Real-world Treatment Sequencing in Patients with Metastatic Castration-resistant Prostate Cancer: Results from the Prospective, International, Observational Prostate Cancer Registry.

Background: Prostate cancer has a multifaceted treatment pattern. Evidence is lacking for optimal treatment sequences for metastatic castration-resistant prostate cancer (mCRPC). Objective: To increase the understanding of real-world treatment pathways and outcomes in patients with mCRPC. Design setting and participants: A prospective, noninterventional, real-world analysis of 3003 patients with mCRPC in the Prostate Cancer Registry (PCR; NCT02236637) from June 14, 2013 to July 9, 2018 was conducted. Intervention: Patients received first- and second-line hormonal treatment and chemotherapy as follows: abiraterone acetate plus prednisone (abiraterone)-docetaxel (ABI-DOCE), abiraterone-enzalutamide (ABI-ENZA), abiraterone-radium-223 (ABI-RAD), docetaxel-abiraterone (DOCE-ABI), docetaxel-cabazitaxel (DOCE-CABA), docetaxel-enzalutamide (DOCE-ENZA), and enzalutamide-docetaxel (ENZA-DOCE). Outcome measurements and statistical analysis: Baseline patient characteristics, quality of life, mCRPC treatments, and efficacy outcomes (progression and survival) were presented descriptively. Results and limitations: Data from 727 patients were eligible for the analysis (ABI-DOCE n = 178, ABI-ENZA n = 99, ABI-RAD n = 27, DOCE-ABI n = 191, DOCE-CABA n = 74, DOCE-ENZA n = 116, and ENZA-DOCE n = 42). Demographics and disease characteristics among patients between different sequences varied greatly. Most patients who started on abiraterone or enzalutamide stopped therapy because of disease progression. No randomisation to allow treatment/sequence comparisons limited this observational study. Conclusions: The real-world PCR data complement clinical trial data, reflecting more highly selected patient populations than seen in routine clinical practice. Baseline characteristics play a role in mCRPC first-line treatment selection, but other factors, such as treatment availability, have an impact. Efficacy observations are limited and should be interpreted with caution. Patient summary: Baseline characteristics appear to have a role in the first-line treatment selection of metastatic castration-resistant prostate cancer in the real-world setting. First-line abiraterone acetate plus prednisone seems to be the preferred treatment option for older patients and those with lower Gleason scores, first-line docetaxel for younger patients and those with more advanced disease, and first-line enzalutamide for patients with fewer metastases and more favourable performance status. The benefit to patients from these observations remains unknown.

Characterising endourologist learning curve during percutaneous nephrolithotomy: implications on occupational dose and patients.

In this study we have characterised the learning curve for percutaneous nephrolithotomy procedures over 301 cases for six years. Different surrogate parameters of clinical expertise have been used, such as dose area product, total procedure time, fluoroscopy time and personal equivalent doses. In addition, two different endourologists have been monitored; one of whom had specific Radiation Protection training (ICRP 85). Eye lens dose was estimated from thermoluminescent dosimeters. Significant differences were observed between both endourologists, especially in the fluoroscopy time. Finally, both entrance skin dose and effective doses of patients have been determined.

Characterizing endourologist learning curve during percutaneous nephrolithotomy: implications on occupational dose and patients.

In this study we have characterized the learning curve of percutaneous nephrolithotomy procedures over 301 cases for six years. Different surrogate parameters of clinical expertise have been used, such as dose area product, total procedure time, fluoroscopy time and personal equivalent doses. In addition, two different endourologists have been monitored; one of whom was subjected to a specific Radiation Protection training (ICRP 85). Eye lens dose is estimated from thermoluminescent dosimeters. Significant differences are observed between both endourologists, especially in the fluoroscopy time. Finally, both entrance skin dose and effective doses of patients have been determined.

Current Patterns of Management of Advanced Prostate Cancer in Routine Clinical Practice in Spain.

