Changing current practice in urology: Improving guideline development and implementation through stakeholder engagement

Effective stakeholder integration for guideline development should improve outcomes and adherence to clinical practice guidelines

AGREE II Quality assessment of National and International Clinical Practice Guidelines on Prostate Cancer Management by the OPTIMA Consortium

Peer reviewe

Ten-year mortality, disease progression, and treatment-related side effects in men with localised prostate cancer from the ProtecT Randomised Controlled Trial according to treatment received

BACKGROUND:The ProtecT trial reported intention-to-treat analysis of men with localised prostate cancer (PCa) randomly allocated to active monitoring (AM), radical prostatectomy, and external beam radiotherapy. OBJECTIVE:To determine report outcomes according to treatment received in men in randomised and treatment choice cohorts. DESIGN, SETTING, AND PARTICIPANTS:This study focuses on secondary care. Men with clinically localised prostate cancer at one of nine UK centres were invited to participate in the treatment trial comparing AM, radical prostatectomy, and radiotherapy. INTERVENTION:Two cohorts included 1643 men who agreed to be randomised; 997 declined randomisation and chose treatment. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:Health-related quality of life impacts on urinary, bowel, and sexual function were assessed using patient-reported outcome measures. Analysis was carried out based on treatment received for each cohort and on pooled estimates using meta-analysis. Differences were estimated with adjustment for known prognostic factors using propensity scores. RESULTS AND LIMITATIONS:According to treatment received, more men receiving AM died of PCa (AM 1.85%, surgery 0.67%, radiotherapy 0.73%), whilst this difference remained consistent with chance in the randomised cohort (p=0.08); stronger evidence was found in the exploratory analyses (randomised plus choice cohort) when AM was compared with the combined radical treatment group (p=0.003). There was also strong evidence that metastasis (AM 5.6%, surgery 2.4%, radiotherapy 2.7%) and disease progression (AM 20.35%, surgery 5.87%, radiotherapy 6.62%) were more common in the AM group. Compared with AM, there were higher risks of sexual dysfunction (95% at 6mo) and urinary incontinence (55% at 6mo) after surgery, and of sexual dysfunction (88% at 6mo) and bowel dysfunction (5% at 6mo) after radiotherapy. The key limitations are the potential for bias when comparing groups defined by treatment received and outdating of the interventions being evaluated during the lengthy follow-up required in trials of screen-detected PCa. CONCLUSIONS:Analyses according to treatment received showed increased rates of disease-related events and lower rates of patient-reported harms in men managed by AM compared with men managed by radical treatment, and stronger evidence of greater PCa mortality in the AM group. PATIENT SUMMARY:More than 90 out of every 100 men with localised prostate cancer do not die of prostate cancer within 10yr, irrespective of whether treatment is by means of monitoring, surgery, or radiotherapy. Side effects on sexual and bladder function are much better after active monitoring, but the risks of spreading of prostate cancer are more common

Identification of urinary markers using proteomics analysis of urine in patients with bladder cancer

14605 Background: The discovery of new urinary markers for non-invasive detection and surveillance of bladder carcinoma remains an active field of current research with an aim to replace invasive investigations such as cystoscopy. We have analysed the urinary proteomes of patients with bladder tumor and compared them the urinary proteomes of a healthy volunteer control group to detect putative, tumour specific urinary markers for bladder tumor. Methods: 24 hour and midstream samples were collected from healthy volunteers and patients with newly diagnosed bladder tumours. Urinary proteins were isolated by a technique previously described by our group (Nabi G, N’Dow J, Hasan ST, Boot IR, Cash P. Proteomic analysis of urine in patients with intestinal segments transposed into the urinary tract. Proteomics. 2005 Apr;5(6):1729–33.)1. Proteins were resolved by 1-dimenional (1-DE) and two dimensional gel electrophoresis (2-DE). The proteins that differed when analysed by either 1-DE or 2-DE between patients and controls were identified using peptide mass mapping. Results: Six patients with newly diagnosed bladder cancer and 5 healthy volunteers were recruited into this study. All patients were found to have superficial transitional cell carcinoma with high grade (3 with grade 3, 3 with grade 2) on subsequent histopathological examination. For the same individual no detectable differences were observed in the protein profiles of midstream and 24 hour urinary samples when analysed by either 1DE or 2-DE. However, between patient and controls a number of proteins differed in abundance and these were identified. Proteins that were present in patients, but absent in controls, included FK506 binding protein 6 isoform, apolipoprotein A-IV, paraliprotein and lipid binding protein. Conclusions: The present study identified some of the novel urinary biomarkers in present with bladder cancer. Some of these have been shown to change their expression with deeper invasion of disease and might be useful in predicting behaviour of superficial bladder cancer. No significant financial relationships to disclose. </jats:p