Care For Prostate Cancer Patients Research Articles

The Director of Prostate Imaging: advancing care for prostate cancer patients.

The radiologist's role extends far beyond interpretation and reporting of medical imaging. In this manuscript, we describe the role of the Director of Prostate Imaging. We believe that this model can and should be implemented at other institutions, ultimately serving to improve the care for prostate cancer patients. Moreover, this model can be translated to support the development of an array of patient-centered service lines not only in abdominal imaging, but throughout radiology practices at large.

PD58-07 MUSIC OCTAVE – COMPOSITE MEASURES TO ASSESS SURGEON PERFORMANCE FOR ROBOTIC PROSTATECTOMY

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety I1 Apr 2017PD58-07 MUSIC OCTAVE – COMPOSITE MEASURES TO ASSESS SURGEON PERFORMANCE FOR ROBOTIC PROSTATECTOMY Rodney L Dunn, James O Peabody, Brian R Lane, Richard Sarle, Tae Kim, Andrew Brachulis, Todd Morgan, Benjamin Stockton, Khurshid R Ghani, and Michigan Urological Surgery Improvement Collaborative Rodney L DunnRodney L Dunn More articles by this author , James O PeabodyJames O Peabody More articles by this author , Brian R LaneBrian R Lane More articles by this author , Richard SarleRichard Sarle More articles by this author , Tae KimTae Kim More articles by this author , Andrew BrachulisAndrew Brachulis More articles by this author , Todd MorganTodd Morgan More articles by this author , Benjamin StocktonBenjamin Stockton More articles by this author , Khurshid R GhaniKhurshid R Ghani More articles by this author , and Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2622AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Michigan Urological Surgery Improvement Collaborative (MUSIC) collects patient-reported outcomes (PRO), peri-operative outcomes, and surgeon-level video assessments of technical skill as a means to facilitate quality improvement for prostate cancer patients in the state of Michigan. In this study, we defined composite measures that could be used to identify better performing surgeons across a variety of outcomes for robot-assisted radical prostatectomy (RARP). METHODS For the urethro-vesical anastomosis, an Outcomes, Competency, and Technical Assessment Video Evaluation (OCTAVE-Anas) score was created by combining PRO urinary function score changes at 3-months post-RARP, percentage of patients having a urethral catheter duration >16 days, percentage of patients readmitted, and blinded peer-review Global Evaluative Assessment of Robotic Skill (GEARS) scores of videos of the anastomosis technique. Similarly, for nerve sparing (NS), OCTAVE-NS score was created based on differences in erectile function at 6-months post-RARP, percentage of organ-confined patients with positive margin, and GEARS assessment of NS technique. All component measures were standardized to represent number of standard deviations better (positive values) or worse (negative values) than population averages, and the OCTAVE score was calculated as the sum of these standardized values. RESULTS From 4/2014 through 4/2016, 20 surgeons from 14 different practices (2,774 total patients) sent video clips of their surgical techniques and had at least 50% of their patients participating in MUSIC PRO. OCTAVE-Anas scores ranged from -6.4 to 3.5, while OCTAVE-NS scores ranged from -3.7 to 3.5. Construct validity was demonstrated with moderate correlation between OCTAVE and the video assessment scores (Anas r=0.59, NS r=0.56, Figure 1). CONCLUSIONS OCTAVE successfully incorporates multi-dimensional assessments to reliably determine better performing surgeons for the anastomosis and nerve-sparing aspects of RARP. This method may be used to identify surgeons to provide peer surgical skill quality improvement, with the aim to advance care for prostate cancer patients in the state of Michigan. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1129-e1130 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Rodney L Dunn More articles by this author James O Peabody More articles by this author Brian R Lane More articles by this author Richard Sarle More articles by this author Tae Kim More articles by this author Andrew Brachulis More articles by this author Todd Morgan More articles by this author Benjamin Stockton More articles by this author Khurshid R Ghani More articles by this author Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Integrating diet and exercise into care of prostate cancer patients on androgen deprivation therapy.

