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Desmond C, Kaul S, Fleishman A, Korets R, Chang P, Wagner A, Kim SP, Aghdam N, Olumi AF, Gershman B. The association of patient and disease characteristics with the overtreatment of low-risk prostate cancer from 2010 to 2016. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00822-2. [PMID: 38555410 DOI: 10.1038/s41391-024-00822-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 03/05/2024] [Accepted: 03/18/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Although active surveillance is the preferred management for low-risk prostate cancer (PCa), some men remain at risk of overtreatment with definitive local therapy. We hypothesized that baseline characteristics may be associated with overtreatment and represent a potential source of health disparities. We therefore examined the associations of patient and disease characteristics with the surgical overtreatment of low-risk PCa. METHODS We identified men aged 45-75 years with cT1 cN0 cM0 prostate adenocarcinoma with biopsy Gleason score 6 and PSA < 10 ng/ml from 2010-2016 in the National Cancer Database (NCDB) and who underwent radical prostatectomy (RP). We evaluated the associations of baseline characteristics with clinically insignificant PCa (iPCa) at RP (i.e., "overtreatment"), defined as organ-confined (i.e., pT2) Gleason 3 + 3 disease, using multivariable logistic regression. RESULTS We identified 36,088 men with low-risk PCa who underwent RP. The unadjusted rate of iPCa decreased during the study period, from 54.7% in 2010 to 40.0% in 2016. In multivariable analyses adjusting for baseline characteristics, older age (OR 0.98, 95% CI 0.97-0.98), later year of diagnosis (OR 0.62, 95% CI 0.57-0.67 for 2016 vs. 2010), Black race (OR 0.85, 95% CI 0.79-0.91), treatment at an academic/research program (OR 0.82, 95% CI 0.73-0.91), higher PSA (OR 0.91, 95% CI 0.90-0.92), and higher number of positive biopsy cores (OR 0.87, 95% CI 0.86-0.88) were independently associated with a lower risk of overtreatment (iPCa) at RP. Conversely, a greater number of biopsy cores sampled (OR 1.01, 95% CI 1.01-1.02) was independently associated with an increased risk of overtreatment (iPCa) at RP. CONCLUSIONS We observed an ~27% reduction in rates of overtreatment of men with low-risk PCa over the study period. Several patient, disease, and structural characteristics are associated with detection of iPCa at RP and can inform the management of men with low-risk PCa to reduce potential overtreatment.
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Affiliation(s)
| | - Sumedh Kaul
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Aaron Fleishman
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ruslan Korets
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Peter Chang
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Andrew Wagner
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Simon P Kim
- Division of Urology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Nima Aghdam
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Aria F Olumi
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Boris Gershman
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Peng Q, Xu L, Zhang G, Zhang D, Zhang J, Zhang X, Bai X, Chen L, Jin Z, Sun H. Effect of preoperative PI-RADS assessment on pathological outcomes in patients who underwent radical prostatectomy. Cancer Imaging 2023; 23:113. [PMID: 38008745 PMCID: PMC10680237 DOI: 10.1186/s40644-023-00619-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/16/2023] [Indexed: 11/28/2023] Open
Abstract
OBJECTIVE To assess the effect of preoperative MRI with standardized Prostate Imaging-Reporting and Data System (PI-RADS) assessment on pathological outcomes in prostate cancer (PCa) patients who underwent radical prostatectomy (RP). PATIENTS AND METHODS This retrospective cohort study included patients who had undergone prostate MRI and subsequent RP for PCa between January 2017 and December 2022. The patients were divided into the PI-RADS group and the non-PI-RADS group according to evaluation scheme of presurgery MRI. The preoperative characteristics and postoperative outcomes were retrieved and analyzed. The pathological outcomes included pathological T stage (pT2 vs. pT3-4) and positive surgical margins (PSMs). Patients were further stratified according to statistically significant preoperative variables to assess the difference in pathological outcomes. A propensity score matching based on the above preoperative characteristics was additionally performed. RESULTS A total of 380 patients were included in this study, with 201 patients in the PI-RADS group and 179 in the non-PI-RADS group. The two groups had similar preoperative characteristics, except for clinical T stage (cT). As for pathological outcomes, the PI-RADS group showed a significantly lower percentage of pT3-4 (21.4% vs. 48.0%, p < 0.001), a lower percentage of PSMs (31.3% vs. 40.9%, p = 0.055), and a higher concordance between the cT and pT (79.1% vs. 64.8%, p = 0.003). The PI-RADS group also showed a lower proportion of pT3-4 (p < 0.001) in the cT1-2 subgroup and the cohort after propensity score matching. The PSM rate of cT3 patients was reduced by 39.2% in the PI-RADS group but without statistical significance (p = 0.089). CONCLUSIONS Preoperative MRI with standardized PI-RADS assessment could benefit the decision-making of patients by reducing the rate of pathologically confirmed non-organ-confined PCa after RP and slightly reducing the PSM rate compared with non-PI-RADS assessment.
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Affiliation(s)
- Qianyu Peng
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Lili Xu
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Gumuyang Zhang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Daming Zhang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Jiahui Zhang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Xiaoxiao Zhang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Xin Bai
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Li Chen
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Zhengyu Jin
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China.
- National Center for Quality Control of Radiology, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China.
| | - Hao Sun
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China.
- National Center for Quality Control of Radiology, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China.
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Low risk is low risk, regardless of race or ethnicity: Outcomes of prostate cancer active surveillance and factors associated with reclassification in a racially diverse cohort. Urol Oncol 2023; 41:204.e7-204.e15. [PMID: 36740489 DOI: 10.1016/j.urolonc.2023.01.007] [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: 07/26/2022] [Revised: 12/04/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Active surveillance (AS) is the standard for very low- and low-risk prostate cancer. Although risk factors for pathologic reclassification while on AS have been identified, results are mixed for non-Hispanic Black (NHB) and Hispanic ethnicity. We aim to further explore how race and ethnicity may be affecting AS participation and outcomes in a primarily urban, diverse, and vulnerable population. MATERIALS AND METHODS Patients eligible for AS from 2005-2020 were reviewed. Demographics, race/ethnicity, prostate specific antigen (PSA), prostate volume, and pathologic characteristics were analyzed between patients enrolled in AS and those that underwent immediate therapy. Kaplan-Meier survival analysis was used to compare biochemical recurrence (BCR) rates. Cox proportional hazards models were used to develop prediction models for clinical reclassification. RESULTS A total of 471 men were eligible for AS. Of those, 188 (39.9%) enrolled in AS while 283 (60.1%) underwent immediate radical therapy. No significant differences were found in racial/ethnic composition between the AS and immediate treatment groups. In our AS cohort, 79 (42.0%) experienced clinical reclassification and underwent deferred treatment. BCR rates were similar between treatment groups. Race/ethnicity were not found to be predictors of clinical reclassification, while metrics at diagnostic biopsy such as elevated PSA, higher PSA density, and lower prostate volume increased reclassification odds. CONCLUSIONS In our diverse population, NHB race and Hispanic ethnicity were not significant predictors of adverse reclassification while on AS. Our findings support utilizing other metrics taken at initial biopsy to identify high-risk patients such as PSA, prostate volume, and PSA density.
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Conant KJ, Huynh HN, Chan J, Le J, Yee MJ, Anderson DJ, Kaye AD, Miller BC, Drinkard JD, Cornett EM, Gomelsky A, Urits I. Racial Disparities and Mental Health Effects Within Prostate Cancer. Health Psychol Res 2022; 10:39654. [PMID: 36425236 PMCID: PMC9680850 DOI: 10.52965/001c.39654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Disparities in prostate cancer (PCa) exist at all stages: screening, diagnosis, treatment, outcomes, and mortality. Although there are a multitude of complex biological (e.g., genetics, age at diagnosis, PSA levels, Gleason score) and nonbiological (e.g., socioeconomic status, education level, health literacy) factors that contribute to PCa disparities, nonbiological factors may play a more significant role. One understudied aspect influencing PCa patients is mental health related to the quality of life. Overall, PCa patients report poorer mental health than non-PCa patients and have a higher incidence of depression and anxiety. Racial disparities in mental health, specifically in PCa patients, and how poor mental health impacts overall PCa outcomes require further study.
