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Purdue MP, Dutta D, Machiela MJ, Gorman BR, Winter T, Okuhara D, Cleland S, Ferreiro-Iglesias A, Scheet P, Liu A, Wu C, Antwi SO, Larkin J, Zequi SC, Sun M, Hikino K, Hajiran A, Lawson KA, Cárcano F, Blanchet O, Shuch B, Nepple KG, Margue G, Sundi D, Diver WR, Folgueira MAAK, van Bokhoven A, Neffa F, Brown KM, Hofmann JN, Rhee J, Yeager M, Cole NR, Hicks BD, Manning MR, Hutchinson AA, Rothman N, Huang WY, Linehan WM, Lori A, Ferragu M, Zidane-Marinnes M, Serrano SV, Magnabosco WJ, Vilas A, Decia R, Carusso F, Graham LS, Anderson K, Bilen MA, Arciero C, Pellegrin I, Ricard S, Scelo G, Banks RE, Vasudev NS, Soomro N, Stewart GD, Adeyoju A, Bromage S, Hrouda D, Gibbons N, Patel P, Sullivan M, Protheroe A, Nugent FI, Fournier MJ, Zhang X, Martin LJ, Komisarenko M, Eisen T, Cunningham SA, Connolly DC, Uzzo RG, Zaridze D, Mukeria A, Holcatova I, Hornakova A, Foretova L, Janout V, Mates D, Jinga V, Rascu S, Mijuskovic M, Savic S, Milosavljevic S, Gaborieau V, Abedi-Ardekani B, McKay J, Johansson M, Phouthavongsy L, Hayman L, Li J, Lungu I, Bezerra SM, Souza AG, Sares CTG, Reis RB, Gallucci FP, Cordeiro MD, Pomerantz M, Lee GSM, Freedman ML, Jeong A, Greenberg SE, Sanchez A, Thompson RH, Sharma V, Thiel DD, Ball CT, Abreu D, Lam ET, Nahas WC, Master VA, Patel AV, Bernhard JC, Freedman ND, Bigot P, Reis RM, Colli LM, Finelli A, Manley BJ, Terao C, Choueiri TK, Carraro DM, Houlston R, Eckel-Passow JE, Abbosh PH, Ganna A, Brennan P, Gu J, Chanock SJ. Multi-ancestry genome-wide association study of kidney cancer identifies 63 susceptibility regions. Nat Genet 2024:10.1038/s41588-024-01725-7. [PMID: 38671320 DOI: 10.1038/s41588-024-01725-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 03/13/2024] [Indexed: 04/28/2024]
Abstract
Here, in a multi-ancestry genome-wide association study meta-analysis of kidney cancer (29,020 cases and 835,670 controls), we identified 63 susceptibility regions (50 novel) containing 108 independent risk loci. In analyses stratified by subtype, 52 regions (78 loci) were associated with clear cell renal cell carcinoma (RCC) and 6 regions (7 loci) with papillary RCC. Notably, we report a variant common in African ancestry individuals ( rs7629500 ) in the 3' untranslated region of VHL, nearly tripling clear cell RCC risk (odds ratio 2.72, 95% confidence interval 2.23-3.30). In cis-expression quantitative trait locus analyses, 48 variants from 34 regions point toward 83 candidate genes. Enrichment of hypoxia-inducible factor-binding sites underscores the importance of hypoxia-related mechanisms in kidney cancer. Our results advance understanding of the genetic architecture of kidney cancer, provide clues for functional investigation and enable generation of a validated polygenic risk score with an estimated area under the curve of 0.65 (0.74 including risk factors) among European ancestry individuals.
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Affiliation(s)
- Mark P Purdue
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
| | - Diptavo Dutta
- Integrative Tumor Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Mitchell J Machiela
- Integrative Tumor Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | | | - Timothy Winter
- Laboratory of Genetic Susceptibility, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | | | | | | | - Paul Scheet
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aoxing Liu
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Chao Wu
- Biosample Repository, Fox Chase Cancer Center-Temple Health, Philadelphia, PA, USA
| | - Samuel O Antwi
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - James Larkin
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Stênio C Zequi
- Department of Urology, A.C. Camargo Cancer Center, São Paulo, Brazil
- National Institute for Science and Technology in Oncogenomics and Therapeutic Innovation INCIT-INOTE, São Paulo, Brazil
- Latin American Renal Cancer Group, São Paulo, Brazil
- Department of Surgery, Division of Urology, São Paulo Federal University, São Paulo, Brazil
| | - Maxine Sun
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Keiko Hikino
- Laboratory for Pharmacogenomics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Ali Hajiran
- Department of Urology, Division of Urologic Oncology, West Virginia University Cancer Institute, Morgantown, WV, USA
| | - Keith A Lawson
- Department of Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Flavio Cárcano
- Department of Medical Oncology, Barretos Cancer Hospital, Barretos, Brazil
| | | | - Brian Shuch
- Department of Urology, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Kenneth G Nepple
- Department of Urology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Gaëlle Margue
- Department of Urology, CHU Bordeaux, Bordeaux, France
| | - Debasish Sundi
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - W Ryan Diver
- Department of Population Science, American Cancer Society, Atlanta, GA, USA
| | - Maria A A K Folgueira
- Departments of Radiology and Oncology, Comprehensive Center for Precision Oncology-C2PO, Centro de Investigação Translacional em Oncologia, Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas, Faculdade de Medicina Universidade de São Paulo, São Paulo, Brazil
| | - Adrie van Bokhoven
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Kevin M Brown
- Laboratory of Translational Genomics, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Jonathan N Hofmann
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Jongeun Rhee
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Meredith Yeager
- Cancer Genomics Research Laboratory, Frederick National Laboratory, Rockville, MD, USA
| | - Nathan R Cole
- Cancer Genomics Research Laboratory, Frederick National Laboratory, Rockville, MD, USA
| | - Belynda D Hicks
- Cancer Genomics Research Laboratory, Frederick National Laboratory, Rockville, MD, USA
| | - Michelle R Manning
- Cancer Genomics Research Laboratory, Frederick National Laboratory, Rockville, MD, USA
| | - Amy A Hutchinson
- Cancer Genomics Research Laboratory, Frederick National Laboratory, Rockville, MD, USA
| | - Nathaniel Rothman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Wen-Yi Huang
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - W Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Adriana Lori
- Department of Population Science, American Cancer Society, Atlanta, GA, USA
| | | | | | - Sérgio V Serrano
- Department of Medical Oncology, Barretos Cancer Hospital, Barretos, Brazil
| | | | - Ana Vilas
- Department of Pathology, Hospital Pasteur, Montevideo, Uruguay
| | - Ricardo Decia
- Department of Urology, Hospital Pasteur, Montevideo, Uruguay
| | | | - Laura S Graham
- Department of Medicine, Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kyra Anderson
- Oncology Clinical Research Support Team, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mehmet A Bilen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Cletus Arciero
- Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Solène Ricard
- Department of Urology, CHU Bordeaux, Bordeaux, France
| | - Ghislaine Scelo
- Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore
| | - Rosamonde E Banks
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Naveen S Vasudev
- Department of Oncology, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Naeem Soomro
- Department of Urology, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Grant D Stewart
- Department of Urology, Western General Hospital, NHS Lothian, Edinburgh, UK
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Adebanji Adeyoju
- Department of Urology, Stockport NHS Foundation Trust, Stockport, UK
| | - Stephen Bromage
- Department of Urology, Stockport NHS Foundation Trust, Stockport, UK
| | - David Hrouda
- Department of Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Norma Gibbons
- Department of Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Poulam Patel
- Division of Oncology, University of Nottingham, Nottingham, UK
| | - Mark Sullivan
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrew Protheroe
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Francesca I Nugent
- Department of Urology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | | | - Xiaoyu Zhang
- Department of Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Lisa J Martin
- Department of Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Maria Komisarenko
- Department of Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Timothy Eisen
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sonia A Cunningham
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Denise C Connolly
- Cancer Signaling and Microenvironment, Biosample Repository Facility, Fox Chase Cancer Center-Temple Health, Philadelphia, PA, USA
| | - Robert G Uzzo
- Department of Urology, Fox Chase Cancer Center-Temple Health, Philadelphia, PA, USA
| | - David Zaridze
- Department of Clinical Epidemiology, N.N. Blokhin National Medical Research Centre of Oncology, Moscow, Russia
| | - Anush Mukeria
- Department of Clinical Epidemiology, N.N. Blokhin National Medical Research Centre of Oncology, Moscow, Russia
| | - Ivana Holcatova
- Institute of Public Health and Preventive Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Oncology, Second Faculty of Medicine and University Hospital Motol, Charles University, Prague, Czech Republic
| | - Anna Hornakova
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lenka Foretova
- Department of Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Vladimir Janout
- Faculty of Health Sciences, Palacky University, Olomouc, Czech Republic
| | - Dana Mates
- Department of Occupational Health and Toxicology, National Center for Environmental Risk Monitoring, National Institute of Public Health, Bucharest, Romania
| | - Viorel Jinga
- Urology Department, Academy of Romanian Scientists, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Stefan Rascu
- Urology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Mirjana Mijuskovic
- Clinic of Nephrology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - Slavisa Savic
- Department of Urology, Clinical Hospital Center Dr Dragisa Misovic Dedinje, Belgrade, Serbia
| | - Sasa Milosavljevic
- International Organisation for Cancer Prevention and Research, Belgrade, Serbia
| | - Valérie Gaborieau
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | | | - James McKay
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Mattias Johansson
