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Mapping European Association of Urology Guideline Practice Across Europe: An Audit of Androgen Deprivation Therapy Use Before Prostate Cancer Surgery in 6598 Cases in 187 Hospitals Across 31 European Countries. Eur Urol 2023; 83:393-401. [PMID: 36639296 DOI: 10.1016/j.eururo.2022.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/30/2022] [Accepted: 12/26/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Evidence-practice gaps exist in urology. We previously surveyed European Association of Urology (EAU) guidelines for strong recommendations underpinned by high-certainty evidence that impact patient experience for which practice variations were suspected. The recommendation "Do not offer neoadjuvant androgen deprivation therapy (ADT) before surgery for patients with prostate cancer" was prioritised for further investigation. ADT before surgery is neither clinically effective nor cost effective and has serious side effects. The first step in improving implementation problems is to understand their extent. A clear picture of practice regarding ADT before surgery across Europe is not available. OBJECTIVE To assess current ADT use before prostate cancer surgery in Europe. DESIGN, SETTING, AND PARTICIPANTS This was an observational cross-sectional study. We retrospectively audited recent ADT practices in a multicentre international setting. We used nonprobability purposive sampling, aiming for breadth in terms of low- versus high-volume, academic, versus community and public versus private centres. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Our primary outcome was adherence to the ADT recommendation. Descriptive statistics and a multilevel model were used to investigate differences between countries across different factors (volume, centre type, and funding type). Subgroup analyses were performed for patients with low, intermediate, and high risk, and for those with locally advanced prostate cancer. We also collected reasons for nonadherence. RESULTS AND LIMITATIONS We included 6598 patients with prostate cancer from 187 hospitals in 31 countries from January 1, 2017 to May 1, 2020. Overall, nonadherence was 2%, (range 0-32%). Most of the variability was found in the high-risk subgroup, for which nonadherence was 4% (range 0-43%). Reasons for nonadherence included attempts to improve oncological outcomes or preoperative tumour parameters; attempts to control the cancer because of long waiting lists; and patient preference (changing one's mind from radiotherapy to surgery after neoadjuvant ADT had commenced or feeling that the side effects were intolerable). Although we purposively sampled for variety within countries (public/private, academic/community, high/low-volume), a selection bias toward centres with awareness of guidelines is possible, so adherence rates may be overestimated. CONCLUSIONS EAU guidelines recommend against ADT use before prostate cancer surgery, yet some guideline-discordant ADT use remains at the cost of patient experience and an additional payer and provider burden. Strategies towards discontinuation of inappropriate preoperative ADT use should be pursued. PATIENT SUMMARY Androgen deprivation therapy (ADT) is sometimes used in men with prostate cancer who will not benefit from it. ADT causes side effects such as weight gain and emotional changes and increases the risk of cardiovascular disease, diabetes, and osteoporosis. Guidelines strongly recommend that men opting for surgery should not receive ADT, but it is unclear how well the guidance is followed. We asked urologists across Europe how patients in their institutions were treated over the past few years. Most do not use ADT before surgery, but this still happens in some places. More research is needed to help doctors to stop using ADT in patients who will not benefit from it.
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Gordon AJ, Dublin JC, Patel E, Papazian M, Chow MS, Persky MJ, Jacobson AS, Patel KN, Suh I, Morris LGT, Givi B. American Thyroid Association Guidelines and National Trends in Management of Papillary Thyroid Carcinoma. JAMA Otolaryngol Head Neck Surg 2022; 148:1156-1163. [PMID: 36326739 PMCID: PMC9634599 DOI: 10.1001/jamaoto.2022.3360] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/07/2022] [Indexed: 11/06/2022]
Abstract
Importance Over time, the American Thyroid Association (ATA) guidelines have increasingly promoted more limited treatments for well-differentiated thyroid cancers. Objective To determine whether the 2009 and 2015 ATA guidelines were associated with changes in the management of low-risk papillary thyroid carcinomas on a national scale. Design, Setting, and Participants This historical cohort study used the National Cancer Database. All papillary thyroid carcinomas diagnosed from 2004 to 2019 in the National Cancer Database were selected. Patients with tumors of greater than 4 cm, metastases, or clinical evidence of nodal disease were excluded. Data were analyzed from August 1, 2021, to September 1, 2022. Main Outcomes and Measures The primary aim was to tabulate changes in the rates of thyroid lobectomy (TL), total thyroidectomy (TT), and TT plus radioactive iodine (RAI) therapy after the 2009 and 2015 ATA guidelines. The secondary aim was to determine in which settings (eg, academic vs community) the practice patterns changed the most. Results A total of 194 254 patients (155 796 [80.2%] female patients; median [range] age at diagnosis, 51 [18-90] years) who underwent treatment during the study period were identified. Among patients who underwent surgery, rates of TL decreased from 15.1% to 13.7% after the 2009 guidelines but subsequently increased to 22.9% after the 2015 changes. Among patients undergoing TT, rates of adjuvant RAI decreased from 48.7% to 37.1% after 2009 and to 19.3% after the 2015 guidelines. Trends were similar for subgroups based on sex and race and ethnicity. However, academic institutions saw larger increases in TL rates (14.9% to 25.7%) than community hospitals (16.3% to 19.5%). Additionally, greater increases in TL rates were observed for tumors 1 to 2 cm (6.8% to 18.9%) and 2 to 4 cm (6.6% to 16.0%) than tumors less than 1 cm (22.8% to 29.2%). Conclusions and Relevance In this cohort study among patients with papillary thyroid carcinomas up to 4 cm, ATA guideline changes corresponded with increased TL and reduced adjuvant RAI. These changes were primarily seen in academic institutions, suggesting an opportunity to expand guideline-based care in the community setting.
