Newly-diagnosed Prostate Cancer Research Articles

Talk, test, and take one click to curb prostate cancer mortality.

6541 Background: Prostate cancer remains the most commonly diagnosed cancer and the second leading cause of cancer-related death in men in the United States. BronxCare Health System (BCHS) serves the Bronx neighborhoods of Morris Heights, Fordham South, and Mount Hope, notable for the highest prostate cancer incidence rate in New York City as per the American Cancer Society Cancer Action Network report 2019, highlighting the need for prostate cancer screening among the patient population we serve. An anonymous voluntary paper survey was performed in 2019 at BCHS to determine primary care physician understanding and implementation of current PSA testing guidelines. The study showed that primary care providers at BCHS approach PSA testing in a wide variety of ways and screen a wide age range of patients suggesting a need for intervention. An electronic medical record (EMR) decision support tool activated during primary care visits for men aged 55-69 years was implemented beginning January 1, 2021 which facilitates the provider and patient engagement in a shared decision-making discussion. This a follow-up study to determine the effect of this EMR application on PSA order rates and prostate cancer diagnosis rates at BCHS. Methods: The total number of patients who had PSA and lipid panel (LP) screening were extracted from the EMR of BCHS for potentially eligible men (aged 55-69) seen during primary care visits during the years 2016-2022. LP is done annually as a part of routine screening for adults aged 55-69 and is taken as an equivalent of primary care visits. PSA screening rates were compared to LP screening rates to control for unforeseen variables. Similarly, the number of newly-diagnosed prostate cancers among the same population of men was extracted for the years 2016-2021. Data for 2022 is still not available. 2016-2020 are pre-EMR and 2021 and 2022 are post-EMR flag years. The pre and post-EMR flag PSA and prostate cancer diagnosis numbers were compared by calculating Z scores and p-values. Results: The year-wise PSA, LP, and newly-diagnosed prostate cancers (PC) are tabulated below. The proportion of men who had PSA testing among all men aged 55-69 who had LP testing in each pre-EMR flag year was compared to each post-EMR flag year. A significant increase (p < 0.00001) was noted in the proportion of men who had PSA screening after implementation of the EMR application. Similarly, the proportion of men with newly-diagnosed prostate cancer among all men aged 55-69 who had PSA screening significantly increased after EMR application (p < 0.00001). Conclusions: A decision support tool embedded in the EMR has been an effective approach in increasing prostate cancer screening rates and may help curb prostate cancer mortality in our patient population as early detection in right men at the right age has the potential to reduce prostate cancer mortality. [Table: see text]

MP54-03 THE EFFECT OF DUAL ELIGIBILITY ON ACCESS TO CARE IN PATIENTS WITH NEWLY DIAGNOSED PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP54-03 THE EFFECT OF DUAL ELIGIBILITY ON ACCESS TO CARE IN PATIENTS WITH NEWLY DIAGNOSED PROSTATE CANCER Kassem Faraj, Rodney Dunn, Brent Hollenbeck, and Lindsey Herrel Kassem FarajKassem Faraj More articles by this author , Rodney DunnRodney Dunn More articles by this author , Brent HollenbeckBrent Hollenbeck More articles by this author , and Lindsey HerrelLindsey Herrel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003307.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Dual eligible beneficiaries are a particularly vulnerable population, as they qualify for Medicare due to age and Medicaid due to low income. Though some dual eligible beneficiaries have access to additional social services, such as transportation coverage, others do not qualify for these services (i.e. partial dual eligibility). This heterogeneity in support services may impact access to treatment for dual eligible men with newly diagnosed prostate cancer, a condition that necessitates timely, repeated interactions with the healthcare system. METHODS: We performed a cohort study of Medicare beneficiaries who were diagnosed with prostate cancer between 2015 and 2019. Beneficiaries were required to have 12-months of eligibility before and after diagnosis date. We compared pre-diagnosis testing, post-diagnosis testing, and primary prostate cancer treatment between beneficiaries who have full dual-eligibility (full duals, “F”), partial dual-eligibility (partial duals, “P”) and those who are not dual-eligible (non-duals, “N”). RESULTS: In 138,785 men with newly diagnosed prostate cancer, 4,611 (3.3%) were full duals and 2,031 (1.5%) were partial duals. Full and partial duals (Figure 1) were more often of Black race than non-duals (p<0.001). Partial duals were less likely to have a PSA (p<0.001) or multiparametric MRI (p<0.001) prior to diagnosis, compared to both duals and non-duals. After diagnosis, full and partial duals less commonly underwent multiparametric MRI (F-17%, P-15%, N-24%, p<0.001) and more commonly underwent bone scan (F-43%, P-42%, N-33%, p<0.001) compared to non-duals. Regarding treatment (Figure 1), full and partial duals less commonly underwent surgery (F-12%, P-13%, N-20%) and more commonly received androgen deprivation therapy as a primary treatment (F-16%, P-13%, N-7%) compared to non-duals (p<0.001). CONCLUSIONS: Our findings demonstrate disparities in access for dual-eligible beneficiaries before and after a new prostate cancer diagnosis. A more advanced stage at diagnosis may be reflected by the higher rates of bone scan testing and treatment with primary androgen deprivation therapy in the duals. A deeper understanding of barriers in access to prostate cancer screening and treatment is needed for this particularly vulnerable population. Source of Funding: This study is supported by funding from the National Cancer Institute Advanced Training in Urologic Oncology T32 Grant No T32CA180984 (Faraj) and by funding from the Prostate Cancer Foundation-Pfizer Health Equity Grant No K08CA237638 (Herrel) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e754 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kassem Faraj More articles by this author Rodney Dunn More articles by this author Brent Hollenbeck More articles by this author Lindsey Herrel More articles by this author Expand All Advertisement PDF downloadLoading ...

