Diseño del instrumento de ayuda para la toma de decisiones: “alternativas de tratamiento para el cáncer de próstata: ¿qué opción prefiero?”

Purpose: To design a Decision-making Aid within the ‘Benign Prostatic Hyperplasia’ healthcare process modelling of the Andalusian Public Health System (SSPA) for the therapeutic approach of early-stage disease. Methods: The Decision Aid design was conducted in four phases: 1) Explore the receptiveness of professionals in the mainstream of the SSPA Decision Aid “Benign Prostatic Hyperplasia” process; 2) Select a Decision Aid from international experiences; 3) Transcultural adaptation of above selected Decision Aid; 4) Decision Aid Validation in the SSPA. Results: The results of the validation of Decision Aid “Alternative treatment for prostate cancer: What option do I prefer?” have shown that the document is well taken by patients, their design is attractive and the quality of clinical information it contains is high. The instrument meets the concerns of patients (95%), the language is simple and suitable (92%) and summarizes the essential information to make the decision (92%). The Decision Aid offers relevant information that help the patient in the decision making process (lack of decisional confl ict: 88.93), generates a sense of support (92.82), concerning the decision (86.88) and a sense of availability of information (90.51). Conclusion: Patients and professionals agree to recommend the use of Decision Aid. To improve information and enhance the tranquillity of the patient, the Decision Aid facilitates communication doctor patient consultation and the involvement of patients during the decision-making process.Objetivo: Diseñar un Instrumento de Ayuda para la Toma de Decisiones (IATD) en el Proceso Asistencial Integrado ‘Hipertrofia benigna de próstata. Cáncer de próstata’ del Sistema Sanitario Público de Andalucía (SSPA) para el abordaje terapéutico de esta enfermedad en estadio inicial. Método: El diseño del IATD se realizó en cuatro fases: 1) Explorar la receptividad de los profesionales del SSPA sobre la incorporación de IATD en el proceso “Cáncer de próstata”. 2. Seleccionar un IATD entre las experiencias internacionales. 3. Adaptar transculturalmente del IATD seleccionado al entorno del SSPA. 4. Validar el IATD en el SSPA. Resultado: Los resultados de la validación del IATD “Alternativas de tratamiento para el cáncer de próstata: ¿Qué opción prefiero?” han mostrado que el documento es bien cogido por los pacientes, su diseño resulta atractivo y la calidad en la información clínica que contiene es elevada. El Instrumento resuelve las dudas de los pacientes (95%), el lenguaje resulta sencillo y asequible (92%) y resume la información esencial para tomar la decisión (92%). El IATD ofrece información relevante que prepara al paciente para la toma de decisiones (ausencia de conflicto decisional: 88,93), genera sentimiento de apoyo (92,82), seguridad en la decisión (86,88) y sensación de disponibilidad de información (90,51). Conclusiones: Pacientes y profesionales coinciden en recomendar la utilización del Instrumento. Al mejorar la información y aumentar la tranquilidad del paciente, el IATD facilita la comunicación médico-paciente en la consulta y la participación en la toma de decisiones

Quality of life impact of primary treatments for localized prostate cancer patients without hormonal treatment

Purpose Earlier studies evaluating the effect on quality of life (QoL) of localized prostate cancer interventions included patients receiving adjuvant hormone therapy, which could have affected their outcomes. Our objective was to compare the QoL impact of the three most common primary treatments on patients who were not receiving adjuvant hormonal treatment. PATIENTS AND METHODS: This was a prospective study of 435 patients treated with radical prostatectomy, external-beam radiotherapy, or brachytherapy. QoL was assessed before and after treatment with the Short Form-36 and the Expanded Prostate Cancer Index Composite. Differences between groups were tested by analysis of variance. Distribution of outcome at 3 years was examined by stratifying according to baseline status. Generalized estimating equation models were constructed to assess the effect of treatment over time. RESULTS: Compared with the brachytherapy group, the prostatectomy group showed greater deterioration on urinary incontinence and sexual scores but better urinary irritative-obstructive results (-18.22, -13.19, and +6.38, respectively, at 3 years; P < .001). In patients with urinary irritative-obstructive symptoms at baseline, improvement was observed in 64% of those treated with nerve-sparing radical prostatectomy. Higher bowel worsening (-2.87, P = .04) was observed in the external radiotherapy group, with 20% of patients reporting bowel symptoms. CONCLUSION: Radical prostatectomy caused urinary incontinence and sexual dysfunction but improved pre-existing urinary irritative-obstructive symptoms. External radiotherapy and brachytherapy caused urinary irritative-obstructive adverse effects and some sexual dysfunction. External radiotherapy also caused bowel adverse effects. Relevant differences between treatment groups persisted for up to 3 years of follow-up, although the difference in sexual adverse effects between brachytherapy and prostatectomy tended to decline over long-term follow-up. These results provide valuable information for clinical decision making

Tumour heterogeneity in glioblastoma assessed by MRI texture analysis: a potential marker of survival

