David S. Aaronson

Salvage permanent perineal radioactive-seed implantation for treating recurrence of localized prostate adenocarcinoma after external beam radiotherapy

To assess our experience with salvage permanent perineal radioactive‐seed implantation (SPPI) as a possible therapeutic option for recurrent prostate adenocarcinoma, as salvage therapies for recurrences after definitive external beam radiotherapy (EBRT) for localized adenocarcinoma of the prostate are associated with significant morbidity and biochemical failure.

Meta-analysis: does lidocaine gel before flexible cystoscopy provide pain relief?

To consolidate previous reports and conduct a meta‐analysis to draw further conclusions on the efficacy of the instillation of lidocaine gel before flexible cystoscopy, as it has had varying efficacy in several randomized controlled studies.

A novel application of 1H magnetic resonance spectroscopy: non-invasive identification of spermatogenesis in men with non-obstructive azoospermia

BACKGROUND About 10% of infertile men have no sperm in their ejaculate due to poor or absent spermatogenesis, also known as non-obstructive azoospermia (NOA). Testis (1)H magnetic resonance spectroscopy ((1)H-MRS) is a non-invasive imaging tool that can potentially identify and localize spermatogenesis in the testis. This study sought to identify metabolic signatures associated with various histological states of spermatogenesis in infertile men. METHODS Quantitative high resolution magic angle spinning spectroscopy was performed on snap frozen testicular tissue from 27 men with three classic histological patterns: (i) normal spermatogenesis (men with prior paternity undergoing vasectomy reversal), (ii) maturation arrest (early or late, MA) or (iii) Sertoli-cell only (SCO). Concentrations of 19 tissue metabolites were acquired from each biopsy specimen. One-way ANOVA analysis was used to determine inter-group differences in metabolite concentrations among the three histologic groups. RESULTS Phosphocholine (PC) and taurine tissue concentrations were significantly different between normal and SCO tissue. Mean PC concentrations were three times higher in normal testes compared with SCO (5.4 +/- 1.4 versus 1.5 +/- 0.3 mmol/kg; P = 0.01). No differences in metabolite concentrations were observed between normal and MA testes or between SCO and MA testes. Further histologic stratification of MA testes into subsets of those with (early) and without (late) spermatids or mature sperm, identified differences in PC concentrations. A predictive model for sperm presence with (1)H-MRS was developed based upon PC tissue concentrations. CONCLUSIONS PC concentrations are significantly higher in testes with spermatogenesis. This suggests that a unique metabolic signature for spermatogenesis is possible using (1)H-MRS which could aid in the non-invasive diagnosis of sperm in men with NOA.

Transcorporal Artificial Urinary Sphincter Placement for Incontinence in High-risk Patients After Treatment of Prostate Cancer

OBJECTIVES To investigate the transcorporal (TC) vs standard (ST) approach of artificial urinary sphincter (AUS) placement for incontinence after treatment of prostate adenocarcinoma (PCa) with radiotherapy or surgery, or both. METHODS A database was created to include the data from all patients who had undergone AUS placement from January 2000 to August 2005 at the University of California, San Francisco, Medical Center. We noted the demographic features, comorbidities, PCa therapy, technique for AUS placement, and postoperative outcome. The continence and failure rates were recorded for TC AUS placement in patients previously treated for PCa. RESULTS A total of 30 patients underwent aus surgery during the study period: 26 for incontinence after PCa treatment. Of the 26 patients, 18 had undergone ST (ST group) and 8 had undergone TC (TC group) AUS placement, with a minimal follow-up of 12 months and a mean follow-up of 31 and 28 months, respectively. The 2 groups did not differ widely in age or comorbidities. Of the patients in the ST and TC groups, 44% and 50% had undergone external beam radiotherapy or brachytherapy and 78% and 100% had undergone radical prostatectomy, respectively. Of the patients in the ST and TC groups, 22% and 89% had undergone >or=2 types of urethral surgery before AUS placement, respectively. A total of 50% of TC group underwent TC placement without having undergone a previous sling or ST AUS procedure. The AUS removal rates were equivalent between the 2 groups at 2 years. Finally, the success rate for social continence was 69% and 81% for ST and TC group, respectively. CONCLUSIONS The results of our study, with 2 years of follow-up, have shown that TC AUS placement is an effective salvage or primary incontinence treatment for high-risk patients after PCa therapy.

