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Re: Efficiency, Satisfaction, and Costs for Remote Video Visits following Radical Prostatectomy: A Randomized Controlled Trial
928
SOCIOECONOMIC FACTORS, UROLOGICAL EPIDEMIOLOGY AND PRACTICE PATTERNS
Suggested Reading Quentin M, Blondin D, Arsov C et al: Prospective evaluation of magnetic resonance imaging guided in-bore prostate biopsy versus systematic transrectal ultrasound guided prostate biopsy in biopsy na€ive men with elevated prostate specific antigen. J Urol 2014; 192: 1374. Vourganti S, Rastinehad A, Yerram NK et al: Multiparametric magnetic resonance imaging and ultrasound fusion biopsy detect prostate cancer in patients with prior negative transrectal ultrasound biopsies. J Urol 2012; 188: 2152.
Socioeconomic Factors, Urological Epidemiology and Practice Patterns Re: National Prostate Cancer Screening Rates after the 2012 US Preventive Services Task Force Recommendation Discouraging Prostate-Specific Antigen-Based Screening M. W. Drazer, D. Huo and S. E. Eggener University of Chicago Medical Center, Chicago, Illinois J Clin Oncol 2015; 33: 2416e2423. doi: 10.1200/JCO.2015.61.6532
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26056181 Editorial Comment: This analysis of data from the National Health Interview Survey confirms what many of us in clinical practice have witnessed during the last 3 yearsdthe U.S. Preventive Services Task Force recommendation against prostate cancer screening has had a profound effect on screening rates in primary care practices. The authors stratify screening rates by age in 2010 and 2013 and find that, while screening in men in their 40s remained fairly constant, screening decreased in men in their 50s, 60s and 70s. They also note that, despite this decrease in screening rates, many men with less than a 10-year life expectancy were still screened. This finding should confirm our worst fearsdthat the men who would benefit most from screening are not being screened, while those who likely would benefit least still are being tested as a result of the task force recommendation. Our response to these findings should not be that prostate cancer screening gets a grade A recommendation. The evidence does not support annual screening on a population wide level. We need to start advocating for better screening strategies targeted at the men at greatest risk for the disease, who are most likely to gain a benefit. For example the AUA Guideline suggests that widening the screening interval to every 2 years would reduce the harms from screening. Urologists should consider this strategy. If we do not start to advocate for “smarter prostate cancer screening,” in the end there will be no screening at all. David F. Penson, MD, MPH
Suggested Reading Carter HB, Albertsen PC, Barry MJ et al: Early detection of prostate cancer: AUA Guideline. J Urol 2013; 190: 419. Barocas DA, Mallin K, Graves AJ et al: Effect of the USPSTF grade D recommendation against screening for prostate cancer on incident prostate cancer diagnoses in the United States. J Urol 2015; 194: 1587.
Re: Efficiency, Satisfaction, and Costs for Remote Video Visits following Radical Prostatectomy: A Randomized Controlled Trial B. R. Viers, D. J. Lightner, M. E. Rivera, M. K. Tollefson, S. A. Boorjian, R. J. Karnes, R. H. Thompson, D. A. O’Neil, R. L. Hamilton, M. R. Gardner, M. Bundrick, S. M. Jenkins, S. Pruthi, I. Frank and M. T. Gettman Department of Urology, Center for Innovation, and Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota Eur Urol 2015; 68: 729e735. doi: 10.1016/j.eururo.2015.04.002
IMAGING
929
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25900782 Editorial Comment: Given the technological advances and the massive growth in online commerce during the last 20 years, it was just a matter of time until health care was formally delivered over the Internet. Currently it is clear that telemedicine is feasible and easy to deliver. The question really is whether providers and patients will accept this mode of delivery. This small randomized clinical trial explores this question in the setting of post-prostatectomy visits. The authors randomized 55 men to either an office visit or a video visit following radical prostatectomy. No significant differences were noted in patient perception of the quality of the visit or satisfaction with the visit. Similarly there were no differences in urologist perception of satisfaction. Costs were lower with the video visits. While this must be considered a preliminary study that is limited by sample size, it still provides solid evidence that telemedicine can be applied to urological conditions. There are many questions that remain to be answered regarding telemedicine. Can providers perform telemedicine visits with patients who live in states where the provider is not licensed? How do providers bill for these visits, and what is the appropriate reimbursement for the visit? Which types of visits are most appropriate for telemedicine? Acknowledging that telemedicine is still in its infancy, it is critical that urologists embrace telemedicine and begin to consider how they can deliver this type of care in their regular practice. David F. Penson, MD, MPH
