Journal of Clinical Urology

Upgrading of Gleason score at radical retropubic prostatectomy (RRP) is a recognised event; however there are few large, national, multicentre studies of upgrading. With the increasing utilisation of active surveillance as an option in the treatment of prostate cancer upgrading is an increasing concern to urologists.

To analyse the discordance between the biopsy Gleason score and the RRP Gleason score using the BAUS database from a non-screened UK population.

Data were obtained from the BAUS cancer registry which holds data on national complex operations. All patients who underwent RRP with pre and post-operative Gleason score were included in the study.

1420 men were included in the study, mean age 62. Comparing Gleason score between the biopsy and the RRP specimen, 30% men were found to upgraded and 9% downgraded. Clinically significant upgrading was seen in 28%. Age and PSA were found to be higher in the upgraded cohort (p< 0.02). Positive margins and seminal vesicle invasion were significantly higher in the upgraded group (p < 0.02). Univariate analysis revealed PSA and age as significant predictors of upgrading at RRP (p<0.05).

This large study provides novel data from a non-screened UK population, nearly one-third of whom had clinically significant upgrading. We have also shown that adverse pathological events, positive margin and seminal vesicle invasion, are more common in the upgraded cohort. This evidence needs to be considered when managing men with localised prostate cancer especially when considering active surveillance.

To prospectively report the acute urinary symptoms associated with three-dimensional conformal radiotherapy (3D-CRT) during and after treatment of localised prostate cancer. Patients and methods: 22 consecutive patients receiving 3D-CRT were recruited into a single-arm prospective study.

There is a significant transient acute rise in International Prostate Symptom Score (IPSS) during 3D-CRT for treatment of localised prostate cancer with a corresponding deterioration in Quality of Life (QoL). Mean total IPSS rose in a progressive manner from 9.75 at baseline to a peak of 20.2 at the end of radiotherapy (week 7). The observed mean difference in total IPSS between baseline and week 7 of treatment was 10.45 (95% CI 6.3–14.6, p<0.0001). By 8 weeks following the end of treatment the IPSS had returned to pre-treatment levels.

This study proves that 3D-CRT for the treatment of prostate cancer is associated with a significant acute and transient rise in the total IPSS and QoL score. It is important that consent before radiotherapy should include a description of these symptoms.

The aim of this study was to determine if patients newly diagnosed with bladder cancer and included in a clinical trial had better outcomes than similar patients treated in the same department before initiation of the trial.

Forty patients presenting with bladder cancer in 2005 and recruited into a randomised trial of photodynamic-assisted tumour resection were compared with a cohort of 40 non-trial patients from 2004. Quality of care was measured by assessing near-miss criteria.

There were fewer near-misses in the Trial Group (TG) than in the Control Group (CG) (52 versus 151) (p< 0.001). There were 15 surgical near-misses in the TG compared with 90 in the CG (p=0.025). Adjuvant intravesical chemotherapy was given within 6 h of resection in 26/31(84%) of the TG and 1/23(4%) of the CG. There were 37 process near-misses in the TG compared with 61 in the CG (p=0.002). The times to first outpatient appointment, diagnostic flexible cystoscopy, and outpatient follow-up were shorter in the TG (median 10.5/25/17.5 days) than the CG (median 17/32.5/26 days).

Patients in the trial had better outcomes than non-trial patients the previous year. The recruitment of patients into trials is a valuable driver of quality improvement.

This study was designed to evaluate the efficacy of the intravesical instillation of single-dose Mitomycin C post-ablation of purely recurrent tumours.

Two patient groups with small-volume, low-grade (1 or 2), superficial (pTa) recurrent disease were studied. Sixty-seven patients at one institution received a single intravesical dose of Mitomycin C following tumour ablation using a Holmium YAG Laser. The other institution provided a control patient group of 68 patients treated with laser ablation alone. Patients were reviewed with regular flexible cystoscopies throughout the study period.

The groups were matched for age and the number and grade of tumours. Recurrence rates were lower, yet not to statistical significance, in the group receiving Mitomycin C post-intervention (48% vs. 62% (p= 0.14) at 12 months and 76% vs. 82% at 24 months (p = 0.64)). The observed beneficial effect at 12 months appeared to depreciate by 24 months. There was no significant improvement in the recurrence-free interval for the Mitomycin C group (log rank test p = 0.28).

This study has failed to demonstrate a beneficial trend for the use of single-dose of Mitomycin C after ablation of recurrent superficial bladder cancer. Further evaluation in the form of a prospective trial is indicated.