Prasanna Sooriakumaran | University College London Hospital (original) (raw)

Papers by Prasanna Sooriakumaran

Cleveland Clinic Journal of Medicine, 2020

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The Journal of Urology, 2007

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BJU international, Jan 6, 2014

To explore preferences in the management of patients with newly diagnosed high-risk prostate canc... more To explore preferences in the management of patients with newly diagnosed high-risk prostate cancer (PCa) among urologists in Europe through a web-based survey. A web-based survey was conducted between 15 August and 15 September 2013 by members of the Prostate Cancer Working Group of the Young Academic Urologists Working Party of the European Association of Urology (EAU). A specific, 29-item multiple-choice questionnaire covering the whole spectrum of diagnosis, staging and treatment of high-risk PCa was e-mailed to all urologists included in the mailing list of EAU members. Europe was divided into four geographical regions: Central-Eastern Europe (CEE), Northern Europe (NE), Southern Europe (SE) and Western Europe (WE). Descriptive statistics were used. Differences among sample segments were obtained from a z-test compared with the total sample. Of the 12 850 invited EAU members, 585 urologists practising in Europe completed the survey. High-risk PCa was defined as serum PSA ≥20 ng...

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The Journal of Urology, 2014

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The Journal of Urology, 2013

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International Journal of Clinical Practice, 2008

Laparoscopy is blossoming as a technique in urological surgery, especially in nephrectomy where t... more Laparoscopy is blossoming as a technique in urological surgery, especially in nephrectomy where there are seldom indications for an open approach. Laparoscopy is less morbid than open surgery, allows a quicker convalescence and shorter hospital stay, and provides greater cosmesis with smaller incisions. In the case of laparoscopic nephrectomy, retrieval of the specimen either requires extension of one of the incisions, with its resultant increased level of pain and morbidity, or morcellation of the specimen. Thus, overall, patients end up with 3–4 incisions 1–4 cm in length. In an effort to reduce the number of external abdominal scars, natural orifice transluminal endoscopic surgery (NOTES) has been developed. This novel technique utilises natural orifices (mouth, vagina and rectum) as the portal for laparoscopic surgery. NOTES has been used in animal models for transgastric and transvesical peritoneoscopy, transvaginal tubal ligation, transvaginal hysterectomy and transvaginal cholecystectomy (1). The first urological application of NOTES was when Gettman et al. (2) successfully completed six laparoscopic transvaginal nephrectomies in anaesthetised pigs. However, in five operations, one conventional laparoscopic port was needed, and the procedure took significantly longer than conventional laparoscopy. The learning curve for NOTES is also steep, and specialised instrumentation that is not readily available is required. Currently, the existing articulating instruments are not flexible enough to provide a stable surgical platform for this technique to be the frontrunner in laparoscopic surgery at this time. An alternative to NOTES and conventional laparoscopy that may have greater potential for widespread uptake is single incision laparoscopic surgery (SILS). This uses articulating or bent instruments with specialised multi-lumen ports to allow triangulation (3). Hirano et al. (4) showed the feasibility of this approach in performing retroperitoneoscopic adrenalectomy with a single port in 53 patients. If the single port is umbilical, the technique is termed one port umbilical surgery (OPUS). OPUS has the potential advantage of a transperitoneal approach with a single hidden incision within the umbilicus. Raman et al. (5) performed eight single port laparoscopic nephrectomies in porcine models and three in human patients. In all cases OPUS was the technique used. They had no perioperative complications as well as a reasonable mean operating time (49 min for the porcine nephrectomies and 133 min for the human ones) suggesting a short learning curve as compared to NOTES. The reason for this may be the more familiar view of the relevant anatomy with OPUS compared with transvaginal, transgastric or transcolonic approaches. Animal or dry laboratory training may further improve this learning curve for SILS ⁄ OPUS. A final advantage of OPUS over NOTES is that it allows easy conversion to conventional transabdominal laparoscopy should an intra-operative complication or failure to progress occurs. In summary, laparoscopic urology is entering a new dawn. The most exciting new kid on the block is definitely OPUS. With further advances in instrument and platform technology to support such instrument innovations, this may indeed become the future laparoscopic modality of choice.

