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Canter DJ, Branch C, Shelnutt J, Foreman AJ, Lehman AM, Sama V, Edwards DK, Abran J. The 17-Gene Genomic Prostate Score Assay Is Prognostic for Biochemical Failure in Men With Localized Prostate Cancer After Radiation Therapy at a Community Cancer Center. Adv Radiat Oncol 2023; 8:101193. [PMID: 37152483 PMCID: PMC10157115 DOI: 10.1016/j.adro.2023.101193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/30/2023] [Indexed: 03/29/2023] Open
Abstract
Purpose The objective of this study was to assess the association between the Oncotype DX Genomic Prostate Score (GPS) assay and long-term outcomes in men with localized prostate cancer (PCa) after radiation therapy (RT). We hypothesized that the GPS assay is prognostic for biochemical failure (BCF), along with distant metastasis (DM) and PCa-specific mortality in patients with PCa receiving RT. Methods and Materials We retrospectively studied men with localized PCa treated with definitive RT at Georgia Urology from 2010 to 2016. The primary objective was to assess the association between GPS results and time to BCF per the Phoenix criteria; we also assessed time to DM and PCa-specific mortality. We used Cox proportional hazards regression models for all analyses, with clinicopathologic covariates determined a priori for multivariable modeling. Results A total of 450 patients (median age, 65 years; 35% Black) met eligibility criteria. There was a strong univariable association between GPS result and time to BCF (hazard ratio [HR] per 20-unit increase = 3.08; 95% confidence interval [CI], 2.11-4.46; P < .001), which persisted after adjusting for clinicopathologic characteristics in multivariable analyses. We also observed this association for time to DM (HR = 5.19; 95% CI, 3.06-8.77; P < .001) and PCa-specific mortality (HR = 13.07; 95% CI, 4.42-49.39; P < .001). Race was not a predictor of time to BCF or DM, and the GPS assay was strongly prognostic for all endpoints in Black and White patients. Conclusions In a community-based cohort, the GPS assay was strongly prognostic for time to BCF as well as long-term outcomes in men treated with RT for localized PCa.
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Affiliation(s)
| | | | | | | | - Amy M. Lehman
- Exact Sciences Corporation, Redwood City, California
| | - Varun Sama
- Exact Sciences Corporation, Redwood City, California
| | | | - John Abran
- Exact Sciences Corporation, Redwood City, California
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2
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Basak R, Usinger DS, Chen RC, Shen X. Patient Decision-Making Factors in Aggressive Treatment of Low-Risk Prostate Cancer. JNCI Cancer Spectr 2022; 6:6506527. [PMID: 35699497 PMCID: PMC8857916 DOI: 10.1093/jncics/pkac003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/28/2021] [Accepted: 10/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background Active surveillance (AS) is underutilized for low-risk prostate cancer. This study examines decision-making factors associated with AS vs aggressive treatment in a population-based cohort of low-risk patients. Methods Newly diagnosed patients (n = 599) were enrolled through the North Carolina Central Cancer Registry from 2011 to 2013 and surveyed regarding 5 factors that may impact treatment decision making: perceived cancer aggressiveness, aggressiveness of treatment intent, most important goal (eg, cure, quality of life), primary information source, and primary decision maker. We examined the association between treatment decision-making factors with patient choice for AS vs aggressive treatment using multivariable logistic regression analysis. Results This is a sociodemographically diverse cohort reflective of the population-based design, with 37.6% overall (47.6% among very low-risk patients) choosing AS. Aggressive treatment intent (odds ratio [OR] = 7.09, 95% confidence interval [CI] = 4.57 to 11.01), perceived cancer aggressiveness (OR = 4.93, 95% CI = 2.71 to 8.97), most important goal (cure vs other, OR = 1.72, 95% CI = 1.12 to 2.63), and primary information source (personal and family vs physician, OR = 1.76, 95% CI = 1.10 to 2.82) were associated with aggressive treatment. Overall, 88.4% of patients (92.2% among very low-risk) who indicated an intent to treat the cancer “not very aggressively” chose AS. Conclusions These data from the patient’s perspective shed new light on potentially modifiable factors that can help further increase AS uptake among low-risk patients. Helping more low-risk patients feel comfortable with a “not very aggressive” treatment approach may be especially important, which can be facilitated through patient education interventions to improve the understanding of the cancer diagnosis and AS having a curative intent.
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Affiliation(s)
- Ramsankar Basak
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Deborah S Usinger
- University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Ronald C Chen
- University of Kansas Medical Center, Department of Radiation Oncology, Kansas City, KS, USA
| | - Xinglei Shen
- University of Kansas Medical Center, Department of Radiation Oncology, Kansas City, KS, USA
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3
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Johnson A, Shukla N, Halley M, Nava V, Budaraju J, Zhang L, Linos E. Barriers and facilitators to mobile health and active surveillance use among older adults with skin disease. Health Expect 2021; 24:1582-1592. [PMID: 34190397 PMCID: PMC8483196 DOI: 10.1111/hex.13229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/29/2021] [Accepted: 02/18/2021] [Indexed: 11/29/2022] Open
Abstract
Background The COVID‐19 pandemic has accelerated the adoption of telemedicine, including teledermatology. Monitoring skin lesions using teledermatology may become increasingly important for several skin diseases, including low‐risk skin cancers. The purpose of this study was to describe the key factors that could serve as barriers or facilitators to skin disease monitoring using mobile health technology (mHealth) in older adults. Methods Older adult dermatology patients 65 years or older and their caregivers who have seen a dermatologist in the last 18 months were interviewed and surveyed between December 2019 and July 2020. The purpose of these interviews was to better understand attitudes, beliefs and behaviours that could serve as barriers and facilitators to the use of mHealth and active surveillance to monitor low‐risk skin cancers. Results A total of 33 interviews leading to 6022 unique excerpts yielded 8 factors, or themes, that could serve as barriers, facilitators or both to mHealth and active surveillance. We propose an integrated conceptual framework that highlights the interaction of these themes at both the patient and provider level, including care environment, support systems and personal values. Discussion and conclusions These preliminary findings reveal factors influencing patient acceptance of active surveillance in dermatology, such as changes to the patient‐provider interaction and alignment with personal values. These factors were also found to influence adoption of mHealth interventions. Given such overlap, it is essential to address barriers and facilitators from both domains when designing a new dermatology active surveillance approach with novel mHealth technology. Patient or public contribution The patients included in this study were participants during the data collection process. Members of the Stanford Healthcare and Denver Tech Dermatology health‐care teams aided in the recruitment phase of the data collection process.
