1701
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Ali A, Hoyle A, Baena E, Clarke NW. Identification and evaluation of clinically significant prostate cancer: a step towards personalized diagnosis. Curr Opin Urol 2017; 27:217-224. [PMID: 28212121 DOI: 10.1097/mou.0000000000000385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Prostate cancer (PCa) diagnostics are evolving rapidly. The quest to differentiate 'clinically significant' from 'clinically insignificant' disease has gathered momentum, leading to substantial change in traditional diagnostic approaches. Herein, we review the relevant information on currently available biomarkers and assess their ability to help physicians and patients in making a shared and personalized decision based on their individual risk of harbouring clinically significant disease. RECENT FINDINGS Serum, urine, tissue and imaging biomarkers have been evaluated to improve the identification of clinically significant disease, and this international effort has yielded promising, but not always consistent results. Changes in MRI technology have realized a quantum change, and this facility is now becoming more widely incorporated into diagnostic and disease risk-stratification protocols. However, standardization and further validation is required. SUMMARY Acceptance and widespread adoption of serum, urine and genetic markers is awaited, but novel and promising techniques alone and in combination have emerged. With validation and further focus, these may be adopted more widely.
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Affiliation(s)
- Adnan Ali
- aProstate Oncobiology bCancer Research UK Manchester Institute cBelfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, University of Manchester dDepartment of Surgery, The Christie NHS Foundation Trust, Manchester eDepartment of Urology, Salford NHS Foundation Trust, Salford, UK
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1702
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Williams SB, Huo J, Chamie K, Smaldone MC, Kosarek C, Fang J, Ynalvez LM, Kim S, Hoffman KE, Giordano SH, Chapin BF. Discerning the survival advantage among patients with prostate cancer who undergo radical prostatectomy or radiotherapy: The limitations of cancer registry data. Cancer 2017; 123:1617-1624. [PMID: 28099688 PMCID: PMC5897905 DOI: 10.1002/cncr.30506] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/08/2016] [Accepted: 11/21/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND The objective of this study was to compare the overall survival of patients who undergo radical prostatectomy or radiotherapy versus noncancer controls to discern whether there is a survival advantage according to prostate cancer treatment and the impact of selection bias on these results. METHODS A matched cohort study was performed using the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database. In total, 34,473 patients ages 66 to 75 years were identified who were without significant comorbidity, were diagnosed with localized prostate cancer, and received treatment treated with surgery or radiotherapy between 2004 and 2011. These patients were matched to a noncancer control cohort. The rates of all-cause mortality that occurred within the study period were compared. Cox proportional hazards regression analysis was used to identify determinants associated with overall survival. RESULTS Of 34,473 patients who were included in the analysis, 21,740 (63%) received radiation therapy, and 12,733 (37%) underwent surgery. There was improved survival in patients who underwent surgery (hazard ratio, 0.35; 95% confidence interval, 0.32-0.38) and in those who received radiotherapy (hazard ratio, 0.72; 95% confidence interval, 0.68-0.75) compared with noncancer controls. Overall survival improved significantly in both treatment groups, with the greatest benefit observed among patients who underwent surgery (log rank P < .001). CONCLUSIONS Population-based data indicated that patients with prostate cancer who received treatment with either surgery or radiotherapy had improved overall survival compared with a cohort of matched noncancer controls. Surgery produce longer survival compared with radiation therapy. These results suggest an inherent selection-bias because of unmeasured confounding variables. Cancer 2017;123:1617-1624. © 2017 American Cancer Society.
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Affiliation(s)
| | - Jinhai Huo
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Karim Chamie
- Department of Urology, University of California Los Angeles, Los Angeles, CA
| | - Marc C. Smaldone
- Department of Urology, Fax Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | | | - Justin Fang
- Division of Urology, The University of Texas Medical Branch, Galveston, TX
| | - Leslie M. Ynalvez
- Division of Urology, The University of Texas Medical Branch, Galveston, TX
| | - Simon Kim
- Department of Urology, Case Western Reserve University, Cleveland, OH
| | - Karen E. Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sharon H. Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX,Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brian F. Chapin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
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1703
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Overactive bladder syndrome and lower urinary tract symptoms after prostate cancer treatment. Curr Opin Urol 2017; 27:307-313. [DOI: 10.1097/mou.0000000000000391] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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1704
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In Regard to Shaverdian et al. Int J Radiat Oncol Biol Phys 2017; 98:216-217. [DOI: 10.1016/j.ijrobp.2017.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 02/08/2017] [Indexed: 11/23/2022]
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1705
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Azria D, Lapierre A, Gourgou S, De Ruysscher D, Colinge J, Lambin P, Brengues M, Ward T, Bentzen SM, Thierens H, Rancati T, Talbot CJ, Vega A, Kerns SL, Andreassen CN, Chang-Claude J, West CML, Gill CM, Rosenstein BS. Data-Based Radiation Oncology: Design of Clinical Trials in the Toxicity Biomarkers Era. Front Oncol 2017; 7:83. [PMID: 28497027 PMCID: PMC5406456 DOI: 10.3389/fonc.2017.00083] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/13/2017] [Indexed: 12/15/2022] Open
Abstract
The ability to stratify patients using a set of biomarkers, which predict that toxicity risk would allow for radiotherapy (RT) modulation and serve as a valuable tool for precision medicine and personalized RT. For patients presenting with tumors with a low risk of recurrence, modifying RT schedules to avoid toxicity would be clinically advantageous. Indeed, for the patient at low risk of developing radiation-associated toxicity, use of a hypofractionated protocol could be proposed leading to treatment time reduction and a cost-utility advantage. Conversely, for patients predicted to be at high risk for toxicity, either a more conformal form or a new technique of RT, or a multidisciplinary approach employing surgery could be included in the trial design to avoid or mitigate RT when the potential toxicity risk may be higher than the risk of disease recurrence. In addition, for patients at high risk of recurrence and low risk of toxicity, dose escalation, such as a greater boost dose, or irradiation field extensions could be considered to improve local control without severe toxicities, providing enhanced clinical benefit. In cases of high risk of toxicity, tumor control should be prioritized. In this review, toxicity biomarkers with sufficient evidence for clinical testing are presented. In addition, clinical trial designs and predictive models are described for different clinical situations.
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Affiliation(s)
- David Azria
- Department of Radiation Oncology, Radiobiology Unit, Biometric and Bio-informatic Divisions, Montpellier Cancer Institute (ICM), IRCM, INSERM U1194, Montpellier, France
| | - Ariane Lapierre
- Department of Radiation Oncology, Radiobiology Unit, Biometric and Bio-informatic Divisions, Montpellier Cancer Institute (ICM), IRCM, INSERM U1194, Montpellier, France
| | - Sophie Gourgou
- Department of Radiation Oncology, Radiobiology Unit, Biometric and Bio-informatic Divisions, Montpellier Cancer Institute (ICM), IRCM, INSERM U1194, Montpellier, France
| | - Dirk De Ruysscher
- Department of Radiation Oncology, Maastricht University Medical Centre, MAASTRO Clinic, Maastricht, Netherlands
- Radiation Oncology, KU Leuven, Leuven, Belgium
| | - Jacques Colinge
- Department of Radiation Oncology, Radiobiology Unit, Biometric and Bio-informatic Divisions, Montpellier Cancer Institute (ICM), IRCM, INSERM U1194, Montpellier, France
| | - Philippe Lambin
- Department of Radiation Oncology, Maastricht University Medical Centre, MAASTRO Clinic, Maastricht, Netherlands
| | - Muriel Brengues
- Department of Radiation Oncology, Radiobiology Unit, Biometric and Bio-informatic Divisions, Montpellier Cancer Institute (ICM), IRCM, INSERM U1194, Montpellier, France
| | - Tim Ward
- Patient Advocate, Manchester, UK
| | - Søren M. Bentzen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hubert Thierens
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
| | - Tiziana Rancati
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Ana Vega
- Fundacion Publica Galega de Medicina Xenomica-SERGAS, Grupo de Medicina Xenomica-USC, IDIS, CIBERER, Santiago de Compostela, Spain
| | - Sarah L. Kerns
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Catharine M. L. West
- Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Christie Hospital NHS Trust, Manchester, UK
| | - Corey M. Gill
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Barry S. Rosenstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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1706
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Tian W, Dorn D, Wei S, Sanders RD, Matoso A, Shah RB, Gordetsky J. GATA3 expression in benign prostate glands with radiation atypia: a diagnostic pitfall. Histopathology 2017; 71:150-155. [DOI: 10.1111/his.13214] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/09/2017] [Accepted: 03/14/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Wei Tian
- Department of Pathology; Miraca Life Sciences; Irving TX USA
| | - David Dorn
- Department of Pathology; University of Alabama at Birmingham; Birmingham AL USA
| | - Shi Wei
- Department of Pathology; University of Alabama at Birmingham; Birmingham AL USA
| | - Ronald D Sanders
- Department of Pathology; University of Alabama at Birmingham; Birmingham AL USA
| | - Andres Matoso
- Department of Pathology; Johns Hopkins Hospital; Baltimore MD USA
| | - Rajal B Shah
- Department of Pathology; Miraca Life Sciences; Irving TX USA
| | - Jennifer Gordetsky
- Department of Pathology; University of Alabama at Birmingham; Birmingham AL USA
- Department of Urology; University of Alabama at Birmingham; Birmingham AL USA
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1707
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Tay KJ, Gupta RT, Holtz J, Silverman RK, Tsivian E, Schulman A, Moul JW, Polascik TJ. Does mpMRI improve clinical criteria in selecting men with prostate cancer for active surveillance? Prostate Cancer Prostatic Dis 2017; 20:323-327. [DOI: 10.1038/pcan.2017.20] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/31/2017] [Accepted: 02/25/2017] [Indexed: 12/30/2022]
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1708
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Abstract
The first results of the UK ProtecT study have been published. A total of 1643 men with localised prostate cancer were randomised between active monitoring, radical prostatectomy, and external-beam radiotherapy. Comparisons between treatments showed no differences between surgery and radiotherapy in terms of cancer-specific survival and overall survival. Moreover, the patient-reported outcomes indicate that although the patterns of treatment-related side effects differ markedly according to the modality, neither surgery nor radiotherapy appears to be "kinder" overall. Conclusions from nonrandomised case series can be misleading, however carefully they are analysed, and this is particularly so for early prostate cancer.
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1709
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Drost FJH, Roobol MJ. The need for active surveillance for low risk prostate cancer. Expert Rev Anticancer Ther 2017; 17:487-489. [DOI: 10.1080/14737140.2017.1319767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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1710
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Parnes HL. Commentary: Prostate cancer screening-A long run for a short slide. Semin Oncol 2017; 44:57-59. [PMID: 28395764 DOI: 10.1053/j.seminoncol.2017.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Howard L Parnes
- Prostate and Urologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute Bethesda, MD.
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1711
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Wijnenga MMJ, Mattni T, French PJ, Rutten GJ, Leenstra S, Kloet F, Taphoorn MJB, van den Bent MJ, Dirven CMF, van Veelen ML, Vincent AJPE. Does early resection of presumed low-grade glioma improve survival? A clinical perspective. J Neurooncol 2017; 133:137-146. [PMID: 28401374 PMCID: PMC5495869 DOI: 10.1007/s11060-017-2418-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/08/2017] [Indexed: 12/31/2022]
Abstract
Early resection is standard of care for presumed low-grade gliomas. This is based on studies including only tumors that were post-surgically confirmed as low-grade glioma. Unfortunately this does not represent the clinicians’ situation wherein he/she has to deal with a lesion on MRI that is suspect for low-grade glioma (i.e. without prior knowledge on the histological diagnosis). We therefore aimed to determine the optimal initial strategy for patients with a lesion suspect for low-grade glioma, but not histologically proven yet. We retrospectively identified 150 patients with a resectable presumed low-grade-glioma and who were otherwise in good clinical condition. In this cohort we compared overall survival between three types of initital treatment strategy: a wait-and-scan approach (n = 38), early resection (n = 83), or biopsy for histopathological verification (n = 29). In multivariate analysis, no difference was observed in overall survival for early resection compared to wait-and-scan: hazard ratio of 0.92 (95% CI 0.43–2.01; p = 0.85). However, biopsy strategy showed a shorter overall survival compared to wait-and-scan: hazard ratio of 2.69 (95% CI 1.19–6.06; p = 0.02). In this cohort we failed to confirm superiority of early resection over a wait-and-scan approach in terms of overall survival, though longer follow-up is required for final conclusion. Biopsy was associated with shorter overall survival.
