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Toren P, Wilkins A, Patel K, Burley A, Gris T, Kockelbergh R, Lodhi T, Choudhury A, Bryan RT. The sex gap in bladder cancer survival - a missing link in bladder cancer care? Nat Rev Urol 2024; 21:181-192. [PMID: 37604983 DOI: 10.1038/s41585-023-00806-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/23/2023]
Abstract
The differences in bladder cancer outcomes between the sexes has again been highlighted. Uncommon among cancers, bladder cancer outcomes are notably worse for women than for men. Furthermore, bladder cancer is three to four times more common among men than among women. Factors that might explain these sex differences include understanding the importance of haematuria as a symptom of bladder cancer by both clinicians and patients, the resultant delays in diagnosis and referral of women with haematuria, and health-care access. Notably, these factors seem to have geographical variation and are not consistent across all health-care systems. Likewise, data relating to sex-specific treatment responses for patients with non-muscle-invasive or muscle-invasive bladder cancer are inconsistent. The influence of differences in the microbiome, bladder wall thickness and urine dwell times remain to be elucidated. The interplay of hormone signalling, gene expression, immunology and the tumour microenvironment remains complex but probably underpins the sexual dimorphism in disease incidence and stage and histology at presentation. The contribution of these biological phenomena to sex-specific outcome differences is probable, albeit potentially treatment-specific, and further understanding is required. Notwithstanding these aspects, we identify opportunities to harness biological differences to improve treatment outcomes, as well as areas of fundamental and translational research to pursue. At the level of policy and health-care delivery, improvements can be made across the domains of patient awareness, clinician education, referral pathways and guideline-based care. Together, we aim to highlight opportunities to close the sex gap in bladder cancer outcomes.
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Affiliation(s)
- Paul Toren
- CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Anna Wilkins
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- The Royal Marsden Hospitals NHS Trust, London, UK
| | - Keval Patel
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Amy Burley
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Typhaine Gris
- CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Roger Kockelbergh
- University Hospitals of Leicester NHS Trust, Leicester, UK
- Action Bladder Cancer UK, Tetbury, UK
| | - Taha Lodhi
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Ananya Choudhury
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Richard T Bryan
- Action Bladder Cancer UK, Tetbury, UK.
- Bladder Cancer Research Centre, Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK.
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Gilbert DC, Nankivell M, Rush H, Clarke NW, Mangar S, Al-Hasso A, Rosen S, Kockelbergh R, Sundaram SK, Dixit S, Laniado M, McPhail N, Shaheen A, Brown S, Gale J, Deighan J, Marshall J, Duong T, Macnair A, Griffiths A, Amos CL, Sydes MR, James ND, Parmar MKB, Langley RE. A Repurposing Programme Evaluating Transdermal Oestradiol Patches for the Treatment of Prostate Cancer Within the PATCH and STAMPEDE Trials: Current Results and Adapting Trial Design. Clin Oncol (R Coll Radiol) 2024; 36:e11-e19. [PMID: 37973477 DOI: 10.1016/j.clon.2023.10.054] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
AIMS Androgen deprivation therapy (ADT), usually achieved with luteinising hormone releasing hormone analogues (LHRHa), is central to prostate cancer management. LHRHa reduce both testosterone and oestrogen and are associated with significant long-term toxicity. Previous use of oral oestrogens as ADT was curtailed because of cardiovascular toxicity. Transdermal oestrogen (tE2) patches are a potential alternative ADT, supressing testosterone without the associated oestrogen-depletion toxicities (osteoporosis, hot flushes, metabolic abnormalities) and avoiding cardiovascular toxicity, and we here describe their evaluation in men with prostate cancer. MATERIALS AND METHODS The PATCH (NCT00303784) adaptive trials programme (incorporating recruitment through the STAMPEDE [NCT00268476] platform) is evaluating the safety and efficacy of tE2 patches as ADT for men with prostate cancer. An initial randomised (LHRHa versus tE2) phase II study (n = 251) with cardiovascular toxicity as the primary outcome measure has expanded into a phase III evaluation. Those with locally advanced (M0) or metastatic (M1) prostate cancer are eligible. To reflect changes in both management and prognosis, the PATCH programme is now evaluating these cohorts separately. RESULTS Recruitment is complete, with 1362 and 1128 in the M0 and M1 cohorts, respectively. Rates of androgen suppression with tE2 were equivalent to LHRHa, with improved metabolic parameters, quality of life and bone health indices (mean absolute change in lumbar spine bone mineral density of -3.0% for LHRHa and +7.9% for tE2 with an estimated difference between arms of 9.3% (95% confidence interval 5.3-13.4). Importantly, rates of cardiovascular events were not significantly different between the two arms and the time to first cardiovascular event did not differ between treatment groups (hazard ratio 1.11, 95% confidence interval 0.80-1.53; P = 0.54). Oncological outcomes are awaited. FUTURE Efficacy results for the M0 cohort (primary outcome measure metastases-free survival) are expected in the final quarter of 2023. For M1 patients (primary outcome measure - overall survival), analysis using restricted mean survival time is being explored. Allied translational work on longitudinal samples is underway.
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Affiliation(s)
- D C Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK; University Hospitals Sussex NHS Foundation Trust, Royal Sussex County Hospital, Brighton, UK.
| | - M Nankivell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - H Rush
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - N W Clarke
- The Christie and Salford Royal Hospitals, Manchester, UK
| | - S Mangar
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - A Al-Hasso
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - S Rosen
- National Heart and Lung Institute, Imperial College, London, UK
| | - R Kockelbergh
- Department of Urology, University Hospitals of Leicester, Leicester, UK
| | - S K Sundaram
- Mid-Yorkshire Teaching NHS Trust, Pinderfields Hospital, Wakefield, UK
| | - S Dixit
- Scunthorpe General Hospital, Scunthorpe, UK
| | | | | | | | - S Brown
- Airedale General Hospital, Keighley, UK
| | - J Gale
- Queen Alexandra Hospital, Portsmouth, UK
| | - J Deighan
- Patient Representative, MRC Clinical Trials Unit at UCL, London, UK
| | - J Marshall
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - T Duong
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - A Macnair
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK; Guys and St Thomas' NHS Foundation Trust, London, UK
| | - A Griffiths
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - C L Amos
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - N D James
- Institute of Cancer Research, Sutton, UK
| | - M K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - R E Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
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Hamdy FC, Donovan JL, Lane JA, Metcalfe C, Davis M, Turner EL, Martin RM, Young GJ, Walsh EI, Bryant RJ, Bollina P, Doble A, Doherty A, Gillatt D, Gnanapragasam V, Hughes O, Kockelbergh R, Kynaston H, Paul A, Paez E, Powell P, Rosario DJ, Rowe E, Mason M, Catto JWF, Peters TJ, Oxley J, Williams NJ, Staffurth J, Neal DE. Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. N Engl J Med 2023; 388:1547-1558. [PMID: 36912538 DOI: 10.1056/nejmoa2214122] [Citation(s) in RCA: 139] [Impact Index Per Article: 139.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND Between 1999 and 2009 in the United Kingdom, 82,429 men between 50 and 69 years of age received a prostate-specific antigen (PSA) test. Localized prostate cancer was diagnosed in 2664 men. Of these men, 1643 were enrolled in a trial to evaluate the effectiveness of treatments, with 545 randomly assigned to receive active monitoring, 553 to undergo prostatectomy, and 545 to undergo radiotherapy. METHODS At a median follow-up of 15 years (range, 11 to 21), we compared the results in this population with respect to death from prostate cancer (the primary outcome) and death from any cause, metastases, disease progression, and initiation of long-term androgen-deprivation therapy (secondary outcomes). RESULTS Follow-up was complete for 1610 patients (98%). A risk-stratification analysis showed that more than one third of the men had intermediate or high-risk disease at diagnosis. Death from prostate cancer occurred in 45 men (2.7%): 17 (3.1%) in the active-monitoring group, 12 (2.2%) in the prostatectomy group, and 16 (2.9%) in the radiotherapy group (P = 0.53 for the overall comparison). Death from any cause occurred in 356 men (21.7%), with similar numbers in all three groups. Metastases developed in 51 men (9.4%) in the active-monitoring group, in 26 (4.7%) in the prostatectomy group, and in 27 (5.0%) in the radiotherapy group. Long-term androgen-deprivation therapy was initiated in 69 men (12.7%), 40 (7.2%), and 42 (7.7%), respectively; clinical progression occurred in 141 men (25.9%), 58 (10.5%), and 60 (11.0%), respectively. In the active-monitoring group, 133 men (24.4%) were alive without any prostate cancer treatment at the end of follow-up. No differential effects on cancer-specific mortality were noted in relation to the baseline PSA level, tumor stage or grade, or risk-stratification score. No treatment complications were reported after the 10-year analysis. CONCLUSIONS After 15 years of follow-up, prostate cancer-specific mortality was low regardless of the treatment assigned. Thus, the choice of therapy involves weighing trade-offs between benefits and harms associated with treatments for localized prostate cancer. (Funded by the National Institute for Health and Care Research; ProtecT Current Controlled Trials number, ISRCTN20141297; ClinicalTrials.gov number, NCT02044172.).
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Affiliation(s)
- Freddie C Hamdy
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - Jenny L Donovan
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - J Athene Lane
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - Chris Metcalfe
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - Michael Davis
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - Emma L Turner
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - Richard M Martin
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - Grace J Young
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - Eleanor I Walsh
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - Richard J Bryant
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - Prasad Bollina
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - Andrew Doble
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - Alan Doherty
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - David Gillatt
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - Vincent Gnanapragasam
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - Owen Hughes
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - Roger Kockelbergh
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - Howard Kynaston
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - Alan Paul
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - Edgar Paez
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - Philip Powell
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - Derek J Rosario
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - Edward Rowe
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - Malcolm Mason
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - James W F Catto
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - Tim J Peters
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - Jon Oxley
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - Naomi J Williams
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - John Staffurth
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
| | - David E Neal
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., R.J.B., D.E.N.), Population Health Sciences (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., G.J.Y., E.I.W., T.J.P., N.J.W.) and Bristol Trials Centre (J.A.L., C.M., G.J.Y.), Bristol Medical School, University of Bristol, the Department of Urology, Southmead Hospital and Bristol Urological Institute (E.R.), and the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), Bristol, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Department of Urology (A. Doble) and the Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus (V.G., D.E.N.), Addenbrooke's Hospital, Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, Cardiff and Vale University Health Board (O.H., H.K.), and the School of Medicine (M.M.) and the Division of Cancer and Genetics (J.S.), Cardiff University, Cardiff, the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P.), the Department of Urology, Freeman Hospital, Newcastle-upon-Tyne (E.P., P.P.), and the Department of Urology, Royal Hallamshire Hospital (D.J.R., J.W.F.C.), and the Academic Urology Unit, Medical School, University of Sheffield (J.W.F.C.), Sheffield - all in the United Kingdom; and the Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney (D.G.)
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4
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Donovan JL, Hamdy FC, Lane JA, Young GJ, Metcalfe C, Walsh EI, Davis M, Steuart-Feilding T, Blazeby JM, Avery KNL, Martin RM, Bollina P, Doble A, Doherty A, Gillatt D, Gnanapragasam V, Hughes O, Kockelbergh R, Kynaston H, Paul A, Paez E, Powell P, Rosario DJ, Rowe E, Mason M, Catto JWF, Peters TJ, Wade J, Turner EL, Williams NJ, Oxley J, Staffurth J, Bryant RJ, Neal DE. Patient-Reported Outcomes 12 Years after Localized Prostate Cancer Treatment. NEJM Evid 2023; 2:EVIDoa2300018. [PMID: 38320051 DOI: 10.1056/evidoa2300018] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Outcomes after Localized Prostate Cancer TreatmentDonovan et al. present the long-term patient-reported outcomes of 1643 randomly assigned participants in the ProtecT (Prostate Testing for Cancer and Treatment) trial. Functional and quality-of-life impacts of prostatectomy, radiotherapy with neoadjuvant androgen deprivation, and active monitoring are described. Over the trial period from 7 to 12 years, generic quality-of-life scores were similar among all groups, with varying degrees of impact on urinary leakage, sexual function, and fecal leakage depending on the treatment group.
