1
|
Braun AE, Chan JM, Neuhaus J, Cowan JE, Kenfield SA, Van Blarigan EL, Tenggara I, Broering JM, Simko JP, Carroll PR, Cooperberg MR. The impact of genomic biomarkers on a clinical risk prediction model for upgrading/upstaging among men with favorable-risk prostate cancer. Cancer 2024; 130:1766-1772. [PMID: 38280206 DOI: 10.1002/cncr.35215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND The challenge of distinguishing indolent from aggressive prostate cancer (PCa) complicates decision-making for men considering active surveillance (AS). Genomic classifiers (GCs) may improve risk stratification by predicting end points such as upgrading or upstaging (UG/US). The aim of this study was to assess the impact of GCs on UG/US risk prediction in a clinicopathologic model. METHODS Participants had favorable-risk PCa (cT1-2, prostate-specific antigen [PSA] ≤15 ng/mL, and Gleason grade group 1 [GG1]/low-volume GG2). A prediction model was developed for 864 men at the University of California, San Francisco, with standard clinical variables (cohort 1), and the model was validated for 2267 participants from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry (cohort 2). Logistic regression was used to compute the area under the receiver operating characteristic curve (AUC) to develop a prediction model for UG/US at prostatectomy. A GC (Oncotype Dx Genomic Prostate Score [GPS] or Prolaris) was then assessed to improve risk prediction. RESULTS The prediction model included biopsy GG1 versus GG2 (odds ratio [OR], 5.83; 95% confidence interval [CI], 3.73-9.10); PSA (OR, 1.10; 95% CI, 1.01-1.20; per 1 ng/mL), percent positive cores (OR, 1.01; 95% CI, 1.01-1.02; per 1%), prostate volume (OR, 0.98; 95% CI, 0.97-0.99; per mL), and age (OR, 1.05; 95% CI, 1.02-1.07; per year), with AUC 0.70 (cohort 1) and AUC 0.69 (cohort 2). GPS was associated with UG/US (OR, 1.03; 95% CI, 1.01-1.06; p < .01) and AUC 0.72, which indicates a comparable performance to the prediction model. CONCLUSIONS GCs did not substantially improve a clinical prediction model for UG/US, a short-term and imperfect surrogate for clinically relevant disease outcomes.
Collapse
Affiliation(s)
- Avery E Braun
- Department of Urology, University of California, San Francisco, California, USA
| | - June M Chan
- Department of Urology, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - John Neuhaus
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Janet E Cowan
- Department of Urology, University of California, San Francisco, California, USA
| | - Stacey A Kenfield
- Department of Urology, University of California, San Francisco, California, USA
| | - Erin L Van Blarigan
- Department of Urology, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Imelda Tenggara
- Department of Urology, University of California, San Francisco, California, USA
| | - Jeanette M Broering
- Department of Urology, University of California, San Francisco, California, USA
- Department of Surgery, University of California, San Francisco, California, USA
| | - Jeffry P Simko
- Department of Urology, University of California, San Francisco, California, USA
- Department of Pathology, University of California, San Francisco, California, USA
| | - Peter R Carroll
- Department of Urology, University of California, San Francisco, California, USA
| | - Matthew R Cooperberg
- Department of Urology, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| |
Collapse
|
2
|
Xiang A, Braun AE, Chang C, Swerdloff D, Gross MS, Simhan J. Penoscrotal inflatable penile prosthesis recipients often fully recover from pain at two weeks following placement. Int J Impot Res 2024:10.1038/s41443-024-00871-0. [PMID: 38561424 DOI: 10.1038/s41443-024-00871-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 12/19/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024]
Abstract
The symptoms and duration of pain following inflatable penile prosthesis (IPP) surgery remains poorly understood. We characterize postoperative pain following penoscrotal 3-piece inflatable penile prosthesis placement in patients managed with a standardized pain management protocol. This is a single-center prospective analysis of 96 virginal penoscrotal 3-piece IPP recipients (9/2019 to 9/2021) excluding patients with chronic pain, IPPs performed with alternative approaches or concomitantly with other surgeries and those with infections. Standardized pain questionnaire was performed by phone on post-operative day (POD) 2, 7, 14, and 30. The primary outcome was self-reported pain scores, measured by pain score 0-10 (0 = no pain, 10 = unbearable, "worst pain you have ever felt") at various locations (incision, penile, scrotal, abdominal) over the first 30 days postoperatively. A majority of pain reported was outside the scrotal area with 67.6% of complaints in the shaft, glans, abdomen and incision. From POD2 to POD30, there was a significant decrease in severe pain from 46.2 to 11.1% (p = 0.05) with an increase in mild pain from 23.1 to 62.4% (p = 0.05). Roughly half of the participants (47.9%, n = 46) reported no pain by POD14. Penoscrotal IPP recipients often fully recover from pain at the two-week period following surgery and those with lingering discomfort predominantly complain of penile shaft and glans pain.