A Large Multiethnic Genome-Wide Association Study of Prostate Cancer Identifies Novel Risk Variants and Substantial Ethnic Differences

UNLABELLED A genome-wide association study (GWAS) of prostate cancer in Kaiser Permanente health plan members (7,783 cases, 38,595 controls; 80.3% non-Hispanic white, 4.9% African-American, 7.0% East Asian, and 7.8% Latino) revealed a new independent risk indel rs4646284 at the previously identified locus 6q25.3 that replicated in PEGASUS (N = 7,539) and the Multiethnic Cohort (N = 4,679) with an overall P = 1.0 × 10(-19) (OR, 1.18). Across the 6q25.3 locus, rs4646284 exhibited the strongest association with expression of SLC22A1 (P = 1.3 × 10(-23)) and SLC22A3 (P = 3.2 × 10(-52)). At the known 19q13.33 locus, rs2659124 (P = 1.3 × 10(-13); OR, 1.18) nominally replicated in PEGASUS. A risk score of 105 known risk SNPs was strongly associated with prostate cancer (P < 1.0 × 10(-8)). Comparing the highest to lowest risk score deciles, the OR was 6.22 for non-Hispanic whites, 5.82 for Latinos, 3.77 for African-Americans, and 3.38 for East Asians. In non-Hispanic whites, the 105 risk SNPs explained approximately 7.6% of disease heritability. The entire GWAS array explained approximately 33.4% of heritability, with a 4.3-fold enrichment within DNaseI hypersensitivity sites (P = 0.004). SIGNIFICANCE Taken together, our findings of independent risk variants, ethnic variation in existing SNP replication, and remaining unexplained heritability have important implications for further clarifying the genetic risk of prostate cancer. Our findings also suggest that there may be much promise in evaluating understudied variation, such as indels and ethnically diverse populations.

Evaluation of Renal Function After Major Renal Injury: Correlation With the American Association for the Surgery of Trauma Injury Scale

PURPOSE In this study we evaluated the effect of major kidney injury on renal function. MATERIALS AND METHODS A retrospective cross-sectional analysis was conducted of all patients who sustained renal trauma between 1977 and 2008 at San Francisco General Hospital, and underwent post-injury dimercapto-succinic acid renal scan (67). Decrease in renal function was defined as the absolute percentage difference between the affected and unaffected kidney on dimercapto-succinic acid scan. Univariate (Spearman rank correlation) and multivariate (linear regression) analyses of the American Association for the Surgery of Trauma renal injury grade, patient age, mechanism of injury (blunt vs penetrating), side of injury, treatment used (nonoperative vs surgery), shock, gender, presence of gross hematuria, serum creatinine on hospital admission, postoperative complications and associated injuries were performed. RESULTS Of the 67 renal injuries 23 (34%) were managed nonoperatively. There were 43 (64%) injuries due to penetrating trauma and 24 (36%) due to blunt injury. Mean decrease in renal function for grade III, IV and V injuries was 15%, 30% and 65%, respectively. Univariate analysis demonstrated a significant association between decrease in renal function and injury grade (rho 0.43, p <0.005). There was no difference in the decrease in kidney function between parenchymal and vascular causes for grade IV and V injuries. Although the right kidney demonstrated a greater decrease in function (rho 0.26, p = 0.033) on univariate analysis, multivariate analysis showed that only American Association for the Surgery of Trauma injury grade correlated with decreased function (correlation coefficient 14.3, 95% CI 4.7-24.8, p <0.005). CONCLUSIONS Decrease in kidney function is directly correlated with American Association for the Surgery of Trauma renal injury grade.

Hydrocele in the Pediatric Patient: Inguinal or Scrotal Approach?

PURPOSE The recommended approach for repairing hydrocele in children is inguinal to address a patent processus vaginalis. Hydrocele repair in adults is performed with a scrotal incision. We identified an age above which a significant percent of children had noncommunicating hydroceles, justifying a scrotal approach. MATERIALS AND METHODS A retrospective chart review was performed of children undergoing hydrocele repair at our institution between 1998 and 2006. Operative reports were reviewed by 2 investigators and intraoperative findings were recorded for statistical analysis relating age and findings at the time of the procedure using logistic regression and ROC analysis. Laterality and recurrence rates were also noted. RESULTS In this retrospective chart review 82.1% of hydroceles in children older than 10 years had intraoperative findings consistent with noncommunicating hydrocele and 86.4% in children older than 12 years were noncommunicating. One hydrocele in the age group older than 12 years was communicating and the history was suggestive of communication. Age was significantly associated with a patent processus vaginalis (OR 0.783, p <0.0001). CONCLUSIONS It is possible in children older than 12 years to repair hydroceles through a scrotal incision unless the clinical history is suggestive of a communication. Children younger than 12 years should undergo inguinal exploration for hydrocele repair.

