Prostate Cancer Outcomes Research Articles

Disparities in access to robotic technology and perioperative outcomes among patients treated with radical prostatectomy.

Most radical prostatectomies are completed with robotic assistance. While studies have previously evaluated perioperative outcomes of robot-assisted radical prostatectomy (RARP), this study investigates disparities in access and clinical outcomes of RARP. The National Cancer Database (NCDB) was used to identify patients who received radical prostatectomy for cancer between 2010 and 2017 with outcomes through 2018. RARP was compared to open radical prostatectomy (ORP). Odds of receiving RARP were evaluated while adjusting for covariates. Overall survival was evaluated using a propensity-score matched cohort. Overall, 354 752 patients were included with 297 676 (83.9%) receiving RARP. Patients who were non-Hispanic Black (82.8%) or Hispanic (81.3%) had lower rates of RARP than non-Hispanic White (84.0%) or Asian patients (87.7%, p < 0.001). Medicaid or uninsured patients were less likely to receive RARP (75.5%) compared to patients with Medicare or private insurance (84.4%, p < 0.001). Medicaid or uninsured status was associated with decreased odds of RARP in adjusted multivariable analysis (OR 0.61, 95% CI 0.49-0.76). RARP was associated with decreased perioperative mortality and improved overall survival compared to ORP. Patients who were underinsured were less likely to receive RARP. Improved access to RARP may lead to decreased disparities in perioperative outcomes for prostate cancer.

Abstract 3315: Evaluating biomarker potential of germline genomic factors for predicting clinical outcomes in prostate cancer

Abstract Prostate cancer is the second-most diagnosed cancer and the second leading cause of cancer death in American men. Early detection is common, but is followed by the more challenging task of prognosing a highly variable clinical course. Current clinical risk-assessment strategies such as serum abundance of prostate specific antigen (PSA), tumor size &amp; extent, and tumor grade based on biopsy are highly imprecise: over a third of patients are over-treated. An improved method of risk stratification may lie in hereditary factors. Prostate cancer is one of the most strongly inherited (h2 = 57%), with accumulating evidence associating rare variants, common variants, and genetic ancestry to clinical outcomes. We have performed germline sequencing on blood from thousands of patients diagnosed with localized prostate cancer and with extensive follow-up data. We quantify the interactions of rare and common variants, and demonstrate that germline features provide insights into patient outcomes and optimal management strategies. Citation Format: Nicole Zeltser, Kathleen E. Houlahan, Sarah M. Al-Hiyari, Stefan E. Eng, Yash Patel, Takafumi N. Yamaguchi, Shu Tao, Rong Rong Huang, Robert E. Reiter, Huihui Ye, Adam S. Kinnaird, Paul C. Boutros. Evaluating biomarker potential of germline genomic factors for predicting clinical outcomes in prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3315.

Abstract 5594: Association of circulating cell-free DNA and prostate cancer risk groups in patients undergoing proton therapy

Abstract Even after radiation treatment, prostate cancer (PCa) patients receiving radiotherapy (RT) are still at risk for disease progression and recurrence. Predicting outcomes associated with cancer treatment is critical to PCa survivorship given that the 5-year survival rates for local and regional stage PCa is nearly 100%. Radiogenomics is a promising field of research focused on identifying genomic markers that can provide clinically useful prognostic predictions regarding radiation response and can potentially serve as the basis for personalized RT where cancer management is tailored to fit each individual patient. Circulating cell-free (ccfDNA) DNA has been found to 1) be associated with radiation sensitivity or toxicity, 2) relapse or recurrence, and 3) risk for the development of metastases before, during or following photon RT. Proton therapy, alternative to photon therapy, is a promising treatment that can reduce excess radiation dose and, in turn, the risk for adverse events. However, few studies have been done to determine if ccfDNA can predict response in proton radiation, which purports superior dose distribution, avoiding healthy tissues, minimizing the exit dose, and potentially reducing overall toxicity. The overall aim of this study is to determine if the quantity of ccfDNA is associated with PCa risk groups. We hypothesized that PCa patients within the highest risk group have quantitatively increased levels of ccfDNA compared to those in low and intermediate risk groups. This study leveraged the University of Florida Health Proton Therapy Institute Outcomes Tracking Protocol biobank of PCa patients with plasma and serum collected before, during and after proton RT. Isolation of ccfDNA at baseline, during treatment, and following treatment was undertaken and ccfDNA quantities were compared among patients in the low, intermediate and high risk groups using ANOVA. Our results indicate that the quantity difference between baseline and day 14 of treatment (p=0.055), 2 weeks post-treatment (p=0.54), and 4 weeks post-treatment (p=0.002) was associated with risk group. There was trend towards increasing ccfDNA quantity, as risk group increased; however, there was no correlation between risk group and treatment times using the Pearson correlation. Our results were consistent in that high ccfDNA quantity was associated with PCa risk. This is the first study determining the application of ccfDNA quantity on prostate cancer outcomes in patients undergoing proton RT. Identifying the determinants of radiation-related adverse outcomes will help inform impending predictive genomic technologies and improve cancer-related outcomes and survivorship. Citation Format: Andrew Bass, Johnny Velasquez, Moein Rajaei, Curtis Bryant, Nancy Mendenhall, Luisel J. Ricks-Santi. Association of circulating cell-free DNA and prostate cancer risk groups in patients undergoing proton therapy. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5594.

Abstract 6486: Single nucleotide polymorphisms that predict serum cholesterol as a prostate cancer prognostic factor - a Mendelian randomization study

Abstract Introduction: Intracellular cholesterol metabolism plays an important role in prostate cancer progression and emergence of treatment resistance. However, it remains unclear whether serum cholesterol and lipoproteins are associated with prostate cancer outcomes. Studies on serum cholesterol and cancer are often confounded by lifestyle factors such as diet and obesity. A possible solution is to use instrumental variables, such as SNPs predicting serum cholesterol. According to the Mendelian randomization theory, germline SNP distribution is unaffected by confounding variables such as diet and lifestyle factors. Objective: To estimate whether SNPs that predict serum cholesterol and lipoproteins also predict mortality among a cohort of men with prostate cancer. Methods: Our study cohort consisted of 3,241 men diagnosed with prostate cancer between 1996-2015, using data collected by the Finnish Randomized Study of Screening for Prostate Cancer. Blood samples were genotyped by PRACTICAL consortium. A UCSC genome browser was utilized for selecting 85 SNPs in lipid metabolism-associated genes. Dates and causes of deaths between 1996-2015 were obtained from the Statistics Finland's statistics on causes of death. Information on serum cholesterol and lipoprotein measurements were obtained from a regional laboratory database.Scores predicting serum cholesterol, LDL, HDL and triglyceride level by SNP genotype were created using linear regression and lasso regression. Risk of prostate cancer death and overall mortality by level of the SNP risk score were evaluated with multivariable-adjusted Cox regression. Follow-up started at prostate cancer diagnosis and continued until death, emigration or common closing date of Dec 31, 2015.Results: SNP score predicting total cholesterol stratified prostate cancer patients both for disease-specific (HR 1.27, 95% CI 0.49-3.28 for highest tertile vs. lowest) and overall survival (HR 1.43, 95% CI 0.94-2.20, p for trend = 0.077), albeit statistical significance was not reached. Similar survival differences were observed for SNP score predicting triglyceride level, but not for scores predicting LDL or HDL.Conclusions: SNPs predicting serum cholesterol and triglycerides are likely prognostic factors for survival of prostate cancer patients. This suggest serum cholesterol and lipoproteins areimportant in prostate cancer progression. Total cholesterol SNP scoreProstate-cancer specific survival Overall survival Citation Format: Sebastian Boele, Aino Siltari, Paavo Raittinen, Johanna Schleutker, Kimmo Taari, Kirsi Talala, Teuvo Tammela, Anssi Auvinen, Teemu J. Murtola. Single nucleotide polymorphisms that predict serum cholesterol as a prostate cancer prognostic factor - a Mendelian randomization study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6486.

