Eric Treat

Survey of Physician Experience, Trends and Outcomes with Atrial Fibrillation Ablation

Objective: We evaluated the prevalence, trends, outcomes and the general experience of physicians performing atrial fibrillation ablation (AF-ABL) in the United States (US).Background: AF-ABL is a non-pharmacological and potentially curative therapy for AF. Success rates for AF-ABL have been reported to be between 80 and 90%. Although there are numerous clinical trial addressing this therapy little is known about the general status of AF-ABL in clinical practice.Methods: We administered a mailed survey to the physician members of a professional arrhythmia society (Heart Rhythm Society, formerly known as the North American Society of Pacing and Electrophysiology) who practiced in the US (n = 1843).Results: There were 304 responses, 66% (n = 204) performed ABL and 30% (n = 92) performed AF-ABL. The study group performed a total of 5,592 AF-ABL from 2000 to 2003, out of 72,575 total ABL procedures during the same time period. There was a four-fold increase in the number of AF-ABL between 2000 and 2003 (2000: 628 vs. 2003: 2,575). In the same period, the self-reported short and long-term success rates of AF-ABL improved an average of 18 ± 4% (p≤ 0.001). In 2003 the average self-reported one-month, one-year, and two-year success rates were: 71 ± 4%, 66 ± 5%, 63 ± 6% respectively. The predicted five-year success was 60 ± 4%. The average procedure took 4.5 ± 0.4 hours. Physicians reported that approximately 29 ± 4% of their patents were potential candidates for AF-ABL.Conclusions: AF-ABL is becoming a much more common procedure in the US. Over the last four years the perceived short and long term success rates of AF-ABL have improved. Success rates in this survey are 10 to 20% lower than those reported in the recent clinical trials.

Telomere DNA content in prostate biopsies predicts early rise in prostate-specific antigen after radical prostatectomy for prostate cancer.

OBJECTIVE To determine whether measurement of telomere DNA content (TC) in prostate biopsy tissue predicts prostate-specific antigen (PSA) recurrence in men after undergoing radical prostatectomy for prostate cancer. METHODS Slot blot titration assay was used to quantitate TC in archived diagnostic prostate needle biopsy specimens for subjects (n = 103) diagnosed with prostate cancer and who subsequently underwent radical prostatectomy between 1993 and 1997. TC was compared to the clinical outcome measure; PSA recurrence, defined as an increase in PSA > or = 0.2 ng/mL on 2 or more consecutive measurements post-prostatectomy, was observed retrospectively, for a mean follow-up period of 114 months (range, 1-165). RESULTS In the cohort, 46 subjects had a PSA recurrence. In a univariate Cox proportional hazards model, low TC (< 0.3 of standard) demonstrated a significant risk for PSA recurrence (HR = 1.94; 95% CI: 1.02-3.69, P = .04). In a subset analysis of men with biopsy Gleason sum < or = 6 (n = 63; 25 recurrences), a univariate Cox proportional hazards model demonstrated that low TC had a greater risk of PSA recurrence (HR = 4.53; 95% CI: 2.00-10.2, P < .01). In a multivariate Cox proportional hazards model, low TC was also significantly associated with PSA recurrence in this subset after controlling for preoperative PSA levels (HR = 6.62; 95% CI: 2.69-16.3, P < .01). CONCLUSIONS Low TC measured in prostate biopsy tissue predicts early likelihood of post-prostatectomy PSA recurrence in a retrospective analysis, and in men with biopsy Gleason sum < or = 6 disease it is also independent of preoperative PSA level.

Organ-wide telomeric status in diseased and disease-free prostatic tissues

Telomere attrition occurs early in the development of prostatic adenocarcinoma. However, little is known about either telomere status in benign prostatic hyperplasia (BPH), or the spatial and organ‐wide distribution of potential telomere aberrations throughout all areas of prostatic glands affected by cancer or BPH.

The SRD5A2 V89L polymorphism is associated with severity of disease in men with early onset prostate cancer

Emerging evidence indicates that testosterone (T), and not dihydrotestosterone (DHT), is the most relevant androgen that promotes carcinogenesis in the prostate. Steroid 5‐alpha reductase type II (SRD5A2) catalyzes the irreversible conversion of T to DHT in male reproductive organs. Because the SRD5A2 gene is highly polymorphic at codon 89, two SRD5A2 isoforms are expressed that differ in Km and Vmax values. The more common and rapid catalytic isoform contains a valine residue at position 89; the slower‐catalytic variant contains leucine at this position.

V4-03 TECHNIQUE AND OUTCOMES OF BLADDER NECK INTUSSUSCEPTION DURING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY: A PARALLEL COMPARATIVE TRIAL

allowing a perfect lymph node dissection (LND), would be of great clinical relevance. Indocyanine Green may be of great value in this scenario, by accurately highlighting the nodes and guiding the LND. OBJECTIVE: We present a video of an Indocyanine Greenguided LND in a high-risk prostate cancer patient. We present the preliminary results from an exploratory study involving 22 consecutive patients undergoing ICG-guided LND. METHODS: The procedure begins with the ultrasound guided transperineal injection of Indocyanine Green (25mg in 5ml of water solution). After few minutes, w e performed a laparoscopic LND guided by the ICG induced fluorescence of lymph channels and nodes. Image 1 SPIES TM with Hopkings 0 optic, H3-LINK and H3-Z FI SPIES Camara is used for the surgery. Nodes are independently coded depending on their anatomical location. The procedure is completed with a extended LND up to the crossing of the ureter and the Iliac vessels, including pre-sacral nodes and later the laparoscopic radical prostatectomy. Preliminary data on sensibility and specificity and initial results from our early experience are detailed at the end of the video. RESULTS: In our initial experience, a mean number of 6 ICGþ nodes were identified, with an average of 22.27 nodes per procedure. Lymph node metastasis were found in 36,4% of patients and metastasis in ICGþ nodes were present in all of them. Hence, no false negatives were found. Thirty-seven out of the 490 nodes studied, 37 were positive, whereas, 27 out of the 142 ICGþ nodes were metastasic. Sensibility, specificity and NPV were 73%, 74.6% and 97.13%, respectively. CONCLUSIONS: ICG-guided pelvic LND is robust, reliable and reproducible. It is inexpensive and relatively quick procedure, allowing a reliable delineation of the lymph vessels and nodes. Furthermore, its high NPV would suggest that an extended LND could potentially be avoided if frozen section of the ICGþ nodes is negative.