Trends and variation in prostate cancer diagnosis via transperineal biopsy in Australia and New Zealand.

BACKGROUND: To describe changes in the use of prostate biopsy techniques among men diagnosed with prostate cancer in Australia and New Zealand and examine factors associated with these changes. METHODS: We extracted data between 2015 and 2019 from 7 jurisdictions of the Australia and New Zealand Prostate Cancer Outcomes Registry (PCOR-ANZ). Distribution and time trend of transrectal (TR) vs. transperineal (TP) biopsy type, differences in the proportion of biopsy type by geographic jurisdiction, diagnosing institute characteristics (public vs. private, metropolitan vs. regional, case volume) and patient characteristics such as socio-economic status (SES), and location of residence were analyzed. RESULTS: We analyzed data from 37,638 patients. The overall proportion of prostate cancer diagnosed by TP increased from 26% to 57% between 2015 and 2019. Patients living in a major city, a more socioeconomically advantaged area or who were diagnosed in a metropolitan or private hospital were more likely to have TP than TR. While all subgroups were observed to increase their use of TP over the study period, uptake grew faster for men from low SES areas and those diagnosed at a regional or low-volume hospital but slower for men living in outer regional/remote areas or treated at a public hospital. CONCLUSIONS: In this binational registry, prostate cancer is now more commonly diagnosed by TP than the TR approach. While the gap between uptakes of TP has diminished for patients with low vs. high SES, disparity has widened for patients from outer regional areas vs major cities and public vs. private hospitals.

Variation in patient reported outcomes following radical prostatectomy: A bi-national registry-based study.

BACKGROUND AND OBJECTIVE: Radical prostatectomy (RP) is a common and widely used treatment for localized prostate cancer. Sequela following RP may include urinary incontinence and sexual dysfunction, outcomes which are recorded within a bi-national Prostate Cancer Outcomes Registry. The objective was to report population-wide urinary incontinence and sexual function outcomes recorded at 12 months following RP; and to quantify and explore factors associated with variation in outcome. MATERIALS AND METHODS: The Prostate Cancer Outcomes Registry of Australia and New Zealand (PCOR-ANZ) was used for this study. Participants were treated with radical prostatectomy between 2016 and 2020. Domain summary scores for urinary incontinence and sexual function from the EPIC-26 instrument were the main outcomes, taken at 12 months following surgery (6-18 months). "Major" urinary and sexual function bother were also assessed. Variation in outcomes was investigated using linear and logistic multivariable regression models adjusted for covariates: age, socioeconomic status, PSA at diagnosis, surgical technique, surgical specimen grade group, margin status, and clinician surgical volume. RESULTS AND CONCLUSIONS: The analytic cohort included 13,083 men with the mean urinary incontinence domain score being 76/100 (SD = 25) with 9.2% reporting major bother. For sexual function, the mean score was 29/100 (SD = 26) with 46% reporting major bother. Of the examined variables, age at surgery and surgical volume category were most predictive of function, with disparities exceeding minimally important differences, though large variation was observed between urologists within volume categories. There is considerable variation in 12-month postprostatectomy functional outcomes. Variation is explained by both patient and clinician factors, though some confounders are unmeasured in this cohort.

Transrectal ultrasound-guided prostate needle biopsy remains a safe method in confirming a prostate cancer diagnosis: a multicentre Australian analysis of infection rates.

PURPOSE: Worldwide, transrectal ultrasound-guided prostate needle remains the most common method of diagnosing prostate cancer. Due to high infective complications reported, some have suggested it is now time to abandon this technique in preference of a trans-perineal approach. The aim of this study was to report on the infection rates following transrectal ultrasound-guided prostate needle biopsy in multiple Australian centres. MATERIALS AND METHODS: Data were collected from seven Australian centres across four states and territories that undertake transrectal ultrasound-guided prostate needle biopsies for the diagnosis of prostate cancer, including major metropolitan and regional centres. In four centres, the data were collected prospectively. Rates of readmissions due to infection, urosepsis resulting in intensive care admission and mortality were recorded. RESULTS: 12,240 prostate biopsies were performed in seven Australian centres between July 1998 and December 2020. There were 105 readmissions for infective complications with rates between centres ranging from 0.19 to 2.60% and an overall rate of 0.86%. Admission to intensive care with sepsis ranged from 0 to 0.23% and overall 0.03%. There was no mortality in the 12,240 cases. CONCLUSION: Infective complications following transrectal ultrasound-guided prostate needle biopsies are very low, occurring in less than 1% of 12,240 biopsies. Though this study included a combination of both prospective and retrospective data and did not offer a comparison with a trans-perineal approach, TRUS prostate biopsy is a safe means of obtaining a prostate cancer diagnosis. Further prospective studies directly comparing the techniques are required prior to abandoning TRUS based upon infectious complications.

