ABSTRACT
UNLABELLED: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Little is known as to the potential for over-treatment of young men diagnosed with prostate cancer. We show that for men aged ≤55 years with PSA screen-detected disease, 45% of the tumours are classified as very low risk and 85% of these have favourable pathology, yet most are actively treated. These findings raise the spectre of over-treatment for a group of men likely to be affected by treatment side-effects. OBJECTIVE: To identify a population of young men (aged <55 years at diagnosis) with very-low-risk prostate cancer (stage cT1c, with prostate-specific antigen [PSA] density of <0.15 ng/mL/g, Gleason score ≤6, and ≤2 positive biopsy cores with <50% tumour involvement) that may be candidates for active surveillance (AS). PATIENTS AND METHODS: We queried a Department of Defense tumour registry and hard-copy records for servicemen diagnosed with prostate cancer from 1987 to 2010. Statistical analyses were undertaken using Fisher's exact and chi-square testing. RESULTS: From 1987-1991 and 2007-2010, PSA screen-detected tumours diagnosed in men aged ≤55 years rose >30-fold. Data for a subset of men (174) with PSA screen-detected cancer were evaluable for disease risk assessment. Of the 174 men with screen-detected disease, 81 (47%) had very-low-risk disease. Of that group, 96% (78/81) selected treatment and, of 57 men undergoing radical prostatectomy (RP), the tumours of 49 (86%) carried favourable pathology (organ confined, <10% gland involvement, Gleason ≤6). CONCLUSIONS: Nearly half of young men with PSA screen-detected prostate cancer are AS candidates but the overwhelming majority seek treatment. Considering that many tumours show favourable pathology at RP, there is a possibility that these patients may benefit from AS management.
Subject(s)
Biomarkers, Tumor/blood , Early Detection of Cancer/methods , Population Surveillance , Prostate-Specific Antigen/blood , Prostate/pathology , Prostatic Neoplasms/immunology , Adult , Age Distribution , Humans , Male , Middle Aged , Military Personnel , Neoplasm Grading , Patient Selection , Predictive Value of Tests , Prostatic Neoplasms/epidemiology , Risk Assessment , United States/epidemiologyABSTRACT
OBJECTIVES: In 2001, we reported a novel technique for pediatric circumcision that has proved to be fast, reliable, and safe during the past 4 years, with good cosmetic results. Inspired by our success with this technique, we have created a similar device to be used for adults. METHODS: We conducted a prospective, randomized, patient-blinded study to compare this device with that of the standard sleeve circumcision. A total of 30 men were randomized to undergo a standard sleeve or template circumcision. They completed the Male Sexual Health Questionnaire before the procedure. We prospectively evaluated the differences in procedure time, patient satisfaction, blood loss, and local anesthetic use between the 2 groups. The patients returned 8-10 weeks later for physical examination and completion of a postprocedure Male Sexual Health Questionnaire and patient satisfaction questionnaire. RESULTS: Of the 30 enrolled patients, 14 underwent standard sleeve circumcision, and 16 underwent template circumcision. Two patients in the sleeve group moved from the area after circumcision and were lost to follow-up, leaving 28 patients available for review at the 8-10-week appointment. The duration of the procedure was significantly shorter in the template group (27.5 minutes) than in the sleeve circumcision group (36.0 minutes; P = .001). No significant differences were noted between the 2 groups with regard to blood loss, amount of local anesthetic used, patient satisfaction, or change in sexual health, as defined by the Male Sexual Health Questionnaire. CONCLUSIONS: The use of the adult circumcision template appears to be a reliable and safe method of circumcision that significantly reduces the operative time.
Subject(s)
Circumcision, Male/instrumentation , Adolescent , Adult , Aged , Blood Loss, Surgical , Bupivacaine , Circumcision, Male/methods , Circumcision, Male/psychology , Equipment Design , Humans , Lidocaine , Male , Middle Aged , Nerve Block , Patient Satisfaction , Prospective Studies , Recovery of Function , Single-Blind Method , Surveys and Questionnaires , Young AdultABSTRACT
Genitourinary tuberculosis (TB) is the second most common form of extrapulmonary TB after peripheral lymphadenopathy. We report the case of a 44-year-old woman referred for hydronephrosis discovered on ultrasound performed due to flank pain. Contrast computed tomography (CT) scan demonstrated a well-circumscribed cystic mass with enhancing septations at the inferior pole of the right kidney, concerning for malignancy. Following extirpative surgery, she was diagnosed with renal TB.
