Prostate Cancer In Canada Research Articles

The use of focal therapy for the treatment of prostate cancer in Canada: Where are we, how did we get here, and where are we going?

Focal therapy is an emerging treatment for localized prostate cancer. The objectives of this review were to: 1) review how focal therapies are regulated and approved; 2) summarize the scope and quality of the literature regarding safety, efficacy, and side-effects; and 3) outline ongoing clinical trials of focal therapy in Canada. Using the PRISMA framework for scoping reviews, we searched PubMed, Embase, and Cochrane from 2021-2024, complementing Hopstaken et al's search up functional and oncologic outcomes. Additionally, we examined the FDA database for regulatory details and ongoing trials in Canada via ClinicalTrial.gov. FDA approval for prostate tissue ablation was granted to high-intensity focused ultrasound (HIFU) in 2015 via the de novo pathway; other therapies followed the 510(k) route, citing equivalence to predicate devices. Most studies are in early stages, primarily single-arm, prospective cohort designs. Oncologic outcomes like cancer detection and survival rates, alongside functional data, such as adverse events and erectile function, were assessed. Recurrence-free survival at 48 months ranged from 58-92%, pad-free rates were greater than 95%, and rates of new-onset erectile dysfunction were variable, ranging from no change to 50%. Rates of serious adverse events (SAEs) were low, ranging from 0-14%. Three Canadian clinical trials are actively enrolling participants, and five private clinics were found offering private HIFU, irreversible electroporation (IRE), or transurethral ultrasound ablation (TULSA). Focal therapy technologies have gained regulatory approval for prostate tissue ablation, and, aside from provincial support for cryoablation in Alberta, are available to Canadians through private payment or clinical trials. Many studies demonstrate promising cancer control and impressive functional outcomes but are limited by their short followup and lack of comparator group. Clinical trial or registry participation should be prioritized to ensure an evidence-based integration into current prostate cancer treatment approaches.

Long term evaluation of optimized Gleason grading in a large cohort of men with prostate cancer in Canada

ObjectivesTo evaluate the International Society of Urological Pathology (ISUP) 5-tier grade grouping (GG) system of prostate cancers as well as previously proposed optimizations. Patients and methodsThe PROCURE biobank is a prospective cohort study of patients with localized prostate cancer who underwent radical prostatectomy in Quebec province between 2005 and 2013. Surgical specimens were graded by experienced genitourinary pathologists using 2019 ISUP criteria. Follow-up was conducted until November 2021. The current 5-tier and a proposed 6-tier GG system were evaluated, the latter having two changes: 1) Gleason 3 + 4 and 4 + 3 tumors with minor/tertiary Gleason 5 patterns were upgraded to GG 3 and 4, respectively; and 2) patients in GG5 were separated based on primary Gleason pattern (4 or 5). Cox proportional hazards models and Harrell's concordance (C) indices were used for statistical analyses. Results2003 patients were included (median follow-up: 8.7 years). The current 5-tier GG system predicted time to recurrence (hazard ratio [HR] 2.12, 95% confidence interval [95%CI] 1.99–2.25, C 0.717), androgen-deprivation therapy (HR 2.58, 95%CI 2.38–2.80, C 0.790), metastasis (HR 2.48, 95%CI 2.17–2.83, C 0.806), castration-resistant prostate cancer (HR 2.67, 95%CI 2.28–3.13, C 0.829), and cancer-specific mortality (HR 2.80, 95%CI 2.27–3.44, C 0.835). Goodness-of-fit further improved with the proposed 6-tier GG system, with Harrell's C of 0.733, 0.807, 0.827, 0.853, and 0.853, respectively. ConclusionsThe 5-tier GG system predicted short- and long-term outcomes for patients with localized prostate cancer, and the proposed 6-tier GG system further improved its accuracy.

User-Centered Design and Usability of a Culturally Adapted Virtual Survivorship Care App for Chinese Canadian Prostate Cancer Survivors: Qualitative Descriptive Study.

Cultural adaptations of digital health innovations are a growing field. However, digital health innovations can increase health inequities. While completing exploratory work for the cultural adaptation of the Ned Clinic virtual survivorship app, we identified structural considerations that provided a space to design digitally connected and collective care. This study used a community-based participatory research and user-centered design process to develop a cultural adaptation of the Ned Clinic app while designing to intervene in structural inequities. The design process included primary data collection and qualitative analysis to explore and distill design principles, an iterative design phase with a multidisciplinary team, and a final evaluation phase with participants throughout the design process as a form of member checking and validation. Participants indicated that they found the final adapted prototype to be acceptable, appropriate, and feasible for their use. The changes made to adapt the prototype were not specifically culturally Chinese. Instead, we identified ways to strengthen connections between the survivor and their providers; improve accessibility to resources; and honor participants' desires for relationality, accountability, and care. We grounded the use of user-centered design to develop a prototype design that supports the acts of caring through digital technology by identifying and designing to resist structures that create health inequities in the lives of this community of survivors. By designing for collective justice, we can provide accessible, feasible, and relational care with digital health through the application of Indigenous and Black feminist ways of being and knowing.

