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Al Hussein Al Awamlh B, Wu X, Barocas DA, Moses KA, Hoffman RM, Basourakos SP, Lewicki P, Smelser WW, Arenas-Gallo C, Shoag JE. Intensity of observation with active surveillance or watchful waiting in men with prostate cancer in the United States. Prostate Cancer Prostatic Dis 2022:10.1038/s41391-022-00580-z. [PMID: 35882950 DOI: 10.1038/s41391-022-00580-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/27/2022] [Accepted: 07/14/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Population-based studies assessing various active surveillance (AS) protocols for prostate cancer, to date, have inferred AS participation by the lack of definitive treatment and use of post-diagnostic testing. This is problematic as evidence suggests that most men do not adhere to AS protocols. We sought to develop a novel method of identifying men on AS or watchful waiting (WW) independent of post-diagnostic testing and aimed to identify possible predictors of follow-up intensity in men on AS/WW. METHODS A predictive model was developed using SEER watchful waiting data to identify men ≥66 years on AS between 2010-2015, irrespective of post-diagnostic testing, and applied to SEER-Medicare database. AS intensity among different variables including age, prostate-specific antigen (PSA) level, number of total and positive biopsy cores, Charlson comorbidity index, race (Black vs. non-Black), US census region, and county poverty, income, and education levels were compared using multivariable regression analyses for PSA testing, surveillance biopsy, and magnetic resonance imaging (MRI). RESULTS A total of 2238 men were identified as being on AS. Of which, 81%, 33%, and 10% had a PSA test, surveillance biopsy, and MRI scan within 1-2 years, respectively. On multivariable analyses, Black men were less likely to have a PSA test (adjusted rate ratio [ARR] 0.60, 95% CI: 0.53-0.69), MRI scan (ARR 0.40, 95% CI: 0.24-0.68), and surveillance biopsy (ARR 0.71, 95% CI: 0.55-0.92) than non-Black men. Men within the highest income quintile were more likely to undergo PSA test (ARR 1.16, 95% CI: 1.05-1.27) and MRI scan (ARR 1.60, 95% CI 1.15-2.27) compared to men with the lowest income. CONCLUSIONS Black men and men with lower incomes on AS underwent less rigorous monitoring. Further study is needed to understand and ameliorate differences in AS rigor stemming from sociodemographic differences.
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Affiliation(s)
| | - Xian Wu
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, USA
| | - Daniel A Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kelvin A Moses
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Richard M Hoffman
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Spyridon P Basourakos
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Patrick Lewicki
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Woodson W Smelser
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Camilo Arenas-Gallo
- University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH, USA
| | - Jonathan E Shoag
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.,Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH, USA
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Lee CU, Choi J, Sung SH, Chung JH, Song W, Kang M, Sung HH, Jeong BC, Seo SI, Jeon SS, Lee HM, Jeon HG. The Role of Prostate Combination Biopsy Consisting of Targeted and Additional Systematic Biopsy. J Clin Med 2021; 10:4804. [PMID: 34768322 PMCID: PMC8584506 DOI: 10.3390/jcm10214804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/02/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To identify the role of combination biopsy, which consists of both targeted and additional systematic cores, in the diagnosis of clinically significant prostate cancer (csPCa). METHODS We retrospectively reviewed patients with PSA levels 2.5-15 ng/mL who have a suspicious prostate lesion (with the Prostate Imaging Reporting and Data System (PI-RADS) ≥ 3) on multiparametric MRI (mpMRI) between January 2016 and December 2018. We analyzed biopsy results by PI-RADS score and biopsy methods (systematic, targeted, and combination biopsy). RESULTS Of the 711 total patients, an average of 4.0 ± 1.8 targeted and 8.6 ± 3.1 additional systematic biopsies were performed. The additional systematic biopsies were sampled outside the targeted biopsy area. The combination biopsies detected more csPCa (201 patients, 28.3%) than did the targeted (175 patients, 24.6%) or systematic (124 patients, 17.4%) biopsies alone (p < 0.001). In the initial biopsy samples, there was a 7% increase in the detection of csPCa than in targeted biopsy (62% to 69%). It increased by 11% in repeat biopsy (46% to 57%). There was no statistical significance in both groups (p = 0.3174). CONCLUSIONS Combination biopsy has the benefit of detecting csPCa in both initial and repeat biopsy when there is a suspicious lesion on mpMRI.
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Affiliation(s)
- Chung Un Lee
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Joongwon Choi
- Department of Urology, VHS Medical Center, Seoul 05368, Korea;
| | - Si Hyun Sung
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Jae Hoon Chung
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Wan Song
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Minyong Kang
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Hyun Hwan Sung
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Byong Chang Jeong
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Seong Il Seo
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Seong Soo Jeon
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Hyun Moo Lee
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Hwang Gyun Jeon
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
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Li M, Zhang Q, Yang K. Role of MRI-Based Functional Imaging in Improving the Therapeutic Index of Radiotherapy in Cancer Treatment. Front Oncol 2021; 11:645177. [PMID: 34513659 PMCID: PMC8429950 DOI: 10.3389/fonc.2021.645177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/30/2021] [Indexed: 02/05/2023] Open
Abstract
Advances in radiation technology, such as intensity-modulated radiation therapy (IMRT), have largely enabled a biological dose escalation of the target volume (TV) and reduce the dose to adjacent tissues or organs at risk (OARs). However, the risk of radiation-induced injury increases as more radiation dose utilized during radiation therapy (RT), which predominantly limits further increases in TV dose distribution and reduces the local control rate. Thus, the accurate target delineation is crucial. Recently, technological improvements for precise target delineation have obtained more attention in the field of RT. The addition of functional imaging to RT can provide a more accurate anatomy of the tumor and normal tissues (such as location and size), along with biological information that aids to optimize the therapeutic index (TI) of RT. In this review, we discuss the application of some common MRI-based functional imaging techniques in clinical practice. In addition, we summarize the main challenges and prospects of these imaging technologies, expecting more inspiring developments and more productive research paths in the near future.
