Extended versus standard lymph node dissection for urothelial carcinoma of the bladder in patients undergoing radical cystectomy

We acknowledge the support received from the author of the in-cluded study, Jürgen E. Gschwend who provided information onthe method of blinding. We are very grateful to Annemarie Uhlig, Guillaume Ploussard,Wassim Kassouf, Caroline Raw and Martin Burton for havingserved as peer reviewers. We thank Cochrane Urology, ManagingEditor Robert Lane and Cochrane Fast-Track Service, ManagingEditor Helen Wakeford, for the support we received.Peer reviewedPublisher PD

Lymphovascular Invasion at the Time of Radical Prostatectomy Adversely Impacts Oncological Outcomes.

Lymphovascular invasion, whereby tumour cells or cell clusters are identified in the lumen of lymphatic or blood vessels, is thought to be an essential step in disease dissemination. It has been established as an independent negative prognostic indicator in a range of cancers. We therefore aimed to assess the impact of lymphovascular invasion at the time of prostatectomy on oncological outcomes. We performed a multicentre, retrospective cohort study of 3495 men who underwent radical prostatectomy for localised prostate cancer. Only men with negative preoperative staging were included. We assessed the relationship between lymphovascular invasion and adverse pathological features using multivariable logistic regression models. Kaplan-Meier curves and Cox proportional hazard models were created to evaluate the impact of lymphovascular invasion on oncological outcomes. Lymphovascular invasion was identified in 19% (n = 653) of men undergoing prostatectomy. There was an increased incidence of lymphovascular invasion-positive disease in men with high International Society of Urological Pathology (ISUP) grade and non-organ-confined disease (p < 0.01). The presence of lymphovascular invasion significantly increased the likelihood of pathological node-positive disease on multivariable logistic regression analysis (OR 15, 95%CI 9.7-23.6). The presence of lymphovascular invasion at radical prostatectomy significantly increased the risk of biochemical recurrence (HR 2.0, 95%CI 1.6-2.4). Furthermore, lymphovascular invasion significantly increased the risk of metastasis in the whole cohort (HR 2.2, 95%CI 1.6-3.0). The same relationship was seen across D'Amico risk groups. The presence of lymphovascular invasion at the time of radical prostatectomy is associated with aggressive prostate cancer disease features and is an indicator of poor oncological prognosis

The Use of Magnetic Resonance Imaging in the Prostate Cancer Primary Diagnostic Pathway: Is It Ready for Primetime?

Multiparametric magnetic resonance imaging (mpMRI) has been increasingly utilized in the prostate cancer diagnostic landscape over the last five years. The majority of the literature has focused on its use in men with a previous negative biopsy. However, over time, clinicians have begun using mpMRI in the work-up of men being considered for primary biopsy and subsequently data characterizing its diagnostic performance in this setting is emerging. This review comprehensively assesses the utility of mpMRI in the primary biopsy setting

Primary follicular lymphoma of an extraordinarily large prostate: A case report and review of the literature

Primary follicular lymphoma of the prostate is rare. This case report and literature review literature describes a 74-year old male patient who presented with worsening urinary symptoms, and imaging showing prostatomegaly compressing and displacing the rectum. He ultimately underwent a Millen retropubic prostatectomy for a prostate of 692 cc. The histology and immunohistochemistry confirmed the diagnosis as follicular lymphoma. His lymphoma underwent high-grade transformation with leptomeningeal involvement

Adjuvant Systemic Treatment for Renal Cancer After Surgery: A Network Meta-Analysis

BackgroundApproximately 15% to 20% of patients will experience disease recurrence following surgical removal of renal cell carcinoma. A range of pharmacological agents is prescribed for metastatic renal cell carcinoma, but there are trials testing whether these have an earlier role in the adjuvant setting. We aim to assess the efficacy of adjuvant systemic treatment following surgery in patients with renal cell carcinoma and to determine the most effective treatment. MethodsThe protocol for this review was published in PROSPERO (CRD42021281588). We searched multiple databases up to August 2021. We included only randomized trials of patients with renal cell carcinoma that had been completely resected. We included patients with locoregional nodal disease if it was surgically removed, and excluded all cases of metastatic disease. We included all adjuvant systemic therapies that were commenced within 90 days of renal surgery. A network meta-analysis was performed using a frequentist approach. ResultsA total of 13 studies with 8103 patients were included for analysis. Only pembrolizumab (HR 0.74; 95%CI 0.57 to 0.96) and pazopanib (HR 0.80; 95%CI 0.68 to 0.95) improved disease-free survival compared with observation. These 2 treatments were the 2 highest ranked comparisons with a P-score of 0.87 and 0.80. No agent improved overall survival. All agents increased the risk of severe adverse events compared with observation. ConclusionsPembrolizumab and pazopanib were the only 2 adjuvant agents that improved time to disease recurrence compared with observation, with the former likely being the more efficacious. None of the treatments improved overall survival and almost all increased severe adverse events

Robotic-assisted radical cystectomy vs open radical cystectomy: systematic review and meta-analysis