Improved diagnosis and treatment regimens have resulted in greater longevity for men with prostate cancer. This has led to an increase in both androgen deprivation therapy (ADT) use and duration of exposure, and therefore to its associated adverse effects, such as sexual dysfunction, osteoporosis, reduced muscle mass, increased fat mass, and increased incidence of cardiovascular disease and type 2 diabetes. Given that the adverse effects of ADT are systemic, often debilitating, and difficult to treat, efforts continue in the development of new strategies for long-term management of prostate cancer. The PubMed database was searched to select trials, reviews, and meta-analyses in English using such search terms as “prostate cancer” and “androgen deprivation therapy”, “cardiovascular risk”, “lean body mass”, “exercise”, and “diet”. The initial searches produced 379 articles with dates 2005 or more recent. Articles published after 2004 were favored. This review utilizes the latest data to provide a status update on the effects of exercise and diet on patients with prostate cancer, focusing on ADT-associated side effects, and it discusses the evidence for such interventions. Since the evidence of large-scale trials in patients with prostate cancer is missing, and an extrapolation of supporting data to all patient subgroups cannot be provided, individualized risk assessments remain necessary before the initiation of exercise and diet programs. Exercise, diet, and nutritional supplementation interventions have the potential to provide effective, accessible, and relatively inexpensive strategies for mitigating ADT-associated toxicities without introducing additional adverse effects.

Biopsychosocial Needs of Patients with Prostate Cancer at Oncology Center

Prostate cancer is the most common cancer among men. Prostate cancer is a tumor that forms in tissues of the prostate gland in the male reproductive system. The failure of providing appropriate care for prostate cancer patients can compromise the effectiveness of nursing care and thereby adversely affect the health of the patients. Aim of the study, this study aimed to assess the biopsychosocial needs of patients with prostate cancer. Design: A descriptive exploratory study was used to meet the aim of the study. Setting: the study was conducted at the clinics of the Oncology Center affiliated to Ain Shams University. Subjects: A purposive sample composed of 80 adult patients with prostate cancer. Data collection tools: 1. An interview questionnaire tool: it was used to assess demographic data of the studied patients. 2. Biopsychosocial needs assessment questionnaire and 3. Informational needs assessment tool. Results: This study revealed that, regarding demographic characteristics, 90% of the study subjects were at age of sixty and more. In relation to physical needs, this study found that, 77.5% of the study subjects had loss of sexual desire, 90% suffered from pain in different body parts,84.5% can`t do their activities due to pain, 93.25% need emotional support, 83.75% feel that they cause a physical burden for families due to medical expenses and 80% had lack of information regarding self care of prostate cancer. Conclusion: this study concluded that patients with prostate cancer had physiological, psychological, social and informational needs. Recommendations: This study recommended the importance of man early screening for prostate cancer at the age of 45 and provision of supportive care services and psycho oncology clinics to meet prostate cancer patient's needs and consequently improve the quality of life for those patients.

Perceptions on coordination of care in prostate cancer patients treated with radiotherapy (RT) and androgen deprivation therapy (ADT): Implications for survivorship care planning.

10102Background: Survivorship care planning upon treatment completion is especially important for prostate cancer patients treated with ADT. These patients need coordinated oncologic and primary ca...

CD169(+) macrophages mediate pathological formation of woven bone in skeletal lesions of prostate cancer.