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Affiliation(s)
- Mei Li
- Department of Gynecology and Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Qin Zhang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Kaixuan Yang
- Department of Gynecology and Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
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Oliveira RARD, Mourão TC, Santana TBM, Favaretto RDL, Zequi SDC, Guimarães GC. Cost-Effectiveness Analysis of Prostate Cancer Screening in Brazil. Value Health Reg Issues 2021; 26:89-97. [PMID: 34146776 DOI: 10.1016/j.vhri.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/01/2021] [Accepted: 02/28/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Prostate cancer is one of the most common malignancies among men worldwide. Prostate-specific antigen (PSA) screening shows uncertain benefits and harms from clinical and economic perspectives, resulting in an important impact on healthcare systems. Because of nonstandardized studies and substantial differences among populations, data are still inconclusive. OBJECTIVE The objective of this study was to carry out long-term cost-effectiveness and cost-utility analysis on the PSA-screened population from the service provider's perspective in the Brazilian population. METHODS We performed a cost-effectiveness and cost-utility analysis using clinical outcomes obtained from 9692 men enrolled in the PSA screening program. Prostate cancer treatments, 5-year follow-up outcomes, and all related costs were examined. Data were compared with a nonscreened prostate cancer population to calculate incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR). ICER and ICUR were compared with the Brazilian-established willingness-to-pay (WTP) threshold (WTP = R$ 114 026.55). RESULTS A total of 251 of 9692 men had a diagnosis of prostate cancer (2.6%), of which 90% had localized disease. Two hundred and five patients were treated as follows: surgery (45.37%); radiation therapy (11.22%); radiation plus androgen deprivation therapy (21.95%); active surveillance (13.17%); exclusive androgen deprivation therapy (7.32%); and watchful waiting (0.98%). Two simulated cohorts were compared based on screening and nonscreening groups. Values obtained were-ICER of R$ 44 491.39 per life saved and ICUR of R$ 10 851.56 per quality-adjusted life year (QALY) gained-below the Brazilian WTP threshold and showed cost-effectiveness and cost-utility advantages. CONCLUSION According to the Brazilian WTP, PSA screening is a cost-effective policy from a hospital and long-term perspective and should have more standardized studies developed in different populations and economies.
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Affiliation(s)
- Renato Almeida Rosa de Oliveira
- Urology Department, Beneficência Portuguesa de São Paulo, São Paulo, Brazil; Instituto de Urologia, Oncologia e Cirurgia Robótica, São Paulo, Brazil.
| | - Thiago Camelo Mourão
- Urology Department, Beneficência Portuguesa de São Paulo, São Paulo, Brazil; Instituto de Urologia, Oncologia e Cirurgia Robótica, São Paulo, Brazil
| | - Thiago Borges Marques Santana
- Urology Department, Beneficência Portuguesa de São Paulo, São Paulo, Brazil; Instituto de Urologia, Oncologia e Cirurgia Robótica, São Paulo, Brazil
| | - Ricardo de Lima Favaretto
- Urology Department, Beneficência Portuguesa de São Paulo, São Paulo, Brazil; Instituto de Urologia, Oncologia e Cirurgia Robótica, São Paulo, Brazil
| | | | - Gustavo Cardoso Guimarães
- Instituto de Urologia, Oncologia e Cirurgia Robótica, São Paulo, Brazil; Surgical Oncology Department, Beneficência Portuguesa de São Paulo, São Paulo, Brazil
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Vickers AJ, Russo G, Lilja H, Evans C, Schalken JA, Klein E, Eggener S. How Should Molecular Markers and Magnetic Resonance Imaging Be Used in the Early Detection of Prostate Cancer? Eur Urol Oncol 2021:S2588-9311(21)00034-1. [PMID: 33608234 DOI: 10.1016/j.euo.2021.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/05/2021] [Accepted: 01/29/2021] [Indexed: 11/21/2022]
Abstract
The literature gives limited data or guidance on how to select or combine biomarkers and magnetic resonance imaging (MRI) for the early detection of prostate cancer. We strongly recommend prospective studies large enough to address questions such as the properties of biomarkers in cases with high versus low Prostate Imaging-Reporting and Data System scores or the correlation between biomarkers and MRI, and that evaluate results in the context of reasonable clinical scenarios.
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Tilki D, Chandrasekar T. Localized Prostate Cancer: Exploring the Boundaries of Current Treatment Paradigms. Eur Urol Focus 2020; 6:199-200. [PMID: 32057738 DOI: 10.1016/j.euf.2020.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/16/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
| | - Thenappan Chandrasekar
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA; Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
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