BACKGROUND:The incidence of prostate cancer is increasing. Screening with an assay of prostate-specific antigen (PSA) has a high rate for false positive results. Genomewide association studies have identified common germline variants in persons with prostate cancer, which can be used to calculate a polygenic risk score associated with risk of prostate cancer. METHODS:We recruited persons 55 to 69 years of age from primary care centers in the United Kingdom. Using germline DNA extracted from saliva, we derived polygenic risk scores from 130 variants known to be associated with an increased risk of prostate cancer. Participants with a polygenic risk score in the 90th percentile or higher were invited to undergo prostate cancer screening with multiparametric magnetic resonance imaging (MRI) and transperineal biopsy, irrespective of PSA level. RESULTS:Among 40,292 persons invited to participate, 8953 (22.2%) expressed interest in participating and 6393 had their polygenic risk score calculated; 745 (11.7%) had a polygenic risk score in the 90th percentile or higher and were invited to undergo screening. Of these 745 participants, 468 (62.8%) underwent MRI and prostate biopsy; prostate cancer was detected in 187 participants (40.0%). The median age at diagnosis was 64 years (range, 57 to 73). Of the 187 participants with cancer, 103 (55.1%) had prostate cancer classified as intermediate or higher risk according to the 2024 National Comprehensive Cancer Network (NCCN) criteria, so treatment was indicated; cancer would not have been detected in 74 (71.8%) of these participants according to the prostate cancer diagnostic pathway currently used in the United Kingdom (high PSA level and positive MRI results). In addition, 40 of the participants with cancer (21.4%) had disease classified as unfavorable intermediate risk or as high or very high risk according to NCCN criteria. CONCLUSIONS:In a prostate cancer screening program involving participants in the top decile of risk as determined by a polygenic risk score, the percentage found to have clinically significant disease was higher than the percentage that would have been identified with the use of PSA or MRI. (Funded by the European Research Council Seventh Framework Program and others; BARCODE1 ClinicalTrials.gov number, NCT03857477.).

Introduction and Objectives:Cystectomy for bladder cancer (BC) in women involves removing gynaecological organs and the anterior vaginal wall, significantly impacting sexual function (SF). Gynaecological organ-preserving cystectomy (GOPC) aims to minimise toxicity, but limited studies assess its impact. We reviewed existing evidence. Methods:A systematic review was conducted using Ovid (Medline, Embase, PsycINFO, CINAHL) and Cochrane Library. Studies assessing survival and SF outcomes of GOPC and SF outcomes of standard cystectomy were included. Results:Fourteen studies (1049 screened) reported on small cohorts (11-41 patients). Most GOPC patients had ≤T2b N0 M0 disease, while standard cystectomy patients had up to T4/N1. In the GOPC cohort median follow-up was 36 months.Over a 16-70 month period, Disease-Free Survival in GOPC patients was 80-100%. Due to heterogeneity in Patient-Reported Outcome Measures (PROMS), a narrative analysis was performed.GOPC patients reported high levels of sexual activity, reduced dyspareunia and moderate-to-high satisfaction. While SF initially declined, recovery improved over time, with Female Sexual Function Index (FSFI) scores exceeding the 26.2 dysfunction threshold in two studies by 12 months.In standard cystectomy, sexual dysfunction was common, with varying distress levels and inadequate patient counselling. Conclusions:Understanding the outcomes of GOPC is limited by study design and measurement variability, and meta-analysis was not possible. In this narrative review, oncological outcomes in the GOPC group appears to have equivalent oncological outcomes to a standard radical cystectomy in carefully selected female patients. Sexual recovery outcomes in either complete or partial sexual organ preserving cystectomy appear to be better than a standard female radical cystectomy. Further prospective studies, particularly those involving nerve-sparing surgery, are needed. Women undergoing either standard cystectomy and GOPC commonly experience sexual dysfunction, and there is a need to improve pre- and post-operative counselling.