Objective. To describe urologists' practice patterns when managing patients with advanced prostate cancer (PCa) in Spain. Methods. This was an observational study conducted by 120 urologists using retrospective data of advanced PCa patients attending hospitals and outpatient centers. Results. Urologists evaluated a total of 375 patients (mean age: 75 years; ECOG 0-1: 77%; mean serum PSA levels at study entry: 50.5 ng/Ml). Approximately 50% of patients had bone metastases, and 60.6% experienced pain as the main symptom of progressive disease. Primary androgen deprivation therapy (ADT) use was 99.7%, with continuous ADT as the dominant strategy (91.9%). After failure of initial ADT, antiandrogen withdrawal was the next method most commonly used in 57% of patients. Choice of secondary hormonal treatment was made mostly by urologists (96%), who continued to monitor patients. Patient follow-up after chemotherapy and supportive care were mainly done in urology units, although responsibility was shared with medical oncologists and radiologists. Conclusion. The urologists' attitudes towards management of PCa in the routine practice in Spain show the urologist as an integral component even when patients progress to advanced stages of the disease.

Bilateral percutaneous nephrostomy as treatment for severe hemorrhagic cystitis.

OBJECTIVE: To report a case of severe hemorrhagic cystitis successfully treated by bilateral percutaneous nephrostomy. METHODS: The case of a 67-year-old female patient who had monosymptomatic gross hematuria with clots is reported. RESULTS: Standard conservative treatments failed and the patient developed a clot-retention plugged bladder. Endoscopic evacuation and electrocoagulation of bleeding areas was unsuccessful. Due to persistent hematuria and development of renal failure and hemodynamic instability, bilateral percutaneous nephrostomy was performed. At 24 hours, hematuria ceased, patient recovered hemodynamic stability, and no additional blood transfusions were required. CONCLUSIONS: Bilateral percutaneous nephrostomy may be a valuable option for the treatment of hemorrhagic cystitis when standard conservative measures have failed and as a prior step to performance of other more invasive procedures.

Nefrostomía percutánea bilateral como tratamiento de las cistitis hemorrágica severa / Bilateral percutaneous nephrostomy as treatment for severe hemorrhagic cystitis

OBJETIVO: Presentar un caso de cistitis hemorrágica severa tratada exitosamente mediante nefrostomía percutánea bilateral.MÉTODO: Presentamos el caso de una mujer de 67 años que presenta hematuria macroscópica monosintomática con coágulos.RESULTADOS: Fracaso de los tratamientos conservadores habituales y desarrollo de vejiga coagulada. Evacuación endoscópica y electrocoagulación de las áreas sangrantes sin éxito. Dada la persistencia de hematuria y desarrollo de insuficiencia renal e inestabilidad hemodinámica se decide nefrostomía percutánea bilateral. A las 24 horas cesa la hematuria, la paciente recupera la estabilidad hemodinámica y no requiere nuevas transfusiones sanguíneas.CONCLUSIONES: La realización de nefrostomía percutánea bilateral puede ser una opción útil en el tratamiento de la cistitis hemorrágica ante el fracaso de las medidas conservadoras habituales y como paso previo a la realización de otros tratamientos más invasivos(AU)

OBJECTIVE: To report a case of severe hemorrhagic cystitis successfully treated by bilateral percutaneous nephrostomy.METHODS: The case of a 67-year-old female patient who had monosymptomatic gross hematuria with clots is reported.RESULTS: Standard conservative treatments failed and the patient developed a clot-retention plugged bladder. Endoscopic evacuation and electrocoagulation of bleeding areas was unsuccessful. Due to persistent hematuria and development of renal failure and hemodynamic instability, bilateral percutaneous nephrostomy was performed. At 24 hours, hematuria ceased, patient recovered hemodynamic stability, and no additional blood transfusions were required.CONCLUSIONS: Bilateral percutaneous nephrostomy may be a valuable option for the treatment of hemorrhagic cystitis when standard conservative measures have failed and as a prior step to performance of other more invasive procedures(AU)