Novel clinical risk calculator for improving cancer predictability of mpMRI fusion biopsy in prostates.

PURPOSE: Prostate Imaging-Reporting and Data System (PI-RADS) assists in evaluating lesions on multiparametric magnetic resonance imaging (mpMRI), but there are still ongoing efforts in improving the predictive value for the presence of clinically significant PCa (csPCa) with a Gleason grade group ≥ 2 on Fusion-Biopsy. This pilot study intends to propose an easily implementable method for augmenting predictability of csPCa for PI-RADS. METHODS: A cohort of 151 consecutive patients underwent mpMRI Fusion and random US Biopsy as a result of having at least one PI-RADS lesion grade 3-5 between January 1, 2019 and December 31, 2022. A single radiologist reads all films in this study applying PI-RADS V2. RESULTS: Of the 151 consecutive patients, 49 had a highest lesion of PI-RADS 3, 82 had a highest lesion of PI-RADS 4, and 20 had a highest lesion of PI-RADS 5. For each respective group, 12, 42, and 18 patients had proven csPCa. Two predictive models for csPCa were created by employing a logistical regression with parameters readily available to providers. The models had an AUC of 0.8133 and 0.8206, indicating promising effective models. CONCLUSION: PI-RADS classification has relevant predictability problems for grades 3 and 4. By applying the presented risk calculators, patients with PI-RADS 3 and 4 are better stratified, and thus, a significant number of patients can be spared biopsies with potential complications, such as infection and bleeding. The presented predictive models may be a valuable diagnostic tool, adding additional information in the clinical decision-making process for biopsies.

Comparison of Intermittent and Continuous Androgen Deprivation Therapy in Prostate Cancer Patients: An Up-to-Date Meta-analysis for Urologists and Medical Providers.

INTRODUCTION: Androgen deprivation therapy first became the treatment of choice for advanced prostate cancer in the 1940s with Charles Huggins' discoveries. Eight decades later, androgen deprivation therapy has significantly evolved, and yet is still utilized in various ways to treat certain forms of prostate cancer. For local recurrence after failed primary treatment and for locally advanced and metastatic disease, continuous androgen deprivation therapy has been standard of treatment. However, intermittent androgen deprivation therapy has emerged as a therapeutic alternative to continuous androgen deprivation therapy. The purpose of this meta-analysis is to provide an update on mortality, specifically prostate cancer-specific and nonprostate cancer causes, in order to offer some guidance when selecting the appropriate form of systemic androgen deprivation therapy. METHODS: The PubMed database was searched for prospective randomized clinical trials. Inclusion and exclusion criteria were defined. Using statistical software, we analyzed random-effects models with the assumption that the data were randomly sampled, estimated the pooled log risk ratio, assessed heterogeneity, and created funnel plots to evaluate publication bias. RESULTS: A total of 12 randomized clinical trials met all inclusion criteria for final analysis. There was no statistically significant difference in prostate cancer-specific mortality between intermittent androgen deprivation therapy and continuous androgen deprivation therapy (RR=1.10 [0.85-1.42]). The analysis of nonprostate cancer mortality favored intermittent androgen deprivation therapy over continuous androgen deprivation therapy, but the difference was statistically insignificant (RR=0.94 [0.76-1.17]). CONCLUSIONS: These 2 treatment modalities can be considered as equivalent in long-term treatment outcomes. As intermittent androgen deprivation therapy is more cost-efficient and less likely to yield adverse side effects, future treatment guidelines should consider these advantages over continuous androgen deprivation therapy.

Association between prostate size and glandular tissue volume of the peripheral zone via novel combined MRI and histopathology: possible pathophysiological implications on prostate cancer development.

