372 Background: Studies on the cost of muscle-invasive bladder cancer treatments lack granularity and are limited to 180 days. This study aimed to compare the one-year costs of trimodal therapy versus radical cystectomy, accounting for survival and intensity effects on total costs. Methods: Using Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data, we included a total of 2,963 patients aged ≥66 years diagnosed with clinical stage T2-4a bladder cancer between 2002 and 2011. We compared total Medicare costs within one year of diagnosis among patients following radical cystectomy or trimodal therapy using inverse probability of treatment weighted (IPTW) propensity score models, which included a two-part estimator to account for intrinsic selection bias. Results: Median total costs were significantly higher for trimodal therapy than radical cystectomy in 90 days ($83,754 vs. $68,692; median difference $11,805, 95% CI $7,745 to $15,864), 180 days ($187,162 vs. $109,078; median difference $62,370, 95% CI $55,581 to $69,160), and 365 days ($289,142 vs. $148,757; median difference $109,027, 95% CI $98,692 to $119,363), respectively. Outpatient, radiology, pharmacy and pathology/laboratory costs contributed largely to the significantly higher costs associated with trimodal therapy. On IPTW-adjusted analyses, patients undergoing trimodal therapy had $142,337 (95% CI $117,423-$175,300) higher costs compared with radical cystectomy one year after treatment (Table). Conclusions: Compared to radical cystectomy, trimodal therapy was associated with higher costs among patients with muscle-invasive bladder cancer. Extrapolating cost figures to the total US population resulted in excess spending of $853 million for trimodal therapy compared with radical cystectomy for patients diagnosed in 2018. [Table: see text]
Objectives To describe a step‐by‐step guide for using the first transperineal targeted prostate biopsy platform available in the USA . Patients and Methods A total of 32 men with elevated prostate‐specific antigen ( PSA ) levels were diagnosed with a region of interest on multiparametric magnetic resonance imaging (mp MRI ) between February 2017 and January 2018. The transperineal targeted prostate biopsy procedure was accomplished via a transperineal approach and used a stepper, combined with advanced mp MRI /transrectal ultrasound fusion software, to perform targeted prostate biopsy. The detection of overall and clinically significant prostate cancer ( PC a) was assessed as well as the rate of complications. Results The median patient age was 68.0 years and the median PSA was 8.0 ng/ mL . Two patients (6%) were active surveillance candidates and 16 (50%) had a prior negative prostate biopsy. The detection rates for overall and clinically significant PC a were 81% and 59%, respectively. The two candidates for active surveillance and eight of the patients with a prior negative prostate biopsy had clinically significant PC a confirmed on targeted biopsy. There were no peri‐operative complications. Conclusion These results demonstrate the promising potential of the first transperineal targeted prostate biopsy platform in the USA as an alternative diagnostic method for PC a.
37 Background: To compare overall survival of patients who underwent radical prostatectomy or radiotherapy versus non-cancer controls in order to discern if there is a survival advantage according to prostate cancer treatment. Methods: A matched cohort study was performedusingthe Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. We identified 34,473 patients age 66 to 75 years without significant comorbidity from who were diagnosed with localized prostate cancer treated with surgery or radiotherapy between 2004 and 2011. These patients were matched to a non-cancer control cohort. We compared the rates of all-cause mortality that occurred within the study period. We used Cox Proportional Hazards Regression analysis to identify determinants associated with overall survival. Results: Of the total 34,473 patients who were included in the analysis, 21,740 (63%) received radiation therapy and 12,733 (37%) received surgery. When compared to the non-cancer control, there was no significant difference between the prostate cancer cohort and the non-cancer control group with exception of race/ethnicity (p < 0.001). There was improved survival in patients treated with surgery (hazard ratio [HR], 0.35; 95% CI, 0.32-0.38) as well as with radiotherapy (HR, 0.72; 95% CI, 0.68-0.75) when compared to non-cancer controls. There was significantly improved overall survival among both treatment groups with most benefit observed among patients who underwent surgery ( log rank p < 0.001). Conclusions: Using population based data, treatment with either surgery or radiotherapy demonstrated improved overall survival when compared to a cohort of matched non-cancer controls. Treatment with surgery resulted in longer overall survival compared to those receiving radiation therapy. These results suggest inherent selection-bias due to unmeasured confounding variables when using cancer registry data.
SUMMARY Using an applanation tonometer, 5 replicate intraocular pressure ( iop ) measurements were obtained from each eye of 12 young, clinically normal, American alligators. Alligator length ranged from 46 to 117 cm, measured from snout to tail tip. All iop were recorded by a single observer at an ambient temperature of approximately 25 C, and ranged from 5 to 35 mm of Hg. Observer reliability was excellent (intraclass r = 0.93), and iop did not change over the ordered sequence of 5 replicate measurements/eye. Replicate iop measurements were, therefore, averaged in each eye for comparison between eyes of the same alligator. Left and right eye iop were highly correlated within individual alligators ( r = 0.92), whereas the mean within-animal difference between left and right eye iop was not statistically significant (95% confidence interval [ ci ] for the left eye-right eye mean difference, −1.9 to 1.5 mm of Hg). Mean iop determined for 5 confirmed females and 3 confirmed males did not differ significantly between the sexes (95% ci for the male-female difference in means, −2.1 to 3.7 mm of Hg). Mean ± sem iop of 23.7 + 2.1 mm of Hg determined for 4 alligators < 50 cm long was significantly ( P = 0.009) greater than mean iop of 11.6 + 0.5 mm of Hg determined for 8 alligators > 50 cm long (95% ci for the difference in means, 8.5 to 15.7 mm of Hg). In young alligators, the relation between body length and iop appears to be nonlinear, possibly with a negative exponent.
