OBJECTIVE To describe the risks of urinary diversion performed to address adverse effects of gyne... more OBJECTIVE To describe the risks of urinary diversion performed to address adverse effects of gynecologic radiation, with the hypothesis that high grade complications would be more common in sarcopenic women and in those undergoing continent diversion (vs noncontinent) or concomitant cystectomy (vs bladder-sparing diversion). METHODS A retrospective review was performed of patient records of women who underwent urinary diversion for urinary adverse effects of gynecologic radiotherapy during the period of 2008-2018 from 3 tertiary centers. Skeletal muscle index was calculated to assess for sarcopenia based on preoperative computed tomography scans. Outcomes include high-grade postoperative complications within 90 days of surgery, 30-day readmission rate, and long-term (>90 days) outcomes. RESULTS Among 34 women who met the inclusion criteria, the majority were white/Caucasian (73.5%). Twenty-six of 34 (76.5%) underwent noncontinent diversion. Seventy nine percent (27/34) (79.4%) of women experienced complications within 90 days; 9 of 34 (26.5%) experienced highgrade (Clavien grade ≥3) complications. Thirty-two percent (11/34) were readmitted within 30 days. Rates of high-grade complications were not significantly impacted by diversion type (P = .49), concurrent cystectomy (P = .70), or sarcopenia (P = 1.0). CONCLUSIONS Urinary diversion for late adverse effects of gynecologic radiotherapy is associated with high peri-operative risk, even in skilled hands. In this series, neither sarcopenia, nor continent diversion, nor cystectomy were associated with increased complications. Patients and surgeons should consider risks and benefits when deciding to proceed with urinary diversion, however further study is needed to elucidate significant preoperative markers which may predispose patients to significant complications. UROLOGY 00: 1−6, 2020.
Clinical competency committee (CCC) identification of residents with performance concerns is crit... more Clinical competency committee (CCC) identification of residents with performance concerns is critical for early intervention. Program directors and 94 CCC members at 14 pediatric residency programs responded to a written survey prompt asking them to describe how they identify residents with performance concerns. Data was analyzed using thematic analysis. Six themes emerged from analysis and were grouped into two domains. The first domain included four themes, each describing a path through which residents could meet or exceed a concern threshold:1) written comments from rotation assessments are foundational in identifying residents with performance concerns, 2) concerning performance extremes stand out, 3) isolated data points may accumulate to raise concern, and 4) developmental trajectory matters. The second domain focused on how CCC members and program directors interpret data to make decisions about residents with concerns and contained 2 themes: 1) using norm- and/or criterion-...
despite the majority (78.5%) reporting that they felt it was important for pediatricians to posse... more despite the majority (78.5%) reporting that they felt it was important for pediatricians to possess this understanding. In 2012, 36.9% of residents felt it was important for pediatricians to be actively engaged in the work of healthcare policy-making bodies, while in the 2016 election cycle, 78.2% felt similarly (p < 0.001). In 2012, 29.3% of residents anticipated spending at least 20% of their future career engaged in healthcare policy, while in 2016, that number increased to 59.4% (p < 0.001). In an uncertain political climate, pediatric trainees increasingly envision themselves as actors on the healthcare policy stage. While they consider it important for pediatricians to understand the details of healthcare-policy formation, residents report a significant lack of confidence in their own knowledge of the organizations that shape healthcare in the United States. These data highlight an opportunity for training programs across the country to enhance their curricula to prepare trainees for leadership in advocacy at the local and national levels.
INTRODUCTION AND OBJECTIVES: Urethral stricture disease is common condition with significant qual... more INTRODUCTION AND OBJECTIVES: Urethral stricture disease is common condition with significant quality of life and economic implications. While endoscopic treatment with incision or dilation is the most common treatment approach, guidelines increasingly recommend urethroplasty based on its high success rates. Whether real world, community practice outcomes mirror those of large volume single center institutional series is unknown. For these reasons, we conducted a population-based study of patients treated with urethroplasty and their outcomes. METHODS: We identified male patients who underwent urethroplasty between 2001 and June 2015 based on ICD-9 codes and administrative claims from a large, national US health insurer (ClinformaticsTM Data Mart Database, OptumInsight, Eden Prairie, MN). We assessed utilization of endoscopic treatments (urethrotomy and dilation) prior to and after urethroplasty. We defined urethroplasty failure by any subsequent urethral dilation, urethrotomy, or urethroplasty after initial urethroplasty. We examined factors associated with failure using multivariable logistic regression and Cox proportional hazards models. RESULTS: We identified 1345 patients treated with urethroplasty. Urethroplasty failure occurred in 344 (26%) of patients. Repeat urethroplasty was performed in 139 (40%) of failures (range 28). Increased number of endoscopic treatments prior to first urethroplasty was associated with urethroplasty failure. The mean ( SD) time to failure was 270 42 days. CONCLUSIONS: Our population-based study demonstrated significantly lower success rates for urethroplasty than previously published reports. Strategies to achieve better outcomes for patients with urethral stricture disease include increasing referrals to reconstructive urologic surgeons, and knowledge and technique transfer to community urologists interested in providing this service rather than repeated, low-value endoscopic treatment.
