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INTRODUCTION AND OBJECTIVE: In 2018, The US Preventive Services Task Force (USPSTF) changed its recommendations for prostate specific antigen (PSA) screening from "non-recommended" to "shared decision-making among men aged 55-69". Thereafter, COVID-19 Pandemic disrupted cancer care with evidence suggesting overall reduced access to and utilization of health care services including preventive screening. We aim to examine the impacts of both events on PSA screening for men aged 55-69. METHOD(S): We analyzed 2013, 2015, 2018, 2019, and 2021 National Health Interview Survey data. Men >54 who reported PSA testing within 12 months preceding survey were considered to have undergone screening. Adjusted difference in differences (DID) analyses were performed to compare changes in screening in men aged 55-69 with reference to men >70 between 2015 and 2019 (pre- and post- 2018 USPSTF recommendation) and between 2019 and 2021 (pre- and post-Pandemic). RESULT(S): A total of 24,308 men were included. PSA screening prevalence was 35.4% (95%CI: 33.7%, 37.1%), 32.1% (95%CI: 30.3%, 33.9%), 33.3% (95%CI: 31.6%, 34.9%), 37.2% (95%CI: 35.7%, 38.8%), and 34.9% (95%CI: 33.3%, 36.5%) respectively for included years. From 2015 to 2019, PSA screening increased 4.6% among men aged 55-69 (95%CI: 1.7, 7.5%) and increased 6.5% among men >70 (95% CI: 2.7, 10.4%). From 2019 to 2021, PSA screening decreased 3.1% among men aged 55-69 (95%CI: 0.58%, 5.8%);PSA screening also decreased 0.8% among older men but did not reach significance (95% CI: -2.6%, 4.2%). DID analysis did not show difference in changes between men aged 55-69 in reference to men >70 from both 2015 to 2019 (DID=-1.9%, 95%CI, -6.7%, 2.9%) and 2019 to 2021 (DID =-2.3%, 95%CI, -6.5%, 1.9%). CONCLUSION(S): We saw an increase in PSA screening after 2018 USPSTF recommendations among its target population e men aged 55-69 and also among older men >70. In contrast, the period from 2019 to 2021 saw a significant decrease in PSA screening in those aged 55-69. The lack of significant DID between groups as well as the downward trend of PSA screening in men >70 together suggest an overall trend of decrease in PSA screening post-Pandemic.
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INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic likely affected the healthcare system's ability to deliver prostate cancer care services. Herein, we sought to evaluate prostate cancer's stage and grade migration resulting from the COVID-19 pandemic. METHOD(S): We retrospectively analyzed the National Cancer Database (NCDB) for men with prostate cancer between 2018-2020. We divided our cohort into the "Pre-Pandemic" (2018/2019) and "Pandemic" (2020) periods. Stage and grade of prostate cancer were stratified according to the severity of disease: PSA value (<=20 vs. >20), clinical T stage (cT1-T2 vs. cT3-T4), clinical M stage (cM0 vs. cM1), International Society of Uropathology (ISUP) grade group (ISUP 1-2-3 vs. ISUP 4-5), and D'Amico risk classification (low risk vs. intermediate & high risk). Pearson's chi-square test was used to assess differences in the distribution of stage and grade across the two periods. We performed multivariable logistic regressions to estimate the effect of the "Pandemic" period on stage and grade distribution adjusting for clinical and socioeconomic covariates. RESULT(S): A total of 398,719 men were diagnosed with prostate cancer during the "Pre-pandemic" (70.6%) and "Pandemic" (29.4%) periods (Table 1). On univariable comparisons, an increase in stage/ grade across the two periods was demonstrated (all p<0.001). After adjusting for covariates, compared to the "Pre-pandemic", the "Pandemic" period was associated with increased odds of PSA >20 levels (aOR 1.06;95% CI 1.03 - 1.08;p-value <0.001), cT3-4 stages (aOR 1.12;95% CI 1.08 - 1.16;p<0.001), cM1 stage (aOR 1.15;95% CI 1.12 - 1.18;p<0.001), ISUP grade group 4 or 5 (aOR 1.03;95% CI 1.01 - 1.05;p=0.003) and D'Amico Intermediate & High risk groups (aOR 1.15;95% CI 1.13 - 1.18;p<0.001). CONCLUSION(S): The COVID-19 pandemic was associated with significant changes in the distribution of both stage and grade of prostate cancer. Possible explanations for this migration include a better selection of patients for prostate biopsy during the pandemic or changes in prostate cancer screening patterns.
