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Alam MU, Kumar J, Norez D, Woolfe J, Tanneru K, Jazayeri SB, Bazargani S, Thomas D, Gautam S, Costa J, Bandyk M, Ganapathi HP, Koochekpour S, Balaji KC. Natural history, and impact of surgery and radiation on survival outcomes of men diagnosed with low-grade prostate cancer at ≤ 55 years of age: a 25-year follow-up of > 60,000 men. Int Urol Nephrol 2023; 55:295-300. [PMID: 36171482 DOI: 10.1007/s11255-022-03363-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 09/10/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Low-grade prostate cancer has low mortality rates at 10 years; however, it is unclear if the response is sustained for up to 25 years of follow-up. METHODS Using Surveillance, Epidemiology, and End Results database, the overall and cancer-specific mortality rates were compared among men ≤ 55 years of age diagnosed with low-grade prostate cancer that either had radical prostatectomy, radiotherapy, or no known treatment. RESULTS Of the 62,772 men diagnosed with low-grade prostate cancer between 1975 and 2016, about 60%, 20% and 20% of men underwent radical prostatectomy, radiotherapy, and no known treatment, respectively. At a median follow-up of 10 years, almost 2% and 7% of men died of prostate cancer and other causes, respectively. The overall mortality was significantly better in radical prostatectomy group compared to no known treatment group (HR 1.99, CI 1.84-2.15, P value < 0.001), but not between the radiotherapy and no known treatment groups. Moreover, the overall and cancer-specific mortality rates in the radiotherapy group were almost two and three times compared to the radical prostatectomy group, respectively (HR 2.15, CI 2.01-2.29, P value < 0.001 for overall mortality and HR 2.87, CI 2.5-3.29, P value < 0.001 for cancer-specific mortality). CONCLUSIONS The study confirms low mortality rates in men diagnosed with low-grade prostate cancer for over 25 years' follow-up. While radical prostatectomy improves survival significantly compared to no known treatment, radiotherapy is associated with an increase in overall and cancer-specific mortality, which may be related to long-term toxicities.
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Affiliation(s)
- Muhammad Umar Alam
- Department of Urology, Armstrong County Memorial Hospital, Kittanning, PA, 16201, USA.
| | - Jatinder Kumar
- Department of Urology, Armstrong County Memorial Hospital, Kittanning, PA, 16201, USA
| | - Daniel Norez
- Department of Biostatistics, University of Florida, Jacksonville, FL, USA
| | - Jennifer Woolfe
- Department of Biostatistics, University of Florida, Jacksonville, FL, USA
| | - Karthik Tanneru
- Department of Urology, Medical University of South Carolina, Florence, South Carolina, USA
| | - Seyed Behzad Jazayeri
- Department of Urology, University of Florida, 655 8th St W, Jacksonville, FL, 32209, USA
| | - Soroush Bazargani
- Department of Urology, University of Florida, 655 8th St W, Jacksonville, FL, 32209, USA
| | - Devon Thomas
- Department of Urology, University of Florida, 655 8th St W, Jacksonville, FL, 32209, USA
| | - Shiva Gautam
- Department of Biostatistics, University of Florida, Jacksonville, FL, USA
| | - Joseph Costa
- Department of Urology, University of Florida, 655 8th St W, Jacksonville, FL, 32209, USA
| | - Mark Bandyk
- Department of Urology, University of Florida, 655 8th St W, Jacksonville, FL, 32209, USA
| | | | - Shahriar Koochekpour
- Department of Urology, University of Florida, 655 8th St W, Jacksonville, FL, 32209, USA
| | - K C Balaji
- Department of Urology, University of Florida, 655 8th St W, Jacksonville, FL, 32209, USA
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Kumar J, Alam MU, Jazayeri SB, Tanneru K, Bazargani S, Shastri C, Gautam S, Koochekpour S, Shukla S, Bandyk M, Costa J, Balaji KC. Combination therapy in metastatic castration sensitive prostate cancer: A Systematic review and network meta-analysis. Indian J Urol 2022; 38:220-226. [PMID: 35983120 PMCID: PMC9380455 DOI: 10.4103/iju.iju_402_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/07/2022] [Accepted: 05/20/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction Studies directly comparing the different combination therapies offered to men with metastatic castration sensitive prostate cancer (mCSPC), are not available yet. This study was designed using the network meta-analysis (NMA) framework to provide a comparison of the different available options for the treatment of men with mCSPC. Methods A systematic search was performed and the prospective randomized controlled trials reporting the overall survival (OS) or failure-free survival (FFS) were selected for review. A total of 14 studies were included in the NMA. Results The addition of abiraterone, apalutamide, docetaxel, and docetaxel with zoledronic acid to the androgen deprivation therapy (ADT) demonstrated a significant improvement in the OS. In indirect comparison, abiraterone had a higher impact on the OS as compared to docetaxel (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 1.0-1.46) and docetaxel with zoledronic acid (HR: 1.31, 95% CI: 1.05-1.63) but not apalutamide. Furthermore, apalutamide was not different than docetaxel or docetaxel with zoledronic acid. There was a significant improvement in the FFS with the combination of abiraterone, apalutamide, docetaxel (HR: 0.61, 95% CI: 0.46-0.81), docetaxel with zoledronic acid (HR: 0.62, 95% CI: 0.43-0.9), and enzalutamide (HR: 0.39, 95% CI: 0.25-0.61) as compared to the ADT alone. Similar to the indirect comparison of OS, abiraterone outperformed docetaxel (HR: 1.66, 95% CI: 1.12-2.47), docetaxel with zoledronic acid (HR: 1.69, 95% CI: 1.06-2.68), and enzalutamide (HR: 1.06, 95% CI: 0.63-1.80), but not apalutamide in terms of impact on the FFS. Conclusion Overall, abiraterone demonstrated better OS and FFS outcomes as compared to all the other combination strategies in this NMA.
