RESUMO
BACKGROUND: We tested for associations between socioeconomic status (SES) and adverse prostate cancer pathology in a population of African American (AA) men treated with radical prostatectomy (RP). PATIENTS AND METHODS: We retrospectively reviewed data from 2 institutions for AA men who underwent RP between 2010 and 2015. Household incomes were estimated using census tract data, and patients were stratified into income groups relative to the study population median. Pathologic outcomes after RP were assessed, including the postsurgical Cancer of the Prostate Risk Assessment (CAPRA-S) score and a definition of adverse pathology (stage ≥ pT3, Gleason score ≥ 4+3, or positive lymph nodes), and compared between income groups. RESULTS: We analyzed data of 347 AA men. Median household income was $37,954. Low-SES men had significantly higher prostate-specific antigen values (mean 10.2 vs. 7.3; P < .01) and CAPRA-S scores (mean 3.4 vs. 2.5; P < .01), more advanced pathologic stage (T3-T4 31.8% vs. 21.5%; P = .03), and higher rates of seminal vesicle invasion (17.3% vs. 8.2%; P < .01), positive surgical margins (35.3% vs. 22.1%; P < .01), and adverse pathology (41.4% vs. 30.1%; P = .03). Linear and logistic regression showed significant inverse associations of SES with CAPRA-S score (P < .01) and adverse pathology (P = .03). CONCLUSION: In a population of AA men who underwent RP, we observed an independent association of low SES with advanced stage or aggressive prostate cancer. By including only patients in a single racial demographic group, we eliminated the potential confounding effect of race on the association between SES and prostate cancer risk. These findings suggest that impoverished populations might benefit from more intensive screening and early, aggressive treatment of prostatic malignancies.
Assuntos
Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Negro ou Afro-Americano/estatística & dados numéricos , Idoso , Humanos , Modelos Logísticos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Antígeno Prostático Específico/metabolismo , Neoplasias da Próstata/etnologia , Neoplasias da Próstata/metabolismo , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Medição de Risco , Classe Social , Análise de Sobrevida , População Branca/estatística & dados numéricosRESUMO
PURPOSE: To study the effectiveness of the Patient Preferences for Prostate Cancer Care (PreProCare) intervention in improving the primary outcome of satisfaction with care and secondary outcomes of satisfaction with decision, decision regret, and treatment choice among patients with localized prostate cancer. METHODS: In this multicenter randomized controlled study, we randomly assigned patients with localized prostate cancer to the PreProCare intervention or usual care. Outcomes were satisfaction with care, satisfaction with decision, decision regret, and treatment choice. Assessments were performed at baseline and at 3, 6, 12, and 24 months, and were analyzed using repeated measures. We compared treatment choice across intervention groups by prostate cancer risk categories. RESULTS: Between January 2014 and March 2015, 743 patients with localized prostate cancer were recruited and randomly assigned to receive PreProCare (n = 372) or usual care (n = 371). For the general satisfaction subscale, improvement at 24 months from baseline was significantly different between groups (P < .001). For the intervention group, mean scores at 24 months improved by 0.44 (SE, 0.06; P < .001) from baseline. This improvement was 0.5 standard deviation, which was clinically significant. The proportion reporting satisfaction with decision and no regret increased over time and was higher for the intervention group, compared with the usual care group at 24 months (P < .05). Among low-risk patients, a higher proportion of the intervention group was receiving active surveillance, compared with the usual care group (P < .001). CONCLUSION: Our patient-centered PreProCare intervention improved satisfaction with care, satisfaction with decision, reduced regrets, and aligned treatment choice with risk category. The majority of our participants had a high income, with implications for generalizability. Additional studies can evaluate the effectiveness of PreProCare as a mechanism for improving clinical and patient-reported outcomes in different settings.
Assuntos
Técnicas de Apoio para a Decisão , Preferência do Paciente , Assistência Centrada no Paciente/métodos , Neoplasias da Próstata/psicologia , Neoplasias da Próstata/terapia , Tomada de Decisões , Humanos , Masculino , Pessoa de Meia-Idade , Participação do Paciente , Satisfação do Paciente , Neoplasias da Próstata/patologia , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: To evaluate the effect of valveless trocar system (VTS) on intra-operative parameters, peri-operative outcomes, and 30-day postoperative complications in patients undergoing robotic-assisted laparoscopic prostatectomy. METHODS: A total of 200 consecutive patients undergoing Robot-assisted radical prostatectomy by a single surgeon were prospectively evaluated using either the valveless trocar (n = 100) or standard trocars (n = 100). Patient demographics, intra-operative parameters, length of stay, presence or absence of postoperative nausea and vomiting, analog pain score at 0-6 hours, 6-12 hours, 12-18 hours, and >24 hours, and 30-day postoperative complications were analyzed. RESULTS: There were no significant differences in estimated blood loss, intra-operative urine output, length of stay, or 30-day complication rates between the two groups. While the VTS group had higher Body Mass Index (BMI) (28.45 vs. 27.23; P = 0.049), the operative time was significantly shorter in the VTS group (146 minutes vs. 167 minutes; P < .005). The VTS group experienced fewer episodes of nausea (2% vs. 10%; P = 0.0172). The VTS group had less pain intensity compared to the control in the first 18 hours: 0-6 hours (1.9 vs. 2.5; P = 0.034), 6-12 hours (2.8 vs. 3.6; P = 0.044), and 12-18 hours (2.2 vs. 3.1; P = 0.049), respectively. CONCLUSION: The use of a valveless trocar system during robot-assisted robotic prostatectomy may shorten operative times, and reduce postoperative pain scores and nausea episodes without increasing the 30-day complication rate. Further prospective randomized trials should be performed to validate these findings.
