Journal of Clinical Urology最新文献

{"title":"Diagnostic value of the abnormal digital rectal examination in the modern MRI-based prostate cancer diagnostic pathway.","authors":"Wasiq Sajjad, Vineetha Thankappannair, Syed Shah, Adham Ahmed, Kasra Saeb-Parsy, Christof Kastner, Benjamin Lamb, Vincent J Gnanapragasam","doi":"10.1177/20514158221091402","DOIUrl":"10.1177/20514158221091402","url":null,"abstract":"<p><strong>Objective: </strong>Currently the National Institute for Health and Care Excellence (NICE) recommends an abnormal digital rectal examination (DRE) as a standalone referral criterion for suspected prostate cancer. Unlike referrals for a raised prostate-specific antigen (PSA) which are triaged directly to magnetic resonance imaging (MRI), an abnormal DRE requires re-examination in a secondary clinic first. Here, we investigated the ongoing value of the abnormal DRE as a referral criterion.</p><p><strong>Methods: </strong>This study is a retrospective review of patients referred to secondary care for suspected prostate cancer based on an abnormal DRE over a 15-month period at a single UK hospital (<i>n</i> = 158). Age, PSA, primary and repeat DRE findings and eventual diagnosis were collated.</p><p><strong>Results: </strong>A concurrent raised PSA was present in 65/158 (41%). Concordance between primary and secondary care DRE was only 72/158 (46%). The overall and significant cancer detection rate was 26/158 (16%) and 22/158 (14%), respectively. Among men with a concurrent raised PSA, 19/65 (29%) had significant cancer found, whereas with an abnormal primary care DRE and normal PSA (<i>n</i> = 93), only 3/93 (3%) had a significant cancer. Mandating a PSA before referral for an abnormal DRE would have redirected 65/158 (41%) of men to MRI first, negating the need for a repeat DRE (<i>p</i> < 0.0001). This finding was recapitulated in a second prospective validation cohort (<i>n</i> = 30) with 9/30 (30%) redirected to MRI first.</p><p><strong>Conclusions: </strong>This is one of the first studies to investigate the value of the DRE in contemporary practice. We propose that PSA is used to triage men with an abnormal DRE to MRI without needing a repeat DRE. If the PSA is normal, the diagnostic yield is low but may still warrant a repeat DRE to assess the need for further investigations. Additional multicentre studies are required to further validate our findings.</p><p><strong>Level of evidence: </strong>4.</p>","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":"412-418"},"PeriodicalIF":0.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10775687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140850427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the diagnostic utility of CHOKAI, STONE and STONE PLUS scores in predicting ureteral stones larger than 5 mm","authors":"Ali Cankut Tatliparmak, Sarper Yılmaz, Rohat Ak, N. M. Hokenek","doi":"10.1177/20514158231214982","DOIUrl":"https://doi.org/10.1177/20514158231214982","url":null,"abstract":"The objective of this study is to assess the diagnostic accuracy of CHOKAI, STONE, and STONE plus scores in detecting ureteral stones larger than 5 mm. This comparative diagnostic accuracy study was performed in a tertiary care emergency department (ED) and included consecutive patients who presented to the ED with flank pain over a 1-year period. The performance of these scoring scales in detecting ureteral stones measuring >5 mm was determined by area under the receiver operating characteristics (AUROC) comparison. Ureteral stones were detected in 270 (70.3%) of 384 patients included in the study. While 146 patients (54.1%) had ureteral stones measuring <5 mm, 124 patients (54.1%) had stones measuring 5 mm or more in size. The performance of the CHOKAI score in predicting ureteral stones was superior to that of the STONE PLUS score; STONE PLUS score was also superior to STONE score ( p < 0.001). Analysis of the diagnostic value of CHOKAI score and STONE PLUS scores in predicting >5-mm stones showed no statistically significant difference ( p = 0.59). CHOKAI and STONE PLUS scores are useful in predicting >5-mm ureteral stones and have similar diagnostic utility to each other. STONE score does not provide accurate diagnostic information about ureteral stones larger than 5 mm. Level 2b","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":"36 9","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138601527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of life and healthcare resource use in patients with bladder pain syndrome: A survey of UK patients","authors":"Sachin Malde, Michael Ho, Jane Griffin","doi":"10.1177/20514158231204591","DOIUrl":"https://doi.org/10.1177/20514158231204591","url":null,"abstract":"Objectives: The main aim of this study is to characterise the humanistic burden of bladder pain syndrome (BPS) on patients within the United Kingdom and to estimate the key healthcare resource usage and cost of treating these patients. Method: An online survey was administered through two charities. Respondents were asked questions on BPS diagnosis, socio-demographics and health-related quality of life using the O’Leary-Sant Interstitial Cystitis Symptom Index (ICSI) and Problem Index (ICPI), the Pelvic Pain and Urinary/Frequency (PUF) and the EQ-5D questionnaires. Healthcare resource and therapy use, for the previous 6 months, were recorded and used to calculate economic burden. Results: A total of 252 patients