The combined role of MRI prostate and prostate health index in improving detection of significant prostate cancer in a screening population of Chinese men

Using prostate-specific antigen (PSA) for prostate cancer (PCa) screening led to overinvestigation and overdiagnosis of indolent PCa. We aimed to investigate the value of prostate health index (PHI) and magnetic resonance imaging (MRI) prostate in an Asian PCa screening program. Men aged 50-75 years were prospectively recruited from a community-based PSA screening program. Men with PSA 4.0-10.0 ng ml -1 had PHI result analyzed. MRI prostate was offered to men with PSA 4.0-50.0 ng ml -1. A systematic prostate biopsy was offered to men with PSA 4.0-9.9 ng ml -1 and PHI ≥35, or PSA 10.0-50.0 ng ml -1. Additional targeted prostate biopsy was offered if they had PI-RADS score ≥3. Clinically significant PCa (csPCa) was defined as the International Society of Urological Pathology (ISUP) grade group (GG) ≥2 or ISUP GG 1 with involvement of ≥30% of total systematic cores. In total, 12.8% (196/1536) men had PSA ≥4.0 ng ml -1. Among 194 men with PSA 4.0-50.0 ng ml -1, 187 (96.4%) received MRI prostate. Among them, 28.3% (53/187) had PI-RADS ≥3 lesions. Moreover, 7.0% (107/1536) men were indicated for biopsy and 94.4% (101/107) men received biopsy. Among the men received biopsy, PCa, ISUP GG ≥2 PCa, and csPCa was diagnosed in 42 (41.6%), 24 (23.8%), and 34 (33.7%) men, respectively. Compared with PSA/PHI pathway in men with PSA 4.0-50.0 ng ml -1, additional MRI increased diagnoses of PCa, ISUP GG ≥2 PCa, and csPCa by 21.2% (from 33 to 40), 22.2% (from 18 to 22), and 18.5% (from 27 to 32), respectively. The benefit of additional MRI was only observed in PSA 4.0-10.0 ng ml -1, and the number of MRI needed to diagnose one additional ISUP GG ≥2 PCa was 20 in PHI ≥35 and 94 in PHI &lt;35. Among them, 45.4% (89/196) men with PSA ≥4.0 ng ml -1 avoided unnecessary biopsy with the use of PHI and MRI. A screening algorithm with PSA, PHI, and MRI could effectively diagnose csPCa while reducing unnecessary biopsies. The benefit of MRI prostate was mainly observed in PSA 4.0-9.9 ng ml -1 and PHI ≥35 group. PHI was an important risk stratification step for PCa screening.</p

Tips and Pitfalls in Using Social Media Platforms for Survey Dissemination

IntroductionSocial media has become a prevalent platform for survey dissemination, despite the paucity of literature on this topic. The purpose of this paper is to outline the benefits and drawbacks of and best practices for social media-based surveys.MethodsWe performed a scoping review of this topic and explored different strategies commonly employed for conducting efficient health care surveys via social media platforms.ResultsThe main advantages of social media-based surveys are the convenience and flexibility of survey design, their relatively low cost, the anonymity of responders, and the ability to reach a broader population of responders across geographical boundaries. Several measures can be adopted to avoid issues inherent in this approach, such as data disruption and response duplication, as well as to enhance ethical behaviors and consent compliance. We discuss limitations associated with unclear distribution of survey respondents and outline survey fraud as a major impediment to the online propagation of surveys on various social media platforms.DiscussionThe use of social media to disseminate surveys on various medical specialty topics has garnered global participation, particularly during the COVID-19 pandemic. Ethical codes of conduct emphasize the need for professionalism and truthfulness, and disclosure of potential conflicts of interest on the part of respondents, and high-quality survey research on the part of researchers.ConclusionWe advocate for the novel use of social media to promote large and diverse health care surveys. Additional studies should further explore the use of emerging social media platforms for survey dissemination and their impact on health care research