Collapse
Affiliation(s)
- Alice Xiang
- Department of Urology, Jefferson Einstein Healthcare Network, Philadelphia, PA, USA
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Avery E Braun
- Department of Urology, Jefferson Einstein Healthcare Network, Philadelphia, PA, USA
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
- Department of Urology, University California of San Francisco, San Francisco, CA, USA
| | - Chrystal Chang
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Daniel Swerdloff
- Department of Urology, Jefferson Einstein Healthcare Network, Philadelphia, PA, USA
| | - Martin S Gross
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jay Simhan
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA.
| |
Collapse
|
3
|
Braun AE, Cowan JE, Hampson LA, Broering JM, Suskind AM, Carroll PR. Association Between Common Urologic Medications and Onset of Alzheimer's Disease and Related Dementias in Men With Prostate Cancer Managed by Different Primary Treatment Modalities. Urology 2023; 182:161-167. [PMID: 37689247 DOI: 10.1016/j.urology.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVE To understand the relationship between common urologic medications phosphodiesterase-5 inhibitors (PDE5i) and anticholinergics (AC) and risk of dementia onset in men who underwent different primary treatments for prostate cancer. MATERIALS AND METHODS Patients (>50years) with prostate cancer (1998-2022) without Alzheimer's disease or related dementias were selected from Cancer of the Prostatic Strategic Urologic Research Endeavor Registry. Minimum medication use was 3months. Fine-Gray regression was performed to determine the association between medication exposure and dementia onset ≥12months after primary treatment in men matched on age, race, comorbid conditions, smoking, and type of clinical site, with competing risk of death. RESULTS Among 5937 men (53% PDE5i; 14% AC), PDE5i users were younger (63 vs 70, P < .01) with less CAD, CVA, DM (all P < .01); AC users were older (68 vs 66, P < .01) with higher incidence of comorbidities (P < .01). Median months of use was 24.3 (IQR 12.1, 48.7) for PDE5i and 12.2 (IQR 6.1, 24.3) for AC users. Cumulative incidence of Alzheimer's disease or related dementias was 6.5% at 15years. PDE5i (P = .07) and AC (P = .06) were not associated with dementia regardless of primary treatment modality. CONCLUSION In this retrospective cohort study, PDE5i and AC use do not appear independently associated with risk of dementia. Notably, our cohort was generally healthy and younger which may limit our ability to detect significance. We recommend prospective investigation into association between PDE5i and dementia and advise continued judicious stewardship of AC in older patient populations.
Collapse
Affiliation(s)
- A E Braun
- Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA.
| | - J E Cowan
- Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA.
| | - L A Hampson
- Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | - J M Broering
- Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA; Department of Surgery, University of California, San Francisco, CA
| | - A M Suskind
- Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | - P R Carroll
- Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA.
| |
Collapse
|
4
|
Braun AE, Washington SL, Cowan JE, Hampson LA, Carroll PR. Impact of Stress Urinary Incontinence After Radical Prostatectomy on Time to Intervention, Quality of Life and Work Status. Urology 2023; 180:242-248. [PMID: 37442296 DOI: 10.1016/j.urology.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE To characterize the incidence of stress urinary incontinence (SUI) after radical prostatectomy (RP), its treatment, and impact on quality of life (QoL) and work status 1year after RP. MATERIALS AND METHODS Prostate cancer patients treated by RP (1998-2016) were selected from CaPSURE. SUI was defined as any pads per day (ppd) 1 year after RP. SUI procedures were tracked by CPT codes (sling and artificial sphincter). Patients reported work status (full-time, part-time, unpaid), UCLA PCa Index urinary function (UF) and bother (UB) and SF36 Index physical function (PF). Associations of incontinence with UF, UB, and PF and work status changes were assessed (ANOVA). Lifetable estimates and Cox proportional hazards regression evaluated risk of undergoing SUI procedures. RESULTS 664/2989 (22%) men treated with RP reported SUI at 1 year. More men with SUI had ≥GG2, intermediate to high-risk disease and non-nerve-sparing surgery (all P < .01). Cumulative incidence of SUI procedures was 1.4% at 10years after RP. Age (HR 2.68 per 10years, 95% CI 1.41-5.08) and number of ppd at 1 year (HR 3.20, 95% CI 2.27-4.50) were associated with undergoing SUI procedures. UF declined at 1year after RP, while UB and PF remained stable. UF, UB, and PF were inversely associated with number of ppd (all P < .01). Change in work status was not associated with incontinence or QoL scores. CONCLUSION Incontinence affected QoL without impacting work status, suggesting that men with SUI after RP may continue working and go under-treated despite impact on QoL.