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Affiliation(s)
- Jatinder Kumar
- Armstrong Center for Medicine and Health, Kittanning, Pennsylvania, USA,
E-mail:
| | | | | | - Karthik Tanneru
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | - Soroush Bazargani
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | - Charu Shastri
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | - Shiva Gautam
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | | | - Sanjeev Shukla
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | - Mark Bandyk
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | - Joseph Costa
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | - K. C. Balaji
- Armstrong Center for Medicine and Health, Kittanning, Pennsylvania, USA
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Tanneru K, Jazayeri SB, Alam MU, Kumar J, Bazargani S, Kuntz G, Palayapalayam Ganapathi H, Bandyk M, Marino R, Koochekpour S, Gautam S, Balaji KC, Costa J. An Indirect Comparison of Newer Minimally Invasive Treatments for Benign Prostatic Hyperplasia: A Network Meta-Analysis Model. J Endourol 2021; 35:409-416. [PMID: 32962442 DOI: 10.1089/end.2020.0739] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: This study was designed to provide an indirect comparison of the urinary and sexual domain outcomes and complications after newer minimally invasive surgical therapy (MIST) of Aquablation, Rezum, and UroLift for benign prostatic hyperplasia (BPH) for transurethral resection of prostate (TURP). Methods: We searched Embase, Medline, and Cochrane in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, in December 2019. Only randomized clinical trials (RCTs) that reported outcomes after treatment of BPH for prostate less than 80 g with Aquablation, Rezum, or UroLift were included in the analysis. Results: A total of four RCTs reporting the outcomes after treatment with newer MIST for BPH were identified. Patients undergoing the resective procedures, that is, TURP and Aquablation, had greater improvement in urinary domain outcomes: International Prostate Symptom Score, quality of life, peak flow rate, and postvoiding residual compared to patients undergoing nonresective procedures: UroLift and Rezum. Patients in UroLift group maintained a higher sexual function domain score compared to TURP, but not Aquablation. Our multiple comparison analysis did not reveal a significant difference in urinary and sexual domain scores between patients undergoing UroLift and Rezum at 24 months of follow-up. Conclusions: Aquablation and TURP necessitate general or regional anesthesia and both produced significantly better urinary domain scores compared to Rezum and UroLift. On the other hand, UroLift demonstrated better sexual function domain scores compared to TURP, but not Aquablation. There was no significant difference in urinary domain scores between UroLift and Rezum at 24 months of follow-up.