PURPOSE: Benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are the two most prevalent urologic diseases affecting elderly men. An inverse relationship between BPH/prostate size and PCa incidence is well documented in the current literature, but the precise mechanism is poorly understood. This study aims to investigate the effect of total prostate volume on total glandular tissue volume of the peripheral zone via a novel combination of magnetic resonance imaging (MRI) and histo-anatomical imaging. METHODS: 42 male patients between ages 53-79 years underwent both radical prostatectomy and pre-operative MRI scans. Prostate sizes ranged from 14.8-133.3cc. Quantitative measurements of surgical capsule thickness and glandular epithelial cell density within the peripheral zone (PZ) were obtained on histo-anatomical slides using computer-based imaging software. Quantitative prostatic zonal measurements were obtained from MRI scans. Combining MRI- and histopathology-obtained parameters allowed measurement of the total glandular tissue volume of the PZ (GVPZ). Statistical analysis was performed to identify associations between total prostate volume (TPV) and GVPZ. RESULTS: The Mann-Whitney U-test showed significant decreases in GVPZ in larger prostates when compared to smaller prostates. CONCLUSIONS: Combined MRI and histopathology techniques provide a novel method for accurate measuring of glandular tissue content within the prostatic PZ. The findings of this pilot study support the hypothesis of PZ compression by an expanding transition zone in large BPH prostates, leading to atrophy of PZ glandular tissue. As the majority of PCa originates in the PZ, this dynamic process may explain the protective effect of large BPH prostates against PCa development.

Efficacy of organo-selenium-incorporated urinary catheter tubing for in vitro growth inhibition of E. coli, K. pneumoniae, P. aeruginosa, and H. influenzae.

PURPOSE: Catheter-associated urinary tract infections are of significant medical burden in cost, morbidity, and mortality. Experimental selenium-coated medical devices have demonstrated non-toxic in vitro and in vivo antimicrobial activity. While antimicrobial-coated catheters have shown efficacy in preventing CAUTIs, selenium has not been tested in this context. The purpose of this in vitro study is to evaluate selenium-incorporated urinary catheters for inhibition of uropathogenic bacterial growth and biofilm formation. METHODS: Urinary catheters incorporated with 1% organo-selenium and standard (uncoated) catheters were incubated in vitro with E. coli, K. pneumoniae, P. aeruginosa, H. influenzae, and combinations of these bacteria. Growth was evaluated by colony-forming unit count and visualized with confocal laser and scanning electron microscopy. Organo-selenium catheter material integrity was also tested by soaking the tubing in phosphate-buffered saline for 12 weeks at 37 °C. RESULTS: Organo-selenium-incorporated catheters demonstrated total reduction (100%) of in vitro bacterial growth and biofilm formation for E. coli, K. pneumoniae, H. influenzae, and a combination of these species when compared to control. P. aeruginosa growth was inhibited by approximately 4 logs (99.99%). Complete inhibition of E. coli growth was maintained after long-term phosphate-buffered saline soaking. CONCLUSION: The results demonstrate that organo-selenium was stably incorporated into catheter tubing and inhibited bacterial attachment, growth, and biofilm formation for multiple uropathogenic organisms. Furthermore, long-term soaking of organo-selenium tubing in phosphate-buffered saline did not show any decline in bacterial growth inhibition or biofilm formation. These findings suggest that organo-selenium-incorporated catheters may be advantageous in preventing catheter-associated urinary tract infections and warrant further in vivo and clinical evaluation.

MRI determined prostate volume and the incidence of prostate cancer on MRI-fusion biopsy: a systemic review of reported data for the last 20 years.

PURPOSE: Magnetic resonance imaging (MRI) is a precise, systemic and advantageous imaging technique when compared to transrectal ultrasound (TRUS) which is very operator dependent. The negative correlation between prostate volume and the incidence of prostate cancer (PCa) obtained by TRUS biopsy has been well documented in the literature. The purpose of this systemic review is analyzing the reported MRI-fusion study results on prostate biopsies regarding any correlation between prostate volume and the incidence of PCa. METHODS: After defining the inclusion and exclusion criteria an in-depth review were performed between 01.01.2000 and 02.08.2022 using the PubMed database and applying the "PRISMA" guidelines. RESULTS: Twelve studies qualified, and all showed an inverse/negative relationship between prostate volume and incidence of PCa. Sample sizes ranged from 33 to 2767 patients in single and multi-institutional studies. All studies showed a statistically significant inverse relationship with a p value < 0.05. The graph summarizing all of studies and using Fisher's method revealed a highly significant combined p level of 0.00001. Additionally, not one single study was found showing the contrary (a positive correlation between prostate size and the incidence of PCa). CONCLUSION: To our knowledge, this is the first systemic review of reported MRI-Fusion data on the incidence of PCa in correlation with prostate volume. This MRI review confirms previous TRUS-biopsy studies which demonstrated an inverse relationship between prostate volume and the incidence of PCa, and thus further supports the hypothesis that large prostates size may be protective against PCa when compared to smaller prostates.

