Abstract:
BACKGROUND:Active surveillance (AS) has become the recommended management strategy for men with low-risk prostate cancer. However, there is considerable uncertainty about the optimal follow-up schedule in terms of the tests to perform and their frequency. OBJECTIVE:To assess the costs and benefits of different AS follow-up strategies compared to watchful waiting (WW) or immediate treatment. DESIGN, SETTING, AND PARTICIPANTS:A state-transition Markov model was developed to simulate the natural history (ie, no testing or intervention) of prostate cancer for a hypothetical cohort of 50-yr-old men newly diagnosed with low-risk prostate cancer. Following diagnosis, men were hypothetically managed with immediate treatment, watchful waiting, or one of several AS strategies. AS follow-up was performed either with transrectal ultrasound-guided biopsy or magnetic resonance imaging (MRI) which was scheduled annually, biennially, every 3yrs, according to the PRIAS protocol (yrs 1, 4, 7, and 10, and then every 5yr) or every 5yr. Diagnosis of higher-grade or -stage disease while on AS resulted in curative treatment. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:We measured discounted quality-adjusted life years (QALYs), discounted lifetime medical costs (2017 US$), and incremental cost-effectiveness ratios (ICERs). RESULTS AND LIMITATIONS:Compared to WW, MRI-based surveillance performed every 5yr improved quality-adjusted survival by 4.47 quality-adjusted months and represented high-value health care at the Medicare reimbursement rate using standard cost-effectiveness metrics. Biopsy-based strategies were less effective and less costly than the corresponding MRI-based strategies for each testing interval. MRI-based surveillance at more frequent intervals had ICERs greater than $800000 per QALY and would not be considered cost-effective according to standard metrics. Our results were sensitive to the diagnostic accuracy and costs of both biopsy modes in detecting clinically significant cancer. CONCLUSIONS:Incorporation of MRI into surveillance protocols at Medicare reimbursement rates and decreasing the intensity of repeat testing may be cost-effective options for men opting for conservative management of low-risk prostate cancer. PATIENT SUMMARY:Our study modeled outcomes for men with low-risk prostate cancer undergoing watchful waiting, immediate treatment, or active surveillance with different follow-up schedules. We found that conservative management of low-risk disease optimizes health outcomes and costs. Furthermore, we showed that decreasing the intensity of active surveillance follow-up and incorporating magnetic resonance imaging (MRI) into surveillance protocols can be cost-effective, depending on the MRI costs.
journal_name
Eur Uroljournal_title
European urologyauthors
Sathianathen NJ,Konety BR,Alarid-Escudero F,Lawrentschuk N,Bolton DM,Kuntz KMdoi
10.1016/j.eururo.2018.10.055subject
Has Abstractpub_date
2019-06-01 00:00:00pages
910-917issue
6eissn
0302-2838issn
1873-7560pii
S0302-2838(18)30853-4journal_volume
75pub_type
杂志文章相关文献
EUROPEAN UROLOGY文献大全abstract:OBJECTIVE:To determine the efficacy and tolerability of flexible dosing with vardenafil in a broad population of men with erectile dysfunction (ED). METHODS:10-week, open-label, flexible-dose study starting with vardenafil 10 mg, titrating to 5 mg or 20 mg at weeks 2 and 6 based on efficacy and tolerability, set in 78...
journal_title:European urology
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1016/j.eururo.2004.03.011
更新日期:2004-07-01 00:00:00
abstract:CONTEXT:Clinical data supporting the use of targeted agents for the treatment of metastatic renal cell carcinoma (RCC) are based predominantly on patients with clear cell histology. Little is known about the efficacy of these drugs in non-clear cell variants. OBJECTIVE:To evaluate the efficacy of different clear cell ...
journal_title:European urology
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.eururo.2014.05.010
更新日期:2015-04-01 00:00:00
abstract:OBJECTIVES:Transurethral electrovaporization of the prostate (TUVP) has become a popular, minimally invasive procedure to treat BPH with promising initial results. This study was conducted to compare the efficacy, safety and durability of TUVP with standard TURP. We report the 2-year follow-up. METHODS:104 consecutive...