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Affiliation(s)
- Kaylynn J Conant
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences
| | - Hanh N Huynh
- College of Osteopathic Medicine, Pacific Northwest University of Health Science
| | - Jolene Chan
- College of Osteopathic Medicine, Pacific Northwest University of Health Science
| | - John Le
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences
| | - Matthew J Yee
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco
| | | | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health
| | | | | | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Health
| | | | - Ivan Urits
- Department of Anesthesiology, Louisiana State University Health
- Southcoast Health, Southcoast Health Pain Management
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Noël J, Moschovas MC, Sandri M, Jaber AR, Rogers T, Patel V. Comparing the outcomes of robotic assisted radical prostatectomy in black and white men: Experience of a high-volume center. Int Braz J Urol 2022; 49:123-135. [PMID: 36512460 PMCID: PMC9881802 DOI: 10.1590/s1677-5538.ibju.2022.9979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 09/30/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Global cancer incidence ranks Prostate Cancer (CaP) as the second highest overall, with Africa and the Caribbean having the highest mortality. Previous literature suggests disparities in CaP outcomes according to ethnicity, specifically functional and oncological are suboptimal in black men. However, recent data shows black men achieve post radical prostatectomy (RP) outcomes equivalent to white men in a universally insured system. Our objective is to compare outcomes of patients who self-identified their ethnicity as black or white undergoing RP at our institution. MATERIALS AND METHODS From 2008 to 2017, 396 black and 4929 white patients underwent primary robotic-assisted radical prostatectomy (RARP) with a minimum follow-up of 5 years. Exclusion criteria were concomitant surgery and cancer status not available. A propensity score (PS) match was performed with a 1:1, 1:2, and 1:3 ratio without replacement. Primary endpoints were potency, continence recovery, biochemical recurrence (BCR), positive surgical margins (PSM), and post-operative complications. RESULTS After PS 1:1 matching, 341 black vs. 341 white men with a median follow-up of approximately 8 years were analyzed. The overall potency and continence recovery at 12 months was 52% vs 58% (p=0.3) and 82% vs 89% (p=0.3), respectively. PSM rates was 13.4 % vs 14.4% (p = 0.75). Biochemical recurrence and persistence PSA was 13.8% vs 14.1% and 4.4% vs 3.2% respectively (p=0.75). Clavien-Dindo complications (p=0.4) and 30-day readmission rates (p=0.5) were similar. CONCLUSION In our study, comparing two ethnic groups with similar preoperative characteristics and full access to screening and treatment showed compatible RARP results. We could not demonstrate outcomes superiority in one group over the other. However, this data adds to the growing body of evidence that the racial disparity gap in prostate cancer outcomes can be narrowed if patients have appropriate access to prostate cancer management. It also could be used in counseling surgeons and patients on the surgical intervention and prognosis of prostate cancer in patients with full access to gold-standard screening and treatment.
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Affiliation(s)
- Jonathan Noël
- AdventHealth Global Robotics InstituteCelebrationFLUSAAdventHealth Global Robotics Institute, Celebration, FL, USA,Guy's and St Thomas’ NHS Foundation TrustLondonUKGuy's and St Thomas’ NHS Foundation Trust, London, UK,Correspondence address: Jonathan Noel, MD, AdventHealth Global Robotics Institute, 380 Celebration Pl Suite 401, Celebration, FL 34747, USA E-mail:
| | - Marcio Covas Moschovas
- AdventHealth Global Robotics InstituteCelebrationFLUSAAdventHealth Global Robotics Institute, Celebration, FL, USA,University of Central FloridaOrlandoFLUSAUniversity of Central Florida (UCF), Orlando, FL, USA
| | - Marco Sandri
- University of BresciaBig and Open Data, Innovation LaboratoryBresciaItalyBig and Open Data, Innovation Laboratory, University of Brescia, Brescia, Italy
| | - Abdel Rahman Jaber
- AdventHealth Global Robotics InstituteCelebrationFLUSAAdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Travis Rogers
- AdventHealth Global Robotics InstituteCelebrationFLUSAAdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Vipul Patel
- AdventHealth Global Robotics InstituteCelebrationFLUSAAdventHealth Global Robotics Institute, Celebration, FL, USA
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Awasthi S, Grass GD, Torres-Roca J, Johnstone PAS, Pow-Sang J, Dhillon J, Park J, Rounbehler RJ, Davicioni E, Hakansson A, Liu Y, Fink AK, DeRenzis A, Creed JH, Poch M, Li R, Manley B, Fernandez D, Naghavi A, Gage K, Lu-Yao G, Katsoulakis E, Burri RJ, Leone A, Ercole CE, Palmer JD, Vapiwala N, Deville C, Rebbeck TR, Dicker AP, Kelly W, Yamoah K. Genomic Testing in Localized Prostate Cancer Can Identify Subsets of African Americans With Aggressive Disease. J Natl Cancer Inst 2022; 114:1656-1664. [PMID: 36053178 PMCID: PMC9745424 DOI: 10.1093/jnci/djac162] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/22/2022] [Accepted: 08/23/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Personalized genomic classifiers have transformed the management of prostate cancer (PCa) by identifying the most aggressive subsets of PCa. Nevertheless, the performance of genomic classifiers to risk classify African American men is thus far lacking in a prospective setting. METHODS This is a prospective study of the Decipher genomic classifier for National Comprehensive Cancer Network low- and intermediate-risk PCa. Study-eligible non-African American men were matched to African American men. Diagnostic biopsy specimens were processed to estimate Decipher scores. Samples accrued in NCT02723734, a prospective study, were interrogated to determine the genomic risk of reclassification (GrR) between conventional clinical risk classifiers and the Decipher score. RESULTS The final analysis included a clinically balanced cohort of 226 patients with complete genomic information (113 African American men and 113 non-African American men). A higher proportion of African American men with National Comprehensive Cancer Network-classified low-risk (18.2%) and favorable intermediate-risk (37.8%) PCa had a higher Decipher score than non-African American men. Self-identified African American men were twice more likely than non-African American men to experience GrR (relative risk [RR] = 2.23, 95% confidence interval [CI] = 1.02 to 4.90; P = .04). In an ancestry-determined race model, we consistently validated a higher risk of reclassification in African American men (RR = 5.26, 95% CI = 1.66 to 16.63; P = .004). Race-stratified analysis of GrR vs non-GrR tumors also revealed molecular differences in these tumor subtypes. CONCLUSIONS Integration of genomic classifiers with clinically based risk classification can help identify the subset of African American men with localized PCa who harbor high genomic risk of early metastatic disease. It is vital to identify and appropriately risk stratify the subset of African American men with aggressive disease who may benefit from more targeted interventions.
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Affiliation(s)
| | - G Daniel Grass
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | | | | | - Julio Pow-Sang
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Jasreman Dhillon
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Jong Park
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | | | | | | | - Yang Liu
- Veracyte Inc, South San Francisco, CA, USA
| | - Angelina K Fink
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Amanda DeRenzis
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Jordan H Creed
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Michael Poch
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Roger Li
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Brandon Manley
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Daniel Fernandez
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Arash Naghavi
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Kenneth Gage
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Grace Lu-Yao
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | | | - Joshua D Palmer
- The James Cancer Hospital at Ohio State University, Columbus, OH, USA
| | - Neha Vapiwala
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Adam P Dicker
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | - William Kelly
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | - Kosj Yamoah
- Correspondence: Kosj Yamoah, MD, PhD, Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Dr, Tampa, FL 33612, USA (e-mail: )
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7
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Treatment patterns and rates of upgrading and upstaging in prostate cancer patients with single GGG1 positive biopsy core. Urol Oncol 2022; 40:407.e9-407.e19. [DOI: 10.1016/j.urolonc.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/29/2022] [Accepted: 06/02/2022] [Indexed: 11/23/2022]
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8
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Awasthi S, Mahal BA, Park JY, Creed JH, Williams VL, Elkenawi A, Meadows SO, Pow-Sang JM, Lu-Yao G, Kelly WK, Lang DLY, Zgibor J, Rebbeck TR, Yamoah K. Substantial Gleason reclassification in Black men with national comprehensive cancer network low-risk prostate cancer - A propensity score analysis. Prostate Cancer Prostatic Dis 2022; 25:547-552. [PMID: 35194179 PMCID: PMC9838824 DOI: 10.1038/s41391-022-00510-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/21/2022] [Accepted: 02/03/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Emerging evidence suggests that a subset of Black men with National Comprehensive Cancer Network (NCCN) low-risk prostate cancer (PCa) may harbor high volume and genomically aggressive disease. However, limited, and ambiguous research exist to evaluate the risk of extreme Gleason reclassification in Black men with low-risk PCa. METHODS This retrospective cohort study included 45,674 low-risk PCa patients who underwent prostatectomy and were not on active surveillance, from National Cancer Database (NCDB). A propensity score matched-pair design was employed, and the final cohort was limited to 1:1 matched 12,340 patients. Gleason score reclassification was used as primary endpoint. As such, any migration to pathologic Gleason score ≥7(3 + 4) was identified as overall, whereas migration to ≥7(4 + 3) was defined as extreme reclassification. A conditional Poisson regression model was used to estimate the risk of reclassification. Whereas spline model was used to estimate the impact of increasing time to treatment as a non-linear function on Gleason reclassification between race group. RESULTS Upon matching there were no differences in the baseline characteristics between race groups. In a matched cohort, higher proportion of low-risk Black men (6.6%) reported extreme reclassification to pathologic Gleason score than White men (5.0%), p < 0.001. In a conditional Poisson regression model adjusted for time to treatment, the risk of overall (RR = 1.09, 95% CI, 1.05-1.13, p < 0.001) and extreme (RR = 1.30, 95% CI, 1.12-1.50, p = 0.004) reclassification was significantly higher in Black men as compared to their White counterpart. In spline model, the probability of Gleason reclassification in Black men was elevated with increasing time to treatment, especially after 180 days (53% vs. 43% between Black and White men). CONCLUSION Risk of Gleason score reclassification is disparately elevated in Black men with low-risk PCa. Furthermore, time to treatment can non-linearly impact Gleason reclassification in Black men.
