The Journal of urology
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The Journal of urology · Mar 2017
Meta AnalysisProperties of the 4-Kallikrein Panel Outside the Diagnostic Gray Zone: Meta-Analysis of Patients with Positive Digital Rectal Examination or Prostate Specific Antigen 10 ng/ml and Above.
The 4-kallikrein panel, commercially available as the 4Kscore™, is a reflex test for prostate cancer early detection that has been extensively validated in multiple international cohorts. It has been suggested that use of such reflex tests be limited to those with prostate specific antigen less than 10 ng/ml and negative digital rectal examination. We aimed to determine the value of the panel in men outside this "diagnostic gray zone." ⋯ The use of the kallikrein panel in men with a positive digital rectal examination or prostate specific antigen 10 to 25 ng/ml is justified.
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The Journal of urology · Feb 2017
Comparative StudyRacial Disparities in Active Surveillance for Prostate Cancer.
Active surveillance protocols track low risk prostate cancer progression over time. However, given the lack of uniform criteria for managing low risk prostate cancer, men who qualify for active surveillance might have less intensive surveillance and, thus, experience poorer outcomes. In this study we examined racial disparities in the frequency and intensity of active surveillance between African-American and Caucasian men. ⋯ Among those not treated for low risk prostate cancer, Caucasian men were placed on active surveillance more frequently than African-American men, who often defaulted to de facto watchful waiting after an initial period of active surveillance. This discrepancy raises questions about the factors favoring watchful waiting over active surveillance. Moreover, given the lack of consensus regarding the most efficient active surveillance strategy, we anticipate that racial disparities in the use of active surveillance will persist, especially in African-American patients.
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The Journal of urology · Feb 2017
Causes, Timing, Hospital Costs and Perioperative Outcomes of Index vs Nonindex Hospital Readmissions after Radical Cystectomy: Implications for Regionalization of Care.
We compared the timing, causes, hospital costs and perioperative outcomes of index vs nonindex hospital readmissions after radical cystectomy. ⋯ This nationally representative study of patients undergoing radical cystectomy demonstrated comparable perioperative outcomes and hospital costs between index and nonindex readmitted patients, which supports the continued regionalization of cystectomy care.
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The Journal of urology · Jan 2017
Multicenter StudyPerioperative Outcomes Following Partial Nephrectomy Performed on Patients Remaining on Antiplatelet Therapy.
We evaluated the risk of bleeding complications in patients undergoing partial nephrectomy in whom perioperative antiplatelet therapy was continued, as antiplatelet therapy is increasingly used and hemorrhage is a significant concern in partial nephrectomy. ⋯ The risk of bleeding complications due to antiplatelet therapy use at partial nephrectomy may be due to clopidogrel. The need to continue perioperative aspirin alone does not appear to be a contraindication to the safe performance of partial nephrectomy.
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The Journal of urology · Dec 2016
Integrating Patient Preference into Treatment Decisions for Men with Prostate Cancer at the Point of Care.
Men with clinically localized prostate cancer face an archetypal "preference sensitive" treatment decision. A shared decision making process incorporating patient values and preferences is paramount. We evaluated the benefit of a novel decision making application, and investigated associations between patient preferences and treatment choice. ⋯ Implementation of this web based intervention was associated with decreased decisional conflict and enhanced elements of shared decision making.