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European Urology, 2014

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BJU International, 2008

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BJU International, 2009

To assess risk factors and predictors of failure of the Hem-o-lok(TM) vascular clip (Weck Closure... more To assess risk factors and predictors of failure of the Hem-o-lok(TM) vascular clip (Weck Closure Systems, Research Triangle Park, NC, USA) using vessels harvested from a porcine model. Vessels of various diameters were harvested from a porcine model, clipped at 90 degrees or 45 degrees using the Hem-o-lok clip and then cut either flush or with a 1-mm cuff. The vessels were then connected to a burst-pressure device and pressures required to burst the clip or to cause it to leak were measured. The Hem-o-lok clip leaked or burst when the vessel to which it was applied was cut flush. The clip became even more likely to fail if the angle of application of the clip was not at 90 degrees to the vessel surface. The Hem-o-lok vascular clip is safe if it is applied at 90 degrees to the vessel surface and, more importantly, if a 1-mm cuff is left between the clip and the point at which the vessel is divided. We would therefore discourage the practice of not leaving this cuff of tissue, in an attempt to maximize vessel length during laparoscopic donor nephrectomy.

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Annals of The Royal College of Surgeons of England, 2009

INTRODUCTION All cancer patients are discussed in multidisciplinary team meetings (MDTs). Certain... more INTRODUCTION All cancer patients are discussed in multidisciplinary team meetings (MDTs). Certain patients are referred to the Central MDT based on specific national criteria. We wanted to see whether the Central MDT aided in the decision-making process above that of the Local MDT alone. PATIENTS AND METHODS All MDT forms (local and central) for 2007 were retrospectively reviewed. RESULTS A total of 217 patients were reviewed at the Local MDT. Of these 217 cases, 102 (47.0%) cases were referred to the Central MDT and 15 of the 102 (14.7%) cases were awaiting investigations at the time of the Local MDT and were, therefore, excluded. For the prostate cancer cases (n = 67), the Central MDT did not change outright the Local MDT decision in any case, but in 6 of 67 (9.0%), advised/excluded patients from clinical trials. For bladder cancer cases (n = 19), 4 of 19 (21.0%) patients had their management changed by the Central MDT. The one kidney cancer case had its Local MDT decision changed...

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Advances in Urology, 2012

Purpose. Port-site metastasis has been a concern with the common use of laparoscopy in urologic o... more Purpose. Port-site metastasis has been a concern with the common use of laparoscopy in urologic oncology. We conducted this study to provide a review of port-site metastases reported after the laparoscopy in managing urologic malignancies, possible contributing factors and preventative measures.Materials and Methods.An electronic search of MEDLINE using the combined MESH key words “port-site metastasis” and “Urology”.Results. 51 articles addressing port-site metastasis after laparoscopic surgery for urolo¬gical malignancy were identified.Conclusion. Port-site metastasis after laparoscopic surgery for urolo¬gical malignancy is rare. The incidence is comparable to the rate for surgical wound metastases.

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European Journal of Surgical Oncology, 2018

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The World Journal of Men's Health

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Oncologic outcomes after robotic-assisted radical prostatectomy (RARP) are surrogated by biochemi... more Oncologic outcomes after robotic-assisted radical prostatectomy (RARP) are surrogated by biochemical recurrence (BCR), itself influenced to some extent by positive surgical margin (PSM) rates. In this chapter, we will review the oncologic outcomes after RARP, focusing on margin rates which are the outcome most immediately accessible and the one directly under the surgeon’s control. We will report our own multi-institutional series examining PSM and BCR in RARP cohorts. The balancing act all RARP surgeons must perform is to maintain oncologic outcomes while minimizing collateral damage and its consequent impact on urinary continence and erectile function. Lowering PSM rates almost always comes at the expense of increasing collateral damage, and hence it is crucial to interrogate the impact PSM have on well-established oncologic parameters like BCR. Finally, not all PSM are the same and the length and location of any PSM appear to be important, with significant differences between RAR...