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Affiliation(s)
- Austin Johnson
- Department of Dermatology, School of Medicine, Program for Clinical Research and Technology, Stanford University, Stanford, CA, USA
| | - Neha Shukla
- Department of Dermatology, School of Medicine, Program for Clinical Research and Technology, Stanford University, Stanford, CA, USA
| | - Meghan Halley
- Department of Dermatology, School of Medicine, Program for Clinical Research and Technology, Stanford University, Stanford, CA, USA.,School of Medicine, Center for Biomedical Ethics, Stanford University, Stanford, CA, USA
| | - Vanessa Nava
- Department of Dermatology, School of Medicine, Program for Clinical Research and Technology, Stanford University, Stanford, CA, USA
| | - Janya Budaraju
- Department of Dermatology, School of Medicine, Program for Clinical Research and Technology, Stanford University, Stanford, CA, USA
| | - Lucy Zhang
- Department of Dermatology, School of Medicine, Program for Clinical Research and Technology, Stanford University, Stanford, CA, USA
| | - Eleni Linos
- Department of Dermatology, School of Medicine, Program for Clinical Research and Technology, Stanford University, Stanford, CA, USA
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4
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Takagi M, Demizu Y, Fujii O, Terashima K, Niwa Y, Daimon T, Tokumaru S, Fuwa N, Hareyama M, Okimoto T. Proton Therapy for Localized Prostate Cancer: Long-Term Results From a Single-Center Experience. Int J Radiat Oncol Biol Phys 2020; 109:964-974. [PMID: 33186616 DOI: 10.1016/j.ijrobp.2020.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/22/2020] [Accepted: 11/02/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Although proton therapy is controversial, it has been used to treat localized prostate cancer over the past 2 decades. The purpose of this study is to examine the long-term efficacy and toxicity of proton therapy for localized prostate cancer. METHODS AND MATERIALS This was a retrospective observational study of 2021 patients from 2003 to 2014 at a single institution. Patients were classified using the risk groups defined by the National Comprehensive Cancer Network guidelines, version 4.2019. Ninety-eight percent of the patients received 74 Gy (relative biological effectiveness) in 37 fractions. Fifty-one and 6% of the patients received neoadjuvant and adjuvant androgen deprivation therapy, respectively. The outcomes were the time of freedom from biochemical relapse and the time to late toxicity by the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0. The outcomes were estimated using the Kaplan-Meier method and were analyzed using multivariable Cox proportional hazards models. RESULTS The median follow-up period was 84 months (interquartile range, 60-110). The 5- and 10-year freedom from biochemical relapse rates were 100% and 100%, 99% and 88%, 93% and 86%, 90% and 79%, 88% and 68%, and 76% and 63% for the very low, low, favorable intermediate, unfavorable intermediate, high, and very high-risk groups, respectively. Patients with higher risk experienced biochemical relapse after shorter periods. The 5-year rates of grade 2 or higher late genitourinary and gastrointestinal toxicity were 2.2% and 4.0%, respectively. The results of multivariable analyses indicate that younger patients more often experienced biochemical relapse. CONCLUSIONS This study demonstrates the favorable biochemical controls of proton therapy even in advanced localized prostate cancer patients with a low incidence of late toxicities, supporting the feasibility of conducting prospective clinical trials. The risk groups defined by the National Comprehensive Cancer Network guidelines, version 4.2019, are useful to classify patients with localized prostate cancer. Our findings might suggest the necessity to develop a treatment strategy that accounts for the patient's age.
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Affiliation(s)
- Masaru Takagi
- Proton Therapy Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan; Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo, Japan.
