Publications by authors named "Paul Doan"

7 Publications

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Perilesional Biopsies Increase Detection of Significant Prostate Cancer in Men with PI-RADS 4/5 Lesions: Validation of the PI-RADS Steering Committee Recommendation.

Eur Urol 2021 Feb 13. Epub 2021 Feb 13.

Department of Urology, Westmead Hospital, Westmead, Australia; Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, Australia. Electronic address:

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http://dx.doi.org/10.1016/j.eururo.2021.01.039DOI Listing
February 2021

Identifying prostate cancer in men with non-suspicious multi-parametric magnetic resonance imaging of the prostate.

ANZ J Surg 2021 04 21;91(4):578-583. Epub 2021 Jan 21.

Department of Urology, Westmead Hospital, Westmead, New South Wales, Australia.

Background: To formulate clinical pathways for identifying clinically significant prostate cancer (csPC) and avoiding insignificant prostate cancer (isPC) in those without suspicious regions of interest on multi-parametric magnetic resonance imaging (mpMRI) of the prostate.

Methods: A retrospective review identified patients with negative mpMRI who underwent subsequent transperineal prostate biopsy across two centres. Patient characteristics and association with biopsy results were evaluated using univariate and multivariate regression analyses.

Results: A total of 144 patients were identified as having negative mpMRI and undergoing subsequent transperineal prostate biopsy; 18% (25/144) of the cohort were found to have csPC. Logistic regression analysis failed to identify statistically significant predictive factors. In this cohort, if all patients with prostate-specific antigen > 3.0 were biopsied the least amount of csPC is missed, at 20% (5/25) however all isPC would be diagnosed. The least amount of isPC is diagnosed with a biopsy threshold of >15% from the European Randomized Study of Screening for Prostate Cancer calculator with 20% (5/25) of isPC diagnoses made however only 10.5% (2/19) csPC would be diagnosed. A biopsy threshold of >5% risk reduces the number of csPC missed to 37% (7/19) however increases isPC diagnoses to 54% (13/24) of the population.

Conclusion: False-negative rates of prostate MRI for csPC are significant within our cohort at 18%. The decision to biopsy should be made in conjunction with a risk profile acceptable by the patient and clinician. The current study demonstrates that there is a need to balance the risk of missing csPC and harm of diagnosing isPC.
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http://dx.doi.org/10.1111/ans.16583DOI Listing
April 2021

Transperineal systematic biopsies in addition to targeted biopsies are important in the detection of clinically significant prostate cancer.

ANZ J Surg 2021 04 5;91(4):584-589. Epub 2021 Jan 5.

Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia.

Background: This study aimed to determine whether the addition of transperineal systematic biopsies (SB) to targeted biopsies (TB) improved clinically significant prostate cancer (csPC) detection rates without high increase in insignificant prostate cancer detection rates in an Australian population.

Methods: In this retrospective review, a total of 254 patients who had a Prostate Imaging-Reporting and Data System score between 3 and 5, and a transperineal TB and SB between 2014 and 2019 from two centres were included in this study. The primary outcome of this study was to determine csPC rates on TB and SB. The secondary outcome was a comparison of the Gleason Grade Group between TB and SB. csPC was defined as an International Society of Urological Pathology Gleason Grade Group of 2 or greater.

Results: SB alone detected more csPC overall compared to TB (152/254 (60%) versus 128/254 (51%), respectively). An additional 40 of 254 (16%) csPC cases were diagnosed with the addition of SB. Furthermore, the cost of diagnosing insignificant prostate cancer by SB when TB were negative was an additional 13/254 (5.1%).

Conclusion: A combination of TB and SB provides the best outcomes for detecting csPC and is especially warranted for patients with a higher Prostate Imaging-Reporting and Data System score on multiparametric magnetic resonance imaging.
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http://dx.doi.org/10.1111/ans.16524DOI Listing
April 2021

A Systematic Review and Meta-Analysis of the Significance of Body Mass Index on Kidney Cancer Outcomes.

J Urol 2021 02 18;205(2):346-355. Epub 2020 Sep 18.

Department of Urology, Westmead Hospital, Westmead, New South Wales, Australia.

Purpose: Obesity is a well-known risk factor for kidney cancer incidence. However, a number of studies have demonstrated more favorable kidney cancer prognosis in patients with elevated body mass index conferring a survival advantage, termed the "obesity paradox." We aimed to evaluate the association between body mass index and kidney cancer outcomes (progression-free survival, cancer specific survival and overall survival).

Materials And Methods: A computerized systematic search of Medline®, Embase®, ProQuest®, PubMed® and Google Scholar™ for literature published in English was performed between its inception and December 2018, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for reporting.

Results: Overall, 34 publications comprising a total of 50,717 patients were included in the analysis. The majority assessed the association between body mass index and cancer specific survival. Overweight and obese patients were associated with improved cancer specific survival compared to patients with normal body mass index (HR 0.85, 95% CI 0.79-0.93). A similar trend was demonstrated for progression-free survival (HR 0.68, 95% CI 0.59-0.78) and overall survival (HR 0.66, 95% CI 0.55-0.79). On the contrary, the underweight group was associated with inferior cancer specific survival (HR 2.16, 95% CI 1.15-4.04). Main drawbacks limiting the interpretation were the retrospective design in the majority of studies, heterogeneity in study population, body mass index classification and covariates in multivariate analysis.

Conclusions: This is the largest systematic review evaluating the potential phenomenon of the obesity paradox in kidney cancer outcomes. It demonstrated a favorable effect of body mass index on kidney cancer outcomes. However, due to significant heterogeneity of studies, multicenter prospective studies and further research on the fundamental biological mechanisms are warranted to confirm the significance of body mass index on kidney cancer prognosis.
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http://dx.doi.org/10.1097/JU.0000000000001377DOI Listing
February 2021

Primary cutaneous malignant melanoma.

Authors:
Paul S Doan

Aviat Space Environ Med 2008 Sep;79(9):919-21

Residency in Areospace Medicine Program, Civil Aerospace Medical Institute, USA.

The Aerospace Medical Certification Division (AMCD) reviews over 8000 special issuance cases per yr. There is an increasing number of melanoma cases requiring an increased vigilance in detecting melanoma in airmen and an understanding of the present certification policy for airmen with melanoma.
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http://dx.doi.org/10.3357/asem.86105.2008DOI Listing
September 2008

You're the flight surgeon. Melanoma.

Authors:
Paul S Doan

Aviat Space Environ Med 2005 Sep;76(9):900-1

Department of Graduate Medical Education, USAF School of Aerospace Medicine, Brooks City-Base, TX 78235-5130, USA.

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September 2005