BACKGROUND:Prostate specific antigen density (PSAd) is one of the strongest predictors of clinically-significant prostate cancer (csPCa) in risk calculators. There is little evidence on the effect of prostate volume on the diagnostic performance of PSAd. Our aim was to define the diagnostic accuracy of PSAd for predicting csPCa across prostate volumes. METHODS:548 patients who underwent magnetic resonance imaging (MRI) and biopsy were included in this retrospective study. Patients were grouped by prostate volume; small (≤ 30 mL), medium (> 30 to < 50 mL), large (≥ 50 mL). Sensitivity and specificity of PSAd were assessed at thresholds of ≥ 0.10, ≥ 0.15, and ≥ 0.20 ng/mL/mL for two definitions of csPCa. RESULTS:At all PSAd thresholds and for both definitions of csPCa, there was a statistically significant and clinically-relevant difference in diagnostic performance across prostate volume groups. Sensitivity was highest in small glands, lowest in large glands; the opposite being true for specificity. Using a PSAd threshold of ≥ 0.15 ng/mL/mL, sensitivity for ISUP grade ≥ 2 PCa was 83.1%, 63.6%, and 33.3% for small, medium and large prostates (p ≤ 0.001) with specificities of 48.5%, 67.5% and 79.3%, respectively (p = 0.005). CONCLUSIONS:Diagnostic performance of PSAd varied significantly by prostate volume, and by applying a single PSAd threshold across all prostate volumes risks missing csPCa in men with larger glands, whilst performing unnecessary biopsies in those with smaller glands. Defining PSAd thresholds according to prostate volume categories can therefore improve its use as a risk predictor for csPCa.

Purpose/ObjectivesWe determine the maximum tolerated tumour focused dose (MTD) for the radical treatment of muscle invasive bladder cancer (MIBC) enabled by image guided adaptive radiotherapy (IGART) and long-term clinical outcomes.Materials/Methods: Fifty-nine patients with T2-T4aN0M0 unifocal urothelial MIBC suitable for daily radical radiotherapy were recruited prospectively to an ethics approved protocol (XX). The uninvolved bladder (PTVbladder) was planned to 52Gy in 32 fractions (f). The bladder tumour (PTVtumour) was planned to an assigned dose level of 68, 70, 72, or 74Gy. If organ at risk (OAR) dose constraints were violated, then PTVtumour was planned to 64Gy. Dose level allocation was determined by concurrent toxicity assessment of all previous patients recruited. Acute toxicity was evaluated using CTCAE v3.0; late toxicity was evaluated using RTOG criteria. The MTD was predefined as the highest dose level with estimated probability of ≤ 15% ≥G3 late toxicity and observed rate <50% acute G3 and <10% acute G4 toxicity.ResultsTwenty-six patients were assigned to 68Gy, of whom 6 were planned to 64Gy; 29 patients were assigned to 70Gy of whom 1 was planned to 68Gy, 2 patients were assigned and planned to 72Gy; no patients were assigned to 74Gy. Three patients did not complete treatment as planned, of whom only 1 patient stopped treatment because dose limiting toxicity occurred. The MTD was 70Gy. Acute genitourinary (GU) and gastrointestinal (GI) G3 acute toxicity was seen in 19% and 7% patients respectively. No grade 4 GU or GI toxicity was seen. Late toxicity (any) G3 and G4 was seen in 14% and 2% patients respectively. The 5-year overall survival was 58% (95% CI 44-71%). The bladder preservation rate was 89% (95% CI, 88 to 96%) with 6 patients not retaining native bladder function.ConclusionBladder tumour focused dose escalation to 70Gy using IGART is feasible with acceptable toxicity. This dose level has been evaluated in a phase II randomised control trial (XXXXX).

PURPOSE:We determine the maximum tolerated tumor-focused dose (MTD) for the radical treatment of muscle invasive bladder cancer enabled by image guided adaptive radiation therapy and long-term clinical outcomes. METHODS AND MATERIALS:Fifty-nine patients with T2 to T4aN0M0 unifocal urothelial muscle invasive bladder cancer suitable for daily radical radiation therapy were recruited prospectively to an ethics-approved protocol (NCT01124682). The uninvolved bladder (PTVbladder) was planned to 52 Gy in 32 fractions. The bladder tumor (PTVtumor) was planned to an assigned dose level of 68, 70, 72, or 74 Gy. If organ at risk dose constraints were violated, then PTVtumor was planned to 64 Gy. Dose level allocation was determined by concurrent toxicity assessment of all previous patients recruited. Acute toxicity was evaluated using Common Terminology Criteria for Adverse Events v3.0; late toxicity was evaluated using Radiation Therapy Oncology Group criteria. The MTD was predefined as the highest dose level with an estimated probability of ≤ 15% ≥ G3 late toxicity and an observed rate of <50% acute G3 and <10% acute G4 toxicity. RESULTS:Twenty-six patients were assigned to 68 Gy, of whom 6 were planned to 64 Gy; 29 patients were assigned to 70 Gy of whom 1 was planned to 68 Gy, 2 patients were assigned and planned to 72 Gy; no patients were assigned to 74 Gy. Three patients did not complete the treatment as planned, of whom only 1 patient stopped treatment because dose-limiting toxicity occurred. The MTD was 70 Gy. Acute genito-urinary and gastro-intestinal G3 acute toxicity was seen in 19% and 7% of patients, respectively. No acute G4 genito-urinary or gastro-intestinal toxicity was seen. Late toxicity (any) G3 and G4 was seen in 14% and 2% of patients, respectively. The 5-year overall survival was 58% (95% CI, 44%-71%). The bladder preservation rate was 89% (95% CI, 88%-96%) with 6 patients not retaining native bladder function. CONCLUSIONS:Bladder tumor-focused dose escalation to 70 Gy using image guided adaptive radiation therapy is feasible with acceptable toxicity. This dose level has been evaluated in a phase II randomized control trial (RAIDER NCT02447549).