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Affiliation(s)
- Jenny L Donovan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - J Athene Lane
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Bristol Trials Centre, Bristol Medical School, University of Bristol, United Kingdom
| | - Grace J Young
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Bristol Trials Centre, Bristol Medical School, University of Bristol, United Kingdom
| | - Chris Metcalfe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Bristol Trials Centre, Bristol Medical School, University of Bristol, United Kingdom
| | - Eleanor I Walsh
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Michael Davis
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Thomas Steuart-Feilding
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jane M Blazeby
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Kerry N L Avery
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Richard M Martin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Prasad Bollina
- Department of Urology and Surgery, Western General Hospital, University of Edinburgh, United Kingdom
| | - Andrew Doble
- Department of Urology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Alan Doherty
- Department of Urology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - David Gillatt
- Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney
| | - Vincent Gnanapragasam
- Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge, United Kingdom
| | - Owen Hughes
- Department of Urology, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Roger Kockelbergh
- Department of Urology, University Hospitals of Leicester, Leicester, United Kingdom
| | - Howard Kynaston
- Department of Urology, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Alan Paul
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Edgar Paez
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Phillip Powell
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Derek J Rosario
- Academic Urology Unit, University of Sheffield, Sheffield, United Kingdom
| | - Edward Rowe
- Department of Urology, Southmead Hospital and Bristol Urological Institute, Bristol, United Kingdom
| | - Malcolm Mason
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, United Kingdom
- Academic Urology Unit, Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Tim J Peters
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Julia Wade
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Emma L Turner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Naomi J Williams
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jon Oxley
- Department of Cellular Pathology, North Bristol NHS Trust, Bristol, United Kingdom
| | - John Staffurth
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Richard J Bryant
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - David E Neal
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
- Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge, United Kingdom
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5
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Macnair A, Nankivell M, Murray ML, Rosen SD, Appleyard S, Sydes MR, Forcat S, Welland A, Clarke NW, Mangar S, Kynaston H, Kockelbergh R, Al-Hasso A, Deighan J, Marshall J, Parmar M, Langley RE, Gilbert DC. Healthcare systems data in the context of clinical trials - A comparison of cardiovascular data from a clinical trial dataset with routinely collected data. Contemp Clin Trials 2023; 128:107162. [PMID: 36933612 DOI: 10.1016/j.cct.2023.107162] [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: 11/18/2022] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Routinely-collected healthcare systems data (HSD) are proposed to improve the efficiency of clinical trials. A comparison was undertaken between cardiovascular (CVS) data from a clinical trial database with two HSD resources. METHODS Protocol-defined and clinically reviewed CVS events (heart failure (HF), acute coronary syndrome (ACS), thromboembolic stroke, venous and arterial thromboembolism) were identified within the trial data. Data (using pre-specified codes) was obtained from NHS Hospital Episode Statistics (HES) and National Institute for Cardiovascular Outcomes Research (NICOR) HF and myocardial ischaemia audits for trial participants recruited in England between 2010 and 2018 who had provided consent. The primary comparison was trial data versus HES inpatient (APC) main diagnosis (Box-1). Correlations are presented with descriptive statistics and Venn diagrams. Reasons for non-correlation were explored. RESULTS From 1200 eligible participants, 71 protocol-defined clinically reviewed CVS events were recorded in the trial database. 45 resulted in a hospital admission and therefore could have been recorded by either HES APC/ NICOR. Of these, 27/45 (60%) were recorded by HES inpatient (Box-1) with an additional 30 potential events also identified. HF and ACS were potentially recorded in all 3 datasets; trial data recorded 18, HES APC 29 and NICOR 24 events respectively. 12/18 (67%) of the HF/ACS events in the trial dataset were recorded by NICOR. CONCLUSION Concordance between datasets was lower than anticipated and the HSD used could not straightforwardly replace current trial practices, nor directly identify protocol-defined CVS events. Further work is required to improve the quality of HSD and consider event definitions when designing clinical trials incorporating HSD.
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Affiliation(s)
- Archie Macnair
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London WC1V 6LJ, UK; Health Data Research, UK; Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Matthew Nankivell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London WC1V 6LJ, UK
| | - Macey L Murray
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London WC1V 6LJ, UK; Health Data Research, UK; NHS DigiTrials, NHS Digital, 7 and 8 Wellington Place, Leeds, West Yorkshire LS1 4AP, UK
| | - Stuart D Rosen
- National Heart and Lung Institute, Imperial College, London, UK
| | - Sally Appleyard
- University Hospitals Sussex NHS Foundation Trust, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London WC1V 6LJ, UK; Health Data Research, UK; BHF Data Science Centre, Health Data Research UK (Central Office), Gibbs Building, 215 Euston Road, London NW1 2BE, UK
| | - Sylvia Forcat
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London WC1V 6LJ, UK
| | - Andrew Welland
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London WC1V 6LJ, UK
| | - Noel W Clarke
- The Christie and Salford Royal Hospitals, Manchester, UK
| | - Stephen Mangar
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Howard Kynaston
- Division of Cancer and Genetics, Cardiff University Medical School, Cardiff, UK
| | - Roger Kockelbergh
- Department of Urology, University Hospitals of Leicester, Leicester, UK
| | | | - John Deighan
- Patient representative, MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London WC1V 6LJ, UK
| | - John Marshall
- Patient representative, MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London WC1V 6LJ, UK
| | - Mahesh Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London WC1V 6LJ, UK
| | - Ruth E Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London WC1V 6LJ, UK
| | - Duncan C Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London WC1V 6LJ, UK; University Hospitals Sussex NHS Foundation Trust, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK.
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6
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Russell B, Spencer‐Bowdage S, Rigby J, O'Kelly J, Kelly P, Page M, Raw C, Allchorne P, Harper P, Crew J, Kockelbergh R, Knight A, Van Hemelrijck M, Bryan RT. The experience of UK patients with bladder cancer during the second wave of the COVID‐19 pandemic. BJUI Compass 2022; 3:324-326. [PMID: 35945948 PMCID: PMC9348423 DOI: 10.1002/bco2.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/22/2022] [Accepted: 03/29/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Beth Russell
- Translational Oncology and Urology Research King's College London London UK
| | | | | | | | | | | | | | - Paula Allchorne
- Action Bladder Cancer UK Tetbury UK
- Barts Health NHS Trust London UK
| | - Peter Harper
- Action Bladder Cancer UK Tetbury UK
- Leaders in Oncology Care London UK
| | - Jeremy Crew
- Action Bladder Cancer UK Tetbury UK
- Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - Roger Kockelbergh
- Action Bladder Cancer UK Tetbury UK
- University Hospitals of Leicester NHS Trust Leicester UK
- Leicester Cancer Research Centre University of Leicester Leicester UK
| | - Allen Knight
- Action Bladder Cancer UK Tetbury UK
- World Bladder Cancer Patient Coalition Brussels Belgium
| | | | - Richard T. Bryan
- Action Bladder Cancer UK Tetbury UK
- Bladder Cancer Research Centre, Institute of Cancer and Genomic Sciences University of Birmingham Birmingham UK
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7
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Langley RE, Gilbert DC, Duong T, Clarke NW, Nankivell M, Rosen SD, Mangar S, Macnair A, Sundaram SK, Laniado ME, Dixit S, Madaan S, Manetta C, Pope A, Scrase CD, Mckay S, Muazzam IA, Collins GN, Worlding J, Williams ST, Paez E, Robinson A, McFarlane J, Deighan JV, Marshall J, Forcat S, Weiss M, Kockelbergh R, Alhasso A, Kynaston H, Parmar M. Transdermal oestradiol for androgen suppression in prostate cancer: long-term cardiovascular outcomes from the randomised Prostate Adenocarcinoma Transcutaneous Hormone (PATCH) trial programme. Lancet 2021; 397:581-591. [PMID: 33581820 DOI: 10.1016/s0140-6736(21)00100-8] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Androgen suppression is a central component of prostate cancer management but causes substantial long-term toxicity. Transdermal administration of oestradiol (tE2) circumvents first-pass hepatic metabolism and, therefore, should avoid the cardiovascular toxicity seen with oral oestrogen and the oestrogen-depletion effects seen with luteinising hormone releasing hormone agonists (LHRHa). We present long-term cardiovascular follow-up data from the Prostate Adenocarcinoma Transcutaneous Hormone (PATCH) trial programme. METHODS PATCH is a seamless phase 2/3, randomised, multicentre trial programme at 52 study sites in the UK. Men with locally advanced or metastatic prostate cancer were randomly allocated (1:2 from August, 2007 then 1:1 from February, 2011) to either LHRHa according to local practice or tE2 patches (four 100 μg patches per 24 h, changed twice weekly, reducing to three patches twice weekly if castrate at 4 weeks [defined as testosterone ≤1·7 nmol/L]). Randomisation was done using a computer-based minimisation algorithm and was stratified by several factors, including disease stage, age, smoking status, and family history of cardiac disease. The primary outcome of this analysis was cardiovascular morbidity and mortality. Cardiovascular events, including heart failure, acute coronary syndrome, thromboembolic stroke, and other thromboembolic events, were confirmed using predefined criteria and source data. Sudden or unexpected deaths were attributed to a cardiovascular category if a confirmatory post-mortem report was available and as other relevant events if no post-mortem report was available. PATCH is registered with the ISRCTN registry, ISRCTN70406718; the study is ongoing and adaptive. FINDINGS Between Aug 14, 2007, and July 30, 2019, 1694 men were randomly allocated either LHRHa (n=790) or tE2 patches (n=904). Overall, median follow-up was 3·9 (IQR 2·4-7·0) years. Respective castration rates at 1 month and 3 months were 65% and 93% among patients assigned LHRHa and 83% and 93% among those allocated tE2. 157 events from 145 men met predefined cardiovascular criteria, with a further ten sudden deaths with no post-mortem report (total 167 events in 153 men). 26 (2%) of 1694 patients had fatal cardiovascular events, 15 (2%) of 790 assigned LHRHa and 11 (1%) of 904 allocated tE2. The time to first cardiovascular event did not differ between treatments (hazard ratio 1·11, 95% CI 0·80-1·53; p=0·54 [including sudden deaths without post-mortem report]; 1·20, 0·86-1·68; p=0·29 [confirmed group only]). 30 (34%) of 89 cardiovascular events in patients assigned tE2 occurred more than 3 months after tE2 was stopped or changed to LHRHa. The most frequent adverse events were gynaecomastia (all grades), with 279 (38%) events in 730 patients who received LHRHa versus 690 (86%) in 807 patients who received tE2 (p<0·0001) and hot flushes (all grades) in 628 (86%) of those who received LHRHa versus 280 (35%) who received tE2 (p<0·0001). INTERPRETATION Long-term data comparing tE2 patches with LHRHa show no evidence of a difference between treatments in cardiovascular mortality or morbidity. Oestrogens administered transdermally should be reconsidered for androgen suppression in the management of prostate cancer. FUNDING Cancer Research UK, and Medical Research Council Clinical Trials Unit at University College London.
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Affiliation(s)
- Ruth E Langley
- Medical Research Council (MRC) Clinical Trials Units at University College London (UCL), London, UK.