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Larry Phouthavongsy
- Ontario Tumour Bank, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Lindsay Hayman
- Diagnostic Development Program, Tissue Portal, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Jason Li
- Diagnostic Development Program, Tissue Portal, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Ilinca Lungu
- Ontario Tumour Bank, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Diagnostic Development Program, Tissue Portal, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | | | - Aline G Souza
- Departments of Medical Imaging, Hematology and Oncology, Division of Medical Oncology, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
| | - Claudia T G Sares
- Departments of Surgery and Anatomy, Division of Urology, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
| | - Rodolfo B Reis
- Departments of Surgery and Anatomy, Division of Urology, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
| | - Fabio P Gallucci
- Surgery Department, Urology Division, Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Mauricio D Cordeiro
- Surgery Department, Urology Division, Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Gwo-Shu M Lee
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Matthew L Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
- Center for Functional Cancer Epigenetics, Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute of MIT and Harvard, Boston, MA, USA
| | - Anhyo Jeong
- Department of Urology, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Samantha E Greenberg
- Department of Population Sciences, Genetic Counseling Shared Resource, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Alejandro Sanchez
- Department of Surgery, Division of Urology, Huntsman Cancer Institute and University of Utah, Salt Lake City, UT, USA
| | | | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - David D Thiel
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
| | - Colleen T Ball
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Diego Abreu
- Department of Urology, Hospital Pasteur, Montevideo, Uruguay
| | - Elaine T Lam
- Department of Medicine, Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - William C Nahas
- Surgery Department, Urology Division, Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Viraj A Master
- Department of Urology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Atlanta, GA, USA
| | | | - Neal D Freedman
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Pierre Bigot
- Department of Urology, CHU Angers, Angers, France
| | - Rui M Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Leandro M Colli
- Departament of Medical Image, Hematology and Oncology, Division of Medical Oncology, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
| | - Antonio Finelli
- Department of Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Brandon J Manley
- Genitourinary Oncology Program, Moffitt Cancer Center, Tampa, FL, USA
| | - Chikashi Terao
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Dirce M Carraro
- Clinical and Functional Genomics Group, CIPE (International Research Center), A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Richard Houlston
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, UK
| | | | - Philip H Abbosh
- Department of Nuclear Dynamics and Cancer, Fox Chase Cancer Center-Temple Health, Philadelphia, PA, USA
| | - Andrea Ganna
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Paul Brennan
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Jian Gu
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen J Chanock
- Laboratory of Genetic Susceptibility, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
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Saad F, Hotte SJ, Noonan K, Malone S, Morash C, Niazi T, Rendon RA, Shayegan B, Basappa NS, Cagiannos I, Danielson B, Delouya G, Fernandes R, Ferrario C, Finelli A, Gotto GT, Hamilton RJ, Izard JP, Kapoor A, Lalani AK, Lavallée LT, Ong M, Pouliot F, So AI, Yip S, Chi KN. Addressing controversial areas in the management of advanced prostate cancer in Canada Areas of consensus and controversy from the third Canadian consensus forum. Can Urol Assoc J 2024; 18:E127-E137. [PMID: 38381937 PMCID: PMC11034961 DOI: 10.5489/cuaj.8537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
INTRODUCTION The management of prostate cancer (PCa) is rapidly evolving. Treatment and diagnostic options grow annually, however, high-level evidence for the use of new therapeutics and diagnostics is lacking. In November 2022, the Genitourinary Research Consortium held its 3rd Canadian Consensus Forum (CCF3) to provide guidance on key controversial areas for management of PCa. METHODS A steering committee of eight multidisciplinary physicians identified topics for discussion and adapted questions from the Advanced Prostate Cancer Consensus Conference 2022 for CCF3. Questions focused on management of metastatic castration-sensitive prostate cancer (mCSPC); use of novel imaging, germline testing, and genomic profiling; and areas of non-consensus from CCF2. Fifty-eight questions were voted on during a live forum, with threshold for "consensus agreement" set at 75%. RESULTS The voting panel consisted of 26 physicians: 13 urologists/uro-oncologists, nine medical oncologists, and four radiation oncologists. Consensus was reached for 32 of 58 questions (one ad-hoc). Consensus was seen in the use of local treatment, to not use metastasis-directed therapy for low-volume mCSPC, and to use triplet therapy for synchronous high-volume mCSPC (low prostate-specific antigen). Consensus was also reached on sufficiency of conventional imaging to manage disease, use of germline testing and genomic profiling for metastatic disease, and poly (ADP-ribose) polymerase (PARP) inhibitors for BRCA-positive prostate cancer. CONCLUSIONS CCF3 identified consensus agreement and provides guidance on >30 practice scenarios related to management of PCa and nine areas of controversy, which represent opportunities for research and education to improve patient care. Consensus initiatives provide valuable guidance on areas of controversy as clinicians await high-level evidence.
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Affiliation(s)
- Fred Saad
- Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC, Canada
| | | | - Krista Noonan
- BC Cancer Agency, University of British Columbia, Surrey, BC, Canada
| | - Shawn Malone
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | | | - Tamim Niazi
- Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Ricardo A. Rendon
- Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Bobby Shayegan
- St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
| | | | - Ilias Cagiannos
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Brita Danielson
- Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Guila Delouya
- Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC, Canada
| | - Ricardo Fernandes
- London Health Science Centre, Western University, London, ON, Canada
| | | | - Antonio Finelli
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Geoffrey T. Gotto
- Southern Alberta Institute of Urology, University of Calgary, Calgary, AB, Canada
| | - Robert J. Hamilton
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Jason P. Izard
- Kingston Health Sciences Centre, Queen’s University, Kingston, ON
| | - Anil Kapoor
- St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
| | - Aly-Khan Lalani
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | | | - Michael Ong
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Frédéric Pouliot
- Quebec City University Hospital Center & Centre de Recherche of Quebec City University Hospital Center, University of Laval, QC, Canada
| | - Alan I So
- Prostate Centre at Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Steven Yip
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Kim N. Chi
- BC Cancer Agency, University of British Columbia, Vancouver, BC, Canada
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Ghai S, Finelli A, Corr K, Lajkosz K, McCluskey S, Chan R, Gertner M, van der Kwast TH, Incze PF, Zlotta AR, Kucharczyk W, Perlis N. MRI-guided Focused Ultrasound Focal Therapy for Intermediate-Risk Prostate Cancer: Final Results from a 2-year Phase II Clinical Trial. Radiology 2024; 310:e231473. [PMID: 38441092 DOI: 10.1148/radiol.231473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Background MRI-guided focal therapy (FT) allows for accurate targeting of localized clinically significant prostate cancer (csPCa) while preserving healthy prostate tissue, but the long-term outcomes of this approach require more study. Purpose To assess the 2-year oncological and functional outcomes of men with intermediate-risk prostate cancer (PCa) treated with targeted FT. Materials and Methods In this single-center prospective phase II trial, men with localized unifocal intermediate-risk PCa underwent transrectal MRI-guided focused ultrasound between July 2016 and July 2019. Planned ablation volumes included 10-mm margins when possible. Data regarding adverse events were collected and quality-of-life questionnaires were completed by participants at 6 weeks and at 5, 12, 18, and 24 months after treatment. Multiparametric MRI and targeted and systematic biopsies were performed at 24 months. Ablation volumes were determined by manual contouring of nonperfused volumes on immediate contrast-enhanced images. Generalized estimating equations were used to model trends in quality-of-life measures. Results Treatment was successfully completed in the 44 participants (median age, 67 years; IQR, 62-70 years; 36 patients with grade group [GG] 2; eight patients with GG 3). No major adverse events from treatment were recorded. One participant refused biopsy at 24 months. After 2 years, 39 of 43 participants (91%) had no csPCa at the treatment site and 36 of 43 (84%) had no cancer in the entire gland. No changes in International Index of Erectile Function-15 score or International Prostate Symptom Score were observed during 2-year follow-up (P = .73 and .39, respectively). Conclusion The majority of men treated with MRI-guided focused ultrasound for intermediate risk PCa had negative results for csPCa at biopsy 2 years after treatment. Additionally, there was no significant decline in quality of life per the validated questionnaires. Clinical trial registration no. NCT02968784 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Woodrum in this issue.