Synergistic Benefit of Adoptive T Cells in Combination With Chemoradiotherapy Against Metastatic Prostate Cancer Cells.

Prostate cancer (PC) is one of the major diseases that affects male health and ranks as the second most frequent cancer in men worldwide. Although most newly-diagnosed PCs are well-differentiated tumors with a high cure probability, there are some patients with aggressive malignancies that show potential for recurrence and metastasis. Cytotoxic T lymphocytes are a specific immune effector cell population that mediates immune responses against cancer. In the present study, the cytotoxicity of peripheral blood mononuclear cells (PBMCs)-derived γδ T cells and cytokine-induced killer (CIK) cells in combination with chemoradiotherapy against PC cells was evaluated using Alamar blue cell viability and cell membrane permeability assays. Advanced PC-3 cells, which were more resistant to docetaxel (Doc), also showed higher viability following pretreatment with radiation. The cell proliferation inhibition was significantly increased upon additional γδ T or CIK treatment. Furthermore, the proportion of apoptotic cells was significantly (p<0.05) increased in the Doc-γδ T cell co-treatment group as compared with the Doc or γδ T cell treated alone group. γδ T cell therapy may provide additional benefit compared to traditional chemoradiotherapy for PC treatment.

Abstract 5064: Patient-specific forecasting of prostate cancer growth during active surveillance using an imaging-informed mechanistic model

Abstract Active surveillance (AS) is a suitable management option for many newly-diagnosed prostate cancer (PCa) cases, which usually exhibit low to intermediate clinical risk. In AS, patients are closely monitored via multiparametric magnetic resonance imaging (mpMRI), prostate-specific antigen tests, and biopsies until these reveal an increase in PCa risk that warrants treatment. Thus, AS can contribute to reduce the current overtreatment of PCa and avoid treatment side-effects that may adversely impact patients’ lives without necessarily improving their longevity. However, current AS protocols rely on assessing PCa according to population-based studies, which complicates the design of personalized monitoring plans and the early detection of tumor progression. To address these issues, we propose to predict PCa growth using patient-specific forecasts based on an mpMRI-informed mechanistic model. Here, we present a preliminary study in a cohort of seven PCa patients who enrolled in AS and had three mpMRI scans over a period of 1.4 to 4.9 years. Our mechanistic model describes PCa growth in terms of tumor cell density dynamics, consisting of mobility and proliferation modeled via a diffusion process and a logistic law, respectively. We segment each patient’s prostate geometry on T2-weighted images and estimate tumor cell density from standard apparent diffusion coefficient (ADC) maps. To facilitate PCa modeling, we co-register each patient’s mpMRI datasets with a biomechanical elastic method that aligns the prostate segmentations across the imaging datasets. The model is initialized with the data from the first mpMRI scan. Model calibration relies on a nonlinear least-squares algorithm that minimizes the mismatch between ADC-measured and model-predicted tumor cell density at the second mpMRI date. For validation, we initialize the patient-specific calibrated model with the second mpMRI dataset and forecast PCa growth at the third mpMRI date, which we compare to the corresponding ADC-estimated tumor cell density. Model calibration resulted in a concordance correlation coefficient (CCC) &amp;gt; 0.99 for both tumor volume and global tumor cell count across the cohort. For each patient, the spatial fit of tumor cell density at the second scan date rendered a median Dice score and CCC of 0.79 and 0.52, respectively. Model validation resulted in CCCs of 0.88 and 0.81 for tumor volume and global tumor cell count across the cohort. Comparing the patient-specific ADC-estimated and model forecasts of tumor cell density at the third scan date, we obtained a median Dice score and CCC of 0.65 and 0.46, respectively. Thus, while improvement and further testing in larger cohorts are still needed, these results do suggest that our computational forecasting approach is a promising technology to predict the spatiotemporal growth of PCa during AS on a patient-specific basis. Citation Format: Guillermo Lorenzo, Jon S. Heiselman, Michael A. Liss, Michael I. Miga, Hector Gomez, Thomas E. Yankeelov, Thomas J. Hughes, Alessandro Reali. Patient-specific forecasting of prostate cancer growth during active surveillance using an imaging-informed mechanistic model [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5064.