Imaging Re: Detection of Local Recurrence of Prostate Cancer after Radical Prostatectomy Using Endorectal Coil MRI at 3 T: Addition of DWI and Dynamic Contrast Enhancement to T2-Weighted MRI K. Kitajima, R. P. Hartman, A. T. Froemming, C. E. Hagen, N. Takahashi and A. Kawashima Department of Radiology, and Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota AJR Am J Roentgenol 2015; 205: 807e816. doi: 10.2214/AJR.14.14275
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26397329 Editorial Comment: These authors look at the role of endorectal 3 T magnetic resonance imaging for local recurrence after radical prostatectomy. The study includes 280 patients with suspected recurrence with a history of a positive biopsy and increasing prostate specific antigen, and no history of hormonal treatment. A total of 83 patients met inclusion criteria. Patients were assessed by 1) T2-weighted imaging alone, 2) T2 plus diffusion weighted imaging, 3) T2 plus dynamic contrast enhanced (DCE) MRI or 4) T2 plus DCE MRI and diffusion imaging. The authors found the addition of diffusion weighted imaging to the T2-weighted imaging led to under detection of prostate cancer when no diffusion restriction was present in an area of abnormality on the T2-weighted imaging. They conclude that T2-weighted imaging plus DCE MRI has the highest sensitivity and specificity to detect local recurrence. Diffusion weighted imaging with apparent diffusion coefficient mapping added little value regarding lesion detection. This is an important article for radiologists reading MRI of the prostate after prostatectomy. High resolution, detailed images with close review of the DCE MRI for focal or multifocal areas and abnormal enhancement will be valuable to identify recurrence. Cary Siegel, MD
SOCIOECONOMIC FACTORS, UROLOGICAL EPIDEMIOLOGY AND PRACTICE PATTERNS
Suggested Reading Quentin M, Blondin D, Arsov C et al: Prospective evaluation of magnetic resonance imaging guided in-bore prostate biopsy versus systematic transrectal ultrasound guided prostate biopsy in biopsy na€ive men with elevated prostate specific antigen. J Urol 2014; 192: 1374. Vourganti S, Rastinehad A, Yerram NK et al: Multiparametric magnetic resonance imaging and ultrasound fusion biopsy detect prostate cancer in patients with prior negative transrectal ultrasound biopsies. J Urol 2012; 188: 2152.
Socioeconomic Factors, Urological Epidemiology and Practice Patterns Re: National Prostate Cancer Screening Rates after the 2012 US Preventive Services Task Force Recommendation Discouraging Prostate-Specific Antigen-Based Screening M. W. Drazer, D. Huo and S. E. Eggener University of Chicago Medical Center, Chicago, Illinois J Clin Oncol 2015; 33: 2416e2423. doi: 10.1200/JCO.2015.61.6532
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26056181 Editorial Comment: This analysis of data from the National Health Interview Survey confirms what many of us in clinical practice have witnessed during the last 3 yearsdthe U.S. Preventive Services Task Force recommendation against prostate cancer screening has had a profound effect on screening rates in primary care practices. The authors stratify screening rates by age in 2010 and 2013 and find that, while screening in men in their 40s remained fairly constant, screening decreased in men in their 50s, 60s and 70s. They also note that, despite this decrease in screening rates, many men with less than a 10-year life expectancy were still screened. This finding should confirm our worst fearsdthat the men who would benefit most from screening are not being screened, while those who likely would benefit least still are being tested as a result of the task force recommendation. Our response to these findings should not be that prostate cancer screening gets a grade A recommendation. The evidence does not support annual screening on a population wide level. We need to start advocating for better screening strategies targeted at the men at greatest risk for the disease, who are most likely to gain a benefit. For example the AUA Guideline suggests that widening the screening interval to every 2 years would reduce the harms from screening. Urologists should consider this strategy. If we do not start to advocate for “smarter prostate cancer screening,” in the end there will be no screening at all. David F. Penson, MD, MPH
Suggested Reading Carter HB, Albertsen PC, Barry MJ et al: Early detection of prostate cancer: AUA Guideline. J Urol 2013; 190: 419. Barocas DA, Mallin K, Graves AJ et al: Effect of the USPSTF grade D recommendation against screening for prostate cancer on incident prostate cancer diagnoses in the United States. J Urol 2015; 194: 1587.