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Affiliation(s)
- Sangeet Ghai
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., K.C., R.C., M.G., W.K.); Division of Urology, Department of Surgical Oncology (A.F., A.R.Z., N.P.), Department of Anesthesia (S.M.), and Department of Pathology, Laboratory Medicine Program (T.H.v.d.K.), University Health Network, University of Toronto, Toronto, Canada; Biostatistics Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada (K.L.); and Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.)
| | - Antonio Finelli
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., K.C., R.C., M.G., W.K.); Division of Urology, Department of Surgical Oncology (A.F., A.R.Z., N.P.), Department of Anesthesia (S.M.), and Department of Pathology, Laboratory Medicine Program (T.H.v.d.K.), University Health Network, University of Toronto, Toronto, Canada; Biostatistics Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada (K.L.); and Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.)
| | - Kateri Corr
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., K.C., R.C., M.G., W.K.); Division of Urology, Department of Surgical Oncology (A.F., A.R.Z., N.P.), Department of Anesthesia (S.M.), and Department of Pathology, Laboratory Medicine Program (T.H.v.d.K.), University Health Network, University of Toronto, Toronto, Canada; Biostatistics Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada (K.L.); and Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.)
| | - Katherine Lajkosz
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., K.C., R.C., M.G., W.K.); Division of Urology, Department of Surgical Oncology (A.F., A.R.Z., N.P.), Department of Anesthesia (S.M.), and Department of Pathology, Laboratory Medicine Program (T.H.v.d.K.), University Health Network, University of Toronto, Toronto, Canada; Biostatistics Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada (K.L.); and Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.)
| | - Stuart McCluskey
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., K.C., R.C., M.G., W.K.); Division of Urology, Department of Surgical Oncology (A.F., A.R.Z., N.P.), Department of Anesthesia (S.M.), and Department of Pathology, Laboratory Medicine Program (T.H.v.d.K.), University Health Network, University of Toronto, Toronto, Canada; Biostatistics Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada (K.L.); and Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.)
| | - Rosanna Chan
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., K.C., R.C., M.G., W.K.); Division of Urology, Department of Surgical Oncology (A.F., A.R.Z., N.P.), Department of Anesthesia (S.M.), and Department of Pathology, Laboratory Medicine Program (T.H.v.d.K.), University Health Network, University of Toronto, Toronto, Canada; Biostatistics Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada (K.L.); and Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.)
| | - Mark Gertner
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., K.C., R.C., M.G., W.K.); Division of Urology, Department of Surgical Oncology (A.F., A.R.Z., N.P.), Department of Anesthesia (S.M.), and Department of Pathology, Laboratory Medicine Program (T.H.v.d.K.), University Health Network, University of Toronto, Toronto, Canada; Biostatistics Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada (K.L.); and Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.)
| | - Theodorus H van der Kwast
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., K.C., R.C., M.G., W.K.); Division of Urology, Department of Surgical Oncology (A.F., A.R.Z., N.P.), Department of Anesthesia (S.M.), and Department of Pathology, Laboratory Medicine Program (T.H.v.d.K.), University Health Network, University of Toronto, Toronto, Canada; Biostatistics Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada (K.L.); and Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.)
| | - Peter F Incze
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., K.C., R.C., M.G., W.K.); Division of Urology, Department of Surgical Oncology (A.F., A.R.Z., N.P.), Department of Anesthesia (S.M.), and Department of Pathology, Laboratory Medicine Program (T.H.v.d.K.), University Health Network, University of Toronto, Toronto, Canada; Biostatistics Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada (K.L.); and Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.)
| | - Alexandre R Zlotta
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., K.C., R.C., M.G., W.K.); Division of Urology, Department of Surgical Oncology (A.F., A.R.Z., N.P.), Department of Anesthesia (S.M.), and Department of Pathology, Laboratory Medicine Program (T.H.v.d.K.), University Health Network, University of Toronto, Toronto, Canada; Biostatistics Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada (K.L.); and Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.)
| | - Walter Kucharczyk
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., K.C., R.C., M.G., W.K.); Division of Urology, Department of Surgical Oncology (A.F., A.R.Z., N.P.), Department of Anesthesia (S.M.), and Department of Pathology, Laboratory Medicine Program (T.H.v.d.K.), University Health Network, University of Toronto, Toronto, Canada; Biostatistics Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada (K.L.); and Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.)
| | - Nathan Perlis
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., K.C., R.C., M.G., W.K.); Division of Urology, Department of Surgical Oncology (A.F., A.R.Z., N.P.), Department of Anesthesia (S.M.), and Department of Pathology, Laboratory Medicine Program (T.H.v.d.K.), University Health Network, University of Toronto, Toronto, Canada; Biostatistics Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada (K.L.); and Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.)
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4
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Elbanna KY, Krishna S, Finelli A, Atri M. Contrast-Enhanced Ultrasound of the Indeterminate Renal Mass, From the AJR "How We Do It" Special Series. AJR Am J Roentgenol 2024. [PMID: 38415576 DOI: 10.2214/ajr.24.30817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Contrast-enhanced ultrasound (CEUS) is distinguished from CT and MRI by the use of microbubble ultrasound contrast agents (UCAs) with intravascular blood pool distribution. When performing CEUS, low-intensity ultrasound allows real-time tissue subtraction imaging, whereas high-intensity ultrasound leads to microbubble destruction, enabling visualization of the contrast inflow pattern. CEUS has exceptional contrast resolution that enables the detection of even minimal blood flow, achieving very high NPV for ruling out vascular perfusion and providing high frame rates in the evaluation of tissue perfusion dynamics. UCAs undergo hepatic metabolism and pulmonary clearance, ensuring safety in patients with renal impairment. CEUS excels in distinguishing solid from cystic renal masses, with higher sensitivity than CT or MRI for detection of lesion enhancement. CEUS can aid the further characterization of both solid and cystic lesions and may have particular applications in the surveillance of cystic masses and surveillance after renal cell carcinoma ablation. This review describes the use of CEUS to help characterize indeterminate renal masses, based on the authors' institutional experience. The article highlights key differences between CEUS and CT or MRI, and provides practical insights for performing and interpreting CEUS of renal masses.
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Affiliation(s)
- Khaled Y Elbanna
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Canada
| | - Satheesh Krishna
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Canada
| | - Antonio Finelli
- Division of Urology, Departments of Surgery and of Surgical Oncology, Princess Margaret Hospital and the University Health Network, University of Toronto, Canada
| | - Mostafa Atri
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Canada
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5
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Graham J, Ghosh S, Breau RH, Wood L, Tanguay S, Bosse D, Lalani AK, Bhindi B, Heng D, Finelli A, Fallah-Rad N, Castonguay V, Basappa NS, Soulières D, Pouliot F, Kollmannsberger C, Bjarnason GA. Association of Cabozantinib Dose Reductions for Toxicity With Clinical Effectiveness in Metastatic Renal Cell Carcinoma (mRCC): Results From the Canadian Kidney Cancer Information System (CKCis). Clin Genitourin Cancer 2024:102060. [PMID: 38521648 DOI: 10.1016/j.clgc.2024.02.011] [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: 10/30/2023] [Revised: 01/30/2024] [Accepted: 02/19/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Cabozantinib, an oral multi-targeted tyrosine kinase inhibitor (TKI), has demonstrated efficacy in metastatic renal cell carcinoma (mRCC). The association between toxicity and therapeutic effectiveness has been established with other TKIs. We investigated whether cabozantinib dose reductions, a surrogate for toxicity and adequate drug exposure, were associated with improved clinical outcomes in mRCC. METHODS Employing the CKCis database, we analyzed patients treated with cabozantinib in the second line or later between 2011 to 2021. The cohort was stratified into those needing dose reductions (DR) during treatment and those not (no-DR). Outcomes, including objective response rate (ORR), time to treatment failure (TTF), and overall survival (OS), were compared based on dose reduction status. The influence of the initial dose on outcomes was also explored. RESULTS Among 319 cabozantinib-treated patients, 48.3% underwent dose reductions. Response rates exhibited no significant difference between the DR and no-DR groups (15.1% vs. 18.2%, P = .55). Patients with DR had superior median OS (26.15 vs. 15.47 months, P = .019) and TTF (12.74 vs. 6.44 months, P = .022) compared to no-DR patients. These differences retained significance following adjustment for IMDC risk group (OS HR = 0.67, P = .032; TTF HR = 0.65, P = .008). There was no association between the initial dose and ORR, OS, or TTF. CONCLUSION This study highlights the link between cabozantinib dose reductions due to toxicity and improved survival and time to treatment failure in mRCC patients. These findings underscore the potential of using on-treatment toxicity as an indicator of adequate drug exposure to individualize dosing and optimize treatment effectiveness. Larger studies are warranted to validate these results and develop individualized strategies for cabozantinib when given alone or in combination with immunotherapy.