10500 Background: Incidence of prostate cancer (PCa) is increasing, but there is no internationally agreed population screening program. Studies using an age-based PSA approach show a high rate of false-positive results as well as over-diagnosis of indolent PCa. Genome wide association studies identify common germline variants to calculate a polygenic risk score (PRS) associated with PCa risk. The BARCODE1 study used PRS to target PCa screening to those at higher risk based on genotype. Methods: European men aged 55-69yrs were recruited via Primary Care in the UK. PRS was constructed by summing weighted risk alleles for 130 PCa risk variants using germline DNA from saliva samples via mailed kits. Men with a PRS > 90th centile were invited for PCa screening using MRI and 12-core transperineal biopsy (including MRI fusion to target additional lesions where identified) irrespective of PSA result. Results: Invitation letters were sent to 40,292 men. 8,953 (22%) expressed an interest; 8,014 were eligible and sent a saliva kit. 6,644 consented; 6,393 were genotyped; 251 failed QC. A total of 6,142 participants had PRS calculated: 745 (12.1%) had a PRS > 90th centile and were invited to screening. 558/745 participants attended screening (121 declined, 66 excluded on health grounds). 551 underwent MRI and 468 had prostate biopsy resulting in 187 (40.0%) diagnoses of PCa, overall PCa detection rate 2.8%. Mean age at diagnosis 64.1yrs (range 57-73; median 64). Using NCCN criteria (2023) 103/187 (55.1%) of cancers were Intermediate or High Risk; 40/187 (21.4%) were Intermediate Unfavourable/High/Very High Risk. 119/187 (63.6%) men had a PSA <3.0ug/L; PPV of biopsy for PSA > 3.0ug/L was 49.6%. PPV of MRI (presence of PI-RADS 3-5 lesion) 60.4%. PPV of PRS alone 40%. 103/187 (55.1%) had Gleason >7; compared with 360/1014 (35.5%) p < 0.001 in the PSA directed ERSPC study. Conclusions: A population PCa screening program using PRS risk-stratification enriches for clinically significant PCa requiring treatment. It detects a high proportion of clinically significant disease compared with PSA or MRI based screening programs and MRI missed a significant proportion (17-67%) of cancers found on biopsy. This is the first study to assess if this approach will be useful in population screening programs. Clinical trial information: NCT03857477 . [Table: see text]

Current treatment for high-grade non-muscle invasive bladder cancer utilizes bacillus Calmette-Guerin (BCG) installations into the bladder. Although effective, BCG toxicities often cause delay or instillation interruptions and this can consequently reduce the treatment efficacy. The importance of a patient questionnaire for identifying symptoms following BCG intravesical therapy, minimizing toxicities and improvements in patient compliance are recognized. However, as yet, a standard questionnaire is not available. The European Association Urology Nurses guidelines have suggested a survey; however, its terminology is potentially too complex to be used by the patients. A project with 3 phases was developed in order to identify the most user-friendly survey to be used in this population group. Phase 1: Identification and assessment of existing BCG side effects questionnaires. Phase 2: Adaptation and assessment of a BCG side-effect questionnaire. Phase 3: Testing of the adapted questionnaire. Following the review in phase 1, four questionnaires' were found and assessed using appraisal and text readability tools. Appraisal showed that the four surveys used difficult language for patients to use independently. Based on patient feedback, a BCG side-effect questionnaire was adapted to be more patient-friendly and appraised using the same tools from phase 1. The adapted questionnaire proved to be beneficial for both patients and health professionals. First, it was more easily understood by patients. Second, it enabled staff to better identify patients at risk, monitor treatment consequences and implement supportive measures. Despite the adaptations, however, patients continued to find the terminology used ambiguous.

