Prostate Cancer In Population Research Articles

The Role of the Advanced Practice Provider in Bone Health Management for the Prostate Cancer Population.

Androgen deprivation therapy (ADT) is standard, first-line therapy for many aspects of prostate cancer treatment. Although ADT can be an effective treatment to inhibit androgen-fueled cell growth in prostate cancer, suppressi.

Prognostic impact of BRCA mutation on metastasis-free survival in a localized/locoregional high-risk real-world prostate cancer population.

Prognostic impact of BRCA mutation on metastasis-free survival in a localized/locoregional high-risk real-world prostate cancer population.

Prevalence and risk evaluation of cardiovascular disease in the newly diagnosed prostate cancer population in China: A nationwide, multi-center, population-based cross-sectional study.

Cardiovascular disease (CVD) has emerged as the leading cause of death from prostate cancer (PCa) in recent decades, bringing a great disease burden worldwide. Men with preexisting CVD have an increased risk for major adverse cardiovascular events when treated with androgen deprivation therapy (ADT). The present study aimed to explore the prevalence and risk evaluation of CVD among people with newly diagnosed PCa in China. Clinical data of newly diagnosed PCa patients were retrospectively collected from 34 centers in China from 2010 to 2022 through convenience sampling. CVD was defined as myocardial infarction, arrhythmia, heart failure, stroke, ischemic heart disease, and others. CVD risk was estimated by calculating Framingham risk scores (FRS). Patients were accordingly divided into low-, medium-, and high-risk groups. χ2 or Fisher's exact test was used for comparison of categorical variables. A total of 4253 patients were enrolled in the present study. A total of 27.0% (1147/4253) of patients had comorbid PCa and CVD, and 7.2% (307/4253) had two or more CVDs. The enrolled population was distributed in six regions of China, and approximately 71.0% (3019/4253) of patients lived in urban areas. With imaging and pathological evaluation, most PCa patients were diagnosed at an advanced stage, with 20.5% (871/4253) locally progressing and 20.5% (871/4253) showing metastasis. Most of them initiated prostatectomy (46.6%, 1983/4253) or regimens involving ADT therapy (45.7%, 1944/4253) for prostate cancer. In the present PCa cohort, 43.1% (1832/4253) of patients had hypertension, and half of them had poorly controlled blood pressure. With FRS stratification, as expected, a higher risk of CVD was related to aging and metabolic disturbance. However, we also found that patients with treatment involving ADT presented an originally higher risk of CVD than those without ADT. This was in accordance with clinical practice, i.e., aged patients or patients at advanced oncological stages were inclined to accept systematic integrative therapy instead of surgery. Among patients who underwent medical castration, only 4.0% (45/1118) received gonadotropin releasing hormone antagonists, in stark contrast to the grim situation of CVD prevalence and risk. PCa patients in China are diagnosed at an advanced stage. A heavy CVD burden was present at the initiation of treatment. Patients who accepted ADT-related therapy showed an original higher risk of CVD, but the awareness of cardiovascular protection was far from sufficient.

Lutetium-177 Labelled Anti-PSMA Monoclonal Antibody (Lu-TLX591) Therapy for Metastatic Prostate Cancer: Treatment Toxicity and Outcomes.

Whilst prostate cancer is the fourth most common cancer globally, effective therapies for patients with advanced disease are lacking. In recent years, interest in using theranostic agents to treat castrate-resistant prostate cancer (CRPC) and metastatic prostate cancer has emerged. Lu-TLX591 monoclonal antibody is a potential agent of significance; however, to date, reports on its toxicity and efficacy have been limited to small clinical trials in heavily pretreated patients. This retrospective study describes the real-world toxicity and efficacy profile of Lu-TLX591. Eighteen patients received Lu-TLX591 at two private oncology centres in Australia. Patients were eligible if they had CRPC or metastatic prostate cancer and prostate-specific membrane antigen (PSMA)-avid disease confirmed by PSMA-positron emission tomography (PET). Patients received two cycles of Lu-TLX591 monoclonal antibody (177 Lu-DOTA-rosopatamab) each dosed from 1.01-2.85 GBq, 14 days apart. Patient side effects, blood test results and radiology reports were recorded on the patient's electronic medical record (eMR). Prominent side effects included fatigue (55.6%), anorexia (16.7%), nausea (11.1%), and transfusion reactions (11.1%). All-grade haematological toxicities included lymphopenia (61.1%), anaemia (22.2%), leukopenia (27.8%), neutropenia (27.8%), and thrombocytopenia (27.8%). Grade 4 toxicity included lymphopenia (6.7%) and thrombocytopenia (6.7%). Patients' prostate-specific antigen (PSA) responses were as follows; ≥ 30% PSA decline (27.8%), ≥ 50% PSA decline (11.4%) and any PSA decline (38.9%). Follow-up radiology revealed 54.5% stable disease, 45.4% disease progression and 9.1% disease regression. Lu-TLX591 was safely administered at acceptable toxicity and its efficacy reflects previous clinical trials. Larger studies are required and are underway (NCT04786847; NCT05146973; NCT04876651) to determine Lu-TLX591 effectiveness amongst different prostate cancer populations and compare its efficacy against peptide-based radiopharmaceutical agents.

