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Weekly Update
 Update No. 118
The Voice of Men With Prostate Cancer in Europe

IN THIS ISSUE:


Combined biopsy more effective in detection of PCa
Use of MRI-targeted and 12-core systematic biopsies

Individualized pelvic physical therapy for the treatment of post-prostatectomy stress urinary incontinence and pelvic pain
A more individualized approach

New Unconfirmed Bone Tumours and Outcomes in Men With mCRPC Treated With Enzalutamide
Secondary Analysis of the PREVAIL and AFFIRM Trials

Postponed Conferences
 
Humour

Responding to Covid-19 By Bill Gates
A Once-in-a-Century Pandemic

A Response to COVID-19 using Big Data Analytics, New Technology, and Proactive Testing
How Taiwan deployed these approaches to good effect?

Recommendations of the American College of Surgeons

Combined biopsy more effective in detection of prostate cancer

Use of MRI-targeted and 12-core systematic biopsies in PCa



With the change in detection procedures for PCa now underway, the role of imaging using mpMRI is a centrepiece of the revised detection and pre-biopsy prococedures. This study published earlier this month in the New England Journal of Medicine suggests for men with an elevated PSA, an MRI plus a 12-core systematic biopsy, is more effective than either on its own. Whether this has any impact on the adoption of procedures recommended by the EAU guidelines committee remains to be seen. The current recommendation is that a positive mpMRI scan should be first obtained and only then should a needle biopsy be undertaken. The study procedure also used TRUS biopsies rather than the lower risk perineal needle biopsies which are now recommended.  

The findings suggest that a combined biopsy provides improved diagnostic accuracy over either systematic or MRI-targeted biopsy alone and better predicts the results of final Gleason grading analysis.

To read more on this study access the report in March issue of ESMO Science: https://www.esmo.org/oncology-news/use-of-both-mri-targeted-and-12-core-systematic-biopsies-in-prostate-cancer?hit=mail-snews&utm_campaign=Scientific&utm_source=hs_email&utm_medium=email&utm_content=84643566&_hsenc=p2ANqtz-_sa47HagHdyowlLw12z1FivA3F2fM8AlI1q-OLjH0ullcYU4cNK7bGAKnNQ3XayaTVdKrjeDoa_bn-iqMJN86LK9cEWg&_hsmi=84643566

Or read the original article in the NEJM of 5 March: https://www.nejm.org/doi/full/10.1056/NEJMoa1910038?query=TOC


 

Individualized pelvic physical therapy for the treatment of post-prostatectomy stress urinary incontinence and pelvic pain 

more individualized approach aims at normalizing the pelvic floor function for each man

 
A study published in International Urology and Nephrology, suggests there may be a subset of patients for Pelvic Physical Therapy instead of Kegel pelvic training may be required for greatest improvement of post-RP incontinence.

The traditional line of reasoning is that men who have Stress Urinary Incontinence SUI after RP need to do Kegel exercises because their pelvic floor muscles are too weak according to one of the authors. However, now it appears that men who have surgery often develop pelvic floor overactivity or muscle tightness postoperatively, and any type of pelvic floor dysfunction can lead to stress incontinence.

The authors suggest moving toward a more individualized approach aimed at normalizing the pelvic floor function for each man. Healthcare providers who specialise in pelvic floor problems have come to understand that Kegel exercises can worsen pelvic floor overactivity and are not the best treatment for every patient.

 “This study is the first to demonstrate that pelvic physical therapy may be a beneficial treatment modality for men who have pelvic pain after prostatectomy, because the pain for some men may be attributable to pelvic floor myofascial pain associated with the pelvic floor overactivity issue,” the lead author Dr Kelly M. Scott told Renal & Urology News.

Reference:
Scott, Kelly M, Gosai E, Bradley MH. et al. Individualized pelvic physical therapy for the treatment of post-prostatectomy stress urinary incontinence and pelvic pain [published online December 5, 2019]. Int Urol Nephrol.

Read more:
https://doi.org/10.1007/s11255-019-02343-7


 

New Unconfirmed Bone Tumours and Outcomes in Men With mCRPC Treated With Enzalutamide

Secondary Analysis of the PREVAIL and AFFIRM Randomized Clinical Trials




For men with metastatic castration-resistant prostate cancer (mCRPC) whose condition is responding to enzalutamide, new unconfirmed bone lesions detected at post-treatment bone scan may indicate a bone tumour reaction that represents healing, known as pseudo-progression, which can lead to premature discontinuation of therapy.

The objective of the study was to determine the association between new unconfirmed lesions detected on a follow-up bone scan and outcomes in enzalutamide-treated men with mCRPC.

A total of 1672 enzalutamide-treated men from the PREVAIL and AFFIRM studies.  Participants were men from the enzalutamide groups with a decrease in prostate-specific antigen level at any time or with stable disease or soft-tissue disease responding to treatment based on radiologic findings.