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European Urology Focus

The comparative effectiveness of robotic-assisted radical cystectomy (RARC) versus open radical c... more The comparative effectiveness of robotic-assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) in terms of perioperative outcomes is still a matter of debate affecting payors, physicians, and patients. To evaluate comparative perioperative and longer-term morbidity of RARC versus ORC in a multicenter contemporary retrospective cohort of patients. This retrospective multicenter study included patients with bladder cancer treated with radical cystectomy at 10 academic centers between 2000 and 2017. Intraoperative outcomes including blood loss and operative time as well as postoperative outcomes including time to discharge, complication, readmission, reoperation, and mortality rates at 30 and 90 d were assessed. Multiple imputation and inverse probability of treatment weighting (IPTW) were used. IPTW-multivariable-adjusted regression and logistic analyses were performed to evaluate the associations of RARC versus ORC with perioperative outcomes at 30 and 90 d. Overall, 1887 patients (1197 RARC and 690 ORC) were included in the study. After IPTW-adjusted analysis, no differences between the groups in terms of preoperative characteristics were observed. RARC was associated with lower blood loss (p<0.001), shorter length of stay (p<0.001), and longer operative time (p=0.007). On IPTW-adjusted multivariable logistic regression analyses, no differences in terms of 30- and 90-d complications, reoperation, and mortality rates were observed. RARC was independently associated with a higher readmission rate at both 30 and 90 d. Limitations are mainly related to the retrospective nature of the study. While RARC was associated with less blood loss and shorter hospital stay, it also led to longer operation times and more readmissions. There were no differences in 30- and 90-d complications. Because there are no apparent differences in safety between ORC and RARC in expert centers, differences in oncologic and cost-effectiveness outcomes are likely to drive decision making regarding RARC utilization. In this study we investigated the differences between RARC and ORC in terms of perioperative outcomes. We found no difference in early and late complications. We concluded that, to date, differences in oncologic and cost-effectiveness outcomes should drive decision making regarding RARC utilization.

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Urologic Oncology: Seminars and Original Investigations

The use of robotic-assisted radical cystectomy (RARC) is becoming more widespread. While its safe... more The use of robotic-assisted radical cystectomy (RARC) is becoming more widespread. While its safety is accepted, its oncological efficacy as compared to the current standard, open radical cystectomy (ORC), remains debatable. The aim of this study is to compare the rates of positive soft tissue surgical margins (STSM), between patients treated with RARC or ORC, using a large contemporaneous collaborative database. We included 2,536 patients with urothelial carcinoma of the bladder treated at 26 institutions. A propensity-score matching 1:1 was performed with 3 ORC patients matched to 1 RARC patient. The final cohort included 1,614 patients. Uni- and multivariable logistic regression analyses tested the impact of surgical technique on STSM status, before and after propensity-score matching. Overall, 870 (34%) patients underwent RARC and 1,666 (66%) ORC. The overall STSM rate was 11%; 10% in the ORC group and 13% in the RARC group. Within the propensity-score-matched cohort, the positive STSM rate were 14% and 13% in the ORC and RARC group, respectively (P = 0.1). In multivariable analysis, after propensity match RARC approach was not associated with the risk of a positive STSM (P = 0.1). These results were confirmed in the subgroup of patients with pathologic non-organ-confined or organ-confined diseases. While treatment with RARC is associated with a higher absolute rate of STSM, the difference did not remain after adjustment for the effects of other established prognostic factors. Results from ongoing trials are awaited to assess the validity of these findings.

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Health technology assessment (Winchester, England), Sep 1, 2018

Prostate cancer (PCa) is the most common cancer in men in the UK. Patients with intermediate-risk... more Prostate cancer (PCa) is the most common cancer in men in the UK. Patients with intermediate-risk, clinically localised disease are offered radical treatments such as surgery or radiotherapy, which can result in severe side effects. A number of alternative partial ablation (PA) technologies that may reduce treatment burden are available; however the comparative effectiveness of these techniques has never been evaluated in a randomised controlled trial (RCT). To assess the feasibility of a RCT of PA using high-intensity focused ultrasound (HIFU) versus radical prostatectomy (RP) for intermediate-risk PCa and to test and optimise methods of data capture. We carried out a prospective, multicentre, open-label feasibility study to inform the design and conduct of a future RCT, involving a QuinteT Recruitment Intervention (QRI) to understand barriers to participation. Five NHS hospitals in England. Men with unilateral, intermediate-risk, clinically localised PCa. Radical prostatectomy com...