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Introduction & Objectives: With the introduction of new modalities for prostate biopsies, detection rates of prostate cancer have been increased on one hand but on the other hand there are still some institutions where transperineal prostate (TP) biopsies cannot be offered due to limitations such as lack of expertise, absence of facilities, financial limitations, immense pressure on health system and especially during Covid pandemic. The aim of our study is to look at the prostate cancer detection rates of mpMRI (multi-parametric) prostate lesions amenable to transrectal ultrasound prostate biopsies (TRUS) and whether or not it can be offered in institutions with limited options. Material(s) and Method(s): Retrospectively we looked at the results of 95 patients with mean age of 67.8 years, mean prostate volume 46.5 cc, median PSA 7.2 ng/mL. TRUS biopsies amenable lesions on MRI prostate comprised of all peripheral or posterior zone lesions with: PIRADS II with rising PSA (1 patient);PIRADS >3 with PSAD of > 0.12 (14 patients), PIRADS IV (42 patients) and PIRADS V (33 patients). In addition to these there were 5 patients where PIRADS category was not clear. All patients underwent prostate biopsies (from both lobes) as per departmental protocol. Result(s): We found 0%, 42.9%, 68.4% and 90.3% in PIRADS II, PIRADS >III with PSAD >0.12, PIRADS IV and PIRADS V, respectively. In those where no PIRADS category was given 2 (40%) patients had the positive histology for prostate cancer. Overall prostate cancer detection rate was 65.2%. A direct proportional link was found between PIRADS category and prostate cancer detection. Only 2 patients with negative prostate biopsies agreed to have TP prostate biopsies repeated, that showed Gleason score 6 in PIRADS IV lesion and benign histology in other patient with PIRADS V lesion. It is also found that 15-50% of lesions in contralateral lobe have not been picked up by the MRI scan that came positive for prostate cancer (see table).(Table Presented) Most common to least common, the following histology was note: Gleason score (GS) > 8 (36 patients, 58%), GS 4+3 (10 patients, 16.1%), GS 3+4 (12 patients, 19.3%), GS 6 (4 patients, 6.4%) and high grade PIN (1 patient, 1.6%). Conclusion(s): It can be concluded that TRUS prostate biopsies can be utilized in a productive way by achieving highly satisfactory results in patients who has MRI prior to biopsies. A careful selection and a proper reading of MRI are warranted to achieve the good outcomes. TRSU biopsies are helpful in those departments with limitations in carrying out TP prostate biopsiesCopyright © 2022 European Association of Urology. Published by Elsevier B.V.
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Background: Prostate cancer is one of the most common cancers worldwide. The proper management of this cancer during the coronavirus disease 2019 (COVID-19) or similar outbreaks could be a serious challenge. Proper timing of surgery, radiotherapy, and other medical modalities are essential in providing the most effective treatment. Objective(s): This systematic review aimed at evaluating the proper management of prostate cancer during the COVID-19 outbreak. Method(s): This study was conducted from 2019 to 2022. An internet search was conducted using the keywords: Diagnosis, man-agement, radical prostatectomy, radiotherapy, hormone ablation therapy, chemotherapy and prostate cancer, and COVID-19. The visited databases included PubMed, Scopus, Web of Sciences, Google Scholar, and Scientific Information Database. The review was performed based on the preferred reporting items for a systematic review and meta-analyses (PRISMA) guidelines. Result(s): Postponing the biopsy for up to three months and adopting of non-invasive diagnostic methods were likely reasonable during the COVID-19 pandemic. Patients with cancer were more prone to severe injuries and were more likely to have serious compli-cations. Surgery, radiation therapy, brachytherapy, palliative radiation, hormone ablation therapy, and chemotherapy were among the pre-institutional treatments that had to be performed according to medical protocols as well as health and professional guide-lines. Conclusion(s): It was recommended that the prostate cancer screening should not be performed for asymptomatic men during the COVID-19 outbreak. It was also suggested that the treatment should be performed in the shortest possible time and in the safest way.Copyright © 2023, Author(s).
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Biomarker detection has attracted increasing interest in recent years due to the minimally or non-invasive sampling process. Single entity analysis of biomarkers is expected to provide real-time and accurate biological information for early disease diagnosis and prognosis, which is critical to the effective disease treatment and is also important in personalized medicine. As an innovative single entity analysis method, nanopore sensing is a pioneering single-molecule detection technique that is widely used in analytical bioanalytical fields. In this review, we overview the recent progress of nanopore biomarker detection as new approaches to disease diagnosis. In highlighted studies, nanopore was focusing on detecting biomarkers of different categories of communicable and noncommunicable diseases, such as pandemic COVID-19, AIDS, cancers, neurologic diseases, etc. Various sensitive and selective nanopore detecting strategies for different types of biomarkers are summarized. In addition, the challenges, opportunities, and direction for future development of nanopore-based biomarker sensors are also discussed.Copyright © 2023 Elsevier B.V.
