BJU international
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Multicenter Study
Association of age and response to androgen-deprivation therapy with or without radiotherapy for prostate cancer: data from CaPSURE.
To assess whether the response to primary androgen-deprivation therapy (PADT) and radiotherapy (RT) plus adjuvant ADT would be muted in older men, as their tumours might already be relatively androgen insensitive, because serum testosterone levels decline with increasing age. ⋯ If we assume that age is a valid proxy measure for free available testosterone levels, then these levels do not seem to affect the likelihood of response to ADT, either used alone or combined with RT.
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Multicenter Study Comparative Study
Prostate cancer survivors who would be eligible for active surveillance but were either treated with radiotherapy or managed expectantly: comparisons on long-term quality of life and symptom burden.
To assess and identify factors associated with the long-term health-related quality of life (HRQL) of prostate cancer survivors managed expectantly, as patients with low-risk prostate cancer can be managed with active surveillance (AS), but research on associated long-term HRQL is scarce. ⋯ Patients managed expectantly at initial diagnosis (AS) have comparable HRQL and a lower symptom burden than patients treated with RT up to 10 years after the diagnosis.
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To determine if the testosterone level achieved with androgen-deprivation therapy (ADT) is directly related to survival and risk of death in men with metastatic prostate cancer, as agonistic analogues of luteinizing hormone-releasing hormones (LHRH) are indicated for palliative treatment of these patients, but there is no consensus about the utility of serum testosterone measurements during the follow-up, and their possible prognostic value. ⋯ These results suggest a direct correlation between the risk of death and testosterone levels achieved during ADT. Based on the present results, lowering the testosterone level as much as possible should be the goal of ADT in patients with metastatic prostate cancer, as this might affect patient survival.
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Health Economic (multiway sensitivity analyses). ⋯ Prostate cancer is associated with increased direct healthcare costs over the natural history of the disease. Costs are highest around two events, cancer diagnosis and cancer death. Future research should evaluate costs borne by private insurers and patients, evaluate the effects of patient and system variables on lifetime costs, and explore differences in end-of-life healthcare costs across countries.
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To report 4-year health-related quality of life (HRQL) outcome data after retropubic mid-urethral synthetic sling (MUS) surgery without concomitant prolapse repair for treating female stress urinary incontinence (SUI) in a single institution. ⋯ In our institution, HRQL improvement at 3 months after retropubic MUS surgery predicts persistence of improvement at 4 years. This is useful clinically in counselling our patients for treatment efficacy. Tension-free placement is associated with minimal risk of postoperative retention or de novo overactive bladder. Although patient numbers are modest, these data contribute to the scarce longer term (> or =4 years) HRQL data on the MUS, which is a safe and durable procedure with a minimal complication profile.