More information:
https://jamanetwork.com/journals/jamaoncology/fullarticle/2757385


 

Postponed Conferences

March 20-24, 2020 -> Postponed to July 17-21, 2020
EAU 2020
7th ESO Observatory on Prostate Cancer
Europa Uomo Board meeting
EAU20 – Game changing session 4
Patient Forum organized by PKS. The Netherlands
Amsterdam, The Netherlands

April 3-7, 2020 -> Postponed to July 31 - August 4, 2020
ESTRO meeting
Vienna, Austria

June 12-14, 2020 -> Postponed to Autumn 2020
ECPC Annual General Meeting
Brussels, Belgium



The planned Europa Uomo Board meeting will go ahead on Friday 20 March as a video conference.

 

Humour

St Patrick’s Day occurred this week so the jokes have a slight Irish tinge.  One of them uses the Gaelic word “Óg” as in Seán Óg to denote the “Seán the younger”

So here are some spirit-raising anecdotes….

 

Two lawyers standing before an Irish judge got into a fierce argument. At last, one lawyer lost his temper and shouted. “Sir, you are the biggest fool I have ever set eyes on!”. “Order, order” said the judge striking his gavel “you seem to forget that I am in the room also!”
 
*    *    *

*A wee boy comes home from school in tears.
“What’s the matter, son? said his mother
“We were doing sums today, Mammy,” he said sobbing.
“And were they too hard?”
“Well, the teacher said either I could not count or I was stupid, or all three!”

*    *    *
 
''Young man,” said the judge, looking rather sternly at the defendant.  “It’s alcohol and alcohol alone that’s responsible for your present state”.

“I am so glad to hear you say that, judge” replied Mr Murphy with a sigh of relief, “Everybody else says it’s all my fault!”
 
*    *    *

Seán Óg opened the morning paper and was dumbfounded to read in the obituary column that he had died. He immediately rang his friend O’Brien.

“Did you see the paper?” asked Seán Óg  “They say I died!!”  “Yes, I saw it!” replied his friend in a rather shaky voice. “Where is it you’re calling from?” 
 

From Jokes, Quotes and Anecdotes…an Anatomy of Wit. by Mick Harkin.


 

Responding to Covid-19 By Bill Gates

A Once-in-a-Century Pandemic



In any crisis, leaders have two equally important responsibilities: solve the immediate problem and keep it from happening again. The Covid-19 pandemic is a case in point. We need to save lives now while also improving the way we respond to outbreaks in general. The first point is more pressing, but the second has crucial long-term consequences.

The long-term challenge - improving our ability to respond to outbreaks - isn’t new. Global health experts have been saying for years that another pandemic whose speed and severity rivaled those of the 1918 influenza epidemic was a matter not of if but of when. The Bill and Melinda Gates Foundation has committed substantial resources in recent years to helping the world prepare for such a scenario.

Now we also face an immediate crisis. In the past week, Covid-19 has started behaving a lot like the once-in-a-century pathogen we’ve been worried about. I hope it’s not that bad, but we should assume it will be until we know otherwise.

See the full article for free in the NEJM: https://www.nejm.org/doi/full/10.1056/NEJMp2003762?query=TOC


 

A Response to COVID-19 using BIG Data Analytics, New Technology, and Proactive Testing

How Taiwan deployed these approaches to good effect?



Taiwan is 81 miles off the coast of mainland China and was expected to have the second highest number of cases of coronavirus disease 2019 (COVID-19) due to its proximity to and number of flights between mainland China and the island of the Taiwan. The island has 23 million citizens of which 850 000 reside in and 404 000 work in mainland China. In 2019, 2.71 million visitors from the mainland travelled to Taiwan. As such, Taiwan has been on constant alert and ready to act on epidemics arising from China ever since the severe acute respiratory syndrome (SARS) epidemic in 2003. Given the continual spread of COVID-19 around the world, understanding the action items that were implemented quickly in Taiwan and assessing the effectiveness of these actions in preventing a large-scale epidemic may be instructive for other countries.

COVID-19 occurred just before the Lunar New Year during which time millions of Chinese and Taiwanese were expected to travel for the holidays. Taiwan quickly mobilized and instituted specific approaches for case identification, containment, and resource allocation to protect the public health. Taiwan leveraged its national health insurance database and integrated it with its immigration and customs database to begin the creation of big data for analytics; it generated real-time alerts during a clinical visit based on travel history and clinical symptoms to aid case identification. It also used new technology, including QR code scanning and online reporting of travel history and health symptoms to classify travellers’ infectious risks based on flight origin and travel history in the past 14 days. Persons with low risk were sent a health declaration border pass via SMS messaging to their phones for faster immigration clearance; those with higher risk were quarantined at home and tracked through their mobile phone to ensure that they remained at home during the incubation period.  

Read further on how Taiwan managed its crisis click on the link below:
https://jamanetwork.com/journals/jama/fullarticle/2762689?guestAccessKey=14313127-fcdd-4b68-86dd-368e2650e7c2&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_term=mostread&utm_content=olf-widget_03132020

 
Prof. Louis Denis draws our attention to the recent recommendations of the American College of Surgeons on COVID-19 

American College of Surgeons releases recommendations for surgical management of elective operations during COVID-19 pandemic.

See ACS Press Release:
https://www.facs.org/media/press-releases/2020/covid-031320 

To read the full ACS recommendations:
https://www.facs.org/about-acs/covid-19/information-for-surgeons

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This Update is published by the Board
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Editorial & Writing - John Dowling
Production - Anja Vancauwenbergh
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