CaP Risk Research Articles

Analysis of Influencing Factors and Construction of Predictive Model for Persistent Cough After Lung Cancer Resection Under Thoracoscopy.

This study aims to explore the influencing factors of cough after pulmonary resection (CAP) after thoracoscopic lung resection in lung cancer patients and to develop a predictive model. A total of 374 lung cancer patients who underwent lung resection in our hospital from March 2020 to October 2023 were randomly divided into a modeling group (n=262) and a validation group (n=112). Based on the occurrence of CAP in the modeling group, the patients were divided into a CAP group (n=85) and a non-CAP group (n=177). Multivariate Logistic regression analysis was used to identify the influencing factors of CAP in lung cancer patients. A nomogram model for predicting the risk of CAP was constructed using R4.3.1. The consistency of the model's predictions was evaluated, and a clinical decision curve (DCA) was drawn to assess the clinical utility of the nomogram. The predictive performance of the model was evaluated using ROC curves and the Hosmer-Lemeshow test. Multivariate Logistic regression analysis showed that smoking history (OR=6.285, 95% CI: 3.031-13.036), preoperative respiratory function training (OR=20.293, 95% CI: 7.518-54.779), surgical scope (OR=20.667, 95% CI: 7.734-55.228), and peribronchial lymph node dissection (OR=5.883, 95% CI: 2.829-12.235) were significant influencing factors of CAP in lung cancer patients (P<0.05). ROC curves indicated good discriminatory power of the model, and the Hosmer-Lemeshow test showed a high degree of agreement between predicted and actual probabilities. The DCA curve revealed that the nomogram model had high clinical value when the high-risk threshold was between 0.08 and 0.98. The nomogram model based on smoking history, preoperative respiratory function training, surgical scope, and peribronchial lymph node dissection has high predictive performance for CAP in lung cancer patients. It is useful for clinical prediction, guiding preoperative preparation, and postoperative care.

Performance of cognitive vs. image-guided fusion biopsy for detection of overall and clinically significant prostate cancer in a multiethnic population

PurposeTransrectal ultrasound-guided prostate biopsy remains the most used method for the detection of prostate cancer. We recently reported that detection of clinically significant prostate cancer (cs-CaP) using image-guided fusion biopsies (IGFB) varied by race/ethnicity, which calls for further comparison between cognitive fusion biopsy (CFB) and IGFB among non-Hispanic black and Hispanic populations. Therefore, the aim of our study is to compare the rates of detection of cs-CaP and overall CaP by CFB and IGFB in a multiethnic community. Material and methodsWe performed a retrospective, cross-sectional review of men who underwent MRI-transrectal ultrasound-guided prostate biopsy at our diverse, urban academic medical center. Agreement and discordance between fusion biopsies and systematic biopsies for detection of cs-CaP and overall CaP were determined using Kappa statistics. Univariate and multivariate mixed-effects logistic regression models were used to find associations between fusion modalities and prostate cancer detection. ResultsIn total, 710 men underwent fusion prostate biopsies between December 2015 and June 2021. Upon univariate and multivariate logistic regression analysis, there was no significant association between IGFB vs. CFB and risk of overall CaP (OR = 0.66, 95% CI: 0.36–1.21, P = 0.18) or cs-CaP (OR = 0.57, 95% CI: 0.30–1.08, P = 0.09). We found moderate agreement between fusion and systematic biopsies for both CFB (κ = 0.56) and IGFB (κ = 0.52) in cs-CaP. ConclusionsCFB and IGFB offer similar detection rates of cs-CaP in a multiethnic population. CFB represents an effective and accessible means of accurately diagnosing prostate cancer.

Abstract C013: Importance of statistical considerations in multi-center, transatlantic cancer disparity studies: Lessons learned from the CaPTC prostate cancer familial cohort study

Abstract The CaPTC prostate cancer (CaP) Familial Cohort study (CaPFCS) was launched in 2017 to explore the CaP risk factors of African Black men (ABM). The study design is a prospective study that observes and follows healthy ABM and ABM diagnosed with CaP. Aim: The specific aim is to provide recommendations on statistical considerations for cohort studies focused on cancer disparities, based on lessons learned from the CaPTC CaPFCS. Methodology: Study participants were ABM in Cameroon, Nigeria, and the US. Using validated measures, data were collected mostly by self-administered or research assistant administered survey using paper survey (especially in Cameroon and Nigeria) with the responses transferred to REDCap by research coordinators. The statistical analysis for the CaPTC CaPFCS focused on the baseline epidemiological, behavioral, clinical and anthropometric measures of Black men. A total of 819 participants were included in the analyses. Statistical analyses included descriptive statistics (sample median, range, frequency and percentages) and unadjusted logistic regression models. Results: Data collection for the CaPTC CaPFCS were by multiple investigators/research coordinators at multiple sites in Cameroon, Nigeria, and the US. In preparation for the data analyses, we noted data entry errors and/or misinterpretation of data entry, which required extensive cleaning of the database prior to the analyses. The biostatisticians spent significant effort cleaning and ensuring data validity prior to the analyses. Confounding variables is another statistical consideration for cohort studies, such as the CaPTC CaPFCS. There was variability observed across age, education levels, employment status, household income and CaP diagnosis based on country of residence. CaP diagnosis was not reported by any of the ABM in the US, which may be due to the fact that they were all recruited within the community and no recruitment took place in the clinic. Finally, the CaPTC CaPFCS has several variables. Performing a lot of statistical tests may result in false-positive findings at P&amp;lt;0.05.Conclusion: The advantage of the CaPFCS is that it allows the CaPTC investigators to study epidemiological, behavioral, clinical and anthropometric variables associated with CaP over time. Being a longitudinal cohort study, investigators can track the changes in exposure and outcomes over time.However, statistical considerations need to be at the fore-front of multi-center, transatlantic cancer disparity studies such as the CaPTC CaPFCS, from data collection to data entry. The use of web-based survey with the ability to enter data directly into REDCaP will significantly reduce (if not totally eliminate) the need for database cleaning. There are multiple strategies that can be used to reduce confounder effect, including statistical adjustment and multivariate analysis to adjust for the confounders. The use of propensity score methods have especially been found to be effective in controlling baseline confounding factors. Citation Format: Daniel Lee, CaPTC Investigators, Jennifer Crook, Ruth Enuka, Fathi Parisa, Emeka Iweala Iweala, Oluwole Kukoyi, Ernest Kaninjing, Oluwaseyi Toye, Paul Jibrin, Folakemi Odedina. Importance of statistical considerations in multi-center, transatlantic cancer disparity studies: Lessons learned from the CaPTC prostate cancer familial cohort study [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C013.