ObjectiveThis study aims to determine local treatment response and long-term survival outcomes in patients with localised muscle-invasive bladder cancer (MIBC) patients receiving neoadjuvant chemotherapy (NAC) using diffusion-weighted MRI (DWI) and apparent diffusion coefficient (ADC) analysis.MethodsPatients with T2-T4aN0-3M0 bladder cancer suitable for NAC were recruited prospectively. DWI was performed prior to NAC and was repeated following NAC completion. Conventional response assessment was performed with cystoscopy and tumour site biopsy. Response was dichotomised into response (15.5% was associated with significant improvement in OS (HR, 0.40; 95% CI, 0.19–0.86; p=0.0179), bCSS (HR, 0.26; 95% CI, 0.08–0.82; p=0.0214), PFS (HR, 0.16; 95% CI, 0.05–0.48; p=0.0012), and time to cystectomy (HR, 0.19; 95% CI, 0.07–0.47; p=0.0004).ConclusionsQuantitative ADC analysis can successfully identify NAC response and improved long-term clinical outcomes. Multi-centre validation to assess reproducibility and repeatability is required before testing within clinical trials to inform MIBC treatment decision making.Advances in knowledgeWe successfully demonstrated that measured change in DWI can successfully identify NAC response and improved long-term survival outcomes.

Background:Bladder cancer (BC) treatments are known to be invasive; nevertheless, research into the long-term effects is limited and in the context of sexual function often male focussed. Female sexual dysfunction (FSD) has been reported in up to 75% of female patients. This systematic scoping review examines the literature on sexual consequences of BC in female patients. Objective:This study aimed to systematically evaluate the evidence on female sexual function in BC to identify areas of unmet need and research priorities. Evidence Acquisition:We performed a critical review of PubMed, PsychMed, CINAHL, MEDLINE and the Cochrane Library in March 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) extension for Scoping Reviews statement following Levac et al. methodology. Identified reports were reviewed according to the Critical Appraisal Skills Programme (CASP) criteria. 45 publications were included. Evidence Synthesis:There was an inconsistent use of patient-reported outcome measures (PROMs), with commonly used PROMs having a narrow symptom focus. However, common symptoms emerged: loss of desire, orgasmic disorders, vaginal dryness, dyspareunia, difficult intromission, reduced clitoral sensation, psychological concerns related to diagnosis, fear of contamination and body image. Sexual activity was reduced in most groups, despite women expressing a motivation to retain sexual function. The degree of symptom distress associated with FSD is underreported. Evidence emerged regarding a gap for women in clinician counselling and follow-up. Conclusions:The patient's perspective of FSD in BC patients is poorly understood and under-addressed in clinical practice. There have been very few qualitative studies of FSD in BC. Any intervention designed to address the problem must start with greater understanding of both the patients' and clinicians' perspective. Lay Summary:We examined the evidence on sexual consequences of BC in women. It is apparent that despite common themes of sexual dysfunction emerging, the problem is poorly understood and addressed in clinical practice.

Objectives:To review the current evidence on the relationship between three proposed mediators (comorbidities, hospital type, and treatment delays) for the relationship between socioeconomic status (SES) and bladder cancer survival.Materials and methods:Six different searches using OVID (Medline and Embase) were carried out to collate information available between the proposed mediators with both SES and survival in bladder cancer. This systematic review was conducted according to a pre-defined protocol and in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Results:A total of 49 studies were included in the review across the six searches (one appeared in two searches). There was a wealth of studies investigating the relationship between each of the proposed mediators with survival in bladder cancer patients. In general, a higher SES, lower comorbidities, and a larger hospital volume were all found to be associated with a decreased risk of death in bladder cancer patients. There was, however, a paucity of studies investigating the associations between these mediators and SES in bladder cancer patients.Conclusions:To gain a deeper understanding of the relationship between SES and survival identified in several observational studies, further investigations into the relationship between the proposed mediators and SES are warranted. Moreover, modifiable mediators, eg, treatment delay, highlight the importance of the standardization of clinical care across SES groups for all bladder cancer patients.