| | - Duncan C Gilbert
- Medical Research Council (MRC) Clinical Trials Units at University College London (UCL), London, UK
| | - Trinh Duong
- Medical Research Council (MRC) Clinical Trials Units at University College London (UCL), London, UK
| | - Noel W Clarke
- The Christie and Salford Royal Hospitals, Manchester, UK
| | - Matthew Nankivell
- Medical Research Council (MRC) Clinical Trials Units at University College London (UCL), London, UK
| | - Stuart D Rosen
- National Heart and Lung Institute, Imperial College, London, UK
| | - Stephen Mangar
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Archie Macnair
- Medical Research Council (MRC) Clinical Trials Units at University College London (UCL), London, UK
| | | | - Marc E Laniado
- Wexham Park Hospital, Frimley Health Foundation Trust, Slough, UK
| | | | - Sanjeev Madaan
- Department of Urology & Nephrology, Dartford and Gravesham NHS Trust, Dartford, UK
| | - Caroline Manetta
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Alvan Pope
- The Hillingdon Hospitals NHS Foundation Trust and Imperial College Healthcare NHS Trust, London, UK
| | | | - Stephen Mckay
- Forth Valley Royal Hospital, Larbert, UK; Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Iqtedar A Muazzam
- Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | - Gerald N Collins
- Macclesfield District General Hospital, East Cheshire NHS Trust, Macclesfield, UK
| | | | | | - Edgar Paez
- Newcastle Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | | | | | - John V Deighan
- Medical Research Council (MRC) Clinical Trials Units at University College London (UCL), London, UK
| | - John Marshall
- Medical Research Council (MRC) Clinical Trials Units at University College London (UCL), London, UK
| | - Silvia Forcat
- Medical Research Council (MRC) Clinical Trials Units at University College London (UCL), London, UK
| | - Melanie Weiss
- Medical Research Council (MRC) Clinical Trials Units at University College London (UCL), London, UK
| | - Roger Kockelbergh
- Department of Urology, University Hospitals of Leicester, Leicester, UK
| | | | - Howard Kynaston
- Division of Cancer and Genetics, Cardiff University Medical School, Cardiff, UK
| | - Mahesh Parmar
- Medical Research Council (MRC) Clinical Trials Units at University College London (UCL), London, UK
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8
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Spencer‐Bowdage S, Russell B, Rigby J, O’Kelly J, Kelly P, Page M, Raw C, Allchorne P, Harper P, Crew J, Kockelbergh R, Knight A, Van Hemelrijck M, Bryan RT. The experience of UK patients with bladder cancer during the COVID-19 pandemic: a survey-based snapshot. BJU Int 2021; 127:179-181. [PMID: 33124729 PMCID: PMC7894556 DOI: 10.1111/bju.15287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Beth Russell
- Translational Oncology and Urology ResearchKing’s College LondonLondonUK
| | | | | | | | | | | | - Paula Allchorne
- Action Bladder Cancer UKTetburyUK
- Barts Health NHS TrustLondonUK
| | - Peter Harper
- Action Bladder Cancer UKTetburyUK
- Leaders in Oncology CareLondonUK
| | - Jeremy Crew
- Action Bladder Cancer UKTetburyUK
- Oxford University Hospitals NHS Foundation TrustOxfordUK
| | - Roger Kockelbergh
- Action Bladder Cancer UKTetburyUK
- University Hospitals of Leicester NHS TrustLeicesterUK
- Leicester Cancer Research CentreUniversity of LeicesterLeicesterUK
| | - Allen Knight
- Action Bladder Cancer UKTetburyUK
- World Bladder Cancer Patient CoalitionBrusselsBelgium
| | | | - Richard T. Bryan
- Action Bladder Cancer UKTetburyUK
- Bladder Cancer Research CentreInstitute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
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Wade J, Donovan J, Lane A, Davis M, Walsh E, Neal D, Turner E, Martin R, Metcalfe C, Peters T, Hamdy F, Kockelbergh R, Catto J, Paul A, Holding P, Rosario D, Kynaston H, Rowe E, Hughes O, Bollina P, Gillatt D, Doherty A, Gnanapragasam VJ, Paez E. Strategies adopted by men to deal with uncertainty and anxiety when following an active surveillance/monitoring protocol for localised prostate cancer and implications for care: a longitudinal qualitative study embedded within the ProtecT trial. BMJ Open 2020; 10:e036024. [PMID: 32907896 PMCID: PMC7482454 DOI: 10.1136/bmjopen-2019-036024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Received: 11/27/2019] [Revised: 04/20/2020] [Accepted: 07/14/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Active surveillance (AS) enables men with low risk, localised prostate cancer (PCa) to avoid radical treatment unless progression occurs; lack of reliable AS protocols to determine progression leaves uncertainties for men and clinicians. This study investigated men's strategies for coping with the uncertainties of active monitoring (AM, a surveillance strategy within the Prostate testing for cancer and Treatment, ProtecT trial) over the longer term and implications for optimising supportive care. DESIGN Longitudinal serial in-depth qualitative interviews every 2-3 years for a median 7 (range 6-14) years following diagnosis. SETTING Four centres within the UK Protect trial. PARTICIPANTS Purposive sample of 20 men with localised PCa: median age at diagnosis 64 years (range 52-68); 15 (75%) had low-risk PCa; 12 randomly allocated to, 8 choosing AM. Eleven men continued with AM throughout the study period (median 7 years). Nine received radical treatment after a median 4 years (range 0.8-13.8 years). INTERVENTION AM: 3-monthly serum prostate-specific antigen (PSA)-level assessment (year 1), 6-12 monthly thereafter; increase in PSA ≥50% during previous 12 months or patient/clinician concern triggered review. MAIN OUTCOMES Thematic analysis of 73 interviews identified strategies to accommodate uncertainty and anxiety of living with untreated cancer; implications for patient care. RESULTS Men sought clarity, control or reassurance, with contextual factors mediating individual responses. Trust in the clinical team was critical for men in balancing anxiety and facilitating successful management change/continued monitoring. Only men from ProtecT were included; men outside ProtecT may have different experiences. CONCLUSION Men looked to clinicians for clarity, control and reassurance. Where provided, men felt comfortable continuing AM or having radical treatments when indicated. Clinicians build patient trust by clearly describing uncertainties, allowing patients control wherever possible and being aware of how context influences individual responses. Insights indicate need for supportive services to build trust and patient engagement over the long term. TRIAL REGISTRATION NUMBER ISRCTN20141297; Pre-results.
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Affiliation(s)
- Julia Wade
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jenny Donovan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Athene Lane
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Davis
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Eleanor Walsh
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - David Neal
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Emma Turner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Richard Martin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Chris Metcalfe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tim Peters
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Freddie Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Roger Kockelbergh
- Department of Urology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - James Catto
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - Alan Paul
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Peter Holding
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Derek Rosario
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Edward Rowe
- Department of Urology, North Bristol NHS Trust, Bristol, UK
| | - Owen Hughes
- Department of Urology, Cardiff and Vale University Health Board, Cardiff, UK
| | | | - David Gillatt
- Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, New South Wales, Australia
| | - Alan Doherty
- Department of Urology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Vincent J Gnanapragasam
- Department of Surgery, University of Cambridge, Cambridge, UK
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Edgar Paez
- Department of Urology, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
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10
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Noble SM, Garfield K, Lane JA, Metcalfe C, Davis M, Walsh EI, Martin RM, Turner EL, Peters TJ, Thorn JC, Mason M, Bollina P, Catto JWF, Doherty A, Gnanapragasam V, Hughes O, Kockelbergh R, Kynaston H, Paul A, Paez E, Rosario DJ, Rowe E, Oxley J, Staffurth J, Neal DE, Hamdy FC, Donovan JL. The ProtecT randomised trial cost-effectiveness analysis comparing active monitoring, surgery, or radiotherapy for prostate cancer. Br J Cancer 2020; 123:1063-1070. [PMID: 32669672 PMCID: PMC7524753 DOI: 10.1038/s41416-020-0978-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 11/07/2019] [Revised: 06/08/2020] [Accepted: 06/25/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND There is limited evidence relating to the cost-effectiveness of treatments for localised prostate cancer. METHODS The cost-effectiveness of active monitoring, surgery, and radiotherapy was evaluated within the Prostate Testing for Cancer and Treatment (ProtecT) randomised controlled trial from a UK NHS perspective at 10 years' median follow-up. Prostate cancer resource-use collected from hospital records and trial participants was valued using UK reference-costs. QALYs (quality-adjusted-life-years) were calculated from patient-reported EQ-5D-3L measurements. Adjusted mean costs, QALYs, and incremental cost-effectiveness ratios were calculated; cost-effectiveness acceptability curves and sensitivity analyses addressed uncertainty; subgroup analyses considered age and disease-risk. RESULTS Adjusted mean QALYs were similar between groups: 6.89 (active monitoring), 7.09 (radiotherapy), and 6.91 (surgery). Active monitoring had lower adjusted mean costs (£5913) than radiotherapy (£7361) and surgery (£7519). Radiotherapy was the most likely (58% probability) cost-effective option at the UK NICE willingness-to-pay threshold (£20,000 per QALY). Subgroup analyses confirmed radiotherapy was cost-effective for older men and intermediate/high-risk disease groups; active monitoring was more likely to be the cost-effective option for younger men and low-risk groups. CONCLUSIONS Longer follow-up and modelling are required to determine the most cost-effective treatment for localised prostate cancer over a man's lifetime. TRIAL REGISTRATION Current Controlled Trials number, ISRCTN20141297: http://isrctn.org (14/10/2002); ClinicalTrials.gov number, NCT02044172: http://www.clinicaltrials.gov (23/01/2014).
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Affiliation(s)
- Sian M Noble
- Bristol Medical School, University of Bristol, Bristol, UK.
| | - Kirsty Garfield
- Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - J Athene Lane
- Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Chris Metcalfe
- Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Michael Davis
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Richard M Martin
- Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research, Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Emma L Turner
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Tim J Peters
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Joanna C Thorn
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Malcolm Mason
- The School of Medicine, University of Cardiff, Cardiff, UK
| | - Prasad Bollina
- Department of Urology and Surgery, Western General Hospital, Edinburgh, UK
| | - James W F Catto
- The Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Alan Doherty
- Department of Urology, Queen Elizabeth Hospital, Birmingham, UK
| | - Vincent Gnanapragasam
- The Academic Urology Group, University of Cambridge, Cambridge, UK
- Cambridge Urology Translational Research and Clinical Trials Office, Cambridge, UK
| | - Owen Hughes
- Department of Urology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Roger Kockelbergh
- Department of Urology, University Hospitals Leicester, Leicester, UK
| | | | - Alan Paul
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Edgar Paez
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Derek J Rosario
- Department of Urology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Edward Rowe
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Jon Oxley
- Department of Cellular Pathology, North Bristol NHS Trust, Bristol, UK
| | - John Staffurth
- The School of Medicine, University of Cardiff, Cardiff, UK
| | - David E Neal
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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11
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Hamdy FC, Donovan JL, Lane JA, Mason M, Metcalfe C, Holding P, Wade J, Noble S, Garfield K, Young G, Davis M, Peters TJ, Turner EL, Martin RM, Oxley J, Robinson M, Staffurth J, Walsh E, Blazeby J, Bryant R, Bollina P, Catto J, Doble A, Doherty A, Gillatt D, Gnanapragasam V, Hughes O, Kockelbergh R, Kynaston H, Paul A, Paez E, Powell P, Prescott S, Rosario D, Rowe E, Neal D. Active monitoring, radical prostatectomy and radical radiotherapy in PSA-detected clinically localised prostate cancer: the ProtecT three-arm RCT. Health Technol Assess 2020; 24:1-176. [PMID: 32773013 PMCID: PMC7443739 DOI: 10.3310/hta24370] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Prostate cancer is the most common cancer among men in the UK. Prostate-specific antigen testing followed by biopsy leads to overdetection, overtreatment as well as undertreatment of the disease. Evidence of treatment effectiveness has lacked because of the paucity of randomised controlled trials comparing conventional treatments. OBJECTIVES To evaluate the effectiveness of conventional treatments for localised prostate cancer (active monitoring, radical prostatectomy and radical radiotherapy) in men aged 50-69 years. DESIGN A prospective, multicentre prostate-specific antigen testing programme followed by a randomised trial of treatment, with a comprehensive cohort follow-up. SETTING Prostate-specific antigen testing in primary care and treatment in nine urology departments in the UK. PARTICIPANTS Between 2001 and 2009, 228,966 men aged 50-69 years received an invitation to attend an appointment for information about the Prostate testing for cancer and Treatment (ProtecT) study and a prostate-specific antigen test; 82,429 men were tested, 2664 were diagnosed with localised prostate cancer, 1643 agreed to randomisation to active monitoring (n = 545), radical prostatectomy (n = 553) or radical radiotherapy (n = 545) and 997 chose a treatment. INTERVENTIONS The interventions were active monitoring, radical prostatectomy and radical radiotherapy. TRIAL PRIMARY OUTCOME MEASURE Definite or probable disease-specific mortality at the 10-year median follow-up in randomised participants. SECONDARY OUTCOME MEASURES Overall mortality, metastases, disease progression, treatment complications, resource utilisation and patient-reported outcomes. RESULTS There were no statistically significant differences between the groups for 17 prostate cancer-specific (p = 0.48) and 169 all-cause (p = 0.87) deaths. Eight men died of prostate cancer in the active monitoring group (1.5 per 1000 person-years, 95% confidence interval 0.7 to 3.0); five died of prostate cancer in the radical prostatectomy group (0.9 per 1000 person-years, 95% confidence interval 0.4 to 2.2 per 1000 person years) and four died of prostate cancer in the radical radiotherapy group (0.7 per 1000 person-years, 95% confidence interval 0.3 to 2.0 per 1000 person years). More men developed metastases in the active monitoring group than in the radical prostatectomy and radical radiotherapy groups: active monitoring, n = 33 (6.3 per 1000 person-years, 95% confidence interval 4.5 to 8.8); radical prostatectomy, n = 13 (2.4 per 1000 person-years, 95% confidence interval 1.4 to 4.2 per 1000 person years); and radical radiotherapy, n = 16 (3.0 per 1000 person-years, 95% confidence interval 1.9 to 4.9 per 1000 person-years; p = 0.004). There were higher rates of disease progression in the active monitoring group than in the radical prostatectomy and radical radiotherapy groups: active monitoring (n = 112; 22.9 per 1000 person-years, 95% confidence interval 19.0 to 27.5 per 1000 person years); radical prostatectomy (n = 46; 8.9 per 1000 person-years, 95% confidence interval 6.7 to 11.9 per 1000 person-years); and radical radiotherapy (n = 46; 9.0 per 1000 person-years, 95% confidence interval 6.7 to 12.0 per 1000 person years; p < 0.001). Radical prostatectomy had the greatest impact on sexual function/urinary continence and remained worse than radical radiotherapy and active monitoring. Radical radiotherapy's impact on sexual function was greatest at 6 months, but recovered somewhat in the majority of participants. Sexual and urinary function gradually declined in the active monitoring group. Bowel function was worse with radical radiotherapy at 6 months, but it recovered with the exception of bloody stools. Urinary voiding and nocturia worsened in the radical radiotherapy group at 6 months but recovered. Condition-specific quality-of-life effects mirrored functional changes. No differences in anxiety/depression or generic or cancer-related quality of life were found. At the National Institute for Health and Care Excellence threshold of £20,000 per quality-adjusted life-year, the probabilities that each arm was the most cost-effective option were 58% (radical radiotherapy), 32% (active monitoring) and 10% (radical prostatectomy). LIMITATIONS A single prostate-specific antigen test and transrectal ultrasound biopsies were used. There were very few non-white men in the trial. The majority of men had low- and intermediate-risk disease. Longer follow-up is needed. CONCLUSIONS At a median follow-up point of 10 years, prostate cancer-specific mortality was low, irrespective of the assigned treatment. Radical prostatectomy and radical radiotherapy reduced disease progression and metastases, but with side effects. Further work is needed to follow up participants at a median of 15 years. TRIAL REGISTRATION Current Controlled Trials ISRCTN20141297. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 37. See the National Institute for Health Research Journals Library website for further project information.