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Background: Lorigerlimab (MGD019) is an investigational, bispecific Fc-bearing (IgG4) DART molecule designed to enhance CTLA-4 blockade on dual expressing, tumor infiltrating lymphocytes, while maintaining maximal PD-1 blockade on PD-1 expressing cells. Lorigerlimab has approximate dose proportional PK across 1-10 mg/kg IV dosing Q3W, with sustained PD-1 receptor occupancy evident at doses >=1 mg/kg Q3W. MGD019-01 is a global first-in-human dose finding and activity estimating study of lorigerlimab in advanced solid tumors (AST). Method(s): The exp phase of MGD019-01 evaluates single agent safety, PK, and antitumor effects of lorigerlimab at the recommended dose for exp of 6 mg/ kg IV Q3W in 4 tumor specific cohorts. Confirmed responses were noted in each cohort. Preliminary results of the mCRPC cohort are reported here. Response evaluable pts received >=1 dose and had >=1 postbaseline imaging evaluation. Measurable lesions were evaluated per RECIST v1.1 and skeletal metastases assessed by bone scan. Prostate specific antigen (PSA) response was defined as a >=50% (PSA50) or>=90% (PSA90) PSA decline from baseline with confirmation>=3 weeks later. Expression of proliferation marker, Ki67, and inducible costimulator (ICOS) by peripheral T cells was assessed by flow cytometry. Result(s): At data cutoff (9/10/22), 127 pts with AST received >=1 dose of lorigerlimab 6 mg/ kg. Median exposure was 10 weeks (range, 0.1, 94.4) with median of 4 infusions. 6 pts remain on therapy;36 discontinued for PD (n=13), AEs (n=17), or patient/physician decision (n=6). Treatment related adverse events (TRAE) occurred in 109/127 (85.8%) pts. TRAEs occurring in>=15% of pts were fatigue, pruritus, hypothyroidism, pyrexia. Rates of grade >=3 TRAEs and immune-related AEs were 32.3% and 7.9%, respectively. AEs leading to drug discontinuation occurred in 22.8% of pts. There were no fatal AEs related to lorigerlimab. In the mCRPC exp cohort (n=42), pts had a median of 2 prior lines of therapy for CRPC, >80% received prior ART or taxanes;88% had visceral (liver, 26%;lung, 26%) or nodal disease and 95% had bone metastases. 42 pts were PSA response evaluable;35 were RECIST evaluable. ORR was 25.7% (9/35;9 confirmed PRs). Median duration of response was 16.1 weeks (range 6-25+ weeks). 5 responders remain on study, 4 discontinued for unrelated fatal AEs: COVID-19 (2) cardiac arrest (1) C. difficile infection (1). Confirmed PSA50 and PSA90 response rates were 28.6%(12/42) and 21.4% (9/42), respectively. Increased frequencies of Ki67+ and ICOS+ T cells were observed on day 8 posttreatment compared to pretherapy per the flow cytometry analyses from 35 pts. Conclusion(s): Lorigerlimab demonstrates a manageable safety profile with evidence of encouraging and durable antitumor activity in a chemotherapy refractory mCRPC population. Randomized evaluation of lorigerlimab in mCRPC is warranted.