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Affiliation(s)
- Karthik Tanneru
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | | | - Muhammad Umar Alam
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | - Jatinder Kumar
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | - Soroush Bazargani
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | - Gretchen Kuntz
- Borland Library, University of Florida, Jacksonville, Florida, USA
| | | | - Mark Bandyk
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | - Robert Marino
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | | | - Shiva Gautam
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | - K C Balaji
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | - Joseph Costa
- Department of Urology, University of Florida, Jacksonville, Florida, USA
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Alam MU, Kumar J, Norez D, Tanneru K, Jazayeri SB, Bazargani S, Costa J, Bandyk M, Ganapathi HP, Koochekpour S, Gautam S, Balaji KC. Pathology grade influences competing mortality risks in elderly men with prostate cancer. Urol Oncol 2021; 39:493.e1-493.e7. [PMID: 33353870 DOI: 10.1016/j.urolonc.2020.12.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/03/2020] [Accepted: 12/08/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recent guidelines recommend active management of prostate cancer (CaP), especially high-risk disease, in elderly men. However, descriptive data from a large cohort with extended follow up on the risk of death from CaP in men diagnosed over 70 years of age and its relationship to Gleason score (GS) and serum prostate specific antigen (PSA) level is lacking. Using the Surveillance, Epidemiology, and End Results database, we evaluated the influence of GS and serum PSA levels on the risks of mortality from PC (PCM) and mortality from other causes in localized (LPC) and metastatic (MPC) disease in elderly population. METHODS Men diagnosed with PC over 70 years of age between 2004 and 2016 were divided into LPC and MPC groups, categorized by age: 70-74, 75-79, 80-84, 85-89, and ≥90 years and stratified by GS <7, 7, and >7, and serum PSA level <4, 4-10, 10-20, 20-50, and >50 ng/mL. Competing risk estimates for PCM and mortality from other causes were generated for both groups. RESULTS Of the 85,649 men, 85.5 % were LPC at diagnosis. Overall, at a median follow up of 4 years, 15% of the men had died including a third from PC. While <15% of men with GS ≤7 died from PC, the PCM was >30% in men with GS >7 in LPC group, which accounted for almost half of total deaths for age 70-84 years. The GS >7 was also significantly associated with PCM in men with MPC. Furthermore, PCM directly correlated with serum PSA levels, with mortality rates reaching up to 50% and 70% for PSA >50 ng/dl for LPC and MPC, respectively. CONCLUSIONS There is a substantial risk of dying in men diagnosed with LPC over 70 years of age with GS >7 or a serum PSA >20 ng/mL. Furthermore, the risk for death for MPC directly correlated with GS with PCM increasing from 10%-30% for GS ≤7 to >50% for GS >7. The data, in conjunction with other clinical parameters such as comorbidities could be used to counsel elderly men on management options of PC for both localized and metastatic PC.
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Affiliation(s)
| | - Jatinder Kumar
- Department of Urology, University of Florida, Jacksonville, FL
| | - Daniel Norez
- Center for Data Solutions, University of Florida, Jacksonville, FL
| | - Karthik Tanneru
- Department of Urology, University of Florida, Jacksonville, FL
| | | | | | - Joseph Costa
- Department of Urology, University of Florida, Jacksonville, FL
| | - Mark Bandyk
- Department of Urology, University of Florida, Jacksonville, FL
| | | | | | - Shiva Gautam
- Center for Data Solutions, University of Florida, Jacksonville, FL
| | - K C Balaji
- Department of Urology, University of Florida, Jacksonville, FL
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Tanneru K, Pichandi RE. A Rare Case of Prolapsed Ureterocele With Large Redundant Flap After Unroofing in Adult Female. Urology 2020; 147:35-36. [PMID: 32739308 DOI: 10.1016/j.urology.2020.07.031] [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: 05/21/2020] [Revised: 07/06/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
We present a case of 26-year female who presented with acute urinary retention and vulvar mass. She denies any urinary complaints in the past except for occasional straining for voiding. Imaging revealed a prolapsed ureterocele, it was successfully managed with incision and excising a flap of ureterocele due to the risk of postoperative protrusion of the redundant ureterocele. On follow-up at 6 months she was voiding well without any complaints.
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Affiliation(s)
- Karthik Tanneru
- Department of Urology, University of Florida, Jacksonville, FL.
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Alam* M, Gautam S, Kumar J, Tanneru K, Norez D, Koochekpour S, Nguyen S, Ganapathi HP, Bandyk M, Costa J, Marino R, Balaji KC. MP14-16 COMBINATION THERAPY FOR METASTATIC RENAL CELL CARCINOMA: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS. J Urol 2020. [DOI: 10.1097/ju.0000000000000839.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tanneru* K, Tanneru K, Gautam S, Norez D, Kumar J, Alam MU, Jazayeri SB, Bazargani S, Bandyk M, Ganapathi HP, K.C B, Koochekpour S, Costa J. MP48-08 EVALUATION OF GENITOURINARY COMPLICATIONS AFTER SPINAL CORD INJURY: RESULTS OF MODEL SPINAL CORD INJURY SYSTEMS 15-YEAR FOLLOW-UP DATA. J Urol 2020. [DOI: 10.1097/ju.0000000000000903.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tanneru K, Gautam S, Norez D, Kumar J, Alam MU, Koocheckpour S, Balaji KC, Joseph C. Meta-analysis and systematic review of intermediate-term follow-up of prostatic urethral lift for benign prostatic hyperplasia. Int Urol Nephrol 2020; 52:999-1008. [DOI: 10.1007/s11255-020-02408-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/06/2020] [Indexed: 12/12/2022]
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Devraj R, Tanneru K, Reddy B, Amancherla H, Chilumala R. Renal stone culture and sensitivity is a better predictor of potential urosepsis than pelvic or midstream urine culture and sensitivity. J NTR Univ Health Sci 2016. [DOI: 10.4103/2277-8632.196559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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