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Affiliation(s)
- Shivanshu Awasthi
- Department of Cancer Epidemiology, H Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Brandon A. Mahal
- University of Miami Miller School of Medicine (MSOM)-Sylvester Comprehensive Cancer Center (SCCC), Miami, FL, USA
| | - Jong Y. Park
- Department of Cancer Epidemiology, H Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Jordan H. Creed
- Department of Health Informatics, H Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Vonetta L. Williams
- Collaborative Data Services Core, H Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Asmaa Elkenawi
- Department of Cancer Epidemiology, H Lee Moffitt Cancer Center, Tampa, FL, USA
| | | | - Julio M. Pow-Sang
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Grace Lu-Yao
- Thomas Jefferson University and Sidney Kimmel Cancer Center, Philadelphia, PA, USA
| | - Wm. Kevin Kelly
- Thomas Jefferson University and Sidney Kimmel Cancer Center, Philadelphia, PA, USA
| | | | - Janice Zgibor
- College of Public Health University of South Florida, Tampa, FL, USA
| | - Timothy R. Rebbeck
- Harvard T.H Chan School of Public Health and Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kosj Yamoah
- Department Cancer Epidemiology and Radiation Oncology, H Lee Moffitt Cancer Center, Tampa, FL, USA.,Correspondence and requests for materials should be addressed to Kosj Yamoah.
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9
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Hougen HY, Iakymenko OA, Punnen S, Ritch CR, Nahar B, Parekh DJ, Kryvenko ON, Gonzalgo ML. Prostate cancer upgrading and adverse pathology in Hispanic men undergoing radical prostatectomy. World J Urol 2022; 40:2017-2023. [PMID: 35689106 DOI: 10.1007/s00345-022-04065-5] [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: 01/28/2022] [Accepted: 05/19/2022] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Radical prostatectomy (RP) outcomes in Hispanic men with prostate cancer are not well-described. Prior studies showed varying results regarding the rate of upgrading and upstaging, and these studies included limited pathologic data and lack of central pathology review. We characterized the rate of upgrading, adverse pathology, and oncologic outcomes in Hispanics after prostatectomy using a large institutional database. METHODS We included Hispanic white (HW), non-Hispanic white (NHW), and black men who underwent (RP) between 2010 and 2021 at a single institution. We recorded differences in grade group between biopsy and prostatectomy and performed multivariable analyses for odds of upgrading and adverse pathologic findings. The primary outcome was rate of upgrading in HWs. Using a sub-cohort with follow-up data, we assessed race/ethnicity and upgrading as a predictor of biochemical recurrence (BCR)-free survival. RESULTS Our cohort included 1877 men: 36.7% were NHW, 40.6% were HW, and 22.7% were black. Rates of upgrading were not different between NHW, NHW, and black men at 34.0, 33.8, and 37.3%, respectively (p = 0.4). In the multivariable analysis for upgrading, significant predictors for upgrading were older age (p = 0.002), higher PSA (p < 0.001), and lower prostate weight (p = 0.02), but race/ethnicity did not predict upgrading. In patients with available follow-up (1083, 58%), upgrading predicted worse BCR-free survival (HR 2.17, CI 1.46-3.22, p < 0.0001) but race/ethnicity did not. CONCLUSIONS HW men undergoing RP had similar rates of upgrading and adverse pathologic outcomes as NHW men. Race/ethnicity does not independently predict upgrading or worse oncologic outcomes after RP.
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Affiliation(s)
- Helen Y Hougen
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.
| | - Oleksii A Iakymenko
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sanoj Punnen
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chad R Ritch
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bruno Nahar
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dipen J Parekh
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Oleksandr N Kryvenko
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mark L Gonzalgo
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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10
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Hansen M, Hamieh NM, Markt SC, Vaselkiv JB, Pernar CH, Gonzalez-Feliciano AG, Peisch S, Chowdhury-Paulino IM, Rencsok EM, Rebbeck TR, Platz EA, Giovannucci EL, Wilson KM, Mucci LA. Racial Disparities in Prostate Cancer: Evaluation of Diet, Lifestyle, Family History, and Screening Patterns. Cancer Epidemiol Biomarkers Prev 2022; 31:982-990. [PMID: 35247879 PMCID: PMC9083301 DOI: 10.1158/1055-9965.epi-21-1064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/09/2021] [Accepted: 02/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Racial disparities in prostate cancer incidence and mortality rates are considerable. We previously found in the Health Professionals Follow-up Study (HPFS) that African-American men had an 80% higher prostate cancer risk than White men. With 21 additional years of follow-up and four-fold increase in cases, we undertook a contemporary analysis of racial differences in prostate cancer incidence and mortality in HPFS. METHODS For 47,679 men, we estimated HRs and 95% confidence intervals (CI) for the association between race and risk of prostate cancer through 2016 using Cox proportional hazards regression. Multivariable models (mHR) were adjusted for lifestyle, diet, family history, and PSA screening collected on biennial questionnaires. RESULTS 6,909 prostate cancer cases were diagnosed in White, 89 in African-American, and 90 in Asian-American men. African-Americans had higher prostate cancer incidence (mHR = 1.31; 95% CI, 1.06-1.62) and mortality (mHR = 1.67; 95% CI, 1.00-2.78), and lower PSA screening prevalence than White men. The excess risk was greater in the pre-PSA screening era (HR = 1.68; 95% CI, 1.14-2.48) than the PSA screening era (HR = 1.20; 95% CI, 0.93-1.56). Asian-Americans had lower prostate cancer risk (mHR = 0.74; 95% CI, 0.60-0.92), but similar risk of fatal disease compared with white men. CONCLUSIONS Racial differences in prostate cancer incidence and mortality in HPFS are not fully explained by differences in lifestyle, diet, family history, or PSA screening. IMPACT Additional research is necessary to address the disproportionately higher rates of prostate cancer in African-American men.
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Affiliation(s)
- Megan Hansen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- University of Massachusetts Medical School, Worcester, MA
| | - Nadine M. Hamieh
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sarah C. Markt
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - Jane B. Vaselkiv
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Claire H. Pernar
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Samuel Peisch
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Emily M. Rencsok
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - Timothy R. Rebbeck
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Elizabeth A. Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Edward L. Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Kathryn M. Wilson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA
| | - Lorelei A. Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA
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11
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The impact of race/ethnicity on upstaging and/or upgrading rates among intermediate risk prostate cancer patients treated with radical prostatectomy. World J Urol 2021; 40:103-110. [PMID: 34436637 DOI: 10.1007/s00345-021-03816-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Race/ethnicity may predispose to less favorable prostate cancer characteristics in intermediate risk prostate cancer (IR PCa) patients. We tested this hypothesis in a subgroup of IR PCa patients treated with radical prostatectomy (RP). METHODS We relied on the Surveillance, Epidemiology and End Results 2004-2016. The effect of race/ethnicity was tested in univariable and multivariable logistic regression analyses predicting upstaging (pT3+/pN1) and/or upgrading (Gleason Grade Group [GGG] 4-5) at RP. RESULTS Of 20,391 IR PCa patients, 15,050 (73.8%) were Caucasian, 2857 (14.0%) African-American, 1632 (8.0%) Hispanic/Latino and 852 (4.2%) Asian. Asian patients exhibited highest age (64 year), highest PSA (6.8 ng/ml) and highest rate of GGG3 (31.9%). African-Americans exhibited the highest percentage of positive cores at biopsy (41.7%) and the highest proportion of NCCN unfavorable risk group membership (54.6%). Conversely, Caucasians exhibited the highest proportion of cT2 stage (35.6%). In univariable analyses, Hispanic/Latinos exhibited the highest rates of upstaging/upgrading among all race/ethnicities, in both favorable and unfavorable groups, followed by Asians, Caucasians and African-Americans in that order. In multivariable analyses, Hispanic/Latino race/ethnicity represented an independent predictor of higher upstaging and/or upgrading in favorable IR PCa (odds ratio [OR] 1.27, p < 0.01), while African-American race/ethnicity represented an independent predictor of lower upstaging and/or upgrading in unfavorable IR PCa (OR 0.79, p < 0.001). CONCLUSION Race/ethnicity predisposes to differences in clinical, as well as in pathological characteristics in IR PCa patients. Specifically, even after full statistical adjustment, Hispanic/Latinos are at higher and African-Americans are at lower risk of upstaging and/or upgrading.