Objective: The main objective of this retrospective work was the study of three-dimensional (3D) heterogeneity measures of post-contrast pre-operative MR images acquired with T1 weighted sequences of patients with glioblastoma (GBM) as predictors of clinical outcome. Methods: 79 patients from 3 hospitals were included in the study. 16 3D textural heterogeneity measures were computed including run-length matrix (RLM) features (regional heterogeneity) and co-occurrence matrix (CM) features (local heterogeneity). The significance of the results was studied using Kaplan?Meier curves and Cox proportional hazards analysis. Correlation between the variables of the study was assessed using the Spearman?s correlation coefficient. Results: Kaplan?Meyer survival analysis showed that 4 of the 11 RLM features and 4 of the 5 CM features considered were robust predictors of survival. The median survival differences in the most significant cases were of over 6 months. Conclusion: Heterogeneity measures computed on the post-contrast pre-operative T1 weighted MR images of patients with GBM are predictors of survival. Advances in knowledge: Texture analysis to assess tumour heterogeneity has been widely studied. However, most works develop a two-dimensional analysis, focusing only on one MRI slice to state tumour heterogeneity. The study of fully 3D heterogeneity textural features as predictors of clinical outcome is more robust and is not dependent on the selected slice of the tumour

Mortality and biochemical recurrence after surgery, brachytherapy, or external radiotherapy for localized prostate cancer: a 10-year follow-up cohort study

To compare the effectiveness at ten years of follow-up of radical prostatectomy, brachytherapy and external radiotherapy, in terms of overall survival, prostate cancer-specific mortality and biochemical recurrence. Cohort of men diagnosed with localized prostate cancer (T1/T2 and low/intermediate risk) from ten Spanish hospitals, followed for 10 years. The treatment selection was decided jointly by patients and physicians. Of 704 participants, 192 were treated with open radical retropubic prostatectomy, 317 with I-125 brachytherapy alone, and 195 with 3D external beam radiation. We evaluated overall survival, prostate cancer-specific mortality, and biochemical recurrence. Kaplan-Meier estimators were plotted, and Cox proportional-hazards regression models were constructed to estimate hazard ratios (HR), adjusted by propensity scores. Of the 704 participants, 542 patients were alive ten years after treatment, and a total of 13 patients have been lost during follow-up. After adjusting by propensity score and Gleason score, brachytherapy and external radiotherapy were not associated with decreased 10-year overall survival (aHR = 1.36, p = 0.292 and aHR = 1.44, p = 0.222), but presented higher biochemical recurrence (aHR = 1.93, p = 0.004 and aHR = 2.56, p < 0.001) than radical prostatectomy at ten years of follow-up. Higher prostate cancer-specific mortality was also observed in external radiotherapy (aHR = 9.37, p = 0.015). Novel long-term results are provided on the effectiveness of brachytherapy to control localized prostate cancer ten years after treatment, compared to radical prostatectomy and external radiotherapy, presenting high overall survival, similarly to radical prostatectomy, but higher risk of biochemical progression. These findings provide valuable information to facilitate shared clinical decision-making. Study identifier at ClinicalTrials.gov: NCT01492751

Design a decision-making aid: "alternative treatment for prostate cancer: what option do you prefer?"

Purpose: To design a Decision-making Aid within the ‘Benign Prostatic Hyperplasia’ healthcare process modelling of the Andalusian Public Health System (SSPA) for the therapeutic approach of early-stage disease. Methods: The Decision Aid design was conducted in four phases: 1) Explore the receptiveness of professionals in the mainstream of the SSPA Decision Aid “Benign Prostatic Hyperplasia” process; 2) Select a Decision Aid from international experiences; 3) Transcultural adaptation of above selected Decision Aid; 4) Decision Aid Validation in the SSPA. Results: The results of the validation of Decision Aid “Alternative treatment for prostate cancer: What option do I prefer?” have shown that the document is well taken by patients, their design is attractive and the quality of clinical information it contains is high. The instrument meets the concerns of patients (95%), the language is simple and suitable (92%) and summarizes the essential information to make the decision (92%). The Decision Aid offers relevant information that help the patient in the decision making process (lack of decisional confl ict: 88.93), generates a sense of support (92.82), concerning the decision (86.88) and a sense of availability of information (90.51). Conclusion: Patients and professionals agree to recommend the use of Decision Aid. To improve information and enhance the tranquillity of the patient, the Decision Aid facilitates communication doctor patient consultation and the involvement of patients during the decision-making process

Uroncor consensus statement: Management of biochemical recurrence after radical radiotherapy for prostate cancer: From biochemical failure to castration resistance

Management of patients who experience biochemical failure after radical radiotherapy with or without hormonal therapy is highly challenging. The clinician must not only choose the type of treatment, but also the timing and optimal sequence of treatment administration. When biochemical failure occurs, numerous treatment scenarios are possible, thus making it more difficult to select the optimal approach. Moreover, rapid and ongoing advances in treatment options require that physicians make decisions that could impact both survival and quality of life.The aim of the present consensus statement, developed by the Urological Tumour Working Group (URONCOR) of the Spanish Society of Radiation Oncology (SEOR), is to provide cancer specialists with the latest, evidence-based information needed to make the best decisions for the patient under all possible treatment scenarios.The structure of this consensus statement follows the typical development of disease progression after biochemical failure, with the most appropriate treatment recommendations given for each stage. The consensus statement is organized into three separate chapters, as follows: biochemical failure with or without local recurrence and/or metastasis; progression after salvage therapy; and treatment of castration-resistant patients