Collapse
Affiliation(s)
- A E Braun
- Department of Urology, University of California, San Francisco, CA.
| | - S L Washington
- Department of Urology, University of California, San Francisco, CA; Department of Epidemiology & Biostatistics, University of California, San Francisco, CA
| | - J E Cowan
- Department of Urology, University of California, San Francisco, CA
| | - L A Hampson
- Department of Urology, University of California, San Francisco, CA
| | - P R Carroll
- Department of Urology, University of California, San Francisco, CA
| |
Collapse
|
5
|
Braun AE, Swerdloff D, Sudhakar A, Patel RD, Gross MS, Simhan J. Defining the incidence and management of postoperative scrotal hematoma after primary and complex three-piece inflatable penile prosthesis surgery. Int J Impot Res 2023:10.1038/s41443-023-00697-2. [PMID: 37156930 PMCID: PMC10166027 DOI: 10.1038/s41443-023-00697-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 05/10/2023]
Abstract
Scrotal hematoma is a challenging complication of penile prosthesis surgery. We characterize the risk of hematoma formation with implementation of standardized techniques to mitigate hematomas and assess for any associated factors in a large multi-institutional penile implant cohort. This was a retrospective review from February 2018 to December 2020 of all patients who underwent inflatable penile prosthesis implantation at 2 high volume implant centers. Cases were defined as "complex" if they involved revision, salvage with removal/replacement, or were performed with concurrent penile, scrotal or intra-abdominal surgeries. The incidence of scrotal hematoma among primary and complex IPP recipients was measured and modifiable and innate risk factors associated with hematoma formation within the two cohorts were tracked. Of 246 men who underwent penile prosthesis surgery, 194 (78.9%) patients underwent primary implantation and 52 (21.1%) were complex. Although hematoma formers in the complex group had comparable drain outputs to primary patients on postoperative day 0 (66.8cc ± 32.5 vs 48.4 ± 27.7, p = 0.470) and postoperative day 1 (40.3cc ± 20.8vs 21.8 ± 11.3 p = 0.125), hematomas in the complex group had a higher propensity for OR evacuation (p = 0.03). Difference in duration of temporary device inflation between 2 (64, 26%) and 4 weeks (182, 74%) did not contribute to hematoma formation (p = 0.562). The incidence of postoperative hematoma formation in complex cases was 9.6% (5/52) and 3.6% in primary cases (7/194) (HR = 2.61, p = 0.072). Complex IPP surgery performed for revision or with ancillary procedures are more likely to result in clinically significant hematomas that require surgical management, suggesting a need for heightened caution in managing these individuals.
Collapse
Affiliation(s)
- Avery E Braun
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Rutul D Patel
- Department of Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Martin S Gross
- Department of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jay Simhan
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA.
| |
Collapse
|
6
|
Abstract
Upper tract urothelial carcinoma (UTUC) accounts for roughly 5% of urothelial carcinomas. Historically, the gold standard for high-risk or bulky low-risk UTUC was an open radical nephroureterectomy with formal bladder cuff excision (BCE). The development of novel endoscopic, laparoscopic, and robotic techniques has transformed this operation, yet no level I evidence exists at present that demonstrates the superiority of one strategy over another. While new approaches to nephroureterectomy in the last decade have shifted the management paradigm to decrease the morbidity of surgery, controversy continues to surround the approach to the distal ureter and bladder cuff. Debate continues within the urologic community over which surgical approach is best when managing UTUC and how various approaches impact clinical outcomes such as intravesical recurrence, recurrence-free survival (RFS) and disease-specific mortality (DSM). When focusing on the existing treatment algorithm, key metrics of quality include (I) removal of the entire specimen en bloc, (II) minimizing the risk of tumor and urine spillage, (III) R0 resection, and (IV) water-tight closure allowing for early use of prophylactic intravesical chemotherapy. In the absence of robust evidence demonstrating a single superior approach, the urologic surgeon should base decisions on technical comfort and each patient's particular clinical circumstance.