Skeletal metastases present a major clinical challenge for prostate cancer patient care, inflicting distinctive mixed osteoblastic and osteolytic lesions that cause morbidity and refractory skeletal complications. Macrophages are abundant in bone and bone marrow and can influence both osteoblast and osteoclast function in physiology and pathology. Herein, we examined the role of macrophages in prostate cancer bone lesions, particularly the osteoblastic response. First, macrophage and lymphocyte distributions were qualitatively assessed in patient's prostate cancer skeletal lesions by immunohistochemistry. Second, macrophage functional contributions to prostate tumour growth in bone were explored using an immune-competent mouse model combined with two independent approaches to achieve in vivo macrophage depletion: liposome encapsulated clodronate that depletes phagocytic cells (including macrophages and osteoclasts); and targeted depletion of CD169(+) macrophages using a suicide gene knock-in model. Immunohistochemistry and histomorphometric analysis were performed to quantitatively assess cancer-induced bone changes. In human bone metastasis specimens, CD68(+) macrophages were consistently located within the tumour mass. Osteal macrophages (osteomacs) were associated with pathological woven bone within the metastatic lesions. In contrast, lymphocytes were inconsistently present in prostate cancer skeletal lesions and when detected, had varied distributions. In the immune-competent mouse model, CD169(+) macrophage ablation significantly inhibited prostate cancer-induced woven bone formation, suggesting that CD169(+) macrophages within pathological woven bone are integral to tumour-induced bone formation. In contrast, pan-phagocytic cell, but not targeted CD169(+) macrophage depletion resulted in increased tumour mass, indicating that CD169(-) macrophage subset(s) and/or osteoclasts influenced tumour growth. In summary, these observations indicate a prominent role for macrophages in prostate cancer bone metastasis that may be therapeutically targetable to reduce the negative skeletal impacts of this malignancy, including tumour-induced bone modelling. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

AB002. Biomarkers for prostate cancer

Prostate cancer is the most commonly diagnosed non-cutaneous solid malignant tumor in the United States. Traditionally, Asian men have been considered low risk for prostate cancer. However, recent research suggests that the prevalence of prostate cancer is increasing in Asian men. This may represent an emerging public health problem with potentially serious consequences for patients and for health care systems. Given a predicted increase in the number of men diagnosed with prostate cancer in Asian countries, there is a clear and present need for optimized protocols for diagnosis and management of this condition in Asian men. Development of such protocols may benefit from novel technologies and lessons learned in Western countries; in this manner patients may receive optimal care and healthcare systems may mitigate the burden of over diagnosis (and subsequent overtreatment) which has complicated management of prostate cancer in the US and other Western nations. Genomic and other molecular testing offers a unique way to stratify oncological risk beyond simple serum, histological, and radiographic markers. These technologies measure genomic or molecular markers that provide novel insights into the biology of prostate tissue and prostate tumors. A variety of molecular biomarkers are in commercial use currently; these include tests designed to: (I) appropriately identify men for prostate biopsy, (II) select men likely to benefit from definitive treatment, and (III) determine which men who should consider adjuvant treatment after initial therapy. Integration of these molecular markers into the care of prostate cancer patients will require changes in how physicians make clinical decisions and counsel patients. These technologies must also be considered in light of improvements in imaging for prostate cancer. In the future, appropriate utilization of traditional, molecular, and radiographic tools will hopefully optimize care of the prostate cancer patients while simultaneously reducing costs to healthcare systems.

Development and evaluation of the TrueNTH-Prostate Cancer Canada electronic Library for Improved (urinary and bowel) Function post Treatment (TrueNTH-PCC-eLIFT).

161 Background: The TrueNTH program is a Movember-funded, pan Canadian effort to develop a comprehensive patient-centered online portal in English and French that will cover a full spectrum of prostate cancer survivor needs. Through the support of Prostate Cancer Canada, the TrueNTH-PCC-eLIFT resource, as part of the TrueNTH program, is being developed by a multi-disciplinary team of urologists, radiation oncologists, gastroenterologists, researchers, nurses and survivors at pilot sites in Victoria, BC and London, ON. eLIFT will address urinary and bowel side effects that may be experienced after curative intent treatment by External Beam Radiation Therapy (EBRT), Brachytherapy (BT), combined EBRT + BT or Radical Prostatectomy (RP). Methods: eLIFT includes a didactic electronic library, symptom assessment tool and content tailored to treatment or symptoms experienced. A sequential prospective cohort study is underway to evaluate the impact of the resource. A baseline cohort of eighty patients per site receiving standard of care is currently open. A second cohort of eighty patients per site will be accrued to receive the eLIFT intervention. The study measurespatient self-efficacy, knowledge, Health Related Quality of Life (HRQoL), urinary and bowel function, health resource usage and satisfaction. Results: eLIFT content, with a total of 22 video modules is complete and in production. Preliminary results from the first cohort of patients, receiving standard care, confirm a need for a reliable, online resource in Canada. Patients note that the oral information provided by their oncologist at their preliminary consultation, while informative, is not easily retained. Information that was provided as print varied and was often outdated. Further, patients deem websites outside of Canada as the most reliable and helpful, which may not reflect Canadian recommendations. Conclusions: eLIFT will provide a unique and scalable centralized resource that will allow for expansion to a National level and increase access to a scientifically-sound library of information with the goal of improving the quality of care for prostate cancer patients across Canada.

