410 Background: Bladder cancer is the second most common urologic malignancy with over 73,350 new cases diagnosed annually of which the incidence is increasing in the elderly. Radical cystectomy (RC), the gold standard for muscle invasive disease, carries a particularly high risk of morbidity and mortality, as well as a protracted length of stay (LOS) and increased readmission rates when compared with other major urologic procedures. Furthermore, in 2013, the Institute of Medicine (IOM) declared cancer care in the US a national crisis with a priority to improve quality of care through care coordination (CC). Simultaneously, enhanced recovery after surgery (ERAS) protocols have surfaced as coordinated, evidence-based models designed to standardize medical care, improve outcomes, and lower healthcare costs. At City of Hope (COH), we evaluated our ERAS and CC pathway. Methods: In April of 2014, an ERAS and CC pathway for bladder cancer was launched at COH with an emphasis on the perioperative care of patients (pts) from a multi-disciplinary team perspective. Preoperatively, pts undergo orientation on stoma education, goals of care, and treatment expectations. The pathway clinically focuses on avoidance of bowel preparation, early feeding, minimizing narcotics, and u-opioid antagonists. On discharge, pts are closely monitored via scheduled phone calls as well as clinic visits. Quality metrics including LOS, complications, and readmissions are reported as median and interquartile range along with descriptive statistics including chi-square and Wilcoxon rank-sum tests. Results: Since implementation, the median LOS was statistically significant between cohorts with 6 days for pts on pathway compared to 8 days for those preceding the pathway (p = 0.0007). Furthermore, the complication and readmission rates have decreased from 67.5% to 50% and from 35% to 30%, respectively. Dehydration and urinary tract infection (UTI) accounted for 17.9% and 21.4% of readmissions for those prior to the pathway, while UTI occurred in 5% of pts readmitted after adhering to the pathway. Conclusions: Our ERAS and CC pathway has reduced LOS without an increase in complication nor readmission rates.

