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Treatment of Oligometastatic Hormone-Sensitive Prostate Cancer: A Comprehensive Review
구교철,Prokar Dasgupta 연세대학교의과대학 2018 Yonsei medical journal Vol.59 No.5
With advancements in diagnostic techniques, including molecular and clinical imaging, that directly target cancer cells, oligometastaticprostate cancer (PCa) is being diagnosed in patients who were, in the past, considered to have localized disease. Withaccumulating evidence, there has been a paradigm shift in considering aggressive treatments targeted at both the primary tumorand metastatic lesions in an aim to avoid and delay the need for palliative treatments and, ultimately, to achieve survival benefits. However, many questions still remain unanswered regarding the understanding of oligometastatic PCa, from its definition to optimaltreatment strategies for each individual. Limited retrospective studies have suggested that interventions, including localand/or metastasis-directed therapy using surgery and radiation therapy (RT), can improve survival outcomes with minimal riskof adverse effects. Such treatments have been shown to decrease the risks of subsequent palliative interventions and to delay thestart of androgen-deprivation therapy. Nevertheless, available data are insufficient to draw a reliable conclusion regarding theireffect on quality of life measures and overall survival. This comprehensive review overviews data from contemporary literaturethat have investigated treatments, including surgery and RT, for patients with oligometastatic PCa, namely pelvic lymph nodepositive disease and limited distant metastases, and summarizes ongoing trials that are evaluating the feasibility of aggressivemultimodal treatments.
Quentin Mak,Julian Greig,Kamran Ahmed,Shamim Khan,Prokar Dasgupta,Sachin Malde,Nicholas Raison 대한배뇨장애요실금학회 2023 International Neurourology Journal Vol.27 No.2
Urinary tract infection (UTI) is a common condition defined as the presence of bacteria within the urine above a certain threshold (usually >100,000 m/L). The lifetime risk in women is estimated to be 50%, of whom 25% will develop recurrence within 6 months. Unfortunately, the use of antibiotics to treat and manage recurrent UTI (rUTI) is a growing problem, due to the burden of growing antibiotic resistance on public health. As such, new approaches to manage rUTI are being investigated and developed. Competitive inoculation via instillation of Escherichia coli 83972 or HU2117 in the bladder is a new prophylactic non-antimicrobial therapy for rUTIs. It utilizes the principle of the protective nature of asymptomatic bacteriuria to prevent recurrence of symptomatic UTIs. However, the effectiveness and safety of this technique remains unclear. This systematic review examined the current outcomes data on competitive inoculation as an effective and safe treatment for rUTI prophylaxis. Based on a limited number of studies, current evidence suggests that competitive inoculation is an effective and safe prophylactic measure against UTIs in a select group of patients with incomplete bladder emptying. However, administration of the technology is both resource and time intensive, and there is strong data demonstrating low successful colonisation rates. Competitive inoculation is an alternative to antibiotics only to rUTI patients with incomplete bladder emptying. There is no evidence to suggest that the technology would be suitable for other subsets of rUTI patients. Further randomized controlled trials should be conducted to improve the evidence base before drawing conclusions for clinical practice, and ideas to improve colonisation rates and simplify the administration process should be explored.
Marieke J. Krimphove,Stephen W. Reese,Xi Chen,Maya Marchese,Daniel Pucheril,Eugene Cone,Wesley Chou,Karl H. Tully,Adam S. Kibel,Richard D. Urman,Steven L. Chang,Luis A. Kluth,Prokar Dasgupta,Quoc-Dien 대한비뇨의학회 2021 Investigative and Clinical Urology Vol.62 No.1
Purpose: Does surgical approach (minimally invasive vs. open) and type (radical vs. partial nephrectomy) affects opioid use and workplace absenteeism. Materials and Methods: Retrospective multivariable regression analysis of 2,646 opioid-naïve patients between 18 and 64 undergoing radical or partial nephrectomy via either a minimally invasive vs. open approach for kidney cancer in the United States between 2012 and 2017 drawn from the IBM Watson Health Database was performed. Outcomes included: (1) opioid use in opioid-naïve patients as measured by opioid prescriptions in the post-operative setting at early, intermediate and prolonged time periods and (2) workplace absenteeism after surgery. Results: Patients undergoing minimally invasive surgery had a lower odds of opioid use in the early and intermediate post-operative periods (early: odds ratio [OR], 0.77; 95% confidence interval [CI], 0.62–0.97; p=0.02, intermediate: OR, 0.60; 95% CI, 0.48–0.75; p<0.01), but not in the prolonged setting (prolonged: OR, 1.00; 95% CI, 0.75–1.34; p=0.98) and had earlier return to work (minimally invasive vs. open: −10.53 days; 95% CI, −17.79 to −3.26; p<0.01). Controlling for approach, patient undergoing partial nephrectomy had lower rates of opioid use across all time periods examined and returned to work earlier than patients undergoing radical nephrectomy (partial vs. radical: −14.41 days; 95% CI, −21.22 to −7.60; p<0.01). Conclusions: Patients undergoing various forms of surgery for kidney cancer had lower rates of peri-operative opioid use, fewer days of workplace absenteeism, but no difference in long-term rates of opioid use in patients undergoing minimally invasive as compared to open surgery.