: Objective: To compare the PCNL surgical results performed in modified supine position with those executed in the standard prone position. Study Design: A prospective randomized controlled trial. Place and Duration: In the Department of Urology, Sindh Institute of Urology and Transplantation, Karachi for one year duration from January 2020 to December 2020. Methods: 186 patients who underwent percutaneous nephrolithotomy were selected for the study, who were randomized into 2 groups of 93, in the first group PCNL was done in modified Supine position and the other was planned for Prone PCNL. Surgery time, number of punctures, complications, radiation time, stay in hospital and stone-free index were compared. Results: There was no variance among the two groups in the number of punctures, number of calculi and complication rates. However, the modified supine group had shorter mean time of radiation, surgery time, and hospital stay. Conclusion: Modified supine PCNL in the supine position has a much shorter exposure of radiation and operation time, shorter hospital stay, and is just as safe as traditional prone PCNL. percentage was calculated for categorical variables like gender, laterality and stone location. Mean and SD was calculated for age, BMI, operative time and stone size. Independent sample t-test was utilized for comparison of the mean operative time and stone clearance rate. P value ≤0.05 was considered as significant. Confounders like stone size and location was controlled.

Objectives To assess the feasibility and uptake of a community‐based prostate cancer (PCa) screening programme selecting men according to their genetic risk of PCa. To assess the uptake of PCa screening investigations by men invited for screening. The uptake of the pilot study would guide the opening of the larger BARCODE1 study recruiting 5000 men. Subjects and Methods Healthy males aged 55–69 years were invited to participate via their general practitioners (GPs). Saliva samples were collected via mailed collection kits. After DNA extraction, genotyping was conducted using a study specific assay. Genetic risk was based on genotyping 130 germline PCa risk single nucleotide polymorphisms (SNPs). A polygenic risk score (PRS) was calculated for each participant using the sum of weighted alleles for 130 SNPs. Study participants with a PRS lying above the 90th centile value were invited for PCa screening by prostate magnetic resonance imaging (MRI) and biopsy. Results Invitation letters were sent to 1434 men. The overall study uptake was 26% (375/1436) and 87% of responders were eligible for study entry. DNA genotyping data were available for 297 men and 25 were invited for screening. After exclusions due to medical comorbidity/invitations declined, 18 of 25 men (72%) underwent MRI and biopsy of the prostate. There were seven diagnoses of PCa (38.9%). All cancers were low‐risk and were managed with active surveillance. Conclusion The BARCODE1 Pilot has shown this community study in the UK to be feasible, with an overall uptake of 26%. The main BARCODE1 study is now open and will recruit 5000 men. The results of BARCODE1 will be important in defining the role of genetic profiling in targeted PCa population screening. Patient Summary What is the paper about? Very few prostate cancer screening programmes currently exist anywhere in the world. Our pilot study investigated if men in the UK would find it acceptable to have a genetic test based on a saliva sample to examine their risk of prostate cancer development. This test would guide whether men are offered prostate cancer screening tests. What does it mean for patients? We found that the study design was acceptable: 26% of men invited to take part agreed to have the test. The majority of men who were found to have an increased genetic risk of prostate cancer underwent further tests offered (prostate MRI scan and biopsy). We have now expanded the study to enrol 5000 men. The BARCODE1 study will be important in examining whether this approach could be used for large‐scale population prostate cancer screening.

Background: The aim of this systematic review was to identify the current endoscopic surveillance strategies in use across the world and to determine whether these were sufficient or if any recommendations for changes in the guidelines could be made. This review focused on the cystoscopic follow-up of non muscle invasive bladder cancer (NMIBC) patients and muscle invasive bladder cancer (MIBC) patients who had undergone bladder sparing treatments. Methods: A literature search was carried out on Medline and Embase using OVID gateway according to a pre-defined protocol. Systematic screening of the identified studies was carried out by two authors. Quality assessment was performed using the Joanna Briggs critical appraisal tools. Data was extracted on various aspects including the follow-up regime utilised, patients included, outcomes investigated and a summary of the results. The studies were compared in a narrative nature. Results: A total of 2,604 studies were identified from the search strategy, of which 14 were deemed suitable for inclusion following the screening process. The studies identified were from nine countries and were mainly observational or qualitative. There was a huge variation in the follow-up regimes utilised within the studies with no clear consensus as to which regime was the most suitable. However, all studies utilised an initial cystoscopy at three months post-TURBT. No studies were identified which investigated the endoscopic follow-up strategies for MIBC patients who opted for bladder conservation with chemoradiation. Conclusions: There is no universally accepted protocol for endoscopic follow-up of patients with NMIBC bladder cancer. Guidance on cystoscopic monitoring of bladder in patients who have undergone chemoradiation for MIBC is also lacking.