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Affiliation(s)
- Alex J. Gordon
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York
| | - Jared C. Dublin
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York
| | - Evan Patel
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco, California
| | - Michael Papazian
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York
| | - Michael S. Chow
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York
| | - Michael J. Persky
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York
| | - Adam S. Jacobson
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York
| | - Kepal N. Patel
- Division of Endocrine Surgery, Department of Surgery, NYU Langone Health, New York, New York
| | - Insoo Suh
- Division of Endocrine Surgery, Department of Surgery, NYU Langone Health, New York, New York
| | - Luc G. T. Morris
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Babak Givi
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York
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Struck JP, Hennig MJP, Hupe MC, Moharam N, Paffenholz P, Nestler T, Frank T, Worst TS, Grabbert M, Pohlmann PF, Dogan S, Hofbauer SL, Kalogirou C, Mattigk A, Brandt MP, Krabbe LM, Reis H, Dressler FF, Kramer MW, Salem J. Discrepancy between German S3 Guideline Recommendations and Daily Urologic Practice in the Management of Nonmuscle Invasive Bladder Cancer: Results of a Binational Survey. Urol Int 2021; 107:35-45. [PMID: 34515257 DOI: 10.1159/000518166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/22/2021] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Guideline recommendations are meant to help minimize morbidity and to improve the care of nonmuscle invasive bladder cancer (NMIBC) patients but studies have suggested an underuse of guideline-recommended care. The aim of this study was to evaluate the level of adherence of German and Austrian urologists to German guideline recommendations. METHODS A survey of 27 items evaluating diagnostic and therapeutic recommendations (15 cases of strong consensus and 6 cases of consensus) for NMIBC was administered among 14 urologic training courses. Survey construction and realization followed the checklist for reporting results of internet e-surveys and was approved by an internal review board. RESULTS Between January 2018 and June 2019, a total of 307 urologists responded to the questionnaire, with a mean response rate of 71%. The data showed a weak role of urine cytology (54%) for initial diagnostics although it is strongly recommended by the guideline. The most frequently used supporting diagnostic tool during transurethral resection of the bladder was hexaminolevulinate (95%). Contrary to the guideline recommendation, 38% of the participants performed a second resection in the case of pTa low-grade NMIBC. Correct monitoring of Bacille Calmette-Guérin (BCG) response with cystoscopy and cytology was performed by only 34% of the urologists. CONCLUSIONS We found a discrepancy between certain guideline recommendations and daily routine practice concerning the use of urine cytology for initial diagnostics, instillation therapy with a low monitoring rate of BCG response, and follow-up care with unnecessary second resection after pTa low-grade NMIBC in particular. Our survey showed a moderate overall adherence rate of 73%. These results demonstrate the need for sharpening awareness of German guideline recommendations by promoting more intense education of urologists to optimize NMIBC care thus decreasing morbidity and mortality rates.