Estimating median overall survival of apalutamide compared to placebo in metastatic hormone-sensitive prostate cancer (mHSPC) populations: Statistical extrapolations of the TITAN study.

223 Background: Apalutamide plus ADT (APA) demonstrated significantly improved overall survival (OS) compared to placebo plus ADT (PBO) for patients with mHSPC in the TITAN study (HR, 0.65; 95% CI, 0.53 to 0.79; P < .0001). At the time of final analysis, the median OS was not reached in the APA arm or subgroups after a median follow up of 44 months. This work aimed to estimate OS medians for APA and PBO arms beyond the TITAN follow-up by fitting validated survival models. Methods: OS was predicted for the overall population treated with APA or PBO, with or without Inverse probability of censoring weighting (IPCW) crossover adjustment, and for the low and high-volume (LVD, HVD), HVD synchronous and HVD metachronous subgroups. General population mortality adjusted TITAN patient-level data was fitted to six parametric models (Weibull, exponential, log-normal, log-logistic, generalized gamma, and Gompertz) using the individual fits approach. Best fit was determined by statistical and visual fits, along with the Akaike Information Criterion (AIC)/Bayesian Information Criterion (BIC) ranking, according to the recommendations of the National Institute for Health and Care Excellence Decision Support Unit 14. Results: Best fit extrapolation estimated median OS of 71.8 months for the overall mHSPC population treated with APA (Table), leading to an estimated median improvement of up to 32 months versus PBO. Median OS values predicted by the other five models ranged from 62.4 to 78.1 months. Across subgroups, best fit models estimated median OS of 113.7 months for APA in LVD and a consistent median OS of 52 months for HVD subgroups. Conclusions: While results of this extrapolation study should not be equated to those of a clinical trial, this analysis meets an evidence gap by predicting median OS in the APA arm of the TITAN study for the overall mHSPC population as well as for various subgroups of this heterogeneous population, strengthening the evidence supporting early treatment with APA across the broad mHSPC population. [Table: see text]

Utility of prescription-based comorbidity indices for predicting mortality among Australian men with prostate cancer

BackgroundDrug prescription registries has become an alternative data source to hospital admission databases for measuring comorbidities. However, the predictive validity of prescription-based comorbidity measures varies based on the population under investigation and outcome of interest. We aimed to determine which prescription-based index of comorbidity has most utility in Australian men with prostate cancer. MethodsWe studied 25,414 South Australian men diagnosed with prostate cancer between 2003 and 2019 from state-wide administrative linked datasets. The Rx-Risk index, Chronic Disease Score (CDS), Drug Comorbidity Index (DCI) and Pharmaceutical Prescribing Profile (P3) with one year lookback period from prostate cancer diagnosis were evaluated. The predictive ability of each index to determine all-cause deaths within two and five years of prostate cancer diagnosis was compared using the c-statistic from flexible parametric survival models, adjusting for age, socioeconomic status and year of prostate cancer diagnosis. ResultsThe Rx-Risk index performed better in predicting two-year (c-statistic = 0.818) and five-year (c-statistic = 0.784) all-cause mortality than P3, CDS and DCI. Including comorbidity measures as continuous scores resulted in a better performance than including them as categories. Grouping scores into four categories (≤0, >0 - ≤1, >1 - ≤2, and >2) resulted in better performance and calibration than using fewer categories. ConclusionRx-Risk was validated in Australia and reflects Australian prescribing patterns. It showed better predictive performance for mortality in our study, with a modest improvement over P3, CDS and DCI. For research with prostate cancer populations, we recommend the use of drug-based comorbidity indices that have been validated in a similar population.

Association between platelet‑to‑lymphocyte ratio and serum prostate specific antigen

Association between platelet‑to‑lymphocyte ratio and serum prostate specific antigen

RWD161 Identifying and Characterizing Metastatic Hormone-Sensitive Prostate Cancer (mHSPC) Population in Finland

RWD161 Identifying and Characterizing Metastatic Hormone-Sensitive Prostate Cancer (mHSPC) Population in Finland

Phenotype plasticity and altered sensitivity to chemotherapeutic agents in aggressive prostate cancer cells.