108 Background: Severe urinary adverse events (UAEs) include surgical treatment of urethral stric... more 108 Background: Severe urinary adverse events (UAEs) include surgical treatment of urethral stricture, urinary incontinence and radiation cystitis. Our objective is to compare the incidence of late UAEs after low dose rate BT (LDR) and high dose rate BT (HDR) as well as LDR+EBRT and HDR+EBRT. Methods: We identified men treated with LDR (n=12,801), HDR (n=685), LDR+EBRT (8,518) and HDR+EBRT (n=2,392) from the SEER-Medicare Database. The populations were balanced by propensity weighting and the Kaplan-Meier incidence of severe UAEs was compared. Propensity-weighted Cox proportional hazards models were used to compare the adjusted hazard of UAEs. These UAEs were compared to a cohort of men not treated for prostate cancer. Results: Median follow-up was 4.3 years. At 8 years, the propensity weighted cumulative UAE incidence was highest after HDR+EBRT (28%) and lowest after LDR (17%; see Figure). The absolute excess risk over non-treated controls of a UAE at 8 years was 1.9%, 3.8%, 8.4% a...
The purpose of this Guideline is to provide a clinical framework for the diagnosis and treatment ... more The purpose of this Guideline is to provide a clinical framework for the diagnosis and treatment of male urethral stricture. A systematic review of the literature using the Pubmed, Embase, and Cochrane databases (search dates 1/1/1990 to 12/1/2015) was conducted to identify peer-reviewed publications relevant to the diagnosis and treatment of urethral stricture. The review yielded an evidence base of 250 articles after application of inclusion/exclusion criteria. These publications were used to create the Guideline statements. Evidence-based statements of Strong, Moderate, or Conditional Recommendation were developed based on benefits and risks/burdens to patients. Additional guidance is provided as Clinical Principles and Expert Opinion when insufficient evidence existed. The Panel identified the most common scenarios seen in clinical practice related to the treatment of urethral strictures. Guideline statements were developed to aid the clinician in optimal evaluation, treatment, ...
We are in the midst of a paradigm shift in the surgical management of benign prostatic hyperplasi... more We are in the midst of a paradigm shift in the surgical management of benign prostatic hyperplasia (BPH). After decades of decline, there is a recent surge in the rate of BPH surgeries—largely represented by laser prostatectomy and office-based thermotherapies. In the United States, the number of transurethral resections of the prostate (TURP) continues to decline, now representing a minority
When exposed to known DNA-damaging alkylating agents, Escherichia coli cells increase production ... more When exposed to known DNA-damaging alkylating agents, Escherichia coli cells increase production of four DNA repair enzymes: Ada, AlkA, AlkB, and AidB. The role of three enzymes (Ada, AlkA, and AlkB) in repairing DNA lesions has been well characterized, while the function of AidB is poorly understood. AidB has a distinct cofactor that is potentially related to the elusive role of AidB in adaptive response: a redox active flavin adenine dinucleotide (FAD). In this study, we report the thermodynamic redox properties of the AidB flavin for the first time, both for free protein and in the presence of potential substrates. We find that the midpoint reduction potential of the AidB flavin is within a biologically relevant window for redox chemistry at −181 mV, that AidB significantly stabilizes the flavin semiquinone, and that small molecule binding perturbs the observed reduction potential. Our electrochemical results combined with structural
To identify the urologic needs of adult patients with spina bifida (SB) at the time of their tran... more To identify the urologic needs of adult patients with spina bifida (SB) at the time of their transition from pediatric to adult care. We hypothesized that delays in transition to adult care would be associated with higher rates of active problems. We retrospectively reviewed patients seen at adult dedicated SB clinics at the Universities of Utah and Minnesota from April 2011 to April 2012. We reviewed bladder management, urologic problems, time from last urologic care, and necessary interventions. We identified 65 patients from these clinics with SB. The mean age was 30.6 years (standard deviation, 11.3). The median time since last urologic evaluation at Utah and Minnesota was 17 months and 12 months, respectively (range 1 month-10 years). Fifty-five patients (85%) reported a urologic problem at the time of their visit. Urinary incontinence was most common in 34 (52%), followed by recurrent urinary tract infection in 22 (34%), catheterization troubles in 8 (12%), and calculi in 6 (9%). Sixty-three patients (97%) required some sort of intervention. These were diagnostic (cystoscopy, ultrasonography, computed tomography scan, urodynamics) in 50 patients (77%), surgical (urinary diversion, onabotulinum toxin A injection, stone surgery, and so forth) in 22 (34%), and medical (antimicrobial prophylaxis, bladder irrigations, anticholinergics, self-catheterization) in 16 (25%). There was no association between longer transition times and higher rates of active problems. On presentation to adult SB clinics, patients had many active urologic problems and operative management was often needed; however, there was no association between longer transition times and higher rates of active problems.