Association Between Prostate Size and MRI Determined Quantitative Prostate Zonal Measurements.

Purpose: Benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are the two most prevalent and common urologic diseases impacting elderly men. The current literature has well documented an inverse relationship between prostate/BPH-size and incidence of PCa, but the exact interaction between these two disease entities is not well understood. The purpose of this study is to analyze prostatic zonal measurements with magnetic resonance imaging (MRI) in order to investigate the dynamic changes of the transition zone (TZ) and peripheral zone (PZ) in response to prostate/BPH growth. Methods: Multiparametric magnetic resonance imaging (mpMRI) scans of 430 consecutive male patients aged 18-89 years were obtained to measure the different zonal areas of the prostate. The data were statistically analyzed to identify specific associations between the different measurement parameters and total prostate volume (TPV). Results: The Mann-Whitney U-test showed a significant decline of the average peripheral zone thickness (PZT) (z = -4.5665, p < 0.0001) in larger prostates when compared to smaller prostates. The Spearman correlation between TPV and PZT demonstrated a significant negative correlation (-0.20, p < 0.0001). Conclusion: The data revealed that PZT was significantly smaller in the subgroup of patients with higher TPV. This supports the hypothesis of PZ compression and thinning caused by the growing and expanding TZ in BPH prostates. This dynamic growth-related process in the different prostatic zones may explain the protective effect of BPH against PCa.

Evolution of Androgen Deprivation Therapy (ADT) and Its New Emerging Modalities in Prostate Cancer: An Update for Practicing Urologists, Clinicians and Medical Providers.

Androgen deprivation therapy (ADT) has been the main management strategy for prostate cancer for more than eight decades, nowadays achieved commonly by administration of luteinizing hormone-releasing hormone agonists. ADT markedly suppresses androgen hormones with the long-term risks of adverse events such as muscle weakness, impairment of glucose and lipid metabolism, impotence, osteoporosis, and secondary fractures. Extensive research has provided significantly better insight into the dynamics of ADT including identification of the benefits of sequential and combination therapies. This has led to the development of new pharmaceutical ADT modalities. This review provides a general overview of the evolution of ADT in the context of the new emerging pharmaceutical ADT modalities so that clinicians and medical providers have a better understanding of personalizing the available ADT options with their different risk-benefit profiles.

Any Correlation Between Prostate Volume and Incidence of Prostate Cancer: A Review of Reported Data for the Last Thirty Years.

PURPOSE: Prostate cancer (PCa) is the most common non-skin cancer in men worldwide and more than 80% of men with PCa also have histo-anatomical findings of benign prostate hyperplasia (BPH). It is well documented that BPH develops in the transition zone (TZ), whereas 80-85% of PCa originates in the peripheral zone (PZ) of the prostate. Possible causal links between both disease entities are controversially discussed in the current literature. Some studies have reported that larger prostates have a decreased incidence of PCa compared to smaller prostates. The purpose of this systematic review is to comprehensively summarize studies analyzing any association between prostate gland volume and incidence of PCa. METHODS: A thorough literature review was performed between 01.01.1990 through 02.28.2020 using PubMed and applying the "PRISMA" guidelines. Inclusion and exclusion criteria were defined. RESULTS: Our systematic review found 41 articles reporting an inverse (negative) relationship between prostate gland volume and incidence of prostate cancer. Sample sizes ranged from 114 to 6692 patients in these single institutional and multi-institutional studies. Thirty-nine (95%) of the 41 articles showed a statistically significant inverse relationship. In our search, no study was found showing a positive correlation between BPH size and the incidence of PCa. CONCLUSION: To our knowledge, this is the first systematic review on the important clinical question of interaction between prostate size and the incidence of PCa. The results are demonstrating an inverse relationship, and therefore reveal strong evidence that large prostates may be protective of PCa when compared to smaller prostates.

Quantitative measurements of prostatic zones by MRI and their dependence on prostate size: possible clinical implications in prostate cancer.