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Affiliation(s)
- Jeffrey Graham
- CancerCare Manitoba, Division of Medical Oncology and Hematology, University of Manitoba, Winnipeg, MB, Canada.
| | - Sunita Ghosh
- Department of Medical Oncology, Faculty of Medicine and Dentistry University of Alberta, Edmonton, AB, Canada
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Lori Wood
- Division of Medical Oncology, QEII Health Sciences Center, Halifax, NS, Canada
| | - Simon Tanguay
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Dominick Bosse
- Division of Medical Oncology, University of Ottawa, Ottawa, ON, Canada
| | - Aly-Khan Lalani
- Division of Medical Oncology, McMaster University, Hamilton, ON, Canada
| | - Bimal Bhindi
- Division of Urology, University of Calgary, Calgary, AB, Canada
| | - Daniel Heng
- Division of Medical Oncology, University of Calgary, Calgary, AB, Canada
| | - Antonio Finelli
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Nazanin Fallah-Rad
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Vincent Castonguay
- Centre de recherche du Centre Hospitalier Universitaire de Québec - Université Laval (CRCHUQc-UL), Centre de recherche sur le cancer (CRC) de l'Université Laval, Québec, QC, Canada
| | - Naveen S Basappa
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada
| | - Denis Soulières
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Frédéric Pouliot
- Cancer Research Center, Centre Hospitalier Universitaire de Québec - Université Laval, Québec, QC, Canada
| | | | - Georg A Bjarnason
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Lemire F, Zhang M, Anderson P, Finelli A, Rendon RA, Tanguay S, Bansal R, Bhindi B, So AI, Pouliot F, Dean L, Mallick R, Lavallée LT, Breau RH. The impact of robotic surgery access on the management of patients with clinical stage I kidney tumors. Can Urol Assoc J 2024; 18:55-60. [PMID: 37931286 PMCID: PMC10841563 DOI: 10.5489/cuaj.8506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Robotic surgery is used in the treatment of kidney tumors. We aimed to determine if robotic access was associated with initial choice of management for patients with a clinical stage I kidney mass. METHODS Patients with a clinical stage I kidney mass were identified from the Canadian Kidney Cancer information system (CKCis) cohort. Sites were classified by year and access to robotic surgery. Associations between robotic access and initial management were determined using logistic regression. Univariable and multivariable analyses were performed, adjusting for tumor size and stage, and presented as relative risks (RR ) or adjusted RR (aRR) and 95% confidence intervals (CI). RESULTS Overall, 4160 patients were included. Among patients treated with surgery, the proportion of partial nephrectomy compared to radical nephrectomy was significantly higher in robotic sites (77.3% for robotic sites vs. 65.9% for non-robotic sites; RR 1.17, 95% CI 1.12-1.23, p<0.0001; aRR 1.12, 95% CI 1.08-1.17, p<0.0001). Patients receiving partial nephrectomy at sites with robotic access were more likely to receive a minimally invasive approach compared to patients at non-robotic sites (61.4% vs. 50.9%, RR 1.21, 95% CI 1.12-1.30; aRR 1.16, 95% CI 1.08-1.25, p<0.0001). The proportion of patients managed by active surveillance was not significantly different between robotic (405, 16.9%) and non-robotic (258, 14.7%) sites (RR 1.15, 95% CI 0.99-1.32; aRR 0.97, 95% CI 0.84-1.12). CONCLUSIONS Access to robotic kidney surgery was associated with increased use of partial nephrectomy and minimally invasive partial nephrectomy. Use of active surveillance was similar at robotic and non-robotic institutions. Limitations of this study include lack of data on perioperative complications and cancer recurrence.
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Affiliation(s)
- Francis Lemire
- Ottawa Hospital Research Institute and the University of Ottawa, Ottawa, ON, Canada
| | - MengQi Zhang
- Ottawa Hospital Research Institute and the University of Ottawa, Ottawa, ON, Canada
| | - Patrick Anderson
- Ottawa Hospital Research Institute and the University of Ottawa, Ottawa, ON, Canada
| | - Antonio Finelli
- Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Ricardo A. Rendon
- Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Simon Tanguay
- McGill University and McGill University Health Centre, Montreal, QC, Canada
| | | | - Bimal Bhindi
- Southern Alberta Institute of Urology, University of Calgary, Calgary, AB, Canada
| | - Alan I. So
- University of British Columbia, Vancouver, BC, Canada
| | - Frédéric Pouliot
- Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, QC, Canada
| | - Lucas Dean
- University of Alberta, Edmonton, AB, Canada
| | - Ranjeeta Mallick
- Ottawa Hospital Research Institute and the University of Ottawa, Ottawa, ON, Canada
| | - Luke T. Lavallée
- Ottawa Hospital Research Institute and the University of Ottawa, Ottawa, ON, Canada
| | - Rodney H. Breau
- Ottawa Hospital Research Institute and the University of Ottawa, Ottawa, ON, Canada
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Downes MR, Liu KN, Yu Y, Lajkosz K, Kroon LJ, Hollemans E, Fleshner N, Finelli A, van Leenders GJLH, Iczkowski KA, van der Kwast TH. Addition of Cribriform and Intraductal Carcinoma Presence to Prostate Biopsy Reporting Strengthens Pretreatment Risk Stratification Using CAPRA and NCCN Tools. Clin Genitourin Cancer 2024; 22:47-55. [PMID: 37558528 DOI: 10.1016/j.clgc.2023.07.013] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Pretreatment stratification tools can help in clinical decision making in prostate cancer. To date, none incorporates well-established routinely reported adverse prognostic pathologic features such as intraductal carcinoma of prostate (IDC) or cribriform pattern 4 (CC). OBJECTIVE To assess the impact of addition of CC and/or IDC on the Cancer of Prostate Risk Assessment (CAPRA) and National Cancer Comprehensive Network (NCCN) tools for predicting biochemical recurrence free survival (BCR-FS) and event-free survival (EFS) across multiple patient cohorts. DESIGN, SETTING, AND PARTICIPANTS Matched prostate biopsies and radical prostatectomies from institutions in Toronto, Wisconsin and Rotterdam. The presence/absence of CC/IDC was recorded on all biopsies. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Relationship to outcome was assessed using Cox proportional hazard models, ANOVA and Harrell's concordance index. RESULTS AND LIMITATIONS We included 1326 patients (Toronto- 612, Wisconsin- 542, Rotterdam- 172) with median follow up of 4.2 years (IQR 2.9-6.4 years); 306 (23.1%) had CC/IDC on biopsy with 207 (20.9%) BCR and 154 (11.6%) events (metastases/death). Addition of CC/IDC improved stratification in CAPRA scores 3 to 5 for BCR-FS (c-index increase 0.633-0.658, P < .001) and scores 6-10 for EFS (c-index increase 0.653-0.697, P < .001). For NCCN, all risk groups apart from score 1 to 2 showed improvement in BCR-FS (c-index increase 0.599-0.636, P < 0.001) and EFS prediction (c-index increase 0.648-0.697, P < .001). Sub-analysis of grade group (GG) 2 biopsies showed similar findings. The retrospective nature and inclusion of cases only reported by genitourinary pathologists are study limitations. CONCLUSIONS The clinical benefit of the addition of CC/IDC to both CAPRA and NCCN pretreatment tools was validated in 3 cohorts, including the subset of biopsy GG2 prostate cancer patients. PATIENT SUMMARY Including additional pathologic features to existing pretreatment, clinical decision making tools improves the ability to predict prostate cancer recurrence, cancer spread and death of disease.
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Affiliation(s)
- Michelle R Downes
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Precision Diagnostic & Therapeutic Program, Toronto, Ontario, Canada.
