Page 10 - CUA2018 Abstracts - Oncology-Prostate

Poster session 1: Prostate Cancer I

Results: There were no cases of febrile UTI in the swabbed cohort, com- and quality of decision aids using IPDAS instrument in duplicate. We
pared to a rate of 1.7% (n=17) in the non–swabbed cohort. Thus, those abstracted knowledge about prostate cancer screening, discussion dur-
who were screened prior to their biopsy had a 100% risk reduction com- ing clinical encounter, decisional conflict, and screening decision. We
pared to those who weren’t screened (p<0.05). Ciprofloxacin resistance analyzed effects using the DerSimonian–Laird’s random effects inverse
was found in 21.4% of patients swabbed. Of the risk factors analyzed variance method for continuous outcomes, and for dichotomous out-
to determine the likelihood of ciprofloxacin resistance, only previous comes using the Cochran–Mantel–Haenszel method.
antibiotic use was a significant predictor (p<0.03), although recent travel Results: Of 7825 reports, 19 RCTs proved eligible (n=9315 randomized).
outside of North America trended towards significance (p=0.07). Logistic In all studies, allocation sequence was adequately generated; in nine
regression modelling also showed that the likelihood of ciprofloxacin (47%), allocation was adequately concealed and in eight (42%), data
resistance increased with increased antibiotic exposure. collectors were blinded. We were able to evaluate 12 decision aids:
Conclusions: Screening with rectal swabs can significantly decrease the they all reported the aim, all but one reported the impact of screening on
incidence of post–biopsy febrile UTI. Furthermore, patients who have mortality, all but two reported screening harms screening; however, only
had prior antibiotic exposure would especially benefit from rectal cul- four reported the likelihood of a true negative results, and three reported
ture–based prophylaxis. those of false negative results, or next steps for a negative result. None
References: were designed to facilitate shared decision–making between patients and
1. Fasugba O, Gardner A, Mitchell BG, et al. Ciprofloxacin resistance physicians. In the pooled analyses (Figs. 1–4), decision aids moderately
in community–and hospital–acquired Escherichia coli urinary tract increased short–term but not long–term knowledge, and demonstrated
infections: A systematic review and meta–analysis of observational a small decrease in decisional conflict. Decision aids had no effect on
studies. BMC Infect Dis 2015;15: 545. https://doi.org/10.1186/ screening discussion and possibly no effect on decision to undergo
s12879–015–1282–4 screening.
2. Williamson DA, Barrett L, Rogers BA, et al. Infectious complications Conclusions: Moderate quality evidence suggests modest impacts of deci-
following transrectal ultrasound–guided prostate biopsy: New chal- sion aids. Work in this area would benefit from decision aids that promote
lenges in the era of multidrug–resistant Escherichia coli. Clin Infect shared decision–making in the patient–physician encounter.
Dis 2013;57:267–74. https://doi.org/10.1093/cid/cit193
3. Roth H, Millar JL, Cheng AC, et al. The state of TRUS biopsy sepsis: UP–1.3
Readmissions to Victorian hospitals with TRUS biopsy–related infec-
tion over 5 years. BJU Int 2015;116:49–53. https://doi.org/10.1111/ Transperineal prostate biopsies under local anesthetic: Experience
bju.13209 with 507 patients 1 1 1
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4. Taylor AK, Zembower TR, Nadler RB, et al. Targeted antimicrobial Veselina Stefanova , Roger J. Buckley , Stanley Flax , Nicole Golda , Jeffrey
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prophylaxis using rectal swab cultures in men undergoing transrectal Noakes , David Hajek , Les Spevack , Andrew Loblaw
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ultrasound–guided prostate biopsy is associated with reduced inci- Urology, North York General Hospital, Toronto, ON, Canada
dence of postoperative infectious complications and cost of care. J Introduction: Prostate cancer has been typically diagnosed via a transrec-
Urol 2012;187:1275–9. https://doi.org/10.1016/j.juro.2011.11.115 tal ultrasound–guided approach (TRUSBx); however, the risk of urosepsis
has been estimated to be between 5–7%, with hospital admission rates
ranging from 2–4%. Transperineal prostate biopsies (TPBx) have yielded
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UP–1.2 a significantly lower urosepsis rate compared to TRUSBx; however, most
Decision aids for prostate cancer screening: A systematic review series of TPBx described in the literature typically involve a general/spinal
and meta–analysis anesthetic, which is a barrier to the uptake of this technique by community
Jarno Riikonen , Philippe Violette , Gordon Guyatt , Tuomas Kilpeläinen , urologists. We report on our results, experience, and patient tolerability
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Samantha Craigie , Arnav Agarwal , Thomas Agoritsas , Rachel Couban , in 507 patients who underwent a TPBx under local anesthetic beginning
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Philipp Dahm , Petrus Järvinen , Victor Montori , Nicholas Power , Patrick in October 2016.
