Howard H. Kim

HEALTH RELATED QUALITY OF LIFE DIFFERENCES BETWEEN BLACK AND WHITE MEN WITH PROSTATE CANCER: DATA FROM THE CANCER OF THE PROSTATE STRATEGIC UROLOGIC RESEARCH ENDEAVOR

PURPOSE Understanding the potential consequences of racial differences in prostate cancer outcomes, from survival rates to quality of life considerations, is important for the clinician and patient. We examined demographic, clinical and health related quality of life data comparing black with white patients just after treatment of prostate cancer and 1 year later. MATERIALS AND METHODS We analyzed data on 1,178 patients who were newly diagnosed with prostate cancer in the Cancer of the Prostate Strategic Urologic Research Endeavor, a national observational database of men recruited from 35 community and academic urology practices throughout the United States. Patient demographics, clinical characteristics and validated health related quality of life questionnaires were reviewed. A total of 958 white and 161 black patients with prostate cancer who completed at least 2 surveys were compared. RESULTS The black patients were younger, and had lower income and education levels than white patients. Controlling for age, education and income differences, black patients generally had worse clinical characteristics at presentation and lower baseline health related quality of life data scores in most generic and disease specific categories at treatment. The most notable exception was sexual function, which was the only score that was higher in black patients at treatment. With time, health related quality of life improved in both groups but black patients had slower rates of improvement for general health, bodily pain, physical function, role function, disease worry and bowel function. They continued to have higher sexual function. CONCLUSIONS Significant differences exist in clinical presentation, sociodemographic characteristics, and health related quality of life between black and white men with prostate cancer. These health related quality of life differences remain after treatment. Physicians should not assume that outcomes in black men would be similar to other patients.

The Shang Ring device for adult male circumcision: a proof of concept study in Kenya.

Objective:To assess safety, preliminary efficacy, and acceptability of the Shang Ring, a novel disposable device for adult male circumcision in Kenya. Methods:Forty HIV-negative men were recruited in Homa Bay, Kenya. Circumcisions were performed by a trained physician or nurse working with 1 assistant. Follow-up was conducted at 2, 7, 9, 14, 21, 28, 35, and 42 days after circumcision. Rings were removed on day 7. Pain was assessed using a visual analog scale (VAS) (0 = no pain, 10 = worst possible). Men were interviewed at enrollment and on days 7 and 42. Results:All 40 procedures were completed successfully. Mean procedure and device removal times were 4.8 (SD ± 2.0) and 3.9 (SD ± 2.6) minutes, respectively. There were 6 mild adverse events, including 3 penile skin injuries, 2 cases of edema, and 1 infection; all resolved with conservative management. In addition, there were 3 partial ring detachments between days 2-7. None required treatment or early ring removal. Erections with the ring were well tolerated, with a mean pain score of 3.5 (SD ± 2.3). By day 2, 80% of men were back to work. At 42 days, all participants were very satisfied with their circumcision and would recommend the procedure to others. Conclusions:Our results demonstrate that the Shang Ring is safe for further study in Africa. Acceptability of the Shang Ring among participants was excellent. With short procedure times, less surgical skill required, and the ease with which it can be used by nonphysicians, the Shang Ring could facilitate rapid roll-out of male circumcision in sub-Saharan Africa.

High complication rates challenge the implementation of male circumcision for HIV prevention in Africa

This commentary discusses the study by Bailey and colleagues, who aimed to assess the safety of male circumcision practices in both clinical and traditional settings in Bungoma, Kenya. The study evaluated 1,007 males who underwent circumcision in a clinical (n = 562) and traditional (n = 445) setting. All young men who underwent circumcision were interviewed after surgery to assess their satisfaction and complication rates, and a sample of the practitioners who performed the circumcisions were interviewed to determine their circumcision training and experience. Additionally, 24 circumcision procedures (12 each in the clinical and traditional settings) were directly observed by the study investigators. The study found complications rates of 17.7% and 35.2% in the clinical and traditional groups, respectively. Furthermore, the study revealed shortcomings in practitioner knowledge, training and resources in both groups. Before scaling up male circumcision services in countries with a high prevalence of HIV, a careful strategy to minimize unnecessary morbidity, and fundamental improvements on current circumcision techniques, are required.

Male circumcision: Africa and beyond?

Purpose of review Male circumcision has become an important component of HIV prevention strategies in Africa. Results of recent trials have renewed interest in this ancient procedure and its potential application in the reduction of sexually transmitted infections (STIs). With renewed interest comes controversy, which has always been a close companion to circumcision. Recent findings Following the three randomized trials in Africa demonstrating the protective effects of male circumcision on HIV infection, studies have reported other benefits of circumcision including protection from certain STIs, including human papillomavirus and herpes simplex virus 2. With data accumulating on the public health benefits of circumcision and the endorsement of circumcision from WHO, investigators have begun to evaluate the feasibility, safety and cost of implementation of large-scale circumcision programs. Limitations of circumcision have also been explored. Summary Male circumcision will likely play an important role in HIV/STI prevention programs in Africa; the inclusion of circumcision in the health policy of developed countries will require further investigation.