38 research outputs found
Teacher Expectations of Minority Exceptional Learners: Impact on āAccuracyā of Self Concepts
Does the introduction of prostate multiparametric MRI into active surveillance of localised prostate cancer improve patient re-classification?
Objectives
To determine whether replacement of protocolādriven repeat prostate biopsy (PB) with multiparametric magnetic resonance imaging (mpMRI) +/ā targeted repeat prostate biopsy (TB) in evaluating men on active surveillance (AS) for lowāvolume lowā to intermediateārisk prostate cancer (PCa) altered the likelihood or time to treatment, or reduced the number of repeat biopsies required to trigger treatment.
Patients and methods
445 patients underwent AS from 2010ā2016 at our institution with median followāup of 2.4 (interquartile range IQR 1.2ā3.7) years. Patients followed a āpreā2014ā³ AS protocol up to 2014, which incorporated PB, and following the 2014 NICE guidelines patients followed a ā2014āpresentā AS protocol including mpMRI. We identified four groups of patients within the cohort (āno mpMRI and no PBā, āPB aloneā, āmpMRI +/ā TBā and āPB and mpMRI +/ā TBā). KaplanāMeier plots and logārank tests were used to compare groups.
Results
132 of 445 (30%) patients came off AS and underwent treatment intervention, with a median (IQR) time to treatment of 1.55 (IQR 0.71ā2.4) years. The commonest trigger for treatment was PCa upgrading following mpMRI and TB (43 of 132 patients, 29%). No significant difference was observed in the time at which men receiving a PB alone or receiving mpMRI +/ā TB came off AS to undergo treatment (median 1.9 versus 1.33 years, p=0.7471). Considering only men undergoing repeat biopsy, a greater proportion of individuals receiving postāmpMRI TB came off AS compared with PB alone (29/66, 44% versus 32/87, 37%, p=0.0033). A single set of repeat biopsies was on average needed to trigger treatment regardless of whether this was a PB or TB.
Conclusions
Replacing a systematic PB with an mpMRI+/āTB as part of an AS protocol increased the likelihood of reāclassifying patients on AS and identifying men with clinically significant disease requiring treatment. mpMRI+/āTB as part of AS thereby represents a significant advance in the oncological safety of the AS protocol
Inclusive education in Nigeria: exploring parental attitude, knowledge and perceived social norms influencing implementation
Does the introduction of prostate multiparametric MRI into active surveillance of localised prostate cancer improve patient re-classification?
Objectives To determine whether replacement of protocolādriven repeat prostate biopsy (PB) with multiparametric magnetic resonance imaging (mpMRI) +/ā targeted repeat prostate biopsy (TB) in evaluating men on active surveillance (AS) for lowāvolume lowā to intermediateārisk prostate cancer (PCa) altered the likelihood or time to treatment, or reduced the number of repeat biopsies required to trigger treatment. Patients and methods 445 patients underwent AS from 2010ā2016 at our institution with median followāup of 2.4 (interquartile range IQR 1.2ā3.7) years. Patients followed a āpreā2014ā³ AS protocol up to 2014, which incorporated PB, and following the 2014 NICE guidelines patients followed a ā2014āpresentā AS protocol including mpMRI. We identified four groups of patients within the cohort (āno mpMRI and no PBā, āPB aloneā, āmpMRI +/ā TBā and āPB and mpMRI +/ā TBā). KaplanāMeier plots and logārank tests were used to compare groups. Results 132 of 445 (30%) patients came off AS and underwent treatment intervention, with a median (IQR) time to treatment of 1.55 (IQR 0.71ā2.4) years. The commonest trigger for treatment was PCa upgrading following mpMRI and TB (43 of 132 patients, 29%). No significant difference was observed in the time at which men receiving a PB alone or receiving mpMRI +/ā TB came off AS to undergo treatment (median 1.9 versus 1.33 years, p=0.7471). Considering only men undergoing repeat biopsy, a greater proportion of individuals receiving postāmpMRI TB came off AS compared with PB alone (29/66, 44% versus 32/87, 37%, p=0.0033). A single set of repeat biopsies was on average needed to trigger treatment regardless of whether this was a PB or TB. Conclusions Replacing a systematic PB with an mpMRI+/āTB as part of an AS protocol increased the likelihood of reāclassifying patients on AS and identifying men with clinically significant disease requiring treatment. mpMRI+/āTB as part of AS thereby represents a significant advance in the oncological safety of the AS protocol