23 research outputs found
KliniÄka praksa hrvatskih urologa i usklaÄenost sa smjernicama u lijeÄenju simptoma donjeg mokraÄnog trakta u muÅ”karaca
The aim of this study was to assess the Croatian urologistsā management of non-neurogenic male lower urinary tract symptoms (LUTS) and their compliance with the European Association of Urology (EAU) guidelines. A cross-sectional survey included 51/179 Croatian
urologists. We developed a questionnaire with questions addressing compliance with EAU guidelines. The rate of performing recommended evaluations on the initial assessment of patients with benign prostate hyperplasia (BPH)/LUTS varied from 8.0% (serum creatinine and voiding diary) to 100.0% (physical examination, prostate specific antigen and ultrasound). The international prostate symptom score was performed by 31%, analysis of urine sediment by 83%, urine culture by 53%, and serum creatinine by 8% of surveyed urologists. Only 8% of urologists regularly used bladder diary in patients with symptoms of nocturia. Our results indicated that 97% of urologists preferred alpha blockers as the first choice of treatment; 5-alpha reductase inhibitors (5ARI) were mostly prescribed (84%) in combination with an alpha-blocker, preferably as a continuous treatment, whilst 29% of urologists used to discontinue 5ARI after 1-2 years. Half of the Croatian urologists used antimuscarinics in the treatment of BPH/LUTS and recommended phytotherapeutic drugs in their practice. In conclusion, Croatian urologists do not completely comply with the guidelines available.Cilj ovoga istraživanja bio je uvrditi kliniÄku praksu hrvatskih urologa u pristupu bolesnicima sa simptomima donjeg mokraÄnog trakta (LUTS) i njihovo pridržavanje Smjernica Europskoga uroloÅ”kog druÅ”tva (EAU). Provedeno je presjeÄno istraživanje meÄu 51/179 (28%) hrvatskih urologa. Izradili smo upitnik koji sadrži pitanja glede poÅ”tivanja smjernica EAU. Primjena preporuÄenih pretraga u poÄetnoj procjeni bolesnika s benignom hiperplazijom prostate (BPH)/LUTS varirala je od 8,0% (kreatinin i dnevnik mokrenja) do 100,0% (fizikalni pregled, antigen specifiÄan za prostatu (PSA) i ultrazvuk). U poÄetnoj procjeni bolesnika s BPH/LUTS uz anamnezu i digitorektalni pregled hrvatski urolozi primjenjuju joÅ” PSA i ultrazvuk (100%). MeÄunarodni zbroj prostatiÄnih simptoma (IPSS) primjenjuje 31%, analizu sedimenta mokraÄe 83%, kulturu mokraÄe 53%, a serumski kreatinin 8% ispitanih urologa. Samo 8% urologa redovito koristi dnevnik mokrenja kod bolesnika sa simptomima nokturije. Rezultati su pokazali kako 62% hrvatskih urologa smatra da provodi dijagnostiÄku obradu koja je u skladu sa smjernicama EAU. U terapijskom pogledu rezultati pokazuju da 97% urologa smatra alfa blokatore lijekom prvog izbora. Inhibitori 5-alfa reduktaze (5ARI) uglavnom (84%) su propisani u kombinaciji s alfa-blokatorima, ponajprije kao kontinuirano lijeÄenje, dok 29% prekida 5ARI nakon 1-2 godine. Polovica hrvatskih urologa rabi antimuskarinike u lijeÄenju BPH/LUTS i preporuÄuje fitoterapiju u svojoj praksi. Praksa hrvatskih urologa nije u potpunosti usklaÄena sa smjernicama
Dijagnostika raka prostate u 2019. - promjene u europskim smjernicama i utjecaj na svakodnevnu praksu
Changes in the diagnostic pathway for prostate cancer advised in the most recent Guidelines of the European Association of Urology bring many endeavors for everyday practice. Availability, costs and radiological expertise are still representing a challenge for the adoption of these
guidelines in everyday clinical practice. In this article we discuss the current situation regarding these issues and future options.Promjene u dijagnostici karcinoma prostate preporuÄene u najnovijim Smjernicama Europskog udruženja za urologiju donose mnoge izazove u svakodnevnoj praksi. Dostupnost, troÅ”kovi i pouzdanost slikovnog nalaza i dalje su izazov za usvajanje ovih smjernica u svakodnevnoj kliniÄkoj praksi. U ovom Älanku raspravljamo o trenutnoj situaciji u Hrvatskoj i svijetu i o buduÄim opcijama