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Affiliation(s)
- Maarten M J Wijnenga
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.
| | - Tariq Mattni
- Department of Neurosurgery, Erasmus MC Cancer Institute, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands
| | - Pim J French
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands
| | - Geert-Jan Rutten
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Sieger Leenstra
- Department of Neurosurgery, Erasmus MC Cancer Institute, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.,Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Fred Kloet
- Department of Neurosurgery, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Martin J van den Bent
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands
| | - Clemens M F Dirven
- Department of Neurosurgery, Erasmus MC Cancer Institute, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands
| | - Marie-Lise van Veelen
- Department of Neurosurgery, Erasmus MC Cancer Institute, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands
| | - Arnaud J P E Vincent
- Department of Neurosurgery, Erasmus MC Cancer Institute, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.
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1712
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March B, Koufogiannis G, Louie-Johnsun M. Management and outcomes of Gleason six prostate cancer detected on needle biopsy: A single-surgeon experience over 6 years. Prostate Int 2017; 5:139-142. [PMID: 29188200 PMCID: PMC5693458 DOI: 10.1016/j.prnil.2017.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/25/2017] [Accepted: 03/30/2017] [Indexed: 10/25/2022] Open
Abstract
Objective To assess the management and oncological outcomes in men diagnosed with Gleason score (GS) 6 prostate cancer on needle biopsy in a regional centre, as compared with published international data. Materials and methods A retrospective analysis was conducted of patients who were diagnosed with GS 6 prostate cancer via transrectal ultrasound-guided or transperineal biopsy between June 2009 and September 2015 under the care of a single surgeon. Data were obtained from a prospectively collected database. Results A total of 166 patients were diagnosed with GS 6 prostate cancer. The mean age was 61 (range 46-79) years, with mean prostate-specific antigen of 6.7 (0.91-26.8) ng/mL at diagnosis. Of 166 patients, 117 (70.5%) patients were enrolled into the active surveillance program with 82 (70%) meeting Prostate Cancer Research International Active Surveillance (PRIAS) criteria, 44 patients underwent immediate definitive treatment (88.6% radical prostatectomy and 9.1% radiotherapy) and five watchful waiting. With a median follow-up of 1.8 years, 37 (31.6%) patients on AS had definitive treatment [30 cases (81%) were attributable to disease progression, 4 cases (10.8%) to an abnormal magnetic resonance imaging result and 3 cases (8.1%) for patient preference]. In the 35 patients who underwent radical prostatectomy immediately after diagnosis, the GS was ≥7 in 29 cases (82.9%), and the final pathology was pT3a in 16 (51.6%) and pT3b in one (2.9%). In patients who underwent radical prostatectomy after being on AS, the proportion of GS ≥7 prostate cancer was 29/32 (90.6%), with pT3a in six (18.8%) and pT3b in three (9.4%) cases. Overall, 23.5% of patients had a multiparametric magnetic resonance imaging scan. Conclusion This single-surgeon cohort of GS 6 prostate cancer patients demonstrates a high proportion of cases managed with active surveillance, with comparable rates to international literature. The majority of cases who underwent immediate definitive treatment had significant disease, indicating that patients are being appropriately selected for active surveillance.
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Affiliation(s)
| | | | - Mark Louie-Johnsun
- Gosford Hospital, Gosford, NSW, Australia.,University of Newcastle, Callaghan, NSW, Australia
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1713
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Extracellular vesicles for liquid biopsy in prostate cancer: where are we and where are we headed? Prostate Cancer Prostatic Dis 2017; 20:251-258. [PMID: 28374743 PMCID: PMC5569339 DOI: 10.1038/pcan.2017.7] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 12/23/2022]
Abstract
Background: Extracellular vesicles (EVs) are a heterogeneous class of lipid bound particles shed by any cell in the body in physiological and pathological conditions. EVs play critical functions in intercellular communication. EVs can actively travel in intercellular matrices and eventually reach the circulation. They can also be released directly in biological fluids where they appear to be stable. Because the molecular content of EVs reflects the composition of the cell of origin, they have recently emerged as a promising source of biomarkers in a number of diseases. EV analysis is particularly attractive in cancer patients that frequently present with increased numbers of circulating EVs. Methods: We sought to review the current literature on the molecular profile of prostate cancer-derived EVs in model systems and patient biological fluids in an attempt to draw some practical and universal conclusions on the use of EVs as a tool for liquid biopsy in clinical specimens. Results: We discuss advantages and limitations of EV-based liquid biopsy approaches summarizing salient studies on protein, DNA and RNA. Several candidate biomarkers have been identified so far but these results are difficult to apply to the clinic. However, the field is rapidly moving toward the implementation of novel tools to isolate cancer-specific EVs that are free of benign EVs and extra-vesicular contaminants. This can be achieved by identifying markers that are exquisitely present in tumor cell-derived EVs. An important contribution might also derive from a better understanding of EV types that may play specific functions in tumor progression and that may be a source of cancer-specific markers. Conclusions: EV analysis holds strong promises for the development of non-invasive biomarkers in patients with prostate cancer. Implementation of modern methods for EV isolation and characterization will enable to interrogate circulating EVs in vivo.
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1714
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Ciezki JP, Weller M, Reddy CA, Kittel J, Singh H, Tendulkar R, Stephans KL, Ulchaker J, Angermeier K, Stephenson A, Campbell S, Haber GP, Klein EA. A Comparison Between Low-Dose-Rate Brachytherapy With or Without Androgen Deprivation, External Beam Radiation Therapy With or Without Androgen Deprivation, and Radical Prostatectomy With or Without Adjuvant or Salvage Radiation Therapy for High-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2017; 97:962-975. [DOI: 10.1016/j.ijrobp.2016.12.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/25/2016] [Accepted: 12/07/2016] [Indexed: 11/26/2022]
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1715
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Reply by Authors. J Urol 2017; 197:1066-1067. [DOI: 10.1016/j.juro.2016.11.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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1716
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Pinsky PF, Prorok PC, Kramer BS. Prostate Cancer Screening - A Perspective on the Current State of the Evidence. N Engl J Med 2017; 376:1285-1289. [PMID: 28355509 DOI: 10.1056/nejmsb1616281] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Paul F Pinsky
- From the Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Philip C Prorok
- From the Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Barnett S Kramer
- From the Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD
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1717
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Nead KT, Sinha S, Nguyen PL. Androgen deprivation therapy for prostate cancer and dementia risk: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2017; 20:259-264. [PMID: 28349979 DOI: 10.1038/pcan.2017.10] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/10/2017] [Accepted: 02/13/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) to treat prostate cancer may be associated with an increased risk of dementia, but existing studies have shown conflicting results. Here we synthesize the literature on the association of ADT for the treatment of prostate cancer with dementia risk. METHODS We conducted a systematic review of articles reporting the outcome of dementia among individuals with prostate cancer in those exposed to ADT versus a lesser-exposed comparison group (for example, ADT versus no-ADT; continuous versus intermittent ADT) using PubMed (1966-present), Web of Science (1945-present), Embase (1966-present) and PsycINFO (1806-present). The search was undertaken on 4 December 2016 by two authors. We meta-analyzed studies reporting an effect estimate and controlling for confounding. Random- or fixed-effects meta-analytic models were used in the presence or absence of heterogeneity per the I2 statistic, respectively. Small study effects were evaluated using Egger and Begg's tests. RESULTS Nine studies were included in the systematic review. Seven studies reported an adjusted effect estimate for dementia risk. A random-effects meta-analysis of studies reporting any dementia outcome, which included 50 541 individuals, showed an increased risk of dementia among ADT users (hazard ratio (HR), 1.47; 95% confidence interval (CI), 1.08-2.00; P=0.02). We separately meta-analyzed studies reporting all-cause dementia (HR, 1.46; 95% CI, 1.05-2.02; P<0.001) and Alzheimer's disease (HR, 1.25; 95% CI, 0.99-1.57; P=0.06). There was no evidence of bias from small study effects (Egger, P=0.19; Begg, P=1.00). CONCLUSION The currently available combined evidence suggests that ADT in the treatment of prostate cancer may be associated with an increased dementia risk. The potential for neurocognitive deficits secondary to ADT should be discussed with patients and evaluated prospectively.
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Affiliation(s)
- K T Nead
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - S Sinha
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - P L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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1718
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Malla B, Zaugg K, Vassella E, Aebersold DM, Dal Pra A. Exosomes and Exosomal MicroRNAs in Prostate Cancer Radiation Therapy. Int J Radiat Oncol Biol Phys 2017; 98:982-995. [PMID: 28721912 DOI: 10.1016/j.ijrobp.2017.03.031] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/14/2017] [Accepted: 03/20/2017] [Indexed: 12/11/2022]
Abstract
Despite current risk stratification systems using traditional clinicopathologic factors, many localized and locally advanced prostate cancers fail radical treatment (ie, radical prostatectomy, radiation therapy with or without androgen deprivation therapy). Therefore, a pressing need exists for enhanced methods of disease stratification through novel prognostic and predictive tools that can reliably be applied in clinical practice. Exosomes are 50- to 150-nm small vesicles released by cancer cells that reflect the genetic and nongenetic materials of parent cancer cells. Cancer cells can contain distinct sets of microRNA profiles, the expression of which can change owing to stress such as radiation therapy. These alterations or distinctions in contents allow exosomes to be used as prognostic and/or predictive biomarkers and to monitor the treatment response. Additionally, microRNAs have been shown to influence multiple processes in prostate tumorigenesis, including cell proliferation, induction of apoptosis, migration, oncogene inhibition, and radioresistance. Thus, comparative exosomal microRNA profiling at different levels could help portray tumor aggressiveness and response to radiation therapy. Although technical challenges persist in exosome isolation and characterization, recent improvements in microRNA profiling have evolved toward in-depth analyses of the exosomal cargo and its functions. We have reviewed the role of exosomes and exosomal microRNAs in biologic processes of prostate cancer progression and radiation therapy response, with a particular focus on the development of clinical assays for treatment personalization.
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Affiliation(s)
- Bijaya Malla
- Department of Radiation Oncology, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Kathrin Zaugg
- Department of Radiation Oncology, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Erik Vassella
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Alan Dal Pra
- Department of Radiation Oncology, Bern University Hospital, Inselspital, Bern, Switzerland.
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1719
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Lokman U, Erickson AM, Vasarainen H, Rannikko AS, Mirtti T. PTEN Loss but Not ERG Expression in Diagnostic Biopsies Is Associated with Increased Risk of Progression and Adverse Surgical Findings in Men with Prostate Cancer on Active Surveillance. Eur Urol Focus 2017; 4:867-873. [PMID: 28753869 DOI: 10.1016/j.euf.2017.03.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 02/15/2017] [Accepted: 03/07/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Active surveillance (AS) is an option for men with low-risk prostate cancer (PCa). PTEN and ERG have been considered as potential biomarkers of PCa progression and survival. OBJECTIVE To study the role of ERG and PTEN status in the Prostate Cancer Research International: Active Surveillance (PRIAS) trial diagnostic biopsies (DBxs) in predicting surveillance discontinuation and adverse surgical findings in subsequent radical prostatectomy (RP). DESIGN, SETTING, AND PARTICIPANTS A total of 231 patients were recruited to the PRIAS between 2007 and 2013 in Helsinki. DBx tissue for immunohistochemistry (IHC) was available from 190 patients. Tissue microarrays (TMAs) were constructed from 57 specimens of subsequent RPs. DBxs containing grade group (GG) 1 PCa and RP TMA sections were stained with ERG and PTEN antibodies, and scored as either negative or positive. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES Outcomes were followed up by biopsy GG upgrade (GG ≥ 2) and protocol-based treatment change, as well as adverse findings in RP (GG ≥ 3 or pathological stage≥3). Clinical variables and biomarker status in DBx were correlated in Cox regression analysis and cumulative survival in Kaplan-Meier analysis, and finally, Gray's competing risk analysis was performed and nonprotocol-based discontinuation was considered as a competing event. RESULTS AND LIMITATIONS In both uni- and multivariate Cox regression analyses, only the number of positive cores in the DBx, the number of rebiopsy sessions, and PTEN status at diagnosis were significantly associated with rebiopsy GG upgrade, treatment change, and adverse histopathology in RP. In Kaplan-Meier analysis, PTEN loss was associated with a shorter time to GG upgrade and treatment change. Patients with PTEN loss had a higher probability for protocol-based discontinuation but not for competing risk factors compared with patients with intact PTEN. Biopsy ERG status was concordant with RP TMA ERG status, while PTEN was not. Limitations include a retrospective analysis of prospective cohort data. CONCLUSIONS PTEN status at diagnosis is a potential biomarker for identifying patients with PCa on AS with a high risk for progression or adverse findings on subsequent RP. PATIENT SUMMARY A simple diagnostic biopsy-based analysis of PTEN status may help identify patients with high risk for prostate cancer progression.