In 2023, approximately 288,300 new diagnoses of prostate cancer will occur, with 34,700 disease-related deaths. Death from prostate cancer is associated with metastasis, enabled by progression of tumor phenotypes and successful extracapsular extension to reach Batson's venous plexus, a specific route to the spine and brain. Using a mouse-human tumor xenograft model, we isolated an aggressive muscle invasive cell population of prostate cancer, called DU145J7 with a distinct biophysical phenotype, elevated histone H3K27, and increased matrix metalloproteinase 14 expression as compared to the non-aggressive parent cell population called DU145WT. Our goal was to determine the sensitivities to known chemotherapeutic agents of the aggressive cells as compared to the parent population. High-throughput screening was performed with 5,578 compounds, comprising of approved and investigational drugs for oncology. Eleven compounds were selected for additional testing, which revealed that vorinostat, 5-azacitidine, and fimepinostat (epigenetic inhibitors) showed 2.6-to-7.5-fold increases in lethality for the aggressive prostate cancer cell population as compared to the parent, as judged by the concentration of drug to inhibit 50% cell growth (IC50). On the other hand, the DU145J7 cells were 2.2-to-4.0-fold resistant to mitoxantrone, daunorubicin, and gimatecan (topoisomerase inhibitors) as compared to DU145WT. No differences in sensitivities between cell populations were found for docetaxel or pirarubicin. The increased sensitivity of DU145J7 prostate cancer cells to chromatin modifying agents suggests a therapeutic vulnerability occurs after tumor cells invade into and through muscle. Future work will determine which epigenetic modifiers and what combinations will be most effective to eradicate early aggressive tumor populations.

Gastrointestinal Toxicity Following Proton and Photon Radiation for Prostate Cancer in Patients with Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD) has been considered a relative contraindication for radiation for prostate cancer (PC) due to concern for gastrointestinal (GI) toxicity. Modern radiation planning techniques such as intensity modulated radiation therapy (IMRT) have resulted in a significant decrease in GI toxicity in the general PC population. Several published case series have suggested overall excellent outcomes using IMRT in PC patients with IBD. Proton therapy (PT) with improved dosimetric sparing of bowel and rectum may offer additional benefit, but to our knowledge, there is no published data assessing outcomes after PT in PC patients with IBD. We report our institutional experience treating PC patients with IBD with both PT and IMRT. We identified patients with an IBD diagnosis treated for PC at our institution from 2012-2022 with either IMRT or PT. Baseline clinical characteristics were captured, along with radiation parameters, including dose, fractionation, inclusion of pelvic nodes, and use of a rectal spacer. IBD specifics captured included type of IBD, use of IBD medication, and pre radiation colonoscopy findings when available. Early and late GI toxicities were captured via retrospective chart review and graded per the Common Terminology Criteria for Adverse Events (CTCAE) version 5. Eighteen patients with IBD were treated with RT for PC at our institution, including 10 with ulcerative colitis, 7 with Crohn's disease, and 1 with IBD NOS. Nine of these patients were treated with PT and 9 with IMRT. Most were treated with conventional fractionation (n = 14) and the rest with moderate hypofractionation. Fourteen received primary RT to an intact prostate, and the rest received salvage RT. In four patients, the pelvic nodes were also treated. Rectal spacers were used for 8 patients. Nine of the patients were on IBD medications, and of the 15 patients with records of pre-RT colonoscopy, only 1 demonstrated inflammatory findings, which were noted in the ileum. Median follow-up was 3.5 years (1-6) Acute grade (Gr)1 GI toxicity was seen in 6(33%) patients with diarrhea and proctitis. No patients developed acute Gr 2 GI toxicity, and 1 patient developed acute Gr 3 diarrhea and proctitis. This patient had asymptomatic Crohn's disease prior to IMRT, not on medication, and was treated to the prostate and pelvic nodes. Late Gr 1 GI toxicity was seen in 4 (22%) patients. Median time to late GI toxicity was 9.5 months. No patients developed late Gr 2 or higher GI toxicity. Modern radiation techniques including IMRT and PT are well tolerated in PC patients with well-controlled IBD. Larger studies with longer follow up would be helpful to further characterize these patients' outcomes. In the meantime, IMRT and PT should be considered as treatment options in patients with well-controlled IBD.