Context: The complexity of bladder cancer diagnosis and staging results in delays in definitive treatment of muscle-invasive bladder cancer by radical cystectomy. Objective: This systematic review and meta-analyses aim to assess the impact of delays in radical cystectomy. Evidence acquisition: A systematic review was conducted by searching Medline and Ovid Gateway using protocol-driven search terms in August 2019, with no time limit on the studies included. The identified studies were assessed according to strict criteria and using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist and Risk of Bias in Non-randomised Studies-of Interventions (ROBINS-I) tool. Meta-analyses were conducted based on the type of delay. Random-effect models were used whereby the presence of a delay was the exposure variable and overall survival was the outcome of interest, for which pooled hazard ratios were calculated. Evidence synthesis: Nineteen studies were eligible for inclusion (17 532 patients), of which 10 were included in the meta-analyses. A longer delay between bladder cancer diagnosis and radical cystectomy resulted in a pooled hazard ratio of 1.34 (95% confidence interval [CI]: 1.18-1.53) for overall death. For a delay between transurethral resection and cystectomy, we found a pooled hazard ratio of 1.18 (95% CI: 0.99-1.41) for overall death. A pooled hazard ratio of 1.04 (95% CI: 0.93-1.16) was calculated for a longer delay between neoadjuvant chemotherapy and radical cystectomy. Conclusions: A delay in radical cystectomy after diagnosis was found to have a significantly detrimental effect on overall survival for bladder cancer patients. However, there was huge heterogeneity in how a delay was defined. Patient summary: In this review, we investigated the effect of a delay in radical treatment on survival. This review highlights the importance of scheduling radical cystectomies in a timely manner whilst monitoring factors such as comorbidities and scheduling, in order to treat patients requiring radical cystectomy without delay. (C) 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Total pelvic exenteration is a complex major operation involving the removal of all organs from the pelvis, which mandates diversion of both urine and faeces. The sequelae of surgery are undeniably life-altering. Carefully considered multidisciplinary, pre-operative preparation is essential to mitigate the psychological and physical stresses of such surgery. There are several areas of unmet need in cancer surgery, and these deficiencies are highlighted in procedures of this complexity. Multiple factors influence pre-operative preparation, including the quality, timing and format of patient information, as well as the patient's language needs and level of literacy. Surgical preparation should also include opportunities for prehabilitation, and therefore timing of information is crucial, particularly as these patients are usually undergoing intensive neo-adjuvant treatments, including chemo- and radiotherapy. Peer support is also considered important, although little is known about the benefits of peer relationships in major pelvic surgery. This article discusses how patients are prepared at the Royal Marsden NHS Foundation Trust and highlights opportunities for further research, the aim of which is to improve outcomes and quality of life.

Background: Urothelial carcinoma arising in a bladder diverticulum (UCBD) is uncommon, and data on treatment and outcome are sparse. Objective: To analyze clinicopathological characteristics of UCBD and to compare outcome after radical cystectomy (RC) and partial cystectomy (PC). Design, setting, and participants: Data of 115 UCBD patients treated with RC (n = 81) or PC (n = 34) between 2000 and 2016 were collected from 11 institutional databases and were analyzed retrospectively. Median follow-up was 5.0 yr (95% confidence interval [CI]: 4.0-6.2). Outcome measurements and statistical analysis: Upstaging of tumor stage at diagnostic transurethral resection (TUR) to the RC/PC specimen was investigated. Overall survival (OS) and metastasis-free survival (MFS) after RC and PC were analyzed using Kaplan-Meier estimates, and compared using the log-rank test. Intravesical recurrences after PC were reported. A multivariable Cox proportional-hazard model was used to identify factors associated with OS. Results and limitations: There were no statistically significant differences in clinicopathological characteristics between RC and PC groups. Fifty-five percent of patients with cTa/is/1 at diagnostic TUR had >= pT2 tumors at RC/PC. Five-year OS and MFS were, respectively, 62% and 66% for RC and 66% and 55% for PC (p = 0.9 and p = 0.6). Intravesical tumor recurrence was seen in six of 34 (18%) PC patients. In multivariable analysis, positive surgical margins and extravesical disease (>= pT2) were associated with worse OS, whereas treatment modality was not (RC: reference; PC: hazard ratio 0.94, [95% CI: 0.47-1.90], p = 0.9). Conclusions: Upstaging of UCBD was frequent, indicating an inaccuracy in clinical staging. We found no differences in OS or MFS between PC and RC groups; therefore, PC may represent a feasible surgical alternative to RC in selected UCBD patients. Patient summary: In this report, we looked at the treatment of urothelial carcinoma arising in a bladder diverticulum (UCBD). We found that bladder-sparing treatment by partial cystectomy may be an alternative to radical cystectomy in carefully selected UCBD patients. (C) 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.