Accuracy of the Vesical Imaging-Reporting and Data System (VIRADS) for pre-treatment staging of bladder cancer in an Australian cohort.

INTRODUCTION: To evaluate the performance of the Vesical Imaging-Reporting and Data System (VIRADS) in differentiating muscle-invasive and non-muscle-invasive bladder cancer and whether this reporting system improves inter-reader agreement. METHODS: Sixty-four cases of multiparametric 3 tesla bladder MRI from January 2014 to May 2020 were reviewed retrospectively. T2-weighted, diffusion and post-contrast images were reviewed. All magnetic resonance images were reported by a radiologist with 15 years' experience (Reader 1) and a final year radiology trainee with a special interest in urogenital imaging with 3 years of experience (Reader 2). Both readers were blinded to clinical history and histopathology results when scoring each lesion. RESULTS: The sensitivity and specificity for differentiating MIBC and NMIBC were 91% and 68%, respectively, for Reader 1 and 91% and 63%, respectively, for Reader 2. The inter-reader agreement for assigning VIRADS scores was 0.79. The area under the receiver operator curve for Reader 1 and 2 were not significantly different (Reader 1 = 0.79, Reader 2 = 0.77, P = 0.83). CONCLUSIONS: Staging of bladder cancer prior to treatment can be accurately and reliably diagnosed using VIRADS, a novel, standardised reporting system for bladder MRI.

PSMA PET Scan Era: A Changing Paradigm PSMA PET and Lymph Node Dissection for Prostate Cancer Management.

OBJECTIVES: Staging of extra-prostatic prostate cancer has traditionally been assessed by computerised tomography (CT), bone scan, and where indicated, pelvic lymph node dissection at the time of surgery. The advent of the prostate-specific membrane antigen (PSMA) positron emission tomography (PET) scan shows promise in improving the accuracy of preoperative staging of this cancer. The role of pelvic lymph node dissection and its associated morbidity will be examined. This article will review current literature assessing the current role of PSMA PET and lymph node dissection in the staging and treatment of prostate cancer. DATA SOURCES: Peer-reviewed literature and databases, including Medline and PubMed. CONCLUSIONS: PSMA PET/CT appears to be a promising and superior staging investigation that may replace bone scan and CT scan in guiding treatment decision-making. It has high specificity and positive predictive value, thus in patients with low-risk prostate cancer, unnecessary extended pelvic lymph node dissection (ePLND) may be avoided. It would also help detect lymph nodes in patients with intermediate- or high-risk prostate cancer where ePLND may be required. ePLND remains the gold standard in staging high-risk patients because the PSMA PET/CT scan may under-stage the cancer. IMPLICATION FOR NURSING PRACTICE: Given the increased utilisation of PSMA PET/CT scan as a primary staging investigation in clinical practice for prostate cancer and as an alternative to bone scan and CT scan, it is timely for prostate cancer specialist nurses to understand and recognise the specificity and sensitivity of PSMA PET/CT scans in prostate cancer staging. Because ePLND is the gold standard for staging high-risk disease, prostate cancer specialist nurses should be aware of the complications associated with pelvic lymph node dissection to optimise supportive care for men affected by complications from ePLND.

Acute ischaemic stroke following cisplatin-based chemotherapy for testicular cancer.

Cisplatin is a widely used chemotherapeutic agent for many cancer types. Its toxicity profile includes drug-induced vascular damage. Clinicians should be aware of its varied presentation, including acute and chronic vascular events involving the arterial and venous system. This is a case of an otherwise well 32-year-old man with testicular cancer who received bleomycin/etoposide/cisplatin, and presented following two cycles of chemotherapy with homonymous hemianopia secondary to acute stroke. Acute arterial complications are rare, but clinicians should maintain a high index of suspicion for such events, even in a patient who otherwise has no vascular risk factors. Primary and secondary prevention measures including lifestyle modifications (smoking cessation, diet and exercise), blood pressure and cholesterol management, and antiplatelet therapy should be considered in patients exposed to cisplatin, during and following their treatment.

Australian ultrasound-guided biopsy trends: a 17-year analysis of national data.