Nepovoljne kliniÄko-patoloÅ”ke znaÄajke u bolesnika s izostavljenom limfadenektomijom tijekom radikalne prostatektomije
Pelvic lymph node dissection (PLND) during radical prostatectomy (RP) is the most accurate staging modality for lymph node assessment in patients with prostate cancer. It is recommended in all patients with intermediate or high-risk disease undergoing radical prostatectomy. The goal of our study was to assess unfavorable clinicopathological characteristics in patients with omitted lymphadenectomy (PLND) during radical prostatectomy based on the nomogram proposed by Briganti and colleagues. In 2011, 200 patients undertook radical prostatectomy in our institution. Among them 53 patients who fulfilled Briganti criteria and in whom we omitted lymphadenectomy based on current guidelines. Unfavorable clinicopathological features considered were: stage T3, positive surgical margins or biochemical relapse (BCR). We registered biopsy Gleason score 6 in 34 patients, and 19 patients had Gleason score 7. Stage pT2 was seen in 49 patients, and pT3 in 4. Gleason score after radical prostatectomy was upgraded from GS 6 to GS 7 in 20 patients (37%) and reduced in 1 patient (2%). After a median follow-up of 49 (44-56) months, there were 12 (22.6%) patients with BCR. Patients with biopsy Gleason score 6 (n=34) compared to biopsy Gleason 7 (n=19) patients showed no difference regarding positive margins (p=0.0738) and BCR (p=0,736) at 49 months follow-up. Thus, PLND according to current guidelines can be safely omitted in low-risk patients using Brigantinomogram.ZdjeliÄna limfadenektomija u vrijeme radikalne prostatektomije (RP) trenutno je najpouzdaniji naÄin otkrivanja metastaza u limfne Ävorove u bolesnika s rakom prostate. Cilj naÅ”eg istraživanja bio je procijeniti nepovoljne kliniÄko-patoloÅ”ke znaÄajke u bolesnika s izostavljenom limfadenektomijom tijekom radikalne prostatektomije temeljene na Briganteovom nomogramu. U 2011. godini, u naÅ”oj je ustanovi 200 bolesnika podvrgnuto radikalnoj prostatektomiji. Identificirali smo 53 bolesnika koji su ispunili Brigantijeve kriterije te su prema aktualnim smjernicama bili poÅ”teÄeni zdjeliÄne limfadenektomije. Nepovoljnim kliniÄko-patoloÅ”kim znaÄajkama smatralo se bilježenje stadija T3 bolesti, pozitivni kirurÅ”ki rubovi ili biokemijski relaps. Na patohistoloÅ”kom (PH) nalazu biopsije Gleason zbroj 6 verificiran je u 34 pacijenta, a 19 je pacijenata imalo Gleason zbroj 7. Na konaÄnom PH nalazu nakon uÄinjene radikalne prostatektomije 49 bolesnika je imalo pT2 stadiji bolesti, a 4 su bolesnika imala pT3. KonaÄni Gleason zbroj nakon radikalne prostatektomije poveÄan je u 20 bolesnika na GS 7 (37%) i smanjen kod jednog bolesnika (2%). Nakon srednjeg praÄenja od 49 (44-56) mjeseci, bilo je 12 (22,6%) bolesnika s biokemijskim relapsom (BR). Usporedba bolesnika s biopsijskim nalazom Gleason zbroja 6 (n = 34) i bolesnika s Gleason zbrojem7 (n = 19) nije pokazala znaÄajnu razliku u odnosu na pozitivne kirurÅ”ke rubove (p = 0,0738) i BR (p = 0,736) nakon 49 mjeseci praÄenja. Stoga se zdjeliÄna limfadenektomija prema aktualnim smjernicama može sigurno izostaviti u bolesnika s procijenjenim niskim rizikom koristeÄi Briganteov nomogram
Usporedba toÄnosti stupnjevanja diferencijacije raka prostate u uzorcima dobivenim ciljanom i sustavnom biopsijom prostate
All malignancies, including prostate cancer, require accurate diagnosing and staging
before making a treatment decision. The introduction of targeted biopsies based on prostate MRI findings
has raised prostate biopsy accuracy. Guided biopsies target the tumor itself during the biopsy instead
of the most common tumor sites as is the case with a systemic biopsy. Some studies report that targeted
biopsies should lower prostate cancer biopsy undergrading and overgrading.