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Seborrhoeic keratosis is a benign brownish-black skin lesion that is almost always seen in middle-aged and elderly populations. The sudden onset and rapid increase in size and/ or number of seborrhoeic keratoses is called the Leser-Trelat sign, suggesting a paraneoplastic manifestation of internal malignancy. However, eruptive seborrhoeic keratoses are also described in some nonmalignant conditions such as human papillomavirus infection and HIV infection. Herein, we report a case with Leser-Trelat sign in a patient following COVID-19 infection. A 50-year-old man presented to our dermatology clinic complaining of the sudden appearance of multiple warty-like lesions on his back, which had occurred 2 months after recovery from COVID-19 infection. According to his medical history, the patient presented with cough, fever and dyspnoea about 2 months prior to the appearance of his skin lesions. He was referred to a health centre, where a nasopharyngeal swab was taken, and his polymerase chain reaction test for COVID-19 was positive. In addition, bilateral patchy ground-glass infiltration was reported in his high-resolution computed tomography (HRCT) scan, all in favour of COVID- 19 infection. The patient was then treated with acetaminophen, dexamethasone (intramuscular injection), salmeterol and a fluticasone inhaler, and his symptoms improved. Two months after recovery from his mild COVID-19 infection, several small asymptomatic pigmented verrucous papules appeared on his back. Physical examination revealed multiple rough, oval-shaped, brownish papules of varying size. Dermatoscopy of the lesions was also performed. Both clinical and dermoscopic findings were in favour of seborrhoeic keratosis. In order to reach a final diagnosis, a skin biopsy was performed, and microscopic examination of the biopsy specimen showed hyperkeratosis and well-defined epidermal hyperplasia composed mainly of the proliferation of benignlooking basaloid cells and fewer squamoid cells and horn cysts and increased melanin, mostly at the dermoepidermal junction. The dermis showed no significant change. Based on the above findings, the patient was diagnosed with eruptive seborrhoeic keratosis. To determine the possible cause of this eruption, the patient was further evaluated. In his past medical history, he was generally healthy before his COVID-19 infection and had no history of comorbidities. The patient underwent a workup to rule out any internal malignancies. Laboratory tests revealed normal results and included a complete blood count, liver and kidney function tests, electrolytes, prostate-specific antigen and urine analysis. Gastrointestinal endoscopy and colonoscopy ruled out any gastrointestinal malignancy. Chest X-ray and HRCT revealed no malignant lesion. In addition, the patient's abdominopelvic sonography was normal. The patient had no family history of similar skin lesions and gave no history of any chronic inflammatory skin diseases or viral conditions. Therefore, the appearance of the Leser-Trelat sign after COVID- 19 infection was a possibility in this patient. The role of transforming growth factor-alpha and tumour necrosis-alpha in eruptive seborrhoeic keratoses, as well as in COVID-19 infection, can be a common area of interest to explore in the aetiology of this entity.
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The article provides an overview of the most significant publications on the male infertility topic. The main selection criteria were considered the practical significance of the article, as well as the impact factor of the journal in which it was published, according to the SCImago Journal Rank (SJR). As a result, a list of 10 works published in the third quarter (July-September) of 2020 was formed. The review included articles on the following issues: Redox balance in the male reproductive system, advanced paternal age, the effect of a new nasal form of testosterone on fertility, the correlation of PSA levels with infertility, as well as new data on the effect of COVID-19 on male fertility.Copyright © 2021 Vestnik Urologii. All rights reserved.
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Background: According to newspaper Bernama, 87.6% of adolescents in Malaysia aged between 12 and 17 have completed their vaccination and 97.7% of the adult population have completed theirs as of 2nd January 2022.The acceptance of patients with rheumatic diseases on Covid-19 vaccination are crucial in the successful long term protection against Covid-19 infection. We conducted a phone interview to determine the acceptance of Covid-19 vaccination amongst adolescents with underlying rheumatic diseases. Objective(s): To determine the acceptance of Covid-19 vaccination amongst adolescents with underlying rheumatic diseases. Method(s): This was a phone survey. The electronic medical records of all rheumatology patients follow up in rheumatology clinic Hospital Sultan Ismail, Malaysia from 1st January 2012 to 31th December 2021 were reviewed and patients with age group from 12 to 21 were identified. Demographic and diagnosis of the patients collected. Result(s): Phone survey was done after data extracted from medical records. For those under the age of 18, guardian of the patients was interviewed. A total of 50 patients were identified. 36 of them were having systemic lupus erythematosus (SLE), 5 of them were having juvenile idiopathic arthritis (JIA),2 of them were having psoriatic arthritis (PSA) and another 2 of them were having Rheumatoid arthritis (RA), followed by rheumatoid arthritis (RA) overlapped SLE, juvenile dermatomyositis, Henoch-Schonlein purpura, SLE overlapped with JIA and mixed connective tissue disease, 1 each respectively. Most of the patients were female (46/50) and majority of them were Malay (33/50). This was followed by Chinese (10/50), Indian (4/50) and others (3/50). The mean age group was 18 (range from 13 to 21). Majority of them patients are keen or already completed Covid-19 vaccination with the acceptance rate as high as 92% (46/50). Only 8% of them not keen for vaccination with the reason of worrying the risk of myocarditis post vaccination. Conclusion(s): The overall acceptance rate of Covid-19 vaccination amongst adolescents with rheumatic diseases are very encouraging with the percentage of >90% despite of lacking knowledge about vaccine Covid-19. This result can assist our Ministry of Health plan for future battle to improve vaccine uptake that hopefully can lead to herd immunity against COVID-19 infection.
