血清前列腺健康指数对 tPSA灰区前列腺癌患者的诊断价值探讨

目的　探讨前列腺健康指数（PHI）在血清总前列腺特应性抗原（tPSA）灰区（4~10 ng/ml）前列腺癌（PCa）患者中的诊断价值。方法　选择 2018年 3月～ 2019年 10月上海市金山区亭林医院泌尿外科收治的 94例血清 tPSA在 4～ 10 ng/ml的老年男性患者临床资料。其中 PCa组 21例,前列腺良性增生（ BPH）73例。检测两组患者血清中 tPSA、游离 PSA（fPSA）以及前列腺特异性抗原前体 2型（p2PSA）的指标水平,从而计算得出 fPSA/tPSA比值和 PHI,并绘制 tPSA, fPSA/tPSA, p2PSA以及 PHI的受试者工作特征（ ROC）曲线,得出曲线下面积（ AUC）、95%CI以及截断值（ cut off value）,分析 tPSA, fPSA/tPSA, p2PSA以及 PHI的检测对 PCa患者的早期诊断价值。结果　两组患者的血清 tPSA,fPSA和p2PSA水平差异均无统计学意义（U=899,450和 261.5,均 P >0.05）;两组患者 fPSA/tPSA（U=261.5, P =0.023）与 PHI（t=1275.5,P<0.001）指标的差异有统计学意义（均 P <0.05）。tPSA, fPSA/tPSA, p2PSA以及 PHI的 ROC曲线下面积分别为 0.586,0.676,0.613和 0.832,其中 tPSA, fPSA/tPSA和 p2PSA（AUC值均 <0.7）的诊断效能较低,而 PHI的诊断效能较高。血清 PHI的准确度（ 81.9%）明显高于 tPSA, fPSA/tPSA和 p2PSA,差异有统计学意义（ χ2=6.975, 4.145和 6.211, 均 P <0.05）。tPSA及 p2PSA指标对提高 PCa的诊断效率无明显助益（均 P >0.05）,fPSA/tPSA和 PHI明显提高 Pca的诊断效力（ P<0.05）,其中 PHI的诊断效果最佳（ P<0.001）,PHI的 AUC值 0.832（95% CI: 0.733～ 0.931）高于 fPSA/tPSA的 AUC值 0.676（95% CI: 0.539～ 0.812）,差异有统计学意义（Z=2.758,P<0.01）。结论　PHI诊断 tPSA灰区 PCa患者的诊断效能与准确性均较高,具有比 tPSA, fPSA/tPSA和 p2PSA更高的诊断价值。     

前列腺癌及前列腺增生症中前列腺特异抗原密度（DPSA）的变化

目的研究前列腺癌及前列腺增生症中前列腺特异抗原密度(DPSA)的变化。方法回顾1997-10-01～1998-03-31间,在北大一院就诊的前列腺癌患者,及同期就诊的相同例数的前列腺增生症患者的前列腺特异抗原密度(DPSA)。所有患者均经组织学证实,并对前列腺癌患者予以分期分级,最后分别对各期前列腺癌及其与前列腺增生症者相比较,数据经统计学处理。结果发现DPSA是前列腺癌诊断的一项有意义的参考指标。当采用一定的界值,其效果明显优于PSA和游离与总PSA的比值(F/T)。无论是总PSA(T-PSA)或游离PSA(F-PSA)值的DPSA与前列腺增生症比较都有显著性差异(分别是P＜0.001,0.001＜P＜0.05);同时,T-PSA和F-PSA的DPSA在PC早期(A-B期)与中期(C期)之间无明显差异,但中期(C期)与晚期(D期)的DtPSA(T-PSA计算的DPSA结果)差异显著。值得注意的是DtPSA在早期(A-B)PC与前列腺增生症比较时,发现其DPSA的差异性是显著的P＜0.001,提示DPSA在PC早期就有诊断意义的可能性。结论DPSA对区分前列腺增生症与PC有较高的临床价值;在PC早期(未发生局限性侵润及转移之前)就有提示PC的可能,对早期诊断PC及彻底根治性切除肿瘤提供更多的机会。但因病例数量较少,其结论有待于更大宗的病例进行证实;因DtPSA在PC的C期与D期呈现显著性的差异,在采用适当的界值时或许能大大减少对晚期PD的手术介入,使激素治疗更有针对性。     