To determine the incidence of prostate cancer biopsy undergrading in patients who underwent
a classic systemic biopsy compared to patients who underwent a mpMRI cognitive targeted biopsy.
We identified the patients from our database who underwent a radical prostatectomy
at our institution from January 1st, 2021, to June 30th, 2021.There were 112 patients identified.
Patients were stratified into two groups based on the type of biopsy that confirmed prostate cancer.
The mpMRI (N=50) group had a mpMRI cognitive guided transrectal ultrasound (TRUS) prostate
biopsy performed, and the non-mpMRI group (N=62) received a classic, systemic TRUS biopsy. We
compared the biopsy results with the final pathological results, and searched for undergrading or overgrading
in the biopsies compared to the final histological reportThe undergrading was found in 17,7 % (N=11) cases in the non-mpMRI group and in 12,0
% (N=6) of cases in the mpMRI group (p=0,02, Mann-Whitney U test). No overgrading was found in
our cohort. All cases of undergrading had Grade Group 1 in the biopsy report and Grade Group 2 in the
final specimen report. The charasteristics of patients are listed in Table 1.
In our cohort, the patients who underwent a mpMRI targeted biopsy
had a lower undergrading incidence. During a systemic TRUS biopsy, the urologist targets the areas of
the prostate where cancer is most commonly located, which is usually the peripheral zone of the prostate.
Since different areas of the tumor have different areas of differentiation, only a low-grade part of the
tumor is sometimes biopsied, which results in a sampling error. Once the prostate is removed, the whole
tumor is analyzed, so the obtained pathological results related to the removed prostate are far more accurate
than the analysis of prostate cores obtained by biopsy.Sve maligne bolesti, ukljuÄujuÄi rak prostate, zahtijevaju preciznu dijagnostiku prije odluke o lijeÄenju. UvoÄenjem
ciljanih biopsija na temelju nalaza MRI prostate poveÄana je toÄnost biopsije prostate. VoÄene biopsije ciljaju na sam tumor
u umjesto na najÄeÅ”Äe lokacije tumora u prostati kao Å”to je sluÄaj sa sistemskom biopsijom. Neke studije pokazuju da bi ciljane
biopsije trebale smanjiti podcjenjivanje stupnja diferenciranosti raka prostate u uzorcima dobivenim biopsijom prostate.
Odrediti incidenciju podcjenjivanje stupnja diferenciranosti raka prostate kod pacijenata koji su bili podvrgnuti
klasiÄnoj sistemskoj biopsiji u usporedbi s pacijentima koji su bili podvrgnuti mpMRI kognitivnoj ciljanoj biopsiji.
Identificirali smo pacijente iz naŔe baze podataka koji su podvrgnuti radikalnoj prostatektomiji u
naÅ”oj ustanovi od 1. sijeÄnja 2021. do 30. lipnja 2021. Identificirano je 112 pacijenata. Pacijenti su podijeljeni u dvije skupine
na temelju vrste biopsije kojom je potvrÄen rak prostate. Skupina mpMRI (N=50) primila je mpMRI kognitivno voÄenu
transrektalnu ultrazvuÄnu (TRUS) biopsiju prostate, a skupina non-mpMRI (N=62) primila je klasiÄnu, sistemsku TRUS
biopsiju. Usporedili smo rezultate biopsije s konaÄnim patoloÅ”kim nalazima i tražili smo podcjenjivanje stupnja diferenciranosti
karcinoma prostate u biopsijama u usporedbi s konaÄnim histoloÅ”kim nalazom.
Podcjenjivanje stupnja diferenciranosti naÄeno je u 17,7 % (N=11) u non-mpMRI skupini i u 12,0 % (N=6)
sluÄajeva u mpMRI skupini (p=0,02, Mann-Whitney U test). U naÅ”oj kohorti nije pronaÄeno precjenjivanje stupnja diferenciranosti.
Svi sluÄajevi podcjenjivanja imali su Gradus grupu 1 na nalazu biopsije prostate i Gradus grupu 2 u konaÄnom
patohistoloŔkom nalazu.