Assuntos
Laparoscopia/instrumentação , Prostatectomia , Procedimentos Cirúrgicos Robóticos , Desenho de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/epidemiologia , Náusea e Vômito Pós-Operatórios/epidemiologia , Estudos Prospectivos , Neoplasias da Próstata/cirurgia , Escala Visual AnalógicaRESUMO
OBJECTIVE: To understand trends in pediatric cases performed during urology residency including intraresident variability and cases performed relative to required minimums. MATERIALS AND METHODS: Case logs of urology residents graduating from 2010 to 2018 were analyzed. Temporal trends in reported pediatric case volume were assessed via ANOVA tests and calculation of compound annual growth rates (CAGRs). Percent differences between the 90th and 10th percentiles of residents were calculated to assess intraresident variability. Reported case volumes were compared with minimum requirements with t tests. RESULTS: 1072 residents from 306 urology residency programs were represented in this study. Minor pediatriccases increased from 2010 to 2018 (105.4 ± 54vs 124.6 ± 65, Pâ¯=â¯.004, CAGRâ¯=â¯2.1%) while major pediatric cases decreased (83.9 ± 40vs 60.8 ± 30, P < .001, CAGRâ¯=â¯-3.9%). Orchiopexy (range, 23%-27%), hypospadias (range, 19%-21%), and hydrocele / hernia (range, 15%-19%) were the highest volume case categories. Mean intraresident variability in reported case volumeswas 338% for minor pediatric (CAGRâ¯=â¯0%) and 382% for major pediatric (CAGRâ¯=â¯1.8%). Mean reported case volumes exceeded the minimum requirement for each case category by several fold (P < .001, range, percent difference 232-675%). All urology residents reported minimum pediatric case requirements in 2018. CONCLUSION: Urology residents report more cases than minimum requirements for pediatric urology by several folds. Future research is needed to understand the implications of increasing intraresident case volume variabilities on residency training in pediatric urology.
Assuntos
Competência Clínica , Internato e Residência/tendências , Pediatria , Procedimentos Cirúrgicos Urológicos/educação , Carga de Trabalho/estatística & dados numéricos , Acreditação , Adulto , Análise de Variância , Estudos de Coortes , Educação de Pós-Graduação em Medicina/métodos , Educação de Pós-Graduação em Medicina/tendências , Feminino , Humanos , Masculino , Estudos Retrospectivos , Estados Unidos , Urologia/educaçãoRESUMO
OBJECTIVE: To elucidate the current portfolio of National Institutes of Health (NIH) funding to departments of urology at U.S. medical schools. MATERIALS AND METHODS: The NIH Research Portfolio Online Reporting Tools Expenditures and Results was used to generate a comprehensive analysis of NIH research grants awarded to urology departments during 2014. Costs, mechanisms, and institutes were summarized with descriptive statistics. Demographic data were obtained for principal investigators and project abstracts were categorized by research type and area. Fiscal totals were calculated for 2005-2014 and compared with other surgical departments during 2014. RESULTS: One hundred one investigators at 36 urology departments received $55,564,952 in NIH funding during 2014. NIH-funded investigators were predominately male (79%) and PhD scientists (52%). Funding totals did not vary by terminal degree or sex, but increased with higher academic rank (P < .001). The National Cancer Institute (54.7%) and National Institute of Diabetes and Digestive and Kidney Diseases (32.2%) supported the majority of NIH-funded urologic research. The R01 grant accounted for 41.0% of all costs. The top 3 NIH-funded clinical areas were urologic oncology (62.1%), urinary tract infection (8.8%), and neurourology (7.6%). A minority of costs supported clinical research (12.9%). In 2014, urology had the least number of NIH grants relative to general surgery, ophthalmology, obstetrics & gynecology, otolaryngology, and orthopedic surgery. CONCLUSION: NIH funding to urology departments lags behind awards to departments of other surgical disciplines. Future interventions may be warranted to increase NIH grant procurement in urology.