completed the survey. Mean ICSI ICPI scores were 12.6 and 11.0, respectively, indicating severe symptoms. Mean PUF score was 21.2, indicating poor health status and a high number of BPS-related symptoms and problems. Mean EQ-5D utility score was 0.541. In the previous 6 months, 172 (68%) saw their general practitioner (GP) and 80 (32%) a primary care nurse, and 165 (65%) had one or more outpatient visits, due to their BPS. Conclusion: This survey adds to our current understanding of BPS in the United Kingdom, highlighting that patients with BPS have poor health-related quality of life and incur high resource use. Level of evidence: Not applicable","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":"CE-23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135268354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of the learning curve for Retzius-sparing robot-assisted radical prostatectomy for a single surgeon","authors":"Hany Hussein, Neil Maitra, Li June Tay, Ioannis Saxionis, Robert Makin, Sailantra Sivathasan, Sonny Smart, Anne Warren, Nimish Shah, Benjamin Wilfrid Lamb","doi":"10.1177/20514158231203766","DOIUrl":"https://doi.org/10.1177/20514158231203766","url":null,"abstract":"Background: The learning curve for Retzius-sparing robotic radical prostatectomy is not fully understood. Objective: This study attempts to identify the learning curve across the first 130 cases of a single surgeon. Design, Setting and Participants: All Retzius-sparing robotic radical prostatectomy cases performed by a single surgeon at a high-volume tertiary hospital between April 2019 and July 2022 were included. Outcome Measurements and Statistical Analysis: Outcome measures included positive surgical margin rate, complication rates and unplanned readmission to hospital, postoperative urinary continence, erectile function and prostate-specific antigen (PSA) measurement. Cases were divided chronologically into three groups and differences between groups assessed. Results and Limitation: A total of 130 Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) cases were identified. Differences were found between groups in several areas. Positive surgical margin rate fell between Group 1 (30.2%) and Group 3 (9.1%). Safety, postoperative continence, erectile function and PSA remained stable. Median patient age increased between Group 1 (59 years) and Group 3 (66.5 years) ( p = 0.04). Proportion of patients with stage >T2 increased between Group 1 (27.9%) and Group 2 (41.9%) ( p = 0.036). Median console time increased between Group 1 (120 minutes) and Group 2 (150 minutes) ( p = 0.01). Median gland weight increased between Group 1 (28 g) and Group 3 (35.5 g) ( p < 0.001). Conclusions: The positive surgical margin rate improved over the learning curve, despite the complexity of cases increasing, reflected in older patients, larger prostates and higher stage disease. Safety and functional outcomes are excellent throughout. The learning curve might be facilitated by careful case selection favouring smaller prostates with less advanced disease. Patient Summary: We analysed the learning curve for Retzius-sparing robotic radical prostatectomy. Across the first 130 cases, positive surgical margin rate fell; safety and continence remained excellent. Selection of smaller and less advanced cases may facilitate learning. Level of evidence: III","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135885198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of intravesical glycosaminoglycans in the treatment of recurrent urinary tract infections: Systematic review and meta-analysis","authors":"Ricardo Contreras-García, Herney Andrés García-Perdomo","doi":"10.1177/20514158231198553","DOIUrl":"https://doi.org/10.1177/20514158231198553","url":null,"abstract":"Objective: The objective of the study was to determine the efficacy of glycosaminoglycans in bladder instillation compared with placebo or other forms of prophylaxis in women with recurrent urinary tract infections (UTIs). Methods: A search strategy was performed in the Cochrane central register, Embase, and Medline until October 2020, along with manual searches and reference-list checking. Randomised and nonrandomized studies in women with recurrent UTIs who received hyaluronic acid (HA) or HA plus chondroitin sulfate (CS) were included. A random-effects model was applied to the pooled results. The risk of bias was evaluated using the Cochrane RoB 2 bias tool for clinical trials and MINORS for nonrandomized studies. The quality of the evidence was evaluated by the GRADE method. Results: One randomised study and eight nonrandomized studies were included. All evaluated HA or HA plus CS. HA or HA plus CS decreased the average UTI patient-years (mean difference (MD) = −2.62; 95% confidence interval (CI) = −4.00 to −1.23), increased the time to recurrence (MD = 145.70; 95% CI = 61.57 to 229.83), and improved symptoms and quality of life as evaluated through the total pelvic pain and urgency/frequency score (MD = −6.08; 95% CI = −7.68 to −4.48) and the visual analog scale (MD = −4.79; 95% CI = −5.55 to −4.03). There was high heterogeneity in the results, a high risk of bias in the one randomised study, and a low quality of evidence according to GRADE. The number of included studies was low. Conclusion: The application of HA or HA plus CS in intravesical instillation is associated with fewer UTI recurrences and improved symptoms and quality of life. The quality of the