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Affiliation(s)
- Julian P Struck
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Martin J P Hennig
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marie C Hupe
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Nadim Moharam
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Pia Paffenholz
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Tim Nestler
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Tanja Frank
- Department of Urology and Pediatric Urology, RoMed Hospital Rosenheim, Rosenheim, Germany
| | - Thomas S Worst
- Department of Urology, University Medical Centre Mannheim, Mannheim, Germany
| | - Markus Grabbert
- Department of Urology, Medical Centre, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Serkan Dogan
- Department of Urology, Heilig Geist Hospital Cologne, Cologne, Germany
| | | | - Charis Kalogirou
- Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Angelika Mattigk
- Department of Urology and Pediatric Urology, University Hospital Ulm, Ulm, Germany
| | | | - Laura-Maria Krabbe
- Department of Urology, The University of Münster Medical Center, Münster, Germany
| | - Henning Reis
- Institute of Pathology, University Hospital Essen, Essen, Germany
| | - Franz F Dressler
- Institute of Pathology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Mario W Kramer
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Johannes Salem
- Department of Urology, Clinic LINKS VOM RHEIN, Cologne, Germany
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Wang M, Xie F, Lin J, Zhao Y, Zhang Q, Liao Z, Wei P. Diagnostic and Prognostic Value of Circulating CircRNAs in Cancer. Front Med (Lausanne) 2021; 8:649383. [PMID: 33816529 PMCID: PMC8012499 DOI: 10.3389/fmed.2021.649383] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/15/2021] [Indexed: 12/24/2022] Open
Abstract
Cancer has been regarded as one of the leading causes of mortality worldwide. Diagnostic and prognostic biomarkers with high sensitivity and specificity for cancer play a crucial role in preventing or treating cancer. Circular RNAs (circRNAs), which hold great potential for the management of cancer patients due to their abundance, stable property, and high specificity in serum, plasma, and other body fluids, can be used as non-invasive and blood-based biomarkers in cancer diagnosis and prognosis. There are four types of circRNAs including exonic circRNAs (ecircRNA), intronic circRNAs, exon-intron circRNAs (EIciRNA), and intergenic circRNAs. CircRNAs can act as miRNA sponges, affect protein translation, interplay with RNA binding proteins, regulate protein recruitment, and modulate protein scaffolding and assembly. Therefore, the multifunctionalities of circRNAs make them ideal for detecting and predicting cancer. Indeed, circRNAs manifest high sensitivity and specificity in more than ten types of cancer. This review aims to consolidate the types and functions of circRNAs, as well as discuss the diagnostic and prognostic value of circulating circRNAs in cancer.
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Affiliation(s)
- Mina Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.,Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing, China
| | - Feiyu Xie
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.,Oncology Department, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiaran Lin
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.,Department of Nephrology and Endocrinology, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Yihan Zhao
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qian Zhang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Zehuan Liao
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore.,Department of Microbiology, Tumor, and Cell Biology (MTC), Karolinska Institutet, Biomedicum, Solnavägen, Sweden
| | - Peng Wei
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
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Follow-Up of Bladder Cancer. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Bladder cancer is the sixth leading cancer in the United States. Radical cystectomy is a lifesaving procedure for bladder cancer with or without muscle invasion. Radical cystectomy is performed on 39% of these patients, and 35% will have a life-threatening recurrence. Distant metastases are the most common; local, upper tract, and urethral recurrence can also occur. Surveillance after cystectomy is critical to diagnosing recurrence early. Functional complications after urinary diversion include bowel dysfunction, vitamin B12 deficiency, acidosis, electrolyte abnormalities, osteopenia, nephrolithiasis, urinary tract infections, renal functional decline, and urinary obstruction, which can be reversed when diagnosed early.
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Affiliation(s)
- Madhumitha Reddy
- Moores Cancer Center, UC San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093, USA
| | - Karim Kader
- Moores Cancer Center, UC San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093, USA.
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Bock H, Madersbacher S. Follow-Up of Bladder Cancer. Urol Oncol 2018. [DOI: 10.1007/978-3-319-42603-7_31-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Alimi Q, Verhoest G, Kammerer-Jacquet SF, Mathieu R, Rioux-Leclercq N, Manunta A, Laguerre B, Guille F, Bensalah K, Peyronnet B. Role of routine computed tomography scan in the oncological follow up of patients treated by radical cystectomy for bladder cancer. Int J Urol 2016; 23:840-846. [DOI: 10.1111/iju.13164] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/14/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Quentin Alimi
- Department of Urology; University Hospital of Rennes; Rennes France
| | - Grégory Verhoest
- Department of Urology; University Hospital of Rennes; Rennes France
| | | | - Romain Mathieu
- Department of Urology; University Hospital of Rennes; Rennes France
| | | | - Andréa Manunta
- Department of Urology; University Hospital of Rennes; Rennes France
| | | | - François Guille
- Department of Urology; University Hospital of Rennes; Rennes France
| | - Karim Bensalah
- Department of Urology; University Hospital of Rennes; Rennes France
| | - Benoit Peyronnet
- Department of Urology; University Hospital of Rennes; Rennes France
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Chi T. Editorial Comment. Urology 2015; 86:921. [PMID: 26590037 PMCID: PMC4966653 DOI: 10.1016/j.urology.2015.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Thomas Chi
- Department of Urology, University of California, San Francisco, CA
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