CYP1A1 gene polymorphism and heavy metal analyses in benign prostatic hyperplasia and prostate cancer: An explorative case-control study.

The prostatic disorder is associated with benign prostatic hyperplasia (BPH) and prostate cancer (CaP). Evidently, prevalent transcription factors and signaling pathways define their relationship. The etiology of the prostatic disorder is multifactorial including heavy metal toxicity like lead (Pb), Cadmium (Cd), and genetic factors. This study elucidates the association between heavy metal toxicity Pb, Cd, and CYP1A1 gene polymorphism with BPH and CaP. a case-control study with (BPH, n = 104), (CaP, n = 58) and (controls, n =107) patients. Heavy metal Pb and Cd estimation by atomic absorption spectrophotometer. The polymorphism of the CYP1A1 T>C (rs4646903) gene was analyzed byPCR-RFLP. Higher levels of Pb and Cd were found in BPH and CaP followed by the control group (P-value: < 0.05). Pb and Cd show a significant correlation among prostate volume in CaP. Additionally, PSA, IPSS score, and pre void volume were positively co-related with Pb in BPH patients. The posthoc test defines the level of Pb and Cd as significantly elevated in the mutant genotype, highest among homozygous mutant genotype of CYP1A1gene among BPH. In CaP, Pb is significantly higher among the homozygous mutant type of CYP1A1 gene. The risk is also influenced by smoking, tobacco, and alcohol. The heavy metal toxicity Pb and Cd were reported to raise the risk of BPH and CaP. However, a person with heavy metal toxicity especially in BPH has a high-risk genetic susceptibility to the CYP1A1 gene in the north Indian population.

Associations between Etiologic or Prognostic Tumor Tissue Markers and Neighborhood Contextual Factors in Male Health Professionals Diagnosed with Prostate Cancer.

There is growing evidence that unfavorable neighborhood contexts may influence prostate cancer progression. Whether these associations may be explained in part by differences in tumor-level somatic alterations remain unclear. Data on tumor markers (PTEN, p53, ERG, and SPINK1) were obtained from 1,157 participants with prostate cancer in the Health Professionals Follow-up Study. Neighborhood greenness, socioeconomic status, and the income Index of Concentration at Extremes were obtained from satellite and census data and linked to participants' address at diagnosis and at study enrollment. Exposures were scaled to an interquartile range and modeled as tertiles. Bivariate associations between tertiles of neighborhood factors and tumor markers were assessed in covariate adjusted logistic regression models to estimate ORs and 95% confidence intervals. There was no association between any of the neighborhood contextual factors and PTEN, p53, ERG, or SPINK1 in bivariate or multivariable adjusted models. Results were generally consistent when modeling exposure using exposure at diagnosis or at study enrollment. In this multilevel study of men with prostate cancer, we found no evidence of associations between neighborhood context and tumor tissue markers. Our results provide some of the first empirical data in support of the hypothesis that prostate cancer risk conferred by tumor tissue markers may arise independently of underlying neighborhood context. Prospective studies in more diverse populations are needed to confirm these findings.

Size and proximity of micro-scale hard-inclusions increase the risk of rupture in fibroatheroma-like laboratory models

