CUA 2018: Postoperative Ileus and Complications Outcomes in the Enhanced Recovery Protocol after Radical Cystectomy for Bladder Cancer
Halifax, Nova Scotia (UroToday.com) Radical cystectomy (RC) is a complex procedure associated with high morbidity rates of approximately 50% of cases.1,2 Enhanced Recovery After Surgery (ERAS) programs were developed to standardize and decrease length of stay (LOS), postoperative ileus (POI), pain, and readmissions in colorectal surgery.3-5 ERAS protocols have been adapted to radical cystectomy6. ERAS protocols allow fluid and carbohydrate loading up to two hours preoperatively and encourage early oral postoperative nutrition. The authors present a study aiming to assess POI, oral feeding, and complication outcomes in patients who underwent the ERAS protocol and patients who underwent traditional management after RC in their institution.
CUA 2018: A Population-Based Study Demonstrating Passive Centralization of Radical Cystectomy: Potential Associations with Other Quality Indicators
Halifax, Nova Scotia (UroToday.com) Referral of complex surgical procedures in higher-volume centers leads to improved patient care and better outcomes. In England, centralization of radical cystectomies (RC) was mandated in 2003. Although not mandated in Canada, the authors hypothesized that centralization of RC has been occurring naturally in a passive way. In the presented study, the authors explored this process of centralization in Canada, and whether it is associated with other process-related quality indicators and outcomes.
CUA 2018: Do Men with Prior Military Service have an Increased Risk for Genitourinary Cancers? Results from the HINTS National Database
Halifax, Nova Scotia (UroToday.com) Data published suggests that the incidence of select malignancies is higher among military personnel than the non-military population . In this interesting study the authors used the Health Information National Trends Survey (HINTS national survey database 4th edition), to assess whether any history of military service predicts an increased incidence of cancers in general, and genitourinary (GU) cancers specifically.
CUA 2018: Evolving Approaches in Diagnosing Prostate Cancer: Beyond PSA
Halifax, Nova Scotia (UroToday.com) This session covered several topics in the diagnosis of prostate cancer (PC). The topics that were covered included:
- Usage of MRI in biopsy naïve patients
- MRI in the optimization of surgical outcomes – a role for nerve-sparing planning and high-risk disease
- Metastatic PC
CUA 2018: Development of a Management Algorithm for Prostate Cancer Patients with a Biochemical Recurrence after Radical Therapy
Halifax, Nova Scotia (UroToday.com) Biochemical recurrence, defined as a PSA recurrence without radiographic evidence of disease following definitive primary therapy for prostate cancer, is a growing clinical entity – and one identified by the Genitourinary Research Consortium (GURC) Best Practice Working Group as a priority to “develop a monitoring and treatment algorithm to support the optimal management of patients with non-metastatic prostate cancer.” As more of the systemic therapies previously limited to patients with metastatic disease or castration-resistance are working their way into the castration-sensitive non-metastatic setting, the authors of this multi-institutional Canadian group offer a management algorithm for these patients.
CUA 2018: A Quantitative Assessment of Residual Confounding in the Comparison Between Surgery and Radiotherapy in the Treatment of Non-Metastatic Prostate Cancer
Halifax, Nova Scotia (UroToday.com) Unfortunately, direct randomized data comparing surgery and radiotherapy for prostate cancer is not easy to obtain – certain patient characteristics favor surgery (younger age, fewer comorbidities, etc) and others favor radiotherapy (older age, poor surgical candidate). As such, head-to-head comparisons are lacking. The literature is riddled with retrospective series comparing outcomes (oncologic and functional) between radiotherapy and surgery for patients with localized prostate cancer – with each specialty expounding their own treatments’ benefits and highlighting the downsides of the other modality.
CUA 2018: Real-World Evidence in Patient-Related Outcomes of Metastatic Castrate-Resistant Prostate Cancer Patients Treated with Abiraterone Acetate Plus Prednisone
Halifax, Nova Scotia (UroToday.com) Abiraterone acetate, given in conjunction with prednisone (AA+P), is an oral androgen biosynthesis inhibitor that targets the androgen axis. It is one of two androgen-receptor axis targeted therapies (the other being enzalutamide) that has dramatically altered the management of advanced prostate cancer. As an oral agent, it is an excellent alternative to chemotherapy (docetaxel) and has become a standard of care for metastatic castration-resistant prostate cancer (mCRPC). Indeed, newer studies have demonstrated benefit in earlier stages of the disease and it may soon be used for hormone-sensitive metastatic prostate cancer.