Abstract 6698: Combinatorial genomic and epigenomic cell-free DNA analysis of high-risk metastatic castration resistant prostate cancer reveals prognostic liquid biopsy signatures

Abstract Background: Androgen receptor signaling inhibitors (ARSI) such abiraterone and enzalutamide have significantly improved clinical outcomes in metastatic castrate-resistant prostate cancer (mCRPC) patients. However, patients with genomic alterations in the androgen receptor (AR) and its enhancer region do not respond well and acquire resistance to these inhibitors. Here, we applied our previously developed cell-free DNA (cfDNA) liquid biopsy assay (EnhanceAR-Seq) to detect these high-risk mCRPC patients prior to the administration of first-line AR-directed therapy and correlated with survival. We also interrogated the plasma methylome to identify differentially methylated regions (DMRs) across these high-risk patients. Methodology: We applied EnhanceAR-Seq to plasma cfDNA isolated from 99 mCRPC patients enrolled from two institutions (n=52 Tulane; n=47 WashU). Plasma samples were collected prior to ARSI initiation (n=63) or during treatment (n=36). We also performed Enzymatic Methyl-seq in pre-treatment plasma from 43 patients. We split these 43 patients into cell-free genomically high-risk and low-risk groups using our EnhanceAR-seq results, and conducted DMR analysis using metilene. To identify significant DMRs, we performed multiple hypothesis testing and required q&amp;lt;0.05 using the Benjamini-Hochberg procedure, and further required at least 5 CpGs per DMR. Results: EnhanceAR-Seq detected AR/enhancer alterations in 35% of all plasma samples. Cell-free AR/enhancer detection was highly prognostic (PFS HR=2.80, p=0.0002; OS HR=2.6, p=0.01). When considering only pre-treatment plasma, AR/enhancer alterations detected in 44% (28/63) of samples correlated significantly with worse PFS (HR=2.21, p=0.009) and OS (HR=2.60, p=0.02). AR/enhancer alterations detected in 19% (7/36) of samples collected during ARSI were also associated with worse PFS (HR=15.6, p=0.0002) and OS (HR=8.09, p=0.05). Plasma methylome analysis revealed that for cell-free genomically high-risk mCRPC patients (based on AR/enhancer alterations detected in cfDNA), significantly hypomethylated DMRs were found in the AR promoter, upstream AR enhancer, and in AR-associated genes including FOXP1 and FOLH1. Significantly hypomethylated DMRs were also observed in DNA damage repair and cell cycle genes including MSH6, MSH3, FANCD2, CDK12 and RAD51B. Hypermethylated DMRs were seen in tumor suppressor genes including ZBTB16, BRCA2, WT1 and GNAS. Conclusions: AR/enhancer alterations detected in plasma cfDNA predicted inferior survival in mCRPC patients. Cell-free genomically high-risk mCRPC patients could be distinguished from low-risk patients based on distinct methylation signatures. Citation Format: Irfan Alahi, Pradeep S. Chauhan, Alexander L. Shiang, Jace Webster, Ha X. Dang, Lilli Greiner, Breanna yang, Elisa M. Ledet, Ramandeep K. Babbra, Wenjia Feng, Peter K. Harris, Ellen B. Jaeger, Patrick J. Miller, Sydney A. Caputo, Giordano Cittolin Santos, Oliver Sartor, Russell K. Pachynski, Christopher A. Maher, Aadel A. Chaudhuri. Combinatorial genomic and epigenomic cell-free DNA analysis of high-risk metastatic castration resistant prostate cancer reveals prognostic liquid biopsy signatures [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6698.

Abstract 6023: Plasma methylome landscape across the spectrum of prostate cancer progression, and differentially methylated region (DMR) based biomarkers of hormonal therapy failure in metastatic hormone-sensitive prostate cancer

Abstract Background: DNA silencing of gene expression can affect tumorigenesis, treatment outcomes and prognosis. Epigenetic silencing of tumor suppressor genes in prostate cancer detected in plasma at different stages of progression and its effect on clinical outcomes has not been determined. In a cohort study across different stages of prostate cancer (PC) progression, we performed plasma cell-free DNA (cfDNA)-based epigenomic profiling for determining the landscape of methylation and Differentially Methylated Region (DMR) classifiers and the potential impact on clinical outcomes in metastatic hormone-sensitive prostate cancer (mHSPC) state. Methods: Plasma was collected prospectively in a longitudinal cohort study of 108 PC patients (pts) of which 24 had non-metastatic Local PC; 28 had mHSPC; 56 had mCRPC. cfDNA was used for enzymatic methylation sequencing (EM-seq) of a targeted panel of genes (N=441) implicated in prostate cancer biology. Methylation status at CpG islands of these genes were examined using Twist targeted cfDNA methylation assay. The Bismark program was used for methylation calls. Temporal trends of differentially methylated regions (DMRs) were identified in different states of progression by comparing the methylation status of target genes in localized PC, mHSPC and mCRPC states using a False Discovery Rate (FDR-q-value) of 0.2 or less. DMRs uniquely associated with mHSPC state were identified and determination of genes with DMRs in pts experiencing early failure of androgen deprivation therapy (ADT)-based therapies was performed. Early failure was defined as progression on ADT within 12 months. Results: We identified 304/441 genes that were differentially methylated between localized PC and advanced PC (mHSPC and mCRPC) (FDR&amp;lt;0.2), of which 237 genes differed between mHSPC and mCRPC (p&amp;lt;0.05) states. mHSPC pts were serially profiles before and after 3 months of ADT-based therapies. All 28 pts experienced a PSA response at 3-months and 112/237 genes showed significant change in methylation status in these serial samples taken before/after 3 months of ADT-based therapies. The median follow up of the cohort was 18 months (range 10-24). 6/28 mHSPC pts experienced early ADT failure (&amp;lt;12 months; median 10 months). 8/112 genes were significantly associated with early failures and included DMRs in RB1, FOXA1, SOX11. GSC, ALDH1L1, SCGB3A1, FLT4, and PTPRN2. Conclusions. A targeted cfDNA plasma liquid-biopsy based epigenomic profiling of PC cancer related genes was able to capture significant differences in DMRs across different states of cancer progression. Candidate differentially expressed CpG methylome gene biomarkers detected in plasma also identified biomarkers associated with early ADT-based treatment failure in mHSPC. Citation Format: Manish Kohli, Jodie Wong, Yijun Tian, Amir Bitaraf, Claire Hanson, Matt Larsen, Jennifer Lloyd, Julia Batten, Neeraj Agarwal, Umang Swami, Benjamin Maughan, Sumati Gupta, Jonathan Tward. Plasma methylome landscape across the spectrum of prostate cancer progression, and differentially methylated region (DMR) based biomarkers of hormonal therapy failure in metastatic hormone-sensitive prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6023.

Current Status and Future Direction to Address Disparities in Diversity, Equity, and Inclusion in Prostate Cancer Care.