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BJU international, Jan 11, 2018

To describe how clinicians conceptualised equipoise in the PART (Partial prostate Ablation vs Rad... more To describe how clinicians conceptualised equipoise in the PART (Partial prostate Ablation vs Radical prosTatectomy in intermediate-risk unilateral clinically localised prostate cancer) feasibility study and how this affected recruitment. PART included a QuinteT Recruitment Intervention (QRI) to optimise recruitment. Phase I aimed to understand recruitment, and included: scrutinising recruitment data, interviewing the trial management group and recruiters (n = 13), and audio-recording recruitment consultations (n = 64). Data were analysed using qualitative content and thematic analysis methods. In Phase II, strategies to improve recruitment were developed and delivered. Initially many recruiters found it difficult to maintain a position of equipoise and held preconceptions about which treatment was best for particular patients. They did not feel comfortable about approaching all eligible patients, and when the study was discussed, biases were conveyed through the use of terminology,...

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European journal of oncology nursing : the official journal of European Oncology Nursing Society, 2018

This study sought to test the acceptability and feasibility of a nurse-led psycho-educational int... more This study sought to test the acceptability and feasibility of a nurse-led psycho-educational intervention (NLPI) delivered in primary care to prostate cancer survivors, and to provide preliminary estimates of the effectiveness of the intervention. Men who reported an ongoing problem with urinary, bowel, sexual or hormone-related functioning/vitality on a self-completion questionnaire were invited to participate. Participants were randomly assigned to the NLPI plus usual care, or to usual care alone. Recruitment and retention rates were assessed. Prostate-related quality of life, self-efficacy, unmet needs, and psychological morbidity were measured at baseline and 9 months. Health-care resource use data was also collected. An integrated qualitative study assessed experiences of the intervention. 61% eligible men (83/136) participated in the trial, with an 87% (72/83) completion rate. Interviews indicated that the intervention filled an important gap in care following treatment compl...

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European Urology Supplements

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Cleveland Clinic Journal of Medicine, 2020

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The Journal of Urology, 2007

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BJU international, Jan 6, 2014

To explore preferences in the management of patients with newly diagnosed high-risk prostate canc... more To explore preferences in the management of patients with newly diagnosed high-risk prostate cancer (PCa) among urologists in Europe through a web-based survey. A web-based survey was conducted between 15 August and 15 September 2013 by members of the Prostate Cancer Working Group of the Young Academic Urologists Working Party of the European Association of Urology (EAU). A specific, 29-item multiple-choice questionnaire covering the whole spectrum of diagnosis, staging and treatment of high-risk PCa was e-mailed to all urologists included in the mailing list of EAU members. Europe was divided into four geographical regions: Central-Eastern Europe (CEE), Northern Europe (NE), Southern Europe (SE) and Western Europe (WE). Descriptive statistics were used. Differences among sample segments were obtained from a z-test compared with the total sample. Of the 12 850 invited EAU members, 585 urologists practising in Europe completed the survey. High-risk PCa was defined as serum PSA ≥20 ng...

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The Journal of Urology, 2014

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The Journal of Urology, 2013

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International Journal of Clinical Practice, 2008

