Canadian Experience with the Adjustable Transobturator Male System for Post-Prostatectomy Incontinence: A Multicenter Study.

PURPOSE: We assessed the efficacy and safety profile of the ATOMS® (Adjustable Transobturator Male System) for post-prostatectomy incontinence in a multicenter North American setting. MATERIALS AND METHODS: We reviewed outcomes from 8 centers in men who underwent treatment of post-prostatectomy incontinence with an ATOMS. Primary study outcomes were pad changes and continence, defined as requiring 1.0 or 0 pad postoperatively in patients who required 2.0 or more pads preoperatively and 0 pad in those who required more than 1.0 or 2.0 pads preoperatively. Secondary outcomes included improvement, 90-day complications and patient satisfaction. RESULTS: A total of 160 patients were enrolled in study with a median followup of 9.0 months. Preoperative median pad use was 4 per day (IQR 3-5). Of the patients 36.3% reported severe preoperative incontinence, 31.3% received prior radiotherapy and 16.3% underwent previous incontinence surgery. Median postoperative pad use after adjustments was 0.5 per day (IQR 0-1, p <0.001). The overall continence rate was 80.0% with improvement in 87.8% of cases. Of the patients 70.1% underwent a mean ± SD of 2.4 ± 2.7 adjustments (IQR 0-16). The patient satisfaction rate was 86.3%, 22.3% experienced 90-day complications of any grade and 7 (4.4%) experienced Clavien III complications primarily related to the injection port. Patients with a history of radiotherapy were less likely to be continent (62.5% vs 87.9%, p=0.002), improved (77.1% vs 92.6%, p=0.02) or satisfied (69.8% vs 93.2%, p=0.001). Similarly patients with previous incontinence surgery had lower rates of continence, improvement and satisfaction (57.7%, 73.1% and 69.6%, respectively). CONCLUSIONS: In the short term the ATOMS is a safe and efficacious device to treat post-prostatectomy incontinence. Patients with concurrent radiotherapy and previous incontinence surgery respond to treatment but are less likely to be continent, improved or satisfied.

Update of the ICUD-SIU consultation on stone technology behind ureteroscopy.

INTRODUCTION: Ureteroscopy is now the most frequent treatment used around the world for stone disease. Technological advancement, efficiency, safety, and minimally invasiveness of this procedure are some of the reasons for this change of trend. MATERIALS AND METHODS: In this review of the literature, a search of the PubMed database was conducted to identify articles related to ureteroscopy and accessories. The committee assigned by the International Consultation on Urological Disease reviewed all the data and produced a consensus statement relating to the ureteroscopy and all the particularities around this procedure. CONCLUSION: This manuscript provides literatures and recommendations for endourologists to keep them informed in regard to the preoperative, intraoperative, and postoperative consideration in regard of a ureteroscopy.

Metabolic evaluation of urinary lithiasis: what urologists should know and do.

INTRODUCTION: Urolithiasis is a complex medical entity and regroups several different types of stones, each caused by a multitude of dietary imbalances or metabolic anomalies. In order to better assess the stone-forming patient, urologists should be competent in performing a thorough metabolic work-up. MATERIALS AND METHODS: We reviewed the litterature in order to provide an appropriate overview of the various components of the metabolic evaluation, including stone analysis, biochemistry tests, and urine collection. CONCLUSION: Performing a metabolic evaluation allows precise intervention in order to treat and mainly prevent stone disease.

Efficacy of botulinum toxin A injection for neurogenic detrusor overactivity and urinary incontinence: a randomized, double-blind trial.