Increased mechanical stresses of the fibroatheroma cap tissue is a crucial risk factor on the pathogenesis of asymptomatic coronary artery disease events. Moreover, both numerical and analytical studies have shown that microcalcifications (μCalcs) located in the fibrous cap can multiply the cap tissue stress by a factor of 2–7. This stress amplification depends on the ratio of the gap between particles (h) and their diameter (D) when they are aligned along the tensile axis. However, the synergistic effect of cap stiffness and uCalcs on the ultimate stress and rupture risk of the atheroma cap has not been fully investigated. In this context, we studied the impact of micro-beads (μBeads) of varying diameters and concentration on the rupture of silicone-based laboratory models mimicking human fibroatheroma caps of different stiffness (shear moduli μsoft = 40 kPa, μstiff = 400 kPa) and thickness (650 μm and 100 μm). A total of 145 samples were tested under uniaxial tension up to failure and the true stress and strain response of each model was derived by means of Digital Image Correlation (DIC). Before testing, samples were scanned using high-resolution Micro-CT, to perform morphometry analyses of the embedded micro-beads and determine the number of closely spaced particles (h/D<0.5). The micro-beads structural and spatial features were then compared to the case of 29 non-ruptured human atheroma fibrous caps presenting μCalcs. Samples with and without μBeads exhibited a distinct hyperelastic behavior typical of arterial tissues. Regardless of the sample stiffness, large μBeads (>80 μm) significantly reduced the ultimate tensile stress (UTS) of the thick cap models with the effect being more pronounced as the particle diameter increases. Stiff models experienced early rupture in the presence of μBeads with 40 μm diameter. Smaller μBeads of 6 μm and 20 μm didn’t affect the ultimate strength of the thick cap models. However, when 6 μm μBeads where introduced in thinner cap models, we observed more than 20% drop in UTS. Increasing the μBeads concentration was also positively correlated with lower stresses at rupture as more clusters formed resulting in lower values of h/D. Morphometry analyses of cap models and human atheroma show that the 6 μm μBeads groups present very similar size distributions to μCalcs and that human μCalcs occupy an average volume ratio of 0.79 ± 0.85%. Our results clearly capture the influence of μBeads on the rupture threshold of a vascular tissue mimicking material. This effect appears to be dependent on the μBeads-to-cap thickness size ratio as well as their proximity. These findings support previous numerical and analytical studies suggesting that μCalcs located within the fibroatheroma cap may be responsible for significantly increasing the risk of cap rupture that precedes myocardial infarction and sudden death.

P261 Rate of Community Acquired Pneumonia, related hospitalization, and mortality among younger unvaccinated Inflammatory Bowel Disease patients

Abstract Background Community Acquired Pneumonia (CAP) is among the most common infections among Inflammatory Bowel Disease (IBD) patients. Current vaccine guidelines recommend vaccination at a younger age in individuals with IBD on immunosuppressive medications. Our aim was to determine the absolute and relative risk of CAP, related hospitalization, and death among unvaccinated IBD patients under the age of 65 years and compare the rates between those exposed and unexposed to immunosuppressive medications. We also sought to determine if exposure to immunosuppressive/immunomodulatory medications was associated with an increased risk of CAP in this group. Methods We conducted a retrospective cohort study utilizing a nationwide cohort of IBD patients under the age of 65 in the Veteran Affairs Healthcare System (VAHS) who were pneumococcal vaccine naive. The unexposed group included those patients on 5-ASA medications only. Exposure was administration of any immunosuppressive medication. The primary outcome was the first occurrence of pneumonia. Secondary outcomes were pneumonia related hospitalization and mortality. We reported event rate per 1000 person-years, hazard ratio, and 95% confidence intervals (CIs) for each outcome. Results A total of 26,707 patients were included in our study. 513 of these patients developed pneumonia (Table 1). The overall crude incidence rate of CAP was 3.2 per 1000 patient-years (4.04/1000 patient years in the exposed vs 1.45/1000 patient-years in the unexposed). The overall crude incidence rates for pneumonia-related-hospitalization and mortality were 1.12 and 0.09 per 1000 patient-years, respectively (Table 2). In Cox regression, exposed group was associated with an increased risk of pneumonia (AHR 2.85; 95% CI 2.21 – 3.66, p &amp;lt; 0.001) and pneumonia-related-hospitalization (AHR 3.46; 95% CI 2.20 – 5.43, p &amp;lt; 0.001) (Table 3). Conclusion Overall incidence of CAP among younger unvaccinated IBD patients was 3.2 per 1000 PY. We observed that while the incidence rates of CAP and CAP-related hospitalization were low overall, they were higher among those who received immunosuppressive therapy compared to those who only received 5-ASA medications. Knowing the exact risk of developing CAP among younger IBD patients will help patients and their physicians make informed decisions during these times of complex vaccine recommendations.

Abstract C004: Importance of statistical considerations in multi-center, transatlantic cancer disparity studies: Lessons learned from the CaPTC prostate cancer familial cohort study

Abstract Background: The CaPTC prostate cancer (CaP) Familial Cohort study (CaPFCS) was launched in 2017 to explore the CaP risk factors of African Black men (ABM). The study design is a prospective study that observes and follows healthy ABM and ABM diagnosed with CaP. Aim: The specific aim is to provide recommendations on statistical considerations for cohort studies focused on cancer disparities, based on lessons learned from the CaPTC CaPFCS. Methodology: Study participants were ABM in Cameroon, Nigeria, and the US. Using validated measures, data were collected mostly by self-administered or research assistant administered survey using paper survey (especially in Cameroon and Nigeria) with the responses transferred to REDCap by research coordinators. The statistical analysis for the CaPTC CaPFCS focused on the baseline epidemiological, behavioral, clinical and anthropometric measures of Black men. A total of 819 participants were included in the analyses. Statistical analyses included descriptive statistics (sample median, range, frequency and percentages) and unadjusted logistic regression models. Results: Data collection for the CaPTC CaPFCS were by multiple investigators/research coordinators at multiple sites in Cameroon, Nigeria, and the US. In preparation for the data analyses, we noted data entry errors and/or misinterpretation of data entry, which required extensive cleaning of the database prior to the analyses. The biostatisticians spent significant effort cleaning and ensuring data validity prior to the analyses. Confounding variables is another statistical consideration for cohort studies, such as the CaPTC CaPFCS. There was variability observed across age, education levels, employment status, household income and CaP diagnosis based on country of residence. CaP diagnosis was not reported by any of the ABM in the US, which may be due to the fact that they were all recruited within the community and no recruitment took place in the clinic. Finally, the CaPTC CaPFCS has several variables. Performing a lot of statistical tests may result in false-positive findings at P&amp;lt;0.05. Conclusion: The advantage of the CaPFCS is that it allows the CaPTC investigators to study epidemiological, behavioral, clinical and anthropometric variables associated with CaP over time. Being a longitudinal cohort study, investigators can track the changes in exposure and outcomes over time.However, statistical considerations need to be at the fore-front of multi-center, transatlantic cancer disparity studies such as the CaPTC CaPFCS, from data collection to data entry. The use of web-based survey with the ability to enter data directly into REDCaP will significantly reduce (if not totally eliminate) the need for database cleaning. There are multiple strategies that can be used to reduce confounder effect, including statistical adjustment and multivariate analysis to adjust for the confounders. The use of propensity score methods have especially been found to be effective in controlling baseline confounding factors. Citation Format: Daniel Lee, Michael Heckman, Zhongwei Peng, Emeka Iweala, Ademola Popoola, Paul Jibrin, Mohammed Faruk, Anthonia Sowumi, Omolara Fatiregun, Nkegoum Blaise, Catherine Oladoyinbo, Ifeoma Okoye, Abdulkadir Ayo Salako, Abidemi Omonisi, Iya Eze Bassey, Kayode Adeniji, Nggada Haruna Asura, Ernest Kaninjing, Oluwole Kukoyi, Fathi Parisa, Ruth Enuka, Oluwaseyi Toye, Jennifer Crook, CaPTC Investigators, Folakemi Odedina. Importance of statistical considerations in multi-center, transatlantic cancer disparity studies: Lessons learned from the CaPTC prostate cancer familial cohort study [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C004.