Laparoscopy is blossoming as a technique in urological surgery, especially in nephrectomy where t... more Laparoscopy is blossoming as a technique in urological surgery, especially in nephrectomy where there are seldom indications for an open approach. Laparoscopy is less morbid than open surgery, allows a quicker convalescence and shorter hospital stay, and provides greater cosmesis with smaller incisions. In the case of laparoscopic nephrectomy, retrieval of the specimen either requires extension of one of the incisions, with its resultant increased level of pain and morbidity, or morcellation of the specimen. Thus, overall, patients end up with 3–4 incisions 1–4 cm in length. In an effort to reduce the number of external abdominal scars, natural orifice transluminal endoscopic surgery (NOTES) has been developed. This novel technique utilises natural orifices (mouth, vagina and rectum) as the portal for laparoscopic surgery. NOTES has been used in animal models for transgastric and transvesical peritoneoscopy, transvaginal tubal ligation, transvaginal hysterectomy and transvaginal cholecystectomy (1). The first urological application of NOTES was when Gettman et al. (2) successfully completed six laparoscopic transvaginal nephrectomies in anaesthetised pigs. However, in five operations, one conventional laparoscopic port was needed, and the procedure took significantly longer than conventional laparoscopy. The learning curve for NOTES is also steep, and specialised instrumentation that is not readily available is required. Currently, the existing articulating instruments are not flexible enough to provide a stable surgical platform for this technique to be the frontrunner in laparoscopic surgery at this time. An alternative to NOTES and conventional laparoscopy that may have greater potential for widespread uptake is single incision laparoscopic surgery (SILS). This uses articulating or bent instruments with specialised multi-lumen ports to allow triangulation (3). Hirano et al. (4) showed the feasibility of this approach in performing retroperitoneoscopic adrenalectomy with a single port in 53 patients. If the single port is umbilical, the technique is termed one port umbilical surgery (OPUS). OPUS has the potential advantage of a transperitoneal approach with a single hidden incision within the umbilicus. Raman et al. (5) performed eight single port laparoscopic nephrectomies in porcine models and three in human patients. In all cases OPUS was the technique used. They had no perioperative complications as well as a reasonable mean operating time (49 min for the porcine nephrectomies and 133 min for the human ones) suggesting a short learning curve as compared to NOTES. The reason for this may be the more familiar view of the relevant anatomy with OPUS compared with transvaginal, transgastric or transcolonic approaches. Animal or dry laboratory training may further improve this learning curve for SILS ⁄ OPUS. A final advantage of OPUS over NOTES is that it allows easy conversion to conventional transabdominal laparoscopy should an intra-operative complication or failure to progress occurs. In summary, laparoscopic urology is entering a new dawn. The most exciting new kid on the block is definitely OPUS. With further advances in instrument and platform technology to support such instrument innovations, this may indeed become the future laparoscopic modality of choice.

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European Urology, 2014

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BJU International, 2008

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BJU International, 2009

To assess risk factors and predictors of failure of the Hem-o-lok(TM) vascular clip (Weck Closure... more To assess risk factors and predictors of failure of the Hem-o-lok(TM) vascular clip (Weck Closure Systems, Research Triangle Park, NC, USA) using vessels harvested from a porcine model. Vessels of various diameters were harvested from a porcine model, clipped at 90 degrees or 45 degrees using the Hem-o-lok clip and then cut either flush or with a 1-mm cuff. The vessels were then connected to a burst-pressure device and pressures required to burst the clip or to cause it to leak were measured. The Hem-o-lok clip leaked or burst when the vessel to which it was applied was cut flush. The clip became even more likely to fail if the angle of application of the clip was not at 90 degrees to the vessel surface. The Hem-o-lok vascular clip is safe if it is applied at 90 degrees to the vessel surface and, more importantly, if a 1-mm cuff is left between the clip and the point at which the vessel is divided. We would therefore discourage the practice of not leaving this cuff of tissue, in an attempt to maximize vessel length during laparoscopic donor nephrectomy.

Bookmarks Related papers MentionsView impact

Annals of The Royal College of Surgeons of England, 2009

INTRODUCTION All cancer patients are discussed in multidisciplinary team meetings (MDTs). Certain... more INTRODUCTION All cancer patients are discussed in multidisciplinary team meetings (MDTs). Certain patients are referred to the Central MDT based on specific national criteria. We wanted to see whether the Central MDT aided in the decision-making process above that of the Local MDT alone. PATIENTS AND METHODS All MDT forms (local and central) for 2007 were retrospectively reviewed. RESULTS A total of 217 patients were reviewed at the Local MDT. Of these 217 cases, 102 (47.0%) cases were referred to the Central MDT and 15 of the 102 (14.7%) cases were awaiting investigations at the time of the Local MDT and were, therefore, excluded. For the prostate cancer cases (n = 67), the Central MDT did not change outright the Local MDT decision in any case, but in 6 of 67 (9.0%), advised/excluded patients from clinical trials. For bladder cancer cases (n = 19), 4 of 19 (21.0%) patients had their management changed by the Central MDT. The one kidney cancer case had its Local MDT decision changed...

