Royal Surrey County Hospital

About: Royal Surrey County Hospital is a healthcare organization based out in Guildford, United Kingdom. It is known for research contribution in the topics: Cancer & Population. The organization has 2222 authors who have published 3064 publications receiving 86753 citations.

Management of screen detected ductal carcinoma in situ of the female breast.

Abstract: Thirty eight ductal carcinomas in situ of the female breast detected during the first 7 years of screening by the Guildford Breast Screening Unit have been treated by one surgeon. Twenty-eight cases were treated conservatively and ten by mastectomy. In the group treated conservatively there have been five local recurrences: four as ductal carcinoma in situ and one as node negative microinvasive carcinoma. There were no clinical or pathological features that predicted local recurrence, which was detected only by follow-up mammography. Based on these early results, an initially conservative approach to screen detected ductal carcinoma in situ is advocated.

Intraocular methotrexate can induce extended remission in some patients in noninfectious uveitis.

Abstract: PURPOSE: To assess the outcomes of the intravitreal administration of methotrexate in uveitis. METHODS: Multicenter, retrospective interventional case series of patients with noninfectious uveitis. Thirty-eight eyes of 30 patients were enrolled, including a total of 54 intravitreal injections of methotrexate at a dose of 400 μg in 0.1 mL. The primary outcome measure was visual acuity. Secondary outcome measures included control of intraocular inflammation and cystoid macular edema, time to relapse, development of adverse events, and levels of systemic corticosteroid and immunosuppressive therapy. RESULTS: Methotrexate proved effective in controlling intraocular inflammation and improving vision in 30 of 38 eyes (79%). The side effect profile was good, with no reported serious ocular adverse events and only one patient having an intraocular pressure of >21 mmHg. Of the 30 eyes that responded to treatment, 8 relapsed, but 22 (73%) entered an extended period of remission, with the Kaplan-Meier estimate of median time to relapse for the whole group being 17 months. The eight eyes that relapsed were reinjected and all responded to treatment. One eye relapsed at 3 months, but 7 eyes again entered extended remission. Of the 14 patients on systemic therapy at the start of the study, 8 (57%) were able to significantly reduce this following intravitreal methotrexate injection. CONCLUSION: In patients with uveitis and uveitic cystoid macular edema, intravitreal MTX can effectively improve visual acuity and reduce cystoid macular edema and, in some patients, allows the reduction of immunosuppressive therapy. Some patients relapse at 3 to 4 months, but a large proportion (73%) enter an extended period of remission of up to 18 months. This larger study extends the results obtained from previous smaller studies suggesting the viability of intravitreal methotrexate as a treatment option in uveitis.

The role of transperineal template prostate biopsies in restaging men with prostate cancer managed by active surveillance

Abstract: Study Type – Diagnostic (exploratory cohort) Level of Evidence 3b What's known on the subject? and What does the study add? The optimal method of active surveillance in prostate cancer remains unknown. This study is one of the first to report on the role of transperineal template prostate biopsies in active surveillance. It demonstrates that around one third of men are reclassified with more significant prostate cancer at an early stage in their management. This is a higher proportion than reported in contemporary cancers using standard transrectal biopsies for restaging. OBJECTIVE • To evaluate the role of transperineal template prostate biopsies in men on active surveillance. PATIENTS AND METHODS • In all, 101 men on active surveillance for prostate cancer underwent restaging transperineal template prostate biopsies at a single centre. • Criteria for active surveillance were ≤75 years, Gleason ≤3+3, prostate-specific antigen (PSA) ≤15 ng/mL, clinical stage T1–2a and ≤50% ultrasound-guided transrectal biopsy cores positive for cancer with ≤10 mm of disease in a single core. • The number of men with an increase in disease volume or Gleason grade on transperineal template biopsy and the number of men who later underwent radical treatment were assessed. • The role of PSA and PSA kinetics were studied. RESULTS • In all, 34% of men had more significant prostate cancer on restaging transperineal template biopsies compared with their transrectal biopsies. • Of these men, 44% had disease predominantly in the anterior part of the gland, an area often under-sampled by transrectal biopsies. • In the group of men who had their restaging transperineal template biopsies within 6 months of commencing active surveillance 38% had more significant disease. • There was no correlation with PSA velocity or PSA doubling time. • In total, 33% of men stopped active surveillance and had radical treatment. CONCLUSIONS • Around one-third of men had more significant prostate cancer on transperineal template biopsies. • This probably reflects under-sampling by initial transrectal biopsies rather than disease progression.