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Affiliation(s)
- Utku Lokman
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Andrew M Erickson
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Hanna Vasarainen
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Antti S Rannikko
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Tuomas Mirtti
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland; Department of Pathology (HUSLAB) and Medicum, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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1720
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Barocas DA, Alvarez J, Resnick MJ, Koyama T, Hoffman KE, Tyson MD, Conwill R, McCollum D, Cooperberg MR, Goodman M, Greenfield S, Hamilton AS, Hashibe M, Kaplan SH, Paddock LE, Stroup AM, Wu XC, Penson DF. Association Between Radiation Therapy, Surgery, or Observation for Localized Prostate Cancer and Patient-Reported Outcomes After 3 Years. JAMA 2017; 317:1126-1140. [PMID: 28324093 PMCID: PMC5782813 DOI: 10.1001/jama.2017.1704] [Citation(s) in RCA: 228] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance Understanding the adverse effects of contemporary approaches to localized prostate cancer treatment could inform shared decision making. Objective To compare functional outcomes and adverse effects associated with radical prostatectomy, external beam radiation therapy (EBRT), and active surveillance. Design, Setting, and Participants Prospective, population-based, cohort study involving 2550 men (≤80 years) diagnosed in 2011-2012 with clinical stage cT1-2, localized prostate cancer, with prostate-specific antigen levels less than 50 ng/mL, and enrolled within 6 months of diagnosis. Exposures Treatment with radical prostatectomy, EBRT, or active surveillance was ascertained within 1 year of diagnosis. Main Outcomes and Measures Patient-reported function on the 26-item Expanded Prostate Cancer Index Composite (EPIC) 36 months after enrollment. Higher domain scores (range, 0-100) indicate better function. Minimum clinically important difference was defined as 10 to 12 points for sexual function, 6 for urinary incontinence, 5 for urinary irritative symptoms, 5 for bowel function, and 4 for hormonal function. Results The cohort included 2550 men (mean age, 63.8 years; 74% white, 55% had intermediate- or high-risk disease), of whom 1523 (59.7%) underwent radical prostatectomy, 598 (23.5%) EBRT, and 429 (16.8%) active surveillance. Men in the EBRT group were older (mean age, 68.1 years vs 61.5 years, P < .001) and had worse baseline sexual function (mean score, 52.3 vs 65.2, P < .001) than men in the radical prostatectomy group. At 3 years, the adjusted mean sexual domain score for radical prostatectomy decreased more than for EBRT (mean difference, -11.9 points; 95% CI, -15.1 to -8.7). The decline in sexual domain scores between EBRT and active surveillance was not clinically significant (-4.3 points; 95% CI, -9.2 to 0.7). Radical prostatectomy was associated with worse urinary incontinence than EBRT (-18.0 points; 95% CI, -20.5 to -15.4) and active surveillance (-12.7 points; 95% CI, -16.0 to -9.3) but was associated with better urinary irritative symptoms than active surveillance (5.2 points; 95% CI, 3.2 to 7.2). No clinically significant differences for bowel or hormone function were noted beyond 12 months. No differences in health-related quality of life or disease-specific survival (3 deaths) were noted (99.7%-100%). Conclusions and Relevance In this cohort of men with localized prostate cancer, radical prostatectomy was associated with a greater decrease in sexual function and urinary incontinence than either EBRT or active surveillance after 3 years and was associated with fewer urinary irritative symptoms than active surveillance; however, no meaningful differences existed in either bowel or hormonal function beyond 12 months or in in other domains of health-related quality-of-life measures. These findings may facilitate counseling regarding the comparative harms of contemporary treatments for prostate cancer.
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Affiliation(s)
- Daniel A. Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - JoAnn Alvarez
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew J. Resnick
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Karen E. Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark D. Tyson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ralph Conwill
- Prostate Cancer Patient Advocate, Vanderbilt Ingram Cancer Center, Nashville, Tennessee
| | - Dan McCollum
- Prostate Cancer Patient Advocate, Vanderbilt Ingram Cancer Center, Nashville, Tennessee
| | - Matthew R. Cooperberg
- Department of Urology, University of California, San Francisco Medical Center, San Francisco, California
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Emory University, Atlanta, Georgia
| | - Sheldon Greenfield
- Center for Health Policy Research and Department of Medicine, University of California, Irvine, Irvine, California
| | - Ann S. Hamilton
- Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mia Hashibe
- Department of Family and Preventative Medicine, University of Utah, Salt Lake City, Utah
| | - Sherrie H. Kaplan
- Health Policy Research Institute, University of California, Irvine, Irvine, California
| | - Lisa E. Paddock
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Antoinette M. Stroup
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Xiao-Cheng Wu
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - David F. Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Tennessee Valley Veterans Administration Health System, Nashville, TN
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1721
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[Prevalence and diversity of management of prostate cancer patients classified as low risk using D'Amico group or Cancer of the Prostate Risk Assessment (CAPRA) score: A French multicenter study]. Prog Urol 2017; 27:158-165. [PMID: 28258910 DOI: 10.1016/j.purol.2017.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 12/19/2016] [Accepted: 01/24/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Currently, the French High Authority for Health does not recommend mass screening for prostate cancer (PCa), due to the risk of over-treatment, notably of low risk patients. Our study is intended to reflect the therapeutic attitudes for the management of patients classified as low risk of progression in French clinical centers. METHODS For all positive prostate biopsies performed during 2012 and 2013 in five French departments of urology, clinicopathological characteristics required to calculate the d'Amico risk group and the Cancer of the Prostate Risk Assessment (CAPRA) score were filled. Information on the first treatment of "low risk" patients was collected. RESULTS A total of 1035 patients were included, with a median age at diagnosis of 66 years old. According to d'Amico and CAPRA classifications, 30.4% and 35.0% of patients were at low, 34.5% and 33.2% at intermediate, 35.1% and 31.8% at high risk. The diagnosis severity increased with age (P<0.0001). The main treatment for low risk patients was radical prostatectomy (41.6% and 42.0% for d'Amico and CAPRA, respectively), but active surveillance was the most frequent treatment if diagnosed after 75 years old. The management of low risk patients varied significantly between centers (P<0.0001), according to the therapeutic platforms available within the hospital. CONCLUSIONS In absence of strong progression predictor, the management of low risk PCa remains based on center habits and local therapeutic platforms. New predictive markers, such as multiparametric MRI or molecular tests, are needed to guide rational management of low risk PCa. LEVEL OF EVIDENCE 4.
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1722
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Glazer DI, Hassanzadeh E, Fedorov A, Olubiyi OI, Goldberger SS, Penzkofer T, Flood TA, Masry P, Mulkern RV, Hirsch MS, Tempany CM, Fennessy FM. Diffusion-weighted endorectal MR imaging at 3T for prostate cancer: correlation with tumor cell density and percentage Gleason pattern on whole mount pathology. Abdom Radiol (NY) 2017; 42:918-925. [PMID: 27770164 DOI: 10.1007/s00261-016-0942-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine if tumor cell density and percentage of Gleason pattern within an outlined volumetric tumor region of interest (TROI) on whole-mount pathology (WMP) correlate with apparent diffusion coefficient (ADC) values on corresponding TROIs outlined on pre-operative MRI. METHODS Men with biopsy-proven prostate adenocarcinoma undergoing multiparametric MRI (mpMRI) prior to prostatectomy were consented to this prospective study. WMP and mpMRI images were viewed using 3D Slicer and each TROI from WMP was contoured on the high b-value ADC maps (b0, 1400). For each TROI outlined on WMP, TCD (tumor cell density) and the percentage of Gleason pattern 3, 4, and 5 were recorded. The ADCmean, ADC10th percentile, ADC90th percentile, and ADCratio were also calculated in each case from the ADC maps using 3D Slicer. RESULTS Nineteen patients with 21 tumors were included in this study. ADCmean values for TROIs were 944.8 ± 327.4 vs. 1329.9 ± 201.6 mm2/s for adjacent non-neoplastic prostate tissue (p < 0.001). ADCmean, ADC10th percentile, and ADCratio values for higher grade tumors were lower than those of lower grade tumors (mean 809.71 and 1176.34 mm2/s, p = 0.014; 10th percentile 613.83 and 1018.14 mm2/s, p = 0.009; ratio 0.60 and 0.94, p = 0.005). TCD and ADCmean (ρ = -0.61, p = 0.005) and TCD and ADC10th percentile (ρ = -0.56, p = 0.01) were negatively correlated. No correlation was observed between percentage of Gleason pattern and ADC values. CONCLUSION DWI MRI can characterize focal prostate cancer using ADCratio, ADC10th percentile, and ADCmean, which correlate with pathological tumor cell density.
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1723
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D'Amico AV. Active Surveillance Versus Treatment of Prostate Cancer: Should Metastasis Be the Primary End Point? J Clin Oncol 2017; 35:1638-1640. [PMID: 28240975 DOI: 10.1200/jco.2016.70.9527] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anthony V D'Amico
- Anthony V. D'Amico, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA
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1724
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Thompson JE, Stricker PD. Diagnostic accuracy of multi-parametric MRI and transrectal ultrasound-guided biopsy in prostate cancer. Lancet 2017; 389:767-768. [PMID: 28126331 DOI: 10.1016/s0140-6736(17)30121-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/16/2016] [Indexed: 01/01/2023]
Affiliation(s)
- James E Thompson
- St Vincents Prostate Cancer Centre, Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.
| | - Phillip D Stricker
- St Vincents Prostate Cancer Centre, Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; University of NSW, Kensington, NSW, Australia
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1725
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Yang DD, Muralidhar V, Mahal BA, Labe SA, Nezolosky MD, Vastola ME, King MT, Martin NE, Orio PF, Choueiri TK, Trinh QD, Spratt DE, Hoffman KE, Feng FY, Nguyen PL. National Trends and Predictors of Androgen Deprivation Therapy Use in Low-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2017; 98:338-343. [PMID: 28463152 DOI: 10.1016/j.ijrobp.2017.02.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/02/2017] [Accepted: 02/13/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Androgen deprivation therapy (ADT) is not recommended for low-risk prostate cancer because of its lack of benefit and potential for harm. We evaluated the incidence and predictors of ADT use in low-risk disease. METHODS AND MATERIALS Using the National Cancer Database, we identified 197,957 patients with low-risk prostate cancer (Gleason score of 3 + 3 = 6, prostate-specific antigen level <10 ng/mL, and cT1-T2a) diagnosed from 2004 to 2012 with complete demographic and treatment information. We used multiple logistic regression to evaluate predictors of ADT use and Cox regression to examine its association with all-cause mortality. RESULTS Overall ADT use decreased from 17.6% in 2004 to 3.5% in 2012. In 2012, 11.5% of low-risk brachytherapy patients and 7.6% of external beam radiation therapy patients received ADT. Among 82,352 irradiation-managed patients, predictors of ADT use included treatment in a community versus academic cancer program (adjusted odds ratio [AOR], 1.60; 95% confidence interval [CI], 1.50-1.71; P<.001; incidence, 14.0% vs 6.0% in 2012); treatment in the South (AOR, 1.51), Midwest (AOR, 1.81), or Northeast (AOR, 1.90) versus West (P<.001); and brachytherapy use versus external beam radiation therapy (AOR, 1.32; 95% CI, 1.27-1.37; P<.001). Among 25,196 patients who did not receive local therapy, predictors of primary ADT use included a Charlson-Deyo comorbidity score of ≥2 versus 0 (AOR, 1.42; 95% CI, 1.06-1.91; P=.018); treatment in a community versus academic cancer program (AOR, 1.61; 95% CI, 1.37-1.90; P<.001); and treatment in the South (AOR, 1.26), Midwest (AOR, 1.52), or Northeast (AOR, 1.28) versus West (P≤.008). Primary ADT use was associated with increased all-cause mortality in patients who did not receive local therapy (adjusted hazard ratio, 1.28; 95% CI, 1.14-1.43; P<.001) after adjustment for age and comorbidity. CONCLUSIONS ADT use in low-risk prostate cancer has declined nationally but may remain an issue of concern in certain populations and regions.