Impact of Frailty on Survivals of Prostate Cancer Patients Treated with Radiotherapy

BACKGROUND: Frailty has been linked to an increased risk of adverse outcomes among older men with prostate cancer (PCa), which in turn impacts survival. We evaluated the associations between frailty and risks of all-cause mortality and cancer-specific mortality in PCa patients treated with radiotherapy (RT). METHODS: We conducted a retrospective cohort study using the Taiwan Cancer Registry Database and National Health Insurance Research Database. Patients aged ≥65 years with newly-diagnosed PCa, and receiving RT as initial treatment between 2011 and 2015 were identified in the study. Frailty was measured using the multimorbidity frailty index (mFI), categorized as fit, mild frailty, moderate frailty, and severe frailty. Cox regression models were used to examine the association between frailty and mortality. RESULTS: Among 4,291 men with a median age of 75 years at PCa diagnosis, 21.87% were categorized as fit, 44.72% were mild frailty, 23.02% were moderate frailty, and 10.42% were severe frailty. With the mean follow-up duration of 4.8 years, patients in the severe frailty group had a significantly higher all-cause mortality risk (HR 1.86; 95% CI, 1.48–2.32) and cancer-specific mortality risk (HR 1.44; 95% CI, 1.05–1.98) than patients in the fit group, whereas no such association was found in the mild frailty group after adjustment. CONCLUSIONS: This is the first population-based cohort study to evaluate the feasibility of mFI on mortality of PCa patients treated with RT. We found that severe frailty was associated with a higher risk of both all-cause mortality and cancer-specific mortality.

P016 - Coping strategies and psychophysiological stress response of newly-diagnosed prostate cancer patients

P016 - Coping strategies and psychophysiological stress response of newly-diagnosed prostate cancer patients

Association of serum prostate-specific antigen with Complete Blood Counts in patients with prostatic cancer

Background: Prostate cancer is the second most common cancer and one of the most leadingcauses of death in men worldwide. The prostate-specific antigen (PSA) as a screening methodshowed that there has been a slight decrease in prostate cancer mortality. Effective biomarkers inscreening and diagnosis would be beneficial for avoiding unnecessary operations. The predictive andprognostic value of complete blood count (CBC) has been manifested by recent studies. We aimed todetermine the association of serum PSA with Complete blood counts in patients with prostate cancer.Method: The present study included 100 subjects, 50 patients diagnosed with new prostate cancerand 50 patients with prostate cancer. All the was undertaken in the central diagnostic laboratory atVIMS and RC. Blood samples were collected from all the subjects after taken permission from theinstitutional ethics committee and consent form. The haemoglobin, RBCs, MCV, MCHC, RDW will beanalysed by using laboratory standard methods (Beckman coulter LH-780) and The serum PSAlevels are estimated by commercially available kits based on enzyme-linked immunosorbent assay(ELISA). Results: In the present study found significantly elevated levels of a prostate specificantigen in both groups of prostatic cancer patients. The reduced levels of hemoglobin, red bloodcells, platelets, neutrophils were observed in prostatic cancer patients when compared to newlydiagnosed prostate cancer patients. The PSA levels were negatively correlated with total bloodcounts. Conclusion: This study suggests that the elevated levels of prostate specific antigen wereuseful for diagnosis and prognosis of prostatic cancers, along with the monitoring of complete bloodcount may be useful for the treatment of patients with prostatic cancers.

Care received by rural and urban patients with newly diagnosed prostate cancer: Results from a population-based prospective cohort.

203 Background: Rural residence is a source of disparity in cancer access and outcomes. It is not known to what extent rurality affects access to care in patients with prostate cancer. Methods: The North Carolina Prostate Cancer Comparative Effectiveness &amp; Survivorship Study (NC ProCESS) is a population-based cohort of newly-diagnosed prostate cancer patients. Patients were enrolled from 2011-2013 through collaboration with the state cancer registry at diagnosis and followed prospectively. Urban/rural residence was defined by the rural urban continuum code (RUCC): 1-3 (urban) and 4-9 (rural). Medical records were collected and abstracted for prostate cancer care received. Individual-level sociodemographic information was collected by patient report. Results: Among 1,456 NC ProCESS participants with a median age of 65 years, 1089 were categorized as urban and 367 (25%) rural. This is a sociodemographically diverse cohort with 30.2% non-White (including 26.9% Black), 34.1% with high school education or less, and 37.3% with household income &lt; = $40,000. The distance to travel for diagnostic scans was greater for rural patients (miles): CT (7.5 urban vs 17.1 rural, p = 0.07), MRI (8.1 vs 12.0, p = 0.04) and bone scan (6.8 vs 14.1, p = 0.009). However, there was no difference in the percent of patients who underwent CT (15.9% urban vs 12.8% rural, p = 0.15), MRI (7.8% vs 8.2%, p = 0.81) and bone scan (15.9% vs 19.4%, p = 0.13); or the percentage of patients with high risk or metastatic disease who had any staging scan (64.2% vs 66.6% p = 0.8). While all patients consulted with a urologist, rural patients were less likely to have had consultation with a radiation oncologist (42.4% vs 35.8%, p = 0.04). Rural patients were also more likely to report that treatment was more difficult due to travel, including robotic prostatectomy (6.8% vs 13.9% p = 0.001) and radiation therapy (8.01% vs 16.07%, p = 0.001). In patients with low risk cancer, rural patients were more likely to have reported treatment at 12 months (68.2% vs 58.7% p = 0.04) instead of surveillance or observation. For high risk patients, both rural and urban patients reported high rates of treatment by 3 months (96.3% vs 91.3%, p = 0.40). After adjustment for age, income, race, education and insurance, rural residence was associated with increased likelihood of receiving treatment at 1 year (OR 1.54, CI 0.99 – 2.39) in low risk patients, but not associated with receiving treatment at 3 months (OR 3.63, CI 0.24 -54.5) among high risk patients. Conclusions: In a population-based cohort, rural patients with prostate cancer have greater barriers such as travel distance, but similar proportions of rural and urban patients received staging scans and timely treatment for high-risk prostate cancer. Rural patients were less likely to receive multidisciplinary consultation prior to treatment, and were less likely to have surveillance for low risk disease.

