Barriers and enablers of active surveillance for prostate cancer: a qualitive study of clinicians.

OBJECTIVES: To identify and explore barriers to, and enablers of, active surveillance (AS) in men with low-risk prostate cancer (LRPCa), as perceived by PCa clinicians. PATIENTS AND METHODS: Urologists and radiation oncologists in Australia and New Zealand were purposively sampled for a cross-section on gender and practice setting (metropolitan/regional; public/private). Using a grounded theory approach, semi-structed interviews were conducted with participants. Interviews were coded independently by two researchers using open, axial, and selective coding. A constant comparative approach was used to analyse data as it was collected. Thematic saturation was reached after 18 interviews, and a detailed model of barriers to, and enablers of, AS for LRPCa, as perceived by clinicians was developed. RESULTS: A model explaining what affects clinician decision making regarding AS in LRPCa emerged. It was underpinned by three broad themes: (i) clinician perception of patients' barriers and enablers; (ii) clinician perception of their own barriers and enablers; and (iii) engagement with healthcare team and resource availability. CONCLUSIONS: Clinicians unanimously agree that AS is an evidence-based approach for managing LRPCa. Despite this many men do not undergo AS for LRPCa, which is due to the interplay of patient and clinician factors, and their interaction with the wider healthcare system. This study identifies strategies to mitigate barriers and enhance enablers, which could increase access to AS by patients with LRPCa.

Modern Active Surveillance in Prostate Cancer: A Narrative Review.

The use of PSA screening has led to downstaging and downgrading of prostate cancer at diagnosis, increasing detection of indolent disease. Active surveillance aims to reduce over-treatment by delaying or avoiding radical treatment and its associated morbidity. However, there is not a consensus on the selection criteria and monitoring schedules that should be used. This article aims to summarize the evidence supporting the safety of active surveillance, the current selection criteria recommended and in use, the incidence of active surveillance, barriers existing to its uptake and future developments in patient selection.

Xanthogranulomatous orchitis: A rare case of testicular mass.

Xanthogranulomatous orchitis is a rare non-malignant condition. This study reports a new case of xanthogranulomatous orchitis in a 77-year-old male, who presented with acute right scrotal mass. Ultrasound and computed tomography showed a heterogenous lesion involving the testis, with a loculated collection in the overlying scrotal wall. Scrotal exploration revealed an abscess involving the scrotal skin, with hard mass involving the testis, with histological evidence of infiltration and replacement of most testicular parenchyma. This case highlights this important consideration for xanthogranulomatous orchitis in the differential of testicular mass, particularly when associated with a purulent collection. Section headings: •Inflammation and Infection•General Urology.

Quality and readability of online patient information on treatment for erectile dysfunction.

Objectives: To investigate the quality and readability of online patient information on treatment for erectile dysfunction using a Google search. Materials and methods: The results of a Google search for "erectile dysfunction treatment" were reviewed. Webpages that contained written information on erectile dysfunction except those containing scientific publications and paywall protected webpages were included in further analysis. Typographic and treatment information were recorded. Readability was assessed using the Fleisch-Kincaid grade level, the Gunning-Fog index, the Coleman-Liau index, and Simple Measure of Gobbledygook. Website quality was assessed using the DISCERN instrument, Journal of the American Medical Association (JAMA) benchmark criteria, and presence of Health on the net (HON) code certification. Website typography, discussed treatment types, readability scores, and quality measures were reported. Parametric and nonparametric statistical tests were used to compare the data as appropriate dependent on the normality of data. Results: Eighty-one webpages were included. Urologists and hospitals were the most common producers with 15 (18%) each. Seventy-four (91%) webpages contained specific information on treatment for erectile dysfunction and 15 (19%) contained advertisements. Seventeen (21%) webpages were HON code certified. The median DISCERN score was 35 (IQR 26.5-44) out of 80. The mean combined readability score was 12.32 (SD 1.91). The median JAMA benchmark score was 1 (IQR 1-2) out of 4. Google rank had a small negative correlation with DISCERN score (τ = -0.16, P = .036). HON code certified webpages had higher DISCERN scores (median of 44 [IQR 35-58.5] vs 32.5 [IQR 25.25-42.25], U = 832, Z = 6561, P < .001). A linear regression was used to predict DISCERN score based on meeting each JAMA benchmark criterion (F(2, 78) = 22.7, P < .001) R 2 = 0.368, P < .001. Within this model the effects of meeting attribution (ß = 11.09) and currency (ß = 8.79) criterion were significant. Conclusions: The quality of online information on treatment for erectile dysfunction is generally poor. However, easy to identify markers of quality like HON code certification, or meeting JAMA benchmark criterion for attribution and currency may help patients to navigate to better quality online information on treatment for erectile dysfunction. Webpages are written at senior high school level, above any recommendations for patient medical information. Health professionals should use validated instruments to assess the quality of online information on treatment for erectile dysfunction prior to publication to improve their utility for patients.