Localised prostate cancer in elderly men aged 80–89 years, findings from a population‐based registry

Vatandoust, Sina; Kichenadasse, Ganessan; O’Callaghan, Michael; Vincent, Andrew; Kopsaftis, Tina; Walsh, Scott; Borg, Martin; Karapetis, Christos S.; Moretti, Kim

doi:10.1111/bju.14228

Cited by 19 publications

(15 citation statements)

References 27 publications

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“…The importance of learning DRE in contemporary medical practice, which has seen the advent of bowel cancer screening and the use of MRI to detect prostate cancer has been debated. Recent studies have shown, however, that older men who are not PSA screening candidates are being diagnosed with localized prostate cancer and subsequently may die from the disease . DRE is important in detecting these high‐risk individuals in addition to detecting prostate cancer in men with normal PSA levels but an abnormal DRE, which is estimated at 11% in a prostate cancer screening trial .…”

Section: Discussionmentioning

confidence: 99%

Teaching medical students digital rectal examination: a randomized study of simulated model vs rectal examination volunteers

2019

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Section: Discussionmentioning

confidence: 99%

Teaching medical students digital rectal examination: a randomized study of simulated model vs rectal examination volunteers

2019

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“…We continue to use the transrectal approach for some repeat biopsies, for tissue diagnosis in men with suspected metastatic prostate cancer, and for those in whom sedation is preferred to general anaesthesia. Registry data suggest selected octogenarians may benefit from prostate cancer treatment, which also raises the ongoing need to evaluate the safety of TRUS‐guided biopsy . Our cohort represents the first Australian operative cohort to be tested for ESBL prevalence.…”

Section: Discussionmentioning

confidence: 99%

Extended‐spectrum β‐lactamase in the rectal flora of patients undergoing transrectal prostate biopsy: a study of the prevalence in a major metropolitan hospital

et al. 2019

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ObjectivesTo determine the prevalence of extended-spectrum blactamase (ESBL) in patients undergoing transrectal prostate biopsy, to assess the incidence of postoperative sepsis, to correlate the development of sepsis with the presence of preoperative ESBL on rectal swabs, and to assess the adequacy of prophylactic antibiotic guidelines in the context of local ESBL prevalence. MethodsPatients undergoing transrectal ultrasonography (TRUS)guided biopsy at the Royal Melbourne Hospital between January 2012 and July 2016 had rectal swabs taken immediately prior to TRUS with specific cultures to identify the presence of ESBL. Patients were given a prophylactic antibiotic, 500 mg oral ciprofloxacin, 1 h before the TRUS procedure. Data were collected prospectively, with retrospective review of all readmitted patient files and audit data to ensure complete capture of events. ResultsA total of 387 TRUS-guided biopsy procedures were performed. Rectal swabs were correctly collected in 352 patients (91%). The median patient age was 65 years. In all, 25 (7%) ESBL-positive swabs were identified. Most ESBL were Escherichia coli. Half (50%) of ESBL were resistant to ciprofloxacin and all were sensitive to meropenem. A small increase in ESBL prevalence over time was not significant (R 2 = 0.35). Four patients (1.1%) were readmitted with sepsis; ESBL Pseudomonas had previously grown in one patient, but sepsis was attributable to non-ESBL E. coli. In one of the readmitted patients ESBL E. coli was present, but this patient did not have ESBL preoperatively. There were no deaths or high-dependency/intensive care unit admissions. ConclusionsThis study represents the largest Australian series to investigate ESBL prevalence, and reveals a rate lower than that of many other nations. Our sepsis rate is lower than many international series, perhaps because of our low ESBL rate and strict antibiotic prophylaxis. Preoperative swab results did not predict postoperative sepsis, and the process was therefore not useful for guiding antibiotic therapy. In this patient population, TRUS biopsy, with ciprofloxacin prophylaxis, remains a safe option for diagnostic prostate biopsy.

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“…Secondly, a multivariable Cox proportional hazard model was used for analyses of OM and CSM after adjusting race, age, marital status, Gleason Score (GS), and prostate specific antigen (PSA). 13 Thirdly, in consideration of baseline characteristics affecting the option of using different treatment methods, propensity score matching (PSM) (ratio 1:1, with a caliper set of 0.05) was performed to ensure that both the RT group and the RP group had similar baseline characteristics with the use of logistic regression to adjust for between-group differences. 14 The matching was conducted based on nearest-neighbor matching principle.…”

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confidence: 99%

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How to choose proper local treatment in men aged ≥75 years with cT2 localized prostate cancer?

Jin

Qiu

et al. 2019

Cancer Medicine

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Background For localized prostate cancer (PCa), radical prostatectomy (RP) and radiotherapy (RT) are two standard interventions to decrease PCa mortality. Contemporary studies contained the elderly people; analyses focusing on patients over 75 years of age were still lacking. Method In the Surveillance Epidemiology and End Results (SEER) database (2004‐2015), people over 75 years of age with cT2 stage were selected in our research. Multivariable Cox proportional hazard models were used to analyze cancer‐specific mortality (CSM) and overall mortality (OM) after adjustment. The propensity score matching was performed to assume the randomization. An instrument variate (IVA) was used to calculate the unmeasured confounders. Results Radical prostatectomy is superior to RT in OM and CSM after adjustment for covariates (HR = 0.54, 95% CI = 0.47‐0.62, P < 0.001 and HR = 0.30, 95% CI = 0.20‐0.45, P < 0.001, respectively). The cox model after matching indicated similar consequence (OM: HR = 0.53, 95% CI = 0.46‐0.62, P < 0.001; CSM: HR = 0.27, 95% CI = 0.17‐0.43, P < 0.001). In the IVA‐adjusted model, the effect of treatment changed slightly (OM: HR = 0.65, 95% CI = 0.54‐0.78, P < 0.001; CSM: HR = 0.21, 95% CI = 0.12‐0.37, P < 0.001). Subgroup analyses showed that for patients with GS = 7, those received RP obtained the highest risk decline for overall death (HR = 0.41, 95% CI = 0.32‐0.52); and for patients with younger age, those received RP obtained the highest risk decline for CSM (HR = 0.11, 95% CI = 0.01‐0.52). Conclusion Patients over 75 years of age with cT2 stage will obtain more benefit from RP compared with RT, especially for patients with GS = 7 and younger age.

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Localised prostate cancer in elderly men aged 80–89 years, findings from a population‐based registry

Abstract: The proportion of prostate cancer deaths was similar in both groups. These findings support carefully selected individualised management of elderly patients diagnosed with localised prostate cancer.

Cited by 19 publications

References 27 publications

Teaching medical students digital rectal examination: a randomized study of simulated model vs rectal examination volunteers

Teaching medical students digital rectal examination: a randomized study of simulated model vs rectal examination volunteers

Extended‐spectrum β‐lactamase in the rectal flora of patients undergoing transrectal prostate biopsy: a study of the prevalence in a major metropolitan hospital

How to choose proper local treatment in men aged ≥75 years with cT2 localized prostate cancer?

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