Re: Efficiency, Satisfaction, and Costs for Remote Video Visits following Radical Prostatectomy: A Randomized Controlled Trial B. R. Viers, D. J. Lightner, M. E. Rivera, M. K. Tollefson, S. A. Boorjian, R. J. Karnes, R. H. Thompson, D. A. O’Neil, R. L. Hamilton, M. R. Gardner, M. Bundrick, S. M. Jenkins, S. Pruthi, I. Frank and M. T. Gettman Department of Urology, Center for Innovation, and Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota Eur Urol 2015; 68: 729e735. doi: 10.1016/j.eururo.2015.04.002
IMAGING
929
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25900782 Editorial Comment: Given the technological advances and the massive growth in online commerce during the last 20 years, it was just a matter of time until health care was formally delivered over the Internet. Currently it is clear that telemedicine is feasible and easy to deliver. The question really is whether providers and patients will accept this mode of delivery. This small randomized clinical trial explores this question in the setting of post-prostatectomy visits. The authors randomized 55 men to either an office visit or a video visit following radical prostatectomy. No significant differences were noted in patient perception of the quality of the visit or satisfaction with the visit. Similarly there were no differences in urologist perception of satisfaction. Costs were lower with the video visits. While this must be considered a preliminary study that is limited by sample size, it still provides solid evidence that telemedicine can be applied to urological conditions. There are many questions that remain to be answered regarding telemedicine. Can providers perform telemedicine visits with patients who live in states where the provider is not licensed? How do providers bill for these visits, and what is the appropriate reimbursement for the visit? Which types of visits are most appropriate for telemedicine? Acknowledging that telemedicine is still in its infancy, it is critical that urologists embrace telemedicine and begin to consider how they can deliver this type of care in their regular practice. David F. Penson, MD, MPH
Imaging Re: Detection of Local Recurrence of Prostate Cancer after Radical Prostatectomy Using Endorectal Coil MRI at 3 T: Addition of DWI and Dynamic Contrast Enhancement to T2-Weighted MRI K. Kitajima, R. P. Hartman, A. T. Froemming, C. E. Hagen, N. Takahashi and A. Kawashima Department of Radiology, and Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota AJR Am J Roentgenol 2015; 205: 807e816. doi: 10.2214/AJR.14.14275
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26397329 Editorial Comment: These authors look at the role of endorectal 3 T magnetic resonance imaging for local recurrence after radical prostatectomy. The study includes 280 patients with suspected recurrence with a history of a positive biopsy and increasing prostate specific antigen, and no history of hormonal treatment. A total of 83 patients met inclusion criteria. Patients were assessed by 1) T2-weighted imaging alone, 2) T2 plus diffusion weighted imaging, 3) T2 plus dynamic contrast enhanced (DCE) MRI or 4) T2 plus DCE MRI and diffusion imaging. The authors found the addition of diffusion weighted imaging to the T2-weighted imaging led to under detection of prostate cancer when no diffusion restriction was present in an area of abnormality on the T2-weighted imaging. They conclude that T2-weighted imaging plus DCE MRI has the highest sensitivity and specificity to detect local recurrence. Diffusion weighted imaging with apparent diffusion coefficient mapping added little value regarding lesion detection. This is an important article for radiologists reading MRI of the prostate after prostatectomy. High resolution, detailed images with close review of the DCE MRI for focal or multifocal areas and abnormal enhancement will be valuable to identify recurrence. Cary Siegel, MD