Evaluating the Impact of Post-Treatment Self-Management Guidelines for Prostate Cancer Survivors

BackgroundWith a rising number of prostate cancer survivors, transitioning patients to follow-up care has become more relevant in the current Albertan cancer care landscape and has led to a need for better patient education resources surrounding this topic. In response, the Alberta Provincial Genitourinary Tumour Team and Cancer Control Alberta have developed self-management guidelines to aid patients with prostate cancer during this transition. This study aimed to evaluate the effectiveness and impact of the new provincial self-management guidelines in facilitating transition from active curative external beam radiation treatment to primary community care.MethodsThis prospective study used convenience sampling to recruit 18 patients with prostate cancer from two major cancer centers in Alberta: Calgary and Edmonton. Participants were given the self-management guidelines within their final week of external beam radiation treatment and a follow-up phone questionnaire 4 weeks later. Participants answered standardized questions regarding the self-management document based on the themes of timeliness, patient-centeredness, safety, effectiveness, and comprehensiveness.Results and DiscussionA thematic analysis of the results suggested that the majority of patients were satisfied with the document in all domains, but some expressed concern with the clarity of the document. They suggested improvements such as adding a side effect timeline, adding an appendix or symptom index, further simplifying the language, and coordinating delivery of the guidelines with an in-person education session.ConclusionOverall, our findings supported the effectiveness of the guidelines in providing self-management information. If implemented into practice, these guidelines could have a positive impact on the perception of patients with prostate cancer regarding transitioning to follow-up care.     

前列腺肿瘤单病种病房的运行模式与护理管理

目的 探讨前列腺肿瘤单病种病房的运行模式及护理管理。方法 成立前列腺肿瘤单病种病房,建立运行模式:优化收治流程、实施医护一体化合作、加强延续护理管理;通过实施单病种病房管理：优化服务质量、强化团队培训、强化安全管理、依托信息平台、实行弹性排班,确保病房安全有效运行。结果 建立前列腺肿瘤单病种病房运行模式及实施护理管理后,床位使用率和周转率得到提高（P<0.001）;平均住院日、术前等待日、入院前等待日缩短（P<0.001）;患者对护理服务满意度显著提高（P<0.001）。结论 前列腺肿瘤单病种病房的建立能够提高床位使用率和周转率,缩短患者住院日和等待时间,降低医疗费用;提高患者满意度,提升护理管理质量,深化优质护理内涵,增强专科竞争力。     

前列腺癌患者子女照护体验的质性研究

目的了解前列腺癌患者子女在照护患者期间的真实感受,为护士对患者子女进行心理支持提供依据。方法采用目的抽样法选取2009年3月至2012年2月在丽水市中心医院接受手术治疗的前列腺癌患者子女12人,采用质性研究中的深度访谈法收集资料,并用现象学分析法进行资料分析。结果前列腺癌患者子女照护体验主要有5个主题:承受较重的心理负荷,承受繁重的照顾任务,经济负担过重,工作压力过大,被患者的护理问题所困扰。结论在前列腺癌患者的治疗过程中,应积极帮助与指导患者子女,教授其必要的知识技能并为其提供人文关怀和情感支持,为其更好地照护患者提供必要帮助,以提高前列腺癌患者的治疗效果及生活质量。     

Association Between the Overall Risk of Prostate Cancer and Use of Calcium Channel Blockers: A Systematic Review and Meta-analysis

PurposeAlthough calcium channel blockers (CCBs) are now commonly prescribed to treat hypertension as a first-line drug therapy, their impact on prostate cancer (PCa) is unclear. This systematic review and meta-analysis was conducted to determine the association between CCB use and the overall risk of PCa.MethodsPubMed, EMBASE, and Cochrane were searched up to December 26, 2019, stratified according to statistical method of outcome [odd ratios (ORs), relative ratios (RRs), hazard ratios (HRs)] and cumulative duration of CCB use. The quality assessment of included studies was evaluated by using the Newcastle–Ottawa Scale. Fixed effects models were used to study the association between CCB use and the risk of PCa. Between-study heterogeneity was quantified by using Cochran's Q-statistic and I² statistics. Sensitivity analysis was performed by excluding the studies one by one, and publication bias was analyzed by using funnel plots.FindingsNineteen studies with 1,418,407 patients were identified for inclusion in the meta-analysis, which was based on the comparison of cohort studies, nested case–control studies, and case–control studies. Pooled estimates showed a RR of 1.08 (95% CI, 1.05–1.11; P < 0.00001) and a HR of 1.07 (95% CI, 1.02–1.13; P = 0.008) for association between CCB use and the risk of PCa. In addition, the results of subgroup analysis showed that CCB users of <5 years had an 8% increased overall risk of PCa (RR, 1.08; 95% CI, 1.04–1.12; P = 0.0001), and CCB users of 5–10 years had a 13% increased overall risk of PCa (RR, 1.13; 95% CI, 1.04–1.23; P = 0.003).ImplicationsCCB use had a tendency to increase the overall risk of PCa, and cumulative duration of CCB use might also be positively correlated with the overall risk of PCa.     