AbstractIntroductionThis study aims to disentangle heterogeneity in the survival of bladder cancer (BC) patients of different socioeconomic status (SES) by identifying potential mediators of the relationship.MethodsThe Bladder Cancer Database Sweden (BladderBaSe) was used to select patients diagnosed between 1997 and 2014 with Tis/Ta‐T4 disease. The education level was used as a proxy for SES. Accelerated failure time models were used to investigate the association between SES and survival. Mediation analysis was used to investigate potential mediators of the association also accounting for interaction.ResultsThe study included 37 755 patients from the BladderBaSe. Patients diagnosed with both non‐muscle invasive bladder cancer (NMIBC) and muscle‐invasive bladder cancer (MIBC) who had high SES were found to have increased overall and BC‐specific survival, when compared to those with low SES. In the NMIBC patients, Charlson Comorbidity Index was found to mediate this relationship by 10% (percentage of the total effect explained by the mediator) and hospital type by 4%. The time from referral to TURBT was a considerable mediator (14%) in the MIBC patients only.ConclusionsMediation analysis suggests that the association between SES and BC survival can be explained by several factors. The mediators identified were not, however, able to fully explain the theoretical causal pathway between SES and survival, therefore, future studies should also include the investigation of other possible mediators to help explain this relationship further. These results highlight the importance of standardization of clinical care across SES groups.

Background Bladder cancer (BC) treatment can have a detrimental effect on the sexual organs of patients and yet assessment of sexual health needs has been greatly overlooked for these patients compared to those who have undergone other cancer therapies. Methods This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines in July 2019. Studies were identified by conducting searches for Medline (using the PubMed interface), the Cochrane Central Register of Controlled Trials (CENTRAL) and Ovid Gateway (Embase and Ovid) using a list of defined search terms. Results 15 out of 37 studies included men only, 10 studies women only and 11 both sexes. Most participants were aged 50 to 65 years. Most studies ( n = 34) focused on muscle invasive BC and only three on non-muscle invasive BC. Measurements of sexual dysfunction, including erection, ejaculation, firmness and desire, were the most commonly used measurements to report sexual health in men. In women, lubrification/dryness, desire, orgasm and dyspareunia were the most commonly reported. Twenty-one studies evaluated sexual dysfunction based on validated questionnaires, two with a non-validated questionnaire and through interviewing participants. Conclusion While recognition of the importance of the inclusion of psychometric measurements to assess sexual health is growing, there is a lack of consistent measures to assess sexual health in BC. With the focus on QoL arising in cancer survivorship, further studies are needed to develop, standardize and implement use of sexual health questionnaires with appropriate psychometrics and social measures to evaluate QoL in BC patients. Trial registration “PROSPERO does not currently accept registrations for scoping reviews, literature reviews or mapping reviews. PROSPERO is therefore unable to accept your application or provide a registration number. This decision should not stop you from submitting your project for publication to a journal.”