Disparities in prostate cancer care and outcomes have been well recognized for decades. The purpose of this review is to methodically highlight known racial disparities in the care of prostate cancer patients, and in doing so, recognize potential strategies for overcoming these disparities moving forward. Over the past few years, there has been a growing recognition and push towards addressing disparities in cancer care. This has led to improvements in care delivery trends and a narrowing of racial outcome disparities, but as we highlight in the following review, there is more to be addressed before we can fully close the gap in prostate cancer care delivery. While disparities in prostate cancer care are well recognized in the literature, they are not insurmountable, and progress has been made in identifying areas for improvement and potential strategies for closing the care gap.

PD21-04 THE IMPACT OF NEIGHBORHOOD DEPRIVATION AND RACE ON PROSTATE CANCER-SPECIFIC MORTALITY FOR WISCONSIN MEN

You have accessJournal of UrologyCME1 Apr 2023PD21-04 THE IMPACT OF NEIGHBORHOOD DEPRIVATION AND RACE ON PROSTATE CANCER-SPECIFIC MORTALITY FOR WISCONSIN MEN Ashanda R. Esdaille, Arighno Das, Glenn O. Allen, Daniel Shapiro, Kyle Richards, E. Jason Abel, David Jarrard, and Tudor Borza Ashanda R. EsdailleAshanda R. Esdaille More articles by this author , Arighno DasArighno Das More articles by this author , Glenn O. AllenGlenn O. Allen More articles by this author , Daniel ShapiroDaniel Shapiro More articles by this author , Kyle RichardsKyle Richards More articles by this author , E. Jason AbelE. Jason Abel More articles by this author , David JarrardDavid Jarrard More articles by this author , and Tudor BorzaTudor Borza More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003287.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Neighborhood deprivation contributes to worsened prostate cancer (PCa) outcomes. In Wisconsin, 54% of the population resides in the most deprived neighborhoods and the state ranks #1 in PCa incidence for Black men. In this study, we aimed to identify the association between neighborhood deprivation, race, and PCa-specific mortality (PCSM) for Wisconsin men. METHODS: Wisconsin Cancer Reporting System (WCRS) data were used to identify all men diagnosed with PCa between 1995-2010. Deprivation was measured by the Area of Deprivation Index (ADI) at the census block group level using the Neighborhood Atlas®, a validated composite measure which allows for rankings of neighborhoods by socioeconomic disadvantage based on income, education, employment, and housing quality. ADIs were categorized into quartiles. Differences in baseline demographic and clinicopathologic characteristics were determined using chi-square tests. Cox proportional hazards models were used to estimate the effect of neighborhood deprivation and race on PCSM, adjusted for age, clinical grade, stage, diagnosis year +/- treatment. RESULTS: 62,474 men with PCa were identified including 58,777 White, 2,706 Black, and 991 Other with a median follow up of 5.7 years (primary) and 9.6 years (sensitivity analyses). 33,558 men resided in the most deprived neighborhoods (Q3-Q4): 30,678 White vs 2,282 Black vs 591 Other. PCa-specific deaths were more prevalent in Q4 (12.5%) vs Q1 (9.6%), p<0.001. Men living in the most deprived neighborhoods had a slightly higher risk for PCSM (Q4: [aHR]=1.1 [95% CI 1.0-1.15], p=0.037). Deprived Black men were at a higher risk of PCSM vs deprived (Q4: HR=1.2 [95%CI 1.06-1.38], p=0.005) and least deprived White men (HR=1.3 [95% CI 1.15-1.52], p<0.001), but these were not statistically significant on adjusted and sensitivity analyses (p=0.13-0.88). The least deprived Black men (Q1: aHR=1.1 [95% CI 0.57-2.05], p=0.79) were no more likely to die from PCa than the least deprived White men. CONCLUSIONS: Race is implicated in worsened PCa outcomes, however, these findings support the association between neighborhood deprivation and PCSM as a potential mediator for race effects. These data support that neighborhood-level resources or interventions, such as access to care, are essential to improve or equalize PCa outcomes. Source of Funding: AUA/UCF Research Scholar Award Grant# 017-822959 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e591 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ashanda R. Esdaille More articles by this author Arighno Das More articles by this author Glenn O. Allen More articles by this author Daniel Shapiro More articles by this author Kyle Richards More articles by this author E. Jason Abel More articles by this author David Jarrard More articles by this author Tudor Borza More articles by this author Expand All Advertisement PDF downloadLoading ...

MP67-05 IMPACTS ON FUNCTIONAL AND ONCOLOGICAL OUTCOMES OF ROBOTIC-ASSISTED RADICAL PROSTATECTOMY 10 YEARS AFTER THE TASKFORCE RECOMMENDATIONS AGAINST PSA SCREENING

You have accessJournal of UrologyCME1 Apr 2023MP67-05 IMPACTS ON FUNCTIONAL AND ONCOLOGICAL OUTCOMES OF ROBOTIC-ASSISTED RADICAL PROSTATECTOMY 10 YEARS AFTER THE TASKFORCE RECOMMENDATIONS AGAINST PSA SCREENING Marcio Covas Moschovas, Jaber Abdel, Shady Saikali, Seetharam Bhat, Marco Sandri, Travis Rogers, David Loy, and Vipul Patel Marcio Covas MoschovasMarcio Covas Moschovas More articles by this author , Jaber AbdelJaber Abdel More articles by this author , Shady SaikaliShady Saikali More articles by this author , Seetharam BhatSeetharam Bhat More articles by this author , Marco SandriMarco Sandri More articles by this author , Travis RogersTravis Rogers More articles by this author , David LoyDavid Loy More articles by this author , and Vipul PatelVipul Patel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003330.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: For experienced surgeons, prostate cancer outcomes are ultimately affected by the pathology of the disease they treat. Over the last decade, we have experienced a dramatic alteration in the pathology we are addressing. During this time, the most significant shift in prostate cancer management was the 2012 USPSTF (United States Preventive Service Task Force) decision to recommend against PSA screening. This has affected the types of prostate cancers we are treating and potentially influenced treatment outcomes. We aimed to analyze the functional and oncologic trends in prostate cancer outcomes in the largest single surgeon series. METHODS: We retrospectively reviewed our prospective IRB-approved prostate cancer registry for 11396 patients that underwent RALP between 2008 and 2021. Each patient had at least a 12-month follow-up. The cohort was divided into two groups before and 6 months after the USPSTF recommendation. Group 1: 1/2008- 12/2012, Group 2: 1/ 2013-12-2021. Group 1 had 4760 patients, and Group 2 had 6636 patients, with a median follow-up of 109 and 38 months, respectively. We assessed the functional and oncologic outcomes of the two groups. RESULTS: We detected time-trend changes after 2012. There was a migration to younger ages, less than 60, and an increase in the median preoperative PSA (5 to 6 ng/ml). There was 18% increase in the higher grade and stage of the disease, Gleason ≥3+4 (19% increase), and ≥ pT3 (18% increase). This translated into a 6% increase in positive surgical margins with an initial rapid increase that was tempered with a surgical adjustment in the amount of (NS) nerve sparing. There was a 24% reduction in full nerve sparing in response to the worsening pathology. Outcomes were also affected by the modification in NS. Comparing groups 1 and 2, there was a significant decline in post-operative outcomes: 12-month continence reduction by 9%, reduction in potency by 27%, and trifecta by 22%. CONCLUSIONS: We have witnessed a significant change in the types of patients we are seeing and the outcomes we are able to deliver. We are seeing younger patients with higher-grade diseases, and the increasing number of high-risk patients has led to worse functional and oncologic outcomes. The initial rapid rise in PSM was leveled by the move towards more partial nerve sparing. The USPSTF recommendation has affected the oncology and outcomes of prostate cancer in an increasingly younger patient population. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e944 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marcio Covas Moschovas More articles by this author Jaber Abdel More articles by this author Shady Saikali More articles by this author Seetharam Bhat More articles by this author Marco Sandri More articles by this author Travis Rogers More articles by this author David Loy More articles by this author Vipul Patel More articles by this author Expand All Advertisement PDF downloadLoading ...