Tips and Pitfalls in Using Social Media Platforms for Survey Dissemination

IntroductionSocial media has become a prevalent platform for survey dissemination, despite the paucity of literature on this topic. The purpose of this paper is to outline the benefits and drawbacks of and best practices for social media-based surveys. MethodsWe performed a scoping review of this topic and explored different strategies commonly employed for conducting efficient health care surveys via social media platforms. ResultsThe main advantages of social media-based surveys are the convenience and flexibility of survey design, their relatively low cost, the anonymity of responders, and the ability to reach a broader population of responders across geographical boundaries. Several measures can be adopted to avoid issues inherent in this approach, such as data disruption and response duplication, as well as to enhance ethical behaviors and consent compliance. We discuss limitations associated with unclear distribution of survey respondents and outline survey fraud as a major impediment to the online propagation of surveys on various social media platforms. DiscussionThe use of social media to disseminate surveys on various medical specialty topics has garnered global participation, particularly during the COVID-19 pandemic. Ethical codes of conduct emphasize the need for professionalism and truthfulness, and disclosure of potential conflicts of interest on the part of respondents, and high-quality survey research on the part of researchers. ConclusionWe advocate for the novel use of social media to promote large and diverse health care surveys. Additional studies should further explore the use of emerging social media platforms for survey dissemination and their impact on health care research

Comparative outcomes of primary versus recurrent high-risk nonmuscle-invasive and primary versus secondary muscle-invasive bladder cancer after radical cystectomy : results from a retrospective multicenter study

BACKGROUND: Radical cystectomy (RC) is indicated in primary or secondary muscle-invasive bladder cancer (primMIBC, secMIBC) and in primary or recurrent high- or very high-risk non–muscle-invasive bladder cancer (primHR-NMIBC, recHR-NMIBC). The optimal timing for RC along the disease spectrum of nonmetastatic urothelial carcinoma remains unclear. OBJECTIVE: To compare outcomes after RC between patients with primHR-NMIBC, recHR-NMIBC, primMIBC, and secMIBC. DESIGN, SETTING, AND PARTICIPANTS: This retrospective, multicenter study included patients with clinically nonmetastatic bladder cancer (BC) treated with RC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We assessed oncological outcomes for patients who underwent RC according to the natural history of their BC. primHR-NMIBC and primMIBC were defined as no prior history of BC, and recHR-NMIBC and secMIBC as previously treated NMIBC that recurred or progressed to MIBC, respectively. Log-rank analysis was used to compare survival outcomes, and univariable and multivariable Cox and logistic regression analyses were used to identify predictors for survival. RESULTS AND LIMITATIONS: Among the 908 patients included, 211 (23%) had primHR-NMIBC, 125 (14%) had recHR-NMIBC, 404 (44%) had primMIBC, and 168 (19%) had secMIBC. Lymph node involvement and pathological upstaging were more frequent in the secMIBC group than in the other groups (p < 0.001). The median follow-up was 37 mo. The 5-year recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were 77.9%, 83.2%, and 72.7% in primHR-NMIBC, 60.0%, 59%, and 48.9% in recHR-NMIBC, 60.9%, 64.5%, and 54.8% in primMIBC, and 41.3%, 46.5%, and 39% in secMIBC, respectively, with statistically significant differences across all survival outcomes except between recHR-NMIBC and primMIBC. On multivariable Cox regression, recHR-NMIBC was independently associated with shorter RFS (hazard ratio [HR] 1.64; p = 0.03), CSS (HR 1.79; p = 0.01), and OS (HR 1.45; p = 0.03), and secMIBC was associated with shorter CSS (HR 1.77; p = 0.01) and OS (HR 1.57; p = 0.006). Limitations include the biases inherent to the retrospective study design. CONCLUSIONS: Patients with recHR-NMIBC and primHR-MIBC had similar survival outcomes, while those with sec-MIBC had the worst outcomes. Therefore, early radical intervention may be indicated in selected patients, and potentially neoadjuvant systemic therapies in some patients with recHR-NMIBC. PATIENT SUMMARY: We compared cancer outcomes in different bladder cancer scenarios in a large, multinational series of patients who underwent removal of the bladder with curative intent. We found that patients who experienced recurrence of non–muscle-invasive bladder cancer (NMIBC) had similar survival outcomes to those with initial muscle-invasive bladder cancer (MIBC), while patients who experienced progression of NMIBC to MIBC had the worst outcomes. Selected patients with non–muscle-invasive disease may benefit from early radical surgery or from perioperative chemotherapy or immunotherapy