Objective. To assess and address participants’ dissatisfaction with departmental morning report (... more Objective. To assess and address participants’ dissatisfaction with departmental morning report (MR). Methods. Three consecutive MR sessions were observed, and those data, in combination with findings from the literature, were used to guide creation of a quantitative survey. The survey was administered to all faculty and housestaff. Survey items addressed the educational focus, leadership, and format of MR and the value of specific educational conferences. Subsequently, 2 interventions were developed to increase participants’ level of satisfaction with MR. The interventions’ effect was measured 1 year later using a second survey. Results. Eighty-two percent of housestaff and 43% of faculty responded to the first survey. Our findings are contrary to those in the literature. For example, respondents rated the presence of all faculty at MR as desirable, and both subspecialty and general pediatric contributions were considered important. Housestaff assigned greater educational value to ...
Staphylococcus lugdunensis, a coagulase-negative staphylococcus first described in 1988, has gain... more Staphylococcus lugdunensis, a coagulase-negative staphylococcus first described in 1988, has gained recognition as an organism with considerable pathogenic capability in adults. In contrast to the indolent presentation characteristic of other coagulase-negative staphylococci, S. lugdunensis infections resemble the aggressive behavior of Staphylococcus aureus. Although the organism has been isolated from a wide variety of infections in adults, it is a very rare cause of pediatric infections. We describe the first two pediatric patients who developed ventriculoperitoneal shunt infections caused by S. lugdunensis. These cases suggest that coagulase-negative staphylococci should be identified to the species level and that, if S. lugdunensis is identified, greater morbidity compared to that associated with other coagulase-negative staphylococcal shunt infections should be anticipated. A longer course of therapy is recommended for S. lugdunensis infections.
INTRODUCTION AND OBJECTIVES: Much of the focus on prostate cancer therapy for the last 20 years h... more INTRODUCTION AND OBJECTIVES: Much of the focus on prostate cancer therapy for the last 20 years has been on the aggressive treatment of localized low risk disease. However, while much less common, high grade disease is responsible for 2–3 fold the number of deaths compared to its incidence. Using the SEER database, we investigated whether progress has been made in the survival of patients with high grade disease. METHODS: The SEER database was interrogated to isolate patients with high grade disease (1992–2002) with at least five years of follow-up. The percentage of patients with high grade disease and treatment modalities were determined. Survival was compared by Kaplan-Meier methods. RESULTS: We analyzed the data for 54,636 patients with high grade disease. The percentage of patients with high grade disease has remained the same relative percentage of 10–15% of the total SEER population with prostate cancer from 1992–2002, The percentage of patients treated with surgery (26–31%) vs. radiation (27–37%) has been unchanged throughout the study period. Kaplan meier five year survival rates amongst patients with high grade disease have only modestly improved from 36% in patients diagnosed in 1995 to 31% in patients diagnosed in 2002. CONCLUSIONS: The percentage of patients with high grade prostate cancer has remained fairly stable. Furthermore, high grade disease remains responsible for a high proportion of the deaths from prostate cancer. The attention of the urology community needs to shift from localized low grade disease to an increased focus on the development of novel therapeutic strategies for the treatment of high grade prostate cancer.