Decision regret, adverse outcomes, and treatment choice in men with localized prostate cancer: Results from a multi-site randomized trial

IntroductionMen diagnosed with localized prostate cancer must navigate a highly preference-sensitive decision between treatment options with varying adverse outcome profiles. We evaluated whether use of a decision support tool previously shown to decrease decisional conflict also impacted the secondary outcome of post-treatment decision regret. MethodsParticipants were randomized to receive personalized decision support via the Personal Patient Profile-Prostate or usual care prior to a final treatment decision. Symptoms were measured just before randomization and 6 months later; decision regret was measured at 6 months along with records review to ascertain treatment choices. Regression modeling explored associations between baseline variables including race and D`Amico risk, study group, and 6-month variables regret, choice, and symptoms. ResultsAt 6 months, 287 of 392 (73%) men returned questionnaires of which 257 (89%) had made a treatment choice. Of that group, 201 of 257 (78%) completely answered the regret scale. Regret was not significantly different between participants randomized to the P3P intervention compared to the control group (P = 0.360). In univariate analyses, we found that Black men, men with hormonal symptoms, and men with bowel symptoms reported significantly higher decision regret (all P < 0.01). Significant interactions were detected between race and study group (intervention vs. usual care) in the multivariable model; use of the Personal Patient Profile-Prostate was associated with significantly decreased decisional regret among Black men (P = 0.037). Interactions between regret, symptoms and treatment revealed that (1) men choosing definitive treatment and reporting no hormonal symptoms reported lower regret compared to all others; and (2) men choosing active surveillance and reporting bowel symptoms had higher regret compared to all others. ConclusionThe Personal Patient Profile-Prostate decision support tool may be most beneficial in minimizing decisional regret for Black men considering treatment options for newly-diagnosed prostate cancer. Trial RegistrationNCT01844999

経尿道的ホルミウムレーザー前立腺核出術 (HoLEP) における偶発癌症例および術後経過観察中に診断された前立腺癌症例の検討

経尿道的ホルミウムレーザー前立腺核出術 (HoLEP) における偶発癌症例および術後経過観察中に診断された前立腺癌症例の検討

PCN359 A CLINICAL ALGORITHM FOR IDENTIFYING PROSTATE CANCER CLINICAL STATES IN ELECTRONIC HEALTH RECORDS OR CLAIMS DATABASES IN THE UNITED STATES

To develop an algorithm for identifying prostate cancer (PC) clinical states. Each state represents a key treatment milestone and is imperative for research using real-world data. Patients with PC from Optum electronic health records (EHR) and claims databases were categorized into five states: (1) localized PC – newly-diagnosed PC without evidence of metastases, castration, or other cancer diagnoses within 90 days of PC diagnosis, (2) non-metastatic hormone-sensitive PC (nmHSPC) – evidence of androgen deprivation therapy (ADT) after new PC diagnosis and no prostate-specific-antigen (PSA) increase (EHR only), (3) metastatic HSPC (mHSPC) – evidence of metastases between PC diagnosis and initial indication of ADT (4) nm castration-resistant PC (nmCRPC) – having ≥1 of the following after evidence of surgical/medical castration: a) diagnosis of hormone-resistant malignancy status, b) new prescription for antiandrogens, or c) PSA level increase after castration (EHR only) (5) mCRPC – evidence of metastases between PC diagnosis and castration-resistance. From 2007 to 2018, we identified 125,505 and 51,299 newly-diagnosed PC patients in Optum EHR and claims databases, respectively. Using our clinical algorithm, patients were categorized into prognostically-relevant clinical states. In the follow-up period, of the total 125,505 patients in the EHR database, 87.5% had localized PC, 3.4% nmHSPC, 1.2% mHSPC, 9.8% nmCRPC, and 3.1% mCRPC, whereas, of the 51,299 patients in claims, 83.5% had localized PC, 30% nmHSPC, 1.7% mHSPC, 34.4% nmCRPC, and 1.6% mCRPC. Complex disease state definitions, missing clinical information (eg, lab values), and limited follow-up confound identification of PC patients in retrospective data. Understanding various states is critical for effective disease management and improving patient health outcomes, yet limited data by clinical states is currently published. Initial application of this claims-EHR algorithm was successful in identifying hormone-sensitive and castration-resistant status. Future work should focus on validation of the algorithm by comparing output to historical cohort sizes.