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12
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Wen W, Luckenbaugh AN, Bayley CE, Penson DF, Shu XO. Racial disparities in mortality for patients with prostate cancer after radical prostatectomy. Cancer 2021; 127:1517-1528. [PMID: 32895938 DOI: 10.1002/cncr.33152] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/18/2020] [Accepted: 07/23/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Although racial disparities in prostate cancer survival are well documented, the relative importance of contributing factors remains unclear. Few studies have examined the disparity between Whites and Hispanics or between Whites and Asian Americans and Pacific Islanders (AAPIs). METHODS Using data from the National Cancer Database for 526,690 patients with prostate cancer who underwent radical prostatectomy between 2004 and 2014, this study systematically evaluated the impact of clinical characteristics and factors related to access to care on survival by race. Included in the analysis were 432,640 White patients (82.1%), 63,602 Black patients (12.1%), 8990 AAPI patients (1.7%), and 21,458 Hispanic patients (4.1%). Multivariable Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals to measure racial survival disparities. Inverse probability weighting was used to adjust for imbalances of prognostic factors. RESULTS When adjustments were made for age and year of diagnosis only, Blacks had 51% higher mortality, AAPIs had 22% lower mortality, and Hispanics had 6% lower mortality than Whites. Overall, with adjustments for all clinical factors and nonclinical factors, the Black-White survival disparity narrowed to 20%, whereas the AAPI-White disparity increased to 35%. Among the controlled-for factors, education, median household income, and insurance status contributed the most to the racial disparity. CONCLUSIONS The overall survival disparity among men undergoing radical prostatectomy was significantly decreased, but not eliminated, for Blacks and significantly increased for AAPIs in comparison with Whites after adjustments for a number of clinical factors and factors related to access to care.
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Affiliation(s)
- Wanqing Wen
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Amy N Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christina E Bayley
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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13
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Wilkins LJ, Tosoian JJ, Reichard CA, Sundi D, Ranasinghe W, Alam R, Schwen Z, Reddy C, Allaf M, Davis JW, Chapin BF, Ross AE, Klein EA, Nyame YA. Oncologic outcomes among Black and White men with grade group 4 or 5 (Gleason score 8-10) prostate cancer treated primarily by radical prostatectomy. Cancer 2021; 127:1425-1431. [PMID: 33721334 DOI: 10.1002/cncr.33419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND The aim of this study was to describe pathologic and short-term oncologic outcomes among Black and White men with grade group 4 or 5 prostate cancer managed primarily by radical prostatectomy. METHODS This was a multi-institutional, observational study (2005-2015) evaluating radical prostatectomy outcomes by self-identified race. Descriptive analysis was performed via nonparametric statistical testing to compare baseline clinicopathologic data. Univariable and multivariable time-to-event analyses were performed to assess biochemical recurrence (BCR), metastasis, cancer-specific mortality (CSM), and overall survival between Black and White men. RESULTS In total, 1662 men were identified with grade group 4 or 5 prostate cancer initially managed by radical prostatectomy. Black men represented 11.3% of the cohort (n = 188). Black men were younger, demonstrated a longer time from diagnosis to surgery, and were at a lower clinical stage (all P < .05). Black men had lower rates of pT3/4 disease (49.5% vs 63.5%; P < .05) but higher rates of positive surgical margins (31.6% vs 26.5%; P = .14) on pathologic evaluation. There was no difference in BCR, CSM, or overall survival over a median follow-up of 40.7 months. Black men had a lower 5-year cumulative incidence of metastasis-free survival (93.6%; 95% confidence interval [CI], 86.5%-97.0%) in comparison with White men (85.8%; 95% CI, 83.1%-88.0%), which did not persist in an age-adjusted analysis. CONCLUSIONS Black and White men with high-grade prostate cancer at diagnosis demonstrated similar oncologic outcomes when they were managed by primary radical prostatectomy. Our findings suggest that racial disparities in prostate cancer mortality are not related to differences in the efficacy of extirpative therapy.
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Affiliation(s)
- Lamont J Wilkins
- Department of Urology, Johns Hopkins University, Baltimore, Maryland
| | | | - Chad A Reichard
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Urology of Indiana, Indianapolis, Indiana
| | - Debasish Sundi
- Department of Urology, Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Weranja Ranasinghe
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ridwan Alam
- Department of Urology, Johns Hopkins University, Baltimore, Maryland
| | - Zeyad Schwen
- Department of Urology, Johns Hopkins University, Baltimore, Maryland
| | - Chandana Reddy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mohammed Allaf
- Department of Urology, Johns Hopkins University, Baltimore, Maryland
| | - John W Davis
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brian F Chapin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ashley E Ross
- Department of Urology, Northwestern University, Chicago, Illinois
| | - Eric A Klein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Yaw A Nyame
- Department of Urology, University of Washington, Seattle, Washington.,Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
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14
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Sayyid RK, Wilson B, Benton JZ, Lodh A, Thomas EF, Goldberg H, Madi R, Terris MK, Wallis CJD, Klaassen Z. Upgrading on radical prostatectomy specimens of very low- and low-risk prostate cancer patients on active surveillance: A population-level analysis. Can Urol Assoc J 2020; 15:E335-E339. [PMID: 33382372 DOI: 10.5489/cuaj.6868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION A proportion of prostate cancer (PCa) patients initially managed with active surveillance (AS) are upgraded to a higher Gleason score (GS) at the time of radical prostatectomy (RP). Our objective was to determine predictors of upgrading on RP specimens using a national database. METHODS The Surveillance, Epidemiology, and End Results Prostate with Watchful Waiting database was used to identify AS patients diagnosed with very low- or low-risk PCa who underwent delayed RP between 2010 and 2015. The primary outcome was upgrading to GS 7 disease or worse. Logistic regression analyses were used to evaluate demographic and oncological predictors of upgrading on final specimen. RESULTS A total of 3775 men underwent RP after a period of AS, 3541 (93.8%) of whom were cT2a; 792 (21.0%) patients were upgraded on RP specimen, with 85.4%, 10.6%, and 3.4% upgraded to GS 7(3+4), 7(4+3), and 8 diseases, respectively. On multivariable analysis, higher prostate-specific antigen (PSA) at diagnosis (5-10 vs. 0-2 ng/ml, odd ratio [OR] 2.59, p<0.001) and percent core involvement (80-100% vs. 0-20%, OR 2.52, p=0.003) were significant predictors of upgrading on final RP specimen, whereas higher socioeconomic status predicted lower odds of upgrading (highest vs. lowest quartile OR 0.75, p=0.013). CONCLUSIONS Higher baseline PSA and percent positive cores involvement are associated with significantly increased risk of upgrading on RP after AS, whereas higher socioeconomic status predicts lower odds of such events. These results may help identify patients at increased risk of adverse pathology on final specimen who may benefit from earlier definitive treatment.
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Affiliation(s)
- Rashid K Sayyid
- Section of Urology, Department of Surgery, Medical College of Georgia-Augusta University, Augusta, GA, United States
| | | | - John Z Benton
- Medical College of Georgia, Augusta, GA, United States
| | - Atul Lodh
- Medical College of Georgia, Augusta, GA, United States
| | - Eric F Thomas
- Section of Urology, Department of Surgery, Medical College of Georgia-Augusta University, Augusta, GA, United States
| | - Hanan Goldberg
- Department of Urology, State University of New York Upstate, Syracuse, NY, United States
| | - Rabii Madi
- Section of Urology, Department of Surgery, Medical College of Georgia-Augusta University, Augusta, GA, United States.,Georgia Cancer Center, Augusta, GA, United States
| | - Martha K Terris
- Section of Urology, Department of Surgery, Medical College of Georgia-Augusta University, Augusta, GA, United States.,Georgia Cancer Center, Augusta, GA, United States
| | | | - Zachary Klaassen
- Section of Urology, Department of Surgery, Medical College of Georgia-Augusta University, Augusta, GA, United States.,Georgia Cancer Center, Augusta, GA, United States
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15
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Deka R, Courtney PT, Parsons JK, Nelson TJ, Nalawade V, Luterstein E, Cherry DR, Simpson DR, Mundt AJ, Murphy JD, D’Amico AV, Kane CJ, Martinez ME, Rose BS. Association Between African American Race and Clinical Outcomes in Men Treated for Low-Risk Prostate Cancer With Active Surveillance. JAMA 2020; 324:1747-1754. [PMID: 33141207 PMCID: PMC7610194 DOI: 10.1001/jama.2020.17020] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE There is concern that African American men with low-risk prostate cancer may harbor more aggressive disease than non-Hispanic White men. Therefore, it is unclear whether active surveillance is a safe option for African American men. OBJECTIVE To compare clinical outcomes of African American and non-Hispanic White men with low-risk prostate cancer managed with active surveillance. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study in the US Veterans Health Administration Health Care System of African American and non-Hispanic White men diagnosed with low-risk prostate cancer between January 1, 2001, and December 31, 2015, and managed with active surveillance. The date of final follow-up was March 31, 2020. EXPOSURES Active surveillance was defined as no definitive treatment within the first year of diagnosis and at least 1 additional surveillance biopsy. MAIN OUTCOMES AND MEASURES Progression to at least intermediate-risk, definitive treatment, metastasis, prostate cancer-specific mortality, and all-cause mortality. RESULTS The cohort included 8726 men, including 2280 African American men (26.1%) (median age, 63.2 years) and 6446 non-Hispanic White men (73.9%) (median age, 65.5 years), and the median follow-up was 7.6 years (interquartile range, 5.7-9.9; range, 0.2-19.2). Among African American men and non-Hispanic White men, respectively, the 10-year cumulative incidence of disease progression was 59.9% vs 48.3% (difference, 11.6% [95% CI, 9.2% to 13.9%); P < .001); of receipt of definitive treatment, 54.8% vs 41.4% (difference, 13.4% [95% CI, 11.0% to 15.7%]; P < .001); of metastasis, 1.5% vs 1.4% (difference, 0.1% [95% CI, -0.4% to 0.6%]; P = .49); of prostate cancer-specific mortality, 1.1% vs 1.0% (difference, 0.1% [95% CI, -0.4% to 0.6%]; P = .82); and of all-cause mortality, 22.4% vs 23.5% (difference, 1.1% [95% CI, -0.9% to 3.1%]; P = 0.09). CONCLUSIONS AND RELEVANCE In this retrospective cohort study of men with low-risk prostate cancer followed up for a median of 7.6 years, African American men, compared with non-Hispanic White men, had a statistically significant increased 10-year cumulative incidence of disease progression and definitive treatment, but not metastasis or prostate cancer-specific mortality. Longer-term follow-up is needed to better assess the mortality risk.