Volatilitas Market Cap Pada BEI Periode 2019-2021

Stocks are indeed one of the most eye-catching investments for investors. As an investor, you need clear directions regarding the volatility of each layer of the market cap of stocks. Knowing the volatility of each layer of the market cap will provide consideration for investors before making an investment. This will involve considering the amount of return and risk that will be faced. The higher the volatility of stock prices, which gives a signal, the higher the risks that will be faced. Lower volatility signals that companies tend to have a higher market cap and lower risk. This research method uses quantitative methods with descriptive analysis and uses secondary data. The population of this study is the shares of companies listed on the IDX from 2019 to 2021, taken by purposive sampling, where at each layer of the market cap there are 30 companies. The results showed that there was a significant difference in the value of volatility in the market cap layer. While the results of risk and stock returns for each layer of market cap have differences but are not significant.

Clinical validation of IsoPSA, a single parameter, structure-focused assay for improved detection of prostate cancer: A prospective, multicenter study.

IsoPSA is a blood-based test that assesses prostate cancer (CaP) risk by partitioning and detecting cancer-specific structural isoforms of prostate specific antigen (PSA) with an aqueous 2- phase system. To validate the diagnostic performance of IsoPSA for High-Grade CaP and Any CaP risk on biopsy in men age ≥ 50 with total PSA ≥ 4 ng/ml. Prospective, multicenter study of 888 men scheduled for prostate biopsy at 8 academic and community sites between August 2015 and August 2020. IsoPSA test. Receiver operating characteristic and likelihood ratio analysis used to validate diagnostic performance for previously established IsoPSA Index cutoffs for High-Grade CaP (Gleason Score ≥ 7) and Any CaP (Gleason Score ≥ 6), compare IsoPSA to total PSA and % free PSA, and evaluate subgroups (total PSA 4-10 ng/ml, total PSA > 10 ng/ml, biopsy naïve, prior negative biopsy). The disease prevalence was 35.6% (High-Grade CaP) and 58.9% (Any CaP). The area under the receiver operating characteristic curve was 0.783 (High-Grade CaP) and 0.770 (Any CaP). IsoPSA outperformed total PSA and % free PSA on area under the receiver operating characteristic curve, specificity, positive and negative predictive value at similar sensitivity. Using selected IsoPSA Index cutoffs, an estimated 46% (High-Grade CaP) and 42% (Any CaP) of biopsies could be avoided in low-risk patients. IsoPSA displayed statistically informative likelihood ratio-based predictive characteristics. IsoPSA maintained accuracy in clinically relevant subgroups. IsoPSA diagnostic performance and predictive value is validated for High-Grade CaP and Any CaP in men age ≥ 50 with total PSA ≥ 4 ng/ml undergoing diagnostic biopsy. IsoPSA outperforms total and % free PSA in discriminating the risk of prostate cancer on biopsy. IsoPSA has the potential to reduce unnecessary biopsies and improve the risk-benefit ratio for CaP early detection.

Dietary consumption of tea and the risk of prostate cancer in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial.

Tea contains polyphenols such as flavonoids, anthocyanidins, flavanols and phenolic acids which in laboratory studies have reported to promote antioxidant enzyme formation, reduces excess inflammation, slow cancer cell proliferation and promote apoptosis. Evidence from epidemiological studies on the effect of tea consumption on prostate cancer (CaP) incidence has been conflicting. We analysed data from 25097 men within the intervention arm of the 155000 participant Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Histologically confirmed cases of prostate cancer were reported in 3088 men (12·3 %) during the median 11·5 year follow-up. Tea consumption was assessed with a FFQ. Baseline characteristics were compared between groups using χ2 and Kruskal-Wallis tests. Cox regression models were used to assess associations between tea intake and CaP incidence. There was no statistical difference between the risk of CaP between men who never drank tea to those who drank tea at any quantity. Amongst tea drinkers, those in the highest third of consumption group had a small but significantly lower risk compared with those in the lowest third (11·2 % v. 13·2 % hazard ratio 1·16; (95 % CI 1·05, 1·29), P = 0·004). This pattern persisted with adjustments for demographics and lifestyle. In conclusion, among tea drinkers, there was a small positive association between drinking tea and a reduced risk of prostate cancer. It does not support starting to drink tea, if men previously did not, to reduce the risk. Further research is needed to establish whether tea is justified for future prospective nutritional intervention studies investigating CaP prevention.