OBJECTIVE To describe the risks of urinary diversion performed to address adverse effects of gyne... more OBJECTIVE To describe the risks of urinary diversion performed to address adverse effects of gynecologic radiation, with the hypothesis that high grade complications would be more common in sarcopenic women and in those undergoing continent diversion (vs noncontinent) or concomitant cystectomy (vs bladder-sparing diversion). METHODS A retrospective review was performed of patient records of women who underwent urinary diversion for urinary adverse effects of gynecologic radiotherapy during the period of 2008-2018 from 3 tertiary centers. Skeletal muscle index was calculated to assess for sarcopenia based on preoperative computed tomography scans. Outcomes include high-grade postoperative complications within 90 days of surgery, 30-day readmission rate, and long-term (>90 days) outcomes. RESULTS Among 34 women who met the inclusion criteria, the majority were white/Caucasian (73.5%). Twenty-six of 34 (76.5%) underwent noncontinent diversion. Seventy nine percent (27/34) (79.4%) of women experienced complications within 90 days; 9 of 34 (26.5%) experienced highgrade (Clavien grade ≥3) complications. Thirty-two percent (11/34) were readmitted within 30 days. Rates of high-grade complications were not significantly impacted by diversion type (P = .49), concurrent cystectomy (P = .70), or sarcopenia (P = 1.0). CONCLUSIONS Urinary diversion for late adverse effects of gynecologic radiotherapy is associated with high peri-operative risk, even in skilled hands. In this series, neither sarcopenia, nor continent diversion, nor cystectomy were associated with increased complications. Patients and surgeons should consider risks and benefits when deciding to proceed with urinary diversion, however further study is needed to elucidate significant preoperative markers which may predispose patients to significant complications. UROLOGY 00: 1−6, 2020.
Clinical competency committee (CCC) identification of residents with performance concerns is crit... more Clinical competency committee (CCC) identification of residents with performance concerns is critical for early intervention. Program directors and 94 CCC members at 14 pediatric residency programs responded to a written survey prompt asking them to describe how they identify residents with performance concerns. Data was analyzed using thematic analysis. Six themes emerged from analysis and were grouped into two domains. The first domain included four themes, each describing a path through which residents could meet or exceed a concern threshold:1) written comments from rotation assessments are foundational in identifying residents with performance concerns, 2) concerning performance extremes stand out, 3) isolated data points may accumulate to raise concern, and 4) developmental trajectory matters. The second domain focused on how CCC members and program directors interpret data to make decisions about residents with concerns and contained 2 themes: 1) using norm- and/or criterion-...
despite the majority (78.5%) reporting that they felt it was important for pediatricians to posse... more despite the majority (78.5%) reporting that they felt it was important for pediatricians to possess this understanding. In 2012, 36.9% of residents felt it was important for pediatricians to be actively engaged in the work of healthcare policy-making bodies, while in the 2016 election cycle, 78.2% felt similarly (p < 0.001). In 2012, 29.3% of residents anticipated spending at least 20% of their future career engaged in healthcare policy, while in 2016, that number increased to 59.4% (p < 0.001). In an uncertain political climate, pediatric trainees increasingly envision themselves as actors on the healthcare policy stage. While they consider it important for pediatricians to understand the details of healthcare-policy formation, residents report a significant lack of confidence in their own knowledge of the organizations that shape healthcare in the United States. These data highlight an opportunity for training programs across the country to enhance their curricula to prepare trainees for leadership in advocacy at the local and national levels.
INTRODUCTION AND OBJECTIVES: Urethral stricture disease is common condition with significant qual... more INTRODUCTION AND OBJECTIVES: Urethral stricture disease is common condition with significant quality of life and economic implications. While endoscopic treatment with incision or dilation is the most common treatment approach, guidelines increasingly recommend urethroplasty based on its high success rates. Whether real world, community practice outcomes mirror those of large volume single center institutional series is unknown. For these reasons, we conducted a population-based study of patients treated with urethroplasty and their outcomes. METHODS: We identified male patients who underwent urethroplasty between 2001 and June 2015 based on ICD-9 codes and administrative claims from a large, national US health insurer (ClinformaticsTM Data Mart Database, OptumInsight, Eden Prairie, MN). We assessed utilization of endoscopic treatments (urethrotomy and dilation) prior to and after urethroplasty. We defined urethroplasty failure by any subsequent urethral dilation, urethrotomy, or urethroplasty after initial urethroplasty. We examined factors associated with failure using multivariable logistic regression and Cox proportional hazards models. RESULTS: We identified 1345 patients treated with urethroplasty. Urethroplasty failure occurred in 344 (26%) of patients. Repeat urethroplasty was performed in 139 (40%) of failures (range 28). Increased number of endoscopic treatments prior to first urethroplasty was associated with urethroplasty failure. The mean ( SD) time to failure was 270 42 days. CONCLUSIONS: Our population-based study demonstrated significantly lower success rates for urethroplasty than previously published reports. Strategies to achieve better outcomes for patients with urethral stricture disease include increasing referrals to reconstructive urologic surgeons, and knowledge and technique transfer to community urologists interested in providing this service rather than repeated, low-value endoscopic treatment.