2036P Prevalence and risk evaluation of cardiovascular disease among newly diagnosed prostate cancer population in China

2036P Prevalence and risk evaluation of cardiovascular disease among newly diagnosed prostate cancer population in China

New insights into molecular signaling pathways and current advancements in prostate cancer diagnostics & therapeutics.

Prostate adenocarcinoma accounts for more than 20% of deaths among males due to cancer. It is the fifth-leading cancer diagnosed in males across the globe. The mortality rate is quite high due to prostate cancer. Despite the fact that advancements in diagnostics and therapeutics have been made, there is a lack of effective drugs. Metabolic pathways are altered due to the triggering of androgen receptor (AR) signaling pathways, and elevated levels of dihydrotestosterone are produced due to defects in AR signaling that accelerate the growth of prostate cancer cells. Further, PI3K/AKT/mTOR pathways interact with AR signaling pathway and act as precursors to promote prostate cancer. Prostate cancer therapy has been classified into luminal A, luminal B, and basal subtypes. Therapeutic drugs inhibiting dihydrotestosterone and PI3K have shown to give promising results to combat prostate cancer. Many second-generation Androgen receptor signaling antagonists are given either as single agent or with the combination of other drugs. In order to develop a cure for metastasized prostate cancer cells, Androgen deprivation therapy (ADT) is applied by using surgical or chemical methods. In many cases, Prostatectomy or local radiotherapy are used to control metastasized prostate cancer. However, it has been observed that after 1.5 years to 2 years of Prostatectomy or castration, there is reoccurrence of prostate cancer and high incidence of castration resistant prostate cancer is seen in population undergone ADT. It has been observed that Androgen derivation therapy combined with drugs like abiraterone acetate or docetaxel improve overall survival rate in metastatic hormone sensitive prostate cancer (mHSPC) patients. Scientific investigations have revealed that drugs inhibiting poly ADP Ribose polymerase (PARP) are showing promising results in clinical trials in the prostate cancer population with mCRPC and DNA repair abnormalities. Recently, RISUG adv (reversible inhibition of sperm under guidance) has shown significant results against prostate cancer cell lines and MTT assay has validated substantial effects of this drug against PC3 cell lines. Current review paper highlights the advancements in prostate cancer therapeutics and new drug molecules against prostate cancer. It will provide detailed insights on the signaling pathways which need to be targeted to combat metastasized prostate cancer and castration resistant prostate cancer.

Abstract B017: Lineage-specific PRC2 targets and response to EZH2 inhibition in neuroendocrine prostate cancer

Abstract Lineage plasticity is an emerging mechanism of treatment-resistance in prostate cancer, which can manifest clinically as histologic transformation from prostate adenocarcinoma to small-cell neuroendocrine prostate cancer (NEPC). NEPC is associated with poor prognosis, and new treatment strategies are urgently needed. Epigenetic dysregulation has been implicated as a key driver of prostate cancer lineage plasticity, mediated in part by EZH2. EZH2 is a component of the polycomb repressive complex (PRC2) regulating the transcriptional repressive mark H3K27me3. EZH2 also controls cell-fate determination during normal development via bivalent promoters bearing both repressive H3K27me3 and active H3K4me3 marks. EZH2 is targetable, and several EZH2 inhibitors are in clinical development; these trials are currently in biomarker-unselected prostate cancer populations. A thorough understanding of the mechanism of action of EZH2 is imperative for predicting optimal response to EZH2i and for the development of robust combination treatment strategies. Cell viability studies across a diverse panel of prostate cancer models representing adenocarcinoma and NEPC indicated variable responses to tazemetostat (EZH2i) treatment. The castration-resistant prostate adenocarcinoma (CRPC) cell line LNCaP-abl showed a greater than 50% reduction in cell viability upon EZH2i (5uM) while LNCaP and 22Rv1 showed moderate response with 15-25% reduction in cell viability. However, none of our 5 NEPC patient-derived models showed significant response to EZH2i which was also validated in vivo. Hierarchical clustering of RNA-seq profiles of responder and non-responder models revealed distinct cell-type specific EZH2 targets and clusters of genes that may be associated with response to EZH2i. Approximately 15% of the EZH2 targets in the NEPC organoid WCM154 carried bivalency in their promoters including neuronal lineage determining genes such as ASCL1 and LHX2. Gene set enrichment analysis of EZH2 targets bearing bivalency in NEPC revealed association with neurogenesis and cell proliferation pathways. Further upregulation of neuronal-lineage PRC2 targets in NEPC models upon EZH2i may provide justification for lack of lineage reversal and maintenance of terminal differentiation. While there is evidence that EZH2i leads to lineage reversion in adeno-to-NEPC transitioning preclinical models, our data shows that EZH2i was associated with modest response in NEPC models and did not revert lineage plasticity. Our results provide insights into a potential role for bivalent promoters in EZH2-mediated lineage reprogramming and sustenance of terminal differentiation upon EZH2i in NEPC. Understanding lineage-specific action of EZH2i may inform biomarkers in ongoing clinical trials. Genes and pathways dysregulated because of their bivalency might also be exploited as potential candidates to be co-targeted with EZH2i. Citation Format: Varadha Balaji Venkadakrishnan, Richa Singh, Yasutaka Yamada, Kei Mizuno, Adam G. Presser, Sheng-Yu Ku, Henry Long, David Rickman, Himisha Beltran. Lineage-specific PRC2 targets and response to EZH2 inhibition in neuroendocrine prostate cancer [abstract]. In: Proceedings of the AACR Special Conference: Advances in Prostate Cancer Research; 2023 Mar 15-18; Denver, Colorado. Philadelphia (PA): AACR; Cancer Res 2023;83(11 Suppl):Abstract nr B017.