HSP90 Inhibitor Encapsulated Photo-Theranostic Nanoparticles for Synergistic Combination Cancer Therapy.

Photodynamic therapy (PDT) is a promising non-invasive therapeutic modality that has been proposed for treating prostate cancer, but the procedure is associated with limited efficacy, tumor recurrence and photo-toxicity. In the present study, we proposed to develop a novel multifunctional nano-platform for targeted delivery of heat, reactive oxygen species (ROS) and heat shock protein 90 (Hsp90) inhibitor simultaneously for combination therapy against prostate cancer. This new nano-platform combines two newly developed entities: 1) a unique organic and biocompatible nanoporphyrin-based drug delivery system that can generate efficient heat and ROS simultaneously with light activation at the tumor sites for dual-modal photothermal- and photodynamic- therapy (PTT/PDT), and 2) new nano-formulations of Hsp90 inhibitors that can decrease the levels of pro-survival and angiogenic signaling molecules induced by phototherapy, therefore, further sensitizing cancer cells to phototherapy. Furthermore, the nanoparticles have activatable near infrared (NIR) fluorescence for optical imaging to conveniently monitor the real-time drug delivery in both subcutaneous and orthotopic mouse models bearing prostate cancer xenograft. This novel multifunctional nano-platform has great potential to improve the care of prostate cancer patients through targeted combination therapy.

The 21st Annual Prostate Cancer Foundation Scientific Retreat report.

The 21st Annual Prostate Cancer Foundation (PCF) Scientific Retreat was held from October 23-25, 2014, in Carlsbad, CA. This event is the world's foremost scientific meeting focusing on prostate cancer and brings together leading basic, translational and clinical researchers in prostate cancer and other diverse disciplines to discuss the newest findings most likely to advance the understanding of prostate cancer and the clinical care of prostate cancer patients. This year's meeting highlighted themes including: (i) research integrity and standards for scientific reproducibility; (ii) prostate cancer disparities; (iii) mechanisms and models of prostate cancer progression and dormancy; (iv) mechanisms of therapeutic resistance; and (v) advancements in precision medicine treatments, treatment models, and predictive and prognostic biomarkers.

MP83-19 REAL-WORLD USE OF EPIC FOR CLINICAL PRACTICE (EPIC-CP) TO ASSESS PATIENT-REPORTED PROSTATE CANCER QUALITY-OF-LIFE IN THE CLINICAL SETTING