| | - Kristen N Liu
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
| | - Yanhong Yu
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Katherine Lajkosz
- Department of Biostatistics, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Lisa J Kroon
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Eva Hollemans
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Neil Fleshner
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, Toronto, Canada
| | - Geert J L H van Leenders
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | | | - Theodorus H van der Kwast
- Laboratory Medicine Program, University Health Network and Princess Margaret Cancer Centre, Toronto, ON, Canada
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8
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Wang A, Shen J, Rodriguez AA, Saunders EJ, Chen F, Janivara R, Darst BF, Sheng X, Xu Y, Chou AJ, Benlloch S, Dadaev T, Brook MN, Plym A, Sahimi A, Hoffman TJ, Takahashi A, Matsuda K, Momozawa Y, Fujita M, Laisk T, Figuerêdo J, Muir K, Ito S, Liu X, Uchio Y, Kubo M, Kamatani Y, Lophatananon A, Wan P, Andrews C, Lori A, Choudhury PP, Schleutker J, Tammela TL, Sipeky C, Auvinen A, Giles GG, Southey MC, MacInnis RJ, Cybulski C, Wokolorczyk D, Lubinski J, Rentsch CT, Cho K, Mcmahon BH, Neal DE, Donovan JL, Hamdy FC, Martin RM, Nordestgaard BG, Nielsen SF, Weischer M, Bojesen SE, Røder A, Stroomberg HV, Batra J, Chambers S, Horvath L, Clements JA, Tilly W, Risbridger GP, Gronberg H, Aly M, Szulkin R, Eklund M, Nordstrom T, Pashayan N, Dunning AM, Ghoussaini M, Travis RC, Key TJ, Riboli E, Park JY, Sellers TA, Lin HY, Albanes D, Weinstein S, Cook MB, Mucci LA, Giovannucci E, Lindstrom S, Kraft P, Hunter DJ, Penney KL, Turman C, Tangen CM, Goodman PJ, Thompson IM, Hamilton RJ, Fleshner NE, Finelli A, Parent MÉ, Stanford JL, Ostrander EA, Koutros S, Beane Freeman LE, Stampfer M, Wolk A, Håkansson N, Andriole GL, Hoover RN, Machiela MJ, Sørensen KD, Borre M, Blot WJ, Zheng W, Yeboah ED, Mensah JE, Lu YJ, Zhang HW, Feng N, Mao X, Wu Y, Zhao SC, Sun Z, Thibodeau SN, McDonnell SK, Schaid DJ, West CM, Barnett G, Maier C, Schnoeller T, Luedeke M, Kibel AS, Drake BF, Cussenot O, Cancel-Tassin G, Menegaux F, Truong T, Koudou YA, John EM, Grindedal EM, Maehle L, Khaw KT, Ingles SA, Stern MC, Vega A, Gómez-Caamaño A, Fachal L, Rosenstein BS, Kerns SL, Ostrer H, Teixeira MR, Paulo P, Brandão A, Watya S, Lubwama A, Bensen JT, Butler EN, Mohler JL, Taylor JA, Kogevinas M, Dierssen-Sotos T, Castaño-Vinyals G, Cannon-Albright L, Teerlink CC, Huff CD, Pilie P, Yu Y, Bohlender RJ, Gu J, Strom SS, Multigner L, Blanchet P, Brureau L, Kaneva R, Slavov C, Mitev V, Leach RJ, Brenner H, Chen X, Holleczek B, Schöttker B, Klein EA, Hsing AW, Kittles RA, Murphy AB, Logothetis CJ, Kim J, Neuhausen SL, Steele L, Ding YC, Isaacs WB, Nemesure B, Hennis AJ, Carpten J, Pandha H, Michael A, Ruyck KD, Meerleer GD, Ost P, Xu J, Razack A, Lim J, Teo SH, Newcomb LF, Lin DW, Fowke JH, Neslund-Dudas CM, Rybicki BA, Gamulin M, Lessel D, Kulis T, Usmani N, Abraham A, Singhal S, Parliament M, Claessens F, Joniau S, den Broeck TV, Gago-Dominguez M, Castelao JE, Martinez ME, Larkin S, Townsend PA, Aukim-Hastie C, Bush WS, Aldrich MC, Crawford DC, Srivastava S, Cullen J, Petrovics G, Casey G, Wang Y, Tettey Y, Lachance J, Tang W, Biritwum RB, Adjei AA, Tay E, Truelove A, Niwa S, Yamoah K, Govindasami K, Chokkalingam AP, Keaton JM, Hellwege JN, Clark PE, Jalloh M, Gueye SM, Niang L, Ogunbiyi O, Shittu O, Amodu O, Adebiyi AO, Aisuodionoe-Shadrach OI, Ajibola HO, Jamda MA, Oluwole OP, Nwegbu M, Adusei B, Mante S, Darkwa-Abrahams A, Diop H, Gundell SM, Roobol MJ, Jenster G, van Schaik RH, Hu JJ, Sanderson M, Kachuri L, Varma R, McKean-Cowdin R, Torres M, Preuss MH, Loos RJ, Zawistowski M, Zöllner S, Lu Z, Van Den Eeden SK, Easton DF, Ambs S, Edwards TL, Mägi R, Rebbeck TR, Fritsche L, Chanock SJ, Berndt SI, Wiklund F, Nakagawa H, Witte JS, Gaziano JM, Justice AC, Mancuso N, Terao C, Eeles RA, Kote-Jarai Z, Madduri RK, Conti DV, Haiman CA. Characterizing prostate cancer risk through multi-ancestry genome-wide discovery of 187 novel risk variants. Nat Genet 2023; 55:2065-2074. [PMID: 37945903 PMCID: PMC10841479 DOI: 10.1038/s41588-023-01534-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/15/2023] [Indexed: 11/12/2023]
Abstract
The transferability and clinical value of genetic risk scores (GRSs) across populations remain limited due to an imbalance in genetic studies across ancestrally diverse populations. Here we conducted a multi-ancestry genome-wide association study of 156,319 prostate cancer cases and 788,443 controls of European, African, Asian and Hispanic men, reflecting a 57% increase in the number of non-European cases over previous prostate cancer genome-wide association studies. We identified 187 novel risk variants for prostate cancer, increasing the total number of risk variants to 451. An externally replicated multi-ancestry GRS was associated with risk that ranged from 1.8 (per standard deviation) in African ancestry men to 2.2 in European ancestry men. The GRS was associated with a greater risk of aggressive versus non-aggressive disease in men of African ancestry (P = 0.03). Our study presents novel prostate cancer susceptibility loci and a GRS with effective risk stratification across ancestry groups.
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Affiliation(s)
- Anqi Wang
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jiayi Shen
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | | | - Fei Chen
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rohini Janivara
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Burcu F. Darst
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Xin Sheng
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yili Xu
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alisha J. Chou
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sara Benlloch
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology,University of Cambridge, Cambridge, UK
| | | | | | - Anna Plym
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Urology Division, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Ali Sahimi
- Department of Population and Public Health Sciences, Keck School of Medicine,University of Southern California, Los Angeles, CA, USA
| | - Thomas J. Hoffman
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
| | - Atushi Takahashi
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Department of Genomic Medicine, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
| | - Koichi Matsuda
- Department of Computational Biology and Medical Sciences, Laboratory of Clinical Genome Sequencing,Graduate school of Frontier Sciences,The University of Tokyo, Tokyo, Japan
| | - Yukihide Momozawa
- Laboratory for Genotyping Development, RIKEN Center of Integrative Medical Sciences, Yokohama, Japan
| | - Masashi Fujita
- Laboratory for Cancer Genomics, RIKEN Center of Integrative Medical Sciences, Yokohama, Japan
| | - Triin Laisk
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Jéssica Figuerêdo
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Kenneth Muir
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Shuji Ito
- Department of Orthopaedics, Shimane University, Izumo, Shimane, Japan
- RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Xiaoxi Liu
- Laboratory for Statistical and Translational Genetics, Center for Integrative Medical Sciences, RIKEN, Yokohama, Japan
| | - The Biobank Japan Project
- Corresponding Author: Christopher A. Haiman, Harlyne J. Norris Cancer Research Tower, USC Norris Comprehensive Cancer Center, 1450 Biggy Street, Rm 1504, Los Angeles, CA 90033 or
| | - Yuji Uchio
- Department of Orthopaedics, Shimane University, Izumo, Shimane, Japan
| | - Michiaki Kubo
- RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Yoichiro Kamatani
- Laboratory for Statistical and Translational Genetics, Center for Integrative Medical Sciences, RIKEN, Yokohama, Japan
- Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | - Artitaya Lophatananon
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester, UK
| | - Peggy Wan
- Department of Population and Public Health Sciences, Keck School of Medicine,University of Southern California, Los Angeles, CA, USA
| | - Caroline Andrews
- Harvard TH Chan School of Public Health and Division of Population Sciences,Dana Farber Cancer Institute, Boston, MA, USA
| | - Adriana Lori
- Department of Population Science, American Cancer Society, Kennesaw, GA, USA
| | | | - Johanna Schleutker
- Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Medical Genetics, Genomics, Laboratory Division, Turku University Hospital, Turku, Finland
| | | | - Csilla Sipeky
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Anssi Auvinen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Graham G. Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health,The University of Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Melissa C. Southey
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Robert J. MacInnis
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health,The University of Melbourne, Victoria, Australia
| | - Cezary Cybulski
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Dominika Wokolorczyk
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Jan Lubinski
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Christopher T. Rentsch
- Yale School of Medicine, New Haven, CT, USA
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Kelly Cho
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | | | - David E. Neal
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headington, Oxford, UK
- University of Cambridge, Department of Oncology, Addenbrooke’s Hospital, Cambridge, UK
- Cancer Research UK, Cambridge Research Institute, Li Ka Shing Centre, Cambridge, UK
| | - Jenny L. Donovan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Freddie C. Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Faculty of Medical Science, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Richard M. Martin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
- Medical Research Council (MRC) Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Borge G. Nordestgaard
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Copenhagen, Denmark
| | - Sune F. Nielsen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Copenhagen, Denmark
| | - Maren Weischer
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Copenhagen, Denmark
| | - Stig E. Bojesen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Copenhagen, Denmark
| | - Andreas Røder
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hein V. Stroomberg
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jyotsna Batra
- Australian Prostate Cancer Research Centre-Qld, Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
| | | | - Lisa Horvath
- Chris O’Brien Lifehouse (COBLH), Camperdown, Sydney, NSW, Australia, Sydney, Australia
- Garvan Institute of Medical Research, Sydney, Australia
| | - Judith A. Clements
- Australian Prostate Cancer Research Centre-Qld, Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
| | - Wayne Tilly
- Dame Roma Mitchell Cancer Research Laboratories, University of Adelaide, Adelaide, Australia
| | - Gail P. Risbridger
- Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
- Prostate Cancer Translational Research Program, Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Henrik Gronberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Markus Aly
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Department of Urology, Karolinska University Hospital, Solna, Stockholm, Sweden
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Robert Szulkin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- SDS Life Sciences, Stockholm, Sweden
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Tobias Nordstrom
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Nora Pashayan
- University College London, Department of Applied Health Research, London, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Strangeways Laboratory, Cambridge, UK
