scholarly journals Sensor-Less Fully Transperineal Fusion-Guided Prostate Biopsy

2017 ◽  
Author(s):  
ChaKaria Hunter ◽  
Marco Cesante ◽  
Sheng Xu ◽  
Bradford J. Wood ◽  
Reza Seifabadi
Keyword(s):  
Prostate Cancer ◽  
Tracking System ◽  
Transrectal Ultrasound ◽  
The United States ◽  
Needle Insertion ◽  
Patient Specific ◽  
3D Volume ◽  
The Cost ◽  
Tracking Devices ◽  
Electromagnetic Tracking System

Prostate cancer is the most common male cancer in the United States with an estimated 181,000 new cases and 26,000 deaths in 2016 [1]. Transrectal ultrasound (TRUS) guided biopsy is the gold standard for definitive diagnosis in which the imaging and needle insertion are both done transrectally. Since ultrasound guidance results in insufficient sensitivity of prostate cancer diagnosis (40–60%), fusion of preoperative MRI with real-time US has been proposed to increase the sensitivity (∼ 90%). Transperineal biopsies have recently gained attention using a brachytherapy grid to biopsy through the perineum rather than the rectum, practically eliminating the possibility of infection. To enable MR-US fusion, electromagnetic tracking system is commonly used to make a 3D volume out of a stack of 2D US images acquired during an initial sweep of prostate. The EM tracking however is somewhat undesirable as it adds to the cost of the procedure and is prone to inaccuracies. Therefore, in this study, we propose a method that eliminates the need for such external tracking devices and inserts the needle transperineally thus reducing infection risks. Also, the procedure is more comfortable to the patient since the TRUS probe is eliminated. A patient specific grid template is designed based on the MR image of the patient.

scholarly journals Current Status of MRI and PET in the NCCN Guidelines for Prostate Cancer

2019 ◽  
Vol 17 (5) ◽  
pp. 506-513 ◽  
Author(s):  
Brandon R. Mason ◽  
James A. Eastham ◽  
Brian J. Davis ◽  
Lance A. Mynderse ◽  
Thomas J. Pugh ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
The United States ◽  
Current Status ◽  
Low Grade ◽  
Nccn Guidelines ◽  
Psa Testing ◽  
Pet Ct

Prostate cancer (PCa) represents a significant source of morbidity and mortality for men in the United States, with approximately 1 in 9 being diagnosed with PCa in their lifetime. The role of imaging in the evaluation of men with PCa has evolved and currently plays a central role in diagnosis, treatment planning, and evaluation of recurrence. Appropriate use of multiparametric MRI (mpMRI) and MRI-guided transrectal ultrasound (MR-TRUS) biopsy increases the detection of clinically significant PCa while decreasing the detection of clinically insignificant PCa. This process may help patients with clinically insignificant PCa avoid the adverse effects of unnecessary therapy. In the setting of a known PCa, patients with low-grade disease can be observed using active surveillance, which often includes a combination of prostate-specific antigen (PSA) testing, serial mpMRI, and, if indicated, follow-up systematic and targeted TRUS-guided tissue sampling. mpMRI can provide important information in the posttreatment setting, but PET/CT is creating a paradigm shift in imaging standards for patients with locally recurrent and metastatic PCa. This article examines the strengths and limitations of mpMRI for initial PCa diagnosis, active surveillance, recurrent disease evaluation, and image-guided biopsies, and the use of PET/CT imaging in men with recurrent PCa. The goal of this review is to provide a rational basis for current NCCN Clinical Practice Guidelines in Oncology for PCa as they pertain to the use of these advanced imaging modalities.

The cost of prostate cancer care to society and to patients in the United States.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 116-116 ◽  
Author(s):  
Nicholas George Zaorsky ◽  
John Lin ◽  
Djibril Ba ◽  
Joel E Segel ◽  
Heath B. Mackley ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Cancer Patient ◽  
Prostate Cancer Patient ◽  
Low Complexity ◽  
International Classification Of Diseases ◽  
The United States ◽  
Office Visits ◽  
Classification Of Diseases ◽  
The Cost