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety I1 Apr 2016PD02-02 ENHANCED RECOVERY AFTER SURGERY AND CARE COORDINATION PATHWAY AT CITY OF HOPE: DECREASED LENGTH OF STAY, READMISSIONS, AND COMPLICATIONS Steven V. Kardos, M.D. Kevin G. Chan, M.D. Bertram Yuh, M.D. Jonathan Yamzon, M.D. Nora H. Ruel, Finly Zachariah, M.D. Clayton S. Lau, andM.D. Laura CrocittoM.D. Steven V. KardosSteven V. Kardos More articles by this author , Kevin G. ChanKevin G. Chan More articles by this author , Bertram YuhBertram Yuh More articles by this author , Jonathan YamzonJonathan Yamzon More articles by this author , Nora H. RuelNora H. Ruel More articles by this author , Finly ZachariahFinly Zachariah More articles by this author , Clayton S. LauClayton S. Lau More articles by this author , and Laura CrocittoLaura Crocitto More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2076AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder cancer is the second most common urologic malignancy with over 73,350 new cases diagnosed annually of which the incidence is increasing in the elderly. Radical cystectomy (RC), the gold standard for muscle invasive disease, carries a particularly high risk of morbidity and mortality, as well as a protracted length of stay (LOS) and increased readmission rates. Furthermore, in 2013, the Institute of Medicine (IOM) declared cancer care in the US a national crisis with a priority to improve quality of care through care coordination. Simultaneously, enhanced recovery after surgery (ERAS) protocols have surfaced as coordinated, evidence-based models designed to standardize medical care, improve outcomes, and lower healthcare costs. At City of Hope (COH), we evaluated our ERAS and care coordination pathway. METHODS In April of 2014, an ERAS and care coordination pathway for bladder cancer was launched at COH with an emphasis on the perioperative care of patients (pts) from a multi-disciplinary team perspective. Preoperatively, pts undergo orientation on stoma education, goals of care, and treatment expectations. The pathway clinically focuses on avoidance of bowel preparation, early feeding and mobilization, minimizing narcotic pain management, and u-opioid antagonists. On discharge, pts are closely monitored via scheduled phone calls as well as clinic visits. Quality metrics including LOS, complications, and readmissions are reported as median and interquartile range (IQR) along with descriptive statistics including chi-square and Wilcoxon rank-sum tests. RESULTS Table 1 illustrates the demographic and clinical characteristics of the cohorts. Since implementation, the median LOS was statistically significant between cohorts with 6 days for pts on pathway compared to 8 days for those preceding the pathway (p=0.0007). Furthermore, the complication and readmission rates have decreased from 67.5% to 50% and from 35% to 30%, respectively. Dehydration and urinary tract infection (UTI) accounted for 17.9% and 21.4% of readmissions for those prior to the pathway, while UTI occurred in 5% of pts readmitted after adhering to the pathway. CONCLUSIONS Our ERAS and care coordination pathway has reduced LOS without an increase in complication nor readmission rates. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e51 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Steven V. Kardos More articles by this author Kevin G. Chan More articles by this author Bertram Yuh More articles by this author Jonathan Yamzon More articles by this author Nora H. Ruel More articles by this author Finly Zachariah More articles by this author Clayton S. Lau More articles by this author Laura Crocitto More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyBladder Cancer: Natural History and Pathophysiology1 Apr 2015MP64-08 ESTABLISHING A CARE COORDINATION PATHWAY FOR BLADDER CANCER CYSTECTOMY PATIENTS Jason Bourque, Kevin Chan, Timothy Wilson, Clayton Lau, Bertram Yuh, Jonathan Yamzon, Finly Zachariah, and Laura Crocitto Jason BourqueJason Bourque More articles by this author , Kevin ChanKevin Chan More articles by this author , Timothy WilsonTimothy Wilson More articles by this author , Clayton LauClayton Lau More articles by this author , Bertram YuhBertram Yuh More articles by this author , Jonathan YamzonJonathan Yamzon More articles by this author , Finly ZachariahFinly Zachariah More articles by this author , and Laura CrocittoLaura Crocitto More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2319AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Institute of Medicine (IOM) identified care coordination as a key strategy with potential to improve the safety and effectiveness of implemented care. This type of delivery of care becomes even more essential with complex medical conditions like bladder cancer. At City of Hope National Medical Center (COH), we developed a pilot program for bladder cancer patients undergoing cystectomy to provide the benefits of care coordination to our patients. METHODS In April of 2014, we convened a multidisciplinary team consisting of representatives from Case management, Medical Oncology, Supportive care medicine and Urology and developed a care pathway (CP) to improve upon these metrics. The CP begins with identification of a newly diagnosed bladder cancer patient. Based on National Comprehensive Cancer Network criteria the patient then proceeds to cystectomy or neoadjuvant chemotherapy followed by cystectomy. The CP involves preoperative planning and orientation with the patient and family. It continues through the perioperative and postoperative period. Post-discharge the patients are monitored closely via phone calls and clinic visits. Quality metrics including length of stay, postoperative complications, readmissions, adherence to the pathway, and patient satisfaction are tracked and regularly assessed. RESULTS There have been 34 cystectomies performed and 29 are available for review, currently. Historically, cystectomy patient's lengths of stay (LOS) and readmission rates at COH have been 10.65 days and 40% respectively, and the most common cause of readmission being dehydration and infection. Since the CP implementation, the LOS and readmission rates are 6.4 days and 31.03% respectively. The most common cause of readmission remains infection at 55.5%, and dehydration only accounts for 22% of readmissions. Major complications rates of Clavien Grade III-IV have been at 24% lower than the historical major complications rate at COH of 32%. Adherence to the CP in the preoperative and postoperative phases has been excellent with only 3 patients deviating from the CP. CONCLUSIONS The IOM has identified care coordination as a national priority for improving quality of care in the US. We believe value-driven care coordination provides the best model to care for complex cystectomy patients. After only 5 months of implementation, we have been able to significantly reduce our LOS and readmission rate. Postoperative readmission for dehydration has also been reduced. As the program matures, we expect the CP to continue to improve the way we deliver care to our cystectomy patients. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e800-e801 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jason Bourque More articles by this author Kevin Chan More articles by this author Timothy Wilson More articles by this author Clayton Lau More articles by this author Bertram Yuh More articles by this author Jonathan Yamzon More articles by this author Finly Zachariah More articles by this author Laura Crocitto More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