| | - Yusuke Demizu
- Department of Radiation Oncology, Hyogo Ion Beam Medical Center Kobe Proton Center, Kobe, Hyogo, Japan; Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo, Japan
| | - Osamu Fujii
- Department of Radiation Oncology, Hakodate Goryoukaku Hospital, Hakodate, Hokkaido, Japan
| | - Kazuki Terashima
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo, Japan
| | - Yasue Niwa
- Department of Radiation Oncology, Tsuyama Chuo Hospital, Tsuyama, Okayama, Japan
| | - Takashi Daimon
- Department of Biostatistics, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Sunao Tokumaru
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo, Japan
| | - Nobukazu Fuwa
- Department of Radiation Oncology, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Masato Hareyama
- Proton Therapy Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Tomoaki Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo, Japan
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5
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Smigelski M, Wallace BK, Lu J, Li G, Anderson CB. Differences in Use of Aggressive Therapy for Localized Prostate Cancer in New York City. Clin Genitourin Cancer 2020; 19:e55-e62. [PMID: 32891565 DOI: 10.1016/j.clgc.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/05/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Socioeconomic factors may impact how a patient is treated for prostate cancer (CaP). Our objective was to determine if county of residence or neighborhood socioeconomic characteristics were associated with treatment for CaP in New York City (NYC). MATERIALS AND METHODS We used the NYSPACED database to identify men aged 40 to 80 years with localized CaP in NYC between 2004 and 2016. We categorized patients into receiving either aggressive local therapy (ALT) or non-aggressive treatment (NT). We identified borough of residence through NYSPACED and used Public Use Microdata Area (PUMA) designation to define neighborhood characteristics using United States Census data. We hypothesized that differences exist in use of ALT according to county of residence and neighborhood characteristics. We used multivariable logistic regression to test the association between county of residence and ALT as well as between ALT and PUMA characteristics. RESULTS Our cohort included 40,668 patients. Overall, 80% had ALT, and 21% had NT. NT use increased over time from 16% in 2004 to 32% in 2016 (P < .001). On multivariable logistic regression, patients in Manhattan were less likely to receive ALT compared with those in other boroughs (P < .001). PUMAs with lower education attainment, larger foreign-born populations, lower crime rate, and higher median income were significantly associated with receipt of ALT (P < .05). CONCLUSIONS We observed significant differences in use of treatment for men with newly diagnosed CaP in NYC. The ability to receive this treatment was associated with borough of residence as well as neighborhood socioeconomic characteristics. Additional research is required to identify barriers in access to NT within NYC.
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Affiliation(s)
- Michael Smigelski
- Department of Urology, New York-Presbyterian Columbia University Medical Center, New York, NY
| | - Brendan K Wallace
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Jun Lu
- Mailman School of Public Health, Columbia University, New York, NY
| | - Gen Li
- Mailman School of Public Health, Columbia University, New York, NY
| | - Christopher B Anderson
- Department of Urology, New York-Presbyterian Columbia University Medical Center, New York, NY.
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6
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Paulk AT, Sesterhenn IA, Burke AP. Recutting Blocks of Prostate Needle Biopsies: How Much Diagnostic Yield Is Gained? Int J Surg Pathol 2020; 28:490-495. [PMID: 32075460 DOI: 10.1177/1066896920907690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives. The criteria for "active surveillance" depend in part on quantification of tumor extent and grade on prostate biopsies. It is known that false-negative biopsies may occur from incomplete sectioning of cores within the paraffin blocks. Methods. We retrospectively analyzed a prostate biopsy series, which were subjected to a second round of sections, in order to determine the rate of missed cancers. Results. Of 1324 sets of prostate biopsies, 4.5% (60) showed additional involved cores or higher grade tumor on recut sections. In 27 patients (2.0%), the changed diagnosis resulted in a potential mild increase in National Comprehensive Cancer Network (NCCN) risk, from negative to very low (12), very low to low (12), and low to favorable intermediate (3). In 3 patients (0.2%), the changed diagnosis resulted in a significant increase in NCCN risk. Comparison of the initial sets of slides to the recuts demonstrated areas of absent tissue in many of the cases in which tumor segments were missed. In 2/3 cases with the significant grade increase, gaps were present in one that should have alerted the pathologist to incomplete sections, and the tumor was fragmented at the edge of the core appearing incompletely sampled. Conclusions. A significant increase in risk was seen in this study in 0.2% of patients when blocks were recut for further sampling, with minor increases in 2%. While embedding issues only rarely resulted in clinically significant sampling error, the 3 significantly underdiagnosed cases underscore the need for pathologists to be alert to incomplete sections of prostate cores.
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Affiliation(s)
| | | | - Allen P Burke
- University of Maryland Medical Center, Baltimore, MD, USA
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7
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Al Hussein Al Awamlh B, Ma X, Scherr D, Hu JC, Shoag JE. Temporal Changes in Demographic and Clinical Characteristics of Men With Prostate Cancer Electing for Conservative Management in the United States. Urology 2020; 137:60-65. [PMID: 31948677 DOI: 10.1016/j.urology.2019.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 11/14/2019] [Accepted: 12/06/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To characterize the role of clinical and sociodemographic factors in the use of conservative management for localized prostate cancer in the US between 2010 and 2015, and to understand how those factors evolved in light of the recent national increase in conservative management rates. METHODS Data from the Surveillance, Epidemiology, and End Results Program "Prostate with Watchful Waiting Database," where conservative treatment was delineated by a distinct classifier, was used to evaluate factors associated with electing for conservative management at initial diagnosis (2010-2015). Men aged ≥40 years with cT1-T2a and T2NOS with Gleason score 3 + 3 and 3 + 4 were included (n = 118,415). Multivariable logistic regression was used to determine the association between clinical and sociodemographic factors and electing conservative management. RESULTS Between 2010 and 15, a total of 22,099 (18.6%) men were managed conservatively. Mean age of men managed conservatively decreased from 66.6 to 64.6 years, and median prostate-specific antigen (PSA) increased from 5.7 to 6.0 ng/mL, P <.0001. Men with lower income experienced a greater increase in conservative management rates compared to those with high income (152% vs 72% for third and fifth [richest] income quintiles, respectively). On multivariable analysis, Gleason score 3 + 3, older age, lower PSA, more recent year, treatment in the West, and higher levels of county income were significantly associated with conservative management. CONCLUSION Characteristics of men undergoing conservative management are rapidly changing. Younger men, men with higher PSAs, and men of all incomes are increasingly being managed conservatively. Narrowing of income-based disparities with concurrent broadening of patients considered eligible for surveillance is encouraging.