U naŔoj kohorti, pacijenti koji su bili podvrgnuti ciljanoj biopsiji imali su nižu incidenciju podcjenjivanja
stupnja diferenciranosti Å”to je posljedica toÄnijeg uzorkovanja. Tijekom sistemske TRUS biopsije, urolog cilja na
podruÄja prostate gdje se rak najÄeÅ”Äe nalazi, Å”to je obiÄno periferna zona prostate. BuduÄi da razliÄita podruÄja tumora imaju
razliÄita podruÄja diferencijacije, ponekad se bioptira samo dio tumora koji je bolje diferenciran, Å”to rezultira pogreÅ”kom
uzorkovanja. Nakon Å”to je prostata uklonjena, analizira se cijeli tumor, tako da su rezultirajuÄi patohistololoÅ”ki rezultati uklonjene
prostate daleko toÄniji od analize uzoraka prostate dobivenih biopsijom
Trenutno mjesto magnetske rezonance u probiru, dijagnostici i lijeÄenju raka prostate
Prostate cancer is the most common cancer in men. Diagnosis of prostate cancer
poses a significant challenge, due to several different key parameters that need to be evaluated, such as
age, history of prostate specific antigen (PSA), clinical examination and more recently magnetic resonance
imaging (MRI). The current diagnostic pathway for prostate cancer has resulted in overdiagnosis
and overtreatment as well as underdiagnosis and missed diagnoses in many men. Multiparametric
MRI (mp-MRI) of the prostate has been identified as a test that could alleviate these diagnostic
errors. Before prostate cancer treatment pathological confirmation is mandatory. Prostate biopsy is
an invasive procedure with rare but not negligible potential complications. There are several methods
of prostate biopsy of which most common are systemic or planar prostate biopsy and cognitive
or targeted MRI-guided prostate biopsy. Multiparametric MRI has demonstrated better accuracy
and reproducibility in detecting, locating and evaluating prostate cancer and also sparing some men
unnecessary biopsies. Recent studies have shown a mpMRI benefit for better procedure planning
regarding prostate cancer location, extent of disease and length of the urethra. There are still some
challenges ahead, such as ensuring high-quality execution and reporting of mpMRI and ensuring that
this diagnostic pathway is cost-effective. According to the latest urological clinical guidelines mpMRI
became fundamental tool in management of prostate cancer. The aim of this study is to give a brief
insight in use of mpMRI in prostate cancer diagnosis and treatment.Rak prostate najÄeÅ”Äi je karcinom u muÅ”karaca. Dijagnoza raka prostate predstavlja znaÄajan izazov zbog nekoliko razliÄitih
kljuÄnih parametara koje je potrebno procijeniti, kao Å”to su dob, povijest prostata specifiÄnog antigena (PSA), kliniÄki pregled
i u novije vrijeme multiparametrijski MRI (mp-MRI). Trenutna dijagnostika raka prostate rezultirala je prekomjernom
dijagnostikom i lijeÄenjem, kao i poddijagnozom i propuÅ”tenom dijagnozom kod mnogih muÅ”karaca. Multiparametrijski
MRI prostate identificiran je kao test koji bi mogao ublažiti ove pogreÅ”ke. Prije lijeÄenja raka prostate obavezna je patoloÅ”ka
potvrda. Biopsija prostate je invazivan postupak s rijetkim, ali ne i zanemarivim potencijalnim komplikacijama. Postoji nekoliko
metoda biopsije prostate od kojih su najÄeÅ”Äe sistemska ili planarna biopsija prostate i kognitivna ili ciljana biopsija prostate
voÄena MRI-om. Mp-MRI pokazao je bolju toÄnost i reproducibilnost u otkrivanju, lociranju i procjeni raka prostate,
a takoÄer je poÅ”tedio neke muÅ”karace nepotrebne biopsije. Nedavne studije pokazale su korist mpMRI-e za bolje planiranje
zahvata s podacima o lokaciji raka prostate, opsegu bolesti i duljini uretre. Pred nama su joÅ” neki izazovi, poput osiguravanja
visokokvalitetne izvedbe i izvjeÅ”Äivanja o mpMRI-u te osiguravanja da je ovaj dijagnostiÄki put isplativ. Prema najnovijim
uroloÅ”kim kliniÄkim smjernicama mpMRI je postao temeljni alat u lijeÄenju raka prostate. Cilj ove studije je dati kratak uvid
