You have accessJournal of UrologyCME1 Apr 2023MP80-08 CLINICAL SIGNIFICANCE OF EXTRAPROSTATIC EXTENSION IN GRADE GROUP 1 PROSTATE CANCER Michael Rezaee, Maximilian Pallauf, Sean Fletcher, Misop Han, Christian Pavlovich, MD Baltimore, Jonathan Epstein, MD Baltimore, Mohamad Allaf, Bruce Trock, and Nirmish Singla Michael RezaeeMichael Rezaee More articles by this author , Maximilian PallaufMaximilian Pallauf More articles by this author , Sean FletcherSean Fletcher More articles by this author , Misop HanMisop Han More articles by this author , Christian PavlovichChristian Pavlovich More articles by this author , MD BaltimoreMD Baltimore More articles by this author , Jonathan EpsteinJonathan Epstein More articles by this author , MD BaltimoreMD Baltimore More articles by this author , Mohamad AllafMohamad Allaf More articles by this author , Bruce TrockBruce Trock More articles by this author , and Nirmish SinglaNirmish Singla More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003357.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Grade group 1 (GG1) prostate cancer (PCa), defined as Gleason 3+3=6 disease, is associated with biological and clinical indolence. Hence, these cancers are amenable to active surveillance (AS) strategies. Despite their exceedingly low risk of metastatic potential, some GG1 tumors have demonstrated the ability to invade locally beyond the prostatic capsule. While extraprostatic extension (EPE; pT3a stage) independently carries a poorer prognosis compared to encapsulated tumors, the oncologic significance of EPE in the setting of pure GG1 disease remains poorly characterized. Therefore, we sought to examine the impact of EPE on biochemical recurrence (BCR) and survival outcomes in men with GG1 disease treated with radical prostatectomy. METHODS: We reviewed our IRB-approved, institutional database of patients who underwent radical prostatectomy for PCa between 2005 and 2022. Patients were categorized into four groups based on final pathology: GG1 without EPE, GG1 with EPE, GG2 (Gleason 3+4=7) without EPE and GG2 with EPE. Kaplan-Meier curves and Fine-Gray competing risk models were used to examine the relationship between disease group and BCR-free, metastasis-free, cancer-specific, and overall survival. BCR and metastasis-free models were adjusted for age, race, preoperative PSA, surgical margin status, year of surgery, and receipt of adjuvant radiation. RESULTS: The final analytic cohort consisted of 6,751 men, of whom 353/3,458 (10.2%) with GG1 disease had EPE. Median follow up was 4 years. BCR occurred in 474/6,751 (7.0%) patients. BCR-free survival was significantly worse for patients with GG1 and EPE (hazard ratio [HR] = 1.9; 95% CI: 1.3-3.1) compared to patients with GG1 and no EPE (Figure 1). Metastasis occurred in 30/6,751 (0.4%) patients. Metastasis-free survival was significantly worse for patients with GG1 and EPE (HR=10.9; 95% CI: 1.2-101.5) compared to patients with GG1 and no EPE. No difference was observed in cancer-specific or overall survival among patients with GG1 PCa in the presence or absence of EPE. CONCLUSIONS: Patients with GG1 PCa and EPE at prostatectomy exhibit worse BCR and metastasis-free survival compared to GG1 patients without EPE. Predicting EPE among patients with pure GG1 disease is critical to better inform personalized strategies for AS or active treatment in this population. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1154 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Rezaee More articles by this author Maximilian Pallauf More articles by this author Sean Fletcher More articles by this author Misop Han More articles by this author Christian Pavlovich More articles by this author MD Baltimore More articles by this author Jonathan Epstein More articles by this author MD Baltimore More articles by this author Mohamad Allaf More articles by this author Bruce Trock More articles by this author Nirmish Singla More articles by this author Expand All Advertisement PDF downloadLoading ...