journal_title:European urology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1159/000019710
更新日期:1998-09-01 00:00:00
abstract:OBJECTIVE:To compare the Bard BTA (bladder tumour antigen) test with voided urine cytology (VUC) in the diagnosis of recurrent bladder cancer (BC). METHODS:Urine specimens for the BTA test and VUC were collected on the same day as before cystoscopy from patients undergoing routine surveillance cystoscopy for recurrent...
journal_title:European urology
pub_type: 杂志文章
doi:
更新日期:1997-01-01 00:00:00
abstract::The role of basic fibroblast growth factor (bFGF) in the control of teratoma cell proliferation was examined. It was found that bFGF stimulates proliferation at low concentrations but induces cell migration at higher doses. These effects could be efficiently counteracted by addition of protamine sulphate. Moreover the...
journal_title:European urology
pub_type: 杂志文章
doi:10.1159/000474573
更新日期:1993-01-01 00:00:00
abstract:BACKGROUND:Clinically significant nonmetastatic prostate cancer (PCa) is currently treated using whole-gland therapy. This approach is effective but can have urinary, sexual, and rectal side effects. OBJECTIVE:To report on 5-yr PCa control following focal high-intensity focused ultrasound (HIFU) therapy to treat indiv...
journal_title:European urology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.eururo.2018.06.006
更新日期:2018-10-01 00:00:00
abstract:OBJECTIVES:The objective of this study was to evaluate the role of p53 immunoreactivity as a prognostic marker in prostate cancer. METHODS:The nuclear accumulation of the aberrant p53 protein was determined by immunohisto-chemistry on surgical specimens and related to stage, grade and cancer-specific survival in 186 p...
journal_title:European urology
pub_type: 杂志文章
doi:10.1159/000474147
更新日期:1996-01-01 00:00:00
abstract:OBJECTIVE:To establish guidelines for the diagnosis, treatment, and follow-up of BPH. METHODS:A search of published work was conducted using Medline. In combination with expert opinions recommendations were made on the usefulness of tests for assessment and follow-up: mandatory, recommended, or optional. In addition, ...
journal_title:European urology
pub_type: 杂志文章
doi:10.1159/000049784
更新日期:2001-09-01 00:00:00
abstract:OBJECTIVES:To study the effect of botulinum toxin A (BoNTA) injections into the detrusor muscle on the incidence of symptomatic urinary infections in patients with neurogenic detrusor overactivity. METHODS:Between February 2004 and June 2005, 30 patients (18 men, 12 women), mean age 39.4+/-12.1 yr, with neurogenic det...
journal_title:European urology
pub_type: 临床试验,杂志文章
doi:10.1016/j.eururo.2007.08.039
更新日期:2008-03-01 00:00:00
abstract:OBJECTIVES:We assessed the incidence of morbidity and bother on quality-of-life (QL) after radical retropubic prostatectomy for prostate cancer. METHODS:At least 12 months after surgery, self-reporting questionnaires were completed and returned by 368 (77.8%) of 473 eligible patients. Surgery related morbidity was eva...
journal_title:European urology
pub_type: 杂志文章
doi:10.1016/s0302-2838(02)00259-2
更新日期:2002-08-01 00:00:00
abstract:PURPOSE:The aim of this study was to evaluate the results of 10 years dynamic sentinel node biopsy experience in penile carcinoma at our institute. PATIENTS AND METHODS:140 patients with clinically node-negative groins were prospectively included. Lymphoscintigraphy was performed after injection of 99mTechnetium-nanoc...
journal_title:European urology
pub_type: 杂志文章
doi:10.1016/j.eururo.2004.11.018
更新日期:2005-05-01 00:00:00
abstract:CONTEXT:Because pelvic lymph node (LN)-positive prostate cancer (PCa) is generally considered a regionally metastatic disease, surgery needs to be better defined. OBJECTIVE:To review the impact of radical prostatectomy (RP) and pelvic lymph node dissection (PLND), possibly in conjunction with a multimodal approach usi...