62 Background: The Institute of Medicine (IOM) identified care coordination as a key strategy with potential to improve the safety and effectiveness of implemented care by deliberately organizing patient care activities and sharing information among all participants concerned. Palliative care maximizes quality of life for patient and family in serious illness and can be provided early and concurrently with curative therapies. At City of Hope National Medical Center (COH), we developed a pilot program for bladder cancer patients undergoing cystectomy to provide the benefits of care coordination and palliative care. Methods: 72 patients underwent cystectomy at COH from 2011-2013, the average case mix index was 3.51, the average length of stay (LOS) was 10.65 days, the LOS index was.92, Cost index 1.61, 30-day readmission rate 32.14%, and the most common causes for readmission were infection and dehydration. Based on comparative data, the urology service supported development of a novel pathway by a multidisciplinary team. The goals of the pathway are to facilitate navigation through the healthcare system, integrate tablet-based bio-psycho-social screening to proactively address patient and caregiver needs and goals, optimize medications to improve symptom management and recovery, empower patients with teach-back education, have anticipated interventions for likely readmission reasons, and develop effective collaboration amongst multidisciplinary providers across settings. The metrics include LOS, readmission rates, patient and family satisfaction, advanced directives on file, and cost index. Results: Hospital leadership and provider buy in was obtained, a daily rounding multidisciplinary team was created, change champions were identified, staff engagement increased, and COH and community agency staff were equipped with needed skills and support. Care model diagrams and clinical pathway orders were developed. Education materials were revised and updated. The pilot launched in April of 2014. Conclusions: We believe that a care coordination model with early integration of palliative care will improve the effectiveness of care delivered to our bladder cancer patients. A six-month retrospective review will be done to assess metric achievement.

WHELAN C, CROCITTOL L, KAWACHIM, CHAN K, SMITH D, WILSON T, SMITH S. The influence of PSA-RNA yield on the analysis of expressed prostatic secretions (EPS) for prostate cancer diagnosis. Can J Urol 2013;20(1):6597-6602. Introduction: In patients with prostate cancer, luminal prostate-specific antigen (P SA) enters the circulation because the basement membrane and glandular epithelium are damaged. Given that excess mobilization of prostate cells during prostatic massage can influence normalization in diagnostic testing, we studied P S A mRNA levels in expressed prostatic secretions (EPS) from patients undergoing biopsy for prostate cancer to determine if prostate cells are preferentially mobilized from patients with prostate cancer during prostatic massage.Materials and methods: Quantitative Reverse-Transcription PCR (qRT-PCR) was used to measure the RNA levels of GAPDH, PSA, TMPRSS2:ERG and PCA3 in EPS specimens obtained from patients undergoing biopsy for prostate cancer.Results: The level of PSA mRNA is significantly elevated in EPS specimens obtained from patients with a subsequent diagnosis of prostate cancer. This correlation influenced diagnostic testing results from EPS in two ways. First, when used as an exclusion parameter it appears to improve the diagnostic performance of TMPRSS2:ERG in EPS. Second, when used as a normalization parameter it appears to decrease the performance of these same tests.Conclusion: When comparing the results of mRNA based prostate cancer diagnostics in EPS it will be essential to consider PSA mRNA as a prostate specific gene and not a housekeeping gene.

We examined the relations among generalized positive expectations (optimism), prostate-cancer specific expectations, and prostate cancer-related quality of life in a prospective sample of 83 men who underwent robotic assisted laparoscopic prostatectomy (RALP) for prostate cancer. Optimism was significantly associated with higher prostate cancer-specific expectations, β = .36, p < .001. In addition, optimism and prostate cancer-specific expectations were independent prospective predictors of better scores on the following prostate cancer-related quality of life scales: Sexual Intimacy and Sexual Confidence; Masculine Self-Esteem (specific expectations only), Health Worry, Cancer Control, and Informed Decision Making (βs > .21, ps < .05). When considered simultaneously, both optimism and specific expectations contributed uniquely to better Health Worry and Cancer Control scores, optimism was a unique predictor of better Sexual Intimacy and Sexual Confidence scores, and specific expectations uniquely predicted higher scores on Informed Decision Making. Although optimism and prostate-cancer specific expectations are related, they contribute uniquely to several prostate cancer-related quality of life outcomes following RALP and may be important targets for quality of life research with this population.