Collapse
Affiliation(s)
- Avery E Braun
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Abhishek Srivastava
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Fenizia Maffucci
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Alexander Kutikov
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| |
Collapse
|
7
|
Abstract
Individuals with Parkinson's disease (PD) perform deficiently on Raven's Coloured Progressive Matrices (RCPM), in contrast to their relatively good performance on many other problem-solving tasks. The question is raised as to whether a visuospatial deficit may account for poor RCPM performance in PD. The authors analyzed RCPM results in 50 nondemented participants with PD and 39 age-matched healthy control participants. The PD group made significantly more errors than the control group on all RCPM subtests, including the subtest that mainly assessed visuospatial function (RCPM-A). For the PD group, the composite score of other visuospatial tests, but not the composite scores of tests of executive function or verbal memory, significantly predicted performance on the RCPM-A. Visuospatial impairment in PD may arise from dysfunction of the basal ganglia-thalamocortical circuit that also includes the dorsolateral prefrontal cortex and, importantly, the posterior parietal lobes.
Collapse
Affiliation(s)
- A Cronin-Golomb
- Department of Psychology, Boston University, Massachusetts 02215, USA.
| | | |
Collapse
|
8
|
Abstract
Individuals with Parkinson's disease (PD) perform deficiently on Raven's Coloured Progressive Matrices (RCPM), in contrast to their relatively good performance on many other problem-solving tasks. The question is raised as to whether a visuospatial deficit may account for poor RCPM performance in PD. The authors analyzed RCPM results in 50 nondemented participants with PD and 39 age-matched healthy control participants. The PD group made significantly more errors than the control group on all RCPM subtests, including the subtest that mainly assessed visuospatial function (RCPM-A). For the PD group, the composite score of other visuospatial tests, but not the composite scores of tests of executive function or verbal memory, significantly predicted performance on the RCPM-A. Visuospatial impairment in PD may arise from dysfunction of the basal ganglia-thalamocortical circuit that also includes the dorsolateral prefrontal cortex and, importantly, the posterior parietal lobes.
Collapse
Affiliation(s)
- A Cronin-Golomb
- Department of Psychology, Boston University, Massachusetts 02215, USA.
| | | |
Collapse
|
9
|
Braun AE. Emergency cardiac care: when arrest is imminent. RN 1994; 57:22-9; quiz 30. [PMID: 8128142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
10
|
Braun AE. Emergency cardiac care. A quick response to life-threatening arrhythmias. RN 1994; 57:54-62; quiz 63. [PMID: 8303173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
11
|
Braun AE. Emergency cardiac care: the new drug protocols. RN 1993; 56:52-8; quiz 59. [PMID: 8235328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
12
|
Braun AE. Emergency cardiac care: fine-tuning for the '90s. RN 1993; 56:50-56. [PMID: 8372329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
13
|
Braun AE. What to do when a patient needs defibrillation or cardioversion. Nursing 1991; 21:50-4. [PMID: 1808565 DOI: 10.1097/00152193-199107000-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
14
|
Braun AE. Drugs that dissolve clots. RN 1991; 54:52-7. [PMID: 1903557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
15
|
Bayley EW, Braun AE, D'Italia JG, Fitzgerald JM, Gandolfo SL, Hoban-Kahn M, Kaplon S, Lowe KE, McLaughlin JF, McMonigle PA. Standards for burn nursing practice. J Burn Care Rehabil 1989; 10:362-73. [PMID: 2793912 DOI: 10.1097/00004630-198907000-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- E W Bayley
- Nurse Advisory Council, Burn Foundation, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Braun AE. Transthoracic pacing in the emergency department. J Emerg Nurs 1986; 12:354-9. [PMID: 3540406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
17
|
Starcher LC, Braun AE. Stevens-Johnson syndrome: applied pathophysiology. Dimens Crit Care Nurs 1985; 4:330-4. [PMID: 3905311 DOI: 10.1097/00003465-198511000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
|
18
|
Braun AE, Schweiger JL. Proper staffing schedules: a must for coronary care. Nurs Manag (Harrow) 1983; 14:27-8. [PMID: 6556487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
|