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Affiliation(s)
| | - Vinayak Muralidhar
- Department of Medicine, Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Shelby A Labe
- Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts; Dana-Farber Cancer Institute, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | - Michelle D Nezolosky
- Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts; Dana-Farber Cancer Institute, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | - Marie E Vastola
- Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts; Dana-Farber Cancer Institute, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | - Martin T King
- Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts; Dana-Farber Cancer Institute, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | - Neil E Martin
- Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts; Dana-Farber Cancer Institute, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | - Peter F Orio
- Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts; Dana-Farber Cancer Institute, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | - Toni K Choueiri
- Department of Medical Oncology, Harvard Medical School, Boston, Massachusetts; Dana-Farber Cancer Institute, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | - Daniel E Spratt
- Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts; University of Michigan, Ann Arbor, Michigan
| | - Karen E Hoffman
- Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts; The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Felix Y Feng
- Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts; Departments of Urology & Medicine and Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California
| | - Paul L Nguyen
- Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts; Dana-Farber Cancer Institute, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts.
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1726
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Re: Long-term Oncological Outcomes of an Active Surveillance Program in Recurrent Low Grade Ta Bladder Cancer. Eur Urol 2017; 72:152. [PMID: 28238411 DOI: 10.1016/j.eururo.2017.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 02/09/2017] [Indexed: 11/21/2022]
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1727
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Peters M, van der Voort van Zyp JRN, Verkooijen HM. Reply to: 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. Hamdy et al. NEJM October 2016. World J Urol 2017; 35:1465. [PMID: 28210766 DOI: 10.1007/s00345-017-2015-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 01/27/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Max Peters
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | | - Helena M Verkooijen
- Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
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1728
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Mandhani A. Roundup. INDIAN JOURNAL OF UROLOGY : IJU : JOURNAL OF THE UROLOGICAL SOCIETY OF INDIA 2017; 33:2-3. [PMID: 28197021 PMCID: PMC5264187 DOI: 10.4103/0970-1591.197326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Anil Mandhani
- Director, Uro-oncology and Minimally Invasive Surgery, Fortis Escorts Kidney and Urology Institute, New Delhi, India
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1729
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Amini A, Raben D, Crawford ED, Flaig TW, Kessler ER, Lam ET, Maroni P, Pugh TJ. Patient characterization and usage trends of proton beam therapy for localized prostate cancer in the United States: A study of the National Cancer Database. Urol Oncol 2017; 35:438-446. [PMID: 28214281 DOI: 10.1016/j.urolonc.2017.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/10/2017] [Accepted: 01/16/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate usage trends and identify factors associated with proton beam therapy (PBT) compared to alternative forms of external beam radiation therapy (RT) (EBRT) for localized prostate cancer. PATIENTS AND METHODS The National Cancer Database was queried for men with localized (N0, M0) prostate cancer diagnosed between 2004 and 2013, treated with EBRT, with available data on EBRT modality (photon vs. PBT). Binary multiple logistic regression identified variables associated with EBRT modality. RESULTS In total, 143,702 patients were evaluated with relatively few men receiving PBT (5,709 [4.0%]). Significant differences in patient and clinical characteristics were identified between those men treated with PBT compared to those treated with photon (odds ratio [OR]; 95% CI). Patients treated with PBT were generally younger (OR = 0.73; CI: 0.67-0.82), National Comprehensive Cancer Network low-risk compared to intermediate (0.71; 0.65-0.78) or high (0.44; 0.38-0.5) risk, white vs. black race (0.66; 0.58-0.77), with less comorbidity (Charlson-Deyo 0 vs. 2+; 0.70; 0.50-0.98), live in higher income counties (1.55; 1.36-1.78), and live in metropolitan areas compared to urban (0.21; 0.18-0.23) or rural (0.14; 0.10-0.19) areas. Most patients treated with PBT travelled more than 100 miles to the treatment facility. Annual PBT utilization significantly increased in both total number and percentage of EBRT over time (2.7%-5.6%; P<0.001). PBT utilization increased mostly in men classified as National Comprehensive Cancer Network low-risk (4%-10.2%). CONCLUSION PBT for men with localized prostate cancer significantly increased in the United States from 2004 to 2013. Significant demographic and prognostic differences between those men treated with photons and protons were identified.
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Affiliation(s)
- Arya Amini
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO
| | - David Raben
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO
| | - E David Crawford
- Department of Internal Medicine, School of Medicine, University of Colorado, Aurora, CO
| | - Thomas W Flaig
- Department of Internal Medicine, School of Medicine, University of Colorado, Aurora, CO
| | - Elizabeth R Kessler
- Department of Internal Medicine, School of Medicine, University of Colorado, Aurora, CO
| | - Elaine T Lam
- Department of Internal Medicine, School of Medicine, University of Colorado, Aurora, CO
| | - Paul Maroni
- Department of Surgery, School of Medicine, University of Colorado, Aurora, CO
| | - Thomas J Pugh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO.
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1730
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Pinsky PF, Prorok PC, Yu K, Kramer BS, Black A, Gohagan J, Crawford ED, Grubb R, Andriole G. Extended mortality results for prostate cancer screening in the PLCO trial with median follow-up of 15 years. Cancer 2017; 123:592-599. [PMID: 27911486 PMCID: PMC5725951 DOI: 10.1002/cncr.30474] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/23/2016] [Accepted: 10/03/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Two large-scale prostate cancer screening trials using prostate-specific antigen (PSA) have given conflicting results in terms of the efficacy of such screening. One of those trials, the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, previously reported outcomes with 13 years of follow-up. This study presents updated findings from the PLCO trial. METHODS The PLCO trial randomized subjects from 1993 to 2001 to an intervention or control arm. Intervention-arm men received annual PSA tests for 6 years and digital rectal examinations for 4 years. This study used a linkage with the National Death Index to extend mortality follow-up to a maximum of 19 years after randomization. RESULTS Men were randomized to the intervention arm (n = 38,340) or the control arm (n = 38,343). The median follow-up time was 14.8 years (25th/75th, 12.7/16.5 years) in the intervention arm and 14.7 years (25th/75th, 12.6/16.4 years) in the control arm. There were 255 deaths from prostate cancer in the intervention arm and 244 deaths from prostate cancer in the control arm; this meant a rate ratio (RR) of 1.04 (95% confidence interval [CI], 0.87-1.24). The RR for all-cause mortality was 0.977 (95% CI, 0.950-1.004). It was estimated that 86% of the men in the control arm and 99% of the men in the intervention arm received any PSA testing during the trial, and the estimated yearly screening-phase PSA testing rates were 46% and 84%, respectively. CONCLUSIONS Extended follow-up of the PLCO trial over a median of 15 years continues to indicate no reduction in prostate cancer mortality for the intervention arm versus the control arm. Because of the high rate of control-arm PSA testing, this finding can be viewed as showing no benefit of organized screening versus opportunistic screening. Cancer 2017;123:592-599. © 2016 American Cancer Society.
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Affiliation(s)
- Paul F. Pinsky
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health
| | - Philip C. Prorok
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health
| | - Kelly Yu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health
| | - Barnett S. Kramer
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health
| | - Amanda Black
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health
| | - John Gohagan
- Office of Disease Prevention, National Institutes of Health
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1731
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Gulati R, Albertsen PC. Insights from the PLCO trial about prostate cancer screening. Cancer 2017; 123:546-548. [PMID: 27906455 PMCID: PMC5293617 DOI: 10.1002/cncr.30472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/02/2016] [Indexed: 11/07/2022]
Abstract
The potential for prostate-specific antigen (PSA) testing to reduce prostate cancer mortality has been uncertain despite its common use in the United States starting in the early 1990s. Updated results from the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial after a median of 15 years of follow-up continue to show no reduction in prostate cancer mortality due to annual PSA testing for 4–6 years relative to usual care, which included less frequent PSA testing. In contrast with trials in Europe, which showed that certain PSA testing protocols can reduce prostate cancer mortality relative to not screening, the PLCO trial provides durable evidence of no benefit to screening more frequently than historical practice. Whether a limited population-based screening program can achieve an acceptable balance of benefit and harm remains to be determined.
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Affiliation(s)
- Roman Gulati
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center,
Seattle, Washington
| | - Peter C. Albertsen
- Division of Urology, Department of Surgery, University of Connecticut Health
Center, Farmington, Connecticut
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1732
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Gandaglia G, Briganti A, Clarke N, Karnes RJ, Graefen M, Ost P, Zietman AL, Roach M. Adjuvant and Salvage Radiotherapy after Radical Prostatectomy in Prostate Cancer Patients. Eur Urol 2017; 72:689-709. [PMID: 28189428 DOI: 10.1016/j.eururo.2017.01.039] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 01/20/2017] [Indexed: 01/17/2023]
Abstract
CONTEXT Prostate cancer (PCa) patients found to have adverse pathologic features following radical prostatectomy (RP) are less likely to be cured with surgery alone. OBJECTIVE To analyze the role of postoperative radiotherapy (RT) in patients with aggressive PCa. EVIDENCE ACQUISITION We performed a systematic literature review of the Medline and EMBASE databases. The search strategy included the terms radical prostatectomy, adjuvant radiotherapy, and salvage radiotherapy, alone or in combination. We limited our search to studies published between January 2009 and August 2016. EVIDENCE SYNTHESIS Three randomized trials demonstrated that immediate RT after RP reduces the risk of recurrence in patients with aggressive PCa. However, immediate postoperative RT is associated with an increased risk of acute and late side effects ranging from 15% to 35% and 2% to 8%, respectively. Retrospective studies support the oncologic efficacy of initial observation followed by salvage RT administered at the first sign of recurrence; however, the impact of this delay on long-term control remains uncertain. Hopefully, ongoing randomized trials will shed light on the role of adjuvant RT versus observation±salvage RT in individuals with adverse features at RP. Accurate patient selection based on clinical characteristics and molecular profile is crucial. Dose escalation, whole-pelvis RT, novel techniques, and the use of hormonal therapy might improve the outcomes of postoperative RT. CONCLUSIONS Immediate RT reduces the risk of recurrence after RP in patients with aggressive disease. However, this approach is associated with an increase in the incidence of short- and long-term side effects. Observation followed by salvage RT administered at the first sign of recurrence might be associated with durable cancer control, but prospective randomized comparison with adjuvant RT is still awaited. Dose escalation, refinements in the technique, and the concomitant use of hormonal therapies might improve outcomes of patients undergoing postoperative RT. PATIENT SUMMARY Postoperative radiotherapy has an impact on oncologic outcomes in patients with aggressive disease characteristics. Salvage radiotherapy administered at the first sign of recurrence might be associated with durable cancer control in selected patients but might compromise cure in others.