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Affiliation(s)
- Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - J Athene Lane
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Malcolm Mason
- School of Medicine, University of Cardiff, Cardiff, UK
| | - Chris Metcalfe
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Holding
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Julia Wade
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Sian Noble
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Grace Young
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Davis
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Tim J Peters
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma L Turner
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jon Oxley
- Department of Cellular Pathology, North Bristol NHS Trust, Bristol, UK
| | - Mary Robinson
- Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - John Staffurth
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Eleanor Walsh
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Jane Blazeby
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Richard Bryant
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Prasad Bollina
- Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - James Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Andrew Doble
- Department of Urology, Addenbrooke's Hospital, Cambridge, UK
| | - Alan Doherty
- Department of Urology, Queen Elizabeth Hospital, Birmingham, UK
| | - David Gillatt
- Department of Urology, Southmead Hospital and Bristol Urological Institute, Bristol, UK
| | | | - Owen Hughes
- Department of Urology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Roger Kockelbergh
- Department of Urology, University Hospitals of Leicester, Leicester, UK
| | - Howard Kynaston
- Department of Urology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Alan Paul
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Edgar Paez
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Philip Powell
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Stephen Prescott
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Derek Rosario
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Edward Rowe
- Department of Urology, Southmead Hospital and Bristol Urological Institute, Bristol, UK
| | - David Neal
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Academic Urology Group, University of Cambridge, Cambridge, UK
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12
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Neal DE, Metcalfe C, Donovan JL, Lane JA, Davis M, Young GJ, Dutton SJ, Walsh EI, Martin RM, Peters TJ, Turner EL, Mason M, Bryant R, Bollina P, Catto J, Doherty A, Gillatt D, Gnanapragasam V, Holding P, Hughes O, Kockelbergh R, Kynaston H, Oxley J, Paul A, Paez E, Rosario DJ, Rowe E, Staffurth J, Altman DG, Hamdy FC. Erratum to 'Ten-year Mortality, Disease Progression, and Treatment-related Side Effects in Men with Localised Prostate Cancer from the ProtecT Randomised Controlled Trial According to Treatment Received' [European Urology 77 (2020) 320-330]. Eur Urol 2020; 78:e139-e143. [PMID: 32624282 DOI: 10.1016/j.eururo.2020.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- David E Neal
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK Professor Emeritus of Surgical Oncology, Universities of Cambridge and Oxford, UK.
| | - Chris Metcalfe
- Bristol Randomised Trials Collaboration (BRTC), Bristol Trials Centre, University of Bristol, Bristol, UK
| | | | - J Athene Lane
- Bristol Randomised Trials Collaboration (BRTC), Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Michael Davis
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Grace J Young
- Bristol Randomised Trials Collaboration (BRTC), Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Susan J Dutton
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | | | - Tim J Peters
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma L Turner
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Richard Bryant
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Prasad Bollina
- Department of Urology & Surgery, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - James Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Alan Doherty
- Department of Urology, Queen Elizabeth Hospital, Birmingham, UK
| | - David Gillatt
- Department of Urology, Southmead Hospital and Bristol Urological Institute, Bristol, UK
| | - Vincent Gnanapragasam
- Academic Urology Group, Department of Surgery & Cambridge Urology Translational Research and Clinical Trials, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Peter Holding
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK Professor Emeritus of Surgical Oncology, Universities of Cambridge and Oxford, UK
| | - Owen Hughes
- Department of Urology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Roger Kockelbergh
- Department of Urology, University Hospitals of Leicester, Leicester, UK
| | - Howard Kynaston
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Jon Oxley
- Department of Cellular Pathology, North Bristol NHS Trust, Bristol, UK
| | - Alan Paul
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Edgar Paez
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Derek J Rosario
- Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
| | - Edward Rowe
- Department of Urology, Southmead Hospital and Bristol Urological Institute, Bristol, UK
| | - John Staffurth
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Doug G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK Professor Emeritus of Surgical Oncology, Universities of Cambridge and Oxford, UK
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13
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Birtle A, Johnson M, Chester J, Jones R, Dolling D, Bryan RT, Harris C, Winterbottom A, Blacker A, Catto JWF, Chakraborti P, Donovan JL, Elliott PA, French A, Jagdev S, Jenkins B, Keeley FX, Kockelbergh R, Powles T, Wagstaff J, Wilson C, Todd R, Lewis R, Hall E. Adjuvant chemotherapy in upper tract urothelial carcinoma (the POUT trial): a phase 3, open-label, randomised controlled trial. Lancet 2020; 395:1268-1277. [PMID: 32145825 PMCID: PMC7181180 DOI: 10.1016/s0140-6736(20)30415-3] [Citation(s) in RCA: 273] [Impact Index Per Article: 68.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Urothelial carcinomas of the upper urinary tract (UTUCs) are rare, with poorer stage-for-stage prognosis than urothelial carcinomas of the urinary bladder. No international consensus exists on the benefit of adjuvant chemotherapy for patients with UTUCs after nephroureterectomy with curative intent. The POUT (Peri-Operative chemotherapy versus sUrveillance in upper Tract urothelial cancer) trial aimed to assess the efficacy of systemic platinum-based chemotherapy in patients with UTUCs. METHODS We did a phase 3, open-label, randomised controlled trial at 71 hospitals in the UK. We recruited patients with UTUC after nephroureterectomy staged as either pT2-T4 pN0-N3 M0 or pTany N1-3 M0. We randomly allocated participants centrally (1:1) to either surveillance or four 21-day cycles of chemotherapy, using a minimisation algorithm with a random element. Chemotherapy was either cisplatin (70 mg/m2) or carboplatin (area under the curve [AUC]4·5/AUC5, for glomerular filtration rate <50 mL/min only) administered intravenously on day 1 and gemcitabine (1000 mg/m2) administered intravenously on days 1 and 8; chemotherapy was initiated within 90 days of surgery. Follow-up included standard cystoscopic, radiological, and clinical assessments. The primary endpoint was disease-free survival analysed by intention to treat with a Peto-Haybittle stopping rule for (in)efficacy. The trial is registered with ClinicalTrials.gov, NCT01993979. A preplanned interim analysis met the efficacy criterion for early closure after recruitment of 261 participants. FINDINGS Between June 19, 2012, and Nov 8, 2017, we enrolled 261 participants from 57 of 71 open study sites. 132 patients were assigned chemotherapy and 129 surveillance. One participant allocated chemotherapy withdrew consent for data use after randomisation and was excluded from analyses. Adjuvant chemotherapy significantly improved disease-free survival (hazard ratio 0·45, 95% CI 0·30-0·68; p=0·0001) at a median follow-up of 30·3 months (IQR 18·0-47·5). 3-year event-free estimates were 71% (95% CI 61-78) and 46% (36-56) for chemotherapy and surveillance, respectively. 55 (44%) of 126 participants who started chemotherapy had acute grade 3 or worse treatment-emergent adverse events, which accorded with frequently reported events for the chemotherapy regimen. Five (4%) of 129 patients managed by surveillance had acute grade 3 or worse emergent adverse events. No treatment-related deaths were reported. INTERPRETATION Gemcitabine-platinum combination chemotherapy initiated within 90 days after nephroureterectomy significantly improved disease-free survival in patients with locally advanced UTUC. Adjuvant platinum-based chemotherapy should be considered a new standard of care after nephroureterectomy for this patient population. FUNDING Cancer Research UK.
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Affiliation(s)
- Alison Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK; University of Manchester, Manchester, UK.
| | - Mark Johnson
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | | | - David Dolling
- The Institute of Cancer Research, Clinical Trials and Statistics Unit, London, UK
| | | | | | - Andrew Winterbottom
- Patient and Public Involvement Representative, Fight Bladder Cancer, Chinnor, UK
| | - Anthony Blacker
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | | | | | | | - Ann French
- Southend University Hospital NHS Foundation Trust, Southend, UK
| | | | - Benjamin Jenkins
- The Institute of Cancer Research, Clinical Trials and Statistics Unit, London, UK
| | | | | | | | | | | | - Rachel Todd
- The Institute of Cancer Research, Clinical Trials and Statistics Unit, London, UK
| | - Rebecca Lewis
- The Institute of Cancer Research, Clinical Trials and Statistics Unit, London, UK
| | - Emma Hall
- The Institute of Cancer Research, Clinical Trials and Statistics Unit, London, UK
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14
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Neal DE, Metcalfe C, Donovan JL, Lane JA, Davis M, Young GJ, Dutton SJ, Walsh EI, Martin RM, Peters TJ, Turner EL, Mason M, Bryant R, Bollina P, Catto J, Doherty A, Gillatt D, Gnanapragasam V, Holding P, Hughes O, Kockelbergh R, Kynaston H, Oxley J, Paul A, Paez E, Rosario DJ, Rowe E, Staffurth J, Altman DG, Hamdy FC. Ten-year Mortality, Disease Progression, and Treatment-related Side Effects in Men with Localised Prostate Cancer from the ProtecT Randomised Controlled Trial According to Treatment Received. Eur Urol 2020; 77:320-330. [PMID: 31771797 DOI: 10.1016/j.eururo.2019.10.030] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/30/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The ProtecT trial reported intention-to-treat analysis of men with localised prostate cancer (PCa) randomly allocated to active monitoring (AM), radical prostatectomy, and external beam radiotherapy. OBJECTIVE To determine report outcomes according to treatment received in men in randomised and treatment choice cohorts. DESIGN, SETTING, AND PARTICIPANTS This study focuses on secondary care. Men with clinically localised prostate cancer at one of nine UK centres were invited to participate in the treatment trial comparing AM, radical prostatectomy, and radiotherapy. INTERVENTION Two cohorts included 1643 men who agreed to be randomised; 997 declined randomisation and chose treatment. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Health-related quality of life impacts on urinary, bowel, and sexual function were assessed using patient-reported outcome measures. Analysis was carried out based on treatment received for each cohort and on pooled estimates using meta-analysis. Differences were estimated with adjustment for known prognostic factors using propensity scores. RESULTS AND LIMITATIONS According to treatment received, more men receiving AM died of PCa (AM 1.85%, surgery 0.67%, radiotherapy 0.73%), whilst this difference remained consistent with chance in the randomised cohort (p=0.08); stronger evidence was found in the exploratory analyses (randomised plus choice cohort) when AM was compared with the combined radical treatment group (p=0.003). There was also strong evidence that metastasis (AM 5.6%, surgery 2.4%, radiotherapy 2.7%) and disease progression (AM 20.35%, surgery 5.87%, radiotherapy 6.62%) were more common in the AM group. Compared with AM, there were higher risks of sexual dysfunction (95% at 6mo) and urinary incontinence (55% at 6mo) after surgery, and of sexual dysfunction (88% at 6mo) and bowel dysfunction (5% at 6mo) after radiotherapy. The key limitations are the potential for bias when comparing groups defined by treatment received and outdating of the interventions being evaluated during the lengthy follow-up required in trials of screen-detected PCa. CONCLUSIONS Analyses according to treatment received showed increased rates of disease-related events and lower rates of patient-reported harms in men managed by AM compared with men managed by radical treatment, and stronger evidence of greater PCa mortality in the AM group. PATIENT SUMMARY More than 90 out of every 100 men with localised prostate cancer do not die of prostate cancer within 10yr, irrespective of whether treatment is by means of monitoring, surgery, or radiotherapy. Side effects on sexual and bladder function are much better after active monitoring, but the risks of spreading of prostate cancer are more common.