108 Background: Severe urinary adverse events (UAEs) include surgical treatment of urethral stric... more 108 Background: Severe urinary adverse events (UAEs) include surgical treatment of urethral stricture, urinary incontinence and radiation cystitis. Our objective is to compare the incidence of late UAEs after low dose rate BT (LDR) and high dose rate BT (HDR) as well as LDR+EBRT and HDR+EBRT. Methods: We identified men treated with LDR (n=12,801), HDR (n=685), LDR+EBRT (8,518) and HDR+EBRT (n=2,392) from the SEER-Medicare Database. The populations were balanced by propensity weighting and the Kaplan-Meier incidence of severe UAEs was compared. Propensity-weighted Cox proportional hazards models were used to compare the adjusted hazard of UAEs. These UAEs were compared to a cohort of men not treated for prostate cancer. Results: Median follow-up was 4.3 years. At 8 years, the propensity weighted cumulative UAE incidence was highest after HDR+EBRT (28%) and lowest after LDR (17%; see Figure). The absolute excess risk over non-treated controls of a UAE at 8 years was 1.9%, 3.8%, 8.4% a...
The purpose of this Guideline is to provide a clinical framework for the diagnosis and treatment ... more The purpose of this Guideline is to provide a clinical framework for the diagnosis and treatment of male urethral stricture. A systematic review of the literature using the Pubmed, Embase, and Cochrane databases (search dates 1/1/1990 to 12/1/2015) was conducted to identify peer-reviewed publications relevant to the diagnosis and treatment of urethral stricture. The review yielded an evidence base of 250 articles after application of inclusion/exclusion criteria. These publications were used to create the Guideline statements. Evidence-based statements of Strong, Moderate, or Conditional Recommendation were developed based on benefits and risks/burdens to patients. Additional guidance is provided as Clinical Principles and Expert Opinion when insufficient evidence existed. The Panel identified the most common scenarios seen in clinical practice related to the treatment of urethral strictures. Guideline statements were developed to aid the clinician in optimal evaluation, treatment, ...
We are in the midst of a paradigm shift in the surgical management of benign prostatic hyperplasi... more We are in the midst of a paradigm shift in the surgical management of benign prostatic hyperplasia (BPH). After decades of decline, there is a recent surge in the rate of BPH surgeries—largely represented by laser prostatectomy and office-based thermotherapies. In the United States, the number of transurethral resections of the prostate (TURP) continues to decline, now representing a minority
When exposed to known DNA-damaging alkylating agents, Escherichia coli cells increase production ... more When exposed to known DNA-damaging alkylating agents, Escherichia coli cells increase production of four DNA repair enzymes: Ada, AlkA, AlkB, and AidB. The role of three enzymes (Ada, AlkA, and AlkB) in repairing DNA lesions has been well characterized, while the function of AidB is poorly understood. AidB has a distinct cofactor that is potentially related to the elusive role of AidB in adaptive response: a redox active flavin adenine dinucleotide (FAD). In this study, we report the thermodynamic redox properties of the AidB flavin for the first time, both for free protein and in the presence of potential substrates. We find that the midpoint reduction potential of the AidB flavin is within a biologically relevant window for redox chemistry at −181 mV, that AidB significantly stabilizes the flavin semiquinone, and that small molecule binding perturbs the observed reduction potential. Our electrochemical results combined with structural
To identify the urologic needs of adult patients with spina bifida (SB) at the time of their tran... more To identify the urologic needs of adult patients with spina bifida (SB) at the time of their transition from pediatric to adult care. We hypothesized that delays in transition to adult care would be associated with higher rates of active problems. We retrospectively reviewed patients seen at adult dedicated SB clinics at the Universities of Utah and Minnesota from April 2011 to April 2012. We reviewed bladder management, urologic problems, time from last urologic care, and necessary interventions. We identified 65 patients from these clinics with SB. The mean age was 30.6 years (standard deviation, 11.3). The median time since last urologic evaluation at Utah and Minnesota was 17 months and 12 months, respectively (range 1 month-10 years). Fifty-five patients (85%) reported a urologic problem at the time of their visit. Urinary incontinence was most common in 34 (52%), followed by recurrent urinary tract infection in 22 (34%), catheterization troubles in 8 (12%), and calculi in 6 (9%). Sixty-three patients (97%) required some sort of intervention. These were diagnostic (cystoscopy, ultrasonography, computed tomography scan, urodynamics) in 50 patients (77%), surgical (urinary diversion, onabotulinum toxin A injection, stone surgery, and so forth) in 22 (34%), and medical (antimicrobial prophylaxis, bladder irrigations, anticholinergics, self-catheterization) in 16 (25%). There was no association between longer transition times and higher rates of active problems. On presentation to adult SB clinics, patients had many active urologic problems and operative management was often needed; however, there was no association between longer transition times and higher rates of active problems.