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Affiliation(s)
- Giorgio Gandaglia
- Unit of Urology/Department of Oncology, URI, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Alberto Briganti
- Unit of Urology/Department of Oncology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Noel Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | | | - Markus Graefen
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Piet Ost
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | | | - Mack Roach
- Department of Radiation Oncology, University of California at San Francisco, San Francisco, CA, USA
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1733
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Affiliation(s)
- Quoc-Dien Trinh
- Division of Urological Surgery; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Alexander P. Cole
- Division of Urological Surgery; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
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1734
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The Long-Term Effect of Radical Prostatectomy on Erectile Function, Urinary Continence, and Lower Urinary Tract Symptoms: A Comparison to Age-Matched Healthy Controls. BIOMED RESEARCH INTERNATIONAL 2017; 2017:9615080. [PMID: 28261619 PMCID: PMC5316428 DOI: 10.1155/2017/9615080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 01/17/2017] [Indexed: 11/17/2022]
Abstract
Introduction. To analyze the impact of radical prostatectomy (RPE) on erectile function and lower urinary tract function in comparison to age-matched healthy men. Materials and Methods. Patients who underwent radical retropubic prostatectomy completed questionnaires containing the IIEF-5, the Bristol female LUTS questionnaire, and the International Prostate Symptom Score (IPSS). Results. Patients after RPE were included (n = 363). Age-matched healthy men (n = 363) were included. The mean IIEF-5 of patients aged 61-70 yrs after RPE was 10.4 ± 6.6 versus 18.8 ± 5.3 in the control cohort; the respective values for men aged 71-80 yrs after RPE were 7.2 ± 6.5 versus 13.6 ± 7.7 in the control cohort. Urinary incontinence after RPE was reported in 41.9% (61-70 years) and 37.7% (71-80) versus 7.5% and 15.1% in the control cohort. The mean IPSS of patients after RPE aged 61-70 yrs was 5.0 ± 4.4 versus 5.5 ± 4.9 in the control cohort; the respective values for men aged 71-80 yrs were 6.0 ± 4.9 versus 7.5 ± 5.7 in the healthy cohort. Conclusions. The negative effect of radical prostatectomy on erectile and urinary incontinence remains substantial. The physiologically declining erectile and lower urinary tract function with ageing reduces the difference between healthy men and those after surgery. Healthy men have a higher IPSS presumably due to the presence of bladder outlet obstruction.
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1735
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Roobol MJ, Verbeek JFM, van der Kwast T, Kümmerlin IP, Kweldam CF, van Leenders GJLH. Improving the Rotterdam European Randomized Study of Screening for Prostate Cancer Risk Calculator for Initial Prostate Biopsy by Incorporating the 2014 International Society of Urological Pathology Gleason Grading and Cribriform growth. Eur Urol 2017; 72:45-51. [PMID: 28162815 DOI: 10.1016/j.eururo.2017.01.033] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/18/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND The survival rate for men with International Society of Urological Pathology (ISUP) grade 2 prostate cancer (PCa) without invasive cribriform (CR) and intraductal carcinoma (IDC) is similar to that for ISUP grade 1. If updated into the European Randomized Study of Screening for Prostate Cancer (ERSPC Rotterdam) risk calculator number 3 (RC3), this may further improve upfront selection of men who need a biopsy. OBJECTIVE To improve the number of possible biopsies avoided, while limiting undiagnosed clinically important PCa by applying the updated RC3 for risk-based patient selection. DESIGN, SETTING, AND PARTICIPANTS The RC3 is based on the first screening round of the ERSPC Rotterdam, which involved 3616 men. In 2015, histopathologic slides for PCa cases (n=885) were re-evaluated. Low-risk (LR) PCa was defined as ISUP grade 1 or 2 without CR/IDC. High-risk (HR) PCa was defined as ISUP grade 2 with CR/IDC and PCa with ISUP grade≥3. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We updated the RC3 using multinomial logistic regression analysis, including data on age, PSA, digital rectal examination, and prostate volume, for predicting LR and HR PCa. Predictive accuracy was quantified using receiver operating characteristic analysis and decision curve analysis. RESULTS AND LIMITATIONS Men without PCa could effectively be distinguished from men with LR PCa and HR PCa (area under the curve 0.70, 95% confidence interval [CI] 0.68-0.72 and 0.92, 95% CI 0.90-0.94). At a 1% risk threshold, the updated calculator would lead to a 34% reduction in unnecessary biopsies, while only 2% of HR PCa cases would be undiagnosed. CONCLUSIONS A relatively simple risk stratification tool augmented with a highly sensitive contemporary pathologic biopsy classification would result in a considerable decrease in unnecessary prostate biopsies and overdiagnosis of potentially indolent disease. PATIENT SUMMARY We improved a well-known prostate risk calculator with a new pathology classification system that better reflects disease burden. This new risk calculator allows individualized prediction of the chance of having (potentially aggressive) biopsy-detectable prostate cancer and can guide shared decision-making when considering prostate biopsy.
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Affiliation(s)
- Monique J Roobol
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Jan F M Verbeek
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Theo van der Kwast
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Intan P Kümmerlin
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
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1736
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Emberton M. Is a negative prostate biopsy a risk factor for a prostate cancer related death? Lancet Oncol 2017; 18:162-163. [DOI: 10.1016/s1470-2045(17)30024-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 12/06/2016] [Accepted: 12/12/2016] [Indexed: 11/25/2022]
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1737
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Burstein HJ, Krilov L, Aragon-Ching JB, Baxter NN, Chiorean EG, Chow WA, De Groot JF, Devine SM, DuBois SG, El-Deiry WS, Epstein AS, Heymach J, Jones JA, Mayer DK, Miksad RA, Pennell NA, Sabel MS, Schilsky RL, Schuchter LM, Tung N, Winkfield KM, Wirth LJ, Dizon DS. Clinical Cancer Advances 2017: Annual Report on Progress Against Cancer From the American Society of Clinical Oncology. J Clin Oncol 2017; 35:1341-1367. [PMID: 28148207 DOI: 10.1200/jco.2016.71.5292] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Harold J Burstein
- Harold J. Burstein and Steven G. DuBois, Dana-Farber Cancer Institute; Rebecca A. Miksad and Nadine Tung, Beth Israel Deaconess Medical Center; Lori J. Wirth and Don S. Dizon, Massachusetts General Hospital, Boston, MA; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Jeanny B. Aragon-Ching, Inova Schar Cancer Institute, Fairfax, VA; E. Gabriela Chiorean, University of Washington, Seattle, WA; Warren Allen Chow, City of Hope, Duarte, CA; John Frederick De Groot and John Heymach, University of Texas MD Anderson Cancer Center, Houston, TX; Steven Michael Devine, Ohio State University, Columbus; Nathan A. Pennell, Cleveland Clinic, Cleveland, OH; Wafik S. El-Deiry, Fox Chase Cancer Center; Joshua Adam Jones, University of Pennsylvania Health Systems; Lynn Mara Schuchter, University of Pennsylvania, Philadelphia, PA; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York, NY; Deborah K. Mayer, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; Karen Marie Winkfield, Wake Forest Baptist Medical Center, Winston-Salem, NC; Michael S. Sabel, University of Michigan, Ann Arbor, MI; and Nancy N. Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Lada Krilov
- Harold J. Burstein and Steven G. DuBois, Dana-Farber Cancer Institute; Rebecca A. Miksad and Nadine Tung, Beth Israel Deaconess Medical Center; Lori J. Wirth and Don S. Dizon, Massachusetts General Hospital, Boston, MA; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Jeanny B. Aragon-Ching, Inova Schar Cancer Institute, Fairfax, VA; E. Gabriela Chiorean, University of Washington, Seattle, WA; Warren Allen Chow, City of Hope, Duarte, CA; John Frederick De Groot and John Heymach, University of Texas MD Anderson Cancer Center, Houston, TX; Steven Michael Devine, Ohio State University, Columbus; Nathan A. Pennell, Cleveland Clinic, Cleveland, OH; Wafik S. El-Deiry, Fox Chase Cancer Center; Joshua Adam Jones, University of Pennsylvania Health Systems; Lynn Mara Schuchter, University of Pennsylvania, Philadelphia, PA; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York, NY; Deborah K. Mayer, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; Karen Marie Winkfield, Wake Forest Baptist Medical Center, Winston-Salem, NC; Michael S. Sabel, University of Michigan, Ann Arbor, MI; and Nancy N. Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jeanny B Aragon-Ching
- Harold J. Burstein and Steven G. DuBois, Dana-Farber Cancer Institute; Rebecca A. Miksad and Nadine Tung, Beth Israel Deaconess Medical Center; Lori J. Wirth and Don S. Dizon, Massachusetts General Hospital, Boston, MA; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Jeanny B. Aragon-Ching, Inova Schar Cancer Institute, Fairfax, VA; E. Gabriela Chiorean, University of Washington, Seattle, WA; Warren Allen Chow, City of Hope, Duarte, CA; John Frederick De Groot and John Heymach, University of Texas MD Anderson Cancer Center, Houston, TX; Steven Michael Devine, Ohio State University, Columbus; Nathan A. Pennell, Cleveland Clinic, Cleveland, OH; Wafik S. El-Deiry, Fox Chase Cancer Center; Joshua Adam Jones, University of Pennsylvania Health Systems; Lynn Mara Schuchter, University of Pennsylvania, Philadelphia, PA; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York, NY; Deborah K. Mayer, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; Karen Marie Winkfield, Wake Forest Baptist Medical Center, Winston-Salem, NC; Michael S. Sabel, University of Michigan, Ann Arbor, MI; and Nancy N. Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nancy N Baxter
- Harold J. Burstein and Steven G. DuBois, Dana-Farber Cancer Institute; Rebecca A. Miksad and Nadine Tung, Beth Israel Deaconess Medical Center; Lori J. Wirth and Don S. Dizon, Massachusetts General Hospital, Boston, MA; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Jeanny B. Aragon-Ching, Inova Schar Cancer Institute, Fairfax, VA; E. Gabriela Chiorean, University of Washington, Seattle, WA; Warren Allen Chow, City of Hope, Duarte, CA; John Frederick De Groot and John Heymach, University of Texas MD Anderson Cancer Center, Houston, TX; Steven Michael Devine, Ohio State University, Columbus; Nathan A. Pennell, Cleveland Clinic, Cleveland, OH; Wafik S. El-Deiry, Fox Chase Cancer Center; Joshua Adam Jones, University of Pennsylvania Health Systems; Lynn Mara Schuchter, University of Pennsylvania, Philadelphia, PA; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York, NY; Deborah K. Mayer, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; Karen Marie Winkfield, Wake Forest Baptist Medical Center, Winston-Salem, NC; Michael S. Sabel, University of Michigan, Ann Arbor, MI; and Nancy N. Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - E Gabriela Chiorean
- Harold J. Burstein and Steven G. DuBois, Dana-Farber Cancer Institute; Rebecca A. Miksad and Nadine Tung, Beth Israel Deaconess Medical Center; Lori J. Wirth and Don S. Dizon, Massachusetts General Hospital, Boston, MA; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Jeanny B. Aragon-Ching, Inova Schar Cancer Institute, Fairfax, VA; E. Gabriela Chiorean, University of Washington, Seattle, WA; Warren Allen Chow, City of Hope, Duarte, CA; John Frederick De Groot and John Heymach, University of Texas MD Anderson Cancer Center, Houston, TX; Steven Michael Devine, Ohio State University, Columbus; Nathan A. Pennell, Cleveland Clinic, Cleveland, OH; Wafik S. El-Deiry, Fox Chase Cancer Center; Joshua Adam Jones, University of Pennsylvania Health Systems; Lynn Mara Schuchter, University of Pennsylvania, Philadelphia, PA; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York, NY; Deborah K. Mayer, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; Karen Marie Winkfield, Wake Forest Baptist Medical Center, Winston-Salem, NC; Michael S. Sabel, University of Michigan, Ann Arbor, MI; and Nancy N. Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Warren Allen Chow