AIM: Many studies support an inverse relationship between benign prostate hypertrophy (BPH) size and incidence of prostate cancer (PCa), but the causal link between these conditions is poorly understood. Recent studies suggest that a growing transition zone (TZ) in the prostate may induce pressure on the outer peripheral zone (PZ), leading to atrophy of the glandular tissue where PCa often originates, providing a possible explanation for this interaction. To further investigate this phenomenon, our pilot study uses magnetic resonance imaging (MRI) to examine quantitative zonal changes in a consecutive cohort of prostates. METHODS: MRI scans of male patients [n = 204, 61.57 ± 13.90 years, average body mass index (BMI) 29.05 kg/m2] with various prostate sizes were analyzed statistically to identify possible associations between prostate parameters, such as total prostate volume (TPV) and peripheral zone thickness (PZT). RESULTS: TPV and PZT demonstrated a weak, inverse correlation (r = -0.21, p = 0.002). However, when examining the plotted data, the relationship between TPV and PZT was significantly different when the cohort was divided into two groups; lower TPV: ⩽87.5 ml (n = 188, TPV x- = 36.01 ± 18.18 ml), and higher TPV: >87.5 ml (n = 17, TPV x- = 125.69 ± 41.13 ml). Average PZT differed significantly between these groups (z = -3.5554, p = 0.0004). CONCLUSIONS: PZT was significantly different for patients with lower versus higher TPVs, suggesting that, above a certain point of BPH growth, the PZ is unable to withstand pressure from an expanding TZ, supporting the notion that growing BPH causes compression of the PZ glandular tissue, and, therefore, BPH may be protective against PCa.

Review of New Implantable Tibial Nerve Stimulators in Comparison to Established Third Line Treatment Modalities for Nonneurogenic Overactive Bladder.

INTRODUCTION: New technologies are currently evolving in the treatment of overactive bladder syndrome, giving physicians and patients additional options when conservative care fails to resolve symptoms. The purpose of this review is to compare the prospective clinical data of the new small implantable devices stimulating the tibial nerve to recent prospective clinical studies of sacral nerve stimulation, percutaneous tibial nerve stimulation and botulinum toxin injection, which are currently the most established third line treatment modalities in overactive bladder syndrome. METHODS: A literature search on PubMed®/MEDLINE® was performed for new technologies in neuromodulation to improve overactive bladder syndrome. Additionally, a search was performed for all currently established third line treatment options for comparison of treatment results. The reported prospective clinical data were statistically compared using Fisher's exact test. RESULTS: Two new small implantable devices that stimulate the tibial nerve have been reported over the recent years, BlueWind RENOVA™ and eCoin™. These new implantable devices that stimulate the tibial nerve show very comparable 3-month and 6-month clinical success rates regarding reduction of urinary incontinence episodes when compared to well-established treatment options such as sacral nerve stimulation, percutaneous tibial nerve stimulation and botulinum toxin injections. CONCLUSIONS: The 2 new small implantable devices stimulating the tibial nerve, BlueWind RENOVA and eCoin, show promising clinical results. Both devices are currently undergoing U.S. Food and Drug Administration approval and 1-year followup data should soon be available. Still more clinical data with larger patient cohorts and multicenter studies are necessary to verify the therapeutic efficacy of these new small implantable devices. If confirmed these new small implantable neuromodulation devices may become well-established in the treatment of patients with overactive bladder syndrome.

Patients Willing to Wait: Arrival Time, Wait Time and Patient Satisfaction in an Ambulatory Urology Clinic.

INTRODUCTION: We evaluated the relationship of patient satisfaction to arrival and wait times. We also sought to determine factors that patients considered important to the visit experience. METHODS: A total of 361 participants completed a survey in clinic to record wait times in various areas of the clinic and then rate satisfaction levels with these times and with the care received. A total of 211 participants ranked 6 factors related to the patient experience in the order considered important. RESULTS: Early, on time and late arriving patients spent 26.0, 15.5 and 17.1 minutes in the waiting room and had a total visit duration of 82.5, 67.9 and 72.0 minutes, respectively. Significant differences existed between these times when the early group was compared with the on time and late groups. Early patients were significantly more satisfied with wait time in the waiting room and total clinic visit time compared to late patients. Receiving treatment or relief from a medical problem was the most important factor valued by this population. CONCLUSIONS: Surprisingly, patients with longer waits were more satisfied with the time in the waiting room and overall visit duration, indicating that other variables influence patient satisfaction with perceived wait times. This study provides evidence that wait time might not be as important to patients or impact patient satisfaction as previously thought. On average wait time was ranked fifth in regard to what was important. Longer wait times did not seem to impact patient satisfaction when asked about overall satisfaction with the care received.

