Volume-outcome relationship in penile cancer treatment: a population based patterns of care and outcomes study from Australia.

OBJECTIVES: To study the patterns of care of penile cancer diagnosed in the state of New South Wales (NSW) over a 10 year period and determine factors that are associated with differences in survival. PATIENTS AND METHODS: All invasive penile cancer diagnosed between 2001 and 2009 in NSW, Australia, were identified from the Central Cancer Registry. Records of treatment from the Admitted Patient Data Collection and deaths from the Registry of Births Deaths and Marriages were electronically linked. Predictors of receiving an inguinal lymph node dissection (ILND) were analysed using multivariable logistic regression. Survival analyses were performed with Kaplan-Meier and Cox proportional hazards models. RESULTS: A total of 220 men were diagnosed with penile cancer over the 10 years from 69 centres. The median number of penile operations performed over 10 years was <4. Radical penile surgery (partial or total penectomy) was performed in 70% of the cases and the proportion of patients receiving radical surgery increased over time (P = 0.015). Only 53/220 men with invasive penile cancer received an ILND. Younger age and higher stage were the only factors that predicted whether ILND was performed. Overall survival (OS) was predicted by age, stage, marital status and co-morbidity status. Low centre volume decreased OS by 37% (HR 0.63 [95% CI: 0.40-0.97]). For men who received ILND, low centre volume decreased OS by 60% (HR 0.40 [95% CI: 0.19-0.85]). CONCLUSIONS: There is a decreasing trend for the use of conservative penile surgery and median centre volumes for penile cancer surgery in NSW are low. A decrease in overall survival is observed in men treated in lower volume surgery centres.

Factors Affecting Satisfaction with the Decision-Making Process and Decision Regret for Men with a New Diagnosis of Prostate Cancer.

For men with newly diagnosed prostate cancer the decisions about treatment options are complex and difficult. The aim of this study was to investigate any association between the extent to which men wanted to be involved in the decision making process, their satisfaction with that process, and their levels of decision regret after treatment. The study population consisted of men diagnosed with prostate cancer at a regional center in Australia. Men (n = 324) were invited to complete a mail out survey which included demographic questions, the treatment chosen, and three validated tools: The Control Preference Scale to measure the degree of control assumed when making decisions about medical interventions; the Treatment Decision-Making Satisfaction Scale (TDM- SAT) to assess satisfaction with the treatment decision making process; and the Decision Regret Scale to assess the level of regret after treatment. The majority of the 151 respondents (47% response rate) expressed an active decision control preference. There was no correlation between age and the treatment chosen or the degree of control men exerted over the decision-making process. Men who preferred a passive role were less satisfied with the decision-making process than were those who took an active or collaborative approach. A strong inverse correlation was demonstrated between regret experienced and satisfaction with the decision-making process. In conclusion, for men newly diagnosed with prostate cancer, taking an active role in the treatment decision making process led to greater satisfaction with that process, which in turn reduced their chances of experiencing regret following treatment.

Prostate cancer detection in men with an initial diagnosis of atypical small acinar proliferation.

OBJECTIVE: To determine the subsequent prostatic adenocarcinoma detection rate amongst men with an initial diagnosis of atypical small acinar proliferation (ASAP). PATIENTS AND METHODS: We reviewed the Illawarra Prostate Pathology Database over a 10-year period (January 1994 to January 2004) for specimens diagnosed as ASAP. These specimens were re-reviewed and clinical data obtained. RESULTS: Of 61 cases of ASAP, there were complete follow-up data for 31. In this group nine patients had no further biopsies at our institution; the other 22 had at least one repeat biopsy. The incidence of prostatic adenocarcinoma in this group was 17/31 (55%). This included 13 diagnoses on second biopsy, three on third biopsy and one diagnosed at another institution. CONCLUSION: This study showed a detection rate for prostatic adenocarcinoma of 55% after an initial diagnosis of ASAP, which indicates that an initial diagnosis of ASAP mandates re-biopsy.