Showing papers by "John T. Wei published in 2005"
TL;DR: In this paper, the authors employed high-throughput immunoblotting in order to interrogate tissue extracts derived from prostate cancer and identified 64 proteins altered in prostate cancer relative to benign prostate and 156 additional proteins that were altered in metastatic disease, revealing only 48%-64% concordance between protein and transcript levels.
782 citations
TL;DR: While the number of outpatient visits for BPH increased consistently during the 1990s, there was a dramatic decrease in the use of transurethral prostatectomy, inpatient hospitalization and length of hospital stay for this condition in 2000.
697 citations
TL;DR: Autoantibodies against peptides derived from prostate-cancer tissue could be used as the basis for a screening test for prostate cancer.
Abstract: Background New biomarkers, such as autoantibody signatures, may improve the early detection of prostate cancer. Methods With a phage-display library derived from prostate-cancer tissue, we developed and used phage protein microarrays to analyze serum samples from 119 patients with prostate cancer and 138 controls, with the samples equally divided into training and validation sets. A phage-peptide detector that was constructed from the training set was evaluated on an independent validation set of 128 serum samples (60 from patients with prostate cancer and 68 from controls). Results A 22-phage-peptide detector had 88.2 percent specificity (95 percent confidence interval, 0.78 to 0.95) and 81.6 percent sensitivity (95 percent confidence interval, 0.70 to 0.90) in discriminating between the group with prostate cancer and the control group. This panel of peptides performed better than did prostate-specific antigen (PSA) in distinguishing between the group with prostate cancer and the control group (area unde...
604 citations
TL;DR: During a 4-year interval from earlier to longer-term phases of PC treatment survivorship, sexual, urinary, and bowel dysfunction remain significant concerns among early-stage PC treatment survivors, compared with control men.
Abstract: Purpose We sought to elucidate long-term changes in health-related quality-of-life (HRQOL) outcomes by prospectively re-evaluating a well-characterized cohort of prostate cancer (PC) survivors 4 to 8 years after primary treatment. Patients and Methods Patients who had been evaluated previously at a median of 2.6 years after radical prostatectomy (RP), external radiation (three-dimensional conformal radiation therapy [3-D CRT]), or brachytherapy (BT) were recontacted at a median of 6.2 years after treatment. The clinical relevance of long-term HRQOL impairment among survivors was established by comparison with controls of similar age. Factors associated with HRQOL changes during this interval were evaluated. Results Of the 964 eligible men, 709 (73.5%) completed measurable questionnaires. In four domains (urinary irritative-obstructive, urinary incontinence, bowel, and sexual), significant HRQOL differences were detected for at least one of the therapy groups, compared with controls (all P < .05). During t...
376 citations
TL;DR: Measurable patient specific risk factors and perioperative processes associated with postoperative morbidity following cystectomy are delineated which allows for improved risk stratification, patient counseling, and the development of novel processes that may incrementally reduce risk and improve outcomes.
255 citations
TL;DR: Bladder exstrophy is rare, occurs in equal numbers of live male and female newborns, and is associated with certain co-morbid conditions, and incidence appears to be stable through time.
152 citations
TL;DR: In prostate cancer, AMACR expression is highest in localized prostate cancer and decreases in metastatic prostate cancer relative to benign prostatic tissue as mentioned in this paper, which is a marker of tumor growth.
Abstract: alpha-Methylacyl CoA racemase (AMACR) is overexpressed in prostate cancer relative to benign prostatic tissue. AMACR expression is highest in localized prostate cancer and decreases in metastatic p ...
130 citations
TL;DR: One of the first attempts to design a decision aid using principles from reading research and document design appears acceptable and useful in decision-making about localized prostate cancer treatment.
Abstract: Background
Decision aids (DA) to assist patients in evaluating treatment options and sharing in decision making have proliferated in recent years. Most require high literacy and do not use plain language principles. We describe one of the first attempts to design a decision aid using principles from reading research and document design. The plain language DA prototype addressed treatment decisions for localized prostate cancer. Evaluation assessed impact on knowledge, decisions, and discussions with doctors in men newly diagnosed with prostate cancer.