Template-based Intensity-Modulated Radiation Therapy: A Cost-effective Intensity-Modulated Radiation Therapy Planning Procedure for Prostate Cancer

IntroductionIntensity-modulated radiation therapy (IMRT) has been widely accepted for the treatment of prostate cancer. In comparison with traditional three-dimensional conformal radiation therapy (3D-CRT), it improves local control while minimizing side effects. However, IMRT comes at a significantly higher cost. In this report, we describe the development of template-based IMRT (TB-IMRT) planning for prostate cancer that does not require additional resources above 3D-CRT.MethodsTwenty patients previously treated using 3D-CRT were retrospectively planned using the TB-IMRT planning technique. Planning target volume coverage, dose to organs at risk, and resource usage were compared between 3D-CRT and TB-IMRT techniques.ResultsAll 3D-CRT and TB-IMRT plans met the planning guidelines. TB-IMRT compared better than 3D-CRT in terms of the homogeneity index (0.039 ± 0.007 vs. 0.052 ± 0.008) and conformity index (0.866 ± 0.024 vs. 0.752 ± 0.054). TB-IMRT also provided better sparing of organs at risk. Planning times were significantly less for TB-IMRT (average 13.43 ± 2.18 minutes) compared with conventional plans (45.4 ± 17.0 minutes). Times required for patient-specific quality assurance were similar between TB-IMRT and 3D-CRT.ConclusionsThe TB-IMRT technique for prostate allows for all the potential benefits of IMRT without any additional resources above conventional 3D-CRT.     

Histotripsy: The Next Generation of High-Intensity Focused Ultrasound for Focal Prostate Cancer Therapy

This article reviews the most current methods and technological aspects of high-intensity focused ultrasound (HIFU), which is termed histotripsy. The rationale for focal therapy for prostate carcinoma rather than prostatectomy, which is being used extensively throughout Europe and Asia, is presented, and an argument for why HIFU is the modality of choice for primary therapy and recurrent disease is offered. The article presents a review of the technical advances including higher ultrasound beam energy than current thermal HIFU which allows for more accurate tissue targeting, less collateral tissue damage, and faster treatment times. Finally, the article presents a discussion about the advantage of ultrasound guidance for histotripsy in preference to magnetic resonance imaging guidance primarily based on cost, ease of application, and portability.     

SHARING THE CARE: A project to enable prostate cancer care to be delivered in the community

Prostate cancer has become the 2nd most common cancer in men worldwide. An ageing population and treatment improvements are increasing the number of men living with and beyond cancer. In 2013, there was both scant evidence to guide as to when, where or how men with prostate cancer should be followed up and neither, it appears, pointing to agreed pathways. Generally, follow up regimes are based on tradition and expert medical opinion rather than research or patient need. For men to have their follow up with their GP, several factors need to be in place such as a single system, an improved exchange of experiences, as well as information and knowledge sharing. A recent presentation of a randomized control trial has shown that there are no differences between secondary and primary care follow up. Understanding that the current model of follow up was not working and was unsustainable, a review of urological services was undertaken in 2011 in a large National Health Service (NHS) district general hospital in the north of England. The review evaluated current services, noting that some follow up pathways did not necessarily need to be undertaken within a secondary are setting. The process of relocating patients for primary care review, involved creating a shared care process for prostate cancer. A workstream consisting of consultant urologists, nurse specialists, GPs, service managers and clinical commissioners was convened. Protocols containing specific responsibilities for secondary and primary care were devised. The review and workstream, included a shared vision for improving and sustaining services. Whilst safely moving follow up from secondary to primary care, benefits were realized such as care closer to the home. In conclusion a radical approach to follow up was needed and undertaken. Shared care has yielded success for the patient, primary and secondary care.     