Aims: Since many biomarkers of both the tumor and its microenvironment are expected to involve differential expression of divalent proteins capable of protein or peptide ligand interaction, we are developing multivalent nanodevices for the identification of biomarkers in prostate cancer. Patients & Methods: We compared a multivalent thioredoxin-targeted nanodevice with monovalent thioredoxin in binding to human prostate cell line(s) and freshly frozen tissue specimens obtained after resection from patients with biopsy-proven prostate cancer. Conclusion: The nanodevice binds specifically with enhanced avidity to tumor microenvironment-associated stromal cells in prostate cancer tissue specimens. Cells that bind the nanodevice also reacted with antibodies to dimeric thioredoxin reductases 1 and 2, suggesting the utility of the nanodevice as a potentially specific and functional marker of tumor stromal cells.

You have accessJournal of UrologyProstate Cancer: Detection and Screening1 Apr 2011847 NANODEVICE-BASED DETECTION OF REACTIVE STROMA IN PROSTATE CANCER SPECIMENS Elizabeth Singer, Laura Crocitto, Yuri Choi, Sofia Loera, Lawrence Weiss, Ashraf Imam, Timothy Wilson, and Steve Smith Elizabeth SingerElizabeth Singer Duarte, CA , Laura CrocittoLaura Crocitto Duarte, CA , Yuri ChoiYuri Choi Duarte, CA , Sofia LoeraSofia Loera Duarte, CA , Lawrence WeissLawrence Weiss Duarte, CA , Ashraf ImamAshraf Imam Pasadena, CA , Timothy WilsonTimothy Wilson Duarte, CA , and Steve SmithSteve Smith Duarte, CA View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.668AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We are developing multivalent nanodevices for the identification of biomarkers in prostate cancer. We have previously shown that the thioredoxin-targeted nanodevice binds selectively to certain tumor cell lines. Here, we evaluate the selectivity of nanodevice binding to cells in freshly frozen tissue specimens obtained after resection from patients with biopsy-proven prostate cancer and identify the targeted biomarker. METHODS The nanodevice is a self-assembling system composed of DNA methyltransferase-thioredoxin fusion proteins covalently linked to a three arm DNA scaffold. Serial sections of frozen prostate tumor specimens of prostate cancer or BPH were placed onto slides and the tumor sections were incubated with varying concentrations of nanodevice in PBS and 1% BSA. Binding fluorescence was observed at 100x with a Zeiss Observer microscope and images of the entire tumor section were obtained by tiling individual pictures. Adjacent sections were immunohistochemically stained with H&E, monoclonal antibodies to α-smooth muscle actin and thioredoxin reductase 1 and 2. RESULTS Frozen tissue sections from 41 patients who underwent robot assisted-prostatectomy were studied. Nine showed significant fluorescence from the reactive stroma surrounding the tumor focus when exposed to the nanodevice. Using the tiled images, we identified the tumor and the region surrounding the tumor as reactive stroma using H&E and Masson′s Trichrome. In order to attempt to identify the nanodevice target, the thioredoxin reductase 2 antibody was used to stain tissue sections adjacent to those studied with the nanodevice using immunohistochemistry. The stain was found to overlap the regions stained by the nanodevice, thus identifying this dimeric reductase as a target of the nanodevice in stromal cells in tumor. CONCLUSIONS We have developed a nanodevice that binds selectively to the reactive stroma in freshly-frozen prostate tissue biopsy specimens obtained from robot-assisted prostatectomies. We indentified thioredoxin reductase 1 and 2 as potential biomarkers of reactive stroma in the tumor microenvironment using the nanodevice. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e340-e341 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elizabeth Singer Duarte, CA More articles by this author Laura Crocitto Duarte, CA More articles by this author Yuri Choi Duarte, CA More articles by this author Sofia Loera Duarte, CA More articles by this author Lawrence Weiss Duarte, CA More articles by this author Ashraf Imam Pasadena, CA More articles by this author Timothy Wilson Duarte, CA More articles by this author Steve Smith Duarte, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

In this prospective, longitudinal study the authors examined changes in cognitive, emotional, and interpersonal components of prostate cancer-related quality of life in 71 men who underwent robotic-assisted prostatectomy for prostate cancer. They identified significant changes across several quality-of-life domains from presurgery to 3-months and 1-year postsurgery. Although some components of quality of life returned to baseline by one year postsurgery, decrements in sexual intimacy, sexual confidence, and masculine self-esteem were enduring. These data can be used to guide patients in their expectations for quality of life following robotic prostatectomy and highlight the need for multidisciplinary approaches aimed at improving men's sexual adjustment after this procedure.