Genetic testing practices among specialist physicians who treat prostate cancer: A Canadian cross-sectional survey.

In patients with prostate cancer (PCa), the identification of an alteration in genes associated with homologous recombination repair (HRR) has implications for prognostication, optimization of therapy, and familial risk mitigation. The aim of this study was to assess the genomic testing landscape of PCa in Canada and to recommend an approach to offering germline and tumor testing for HRR-associated genes. The Canadian Genitourinary Research Consortium (GURC) administered a cross-sectional survey to a largely academic multidisciplinary group of investigators across 22 GURC sites between January and June 2022. Thirty-eight investigators from all 22 sites responded to the survey. Germline genetic testing was initiated by 34%, while 45% required a referral to a genetic specialist. Most investigators (82%) reported that both germline and tumor testing was needed; with 92% currently offering germline and 72% offering tissue testing to patients with advanced PCa. The most cited reasons for not offering testing were an access gap (50%), uncertainties around who to test and which genes to test, (33%) and interpreting results (17%). A majority reported that patients with advanced PCa (74-80%) should be tested, with few investigators testing patients with localized disease except when there is a family history of PCa (45-55%). Canadian physicians with academic subspecialist backgrounds in genitourinary malignancies recognize the benefits of both germline and somatic testing in PCa; however, there are challenges in accessing testing across practices and specialties. An algorithm to reduce uncertainty for providers when ordering genetic testing for patients with PCa is proposed.

MP44-12 mpMRI-TARGETED BIOPSY COMPARED TO SYSTEMATIC TRUS BIOPSY FOR MEN AT RISK FOR PROSTATE CANCER: 2 YEAR FOLLOW UP DATA AND ECONOMIC ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP44-12 mpMRI-TARGETED BIOPSY COMPARED TO SYSTEMATIC TRUS BIOPSY FOR MEN AT RISK FOR PROSTATE CANCER: 2 YEAR FOLLOW UP DATA AND ECONOMIC ANALYSIS Laurence Klotz, Joseph Chin, Peter Black, Antonio Finelli, Maurice Anidjar, Marlene Kebabdjian, Nicole Mittmann, and Soo Jin Seung Laurence KlotzLaurence Klotz More articles by this author , Joseph ChinJoseph Chin More articles by this author , Peter BlackPeter Black More articles by this author , Antonio FinelliAntonio Finelli More articles by this author , Maurice AnidjarMaurice Anidjar More articles by this author , Marlene KebabdjianMarlene Kebabdjian More articles by this author , Nicole MittmannNicole Mittmann More articles by this author , and Soo Jin SeungSoo Jin Seung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003290.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Precise study, a prospective randomized trial, demonstrated that MRI with only targeted biopsy was non-inferior to systematic TRUS guided biopsies in the detection of GG ≥2 PCa. An unanswered question is the outcome in those patients who avoided a biopsy due to a negative MRI.We addressed the outcome of patients on this trial who were unbiopsied, or had a negative or GG1 targeted biopsy, compared to those whose systematic biopsy was negative or GG1, with respect to the rate of subsequent prostate cancer diagnosis based on a 2 year MRI performed in all patients. In addition, we used administrative provincial data to compare the net costs of systematic biopsy vs MRI and targeted biopsy. METHODS: The study was carried out at 5 Canadian centres. The Precise trial accrued 453 biopsy-naïve men with a clinical suspicion of PCa advised to have a prostate biopsy. All those not initially diagnosed with GG≥2 PCa (unbiopsied due to a negative MRI, or a negative biopsy, or GG1 disease if biopsied) were entered in the follow up study. All Ontario patients were entered in the economic analysis. The intervention was an MRI at year 2 in all men in both MRI and systematic biopsy groups. Biopsy was performed for PiRads ≥ 3 or clinical suspicion. RESULTS: 73 patients in the MRI arm and 69 patients in the systematic biopsy arm had a 2 year evaluable MRI. In the MRI and syst bx arm, 70% and 72% had a negative 2 year MRI. Of the 16 patients in the systematic biopsy arm who had a 2 year biopsy, 8 were negative, 2 were GG1, and 6 were GG ≥2. In the MRI arm, 8 were biopsied; 4 were negative, and 4 were GG ≥2. At 2 years, in the Syst Bx and MRI groups, 27% and 30% either were diagnosed with GG≥2. disease; treated, died, or progressed. 15% from the TRUS biopsy group had a hospital visit after biopsy compared to less 6% from the MRI+ group. The mean per person per year (PPPY) costs for the TRUS and All MRI groups (MRI- and MRI+) were $7,828 and $8,525, respectively. CONCLUSIONS: After 2 years of follow up including an MRI in all patients, there was no difference in the rate of CS Pca diagnosis between the MRI with only targeted biopsy and systematic biopsy groups, despite 40% of men in the MRI group avoiding biopsy. These patients will be followed for an additional 6 years to confirm this finding. Economic analysis using a linked provincial databased demonstrated no significant difference in net cost between the 2 strategies. This data reinforces that an imaging first diagnostic strategy is safe and cost-effective. ClinicalTrials.gov Identifier: NCT02936258 Source of Funding: This study was co-funded by the OICR, and Prostate Cancer Canada © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e616 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laurence Klotz More articles by this author Joseph Chin More articles by this author Peter Black More articles by this author Antonio Finelli More articles by this author Maurice Anidjar More articles by this author Marlene Kebabdjian More articles by this author Nicole Mittmann More articles by this author Soo Jin Seung More articles by this author Expand All Advertisement PDF downloadLoading ...