PURPOSE: We determined the efficacy of onabotulinumtoxinA for neurogenic detrusor overactivity secondary to spinal cord injury or multiple sclerosis. MATERIALS AND METHODS: In a prospective, double-blind, multicenter study 57 patients 18 to 75 years old with neurogenic detrusor overactivity secondary to spinal cord injury or multiple sclerosis and urinary incontinence (defined as 1 or more occurrences daily) despite current antimuscarinic treatment were randomized to onabotulinumtoxinA 300 U (28) or placebo (29) via cystoscopic injection at 30 intradetrusor sites, sparing the trigone. Patients were offered open label onabotulinumtoxinA 300 U at week 36 and followed a further 6 months while 24 each in the treatment and placebo groups received open label therapy. The primary efficacy parameter was daily urinary incontinence frequency on 3-day voiding diary at week 6. Secondary parameters were changes in the International Consultation on Incontinence Questionnaire and the urinary incontinence quality of life scale at week 6. Diary and quality of life evaluations were also done after open label treatment. RESULTS: The mean daily frequency of urinary incontinence episodes was significantly lower for onabotulinumtoxinA than for placebo at week 6 (1.31 vs 4.76, p <0.0001), and for weeks 24 and 36. Improved urodynamic and quality of life parameters for treatment vs placebo were evident at week 6 and persisted to weeks 24 to 36. The most common adverse event in each group was urinary tract infection. CONCLUSIONS: In adults with antimuscarinic refractory neurogenic detrusor overactivity and multiple sclerosis onabotulinumtoxinA is well tolerated and provides clinically beneficial improvement for up to 9 months.

Comparative study of inguinal hernia repair after radical prostatectomy, prostate biopsy, transurethral resection of the prostate or pelvic lymph node dissection.

PURPOSE: Inguinal hernia is considered one of the major morbidities after radical prostatectomy. We compared inguinal hernia repair rates in patients treated with radical prostatectomy for localized prostate cancer relative to those of 2 nonsurgically treated groups of patients, namely individuals who underwent prostate biopsy or transurethral resection of the prostate, and a surgically treated group of patients who underwent pelvic lymph node dissection, within a large North American database. MATERIALS AND METHODS: Using the Quebec Health Plan database we identified 5,478 men treated with radical prostatectomy vs 6,933, 7,697 and 532 who underwent prostate biopsy, transurethral resection of the prostate or pelvic lymph node dissection, respectively, between 1990 and 2000. Kaplan-Meier plots graphically explored inguinal hernia repair rates. Univariable and multivariable Cox regression analyses examined variables associated with inguinal hernia repair after either group. Covariates consisted of age, year of treatment and the Charlson comorbidity index. RESULTS: The 1, 2, 5 and 10-year inguinal hernia repair rates after radical prostatectomy were 4.4%, 6.7%, 11.7% and 17.1%, respectively. For the same points after prostate biopsy the rates were 1.7%, 2.9%, 6.1% and 9.8% vs 1.7%, 2.6%, 5.5% and 9.2%, respectively, after transurethral resection of the prostate, and 0.8%, 2.4%, 4.9% and 9.3% after pelvic lymph node dissection (pairwise log rank tests p <0.001). On multivariable Cox regression analyses the rate of inguinal hernia repair was 1.9, 2.1 and 1.7-fold higher for patients who underwent radical prostatectomy vs prostate biopsy, transurethral resection of the prostate and pelvic lymph node dissection, respectively (all p <0.001). CONCLUSIONS: Radical prostatectomy predisposes to higher inguinal hernia repair rates than in the 3 examined control groups. A higher rate of inguinal hernia repair after radical prostatectomy warrants consideration in the discussion of radical prostatectomy perioperative complications.

Development and external validation of a highly accurate nomogram for the prediction of perioperative mortality after transurethral resection of the prostate for benign prostatic hyperplasia.