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Affiliation(s)
| | - Xiaoyue Ma
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY
| | - Douglas Scherr
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY
| | - Jim C Hu
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY
| | - Jonathan E Shoag
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY.
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8
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Hoffman RM, Lobo T, Van Den Eeden SK, Davis KM, Luta G, Leimpeter AD, Aaronson D, Penson DF, Taylor K. Selecting Active Surveillance: Decision Making Factors for Men with a Low-Risk Prostate Cancer. Med Decis Making 2019; 39:962-974. [PMID: 31631745 DOI: 10.1177/0272989x19883242] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Men with a low-risk prostate cancer (PCa) should consider observation, particularly active surveillance (AS), a monitoring strategy that avoids active treatment (AT) in the absence of disease progression. Objective. To determine clinical and decision-making factors predicting treatment selection. Design. Prospective cohort study. Setting. Kaiser Permanente Northern California (KPNC). Patients. Men newly diagnosed with low-risk PCa between 2012 and 2014 who remained enrolled in KPNC for 12 months following diagnosis. Measurements. We used surveys and medical record abstractions to measure sociodemographic and clinical characteristics and psychological and decision-making factors. Men were classified as being on observation if they did not undergo AT within 12 months of diagnosis. We performed multivariable logistic regression analyses. Results. The average age of the 1171 subjects was 61.5 years (s = 7.2 years), and 81% were white. Overall, 639 (57%) were managed with observation; in adjusted analyses, significant predictors of observation included awareness of low-risk status (odds ratio 1.75; 95% confidence interval 1.04-2.94), knowing that observation was an option (3.62; 1.62-8.09), having concerns about treatment-related quality of life (1.21, 1.09-1.34), reporting a urologist recommendation for observation (8.20; 4.68-14.4), and having a lower clinical stage (T1c v. T2a, 2.11; 1.16-3.84). Conversely, valuing cancer control (1.54; 1.37-1.72) and greater decisional certainty (1.66; 1.18-2.35) were predictive of AT. Limitations. Results may be less generalizable to other types of health care systems and to more diverse populations. Conclusions. Many participants selected observation, and this was associated with tumor characteristics. However, nonclinical decisional factors also independently predicted treatment selection. Efforts to provide early decision support, particularly targeting knowledge deficits, and reassurance to men with low-risk cancers may facilitate better decision making and increase uptake of observation, particularly AS.
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Affiliation(s)
- Richard M Hoffman
- Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Tania Lobo
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | - Kimberly M Davis
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | - David Aaronson
- Department of Urology, Kaiser Permanente East Bay, Oakland, CA, USA
| | - David F Penson
- Department of Urological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kathryn Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
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9
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Roy S, Hyndman ME, Danielson B, Fairey A, Lee-Ying R, Cheung WY, Afzal AR, Xu Y, Abedin T, Quon HC. Active treatment in low-risk prostate cancer: a population-based study. ACTA ACUST UNITED AC 2019; 26:e535-e540. [PMID: 31548822 DOI: 10.3747/co.26.4953] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Active surveillance instead of active treatment (at) is preferred for patients with low-risk prostate cancer (lr-pca), but practice varies widely. We conducted a population-based study to assess the proportion of patients who underwent at between January 2011 and December 2014, and to evaluate factors associated with at. Methods The provincial cancer registry was linked to administrative health datasets to identify patients with lr-pca and to acquire demographic, tumour, and treatment data. The primary outcome was receipt of at during the first 12 months after diagnosis, defined as any receipt of external-beam radiotherapy, brachytherapy, radical prostatectomy, cryotherapy, or androgen deprivation. Univariate and multivariate logistic regression were used to analyze the correlation between patient and tumour factors and at. Results Of 1565 patients with lr-pca, 554 (35.4%) underwent at within 12 months of diagnosis. Radical prostatectomy was the most common treatment (58%), followed by brachytherapy (29.6%). Younger age [odds ratio (or) 0.92; 95% confidence interval (ci): 0.91 to 0.94], lower score (≥3) on the Charlson comorbidity index (OR: 0.36; 95% ci: 0.19 to 0.68), T2 stage (or: 3.05; 95% ci: 2.03 to 4.58), higher prostate-specific antigen (psa) at diagnosis (or: 1.13; 95% ci: 1.06 to 1.21), radiation oncologist consultation (or: 3.35; 95% ci: 2.55 to 4.39), and earlier diagnosis year (2012 or: 0.46; 95% ci: 0.34 to 0.63; 2013 or: 0.45; 95% ci: 0.32 to 0.63; 2014 or: 0.33; 95% ci: 0.23 to 0.47) were associated with a higher probability of at. Conclusions This contemporary population-based study demonstrates that approximately one third of patients with lr-pca undergo at. Patients of younger age, with less comorbidity, a higher tumour stage, higher psa, earlier year of diagnosis, and radiation oncologist consultation were more likely to undergo at. Further investigation is needed to identify strategies that could minimize overtreatment.