BACKGROUND: Prostate cancer diagnosis is primarily performed through ultrasound-guided biopsy. Australia has a Stage 4 aging population and as prostate cancer is a disease of middle aged to elderly patients, it would be expected that there would be an increase in the diagnosis of prostate cancer. However, several key events have occurred in the last 10 years including the introduction of multiparametric magnetic resonance imaging (mpMRI) of the prostate and publication of major prostate cancer screening trials and guidelines. We aimed to characterize the trends in prostate biopsy in Australia in the context of these changes. METHODS: Population and prostate biopsy data were obtained from the Australian Government Bureau of Statistics Census data and the Australian Department of Health Medicare Benefits Schedule between 2000 and 2017. A meta narrative review of publications, guidelines, and policy announcements regarding prostate cancer screening and diagnosis in Australia was performed. Prostate biopsy trends were analyzed from 2000 to 2017 by age-group and year. RESULTS: The 2016 Census data showed the male population of Australia was 11,546,638. Between 2000 and 2017, a total of 373,158 ultrasound-guided biopsies were performed in Australia. A general decline in the total number of prostate biopsies performed was observed from 2009 onwards. There was a transition of the highest prostate biopsy age-group from 55-64 to 65-74 years with the transition occurring in 2012. Biopsy numbers in the age-group 75-84 years also slowly increased from 2000 to 2009 and declined for a short period of time till 2013 and is on the rise again.The decrease in 2010 coincides with the increased uptake of mpMRI in Australia as a new tool in the screening for prostate cancer. Furthermore, this decrease also coincides with the release of the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) prostate cancer screening trials in 2009 and the policy statements developed as a result of these by Royal Australian College of General Practitioners and Urological Society of Australia and New Zealand. CONCLUSION: Interesting trends have been identified through this population study. With an aging population, it would be expected that the number of prostate biopsies would be increasing. It is likely that the introduction of mpMRI in Australia and the release of prostate cancer screening guidelines have decreased the number of patients being screened for prostate cancer. Furthermore, increasing use of active surveillance may be responsible for the increase in the prostate biopsies occurring in the older age-groups.

A Large Stone Within a Ureteroceles: A Diagnostic Pitfall and the Utility of Holmium Laser Deroofing as a Viable Surgical Option.

We describe a case of a partial unilateral duplex system and ureterocele containing a 4 cm stone in a 66-year-old woman who presented with renal colic. Cystoscopic stone removal and deroofing of the ureterocele were performed and a ureteral stent was placed for a total of 6 weeks. Our case is unique as it highlighted the diagnostic pitfalls of ureteroceles, especially when obscured by a large calculus. We also described the use of a Holmium laser to simultaneously incise the ureterocele and fragment the calculus.

Penile Epithelioid Angiomatoid Nodule.

Cutaneous epithelioid angiomatoid nodule is a rare clinical entity that is common on the trunk and limbs. This is the first report of penile cutaneous epithelioid angiomatoid nodule. Although it is a benign entity, it must be differentiated from vascular neoplasms, as it can bear similar clinical and pathologic features.

Anxiety and health-related quality of life (HRQL) in patients undergoing active surveillance of prostate cancer in an Australian centre.

OBJECTIVE: To assess anxiety, health-related quality of life (HRQL) and understanding of active surveillance (AS) in a cohort of patients enrolled in AS of prostate cancer in an Australian setting. PATIENTS AND METHODS: Survey of 61 men currently enrolled in AS for prostate cancer, which included validated measures of sexual function using the International Index of Erectile Function (IIEF-5), voiding using the International Prostate Symptom Severity Score (IPSS) and the Memorial Anxiety Scale for Prostate Cancer (MAX-PC), a measure of prostate cancer specific anxiety. Three novel questions to assess patients' Understanding of AS (UAS). IIEF-5 and IPSS scores obtained through the present survey were compared with patients' scores at initiation of AS. RESULTS: In all, 47 of 61 (77%) patients responded to the survey. There was no significant difference in patients' IIEF-5 and IPSS scores at commencement of AS compared with the survey results. Our patients' on AS MAX-PC scores were consistent with other published cohorts and did not suggest high rates of clinically significant anxiety amongst this cohort. Most (89%) of the patients' responses to the UAS indicated a correct understanding of AS. CONCLUSION: Our patients on AS maintained their HRQL with low levels of anxiety, which did not differ from those reported in other groups of men with prostate cancer and most had an appropriate understanding of AS. This study represents one of the first Australasian investigations on HRQL and anxiety in men on AS of prostate cancer.

Laparoscopic repair of spontaneous perforation of augmentation ileocystoplasty.

Spontaneous perforation complicating augmentation cystoplasty is reported to occur in ≤ 13% of cases. The standard treatment is open surgical repair of the perforation. To our knowledge, this is the first report of laparoscopic repair of a perforated augmentation cystoplasty.