- Department of Applied Health Research, University College London, London, UK
| | - Alison M. Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Strangeways Laboratory, Cambridge, UK
| | - Maya Ghoussaini
- Open Targets, Wellcome Sanger Institute, Hinxton, Saffron Walden, Hinxton, UK
| | - Ruth C. Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Tim J. Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Jong Y. Park
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Thomas A. Sellers
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Hui-Yi Lin
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Demetrius Albanes
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Stephanie Weinstein
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Michael B. Cook
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH,, Bethesda, MD, USA
| | - Lorelei A. Mucci
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Edward Giovannucci
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Sara Lindstrom
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Peter Kraft
- Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - David J. Hunter
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kathryn L. Penney
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, USA
| | - Constance Turman
- Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Catherine M. Tangen
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Phyllis J. Goodman
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ian M. Thompson
- CHRISTUS Santa Rosa Hospital – Medical Center, San Antonio, TX, USA
| | - Robert J. Hamilton
- Dept. of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Canada
- Dept. of Surgery (Urology), University of Toronto, Toronto, Canada
| | - Neil E. Fleshner
- Dept. of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Antonio Finelli
- Division of Urology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Marie-Élise Parent
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Laval, QC, Canada
| | - Janet L. Stanford
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Elaine A. Ostrander
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Stella Koutros
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Laura E. Beane Freeman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Meir Stampfer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, USA
| | - Alicja Wolk
- Division of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Niclas Håkansson
- Division of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gerald L. Andriole
- Brady Urological Institute in National Capital Region, Johns Hopkins University, Baltimore, MD, USA
| | - Robert N. Hoover
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Mitchell J. Machiela
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Karina Dalsgaard Sørensen
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Michael Borre
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - William J. Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- International Epidemiology Institute, Rockville, MD, USA
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - James E. Mensah
- University of Ghana Medical School, Accra, Ghana
- Korle Bu Teaching Hospital, Accra, Ghana
| | - Yong-Jie Lu
- Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, John Vane Science Centre, London, UK
| | | | - Ninghan Feng
- Wuxi Second Hospital, Nanjing Medical University, Wuxi, Jiangzhu Province, China
| | - Xueying Mao
- Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, John Vane Science Centre, London, UK
| | - Yudong Wu
- Department of Urology, First Affiliated Hospital, The Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Shan-Chao Zhao
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zan Sun
- The People’s Hospital of Liaoning Proviouce, The People’s Hospital of China Medical University, Shenyang, China, Shenyang, China
| | - Stephen N. Thibodeau
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Daniel J. Schaid
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Catharine M.L. West
- Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Radiotherapy Related Research, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Gill Barnett
- University of Cambridge Department of Oncology, Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | | | - Adam S. Kibel
- Division of Urologic Surgery, Brigham and Womens Hospital, Boston, MA, USA
| | | | - Olivier Cussenot
- GRC 5 Predictive Onco-Urology, Sorbonne Université, Paris, France
- CeRePP, Paris, France
| | | | - Florence Menegaux
- Exposome and Heredity, CESP (UMR 1018), Paris-Saclay Medical School, Paris-Saclay University, Inserm, Gustave Roussy, Villejuif, France
| | - Thérèse Truong
- Exposome and Heredity, CESP (UMR 1018), Paris-Saclay Medical School, Paris-Saclay University, Inserm, Gustave Roussy, Villejuif, France
| | - Yves Akoli Koudou
- Cancer & Environment Group, Center for Research in Epidemiology and Population Health (CESP), INSERM, University Paris-Sud, University Paris-Saclay, Villejuif Cédex, France
| | - Esther M. John
- Department of Medicine, Stanford Cancer Institute,Stanford University School of Medicine, Stanford, CA, USA
| | | | - Lovise Maehle
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Kay-Tee Khaw
- Clinical Gerontology Unit, University of Cambridge, Cambridge, UK
| | - Sue A. Ingles
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Mariana C Stern
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Ana Vega
- Fundación Pública Galega Medicina Xenómica, Santiago De Compostela, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago De Compostela, Spain
- Centro de Investigación en Red de Enfermedades Raras (CIBERER), Spain
| | - Antonio Gómez-Caamaño
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Laura Fachal
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago De Compostela, Spain
- Centro de Investigación en Red de Enfermedades Raras (CIBERER), Spain
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
- Fundación Pública Galega Medicina Xenómica, Santiago de Compostela, Spain
| | - Barry S. Rosenstein
- Department of Radiation Oncology and Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah L. Kerns
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Harry Ostrer
- Professor of Pathology and Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Manuel R. Teixeira
- Department of Laboratory Genetics, Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center, Porto, Portugal
- Cancer Genetics Group, IPO Porto Research Center (CI-IPOP) / RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center, Porto, Portugal
- School of Medicine and Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal
| | - Paula Paulo
- Cancer Genetics Group, IPO Porto Research Center (CI-IPOP) / RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center, Porto, Portugal
| | - Andreia Brandão
- Cancer Genetics Group, IPO Porto Research Center (CI-IPOP) / RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center, Porto, Portugal
| | | | | | - Jeannette T. Bensen
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ebonee N. Butler
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James L. Mohler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jack A. Taylor
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
- Laboratory of Molecular Carcinogenesis, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Manolis Kogevinas
- ISGlobal, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Trinidad Dierssen-Sotos
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- University of Cantabria-IDIVAL, Santander, Spain
| | - Gemma Castaño-Vinyals
- ISGlobal, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Lisa Cannon-Albright
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Craig C. Teerlink
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Chad D. Huff
- Department of Epidemiology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Patrick Pilie
- Department of Genitourinary Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Yao Yu
- Department of Epidemiology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Ryan J. Bohlender
- Department of Epidemiology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Jian Gu
- Department of Epidemiology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Sara S. Strom
- The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Luc Multigner
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Rennes, France
| | - Pascal Blanchet
- CHU de Pointe-à-Pitre, Univ Antilles, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Pointe-à-Pitre, France
| | - Laurent Brureau
- CHU de Pointe-à-Pitre, Univ Antilles, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Pointe-à-Pitre, France
| | - Radka Kaneva
- Molecular Medicine Center, Department of Medical Chemistry and Biochemistry, Medical University of Sofia, Sofia, Bulgaria
| | - Chavdar Slavov
- Department of Urology and Alexandrovska University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Vanio Mitev
- Molecular Medicine Center, Department of Medical Chemistry and Biochemistry, Medical University of Sofia, Sofia, Bulgaria
| | - Robin J. Leach
- Department of Cell Systems and Anatomy and Mays Cancer Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Xuechen Chen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eric A. Klein
- Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ann W. Hsing
- Department of Medicine and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Adam B. Murphy
- Department of Urology, Northwestern University, Chicago, IL, USA
| | - Christopher J. Logothetis
- The University of Texas M. D. Anderson Cancer Center, Department of Genitourinary Medical Oncology, Houston, TX, USA
| | - Jeri Kim
- The University of Texas M. D. Anderson Cancer Center, Department of Genitourinary Medical Oncology, Houston, TX, USA
| | - Susan L. Neuhausen
- Department of Population Sciences, Beckman Research Institute of the City of Hope, Duarte, CA, USA
| | - Linda Steele
- Department of Population Sciences, Beckman Research Institute of the City of Hope, Duarte, CA, USA
| | - Yuan Chun Ding
- Department of Population Sciences, Beckman Research Institute of the City of Hope, Duarte, CA, USA
| | - William B. Isaacs
- James Buchanan Brady Urological Institute, Johns Hopkins Hospital and Medical Institution, Baltimore, MD, USA
| | - Barbara Nemesure
- Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Anselm J.M. Hennis
- Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
- Chronic Disease Research Centre and Faculty of Medical Sciences, University of the West Indies, Bridgetown, Barbados
| | - John Carpten
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | | | - Kim De Ruyck
- Ghent University, Faculty of Medicine and Health Sciences, Basic Medical Sciences, Ghent, Belgium
| | - Gert De Meerleer
- Ghent University Hospital, Department of Radiotherapy, Ghent, Belgium
| | - Piet Ost
- Ghent University Hospital, Department of Radiotherapy, Ghent, Belgium
| | - Jianfeng Xu
- Program for Personalized Cancer Care and Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Azad Razack
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jasmine Lim
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Soo-Hwang Teo
- Cancer Research Malaysia (CRM), Outpatient Centre, Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
| | - Lisa F. Newcomb
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Daniel W. Lin
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Jay H. Fowke
- Department of Preventive Medicine, Division of Epidemiology,The University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Benjamin A. Rybicki
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Detroit, MI, USA
| | - Marija Gamulin
- Division of Medical Oncology, Urogenital Unit, Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Davor Lessel
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tomislav Kulis