You have accessJournal of UrologyProstate Cancer: Localized IX1 Apr 2015MP83-19 REAL-WORLD USE OF EPIC FOR CLINICAL PRACTICE (EPIC-CP) TO ASSESS PATIENT-REPORTED PROSTATE CANCER QUALITY-OF-LIFE IN THE CLINICAL SETTING Peter Chang, Arie Carneiro, Ostap Dovirak, Kimberly Taylor, Catrina Crociani, Kyle McAnally, Andrew Percy, Martin G. Sanda, and Andrew A. Wagner Peter ChangPeter Chang More articles by this author , Arie CarneiroArie Carneiro More articles by this author , Ostap DovirakOstap Dovirak More articles by this author , Kimberly TaylorKimberly Taylor More articles by this author , Catrina CrocianiCatrina Crociani More articles by this author , Kyle McAnallyKyle McAnally More articles by this author , Andrew PercyAndrew Percy More articles by this author , Martin G. SandaMartin G. Sanda More articles by this author , and Andrew A. WagnerAndrew A. Wagner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1894AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate cancer practitioners tend to underestimate the severity of patients' treatment-related side effects. We developed the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) to facilitate patient-reported health-related quality of life (HRQOL) assessment at the point-of-care (Chang P et al, J Urol Sep 2011). In this study, we sought to demonstrate the feasibility of EPIC-CP use in the routine clinical care of prostate cancer patients, and to compare longitudinal patient-reported and practitioner-reported prostate cancer outcomes. METHODS We reviewed practitioner- and patient-reported HRQOL outcomes in 482 patients who underwent radical prostatectomy at our institution from 2010 to 2014. All EPIC-CP questionnaires were administered and interpreted in routine clinical practice flow without research personnel. To assess practitioner-reported outcomes, we reviewed practitioners' documentation of patients' incontinence pad use (yes/no) and erections sufficient for intercourse (yes/no). We used the paired t-test and Wilcoxon signed-rank test to compare pre- and post-treatment EPIC-CP domain scores, and Fisher's exact test to compare patient-reported and practitioner-reported outcomes. We considered p-values < 0.05 statistically significant. RESULTS A total of 708 EPIC-CP questionnaires were completed. Mean urinary incontinence domain scores were significantly higher (worse) than baseline (0.6±0.2) at 3 months (3.1±2.3; p < 0.05) and 6 months (2.2±2.1; p < 0.05) post-treatment, and statistically returned to baseline at 12 months (1.6±1.7; p > 0.05). Patient-reported incontinence pad-free rates using EPIC-CP at 3, 6, and 12 months were 39%, 70%, and 76%, respectively, which were consistent with our practitioner-reported rates. Mean sexual domain scores were significantly worse than baseline (2.4±2.8) at 3 months (7.0±3.5), 6 months (5.7±3.1), and 12 months (5.9±3.3; p < 0.05 for all). Practitioners significantly overestimated the rate of functional erections compared to patients' EPIC-CP-reported rates at 3 months (18% vs 12%, p < 0.05) and 12 months (45% vs 23%, p < 0.05). Bowel and vitality/hormonal scores were unchanged, and urinary irritation/obstruction scores significantly improved after surgery. CONCLUSIONS EPIC-CP is feasible to use in the routine clinical care of prostate cancer patients without requiring research infrastructure. Using EPIC-CP in clinical practice may help practitioners objectively assess the severity of patients' post-treatment side effects. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1057 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Peter Chang More articles by this author Arie Carneiro More articles by this author Ostap Dovirak More articles by this author Kimberly Taylor More articles by this author Catrina Crociani More articles by this author Kyle McAnally More articles by this author Andrew Percy More articles by this author Martin G. Sanda More articles by this author Andrew A. Wagner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Real-world use of epic for clinical practice (EPIC-CP) to assess patient-reported prostate cancer quality of life in the clinical setting.

18 Background: Prostate cancer practitioners tend to underestimate patients’ treatment-related side effects. We developed the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) to facilitate patient-reported health-related quality of life (HRQOL) assessment at the point-of-care (Chang P et al, J Urol Sep 2011). We sought to demonstrate the feasibility of EPIC-CP use in routine clinical care, and to compare longitudinal patient-reported and practitioner-reported prostate cancer outcomes. Methods: We reviewed practitioner- and patient-reported HRQOL outcomes in 482 patients who underwent radical prostatectomy at our institution from 2010 to 2014. All EPIC-CP questionnaires were administered and interpreted without research personnel. Practitioner-reported outcomes were assessed using chart review. We used the paired t-test and Wilcoxon signed-rank test to compare pre- and post-treatment EPIC-CP domain scores, and Fisher’s exact test to compare patient-reported and practitioner-reported outcomes. We considered p-values &lt; 0.05 statistically significant. Results: 708 total EPIC-CP questionnaires were completed. Mean urinary incontinence domain scores increased (worsened) significantly from baseline (0.6±0.2) to 3 (3.1±2.3) and 6 months (2.2±2.1) post-treatment, but were not statistically changed from baseline at 12 months (1.6±1.7). Patient-reported incontinence pad-free rates using EPIC-CP at 3, 6, and 12 months were 47%, 76%, and 78%, respectively, which were consistent with practitioner-reported rates. Mean sexual domain scores were significantly worse at 12 months (5.9±3.3) compared to baseline (2.4±2.8). Practitioners significantly overestimated the rate of functional erections compared to patients’ EPIC-CP-reported rates at 3 months (18% vs 12%, p &lt; 0.05) and 12 months (45% vs 23%, p &lt; 0.05). Bowel and vitality/hormonal scores were unchanged, and urinary irritation/obstruction scores improved after surgery. Conclusions: EPIC-CP is feasible to use in the routine clinical care of prostate cancer patients, and can help practitioners more accurately assess patients’ post-treatment symptom severity.