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Affiliation(s)
- David E Neal
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
| | - Chris Metcalfe
- Bristol Randomised Trials Collaboration (BRTC), Bristol Trials Centre, University of Bristol, Bristol, UK
| | | | - J Athene Lane
- Bristol Randomised Trials Collaboration (BRTC), Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Michael Davis
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Grace J Young
- Bristol Randomised Trials Collaboration (BRTC), Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Susan J Dutton
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | | | - Tim J Peters
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma L Turner
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Richard Bryant
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Prasad Bollina
- Department of Urology & Surgery, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - James Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Alan Doherty
- Department of Urology, Queen Elizabeth Hospital, Birmingham, UK
| | - David Gillatt
- Department of Urology, Southmead Hospital and Bristol Urological Institute, Bristol, UK
| | - Vincent Gnanapragasam
- Academic Urology Group, Department of Surgery & Cambridge Urology Translational Research and Clinical Trials, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Peter Holding
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Owen Hughes
- Department of Urology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Roger Kockelbergh
- Department of Urology, University Hospitals of Leicester, Leicester, UK
| | - Howard Kynaston
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Jon Oxley
- Department of Cellular Pathology, North Bristol NHS Trust, Bristol, UK
| | - Alan Paul
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Edgar Paez
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Derek J Rosario
- Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
| | - Edward Rowe
- Department of Urology, Southmead Hospital and Bristol Urological Institute, Bristol, UK
| | - John Staffurth
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Doug G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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15
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Hussain T, Lam V, Farhad M, Lee S, Stephenson JA, Kockelbergh R, Rajesh A. Can subcentimetre ultrasound detected angiomyolipomas be safely disregarded? Clin Radiol 2020; 75:287-292. [PMID: 31916983 DOI: 10.1016/j.crad.2019.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/04/2019] [Indexed: 01/20/2023]
Abstract
AIM To optimise follow-up by dismissing lesions on baseline ultrasound (US) if renal lesions conform to US criteria of an angiomyolipoma (AML). METHOD AND MATERIALS The present study was a 10-year retrospective review of patients who were found to have incidental hyperechoic renal lesions on US to ascertain the outcome from subsequent imaging, clinical encounters, and cancer registrations. Exclusions included renal calculi, tuberous sclerosis, Von-Hippel-Lindau, or a known cancer. RESULTS After excluding 39 patients, 1,493 patients were identified. One hundred and sixty had more than one lesion with 87 patients having bilateral lesions. Regardless of indication, 889 patients had subsequent imaging within 5 years (59.5%). The average size of all AMLs was 13.2 mm. In the group with lesions that were <10 mm (807), 438 had imaging follow-up with an average follow-up time of 1.5 years. Mean lesion size in this group was 7 mm, with an average increase of <0.5 mm on follow-up. No lesions were found to be malignant on subsequent imaging nor did any of these patients have a subsequent renal cancer diagnosis registered at local multidisciplinary team meetings. CONCLUSION No incidental subcentimetre hyperechoic renal lesion with imaging characteristics of an AML demonstrated significant growth or developed into a malignancy on follow-up.
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Affiliation(s)
- T Hussain
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - V Lam
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - M Farhad
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - S Lee
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - J A Stephenson
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - R Kockelbergh
- Department of Urology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - A Rajesh
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK.
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16
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Birtle A, Catto J, Johnson M, Kockelbergh R, Keeley F, Bryan R, Chester J, Jones R, Hill M, Donovan J, French A, Harris C, Powles T, Todd R, Tregellas L, Wilson C, Winterbottom A, Lewis R, Hall E. MP18-03 RESULTS OF POUT - A PHASE III RANDOMISED TRIAL OF PERI-OPERATIVE CHEMOTHERAPY VERSUS SURVEILLANCE IN UPPER TRACT UROTHELIAL CANCER (UTUC). J Urol 2018. [DOI: 10.1016/j.juro.2018.02.579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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17
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Birtle AJ, Chester JD, Jones RJ, Johnson M, Hill M, Bryan RT, Catto J, Donovan J, French A, Harris C, Keeley F, Kockelbergh R, Powles T, Todd R, Tregellas L, Wilson C, Winterbottom A, Lewis R, Hall E. Results of POUT: A phase III randomised trial of perioperative chemotherapy versus surveillance in upper tract urothelial cancer (UTUC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.407] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [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
407 Background: The role of post nephro-ureterectomy (NU) treatment for UTUC is unclear. POUT (CRUK/11/027; NCT01993979) addresses whether adjuvant chemotherapy improves disease free survival (DFS) for pts with histologically confirmed pT2-T4 N0-3 M0 UTUC. Methods: Pts (max n = 345) ≤90 days post NU were randomised (1:1) to 4 cycles of gemcitabine-cisplatin (gemcitabine-carboplatin if GFR 30-49ml/min) or surveillance with subsequent chemotherapy if required. Pts had 6 monthly cross sectional imaging and cystoscopy for the first 2 years, then annually to 5 years. Toxicity was assessed by CTCAE v4. Primary endpoint was DFS. The trial was powered to detect a hazard ratio (HR) of 0.65 (i.e. improvement in 3 year DFS from 40% to 55%; 2-sided alpha = 5%, 80% power) with Peto-Haybittle (p < 0.001) early stopping rules for efficacy & inefficacy. Secondary endpoints included metastasis-free survival (PFS), overall survival (OS), toxicity & quality of life. Results: Between May 2012 & Sept 2017, 248 pts were recruited (123 surveillance; 125 chemotherapy) at 57 UK centres. In Oct 2017, the independent trial oversight committees recommended POUT close to recruitment as data collected thus far (data snapshot 05/09/2017) met the early stopping rule for efficacy. At the time of interim analysis, median follow-up was 17.6 months (IQR 7.5-33.6). Pts had median age 69 years (range 36-88), 30% pT2, 65% pT3; 91% pN0;. Grade ≥3 toxicities were reported in 60% chemotherapy pts & 24% surveillance pts. 47/123 (surveillance) & 29/125 (chemotherapy) DFS events were reported; unadjusted HR = 0.47 (95% CI: 0.29, 0.74) in favour of chemotherapy (log-rank p = 0.0009). Two year DFS was 51% for surveillance (95% CI: 39, 61) and 70% for chemotherapy (95% CI: 58, 79). PFS favoured chemotherapy: HR = 0.49 (95% CI: 0.30, 0.79, p = 0.003). Conclusions: Adjuvant chemotherapy improved PFS in UTUC. POUT is the largest randomised trial in this pt population; the trial was terminated early because of efficacy favouring the chemotherapy arm. Whilst follow up for OS continues, this should be considered a new standard of care in these patients. Clinical trial information: ISRCTN98387754.
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Affiliation(s)
| | | | - Robert Jones Jones
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Mark Johnson
- Newcastle upon Tyne Hospitals NHS Trust, Newcastle, United Kingdom
| | - Michaela Hill
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | | | - James Catto
- University of Sheffield, Sheffield, United Kingdom
| | | | - Ann French
- Southend University Hospital NHS Foundation Trust, Southend, United Kingdom
| | | | | | | | - Thomas Powles
- Barts Health NHS Trust – St Bartholomew’s Hospital, London, United Kingdom
| | - Rachel Todd
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Lucy Tregellas
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton, United Kingdom
| | | | | | - Rebecca Lewis
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
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18
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Trainor S, Choudhury A, Huddart R, Kiltie AE, Kockelbergh R, Turner W, Birtle A, Crabb SJ. The National Institute for Health and Care Excellence (NICE) Guidance on Bladder Cancer; a Step in the Right Direction? Clin Oncol (R Coll Radiol) 2017; 29:344-347. [PMID: 28190637 DOI: 10.1016/j.clon.2017.01.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 01/19/2017] [Indexed: 01/08/2023]
Affiliation(s)
- S Trainor
- Department of Medical Oncology, St James's Institute of Oncology, Leeds, UK
| | - A Choudhury
- The Christie NHS Foundation Trust and Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - R Huddart
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK
| | - A E Kiltie
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - R Kockelbergh
- Department of Urology, University Hospitals of Leicester, Leicester, UK
| | - W Turner
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, UK
| | - S J Crabb
- Cancer Sciences Unit, University of Southampton, Southampton, UK.
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19
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Abstract
Background: The purpose of the NCRAS Urological Cancer Site-Specific Clinical Reference Group (SSCRG) is to link the knowledge of clinicians with the large amount of routine data collected by cancer registration. This study considers the latest available data and trends in incidence, mortality and survival and offers interpretation of findings in a clinical context. Methods: New diagnoses of urological cancer in England for 2001 to 2013 were extracted from the National Cancer Registration and Analysis Service (NCRAS). Deaths were counted from Office for National Statistics (ONS) data for the same years. Directly age-standardised rates (ASRs) and net survival were calculated. Results: Prostate cancer incidence has increased to 40,000 cases per year. Mortality rates are falling and hence the improvement seen in five-year survival is likely to be due to changes in treatment rather than artefact. Bladder cancer (including CIS and pTa disease) shows a stable incidence and decreasing mortality rates. Survival from T1–T4 bladder cancer is stable. There has been a marked rise in kidney cancer incidence in both sexes with a stable mortality. The stable mortality suggests that improved five-year survival may be an artefact due to increased detection as a result of more widespread use of diagnostic imaging. Incidence of upper-urinary-tract cancer has risen both for invasive and non-invasive disease, and mortality in men has risen for invasive disease. This may be down to better recognition and attribution of disease. Testicular cancer has shown little change. Deaths are now rare, and survival is the highest for any cancer. There have been no significant changes in penis cancer, which remains the rarest urological cancer. Conclusion: The epidemiological data suggest a generally improving picture for urological cancer. However, there are some areas which require further consideration. Population-based studies can show variation in rare cancers and highlight previously unrecognised inequalities.
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Affiliation(s)
| | - Luke Hounsome
- National Cancer Intelligence Network, Public Health England, UK
| | - Erik Mayer
- Department of Surgery & Cancer, Imperial College London, UK
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20
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Mensah EE, Hounsome L, Verne J, Kockelbergh R, Mayer E. Cardiovascular outcomes in kidney cancer patients. Journal of Clinical Urology 2017. [DOI: 10.1177/2051415816685245] [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: 11/16/2022]
Abstract
Introduction: In the surgical management of small renal tumours, current guidelines recommend that partial nephrectomy should be the preferred option wherever possible. This is based on evidence suggesting improved quality of life outcomes, morbidity and mortality and equivalent oncological outcomes when compared with radical nephrectomy. Chronic kidney disease is a significant risk factor for cardiovascular disease and subsequent mortality. This study explored differences in cardiac-related events and co-morbidity, using linked registry data for patients undergoing radical or partial nephrectomy for T1 renal tumours. Methods: Data from the National Cancer Registration Service was searched to identify T1 renal cancer diagnoses between 1999 and 2012. This data was matched against hospital episode statistics to identify those patients who had undergone radical or partial nephrectomy between 1999 and 2013 using OPCS codes. Data was collected on cardiac-related admissions and deaths in nephrectomy patients. Equivalent data was also collected for the general population to allow age-standardized comparison. Charlson score was used as a proxy for pre-operative co-morbidity. Results: Radical/partial nephrectomy patients had a greater risk of cardiac-related admissions compared with the general population (relative risk (RR) 3.32, 95% confidence interval (CI) 3.24–3.40), but with no increase in cardiac-related deaths (RR 0.84, 95% CI 0.70–1.01). There was no difference in the admission risk, or death, comparing radical or partial nephrectomy for T1 renal tumours (RR 1.02, 95% CI 0.88–1.17) using ‘time to event’ analysis. There was no difference in the comorbidity index between radical nephrectomy and partial nephrectomy patients. Conclusion: The higher incidence of cardiac-related admissions seen for radical/partial nephrectomy patients may be explained by a higher proportion of patients with medical illnesses including cardiovascular risk factors (hypertension, diabetes) undergoing renal imaging. The absence of a difference between the radical nephrectomy and partial nephrectomy groups supports the phenomenon of surgically-induced chronic kidney disease, which may not have the same morbidity implications as medically-induced chronic kidney disease.
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Affiliation(s)
| | | | - Julia Verne
- National Cancer Intelligence Network, London, UK
| | | | - Erik Mayer
- Department of Surgery & Cancer, Imperial College London, UK
- National Cancer Intelligence Network, London, UK
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21
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Hounsome L, Rowe E, Verne J, Kockelbergh R, Payne H. Variation in usage of radical prostatectomy and radical radiotherapy for men with locally advanced prostate cancer. Journal of Clinical Urology 2017. [DOI: 10.1177/2051415816681247] [Citation(s) in RCA: 2] [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: 11/16/2022]
Abstract
Locally advanced prostate cancer is defined as primary tumours extending outside the prostate gland to the surrounding tissues or seminal vesicles but without spread beyond the pelvic region. With radical treatment there is good prospect of cure. Radiotherapy in combination with hormone therapy is well established, but specific NICE guidelines have only recently been published. The guidelines recommend offering either radical prostatectomy (RP), possibly with adjuvant radiotherapy, or radical radiotherapy (RT) with neo-adjuvant hormone therapy as treatment for men with locally advanced prostate cancer. Given that guidelines on managing locally advanced prostate cancer have recently changed, we wanted to quantify the baseline variation in use of radical treatments for this patient group. Methods: Men with T3/T4 N0 M0 prostate cancer who were diagnosed in 2010–2012 were identified using data from the National Cancer Registration and Analysis Service (NCRAS). Data on age, ethnicity, deprivation, Charlson comorbidity score, Strategic Clinical Network (SCN) of residence, and treatments delivered were extracted. A multivariable logistic regression was undertaken to identify important variables. Results: Overall, 1692 (14%) of men in the cohort had a record of radical prostatectomy. A total of 6212 (52%) had a record of curative RT. In a regression model each decade increase in age yielded odds of 0.39 ( p < 0.001) for receiving radical treatment. Black men were only half as likely as white men to receive radical treatment (OR = 0.54; p < 0.001). Deprivation, comorbidity and SCN of residence had smaller effects. The variation observed in radical treatment between SCNs largely disappeared once the multiple variables were accounted for. Conclusion: Radical treatments vary by 71% to 85% between networks for men aged 60–69 years. Given that men >80 years made up 12% of the study population and only 6% had a Charlson comorbidity score >0, there is a possibility that some men with ‘clinically significant’ disease are undertreated.