evidence provided by the studies is limited, so more studies of higher quality are needed to yield definitive conclusions. Level of evidence: Not applicable","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136112299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of functional, perioperative outcomes and common complications of robot-assisted vs open construction of orthotopic neobladder following a radical cystectomy in patients with bladder cancer: A systematic review","authors":"Mansha Bhiryani, Omar El-Taji, Vishwanath Hanchanale","doi":"10.1177/20514158231202280","DOIUrl":"https://doi.org/10.1177/20514158231202280","url":null,"abstract":"Introduction: Orthotopic neobladder (ONB) reconstruction following radical cystectomy for bladder cancer is a viable alternative to the formation of an ileal conduit. Although robotic surgery is gaining popularity, neobladder reconstruction is still most commonly done extra-corporeally (eONB) with a lower midline-laparotomy rather than intra-corporeal ONB (iONB) reconstruction. The novelty of a robotic approach has made several centres apprehensive to adopt this. This systematic review aims to compare functional outcomes as well as perioperative outcomes and common complications of robotic-assisted radical cystectomy with iONB versus eONB reconstruction. Materials and methods: A search of the literature from 2011 to 2021 was performed through PubMed, EMBASE, Medline and Scopus to identify articles comparing eONB formation with iONB formation. Urodynamic (UDS) outcomes (bladder volume, flow rate, post-voiding residual volume, continence rates and rate of clean intermittent catheterization (CIC) use) and perioperative outcomes (estimated blood loss, length of stay and operative time) were extracted as endpoints of interest. This review was registered with PROSPERO on 19 October 2022 (CRD42022366667). Results: Our searches identified 84 abstracts, of which 4 articles with 410 patients were eligible. Our results showed patients undergoing iONB had a higher bladder capacity and continence rate and achieved full continence much sooner than eONBs. iONBs, however, seemed to be left with higher residual volumes and a higher percentage of patients who needed CIC to void. Conclusion: Both perioperative outcomes and complications favoured the iONB technique; however, eONB seemed to give better functional outcomes. Level of evidence: Not applicable","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136210699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short (23-hour)-stay robotic-assisted radical prostatectomy in a state-funded national health service – Is it safe and feasible?","authors":"Li June Tay, Kemal Gillangullari, Neil Maitra, Lourdes Samson, Vishal Patil, Benjamin W Lamb, Nimish Shah","doi":"10.1177/20514158231198362","DOIUrl":"https://doi.org/10.1177/20514158231198362","url":null,"abstract":"Objectives: The COVID-19 pandemic has led to a long waiting list for elective surgery and increasing bed pressures from acute admissions. This led to widespread cancellations on the day of surgery even for cancer procedures. To address this, all inpatient stay robotic-assisted radical prostatectomy (RARP) cases were managed via our day surgery unit as a 23-hour stay. We report the safety and feasibility of our initial implementation. Methods: A standard operating procedure for admission via the day surgery unit, including a modified enhanced recovery pathway, for patients undergoing RARP with or without pelvic lymph node dissection (PLND) was devised. All pre-operative variables were collected, and all perioperative outcomes analysed. Primary outcomes were number of on the day cancellations, discharge failure as 23-hour stay and 30-day readmissions. Results: Between November 2021 and June 2022, 135 patients underwent RARP with or without PLND via the day surgery unit. Mean patient age was 65 (46–76) years. Mean operative time and estimated blood loss were 153 (67–281) minutes and 197 (50–700) mL, respectively. Concomitant lymph node dissection was performed in 32.7% of cases. No patient required blood transfusion or conversion to open. We had 3 (2.2%) discharge failures, all of which were due to clinical reasons. Our 30-day hospital readmission rate was 3.7%, while another 5.2% attended emergency department and were discharged without admission. Conclusion: Short (23-hour)-stay RARP is safe and feasible and reduces pressure on inpatient beds but requires a multidisciplinary approach and engagement from all stakeholders. Level of evidence: 2","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135014881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HaEmaturia After Transurethral resection of bladder Tumour (HEATT): A multicentre, regional collaborative analysis of factors associated with emergency re-admission with haematuria following TURBT","authors":"P. Sarmah, W. Al-Dhahir, A. Chellapuri, A. Damola, Nnaemeka Eli, Rebecca Foulger, Maria Harrington-Vogt, S. Hulligan, A. Kanthabalan, M. Kitchen, S. Malik, Madeline Moore, D. Nyanhongo, Ridwaan Sohawon, H. Thursby, S. Yallappa, D. Mak, A. Chakravarti","doi":"10.1177/20514158231190035","DOIUrl":"https://doi.org/10.1177/20514158231190035","url":null,"abstract":"To calculate the re-admission rate with haematuria within 30 days of elective transurethral resection of bladder tumour (TURBT), and identify factors associated with this. This was a multicentre, retrospective audit, identifying all adult patients over the age of 16 who underwent elective TURBT between 1 September and 30 November 2019. Data were collected from medical records and operation notes on patient demographics, intra-operative factors and post-operative management. Primary outcome measure was the proportion of patients emergently re-admitted with haematuria. Secondary outcome measures were the re-operation rate for haematuria, and the rate of new acute thrombotic event (TE). Fisher’s exact test was used to calculate p values within subgroups for re-admission rates. 