MP23-19 DECISION REGRET, ADVERSE OUTCOMES AND TREATMENT CHOICE IN MEN WITH LOCALIZED PROSTATE CANCER: RESULTS FROM A MULTI-SITE RANDOMIZED TRIAL

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I (MP23)1 Apr 2020MP23-19 DECISION REGRET, ADVERSE OUTCOMES AND TREATMENT CHOICE IN MEN WITH LOCALIZED PROSTATE CANCER: RESULTS FROM A MULTI-SITE RANDOMIZED TRIAL Donna L. Berry*, Fangxin Hong, Traci Blonquist, Barbara Halpenny, Niya Xiong, Christopher P Filson, Viraj A Master, Martin G Sanda, Peter Chang, Gary Chien, Randy Jones, Tracey Krupski, Seth Wolpin, Leslie Wilson, Julia Hayes, Quoc-Dien Trinh, and Mitch Sokoloff Donna L. Berry*Donna L. Berry* More articles by this author , Fangxin HongFangxin Hong More articles by this author , Traci BlonquistTraci Blonquist More articles by this author , Barbara HalpennyBarbara Halpenny More articles by this author , Niya XiongNiya Xiong More articles by this author , Christopher P FilsonChristopher P Filson More articles by this author , Viraj A MasterViraj A Master More articles by this author , Martin G SandaMartin G Sanda More articles by this author , Peter ChangPeter Chang More articles by this author , Gary ChienGary Chien More articles by this author , Randy JonesRandy Jones More articles by this author , Tracey KrupskiTracey Krupski More articles by this author , Seth WolpinSeth Wolpin More articles by this author , Leslie WilsonLeslie Wilson More articles by this author , Julia HayesJulia Hayes More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author , and Mitch SokoloffMitch Sokoloff More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000856.019AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Men diagnosed with localized prostate cancer must navigate a highly preference-sensitive decision between treatment options with varying adverse outcome profiles. Decisional regret has been documented in men after treatment. We evaluated whether use of a decision support tool previously shown to decrease decisional conflict also impacted post-treatment decisional regret. METHODS: Participants at 10 urology or radiation oncology clinics across the United States were randomized to receive personalized decision support via the Personal Patient Profile-Prostate or usual care. Symptoms were measured at baseline and 6 months after enrollment; decision regret was measured at 6 months along with medical records review to ascertain treatment choices. Regression modeling explored associations between regret, 6-month symptoms and baseline variables including race, study group, choice, D`Amico risk, and symptoms. RESULTS: At 6 months, 287 of 392 (73%) men returned questionnaires of which 257 (89%) had made a treatment choice. Of that group, 201/257 (78%) completely answered the regret scale. While there was no significant difference between study groups (p=0.360), univariate analyses revealed Black men (p=0.019), men with any hormonal symptoms (p=0.009), and men with any bowel symptoms (p=0.032) reported higher regret. Significant interactions between treatment choice, regret and symptoms were detected. Men receiving definitive treatment and reporting no hormonal symptoms reported lower regret compared to all others (p=0.002). Men choosing active surveillance and reporting bowel symptoms had higher regret compared to all others (p=0.002). Significant interactions were detected between race and study group (intervention vs usual care) in the multivariable model; use of Personal Patient Profile-Prostate was associated with significantly decreased decisional regret among Black men (p=0.037). CONCLUSIONS: Decisional regret was associated with active surveillance and adverse symptom outcomes for men of various races. The Personal Patient Profile-Prostate decision support tool may be most beneficial in minimizing decisional regret for Black men considering treatment options for newly-diagnosed prostate cancer. Source of Funding: NIH R01NR009692 © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e345-e346 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Donna L. Berry* More articles by this author Fangxin Hong More articles by this author Traci Blonquist More articles by this author Barbara Halpenny More articles by this author Niya Xiong More articles by this author Christopher P Filson More articles by this author Viraj A Master More articles by this author Martin G Sanda More articles by this author Peter Chang More articles by this author Gary Chien More articles by this author Randy Jones More articles by this author Tracey Krupski More articles by this author Seth Wolpin More articles by this author Leslie Wilson More articles by this author Julia Hayes More articles by this author Quoc-Dien Trinh More articles by this author Mitch Sokoloff More articles by this author Expand All Advertisement PDF downloadLoading ...

Analysis of the prognostic utility of the cell cycle progression (CCP) score generated from needle biopsy in men treated with definitive therapy

BackgroundAccurate risk stratification can help guide appropriate treatment decisions in men with localized prostate cancer. Here, we evaluated the independent ability of the molecular cell cycle progression (CCP) score and the combined cell-cycle clinical risk (CCR) score to predict 10-year risk of progression to metastatic disease in a large, pooled analysis of men with definitively treated prostate cancer.MethodsThe pooled analysis included 1,062 patients from four institutions (Martini Clinic, Durham VA Medical Center, Intermountain Healthcare, Ochsner Clinic) treated definitively for localized prostate cancer by either radical prostatectomy or radiotherapy (brachytherapy or external beam radiotherapy ± hormone therapy). The CCP score was determined using the RNA expression of 46 genes from archival formalin-fixed paraffin-embedded biopsy tissue. The CCR score was calculated using a predefined linear combination of the CCP score and the Cancer of the Prostate Risk Assessment (CAPRA) score. The scores were evaluated for association with 10-year risk of metastatic disease following definitive therapy after adjusting for other clinical variables.ResultsThe CCP score was strongly associated with 10-year risk of metastatic disease in multivariable analysis [Hazard Ratio per unit score = 2.21; 95% confidence interval (CI) 1.64, 2.98; p = 1.9 × 10−6] after adjusting for CAPRA, treatment type, and cohort. CCR was also highly prognostic (Hazard Ratio per unit score = 4.00; 95% CI 2.95, 5.42; p = 6.3 × 10−21). There was no evidence of interaction between CCP or CCR and cohort (p = 0.79 and p = 0.86, respectively) or treatment type (p = 0.55 and p = 0.78, respectively). Observed patient CCR-based predicted risks for metastatic disease by 10 years ranged from 0.1 to 99.4%, (IQR 0.7%, 4.6%).ConclusionsBoth CCP and CCR scores provided independent prognostic information for predicting progression to metastatic disease after both surgery and radiation. These results further demonstrate their potential use as a risk stratification tool in patients with newly-diagnosed prostate cancer.