BackgroundIt is rare for extraprostatic extension (EPE) on biopsy to be seen with Grade Groups (GG) 1-3 (Gleason scores 3 + 3 = 6; 3 + 4 = 7; 4 + 3 = 7) prostatic adenocarcinoma, and there is no data whether this finding should be a contraindication for performing radical prostatectomy (RP). MethodsThirty eight cases with GG 1-3 prostatic adenocarcinoma as the highest grade in the case with EPE on biopsy were identified from our consultation files. Highly unfavorable findings at RP were those that if they could have been predicted preoperatively, might have factored into the decision of whether to proceed with surgery. For these purposes, highly unfavorable pathology at RP was defined as either the presence of seminal vesicle invasion or lymph node metastases or GG5 (Gleason score 9-10). ResultsAmong 37 patients with clinical follow-up data, 18 (49%) received radiation and/or hormonal therapy (RT/HT), 13 patients (35%) either underwent (n = 11) or are planning (n = 2) RP, and 6 patients (16%) received either ablation therapy or active surveillance. Based on the 11 RP pathology reports, 8 were GG2, one GG3 with tertiary pattern 5, and two GG3. Ten cases were reported to have EPE and six cases had positive margins. Only one had highly unfavorable pathology with pT3bN1 disease. The only difference between the RP and the RT/HT groups in their pretreatment parameters was the mean age of the RP patients was 61 compared with 69 for the RT/HT men (p = 0.02); the lack of many cases with highly unfavorable pathology at RP cannot be attributable to a selection bias of men with lower volume cancer on biopsy or lower serum prostate-specific antigen levels choosing RP over RT/HT. ConclusionsDespite EPE on biopsy, most men do not have highly unfavorable pathology at RP, and this treatment should remain an option in this setting.

Supplementary Data from Pro–Prostate-Specific Antigen Measurements in Serum and Tissue Are Associated with Treatment Necessity among Men Enrolled in Expectant Management for Prostate Cancer

You have accessJournal of UrologyCME1 May 2022MP43-01 CLINICAL SIGNIFICANCE OF DETECTION OF PERINEURAL INVASION IN LOW-RISK MEN ON ACTIVE SURVEILLANCE Claire de la Calle, Mufaddal Mamawala, Patricia Landis, Jonathan Epstein, Bruce Trock, Ballentine Carter, and Christian Pavlovich Claire de la CalleClaire de la Calle More articles by this author , Mufaddal MamawalaMufaddal Mamawala More articles by this author , Patricia LandisPatricia Landis More articles by this author , Jonathan EpsteinJonathan Epstein More articles by this author , Bruce TrockBruce Trock More articles by this author , Ballentine CarterBallentine Carter More articles by this author , and Christian PavlovichChristian Pavlovich More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002609.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Perineural Invasion (PNI) is a well described mechanism of extracapsular tumor growth in prostate cancer (PCa). The clinical significance of PNI is unclear however, especially when noted on biopsy in patients with low-risk PCa considering active surveillance (AS). Here we aimed to evaluate the clinical significance of PNI in a cohort of men on AS. METHODS: We retrospectively reviewed 1969 men enrolled in the Johns Hopkins AS registry from 1995 to 2021. All men had either very low-risk (n=1,282) or low-risk (n=687) disease at diagnosis and at least 1 follow-up biopsy. A time dependent cox model was used to assess the association between PNI and grade reclassification (GR) defined as the detection of Gleason grade group (GG) ³2 PCa on a surveillance biopsy, adjusting for age, PSA density, cancer volume metrics, and year of PCa diagnosis. RESULTS: Overall, median age was 66.0 years (IQR 61.0-69.0) and median PSA 4.9 ng/mL (IQR 3.9-6.4). Median follow-up after AS enrollment was 36 months (IQR 15-66). We identified 198 men (10.0%) with PNI detected on at least one prostate biopsy during AS (including the diagnostic biopsy). The men with PNI had significantly higher number of positive cores (median [IQR]: 1 [1-2] vs. 1 [1-2], p <0.001) and maximum percent core involvement (median [IQR]: 10 [1-20] vs. 5 [1-5], p =0.004) than the men without PNI. During AS, the men with PNI had more GR (87 patients (43.9%) vs. 465 (26.3%), p <0.001), and were more likely to undergo any treatment than the men without PNI (120 patients (60.6%) vs. 667 (37.7%), p <0.001). In a multivariable analysis PNI was significantly associated with GR (Table 1). Sixty-three patients with PNI underwent radical prostatectomy (RP) (31.8%) vs. 390 men without PNI (22.0%) (p =0.003). The men with PNI had more extraprostatic extension at RP compared to the group of men without PNI detected at biopsy (33.3% vs. 19.5%, p =0.02), but there was no difference in adverse pathology (defined at GG3 or higher and/or pT3 or higher and/or lymph node involvement) between the two groups. CONCLUSIONS: PNI detected on biopsy in patients with low-risk PCa on AS is strongly associated with grade reclassification. PNI should not preclude low-risk patients from AS but our findings will allow us to better counsel men with PNI choosing AS versus treatment and help us determine how aggressively to monitor them while on AS. Source of Funding: Funded by the James Buchanan Brady Urological Institute © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e740 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Claire de la Calle More articles by this author Mufaddal Mamawala More articles by this author Patricia Landis More articles by this author Jonathan Epstein More articles by this author Bruce Trock More articles by this author Ballentine Carter More articles by this author Christian Pavlovich More articles by this author Expand All Advertisement PDF downloadLoading ...

