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  • Saarinen, Irena; Mirtti, Tuomas; Seikkula, Heikki; Bostrom, Peter J.; Taimen, Pekka (2015)
    Background Prostate cancer (PCa) is the most common cancer among men in western countries. While active surveillance is increasingly utilized, the majority of patients are currently treated with radical prostatectomy. In order to avoid over-treatment, there is an indisputable need for reliable biomarkers to identify the potentially aggressive and lethal cases. Nuclear intermediate filament proteins called lamins play a role in chromatin organization, gene expression and cell stiffness. The expression of lamin A is associated with poor outcome in colorectal cancer but to date the prognostic value of the lamins has not been tested in other solid tumors. Methods We studied the expression of different lamins with immunohistochemistry in a tissue microarray material of 501 PCa patients undergoing radical prostatectomy and lymph node dissection. Patients were divided into two staining categories (low and high expression). The correlation of lamin expression with clinicopathological variables was tested and the association of lamin status with biochemical recurrence (BCR) and disease specific survival (DSS) was further analyzed. Results Low expression of lamin A associated with lymph node positivity (p Conclusions These results suggest differential roles for lamins in PCa progression. Reduced amounts of lamin A/C and B2 increase risk for lymph node metastasis and disease specific death possibly through increased nuclear deformability while high expression of lamin B1 predicts disease recurrence.
  • Kalalahti, Inari; Vasarainen, Hanna; Erickson, Andrew M.; Siipola, Arttu; Tikkinen, Kari A. O.; Rannikko, Antti (2021)
    Background: Active surveillance (AS) is the preferred option for initial management for low-risk prostate cancer (PC). Although many AS protocols exist, there is little evidence to support one over another. Objective: To assess whether there is difference in overall (OS), prostate cancer-specific (CSS), metastasis-free (MFS), or treatment-free (TFS) survival between a strict (Prostate cancer Research International: Active Surveillance [PRIAS]) and a loose (European Randomized study of Screening for Prostate Cancer [ERSPC]) AS protocol. Design, setting, and participants: This study included two cohorts of men (n = 518) with low-risk, localized, Gleason score
  • Brausi, Maurizio; Hoskin, Peter; Andritsch, Elisabeth; Banks, Ian; Beishon, Marc; Boyle, Helen; Colecchia, Maurizio; Delgado-Bolton, Roberto; Hoeckel, Michael; Leonard, Kay; Loevey, Jozsef; Maroto, Pablo; Mastris, Ken; Medeiros, Rui; Naredi, Peter; Oyen, Raymond; de Reijke, Theo; Selby, Peter; Saarto, Tiina; Valdagni, Riccardo; Costa, Alberto; Poortmans, Philip (2020)
    Background ECCO Essential Requirements for Quality Cancer Care (ERQCC) are written by experts representing all disciplines involved in cancer care in Europe. They give oncology teams, patients, policymakers and managers an overview of essential care throughout the patient journey. Prostate cancer Prostate cancer is the second most common male cancer and has a wide variation in outcomes in Europe. It has complex diagnosis and treatment challenges, and is a major healthcare burden. Care must only be a carried out in prostate/urology cancer units or centres that have a core multidisciplinary team (MDT) and an extended team of health professionals. Such units are far from universal in European countries. To meet European aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.
  • Kilpeläinen, Tuomas P.; Tikkinen, Kari A. O.; Guyatt, Gordon H.; Vernooij, Robin W. M. (2021)
    In randomized controlled trials, investigators often explore the possibility that the treatment effects differ between subgroups (eg, women vs men, old vs young, more versus less severe disease). Investigators often inappropriately claim subgroup effects (also called "effect modification"or "interaction") when the likelihood of a true effect modification is low. Criteria for assessing the credibility of subgroup analyses, nicely summarized in a formal Instrument for Assessing the Credibility of Effect Modification Analyses (ICEMAN), include investigator postulation of a priori hypotheses with a specified direction; support from prior evidence; a low likelihood that chance explains the apparent subgroup effect; and only testing a small number of subgroup hypotheses. Patient summary: Randomized clinical trials often use subgroup analyses to explore whether a treatment is more or less effective in a particular patient subgroup (eg, women vs men, old vs young). In this mini-review, we explore the common pitfalls of subgroup analyses. (c) 2021 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).
  • Tikkinen, Kari A. O.; Craigie, Samantha; Agarwal, Arnav; Violette, Philippe D.; Novara, Giacomo; Cartwright, Rufus; Naspro, Richard; Siemieniuk, Reed A. C.; Ali, Bassel; Eryuzlu, Leyla; Geraci, Johanna; Winkup, Judi; Yoo, Daniel; Gould, Michael K.; Sandset, Per Morten; Guyatt, Gordon H. (2018)
    Context: Pharmacological thromboprophylaxis involves balancing a lower risk of venous thromboembolism (VTE) against a higher risk of bleeding, a trade-off that critically depends on the risks of VTE and bleeding in the absence of prophylaxis (baseline risk). Objective: To provide estimates of the baseline risk of symptomatic VTE and bleeding requiring reoperation in urological cancer surgery. Evidence acquisition: We identified contemporary observational studies reporting symptomatic VTE or bleeding after urological procedures. We used studies with the lowest risk of bias and accounted for use of thromboprophylaxis and length of follow-up to derive best estimates of the baseline risks within 4wk of surgery. We used the GRADE approach to assess the quality of the evidence. Evidence synthesis: We included 71 studies reporting on 14 urological cancer procedures. The quality of the evidence was generally moderate for prostatectomy and cystectomy, and low or very low for other procedures. The duration of thromboprophylaxis was highly variable. The risk of VTE in cystectomies was high (2.6-11.6% across risk groups) whereas the risk of bleeding was low (0.3%). The risk of VTE in prostatectomies varied by procedure, from 0.2-0.9% in robotic prostatectomy without pelvic lymph node dissection (PLND) to 3.9-15.7% in open prostatectomy with extended PLND. The risk of bleeding was 0.1-1.0%. The risk of VTE following renal procedures was 0.7-2.9% for low-risk patients and 2.6-11.6% for high-risk patients; the risk of bleeding was 0.1-2.0%. Conclusions: Extended thromboprophylaxis is warranted in some procedures (eg, open and robotic cystectomy) but not others (eg, robotic prostatectomy without PLND in low-risk patients). For "close call'' procedures, decisions will depend on values and preferences with regard to VTE and bleeding. Patient summary: Clinicians often give blood thinners to patients to prevent blood clots after surgery for urological cancer. Unfortunately, blood thinners also increase bleeding. This study provides information on the risk of clots and bleeding that is crucial in deciding for or against giving blood thinners. (C) 2017 European Association of Urology. Published by Elsevier B.V.