4645 Background: Prostate cells released into expressed prostatic secretions (EPS) during prostatic massage are easily collected and analyzed. Prior work has shown EPS to perform well as a noninvasive test to predict prostate biopsy outcomes. We evaluate the utility of EPS biomarkers to predict surgical pathology outcomes in patients undergoing radical prostatectomy. Methods: We collected EPS specimens in a blinded prospective study from 138 men undergoing radical prostatectomy for prostate cancer. Specimens were obtained in the operating room under general anesthesia before commencing with radical prostatectomy. Specimens were analyzed for expression of GADH, PC3, Type III and VI TMPRSS2:ERG gene fusions using quantitative PCR. Their characteristic performance for predicting extracapsular extension (ECE) and Gleason sum on surgical pathology specimens was evaluated. These were compared to pre-biopsy PSA, biopsy Gleason sum and digital rectal exam (DRE) findings as predictors of surgical pathology outcome...

6022 Background: Racial differences in prostate cancer-specific survival account for 50% of observed disparities in cancer survival between Caucasians and African Americans. These differences could be due to sociodemographics, disease characteristics, or disease management. NCI confers a “comprehensive” designation to cancer centers, if they demonstrate excellence in research and patient care. Racial differences in receiving care at NCICCCs could possibly contribute to disparity in survival. Methods: Using data from Los Angeles Cancer Surveillance Program, we examined underlying causes of racial differences in prostate-specific survival in 65,203 men (African Americans: 11,842; Caucasians: 53,361) diagnosed with prostate cancer between 1976 and 2003, and followed until 2008. Three NCICCCs serve this area: USC-Norris, UCLA- Jonsson, and City of Hope. Results: Data were examined overall, and for 3 eras: 1976-1987, 1988-1997, and 1998-2003. Overall, African Americans were significantly (p < 0.001) more likely to have low socioeconomic status (33% vs. 6%); no insurance (4% vs. 1%); distant disease (13% vs. 9%); and be managed with “watchful waiting” (23% vs. 15%). Univariately, 5-yr prostate-specific survival was significantly (p < 0.001) inferior for African Americans (86% vs. 89%) and for patients treated at non-NCICCCs (88% vs. 96%), irrespetive of race. After adjustment for sociodemographics, race, insurance, clinical factors, and treatment, care at NCICCC was associated with lower prostate-specific mortality for the 3 eras (HR = 0.81, 0.66, 0.59, p < 0.01). African Americans were less likely to utilize NCICCCs (OR = 1.46, 2.34, 2.50, for 3 eras). Finally, adjustment for treatment at NCICCCs abrogated racial difference in prostate-specific mortality (HR = 1.05, p = 0.5) in the most recent era. Conclusions: Treatment at NCICCCs is associated with > 40% reduction in prostate-specific mortality. African Americans are less likely to utilize NCICCCs for prostate cancer. African Americans and Caucasians have comparable prostate-specific survival if they receive care at NCICCCs. We are currently conducting studies to understand barriers to utilization of NCICCCs. No significant financial relationships to disclose.

September–March mean temperature has been reconstructed to A.D. 1680 for the Kaiduhe River watershed on the southern slope of the Tien Shan Mountains, China, using the Picea schrenkiana tree-ring width. The reconstruction explains the variance of 47% in the observed mean temperature from 1953 to 2011. Power spectral and wavelet analyses demonstrated the existence of significant 50-year and 2- to 7-year cycles of variability. The results of the spatial correlations suggest that our reconstruction contains climatic signals for Central Asia. Warm periods occurred during 1696–1708, 1730–1748, 1784–1804, 1832–1855, 1892–1903, 1924–1928, 1937–1943, and 1987–2006; while the periods of 1685–1695, 1709–1729, 1749–1783, 1805–1831, 1856–1891, 1904–1923, 1929–1936, and 1944–1986 were relatively cold. The significant correlation coefficient between the reconstruction and the temperature reconstruction for the Urumqi River source reveals that the temperature variations in the annual cold period for the southern and the northern slope of the central Tien Shan Mountains are roughly synchronous over the last nearly 300 years. A comparison between the reconstruction and three winter North Atlantic Oscillation indexes revealed similar long-term trends.

The assessment of prostate weight as a determinant of a high prostate margin rate after laparoscopic radical prostatectomy has not been studied.