Why patients should arrive late: The impact of arrival time on patient satisfaction in an academic clinic.

INTRODUCTION: When considering quality improvement of healthcare practices, patient flow, wait time, and satisfaction are important factors to monitor. Patient wait time can affect satisfaction with the care received, and it can be dependent on many different factors. The purpose of this study was to investigate the impact of patients' arrival times to his/her appointment (early vs. on time vs. late) on patients' wait times and satisfaction. METHODS: 171 patients in an otolaryngology outpatient clinic completed surveys that asked them to record wait times in various areas of the clinic and to provide a satisfaction level for these wait times. Statistical analysis tested for any significant differences in wait time and satisfaction for patients that arrived early, on time, or late. RESULTS: Late, on time, and early arriving patients spent 18.2, 30.7, and 38.8min in the waiting room, respectively. Late, on time, and early arriving patients had a total visit length of 57.4, 68.6, and 81.9min, respectively. There was a significant difference with total time spent in the clinic (p=0.0034) and for overall satisfaction with the total length of the visit (p=0.0202) between late and early arriving patients. CONCLUSIONS: This study indicates patients arriving late had shorter wait times and, not surprisingly, were more satisfied with the visit. The study provides evidence that patients view their wait as starting when they arrive to the clinic and not the actual time of the appointment. It questions the traditional scheduling systems that many clinics still use and proposes that there may be "out-of-the-box" approaches that positively impact patient satisfaction.

Implications on clinical management of the small renal mass in patients 80 years of age and older based on a retrospective review of the SEER database.

PURPOSE: Incidental detection of small renal masses has increased in recent years with increased use of various imaging modalities, and a substantial number of diagnoses are made in the elderly population. Minimally invasive surgical procedures have previously been established as options with excellent long-term oncological results, but surveillance strategies have more recently been introduced as alternatives for surgical intervention. This study reviews the outcomes for elderly patients treated with observation or surgery for small renal masses in order to better elucidate optimal management strategies. METHODS: A total of 4647 patients from the SEER database met criteria for inclusion in this study. Cumulative incidences of RCC-specific mortality and non-RCC-related mortality were estimated, and frequency distributions by tumor size and surgical status were calculated. RESULTS: No difference in RCC-related mortality was observed among all treatment groups, including surveillance, for tumors 1-30 mm in size. RCC-related mortality was significantly lower for surgically treated patients for all other tumor size groups. Mortality unrelated to RCC was significantly higher in patients undergoing surveillance compared to those undergoing surgical intervention for tumor sizes 1-30 or 1-40 mm. CONCLUSIONS: A small renal mass in patients of 80+ years of age is best defined as up to 3 cm in size. For these patients, observation appears be a valid, if not preferential strategy. Patients 80+ years of age with renal masses greater than 3 cm still appear to benefit from surgical intervention.

A Cost-Benefit Analysis of Medical Scribes and Electronic Medical Record System in an Academic Urology Clinic.

INTRODUCTION: Electronic medical records have introduced an additional level of complexity to the patient-provider encounter and medical scribes may offer a solution. We examined how a medical scribe system could support an academic urology clinic. To assess the financial feasibility of this model, we analyzed the additional costs associated with adding medical scribes and we discuss the potential benefits of this system. METHODS: We measured total patient wait and interaction times with staff, and estimated the additional staff required to maintain an increased patient load if medical scribes were introduced. We then calculated the average revenue per patient during the most recent 9 months of data to estimate the minimum increase in the number of patient visits needed to offset the additional staffing needs. RESULTS: Mean ± SD total wait time was 23 minutes 28 seconds ± 13 minutes 4 seconds. Average monthly expenses would increase by $17,452.50 for 6 additional staff members, including 1 nursing assistant, 1 patient service specialist, 1 nurse and 3 scribes. There was an average of 666 monthly office visits and average net revenue to the department was $107.78 per patient visit. The increase in the number of patient visits required to break even would be 162 additional patients per month, representing a 24.3% increase. Additional downstream revenue was considered. CONCLUSIONS: A medical scribe system in the example of an academic urology clinic setting could increase patient flow and decrease the burden on medical providers by reducing computer charting. This model is only financially prudent if the increased expenses are offset by additional revenue from increased patient visits.