PURPOSE: Benign prostatic hyperplasia affects 60% of men at the age of 60 years. Transurethral resection of the prostate is the gold standard of therapy. We assessed the 30-day mortality rate after transurethral resection of the prostate for benign prostatic hyperplasia, identified risk factors related to 30-day mortality and developed a model that discriminates among individual 30-day mortality risk levels. MATERIALS AND METHODS: We performed development (7,362) and external validation (7,362) of a multivariable logistic regression model predicting the individual probability of 30-day mortality after transurethral resection of the prostate based on an administrative data set (Quebec Health Plan) of 14,724 patients 43 to 99 years old treated between January 1, 1989 and December 31, 2000. RESULTS: Overall 30-day mortality occurred in 58 patients (0.4%) undergoing transurethral resection of the prostate. On univariable analyses increasing age (p <0.001) and increasing Charlson comorbidity index (p <0.001) were statistically significant predictors of 30-day mortality after transurethral resection of the prostate. Conversely annual surgical volume was not. On multivariable analyses age (p <0.001) and Charlson comorbidity index (p <0.001) reached independent predictor status. The accuracy of the age and Charlson comorbidity index based nomogram that predicts the individual probability of 30-day mortality after transurethral resection of the prostate was 83% in the external validation cohort. CONCLUSIONS: Age and Charlson comorbidity index are important determinants of 30-day mortality after transurethral resection of the prostate. The combination of these parameters allows an 83% accurate prediction of individual 30-day mortality risk after transurethral resection of the prostate. Despite limitations such as the need for additional external validations and possibly the need for inclusion of clinical parameters, the use of the current model is warranted for the purpose of informed consent before transurethral resection of the prostate and/or for patient counseling.

A population based assessment of perioperative mortality after cystectomy for bladder cancer.

PURPOSE: Large variability exists in the rates of perioperative mortality after cystectomy. Contemporary estimates range from 0.7% to 5.6%. We tested several predictors of perioperative mortality and devised a model for individual perioperative mortality prediction. MATERIALS AND METHODS: We relied on life tables to quantify 30, 60 and 90-day mortality rates according to age, gender, stage (localized vs regional), grade, type of surgery (partial vs radical cystectomy), year of cystectomy and histological bladder cancer subtype. We fitted univariable and multivariable logistic regression models using 5,510 patients diagnosed with bladder cancer and treated with partial or radical cystectomy within 4 SEER (Surveillance, Epidemiology, and End Results) registries between 1984 and 2004. We then externally validated the model on 5,471 similar patients from 5 other SEER registries. RESULTS: At 30, 60 and 90 days the perioperative mortality rates were 1.1%, 2.4% and 3.9%, respectively. Age, stage and histological subtype represented statistically significant and independent predictors of 90-day mortality. The combined use of these 3 variables and of tumor grade resulted in the most accurate model (70.1%) for prediction of individual probability of 90-day mortality after cystectomy. CONCLUSIONS: The accuracy of our model could potentially be improved with the consideration of additional parameters such as surgical and hospital volume or comorbidity. While better models are being developed and tested we suggest the use of the current model in individual decision making and in informed consent considerations because it provides accurate predictions in 7 of 10 patients.

Accuracy of life tables in predicting overall survival in patients after radical prostatectomy.

OBJECTIVE: To test the accuracy of life tables (LT), the standard tool for predicting life-expectancy (LE), but the accuracy of which is unknown in patients with prostate cancer, where the 10-year LE is a widely accepted threshold for the delivery of definitive therapy. PATIENTS AND METHODS: We tested the accuracy of predictions of LE from LT in 9678 men treated with radical prostatectomy (RP) for prostate cancer. The predictions of LE from LT at 10 years after RP were compared to Kaplan Meier-derived 10-year survival values. Moreover, the accuracy of LT predictions was quantified in a Cox-regression using Harrell's concordance index. To control for the effect of prostate cancer mortality, analyses were repeated in a subset of 5955 patients with no evidence of disease recurrence. Additional stratification schemes were applied to control for age and comorbidity. RESULTS: At RP, the median age was 64 years, the median Charlson Comorbidity Index (CCI) was 1 and the median LT-derived LE was 16 years. The median actuarial survival was not reached (mean 12.4 years). In the whole group the LT-predicted 10-year survival was 96.8%, vs an observed of 75.3%. In men with no disease recurrence the LT-predicted survival was 97.3%, vs 81.1% observed. After age and CCI stratification, LT overestimated the 10-year survival the most in those aged 65-69 years and in patients with CCI scores of >2. CONCLUSION: The overestimation of LE can lead to overtreatment of prostate cancer, especially in those men who die early from other causes.