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Affiliation(s)
- S Roy
- Tom Baker Cancer Centre, Calgary, AB.,Department of Oncology, University of Calgary, Calgary, AB
| | - M E Hyndman
- Southern Alberta Institute of Urology, Calgary, AB.,Department of Surgical Oncology, University of Calgary, Calgary, AB
| | - B Danielson
- Cross Cancer Institute, Edmonton, AB.,Department of Oncology, University of Alberta, Edmonton, AB
| | - A Fairey
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB
| | - R Lee-Ying
- Tom Baker Cancer Centre, Calgary, AB.,Department of Oncology, University of Calgary, Calgary, AB
| | - W Y Cheung
- Tom Baker Cancer Centre, Calgary, AB.,Department of Oncology, University of Calgary, Calgary, AB
| | - A R Afzal
- Tom Baker Cancer Centre, Calgary, AB
| | - Y Xu
- Department of Community Health Sciences, University of Calgary, Calgary, AB
| | - T Abedin
- Tom Baker Cancer Centre, Calgary, AB
| | - H C Quon
- Tom Baker Cancer Centre, Calgary, AB.,Department of Oncology, University of Calgary, Calgary, AB
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10
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Bhattacharjee A, Budukh A, Dikshit R. Prostate cancer survival estimates: An application with piecewise hazard function derivation. South Asian J Cancer 2019; 8:150-159. [PMID: 31489286 PMCID: PMC6699225 DOI: 10.4103/sajc.sajc_245_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The hazard function is defined as time-dependent. However, it is an overlooked area of research about the estimation of hazard function within the frame of time. The possible explanation could be carried by estimating function through the changes of time points. It is expected that it will provide us the overall idea of survival trend. This work is dedicated to propose a method to work with piecewise hazard rate. It is a data-driven method and provides us the estimates of hazard function with different time points. Methods: The proposed method is explored with prostate cancer patients, registered in the Surveillance, Epidemiology, and End Results Program and having aged at diagnosis with range 40–80 years and above. A total of 610,814 patients are included in this study. The piecewise hazard rate is formulated to serve the objective. The measurement of piecewise hazard rate is compared with Wald-type test statistics, and corresponding R function is provided. The duration of follow-ups is split into different intervals to obtain the piecewise hazard rate estimates. Results: The maximum duration of follow-up observed in this study is 40 years. The piecewise hazard rate changes at different intervals of follow-ups are observed almost same except few later intervals in the follow-up. The likelihood of hazard in earlier aged patients observed lower in comparison to older patients. The hazard rates in different grades of prostate cancer also observed separately. Conclusion: The application of piecewise hazard helps to generate statistical inference in a deeper manner. This analysis will provide us the better understanding of a requirement of effective treatment toward prolonged survival benefit for different aged patients.
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Affiliation(s)
- Atanu Bhattacharjee
- Centre for Cancer Epidemiology, The Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, Maharastra, India
| | - Atul Budukh
- Centre for Cancer Epidemiology, The Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, Maharastra, India
| | - Rajesh Dikshit
- Centre for Cancer Epidemiology, The Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, Maharastra, India
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11
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Dasgupta P, Baade PD, Aitken JF, Ralph N, Chambers SK, Dunn J. Geographical Variations in Prostate Cancer Outcomes: A Systematic Review of International Evidence. Front Oncol 2019; 9:238. [PMID: 31024842 PMCID: PMC6463763 DOI: 10.3389/fonc.2019.00238] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/18/2019] [Indexed: 01/09/2023] Open
Abstract
Background: Previous reviews of geographical disparities in the prostate cancer continuum from diagnosis to mortality have identified a consistent pattern of poorer outcomes with increasing residential disadvantage and for rural residents. However, there are no contemporary, systematic reviews summarizing the latest available evidence. Our objective was to systematically review the published international evidence for geographical variations in prostate cancer indicators by residential rurality and disadvantage. Methods: Systematic searches of peer-reviewed articles in English published from 1/1/1998 to 30/06/2018 using PubMed, EMBASE, CINAHL, and Informit databases. Inclusion criteria were: population was adult prostate cancer patients; outcome measure was PSA testing, prostate cancer incidence, stage at diagnosis, access to and use of services, survival, and prostate cancer mortality with quantitative results by residential rurality and/or disadvantage. Studies were critically appraised using a modified Newcastle-Ottawa Scale. Results: Overall 169 studies met the inclusion criteria. Around 50% were assessed as high quality and 50% moderate. Men from disadvantaged areas had consistently lower prostate-specific antigen (PSA) testing and prostate cancer incidence, poorer survival, more advanced disease and a trend toward higher mortality. Although less consistent, predominant patterns by rurality were lower PSA testing, prostate cancer incidence and survival, but higher stage disease and mortality among rural men. Both geographical measures were associated with variations in access and use of prostate cancer-related services for low to high risk disease. Conclusions: This review found substantial evidence that prostate cancer indicators varied by residential location across diverse populations and geographies. While wide variations in study design limited comparisons across studies, our review indicated that internationally, men living in disadvantaged areas, and to a lesser extent more rural areas, face a greater prostate cancer burden. This review highlights the need for a better understanding of the complex social, environmental, and behavioral reasons for these variations, recognizing that, while important, geographical access is not the only issue. Implementing research strategies to help identify these processes and to better understand the central role of disadvantage to variations in health outcome are crucial to inform the development of evidence-based targeted interventions.