The use of 29 MHz transrectal micro-ultrasound to stratify the prostate cancer risk in patients with PI-RADS III lesions at multiparametric MRI: A single institutional analysis

IntroductionMagnetic Resonance Imaging (MRI) has emerged as the most accurate diagnostic tool, showing a high sensitivity in the diagnosis of clinically significant prostate cancer (csCaP). However only a minority of patients with a PI-RADS 3 lesion at multiparametric magnetic resonance imaging (MRI) are diagnosed with csCaP. The aim of the current study was to assess whether high resolution micro-ultrasound (microUS) could help in sub-stratifying the risk of csCaP in this specific population. Material and methodsWe retrospectively analyzed the records of 111 consecutive patients scheduled for a prostate biopsy with at least 1 PI-RADS 3 lesions at MRI. We excluded patients with a PIRADS >3 lesion, even if they had a coexisting PIRADS 3 lesions. MicroUS was performed in all patients before prostate biopsy by an operator blind to MRI results. The Prostate Risk Identification using MicroUS (PRI-MUS) protocol was used to assess the risk of CaP and csCaP. All patients received both targeted and systematic biopsies. The primary endpoint was to determine the diagnostic accuracy of microUS in detection of csCaP in patients with a PI-RADS 3 lesion at MRI. Specifically, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of microUS were determined. Multivariable logistic regression models (MLRMs) were fitted to identify predictors of CaP. The diagnostic accuracy was reported as area under the receiver operator characteristic (ROC) curve. ResultsOverall, 43 patients (38.7%) harboured CaP and 22 (20%) csCaP. MicroUS showed a high sensitivity and negative predictive value (100%), while its specificity and positive predictive value were 33.7% and 27.2%, respectively. Among patients without lesions at microUS, 25 (83.3%) did not harbour CaP, while 5 (16.7%) patients were diagnosed with a Gleason score 6 CaP, with no patients harbouring csCaP. Using microUS, the csCaP detection would have remained 100%, while reducing the detection of insignificant CaP of a 23.8% extent (n = 5). In MLRMs, lesion identified at microUS and continuously-coded PSAd were independent predictors of CaP. The accuracy of a model including PRI-MUS score, digital rectal examination (DRE), PSA density, age and family history was 0.744 (95% CI: 0.645 – 0.843). ConclusionIn our single-institutional retrospective study, microUS was potentially capable to stratify the presence of CaP in patients with an equivocal MRI. Further prospective studies on larger populations are needed to validate our results.

648 External Validation of The European Randomized Study of Screening for Prostate Cancer Risk Calculator 3 (ERSPC-RC3) In the Detection of Prostate Cancer and Avoiding Unnecessary Prostate Biopsies

Abstract Introduction The Prostate Cancer Research Foundation – Stichting Wetenschappelijk Onderzoek Prostaatkanker group has devised the European Randomized Study of Screening for Prostate Cancer (CaP) Risk Calculator 3 (ERSPC-RC3) tool which aims to increase prostate cancer detection rates and avoid unnecessary prostate biopsies. We report the external validation and accuracy of the ERSPC-RC3 in our UK cohort. Method Retrospective data was collected for patients who had prostate biopsy at a multi-centre district general hospital over an 18-month period. The ERSPC-RC3 was applied to identify the probability of a positive biopsy for CaP (Gleason score ≥7). Results Out of 121 TRUS biopsies, 78 patients met the ERSPC-RC3 inclusion criteria. Patients were stratified as low-risk (detectable CaP risk &amp;lt;12.5%) n = 10, intermediate-risk (detectable CaP risk 12.5-20%) n = 8, and high-risk (detectable CaP risk &amp;gt;20%) n = 60 groups. All low-risk patients had a benign histology. Gleason 7 CaP was found in 37.5% from the intermediate-risk group and 41.7% in the high-risk group respectively. Conclusions Our results demonstrate that using ERSPC-RC3 could have prevented 44% (n = 34) of patients from having unnecessary biopsies. We recommend the use of ERSPC-RC3 to risk stratify patients being investigated for suspected CaP.

1499. Incidence of Community Acquired Pneumonia by Age and Comorbid Conditions in the Veterans Health Administration (VHA)