A nomogram is more accurate than a regression tree in predicting lymph node invasion in prostate cancer.

OBJECTIVE: To compare the performance and discriminant properties of two instruments (a tree-structured regression model and a logistic regression-based nomogram), recently developed to predict lymph node invasion (LNI) at radical prostatectomy (RP), in a contemporary cohort of European patients. PATIENTS AND METHODS: The cohort comprised 1525 consecutive men treated with RP and bilateral pelvic LN dissection (PLND) in two tertiary academic centres in Europe. Clinical stage, pretreatment prostate-specific antigen (PSA) level and biopsy Gleason sum were used to test the ability of the regression tree and the nomogram to predict LNI. Accuracy was quantified by the area under the receiver operating characteristic curve (AUC). All analyses were repeated for each participating institution. RESULTS: The AUC for the nomogram was 81%, vs 77% for the regression tree (P = 0.007). When data were stratified according to institution, the nomogram invariably had a higher AUC than the regression tree (Hamburg cohort: nomogram 82.1% vs regression tree 77.0%, P = 0.002; Milan cohort: 82.4% vs 75.9%, respectively; P = 0.03). CONCLUSIONS: Nomogram-based predictions of LNI were more accurate than those derived from a regression tree; therefore, we recommend the use of nomogram-derived predictions.

Baseline prevalence of erectile dysfunction in a prostate cancer screening population.

INTRODUCTION: Erectile dysfunction (ED) is common in older men and can be worsened by prostate cancer (PCa) treatment. True ED rates before PCa treatment are mandatory, in order to assess the rate of ED attributable to PCa treatment. Data derived from population-based studies or from patients surveyed after PCa diagnosis, as well as just prior to treatment may not represent a valid benchmark, as health profiles of the general population might be different to those undergoing PCa screening or as anxiety may worsen existent ED. AIM: To circumvent these limitations, we assessed the baseline rate of ED in PCa diagnosis-free men participating in a PCa awareness event. METHODS: ED was classified according to the International Index of Erectile Function (IIEF) score as absent (IIEF: 25-30), mild (22-24), mild to moderate (17-21), moderate (11-16), or severe (

Lower urinary tract symptoms affect one-third of men in a prostate cancer screening population.

PURPOSE: Lower urinary tract symptoms (LUTS) are common in elderly men. Radical prostatectomy may relieve obstructive symptoms, whereas radiation therapy may exacerbate obstructive or irritative symptoms. Baseline LUTS rates are unknown in populations screened for prostate cancer (PCa). Thus, it is difficult to determine the changes in LUTS that can be attributed to PCa treatment. Therefore, we assessed baseline rates of LUTS in a PCa screening cohort and assessed which of the International Prostate Symptom Score (IPSS) symptoms had the most detrimental effect on quality of life (QoL). METHODS: The IPSS was completed by 1273 men without clinical evidence of PCa who participated in an annual PCa screening event. Presence of irritative or obstructive symptoms was considered when they were reported at least two of five times. Using linear regression analyses, we evaluated the effect of each questionnaire symptom on the IPSS QoL domain. RESULTS: Mean age was 57.6 years (range 40-89 years). Of all in the cohort, 40% (n = 472) reported moderate to severe LUTS (IPSS score > or =8), and 21% (n = 255) were mostly dissatisfied with this condition. Irritative symptoms were reported by 39% (n = 495) and obstructive symptoms by 37%. Of all IPSS symptoms, urinary straining was associated with the least favorable QoL, followed by urinary frequency. CONCLUSION: More than one-third of persons at risk of PCa are affected by either irritative or obstructive symptoms, and one in five of these men is bothered by LUTS. Because PCa treatment may exacerbate LUTS, the severity and impact on QoL should be considered carefully before diagnosis and/or treatment.