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Affiliation(s)
- Paramita Dasgupta
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia
| | - Peter D Baade
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,School of Mathematical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Joanne F Aitken
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Nicholas Ralph
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD, Australia.,St Vincent's Private Hospital, Toowoomba, QLD, Australia.,School of Nursing & Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Suzanne Kathleen Chambers
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,Health and Wellness Institute, Edith Cowan University, Perth, WA, Australia.,Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - Jeff Dunn
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD, Australia.,Faculty of Health, University of Technology, Sydney, NSW, Australia
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12
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Shiff B, Patel P, Trpkov K, Gotto GT. Changes in risk-group stratification of patients undergoing radical prostatectomy at the Southern Alberta Institute of Urology over time. Res Rep Urol 2019; 11:69-75. [PMID: 30937290 PMCID: PMC6430990 DOI: 10.2147/rru.s188966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Prostate cancer is the most common cancer among men, but overall mortality rates remain low, due to the preponderance of low-risk disease. Over the last decade, there has been a shift toward more conservative management in low-risk prostate cancer, in order to minimize unnecessary intervention. This study aimed to evaluate the number of low-risk radical prostatectomies (RPs) being performed at the Southern Alberta Institute of Urology over a 10-year period. Methods We retrospectively reviewed all patients who underwent RP from 2005 to 2014 at our institution. Patients were stratified by D’Amico risk classification and grade group based on 12-core transrectal ultrasound–guided biopsy (TRUS-bx) results. RP findings are reported from February 2005 to October 2014 to describe concordance between TRUS-bx and RPs. Basic descriptive analyses were used for this study. Results Over the study period, 2,310 RPs were performed in our institution. Overall, 35.2% of these were performed on men with low-risk prostate cancer. From 2005 to 2014, the proportion of RPs performed for low-risk prostate cancer dropped from 54.0% to 8.9%, and 49.8% of patients who underwent RP for low-risk disease experienced pathologic upgrading, though only 3.8% were upgraded to grade group 3 or greater. Other adverse pathological findings were uniformly low among the low-risk group. Conclusion The proportion of patients undergoing RP at our center for low-risk prostate cancer decreased significantly over the 10 years evaluated in this study, reflecting current global trends toward active surveillance in the management of low-risk prostate cancer.
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Affiliation(s)
- Benjamin Shiff
- Division of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada,
| | - Premal Patel
- Division of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada,
| | - Kiril Trpkov
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Geoffrey T Gotto
- Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
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13
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James BC, Timsina L, Graham R, Angelos P, Haggstrom DA. Changes in total thyroidectomy versus thyroid lobectomy for papillary thyroid cancer during the past 15 years. Surgery 2019; 166:41-47. [PMID: 30904172 DOI: 10.1016/j.surg.2019.01.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/19/2018] [Accepted: 01/08/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND The incidence of papillary thyroid cancer has increased substantially during the past 15 years, which is likely related to an increased detection of small, nonlethal cancers. Studies have shown that patients may have a similar prognosis when undergoing less aggressive surgical intervention, such as thyroid lobectomy. The objective of this study is to determine whether surgical treatment patterns for papillary thyroid cancer have changed during the past 15 years. METHODS We performed a retrospective cohort study evaluating changes in the incidence and proportion of total thyroidectomy versus thyroid lobectomy for histologically confirmed papillary thyroid cancers, using the National Cancer Institute Surveillance, Epidemiology, and End Results cancer registries between 2000 and 2014. RESULTS During the study period, 44,537 patients underwent surgical treatment for papillary thyroid cancer, of which 77% were female and 81.3% were white. The incidence of papillary thyroid cancer more than doubled: from 6.2 (5.9-6.5) to 13.0 (12.5-13.4) per 100,000. The proportion of total thyroidectomy among all papillary cases increased from 78.16% in 2000 to 85.67% in 2014, and the proportion of thyroid lobectomy dropped from 16.62% to 11.41%. When stratified by tumor size, we observed a sustained and increasing gap in the proportions of total thyroidectomy and thyroid lobectomy. CONCLUSION The incidence of total thyroidectomy has not decreased despite recommendations encouraging consideration of lobectomy for patients with small papillary thyroid cancers. Although these findings could be attributed to the lag between scientific evidence and clinical practice, further work is warranted to explore any additional patient and provider factors that may explain this lack of change.
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Affiliation(s)
- Benjamin C James
- Section of Endocrine Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Lava Timsina
- Indiana University School of Medicine, Department of Surgery, Indianapolis
| | - Ryan Graham
- Indiana University School of Medicine, Indianapolis
| | - Peter Angelos
- Section of Endocrine Surgery, Department of Surgery, University of Chicago, IL
| | - David A Haggstrom
- Indiana University School of Medicine, Department of Medicine, Division of General Internal Medicine and Geriatrics, Indianapolis; Center for Health Information and Communication, US Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, Richard L. Roudebush VA Medical Center, Indianapolis, IN; Regenstrief Institute, Inc, Indianapolis, IN
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14
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Regional Differences in the Treatment of Localized Prostate Cancer: An Analysis of Surgery and Radiation Utilization in the United States. Adv Radiat Oncol 2019; 4:331-336. [PMID: 31011678 PMCID: PMC6460229 DOI: 10.1016/j.adro.2019.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/13/2019] [Indexed: 12/21/2022] Open
Abstract
Purpose Men with localized prostate cancer have various treatment options available in their management. The optimal approach is controversial and can be influenced by multiple factors. This study aimed to investigate the influence of geographic region on the selection of treatment for prostate cancer. Methods and Materials Using the National Cancer Database, we identified men diagnosed with localized prostate cancer between 2010 and 2014. The United States was divided into 11 regions per the American Cancer Society Divisions. The first course of treatment was recorded as radiation therapy (RT), radical prostatectomy (RP), or active surveillance (AS). The RT subgroup consisted of patients receiving all forms of RT, including external beam and brachytherapy, or RT plus androgen deprivation therapy. The RP subgroup consisted of patients receiving RP alone or combined with RT or androgen deprivation therapy. A χ2 test was performed to assess the association between region and frequency of RT and RP. Results This study included 462,811 men with localized prostate cancer who were treated in the United States, of whom 63.46% underwent RP, 31.54% underwent RT, and 5.00% underwent AS. Significant regional differences in RP and RT were observed (P ≤ .0001). RP was used most commonly in the Midwest (75.07%) and High Plains (73.37%) regions, whereas RP was least used in the South Atlantic (59.04%) region. Similarly, RT was used most commonly in South Atlantic (40.96%) and New England (38.98%) regions and least commonly in the Midwest (24.93%) region. AS was used most in the New England (7.27%) and Midwest (6.8%) regions and least used in the High Plains (2.57%) and Mid-South (2.84%) regions. Conclusions Regional differences exist in the United States with regard to the definitive treatment of localized prostate cancer. The etiology for these regional differences is likely multifactorial.