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Affiliation(s)
| | | | | | | | - Heather Payne
- University College London Hospitals NHS Foundation Trust, UK
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22
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Ball KS, Hounsome L, Verne J, Kockelbergh R. Non-transitional cell carcinoma only partly explains adverse survival outcomes in females with T1–T4 bladder cancer: A summary of UK epidemiological data. Journal of Clinical Urology 2017. [DOI: 10.1177/2051415816679529] [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: 11/15/2022]
Abstract
Objective: The objective of this article is to investigate why bladder cancer (BC) survival is worse in females using national cancer datasets. Patients and methods: All BC diagnoses since the year 2000 were identified from the National Cancer Data Repository (NCDR) using ICD-10 Code C67 (Bladder cancer T1–T4). Age-standardised relative survival rates for males and females diagnosed with BC between 2000 and 2010 were obtained from Public Health England. Results: Five-year relative survival of men with transitional cell carcinoma (TCC) BC (Code C67) was 61%, but in females was significantly less at 52%. One in four female BC (27%) patients are non-TCC, proportionately far more compared to 1:6 (16%) non-TCC BC in males. Five-year relative survival in non-TCC BC subtypes was notably reduced to 23% in females compared to 35% in men. Only 47% of patients with non-TCC BC receive surgical treatment compared to 82% for all BC. Conclusion: Relative survival from non-TCC BC is significantly less than the overall survival from TCC BC. Female patients with invasive BC have a worse survival than men. This is partly explained by the proportionately higher incidence of non-TCC BC in females, but women with TCC BC also have worse outcomes so other factors must contribute. Female gender should be recognised as an adverse risk factor in BC survival and influence management decisions.
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Affiliation(s)
| | - Luke Hounsome
- Knowledge and Intelligence Team (South West), Public Health England, UK
| | - Julia Verne
- Knowledge and Intelligence Team (South West), Public Health England, UK
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23
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Hamdy FC, Donovan JL, Lane JA, Mason M, Metcalfe C, Holding P, Davis M, Peters TJ, Turner EL, Martin RM, Oxley J, Robinson M, Staffurth J, Walsh E, Bollina P, Catto J, Doble A, Doherty A, Gillatt D, Kockelbergh R, Kynaston H, Paul A, Powell P, Prescott S, Rosario DJ, Rowe E, Neal DE. 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. N Engl J Med 2016; 375:1415-1424. [PMID: 27626136 DOI: 10.1056/nejmoa1606220] [Citation(s) in RCA: 1759] [Impact Index Per Article: 219.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The comparative effectiveness of treatments for prostate cancer that is detected by prostate-specific antigen (PSA) testing remains uncertain. METHODS We compared active monitoring, radical prostatectomy, and external-beam radiotherapy for the treatment of clinically localized prostate cancer. Between 1999 and 2009, a total of 82,429 men 50 to 69 years of age received a PSA test; 2664 received a diagnosis of localized prostate cancer, and 1643 agreed to undergo randomization to active monitoring (545 men), surgery (553), or radiotherapy (545). The primary outcome was prostate-cancer mortality at a median of 10 years of follow-up. Secondary outcomes included the rates of disease progression, metastases, and all-cause deaths. RESULTS There were 17 prostate-cancer-specific deaths overall: 8 in the active-monitoring group (1.5 deaths per 1000 person-years; 95% confidence interval [CI], 0.7 to 3.0), 5 in the surgery group (0.9 per 1000 person-years; 95% CI, 0.4 to 2.2), and 4 in the radiotherapy group (0.7 per 1000 person-years; 95% CI, 0.3 to 2.0); the difference among the groups was not significant (P=0.48 for the overall comparison). In addition, no significant difference was seen among the groups in the number of deaths from any cause (169 deaths overall; P=0.87 for the comparison among the three groups). Metastases developed in more men in the active-monitoring group (33 men; 6.3 events per 1000 person-years; 95% CI, 4.5 to 8.8) than in the surgery group (13 men; 2.4 per 1000 person-years; 95% CI, 1.4 to 4.2) or the radiotherapy group (16 men; 3.0 per 1000 person-years; 95% CI, 1.9 to 4.9) (P=0.004 for the overall comparison). Higher rates of disease progression were seen in the active-monitoring group (112 men; 22.9 events per 1000 person-years; 95% CI, 19.0 to 27.5) than in the surgery group (46 men; 8.9 events per 1000 person-years; 95% CI, 6.7 to 11.9) or the radiotherapy group (46 men; 9.0 events per 1000 person-years; 95% CI, 6.7 to 12.0) (P<0.001 for the overall comparison). CONCLUSIONS At a median of 10 years, prostate-cancer-specific mortality was low irrespective of the treatment assigned, with no significant difference among treatments. Surgery and radiotherapy were associated with lower incidences of disease progression and metastases than was active monitoring. (Funded by the National Institute for Health Research; ProtecT Current Controlled Trials number, ISRCTN20141297 ; ClinicalTrials.gov number, NCT02044172 .).
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Affiliation(s)
- Freddie C Hamdy
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Jenny L Donovan
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - J Athene Lane
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Malcolm Mason
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Chris Metcalfe
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Peter Holding
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Michael Davis
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Tim J Peters
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Emma L Turner
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Richard M Martin
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Jon Oxley
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Mary Robinson
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - John Staffurth
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Eleanor Walsh
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Prasad Bollina
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - James Catto
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Andrew Doble
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Alan Doherty
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - David Gillatt
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Roger Kockelbergh
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Howard Kynaston
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Alan Paul
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Philip Powell
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Stephen Prescott
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Derek J Rosario
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Edward Rowe
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - David E Neal
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
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Donovan JL, Hamdy FC, Lane JA, Mason M, Metcalfe C, Walsh E, Blazeby JM, Peters TJ, Holding P, Bonnington S, Lennon T, Bradshaw L, Cooper D, Herbert P, Howson J, Jones A, Lyons N, Salter E, Thompson P, Tidball S, Blaikie J, Gray C, Bollina P, Catto J, Doble A, Doherty A, Gillatt D, Kockelbergh R, Kynaston H, Paul A, Powell P, Prescott S, Rosario DJ, Rowe E, Davis M, Turner EL, Martin RM, Neal DE. Patient-Reported Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. N Engl J Med 2016; 375:1425-1437. [PMID: 27626365 PMCID: PMC5134995 DOI: 10.1056/nejmoa1606221] [Citation(s) in RCA: 827] [Impact Index Per Article: 103.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Robust data on patient-reported outcome measures comparing treatments for clinically localized prostate cancer are lacking. We investigated the effects of active monitoring, radical prostatectomy, and radical radiotherapy with hormones on patient-reported outcomes. METHODS We compared patient-reported outcomes among 1643 men in the Prostate Testing for Cancer and Treatment (ProtecT) trial who completed questionnaires before diagnosis, at 6 and 12 months after randomization, and annually thereafter. Patients completed validated measures that assessed urinary, bowel, and sexual function and specific effects on quality of life, anxiety and depression, and general health. Cancer-related quality of life was assessed at 5 years. Complete 6-year data were analyzed according to the intention-to-treat principle. RESULTS The rate of questionnaire completion during follow-up was higher than 85% for most measures. Of the three treatments, prostatectomy had the greatest negative effect on sexual function and urinary continence, and although there was some recovery, these outcomes remained worse in the prostatectomy group than in the other groups throughout the trial. The negative effect of radiotherapy on sexual function was greatest at 6 months, but sexual function then recovered somewhat and was stable thereafter; radiotherapy had little effect on urinary continence. Sexual and urinary function declined gradually in the active-monitoring group. Bowel function was worse in the radiotherapy group at 6 months than in the other groups but then recovered somewhat, except for the increasing frequency of bloody stools; bowel function was unchanged in the other groups. Urinary voiding and nocturia were worse in the radiotherapy group at 6 months but then mostly recovered and were similar to the other groups after 12 months. Effects on quality of life mirrored the reported changes in function. No significant differences were observed among the groups in measures of anxiety, depression, or general health-related or cancer-related quality of life. CONCLUSIONS In this analysis of patient-reported outcomes after treatment for localized prostate cancer, patterns of severity, recovery, and decline in urinary, bowel, and sexual function and associated quality of life differed among the three groups. (Funded by the U.K. National Institute for Health Research Health Technology Assessment Program; ProtecT Current Controlled Trials number, ISRCTN20141297 ; ClinicalTrials.gov number, NCT02044172 .).
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Johnston TJ, Shaw GL, Lamb AD, Parashar D, Greenberg D, Xiong T, Edwards AL, Gnanapragasam V, Holding P, Herbert P, Davis M, Mizielinsk E, Lane JA, Oxley J, Robinson M, Mason M, Staffurth J, Bollina P, Catto J, Doble A, Doherty A, Gillatt D, Kockelbergh R, Kynaston H, Prescott S, Paul A, Powell P, Rosario D, Rowe E, Donovan JL, Hamdy FC, Neal DE. Mortality Among Men with Advanced Prostate Cancer Excluded from the ProtecT Trial. Eur Urol 2016; 71:381-388. [PMID: 27720537 PMCID: PMC5289293 DOI: 10.1016/j.eururo.2016.09.040] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 07/28/2016] [Accepted: 09/26/2016] [Indexed: 11/21/2022]
Abstract
Background Early detection and treatment of asymptomatic men with advanced and high-risk prostate cancer (PCa) may improve survival rates. Objective To determine outcomes for men diagnosed with advanced PCa following prostate-specific antigen (PSA) testing who were excluded from the ProtecT randomised trial. Design, setting, and participants Mortality was compared for 492 men followed up for a median of 7.4 yr to a contemporaneous cohort of men from the UK Anglia Cancer Network (ACN) and with a matched subset from the ACN. Outcome measurements and statistical analysis PCa-specific and all-cause mortality were compared using Kaplan-Meier analysis and Cox's proportional hazards regression. Results and limitations Of the 492 men excluded from the ProtecT cohort, 37 (8%) had metastases (N1, M0 = 5, M1 = 32) and 305 had locally advanced disease (62%). The median PSA was 17 μg/l. Treatments included radical prostatectomy (RP; n = 54; 11%), radiotherapy (RT; n = 245; 50%), androgen deprivation therapy (ADT; n = 122; 25%), other treatments (n = 11; 2%), and unknown (n = 60; 12%). There were 49 PCa-specific deaths (10%), of whom 14 men had received radical treatment (5%); and 129 all-cause deaths (26%). In matched ProtecT and ACN cohorts, 37 (9%) and 64 (16%), respectively, died of PCa, while 89 (22%) and 103 (26%) died of all causes. ProtecT men had a 45% lower risk of death from PCa compared to matched cases (hazard ratio 0.55, 95% confidence interval 0.38–0.83; p = 0.0037), but mortality was similar in those treated radically. The nonrandomised design is a limitation. Conclusions Men with PSA-detected advanced PCa excluded from ProtecT and treated radically had low rates of PCa death at 7.4-yr follow-up. Among men who underwent nonradical treatment, the ProtecT group had a lower rate of PCa death. Early detection through PSA testing, leadtime bias, and group heterogeneity are possible factors in this finding. Patient summary Prostate cancer that has spread outside the prostate gland without causing symptoms can be detected via prostate-specific antigen testing and treated, leading to low rates of death from this disease.
