Purpose: We sought to identify and validate known predictors of disease reclassification at 1 or 4 years to support risk-based selection of patients suitable for active surveillance.Materials and... Show morePurpose: We sought to identify and validate known predictors of disease reclassification at 1 or 4 years to support risk-based selection of patients suitable for active surveillance.Materials and Methods: An individual participant data meta-analysis using data from 25 established cohorts within the Movember Foundations GAP3 Consortium. In total 5,530 men were included. Disease reclassification was defined as any increase in Gleason grade group at biopsy at 1 and 4 years. Associations were estimated using random effect logistic regression models. The discriminative ability of combinations of predictors was assessed in an internaleexternal validation procedure using the AUC curve.Results: Among the 5,570 men evaluated at 1 year, we found 815 reclassifications to higher Gleason grade group at biopsy (pooled reclassification rate 13%, range 0% to 31%). Important predictors were age, prostate specific antigen, prostate volume, T-stage and number of biopsy cores with prostate cancer. Among the 1,515 men evaluated at 4 years, we found 205 reclassifications (pooled reclassification rates 14%, range 3% to 40%), with similar predictors. The average areas under the receiver operating characteristic curve at internaleexternal validation were 0.68 and 0.61 for 1-year and 4-year reclassification, respectively.Conclusions: Disease reclassification occurs typically in 13% to 14% of biopsies at 1 and 4 years after the start of active surveillance with substantial between-study heterogeneity. Current guidelines might be extended by considering prostate volume to improve individualized selection for active surveillance. Additional predictors are needed to improve patient selection for active surveillance. Show less
Stalenhoef, J.E.; Nieuwkoop, C. van; Menken, P.H.; Bernards, S.T.; Elzevier, H.W.; Dissel, J.T. van 2019
Purpose: Despite intravesical therapy with immunotherapy or chemotherapy intermediate and high risk nonmuscle invasive bladder cancer is associated with a high risk of recurrence and progression to... Show morePurpose: Despite intravesical therapy with immunotherapy or chemotherapy intermediate and high risk nonmuscle invasive bladder cancer is associated with a high risk of recurrence and progression to muscle invasive bladder carcinoma. While intravesical hyperthermia combined with mitomycin C has proved effective to treat nonmuscle invasive bladder cancer, there is less experience with invasive regional 70 MHz hyperthermia and mitomycin C. Therefore, we examined the safety and feasibility of this treatment combination for intermediate and high risk nonmuscle invasive bladder cancer.Materials and Methods: Between 2009 and 2011, 20 patients with intermediate and high risk nonmuscle invasive bladder cancer were treated with intravesical mitomycin C (40 mg) combined with regional hyperthermia. Treatment consisted of 6 weekly sessions followed by a maintenance period of 1 year with 1 hyperthermia-mitomycin C session every 3 months. Regional hyperthermia was administered using a 70 MHz phased array system with 4 antennas. Toxicity was scored using CTC (Common Toxicity Criteria) 3.0.Results: The records of 18 of 20 patients could be analyzed. Median followup was 46 months. Of the 18 patients 15 (83%) completed the induction period of 6 treatments. Four patients (22%) discontinued treatment because of physical complaints without exceeding grade 2 toxicity. Toxicity scored according to CTC 3.0 was limited to grade 1 in 43% of cases and grade 2 in 14%. Mean T90 and T50 bladder temperatures were 40.6C and 41.6C, respectively. The 24-month recurrence-free survival rate was 78%.Conclusions: Treatment with regional hyperthermia combined with mitomycin C in patients with intermediate and high risk nonmuscle invasive bladder cancer is feasible with low toxicity and excellent bladder temperatures. Show less
Brouwer, O.R.; Berg, N.S. van den; Matheron, H.M.; Wendler, T.; Poel, H.G. van der; Horenblas, S.; ... ; Leeuwen, F.W.B. van 2014
Purpose: In a prospective 2-center study we confirmed and extended published results of the positive effect on post-prostatectomy stress incontinence of transobturator sling suspension using an... Show morePurpose: In a prospective 2-center study we confirmed and extended published results of the positive effect on post-prostatectomy stress incontinence of transobturator sling suspension using an Advance (TM) male sling. Materials and Methods: From September 2007 to June 2008 a male sling was placed and evaluated in 36 men according to the Rehder and Gozzi method. Diagnosis was based on 24-hour urine loss measured by a pad test, a 24-hour micturition frequency volume chart and cystoscopy. A visual analog scale for continence and bother, and a pad test were used preoperatively and postoperatively to objectively evaluate operative results. Results: At 1-year followup cure was achieved in 9.0% of patients and improvement was achieved in 45.5%. No effect on incontinence was seen in 36.5% of patients and 9.0% experienced worsening incontinence by pad test. The mean SD visual analogue scale score of 6.1 +/- 2.2 (range 0 to 10) preoperatively improved significantly to 4.6 +/- 3.0 at 3 months (p = 0.024) and not significantly to 4.9 +/- 3.1 by 1 year postoperatively (p = 0.39). Improved incontinence did not correlate with patient age or incontinence severity. Complications developed in 2 patients, including sling infection and postoperative urinary retention in 1 each. Conclusions: The transobturator sling suspension operation is a minimally invasive, safe procedure for male postoperative stress incontinence. Significantly improved continence was not observed on pad test but significant improvement in continence and bother was seen on the visual analog scale at 3 months. Show less
Purpose: We determined whether chronic testicular pain is related to pelvic floor overactivity after ruling out other disease pathology. Materials and Methods: A total of 41 patients with chronic... Show morePurpose: We determined whether chronic testicular pain is related to pelvic floor overactivity after ruling out other disease pathology. Materials and Methods: A total of 41 patients with chronic testicular pain evaluated at our Pelvic Floor Department at a tertiary academic center were included in this retrospective study. All patients underwent standard pelvic floor investigation, including history using a standardized questionnaire and electromyography registration of the pelvic floor. In the questionnaire patients were asked about complaints in 3 domains (micturition, defecation and sexual function) suggestive of pelvic floor dysfunction. Electromyography registration of the pelvic floor was performed. The resting tone of the pelvic floor was considered increased at 3 mu V or greater. Results: Mean patient age was 48 years. Of the patients 93% had at least 1 symptom suspicious of pelvic floor dysfunction. A total of 22% had complaints in 1 of the domains of micturition, defecation or sexual function, 24% had complaints in 2 domains and 49% had complaints in all 3 domains. On electromyography registration of the pelvic floor 88% of patients appeared to have an increased resting tone of the pelvic floor muscles at a mean of 6.7 AV (normal less than 3). The patients with a normal pelvic floor resting tone were significantly older than those with an increased resting tone (65.6 vs 45.6, p = 0.0001). Conclusions: Chronic testicular pain can be a symptom of pelvic floor overactivity, especially in younger patients. A diagnostic evaluation should be performed when no pathophysiology can be found. Show less