Background: Cooling thermal burns with running water is a recommended first aid intervention. However, guidance on the ideal duration of cooling remains controversial and inconsistent across organisations. Aim: To perform a systematic review of the evidence for the question; Among adults and children with thermal burn, does active cooling using running water as an immediate first aid intervention for 20 min or more, compared with active cooling using running water for any other duration, change the outcomes of burn size, burn depth, pain, adverse outcome (hypothermia) or complications? Method: We searched Medline, Embase, Cochrane Database of Systematic Reviews and used ROBINS-I to assess for risk of bias. We used Grading of Recommendations, Assessment, Development and Evaluation methodology for determining the certainty of evidence. We included all studies that compared the selected outcomes of the duration of cooling of thermal burns with water in all patient ages. (PROSPERO registration number: CRD42021180665). From 560 screened references, we included four observational studies. In these studies, 48% of burns were cooled for 20 min or more. We found no benefit for a duration of 20 min or more of cooling when compared with less than 20 min of cooling for the outcomes of size and depth of burn, re-epithelialization, or skin grafting. The evidence is of very low certainty owing to limitations in study design, risk of bias and indirectness. Conclusion: The optimal duration of cooling for thermal burns remains unknown and future prospective research is indicated to better define this treatment recommendation. (C) 2021 The Author(s). Published by Elsevier Ltd.

The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.

The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.

The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.

Objective Trauma, with resultant bleeding, is a significant cause of morbidity and mortality throughout the world; however, the best possible method of bleeding control by immediate responders is unknown. We performed a systematic review of the effectiveness of treatment modalities for severe, life-threatening external bleeding in the out-of-hospital first aid setting. Methods: We followed the Cochrane Handbook for Systematic Reviews of Interventions methodology and report results according to PRISMA guidelines. We included randomized controlled trials, non-randomized comparative studies and case series investigating adults and children with severe, life-threatening external bleeding who were treated with therapies potentially suitable for first aid providers. We assessed the certainty of the evidence and risk of bias. Outcomes were prioritized by first aid specialists based on importance for patients and decision-makers and included mortality due to bleeding, all-cause mortality, cessation of bleeding, time to cessation of bleeding, a decrease in bleeding, and complications/adverse effects. Results were reported in Evidence Profiles. Results: Of the 1,051 full-text articles screened, 107 were included for analysis including 22,798 patients. The primary methods of bleeding control were tourniquets (n = 49), hemostatic dressings (n = 34), hemostatic devices (n = 14), pressure dressings/bandages/devices (n = 8), pressure points (n = 4), including 2 studies that reported multiple hemorrhage control methods. Overall, certainty of evidence was very low and often relied on indirect evidence and poorly controlled studies. Tourniquets were associated with a decrease in mortality when compared with direct manual pressure. Hemostatic dressings resulted in a shorter time to hemostasis than direct manual pressure using standard dressings. Direct manual compression resulted in a shorter time to hemostasis than pressure dressings/devices. Conclusion: Overall, data regarding the control of life-threatening bleeding is of very low certainty, making it difficult to draw robust conclusions for treatment by immediate responders. While more robust data is needed on first aid treatments of life-threatening bleeding, this systematic review aggregates the most comprehensive to date to help guide recommendations. Key words: bleeding; hemorrhage; tourniquet; hemostatic dressing; direct pressure