MP12-10 THE EFFECT OF LIMITED ENGLISH PROFICIENCY ON PSA SCREENING RATES IN AMERICAN MEN

You have accessJournal of UrologyCME1 Apr 2023MP12-10 THE EFFECT OF LIMITED ENGLISH PROFICIENCY ON PSA SCREENING RATES IN AMERICAN MEN Benjamin V. Stone, Muhieddine Labban, Dejan K. Filipas, Edoardo Beatrici, Nicola Frego, Zhiyu (Jason) Qian, Sandeep S. Voleti, Stuart R. Lipsitz, Adam S. Kibel, Alexander P. Cole, and Quoc-Dien Trinh Benjamin V. StoneBenjamin V. Stone More articles by this author , Muhieddine LabbanMuhieddine Labban More articles by this author , Dejan K. FilipasDejan K. Filipas More articles by this author , Edoardo BeatriciEdoardo Beatrici More articles by this author , Nicola FregoNicola Frego More articles by this author , Zhiyu (Jason) QianZhiyu (Jason) Qian More articles by this author , Sandeep S. VoletiSandeep S. Voleti More articles by this author , Stuart R. LipsitzStuart R. Lipsitz More articles by this author , Adam S. KibelAdam S. Kibel More articles by this author , Alexander P. ColeAlexander P. Cole More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003227.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There exist disparities in prostate-specific antigen (PSA) screening and prostate cancer outcomes among racial and ethnic groups, but it is unknown how limited English proficiency impacts rates of PSA screening. METHODS: The Medical Expenditure Panel Survey was utilized to identify rates of PSA screening between 2013 and 2016 among men without prostate cancer ≥55 for whom guidelines recommend shared decision-making regarding prostate cancer screening. Men were stratified by self-reported levels of English proficiency (men who speak English very well, well, not well, or not at all). Survey weights were applied, and groups were compared using the adjusted Wald test. A multivariable logistic regression model was used to identify predictors of ever receiving PSA screening adjusting for patient-level covariates. RESULTS: The cohort included 2,889 men, corresponding to a weighted national estimate of 4,765,682 men. The rates of PSA screening varied significantly according to levels of English proficiency (p<0.0001, Figure 1). 79.6% of men who speak English very well reported receiving at least one lifetime PSA test, compared with 58.4% of men who do not speak English at all (p<0.001). Approximately half of the men who speak English very well reported PSA testing within the prior year (52.0%) compared with 34.5% of men who do not speak English at all. Significant predictors of receiving at least one lifetime PSA test included older age, income >400% of the federal poverty level, and insurance coverage (Table 1). Asian compared to White race was associated with lower rates of PSA screening (aOR 0.35; 95% CI 0.21-0.60; p<0.001). Compared to those who reported speaking English very well, men who reported not speaking English at all had significantly lower rates of PSA screening (aOR 0.55; 95% CI 0.35-0.88; p=0.012). CONCLUSIONS: Limited English proficiency is associated with significantly lower rates of PSA screening. Interventions to mitigate disparities in prostate cancer outcomes need to account for limited English proficiency among the barriers to guideline-concordant care. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e137 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin V. Stone More articles by this author Muhieddine Labban More articles by this author Dejan K. Filipas More articles by this author Edoardo Beatrici More articles by this author Nicola Frego More articles by this author Zhiyu (Jason) Qian More articles by this author Sandeep S. Voleti More articles by this author Stuart R. Lipsitz More articles by this author Adam S. Kibel More articles by this author Alexander P. Cole More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement PDF downloadLoading ...

MP29-20 FACTORS ASSOCIATED WITH POOR SURVIVAL OUTCOMES IN PROSTATE CANCER (PCA) PATIENTS WITH RADIOGRAPHIC DISEASE PROGRESSION IN THE SETTING OF LOW PSA

You have accessJournal of UrologyCME1 Apr 2023MP29-20 FACTORS ASSOCIATED WITH POOR SURVIVAL OUTCOMES IN PROSTATE CANCER (PCA) PATIENTS WITH RADIOGRAPHIC DISEASE PROGRESSION IN THE SETTING OF LOW PSA Mohamed Ahmed, Jack Andrews, Ahmed Mahmoud, Matthew Lee, Elizabeth Bearrick, Daniel Childs, A. Tuba Kendi, Matthew Tollefson, Stephen Boorjian, R. Jeff Karnes, and Eugene Kwon Mohamed AhmedMohamed Ahmed More articles by this author , Jack AndrewsJack Andrews More articles by this author , Ahmed MahmoudAhmed Mahmoud More articles by this author , Matthew LeeMatthew Lee More articles by this author , Elizabeth BearrickElizabeth Bearrick More articles by this author , Daniel ChildsDaniel Childs More articles by this author , A. Tuba KendiA. Tuba Kendi More articles by this author , Matthew TollefsonMatthew Tollefson More articles by this author , Stephen BoorjianStephen Boorjian More articles by this author , R. Jeff KarnesR. Jeff Karnes More articles by this author , and Eugene KwonEugene Kwon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003257.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recent studies, including a post-hoc analysis of the ARCHES trial, highlight radiographic disease progression (rDP) occurring without concordant rise in prostate specific antigen (PSA). In a previous study by our group, we reported that almost 40% of patients on 2nd generation hormone therapy experience rDP with non-rising PSA and have poor survival outcomes. The current analysis more specifically focuses on the subgroup of patients with rDP occurring at low PSA (<0.5 ng/dL) and describes factors associated with poorer survival outcomes in this patient population. METHODS: In a single institution study, we reviewed the prospectively maintained Mayo Clinic C-11 Choline PET registry for patients treated between 2011 and 2021, who experienced rDP at low PSA (value < 0.5 ng/mL). Disease progression on C-11 choline PET was confirmed by either tissue biopsy or subsequent response to therapy. We investigated factors associated with poor cancer-specific survival outcomes in univariable and multivariable cox regression analyses. RESULTS: In total, 220 (16%) patients experiencing rDP at low PSA were identified. Median (IQR) age at rDP was 67.91 (61.10 – 73.87) yrs., median (IQR) primary Gleason score was 9 (7-9), and median (IQR) PSA was 0.17 (0 – 0.32) ng/ml. 75% of the patients (n=166) had CRPC disease status at time of rDP. Prior systemic treatments included 2nd generation HT in 18% (n= 40) and chemotherapy in 31% (n=70). Sites of rDP were divided into 7% local (n=16), 42% lymph nodes (n=91), 43% bone (n=95), and 8% visceral metastases (n=18). Over a median follow-up duration of 55 months, 46% of patients (n=100) reported death. Factors associated with poor survival outcomes are demonstrated in table-1 and include age at rDP, CRPC status, and disease location (P-value <0.05). CONCLUSIONS: We found that radiographic disease progression commonly occurs at low PSA (<0.5 ng/mL). CRPC-disease status and the development of visceral metastases are associated with particularly poor survival outcomes. To identify early progression, monitoring with imaging may be warranted, even in the patients with low PSA. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e390 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Ahmed More articles by this author Jack Andrews More articles by this author Ahmed Mahmoud More articles by this author Matthew Lee More articles by this author Elizabeth Bearrick More articles by this author Daniel Childs More articles by this author A. Tuba Kendi More articles by this author Matthew Tollefson More articles by this author Stephen Boorjian More articles by this author R. Jeff Karnes More articles by this author Eugene Kwon More articles by this author Expand All Advertisement PDF downloadLoading ...