Racial disparities in late-stage prostate cancer: A SEER database analysis 2005–2015.

115 Background: Incidence of metastatic prostate cancer in U.S. males has increased over the past ten years, but it is unknown how this trend varies over time within different racial and ethnic populations. Methods: We identified all men first diagnosed with prostate cancer from 2005-2015 in the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute, which monitors 18 population-based cancer registries. Yearly cancer diagnosis frequency from 2005 to 2015 was categorized and analyzed by stage (in situ/localized, regional, and distant), race/ethnicity [White, Asian American/Pacific Islander (AAPI), Black], and age group (45-54, 55-69, 70-75). Chi-square tests, multivariable logistic regression models were used for data analysis with p &lt; 0.05 considered significant. Results: In the 10-year study period, the proportion of regional-stage prostate cancer increased from 14.2% to 16.6% of cases (p &lt; .0001) and distant-stage increased from 3.3% to 5.8% (p &lt; .0001). The odds of being diagnosed with regional-stage prostate cancer in 2013-2015 compared to 2005-2008 were 1.3 times higher for Black men (95% CI: 1.2-1.5), 1.3 times higher for AAPI men (95% CI: 1.1-1.5), and 1.2 times higher for White men (95% CI: 1.2-1.3). The odds of being diagnosed with distant-stage prostate cancer in 2013-2015 compared to 2005-2008 were 1.6 times higher for Black men (95% CI: 1.4-1.9), 1.8 times higher for AAPI men (95% CI: 1.5-2.3), and 2.1 times higher for White men (95% CI: 1.9-2.2). Conclusions: The incidence of late-stage prostate cancer has increased significantly in all US male despite race and ethnicity. However, reginal-stage prostate cancer increased the most over time in AAPI and Black men, while newly-diagnosed distant prostate cancer increased the most over time in White men.

A randomized trial comparing fluorocholine-PET/CT with conventional imaging in prostate cancer.

2 Background: We conducted a randomised trial comparing 18Flourocholine-PET/CT (FCH) to Computed Tomography (abdomen and pelvis) plus 99mTc-Whole Body Bone Scan (Conventional Imaging [CIm]) to determine imaging performance in prostate cancer (PC). Methods: This prospective two-arm 1:1 randomised trial enrolled men with newly diagnosed or biochemically recurrent PC to first-line imaging (FLI) with either CIm or FCH. Participants without evidence of metastases proceeded to second-line imaging (SLI) using the alternative imaging strategy. The primary aim was to determine whether FCH was more effective as a FLI approach in changing management. Secondary endpoints included incremental utility of SLI and negative predictive value (NPV) based on progression-free survival (PFS). Australian New Zealand Clinical Trials Registry ACTRN12608000641392. Results: 108 men were enrolled; 44% were for staging of newly-diagnosed PC and median follow-up 43 months. Imaging impacted clinical management in 32.4% of men (95% CI=23.7-42.1%), mostly with FLI (n=30). High-impact management changes occurred in 27.8% (95% CI=16.5-41.6%) of FCH cases compared with 11.1% (95% CI=4.2-22.6%) in the CIm arm (p=0.032). The final management plan was derived using FCH in 98.1% (95% CI = 90.1-100%) of cases and 92.6% (95%CI = 82.1-97.9%) of CIm cases (p=0.242). FLI with FCH showed unequivocally N1 or M1 disease in 22.2% (95% CI = 12-35.6%), and 16.7% (95% CI = 7.9-29.3%; p= 0.531) of CIm cases. The overall NPV for stage TxN0M0 (from all imaging) was 26.3% (95% CI: 13.9 - 41.2%), with no significant difference between arms (p=0.9). For N1M0 cases, the NPV was 14.3% (95% CI: 7.1 - 35.7%). The identification of N1M0 by FCH resulted in a longer time to identification of progressive disease, with a median PFS of 32 months (95% CI=2-68months) compared with 3 months (95% CI=1-16 months) in the CIm N1M0 cohort (p=0.05). Conclusions: FCH-PET/CT identifies more high-clinical-impact lesions than CIm as first-line imaging. All imaging modalities were poor at predicting subsequent progressive disease. Isolated node-positive disease seen with FCH is associated with a longer time to - but similarly high rates of - recurrence, suggesting a lead-time bias. Clinical trial information: ACTRN12608000641392.