PD16-07 POST-PROSTATECTOMY ADJUVANT ANDROGEN DEPRIVATION THERAPY-- PATIENT OPINIONS AND GOALS OF CARE

You have accessJournal of UrologyCME1 Apr 2023PD16-07 POST-PROSTATECTOMY ADJUVANT ANDROGEN DEPRIVATION THERAPY-- PATIENT OPINIONS AND GOALS OF CARE Max Levitt, Ameeta Nayak, Dean Fergusson, Luke Lavallee, Christopher Morash, Ilias Cagiannos, and Rodney Breau Max LevittMax Levitt More articles by this author , Ameeta NayakAmeeta Nayak More articles by this author , Dean FergussonDean Fergusson More articles by this author , Luke LavalleeLuke Lavallee More articles by this author , Christopher MorashChristopher Morash More articles by this author , Ilias CagiannosIlias Cagiannos More articles by this author , and Rodney BreauRodney Breau More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003271.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite the proven benefit of adjuvant androgen deprivation therapy (ADT) for patients receiving primary radiation, few studies evaluate adjuvant ADT after prostatectomy. We surveyed Canadian prostate cancer patients about adjuvant ADT with the goal of informing an adjuvant ADT clinical trial. METHODS: An electronic survey was devised and distributed using a modified Dillman approach. The survey was sent to members of Prostate Cancer Canada, a patient advocacy group. In addition to demographic information, we asked patients about their experience with prostate cancer, if they received post-operative therapy, and about their opinions to inform the design of an adjuvant ADT clinical trial. The survey was sent on May 2021, and all responses were received by July 2021. RESULTS: Forty patients completed the survey. The average participant age was 71±7.3 years old. The average age at prostate cancer diagnosis was 64±6.7 years. Thirty-eight (95%) patients were previously treated with radical prostatectomy and 24 (60%) subsequently developed biochemical recurrence. If it had been available, 30 (75%) participants indicated that they would have been interested in an adjuvant ADT trial to prevent biochemical recurrence. Most (15; 37.5%) stated that 12 months would be the longest duration of ADT that they would consider. The remainder of participants would have considered up to 6 months (9; 22.5%), up to 18 months (3; 7.5%), up to 24 months (5; 12.5%), or greater than 24 months (8; 20%) of adjuvant ADT. A daily oral tablet (31; 52.5%) or injection every 6 months (9; 22.5%) were favoured in a clinical trial over an injection at shorter time intervals. The most important outcomes for a trial of adjuvant ADT were prevention of cancer related death (38; 95%) and cancer recurrence (37; 92%). If 1 year of adjuvant ADT reduced PSA recurrence by 50%, many (29; 47.5%) stated they would have chosen this intervention. CONCLUSIONS: Few trials have assessed adjuvant ADT after radical prostatectomy and many patients claim they would have been interested in participating in a trial if it had been available. Based on these results, a randomized trial is warranted and patient preferences should be incorporated in trial design. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e491 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Max Levitt More articles by this author Ameeta Nayak More articles by this author Dean Fergusson More articles by this author Luke Lavallee More articles by this author Christopher Morash More articles by this author Ilias Cagiannos More articles by this author Rodney Breau More articles by this author Expand All Advertisement PDF downloadLoading ...