Development of a highly accurate nomogram for prediction of the need for exploration in patients with renal trauma.

BACKGROUND: To develop and validate a nomogram for predicting the need for renal exploration after renal trauma. METHODS: From 1995 through 2004, 419 consecutive patients presented to our institution with traumatic renal injury. All were randomly divided into a development (50%, n = 210) and a split sample validation cohort (50%, n = 209). Logistic regression models were used to develop a nomogram for prediction of the need for renal exploration after renal trauma. Internal (200 bootstrap resamples) and 50% split sample validations were performed. RESULTS: Overall, 89 patients (21.2%) underwent renal exploration, from which 60.7% (54 of 89) underwent nephrectomy and 39.3% (35 of 89) underwent renorrhaphy. Nine percent of patients with grade II injury underwent renal exploration, 16% with grade III injuries, 41% with grade IV injuries, and 100% of grade V injuries. The kidney injury scale, the mechanism of injury, the need for transfusion, blood urea nitrogen level, and serum creatinine represented the most informative predictors and were included in the nomogram. The split sample accuracy of the nomogram for prediction of the need for renal exploration was 96.9%. It significantly (p < 0.001) exceeded the accuracy of each of its components including the American Association for the Surgery of Trauma kidney injury scale (87.7%). CONCLUSION: The nomogram generates highly accurate and reproducible predictions of the probability for renal exploration according to our decision-making. It could help standardize the management of patients with renal trauma (i.e., inclusion criteria for clinical trials) and serves as a proof-of-principle that predictive tools can be applied to the trauma setting. Its use may improve the management of renal trauma patients at institutions with limited trauma experience.

Body mass index does not predict prostate-specific antigen or percent free prostate-specific antigen in men undergoing prostate cancer screening.

OBJECTIVES: Body mass index (BMI) may alter serum prostate specific antigen (PSA) and percent free PSA (%fPSA) and may mask the risk of prostate cancer. We investigated the relationship between BMI and PSA or %fPSA. MATERIALS AND METHODS: Height, weight, PSA and %fPSA were assessed in 616 consecutive screened men without prostate cancer. Continuously coded and categorised BMI was studied. Statistical analyses consisted of ANOVA, linear regression, bivariate and partial correlations. RESULTS: Median age was 57 years. Median PSA was 1.0 and median %fPSA was 26. Median BMI was 25.8 kg/m(2). Neither continuously coded nor categorised BMI correlated with either PSA or %fPSA in unadjusted or age-adjusted analyses (all p values > or = 0.3). CONCLUSIONS: Body mass index does not affect PSA or %fPSA in men without known prostate cancer, who undergo prostate cancer screening. Therefore, PSA or %fPSA-based screening or early detection efforts do not require an adjustment for BMI.

Body mass index does not improve the ability to predict biochemical recurrence after radical prostatectomy.

PURPOSE: To test whether body mass index (BMI) improves pre- or post-operative biochemical recurrence (BCR) predictions after radical prostatectomy. MATERIALS AND METHODS: Pre- and post-operative data were available in 2416 and 2499 men, respectively. Cox regression models addressed the association between BMI and the rate of BCR after adjusting for pre- and post-operative predictors. Predictive accuracy was quantified using Harrell's concordance index, with and without BMI and subjected to 200 bootstraps to reduce overfit bias. Differences in predictive accuracy were compared using the Mantel-Haenszel test. RESULTS: After adjusting for either pre- or post-operative variables, increasing BMI was a statistically independent risk factor of BCR in both models (both p0.003). Its addition to pre- and post-operative variables respectively increased predictive accuracy measures from 69.6 to 70.2% (+0.6%, p=0.7) and from 78.1 to 78.4% (+0.3%, p=0.8). CONCLUSION: Our data emphasise that despite its significance, inclusion of BMI into models, to predict BCR, does not improve their accuracy.