116 Background: Our objectives are to characterize prostate cancer patient resource consumption and cost (I) to society, in 1 calendar year; and (II) to the patient, 1 year after his diagnosis. Methods: The MarketScan database was used to summarize cost, including gross payment to provider for service, copayment, and deductibles. We identified the top 20 Current Procedural Terminology (CPT) codes to characterize which procedures drove costs for both objectives. For Objective I, diagnoses were identified in 1 calendar year (2014); codes and their costs for all patients were calculated. For Objective II, diagnoses were set at time = 0, and all CPT and International Classification of Diseases codes were characterized 1 year after diagnosis (2012-2013). Results: For objective I, there were 95,642 procedures totalling $38,696,423. The plurality of procedures were hospital consultations, level 2 (i.e. history + physical + straightforward decision-making; 17,103 performed, average $80 each, total $1,418,954) and level 3 (+ low complexity decision-making; 9,726 performed; average $127 each, total $1,232,928). The most costly procedure to society was a radical prostatectomy (8,883 performed, average $2,003 each, total $17,694,508) with accompanying anesthesia (7,960 performed, average $1262 each, total $10,048,653). For objective II (characterized in Table), the mean payment per month was $2,794, including mean gross cost $2,673, mean copayment $32, and mean deductible $46. Conclusions: The typical cost of therapy to a prostate cancer patient is $2,800/month after diagnosis, primarily from surgery (constituting the majority of cost to society) and subsequently from office visits (constituting the plurality of procedures). Societal measures to reduce cost should be aimed at the operating room and consultations.[Table: see text]

scholarly journals The Financial Impact of Hypofractionated Radiation for Localized Prostate Cancer in the United States

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Assaf Moore ◽  
Ido Stav ◽  
Robert B. Den ◽  
Noa Gordon ◽  
Michal Sarfaty ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
External Beam Radiotherapy ◽  
The United States ◽  
Similar Efficacy ◽  
Localized Prostate Cancer ◽  
The Us ◽  
Moderate Hypofractionation ◽  
Cancer Multiple ◽  
The Cost

Background. Until recently, dose intensified radiotherapy was the standard radiation method for localized prostate cancer. Multiple studies have demonstrated similar efficacy and tolerability with moderate hypofractionation. In recent years there has been an increasing focus placed on understanding the cost and value of cancer care. In this study we aimed to assess the economic impact of moderate hypofractionation for payers in the United States.Methods. We performed a population-based analysis of the total cost of external beam radiotherapy (EBRT) for localized prostate cancer in the US annually. The national annual target population of patients treated with definitive EBRT was calculated using the Surveillance, Epidemiology, and End Results (SEER) database. Treatment costs for various fractionation schemes were based on billing codes and 2018 pricing by the Centers for Medicare and Medicaid Services (CMS).Results. We estimate that 27,146 patients with localized prostate cancer are treated with EBRT annually in the US. The cost of standard fractionation in 45 or 39 fractions is US$26,782 and 23,625 per patient, respectively. With moderate hypofractionation in 28 or 20 fractions, the cost is US$17,793 and 13,402 per patient, respectively. The use of moderate hypofractionation would lead to 25-50% annual savings US$158,315,472-US$363,213,480 in the US.Conclusions. Moderate hypofractionation may have the potential to save approximately US$0.16-0.36 billion annually, likely without impacting survival or tolerability. This may lead to lower personal financial toxicity. It would be reasonable for public and private payers to consider which type of radiation is most suited to reimbursement.

Demonstrating Nutrient Cost Gradients: A Brooklyn Case Study

2014 ◽  
Vol 84 (5-6) ◽  
pp. 244-251 ◽  
Author(s):  
Robert J. Karp ◽  
Gary Wong ◽  
Marguerite Orsi
Keyword(s):  
Low Income ◽  
Energy Content ◽  
Food Selection ◽  
The United States ◽  
United States Department ◽  
Micronutrient Deficiencies ◽  
Caloric Density ◽  
Low Income Families ◽  
The Cost ◽  
The Impact

Abstract. Introduction: Foods dense in micronutrients are generally more expensive than those with higher energy content. These cost-differentials may put low-income families at risk of diminished micronutrient intake. Objectives: We sought to determine differences in the cost for iron, folate, and choline in foods available for purchase in a low-income community when assessed for energy content and serving size. Methods: Sixty-nine foods listed in the menu plans provided by the United States Department of Agriculture (USDA) for low-income families were considered, in 10 domains. The cost and micronutrient content for-energy and per-serving of these foods were determined for the three micronutrients. Exact Kruskal-Wallis tests were used for comparisons of energy costs; Spearman rho tests for comparisons of micronutrient content. Ninety families were interviewed in a pediatric clinic to assess the impact of food cost on food selection. Results: Significant differences between domains were shown for energy density with both cost-for-energy (p < 0.001) and cost-per-serving (p < 0.05) comparisons. All three micronutrient contents were significantly correlated with cost-for-energy (p < 0.01). Both iron and choline contents were significantly correlated with cost-per-serving (p < 0.05). Of the 90 families, 38 (42 %) worried about food costs; 40 (44 %) had chosen foods of high caloric density in response to that fear, and 29 of 40 families experiencing both worry and making such food selection. Conclusion: Adjustments to USDA meal plans using cost-for-energy analysis showed differentials for both energy and micronutrients. These differentials were reduced using cost-per-serving analysis, but were not eliminated. A substantial proportion of low-income families are vulnerable to micronutrient deficiencies.

Sign in / Sign up

Export Citation Format

Share Document