114 citations
TL;DR: There was a significant increase in the rate of newborn circumcision between 1988 and 2000 and may be related to increased recognition of the potential medical benefits of circumcision, however, the increase may also result in a higher incidence of surgical complications of circumcision.
106 citations
TL;DR: A significant increase in the incidence of congenital penile anomalies is observed over time, with striking variation by race, region and SES, even after adjusting for race/ethnicity, geographic region, insurance status and Ses.
100 citations
TL;DR: Treatment trends over the period 1992–1999 for localized/regional prostate carcinoma among white, Hispanic, and African‐American men are described.
Abstract: BACKGROUND
African-American men have a greater incidence of and mortality from prostate carcinoma compared with white men, and they are less likely to receive definitive therapy (radical prostatectomy or external beam radiation therapy). During the 1990s, the use of brachytherapy increased; however, its influence on racial and ethnic prostate carcinoma treatment trends remains unclear. The objective of this study was to describe treatment trends over the period 1992–1999 for localized/regional prostate carcinoma among white, Hispanic, and African-American men.
METHODS
Using the Surveillance, Epidemiology, and End Results (SEER) registry data from 1992 through 1999, logistic regression models were used to determine whether the odds of receiving a specific treatment modality differed by racial and ethnic group and whether the differences changed over time when the models were adjusted for age, marital status, tumor grade, and SEER site (geography).
RESULTS
The authors identified 142,340 men, including white men (81.6%), Hispanic men (6.4%), and African-American men (12.0%). Racial and ethnic differences in the rates of use of androgen-deprivation therapy/expectant management were noted; however, these differences appeared to lessen over time (P < 0.001). The rate of utilization of radical prostatectomy increased for Hispanic men, remained flat for African-American men, and decreased for white men. The utilization of brachytherapy and combination therapy increased for all three groups; however, the greatest increase in utilization was among white men.
CONCLUSIONS
Further research will be required to determine the patient-level and provider-level variables that influence racial and ethnic treatment differences in localized/regional prostate cancer. Cancer 2005. © 2005 American Cancer Society.
TL;DR: Variations between high and low volume hospitals in practice patterns and case mix may contribute to observed differences in resource use, LOS and clinical outcomes.
TL;DR: A novel framework for characterizing regionalization was established and implemented to determine the extent to which regionalization of radical cystectomy has occurred and whether specific patient characteristics are associated with this phenomenon.
TL;DR: Using an extended prostate biopsy pattern involving more than 10 cores increases the likelihood of detecting prostate cancer and is not found to be associated with an increased risk of detecting smaller or clinically insignificant cancer.
TL;DR: The condition-specific health-related quality-of-life assessment is reliable and valid in women after surgical procedures for pelvic floor disorders, and these findings support the inclusion of condition- Specific quality- of-life measures in clinical trials for women with pelvicfloor disorders.
TL;DR: Understanding of HRQOL in patients undergoing cystectomy for bladder cancer remains poor and patients could be counseled not only about their predicted surgical risks and survival but also about the impact their disease will have on their longer-term quality of survival.
TL;DR: Partial cystectomy is disproportionately used in certain medical centers (nonteaching, rural, low volume) and patient populations (elderly, black, females, stage I disease) reflecting selective referral or overuse.
TL;DR: Downstaging at the time of radical cystectomy is associated with better overall and cancer-specific survival, and such data is useful when counseling patients postoperatively.
Abstract: Introduction Discrepancies between clinical and pathologic staging, herein referred to as stage divergence, are common after radical cystectomy. The implications of stage divergence on survival are ill defined in the context of those treated by surgery alone and would facilitate patient counseling and enhance prognostication. Methods There were 78 consecutive radical cystectomy patients with clinical stage T2 or less urothelial carcinoma who comprised our study population. Kaplan-Meier plots were constructed to determine the effects of stage divergence on survival and the log-rank test employed to assess the significance. Regression models were developed to determine predictors of overall and cancer-specific survival. Results Stage divergence was common after radical cystectomy with downstaging and upstaging occurring in 27% and 49% of patients, respectively. Downstaged patients had better overall (P = 0.003) and bladder cancer-specific (P = 0.0004) survivals. None of the downstaged patient died from bladder cancer (median follow-up 35.9 months). Upstaged patients were five times as likely to succumb from bladder cancer or other illness compared to downstaged patients. This effect was not isolated to patients with lower clinical stages but also demonstrated in patients with clinical stage T2 bladder cancer. Conclusions Stage divergence is common after radical cystectomy occurring in 76% of patients in this study. The implications of stage divergence are equally relevant for those who are upstaged or downstaged in terms of survival, and such data is useful when counseling patients postoperatively. Downstaging at the time of radical cystectomy is associated with better overall and cancer-specific survival.