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Affiliation(s)
- Rishi Deka
- VHA San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla
| | - P. Travis Courtney
- VHA San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla
| | - J. Kellogg Parsons
- VHA San Diego Health Care System, La Jolla, California
- Department of Urology, University of California San Diego School of Medicine, La Jolla
| | - Tyler J. Nelson
- VHA San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla
| | - Vinit Nalawade
- VHA San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla
| | - Elaine Luterstein
- VHA San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla
| | - Daniel R. Cherry
- VHA San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla
| | - Daniel R. Simpson
- VHA San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla
| | - Arno J. Mundt
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla
| | - James D. Murphy
- VHA San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla
| | - Anthony V. D’Amico
- Department of Radiation Oncology, Harvard Medical School, Cambridge, Massachusetts
- Dana-Farber Cancer Institute, Harvard Medical School, Cambridge, Massachusetts
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher J. Kane
- Department of Urology, University of California San Diego School of Medicine, La Jolla
| | - Maria Elena Martinez
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla
| | - Brent S. Rose
- VHA San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla
- Department of Urology, University of California San Diego School of Medicine, La Jolla
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16
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Singh S, Patil S, Tamhankar AS, Ahluwalia P, Gautam G. Low-risk prostate cancer in India: Is active surveillance a valid treatment option? Indian J Urol 2020; 36:184-190. [PMID: 33082633 PMCID: PMC7531380 DOI: 10.4103/iju.iju_37_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/08/2020] [Accepted: 05/03/2020] [Indexed: 01/24/2023] Open
Abstract
Introduction and Objective: Carcinoma prostate is considered highly aggressive in Asian countries such as India. This raises an argument whether active surveillance (AS) gives a false sense of security as opposed to upfront radical prostatectomy (RP) in Indian males with low-risk prostate cancer (PCa). We analyzed our prospectively maintained robot-assisted RP (RARP) database to address this question. Materials and Methods: Five hundred and sixty-seven men underwent RARP by a single surgical team from September 2013 to September 2019. Of these, 46 (8.1%) were low risk considering the National Comprehensive Cancer Network criteria. Gleason grade group and stage were compared before and after surgery to ascertain the incidence of upgrading and upstaging. Preoperative clinical and pathological characteristics were analyzed for association with the probability of upstaging and upgrading. Results: The mean age was 60.8 ± 6.8 years. Average prostate-specific antigen level was 6.7 ± 2.0 ng/mL. 40 (86.9%) patients had a T1 stage disease and 6 (13%) patients were clinically in T2a stage. A total of 25 (54.3%) cases were either upstaged or upgraded, 19 (41.3%) showed no change, and the remaining 2 (4.3%) had no malignancy on the final RP specimen. Upstaging occurred in 8 (17.4%) cases: 5 (10.9%) to pT3a and 3 (6.5%) to pT3b. Upgrading occurred in 23 (50%) cases: 19 (41.3%) to Grade 2; 3 (6.5%) to Grade 3; and 1 (2.2%) to Grade 4. Conclusions: There is a 50% likelihood of upstaging or upgrading in Indian males with low-risk PCa eligible for AS. Decision to proceed with AS should be taken carefully.
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Affiliation(s)
- Shanky Singh
- Department of Urology, AIIMS, Rishikesh, Uttarakhand, India
| | - Saurabh Patil
- Department of Urooncology, Max Institute of Cancer Care, New Delhi, India
| | | | - Puneet Ahluwalia
- Department of Urooncology, Max Institute of Cancer Care, New Delhi, India
| | - Gagan Gautam
- Department of Urooncology, Max Institute of Cancer Care, New Delhi, India
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17
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No detrimental effect of a positive family history on postoperative upgrading and upstaging in men with low risk and favourable intermediate-risk prostate cancer: implications for active surveillance. World J Urol 2020; 39:2499-2506. [PMID: 33048258 PMCID: PMC8332649 DOI: 10.1007/s00345-020-03485-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/03/2020] [Indexed: 01/14/2023] Open
Abstract
Purpose To assess whether a first-degree family history or a fatal family history of prostate cancer (PCa) are associated with postoperative upgrading and upstaging among men with low risk and favourable intermediate-risk (FIR) PCa and to provide guidance on clinical decision making for active surveillance (AS) in this patient population. Methods Participants in the German Familial Prostate Cancer database diagnosed from 1994 to 2019 with (1) low risk (clinical T1c–T2a, biopsy Gleason Grade Group (GGG) 1, PSA < 10 ng/ml), (2) Gleason 6 FIR (clinical T1c–T2a, GGG 1, PSA 10–20 ng/ml), and (3) Gleason 3 + 4 FIR (clinical T1c–T2a, GGG 2, PSA < 10 ng/ml) PCa who were subsequently treated with radical prostatectomy (RP) were analysed for upgrading, defined as postoperative GGG 3 tumour or upstaging, defined as pT3–pT4 or pN1 disease at RP. Logistic regression analysis was used to assess whether PCa family history was associated with postoperative upgrading or upstaging. Results Among 4091 men who underwent RP, mean age at surgery was 64.4 (SD 6.7) years, 24.7% reported a family history, and 3.4% a fatal family history. Neither family history nor fatal family history were associated with upgrading or upstaging at low risk, Gleason 6 FIR, and Gleason 3 + 4 FIR PCa patients. Conclusion Results from the current study indicated no detrimental effect of family history on postoperative upgrading or upstaging. Therefore, a positive family history or fatal family history of PCa in FIR PCa patients should not be a reason to refrain from AS in men otherwise suitable. Electronic supplementary material The online version of this article (10.1007/s00345-020-03485-5) contains supplementary material, which is available to authorized users.
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18
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Collà Ruvolo C, Stolzenbach LF, Nocera L, Deuker M, Mistretta FA, Luzzago S, Tian Z, Longo N, Graefen M, Chun FKH, Saad F, Briganti A, De Cobelli O, Mirone V, Karakiewicz PI. Comparison of Mexican-American vs Caucasian prostate cancer active surveillance candidates. Urol Oncol 2020; 39:74.e1-74.e7. [PMID: 32950397 DOI: 10.1016/j.urolonc.2020.08.012] [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] [Received: 04/27/2020] [Revised: 06/26/2020] [Accepted: 08/05/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND We compared upgrading and upstaging rates in low risk and favorable intermediate risk prostate cancer (CaP) patients according to racial and/or ethnic group: Mexican-Americans and Caucasians. METHODS Within Surveillance, Epidemiology and End Results database (2010-2015), we identified low risk and favorable intermediate risk CaP patients according to National Comprehensive Cancer Network guidelines. Descriptives and logistic regression models were used. Furthermore, a subgroup analysis was performed to test the association between Mexican-American vs. Caucasian racial and/or ethnic groups and upgrading either to Gleason-Grade Group (GGG II) or to GGG III, IV or V, in low risk or favorable intermediate risk CaP patients, respectively. RESULTS We identified 673 (2.6%) Mexican-American and 24,959 (97.4%) Caucasian CaP patients. Of those, 14,789 were low risk (434 [2.9%] Mexican-Americans vs. 14,355 [97.1%] Caucasians) and 10,834 were favorable intermediate risk (239 [2.2%] Mexican-Americans vs. 10,604 [97.8%] Caucasians). In low risk CaP patients, Mexican-American vs. Caucasian racial and/or ethnic group did not result in either upgrading or upstaging differences. However, in favorable intermediate risk CaP patients, upgrading rate was higher in Mexican-Americans than in Caucasians (31.4 vs. 25.5%, OR 1.33, P = 0.044), but no difference was recorded for upstaging. When comparisons focused on upgrading to GGG III, IV or V, higher rate was recorded in Mexican-American relative to Caucasian favorable intermediate risk CaP patients (20.4 vs. 15.4%, OR 1.41, P = 0.034). CONCLUSION Low risk Mexican-American CaP patients do not differ from low risk Caucasian CaP patients. However, favorable intermediate risk Mexican-American CaP patients exhibit higher rates of upgrading than their Caucasian counterparts. This information should be considered at treatment decision making.