Prostate-Specific Membrane Antigen PET-CT Imaging for the Staging of Prostate Cancer in Canada


 Health Canada approved the first prostate-specific membrane antigen (PSMA)-PET radiopharmaceutical in October 2022 for the staging of PSMA-positive lesions in those with prostate cancer. Health Canada also approved a lutetium-177 PSMA-617 therapy for patients with advanced PSMA-positive metastatic castration-resistant prostate cancer in September 2022, a therapy for which patient eligibility is identified with a gallium-68 PSMA-PET exam.
 With 57 PET-CT units in 9 provinces, access to PET-CT may be limited by the health care system’s capacity to conduct these exams due to wait lists, competing clinical priorities, and staff shortages.
 It is anticipated that the public funding of PSMA-PET across Canada will increase existing demand for PET-CT by a minimum of 23%.
 The provision of PSMA-PET would occur within the context of managing competing new demands for this service that could double existing exam volume.
 Sufficient staffing is needed to ensure sustainable operation and development of PET-CT services, supported by investment in the workforce through education and training opportunities.
 There is potential to increase the hours of operation of PET-CT units in many facilities, with consideration to the many dependencies, including staffing and the fact that the operating times of PET-CT units are closely tied to the operating times of the cyclotrons that supply the radiopharmaceuticals used in PET-CT exams.
 The upfront capital and ongoing operational costs of PET-CT, radiopharmaceutical products, and equipment may act as barriers to the further adoption of this technology.
 A combination of both generator-produced and cyclotron-produced PSMA-PET radiopharmaceuticals will likely be needed to meet the geography of Canadian jurisdictions and to secure a reliable and resilient supply chain.

UGT2B28 accelerates prostate cancer progression through stabilization of the endocytic adaptor protein HIP1 regulating AR and EGFR pathways

The androgen inactivating UGT2B28 pathway emerges as a predictor of progression in prostate cancer (PCa). However, the clinical significance of UGT2B28 tumoral expression and its contribution to PCa progression remain unclear. Using the Canadian Prostate Cancer Biomarker Network biobank (CPCBN; n = 1512), we analyzed UGT2B28 tumor expression in relation to clinical outcomes in men with localized PCa. UGT2B28 was overexpressed in tumors compared to paired normal adjacent prostatic tissue and was associated with inferior outcomes. Functional analyses indicated that UGT2B28 promoted cell proliferation, and its expression was regulated by the androgen receptor (AR)/ARv7. Mechanistically, UGT2B28 was shown to be a protein partner of the endocytic adaptor protein huntingtin-interacting protein 1 (HIP1), increasing its stability and priming AR/epidermal growth factor receptor (EGFR) pathways, leading to ERK1/2 activation triggering cell proliferation and epithelial-to-mesenchymal transition (EMT). HIP1 knockdown in UGT2B28 positive cells, and dual pharmacological targeting of AR and EGFR pathways, abolished cell proliferative advantages conferred by UGT2B28.In conclusion, UGT2B28 is a prognosticator of progression in localized PCa, regulates both AR and EGFR oncogenic signaling pathways via HIP1, and therefore can be therapeutically targeted by using combination of existing AR/EGFR inhibitors.

Cost-effectiveness of enzalutamide versus apalutamide versus androgen deprivation therapy alone for the treatment of metastatic castration-sensitive prostate cancer in Canada

Aims There are no direct comparisons of the relative cost-effectiveness of second-generation anti-androgens (enzalutamide and apalutamide) used in managing metastatic castration-sensitive prostate cancer (mCSPC) in Canada. This study compared the cost-effectiveness of enzalutamide versus apalutamide versus androgen deprivation therapy (ADT) alone (standard of care) in patients with mCSPC from the Canadian public payer perspective using a Markov model with a 15-year time horizon. Materials and methods Efficacy data for enzalutamide and ADT alone were informed by the ARCHES and ENZAMET clinical trials, while a Bayesian network meta-analysis enabled comparison with apalutamide and ADT alone. Results Over the 15-year period, enzalutamide achieved the highest number of life-years (LY, 7.6) and quality-adjusted life-years (QALY, 5.62) compared with apalutamide (LY, 6.1; QALY, 4.59) and ADTs (LY, 4.9; QALY, 3.61). Enzalutamide incurred the most costs ($349,345) compared with apalutamide ($294,349) and ADT ($162,550). Sequential analysis showed that enzalutamide lies on the cost-effectiveness frontier with ADT alone (incremental cost-effectiveness ratio: $92,868/QALY), with apalutamide extendedly dominated through enzalutamide and ADT alone. Limitations Limitations include the heterogeneity of the studies included in the network meta-analysis and the validations for the treatment sequencing assumptions in the modeling. Conclusions Enzalutamide was the most effective treatment option for mCSPC in the Canadian market, with the greatest LYs and QALYs, and incurred the most costs.

Post-prostatectomy adjuvant androgen deprivation therapy- Current opinions and practices of Canadian urologists.