- Department of Urology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Nawaid Usmani
- Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Aswin Abraham
- Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Sandeep Singhal
- Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew Parliament
- Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Frank Claessens
- Molecular Endocrinology Laboratory, Department of Cellular and Molecular Medicine, Leuven, Belgium
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Thomas Van den Broeck
- Molecular Endocrinology Laboratory, Department of Cellular and Molecular Medicine, Leuven, Belgium
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Manuela Gago-Dominguez
- Genomic Medicine Group, Galician Foundation of Genomic Medicine, Instituto de Investigacion Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saúde, SERGAS, Santiago de Compostela, Spain
- University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Jose Esteban Castelao
- Genetic Oncology Unit, CHUVI Hospital, Complexo Hospitalario Universitario de Vigo, Instituto de Investigación Biomédica Galicia Sur (IISGS), Vigo (Pontevedra), Spain
| | - Maria Elena Martinez
- University of California San Diego, Moores Cancer Center, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Samantha Larkin
- Scientific Education Support, Thames Ditton, Surrey, Formerly Cancer Sciences, University of Southampton, Southampton, UK
| | - Paul A. Townsend
- School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Surrey, UK
| | | | - William S. Bush
- Department of Population and Quantitative Health Sciences, Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, USA
| | - Melinda C. Aldrich
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dana C. Crawford
- Department of Population and Quantitative Health Sciences, Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, USA
| | - Shiv Srivastava
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, Washington, DC, USA
| | - Jennifer Cullen
- Department of Population and Quantitative Health Sciences, Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, USA
- Department of Surgery, Center for Prostate Disease Research,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Gyorgy Petrovics
- Department of Surgery, Center for Prostate Disease Research,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Graham Casey
- Department of Public Health Science, Center for Public Health Genomics,University of Virginia, Charlottesville, VA, USA
| | - Ying Wang
- Department of Population Science, American Cancer Society, Kennesaw, GA, USA
| | - Yao Tettey
- Korle Bu Teaching Hospital, Accra, Ghana
- Department of Pathology, University of Ghana, Accra, Ghana
| | - Joseph Lachance
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Wei Tang
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | | | - Andrew A. Adjei
- Department of Pathology, University of Ghana Medical School, Accra, Ghana
| | - Evelyn Tay
- Korle Bu Teaching Hospital, Accra, Ghana
| | | | | | - Kosj Yamoah
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | | | | | - Jacob M. Keaton
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jacklyn N. Hellwege
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Nashville, TN, USA
| | - Peter E. Clark
- Atrium Health/Levine Cancer Institute, Charlotte, NC, USA
| | | | | | | | - Olufemi Ogunbiyi
- Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olayiwola Shittu
- Department of Surgery, College of Medicine, University of Ibadan and Univerity College Hospital, Ibadan, Nigeria
| | - Olukemi Amodu
- Institute of Child Health, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Akindele O. Adebiyi
- Clinical Epidemiology Unit, Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oseremen I. Aisuodionoe-Shadrach
- College of Health Sciences, University of Abuja, University of Abuja Teaching Hospital and Cancer Science Center, Abuja, Nigeria
| | - Hafees O. Ajibola
- College of Health Sciences, University of Abuja, University of Abuja Teaching Hospital and Cancer Science Center, Abuja, Nigeria
| | - Mustapha A. Jamda
- College of Health Sciences, University of Abuja, University of Abuja Teaching Hospital and Cancer Science Center, Abuja, Nigeria
| | - Olabode P. Oluwole
- College of Health Sciences, University of Abuja, University of Abuja Teaching Hospital and Cancer Science Center, Abuja, Nigeria
| | - Maxwell Nwegbu
- College of Health Sciences, University of Abuja, University of Abuja Teaching Hospital and Cancer Science Center, Abuja, Nigeria
| | | | | | | | - Halimatou Diop
- Laboratoires Bacteriologie et Virologie, Hôpital Aristide Le Dantec, Dakar, Senegal
| | - Susan M. Gundell
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Monique J. Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Guido Jenster
- Department of Urology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ron H.N. van Schaik
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Jennifer J. Hu
- The University of Miami School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Maureen Sanderson
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, USA
| | - Linda Kachuri
- Department of Epidemiology and Population Health, Stanford Cancer Institute, Stanford, CA, USA
| | - Rohit Varma
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, CA, USA
| | - Roberta McKean-Cowdin
- Department of Population and Public Health Sciences, Keck School of Medicine,University of Southern California, Los Angeles, CA, USA
| | - Mina Torres
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, CA, USA
| | - Michael H. Preuss
- The Charles Bronfman Institute for Personalized Medicine,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ruth J.F. Loos
- The Charles Bronfman Institute for Personalized Medicine,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew Zawistowski
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Sebastian Zöllner
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Zeyun Lu
- Department of Population and Public Health Sciences, Keck School of Medicine,University of Southern California, Los Angeles, CA, USA
| | | | - Douglas F. Easton
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology,, Cambridge, UK
| | - Stefan Ambs
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Todd L. Edwards
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Reedik Mägi
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Timothy R. Rebbeck
- Harvard TH Chan School of Public Health and Division of Population Sciences, Dana Farber Cancer Institute, Boston, MA, USA
| | - Lars Fritsche
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Stephen J. Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Sonja I. Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Fredrik Wiklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Hidewaki Nakagawa
- Laboratory for Cancer Genomics, RIKEN Center of Integrative Medical Sciences, Yokohama, Japan
| | - John S. Witte
- Department of Epidemiology and Population Health, Stanford Cancer Institute, Stanford, CA, USA
- Departments of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - J. Michael Gaziano
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | | | - Nick Mancuso
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Chikashi Terao
- Laboratory for Statistical and Translational Genetics, Center for Integrative Medical Sciences, RIKEN, Yokohama, Japan
- Clinical Research Center, Shizuoka General Hospital, Shizuoka, Japan
- The Department of Applied Genetics, School of Pharmaceutical Sciences, Shizuoka, Japan
| | - Rosalind A. Eeles
- The Institute of Cancer Research, London, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | | | | | - David V. Conti
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christopher A. Haiman
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Deivasigamani S, Kotamarti S, Rastinehad AR, Salas RS, de la Rosette JJMCH, Lepor H, Pinto P, Ahmed HU, Gill I, Klotz L, Taneja SS, Emberton M, Lawrentschuk N, Wysock J, Feller JF, Crouzet S, Kumar M P, Seguier D, Adams ES, Michael Z, Abreu A, Jack Tay K, Ward JF, Shinohara K, Katz AE, Villers A, Chin JL, Stricker PD, Baco E, Macek P, Ahmad AE, Chiu PKF, Crawford ED, Rogers CG, Futterer JJ, Rais-Bahrami S, Robertson CN, Hadaschik B, Marra G, Valerio M, Chong KT, Kasivisvanathan V, Tan WP, Lomas D, Walz J, Guimaraes GC, Mertziotis NI, Becher E, Finelli A, Kasraeian A, Lebastchi AH, Vora A, Rosen MA, Bakir B, Arcot R, Yee S, Netsch C, Meng X, de Reijke TM, Tan YG, Regusci S, Benjamin TGR, Olivares R, Noureldin M, Bianco FJ, Sivaraman A, Kim FJ, Given RW, Dason S, Sheetz TJ, Shoji S, Schulman A, Royce P, Shah TT, Scionti S, Salomon G, Laguna P, Tourinho-Barbosa R, Aminsharifi A, Cathelineau X, Gontero P, Stabile A, Grummet J, Ledbetter L, Graton M, Stephen Jones J, Polascik TJ. Primary Whole-gland Ablation for the Treatment of Clinically Localized Prostate Cancer: A Focal Therapy Society Best Practice Statement. Eur Urol 2023; 84:547-560. [PMID: 37419773 DOI: 10.1016/j.eururo.2023.06.013] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/25/2023] [Accepted: 06/19/2023] [Indexed: 07/09/2023]
Abstract
CONTEXT Whole-gland ablation is a feasible and effective minimally invasive treatment for localized prostate cancer (PCa). Previous systematic reviews supported evidence for favorable functional outcomes, but oncological outcomes were inconclusive owing to limited follow-up. OBJECTIVE To evaluate the real-world data on the mid- to long-term oncological and functional outcomes of whole-gland cryoablation and high-intensity focused ultrasound (HIFU) in patients with clinically localized PCa, and to provide expert recommendations and commentary on these findings. EVIDENCE ACQUISITION We performed a systematic review of PubMed, Embase, and Cochrane Library publications through February 2022 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. As endpoints, baseline clinical characteristics, and oncological and functional outcomes were assessed. To estimate the pooled prevalence of oncological, functional, and toxicity outcomes, and to quantify and explain the heterogeneity, random-effect meta-analyses and meta-regression analyses were performed. EVIDENCE SYNTHESIS Twenty-nine studies were identified, including 14 on cryoablation and 15 on HIFU with a median follow-up of 72 mo. Most of the studies were retrospective (n = 23), with IDEAL (idea, development, exploration, assessment, and long-term study) stage 2b (n = 20) being most common. Biochemical recurrence-free survival, cancer-specific survival, overall survival, recurrence-free survival, and metastasis-free survival rates at 10 yr were 58%, 96%, 63%, 71-79%, and 84%, respectively. Erectile function was preserved in 37% of cases, and overall pad-free continence was achieved in 96% of cases, with a 1-yr rate of 97.4-98.8%. The rates of stricture, urinary retention, urinary tract infection, rectourethral fistula, and sepsis were observed to be 11%, 9.5%, 8%, 0.7%, and 0.8%, respectively. CONCLUSIONS The mid- to long-term real-world data, and the safety profiles of cryoablation and HIFU are sound to support and be offered as primary treatment for appropriate patients with localized PCa. When compared with other existing treatment modalities for PCa, these ablative therapies provide nearly equivalent intermediate- to long-term oncological and toxicity outcomes, as well as excellent pad-free continence rates in the primary setting. This real-world clinical evidence provides long-term oncological and functional outcomes that enhance shared decision-making when balancing risks and expected outcomes that reflect patient preferences and values. PATIENT SUMMARY Cryoablation and high-intensity focused ultrasound are minimally invasive treatments available to selectively treat localized prostate cancer, considering their nearly comparable intermediate- to long term cancer control and preservation of urinary continence to other radical treatments in the primary setting. However, a well-informed decision should be made based on one's values and preferences.