MP38-11 IS THERE AN IMPACT OF THE CENTER PERFORMING BASELINE MULTIPARAMETRIC MRI ON ACTIVE SURVEILLANCE OUTCOMES IN PROSTATE CANCER PATIENTS?

You have accessJournal of UrologyCME1 Apr 2023MP38-11 IS THERE AN IMPACT OF THE CENTER PERFORMING BASELINE MULTIPARAMETRIC MRI ON ACTIVE SURVEILLANCE OUTCOMES IN PROSTATE CANCER PATIENTS? Riccardo Leni, Armando Stabile, Giorgio Gandaglia, Vito Cucchiara, Giuseppe Rosiello, Elio Mazzone, Gabriele Sorce, Francesco Pellegrino, Simone Scuderi, Daniele Robesti, Donato Cannoletta, Mario De Angelis, Leonardo Quarta, Paolo Zaurito, Giorgio Brembilla, Francesco De Cobelli, Francesco Montorsi, and Alberto Briganti Riccardo LeniRiccardo Leni More articles by this author , Armando StabileArmando Stabile More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Vito CucchiaraVito Cucchiara More articles by this author , Giuseppe RosielloGiuseppe Rosiello More articles by this author , Elio MazzoneElio Mazzone More articles by this author , Gabriele SorceGabriele Sorce More articles by this author , Francesco PellegrinoFrancesco Pellegrino More articles by this author , Simone ScuderiSimone Scuderi More articles by this author , Daniele RobestiDaniele Robesti More articles by this author , Donato CannolettaDonato Cannoletta More articles by this author , Mario De AngelisMario De Angelis More articles by this author , Leonardo QuartaLeonardo Quarta More articles by this author , Paolo ZauritoPaolo Zaurito More articles by this author , Giorgio BrembillaGiorgio Brembilla More articles by this author , Francesco De CobelliFrancesco De Cobelli More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003276.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Magnetic resonance imaging (MRI) of the prostate has been incorporated as a tool to confirm eligibility for active surveillance (AS). The impact of radiologist expertise on MRI diagnostic performance has been widely demonstrated. However, the increased number of centers performing MRI has increased the variability of both quality and performance. In this study, we assessed the diagnostic accuracy of MRI performed at a single high volume center vs external centers for patients under AS. METHODS: We identified 535 men on AS at our Institution with baseline MRI and at least one surveillance biopsy (sBx). MRIs were stratified according to centers performing the scan (high volume single center performing > 500 MRIs per year vs external centers) and to the detection of visible lesions (negative: PI-RADS 1-2, positive: PI-RADS 3-5). Reclassification was defined as increase in Gleason score at sBx, or higher disease volume ( >33% of involved cores, or >50% of a single core involved). Reclassification-free survival (RFS) was estimated with the Kaplan-Meier method. A Cox model tested the prognostic impact of the center performing MRI according to lesion visibility, after adjusting for covariates. RESULTS: Median age was 65 years (IQR 59-70), 52% (n=280) and 48% (n=255) of patients underwent baseline MRI at our Institution (internal) vs external Institutions. A lower proportion of negative scans was observed among the external MRI scans (18% vs 35%, p<0.001). After a median follow-up of 43 months, 47% (n=253) of men were reclassified. The 5-year RFS was 76% vs 40% for internal vs external negative MRI scans (p<0.001). A negative external MRI was associated with a 1.98-fold increased risk of reclassification compared to a negative internal MRI (95% CI 1.07-3.65, p=0.03). In contrast, the 5-year RFS was 37% vs 35% for internal vs external positive MRI scans, respectively (p=0.2). CONCLUSIONS: We demonstrated that the negative predictive value of MRI scans performed at high volume centers is significantly higher compared to MRIs performed externally. Our findings indirectly support the need for centralization of MRIs in men on AS, as well as the invariable need of follow-up biopsies for those with negative MRIs performed externally. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e528 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Riccardo Leni More articles by this author Armando Stabile More articles by this author Giorgio Gandaglia More articles by this author Vito Cucchiara More articles by this author Giuseppe Rosiello More articles by this author Elio Mazzone More articles by this author Gabriele Sorce More articles by this author Francesco Pellegrino More articles by this author Simone Scuderi More articles by this author Daniele Robesti More articles by this author Donato Cannoletta More articles by this author Mario De Angelis More articles by this author Leonardo Quarta More articles by this author Paolo Zaurito More articles by this author Giorgio Brembilla More articles by this author Francesco De Cobelli More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...

Impact of COVID-19 pandemic on prostate cancer outcomes at an uro-oncology referral center.

To evaluate the possible effects of the coronavirus disease 2019 (COVID-19) pandemic on the oncologic results of patients with prostate cancer regarding clinical staging, presence of adverse pathological outcomes, and perioperative complications. This retrospective study included patients who underwent radical prostatectomy. The time between biopsy and surgery, staging tests, final histopathological evaluation after surgery, lymphadenectomy rate, postoperative complications, and prostatic specific antigen (PSA) levels (initial and 30 days after surgery) were analyzed and compared in a group of patients before and during the pandemic period. We included 226 patients: 88 in the pre-pandemic period and 138 during the pandemic period. There was no statistically significant difference in mean age, body mass index, ASA, pathological locally advanced disease, the proportion of patients who underwent lymphadenectomy, and ISUP grade in the biopsy between the groups. Positive surgical margins, prostatic extracapsular extension, and PSA levels at 30 days were also similar between the groups. The mean time between medical consultation and surgery was longer in the pandemic period than in the pre-pandemic (124 vs. 107 days, p<0.001), and the mean time between biopsy and medical consultation (69.5 days vs. 114 days, p<0.001) and between biopsy and surgery (198.5 days vs. 228 days, p=0.013) was shorter during the pandemic. The incidence of severe early and late perioperative complications was similar between the periods. There was no delay between diagnosis and treatment at our institution during the COVID-19 pandemic period. No worsening of the prostate cancer features was observed.

MP61-03 COMPARING THE OUTCOMES OF ROBOTIC ASSISTED RADICAL PROSTATECTOMY IN BLACK AND WHITE MEN: EXPERIENCE OF A HIGH-VOLUME CENTER