- Harold J. Burstein and Steven G. DuBois, Dana-Farber Cancer Institute; Rebecca A. Miksad and Nadine Tung, Beth Israel Deaconess Medical Center; Lori J. Wirth and Don S. Dizon, Massachusetts General Hospital, Boston, MA; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Jeanny B. Aragon-Ching, Inova Schar Cancer Institute, Fairfax, VA; E. Gabriela Chiorean, University of Washington, Seattle, WA; Warren Allen Chow, City of Hope, Duarte, CA; John Frederick De Groot and John Heymach, University of Texas MD Anderson Cancer Center, Houston, TX; Steven Michael Devine, Ohio State University, Columbus; Nathan A. Pennell, Cleveland Clinic, Cleveland, OH; Wafik S. El-Deiry, Fox Chase Cancer Center; Joshua Adam Jones, University of Pennsylvania Health Systems; Lynn Mara Schuchter, University of Pennsylvania, Philadelphia, PA; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York, NY; Deborah K. Mayer, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; Karen Marie Winkfield, Wake Forest Baptist Medical Center, Winston-Salem, NC; Michael S. Sabel, University of Michigan, Ann Arbor, MI; and Nancy N. Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John Frederick De Groot
- Harold J. Burstein and Steven G. DuBois, Dana-Farber Cancer Institute; Rebecca A. Miksad and Nadine Tung, Beth Israel Deaconess Medical Center; Lori J. Wirth and Don S. Dizon, Massachusetts General Hospital, Boston, MA; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Jeanny B. Aragon-Ching, Inova Schar Cancer Institute, Fairfax, VA; E. Gabriela Chiorean, University of Washington, Seattle, WA; Warren Allen Chow, City of Hope, Duarte, CA; John Frederick De Groot and John Heymach, University of Texas MD Anderson Cancer Center, Houston, TX; Steven Michael Devine, Ohio State University, Columbus; Nathan A. Pennell, Cleveland Clinic, Cleveland, OH; Wafik S. El-Deiry, Fox Chase Cancer Center; Joshua Adam Jones, University of Pennsylvania Health Systems; Lynn Mara Schuchter, University of Pennsylvania, Philadelphia, PA; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York, NY; Deborah K. Mayer, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; Karen Marie Winkfield, Wake Forest Baptist Medical Center, Winston-Salem, NC; Michael S. Sabel, University of Michigan, Ann Arbor, MI; and Nancy N. Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Steven Michael Devine
- Harold J. Burstein and Steven G. DuBois, Dana-Farber Cancer Institute; Rebecca A. Miksad and Nadine Tung, Beth Israel Deaconess Medical Center; Lori J. Wirth and Don S. Dizon, Massachusetts General Hospital, Boston, MA; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Jeanny B. Aragon-Ching, Inova Schar Cancer Institute, Fairfax, VA; E. Gabriela Chiorean, University of Washington, Seattle, WA; Warren Allen Chow, City of Hope, Duarte, CA; John Frederick De Groot and John Heymach, University of Texas MD Anderson Cancer Center, Houston, TX; Steven Michael Devine, Ohio State University, Columbus; Nathan A. Pennell, Cleveland Clinic, Cleveland, OH; Wafik S. El-Deiry, Fox Chase Cancer Center; Joshua Adam Jones, University of Pennsylvania Health Systems; Lynn Mara Schuchter, University of Pennsylvania, Philadelphia, PA; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York, NY; Deborah K. Mayer, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; Karen Marie Winkfield, Wake Forest Baptist Medical Center, Winston-Salem, NC; Michael S. Sabel, University of Michigan, Ann Arbor, MI; and Nancy N. Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Steven G DuBois
- Harold J. Burstein and Steven G. DuBois, Dana-Farber Cancer Institute; Rebecca A. Miksad and Nadine Tung, Beth Israel Deaconess Medical Center; Lori J. Wirth and Don S. Dizon, Massachusetts General Hospital, Boston, MA; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Jeanny B. Aragon-Ching, Inova Schar Cancer Institute, Fairfax, VA; E. Gabriela Chiorean, University of Washington, Seattle, WA; Warren Allen Chow, City of Hope, Duarte, CA; John Frederick De Groot and John Heymach, University of Texas MD Anderson Cancer Center, Houston, TX; Steven Michael Devine, Ohio State University, Columbus; Nathan A. Pennell, Cleveland Clinic, Cleveland, OH; Wafik S. El-Deiry, Fox Chase Cancer Center; Joshua Adam Jones, University of Pennsylvania Health Systems; Lynn Mara Schuchter, University of Pennsylvania, Philadelphia, PA; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York, NY; Deborah K. Mayer, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; Karen Marie Winkfield, Wake Forest Baptist Medical Center, Winston-Salem, NC; Michael S. Sabel, University of Michigan, Ann Arbor, MI; and Nancy N. Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Wafik S El-Deiry
- Harold J. Burstein and Steven G. DuBois, Dana-Farber Cancer Institute; Rebecca A. Miksad and Nadine Tung, Beth Israel Deaconess Medical Center; Lori J. Wirth and Don S. Dizon, Massachusetts General Hospital, Boston, MA; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Jeanny B. Aragon-Ching, Inova Schar Cancer Institute, Fairfax, VA; E. Gabriela Chiorean, University of Washington, Seattle, WA; Warren Allen Chow, City of Hope, Duarte, CA; John Frederick De Groot and John Heymach, University of Texas MD Anderson Cancer Center, Houston, TX; Steven Michael Devine, Ohio State University, Columbus; Nathan A. Pennell, Cleveland Clinic, Cleveland, OH; Wafik S. El-Deiry, Fox Chase Cancer Center; Joshua Adam Jones, University of Pennsylvania Health Systems; Lynn Mara Schuchter, University of Pennsylvania, Philadelphia, PA; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York, NY; Deborah K. Mayer, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; Karen Marie Winkfield, Wake Forest Baptist Medical Center, Winston-Salem, NC; Michael S. Sabel, University of Michigan, Ann Arbor, MI; and Nancy N. Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Andrew S Epstein
- Harold J. Burstein and Steven G. DuBois, Dana-Farber Cancer Institute; Rebecca A. Miksad and Nadine Tung, Beth Israel Deaconess Medical Center; Lori J. Wirth and Don S. Dizon, Massachusetts General Hospital, Boston, MA; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Jeanny B. Aragon-Ching, Inova Schar Cancer Institute, Fairfax, VA; E. Gabriela Chiorean, University of Washington, Seattle, WA; Warren Allen Chow, City of Hope, Duarte, CA; John Frederick De Groot and John Heymach, University of Texas MD Anderson Cancer Center, Houston, TX; Steven Michael Devine, Ohio State University, Columbus; Nathan A. Pennell, Cleveland Clinic, Cleveland, OH; Wafik S. El-Deiry, Fox Chase Cancer Center; Joshua Adam Jones, University of Pennsylvania Health Systems; Lynn Mara Schuchter, University of Pennsylvania, Philadelphia, PA; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York, NY; Deborah K. Mayer, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; Karen Marie Winkfield, Wake Forest Baptist Medical Center, Winston-Salem, NC; Michael S. Sabel, University of Michigan, Ann Arbor, MI; and Nancy N. Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John Heymach
- Harold J. Burstein and Steven G. DuBois, Dana-Farber Cancer Institute; Rebecca A. Miksad and Nadine Tung, Beth Israel Deaconess Medical Center; Lori J. Wirth and Don S. Dizon, Massachusetts General Hospital, Boston, MA; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Jeanny B. Aragon-Ching, Inova Schar Cancer Institute, Fairfax, VA; E. Gabriela Chiorean, University of Washington, Seattle, WA; Warren Allen Chow, City of Hope, Duarte, CA; John Frederick De Groot and John Heymach, University of Texas MD Anderson Cancer Center, Houston, TX; Steven Michael Devine, Ohio State University, Columbus; Nathan A. Pennell, Cleveland Clinic, Cleveland, OH; Wafik S. El-Deiry, Fox Chase Cancer Center; Joshua Adam Jones, University of Pennsylvania Health Systems; Lynn Mara Schuchter, University of Pennsylvania, Philadelphia, PA; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York, NY; Deborah K. Mayer, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; Karen Marie Winkfield, Wake Forest Baptist Medical Center, Winston-Salem, NC; Michael S. Sabel, University of Michigan, Ann Arbor, MI; and Nancy N. Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Joshua Adam Jones
- Harold J. Burstein and Steven G. DuBois, Dana-Farber Cancer Institute; Rebecca A. Miksad and Nadine Tung, Beth Israel Deaconess Medical Center; Lori J. Wirth and Don S. Dizon, Massachusetts General Hospital, Boston, MA; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Jeanny B. Aragon-Ching, Inova Schar Cancer Institute, Fairfax, VA; E. Gabriela Chiorean, University of Washington, Seattle, WA; Warren Allen Chow, City of Hope, Duarte, CA; John Frederick De Groot and John Heymach, University of Texas MD Anderson Cancer Center, Houston, TX; Steven Michael Devine, Ohio State University, Columbus; Nathan A. Pennell, Cleveland Clinic, Cleveland, OH; Wafik S. El-Deiry, Fox Chase Cancer Center; Joshua Adam Jones, University of Pennsylvania Health Systems; Lynn Mara Schuchter, University of Pennsylvania, Philadelphia, PA; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York, NY; Deborah K. Mayer, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; Karen Marie Winkfield, Wake Forest Baptist Medical Center, Winston-Salem, NC; Michael S. Sabel, University of Michigan, Ann Arbor, MI; and Nancy N. Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Deborah K Mayer
- Harold J. Burstein and Steven G. DuBois, Dana-Farber Cancer Institute; Rebecca A. Miksad and Nadine Tung, Beth Israel Deaconess Medical Center; Lori J. Wirth and Don S. Dizon, Massachusetts General Hospital, Boston, MA; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Jeanny B. Aragon-Ching, Inova Schar Cancer Institute, Fairfax, VA; E. Gabriela Chiorean, University of Washington, Seattle, WA; Warren Allen Chow, City of Hope, Duarte, CA; John Frederick De Groot and John Heymach, University of Texas MD Anderson Cancer Center, Houston, TX; Steven Michael Devine, Ohio State University, Columbus; Nathan A. Pennell, Cleveland Clinic, Cleveland, OH; Wafik S. El-Deiry, Fox Chase Cancer Center; Joshua Adam Jones, University of Pennsylvania Health Systems; Lynn Mara Schuchter, University of Pennsylvania, Philadelphia, PA; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York, NY; Deborah K. Mayer, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; Karen Marie Winkfield, Wake Forest Baptist Medical Center, Winston-Salem, NC; Michael S. Sabel, University of Michigan, Ann Arbor, MI; and Nancy N. Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca A Miksad
- Harold J. Burstein and Steven G. DuBois, Dana-Farber Cancer Institute; Rebecca A. Miksad and Nadine Tung, Beth Israel Deaconess Medical Center; Lori J. Wirth and Don S. Dizon, Massachusetts General Hospital, Boston, MA; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Jeanny B. Aragon-Ching, Inova Schar Cancer Institute, Fairfax, VA; E. Gabriela Chiorean, University of Washington, Seattle, WA; Warren Allen Chow, City of Hope, Duarte, CA; John Frederick De Groot and John Heymach, University of Texas MD Anderson Cancer Center, Houston, TX; Steven Michael Devine, Ohio State University, Columbus; Nathan A. Pennell, Cleveland Clinic, Cleveland, OH; Wafik S. El-Deiry, Fox Chase Cancer Center; Joshua Adam Jones, University of Pennsylvania Health Systems; Lynn Mara Schuchter, University of Pennsylvania, Philadelphia, PA; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York, NY; Deborah K. Mayer, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; Karen Marie Winkfield, Wake Forest Baptist Medical Center, Winston-Salem, NC; Michael S. Sabel, University of Michigan, Ann Arbor, MI; and Nancy N. Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nathan A Pennell