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Background: How COVID-19 affects lower urinary tract symptoms (LUTS) in men has not been demonstrated by published research. This study examined the de novo development of LUTS and the change in the severity of pre-existing LUTS in men hospitalized with COVID-19. A follow-up period of 12 months after COVID-19 infection provided data on the long-term effect of COVID-19 vs. LUTS. Methods: Data were collected from 70 male patients diagnosed with COVID-19 via nasopharyngeal swab RT-PCR technology between June 2020 and April 2021. The patient’s age, comorbidities, date of COVID-19 diagnosis, date of LUTS, International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA), creatinine, and D-dimer levels, urinalysis, urine culture and duration of hospital stay were recorded. Statistical analyses were conducted to compare between pre-COVID and post-COVID IPSS and other data. Results: 42 patients were included in this study with a, mean age of patients were 54.76 ± 11.95 years. In 8 patients there was no change in IPSS prevs. post-COVID. In the remaining 34 patients (80.9%), the median IPSS increased from a pre-COVID value of 2 to 10 during COVID (p < 0.001). In the subgroup analysis based on age <50 years vs. ≥50 years, statistically significant increase in IPSS were found in both age groups pre- and post-COVID. Conclusions: In male patients of all ages, COVID-19 results in the de novo occurrence of LUTS and an increase in pre-existing LUTS in approximately 80% of patients. These symptoms were found to persist at a 12-months follow-up.
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Prostate-specific antigen (PSA) screening remains the mainstay for early detection of prostate cancer. Although PSA is a nonspecific prostate cancer biomarker, its specificity for high grade prostate cancer can be enhanced by pre-biopsy liquid biomarkers including the Exosome Dx Prostate IntelliScore (EPI) test. EPI is a stand-alone urine genomic test that measures 3 exosome-derived gene expression signatures without the need for digital rectal examination (DRE) or inclusion of standard of care parameters in the test algorithm. EPI has broad clinical utility as a risk stratification tool for clinically significant high grade prostate cancer in men considering diagnostic prostate biopsy (MRI-targeted and systematic biopsy). During the COVID-19 pandemic, the EPI At-Home Collection Kit was introduced and quickly became an important component of tele-urology. The EPI test has emerged as a prioritization tool for primary care referral to urologists and for prostate biopsy scheduling. EPI provides an objective and actionable genomic risk assessment tool for high grade prostate cancer and is a critical part of the informed decision-making regarding biopsy (targeted, systematic or both) in both urology and primary care practices.
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Exosomes , Primary Health Care , Prostatic Neoplasms , Self-Testing , Urology , Biomarkers, Tumor/genetics , Biopsy , COVID-19 , Exosomes/genetics , Exosomes/pathology , Humans , Male , Pandemics , Prostate/pathology , Prostate-Specific Antigen , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/genetics , Prostatic Neoplasms/pathologyABSTRACT
PURPOSE: We calculated rates of breast and prostate cancer screening and diagnostic procedures performed during the COVID-19 pandemic through December 2021 compared to the same months in 2019 in a large healthcare provider group in central Massachusetts. METHODS: We included active patients of the provider group between January 2019 and December 2021 aged 30-85 years. Monthly rates of screening mammography and digital breast tomosynthesis, breast MRI, total prostate specific antigen (PSA), and breast or prostate biopsy per 1,000 people were compared by year overall, by age, and race/ethnicity. Completed procedures were identified by relevant codes in electronic health record data. RESULTS: Rates of screening mammography, tomosynthesis, and PSA testing reached the lowest levels in April-May 2020. Breast cancer screening rates decreased 43% in March and 99% in April and May 2020, compared to 2019. Breast cancer screening rates increased gradually beginning in June 2020 through 2021, although more slowly in Black and Hispanic women and in women aged 75-85. PSA testing rates decreased 34% in March, 78% in April, and 53% in May 2020, but rebounded to pre-pandemic levels by June 2020; trends were similar across groups defined by age and race/ethnicity. CONCLUSION: The observed decline in two common screening procedures during the COVID-19 pandemic reflects the impact of the pandemic on cancer early detection and signals potential downstream effects on the prognosis of delayed cancer diagnoses. The slower rate of return for breast cancer screening procedures in certain subgroups should be investigated to ensure all women return for routine screenings.