This is the summary publication of the International Liaison Committee on Resuscitation's 2020 International Consensus on First Aid Science With Treatment Recommendations. It addresses the most recent published evidence reviewed by the First Aid Task Force science experts. This summary addresses the topics of first aid methods of glucose administration for hypoglycemia; techniques for cooling of exertional hyperthermia and heatstroke; recognition of acute stroke; the use of supplementary oxygen in acute stroke; early or first aid use of aspirin for chest pain; control of life-threatening bleeding through the use of tourniquets, hemostatic dressings, direct pressure, or pressure devices; the use of a compression wrap for closed extremity joint injuries; and temporary storage of an avulsed tooth. Additional summaries of scoping reviews are presented for the use of a recovery position, recognition of a concussion, and 6 other first aid topics. The First Aid Task Force has assessed, discussed, and debated the certainty of evidence on the basis of Grading of Recommendations, Assessment, Development, and Evaluation criteria and present their consensus treatment recommendations with evidence-to-decision highlights and identified priority knowledge gaps for future research.

Background: Heat stroke is an emergent condition characterized by hyperthermia (>40 degrees C/> 104 degrees F) and nervous system dysregulation. There are two primary etiologies: exertional which occurs during physical activity and non-exertional which occurs during extreme heat events without physical exertion. Left untreated, both may lead to significant morbidity, are considered a special circumstance for cardiac arrest, and cause of mortality. Methods: We searched Medline, Embase, CINAHL and SPORTDiscus. We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods and risk of bias assessments to determine the certainty and quality of evidence. We included randomized controlled trials, non-randomized trials, cohort studies and case series of five or more patients that evaluated adults and children with non-exertional or exertional heat stroke or exertional hyperthermia, and any cooling technique applicable to first aid and prehospital settings. Outcomes included: cooling rate, mortality, neurological dysfunction, adverse effects and hospital length of stay. Results: We included 63 studies, of which 37 were controlled studies, two were cohort studies and 24 were case series of heat stroke patients. Water immersion of adults with exertional hyperthermia [cold water (14-17 degrees C/57.2-62.6 degrees F), colder water (8-12 degrees C/48.2 -53.6 degrees F) and ice water (1-5 degrees C/33.8-41 degrees F)] resulted in faster cooling rates when compared to passive cooling. No single water temperature range was found to be associated with a quicker core temperature reduction than another (cold, colder or ice). Conclusion: Water immersion techniques (using 1-17 degrees C water) more effectively lowered core body temperatures when compared with passive cooling, in hyperthermic adults. The available evidence suggests water immersion can rapidly reduce core body temperature in settings where it is feasible.

This 2019 focused update to the American Heart Association and American Red Cross first aid guidelines follows the completion of a systematic review of treatments for presyncope of vasovagal or orthostatic origin. This review was commissioned by the International Liaison Committee on Resuscitation and resulted in the development of an international summary statement of the International Liaison Committee on Resuscitation First Aid Task Force Consensus on Science With Treatment Recommendations. This focused update highlights the evidence supporting specific interventions for presyncope of orthostatic or vasovagal origin and recommends the use of physical counterpressure maneuvers. These maneuvers include the contraction of muscles of the body such as the legs, arms, abdomen, or neck, with the goal of elevating blood pressure and alleviating symptoms. Although lower-body counterpressure maneuvers are favored over upper-body counterpressure maneuvers, multiple methods can be beneficial, depending on the situation.

This 2019 focused update to the American Heart Association and American Red Cross first aid guidelines follows the completion of a systematic review of treatments for presyncope of vasovagal or orthostatic origin. This review was commissioned by the International Liaison Committee on Resuscitation and resulted in the development of an international summary statement of the International Liaison Committee on Resuscitation First Aid Task Force Consensus on Science With Treatment Recommendations. This focused update highlights the evidence supporting specific interventions for presyncope of orthostatic or vasovagal origin and recommends the use of physical counterpressure maneuvers. These maneuvers include the contraction of muscles of the body such as the legs, arms, abdomen, or neck, with the goal of elevating blood pressure and alleviating symptoms. Although lower-body counterpressure maneuvers are favored over upper-body counterpressure maneuvers, multiple methods can be beneficial, depending on the situation.