BackgroundCommunity acquired pneumonia (CAP) remains a major cause of morbidity and mortality. Risk factors for CAP are often grouped as moderate- (e.g., diabetes mellitus, chronic liver, lung, or heart disease) and high-risk (e.g., immunosuppressive) conditions, which in turn influences preventative strategies, notably pneumococcal vaccination. Here, we use the national VHA databases to assess the risk of CAP among adults, expanding on previous work by using administrative data to assess the incidence of CAP among people with > 1 moderate risk conditionMethodsWe used the national VHA databases merged with claims summaries from the Centers for Medicare and Medicaid Services (CMS) to identify patients receiving clinical care in the VHA without clinical Medicare claims in 2016-2017. Within this population, we identified CAP cases defined by the presence of a diagnostic code for pneumonia, chest X-ray, and antibiotics as well as the absence of healthcare exposure or antibiotics in prior 90 days. We determined the total patient years at risk and calculated incidence rates by age group and by moderate- and high-risk comorbid conditions.ResultsWe identified 37,348 CAP cases in 7.9 million person-years at risk and observed similar annual rates in 2016 and 2017 (468.9 and 472.2 cases/100,000 person-years, respectively). The prevalence of high-risk conditions and incidence of CAP increased with age whereas the prevalence of >1 moderate-risk condition peaked for ages 50-64 and 65-74 years (Table). The incidence of CAP among those with > 1 moderate-risk condition exceeded that of patients with high-risk conditions across all age strata (Figure).Table Figure ConclusionAge-adjusted analysis revealed that the greatest burden of CAP occurs in patients with > 1 moderate-risk condition, even compared to those with a high-risk condition. Our analysis of CAP based on national VHA data suggest that additional preventative health measures directed at individuals older than 50 years with > 1 moderate-risk condition may help to reduce the burden of CAP and limit its morbidity and mortality.Disclosures Robin Jump, MD, PhD, Accelerate (Grant/Research Support)Merck (Grant/Research Support)Pfizer (Grant/Research Support, Advisor or Review Panel member)Roche (Advisor or Review Panel member) Federico Perez, MD, MS, Accelerate (Research Grant or Support)Merck (Research Grant or Support)Pfizer (Research Grant or Support)

Abstract PO-010: Clustering of prostate cancer risk behaviors in West African men: The familial cohort study

Abstract Background: The risk of developing prostate cancer (CaP) is higher in Black Africans compared to non-Hispanic whites. Smoking, alcohol consumption, Unhealthy dietary behavior (consumption of high fat, sugar and salt diets) and chronic exposure to pesticides have been strongly associated with the risk of CaP. However, there is scarcity of information on clustering pattern of these risk behaviors among African men. Specific Aim(s)/Methods: Cross-sectional data of 500 West-African Black men representative from the Prostate Cancer Familial Cohort Study was analyzed. Two- step cluster analysis was used to identify cluster groups and multinomial logistic regression analysis was used to determine the association between behavioral risk factors and socio-demographic data. Results: The mean (95% CI) age and years spent in school were 47.93(47.05, 48.82) and 14.11(13.41, 14.80). The prevalence of smoking, alcohol drinking, chronic pesticide exposure and unhealthy diet was 26.2%, 44.7%, 39.0% and 82.4% respectively. Men of ages 35-34 years consumed High fat, sugar and salt (HFSS) diet most frequently. Most (96.6%) of the respondents were involved in at least one CaP risk behavior. Eleven clusters were identified in the clustering analysis, 3.4% had no risk, 24.4% had single risk behavior, 48.8% had double risk behaviors and 23.4% had multiple risk behaviors. Men with uncompleted college education were more likely to have multiple risk behaviors. Nigerian men were more likely to smoke or consume alcohol in addition to HFSS dietary intake. Men with Chronic exposure to pesticide consuming HFSS diet and/or smoking were more likely to have low body mass index. Cameroon men were more likely to have chronic exposure to pesticide in addition to HFSS diet intake and/or smoking. Conclusion: Policies and Behavior change interventions focused on double and multiple risk behaviors for CaP with consideration for socio-demoographic differences is essential for reducing the risk of CaP in Black men. Citation Format: Oluwafunke Akinbule, Catherine Oladoyinbo, Opeyemi Bolajoko. Clustering of prostate cancer risk behaviors in West African men: The familial cohort study [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-010.

Modelling and optimisation of treatment parameters in high-dose-rate mono brachytherapy for localised prostate carcinoma using a multilayer artificial neural network and a genetic algorithm: Pilot study

BackgroundHigh-dose-rate mono brachytherapy (HDR-MB) is employed in the treatment of prostate carcinoma (CaP). As an ideal plan of CaP brachytherapy cannot be created, it is necessary to identify a reliable tool to optimise the parameters of HDR-MB. This paper applies a multilayer artificial neural network (MANN) and a genetic algorithm (GA) to optimise brachytherapy parameters based on an individual dose-volumetric analysis. MethodsPatients with localised CaP of various risks were treated with HDR–MB. Consecutive levels of the biochemical control parameter (prostate specific antigen (PSA) nadir) have been collected after completion of HDR-MB in the range 2–9 years. The Kaplan–Meier regression analysis of biochemical-free survival (BFS) was applied. The clinical risk of recurrent CaP (RCaP), the therapy dose (TD), TD coverage index (CI100%) and PSA nadir were modelled using the MANN and GA. ResultsIn the low-risk group, BFS was achieved in 100% of treated patients, while in the group of patients with high risk, BFS was achieved in 95.8% of treated patients. The MANN-GA model optimises a TD of 47.3 Gy and CI100% of 1.14 as well as a TD of 50.4 Gy and CI100% of 1.6 for the low-risk group and high-risk group, respectively, of localised CaP. The optimised PSA nadir was 0.047 and 0.25 ng cm−3 for low-risk group and high-risk group, respectively. ConclusionsThe developed MANN-GA model presents a method for optimising the treatment parameters in radiation therapy, which could be a valuable tool in planning of the HDR-MB.