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV (MP30)1 Apr 2019MP30-05 ADDED VALUE OF SYSTEMATIC PROSTATE SAMPLING TO MPMRI-TARGETED PROSTATE BIOPSY IN A LARGE MULTICENTER RETROSPECTIVE SERIES Marco Oderda, Giancarlo Marra, Giorgio Calleris, Simone Albisinni, Emanuela Altobelli, Eduard Baco, Valerio Beatrici, Marco Dellabella, Jean-Luc Descotes, David Eldred-Evans, Fasolis Giuseppe, Mariaconsiglia Ferriero, Gaelle Fiard, Alessandro Giacobbe, Pardeep Kumar, Vito Lacetera, Pierre Mozer, Giovanni Muto, Rocco Papalia, Alexandre Peltier, Thierry Piechaud, Tiziana Pierangeli, Giuseppe Simone, Jean-Baptiste Roche, Morgan Roupret, and Paolo Gontero* Marco OderdaMarco Oderda More articles by this author , Giancarlo MarraGiancarlo Marra More articles by this author , Giorgio CallerisGiorgio Calleris More articles by this author , Simone AlbisinniSimone Albisinni More articles by this author , Emanuela AltobelliEmanuela Altobelli More articles by this author , Eduard BacoEduard Baco More articles by this author , Valerio BeatriciValerio Beatrici More articles by this author , Marco DellabellaMarco Dellabella More articles by this author , Jean-Luc DescotesJean-Luc Descotes More articles by this author , David Eldred-EvansDavid Eldred-Evans More articles by this author , Fasolis GiuseppeFasolis Giuseppe More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Gaelle FiardGaelle Fiard More articles by this author , Alessandro GiacobbeAlessandro Giacobbe More articles by this author , Pardeep KumarPardeep Kumar More articles by this author , Vito LaceteraVito Lacetera More articles by this author , Pierre MozerPierre Mozer More articles by this author , Giovanni MutoGiovanni Muto More articles by this author , Rocco PapaliaRocco Papalia More articles by this author , Alexandre PeltierAlexandre Peltier More articles by this author , Thierry PiechaudThierry Piechaud More articles by this author , Tiziana PierangeliTiziana Pierangeli More articles by this author , Giuseppe SimoneGiuseppe Simone More articles by this author , Jean-Baptiste RocheJean-Baptiste Roche More articles by this author , Morgan RoupretMorgan Roupret More articles by this author , and Paolo Gontero*Paolo Gontero* More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000557560.12985.64AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: In a large multicenter series, we assessed the impact of performing a standard systematic sampling of the prostate in addition to mpMRI-targeted biopsies, in terms of prostate cancer (PCa) and clinically significant (cs) PCa detection. METHODS: We retrospectively enrolled 1.119 patients out of a multicenter retrospective database of 2.115 mpMRI-targeted biopsies. Biopsies were performed using the KoelisTM platform between 2010 and 2017 and consisted in targeted (median 3 cores per target) and systematic (12 to 14 cores) sampling. Overall and csPCa detection rate (CDR) of both target and systematic biopsies represented our primary outcomes. We also investigated potential predictors of PCa detection. RESULTS: Targeted cores alone detected PCa in about half of the patients undergoing biopsy (48%), while csPCa was diagnosed in one-third (33%). The addition of a systematic sampling improved detection by 15% for all cancers and by 12% for csPCa. Lesion scored as PI-RADS 3, 4 and 5 corresponded to 35%, 69%, and 92% of PCa detection rates, respectively. Higher PI-RADS score and positive digital rectal examination were positively associated with PCa diagnosis, whereas biopsy-naive status was a predictor of csPCa. CONCLUSIONS: Targeted biopsies attain high CDR for both every PCa and csPCa, in daily practice; nevertheless, the addition of a systematic sampling of the gland significantly improves detection rate. Patients with an elevated PI-RADS score and/or a positive DRE had a significantly increased risk to be diagnosed with PCa. Moreover, csPCa detection was associated with a biopsy-naive status. Source of Funding: None Torino, Italy; Bruxelles, Belgium; Roma, Italy; Oslo, Norway; Pesaro-Fano, Italy; Ancona, Italy; Grenoble, France; London, United Kingdom; Alba, Italy; Roma, Italy; Grenoble, France; Torino, Italy; London, United Kingdom; Pesaro-Fano, Italy; Paris, France; Torino, Italy; Roma, Italy; Bruxelles, Belgium; Bordeaux, France; Ancona, Italy; Roma, Italy; Bordeaux, France; Paris, France; Torino, Italy© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e424-e424 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marco Oderda More articles by this author Giancarlo Marra More articles by this author Giorgio Calleris More articles by this author Simone Albisinni More articles by this author Emanuela Altobelli More articles by this author Eduard Baco More articles by this author Valerio Beatrici More articles by this author Marco Dellabella More articles by this author Jean-Luc Descotes More articles by this author David Eldred-Evans More articles by this author Fasolis Giuseppe More articles by this author Mariaconsiglia Ferriero More articles by this author Gaelle Fiard More articles by this author Alessandro Giacobbe More articles by this author Pardeep Kumar More articles by this author Vito Lacetera More articles by this author Pierre Mozer More articles by this author Giovanni Muto More articles by this author Rocco Papalia More articles by this author Alexandre Peltier More articles by this author Thierry Piechaud More articles by this author Tiziana Pierangeli More articles by this author Giuseppe Simone More articles by this author Jean-Baptiste Roche More articles by this author Morgan Roupret More articles by this author Paolo Gontero* More articles by this author Expand All Advertisement PDF downloadLoading ...