Objective. To assess and address participants’ dissatisfaction with departmental morning report (... more Objective. To assess and address participants’ dissatisfaction with departmental morning report (MR). Methods. Three consecutive MR sessions were observed, and those data, in combination with findings from the literature, were used to guide creation of a quantitative survey. The survey was administered to all faculty and housestaff. Survey items addressed the educational focus, leadership, and format of MR and the value of specific educational conferences. Subsequently, 2 interventions were developed to increase participants’ level of satisfaction with MR. The interventions’ effect was measured 1 year later using a second survey. Results. Eighty-two percent of housestaff and 43% of faculty responded to the first survey. Our findings are contrary to those in the literature. For example, respondents rated the presence of all faculty at MR as desirable, and both subspecialty and general pediatric contributions were considered important. Housestaff assigned greater educational value to ...
Staphylococcus lugdunensis, a coagulase-negative staphylococcus first described in 1988, has gain... more Staphylococcus lugdunensis, a coagulase-negative staphylococcus first described in 1988, has gained recognition as an organism with considerable pathogenic capability in adults. In contrast to the indolent presentation characteristic of other coagulase-negative staphylococci, S. lugdunensis infections resemble the aggressive behavior of Staphylococcus aureus. Although the organism has been isolated from a wide variety of infections in adults, it is a very rare cause of pediatric infections. We describe the first two pediatric patients who developed ventriculoperitoneal shunt infections caused by S. lugdunensis. These cases suggest that coagulase-negative staphylococci should be identified to the species level and that, if S. lugdunensis is identified, greater morbidity compared to that associated with other coagulase-negative staphylococcal shunt infections should be anticipated. A longer course of therapy is recommended for S. lugdunensis infections.
INTRODUCTION AND OBJECTIVES: Much of the focus on prostate cancer therapy for the last 20 years h... more INTRODUCTION AND OBJECTIVES: Much of the focus on prostate cancer therapy for the last 20 years has been on the aggressive treatment of localized low risk disease. However, while much less common, high grade disease is responsible for 2–3 fold the number of deaths compared to its incidence. Using the SEER database, we investigated whether progress has been made in the survival of patients with high grade disease. METHODS: The SEER database was interrogated to isolate patients with high grade disease (1992–2002) with at least five years of follow-up. The percentage of patients with high grade disease and treatment modalities were determined. Survival was compared by Kaplan-Meier methods. RESULTS: We analyzed the data for 54,636 patients with high grade disease. The percentage of patients with high grade disease has remained the same relative percentage of 10–15% of the total SEER population with prostate cancer from 1992–2002, The percentage of patients treated with surgery (26–31%) vs. radiation (27–37%) has been unchanged throughout the study period. Kaplan meier five year survival rates amongst patients with high grade disease have only modestly improved from 36% in patients diagnosed in 1995 to 31% in patients diagnosed in 2002. CONCLUSIONS: The percentage of patients with high grade prostate cancer has remained fairly stable. Furthermore, high grade disease remains responsible for a high proportion of the deaths from prostate cancer. The attention of the urology community needs to shift from localized low grade disease to an increased focus on the development of novel therapeutic strategies for the treatment of high grade prostate cancer.
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