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I (MP48)1 Apr 2019MP48-12 ACTIVE SURVEILLANCE OF VERY LOW AND LOW RISK PROSTATE CANCER: LONG-TERM OUTCOMES FROM A LARGE PROSPECTIVE COHORT Mufaddal Mamawala*, Jeffrey Tosoian, Jonathan Epstein, Patricia Landis, Demetrios Simopoulos, Katarzyna Macura, Michael Gorin, and H. Ballentine Carter Mufaddal Mamawala*Mufaddal Mamawala* More articles by this author , Jeffrey TosoianJeffrey Tosoian More articles by this author , Jonathan EpsteinJonathan Epstein More articles by this author , Patricia LandisPatricia Landis More articles by this author , Demetrios SimopoulosDemetrios Simopoulos More articles by this author , Katarzyna MacuraKatarzyna Macura More articles by this author , Michael GorinMichael Gorin More articles by this author , and H. Ballentine CarterH. Ballentine Carter More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556425.40797.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Active surveillance (AS) is a first-line management option for men with very low risk (VLR) and low risk (LR) prostate cancer. We sought to assess and describe long-term clinical outcomes and the optimal approach to AS. METHODS: Prospectively-defined cohort study initiated in January 1995 and followed clinically through July 2018, comprised of men diagnosed with VLR (n=1293) or LR (n=525) prostate cancer who elected initial management with AS in favor of immediate definitive therapy. The 10- and 15-year cumulative incidence were evaluated using a competing risk analysis for primary outcomes: all-cause mortality, prostate cancer-specific mortality or metastatic disease; and secondary outcomes: biopsy grade reclassification (BGR) to Grade Group (GG) ≥ 2, BGR to GG ≥ 3, and curative intervention. Additionally, the use of targeted biopsy was assessed. RESULTS: 1818 men (median age 66, IQR 61 -69) were enrolled in AS during the study period with a median follow-up of 5.0 years (range 0.01-20.0); 920 men ≥5 years and 305 ≥10 years. The median interval between surveillance biopsies was 13 months (IQR 12 -15). There were 88 deaths due to causes other than prostate cancer, 4 deaths due to prostate cancer, and a total of 10 patients who experienced prostate cancer death or metastatic disease (6 VLR and 4 LR). The cumulative incidence of prostate cancer death or metastasis was 0.6% at 10 years and 1.4% at 15 years. The cumulative hazard ratio of non-prostate-cancer death to prostate cancer death or metastasis was 26:1 (Figure). The 10- and 15-year cumulative incidence of BGR to GG ≥ 2, BGR to GG ≥ 3, and curative intervention was 30% and 32%; 10% and 11%; and 48% and 52%, respectively. The median treatment free survival was 11 years. Since it was introduced, the use of targeted biopsy significantly increased from 21% in 2014 to 36% in 2017 (p= <0.001), while misclassification rates, i.e., BGR within first 2 surveillance biopsies, significantly decreased from 21% in 2014 to 7% in 2017 (p = 0.002). CONCLUSIONS: In a large, single-institution, prospective AS cohort under careful monitoring, the risk of cancer death or metastasis was low over long-term follow-up. These data continue to support the use of AS in the management of most patients with favorable-risk prostate cancer. Source of Funding: none Baltimore, MD; Ann Arbor, MI; Baltimore, MD© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e701-e701 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mufaddal Mamawala* More articles by this author Jeffrey Tosoian More articles by this author Jonathan Epstein More articles by this author Patricia Landis More articles by this author Demetrios Simopoulos More articles by this author Katarzyna Macura More articles by this author Michael Gorin More articles by this author H. Ballentine Carter More articles by this author Expand All Advertisement PDF downloadLoading ...

This 2019 focused update to the American Heart Association and American Red Cross first aid guidelines follows the completion of a systematic review of treatments for presyncope of vasovagal or orthostatic origin. This review was commissioned by the International Liaison Committee on Resuscitation and resulted in the development of an international summary statement of the International Liaison Committee on Resuscitation First Aid Task Force Consensus on Science With Treatment Recommendations. This focused update highlights the evidence supporting specific interventions for presyncope of orthostatic or vasovagal origin and recommends the use of physical counterpressure maneuvers. These maneuvers include the contraction of muscles of the body such as the legs, arms, abdomen, or neck, with the goal of elevating blood pressure and alleviating symptoms. Although lower-body counterpressure maneuvers are favored over upper-body counterpressure maneuvers, multiple methods can be beneficial, depending on the situation.

The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research.