National incidence and outcomes of postoperative urinary retention in the Surgical Care Improvement Project

BACKGROUND The national incidence of postoperative urinary retention (POUR), its risk factors, and associated outcomes are not well understood. METHODS We identified patients undergoing one of the Surgical Care Improvement Project surgeries using the National Inpatient Sample. By using International Classification of Diseases, 9th revision, Clinical Modification codes (ICD-9-CM), we identified POUR and the outcomes urinary tract infection, noninfectious catheter-related complications, length of stay, and posthospitalization care. Multivariable analysis identified predictors of POUR and its associated outcomes. RESULTS A total of 415,409 patients, representing 2,077,045 nationally, underwent one of the Surgical Care Improvement Project procedures with 43,030 (2.1%) developing POUR. Age, sex, type of surgery, and medical comorbidities were predictive of POUR with a .71 area under the curve. Patients with POUR had greater odds of having urinary tract infections (odds ratio [OR], 2.3; 95% confidence interval [CI], 2.2-2.5), suffering catheter-related complications (OR, 5.2; 95% CI, 3.8-7.0), and needing additional posthospitalization care (OR, 1.3; 95% CI, 1.25-1.4), and they had a greater length of stay (.24 extra days). CONCLUSIONS Patients at risk for POUR can be identified, and they may benefit from interventions to prevent POUR.

National Incidence and Impact of Noninfectious Urethral Catheter Related Complications on the Surgical Care Improvement Project

PURPOSE We defined the incidence and health outcomes related impact of noninfectious urethral catheter related complications for the 7 surgical procedures monitored by the Joint Commission as part of the Surgical Care Improvement Project. MATERIALS AND METHODS We performed a cross-sectional analysis of the 2007 National Inpatient Sample (a 20% stratified sampling of nonfederal United States hospitals) using ICD-9-CM procedure and diagnostic codes to identify the incidence of catheter related complications for coronary artery bypass graft, and noncoronary artery bypass graft cardiac surgery, hysterectomy, colon, hip, knee and major vascular surgery. Univariate and multivariate analysis (with a significance level of less than 0.05) was performed to determine if these complications were associated with length of stay, urinary tract infections and/or deaths. RESULTS A total of 1,420 cases of catheter related complications were identified nationally. The incidence of catheter related complications varied by surgical procedure (average 1 in 528 men and 1 in 5,217 women for all procedures). Univariate analysis revealed that in the presence of catheter related complications, mean length of stay (6 of 7 procedures, range 1.5 to 3.0 days, p <0.05) and urinary tract infection (5 of 7 procedures, absolute range 6.9% to 11.8%, p <0.05) were statistically increased for most procedures. Multivariate analysis demonstrated a significant association between catheter related complications, and increased length of stay (range 1.5 to 3.5 days, p <0.05) and urinary tract infection (OR 2.4-6.8, p <0.05) for 5 and 6 of 7 procedure types, respectively, but not mortality rate (0 of 7 procedures). CONCLUSIONS Catheter related complications are reported rarely, but are associated with increased length of stay and urinary tract infection rates for patients in the Surgical Care Improvement Project.

Treatment Preferences for Active Surveillance versus Active Treatment among Men with Low-Risk Prostate Cancer

Background: Due to the concerns about the overtreatment of low-risk prostate cancer, active surveillance (AS) is now a recommended alternative to the active treatments (AT) of surgery and radiotherapy. However, AS is not widely utilized, partially due to psychological and decision-making factors associated with treatment preferences. Methods: In a longitudinal cohort study, we conducted pretreatment telephone interviews (N = 1,140, 69.3% participation) with newly diagnosed, low-risk prostate cancer patients (PSA ≤ 10, Gleason ≤ 6) from Kaiser Permanente Northern California. We assessed psychological and decision-making variables, and treatment preference [AS, AT, and No Preference (NP)]. Results: Men were 61.5 (SD, 7.3) years old, 24 days (median) after diagnosis, and 81.1% white. Treatment preferences were: 39.3% AS, 30.9% AT, and 29.7% NP. Multinomial logistic regression revealed that men preferring AS (vs. AT) were older (OR, 1.64; CI, 1.07–2.51), more educated (OR, 2.05; CI, 1.12–3.74), had greater prostate cancer knowledge (OR, 1.77; CI, 1.43–2.18) and greater awareness of having low-risk cancer (OR, 3.97; CI, 1.96–8.06), but also were less certain about their treatment preference (OR, 0.57; CI, 0.41–0.8), had greater prostate cancer anxiety (OR, 1.22; CI, 1.003–1.48), and preferred a shared treatment decision (OR, 2.34; CI, 1.37–3.99). Similarly, men preferring NP (vs. AT) were less certain about treatment preference, preferred a shared decision, and had greater knowledge. Conclusions: Although a substantial proportion of men preferred AS, this was associated with anxiety and uncertainty, suggesting that this may be a difficult choice. Impact: Increasing the appropriate use of AS for low-risk prostate cancer will require additional reassurance and information, and reaching men almost immediately after diagnosis while the decision-making is ongoing. Cancer Epidemiol Biomarkers Prev; 25(8); 1240–50. ©2016 AACR.