Editor’s Choice
them mainly for specialist pathologists to ensure consistent and high-quality assessment of penile cancer to inform the penile cancer team. In the UK, expert pathological review of penile cancer is already the norm for the penile supra-networks, but it would be difficult to make this the global standard for several reasons. Sub-specialization in penile cancer management is not widely practised outside Britain and there are few specialist high-volume centres, with some notable exceptions in Europe and the USA. Without clinical sub-specialization it is difficult for pathologists to develop an interest and sufficient expertise to offer an expert second opinion because the numbers seen by any individual pathologist will be too small. The UK penile supra-network system works well and has led to a group of pathologists developing an interest in this area simply because they are seeing a large number of such cases and working with dedicated clinical teams. Penile supra-networks should be adopted worldwide. Following this, a group of expert and experienced pathologists will ultimately be developed, who can offer a central review and expert second opinion service, as has happened over the last 10 years in the UK.
Catherine M. Corbishley Department of Cellular Pathology, St George’s Healthcare NHS Trust, London, UK e-mail: [email protected]
References 1
2
3
4
5
6
Tang V, Clarke L, Gall Z et al. Should centralised histopathological review in penile cancer be the global standard? BJU Int 2014; 114: 340–3 Manual for Cancer services. Urology measures Version 2.1. NHS National Cancer Peer Review Programme 2011 and Evidence guide for Urology Supraregional Penile MDT NHS National Cancer Peer Review Programme 2010. Available at: http://www.cquins.nhs.uk/?menu =resources. Accessed 20 January 2014 Royal College of Pathologists. Cancer Datasets and Tissue Pathways. Available at: http://www.rcpath.org/publications-media/ publications/datasets. Accessed 20 January 2014 Epstein JI, Cubilla AL, Humphrey PA. Tumours of the Prostate Gland, Seminal Vesicles, Penis and Scrotum. American Registry of Pathology, Washington DC published in collaboration with the Armed Forces Institute of Pathology, 2011, 405–612 Gospodarowicz MK (section editor, Genitourinary Tumours). TNM classification of malignant tumours (7th edition) penis. In Edge SB, Byrd DR, Compton CC Fritz AG, Greene FL, Trotti A eds, AJCC Cancer Staging Manual, 7th edn. New York: Springer, 2010: 447–55 Velazquez EF, Chaux A, Cubilla AL. Histologic classification of penile intraepithelial neoplasia. Semin Diagn Pathol 2012; 29: 96–102
Conflict of Interest None declared.
Perioperative aspirin: To give or not to give? As the population ages and life expectancy increases, one may safely assume that more men will be diagnosed with diseases of the elderly such as prostate cancer. In the USA, it is estimated that the number of older adults (≥65 years old) will double between 2010 and 2030, contributing to a 45% increase in cancer incidence [1]. Also, it is likely that these older patients will present with multiple comorbidities, commonly described as ‘multimorbidity’ in the contemporary medical literature, including chronic cardiac and pulmonary conditions requiring multidisciplinary medical management. Hence, the present study by Leyh-Bannurah et al. [2] examining the peri-operative use of aspirin in patients undergoing radical prostatectomy (RP) is a timely and important contribution, and may very well influence our clinical decision-making regarding the perioperative management of the anti-coagulated patient. Their results show that perioperative continuation of aspirin made no
318
© 2014 The Authors BJU International © 2014 BJU International
difference in peri and postoperative outcomes following RP. Previous studies have assessed the effect of aspirin continuation in patients undergoing minimally invasive RP, but the present study is the first to evaluate the effect of aspirin continuation in patients undergoing minimally invasive and open RP at a high-volume tertiary centre. Studies from other surgical specialties evaluating the role of anti-platelet therapy and its timing before surgery have shown conflicting results. The study by Park et al. [3], looking at discontinuation of aspirin for ≥7 days vs
them mainly for specialist pathologists to ensure consistent and high-quality assessment of penile cancer to inform the penile cancer team. In the UK, expert pathological review of penile cancer is already the norm for the penile supra-networks, but it would be difficult to make this the global standard for several reasons. Sub-specialization in penile cancer management is not widely practised outside Britain and there are few specialist high-volume centres, with some notable exceptions in Europe and the USA. Without clinical sub-specialization it is difficult for pathologists to develop an interest and sufficient expertise to offer an expert second opinion because the numbers seen by any individual pathologist will be too small. The UK penile supra-network system works well and has led to a group of pathologists developing an interest in this area simply because they are seeing a large number of such cases and working with dedicated clinical teams. Penile supra-networks should be adopted worldwide. Following this, a group of expert and experienced pathologists will ultimately be developed, who can offer a central review and expert second opinion service, as has happened over the last 10 years in the UK.
Catherine M. Corbishley Department of Cellular Pathology, St George’s Healthcare NHS Trust, London, UK e-mail: [email protected]
References 1
2
3
4
5
6
Tang V, Clarke L, Gall Z et al. Should centralised histopathological review in penile cancer be the global standard? BJU Int 2014; 114: 340–3 Manual for Cancer services. Urology measures Version 2.1. NHS National Cancer Peer Review Programme 2011 and Evidence guide for Urology Supraregional Penile MDT NHS National Cancer Peer Review Programme 2010. Available at: http://www.cquins.nhs.uk/?menu =resources. Accessed 20 January 2014 Royal College of Pathologists. Cancer Datasets and Tissue Pathways. Available at: http://www.rcpath.org/publications-media/ publications/datasets. Accessed 20 January 2014 Epstein JI, Cubilla AL, Humphrey PA. Tumours of the Prostate Gland, Seminal Vesicles, Penis and Scrotum. American Registry of Pathology, Washington DC published in collaboration with the Armed Forces Institute of Pathology, 2011, 405–612 Gospodarowicz MK (section editor, Genitourinary Tumours). TNM classification of malignant tumours (7th edition) penis. In Edge SB, Byrd DR, Compton CC Fritz AG, Greene FL, Trotti A eds, AJCC Cancer Staging Manual, 7th edn. New York: Springer, 2010: 447–55 Velazquez EF, Chaux A, Cubilla AL. Histologic classification of penile intraepithelial neoplasia. Semin Diagn Pathol 2012; 29: 96–102
Conflict of Interest None declared.
Perioperative aspirin: To give or not to give? As the population ages and life expectancy increases, one may safely assume that more men will be diagnosed with diseases of the elderly such as prostate cancer. In the USA, it is estimated that the number of older adults (≥65 years old) will double between 2010 and 2030, contributing to a 45% increase in cancer incidence [1]. Also, it is likely that these older patients will present with multiple comorbidities, commonly described as ‘multimorbidity’ in the contemporary medical literature, including chronic cardiac and pulmonary conditions requiring multidisciplinary medical management. Hence, the present study by Leyh-Bannurah et al. [2] examining the peri-operative use of aspirin in patients undergoing radical prostatectomy (RP) is a timely and important contribution, and may very well influence our clinical decision-making regarding the perioperative management of the anti-coagulated patient. Their results show that perioperative continuation of aspirin made no
318
© 2014 The Authors BJU International © 2014 BJU International
difference in peri and postoperative outcomes following RP. Previous studies have assessed the effect of aspirin continuation in patients undergoing minimally invasive RP, but the present study is the first to evaluate the effect of aspirin continuation in patients undergoing minimally invasive and open RP at a high-volume tertiary centre. Studies from other surgical specialties evaluating the role of anti-platelet therapy and its timing before surgery have shown conflicting results. The study by Park et al. [3], looking at discontinuation of aspirin for ≥7 days vs