Impact of state health disparity on lung, breast, and prostate cancer incidence and mortality in the United States.

e18639 Background: Lung cancer is the second most common cancer and the leading cause of cancer deaths in both sex in the United States (US). Prostate cancer is the most common in men, while in women being breast cancer. America’s Health Rankings (AHR) is a comprehensive assessment of the nation's health on a state-by-state basis to determine state health rankings annually. We aimed to evaluate the association, which has not been investigated, between state-level health disparity as measured by AHR and lung, breast, and prostate cancer incidence and mortality in the US. Methods: We examined lung, breast and prostate cancer incidence and mortality data for 2015-2019 from the United States Cancer Statistics (USCS) database provided by the Centers for Disease Control and Prevention (CDC). Overall state health rankings were obtained from AHR and calculated by an equation using weighted measures in five different categories: 25% Behaviors, 22.5% Community & Environment, 12.5% Policy, 15% Clinical Care, and 25% Outcomes. We extracted 2015-2019 AHR data and further classified state health rankings into quartiles (1st [the healthiest] = rank 1 to 13; 4th [the least healthy] = rank 38 to 50). Associations of cancer incidence and mortality with overall state health rankings were analyzed by negative binomial regressions. Results: From 2015 to 2019, age-adjusted incidence rate per 100,000 population for lung, breast, and prostate cancer were 56.3, 128.0 and 109.8, respectively. Age-adjusted mortality rate per 100,000 population for lung, breast, and prostate cancer were 36.7, 19.9 and 18.9, respectively. Among 50 states we included for analysis, AHR indicated that Hawaii was the healthiest state (No.1) whereas Mississippi was the least healthy state (No. 50) for overall health rankings. States in the 4th quartile of health ranking were significantly associated with greater lung cancer incidence (Rate Ratio [RR]: 1.34 [95% CI, 1.18-1.52]) and mortality (1.50 [1.32-1.71]) than those in the 1st quartile. This was pronounced for age < 65 (Incidence [I]: 1.63 [1.36-1.96]; Mortality [M]: 1.93 [1.51-2.48]), Male (I: 1.48 [1.30-1.67]); M: 1.66 [1.47-1.87]), and Black (I: 1.43 [1.22-1.66]; M: 1.54 [1.32-1.79]). Black women living in states with worse health rankings had higher relative risks of breast cancer incidence (1.14 [1.03-1.26]) and mortality (1.27 [1.05-1.53]). There was no significant association between state health rankings and prostate cancer incidence and mortality in the US. Conclusions: There are significant differences in lung, breast, and prostate cancer incidence and mortality within the US. States with worse health rankings had higher cancer incidence and mortality, and varied by different demographics. Our findings suggests that advanced cancer screening and targeted public health interventions should be prioritized in areas with health disadvantages to improve cancer disparity.

Risk of early mortality in patients with cancer experiencing adverse financial events.

