Developing a men's health program.

INTRODUCTION: Many healthcare disparities exist between men and women due to differences in lifestyles and health seeking behaviors. Such differences lead to higher mortality and lower life expectancy in men. The field of urology has the unique opportunity of acting as a gateway to men's overall health, where a urologist can diagnose medical diseases in patients and refer them to the appropriate specialist. In this review article we discuss the need for men's health programs and our experience with creating such program in Philadelphia. METHODS AND MATERIALS: In this review article we outline our experience with creating a men's health program to serve the diverse Philadelphia population. We discuss the healthcare needs and demographics of our geographical area. RESULTS: We identify factors essential for the success of our men's health program such as: developing a business model, drawing support from our institution, identifying key medical specialties to include in the program, assigning patient navigators and integration of electronic medical records. CONCLUSION: Men's health program provide tailored care for male patients that best suits their needs and healthcare seeking behaviors. The success of such programs requires commitment from physicians from many medical specialties to provide holistic care.

Gross hematuria: An unusual presenting symptom of systemic wild-type transthyretinamyloidosis.

Amyloidosis of the urinary bladder is a rare cause of gross hematuria. In patients with systemic amyloidosis, identification is nearly always related to cardiac complaints; urologic presenting symptoms are extremely uncommon. We present a 77-year-old male patient with painless gross hematuria ultimately found to be secondary to systemic wild-type transthyretin amyloidosis. He underwent transurethral resection of the bladder lesion and was initiated on transthyretin stabilizing medication. In the 6 months since starting treatment, the patient has had no further episodes of gross hematuria, but will require cystoscopic surveillance for evidence of recurrence or concomittment urothelial carcinoma.

Pretest Genetic Education Video Versus Genetic Counseling for Men Considering Prostate Cancer Germline Testing: A Patient-Choice Study to Address Urgent Practice Needs.

PURPOSE: Germline testing (GT) for prostate cancer (PCA) is now central to treatment and hereditary cancer assessment. With rising demand for and shortage of genetic counseling (GC), tools to deliver pretest informed consent across practice settings are needed to improve access to GT and precision care. Here, we report on Evaluation and Management for Prostate Oncology, Wellness, and Risk (EMPOWER), a patient-choice study for pretest video-based genetic education (VBGE) versus GC to inform urgent practice needs. PATIENTS AND METHODS: Men with PCA or at risk for PCA (family history of PCA) were eligible and could choose pretest VBGE or GC. Outcomes included decisional conflict for GT, change in genetics knowledge, satisfaction, and intention to share results with family and/or providers. Descriptive statistics summarized results with counts and percentages for categorical variables and mean ± standard deviation for continuous variables. Data were compared with Fisher's exact, chi-squared, or Wilcoxon two-sample tests. Mean change in genetics knowledge was compared with t tests. The significance level was set a priori at .05. RESULTS: Data on the first 127 participants were analyzed. Characteristics were White (85.8%), bachelor's degree (66.9%), and PCA diagnosis (90.6%). The majority chose VBGE (71%) versus GC (29%; P < .001). No differences were observed in decisional conflict for GT or satisfaction. Cancer genetics knowledge improved in both groups without significant difference (+0.9 VBGE, +1.8 GC, P = .056). Men who chose VBGE had higher intention to share GT results (96.4% VBGE v 86.4% GC, P = .02). Both groups had high rates of GT uptake (VBGE 94.4%, GC 92%). CONCLUSION: A substantial proportion of men opted for pretest VBGE, with comparable patient-reported outcomes and uptake of GT. The results support the use of pretest video to address the critical GC shortage in the precision era.

Re-implantation of suboptimal prostate seed implantation: technique with intraoperative treatment planning.

PURPOSE: Post-implant dosimetry following prostate seed implantation (PSI) occasionally reveals suboptimal dosimetric coverage of the gland. Published reports of re-implantation techniques have focused on earlier-generation techniques, including preplanned approaches and stranded seeds. The purpose of this case report is to describe a customizable approach to perform corrective re-implantation using loose seeds and intraoperative planning technique. MATERIAL AND METHODS: This case report describes a 63-year-old male with favorable risk prostate adenocarcinoma receiving PSI. Thirty day post-implant dosimetric evaluation revealed suboptimal coverage of the base of the gland. Using guidance from post-implant CT-images and real-time planning, the patient received a corrective re-implantation with intraoperative planning. RESULTS: Post-implant dosimetry after re-implantation procedure with intraoperative planning yielded improved target volume coverage that achieved standard dosimetric criteria. CONCLUSIONS: Re-implantation as a salvage treatment technique after sub-optimal PSI is a valid treatment option performed with intraoperative real-time planning.

Technique of outpatient placement of intraprostatic fiducial markers before external beam radiotherapy.

OBJECTIVES: To describe our technique and preliminary toxicity profile for ultrasound-guided outpatient placement of intraprostatic fiducial markers before intensity-modulated radiotherapy (IMRT) for prostate cancer. METHODS: A total of 98 men with prostate cancer who underwent IMRT from August 2003 through September 2006 were included in the present study. All subjects underwent ultrasound-guided transrectal placement of 3 gold intraprostatic fiducial markers under local anesthesia using our standard technique. Daily on-line image guidance adjustments were made according to the location of the fiducial markers. The charts were reviewed to evaluate the acute toxicity profile of IMRT with fiducial markers during the treatment course using the Common Toxicity Criteria, version 3.0. The International Prostate Symptom Score, clinical stage, and Gleason score were tabulated. RESULTS: Fiducial marker placement proceeded without complications. The median radiation dose administered was 75.6 Gy (range 50-79.2). Grade 1 or 2 enteritis was observed in 30 of 98 patients (31%), with no cases of rectal bleeding. Grade 1 or 2 perineal dermatitis occurred in 9 patients (9.2%). Genitourinary toxicity manifested in 75 patients (77%) as grade 1 or 2 cystitis. Four patients (4%) developed urinary retention, requiring catheterization. One patient (1%) had an episode of gross hematuria. No grade 3 toxicities were observed. No significant change in the International Prostate Symptom Score at 3 months in patients with available follow-up was found (P = .34). CONCLUSIONS: The placement of intraprostatic fiducial markers before prostate IMRT is a safe and efficacious method for prostate localization that produces an excellent toxicity profile.