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Breast Neoplasms , COVID-19 , Prostatic Neoplasms , Aged , Aged, 80 and over , Breast Neoplasms/diagnosis , Breast Neoplasms/epidemiology , Breast Neoplasms/pathology , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19 Testing , Early Detection of Cancer/methods , Humans , Male , Mammography/methods , Mass Screening/methods , Pandemics , Prostate-Specific Antigen , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/epidemiologyABSTRACT
Point-of-care (POC) technology reduces the time required for diagnosis at a reduced cost to facilitate early treatment, continuous monitoring, and prevention of fatal outcomes. Biosensors are the key to the development of reliable and accurate POC devices as they are capable of detecting clinical biomarkers based on bio-recognition events. Paper-based microfluidics and lateral flow assays (LFAs) are the most commonly used techniques for the development of POC devices. Electrochemical biosensors provide high sensitivity and reproducibility in comparison to optical biosensors. Sensitivity enhancement of POC devices is imperative to lower their detection limit for improved analysis of target biomarkers at low concentrations. In this review, we have discussed the need for sensitivity enhancement in POC devices. Various sensitivity enhancement strategies such as physical, chemical, electrochemical, nanomaterial, nucleic acid, enzymatic, label-based, etc. are discussed along with numerous examples. The role of biosensors in the sensitivity enhancement of POC devices is also described herein. We have illustrated the relationship between sensitivity and the limit of detection of POC devices. Several sensitivity enhancement strategies that have been either adopted or have the potential to be realized for POC devices have been summarized in tabular form. In terms of future perspectives, the sensitivity enhancement of POC devices for the detection of important biomarkers is yet to be comprehended copiously amid the rising market for POC devices.
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Purpose or Objective To assess the pattern of response on dynamic contrast enhancement magnetic resonance imaging (DCE-MRI) of presumed local lesions in the setting of salvage radiotherapy (sRT) after radical prostatectomy (RP). Materials and Methods The present prospective study (NCT04703543) was conducted at a single Institution between August 2017 and June 2020. Eligibility criteria were: undetectable prostate specific antigen (PSA) after RP;biochemical recurrence (2 consecutive PSA rises to 0.2 ng/ml or greater);a presumed local failure at DCE-MRI (early/fast enhancing discrete lesion on DCE sequences);no distant metastases at choline-PET/CT;no previous history of androgen deprivation therapy and/or RT. Accrued patients underwent sRT as it follows: 66-69 Gy/30 fractions to the prostatic bed, 73.5 Gy/30 fractions to the local failure at DCE-MRI, 54 Gy/30 fractions to the pelvic nodes (when treated). All patients were offered DCE-MRI 3 months after sRT, and repeated at 3-month intervals until complete disappearance or a maximum of 4 scans. The endpoint of the study, complete response (CR), was defined as the complete disappearance of the target lesion at DCE-MRI. In case of misses before CR, the observation was considered as a persisting partial response (PR). Results 62 patients with 72 nodules at DCE-MRI were accrued. All patients underwent the 1st DCE-MRI at a median of 3.3 months (IQR: 3.1-4.1) after sRT, 33 patients (53.2%) presented a CR, 27 (43,5%) a PR, 2 (3.2%) no response. One patient, implanted with a cardiac device, did not undergo further MRI. Three more patients declined further testing after the 1st (N=2) or the 2nd (N=1) re-evaluation due to the COVID-19 pandemic. Twenty-eight patients underwent a 2nd DCE-MRI after a median of 6.8 months (IQR: 6.5-7.6) from sRT, 20 had a CR, 8 had a PR. After a median time of 10.7 months (IQR: 10.6-12.6), 6 patients were scanned for a 3nd DCE-MRI: 4 CR, 2 PR. The last patient reported a CR after 16.7 months. The majority (94.3%, 95%CI: 88.0-100.0%) of lesions had completely disappeared by the 3rd re-evaluation or a median time of 10.7 months from the end of sRT (Figure).(Figure Presented) Independent predictors of CR at 1st re-evaluation on multivariable analysis were: the volume of the lesion at pre-sRT DCEMRI (OR 0.076, 95%CI 0.009-0.667;p=0.02), the time of re-evaluation from treatment (OR 3.39, 95%CI 1.156-9.993;p=0.026) and the PSA percent decrease at the 5th week of sRT (OR 1.02, 95%CI 0.999-1.050;p= 0.058) (Table). (Table Presented) Receiver-operating characteristic curve (ROC) analysis identified the best cut-off on CR for baseline volume at 0.545 cc, AUC 0.683 (95%CI: 0.548-0.818, p=0.014). The probability of a CR for lesions larger than the cut-off identified at ROC analysis was only around 75% at 10.7 months. Conclusion The vast majority of local lesions disappears at DCE-MRI after sRT, though larger lesions may require more than 10 months from treatment end.