journal_title:European urology
pub_type: 杂志文章,评审
doi:10.1016/j.eururo.2013.05.033
更新日期:2014-08-01 00:00:00
abstract::In 16 patients who underwent radical retropubic prostatectomy because of adenocarcinoma of the prostate after previous transurethral resection, the difficulty of the operation, the morbidity rate, and the survival time were evaluated. Eleven patients had tumours staged A2, 5 patients tumours staged B1. Duration of the...
journal_title:European urology
pub_type: 杂志文章
doi:10.1159/000473428
更新日期:1988-01-01 00:00:00
abstract:OBJECTIVE:Bropirimine is an oral immunostimulant found to have efficacy in human transitional cell carcinoma in situ following the initial discovery of its antitumor activity against the murine bladder cancer MBT-2. To determine if bropirimine might have activity in prostate cancer, it was tested against two rodent pro...
journal_title:European urology
pub_type: 杂志文章
doi:10.1159/000474525
更新日期:1997-01-01 00:00:00
abstract:AIM:In this prospective study our aim was to establish the time it takes cystectomized patients' to adapt to their new health status. MATERIALS AND METHOD:A total of 68 patients, having radical cystectomy for bladder cancer (64 males and 4 females) were enrolled in the study. The mean age of the group was 55.4 +/- 8.0...
journal_title:European urology
pub_type: 杂志文章
doi:10.1016/s0302-2838(02)00351-2
更新日期:2002-10-01 00:00:00
abstract:BACKGROUND:Metastatic castration-resistant prostate cancer (mCRPC) is the lethal form of the disease. Several recent studies have identified genomic alterations in mCRPC, but the clinical implications of these genomic alterations have not been fully elucidated. OBJECTIVE:To use whole-genome sequencing (WGS) to assess ...
journal_title:European urology
pub_type: 杂志文章
doi:10.1016/j.eururo.2019.03.020
更新日期:2019-11-01 00:00:00
abstract::Despite the high cure rate in men with testicular cancer, efforts should be made to diagnose the disease at the preinvasive stage. The disease, which affects young males, is potentially lethal. Furthermore, testicular neoplasia diagnosed at the stage of CIS can be cured without the negative impact on the life-quality ...
journal_title:European urology
pub_type: 杂志文章,评审
doi:
更新日期:1993-01-01 00:00:00
abstract:OBJECTIVES:To evaluate some risk factors which could affect the isolation rates of various uropathogens and their in vitro susceptibility to antibiotics in ambulatory and hospitalized patients. PATIENTS AND METHODS:A prospective study was conducted in a microbiological laboratory at Pisa Hospital. Nine-hundred and sev...
journal_title:European urology
pub_type: 杂志文章
doi:10.1159/000049813
更新日期:2001-10-01 00:00:00
abstract::A 52-year-old patient underwent left radical nephrectomy for renal cell carcinoma and received adjuvant chemotherapy postoperatively with adriamycin and 5-fluoruracil. Twenty months afterwards he developed cerebral and multiple bilateral pulmonary metastases. The cerebral metastasis was excised and nonspecific immunos...
journal_title:European urology
pub_type: 杂志文章
doi:10.1159/000473417
更新日期:1988-01-01 00:00:00
abstract:CONTEXT:Salvage radiotherapy (SRT) is a standard of care for men who recur postprostatectomy, and recent randomized trials have assessed the benefit and toxicity of adding hormone therapy (HT) to SRT with differing results. OBJECTIVE:To perform a systematic review of randomized phase III trials of the use of SRT ± HT ...
journal_title:European urology
pub_type: 杂志文章
doi:10.1016/j.eururo.2017.06.027
更新日期:2018-02-01 00:00:00
abstract::Contralateral biopsies taken from 1,188 patients with testicular germ-cell tumour were examined immunohistologically by staining for placental alkaline phosphatase. Testicular intraepithelial neoplasia (TIN; carcinoma in situ) was detected in 53 patients (4.5%; 95% confidence interval 3.3-5.7%). Testicular atrophy was...
