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Study Type - Outcomes (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Patients with localized prostate cancer face a bewildering number of treatment choices. Modern technology and innovation in treatment techniques have seen patient expectations rise exponentially, leading to an increase in regret of treatment choice. This study has shown that the demonstration of erectile function techniques helps inform decision-making and reduce long-term regret of treatment choice in localized prostate cancer. OBJECTIVE • To determine whether preoperative demonstrations of intracavernosal and vacuum therapies for erectile dysfunction (ED) influence the decision of treatment choice, reducing long-term regret. PATIENTS AND METHODS • In all, 82 consecutive men with localized prostate cancer, scheduled for radical prostatectomy and reporting an International Index of Erectile Function score of >21, were prospectively enrolled at a single cancer centre. • Following standard preoperative counselling, half of the men were invited to attend a further consultation for intracavernosal and vacuum therapy demonstrations. • All patients were evaluated pretreatment and then 3 monthly using the five-point International Index of Erectile Function score and the 14-item Hospital Anxiety and Depression scale. • At 12 months treatment choice changes were recorded and patients were assessed for treatment choice regret using Clark's validated two-item regret questionnaire. Statistical analysis was performed using the Mann-Whitney and Fisher's exact tests. Results were compared with a control population of 41 men who did not undergo additional ED counselling. RESULTS • In all, 8/41 men (19%) changed their treatment choice, opting for brachytherapy rather than radical prostatectomy. • Only 1/41 in the control population changed their decision before surgery. • At 1 year, one patient (2%) in the intervention group expressed regret at his treatment choice (radical prostatectomy) compared with eight (20%) in the control group ( P= 0.03, two-sided Fisher's exact test); ED was identified as the major cause of this regret. CONCLUSION • Preoperative demonstrations of ED therapies can optimize decision making in prostate cancer and help reduce long-term regret. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate how accurate a 12-core transrectal biopsy derived low-risk prostate cancer diagnosis is for an active surveillance programme by comparing the histological outcome with that from confirmatory transperineal sector biopsy. Subjects and methods: The cohort included 166 men diagnosed with low volume Gleason score 3+3 prostate cancer on initial transrectal biopsy who also underwent a confirmatory biopsy. Both biopsy techniques were performed according to standard protocols and samples were taken for histopathology analysis. Subgroup analysis was performed according to disease severity at baseline to determine possible disease parameters of upgrading at confirmatory biopsy. Results: After confirmatory biopsy, 34% demonstrated Gleason score upgrade, out of which 25% were Gleason score 3+4 and 8.5% primary Gleason pattern 4. Results remained consistent for the subgroup analysis and a weak positive association, but not statistically significant, between prostate specific antigen (PSA), age, and percentage of positive cores, and PCa upgrading at confirmatory biopsy was found. Conclusion: In our single centre study, we found that one-third of patients had higher Gleason score at confirmatory biopsy. Furthermore 8.5% of these upgraders had a primary Gleason pattern 4. Our results together with previously published evidence highlight the need for the revision of current guidelines in prostate cancer diagnosis for the selection of men for active surveillance. [ABSTRACT FROM AUTHOR]

Objective To describe a protocol for transperineal sector biopsies ( TPSB) of the prostate and present the clinical experience of this technique in a UK population., Patients and Methods A retrospective review of a single-centre experience of TPSB approach was undertaken that preferentially, but not exclusively, targeted the peripheral zone of the prostate with 24-38 cores using a 'sector plan'. Procedures were carried out under general anaesthetic in most patients., Between January 2007 and August 2011, 634 consecutive patients underwent TPSB for the following indications: prior negative transrectal biopsy ( TRB; 174 men); primary biopsy in men at risk of sepsis (153); further evaluation after low-risk disease diagnosed based on a 12-core TRB (307)., Results Prostate cancer was found in 36% of men after a negative TRB; 17% of these had disease solely in anterior sectors., As a primary diagnostic strategy, prostate cancer was diagnosed in 54% of men (median PSA level was 7.4 ng/mL)., Of men with Gleason 3+3 disease on TRB, 29% were upgraded and went on to have radical treatment., Postoperative urinary retention occurred in 11 (1.7%) men, two secondary to clots. Per-urethral bleeding requiring hospital stay occurred in two men. There were no cases of urosepsis., Conclusions TPSB of the prostate has a role in defining disease previously missed or under-diagnosed by TRB. The procedure has low morbidity. [ABSTRACT FROM AUTHOR]

This study reports the use of intravesical gemcitabine in managing patients with high-risk bladder cancer, refractory to Bacillus Calmette-Guerin (BCG). Patients were given gemcitibine; treatment response was evaluated by fluorescence-cystoscopy, biopsy, and urine cytology. Time to reoccurrence increased with instillation time. [ABSTRACT FROM AUTHOR]