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Introduction & Objectives: Minimally invasive transurethral therapies for benign prostatic hypertension are becoming increasingly common in Europe and America. They may be performed under local anaesthetic and provide a good alternative to invasive procedures in a COVID era. REZUM, a minimally invasive transurethral water-vapor therapy, has been shown to be a safe and effective treatment for BPH, especially where preserved sexual function is a priority. Although short-term clinical outcomes are promising, long-term data from robust studies is lacking. In Australia, there are few providers of REZUM, which utilises steam injections to reduce prostatic tissue. This study aims to investigate the safety and efficacy of REZUM in an Australian cohort. Methods: A clinical audit was conducted of 50 patients who underwent REZUM to treat symptoms of BPH over a 12-month period. Procedures were performed under general anaesthetic. Demographics, comorbidities, sexual function, prostate volume, PSA, voiding flow rate, post-void residual volume and International Prostate Symptom Score were extracted from medical records, in addition to patient's reasons for seeking minimally invasive treatment. Corresponding post-operative data was collected. Descriptive statistics of the cohort were obtained using Stata 16.0. Paired t-test was used to identify if there was a significant difference between IPSS scores pre- and postprocedure Results: Patients accessing treatment ranged from 48 to 84 years (mean 64.6). Median prostate volume was 55mL (inter-quartile range 45-78mls) and mean International Prostate Symptom Score (IPSS) was 20.3. 28% of the cohort cited concern for ejaculatory function, either from medication side effects or TURP, as their primary reason for seeking minimally invasive treatment. A further 25% of the cohort was additionally concerned about other side effects from medications and/or TURP or had experienced medication failure. The mean follow up period was 6 months (range 6-weeks-26 months). 69% of men were satisfied with their symptom improvement at the time of review, with the expectation of ongoing improvement in men who had attended a 6-week post-operative review only. Postprocedure mean IPSS was 7.9 (range 2-33). Mean reduction in IPSS score post-procedure was 12.7 points (p<0.001). 3 men experienced complications (retention, infection, bulbar stricture). Conclusions: REZUM provides a safe alternative to traditional invasive prostatic treatments. It may be performed under local anaesthetic, providing an effective alternative in a COVID era. Men concerned about medications, more invasive treatments and ejaculatory dysfunction are increasingly seeking relief from this minimally invasive option and experiencing good outcomes including significant symptom improvement sustained over medium-term follow up.
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Introduction & Objectives: The effects of the COVID-19 pandemic on healthcare in Australia have yet to be fully determined. There are well documented decreases in the rates of screening & diagnostic testing for many cancers in 2020, with commensurate stage migration of cancers when they are eventually detected. Early evidence from overseas has suggested decreased levels of PSA testing in highly impacted communities, & many Australian urologists fear that there are men with potentially curable prostate cancers will have missed their opportunity for cure because of decreased uptake of screening tests. We aimed to determine whether there was a decrease in the rate of prostate Cancer screening & testing in Australia in 2020. Methods: Using the Medicare Statistics Reports tool, the Medicare Benefit Schedule number for screening & diagnostic tests for prostate cancer were analyzed over a 6-year period (2015 - 2020). The items numbers covered prostate biopsies (37219) PSA testing for men without an existing diagnosis of prostate cancer (66655), & MRIs performed in men without a diagnosis of cancer (63541, data available for 2019-2020). Sub group analysis were conducted for Victoria & the rest of the country excluding Victoria (to account for the Victorian lock-downs of 2020) Results: Data was extracted for 2015- 2020, these are shown in Table 1. As can be seen, the difference between 2020 & the preceding years is relatively modest. A modelling exercise was also performed in order to estimate test usage in 2020 based on population. The predicted test usage was similar to the average use, & the actual testing rate fell within the Predictive Interval. A subgroup analysis for Victoria only did show a statistically significant difference with regards to PSA tests (8% less than average, p = 0.002), however an analysis of testing by month shows that the vast majority of this reduction coincided with the first Melbourne lockdown (March to May 2020). Conclusions: On the available evidence, the rates of testing for prostate cancer in 2020 did not differ significantly from previous years with the exception of prostate biopsies & MRI conducted within Victoria, & this may be at least partly artifactual. As such there is no basis to believe that there will be a stage migration in prostate cancer in Australia owing to the COVID pandemic.
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The article discusses Patients who take anxiety or depression medication are more likely to obtain prostate-specific antigen (PSA) tests.