ASTRO 2013

ASTRO 2013

Molecularly Targeted Agents as Radiosensitizers in Cancer Therapy—Focus on Prostate Cancer

As our understanding of the molecular pathways driving tumorigenesis improves and more druggable targets are identified, we have witnessed a concomitant increase in the development and production of novel molecularly targeted agents. Radiotherapy is commonly used in the treatment of various malignancies with a prominent role in the care of prostate cancer patients, and efforts to improve the therapeutic ratio of radiation by technologic and pharmacologic means have led to important advances in cancer care. One promising approach is to combine molecularly targeted systemic agents with radiotherapy to improve tumor response rates and likelihood of durable control. This review first explores the limitations of preclinical studies as well as barriers to successful implementation of clinical trials with radiosensitizers. Special considerations related to and recommendations for the design of preclinical studies and clinical trials involving molecularly targeted agents combined with radiotherapy are provided. We then apply these concepts by reviewing a representative set of targeted therapies that show promise as radiosensitizers in the treatment of prostate cancer.

Opinions from the Experts: Exploring What Prostate Cancer Patients Should Know About Post-Operative Radiotherapy

The present study investigated health professionals' opinions about important questions that should be discussed with patients who may require post-prostatectomy radiotherapy. A 74-question survey was conducted among radiation oncologists, urologists, nurses, and radiation therapists involved in the care of prostate cancer patients. Survey questions covered six domains: understanding my situation and prostate cancer diagnosis, making a decision, radiotherapy: procedures involved, potential benefits, side effects, and my support network during radiation treatment. Respondents rated the importance of addressing these questions as either essential, important, no opinion, or avoid with a hypothetical post-prostatectomy case. The majority of questions were rated as either essential or important. There was disagreement between professions on essential questions, mostly between nurses and urologists in the side-effects domain. There was agreement between all professions regarding which questions should be avoided.

International comparison of androgen-deprivation therapy (ADT) for the treatment of nonmetastatic (M0) prostate cancer (PC).

e16040 Background: ADT represents standard of care for PC patients (pts) with signs of recurrence after primary therapy (tx). Nature and extent of ADT among M0 pts is not well-characterized, and nearly all ADT-treated pts relapse to develop castration-resistant PC (CRPC) after a median 18-24 months (mos) (Felici 2012). This physician survey quantifies ADT in populations with high or increasing incidence of M0 PC (Ferlay 2010). Methods: A 45-minute online survey was completed by urology and oncology practitioners (MDs) from 19 countries. Eligibility ensured MDs were responsible for tx decisions in the care of M0 PC, and had ≥10 pts on ADT. MDs were asked about tx at different points in the PC pathway, focusing on ADT (gonadotropin-releasing hormone [GnRH] or bilateral orchiectomy [bil orch]), type and duration of GnRH (intermittent vs. continuous), concurrent tx, and pts with CRPC (high risk CRPC definitions explored). Results: In total, 441 MDs completed the survey; predominantly urologists (88%). MDs had 98,689 PC pts under their care, 76,386 (77%) M0 PC. Of M0 PC, 38% received ADT: 37% (28104) GnRH (mainly leuprorelin [47%] or goserelin [21%]) and 1.6% (1251) bil orch (Table). The 34% tx rate reported by US MDs is consistent with decreasing ADT use (Shahinian 2010), whereas rates remain higher in Europe, particularly for Eastern European pts. Across regions, 74% (20,729) of GnRH pts received ≥6 mos, 48% (13,594) continuously; of these, 71% were expected to develop CRPC, 57% of CRPC were considered high risk for bone metastasis (BM). PSA doubling time ≤6 mos was most commonly cited high risk definition. Conclusions: These findings further our understanding of ADT use among M0 PC, which differs by country, by region, with highest rates reported in Europe. ADT rates have public health implications on the number of men expected to develop CRPC and be at high risk of BM in the future. [Table: see text]