- Harold J. Burstein and Steven G. DuBois, Dana-Farber Cancer Institute; Rebecca A. Miksad and Nadine Tung, Beth Israel Deaconess Medical Center; Lori J. Wirth and Don S. Dizon, Massachusetts General Hospital, Boston, MA; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Jeanny B. Aragon-Ching, Inova Schar Cancer Institute, Fairfax, VA; E. Gabriela Chiorean, University of Washington, Seattle, WA; Warren Allen Chow, City of Hope, Duarte, CA; John Frederick De Groot and John Heymach, University of Texas MD Anderson Cancer Center, Houston, TX; Steven Michael Devine, Ohio State University, Columbus; Nathan A. Pennell, Cleveland Clinic, Cleveland, OH; Wafik S. El-Deiry, Fox Chase Cancer Center; Joshua Adam Jones, University of Pennsylvania Health Systems; Lynn Mara Schuchter, University of Pennsylvania, Philadelphia, PA; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York, NY; Deborah K. Mayer, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; Karen Marie Winkfield, Wake Forest Baptist Medical Center, Winston-Salem, NC; Michael S. Sabel, University of Michigan, Ann Arbor, MI; and Nancy N. Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael S Sabel
- Harold J. Burstein and Steven G. DuBois, Dana-Farber Cancer Institute; Rebecca A. Miksad and Nadine Tung, Beth Israel Deaconess Medical Center; Lori J. Wirth and Don S. Dizon, Massachusetts General Hospital, Boston, MA; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Jeanny B. Aragon-Ching, Inova Schar Cancer Institute, Fairfax, VA; E. Gabriela Chiorean, University of Washington, Seattle, WA; Warren Allen Chow, City of Hope, Duarte, CA; John Frederick De Groot and John Heymach, University of Texas MD Anderson Cancer Center, Houston, TX; Steven Michael Devine, Ohio State University, Columbus; Nathan A. Pennell, Cleveland Clinic, Cleveland, OH; Wafik S. El-Deiry, Fox Chase Cancer Center; Joshua Adam Jones, University of Pennsylvania Health Systems; Lynn Mara Schuchter, University of Pennsylvania, Philadelphia, PA; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York, NY; Deborah K. Mayer, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; Karen Marie Winkfield, Wake Forest Baptist Medical Center, Winston-Salem, NC; Michael S. Sabel, University of Michigan, Ann Arbor, MI; and Nancy N. Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Richard L Schilsky
- Harold J. Burstein and Steven G. DuBois, Dana-Farber Cancer Institute; Rebecca A. Miksad and Nadine Tung, Beth Israel Deaconess Medical Center; Lori J. Wirth and Don S. Dizon, Massachusetts General Hospital, Boston, MA; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Jeanny B. Aragon-Ching, Inova Schar Cancer Institute, Fairfax, VA; E. Gabriela Chiorean, University of Washington, Seattle, WA; Warren Allen Chow, City of Hope, Duarte, CA; John Frederick De Groot and John Heymach, University of Texas MD Anderson Cancer Center, Houston, TX; Steven Michael Devine, Ohio State University, Columbus; Nathan A. Pennell, Cleveland Clinic, Cleveland, OH; Wafik S. El-Deiry, Fox Chase Cancer Center; Joshua Adam Jones, University of Pennsylvania Health Systems; Lynn Mara Schuchter, University of Pennsylvania, Philadelphia, PA; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York, NY; Deborah K. Mayer, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; Karen Marie Winkfield, Wake Forest Baptist Medical Center, Winston-Salem, NC; Michael S. Sabel, University of Michigan, Ann Arbor, MI; and Nancy N. Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Lynn Mara Schuchter
- Harold J. Burstein and Steven G. DuBois, Dana-Farber Cancer Institute; Rebecca A. Miksad and Nadine Tung, Beth Israel Deaconess Medical Center; Lori J. Wirth and Don S. Dizon, Massachusetts General Hospital, Boston, MA; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Jeanny B. Aragon-Ching, Inova Schar Cancer Institute, Fairfax, VA; E. Gabriela Chiorean, University of Washington, Seattle, WA; Warren Allen Chow, City of Hope, Duarte, CA; John Frederick De Groot and John Heymach, University of Texas MD Anderson Cancer Center, Houston, TX; Steven Michael Devine, Ohio State University, Columbus; Nathan A. Pennell, Cleveland Clinic, Cleveland, OH; Wafik S. El-Deiry, Fox Chase Cancer Center; Joshua Adam Jones, University of Pennsylvania Health Systems; Lynn Mara Schuchter, University of Pennsylvania, Philadelphia, PA; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York, NY; Deborah K. Mayer, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; Karen Marie Winkfield, Wake Forest Baptist Medical Center, Winston-Salem, NC; Michael S. Sabel, University of Michigan, Ann Arbor, MI; and Nancy N. Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nadine Tung
- Harold J. Burstein and Steven G. DuBois, Dana-Farber Cancer Institute; Rebecca A. Miksad and Nadine Tung, Beth Israel Deaconess Medical Center; Lori J. Wirth and Don S. Dizon, Massachusetts General Hospital, Boston, MA; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Jeanny B. Aragon-Ching, Inova Schar Cancer Institute, Fairfax, VA; E. Gabriela Chiorean, University of Washington, Seattle, WA; Warren Allen Chow, City of Hope, Duarte, CA; John Frederick De Groot and John Heymach, University of Texas MD Anderson Cancer Center, Houston, TX; Steven Michael Devine, Ohio State University, Columbus; Nathan A. Pennell, Cleveland Clinic, Cleveland, OH; Wafik S. El-Deiry, Fox Chase Cancer Center; Joshua Adam Jones, University of Pennsylvania Health Systems; Lynn Mara Schuchter, University of Pennsylvania, Philadelphia, PA; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York, NY; Deborah K. Mayer, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; Karen Marie Winkfield, Wake Forest Baptist Medical Center, Winston-Salem, NC; Michael S. Sabel, University of Michigan, Ann Arbor, MI; and Nancy N. Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Karen Marie Winkfield
- Harold J. Burstein and Steven G. DuBois, Dana-Farber Cancer Institute; Rebecca A. Miksad and Nadine Tung, Beth Israel Deaconess Medical Center; Lori J. Wirth and Don S. Dizon, Massachusetts General Hospital, Boston, MA; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Jeanny B. Aragon-Ching, Inova Schar Cancer Institute, Fairfax, VA; E. Gabriela Chiorean, University of Washington, Seattle, WA; Warren Allen Chow, City of Hope, Duarte, CA; John Frederick De Groot and John Heymach, University of Texas MD Anderson Cancer Center, Houston, TX; Steven Michael Devine, Ohio State University, Columbus; Nathan A. Pennell, Cleveland Clinic, Cleveland, OH; Wafik S. El-Deiry, Fox Chase Cancer Center; Joshua Adam Jones, University of Pennsylvania Health Systems; Lynn Mara Schuchter, University of Pennsylvania, Philadelphia, PA; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York, NY; Deborah K. Mayer, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; Karen Marie Winkfield, Wake Forest Baptist Medical Center, Winston-Salem, NC; Michael S. Sabel, University of Michigan, Ann Arbor, MI; and Nancy N. Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Lori J Wirth
- Harold J. Burstein and Steven G. DuBois, Dana-Farber Cancer Institute; Rebecca A. Miksad and Nadine Tung, Beth Israel Deaconess Medical Center; Lori J. Wirth and Don S. Dizon, Massachusetts General Hospital, Boston, MA; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Jeanny B. Aragon-Ching, Inova Schar Cancer Institute, Fairfax, VA; E. Gabriela Chiorean, University of Washington, Seattle, WA; Warren Allen Chow, City of Hope, Duarte, CA; John Frederick De Groot and John Heymach, University of Texas MD Anderson Cancer Center, Houston, TX; Steven Michael Devine, Ohio State University, Columbus; Nathan A. Pennell, Cleveland Clinic, Cleveland, OH; Wafik S. El-Deiry, Fox Chase Cancer Center; Joshua Adam Jones, University of Pennsylvania Health Systems; Lynn Mara Schuchter, University of Pennsylvania, Philadelphia, PA; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York, NY; Deborah K. Mayer, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; Karen Marie Winkfield, Wake Forest Baptist Medical Center, Winston-Salem, NC; Michael S. Sabel, University of Michigan, Ann Arbor, MI; and Nancy N. Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Don S Dizon
- Harold J. Burstein and Steven G. DuBois, Dana-Farber Cancer Institute; Rebecca A. Miksad and Nadine Tung, Beth Israel Deaconess Medical Center; Lori J. Wirth and Don S. Dizon, Massachusetts General Hospital, Boston, MA; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Jeanny B. Aragon-Ching, Inova Schar Cancer Institute, Fairfax, VA; E. Gabriela Chiorean, University of Washington, Seattle, WA; Warren Allen Chow, City of Hope, Duarte, CA; John Frederick De Groot and John Heymach, University of Texas MD Anderson Cancer Center, Houston, TX; Steven Michael Devine, Ohio State University, Columbus; Nathan A. Pennell, Cleveland Clinic, Cleveland, OH; Wafik S. El-Deiry, Fox Chase Cancer Center; Joshua Adam Jones, University of Pennsylvania Health Systems; Lynn Mara Schuchter, University of Pennsylvania, Philadelphia, PA; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York, NY; Deborah K. Mayer, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill; Karen Marie Winkfield, Wake Forest Baptist Medical Center, Winston-Salem, NC; Michael S. Sabel, University of Michigan, Ann Arbor, MI; and Nancy N. Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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1738
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Kalina JL, Neilson DS, Comber AP, Rauw JM, Alexander AS, Vergidis J, Lum JJ. Immune Modulation by Androgen Deprivation and Radiation Therapy: Implications for Prostate Cancer Immunotherapy. Cancers (Basel) 2017; 9:cancers9020013. [PMID: 28134800 PMCID: PMC5332936 DOI: 10.3390/cancers9020013] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 01/20/2017] [Indexed: 12/17/2022] Open
Abstract
Prostate cancer patients often receive androgen deprivation therapy (ADT) in combination with radiation therapy (RT). Recent evidence suggests that both ADT and RT have immune modulatory properties. First, ADT can cause infiltration of lymphocytes into the prostate, although it remains unclear whether the influx of lymphocytes is beneficial, particularly with the advent of new classes of androgen blockers. Second, in rare cases, radiation can elicit immune responses that mediate regression of metastatic lesions lying outside the field of radiation, a phenomenon known as the abscopal response. In light of these findings, there is emerging interest in exploiting any potential synergy between ADT, RT, and immunotherapy. Here, we provide a comprehensive review of the rationale behind combining immunotherapy with ADT and RT for the treatment of prostate cancer, including an examination of the current clinical trials that employ this combination. The reported outcomes of several trials demonstrate the promise of this combination strategy; however, further scrutiny is needed to elucidate how these standard therapies interact with immune modulators. In addition, we discuss the importance of synchronizing immune modulation relative to ADT and RT, and provide insight into elements that may impact the ability to achieve maximum synergy between these treatments.
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Affiliation(s)
- Jennifer L Kalina
- Trev and Joyce Deeley Research Centre, British Columbia Cancer Agency, Victoria, BC V8R 6V5, Canada.
| | - David S Neilson
- Trev and Joyce Deeley Research Centre, British Columbia Cancer Agency, Victoria, BC V8R 6V5, Canada.
- Department of Biochemistry & Microbiology, University of Victoria, Victoria, BC V8P 5C2, Canada.
| | - Alexandra P Comber
- Trev and Joyce Deeley Research Centre, British Columbia Cancer Agency, Victoria, BC V8R 6V5, Canada.
- Department of Biochemistry & Microbiology, University of Victoria, Victoria, BC V8P 5C2, Canada.
| | - Jennifer M Rauw
- British Columbia Cancer Agency, Victoria, BC, V8R 6V5, Canada.
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada.
| | - Abraham S Alexander
- British Columbia Cancer Agency, Victoria, BC, V8R 6V5, Canada.
- Department of Surgery, University of British Columbia, Vancouver, BC V5Z 1M9, Canada.
| | - Joanna Vergidis
- British Columbia Cancer Agency, Victoria, BC, V8R 6V5, Canada.
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada.
| | - Julian J Lum
- Trev and Joyce Deeley Research Centre, British Columbia Cancer Agency, Victoria, BC V8R 6V5, Canada.
- Department of Biochemistry & Microbiology, University of Victoria, Victoria, BC V8P 5C2, Canada.