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We compared outcomes between two groups: a) High PSA testing (screening) group which included men who received two or more PSA tests that were at least one year apart and b) Low PSA testing group. B Methods: b Using the Medicare Statistics Reports tool, the Medicare Benefit Schedule number for screening & diagnostic tests for prostate cancer were analyzed over a 6-year period (2015 - 2020). Presentation Type: Villis Marshall Theme: Other Urological imaging trends in Australia and the impact of COVID-19: A ten-year analysis of nat... EMMA CLAREBROUGH SP 1 sp , ANDREW O'BRIEN SP 1 sp , ROHAN HALL SP 1 sp SP I 1 i sp I Bendigo Hospital, Bendigo, Australia i B Introduction & Objectives: b During the COVID-19 pandemic there has been a drastic shift in access and utilisation of healthcare resources globally. [Extracted from the article] Copyright of BJU International is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Background-aim: Tumor markers (TM) in body fluids have been studied for years and several authors have proposed different cut-off. An apparently more accurate strategy is the one proposed by Molina et al. considering that the ratio TM in fluid with regard to TM in serum >1.2 indicates local production in the pleura, however if the ratio is <1.2 the presence of TM in the fluid would be explained by serum extravasation. Despite enough evidence to manage this biomarkers in body fluids, the practice is not widely extended in the clinical setting yet. Methods: AFP, CA19.9, CA15.3, CEA, CA125, PSA and SCC were analyzed in Alinity i platform (Abbott diagnostics) HCG and NSE was performed in Cobas e411 (Roche diagnostics). Results: Here we describe the case of a 69-year-old patient attending the Emergency Room due to pain in both hemythoraxes. Also remarkable was a wasting syndrome (5 kg weight loss in the past month). In Emergency blood analysis: VSG 50, PT 75%, DD 765 ng/mL, ferritin 368 ng/mL and LDH 385 U/L were outsdanding. Thorax radiology showed a pleural effusion. The patient was diagnosed with COVID19 bronchitis.TC scan evidenced pleural solid metastasis, multiple bone lesions and hepatic M1. Serum TM: AFP, CA19.9, PSA, NSE, SCC and HCG were normal. CA125 2992,60 U/mL (<35), CA15.3 614,70 U/mL (<32), CEA 400.82 ng/mL (<5). Pleural fluid TM: CEA 284.32 ng/mL;CA15.3 2210.3 U/mL. TM ratio: CA15.3: 3.6 (>1.2) this result indicates local synthesis of CA15.3, therefore pleural metastasis;CEA: 0.7 (<1.2) indicates that the CEA found un the fluid was extravasated from serum. Pathological examination was only positive for CK7 and mixt CK. All other markers were negative. It was concluded to be an undifferentiated carcinoma, cytologically reminding of an adenocarcinoma. Due to TTF1 and napsine negativity lung neoplasm could not be discarded.The patient was diagnosed with undifferentiated lung cancer stage IV. Conclusions: This a good example of different molecular patterns reflecting tumor heterogeneity evidenced by protein expression by each lesion: Pleural metastases expressed high amounts of CA15.3, however not CEA. Hepatic metastases and probably main tumor in the lung expressed CEA and CA15.3. It is arguable whether CA15.3 was expressed at lower quantities from the main tumor or the dilution of the protein in the bloodstream results in lower concentrations in relation to the ones found in the pleura.
ABSTRACT
INTRODUCTION AND OBJECTIVE: Since early 2020, the global pandemic caused by COVID-19 has resulted in considerable healthcare related and economic impacts. To mitigate health impact to the wider population, restrictions on non-essential services were imposed. Australia performed favourably compared to other developed countries, largely due to these state-initiated transient 'lock-downs' to control local outbreaks. Recommendations to limit non-urgent urologic care were formulated to optimise patient safety and many of these were adopted in Australia. We aimed to extend this analysis to observe the trend in PSA tests, biopsies, and radical prostatectomies in the first 18 months of the pandemic, from January 2020 through to mid-2021, and compare these to the previous ten years. METHODS: Medicare Benefits Schedule data was extracted per state and per month from January 2010 to June 2021 for PSA tests, prostate biopsies, and radical prostatectomies. Each item was plotted as a two-year trend, with the count of tests/procedures expressed as a ratio to the first January count of that two-year period. Data on the number of covid cases per day to 30th June 2021, as a 7-day average. RESULTS: A sharp fall in PSA tests among all states was seen in April 2020 as the first wave of COVID-19 cases were detected and lockdown measures initiated. Test numbers rebounded quickly but remained slightly below the long-term trend (Figure 1, green line). For biopsy procedures, a decline from the expected trend began in March/ April 2020 but generally remained below trend for the remainder of the year for most states within Australia. The observed deviation for radical prostatectomies commenced later than biopsies, with an apparent two- or three-month lag. In comparison to the longer-term average trend, from Jan 2020 to Jun 2021 it is estimated that there were 15% fewer PSA tests, 16% fewer biopsies and 17% fewer prostatectomies in Australia. CONCLUSIONS: The consequence of periodic lockdowns in response to COVID19 on patterns of care on stage at presentation and oncological outcomes is unknown but should be measured. As vaccination rates rise globally, it is expected that strict COVID-19 mitigation measures will not be required, therefore limiting the consequent impact on prostate cancer management contained.