Despite the proven benefit of adjuvant androgen deprivation therapy (ADT) for patients receiving primary radiation, there are few studies evaluating adjuvant ADT after prostatectomy. In the absence of evidence, opinions and practice patterns vary. We surveyed Canadian prostate cancer surgeons about their use of adjuvant ADT and their opinions on the design of a potential adjuvant ADT trial. An electronic survey was devised and distributed using a modified Dillman approach. The survey was sent to 38 Canadian urologists that perform radical prostatectomy and representing all 17 major academic institutions in Canada and all 10 Canadian provinces. Reminders were sent three and four weeks following the original request. In addition to demographic information, we asked surgeons about their current use of postoperative adjuvant ADT and their opinion about the need for a clinical trial. To inform trial design, we asked respondents their opinions about which patients should be eligible, what duration of ADT was most appropriate, and which outcomes are clinically meaningful. The survey was sent in February 2020 and all responses were received by March 2020. All 38 (100%) invited urologists completed the survey. Only 3 (7%) respondents currently offer postoperative adjuvant ADT as an option for patients without metastases. 35 (92%) urologists believed that a trial is needed before short-term adjuvant treatment should be offered to prevent recurrence. 15 (45%) urologists believed an adjuvant ADT trial was most appropriate for patients with an estimated PSA recurrence risk of >25% and 16 (42%) believed a recurrence risk of >50% was most appropriate. 25 (66%) respondents believed 12-month was the optimal duration of treatment with adjuvant ADT for a randomized trial. 37 (97%) respondents felt that prolonging the time to PSA recurrence and/or pelvic radiation was a clinically important outcome. The majority (20; 53%) of respondents would recommend 12 months of adjuvant ADT in their practice if a randomized trial showed a 50% relative risk reduction in PSA recurrence at 5-year postoperative. The vast majority of Canadian prostate cancer surgeons do not offer adjuvant ADT following prostatectomy in patients without metastases. Based on the results from this survey, a randomized trial was considered warranted and feasible, and would influence patient care.

Incidence and Mortality of Prostate Cancer in Canada during 1992-2010.

In Canada, prostate cancer is the most common reportable malignancy in men. We assessed the temporal trends of prostate cancer to gain insight into the geographic incidence and mortality trends of this disease. Three independent population-based cancer registries were used to retrospectively analyze demographic data on Canadian men diagnosed with prostate cancer and men who died of prostate cancer between the years of 1992 and 2010. The incidence and mortality rates were calculated at the provincial, city, and forward sortation area (FSA) postal code levels by using population counts that were obtained from the Canadian Census of Population. The Canadian average incidence rate was 113.57 cases per 100,000 males. There has been an overall increasing trend in crude prostate cancer incidence between 1992 and 2010 with three peaks, in 1993, 2001, and 2007. However, age-adjusted incidence rates showed no significant increase over time. The national mortality rate was calculated to be 24.13 deaths per 100,000 males per year. A decrease was noted in crude and age-adjusted mortality rates between 1992 and 2010. Several provinces, cities, and FSAs had higher incidence/mortality rates than the national average. Several of the FSA postal codes with the highest incidence/mortality rates were adjacent to one another. Several Canadian regions of high incidence for prostate cancer have been identified through this study and temporal trends are consistent with those reported in the literature. These results will serve as a foundation for future studies that will seek to identify new regional risk factors and etiologic agents.

Editorial introductions

Editorial introductions

Abstract 829: Global tumor transcriptional activity reveals aggressiveness across multiple cancers

Abstract Background: At present, conventional clinical and histopathological evaluations are not sufficient to distinguish biologically indolent cancers from those that will exhibit aggressive behavior. We hypothesize that global transcriptomic activity of tumor cells reflects the end cumulative result of somatic, germline, and epigenetic alterations, as well as additional transcriptional regulatory events. Therefore, it may be more directly associated with clinical outcomes. However, the total number of mRNA molecules is not directly measurable, either in bulk or single-cell RNA sequencing data. To this end, we develop a novel metric: the transcriptional activity score (TAS), to measure the relative global tumor-cell specific transcriptional activity in heterogeneous tumor samples. Materials and Methods: We propose TAS as the ratio of average total transcript proportion over the count proportion of tumor cells versus surrounding non-tumor cells. The transcript proportions are estimated using RNAseq deconvolution method DeMixT and the count proportions are estimated using DNAseq deconvolution methods such as ASCAT and ABSOLUTE. Using matching bulk RNA and DNA sequencing data from the Cancer Genome Atlas (TCGA) and the International Cancer Genome Consortium (ICGC), we calculated TAS for a total of 5,031 patient samples across 15 cancer types. For validation, we obtained TAS for two genomic studies: 1) from patients with early-onset prostate cancer (n=99) as part of the ICGC, and 2) from patients with localized prostate cancer as part of the Canadian Prostate Cancer Genome Network (CPC-GENE, n=144). Results: We found that higher TAS corresponds to a more aggressive state of cancer, as characterized by MYC dysregulation, genome instability, known marker genes, and molecular subtypes. By examining the association between TAS and survival outcomes across cancer types, we also found that TAS refines the prognostic ability of pathologic stage, identifying aggressive early-stage tumors associated with poor survival as well as late-stage tumors with favorable outcomes. In prostate cancer, TAS is linearly associated with progression-free probabilities, useful to rank patients within the median risk group (Gleason score = 7). This added prediction power is consistent in TCGA and two independent validation data (ICGC and CPC-GENE). Conclusion: We have developed a new summary metric using matched DNA and RNA sequencing data from tumor samples, to compute, in vivo and using deconvolution, the relative global gene expression level of tumor cells. The TAS metric evaluates global transcriptional activity, an intrinsic behavior of cells that is well-known, but now for the first time is shown through TAS to be associated with prognosis. TAS may serve as a tractable phenotype to help elucidate the biology that underlies metastasis, prognosis and response to treatment in cancer patients. Citation Format: Shaolong Cao, Jennifer R. Wang, Jonas Demeulemeester, Jingxiao Chen, Kaixian Yu, Peng Yang, Bora Lim, Alfonso Urbanucci, Peter Campbell, Hongtu Zhu, Peter Van loo, Wenyi Wang. Global tumor transcriptional activity reveals aggressiveness across multiple cancers [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 829.