Positive Association of Male Overactive Bladder Symptoms and Androgen Deprivation: A Nationwide Population-based Cohort Study

The role of androgen in the modulation of voiding function is still uncertain. The aim of this study was to evaluate the association of androgen deprivation therapy (ADT) and overactive bladder (OAB) in men in a population-based cohort. This study examined the records of newly-diagnosed prostate cancer subjects receiving ADT only in the Taiwan National Health Insurance Research Database in the years between 2001 and 2007. As controls men without cancer were selected and divided into three groups, 1) benign prostate hyperplasia treated with an alpha-blocker (BPH-alpha blocker), 2) BPH treated with a 5-alpha reductase inhibitor (BPH-5ARI) and 3) healthy controls. OAB events were censored by definition of drug prescriptions for more than one month and risk analysis among each group was performed. The healthy control group had decreased risk of OAB compared to the prostate cancer group and the BPH-5ARI group showed a higher risk of OAB than the prostate cancer group. Subgroup analysis showed that independently of age or comorbidities, the prevalence of OAB was significantly lower in the healthy control group. Moreover, the cumulative incidence of OAB showed a time-dependent pattern with a significant increase after ADT for 5 years. Androgen deprivation in prostate cancer patients was associated with an increased risk of OAB that was treatment duration-dependent. This result is consistent with an inhibitory role of androgen in the modulation of male voiding function.

Quality of care and economic considerations of active surveillance of men with prostate cancer.

The current health care climate mandates the delivery of high-value care for patients considering active surveillance for newly-diagnosed prostate cancer. Value is defined by increasing benefits (e.g., quality) for acceptable costs. This review discusses quality of care considerations for men contemplating active surveillance, and highlights cost implications at the patient, health-system, and societal level related to pursuit of non-interventional management of men diagnosed with localized prostate cancer. In general, most quality measures are focused on prostate cancer care in general, rather that active surveillance patients specifically. However, most prostate cancer quality measures are pertinent to men seeking close observation of their prostate tumors with active surveillance. These include accurate documentation of clinical stage, informed discussion of all treatment options, and appropriate use of imaging for less-aggressive prostate cancer. Furthermore, interventions that may help improve the quality of care for active surveillance patients are reviewed (e.g., quality collaboratives, judicious antibiotic use, etc.). Finally, the potential economic impact and benefits of broad acceptance of active surveillance strategies are highlighted.

Evaluating an educational intervention to alleviate distress among men with newly-diagnosed prostate cancer and their partners.

194 Background: Diagnoses of cancer distress both patients and their partners. Providing accurate information about diagnosis and treatment options promotes active and informed decision-making and can decrease distress and anxiety. We sought to determine whether an education session alleviated distress for both prostate cancer (PC) patients and their partners, and whether their partner’s attendance at the session, as well as specific disease, treatment, and socio-demographic characteristics affect changes in distress levels. Methods: The session consists of a 90-minute didactic presentation, followed by an 8- to 10-minute private session with a urologist and radiation oncologist. We assessed distress using the Distress Thermometer (DT) and compared pre- and post-session distress, and change in distress between patients and partners using matched and unmatched t-tests. We also assessed before-the-session anxiety using the Generalized Anxiety Disorder measure (GAD), and decisional certainty using the Decisional Conflict Scale. Results: 71 patients and 48 partners participated in the study. Attending the session led to a significant reduction in median DT score for both patients (4.0 to 3.0, p = 0.0009) and partners (5.0 vs. 4.0, p = 0.0176). Partners reported higher distress both before and after the session compared to patients (4.9 vs. 3.8, p = 0.025 pre-session and 4.2 vs. 3.1, p = 0.032 post-session). The presence of a partner at the session did not appear to affect patients’ pre- or post-session distress nor the success of the session at alleviating distress. Sociodemographic and clinical characteristics had little effect on distress levels. Conclusions: Our study demonstrates that an interdisciplinary education session is equally effective at alleviating distress for both PC patients and their partners. These results can be used to guide the development of supportive care programs more broadly in terms of their ability to address the physiological and psychological needs of PC patients and their families.

Abstract 806: SNPs in vitamin D-related genes are associated with prostate cancer aggressiveness in the North Carolina-Louisiana Prostate Cancer Project (PCaP)