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Affiliation(s)
- Claudia Collà Ruvolo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Italy; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
| | - Lara Franziska Stolzenbach
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Luigi Nocera
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy
| | - Marina Deuker
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Stefano Luzzago
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Nicola Longo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Italy
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio De Cobelli
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy; Dipartimento di Oncologia ed Ematoncologia - DIPO- Univeristà degli Studi di Milano, Milan, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
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19
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Percot M, Robert G, Bladou F, Ferrière JM, Bensadoun H, Bernhard JC, Alezra E, Capon G, Sénéchal C, Gourtaud G, Brureau L, Roux V, Blanchet P, Eyraud R. Active surveillance in prostate cancer is possible for Afro-Caribbean population: Comparison of oncological outcomes with a Caucasian cohort. Prog Urol 2020; 30:532-540. [DOI: 10.1016/j.purol.2020.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/03/2020] [Accepted: 05/17/2020] [Indexed: 12/24/2022]
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20
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Gosein MA, Narinesingh D, Motilal S, Ramkissoon AP, Goetz CM, Sadho K, Mosodeen MD, Banfield R. Biparametric MRI prior to Radical Radiation Therapy for Prostate Cancer in a Caribbean Population: Implications for Risk Group Stratification and Treatment. Radiol Imaging Cancer 2020; 2:e200007. [PMID: 33778724 PMCID: PMC7983799 DOI: 10.1148/rycan.2020200007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/20/2020] [Accepted: 04/07/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE To assess risk-group migration and subsequent management change following biparametric MRI using a risk-stratified approach in a group of Caribbean men with prostate adenocarcinoma being offered external beam radiation therapy (EBRT). MATERIALS AND METHODS This retrospective study assessed the biparametric MRI findings in men who opted for EBRT from January 2018 to June 2019 (n = 79; mean age, 67.9 years ± 6.2 [standard deviation]). Serum prostate-specific antigen level, digital rectal examination findings, histologic grade group (GG) from transrectal US-guided biopsy, prior androgen deprivation therapy (ADT), and any prior CT results were used to stratify patients into low-, intermediate-, and high-risk groups, according to the National Comprehensive Cancer Network risk categories. Risk-group stratification prior to MRI separated patients into low- (seven of 79 [8.9%]), intermediate- (36 of 79 [45.6%]) and high-risk (36 of 79 [45.6%]) groups. Following MRI, any risk group (low, intermediate, high, nodal involvement, and metastatic disease) or oncologic management changes were recorded. Multivariable binary logistic regression analyses were used to assess predictor of upgrade status, with adjustment for demographic covariates jointly. RESULTS Following MRI, 30 of 79 (38.0%) patients had risk-group upshifts compared with their original assessment. Patients were recategorized into low risk (one of 79, 1.3%), intermediate risk (19 of 79, 24.1%), high risk (51 of 79, 64.6%), nodal involvement (one of 79, 1.3%), and metastatic disease (seven of 79, 8.9%). From the original groupings, there were six of seven (85.7%) from the low group, 18 of 36 (50.0%) from the intermediate group, and six of 36 (16.7%) from the high group that had risk group upward shifts. There was no association with GG: GG2 versus GG1, P = .53; GG3 versus GG1, P = .98; or prior ADT (P = .37) and the adjusted odds of risk-group upshifts. MRI findings resulted in treatment plan modification for 39 of 79 (49.4%) men overall. CONCLUSION Prostate MRI should be considered for patients in high-risk populations prior to EBRT because upstaging from MR image assessment may have implications for modification of treatment.Keywords: MR-Imaging, Prostate, Radiation Therapy© RSNA, 2020See the commentary by Davenport and Shankar in this issue.
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21
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Azal Neto W, Andrade GM, Billis A, Reis LO. Biopsy core length in white versus African descendant prostate cancer patients. Scand J Urol 2020; 54:188-193. [PMID: 32343184 DOI: 10.1080/21681805.2020.1754907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To explore whether distinct prostate cancer (PCa) prognoses between ethnicities could be explained by diverse characteristics in the prostate biopsy.Methods: Clinical, prostate biopsy and surgical single-institution data of whites and African descendants with similar access to the health system who underwent radical prostatectomy whole gland histopathology within 60 days after biopsy from 2010 to 2011 and followed for 5 years minimum were compared.Results: Among 203 included patients, 153 (75.4%) were whites and 50 (24.6%) were African descendants. The mean patients' age was 63.7 (± 6.8) years. Digital rectal examination (DRE) was suspected of cancer in 45.2% of the patients. The prostate biopsy core length was smaller in African descendants than in whites, overall 11.0 ± 3.2 vs 12.0 ± 2.9 mm, p = 0.037, and without neoplasia, 10.4 ± 3.8 vs 11.7 ± 3.1 mm, p = 0.038, respectively. Also, suspicious DRE showed smaller biopsy core length, overall 11.1 ± 3.2 mm vs 12.4 ± 2.6, p = 0.003, cancer positive 12.0 ± 4.8 mm vs 13.3 ± 3.7, p = 0.022 and negative 10.6 ± 3.6 mm vs 12.2 ± 3.0, p = 0.002. On 81 months median follow-up, more African descendants were lost to follow-up (10%, n = 5 vs 3.9%, n = 6) and the biochemical recurrence rate was the same between the groups (33.3%).Conclusion: In a PCa population with similar access to the health system, prostate biopsy core length in African descendant men is significantly smaller than in whites. This finding is new and may add to the controversial argument of PCa having a worse prognosis in African descendant patients.
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Affiliation(s)
- Wilmar Azal Neto
- UroScience, Department of Urology, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil
| | - Guilherme Miranda Andrade
- UroScience, Department of Urology, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil
| | - Athanase Billis
- UroScience, Department of Urology, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil
| | - Leonardo O Reis
- UroScience, Department of Urology, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil
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22
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Deka R, Parsons JK, Simpson DR, Riviere P, Nalawade V, Vitzthum LK, Kader AK, Kane CJ, Rock CS, Murphy JD, Rose BS. African-American men with low-risk prostate cancer treated with radical prostatectomy in an equal-access health care system: implications for active surveillance. Prostate Cancer Prostatic Dis 2020; 23:581-588. [DOI: 10.1038/s41391-020-0230-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/24/2020] [Accepted: 03/31/2020] [Indexed: 12/31/2022]
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23
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The impact of time from biopsy to radical prostatectomy on Gleason score undergrading and other related factors. Actas Urol Esp 2020; 44:187-195. [PMID: 31843220 DOI: 10.1016/j.acuro.2019.08.004] [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] [Received: 06/23/2019] [Revised: 07/15/2019] [Accepted: 08/27/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Gleason score biopsy undergrading (GSBU) can have an impact on the management and prognosis of patients with prostate cancer. We analyze the possible impact of time and other clinical and analytical factors in the appearance of GSBU in our series. PATIENTS AND METHOD Ambispective, multicenter study of 1955 patients with localized prostate cancer undergoing radical prostatectomy between 2005 and 2018. Descriptive statistics and hypothesis testing are reported by univariate and multivariate analyses. RESULTS Mean age 63.69 (44-80) years, median PSA 8.70 ng / ml (1.23-99). GSBU was observed in 34.7% of the entire cohort. In 72.8% of the cases, the GSBU occurred in one consecutive Gleason score, with the progression from 3 + 3 to 3 + 4 being the most frequent (289 patients, 47.6%). Performing radical prostatectomy 90-180 days before or after the biopsy does not have an impact on its undergrading in any of the groups. In the univariate and multivariate analysis, the presence of tumor or pathological rectal examination in both lobes, the tumor load ≥50% of cylinders and a DPSA ≥0.20, showed independent discriminative capacity to select patients who presented GSBU. CONCLUSIONS The time from biopsy to radical prostatectomy did not show impact on GSBU. The number of affected cylinders, bilateral tumor and DPSA are easily accessible parameters that can help us select patients with greater probability of presenting GSBU.