Purpose: Existing research indicates that physical activity (PA) is beneficial to men with prostate cancer (PCa). We examined the potential of a single-contact peer-support-based behavioural intervention to promote PA engagement in men treated for PCa. Methods: A mixed methods design was employed, comprising a two-arm pragmatic trial and semi-structured interviews. The intervention was a 10-min PA-based presentation by a former patient, delivered in group seminars that are provided for patients as standard care. Seminars were alternately allocated to (a) cancer exercise specialist talk + patient speaker talk or (b) cancer exercise specialist talk only. Self-reported PA, exercise motivation, quality of life, fatigue and clinical and demographic characteristics were obtained from n = 148 (intervention: n = 69; control: n = 79) patients immediately prior to the seminar, and at follow-up ≈ 100 days later. Data were analysed using ANCOVA models and χ2 tests. Fourteen semi-structured interviews with intervention participants, which explored how the intervention was experienced, were analysed using a grounded theory-style approach. Results: The intervention had no significant effect on quantitatively self-reported PA (p = 0.4). However, the intervention was statistically and clinically beneficial for fatigue (p = 0.04) and quality of life (p = 0.01). Qualitative analysis showed that the intervention was beneficial to psychological wellbeing and some participants had increased intention to engage in PA as a result of the intervention. Conclusions: A brief one-off PA-based presentation for men with PCa, delivered by a former patient alongside cancer exercise specialist advice, may result in clinically significant benefits to quality of life and may influence PA intention in certain individuals. [ABSTRACT FROM AUTHOR]

We wanted to determine whether serial transperineal sector prostate biopsies have a long-term effect on erectile dysfunction (ED). A total of 64 men with prostate cancer entered our active surveillance (AS) programme after a transrectal prostate biopsy as well as a confirmatory initial transperineal sector prostate biopsy (TPSBx). A repeat TPSBx was performed 24 months later as part of our active surveillance protocol. The International Index of Erectile Function-5 (IIEF-5) questionnaire assessed ED at baseline prior to each TPSBx, and at one, three, and six months after first and second TPSBx. There was a significant short-term deterioration in erectile function on mean IIEF-5 score between baseline (19.5), when compared to one month (10.5) (P <0.001) and three months (18.7) (P = 0.001) following first TPSBx. This resolved at six month follow-up (19.6) (P = 0.681). Following second TPSBx, there was a deterioration in erectile function between baseline (16.6), compared to one month (7.3), three months (13.8), and six months (15.9) (P <0.05) following second TPSBx. Initial TPSBx caused significant short-term ED, which resolved by six months. Serial TPSBx appears to have an adverse impact on erectile function in men monitored on AS, increasing the risk of long-term ED. This risk should be highlighted and discussed during the consent process. [ABSTRACT FROM AUTHOR]

Objective: To describe our technique and determine the feasibility and tolerability of transperineal template prostate (TP) biopsies under local anesthesia (LA). Methods: Fifty consecutive patients underwent TP biopsies under LA for investigation of an elevated prostate-specific antigen level or risk stratification as part of our active surveillance protocol. Tolerability was evaluated with a visual analog scale assessing probe discomfort, LA infiltration, and the biopsy procurement. Patients were also asked if they would have the procedure again, and in those who had undergone previous transrectal biopsies, how the TP technique compared. Pathologic data, clinical outcomes, and complications were recorded at 2 weeks. Results: Mean age was 62.8 years (standard deviation [SD], 6.34 years) and the mean prostate-specific antigen level was 8.49 ng/mL (SD, 6.36 ng/mL). Mean prostate volume was 48.2 mL (SD, 19.4 mL). Mean visual analog scale scores for discomfort caused by the ultrasound probe, LA injections, and biopsies were 3.08 (SD, 1.64), 3.29 (SD, 1.13), and 2.88 (SD, 1.28), respectively. Thirty-four of 50 men (68%) had positive histology, 26 men had Gleason score ≤3 + 4, 5 men had Gleason score ≥4 + 3, and 3 had recurrent adenocarcinoma after radiotherapy. There were 2 complications: 1 Clavien score 1 and 1 Clavien score 3a. Conclusion: LA TP biopsies are well tolerated, acceptable, and feasible when carried out within an outpatient setting. [ABSTRACT FROM AUTHOR]

Abstract: Background and purpose: To assess the agreement between intraoperative and post-operative dosimetry and to identify factors that influence dose calculations of prostate brachytherapy implants. Materials and methods: Patients treated with prostate brachytherapy implants underwent post-operative CT and XMR (combined X-ray and MR) imaging. Dose–volume histograms were calculated from CT, XMR and CT–MR fusion data and compared with intraoperative values for two observers. Multiple linear regression models assessed the influences of intraoperative D90, gland oedema, gland volume, source loss and migration, and implanted activity/volume prostate on post-operative D90. Results: Forty-nine patients were studied. The mean D90 differences (95% confidence limits) between intraoperative and post-operative CT, XMR and CT–MR fusion assessments were: 11Gy (−22, 45), 18Gy (−13, 49) and 20Gy (−17, 58) for Observer 1; and 15Gy (−34, 63), 13Gy (−29, 55) and 14Gy (−27, 54) for Observer 2. Multiple linear regression modelling showed that the observed oedema and intraoperative D90 were significant independent variables for the prediction of post-operative D90 values for both observers using all modalities. Conclusion: This is the first study to report Bland–Altman agreement analysis between intraoperative and post-operative dosimetry. Agreement is poor. Post-operative dosimetry is dependent on the intraoperative D90 and the subjectively outlined gland volume. [Copyright &y& Elsevier]