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Affiliation(s)
| | - Greg L Shaw
- Academic Urology Group, University of Cambridge, Cambridge, UK; Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK
| | - Alastair D Lamb
- Academic Urology Group, University of Cambridge, Cambridge, UK; Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK
| | - Deepak Parashar
- Statistics and Epidemiology Unit & Cancer Research Centre, University of Warwick, Coventry, UK
| | - David Greenberg
- National Cancer Registration Service - Eastern Office, Public Health England, Cambridge, UK
| | - Tengbin Xiong
- Academic Urology Group, University of Cambridge, Cambridge, UK
| | | | | | - Peter Holding
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Michael Davis
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - J Athene Lane
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jon Oxley
- Department of Cellular Pathology, North Bristol NHS Trust, Bristol, UK
| | - Mary Robinson
- Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
| | - Malcolm Mason
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - John Staffurth
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Prasad Bollina
- Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - James Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Andrew Doble
- Department of Urology, Addenbrooke's Hospital, Cambridge, UK
| | - Alan Doherty
- Department of Urology, Queen Elizabeth Hospital, Birmingham, UK
| | - David Gillatt
- Department of Urology, Southmead Hospital and Bristol Urological Institute, Bristol, UK
| | - Roger Kockelbergh
- Department of Urology, University Hospitals of Leicester, Leicester, UK
| | - Howard Kynaston
- Department of Urology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Steve Prescott
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Alan Paul
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Philip Powell
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Derek Rosario
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Edward Rowe
- Department of Urology, Southmead Hospital and Bristol Urological Institute, Bristol, UK
| | - Jenny L Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - David E Neal
- Academic Urology Group, University of Cambridge, Cambridge, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
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Burge F, Kockelbergh R. Closing the Gender Gap: Can We Improve Bladder Cancer Survival in Women? - A Systematic Review of Diagnosis, Treatment and Outcomes. Urol Int 2016; 97:373-379. [PMID: 27595416 DOI: 10.1159/000449256] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 08/19/2016] [Indexed: 11/02/2023]
Abstract
INTRODUCTION Despite recent attention, there are no gender specific guidelines to address the disparity in bladder cancer survival between the sexes. The focus of this review was to identify areas of clinical practice that may influence bladder cancer outcomes and to provide evidence-based recommendations to improve bladder cancer survival in women. METHOD A systematic search of MEDLINE was conducted to identify studies related to referral, diagnosis, treatment and outcomes of patients with bladder cancer with particular reference to gender differences. RESULTS Patients' knowledge of key signs and symptoms of bladder cancer is poor. There is evidence that there is a gender difference in referral patterns both at patient and primary care level. The presence of cystits, in particular, delays referral. Treatment and surveillance of high-risk non-muscle invasive cancers is variable and non-urothelial bladder cancer, which has higher incidence in women is more likely to be treated non-operatively than urothelial bladder cancer. CONCLUSION We have offered recommendations to improve patient education and streamline referrals and suggested considerations for treatment of high-risk cancers to help improve survival in female bladder cancer patients.
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Affiliation(s)
- Frances Burge
- Department of Urology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Birtle AJ, Maynard L, Johnson M, Kockelbergh R, Lewis R, Newton M, Jones RJ, Chester JD, Blacker A, Catto J, Hall E. Acute toxicity data from POUT: A phase III randomized trial of peri-operative chemotherapy versus surveillance in upper tract urothelial cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e16138] [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: 11/20/2022] Open
Affiliation(s)
- Alison J. Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, United Kingdom
| | - Lauren Maynard
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Mark Johnson
- Newcastle upon Tyne Hospitals NHS Trust, Newcastle, United Kingdom
| | | | - Rebecca Lewis
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Michelle Newton
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Robert J. Jones
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | - Anthony Blacker
- University Hospitals of Coventry and Warwickshire, West Midlands, United Kingdom
| | - James Catto
- The University of Sheffield, Sheffield, United Kingdom
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
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Affiliation(s)
- Roger Kockelbergh
- Department of Urology, University Hospitals of Leicester, Leicester, UK.
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Chauhan M, Kockelbergh R, Faust G. A unique case of gliomatosis peritonei in a man, following a retroperitoneal teratoma. BMJ Case Rep 2015; 2015:bcr-2015-210736. [PMID: 26374776 DOI: 10.1136/bcr-2015-210736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present an unusual case of a 56-year-old man presenting with abdominal swelling. Imaging revealed a large abdominal 23 cm cystic mass, which radiologically appeared to be related to the small bowel. There was an attempted surgical removal by the general surgeons. It was histologically confirmed as a retroperitoneal cystic teratoma with immature neural elements with incomplete resection margins. Residual disease was found at re-imaging 3 months later and a further block dissection was performed, with histology confirming recurrence. Thirteen months later, imaging revealed recurrent disease with peritoneal involvement. At laparoscopic exploration, there was peritoneal seeding, and biopsies confirmed a diagnosis of gliomatosis peritonei, secondary to the retroperitoneal teratoma. The patient proceeded to have combination chemotherapy to achieve stable disease on imaging. A month after completion, sadly, the disease progressed; the patient received best supportive care.
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Affiliation(s)
- Meera Chauhan
- Department of Oncology, University Hospitals of Leicester NHS Trust, Leicester, Leicestershire, UK
| | - Roger Kockelbergh
- Department of Urology, University Hospitals of Leicester NHS Trust, Leicester, Leicestershire, UK
| | - Guy Faust
- Department of Oncology, University Hospitals of Leicester NHS Trust, Leicester, Leicestershire, UK
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Verne J, Hounsome L, Kockelbergh R, Rashbass J. Improving Outcomes from Prostate Cancer: Unlocking the Treasure Trove of Information in Cancer Registries. Eur Urol 2015. [PMID: 26215611 DOI: 10.1016/j.eururo.2015.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Julia Verne
- Knowledge and Intelligence Service, Public Health England, Bristol, UK.
| | - Luke Hounsome
- Knowledge and Intelligence Service, Public Health England, Bristol, UK
| | | | - Jem Rashbass
- National Disease Registration Service, Public Health England, London, UK
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Langley RE, Duong T, Godsland IF, Kynaston H, Kockelbergh R, Rosen SD, Alhasso AA, Dearnaley DP, Clarke NW, Jovic G, Carpenter R, Bara A, Welland A, Parmar MK, Abel PD. Oestrogen patches (OP) to treat prostate cancer (PC) – Are different commercial brands interchangeable? Maturitas 2015. [DOI: 10.1016/j.maturitas.2015.02.320] [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]
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Murtagh K, Kockelbergh R. Complication of treatment of carcinoma in situ of the bladder with photodynamic targeted cystodiathermy. Ann R Coll Surg Engl 2014; 96:e30-1. [PMID: 25245722 DOI: 10.1308/003588414x13946184903360] [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: 11/22/2022] Open
Abstract
We report two cases of bladder contracture following photodynamic or 'blue light' detection and cystodiathermy for bladder carcinoma in situ. These patients were unsuitable for treatment with immunotherapy/chemotherapy or had disease recurrence following such treatment. Radical cystectomy was not a treatment option in either patient. Each underwent serial photodynamic cystodiathermy over a three-year period. Neither patient developed muscle invasive disease. However, treatment resulted in contracture of the bladder and incontinence of urine. Patients need to be fully aware of this potential complication in order to make informed choices about their care.
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Affiliation(s)
- K Murtagh
- University Hospitals of Leicester NHS Trust, UK
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Langley RE, Duong T, Jovic G, Alhasso AA, Kynaston H, Dearnaley DP, Rosen SD, Kockelbergh R, Clarke NW, Godsland IF, Sundaram SK, Dixit S, Laniado M, Stockdale A, Pope A, Paez EM, Spittle B, Bara A, Parmar MMK, Abel PD. Prostate Adenocarcinoma: TransCutaneous Hormones, PR09 (PATCH): A randomized controlled trial of transdermal estrogen patches versus luteinising hormone releasing hormone agonists in locally advanced and metastatic prostate cancer. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.tps5099] [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: 11/20/2022] Open
Affiliation(s)
- Ruth E Langley
- Medical Research Council, Clinical Trials Unit at University College London, London, United Kingdom
| | - Trinh Duong
- Medical Research Council, Clinical Trials Unit at University College London, London, United Kingdom
| | - Gordana Jovic
- Medical Research Council, Clinical Trials Unit at University College London, London, United Kingdom
| | | | | | | | - Stuart D Rosen
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | | | - Noel W. Clarke
- The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Ian F Godsland
- Division of Diabetes Endocrinology and Metabolism, Imperial College London, London, United Kingdom
| | - Subramanian K Sundaram
- Mid-Yorkshire Hospitals NHS Trust, Pinderfields General Hospital, Wakefield, United Kingdom
| | - Sanjay Dixit
- Scunthorpe General Hospital, North Lincolnshire and Goole NHS Trust, Scunthorpe, United Kingdom
| | - Marc Laniado
- Heatherwood and Wexham Park NHS Foundation Trust, London, United Kingdom
| | - Andrew Stockdale
- Arden Cancer Centre, University Hospital, Coventry, United Kingdom
| | - Alvan Pope
- The Hillingdon Hospitals NHS Foundation Trust, London, United Kingdom
| | - Edgar M Paez
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Ben Spittle
- Medical Research Council, Clinical Trials Unit at University College London, London, United Kingdom
| | - Anna Bara
- Medical Research Council, Clinical Trials Unit at University College London, London, United Kingdom
| | - Mahesh M K Parmar
- Medical Research Council, Clinical Trials Unit at University College London, London, United Kingdom
| | - Paul D Abel
- Imperial College London, London, United Kingdom
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Langley RE, Cafferty FH, Alhasso AA, Rosen SD, Sundaram SK, Freeman SC, Pollock P, Jinks RC, Godsland IF, Kockelbergh R, Clarke NW, Kynaston HG, Parmar MK, Abel PD. Cardiovascular outcomes in patients with locally advanced and metastatic prostate cancer treated with luteinising-hormone-releasing-hormone agonists or transdermal oestrogen: the randomised, phase 2 MRC PATCH trial (PR09). Lancet Oncol 2013; 14:306-16. [PMID: 23465742 PMCID: PMC3620898 DOI: 10.1016/s1470-2045(13)70025-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Luteinising-hormone-releasing-hormone agonists (LHRHa) to treat prostate cancer are associated with long-term toxic effects, including osteoporosis. Use of parenteral oestrogen could avoid the long-term complications associated with LHRHa and the thromboembolic complications associated with oral oestrogen. METHODS In this multicentre, open-label, randomised, phase 2 trial, we enrolled men with locally advanced or metastatic prostate cancer scheduled to start indefinite hormone therapy. Randomisation was by minimisation, in a 2:1 ratio, to four self-administered oestrogen patches (100 μg per 24 h) changed twice weekly or LHRHa given according to local practice. After castrate testosterone concentrations were reached (1·7 nmol/L or lower) men received three oestrogen patches changed twice weekly. The primary outcome, cardiovascular morbidity and mortality, was analysed by modified intention to treat and by therapy at the time of the event to account for treatment crossover in cases of disease progression. This study is registered with ClinicalTrials.gov, number NCT00303784. FINDINGS 85 patients were randomly assigned to receive LHRHa and 169 to receive oestrogen patches. All 85 patients started LHRHa, and 168 started oestrogen patches. At 3 months, 70 (93%) of 75 receiving LHRHa and 111 (92%) of 121 receiving oestrogen had achieved castrate testosterone concentrations. After a median follow-up of 19 months (IQR 12-31), 24 cardiovascular events were reported, six events in six (7·1%) men in the LHRHa group (95% CI 2·7-14·9) and 18 events in 17 (10·1%) men in the oestrogen-patch group (6·0-15·6). Nine (50%) of 18 events in the oestrogen group occurred after crossover to LHRHa. Mean 12-month changes in fasting glucose concentrations were 0·33 mmol/L (5·5%) in the LHRHa group and -0·16 mmol/L (-2·4%) in the oestrogen-patch group (p=0·004), and for fasting cholesterol were 0·20 mmol/L (4·1%) and -0·23 mmol/L (-3·3%), respectively (p<0·0001). Other adverse events reported by 6 months included gynaecomastia (15 [19%] of 78 patients in the LHRHa group vs 104 [75%] of 138 in the oestrogen-patch group), hot flushes (44 [56%] vs 35 [25%]), and dermatological problems (10 [13%] vs 58 [42%]). INTERPRETATION Parenteral oestrogen could be a potential alternative to LHRHa in management of prostate cancer if efficacy is confirmed. On the basis of our findings, enrolment in the PATCH trial has been extended, with a primary outcome of progression-free survival. FUNDING Cancer Research UK, MRC Clinical Trials Unit.