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15
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Validation of the Decipher Test for predicting adverse pathology in candidates for prostate cancer active surveillance. Prostate Cancer Prostatic Dis 2018; 22:399-405. [PMID: 30542054 PMCID: PMC6760567 DOI: 10.1038/s41391-018-0101-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/28/2018] [Accepted: 08/31/2018] [Indexed: 02/07/2023]
Abstract
Background Many men diagnosed with prostate cancer are active surveillance (AS) candidates. However, AS may be associated with increased risk of disease progression and metastasis due to delayed therapy. Genomic classifiers, e.g., Decipher, may allow better risk-stratify newly diagnosed prostate cancers for AS. Methods Decipher was initially assessed in a prospective cohort of prostatectomies to explore the correlation with clinically meaningful biologic characteristics and then assessed in diagnostic biopsies from a retrospective multicenter cohort of 266 men with National Comprehensive Cancer Network (NCCN) very low/low and favorable-intermediate risk prostate cancer. Decipher and Cancer of the Prostate Risk Assessment (CAPRA) were compared as predictors of adverse pathology (AP) for which there is universal agreement that patients with long life-expectancy are not suitable candidates for AS (primary pattern 4 or 5, advanced local stage [pT3b or greater] or lymph node involvement). Results Decipher from prostatectomies was significantly associated with adverse pathologic features (p-values < 0.001). Decipher from the 266 diagnostic biopsies (64.7% NCCN-very-low/low and 35.3% favorable-intermediate) was an independent predictor of AP (odds ratio 1.29 per 10% increase, 95% confidence interval [CI] 1.03–1.61, p-value 0.025) when adjusting for CAPRA. CAPRA area under curve (AUC) was 0.57, (95% CI 0.47–0.68). Adding Decipher to CAPRA increased the AUC to 0.65 (95% CI 0.58–0.70). NPV, which determines the degree of confidence in the absence of AP for patients, was 91% (95% CI 87–94%) and 96% (95% CI 90–99%) for Decipher thresholds of 0.45 and 0.2, respectively. Using a threshold of 0.2, Decipher was a significant predictor of AP when adjusting for CAPRA (p-value 0.016). Conclusion Decipher can be applied to prostate biopsies from NCCN-very-low/low and favorable-intermediate risk patients to predict absence of adverse pathologic features. These patients are predicted to be good candidates for active surveillance.
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16
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Kinsella N, Stattin P, Cahill D, Brown C, Bill-Axelson A, Bratt O, Carlsson S, Van Hemelrijck M. Factors Influencing Men's Choice of and Adherence to Active Surveillance for Low-risk Prostate Cancer: A Mixed-method Systematic Review. Eur Urol 2018; 74:261-280. [PMID: 29598981 PMCID: PMC6198662 DOI: 10.1016/j.eururo.2018.02.026] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/26/2018] [Indexed: 12/13/2022]
Abstract
CONTEXT Despite support for active surveillance (AS) as a first treatment choice for men with low-risk prostate cancer (PC), this strategy is largely underutilised. OBJECTIVE To systematically review barriers and facilitators to selecting and adhering to AS for low-risk PC. EVIDENCE ACQUISITION We searched PsychINFO, PubMed, Medline 2000-now, Embase, CINAHL, and Cochrane Central databases between 2002 and 2017 using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. The Purpose, Respondents, Explanation, Findings and Significance (PREFS) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) quality criteria were applied. Forty-seven studies were identified. EVIDENCE SYNTHESIS Key themes emerged as factors influencing both choice and adherence to AS: (1) patient and tumour factors (age, comorbidities, knowledge, education, socioeconomic status, family history, grade, tumour volume, and fear of progression/side effects); (2) family and social support; (3) provider (speciality, communication, and attitudes); (4) healthcare organisation (geography and type of practice); and (5) health policy (guidelines, year, and awareness). CONCLUSIONS Many factors influence men's choice and adherence to AS on multiple levels. It is important to learn from the experience of other chronic health conditions as well as from institutions/countries that are making significant headway in appropriately recruiting men to AS protocols, through standardised patient information, clinician education, and nationally agreed guidelines, to ultimately decrease heterogeneity in AS practice. PATIENT SUMMARY We reviewed the scientific literature for factors affecting men's choice and adherence to active surveillance (AS) for low-risk prostate cancer. Our findings suggest that the use of AS could be increased by addressing a variety of factors such as information, psychosocial support, clinician education, and standardised guidelines.
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Affiliation(s)
- Netty Kinsella
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK; Department of Urology, The Royal Marsden Hospital, London, UK.