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24
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Morrison BF, Aiken WD, Reid G, Mayhew R, Hanchard B. Pathological upgrading and upstaging at radical prostatectomy in Jamaican men with low-risk prostate cancer. Ecancermedicalscience 2019; 13:971. [PMID: 31921342 PMCID: PMC6834384 DOI: 10.3332/ecancer.2019.971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Indexed: 01/05/2023] Open
Abstract
Several studies suggest race-based health disparities in men with low-risk prostate cancer (PCa), with African American males having poorer oncological outcomes. We sought to determine the prevalence and predictors of pathological upgrading and upstaging in Jamaican men with low-risk PCa treated with radical prostatectomy (RP). Data on 141 men who met the National Comprehensive Cancer Network criteria for low-risk PCa and underwent RP at a single institution were reviewed. All men had a transrectal ultrasound-guided biopsy. Pre-operative clinical and final pathological data were obtained. Data were summarised as means and standard deviations or percentages as appropriate. Bivariate analyses such as independent samples t-tests and chi-square tables were conducted and logistic regression models were estimated to predict upgrading (>Gleason 6) and upstaging (p ≥ T3). The mean age was 59.5 ± 7.8 years with mean prostate specific antigen (PSA) of 6.6 ± 2 ng/mL. A total of 48.3% of men were upgraded and 11.4% were upstaged. Bivariate analyses indicated that PSA (p = 0.008) and percentage positive cores (p = 0.002) were associated with upgrading. PSA (p = 0.042) and percentage positive cores (p = 0.003) were significantly associated with upstaging. The odds of upgrading increased with increased PSA levels (OR 1.40, 95% CI 1.05-1.87, p = 0.021) or increased percentage positive cores (OR 8.27, 95% CI 2.19-31.16, p = 0.002). The odds of upstaging increased with increased PSA levels (OR 1.4, 95% CI 1.01-1.96, p = 0.046) and with increased percentages positive cores (OR 11.4; 95% CI 2.06-63.09, p = 0.005). Jamaican men with low-risk PCa are at high risk of pathological upgrading and upstaging at RP. These findings should be taken into consideration when discussing treatment options with these patients.
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Affiliation(s)
| | | | - Gareth Reid
- University of the West Indies, Mona PO, Kingston 7, Jamaica
| | - Richard Mayhew
- University of the West Indies, Mona PO, Kingston 7, Jamaica
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25
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Yoneyama T, Tobisawa Y, Kaneko T, Kaya T, Hatakeyama S, Mori K, Sutoh Yoneyama M, Okubo T, Mitsuzuka K, Duivenvoorden W, Pinthus JH, Hashimoto Y, Ito A, Koie T, Suda Y, Gardiner RA, Ohyama C. Clinical significance of the LacdiNAc-glycosylated prostate-specific antigen assay for prostate cancer detection. Cancer Sci 2019; 110:2573-2589. [PMID: 31145522 PMCID: PMC6676104 DOI: 10.1111/cas.14082] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/27/2019] [Accepted: 05/29/2019] [Indexed: 01/02/2023] Open
Abstract
To reduce unnecessary prostate biopsies (Pbx), better discrimination is needed. To identify clinically significant prostate cancer (CSPC) we determined the performance of LacdiNAc‐glycosylated prostate‐specific antigen (LDN‐PSA) and LDN‐PSA normalized by prostate volume (LDN‐PSAD). We retrospectively measured LDN‐PSA, total PSA (tPSA), and free PSA/tPSA (F/T PSA) values in 718 men who underwent a Pbx in 3 academic urology clinics in Japan and Canada (Pbx cohort) and in 174 PC patients who subsequently underwent radical prostatectomy in Australia (preop‐PSA cohort). The assays were evaluated using the area under the receiver operating characteristics curve (AUC) and decision curve analyses to discriminate CSPC. In the Pbx cohort, LDN‐PSAD (AUC 0.860) provided significantly better clinical performance for discriminating CSPC compared with LDN‐PSA (AUC 0.827, P = 0.0024), PSAD (AUC 0.809, P < 0.0001), tPSA (AUC 0.712, P < 0.0001), and F/T PSA (AUC 0.661, P < 0.0001). The decision curve analysis showed that using a risk threshold of 20% and adding LDN‐PSA and LDN‐PSAD to the base model (age, digital rectal examination status, tPSA, and F/T PSA) permitted avoidance of even more biopsies without missing CSPC (9.89% and 18.11%, respectively vs 2.23% [base model]). In the preop‐PSA cohort, LDN‐PSA values positively correlated with tumor volume and tPSA and were significantly higher in pT3, pathological Gleason score ≥ 7. Limitations include limited sample size, retrospective nature, and no family history information prior to biopsy. LacdiNAc‐glycosylated PSA is significantly better than the conventional PSA test in identifying patients with CSPC. This study was approved by the ethics committee of each institution (“The Study about Carbohydrate Structure Change in Urological Disease”; approval no. 2014‐195).
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Affiliation(s)
- Tohru Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuki Tobisawa
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Takatoshi Kaya
- Corporate R&D Headquarters, Konica Minolta, Tokyo, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kazuyuki Mori
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Mihoko Sutoh Yoneyama
- Department of Cancer Immunology and Cell Biology, Oyokyo Kidney Research Institute, Hirosaki, Japan
| | - Teppei Okubo
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koji Mitsuzuka
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | | | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Akihiro Ito
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yoshihiko Suda
- Corporate R&D Headquarters, Konica Minolta, Tokyo, Japan
| | - Robert A Gardiner
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Chikara Ohyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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26
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Bloom JB, Lebastchi AH, Gold SA, Hale GR, Sanford T, Mehralivand S, Ahdoot M, Rayn KN, Czarniecki M, Smith C, Valera V, Wood BJ, Merino MJ, Choyke PL, Parnes HL, Turkbey B, Pinto PA. Use of multiparametric magnetic resonance imaging and fusion-guided biopsies to properly select and follow African-American men on active surveillance. BJU Int 2019; 124:768-774. [PMID: 31141307 DOI: 10.1111/bju.14835] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine the rate of Gleason Grade Group (GGG) upgrading in African-American (AA) men with a prior diagnosis of low-grade prostate cancer (GGG 1 or GGG 2) on 12-core systematic biopsy (SB) after multiparametric magnetic resonance imaging (mpMRI) and fusion biopsy (FB); and whether AA men who continued active surveillance (AS) after mpMRI and FB fared differently than a predominantly Caucasian (non-AA) population. PATIENTS AND METHODS A database of men who had undergone mpMRI and FB was queried to determine rates of upgrading by FB amongst men deemed to be AS candidates based on SB prior to referral. After FB, Kaplan-Meier curves were generated for AA men and non-AA men who then elected AS. The time to GGG upgrading and time continuing AS were compared using the log-rank test. RESULTS AA men referred with GGG 1 disease on previous SB were upgraded to GGG ≥3 by FB more often than non-AA men, 22.2% vs 12.7% (P = 0.01). A total of 32 AA men and 258 non-AA men then continued AS, with a median (interquartile range) follow-up of 39.19 (24.24-56.41) months. The median time to progression was 59.7 and 60.5 months, respectively (P = 0.26). The median time continuing AS was 61.9 months and not reached, respectively (P = 0.80). CONCLUSIONS AA men were more likely to be upgraded from GGG 1 on SB to GGG ≥3 on initial FB; however, AA and non-AA men on AS subsequently progressed at similar rates following mpMRI and FB. A greater tendency for SB to underestimate tumour grade in AA men may explain prior studies that have shown AA men to be at higher risk of progression during AS.