Abstract D034: Patient and provider concordance and trust in providers among West African Immigrants: Findings from the CaPTC Familial Cohort Study

Abstract Background Healthcare disparities among racial and ethnic groups have been well documented across all aspects of clinical healthcare, and disparities in attainment of preventive services are particularly prevalent. African immigrants may be particularly susceptible to factors that contribute to healthcare disparities but little is known about this population. The purpose of this study was to assess patient-provider concordance and trust of health care providers among West African immigrants in the US. In addition, we explored the relationship between these variables and the prostate cancer (CaP) screening behavior of participants. Methods Data collection was part of a global study of prostate cancer in West African men. A study questionnaire was used to collect data from West African male immigrants in the US between the ages of 35 and 70 years. Survey scales for this study included country of birth, years since immigration, patient–provider concordance, trust of healthcare provider, attitude and cues towards CaP screening (PSA and DRE), and CaP screening history. Results There were 38 African immigrants from Cameroon, Nigeria, Sierra Leone, and Ghana. Participants’ average age was 46.2 years and they had spent an average of 13.9 years in the US. Most of the participants (over 60%) stated that they had no preference in regards to their provider race, ethnicity or gender. Over 70% indicated that their physician was of different ethnicity and race while 50% indicated that their physician was of a different gender. Furthermore, most respondents noted that they trusted their physicians with health decisions. However, 61% and 68% of participants did not complete PSA or DRE testing, respectively. Most stated that they did not discuss the advantages or disadvantages of prostate cancer screening with their physicians, noting they mostly received cues to getting tested from reading information, radio, and/or TV. Conclusion Although health disparities can be explained by socioeconomic status such as lack of insurance and various other observable impediments to accessing health care, others barriers persist. It is important to explore other contributing factors such as patient-physician relationships. This study suggests that patient-provider concordance may not be a priority. Emphasis should be placed on encouraging physician-initiated discussion on CaP screening. Unfortunately, current physician guidelines do not stress CaP screening and fail to account for the documented increased risk and early onset of CaP in Black men. Citation Format: Nissa Askins, Ruth Agaba, Oluwaseyi Adeniji, Adaora Ezeani, Ernest Kaninjing, Folakemi Odedina, Catherine Badejo, Anthonia Sowunmi, Omolara Fatiregun, Ayo Salako, A. A Popoola, Mohammed Faruk, Emeka Iweala, Iya Bassey, Chidiebere Ogo, O. P. Oluwole, H. A. Nggada, Paul Jibrin, Ifeoma Okoye, Abidemi Omonisi, Iheanyi Okpala, A Adeniji, Toye Adeniji. Patient and provider concordance and trust in providers among West African Immigrants: Findings from the CaPTC Familial Cohort Study [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D034.

Abstract C024: Impact of migration on prostate health factors among West African men in US, Nigeria and Cameroon: Findings from the CaPTC familial cohort study

Abstract INTRODUCTION Prostate Cancer (CaP) disproportionately overburden men of African ancestry, especially Black men (BM). Unfortunately, few CaP studies have focused on the heterogeneity of BM within the US as well as the source population of US BM in Africa. The Prostate Cancer Transatlantic Consortium (CaPTC) team has documented differences in CaP-related behavioral factors, health-seeking behaviors and experiences between US-born and foreign-born Blacks since 2005. The CaPTC familial cohort study was developed to understand the genetic, environmental and behavioral etiology of CaP in West African men (WAm). This presentation focuses on the impact of migration on prostate health factors among WAm. Methodology The CaPTC cohort study in a longitudinal study and is still ongoing. The inclusion criteria are WAm, age 35-70 years, and residing in the US, Nigeria and Cameroon. Participants were recruited in diverse community settings. Data were collected from participants who provided informed consent using the CaPTC-AC3 Global Prostate Cancer Measure. The variables included in this presentation are general demographics, cultural beliefs and values, health beliefs, sun exposure, vitamins, body shape, and baldness. In addition, self-reported measures of prostate health were assessed. In addition to descriptive analyses, ANOVA/comparative analyses was used to examine differences among WAm in the US, Nigeria and Cameroon. Results The scales employed for the construct were highly reliable (alpha over 0.80). By December 2018, the sample size was 704 WAm with 81% recruited in Nigeria, 10% recruited in Cameroon and 9% recruited in the US. The average age was 48. Most of the WAm live in Nigeria, are married, middle-income level, Christian by faith and had never been screened for CaP. There was statistically significant differences among the WAm based on their country of residence with respect to CaP history (Nigeria), skin color (darker skin color in Cameroun), vitamin use (mostly by WAm in US), and pattern of baldness at age 30 (WAm in Nigeria). In addition, there was statistically significantly differences relative to cultural beliefs and values (cancer fatalism, religiosity, temporal orientation) and health beliefs (perceived barrier, perceived benefit). Cancer fatalism was lowest among WAm in US; religiosity was highest among WAm in Nigeria; WAm in the US were more future-oriented and WAm in Cameroun more present-oriented; perceived barrier was lowest for WAm in US; and perceived benefit highest for WAm in the US. Conclusion The increasing number of the African immigrant group in the US underscores the need to study within group difference among Blacks in the US. Unfortunately, this group is understudied and may offer a novel approach to fully understand cancer disparities in Blacks. Studying the impact of migration on CaP burden in this population provides several advantages, including identification of CaP risk factors. Our study confirms that migration impacts prostate health factors among WAm. Note: This abstract was not presented at the conference. Citation Format: Folakemi Odedina, Getachew Dagne, Adaora Ezeani, Ernest Kaninjing, Catherine Badejo, Anthonia Sowunmi, Omolara Fatiregun, Ayo Salako, Ademola Popoola, Mohammed Faruk, Emeka Iweala, Iya Bassey, Chidiebere Ogo, HA Nggada, Paul Jibrin, Oluwole Kukoyi, Ifeoma Okoye, Abidemi Omonisi, Iheanyi Okpala, Kayode Adeniji, Ruth Agaba, Oluwaseyi Adeniji, Desiree Rivers, Renee Reams, Clayton Yates. Impact of migration on prostate health factors among West African men in US, Nigeria and Cameroon: Findings from the CaPTC familial cohort study [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C024.