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Declan Cahill
- Department of Urology, The Royal Marsden Hospital, London, UK
| | | | - Anna Bill-Axelson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Ola Bratt
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Sweden
| | - Sigrid Carlsson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Sweden; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mieke Van Hemelrijck
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK; Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
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17
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Modi PK, Kaufman SR, Qi J, Lane BR, Cher ML, Miller DC, Hollenbeck BK, Shahinian VB, Dupree JM. National Trends in Active Surveillance for Prostate Cancer: Validation of Medicare Claims-based Algorithms. Urology 2018; 120:96-102. [PMID: 29990573 DOI: 10.1016/j.urology.2018.06.037] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 06/11/2018] [Accepted: 06/18/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To better describe the real-world use of active surveillance. Active surveillance is a preferred management option for low-risk prostate cancer, yet its use outside of high-volume institutions is poorly understood. We created multiple claims-based algorithms, validated them using a robust clinical registry, and applied them to Medicare claims to describe national utilization. MATERIALS AND METHODS We identified men with prostate cancer from 2012-2014 in a 100% sample of Michigan Medicare data and linked them with the Michigan Urologic Surgery Improvement Collaborative (MUSIC) registry. Using MUSIC treatment assignment as the standard, we determined the performance of 8 claims-based algorithms to identify men on active surveillance. We selected 3 algorithms (the most sensitive, the most specific, and a balanced algorithm incorporating age and comorbidity) and applied them to a 20% national Medicare sample to describe national trends. RESULTS We identified 1186 men with incident prostate cancer and completely linked data. Eight algorithms were tested with sensitivity ranging from 23.5% to 88.2% and specificity ranging from 93.5% to 99.1%. We found that the use of surveillance for men with incident prostate cancer increased from 2007 to 2014, nationally. However, among all men in the population, there was a large decrease in the rate of prostate cancer diagnosis and an increased or stable rate in the use of active surveillance, depending on the algorithm used. Less than 25% of men on active surveillance underwent a confirmatory prostate biopsy. CONCLUSION We describe the performance of claims-based algorithms to identify active surveillance.
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Affiliation(s)
- Parth K Modi
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
| | - Samuel R Kaufman
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
| | - Ji Qi
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
| | - Brian R Lane
- Urologic Oncology, Spectrum Health, Grand Rapids, MI.
| | - Michael L Cher
- Department of Urology, Wayne State University, Detroit, MI.
| | - David C Miller
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
| | - Brent K Hollenbeck
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
| | - Vahakn B Shahinian
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI.
| | - James M Dupree
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
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18
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Barry MJ, Rosenkrantz AB. MRI-Targeted versus Ultrasonography-Guided Biopsy for Suspected Prostate Cancer. N Engl J Med 2018; 378:1835-1836. [PMID: 29742381 DOI: 10.1056/nejme1804231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Michael J Barry
- From the Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (M.J.B.); and the Department of Radiology, NYU Langone Health, New York (A.B.R.)
| | - Andrew B Rosenkrantz
- From the Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (M.J.B.); and the Department of Radiology, NYU Langone Health, New York (A.B.R.)
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19
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Parikh RR, Kim S, Stein MN, Haffty BG, Kim IY, Goyal S. Trends in active surveillance for very low-risk prostate cancer: do guidelines influence modern practice? Cancer Med 2017; 6:2410-2418. [PMID: 28925011 PMCID: PMC5633554 DOI: 10.1002/cam4.1132] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 05/25/2017] [Accepted: 05/26/2017] [Indexed: 11/30/2022] Open
Abstract
As recommended by current NCCN guidelines, patients with very low‐risk prostate cancer may be treated with active surveillance (AS), but this may be underutilized. Using the National Cancer Database (NCDB), we identified men (2010–2013) with biopsy‐proven, very low‐risk prostate cancer that met AS criteria as suggested by Epstein (stage ≤ T1c; Gleason score (GS) ≤ 6; PSA < 10; and ≤2 [or <33%] positive biopsy cores) and aged ≤76, and low comorbidity index (Charlson‐Deyo score = 0). For those patients meeting this criteria, we performed generalized estimation equation (GEE) method with incorporation of correlation in patients clustered within facility to determine the likelihood of undergoing AS. Among the 448 773 patients in the NCDB with low‐risk prostate cancer, 40 839 patients met the inclusion criteria. AS was utilized in 5798 patients (14.2%), while within the very low‐risk patients receiving treatment, up to 52.2% received radical prostatectomy. In univariate analyses, AS utilization was associated with older age, uninsured status (compared to private insurance), farther distance from facility, academic/research institutions and particularly in the New England region (all P < 0.01). After adjustments of other predictors in multivariate analysis, patients preferentially received AS if they were older (all OR's > 1 compared to younger groups), uninsured (vs. any insurance type, OR's > 1); or treated at academic/research center (OR > 1). The overall use of AS increased from 11.6% (2010) to 27.3% (2013). We found a low, but rising rate of AS in a nationally representative group of very low‐risk prostate cancer patients. Disparities in the use of AS may be targeted to improve adherence to national guidelines.
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Affiliation(s)
- Rahul R Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903
| | - Sinae Kim
- Biometrics Division, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903.,Department of Biostatistics, Rutgers School of Public Health, New Brunswick, NJ, 08903
| | - Mark N Stein
- Department of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903
| | - Bruce G Haffty
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903
| | - Isaac Y Kim
- Department of Urology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903
| | - Sharad Goyal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903
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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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