u upotrebu mpMRI-e u dijagnostici i lijeÄenju raka prostate
Multiparametrijska magnetska rezonancija u procjeni karcinoma prostate
Multiparametric magnetic resonance is assuming an increasingly important role in the diagnosis, initial assessment and monitoring of patients with prostate cancer. This paper offers a more complex insight into the application of magnetic resonance imaging with prostate cancer, with a current literature overview. The focus is on the problem of initial prostate cancer evaluation which strongly affects further decision-making and therapeutic interventions. Clinical suggestions based on the current guidelines are also offered.Multiparametrijska magnetska rezonancija preuzima sve znaÄajniju ulogu u dijagnostici, inicijalnoj procjeni, kao i praÄenju pacijenata s karcinomom prostate. Ovaj rad nudi složeniji uvid u pitanje primjene magnetske rezonancije kod karcinoma prostate, uz pregled trenutne literature iz podruÄja. Posebno težiÅ”te je stavljeno na problem inicijalne procjene karcinoma prostate koje uvelike determinira daljnje odluÄivanje i terapijsko postupanje. PonuÄene su i preporuke temeljene na trenutnim smjernicama
DIJAGNOSTIÄKI ZNAÄAJ BIOPSIJE PROSTATE VOÄENE KOGNITIVNOM FUZIJOM MULTIPARAMETRIJSKE MAGNETNE REZONANCE I TRANSREKTALNOG ULTRAZVUKA (mpmri-TRUS) KOD BOLESNIKA S PRETHODNO NEGATIVNOM TRUS VOÄENOM BIOPSIJOM
The aim of this prospective clinical study was to determine the detection rate of prostate cancers by multiparametric magnetic resonance and transrectal ultrasound (mpMRI-TRUS) cognitive fusion biopsies in patients with a previously negative TRUS-guided biopsy. Between 1 October 2016 and 1 July 2017, in 101 consecutive patients with elevated antigen (PSA) and/or positive digital rectal examination and after a negative first TRUS biopsy, a second, repeated prostate biopsy was performed. In 24 patients, cognitive fusion mpMRI-TRUS biopsy of the prostate with 8-10 system cores and 1-3 target biopsies was performed, in line with the European Association of Urology guidelines. In 77 patients, only a classic, repeated TRUS guided biopsy was performed. In patients with mpMRI, the detection rate according to PIRADS-v2 reporting system was: PIRADS 1, n = 0; PIRADS 2, n = 0; PIRADS 3, n = 0; PIRADS 4, n = 6/8 (75%); and PIRADS 5, n = 2/3 (67%). In the group of patients with MR-TRUS cognitive fusion biopsy, the prostate cancer detection rate was 8/24 (33%), while in the control group the detection rate was 12/77 (16%), which was statistically significant (t test, p = 0.037, CI 95% is 0.01 to 0.37). Patients with PIRADS ā¤ 3 (54%) could have avoided the biopsy.U ovoj prospektivnoj kliniÄkoj studiji cilj je odrediti stopu detekcije raka prostate biopsije voÄene kognitivnom fuzijom multiparametrijske magnetne rezonance i transrektalnog ultrazvuka (mpMRI-TRUS) kod bolesnika s prethodno negativnom TRUS voÄenom biopsijom. U razdoblju od 1. 10. 2016. do 1. 7. 2017. kod 101 uzastopnog bolesnika s poviÅ”enim prostata specifiÄnim antigenom (PSA) i/ili pozitivnim digitorektalnim pregledom, a nakon negativne prve TRUS biopsije je uÄinjena druga, ponovljena biopsija prostate. Kod 24 bolesnika uÄinjena je, u skladu sa Smjernicama Europskog uroloÅ”kog druÅ”tva, prethodna mpMRI i potom kognitivna fuzijska biopsija prostate s 8-10 sistemskih cilindara i 1-3 ciljane biopsije prema mpMRI nalazu. Kod 77 bolesnika je uÄinjena samo klasiÄna, ponovljena TRUS biopsija bez prethodne slikovne obrade. Kod bolesnika s mpMRI, stopa detekcije raka prema PIRADSU-v2 je PIRADS 1, n = 0; PIRADS 2, n = 0; PIRADS 3, n = 0; PIRADS 4, n = 6/8 (75%) i PIRADS 5, n = 2/3 (67%). U skupini bolesnika s MR-TRUS kognitivnom fuzijskom biopsijom stopa detekcije raka prostate je 8/24 (33%), dok je u kontrolnoj skupini stopa detekcije 12/77 (16%), Å”to se pokazalo statistiÄki znaÄajnom razlikom (t test; p=0.037, CI 95% je 0.01 to 0.37). Bolesnici s PIRADS ā¤ 3 (54%) su mogli izbjeÄi biopsiju