Accuracy of life tables in predicting overall survival in candidates for radiotherapy for prostate cancer.

PURPOSE: To test the accuracy of life tables (LTs) in predicting survival in men treated with radiotherapy for localized prostate cancer. METHODS AND MATERIALS: We selected the records of 3,176 patients treated with radiotherapy and who had no clinical evidence of disease relapse. Life table-derived life expectancy (LE) was defined for every individual using a population-specific LT. Age, Charlson Comorbidity Index (CCI), and LT-derived LE were then used as predictors of overall mortality in Cox regression models. Predictive accuracy (PA) was estimated with the Harrell's concordance index and was internally validated with 200 bootstrap resamples. RESULTS: The actuarial median survival was 4.7 years (mean, 6.4 years). At radiotherapy, median age was 70.6 years, median CCI was 2, and median LT-derived LE was 12 years. All variables were statistically significant predictors of overall mortality (all p values <0.001). Age (PA, 60.2%), CCI (PA, 60.1%), and LT-derived LE (PA, 60.2%) were equally accurate. Finally, when age and CCI were combined (PA, 63.2%), both variables provided more accurate mortality predictions than either variable alone (all p values = 0.01). CONCLUSIONS: Life tables have a limited ability to predict LE in patients treated with radiotherapy for prostate cancer. We, therefore, recommend the use of multivariate prognostic models that integrate several variables, such as at least age and comorbidities, to estimate LE. This might help to improve LE estimation during prostate cancer treatment decision making.

Impact of chronic prostatitis-like symptoms on the quality of life in a large group of men.

OBJECTIVE: To assess the prevalence of chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS) symptoms in a large group of men, using the National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), and to evaluate which of the NIH-CPSI symptoms had the most detrimental effect on quality of life (QoL). SUBJECTS AND METHODS: The NIH-CPSI was completed by 1273 men during a male-health promotion event. The presence of CP/CPPS-like symptoms was defined according to the NIH-CPSI criteria (perineal pain or ejaculatory pain and NIH-CPSI-pain score >/= 4). Finally, using linear regression analyses we evaluated the effect of each questionnaire symptom on the NIH-CPSI-QoL domain. RESULTS: The mean (range) age of the men was 57.6 (40-89) years; 133 (10.5%) reported CP/CPPS-like symptoms, with 62 (4.9%) reporting mild and 71 (5.6%) reporting moderate to severe CP/CPPS-like symptoms. Men with CP/CPPS-like symptoms had higher NIH-CPSI-QoL scores, showing a greater detriment of QoL (4.9 vs 2.5; P < 0.001). Of all NIH-CPSI symptoms, urinary frequency was associated with the least favourable QoL, followed by incomplete bladder emptying, pain frequency and pain intensity. The individual pain location had no significant impact on the QoL. CONCLUSION: In a large healthy population CP/CPPS-like symptoms are common and have an important impact on QoL. Functional CP/CPPS-like symptoms have a greater detrimental effect on QoL than pain symptoms. Therefore, these symptoms should represent the main therapeutic targets in affected patients.

Clinicians are poor raters of life-expectancy before radical prostatectomy or definitive radiotherapy for localized prostate cancer.