PD62-04 LONG-TERM ONCOLOGICAL OUTCOMES FOLLOWING ACTIVE SURVEILLANCE OF LOW RISK PROSTATE CANCER: A POPULATION-BASED STUDY

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II (PD62)1 Apr 2020PD62-04 LONG-TERM ONCOLOGICAL OUTCOMES FOLLOWING ACTIVE SURVEILLANCE OF LOW RISK PROSTATE CANCER: A POPULATION-BASED STUDY Narhari Timilshina*, Antonio Finelli, Patrick Richard, Maria Komisarenko, Lisa Martin, George Tomlinson, Beate Sander, and Shabbir Alibhai Narhari Timilshina*Narhari Timilshina* More articles by this author , Antonio FinelliAntonio Finelli More articles by this author , Patrick RichardPatrick Richard More articles by this author , Maria KomisarenkoMaria Komisarenko More articles by this author , Lisa MartinLisa Martin More articles by this author , George TomlinsonGeorge Tomlinson More articles by this author , Beate SanderBeate Sander More articles by this author , and Shabbir AlibhaiShabbir Alibhai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000979.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) is a widely accepted management strategy for low-risk prostate cancer (PC), but limited data exist regarding long-term outcomes after initial AS at a population level. We assessed the long-term outcomes of low-risk PC following initial AS at a population level. METHODS: In this population-based study using linked administrative databases from Ontario, Canada, we identified PC patients with low-risk (Gleason score ≤6) cancer who were initially managed with AS between 2002-2014. Our primary outcomes of metastases (mets) rate, overall mortality (OM) and prostate cancer-specific mortality (PCSM) were compared between AS patients and low-risk patients who received initial definitive treatment (either surgery or radiation) using Cox proportional hazards models. RESULTS: The cohort was comprised of 31,004 (11,259 Initial AS, 6,819 Watchful Waiting (WW) and 12,926 Initial Treatment) low-risk PC patients (median age, 65 years) with median follow-up of 107 months (IQR 76-140). AS patients had lower PSA (median 5.9, no IQR), had lower positive cores (mean 2, SD 1.6) and lower maximum % core (median 10, IQR 5-15) than WW or Initial treatment. Mets rate was lower in AS (3.9%) than initial treatment (6.6%) or WW (5.5%). Unadjusted OM was lower among those with initial AS (7.7%) than with initial treatment (9.4%) or WW (25.1%), with median follow-up of 9 years. Factors associated with OM were WW, age, higher ACG comorbidity, higher PSA, number of positive cores and max. % core at diagnosis, lower income and geographical region. In adjusted multivariate model for OM, AS was not statistically different than initial treatment (HR 1.03, 95%CI 0.93-1.14). Unadjusted PCSM was higher among patients undergoing WW (1.44%) versus initial AS (0.73%) or when compared to initial treatment (0.60%). CONCLUSIONS: The study reports real-world long-term outcomes of AS in men with low-risk PC. Our results suggest that AS is not associated with worse OM but slightly higher PCSM with AS than upfront treatment after 9 years of follow-up. Source of Funding: The Prostate Cancer Canada © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1286-e1287 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Narhari Timilshina* More articles by this author Antonio Finelli More articles by this author Patrick Richard More articles by this author Maria Komisarenko More articles by this author Lisa Martin More articles by this author George Tomlinson More articles by this author Beate Sander More articles by this author Shabbir Alibhai More articles by this author Expand All Advertisement PDF downloadLoading ...