Risk of subsequent primary cancer among prostate cancer patients in Bavaria, Germany

As the prevalence of prostate cancer in Germany is increasing, the issue of subsequent primary cancer (SPC) becomes more relevant. The aim of this study was to estimate the risk and its changes over time of developing SPC among prostate cancer patients compared with the general male population in Bavaria, southern Germany. Utilizing data from the Population-Based Cancer Registry Bavaria, the risk of SPC was evaluated in 59 259 men with prostate cancer diagnosed between 2002 and 2008 who contributed 159 892 person-years. The relative and absolute risk of developing SPC were calculated using the standardized incidence ratio (SIR) and the excess absolute risk. Changes in the risk were examined by plotting the SIR and its 95% confidence interval against time after the diagnosis of prostate cancer. The overall risk of SPC was significantly increased by 14% compared with the general male population. With regard to specific cancer types, a significantly increased risk of SPC was found for the urinary bladder, kidney, pancreas, melanoma of skin, leukemia, myeloma, brain/nervous system, renal pelvis/ureter, thyroid, and the small intestine. The absolute risk of SPC for most cancer types, however, was below 10 cases per 10 000 person-years. A significantly decreased risk of SPC was found in the lung/bronchus and the liver. Although detection bias cannot be excluded as a contributing factor for our results, we recommend continuing follow-up care of prostate cancer patients particularly with respect to SPC of the urinary system as a precaution.

Improving self care of patients with chronic disease using online personal health record

Effective management of chronic diseases such as prostate cancer is important. Research suggests a tendency to use self-care treatment options such as over-the-counter (OTC) complementary medications among prostate cancer patients. The current trend in patient-driven recording of health data in an online Personal Health Record (PHR) presents an opportunity to develop new data-driven approaches for improving prostate cancer patient care. However, the ability of current online solutions to share patients' data for better decision support is limited. An informatics approach may improve online sharing of self-care interventions among these patients. It can also provide better evidence to support decisions made during their self-managed care. To identify requirements for an online system and describe a new case-based reasoning (CBR) method for improving self-care of advanced prostate cancer patients in an online PHR environment. A non-identifying online survey was conducted to understand self-care patterns among prostate cancer patients and to identify requirements for an online information system. The pilot study was carried out between August 2010 and December 2010. A case-base of 52 patients was developed. The data analysis showed self-care patterns among the prostate cancer patients. Selenium (55%) was the common complementary supplement used by the patients. Paracetamol (about 45%) was the commonly used OTC by the patients. The results of this study specified requirements for an online case-based reasoning information system. The outcomes of this study are being incorporated in design of the proposed Artificial Intelligence (Al) driven patient journey browser system. A basic version of the proposed system is currently being considered for implementation.

Die ossäre Metastasierung des Prostatakarzinoms

Bone metastasis and skeletal complications have a devastating impact on the quality of life and are a major cause of morbidity in prostate cancer patients. In addition to established bone-targeted therapies, new drugs such as endothelin A receptor antagonists, MET and VEGFR-2 antagonists or radiopharmaceuticals are in the focus of development. The standard care in prostate cancer patients with bone metastases to prevent skeletal-related events (SRE) are bisphosphonates. Denosumab, a human monoclonal antibody against RANKL, appeared to be superior to zoledronic acid for prevention of SRE and has been shown to prolong bone metastases-free survival. In contrast to zoledronic acid, denosumab clearance is not dependent on kidney function and can be administered subcutaneously. Similar rates of toxicity were observed for both substances; however, long-term data for denosumab are limited.

Sexuality as an Aspect of Nursing Care for Prostate Cancer Patients and the Awareness of Nurses Providing Such Care

Sexuality as an Aspect of Nursing Care for Prostate Cancer Patients and the Awareness of Nurses Providing Such Care