journal_title:European urology
pub_type: 杂志文章,多中心研究
doi:10.1159/000474579
更新日期:1993-01-01 00:00:00
abstract::In 21 women undergoing simultaneous urethrocystometry because of dysuria, urge, and difficulties to empty the bladder, the effects of prostaglandin E2 (PGE2) applied locally in the bladder and urethra were investigated. In all 9 patients receiving PGE2 intravesically, the bladder pressure increased. Simultaneously, th...
journal_title:European urology
pub_type: 杂志文章
doi:10.1159/000473995
更新日期:1978-01-01 00:00:00
abstract:OBJECTIVE:To evaluate the relationship between neuroendocrine differentiation (NED) status and hormone refractory prostate cancer (HRPC) following hormone therapy based on immunohistochemical study. METHODS:Seventy-two prostate cancer specimens obtained at radical prostatectomy and 21 prostate cancer autopsy specimens...
journal_title:European urology
pub_type: 杂志文章
doi:10.1016/j.eururo.2003.11.032
更新日期:2004-05-01 00:00:00
abstract:OBJECTIVE:evaluation of a self-injection program with a mixture of papaverine, phentolamine and prostaglandin E1 (PGE1). METHOD:a self-injection program for erectile dysfunction was started by 48 patients, using a 1-ml mixture of 4.5 mg papaverine, 0.2 mg phentolamine and 1.5 micrograms PGE1. Patients completed a ques...
journal_title:European urology
pub_type: 临床试验,杂志文章
doi:10.1159/000475407
更新日期:1994-01-01 00:00:00
abstract::A short version of the UTI Guidelines elaborated by the Urinary Tract Infection Working Group of the Health Care Office of the European Association of Urology is presented. The topics include classification, diagnosis, treatment and follow-up of uncomplicated UTI, UTI in children, UTI in diabetes mellitus, renal insuf...
journal_title:European urology
pub_type: 指南,杂志文章,实务指引
doi:10.1159/000049840
更新日期:2001-11-01 00:00:00
abstract:BACKGROUND:In prostate cancer (PCa) patients treated with radical prostatectomy (RP), the rate of urinary continence (UC) and erectile function (EF) recovery may change significantly depending on the time interval between surgery and patient assessment. This effect, known as conditional survival, has not yet been asses...
journal_title:European urology
pub_type: 杂志文章
doi:10.1016/j.eururo.2012.02.057
更新日期:2012-07-01 00:00:00
abstract::We present our modified technique of short-term culture assay. As an experimental set-up we used the KK-47 bladder cancer cell line for chemosensitivity testing. The technique is very easy and requires only 3 days. The results were found to be reproducible. ...
journal_title:European urology
pub_type: 杂志文章
doi:10.1159/000472528
更新日期:1985-01-01 00:00:00
abstract:PURPOSE:To evaluate the impact of androgen deprivation on health related quality of life (HRQOL) in patients with asymptomatic lymph node positive prostatic carcinoma (LPPC). MATERIALS AND METHODS:HRQOL domains were measured, using standard instruments in 91 patients with histologically proven LPPC. Most patients were...
journal_title:European urology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0302-2838(03)00208-2
更新日期:2003-08-01 00:00:00
abstract:OBJECTIVE:In 60-70% of patients with renal cell carcinoma (RCC), metastases develop in the course of the disease. In the present analysis, the surgical management of metastases is described, and survival data are presented. This retrospective analysis may help in the management of future cases. Due to the retrospective...
journal_title:European urology
pub_type: 杂志文章,多中心研究
doi:10.1159/000019849
更新日期:1999-01-01 00:00:00
abstract::The present study was designed to evaluate the role of the cytokeratin-19 fragment (CYFRA 21-1) as a tumor marker in bladder cancer. The bladder cancer cell line JMSU1 was used in the preclinical study. Subjects comprised 120 healthy volunteers, 20 patients with benign bladder diseases including acute cystitis and bla...
journal_title:European urology
pub_type: 杂志文章
doi:
更新日期:1997-01-01 00:00:00