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Advances in Urology, 2012

Purpose. Port-site metastasis has been a concern with the common use of laparoscopy in urologic o... more Purpose. Port-site metastasis has been a concern with the common use of laparoscopy in urologic oncology. We conducted this study to provide a review of port-site metastases reported after the laparoscopy in managing urologic malignancies, possible contributing factors and preventative measures.Materials and Methods.An electronic search of MEDLINE using the combined MESH key words “port-site metastasis” and “Urology”.Results. 51 articles addressing port-site metastasis after laparoscopic surgery for urolo¬gical malignancy were identified.Conclusion. Port-site metastasis after laparoscopic surgery for urolo¬gical malignancy is rare. The incidence is comparable to the rate for surgical wound metastases.

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European Journal of Surgical Oncology, 2018

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The World Journal of Men's Health

Bookmarks Related papers MentionsView impact

Oncologic outcomes after robotic-assisted radical prostatectomy (RARP) are surrogated by biochemi... more Oncologic outcomes after robotic-assisted radical prostatectomy (RARP) are surrogated by biochemical recurrence (BCR), itself influenced to some extent by positive surgical margin (PSM) rates. In this chapter, we will review the oncologic outcomes after RARP, focusing on margin rates which are the outcome most immediately accessible and the one directly under the surgeon’s control. We will report our own multi-institutional series examining PSM and BCR in RARP cohorts. The balancing act all RARP surgeons must perform is to maintain oncologic outcomes while minimizing collateral damage and its consequent impact on urinary continence and erectile function. Lowering PSM rates almost always comes at the expense of increasing collateral damage, and hence it is crucial to interrogate the impact PSM have on well-established oncologic parameters like BCR. Finally, not all PSM are the same and the length and location of any PSM appear to be important, with significant differences between RAR...

Bookmarks Related papers MentionsView impact

European Urology Focus

The comparative effectiveness of robotic-assisted radical cystectomy (RARC) versus open radical c... more The comparative effectiveness of robotic-assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) in terms of perioperative outcomes is still a matter of debate affecting payors, physicians, and patients. To evaluate comparative perioperative and longer-term morbidity of RARC versus ORC in a multicenter contemporary retrospective cohort of patients. This retrospective multicenter study included patients with bladder cancer treated with radical cystectomy at 10 academic centers between 2000 and 2017. Intraoperative outcomes including blood loss and operative time as well as postoperative outcomes including time to discharge, complication, readmission, reoperation, and mortality rates at 30 and 90 d were assessed. Multiple imputation and inverse probability of treatment weighting (IPTW) were used. IPTW-multivariable-adjusted regression and logistic analyses were performed to evaluate the associations of RARC versus ORC with perioperative outcomes at 30 and 90 d. Overall, 1887 patients (1197 RARC and 690 ORC) were included in the study. After IPTW-adjusted analysis, no differences between the groups in terms of preoperative characteristics were observed. RARC was associated with lower blood loss (p<0.001), shorter length of stay (p<0.001), and longer operative time (p=0.007). On IPTW-adjusted multivariable logistic regression analyses, no differences in terms of 30- and 90-d complications, reoperation, and mortality rates were observed. RARC was independently associated with a higher readmission rate at both 30 and 90 d. Limitations are mainly related to the retrospective nature of the study. While RARC was associated with less blood loss and shorter hospital stay, it also led to longer operation times and more readmissions. There were no differences in 30- and 90-d complications. Because there are no apparent differences in safety between ORC and RARC in expert centers, differences in oncologic and cost-effectiveness outcomes are likely to drive decision making regarding RARC utilization. In this study we investigated the differences between RARC and ORC in terms of perioperative outcomes. We found no difference in early and late complications. We concluded that, to date, differences in oncologic and cost-effectiveness outcomes should drive decision making regarding RARC utilization.