Assessing the nutritional needs of men with prostate cancer

BackgroundNutrition is important for prostate cancer (PC) survivorship care to help achieve a healthy weight, reduce treatment side effects and reduce the risk of developing other chronic diseases. We aimed to advance the understanding of the nutritional needs of men with PC and services that could be potentially implemented to address them.MethodsWe conducted a needs assessment of nutrition services for men with PC drawing on four perspectives; 1) patient evaluation of a nutrition education session in British Columbia (BC), 2) survey of BC health professionals, 3) an environmental scan of existing nutrition services across Canada and 4) a scoping literature review.ResultsPatients expressed a need for more nutrition information and a desire for additional nutrition services. More than 60% of health professionals believed there is a need for more nutrition services for men with PC, and reported the focus should be on weight management or management of PC progression. The environmental scan revealed few existing services for men with PC across Canada, most were inclusive of multiple cancers and not tailored for men with PC. Eighteen completed studies were identified in the scoping literature review. The majority provided combined diet and exercise programs with various formats of delivery such as individual, group and home-based. Overall, 78% of studies reported improvements in one or more of the following measures: dietary intake/ diet quality, body composition, self-efficacy, quality of life, fatigue, practicing health behavior goals and physical function/ exercise. Four studies assessed feasibility, adherence or satisfaction with all reporting positive findings.ConclusionDespite the high prevalence of PC in Canada, and the perceived need for more support by patients and health professionals, there are limited nutrition services for men with PC. Evidence from the literature suggests nutrition services are effective and well-accepted by men with PC. Our findings define a need for standardized nutrition services for men with PC that assess and meet long term nutritional needs. Our findings also provide insight into the type and delivery of nutrition services that may help close the gap in care for men with PC.

Ultrahypofractionation Should be a Standard of Care Option for Intermediate-Risk Prostate Cancer

Ultrahypofractionation Should be a Standard of Care Option for Intermediate-Risk Prostate Cancer

Health-Related Internet Use Among Men With Prostate Cancer in Canada: Cancer Registry Survey Study.

BackgroundAfter a prostate cancer diagnosis, men want information about their disease and treatment options. The internet offers a convenient means to deliver health information to patients with prostate cancer. However, there are concerns about the use of the internet among this largely senior population.ObjectiveThis study aimed to determine the patterns and factors associated with the use of the internet as a source of health information among Canadian men with prostate cancer and the features and information required in a website.MethodsPopulation surveys were conducted in four Canadian provinces (British Columbia, Alberta, Saskatchewan, and Ontario) in 2014-2015. Data analyses included descriptive, bivariable, and multivariable analyses. The Pearson Chi-square and univariable regression were used to examine associations between independent variables and health-related internet use. Correlates of health-related internet use were analyzed using multivariable logistic regression.ResultsA total of 1362 patients responded across the four provinces. The mean age of respondents was 69 years (SD 8.2). In addition, 82% (n=1071) were internet users and 71% (n=910) used the internet daily. Further, 65% (n=784) used the internet as a source of prostate cancer information, and 40% (n=521) were confident about using information obtained from the internet to make health decisions. Men who used the internet to obtain prostate cancer information were more likely to be active information seekers (odds ratio [OR]: 4.5, 95% CI 2.6-7.8), be confident using information from the internet to make health decisions (OR: 3.6, 95% CI 2.3-5.7), have broadband internet access (OR: 1.8, 95% CI 1.2-2.7), and have more unmet supportive care needs (OR: 1.05, 95% CI 1.0-1.1). Top features wanted in a website, reported by more than 50% of respondents, were a library of resources (n=893, 65.6%), tools to support treatment decision making (n=815, 59.8%), and tools to help navigate the prostate cancer journey (n=698, 51.2%). Top three topics of information wanted in such a website were treatment options (n=916, 67.3%), disease progression (n=904, 66.4%), and management of side effects (n=858, 63%).ConclusionsOver two-thirds of Canadian patients with prostate cancer surveyed use the internet as a source of health information about prostate cancer, but over half did not feel confident using information from the internet to make health decisions. Being an active information seeker, having confidence in using information from the internet to make health decisions, having broadband internet, and having more unmet supportive care needs were significantly associated with health-related internet use. Future work should examine electronic health literacy interventions as a means to boost men’s confidence in using information from the internet and design websites that include information and features that help men navigate the prostate cancer journey and support treatment decision making and management of side effects.

Two-year review of the electronic Patient Reported Outcome (ePRO) system in the Prostate Clinic at the Vancouver Prostate Centre (VPC).