You have accessJournal of UrologyCME1 Apr 2023MP61-03 COMPARING THE OUTCOMES OF ROBOTIC ASSISTED RADICAL PROSTATECTOMY IN BLACK AND WHITE MEN: EXPERIENCE OF A HIGH-VOLUME CENTER Jonathan Noel, Marcio Moschovas, Abdel Rahman Jaber, Marco Sandri, Travis Rogers, and Vipul Patel Jonathan NoelJonathan Noel More articles by this author , Marcio MoschovasMarcio Moschovas More articles by this author , Abdel Rahman JaberAbdel Rahman Jaber More articles by this author , Marco SandriMarco Sandri More articles by this author , Travis RogersTravis Rogers More articles by this author , and Vipul PatelVipul Patel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003319.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Global cancer incidence ranks Prostate Cancer (CaP) as the second highest overall, with Africa and the Caribbean having the highest mortality. Previous literature suggests disparities in CaP outcomes according to ethnicity, specifically functional and oncological are suboptimal in black men. However, recent data shows black men achieve post radical prostatectomy (RP) outcomes equivalent to white men in a universally insured system. Our objective is to compare outcomes of patients who self-identified their ethnicity as black or white undergoing RP at our institution. METHODS: From 2008 to 2017, 396 black and 4929 white patients underwent primary robotic-assisted radical prostatectomy (RARP) with a minimum follow-up of 5 years. Exclusion criteria were concomitant surgery and cancer status not available. A propensity score (PS) match was performed with a 1:1, 1:2, and 1:3 ratio without replacement. Primary endpoints were potency, continence recovery, biochemical recurrence (BCR), positive surgical margins (PSM), and post-operative complications. RESULTS: After PS 1:1 matching, 341 black vs. 341 white men with a median follow-up of approximately 8 years were analyzed. The overall potency and continence recovery at 12 months was 52% vs 58% (p=0.3) and 82% vs 89% (p=0.3), respectively. PSM rates was 13.4 % vs 14.4% (p=0.75). Biochemical recurrence and persistence PSA was 13.8% vs 14.1% and 4.4% vs 3.2% respectively (p=0.75).Clavien-Dindo complications (p=0.4) and 30-day readmission rates (p=0.5) were similar. CONCLUSIONS: In our study, comparing two ethnic groups with similar preoperative characteristics and full access to screening and treatment showed compatible RARP results. We could not demonstrate outcomes superiority in one group over the other. However, this data adds to the growing body of evidence that the racial disparity gap in prostate cancer outcomes can be narrowed if patients have appropriate access to prostate cancer management. It also could be used in counseling surgeons and patients on the surgical intervention and prognosis of prostate cancer in patients with full access to gold standard screening and treatment. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e853 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Noel More articles by this author Marcio Moschovas More articles by this author Abdel Rahman Jaber More articles by this author Marco Sandri More articles by this author Travis Rogers More articles by this author Vipul Patel More articles by this author Expand All Advertisement PDF downloadLoading ...

MP12-15 DISPARITIES IN PROSTATE CANCER SCREENING AND DIAGNOSIS AMONG PATIENTS WITH MEDICAID

You have accessJournal of UrologyCME1 Apr 2023MP12-15 DISPARITIES IN PROSTATE CANCER SCREENING AND DIAGNOSIS AMONG PATIENTS WITH MEDICAID Henry Gold, Andrew Stevens, Tasha Posid, Dairon Denis-Diaz, Hafsa Asif, Aliza Khuhro, and Shawn Dason Henry GoldHenry Gold More articles by this author , Andrew StevensAndrew Stevens More articles by this author , Tasha PosidTasha Posid More articles by this author , Dairon Denis-DiazDairon Denis-Diaz More articles by this author , Hafsa AsifHafsa Asif More articles by this author , Aliza KhuhroAliza Khuhro More articles by this author , and Shawn DasonShawn Dason More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003227.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Medicaid patients with prostate cancer are four times more likely to present with metastatic disease and twice as likely to die of their cancer compared to patients with private insurance. Medicaid participation is related to other factors that limit healthcare access, including socioeconomic status (18,000/year individual income limit in Ohio) and race (48% of Medicaid enrollees are black in our county vs. 24% of population). We hypothesize that adverse prostate cancer outcomes in the Medicaid population relate to limited access to both PSA screening and evaluation of abnormal results. We reviewed our institutional triage process for patients referred for an abnormal prostate cancer screen with the goal of ensuring equitable intake processes based on payor status. METHODS: This is a retrospective study of patients who presented to our institution with an elevated PSA or an abnormal prostate exam from 2012-2021. Initial data on demographics, payor status, time to first appointment, screening history, and diagnostic testing are reported. Statistical analysis was performed with SPSS (IBM Inc.). Means were compared with the student’s t-test and logistic regression was used for correlative analysis with two-tailed p values <0.05 considered significant. RESULTS: Our initial analysis cohort included 149 patients who were predominantly Caucasian (58.0%) and had a mean age of 67.5 years (SD=9.11). Mean income based on home address zip code was $83,726 (SD=$30,488) and patients had a mean of 2.91 (SD=1.2) prior PSAs. We had a much lower proportion of patients with Medicaid status (6.7%) than expected based on our overall departmental payor mix and the size of the Medicaid population in our catchment area. Patients with Medicaid were almost 10 times more likely to not show up to their first appointment than those with other insurance types (p=0.014). Medicaid patients were also less likely to receive a biopsy (p=0.07) and had a lower number of PSA tests prior to referral (p=0.08). A zip code with lower mean income negatively predicted receipt of MRI prior to a biopsy (p=0.02). Times between referral, scheduling, and appointment were not impacted by payor status or zip code. CONCLUSIONS: Our data confirm disparities in several factors in our prostate cancer screening referrals known to relate to prostate cancer outcomes. To address this, we are implementing a Medicaid-focused program at our institution to improve on “No-show” rates and optimize guideline concordant care. Outreach to primary care providers with a large Medicaid patient population is also critical in promoting equity in PSA screening. Source of Funding: Ohio State University Patient Care Innovation Award © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e139 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Henry Gold More articles by this author Andrew Stevens More articles by this author Tasha Posid More articles by this author Dairon Denis-Diaz More articles by this author Hafsa Asif More articles by this author Aliza Khuhro More articles by this author Shawn Dason More articles by this author Expand All Advertisement PDF downloadLoading ...

PD27-12 CORRELATION OF POST-PROSTATECTOMY DECIPHER GENOMIC CLASSIFICATION TO CLINICAL OUTCOMES IN PROSTATE CANCER OVER 8 YEAR FOLLOW-UP

You have accessJournal of UrologyCME1 Apr 2023PD27-12 CORRELATION OF POST-PROSTATECTOMY DECIPHER GENOMIC CLASSIFICATION TO CLINICAL OUTCOMES IN PROSTATE CANCER OVER 8 YEAR FOLLOW-UP Benjamin Behers, Spencer Kortum, Genesis Dolgetta, Karim Ghazli, Tonya King, Victoria Bird, and Robert Carey Benjamin BehersBenjamin Behers More articles by this author , Spencer KortumSpencer Kortum More articles by this author , Genesis DolgettaGenesis Dolgetta More articles by this author , Karim GhazliKarim Ghazli More articles by this author , Tonya KingTonya King More articles by this author , Victoria BirdVictoria Bird More articles by this author , and Robert CareyRobert Carey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003305.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Decipher genomic classification (DGC) has been developed to predict disease severity in prostate cancer. This study seeks to evaluate how well Decipher scores predicted actual clinical outcome in 192 patients that underwent robotic prostatectomy (RALRP) with 8-year follow-up of survival outcomes. METHODS: Data is collected from an IRB-approved, prospectively-maintained database of 192 patients who underwent RALRP with DGC testing of the post prostatectomy specimens with mean 8 year follow-up outcomes. The Decipher prediction signatures were Metastasis Risk, Androgen Deprivation Therapy (ADT) Response, Post-Operative Radiation Response, Docetaxel Sensitivity, Seminal Vesicle Invasion, Genomic Gleason Score of Primary 4 or 5, Genomic CAPRA-S Score of High (>5), Pathology Stage T3 (pT3 Disease), Tumor Cell Proliferation, and Androgen Receptor (AR) Signaling Activity. A logistic regression analysis test evaluated these signatures with the actual clinical outcomes of metastatic castration-resistant prostate cancer (mCRPC), metastasis, ADT use, overall mortality (OM), and disease-specific mortality (DSM). RESULTS: Higher Decipher scores for pT3 Disease was the most significant predictor of requiring ADT. The odds of ADT were 1.8 times greater for every 25-unit increase in pT3 Disease (95% CI 1.84-4.96, p<0.001). A negative relationship was seen between the Decipher prediction of Genomic Gleason Score of Primary 4 or 5 and no disease progression. The odds of no progression was 0.6 times lower for every 25-unit increase in Genomic Gleason Score of Primary 4 or 5 (95% CI 0.41-0.82, p=0.002). Higher Decipher scores for Post-Operative Radiation Response had a positive relationship with overall mortality. For every 25-unit increase in Post-Operative Radiation Response, OM was 1.9 times greater (95% CI 1.32-2.87, p<0.001). Finally, AR Signaling Activity had a negative relationship with disease-specific mortality. DSM was 0.21 times lower for every 25-unit increase in AR Signaling Activity (95% CI 0.05-0.85, p=0.028). CONCLUSIONS: This paper finds correlation between Decipher genomic predictions with actual clinical outcomes at 8 year post prostatectomy follow-up. Decipher scores for pT3 Disease and Genomic Gleason Score of Primary 4 or 5 signature were the best predictors of requiring ADT treatment and of no disease progression, respectively. AR Signaling Activity signature was the best predictor of disease-specific mortality, whereas Post-Operative Radiation Response was the best predictor of overall mortality. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e746 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin Behers More articles by this author Spencer Kortum More articles by this author Genesis Dolgetta More articles by this author Karim Ghazli More articles by this author Tonya King More articles by this author Victoria Bird More articles by this author Robert Carey More articles by this author Expand All Advertisement PDF downloadLoading ...

