soil characteristics. This is of relevance in the context of radioecological assessments, given that soil solution is the key reservoir for plant uptake.
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Affiliation(s)
- M Izquierdo
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, United Kingdom; Institute of Environmental Assessment and Water Research, 18-26 Jordi Girona, Barcelona, 08034, Spain.
| | - S D Young
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, United Kingdom
| | - E H Bailey
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, United Kingdom
| | - N M J Crout
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, United Kingdom
| | - S Lofts
- UK Centre for Ecology and Hydrology, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP, United Kingdom
| | - S R Chenery
- British Geological Survey, Environmental Science Centre, Keyworth, Nottingham, NG12 5GG, United Kingdom
| | - G Shaw
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, United Kingdom
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Nathan A, Hanna N, Rashid A, Patel S, Phuah Y, Flora K, Cleaveland P, Kasivisvanathan V, Miah S, Collins J, Sridhar A, Kelkar A, Hines J, Kelly J, Shah N, Briggs T, Shaw G, Sooriakumaran P, Rajan P, Lamb B, Nathan S. Novel guidelines to avoid routine blood tests after Robot Assisted Radical Prostatectomy (RARP). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35850-x] [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: 10/23/2022] Open
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Hardie J, Oeppen R, Shaw G, Holden C, Tayler N, Brennan P. You Have Control: aviation communication application for safety-critical times in surgery. Br J Oral Maxillofac Surg 2020; 58:1073-1077. [PMID: 32933788 PMCID: PMC7449978 DOI: 10.1016/j.bjoms.2020.08.104] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/20/2020] [Indexed: 12/26/2022]
Abstract
High-risk organisations (HRO), including aviation, undergo formal communication training, with emphasis on safety-critical moments. Such training is not widespread or mandatory in healthcare, and while there are many differences both share the 'human element' with circumstances leading to an increased risk of harm. A typical operating theatre consists of an operating surgeon, and an assisting surgeon, roles that may change throughout the course of a procedure. Similarly, a training aircraft or multi-crew cockpit (flight deck) has a pilot in control, or 'pilot flying', and a 'pilot not flying'. Both interact with wider teams, for example the scrub team and air traffic controllers, respectively. Surgical error is the second most prevalent cause of preventable harm to patients after drug errors. Every year in the UK National Health Service (NHS), there are typically 500 never events, 21,000 serious incidents, and many more episodes of physical or psychological harm. Ineffective communication (46%) is the most common behavioural factor leading to a never event. In this review, we examine the concept of 'sterile cockpit', use of unambiguous terminology, callsigns, important information readback, sharing of mental models, and the mini-brief, and how these may be used to reduce patient harm during safety-critical moments.
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Affiliation(s)
- J.A. Hardie
- Trauma & Orthopaedic Department, Frimley Park Hospital, Camberley, GU16 7UJ, UK,Corresponding author
| | - R.S. Oeppen
- Department of Clinical Radiology, University Hospitals Southampton, SO16 6YD, UK
| | - G. Shaw
- Captain B777/787, C/o Critical Factors, 2 Melrose Avenue, Borehamwood, WD6 2BJ, UK
| | - C. Holden
- Captain B777/787, C/o Critical Factors, 2 Melrose Avenue, Borehamwood, WD6 2BJ, UK
| | - N. Tayler
- Captain B777/787, C/o Critical Factors, 2 Melrose Avenue, Borehamwood, WD6 2BJ, UK
| | - P.A. Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK
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