An Analysis of Electronic Health Record Work to Manage Asynchronous Clinical Messages among Breast Cancer Care Teams

Objective  Asynchronous messaging is an integral aspect of communication in clinical settings, but imposes additional work and potentially leads to inefficiency. The goal of this study was to describe the time spent using the electronic health record (EHR) to manage asynchronous communication to support breast cancer care coordination. Methods  We analyzed 3 years of audit logs and secure messaging logs from the EHR for care team members involved in breast cancer care at Vanderbilt University Medical Center. To evaluate trends in EHR use, we combined log data into sequences of events that occurred within 15 minutes of any other event by the same employee about the same patient. Results  Our cohort of 9,761 patients were the subject of 430,857 message threads by 7,194 employees over a 3-year period. Breast cancer care team members performed messaging actions in 37.5% of all EHR sessions, averaging 29.8 (standard deviation [SD] = 23.5) messaging sessions per day. Messaging sessions lasted an average of 1.1 (95% confidence interval: 0.99–1.24) minutes longer than nonmessaging sessions. On days when the cancer providers did not otherwise have clinical responsibilities, they still performed messaging actions in an average of 15 (SD = 11.9) sessions per day. Conclusion  At our institution, clinical messaging occurred in 35% of all EHR sessions. Clinical messaging, sometimes viewed as a supporting task of clinical work, is important to delivering and coordinating care across roles. Measuring the electronic work of asynchronous communication among care team members affords the opportunity to systematically identify opportunities to improve employee workload.     

Diarrhea A to Z: America to Zimbabwe

Purpose: To review international statistics on the morbidity and mortality of diarrhea, pathophysiology, global incidence, and implications for the clinical practice of nurse practitioners (NPs).
Data sources: Selective review of literature.
Conclusions: Because of ever-increasing international travel, immigration, and rising awareness of global health issues, NPs must be current on the prevention, diagnosis, and treatment of diarrhea.
Implications for Practice: Increased awareness of diarrhea as a significant international health issue mandates that NPs counsel clients who travel to high-risk areas about preventive measures to avoid exposure or manage symptoms while traveling. Guidelines for evidence-based treatments of diarrheal illness are widely available and should be followed.     

An Observational Study of Concomitant Use of Emerging Therapies and Denosumab or Zoledronic Acid in Prostate Cancer

Purpose

This observational study of oncologic clinical practices was designed to describe real-world patterns of use of emerging therapies (abiraterone acetate, cabazitaxel, enzalutamide, radium-223, sipuleucel-T) in patients with castration-resistant prostate cancer and to characterize their concomitant use with denosumab or zoledronic acid.

The Impact of Exercise during Radiation Therapy for Prostate Cancer on Fatigue and Quality of Life: A Systematic Review and Meta-analysis

BackgroundRadiation therapy (RT) is clinically proven to improve survival in men with prostate cancer. Despite these advantages, it is known to cause adverse effects such as fatigue. This review proposes to summarize the totality of evidence from randomized controlled trials regarding the effectiveness of exercise on fatigue in men with prostate cancer as a primary outcome. Quality of life was a secondary outcome.MethodsRCTs that explored the effect of exercise during RT on fatigue for men with prostate cancer were searched using MEDLINE, Embase, CINAHL, Cochrane Library, AMED, ClinicalTrials.gov, and ISRTCN registry. Reference lists of included studies and reviews were also examined. Trials were excluded if they included a mixed cohort of patients where data could not be extracted for prostate cancer patients alone or if the intervention took place after RT had finished. Preferred Reporting Items for Systematic Reviews and Meta-Analyses standardized reporting guidelines were followed to ensure the standardised conduct and reporting of the research.ResultsThe search strategy yielded a total of 278 studies, of which five met the inclusion criteria. A meta-analysis pooled data of 392 participants using the Cochrane Review Manager 5.3 random-effects model (DerSimonian-Laird approach) with the post-test means of the control and intervention groups and associated standard deviations. Exercise was significant at alleviating fatigue when compared to the control group (standardized mean differences, −1.03; 95% confidence interval, −1.82 to −0.24).ConclusionExercise during RT is an effective approach to alleviate fatigue in men with prostate cancer. The effect on quality of life was not significant, possibly because of considerable heterogeneity across studies.