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Birtle A, Lewis R, Chester J, Donovan J, Johnson M, Jones R, Kockelbergh R, Powles T, Jones E, Hall E. Peri-Operative Chemotherapy or Surveillance in Upper Tract Urothelial Cancer (POUT - CRUK/11/027) - A New Randomised Controlled Trial to Define Standard Post-Operative Management. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33355-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Frew G, Smith A, Zutshi B, Young N, Aggarwal A, Jones P, Kockelbergh R, Richards M, Maher EJ. Results of a quantitative survey to explore both perceptions of the purposes of follow-up and preferences for methods of follow-up delivery among service users, primary care practitioners and specialist clinicians after cancer treatment. Clin Oncol (R Coll Radiol) 2010; 22:874-84. [PMID: 20615678 DOI: 10.1016/j.clon.2010.06.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 03/31/2010] [Accepted: 05/06/2010] [Indexed: 10/19/2022]
Abstract
AIMS To ascertain perceptions of reasons for follow-up after cancer treatment among service users (patients and carers), primary care practitioners and specialist clinicians (doctors and specialist nurses) and to identify levels of preference for different models of follow-up and the effect of an individual's experience on preferred models. MATERIALS AND METHODS A national survey designed to meet the needs of each key respondent group was carried out after a structured literature review, an extensive consultation process and a pilot scheme. Respondents were asked to assess their degree of preference for 10 pre-selected indications for follow-up. Eight models of follow-up were also identified and respondents were asked to state their experience and preference for each type. The questionnaire was distributed nationally via the 34 cancer networks in England and was available both online and in hard copy (postal). The uptake for the electronic format was in the main by primary care practitioners and specialist clinicians. Service users preferred the paper (postal) format. The survey was also publicised through the primary care and patient partnership forums at a Cancer Network Development event. RESULTS In total, 2928 responses were received, comprising service users (21% of the sample), primary care practitioners (32%) and specialist clinicians (47%). Eighty-six per cent of responses were received from the 10 strategic health authorities in England, with the remaining 14% from Scotland, Wales and The Isle of Man. The responses from Scotland, Wales and the Isle of Man generally occurred where they interfaced with English cancer networks or had been engaged through word of mouth by colleagues. Among all respondents the main aims of cancer follow-up were considered to be: (1) to monitor for early complications after treatment; (2) to detect recurrences early; (3) to detect late effects of treatment. The most commonly experienced method of follow-up among all respondent groups was outpatient review with a doctor. This was considered to be the most preferred follow-up option among service users (86%). The least preferred option among service users was postal follow-up (32%). Primary care practitioners and specialist clinicians were more likely than service users to have experienced alternative methods of follow-up, such as telephone follow-up, self-triggered referral and non-specialist follow-up. These models were highly rated by those who had experience of them. CONCLUSIONS There was a reasonable level of consensus between service users, primary care practitioners and specialist clinicians as to the reasons for follow-up. Service users seemed to have higher expectations of follow-up, particularly in relation to detecting recurrences early. As respondents were more likely to prefer a method of follow-up delivery that they had experienced than one they had not; there could be resistance to change from established methods to new methods without adequate explanation. This suggests that the communication of new methods could be critical to their successful introduction.
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Affiliation(s)
- G Frew
- Cancer Improvement NHS Improvement, Leicester, UK.
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Bunce C, Ayres BE, Griffiths TL, Mostafid H, Kelly J, Persad R, Kockelbergh R. The role of hexylaminolaevulinate in the diagnosis and follow-up of non-muscle-invasive bladder cancer. BJU Int 2010; 105 Suppl 2:2-7. [DOI: 10.1111/j.1464-410x.2009.09150.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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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Sinfield P, Baker R, Camosso-Stefinovic J, Colman AM, Tarrant C, Mellon JK, Steward W, Kockelbergh R, Agarwal S. Men's and carers' experiences of care for prostate cancer: a narrative literature review. Health Expect 2009; 12:301-12. [PMID: 19754693 DOI: 10.1111/j.1369-7625.2009.00546.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review studies of patients' and carers' experience of prostate cancer care. DESIGN Narrative literature review. METHODS Search strategies were developed for the following databases: MEDLINE (1966-2006), EMBASE (1980-2006), CINAHL (1982-2006) and PsycINFO (1987-2006). A search of SIGLE (System for Information on Grey Literature in Europe) was also undertaken. Experience was defined as patients' and carers' reports of how care was organized and delivered to meet their needs. A narrative summary of the included papers was undertaken. RESULTS A total of 90 relevant studies were identified. Most studies reported on experiences of screening, diagnosis, the treatment decision, treatment and post-initial treatment. Few studies reported on experiences of the stages of referral, testing, and further treatment and palliative care, and no studies reported on monitoring or terminal care. CONCLUSIONS Although some phases of care have not been investigated in detail, there is evidence that: (i) many patients have a low level of knowledge of prostate cancer; (ii) patients with prostate cancer and their carers need information throughout the care pathway to enable them to understand the diagnosis, treatment options, self-care and support available; and (iii) increasing patient knowledge and understanding of prostate cancer (e.g. through interventions) are often associated with a more active role in decision making (e.g. screening, treatment decision).
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Affiliation(s)
- Paul Sinfield
- Department of Health Sciences, University of Leicester, Leicester, UK.
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Sinfield P, Baker R, Tarrant C, Agarwal S, Colman AM, Steward W, Kockelbergh R, Mellon JK. The Prostate Care Questionnaire for Carers (PCQ-C): reliability, validity and acceptability. BMC Health Serv Res 2009; 9:229. [PMID: 20003338 PMCID: PMC2797790 DOI: 10.1186/1472-6963-9-229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 12/11/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient experience is commonly monitored in evaluating and improving health care, but the experience of carers (partners/relatives/friends) is rarely monitored even though the role of carers can often be substantial. For carers to fulfil their role it is necessary to address their needs. This paper describes an evaluation of the reliability, validity and acceptability of the PCQ-C, a newly developed instrument designed to measure the experiences of carers of men with prostate cancer. METHODS The reliability, acceptability and validity of the PCQ-C were tested through a postal survey and interviews with carers. The PCQ-C was posted to 1087 prostate cancer patients and patients were asked to pass the questionnaire on to their carer. Non-responders received one reminder. To assess test-retest reliability, 210 carers who had responded to the questionnaire were resent it a second time three weeks later. A subsample of nine carers from patients attending one hospital took part in qualitative interviews to assess validity and acceptability of the PCQ-C. Acceptability to service providers was evaluated based on four hospitals' experiences of running a survey using the PCQ-C. RESULTS Questionnaires were returned by 514 carers (47.3%), and the majority of questions showed less than 10% missing data. Across the sections of the questionnaire internal consistency was high (Cronbach's alpha ranging from 0.80 to 0.89), and test-retest stability showed moderate to high stability (intraclass correlation coefficients ranging from 0.52 to 0.83). Interviews of carers indicated that the PCQ-C was valid and acceptable. Feedback from hospitals indicated that they found the questionnaire useful, and highlighted important considerations for its future use as part of quality improvement initiatives. CONCLUSIONS The PCQ-C has been found to be acceptable to carers and service providers having been used successfully in hospitals in England. It is ready for use to measure the aspects of care that need to be addressed to improve the quality of prostate cancer care, and for research.
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Affiliation(s)
- Paul Sinfield
- Department of Health Sciences, University of Leicester, Leicester, UK.
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Affiliation(s)
- Hugh Mostafid
- Department of Urology, North Hampshire Hospital, Basingstoke, Hampshire, UK.
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Tarrant C, Baker R, Colman AM, Sinfield P, Agarwal S, Mellon JK, Steward W, Kockelbergh R. The prostate care questionnaire for patients (PCQ-P): reliability, validity and acceptability. BMC Health Serv Res 2009; 9:199. [PMID: 19889223 PMCID: PMC2777154 DOI: 10.1186/1472-6963-9-199] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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: 07/21/2009] [Accepted: 11/04/2009] [Indexed: 11/25/2022] Open
Abstract
Background In England, prostate cancer patients report worse experience of care than patients with other cancers. However, no standard measure of patient experience of prostate cancer care is currently available. This paper describes an evaluation of the reliability, validity and acceptability of the PCQ-P, a newly developed instrument designed to measure patient experience of prostate cancer care. Methods The reliability, acceptability and validity of the PCQ-P were tested through a postal survey and interviews with patients. The PCQ-P was posted to 1087 prostate cancer patients varying in age, occupation, and overall health status, sampled from five hospitals in England. Nonresponders received one reminder. To assess criterion validity, 935 patients were also sent sections of the National Centre for Social Research Shortened Questionnaire; and to assess test-retest reliability, 296 patients who responded to the questionnaire were resent it a second time three weeks later. A subsample of 20 prostate cancer patients from one hospital took part in qualitative interviews to assess validity and acceptability of the PCQ-P. Acceptability to service providers was evaluated based on four hospitals' experiences of running a survey using the PCQ-P. Results Questionnaires were returned by 865 patients (69.2%). Missing data was low across the sections, with the proportion of patients completing less than 50% of each section ranging from 4.5% to 6.9%. Across the sections of the questionnaire, internal consistency was moderate to high (Cronbach's alpha ranging from 0.63 to 0.80), and test-retest stability was acceptable (intraclass correlation coefficients ranging from 0.57 to 0.73). Findings on criterion validity were significant. Patient interviews indicated that the PCQ-P had high face validity and acceptability. Feedback from hospitals indicated that they found the questionnaire useful, and highlighted important considerations for its future use as part of quality improvement initiatives. Conclusion The PCQ-P has been found to be acceptable to patients and service providers, and is ready for use for the measurement of patient experience in routine practice, service improvement programmes, and research.
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Affiliation(s)
- Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, UK.
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Langley RE, Godsland IF, Kynaston H, Clarke NW, Rosen SD, Morgan RC, Pollock P, Kockelbergh R, Lalani EN, Dearnaley D, Parmar M, Abel PD. Early hormonal data from a multicentre phase II trial using transdermal oestrogen patches as first-line hormonal therapy in patients with locally advanced or metastatic prostate cancer. BJU Int 2008; 102:442-5. [PMID: 18422771 DOI: 10.1111/j.1464-410x.2008.07583.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the hormonal effects of Fem7 (Merck, KGaA, Darmstadt, Germany) 100 microg transdermal oestrogen patches on men undergoing first-line androgen-deprivation therapy for prostate cancer. PATIENTS AND METHODS PATCH is a multicentre, randomized, phase II trial for men with locally advanced or metastatic prostate cancer, comparing luteinizing hormone-releasing hormone agonist therapy with oestrogen patches. To assess the dosing schedule for the patches, as this was the first time that this brand of patch had been used in men, and to reassure patients and participating clinicians, the Independent Data Monitoring Committee agreed to early release of hormonal data from this study. RESULTS Oestradiol, testosterone and prostate-specific antigen (PSA) levels are presented for the first group of 14 patients who received the patches (with 1 withdrawal) and for whom there were > or =12 weeks of follow-up by March 2007. After 12 weeks, testosterone levels (nmol/L) in eight of the 13 patients were <1.7, two were 1.7-2 and three were >2. The median (range) serum oestradiol levels was 442 (52.1-1542) pmol/L and all patients had a PSA response, with eight having a PSA level of <4 ng/mL. CONCLUSION These results confirm that oestrogen patches produce castrate levels of testosterone and concomitant PSA responses. They also highlighted the potential differences between different brands of oestrogen patches, and the need to monitor hormonal response, toxicity and efficacy until more experience with oestrogen patches for this clinical indication is obtained. The number of patches recommended in the PATCH study has now been increased.
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Affiliation(s)
- Ruth E Langley
- Endocrinology and Metabolic Medicine, Imperial College, London, UK.
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Harland SJ, Kynaston H, Grigor K, Wallace DM, Beacock C, Kockelbergh R, Clawson S, Barlow T, Parmar MKB, Griffiths GO. A Randomized Trial of Radical Radiotherapy for the Management of pT1G3 NXM0 Transitional Cell Carcinoma of the Bladder. J Urol 2007; 178:807-13; discussion 813. [PMID: 17631326 DOI: 10.1016/j.juro.2007.05.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE We conducted a multicenter randomized trial in the United Kingdom to determine the efficacy of radical radiotherapy in reducing the incidence of progression of pT1G3 transitional cell carcinoma of the bladder to muscle invasive disease and subsequent disease fatality. MATERIALS AND METHODS Patients with a new diagnosis of pT1G3 NXM0 transitional cell carcinoma with unifocal disease and no carcinoma in situ (group 1), or with multifocal disease and/or carcinoma in situ (group 2) were eligible for the trial. Patients in group 1 were randomized between observation and radiotherapy to the bladder, and in group 2 between intravesical therapy and radiotherapy. RESULTS From September 1991 to February 2003 a total of 210 patients from 37 centers in the United Kingdom were entered into the study. There were 77 patients in group 1 and 133 patients in group 2, and 6 patients were excluded from analysis because they were found to have pT2 disease by the reference pathologist. No evidence of an advantage with radiotherapy was found in terms of progression-free interval (hazard ratio 1.07; 95% CI 0.65, 1.74; p = 0.785), progression-free survival (hazard ratio 1.35; 95% CI 0.92, 1.98; p = 0.133) or overall survival (hazard ratio 1.32; 95% CI 0.86, 2.04; p = 0.193). CONCLUSIONS To our knowledge this is the largest randomized trial performed in patients with pT1G3 disease for which 210 patients were recruited during 11 years. There is no evidence that radiotherapy is better than more conservative treatment. The prognosis of this group of patients appears to be poor irrespective of treatment and new treatment strategies need to be investigated.
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Affiliation(s)
- S J Harland
- Institute of Urology and Department of Oncology, University College London, London, UK.
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Affiliation(s)
- Roger Kockelbergh
- Department of Urology, University Hospitals of Leicester, Leicester, UK.
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Francis DM, Millar RJ, Walker RG, Nicholls K, Powell H, Jones C, Kockelbergh R, Becker G. Live donor renal transplantation with low-dose triple immunosuppression. Transplant Proc 1992; 24:2243. [PMID: 1413041] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- D M Francis
- Department of Surgery, Royal Melbourne Hospital, Victoria, Australia
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