TL;DR: Adolescent boys and men with failed hypos padias repairs, as well as parents of boys with hypospadias, can be counseled that most patients who undergo OMGU are likely to have satisfactory sexual function as adults and long-term sexual function and satisfaction was excellent in these patients after OMGU.
TL;DR: Many patients report good long-term outcomes of OMGU, although a subset of patients has significant urinary and cosmetic complaints that are more prevalent in association with surgical complications.
TL;DR: Practice patterns in pediatric pyeloplasty evolved between 1988 and 2000, suggesting that patients with prenatal hydronephrosis are increasingly being observed instead of undergoing early surgery.
TL;DR: Prostate cancer quality of care assessment represents a burgeoning domain of urological health services research and urologists should maintain a leading role in efforts to further define of quality of Care as it relates to prostate cancer and radical prostatectomy.
TL;DR: The objective is to describe complications following surgery for SUI and how they affect resource utilization and post‐operative morbidity.
Abstract: Aims: Stress urinary incontinence (SUI) impacts many women. Treatment is primarily surgical. Post-operative morbidity considerably aiects individuals and the health care system. Our objective is to describe complications following surgery for SUI and how they aiect resource utilization. Methods: Utilizing the Nationwide Inpatient Sample (a nationally representative dataset), 147,473 patients who underwent surgery for SUI from 1988 to 2000 were identi¢ed by ICD-9 codes. Comorbid conditions/complications were extracted using ICD-9 codes, including complication rates, length of stay (LOS), hospital charges, and discharge status. Results: Overall complication rate was 13.0% (not equal to sum of complication sub-types, as each woman may have had ¼ 1 complication), with 2.8% bleeding, 1.4% surgical injury, 4.3% urinary/renal, 4.4% infectious, 0.1% wound, 1.1% pulmonary insu⁄ciency, 0.5% myocardial infarction, 0.2% thromboembolic. The ‘‘gold standard’’ surgical technique for SUI, the pubovaginal sling, had the lowest morbidity at 12.5%. Mean LOS increased with morbidity: from 2.9 to 4.1 to 6.1 days for those with 0, 1, and ¼2 complications respectively (P < 0.001). Similarly, in£ation-adjusted hospital charges increased with morbidity: from $7,918 to $9,828 to $15,181 for those with 0, 1, and ¼2 complications respectively (P < 0.001). The percentage of patients requiring post-discharge subacute or home care increased with morbidity: from 4.4% to 8.4% to 14.3% for those with 0, 1, and ¼2 complications (P < 0.001). Conclusions: A substantial percentage of women experience complications following surgery for SUI. Post-operative morbidity leads to dramatically increased resource utilization. Prospective studies are needed to identify pre-operative risk factors and intraoperative process measures to optimize the quality of care. Neurourol. Urodynam. 24:659 ^665, 2005. 2005 Wiley-Liss, Inc.
TL;DR: A conceptual model for measuring quality of care in the context of radical cystectomy for bladder cancer is described and a framework for future research is provided by presenting an overview of recent work pertaining to Cystectomy and quality of Care.
Abstract: Defining surgical quality is an imperative and substantial undertaking before its measurement and ultimate improvement. This article defines quality of care and a rationale for its measurement. In the context of radical cystectomy for bladder cancer, we describe a conceptual model for measuring quality of care. Finally, we provide a framework for future research by presenting an overview of recent work pertaining to cystectomy and quality of care.
TL;DR: Adolescent boys and men with failed hypos padias repairs, as well as parents of boys with hypospadias, can be counseled that most patients who undergo OMGU are likely to have satisfactory sexual function as adults, and long-term sexual function and satisfaction was excellent in these patients after OMGU.