Use of beta-blocker types and risk of incident prostate cancer in a multiethnic population

PurposeIncreased adrenergic innervation is observed in prostate cancer (CaP) and is associated with aggressive disease. Emerging evidence suggests that beta-adrenergic blockade inhibits CaP progression. However, the association between type of beta-blocker use and risk of incident CaP on initial prostate biopsy has not been investigated in multiethnic populations. Materials and methodsA retrospective study of racially/ethnically diverse men (64% African-American and Hispanic), who underwent initial prostate biopsy between 2006 and 2016 in a large healthcare system was performed. Oral use of beta-blocker type was assessed by reviewing active prescriptions within the 5-year period preceding initial biopsy. Patient demographics and clinical factors were collected. ResultsOf 4,607 men who underwent initial prostate biopsy, 4,516 met criteria and 2,128 had a biopsy positive for CaP; 20% high-risk, 41% intermediate-risk, and 39% low or very-low risk (National Comprehensive Cancer Network classification). Overall, 15% of patients were taking a beta-blocker prior to initial biopsy, with Metoprolol, Atenolol, and Carvedilol accounting for the majority. Of beta-blocker types, Atenolol alone was associated with a 38% reduction in odds of incident CaP (P= 0.01), with a 40% and 54% reduction in risks of National Comprehensive Cancer Network intermediate and high-risk CaP (P = 0.03 and P = 0.03, respectively) compared to men not taking a beta-blocker. Furthermore, longer duration of Atenolol use (3–5 years) was associated with a 54% and 72% reduction in intermediate and high-risk disease, (P = 0.03 and P = 0.03, respectively). ConclusionsAmong beta blocker types, long-term Atenolol use is associated with a significant reduction in incident CaP risk on initial prostate biopsy for clinically-significant intermediate and high-risk disease compared to men not taking a beta-blocker.

PD13-02 TRENDS IN PROSTATE CANCER TREATMENT: DATA FROM THE MICHIGAN UROLOGIC SURGICAL IMPROVEMENT COLLABORATIVE

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History I (PD13)1 Apr 2020PD13-02 TRENDS IN PROSTATE CANCER TREATMENT: DATA FROM THE MICHIGAN UROLOGIC SURGICAL IMPROVEMENT COLLABORATIVE Richard C. Wu*, Ji Qi, Susan Linsell, Khurshid Ghani, James Montie, David C. Miller, Arvin George, Richard Sarle, and for the Michigan Urological Surgery Improvement Collaborative Richard C. Wu*Richard C. Wu* More articles by this author , Ji QiJi Qi More articles by this author , Susan LinsellSusan Linsell More articles by this author , Khurshid GhaniKhurshid Ghani More articles by this author , James MontieJames Montie More articles by this author , David C. MillerDavid C. Miller More articles by this author , Arvin GeorgeArvin George More articles by this author , Richard SarleRichard Sarle More articles by this author , and for the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000847.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Michigan Urological Surgery Improvement Collaborative (MUSIC) is a quality improvement program focused on improving the care of men with prostate cancer (CaP). Data collected from MUSIC to support quality improvement initiatives has helped shaped the CaP landscape in the state of Michigan. We aim to describe the evolving trends in the diagnosis and management of CaP within the collaborative. METHODS: MUSIC is a state-wide clinical consortium comprised of 45 diverse urology practices. The consortium maintains a prospective registry of men with CaP including patient demographic characteristics, disease severity, and treatment choice. Descriptive analytics were used to describe trends from 2012 to 2019. RESULTS: There are 33,000 prostate cancer patients in the registry among 45 practices. Median age and PSA at diagnosis increased from 2012 to 2019 (64 vs. 66) and (5.4 ng/ml vs. 6.6 ng/ml), respectively. We observed an increase in the positive biopsy rate, increasing from 58% in 2012 to 64% in 2018, and 61% in 2019. The proportion of GG1 diagnosed decreased from 34.4% to 27.4%, while ≥GG2 saw corresponding increase. Perhaps the most significant finding within the collaborative was the change in NCCN low risk CaP where surveillance increased from 46.6% to 89.2%. We also observed a decline in definitive treatment in the low risk patients, decreasing from 46.6% to 9.8%. A similar trend was found in intermediate risk CaP (Figures 1 and 2). The rate of metastatic disease at diagnosis remained unchanged (4.9 vs 4.7%). CONCLUSIONS: The diagnosis of ≥GG2 CaP has increased likely reflecting changes in screening and biopsy practice patterns. The utilization of active surveillance in MUSIC has increased to 89% as of 2019 representing one of the highest rates of AS for low risk CaP in the nation. Changes in practice likely reflect evolving guideline recommendations, novel biomarkers and imaging that improve CaP risk stratification, and considerable physician-directed quality improvement activities within MUSIC. Source of Funding: Blue Cross Blue Shield of Michigan © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e266-e266 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Richard C. Wu* More articles by this author Ji Qi More articles by this author Susan Linsell More articles by this author Khurshid Ghani More articles by this author James Montie More articles by this author David C. Miller More articles by this author Arvin George More articles by this author Richard Sarle More articles by this author for the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...