OBJECTIVE: To test the accuracy of predicting life-expectancy (LE) among 19 raters, as the accurate prediction of LE in candidates for definitive therapy for localized prostate cancer is crucial, and little is known of the ability of clinicians to predict LE. SUBJECTS AND METHODS: We randomly selected the case-vignettes of 50 patients treated with either radical prostatectomy (RP, 25) or external beam radiotherapy (EBRT, 25) for prostate cancer, and who either survived for > 10 years or died earlier with no evidence of disease relapse. The median age at treatment was 67 years and the median Charlson Comorbidity Index (CCI) was 2. The raters consisted of urology staff (six), urology residents (10) and medical students (three). The case-vignettes included patient age, comorbidities and CCI score, and raters were asked to predict the survival at 10 years (yes vs no), assuming no disease relapse. RESULTS: Of the 50 cases, 20 (40%) did not survive for > 10 years; clinicians estimated a mean (range) of 23 (10-35) deaths before 10 years. The mean (95% confidence interval) overall predictive accuracy (0.5 = chance, 1.0 = perfect prediction) of LE predictions was 0.68 (0.64-0.71). Individual accuracy ranged from 0.52 (staff) to 0.78 (staff). There were no important differences among the rater groups (residents 0.69 vs staff 0.67 vs medical students 0.67). CONCLUSIONS: Clinicians are relatively poor at predicting LE; tools to predict LE might be able to improve clinicians' performance in this important part of decision-making about prostate cancer treatment. It remains to be determined whether this limitation exclusively applies to prostate cancer or also to other malignancies.

External validation of a nomogram for prediction of side-specific extracapsular extension at robotic radical prostatectomy.

BACKGROUND AND PURPOSE: Several staging tools have been developed for open radical prostatectomy (ORP) patients. However, the validity of these tools has never been formally tested in patients treated with robot-assisted laparoscopic radical prostatectomy (RALP). We tested the accuracy of an ORP-derived nomogram in predicting the rate of extracapsular extension (ECE) in a large RALP cohort. PATIENTS AND METHODS: Serum prostate specific antigen (PSA) and side-specific clinical stage and biopsy Gleason sum information were used in a previously validated nomogram predicting side-specific ECE. The nomogram-derived predictions were compared with the observed rate of ECE, and the accuracy of the predictions was quantified. Each prostate lobe was analyzed independently. As complete data were available for 576 patients, the analyses targeted 1152 prostate lobes. Median age and serum PSA concentration at radical prostatectomy were 60 years and 5.4 ng/mL, respectively. RESULTS: The majority of side-specific clinical stages were T(1c) (993; 86.2%). Most side-specific biopsy Gleason sums were 6 (572; 49.7%). The median side-specific percentages of positive cores and of cancer were, respectively, 20.0% and 5.0%. At final pathologic review, 107 patients (18.6%) had ECE, and side-specific ECE was present in 117 patients (20.3%). The nomogram was 89% accurate in the RALP cohort v 84% in the previously reported ORP validation. CONCLUSIONS: The ORP side-specific ECE nomogram is highly accurate in the RALP population, suggesting that predictive and possibly prognostic tools developed in ORP patients may be equally accurate in their RALP counterparts.

Screening men for prostate cancer and colorectal cancer: is practice evidence-based?

INTRODUCTION: Controversy persists about whether men should be screened for prostate cancer. On the other hand, the benefit of colorectal cancer screening has been proven for men starting at age 50. We aimed to examine the rate of exposure to previous screening tests for prostate cancer and colorectal cancer in a cohort of men living in Quebec. MATERIALS AND METHODS: As part of an event promoting early prostate cancer detection, 347 men aged 50 to 69 without an established diagnosis of prostate cancer agreed to reply to questions in a previously validated questionnaire. The self-administered questionnaire, which asked about previous screening tests for prostate cancer and colorectal cancer, was completed on-site. RESULTS: Among men aged 50 to 69, previous exposure to a digital rectal examination (DRE), a prostate-specific antigen (PSA) test, a fecal occult blood test (FOBT), and sigmoidoscopy were reported by 132 men (62.9%), 73 men (34.8%), 37 men (17.6%), and 39 men (18.6%) , respectively. Across all age strata (< 50, 50-69, > or = 70 years), PSA and DRE testing were highest in men aged 50 to 69 and were 2- to 3-fold higher than screening tests for colorectal cancer. CONCLUSIONS: In this cohort of asymptomatic Canadian men, overall and age-stratified exposure to tests to detect colon cancer early is far from ideal. Conversely, far more men have been subjected to PSA testing and DRE. Patients should be informed of the benefits and risks of colorectal cancer screening and PSA testing.