6503 Background: Patients with cancer are at higher risk for experiencing severe adverse financial events (AFEs) compared to similar individuals without cancer. Among persons with cancer, those experiencing bankruptcy have poorer survival. In this study, we sought to determine whether AFEs less severe than bankruptcy have an increased risk of death among patients with cancer. Methods: Records for all patients diagnosed with a solid tumor between 2013 and 2018 were identified through the Western Washington State SEER cancer registry and were linked to quarterly credit reports from TransUnion. Patients who survived at least 2 years from date of diagnosis were included. Cancer patients experiencing any AFE, defined as third-party collections, charge-offs, delinquent mortgage payments, tax liens, foreclosures, and repossessions within 2 years of diagnosis were compared with cancer cases who did not experience these events. After adjusting for age, sex, race, area deprivation index, rural/urban status, marital status, AFE at diagnosis, cancer type, and stage of cancer, we fit a Cox proportional hazards model to examine the relationship between AFEs and overall survival, and also fit a separate model for each cancer type. Results: A total of 64,637 patients were diagnosed with cancer between 2013 and 2018, and survived 2 years post-diagnosis. The overall population was 84% white, 53% female, and had a median age of 64. 12,698 patients experienced any severe financial event. The adjusted hazard ratio for mortality among patients who did versus did not experience an AFE was 1.22 (95% CI, 1.145-1.299, p <0.001), with age >65, Asian/Pacific Islander race, greater area deprivation index, and higher stage of cancer associated with increased risk for mortality. Among differing cancer types, patients with prostate cancer who experienced an AFE had the highest risk of death compared with patients with prostate cancer who did not experience an AFE (HR 1.703,95% CI, 1.395 to 2.08, p <0.001). Conclusions: Patients with cancer who experience severe AFEs within 2 years of diagnosis are at higher risk for mortality after adjusting for sociodemographic and clinical factors. When comparing within separate cancer groups, this association is strongest among patients with prostate cancer. Current analysis is limited by restricting population to those who survived at least 2 years after diagnosis; future work will expand population to include patients who died at any time point. Further research should investigate mechanisms for this increased mortality risk, to inform potential interventions and policy solutions, especially among the prostate cancer population. [Table: see text]

The Intersection of Prostate Cancer and Hypertension: a Call to Action.

With improvements in treatment and survival from prostate cancer, comorbid cardiac conditions will significantly impact overall morbidity and mortality from prostate cancer. Hypertension is a well-established cardiovascular risk factor that increases the risk of heart failure, myocardial infarction, and stroke. Therapies used in the treatment of prostate cancer, including GnRH agonists, GnRH antagonists, enzalutamide, abiraterone, and others, can directly or indirectly increase the risk of hypertension. In this paper, we review the evidence available on the incidence and mechanism of hypertension in prostate cancer patients. In addition, we provide recommendations on the assessment, treatment, and future directions for hypertension management in the prostate cancer population. We propose an individualized goal for blood pressure in prostate cancer patients, balancing the target goal of 130/80mmHg with common comorbidities of frailty, orthostatic symptoms, and imbalance in this population. The presence of additional comorbidities (myocardial infarction, heart failure, renal disease, diabetes) can assist in preference of anti-hypertensive drugs.

MP19-11 RACIAL AND ETHNIC DISPARITIES IN VALUATION OF LIFE EXPECTANCY IN PROSTATE CANCER TREATMENT DECISION MAKING

You have accessJournal of UrologyCME1 Apr 2023MP19-11 RACIAL AND ETHNIC DISPARITIES IN VALUATION OF LIFE EXPECTANCY IN PROSTATE CANCER TREATMENT DECISION MAKING John M. Masterson, Michael Luu, Rebecca Gale, Brennan Spiegel, Stephen J. Freedland, and Timothy J. Daskivich John M. MastersonJohn M. Masterson More articles by this author , Michael LuuMichael Luu More articles by this author , Rebecca GaleRebecca Gale More articles by this author , Brennan SpiegelBrennan Spiegel More articles by this author , Stephen J. FreedlandStephen J. Freedland More articles by this author , and Timothy J. DaskivichTimothy J. Daskivich More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003244.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Given the indolent nature of prostate cancer (PC), life expectancy (LE) is essential in triage between aggressive local therapy and conservative management for all tumor risk subtypes. Black men are more likely to be overtreated for low-risk PC. We sought to investigate racial or ethnic disparities in how Black and Hispanic men value LE in PC treatment decision making. METHODS: We used targeted crowdsourcing to query a group of men reflecting sociodemographics of a typical US PC population. Subjects completed a conjoint analysis exercise in which they iteratively chose between aggressive treatment vs conservative management across varying levels of 4 tradeoffs: tumor risk; risk of erectile dysfunction; risk of incontinence; and risk of irritative urinary symptoms. Subjects were asked to consider their LE when making decisions, which was calculated using the Prostate Cancer Comorbidity Index. Multinomial conditional logistic regression compared the odds of choosing aggressive vs conservative treatment across LEs ranging from 0 to 20 years by racial and ethnic subgroups. We calculated the interaction between LE and race/ethnicity in predicting treatment choice overall and across levels of tumor risk. RESULTS: Of 2,046 men, 435 (22%) were Black and 230 (11%) were Hispanic. Across all men, the odds of aggressive treatment choice increased by 17% for every 5 years of additional LE (OR 1.17, 95%CI 1.12-1.22), with men more likely to choose aggressive treatment at LE of >13 years and non-aggressive treatment at LE of £10 years. However, among Black men, LE was not associated with treatment choice (OR 0.97, 95%CI 0.90–1.05) (Figure 1A). Black men were more likely to choose aggressive treatment overall, regardless of LE or tumor risk. Among Hispanic men, LE was associated with treatment choice, akin to the non-Hispanic population (OR 1.14, 95%CI 1.02–1.27) (Figure 1B). While Hispanic men were more likely to choose aggressive treatment overall, their choices differed by both LE and tumor risk. Healthy literacy was equivalent by race/ ethnicity. CONCLUSIONS: Black men did not take LE into account when making treatment decisions, in stark contrast to other races and ethnicities. Culturally sensitive approaches to communication of competing risks of mortality may be needed to improve decision making in these men. Source of Funding: © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e269 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information John M. Masterson More articles by this author Michael Luu More articles by this author Rebecca Gale More articles by this author Brennan Spiegel More articles by this author Stephen J. Freedland More articles by this author Timothy J. Daskivich More articles by this author Expand All Advertisement PDF downloadLoading ...