To perform an updated systematic review and meta-analysis evaluating patient important outcomes for patients undergoing robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC). Multiple scientific databases were searched up to July 2018 for randomized controlled trials that compared RARC and ORC. The primary outcomes of interest were: disease progression, major (Clavien III-V) complications and 90-day quality of life. The quality of evidence was evaluated according to the framework in the Cochrane Handbook for Systematic Reviews of Interventions. Five studies with a total of 540 participants were included in this review. There was no difference between RARC and ORC for disease progression [RR 0.94, 95%CI 0.69-1.29], major complications [RR 1.06, 95%CI 0.75-1.49] or quality-of-life [SMD -0.03, 95%CI -0.27-0.21]. However, RARC demonstrated a reduced risk of requiring a perioperative blood transfusion [RR 0.58, 95%CI 0.43-0.80] and had a marginally lower duration of hospital stay [RR -0.63 days, 95%CI -1.21- -0.05]. Operative time was longer in the RARC group [MD 68.51 minutes, 95%CI 30.55-105.48]. There was no statistically significant difference in local recurrence rates between the procedures [RR 2.08, 95%CI 0.96-4.50], but this difference may be clinically significant and favors ORC. The overall quality of evidence was judged to be moderate. Surgical approach does not have a considerable impact on oncological, safety and quality-of-life outcomes for patients undergoing radical cystectomy. The benefits conferred by RARC are the decreased need for blood transfusion and an earlier discharge from hospital

Evaluating the effectiveness of an online journal club: experience from the International Urology Journal Club

The International Urology Journal Club attracts global participation; however, its effectiveness as an educational resource is undetermined.To evaluate the effectiveness of the international Twitter-based urology journal club (#urojc) using Kirkpatrick's evaluation model and to quantify the development of #urojc into a robust educational platform.A 13-item survey was sent to 3127 followers of #urojc. Twitter metrics including number of users, tweets, and impressions during 24 mo of operation were obtained via a third-party service "Symplur." Tweets were qualitatively analyzed to assess for relevance. Kirkpatrick's four-level evaluation model (reaction, learning, behavior, and results) was applied to analyze impact and effectiveness.Survey participation rate was 48% (after accounting for spam and inactive accounts). The reaction (Kirkpatrick level 1) to #urojc was overwhelmingly positive. Consultant urologists were the most active participants while trainees reported highest educational value. As much as 45% of junior consultant urologists and trainees reported a change in practice as a result of #urojc participation. The number of unique users of #urojc almost doubled from yr 1 to 2. The number of tweets per month and author participation increased from yr 1 to 2. The proportion of content-relevant tweets remained stably high at approximately 60%. This study was unable to document any impact on knowledge, behavior, or outcomes of #urojc (Kirkpatrick levels 2-4). Silent observers who do not follow #urojc were not captured.To our knowledge, this is the first time Kirkpatrick's evaluation model has been applied to a journal club. The reaction to #urojc among survey responders is positive with change in practice also reported. It appears that #urojc achieves level 1 of Kirkpatrick's evaluation model. Further investigation is required for levels 2-4. Twitter-based journal clubs draw robust global participation and have inspired journal clubs in other specialties.This report highlights the importance of the International Urology Journal Club as a potential educational resource of consultant urologists and trainees alike. Global participation was a major advantage of this platform. This journal club has inspired other medical specialties to follow suit

Corrigendum to “Early Online Attention Can Predict Citation Counts for Urological Publications: The #UroSoMe_Score” [Eur Urol Focus 6 (2020) 458–62] (European Urology Focus (2020) 6(3) (458–462), (S2405456919303372), (10.1016/j.euf.2019.10.015))

In the original publication, Isaac Thangasamy was omitted from the list of authors and author Benjamin Condon was incorrectly assigned to a number of affiliations. The authors would like it to be noted that Isaac Thangasamy contributed to the manuscript and that Benjamin Condon is affiliated to the Department of Surgical Oncology in the Peter MacCallum Cancer Centre, Melbourne, Australia. Conflicts of interest: The authors have nothing to disclose

Prostate Cancer Survival Estimates by the General Public Using Unrestricted Internet Searches and Online Nomograms.

BACKGROUND: Patient understanding of cancer-associated risk influences treatment preferences and is vital for making informed treatment decisions. Although patients traditionally relied on physician visits for cancer information, most adults now use the Internet as a primary source of health information. OBJECTIVE: To evaluate whether US adults can accurately estimate survival for hypothetical prostate cancer patients using unrestricted Internet searching and an online nomogram. DESIGN, SETTING, AND PARTICIPANTS: Adults were recruited at the Minnesota State Fair. Participants were shown a pathology report for a prostatectomy cancer specimen and asked to estimate the patient\u27s 15-yr survival using an unrestricted Internet search. Participants were then asked to re-estimate using a freely available, validated prostate cancer nomogram. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Participants\u27 answers were compared to a reference estimate and a ballpark estimate of ±10 percentage points of the reference value. RESULTS AND LIMITATIONS: A total of 129 participants met the inclusion criteria and generated complete responses. Only 12% (95% confidence interval [CI] 7.8-19.2%) were within the ballpark estimate when using unrestricted Internet searching for overall survival estimates. 23% (95% CI 16.8-31.3%) correctly used the nomogram and 51% (95% CI 42.6-59.6%) estimated within the ballpark when using the nomogram. CONCLUSIONS: Use of an unrestricted Internet search often yields inaccurate estimations of life expectancy, while estimations significantly improve with nomogram use. Physicians should educate and guide patients towards credible online health resources, facilitate their effective use, and engage in discussion with patients regarding the utility of this information. PATIENT SUMMARY: The general public finds it difficult to estimate prostate cancer survival using unrestricted Internet searches. Most patients would benefit from Internet guidance from their clinicians to better understand prostate cancer pathology reports