You have accessJournal of Urology1 Apr 2009ROBOTIC ASSISTED LAPAROSCOPIC RADICAL CYSTECTOMY: THE CITY OF HOPE EXPERIENCE Ciamack Kamdar, Rebecca A. Nelson, David Y. Josephson, Kevin G. Chan, Clayton S. Lau, Jason T. Jankowski, Laura E. Crocitto, Josh Carleton, and Timothy G. Wilson Ciamack KamdarCiamack Kamdar More articles by this author , Rebecca A. NelsonRebecca A. Nelson More articles by this author , David Y. JosephsonDavid Y. Josephson More articles by this author , Kevin G. ChanKevin G. Chan More articles by this author , Clayton S. LauClayton S. Lau More articles by this author , Jason T. JankowskiJason T. Jankowski More articles by this author , Laura E. CrocittoLaura E. Crocitto More articles by this author , Josh CarletonJosh Carleton More articles by this author , and Timothy G. WilsonTimothy G. Wilson More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(09)61222-2AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "ROBOTIC ASSISTED LAPAROSCOPIC RADICAL CYSTECTOMY: THE CITY OF HOPE EXPERIENCE." The Journal of Urology, 181(4S), p. 430 © 2009 by American Urological AssociationFiguresReferencesRelatedDetails Volume 181Issue 4SApril 2009Page: 430 Advertisement Copyright & Permissions© 2009 by American Urological AssociationMetricsAuthor Information Ciamack Kamdar More articles by this author Rebecca A. Nelson More articles by this author David Y. Josephson More articles by this author Kevin G. Chan More articles by this author Clayton S. Lau More articles by this author Jason T. Jankowski More articles by this author Laura E. Crocitto More articles by this author Josh Carleton More articles by this author Timothy G. Wilson More articles by this author Expand All Advertisement PDF downloadLoading ...

6520 Background: A significant gap exists between Caucasians and African-Americans (AAs) in prostate cancer mortality, possibly due to sociodemographics, disease biology, or treatment. Furthermore, differential access to care at NCI-designated Comprehensive Cancer Centers (NCICCCs) conceivably contributes to this difference. Methods: Using data from the Los Angeles Cancer Surveillance Program, we studied the underlying causes of differences in mortality in 18,790 men (AAs: 4,211; Caucasians: 14,579) diagnosed with prostate cancer between 1998 and 2003, and followed until 2006. Three NCICCCs serve this area: USC-Norris, UCLA-Jonsson, and City of Hope. Results: Median age at diagnosis was 67.5 yrs; AAs were significantly more likely to have lower SES; carry no insurance; have distant disease; and be managed with “watchful waiting.” The overall and prostate-specific survival was significantly superior for patients treated at NCICCCs, and for Caucasians (Table). Multivariate analysis, after adjustment for sociodemographics, race, insurance, tumor-related factors, and treatment-modality, revealed that treatment at NCICCCs was associated with lower overall (HR=0.74, 95% CI=0.6–0.9) and prostate-specific mortality (HR=0.69, 95% CI=0.5–0.97). AAs were less likely to utilize NCICCCs (OR=0.42, 95%CI=0.4–0.5). Finally, adjustment for sociodemographic, tumor/treatment-related factors, and treatment site abrogated the racial difference in overall (HR=1.08, 95%CI=0.99–1.2) and prostate-specific (HR=1.11, 95%CI=0.9–1.3) mortality. Conclusions: Patients treated at NCICCCs have lower mortality compared with other facilities. AAs are less likely to utilize NCICCCs for prostate cancer. AAs and Caucasians have comparable overall and prostate-specific survival, after adjustment for sociodemographic, tumor/treatment-related factors, and treatment site. Future studies are needed to understand barriers and facilitators to utilization of NCICCCs for management of prostate cancer. [Table: see text] No significant financial relationships to disclose.