MP38-01 PATIENT-LEVEL VALIDATION OF LIFE EXPECTANCY CUTOFFS FOR TRIAGE OF AGGRESSIVE TREATMENT BY TUMOR RISK USING TARGETED CROWDSOURCING

You have accessJournal of UrologyCME1 Apr 2023MP38-01 PATIENT-LEVEL VALIDATION OF LIFE EXPECTANCY CUTOFFS FOR TRIAGE OF AGGRESSIVE TREATMENT BY TUMOR RISK USING TARGETED CROWDSOURCING John M. Masterson, Michael Luu, Rebecca Gale, Brennan Spiegel, Stephen J. Freedland, and Timothy J. Daskivich John M. MastersonJohn M. Masterson More articles by this author , Michael LuuMichael Luu More articles by this author , Rebecca GaleRebecca Gale More articles by this author , Brennan SpiegelBrennan Spiegel More articles by this author , Stephen J. FreedlandStephen J. Freedland More articles by this author , and Timothy J. DaskivichTimothy J. Daskivich More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003276.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Life expectancy (LE) thresholds for triage of treatment vs conservative management (CM) in prostate cancer (PC) guidelines are based on expert opinion. However, patient opinion of when to defer treatment based on LE is lacking. We crowdsourced a conjoint analysis to define at which LE men are more likely to choose against treatment. METHODS: We used targeted crowdsourcing to query 2,046 men sociodemographically reflecting a US PC population based on SEER. We asked subjects to complete a conjoint analysis exercise in which they chose between treatment versus CM considering 4 tradeoffs: tumor risk, risk of erectile dysfunction, risk of urinary incontinence, risk of irritative urinary symptoms. Subjects were asked to consider LE throughout, which was calculated using the validated Prostate Cancer Comorbidity Index. Multinomial logistic regression defined the LE at which men were more likely to choose no treatment overall and in subgroups of tumor risk. RESULTS: We found an interaction between LE and treatment, indicating the odds of treatment vs CM choice is dependent on LE (p<0.001). The predicted probability of treatment decreased 15% with every 5 years of decreasing LE (OR 0.85, 95% CI .82-.89, p <0.001). Across all tumor risk levels, men were more likely to choose CM at a LE threshold <10 years (OR<1, p<0.05) (Figure 1). For low-, favorable intermediate-, unfavorable intermediate-, and high-risk cancers, men were more likely to choose CM at LE thresholds of <15, <10, <9, and <7 years, respectively. NCCN guidelines recommend CM overall at LE thresholds of £10 and <5–10 years for favorable and unfavorable intermediate-risk disease, and <5 years for high-risk disease (Figure 2). CONCLUSIONS: Patient preferences for LE cutoffs for when to consider CM align well with current guidelines recommendations, except for low-risk disease, for which patients are likely to consider conservative management even at LE <15 years, rather than <10. Guidelines should take patient preferences into account when recommending thresholds for CM. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e523 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information John M. Masterson More articles by this author Michael Luu More articles by this author Rebecca Gale More articles by this author Brennan Spiegel More articles by this author Stephen J. Freedland More articles by this author Timothy J. Daskivich More articles by this author Expand All Advertisement PDF downloadLoading ...