MP73-19 FOCAL CRYOABLATION VS FOCAL HIGH INTENSITY FOCUSED ULTRASOUND FOR INTERMEDIATE AND HIGH-RISK PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP73-19 FOCAL CRYOABLATION VS FOCAL HIGH INTENSITY FOCUSED ULTRASOUND FOR INTERMEDIATE AND HIGH-RISK PROSTATE CANCER Masatomo Kaneko, Alireza Ghoreifi, Samuel Peretsman, Jessica Cummins, Lorenzo Storino Ramacciotti, Giovanni E. Cacciamani, Amir H. Lebastchi, Suzanne L. Palmer, Manju Aron, Osamu Ukimura, Duke Bahn, Inderbir Gill, and Andre Luis Abreu Masatomo KanekoMasatomo Kaneko More articles by this author , Alireza GhoreifiAlireza Ghoreifi More articles by this author , Samuel PeretsmanSamuel Peretsman More articles by this author , Jessica CumminsJessica Cummins More articles by this author , Lorenzo Storino RamacciottiLorenzo Storino Ramacciotti More articles by this author , Giovanni E. CacciamaniGiovanni E. Cacciamani More articles by this author , Amir H. LebastchiAmir H. Lebastchi More articles by this author , Suzanne L. PalmerSuzanne L. Palmer More articles by this author , Manju AronManju Aron More articles by this author , Osamu UkimuraOsamu Ukimura More articles by this author , Duke BahnDuke Bahn More articles by this author , Inderbir GillInderbir Gill More articles by this author , and Andre Luis AbreuAndre Luis Abreu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003341.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess outcomes of focal Cryoablation (CRYO) and focal High Intensity Focused Ultrasound (HIFU) for Intermediate to high-risk prostate cancer (PCa). METHODS: Consecutive patients who underwent hemi-gland CRYO (h-CRYO) or hemi-gland HIFU (h-HIFU) as primary treatment for D’Amico intermediate risk and high-risk PCa were identified (IRB# HS-17-00749). Patients were followed by prostate biopsy (PBx) 6-12 mo and every 2 yr thereafter. The primary endpoint was treatment failure (TF) defined as Grade Group (GG) ≥2 on follow-up (FU) PBx, any whole-gland treatment, systemic therapy, metastases, or PCa-specific mortality. Secondary endpoints included survival-free from i) biochemical failure (BF, PSA nadir+2 ng/mL); ii) GG≥2 on FU-PBx, and iii) radical treatment. Kaplan-Meier and Cox regression analyses were performed for survival evaluation. International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF-5) were evaluated. Statistically significant if p<0.05. RESULTS: A total of 294 patients met the inclusion criteria: 192 (65%) CRYO and 102 (35%) HIFU. The baseline characteristics were comparable between h-CRYO vs h-HIFU, as follows: median age (68 vs 66yr, p=0.2), PSA (6.6 vs 6.1 ng/mL, p=0.08), PSA density (PSAD, 0.17 vs 0.16 ng/mL2, p=0.6), respectively. The distribution of GG for h-CRYO vs h-HIFU were as follows: GG1 (7.3% vs 2.0%), GG2-3 (77% vs 93%), and GG4-5 (15% vs 5.0%) (p<0.004), respectively. The median FU was longer for h-CRYO (46 mo) vs h-HIFU (22 mo); p<0.001. The 3-year TF-free survival was: 86% for h-CRYO and 62% for h-HIFU, p=0.003. PSAD per 0.01 was an independent predictor of TF on multivariate Cox regression analysis (hazard ratio [HR] 1.02, 95% confidence interval [95%CI] 1.01-1.03), but h-HIFU vs h-CRYO was not (HR 1.27, 95%CI 0.69-2.33). The 3-year free survival were, for h-CRYO vs h-HIFU: BF (75% vs 81%, p=0.76); GG≥2 on FU-PBx (88% vs 62%, p<0.001), and radical treatment (97% vs 83%, p=0.1), respectively. PSAD per 0.01 and the number of cancer cores on baseline PBx were independent predictors of GG≥2 on FU-PBx, but h-HIFU vs h-CRYO was not (HR 1.34, 95%CI 0.72-2.48). The median difference from pre- to post-FT IPSS (0 vs 1; p=0.27) was similar for h-CRYO vs h-HIFU, respectively. The median IIEF-5 decreased more after CRYO than HIFU (2 vs 0; p=0.005). Continence (zero pad) was maintained in 97% for h-CRYO and in 97% for h-HIFU (p=1.00). CONCLUSIONS: Hemi-gland CRYO and HIFU provide comparable and acceptable medium-term oncologic outcomes for intermediate-high risk PCa, with excellent functional outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1043 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Masatomo Kaneko More articles by this author Alireza Ghoreifi More articles by this author Samuel Peretsman More articles by this author Jessica Cummins More articles by this author Lorenzo Storino Ramacciotti More articles by this author Giovanni E. Cacciamani More articles by this author Amir H. Lebastchi More articles by this author Suzanne L. Palmer More articles by this author Manju Aron More articles by this author Osamu Ukimura More articles by this author Duke Bahn More articles by this author Inderbir Gill More articles by this author Andre Luis Abreu More articles by this author Expand All Advertisement PDF downloadLoading ...