With the incidence of robot-assisted radical prostatectomy (RALP) increasing, questions regarding the significance of margin status have arisen. Patients with a history of a prior transurethral resection of the prostate (TURP) may have a higher incidence of positive margins because of the prior surgery. We examined our IRB-approved database to determine whether patients who had undergone a prior TURP had higher rates of positive margins than patients who had no history of TURP. Between July 2003 and March 2007, six urologic surgeons in our medical group (City of Hope medical group) performed RALP on 2,041 patients. Consent to enter the database was obtained from 1,768 patients. Of these, 51 had undergone prior TURP. Patients with a history of TURP before undergoing RALP had positive margin rates of 35.3% (18 of 51) compared with 17.6% (18 of 102) of patients without a history of TURP (P = 0.015). The location of the positive margins was statistically more prevalent at the bladder neck in TURP patients (13.7 vs. 2.0%) than in non-TURP patients (Fisher’s exact P value = 0.004). These two groups were statistically similar with regard to other variables examined including race, BMI, preoperative PSA, Gleason score, and pathologic stage. Patients who underwent RALP following TURP were found to have a higher positive margin rate. The positive margins were more likely to be located at the bladder neck in TURP versus non-TURP patients.

You have accessJournal of Urology1 Apr 2008SERUM PSA, DRE, DNA METHYLATION, PCA3, AND TMPRSS2:ERG IN EXPRESSED PROSTATIC SECRETION AS NON-INVASIVE PREDICTORS OF BIOPSY OUTCOME Jarrod P Clark, Kristofer W Munson, Katarzyna Lamparska-Kupsik, Jesse W Gu, Ziding Feng, Kevin G Chan, Jeffrey S Yoshida, Mark H Kawachi, Laura E Crocitto, Timothy G Wilson, and Steven S Smith Jarrod P ClarkJarrod P Clark More articles by this author , Kristofer W MunsonKristofer W Munson More articles by this author , Katarzyna Lamparska-KupsikKatarzyna Lamparska-Kupsik More articles by this author , Jesse W GuJesse W Gu More articles by this author , Ziding FengZiding Feng More articles by this author , Kevin G ChanKevin G Chan More articles by this author , Jeffrey S YoshidaJeffrey S Yoshida More articles by this author , Mark H KawachiMark H Kawachi More articles by this author , Laura E CrocittoLaura E Crocitto More articles by this author , Timothy G WilsonTimothy G Wilson More articles by this author , and Steven S SmithSteven S Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)62056-XAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "SERUM PSA, DRE, DNA METHYLATION, PCA3, AND TMPRSS2:ERG IN EXPRESSED PROSTATIC SECRETION AS NON-INVASIVE PREDICTORS OF BIOPSY OUTCOME." The Journal of Urology, 179(4S), p. 706 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 706 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Jarrod P Clark More articles by this author Kristofer W Munson More articles by this author Katarzyna Lamparska-Kupsik More articles by this author Jesse W Gu More articles by this author Ziding Feng More articles by this author Kevin G Chan More articles by this author Jeffrey S Yoshida More articles by this author Mark H Kawachi More articles by this author Laura E Crocitto More articles by this author Timothy G Wilson More articles by this author Steven S Smith More articles by this author Expand All Advertisement PDF DownloadLoading ...

PURPOSE:We determined whether prostate weight has an impact on the pathological and operative outcomes of robot assisted laparoscopic radical prostatectomy.MATERIALS AND METHODS:We reviewed the records of 1,847 consecutive patients who underwent robot assisted laparoscopic radical prostatectomy at our institution. Variables were compared across quartile distributions of prostate size as defined by weight, including group 1-less than 30 gm, group 2-30 to 49.9, group 3-50 to 69.9 and group 4-70 or greater. Factors assessed in this analysis were patient age, body mass index, prostate specific antigen, Gleason score, pathological stage, margin status, operative time, blood loss, transfusion rate, length of stay and rehospitalization rate.RESULTS:Patients with a larger prostate (group 4) were older (mean age 66.2 years), had higher pretreatment prostate specific antigen (median 6.5 ng/ml), lower Gleason score (mean 6.3), longer operative time (mean 3.2 hours), higher estimated blood loss (median 250 cc) and longer hospital stay (p = 0.0002). There was a trend toward higher risk disease based on D'Amico risk stratification and positive margin status in group 1, although evidence of extracapsular extension was more common in groups 2 and 3. There was no association between prostate size and body mass index, lymph node status, blood transfusion rate, seminal vesicle involvement and rehospitalization rate.CONCLUSIONS:Robot assisted laparoscopic radical prostatectomy in patients with an enlarged prostate is feasible with slightly longer operative time, urinary leakage rates and hospital stay. Pathologically larger prostates are generally associated with lower Gleason score and risk group stratification. One-year continence rates and biochemical recurrence rates are similar across all groups.