Analiza isplativosti uvoÄenja biopsije prostate navoÄene multiparametrijskom magnetskom rezonancom
Continuous increase of the cost of medical services around the world has become a major topic in the world today. Multiparametric prostate MRI has recently become a new standard in prostate cancer detection, especially in repeated biopsy settings. The method, although superior in cancer detection rates, is costly and requires additional training and equipment. The purpose of our study was to determine the costs and benefits that arise when introducing this method in prostate cancer diagnostics. Repeated prostate biopsy was performed in 101 consecutive patients in the period from 1 October 2016 to 1 July 2017. Patients were divided into two groups based on whether prostate mp-MRI was performed or not. The prices of specific procedures were obtained from the billing service of the Sestre milosrdnice University Hospital Center and patient models were created to determine financial costs and benefits. The cost of the entire diagnostic process per patient in the non-MRI group was HRK 1.931,05 and HRK 1.848,42 in the mpMRI group, or 4.28% less. Prostate mpMRI and subsequent mpMRI guided biopsies can reduce the overall cost in prostate cancer diagnostics despite the procedure itself being an additional cost. This is achieved by omitting prostate biopsies in patients with low malignancy risk.Kontinuirani rast troÅ”kova medicinskih postupaka aktualna je tema i razlog zabrinutosti u cijelome svijetu. Ciljana, multiparametrijskim magnetom (mpMRI) navoÄena biopsija prostate polako postaje standard u dijagnostici karcinoma prostate, pogotovo kod ponovljene biopsije. Iako superiorna klasiÄnoj, sistemskoj biopsiji prostate, navedena metoda zahtijeva skupu dodatnu opremu i vjeÅ”te, educirane kliniÄare. NaÅ” cilj je analizirati ekonomsku isplativost uvoÄenja multiparametrijske magnetne rezonance prostate i posljediÄne kognitivno mpMRI-om navoÄene biopsije prostate u dijagnostiÄki protokol bolesnika sa inicijalno negativnom sistemskom biopsijom prostate, kod kojih postoji daljnja kliniÄka sumnja na karcinom prostate. U periodu od 01.10.2016. do 01.07.2017 kod 101 uzastopnog bolesnika s poviÅ”enim PSA i/ili pozitivnim DRP, a nakon negativne prve TRUS biopsije uÄinjena je druga, ponovljena biopsija prostate. Bolesnici su podijeljeni u dvije skupine ovisno o tome dali je uÄinjen mpMRI prostate ili ne. UÄinjena je analiza broja i troÅ”kova posjeta specijalisti urologu kao i broja i troÅ”kova ordiniranih pretraga za svaku skupinu. Tijek kliniÄkih postupaka standardiziran je na temelju prosjeka za pojedine promatrane skupine te preraÄunat na 100 bolesnika za svaku skupinu radi lakÅ”e usporedbe rezultata. Kalkulacije su vrÅ”ene na temelju dobivenih modela. ProsjeÄna cijena obrade bolesnika u skupini bez mpMRI-a iznosi 1931,05 HRK dok u sa mpMRI-em iznosi 1848,42 HRK tj. 4,28% manje. Iako mpMRI prostate pojedinaÄno predstavlja znaÄajan dodatan troÅ”ak u dijagnostici karcinoma prostate, kod bolesnika sa inicijalno negativnom biopsijom prostate isti omoguÄava velikom broju bolesnika izbjegavanje biopsije te posljediÄno smanjenje ukupnog troÅ”ka
PatohistoloŔki nalaz nakon radikalne prostatektomije temeljene na novom sustavu ocjenjivanja
One of the main reasons for the introduction of a new grading system was Gleason sum 7, which differed significantly in the prognosis of the disease depending on the primary Gleason. The aim of this study was to compare grade group 2 and grade group 3, and the impact of cancer percentages in final pathology reports after radical prostatectomy on the occurrence of T3 stage of the disease after radical prostatectomy of clinically localized prostate cancer. The study covered 365 patients with clinically localized prostate cancer who underwent radical retropubic prostatectomy (RRP) over the period of two years. The average percentage of carcinomas found in pathology