107 Background: The Vancouver Prostate Centre (VPC) implemented an electronic patient reported outcomes (ePRO) system in April 2017 to collect data on a research protocol in collaboration with University Health Network of Toronto, funded by Prostate Cancer Canada. Responses to ePRO questionnaires collected on iPads were entered into the national PC360 registry initially and a global TrueNorth registry thereafter funded by Movember Foundation. Herein we describe our experience implementing the ePRO system over the last two years. Methods: All patients (pts) with a new diagnosis of localized prostate cancer, either before or just after therapy, were identified using the electronic medical record and were consented in person in clinic. After signing consent, pts were asked to complete ePROs, including EPIC-26, EQ-5D-5L, WHODAS 2.0, and Distress Thermometer, on iPads at designated clinic appointment. Results: Between April 3, 2017-March 31, 2019, 1027 pts were identified as being eligible to complete ePRO: 878 pts (85.5%) consented and completed ePRO at least once. In Year 1 (Apr 2017-Mar 2018), 76.7% of the 1075 planned ePRO questionnaires were completed vs 75% completed of 1258 planned in year 2. Most pts (82.3%,723/878) agreed to be contacted for future research. Of those, 424/723 were recruited to at least one additional registry study. Data for consented pts was missing for 155/878 (17.7%) each year, usually due to difficulty locating the pt to give him the iPad before he left the clinic. In a small percentage of cases, ePRO reports were incomplete due to fluctuating WiFi connectivity, inadequate time to complete the questions before the clinic appointment, refusal, or no show. Conclusions: ePROs for research were successfully implemented into clinical practice in the PCSC program as evidenced by high completion and low refusal rates but required significant manpower due to ethics board requirements. Challenges encountered included: training clinic staff and coordinators to direct pts to the iPad system to minimize missing ePRO assessments, technical difficulties with WiFi connectivity, requirement of ethics board mandating that staff interact with each pt individually to ensure the ePRO assessments are completed. The next step is to incorporate ePROs into clinical practice, in which case consent will not be required.

Factors associated with exercise preferences, barriers and facilitators of prostate cancer survivors.

The purpose of this study was to understand the exercise levels, preferences and interests of prostate cancer survivors in Canada. An electronic survey was administered via a prostate cancer-specific website and assessed self-reported exercise levels, exercise preferences and interests, exercise barriers and facilitators to exercise. Based on 103 participants, the majority (75.7%) of prostate cancer survivors did not meet both aerobic and resistance exercise guidelines, despite an interest in exercise. Strongest exercise preferences were shown for resistance exercise, walking, flexibility and bicycling and for performing exercise from a community-based gym or from home. Significant differences in exercise interests and facilitators were found between individuals who were meeting exercise guidelines compared to those who were not. The majority of Canadian prostate cancer survivors are insufficiently active. Exercise preferences and facilitators appear to be influenced by current exercise levels. Resistance and aerobic exercise should be considered when programming exercise for prostate cancer survivors.

Validation of the prognostic value of NF-κB p65 in prostate cancer: A retrospective study using a large multi-institutional cohort of the Canadian Prostate Cancer Biomarker Network.

BackgroundThe identification of patients with high-risk prostate cancer (PC) is a major challenge for clinicians, and the improvement of current prognostic parameters is an unmet clinical need. We and others have identified an association between the nuclear localization of NF-κB p65 and biochemical recurrence (BCR) in PC in small and/or single-centre cohorts of patients.Methods and findingsIn this study, we accessed 2 different multi-centre tissue microarrays (TMAs) representing cohorts of patients (Test-TMA and Validation-TMA series) of the Canadian Prostate Cancer Biomarker Network (CPCBN) to validate the association between p65 nuclear frequency and PC outcomes. Immunohistochemical staining of p65 was performed on the Test-TMA and Validation-TMA series, which include PC tissues from patients treated by first-line radical prostatectomy (n = 250 and n = 1,262, respectively). Two independent observers evaluated the p65 nuclear frequency in digital images of cancer tissue and benign adjacent gland tissue. Kaplan–Meier curves coupled with a log-rank test and univariate and multivariate Cox regression models were used for statistical analyses of continuous values and dichotomized data (cutoff of 3%). Multivariate analysis of the Validation-TMA cohort showed that p65 nuclear frequency in cancer cells was an independent predictor of BCR using continuous (hazard ratio [HR] 1.02 [95% CI 1.00–1.03], p = 0.004) and dichotomized data (HR 1.33 [95% CI 1.09–1.62], p = 0.005). Using a cutoff of 3%, we found that this biomarker was also associated with the development of bone metastases (HR 1.82 [95% CI 1.05–3.16], p = 0.033) and PC-specific mortality (HR 2.63 [95% CI 1.30–5.31], p = 0.004), independent of clinical parameters. BCR-free survival, bone-metastasis-free survival, and PC-specific survival were shorter for patients with higher p65 nuclear frequency (p < 0.005). As the small cores on TMAs are a limitation of the study, a backward validation of whole PC tissue section will be necessary for the implementation of p65 nuclear frequency as a PC biomarker in the clinical workflow.ConclusionsWe report the first study using the pan-Canadian multi-centre cohorts of CPCBN and validate the association between increased frequency of nuclear p65 frequency and a risk of disease progression.