MP77-19 IS ANDROGEN DEPRIVATION THERAPY ASSOCIATED WITH CEREBRAL INFARCTION IN PATIENTS WITH PROSTATE CANCER? A KOREAN NATIONWIDE POPULATION-BASED PROPENSITY SCORE MATCHING STUDY

You have accessJournal of UrologyCME1 Apr 2023MP77-19 IS ANDROGEN DEPRIVATION THERAPY ASSOCIATED WITH CEREBRAL INFARCTION IN PATIENTS WITH PROSTATE CANCER? A KOREAN NATIONWIDE POPULATION-BASED PROPENSITY SCORE MATCHING STUDY Bum Sik Tae, Jung Wan Yoo, Hoon Choi, Jae Hyun Bae, and Jae Young Park Bum Sik TaeBum Sik Tae More articles by this author , Jung Wan YooJung Wan Yoo More articles by this author , Hoon ChoiHoon Choi More articles by this author , Jae Hyun BaeJae Hyun Bae More articles by this author , and Jae Young ParkJae Young Park More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003351.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Previous studies have suggested that androgen deprivation therapy (ADT) is associated with cerebral infarction. However, conflicting results have been reported by other researchers. The aim of the present study was to evaluate the association between ADT and cerebral infarction in patients with prostate cancer (PC) using big data. METHODS: Using information from the National Health Insurance Service database representative of the entire Korean adult PC population (n=206,735), data regarding ADT and cerebral infarction between 2009 and 2016 were analyzed. Adjusted hazard ratios for cerebral infarction associated with ADT were estimated using propensity score-matched Cox proportional hazards models and Kaplan-Meier survival analyses. RESULTS: The final cohort comprised 36,146 individuals with PC, including 24,069 men (66.6%) who underwent ADT. During the mean follow-up of 4.1 years, 2792 patients were newly diagnosed with cerebral infarction. In the unmatched cohort, there was a significant difference in the annual incidence of cerebral infarction between the ADT and non-ADT groups (22.8 versus [vs] 14.6 per 1000 person-years, respectively). However, there was no significant difference between the ADT and non-ADT groups in the matched cohort (14.9 vs 14.6 per 1000 person-years). The adjusted hazard ratio for cerebral infarction for PC patients who underwent ADT was 1.045 (95% CI 0.943–1.159; p=0.401) compared with those who did not undergo ADT. In addition, the cumulative duration of ADT was also not associated with an increased risk for cerebral infarction. However, older age, hypertension, diabetes, myocardial infarction, congestive heart failure, peripheral vascular disease, renal disease, dementia, and atrial fibrillation were revealed to be factors contributing to cerebral infarction. CONCLUSIONS: This nationwide population-based study revealed that ADT was not associated with cerebral infarction after adjusting for potential confounders. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1109 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bum Sik Tae More articles by this author Jung Wan Yoo More articles by this author Hoon Choi More articles by this author Jae Hyun Bae More articles by this author Jae Young Park More articles by this author Expand All Advertisement PDF downloadLoading ...

GI factors, potential to predict prostate motion during radiotherapy; a scoping review

PurposeA scoping literature review was conducted to identify gastrointestinal (GI) factors most likely to influence prostate motion during radiotherapy. We proffer that patient specific measurement of these GI factors could predict motion uncertainty during radiotherapy, facilitating personalised care by optimising treatment technique e.g., daily adaption or via bespoke patient pre-habilitation and preparation. MethodsThe scoping review was undertaken as per JBI guidelines. Searches were conducted across four databases: Ovid Medline®, EMBASE, CINAHL and EBSCO discovery. Articles written in English from 2010-present were included. Those pertaining to paediatrics, biological women exclusively, infectious and post-treatment GI morbidity and diet were excluded.Common GI factors impacting men were identified and related symptoms, incidence and measurement tools examined. Prevalence among persons with prostate cancer was explored and suitable assessment tools discussed. ResultsA preliminary search identified four prominent GI-factors: mental health, co-morbidity and medication, physical activity, and pelvic floor disorder. The scoping search found 3644 articles; 1646 were removed as duplicates. A further 1249 were excluded after title and abstract screening, 162 remained subsequent to full text review: 42 mental health, 53 co-morbidity and medication, 39 physical activity and 28 pelvic floor disorder.Six GI factors prevalent in the prostate cancer population and estimated most likely to influence prostate motion were identified: depression, anxiety, diabetes, obesity, low physical activity, and pelvic floor disorder. Reliable, quick, and easy to use tools are available to quantify these factors. ConclusionA comprehensive GI factor assessment package suitable to implement into the radiotherapy clinic has been created. Unveiling these GI factors upfront will guide improved personalisation of radiotherapy.