MP77-05 PROSTATE CANCER TRENDS AMONG INDIVIDUAL ASIAN AND PACIFIC ISLANDERS (AAPI) POPULATIONS IN HAWAII

You have accessJournal of UrologyCME1 Apr 2023MP77-05 PROSTATE CANCER TRENDS AMONG INDIVIDUAL ASIAN AND PACIFIC ISLANDERS (AAPI) POPULATIONS IN HAWAII Lauren Muramoto, Brenda Hernandez, and Tom Feng Lauren MuramotoLauren Muramoto More articles by this author , Brenda HernandezBrenda Hernandez More articles by this author , and Tom FengTom Feng More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003351.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Asians and Pacific Islanders (AAPIs) are often grouped together as a single racial demographic when reporting prostate cancer trends despite the heterogeneity within this community. Hawaii’s multi-ethnic community poses a unique environment to study the epidemiology of prostate cancer. We examine differences in incidence and mortality of prostate cancer among AAPIs within Hawaii. METHODS: Data were obtained from the Hawaii Tumor Registry Cancer at a Glance 2014-2018 report. All reported rates were age adjusted per 100,000 to the 2000 US standard population. Differences in incidence and mortality rates were compared among the major AAPI groups: Chinese, Filipino, Japanese, and Native Hawaiian. RESULTS: Prostate cancer is the most common cancer diagnosed in men in Hawaii with an incidence of 22.8% and responsible for 9.6% of cancer related deaths from 2014-2018. Incidence rates among the four major AAPI groups were not statistically different (Figure 1a). Despite this, mortality rates were significantly lower in Chinese (5.5 per 100,000) and Japanese (8.7) compared to Filipinos (16.4) and native Hawaiians (21.6, p<0.05, Figure 1b). Native Hawaiians had the lowest incidence rate (80.2) but had the highest mortality rates among Asians (21.6 per 100,000). Filipinos, despite having similar incidence as Chinese and Japanese, had much higher mortality rates (p<0.05) and the highest proportion of advanced prostate cancer 34.7% at diagnosis. CONCLUSIONS: Hawaii’s diversity plays an important role in reporting cancer incidence and mortality among AAPI. Differences could be related to access to care, genetics, education level or lifestyle related exposures. These data support the need to disaggregate AAPI subpopulations to better understand individual prostate cancer risk profiles. Further research is needed to determine these differing factors among AAPI ethnicities affect prostate cancer risk and outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1103 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lauren Muramoto More articles by this author Brenda Hernandez More articles by this author Tom Feng More articles by this author Expand All Advertisement PDF downloadLoading ...

MP72-11 A DECADE OF DECLINING PROSTATECTOMY MARGIN POSITIVITY WITHIN A PROSTATE CANCER CLINICAL QUALITY REGISTRY

You have accessJournal of UrologyCME1 Apr 2023MP72-11 A DECADE OF DECLINING PROSTATECTOMY MARGIN POSITIVITY WITHIN A PROSTATE CANCER CLINICAL QUALITY REGISTRY Marlon Perera, Nathan Papa, Jonathan Bensley, Melanie Evans, Jeremy Millar, Mark Frydenberg, Declan Murphy, and Damien Bolton Marlon PereraMarlon Perera More articles by this author , Nathan PapaNathan Papa More articles by this author , Jonathan BensleyJonathan Bensley More articles by this author , Melanie EvansMelanie Evans More articles by this author , Jeremy MillarJeremy Millar More articles by this author , Mark FrydenbergMark Frydenberg More articles by this author , Declan MurphyDeclan Murphy More articles by this author , and Damien BoltonDamien Bolton More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003340.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Positive surgical margin (PSM) on radical prostatectomy (RP) is associated with an increased risk of biochemical recurrence and use of salvage therapies. Given these adverse consequences, exploration of time trends and predictors of PSM will improve the patient outcomes following surgery for prostate cancer. METHODS: Pathological data from RP patients treated from 2011-2020 was extracted from the Victorian Prostate Cancer Outcomes Registry. This is a clinical quality registry that regularly benchmarks and reports back to individual clinicians the PSM percentage for their patients. Trends in PSM over time were visualised with separate running mean plots for both pT2 and pT3/4 disease. Predictors of PSM were explored with multivariable regression with date of surgery, surgical method, and hospital type, public or private, entered as covariates. RESULTS: In total, 12394 patients formed the sample with PSM recorded in 25% (n=3141) of patients, 12% (777/6640) in pT2 disease and 41% (2364/5754) in pT3/4 disease. Comparing 2011-12 to 2019-20, the pT3/4 PSM proportion declined from 50% to 38% while pT2 percentages were steady at 13%. In "high volume" institutions, pT2 PSM fell from 12% to 6.5%. Independent predictors of lower PSM were robotic vs open method and being treated at a private vs public institution. CONCLUSIONS: A clear decline in the proportion of pT3 PSM was observed in a large prostate cancer registry. Proposed explanatory factors include improved technical proficiency with robotic surgery and participation in a registry-based quality improvement initiative. Source of Funding: The Victorian Prostate Cancer Outcomes Registry is supported by Movember.Marlon Perera is sponsored by the Australian-America Fulbright Commission administered through a 2021-2022 Fulbright Future Scholarship funded by The Kinghorn Foundation. MSKCC is supported by NIH/NCI Cancer Center Support Grant to Memorial Sloan Kettering Cancer Center (P30 CA008748) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1028 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marlon Perera More articles by this author Nathan Papa More articles by this author Jonathan Bensley More articles by this author Melanie Evans More articles by this author Jeremy Millar More articles by this author Mark Frydenberg More articles by this author Declan Murphy More articles by this author Damien Bolton More articles by this author Expand All Advertisement PDF downloadLoading ...

MP67-01 THE IMPACT OF LYMPHOVASCULAR INVASION ON LONG-TERM CANCER OUTCOMES FOLLOWING RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP67-01 THE IMPACT OF LYMPHOVASCULAR INVASION ON LONG-TERM CANCER OUTCOMES FOLLOWING RADICAL PROSTATECTOMY Niranjan Sathianathen, Marc Furrer, Clancy Mulholland, Nathan Lawrentschuk, and Niall Corcora Niranjan SathianathenNiranjan Sathianathen More articles by this author , Marc FurrerMarc Furrer More articles by this author , Clancy MulhollandClancy Mulholland More articles by this author , Nathan LawrentschukNathan Lawrentschuk More articles by this author , and Niall CorcoraNiall Corcora More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003330.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Lymphovascular invasion (LVI) has been shown to be associated with higher grade and stage of prostate cancer. However, the literature is scarce on its ability to predict long-term oncological outcomes. Therefore, we aim to evaluate the impact of LVI on long-term prostate cancer outcomes following radical prostatectomy. METHODS: A consecutive sample of patients with localised prostate cancer undergoing radical prostatectomy in a multicentre database was included in the analysis. Postoperative PSA measurements and clinical examinations were taken at 3, 6 and 12 months and afterwards yearly. Further diagnostic imaging was obtained with a rising PSA or clinical suspicion. Recurrence-free survival (RFS) and metastases-free survival (MFS) were analysed as a time-to-event outcome using Kaplan-Meier analyses with log-rank tests. To assess the effect of LVI, we created multivariable Cox proportional hazards models adjusting for relevant clinical and demographic characteristics. Ethics committee approval was obtained. RESULTS: A total of 3,732 men were included for analysis with a median follow-up of 44 months. LVI was detected in 18% (n=682). LVI was more common with increasing ISUP grade [RR 4.2, 95%CI 3.8-4.6] and pathological stage [RR 6.5, 95%CI 5.9-7.2]. The incidence of metastasis at 5-years was 12%. Men that were LVI+were more likely to develop metastatic disease than those that were LVI- (39% vs 6%, p<0.01). LVI was an independent predictor of metastasis [HR 2.2, 95%CI 1.7-3.0] and biochemical recurrence [HR 2.1, 95%CI 1.8-2.5]. This finding was consistently noted on subgroup analysis of men with both intermediate- and high-risk prostate cancer. CONCLUSIONS: Lymphovascular invasion is a prognostic indicator of adverse recurrence- and metastasis-free survival following surgery for prostate cancer. This can assist with risk-stratification following radical treatment and possibly aid decision-making regarding adjuvant treatment. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e943 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Niranjan Sathianathen More articles by this author Marc Furrer More articles by this author Clancy Mulholland More articles by this author Nathan Lawrentschuk More articles by this author Niall Corcora More articles by this author Expand All Advertisement PDF downloadLoading ...