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Richard , Jarno Rutanen , Henrikki Santti , Thomas Tailly , Qi Zhou , Methods: The NYGH REB reviewed and approved this study. A retrospec-
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Kari Tikkinen 3,13 tive chart review was conducted on consecutive patients who underwent
1 Department of Urology, Tampere University Hospital, Tampere, Finland; TPBx at NYGH from October 12, 2016 to August 31, 2017.
2 Department of Health Research Methods, Evidence, and Impact, McMaster Results: A total of 507 patients underwent a TPBx under local anes-
University, Hamilton, ON, Canada; Department of Urology, Helsinki thetic. Two patients were excluded from the study because of positional
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University Hospital and University of Helsinki, Helsinki, Finland; Faculty limitations. Median age was 65 years and median prostate–specific
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of Medicine, University of Toronto, Toronto, ON, Canada; Department antigen (PSA) was 7.1. Two hundred forty–eight patients had a positive
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of Internal Medicine, Rehabilitation and Geriatrics, University Hospitals pathology for a cancer detection rate of 48.9%. Nine patients developed
of Geneva, Geneva, Switzerland; Department of Urology, University acute urinary retention (1.8%). One patient was admitted with multiple
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of Minnesota, Minneapolis, MN, United States; Department of Internal comorbidities for profound hypotension, but his blood and urine cultures
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Medicine, Mayo Clinic, Rochester, MN, United States; Department of were negative. There were no emergency room visits for urosepsis. Patient
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Surgery – Division of Urology, Western University, London, ON, Canada; tolerability was assessed in our last 62 patients with VAS scores of 2.5 for
9 Faculty of Medicine and Health Sciences, Université de Sherbrooke, ultrasound probe insertion, 3.3 for local skin infiltration, 3.0 for peri–pros-
Sherbrooke, QC, Canada; Department of Internal Medicine, Tampere tatic local infiltration, and 2.4 for the actual biopsy. The clinical patient
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University Hospital, Tampere, Finland; Department of Urology, Ghent characteristics, pathological results, and pain scores are listed in Tables
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University Hospital, Gent, Belgium; Department of Surgery, Woodstock 1, 2, and 3 (available at https://cua.guide/).
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General Hospital, Woodstock, ON, Canada; Department of Public Conclusions: TPBx under local anesthetic is feasible to integrate into a
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Health, University of Helsinki, Helsinki, Finland busy urology practice with a fast learning curve. It has a good cancer
Study Groups: Clinical Urology and Epidemiology (CLUE) Working Group. detection rate and is well–tolerated by patients. Most importantly, a sig-
Introduction: Prostate cancer screening is preference–sensitive. Decision nificant number of urosepsis admissions secondary to TRUSBx can be
aids are intended to facilitate shared decision–making. We conducted prevented with adoption of the TPBx technique.
a systematic review and meta–analysis of randomized controlled trials Reference:
(RCTs) that addressed the impact of decision aids on decisional outcomes 1. Liss MA, Ehdaie B, Loeb S, et al: An update of the American
and screening decisions. Urological Association white paper on the prevention and treat-
Methods: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and ment of the more common complications related to prostate biopsy.
Cochrane CENTRAL up to June 2017. We performed screening, data J Urol 2017; 198:329–34. https://doi.org/10.1016/j.juro.2017.01.103
extraction, assessment of risk of bias using a modified Cochrane tool,
S68 CUAJ • June 2018 • Volume 12(6Suppl2)