www.renalandurologynews.com
SUMMER 2022
Renal & Urology News 11
AS Rate Increasing for Low-Risk PCa Study identifies a concomitant decline in the use of radical prostatectomy and radiation therapy THE PROPORTION OF men with low-risk prostate cancer (PCa) managed initially with active surveillance (AS) more than doubled from 2014 to mid2021 in the United States, with a concomitant decrease in the use of active treatments, according to investigators. Matthew Cooperberg, MD, of the University of California, San Francisco, and colleagues examined data from the AUA Quality (AQUA) Registry, which was launched by the AUA in 2013 to help urology practices understand and improve their quality of care and streamline reporting as mandated by the Centers for Medicare and Medicaid Services. Data are obtained directly from a range of electronic health record systems at participating practices. By mid-2021, the registry included data from 1945 urologists at 349 practices across the United States. The investigators analyzed data from 20,809 men with low-risk PCa and known primary treatment. The
Complications Following RC Are Declining RADICAL cystectomy (RC) complications overall appear to be decreasing in the United States, investigators reported. Using the 2006-2018 American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) database, investigators identified 11,351 RC cases. Mean hospital length of stay (LOS) significantly decreased from 10.5 to 9.8 to 8.6 days, across the 3 contemporary eras: 20062011, 2012-2014, and 2015-2018, respectively, likely reflecting improvements in perioperative care, Kevin Chua, MD, of Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, reported on behalf of his team. The readmission rate held steady at 20.0%, 21.3%, and 21.0%, respectively. The 30-day mortality rate also remained unchanged at 2.7%, 1.7%, and 2.0%, respectively.
Rapid Rise in Active Surveillance An analysis of data from 20,809 men with low-risk prostate cancer and known primary treatment revealed that the use of active surveillance (AS) more than doubled from 2014 to mid-2021, with concomitant decreases in the use of radical prostatectomy (RP) and external beam radiation therapy (EBRT). 60
■ 2014 ■ Mid-2021
50 40 30 20 10 0
26.5%
59.6%
29.7%
AS
15.8% RP
28.2%
20.9%
EBRT
Source: Cooperberg M, et al. Active surveillance for low-risk prostate cancer: Time trends and variation in the AUA Quality (AQUA) Registry. Presented at: AUA2022, May 13-16, 2022. Poster MP43-03.
patients had a median age of 65 years at diagnosis. The proportion of men managed with AS rose from 26.5% in 2014 to 59.6% in the first half of 2021, Dr Cooperberg and colleagues reported in a poster presentation. During that same period, the proportion of men treated with radical
The rate of any postoperative complication significantly decreased from 56.5% in 2006-2011 to 50.6% in 2015-2018, Dr Chua reported. The rate of major complications within 30 days of RC did not change significantly. Sepsis rates remained high. Deep incisional surgical site infections, however, decreased from 1.9% to 0.8%. Pulmonary embolism significantly decreased from 3.0% to 1.5%. The rate of minor complications within 30 days of RC significantly declined from 46.4% in 2006-2011 to 41.0% in 2015-2018. Superficial surgical site infections significantly decreased from 6.5% to 4.6% and transfusions from 34.2% to 31.7% over the 12-year span. But the rate of urinary tract infections stayed the same. “An analysis of the contemporary era shows continued decrease in LOS after RC and a decrease in overall complications,” Dr Chua and colleagues concluded in a study abstract. “This may reflect beneficial effects of changes in perioperative bladder cancer management such as increased use of neoadjuvant chemotherapy, enhanced recovery after surgery protocols and laparoscopic/robotic techniques.” ■
prostatectomy decreased from 29.7% to 15.8% and the proportion who received external beam radiation therapy decreased from 28.2% to 20.9%. The proportion of patients with lowrisk PCa managed with AS ranged from 4% to 78% at the practice level and 0% to 100% at the provider level.
Overall, AS rates were not meaningfully different between Black and White patients (39.4% and 39.8%, respectively). On logistic regression, age, year of diagnosis, and provider volume of lowrisk disease were strongly associated with AS receipt, whereas race and practice volume of low-risk disease were not, according to the investigators. “AS rates are improving but are still suboptimal, and variation across providers is excessive,” the investigators concluded. The latest findings are consistent with those of previous studies. In a paper published in JAMA, Brandon A. Mahal, MD, of the Dana-Farber Cancer Institute in Boston, and colleagues reported that the use of AS or watchful waiting (WW) for men with low-risk PCa increased from 14.5% in 2020 to 42.1% in 2015. During the same period, use of RP declined from 47.4% to 31.3% and use of radiation therapy decreased from 38.0% to 26.6%. ■
Kidneys from Donors With COVID-19 Safe to Transplant TRANSPLANTING KIDNEYS from COVID-
prior to surgery, whereas 7.3% received
19-positive deceased donors appears
1 dose and 25.5% were not vaccinated.
to be safe, according to researchers.
By 4 weeks after transplant surgery,
At an American Urological Association
no recipient had tested positive for
press conference, Alvin Wee, MD, MBA,
COVID-19 on polymerase chain reaction
program director for kidney transplan-
assays, the study found. There was no
tation at Glickman Urologic and Kidney
change in postoperative management,
Institute at Cleveland Clinic in Ohio,
including immunosuppression.
reported results from 55 patients (36
Delayed graft function occurred in
men and 19 women) who received
19.6% of the recipients, which the
kidneys from 34 deceased donors
investigators attributed to more dona-
who tested positive for COVID-19 from
tion after cardiac death (59%) and longer
February to October 2021. Donor
cold ischemia time. At a mean 3.5
selection criteria evolved to the point
months of follow-up, all grafts were func-
that only COVID-19-positive donors
tional. They observed no transmission
without significant primary or second-
of COVID-19 through transplantation.
ary kidney injury were selected. The
Kidneys from COVID-19-positive
average Kidney Donor Profile Index
donors are safe to transplant and
was 36.9.
recipient outcomes are not different
Among recipients, 67.3% completed standard 2-dose COVID-19 vaccination
from regular donors, the investigators noted in their study abstract. ■