443 patients from 12 hospitals were included. Median age was 75 years (17–99). 15 patients (3.4%) were re-admitted with haematuria. Subgroup analysis demonstrated higher rate of re-admission for pre-existing antithrombotic agents (ATAs) (2.0% vs. 6.1%, p = 0.046), increased for non-Aspirin ATAs (10.5%, p = 0.0015). 52% of non-Aspirin ATAs were restarted within 48 hours of surgery; post-operative plan for restarting was not documented in 22.1%. One patient (0.23%) developed acute TE (pulmonary embolus). Pre-existing use of non-Aspirin ATAs is associated with increased risk of post-TURBT haematuria, with variable practice in post-operative recommencement. Level 3","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41935316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stress among UK consultant urologists and factors influencing when they leave full-time NHS practice","authors":"Steven Payne, Amy Kane, K. Thomas, H. Bolderston, M. Greville-harris, K. Turner","doi":"10.1177/20514158231190949","DOIUrl":"https://doi.org/10.1177/20514158231190949","url":null,"abstract":"The UK medical workforce is in crisis. The number of surgeons in National Health Service (NHS) practice has decreased, partly because newly qualified doctors withdraw from the workforce, and partly because of the early retirement of experienced surgeons. The reasons for urological trainee loss are largely known, but stress factors influencing the retirement of consultants before state pension age (SPA) are not. An online survey of the consultant membership of the British Association of Urological Surgeons was carried out over a 12-week period starting in September 2020. Information was sought regarding stresses at work and home, together with factors affecting retirement decisions. Data analysis was performed if > 90% of questions were complete. Overall, 36.5% of 1374 invitees completed the survey. Workplace-based issues were the main causes of stress: on-call, an unsupportive working environment, complaint handling and poor relations with hospital managers were predominant factors which were exacerbated by punitive taxation. Experienced urologists ameliorated these factors by reducing their contracted activity, increasing part-time working and, ultimately, retiring before SPA. Workplace-based factors are associated with stress reported by consultant urologists. Alleviation of stressor factors, especially those related to on-call activity, should be explored to reduce the erosion of the senior workforce. Not applicable","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45521945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-operative risk stratification of high-risk prostate cancer patients can predict risk of biochemical recurrence for individual patients post radical surgery: A multi-institutional study","authors":"C. Devlin, M. Raslan, A. Deytrikh, Shacheesh Sinha, Samuel Murgatroyd, D. Yates, M. Dooldeniya, Nicholas Smith, M. Simms, R. Beekharry, Rajindra Singh, C. Molokwu, R. Chahal","doi":"10.1177/20514158231185993","DOIUrl":"https://doi.org/10.1177/20514158231185993","url":null,"abstract":"The aim of this study was to identify which high-risk prostate cancer (HRPCa) patients would suffer biochemical recurrence (BCR) after radical prostatectomy (RP), providing a personalised % risk at initial consultation. BCR is more likely in HRPCa; however, the incidence is not equal in this cohort. A total of 850 patients underwent RP for HRPCa in four institutions between 2013 and 2019. Immediate additional treatment post RP was exclusion criteria, leaving 832 patients. Patient demographics, pre-operative, histological features and incidence of BCR (PSA ⩾ 0.2 ng/mL) were recorded. Patients were risk-stratified patients according to having one, two or three high-risk factors. Chi-square test was used for categorical variables. Univariate analysis was performed, and BCR-free survival between groups was explored with Kaplan–Meier method. Median follow-up was 48 months. Overall rate of BCR was 19.8%. Median time to BCR was 19 months. In the risk stratification analysis, 75% of patients had one risk feature. Multiple risk features carried a significantly higher risk of positive surgical margin and incidence of BCR ( p < 0.001), but not time to BCR ( p = 0.06) compared with single features. Univariate analysis demonstrated that the risk of BCR was greater with a PSA ⩾ 20 ng/mL compared to GS ⩾ 8 ( p = 0.05). Limitations of the study include limited follow-up time and BCR numbers for analysis. Overall, one in five high-risk patients will develop BCR by 4 years. However, those with multiple risk factors have a significantly increased risk. This aids the consultation regarding potential additional therapies alongside surgery in the treatment of HRPCa. Not applicable","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47624618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}