reports after RRP was 20.1%. With the increase in the grade group, the average percentage of carcinomas in pathology reports increased significantly, p<0.001. With regard to grade groups 2 and 3, irrespective of cancer percentages in pathology reports, more cases of T3 stage were found in grade group 3 when compared to grade group 2, which was statistically significant (p<0.001). However, grade group 2 and grade group 3 patients with ā¤10% cancer occurrences in final pathology reports after RRP did not show any statistical significance in the occurrence of T3 stage, p=0.96. Prognostic differences in grade group 2 and grade group 3 patients after RRP are significant, but not in all cases, because of their dependence on the percentage of cancer in the final pathology report after RRP of clinically localized prostate cancer.Kao jedan od glavnih uzroka uvoÄenja novih gradus skupina bio je Gleasonov zbroj 7, koji se bitno razlikovao u prognozi bolesti ovisno o primarnom Gleasonu. U ovom istraživanju usporedili smo gradus skupinu 2 (GZ 3+4) i gradus skupinu 3 (GZ 4+3) u pojavnosti T3 stadija kod pacijenata s ā¤10% karcinoma u patohistoloÅ”kom nalazu nakon retropubiÄne radikalne prostatektomije, kliniÄki lokaliziranog karcinoma prostate. Studijom je obuhvaÄeno 365 pacijenata s kliniÄki lokaliziranim karcinomom prostate koji su podvrgnuti radikanoj retropubiÄnoj prostatektomiji izmeÄu 1. sijeÄnja 2015. i 31. prosinca 2016. godine. Najzastupljenije gradus skupine bile su gradus skupina 2 s 50,41% i gradus skupina 3, s udjelom od 36,16%. Postotak karcinoma u PHD nalazu nakon RRP bio je u rasponu od 5 do 80%, prosjek 20,1%. Kod gradus skupina 2 i 3, neovisno o postotku karcinoma prostate u konaÄnom PHD nalazu, bilo je statistiÄki znaÄajno viÅ”e T3 stadija u gradus skupini 3 u odnosu na gradus skupinu 2, p=0,001. MeÄutim, pacijenti gradus skupina 2 i 3 s postotkom karcinoma ā¤10% u konaÄnom PHD nalazu nakon RRP nisu pokazali razliku u pojavnosti T3 stadija, p=0,96. Razlike u prognozi za pacijente gradus skupine 2 i gradus skupine 3 nakon RRP su znaÄajne, ali ne uvijek. Svakako pri procjeni rizika moramo uzeti u obzir i znaÄajnost postotka karcinoma prostate nakon RRP, u ovom istraživanju niži postotak karcinoma (ā¤10%)
Annual educational expenses of European urology residents and the role of sponsorship in urology training: a survey-based analysis.
Introduction
The aim of this article was to evaluate the personal monetary costs associated with the urology residency.
Material and methods
The European Society of Residents in Urology (ESRU) designed a 35-item survey and distributed it via email and social media to urology residents in Europe.Monthly net salary and educational expenses (general expenses, literature, congresses and courses) and opinions regarding sponsorship and expenditure were evaluated. Comparisons between different countries and salary cut-offs were made.
Results
A total of 211 European urology residents completed the survey from 21 European countries. The median interquartile range (IQR) age was 30 (18-42) years and 83.0% were male. A total of 69.6% receive less than ā¬1500 net per month and 34.6% spent ā„ā¬3000 on education in the previous 12 months. Sponsorships came mainly from the pharmaceutical industry (57.8%), but 56.4% of trainees thought that the ideal sponsor should be the hospital/urology department. Only 14.7% of respondents stated that their salary is sufficient to cover training expenses, and 69.2% agreed that training costs have an influence on family dynamics.
Conclusions
Personal expenses during training are high, are not sufficiently covered by the salary and impact family dynamics for a majority of residents in Europe. The majority thought that hospitals/national urology associations should contribute to the educational costs. For homogeneous opportunities across Europe, institutions should strive to increase sponsorship.post-print1388 K