Abstract Introduction: African Americans have higher incidence of, and mortality from, prostate cancer (PCa) compared to other racial/ethnic groups. Frequency of polymorphisms in genes involved in vitamin D metabolism, transport, and activity differ by race/ethnicity. Examining the association between polymorphisms in vitamin D-related genes and PCa aggressiveness may explain differing susceptibility to aggressive PCa among individuals and across different racial/ethnic groups. Methods: TagSNPs (n = 315) in 13 genes (VDR, GC, CYP24A1, CYP27A1, CYP27B1, CYP2R1, CYP3A4, DHCR7, CASR, NADSYN1, RXRA, RXRB, RXRG) were genotyped using Illumina GoldenGate or Sequenom assays in 524 African-American and 657 European-American men with newly-diagnosed PCa from PCaP. DNA extracted from blood samples collected at enrollment was stored at -80C prior to analyses. Research subjects were classified as high aggressive if Gleason sum ≥8, or Gleason score (4+3), or PSA &amp;gt;20 ng/ml, or Gleason score (3+4) AND clinical stage = T3-T4. The comparison group (low aggressive) included research subjects with Gleason sum &amp;lt;7 AND Stage T1-T2 AND PSA &amp;lt; 9 ng/ml. Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated for high aggressive PCa for each SNP using logistic regression with adjustment for age and proportion of African ancestry. Associations were considered statistically significant at p&amp;lt;0.05. A polygenic score based on a previous study of SNP predictors of serum 25-hydroxy-vitamin D levels was calculated utilizing SNPs in the GC, CYP24A1, CYP2R1, and NADSYN1 genes. Results: Among African Americans, 21 SNPs were associated with PCa aggressiveness. The variant allele was associated negatively or positively with high aggressive PCa in eleven and ten SNPs, respectively. For example, two SNPs in the vitamin D binding protein gene known as GC, were inversely associated (rs222054: OR, 0.55, 95%CI, 0.38-0.80; and rs16847028: OR, 0.61, 95%CI, 0.39-0.94). Among European Americans, the variant allele was inversely associated with high aggressive PCa for four SNPs in three genes (CASRrs3863977; CYP24A1rs4809960; RXRArs1007971; and RXRArs3118526), and positively associated with high aggressive PCa for three SNPs in the CYP27B1 gene (rs703842, rs4646536, and rs10877013). There was no association between higher number of ‘low vitamin D’ alleles in the four SNPs that comprised the polygenic score and PCa aggressiveness for either race. Conclusions: Polymorphisms in genes involved in vitamin D etabolism and activity, the vitamin D binding protein and calcium sensing receptor were associated with PCa aggressiveness, and there was no overlap in SNPs between race groups. Our ongoing work will examine interaction between polymorphisms of vitamin D-related genes and vitamin D metabolite levels on PCa aggressiveness. Citation Format: Susan E. Steck, Anna Woloszynska-Read, Samuel Antwi, Hongmei Zhang, Lenore Arab, Elizabeth T.H. Fontham, James Mohler, L. Joseph Su, Feifei Xiao, Gary Smith, Donald Trump, Candace Johnson, Jeannette Bensen. SNPs in vitamin D-related genes are associated with prostate cancer aggressiveness in the North Carolina-Louisiana Prostate Cancer Project (PCaP). [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 806.

MP04-09 DOES A CLEAR UNDERSTANDING OF LIFE EXPECTANCY INCREASE DECISIONAL CONFLICT AND ANXIETY FOR MEN WITH NEWLY DIAGNOSED PROSTATE CANCER?

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History I1 Apr 2016MP04-09 DOES A CLEAR UNDERSTANDING OF LIFE EXPECTANCY INCREASE DECISIONAL CONFLICT AND ANXIETY FOR MEN WITH NEWLY DIAGNOSED PROSTATE CANCER? Mazen Alsinnawi, April E. Slee, John S. Banerji, Kathryn L. Dahl, Sydney Akapame, John D Massman III, Erika M. Wolff, and John M. Corman Mazen AlsinnawiMazen Alsinnawi More articles by this author , April E. SleeApril E. Slee More articles by this author , John S. BanerjiJohn S. Banerji More articles by this author , Kathryn L. DahlKathryn L. Dahl More articles by this author , Sydney AkapameSydney Akapame More articles by this author , John D Massman IIIJohn D Massman III More articles by this author , Erika M. WolffErika M. Wolff More articles by this author , and John M. CormanJohn M. Corman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1944AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate cancer (CaP) decision making is complicated by multiple treatment choices with implications for survival and quality of life. Although knowledge of the effect of co-morbidities on life expectancy helps clinicians to determine the range of treatment options available for their patients, patients are not usually, explicitly given this information. We utilized the Charlson Comorbidity Index (CCI) to predict life expectancy in men with newly diagnosed CaP. The objective of this study is to determine whether providing patients with their CCI score increases treatment decisional conflict and anxiety about death. METHODS Patients with newly diagnosed CaP were randomized to receive standard multidisciplinary care versus the same counseling with the addition of the patient's prospective understanding of his CCI score. Patients subsequently completed the Decisional Conflict Scale (DCS) and the Death Anxiety Scale (DAS). The primary objective was to determine whether telling patients their life expectancy complicated their treatment decisions and increased their anxiety levels. Five percent non inferiority margin was used for both instruments. Because the primary hypothesis was safety, patients were analyzed according to the intervention they received. RESULTS A total of 228 patients returned surveys, 123 received standard counselling and 105 were prospectively informed of their CCI. Mean age was 65 years. 17% had high risk CaP and the median 10-year survival probability was 80.9%. There was no statistical significant difference in planned treatment choice (active surveillance vs active treatment).18.7 % of the standard counselling group reported significant decisional conflict (> 37.5 points) compared to 10.5 % in the CCI group (p=0.08). Those who received CCI counseling had a mean decisional conflict score of 19.4, compared to 22.1 for the standard group. The difference between these was on average -2.7 points (95% CI -6.8, 1.3) which excludes the 5 % non-inferiority margin (range 0-100). The difference for DAS was -0.24 (95% CI, -1.08, 0.60) which excludes the 5 % margin (range 0-15). CONCLUSIONS Knowledge of CCI does not increase decisional conflict or anxiety about death, and may reduce the incidence of significant conflict. As we embrace the concept of shared decision making in urology, it is expected that the full disclosure of life expectancy will be standard of care. This study suggest that this disclosure can be made without contributing to patient stress and anxiety. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e31 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Mazen Alsinnawi More articles by this author April E. Slee More articles by this author John S. Banerji More articles by this author Kathryn L. Dahl More articles by this author Sydney Akapame More articles by this author John D Massman III More articles by this author Erika M. Wolff More articles by this author John M. Corman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...