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Affiliation(s)
| | | | - Samuel A Gold
- Urologic Oncology Branch, NCI, NIH, Bethesda, MD, USA
| | - Graham R Hale
- Urologic Oncology Branch, NCI, NIH, Bethesda, MD, USA
| | - Thomas Sanford
- Urologic Oncology Branch, NCI, NIH, Bethesda, MD, USA.,Molecular Imaging Program, NCI, NIH, Bethesda, MD, USA
| | - Sherif Mehralivand
- Urologic Oncology Branch, NCI, NIH, Bethesda, MD, USA.,Molecular Imaging Program, NCI, NIH, Bethesda, MD, USA.,Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | | | - Kareem N Rayn
- Urologic Oncology Branch, NCI, NIH, Bethesda, MD, USA
| | | | - Clayton Smith
- Molecular Imaging Program, NCI, NIH, Bethesda, MD, USA
| | | | - Bradford J Wood
- Center for Interventional Oncology, NCI, NIH, Bethesda, MD, USA
| | | | | | | | - Baris Turkbey
- Molecular Imaging Program, NCI, NIH, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, NCI, NIH, Bethesda, MD, USA.,Center for Interventional Oncology, NCI, NIH, Bethesda, MD, USA
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27
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Canter DJ, Reid J, Latsis M, Variano M, Halat S, Rajamani S, Gurtner KE, Sangale Z, Brawer M, Stone S, Bardot S. Comparison of the Prognostic Utility of the Cell Cycle Progression Score for Predicting Clinical Outcomes in African American and Non-African American Men with Localized Prostate Cancer. Eur Urol 2019; 75:515-522. [DOI: 10.1016/j.eururo.2018.10.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/12/2018] [Indexed: 12/27/2022]
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28
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Teslow EA, Bao B, Dyson G, Legendre C, Mitrea C, Sakr W, Carpten JD, Powell I, Bollig-Fischer A. Exogenous IL-6 induces mRNA splice variant MBD2_v2 to promote stemness in TP53 wild-type, African American PCa cells. Mol Oncol 2018; 12:1138-1152. [PMID: 29741809 PMCID: PMC6026877 DOI: 10.1002/1878-0261.12316] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/07/2018] [Accepted: 04/25/2018] [Indexed: 11/12/2022] Open
Abstract
African American men (AAM) are at higher risk of being diagnosed with prostate cancer (PCa) and are at higher risk of dying from the disease compared to European American men (EAM). We sought to better understand PCa molecular diversity that may be underlying these disparities. We performed RNA‐sequencing analysis on high‐grade PCa to identify genes showing differential tumor versus noncancer adjacent tissue expression patterns unique to AAM or EAM. We observed that interleukin‐6 (IL‐6) was upregulated in the nonmalignant adjacent tissue in AAM, but in EAM IL‐6 expression was higher in PCa tissue. Enrichment analysis identified that genes linked to the function of TP53 were overrepresented and downregulated in PCa tissue from AAM. These RNA‐sequencing results informed our subsequent investigation of a diverse PCa cell line panel. We observed that PCa cell lines that are TP53 wild‐type, which includes cell lines derived from AAM (MDA‐PCa‐2b and RC77T), did not express detectable IL‐6 mRNA. IL‐6 treatment of these cells downregulated wild‐type TP53 protein and induced mRNA and protein expression of the epigenetic reader methyl CpG binding domain protein 2 (MBD2), specifically the alternative mRNA splicing variant MBD2_v2. Further investigation validated that upregulation of this short isoform promotes self‐renewal and expansion of PCa cancer stem‐like cells (CSCs). In conclusion, this report contributes to characterizing gene expression patterns in high‐grade PCa and adjacent noncancer tissues from EAM and AAM. The results we describe here advance what is known about the biology associated with PCa race disparities and the molecular signaling of CSCs.
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Affiliation(s)
- Emily A Teslow
- Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA.,Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Bin Bao
- Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA.,Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Greg Dyson
- Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA.,Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Christophe Legendre
- Integrated Cancer Genomics Division, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Cristina Mitrea
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA.,Department of Computer Science, Wayne State University, Detroit, MI, USA
| | - Wael Sakr
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA
| | - John D Carpten
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Isaac Powell
- Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA.,Department of Urology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Aliccia Bollig-Fischer
- Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA.,Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
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Patel NH, Bloom J, Hillelsohn J, Fullerton S, Allman D, Matthews G, Eshghi M, Phillips JL. Prostate Cancer Screening Trends After United States Preventative Services Task Force Guidelines in an Underserved Population. Health Equity 2018; 2:55-61. [PMID: 29806045 PMCID: PMC5963250 DOI: 10.1089/heq.2018.0004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Prostate cancer screening is a controversial topic. We examined trends in Prostate Specific Antigen (PSA) testing in an underserved population before and after the United States Preventative Services Task Force (USPSTF) recommendation against screening. Methods: Data were collected on all PSA and cholesterol screening tests from 2008 to 2014. We examined the trend of these tests and prostate biopsies while comparing this data to lipid panel data to adjust for changes in patient population. Results: A decrease in PSA screening was observed from 2010 through 2014, with the greatest decline in 2012. The age group most affected was patients aged 55–69 years. The amount of prostate biopsies during this period decreased as well. Conclusions: Decreased rates of PSA screening were observed in our urban hospital population that preceded the publication of the USPSTF guidelines. The incidence of prostate biopsies decreased in this timeframe. It now remains to be demonstrated whether decreased PSA screening rates impact the diagnosis of and ultimately the survival from prostate cancer.
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Affiliation(s)
- Neel H Patel
- Department of Urology, New York Medical College, Valhalla, New York
| | - Jonathan Bloom
- Urologic Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Joel Hillelsohn
- Department of Urology, New York Medical College, Valhalla, New York
| | - Sean Fullerton
- Department of Urology, New York Medical College, Valhalla, New York
| | - Denton Allman
- Department of Urology, New York Medical College, Valhalla, New York
| | - Gerald Matthews
- Department of Urology, New York Medical College, Valhalla, New York
| | - Majid Eshghi
- Department of Urology, New York Medical College, Valhalla, New York
| | - John L Phillips
- Department of Urology, New York Medical College, Valhalla, New York
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Reply by Authors. J Urol 2018; 199:306. [DOI: 10.1016/j.juro.2017.08.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this review is to examine prostate cancer racial disparities specific to the African-American population. RECENT FINDINGS African-American men are more likely to be diagnosed with prostate cancer, present at an earlier age; are more likely to have locally advanced or metastatic disease at diagnosis; and have suboptimal outcomes to standard treatments. Prostate cancer treatment requires a nuanced approach, particularly when applying screening, counseling, and management of African-American men. Oncological as well as functional outcomes may differ and are potentially due to a combination of genetic, molecular, behavioral, and socioeconomic factors.
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Affiliation(s)
- Zachary L Smith
- Department of Surgery, Section of Urology, The University of Chicago Medicine, 5841 S. Maryland Avenue, MC 6038, Chicago, IL, 60637, USA.
| | - Scott E Eggener
- Department of Surgery, Section of Urology, The University of Chicago Medicine, 5841 S. Maryland Avenue, MC 6038, Chicago, IL, 60637, USA
| | - Adam B Murphy
- Department of Urology, Northwestern University Feinberg School of Medicine, Tarry Building Room 16-703, 300 E. Superior Street, Chicago, IL, 60611, USA
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Smith JA. This Month in Adult Urology. J Urol 2017. [DOI: 10.1016/j.juro.2016.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hagiwara K, Tobisawa Y, Kaya T, Kaneko T, Hatakeyama S, Mori K, Hashimoto Y, Koie T, Suda Y, Ohyama C, Yoneyama T. Wisteria floribunda Agglutinin and Its Reactive-Glycan-Carrying Prostate-Specific Antigen as a Novel Diagnostic and Prognostic Marker of Prostate Cancer. Int J Mol Sci 2017; 18:ijms18020261. [PMID: 28134773 PMCID: PMC5343797 DOI: 10.3390/ijms18020261] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 01/17/2017] [Accepted: 01/19/2017] [Indexed: 01/09/2023] Open
Abstract
Wisteria floribunda agglutinin (WFA) preferably binds to LacdiNAc glycans, and its reactivity is associated with tumor progression. The aim of this study to examine whether the serum LacdiNAc carrying prostate-specific antigen–glycosylation isomer (PSA-Gi) and WFA-reactivity of tumor tissue can be applied as a diagnostic and prognostic marker of prostate cancer (PCa). Between 2007 and 2016, serum PSA-Gi levels before prostate biopsy (Pbx) were measured in 184 biopsy-proven benign prostatic hyperplasia patients and 244 PCa patients using an automated lectin-antibody immunoassay. WFA-reactivity on tumor was analyzed in 260 radical prostatectomy (RP) patients. Diagnostic and prognostic performance of serum PSA-Gi was evaluated using area under the receiver-operator characteristic curve (AUC). Prognostic performance of WFA-reactivity on tumor was evaluated via Cox proportional hazards regression analysis and nomogram. The AUC of serum PSA-Gi detecting PCa and predicting Pbx Grade Group (GG) 3 and GG ≥ 3 after RP was much higher than those of conventional PSA. Multivariate analysis showed that WFA-reactivity on prostate tumor was an independent risk factor of PSA recurrence. The nomogram was a strong model for predicting PSA-free survival provability with a c-index ≥0.7. Serum PSA-Gi levels and WFA-reactivity on prostate tumor may be a novel diagnostic and pre- and post-operative prognostic biomarkers of PCa, respectively.
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Affiliation(s)
- Kazuhisa Hagiwara
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
| | - Yuki Tobisawa
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
| | - Takatoshi Kaya
- Corporate R&D Headquarters, Konica Minolta, Inc., Hino-shi, Tokyo 191-8511, Japan.
| | - Tomonori Kaneko
- Corporate R&D Headquarters, Konica Minolta, Inc., Hino-shi, Tokyo 191-8511, Japan.
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
| | - Kazuyuki Mori
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
| | - Yasuhiro Hashimoto
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
| | - Takuya Koie
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
| | - Yoshihiko Suda
- Corporate R&D Headquarters, Konica Minolta, Inc., Hino-shi, Tokyo 191-8511, Japan.
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
| | - Tohru Yoneyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
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