Bookmarks Related papers MentionsView impact

Urologic Oncology: Seminars and Original Investigations

The use of robotic-assisted radical cystectomy (RARC) is becoming more widespread. While its safe... more The use of robotic-assisted radical cystectomy (RARC) is becoming more widespread. While its safety is accepted, its oncological efficacy as compared to the current standard, open radical cystectomy (ORC), remains debatable. The aim of this study is to compare the rates of positive soft tissue surgical margins (STSM), between patients treated with RARC or ORC, using a large contemporaneous collaborative database. We included 2,536 patients with urothelial carcinoma of the bladder treated at 26 institutions. A propensity-score matching 1:1 was performed with 3 ORC patients matched to 1 RARC patient. The final cohort included 1,614 patients. Uni- and multivariable logistic regression analyses tested the impact of surgical technique on STSM status, before and after propensity-score matching. Overall, 870 (34%) patients underwent RARC and 1,666 (66%) ORC. The overall STSM rate was 11%; 10% in the ORC group and 13% in the RARC group. Within the propensity-score-matched cohort, the positive STSM rate were 14% and 13% in the ORC and RARC group, respectively (P = 0.1). In multivariable analysis, after propensity match RARC approach was not associated with the risk of a positive STSM (P = 0.1). These results were confirmed in the subgroup of patients with pathologic non-organ-confined or organ-confined diseases. While treatment with RARC is associated with a higher absolute rate of STSM, the difference did not remain after adjustment for the effects of other established prognostic factors. Results from ongoing trials are awaited to assess the validity of these findings.

Bookmarks Related papers MentionsView impact

Health technology assessment (Winchester, England), Sep 1, 2018

Prostate cancer (PCa) is the most common cancer in men in the UK. Patients with intermediate-risk... more Prostate cancer (PCa) is the most common cancer in men in the UK. Patients with intermediate-risk, clinically localised disease are offered radical treatments such as surgery or radiotherapy, which can result in severe side effects. A number of alternative partial ablation (PA) technologies that may reduce treatment burden are available; however the comparative effectiveness of these techniques has never been evaluated in a randomised controlled trial (RCT). To assess the feasibility of a RCT of PA using high-intensity focused ultrasound (HIFU) versus radical prostatectomy (RP) for intermediate-risk PCa and to test and optimise methods of data capture. We carried out a prospective, multicentre, open-label feasibility study to inform the design and conduct of a future RCT, involving a QuinteT Recruitment Intervention (QRI) to understand barriers to participation. Five NHS hospitals in England. Men with unilateral, intermediate-risk, clinically localised PCa. Radical prostatectomy com...

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BJU international, Jan 11, 2018

To describe how clinicians conceptualised equipoise in the PART (Partial prostate Ablation vs Rad... more To describe how clinicians conceptualised equipoise in the PART (Partial prostate Ablation vs Radical prosTatectomy in intermediate-risk unilateral clinically localised prostate cancer) feasibility study and how this affected recruitment. PART included a QuinteT Recruitment Intervention (QRI) to optimise recruitment. Phase I aimed to understand recruitment, and included: scrutinising recruitment data, interviewing the trial management group and recruiters (n = 13), and audio-recording recruitment consultations (n = 64). Data were analysed using qualitative content and thematic analysis methods. In Phase II, strategies to improve recruitment were developed and delivered. Initially many recruiters found it difficult to maintain a position of equipoise and held preconceptions about which treatment was best for particular patients. They did not feel comfortable about approaching all eligible patients, and when the study was discussed, biases were conveyed through the use of terminology,...

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European journal of oncology nursing : the official journal of European Oncology Nursing Society, 2018

This study sought to test the acceptability and feasibility of a nurse-led psycho-educational int... more This study sought to test the acceptability and feasibility of a nurse-led psycho-educational intervention (NLPI) delivered in primary care to prostate cancer survivors, and to provide preliminary estimates of the effectiveness of the intervention. Men who reported an ongoing problem with urinary, bowel, sexual or hormone-related functioning/vitality on a self-completion questionnaire were invited to participate. Participants were randomly assigned to the NLPI plus usual care, or to usual care alone. Recruitment and retention rates were assessed. Prostate-related quality of life, self-efficacy, unmet needs, and psychological morbidity were measured at baseline and 9 months. Health-care resource use data was also collected. An integrated qualitative study assessed experiences of the intervention. 61% eligible men (83/136) participated in the trial, with an 87% (72/83) completion rate. Interviews indicated that the intervention filled an important gap in care following treatment compl...

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European Urology Supplements

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