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1739
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Jones JS. Editorial Comment. J Urol 2017; 197:1066. [PMID: 28093245 DOI: 10.1016/j.juro.2016.11.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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1740
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Bryant AK, Banegas MP, Martinez ME, Mell LK, Murphy JD. Trends in Radiation Therapy among Cancer Survivors in the United States, 2000–2030. Cancer Epidemiol Biomarkers Prev 2017; 26:963-970. [DOI: 10.1158/1055-9965.epi-16-1023] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 11/16/2022] Open
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1741
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Rischmann P. Reply to Thomas Zilli, Gilles Créhange and Olivier Chapet's Letter to the Editor re: Pascal Rischmann, Albert Gelet, Benjamin Riche, et al. Focal High Intensity Focused Ultrasound of Unilateral Localized Prostate Cancer: A Prospective Multicentric Hemiablation Study of 111 Patients. Eur Urol 2017;71:267-73. Eur Urol 2017; 72:e15-e16. [PMID: 28089305 DOI: 10.1016/j.eururo.2017.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 01/04/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Pascal Rischmann
- Department of Urology, Rangueil University Hospital, Toulouse, France.
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1742
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Traeger AC, O'Hagan ET, Cashin A, McAuley JH. Reassurance for patients with non-specific conditions - a user's guide. Braz J Phys Ther 2017; 21:1-6. [PMID: 28442069 PMCID: PMC5537438 DOI: 10.1016/j.bjpt.2016.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 11/23/2016] [Accepted: 11/25/2016] [Indexed: 12/14/2022] Open
Abstract
Reassurance is a frequently utilized yet poorly understood clinical skill. Emotional distress is an important driver of healthcare use. Diagnostic test results are not reassuring. Some attempts at reassurance can increase rather than decrease concern. Patient education is a promising way for clinicians to manage emotional distress.
Introduction Reassurance is the removal of fears and concerns about illness. In practice reassurance for non-specific conditions, where a diagnosis is unclear or unavailable, is difficult and can have unexpected effects. Many clinical guidelines for non-specific conditions such as low back pain recommend reassurance. Until recently, there was little evidence on how to reassure patients effectively. Results High distress causes patients to consult more often for low back pain. To reduce distress, clinicians should provide structured education, which is effective in the short- and long-term. A newly developed online prognostic tool has the potential to improve the quality of reassurance and reduce the number of inappropriate interventions provided for low back pain. Conclusion Targeted reassurance, including enhanced, prognosis-specific education, could optimize reassurance and possibly prevent disabling symptoms.
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Affiliation(s)
- Adrian C Traeger
- Neuroscience Research Australia, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
| | - Edel T O'Hagan
- Neuroscience Research Australia, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Aidan Cashin
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - James H McAuley
- Neuroscience Research Australia, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
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1743
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Klemann N, Røder MA, Helgstrand JT, Brasso K, Toft BG, Vainer B, Iversen P. Risk of prostate cancer diagnosis and mortality in men with a benign initial transrectal ultrasound-guided biopsy set: a population-based study. Lancet Oncol 2017; 18:221-229. [PMID: 28094199 DOI: 10.1016/s1470-2045(17)30025-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/14/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The risk of missing prostate cancer in the transrectal ultrasound-guided systematic biopsies of the prostate in men with suspected prostate cancer is a key problem in urological oncology. Repeat biopsy or MRI-guided biopsies have been suggested to increase sensitivity for diagnosis of prostate cancer, but the risk of disease-specific mortality in men who present with raised prostate-specific antigen (PSA) concentration and a benign initial biopsy result remains unknown. We investigated the risk of overall and prostate cancer-specific mortality in men with a benign initial biopsy set. METHODS Data were extracted from the Danish Prostate Cancer Registry-a population-based registry including all men undergoing histopathological assessment of prostate tissue. All men who were referred for transrectal ultrasound-guided biopsy for assessment of suspected prostate cancer between Jan 1, 1995, and Dec 31, 2011, in Denmark were eligible for inclusion. Follow-up data were obtained on April 28, 2015. The primary endpoint was the cumulative incidence of prostate cancer-specific mortality, analysed in a competing risk setting, with death from other causes as the competing event. FINDINGS Between Jan 1, 1995, and Dec 31, 2011, 64 430 men were referred for transrectal ultrasound-guided biopsy, of whom 63 454 were eligible for inclusion. Median follow-up was 5·9 years (IQR 3·8-8·5) and the total follow-up time, from the enrolment of the first patient on Jan 1, 1995, until the extraction of causes of death on April 28, 2015, was 20 years. 10 407 (30%) of 35 159 men with malignant initial biopsy sets died from prostate cancer, compared with 541 (2%) of 27 181 men with benign initial biopsy sets. Estimated overall 20-year mortality was 76·1% (95% CI 73·0-79·2). In all men referred for transrectal ultrasound-guided biopsy, the cumulative incidence of prostate cancer-specific mortality after 20 years was 25·6% (24·7-26·5) versus 50·5% (47·5-53·5) for mortality from other causes. In men with benign initial biopsy sets, the cumulative incidence of prostate cancer-specific mortality was 5·2% (3·9-6·5) versus 59·9% (55·2-64·6) for mortality from other causes. In men with PSA concentrations 10 μg/L or lower and benign initial biopsy sets (2779 men), the cumulative incidence of prostate cancer-specific mortality was 0·7% (0·2-1·3). Cumulative incidence of prostate cancer specific mortality in men with benign initial biopsy sets was 3·6% (95% CI 0·1-7·2) for men with a PSA higher than 10 ng/mL but 20 ng/mL or less (855 men) and 17·6% (12·7-22·4) and for men with a PSA higher than 20 ng/mL (454 men). INTERPRETATION The first systematic transrectal ultrasound-guided biopsy set holds important prognostic information. The 20-year risk of prostate cancer-specific mortality in men with benign initial results is low. Our findings question whether men with low PSA concentration and a benign initial biopsy set should undergo further diagnostic assessment in view of the high risk of mortality from other causes. FUNDING Capital Region of Denmark's Fund for Health Research, Danish Cancer Society, Danish Association for Cancer Research, and Krista and Viggo Petersen's Foundation.
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Affiliation(s)
- Nina Klemann
- Copenhagen Prostate Cancer Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - M Andreas Røder
- Copenhagen Prostate Cancer Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - J Thomas Helgstrand
- Copenhagen Prostate Cancer Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Birgitte G Toft
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ben Vainer
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Iversen
- Copenhagen Prostate Cancer Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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1745
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Prostate cancer in 2016: Improved outcomes and precision medicine come within reach. Nat Rev Urol 2017; 14:71-72. [PMID: 28050016 DOI: 10.1038/nrurol.2016.270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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1746
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Wang LL, Wallis CJ, Sathianathen N, Lawrentschuk N, Murphy DG, Nam R, Moon D. ‘ProtecTion’ from overtreatment: does a randomized trial finally answer the key question in localized prostate cancer? BJU Int 2017; 119:513-514. [DOI: 10.1111/bju.13734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Luke L. Wang
- Australian Urology Associates; Malvern Vic. Australia
- Department of Surgery; Central Clinical School; Monash University; Melbourne Vic. Australia
| | - Christopher J.D. Wallis
- Division of Urology; Sunnybrook Health Sciences Centre; University of Toronto; Toronto ON Canada
| | - Niranjan Sathianathen
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; University of Melbourne; Melbourne Vic. Australia
| | - Nathan Lawrentschuk
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; University of Melbourne; Melbourne Vic. Australia
- Department of Surgery, Austin Health; University of Melbourne; Melbourne Vic. Australia
| | - Declan G. Murphy
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; University of Melbourne; Melbourne Vic. Australia
- Australian Prostate Cancer Research Centre; Epworth Healthcare; Richmond Vic. Australia
| | - Robert Nam
- Division of Urology; Sunnybrook Health Sciences Centre; University of Toronto; Toronto ON Canada
| | - Daniel Moon
- Australian Urology Associates; Malvern Vic. Australia
- Department of Surgery; Central Clinical School; Monash University; Melbourne Vic. Australia
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; University of Melbourne; Melbourne Vic. Australia
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1747
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Natural History of Untreated Localized Prostate Cancer: Rational for Active Surveillance. Urol Oncol 2017. [DOI: 10.1007/978-3-319-42603-7_72-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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1748
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Canfield S, Kemeter MJ, Hornberger J, Febbo PG. Active Surveillance Use Among a Low-risk Prostate Cancer Population in a Large US Payer System: 17-Gene Genomic Prostate Score Versus Other Risk Stratification Methods. Rev Urol 2017; 19:203-212. [PMID: 29472824 PMCID: PMC5811877 DOI: 10.3909/riu0786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Many men with low-risk prostate cancer (PCa) receive definitive treatment despite recommendations that have been informed by two large, randomized trials encouraging active surveillance (AS). We conducted a retrospective cohort study using the Optum™ Research Database (Eden Prairie, MN) of electronic health records and administrative claims data to assess AS use for patients tested with a 17-gene Genomic Prostate Score™ (GPS; Genomic Health, Redwood City, CA) assay and/or prostate magnetic resonance imaging (MRI). De-identified records were extracted on health plan members enrolled from June 2013 to June 2016 who had ≥1 record of PCa (n 5 291,876). Inclusion criteria included age ≥18 years, new diagnosis, American Urological Association low-risk PCa (stage T1-T2a, prostate-specific antigen ≤10 ng/mL, Gleason score 5 6), and clinical activity for at least 12 months before and after diagnosis. Data included baseline characteristics, use of GPS testing and/or MRI, and definitive procedures. GPS or MRI testing was performed in 17% of men (GPS, n 5 375, 4%; MRI, n 5 1174, 13%). AS use varied from a low of 43% for men who only underwent MRI to 89% for GPStested men who did not undergo MRI (P <.001). At 6-month follow-up, AS use was 31.0% higher (95% CI, 27.6%-34.5%; P <.001) for men receiving the GPS test only versus men who did not undergo GPS testing or MRI; the difference was 30.5% at 12-month follow-up. In a large US payer system, the GPS assay was associated with significantly higher AS use at 6 and 12 months compared with men who had MRI only, or no GPS or MRI testing.
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Affiliation(s)
- Steven Canfield
- Division of Urology, University of Texas Health Science Center Houston, TX
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1749
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The Burden of Healthcare Costs Associated with Prostate Cancer in Ireland. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2017. [DOI: 10.5301/grhta.5000249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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1750
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Morgans AK, Dale W, Briganti A. Screening and Treating Prostate Cancer in the Older Patient: Decision Making Across the Clinical Spectrum. Am Soc Clin Oncol Educ Book 2017; 37:370-381. [PMID: 28561697 DOI: 10.1200/edbk_175491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Treatment of the growing geriatric patient population is increasingly being recognized as a necessary priority of the oncology community. As the most common cancer among men in developed countries, prostate cancer afflicts a sizable portion of elderly men. Caring for this population requires knowledge of aspects of disease presentation, screening strategies, treatment approaches, and survivorship care considerations unique to the geriatric population. In this article, we review characteristics of prostate cancer screening and treatment decision making for localized disease in elderly men, including a discussion of the biology of disease in the elderly population. We also review best practices for providing treatment for localized and recurrent disease in an elderly population, including engaging in a basic geriatric assessment to determine fitness for treatment, eliciting information about patient preferences and support systems, and balancing treatment decisions in the context of these factors using the resources of a multidisciplinary care team. We then consider complications of prostate cancer survivorship related to systemic treatment in the elderly population of men with this disease. Finally, we emphasize the importance of engaging patients in treatment decision making across the spectrum of disease to personalize treatment plans and provide optimal care.
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Affiliation(s)
- Alicia K Morgans
- From the Vanderbilt University Medical Center, Nashville, TN; The University of Chicago, Chicago, IL; Division of Oncology/Unit of Urology, Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Osperdale San Faffaele, Milan, Italy
| | - William Dale
- From the Vanderbilt University Medical Center, Nashville, TN; The University of Chicago, Chicago, IL; Division of Oncology/Unit of Urology, Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Osperdale San Faffaele, Milan, Italy
| | - Alberto Briganti
- From the Vanderbilt University Medical Center, Nashville, TN; The University of Chicago, Chicago, IL; Division of Oncology/Unit of Urology, Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Osperdale San Faffaele, Milan, Italy
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