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Affiliation(s)
| | - Srinath Kotamarti
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | | | | | | | - Herbert Lepor
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - Peter Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Hashim U Ahmed
- Division of Urology, Imperial College London & Imperial College Healthcare NHS Trust, London, UK
| | - Inderbir Gill
- Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Laurence Klotz
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Samir S Taneja
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - Mark Emberton
- Division of Surgery, University College London, London, UK
| | - Nathan Lawrentschuk
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - James Wysock
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | | | | | | | - Denis Seguier
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA; Department of Urology, University Lille Nord de France, Lille, France
| | - Eric S Adams
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | - Zoe Michael
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | - Andre Abreu
- Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Singapore
| | - John F Ward
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Katsuto Shinohara
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Aaron E Katz
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - Arnauld Villers
- Department of Urology, University Lille Nord de France, Lille, France
| | - Joseph L Chin
- Department of Urology, University of Western Ontario, London, Ontario, Canada
| | | | - Eduard Baco
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Petr Macek
- Department of Urology, Institute Mutualiste Montsouris, Paris, France
| | - Ardalan E Ahmad
- Department of Urology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Peter K F Chiu
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong
| | - E David Crawford
- Department of Urology, University of California San Diego, San Diego, CA, USA
| | - Craig G Rogers
- Vattikuti Urology Institute, Henry Ford Health, Detroit, MI, USA
| | - Jurgen J Futterer
- Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | | | - Cary N Robertson
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | - Boris Hadaschik
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Giancarlo Marra
- Department of Urology, The University Hospital of Turin, Turin, Italy
| | - Massimo Valerio
- Service of Urology, University Hospital of Lausanne, Lausanne, Switzerland
| | | | | | - Wei Phin Tan
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - Derek Lomas
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Jochen Walz
- Department of Urology, Paoli-Calmettes Institute Cancer Center, Marseille, France
| | | | | | | | - Antonio Finelli
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | | | - Amir H Lebastchi
- Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Anup Vora
- Chesapeake Urology, Silver Spring, MD, USA
| | - Mark A Rosen
- Department of Urology, Sutter Health, Sacramento, CA, USA
| | - Baris Bakir
- Department of Radiology, Istanbul University, Istanbul, Turkey
| | - Rohit Arcot
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA; Department of Urology, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Samuel Yee
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong
| | | | - Xiaosong Meng
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Theo M de Reijke
- Department of Urology, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Yu Guang Tan
- Department of Urology, Singapore General Hospital, Singapore
| | - Stefano Regusci
- Department of Interventional Oncology, Swiss International Prostate Centelenor, Geneva, Switzerland
| | | | - Ruben Olivares
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Fernando J Bianco
- Urological Research Network, Urologist Specialist Group, Miami Lakes, FL, USA
| | - Arjun Sivaraman
- Division of Urology, Washington University School of Medicine, St Louis, MO, USA
| | - Fernando J Kim
- Division of Urology, Denver Health Medical Center and University of Colorado Hospital, Denver, CO, USA
| | | | - Shawn Dason
- Department of Urology, The Ohio State University, Columbus, OH, USA
| | - Tyler J Sheetz
- Department of Urology, The Ohio State University, Columbus, OH, USA
| | - Sunao Shoji
- Department of Urology, Tokai University School of Medicine, Tokyo, Japan
| | - Ariel Schulman
- Department of Urology, Maimonides Health Medical Center, New York, NY, USA
| | - Peter Royce
- Division of Urology, Monash University, Melbourne, Australia
| | - Taimur T Shah
- Division of Urology, Imperial College London & Imperial College Healthcare NHS Trust, London, UK
| | | | - Georg Salomon
- Martini-Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany
| | - Pilar Laguna
- Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey
| | | | - Alireza Aminsharifi
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Paolo Gontero
- Department of Urology, The University Hospital of Turin, Turin, Italy
| | - Armando Stabile
- Unit of Urology/Division of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Jeremy Grummet
- Division of Urology, Monash University, Melbourne, Australia
| | - Leila Ledbetter
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | - Margaret Graton
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | | | - Thomas J Polascik
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA.
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Klotz L, Chin J, Black PC, Finelli A, Anidjar M, Machado A, Levental M, Ghai S, Chang SD, Patel C, Kassam Z, Loblaw A, Kebabdjian M, Pond G, Haider MA. Magnetic Resonance Imaging-Targeted Versus Systematic Prostate Biopsies: 2-year Follow-up of a Prospective Randomized Trial (PRECISE). Eur Urol Oncol 2023:S2588-9311(23)00204-3. [PMID: 37838556 DOI: 10.1016/j.euo.2023.09.013] [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: 06/07/2023] [Revised: 08/16/2023] [Accepted: 09/11/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND The prospective randomized PRECISE trial demonstrated that magnetic resonance imaging (MRI) with only targeted biopsy (TBx) was noninferior to systematic transrectal ultrasound biopsy (SBx) in the detection of International Society of Urological Pathology grade group (GG) ≥2 prostate cancer (PC). An unanswered question is the outcome for patients who avoided a biopsy because of negative MRI findings. OBJECTIVE To explore the rate of PC diagnosis based on 2-yr MRI for PRECISE participants who had no biopsy and for patients who had a negative result or GG 1 on TBx in comparison to those with a negative result or GG 1 on SBx. DESIGN, SETTING, AND PARTICIPANTS The PRECISE prospective trial was conducted at five Canadian academic centers. The present analysis was for trial participants who were not diagnosed with clinically significant PC (csPC) at baseline. Of 453 randomized patients, 146 were diagnosed with GG ≥2 at baseline and were excluded. Eligible patients for this study included 83 men from the MRI arm who had negative MRI findings and no biopsy, 120 from the overall cohort who had a negative SBx or TBx, and 72 from the overall cohort who were diagnosed with GG 1 disease. INTERVENTION MRI at 2 yr in all men in the MRI and SBx arms and TBx for lesions with a Prostate Imaging-Reporting and Data System score of ≥3 or on the basis of clinical suspicion. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was the proportion of men diagnosed with GG ≥2 cancer. Secondary outcomes included the MRI outcome and the proportion of men diagnosed with GG 1 PC. RESULTS AND LIMITATIONS Evaluable 2-yr MRI scans were available for 75 (56%) eligible patients in the MRI arm and 69 (49%) in the SBx arm. Of these patients, 55 (73%) in the MRI arm and 51 (67%) SBx arm had negative 2-yr MRI. Of the 76 patients in the SBx arm with 2-yr MRI, 16 (21%) had a biopsy, for which the result was negative in eight (10%), GG1 in two (2.6%), and GG ≥2 in six (7.9%) cases. Of the 75 men in the MRI arm with 2-yr MRI, eight (11%) were biopsied, for which the result was negative in four cases (5%) and GG ≥2 in the other four (5%). At 2 yr, including baseline biopsy results, 116/221 (52.5%) in the MRI arm and 113/204 (55%) in the SBx arm were free of GG ≥2 disease, treatment, death from any cause, or progression (OR 1.08; p = 0.66). CONCLUSIONS After 2-yr follow-up including MRI for patients in both arms of PRECISE, there was no difference in the rate of csPC diagnosis between the MRI and SBx groups, even though 38% of men in the MRI group avoided an initial biopsy. PATIENT SUMMARY The PRECISE trial compared systematic biopsy of the prostate to a strategy of magnetic resonance imaging (MRI) with targeted biopsy of any lesions suspicious for cancer on the scan. After 2 years of follow-up that included 2-year MRI with or without biopsy in both groups, there was no difference in the rate of diagnosis of significant cancer, even though 38% of men in the initial MRI arm avoided an initial biopsy, and 30% avoided biopsy altogether. The PRECISE trial is registered on ClinicalTrials.gov as NCT02936258.
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Affiliation(s)
- Laurence Klotz
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Canada.
| | - Joseph Chin
- London Health Sciences Centre, University of Western Ontario, London, Canada
| | - Peter C Black
- Vancouver Prostate Centre, The University of British Columbia, Vancouver, Canada
| | - Antonio Finelli
- Princess Margaret Hospital, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maurice Anidjar
- Jewish General Hospital, McGill University, Montreal, Canada
| | - Ashley Machado
- Vancouver Prostate Centre, The University of British Columbia, Vancouver, Canada
| | - Mark Levental
- Jewish General Hospital, McGill University, Montreal, Canada
| | - Sangeet Ghai
- Princess Margaret Hospital, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Silvia D Chang
- Vancouver Prostate Centre, The University of British Columbia, Vancouver, Canada
| | - Chirag Patel
- Department of Medical Imaging, University Health Network, Toronto, Canada
| | - Zahra Kassam
- London Health Sciences Centre, University of Western Ontario, London, Canada
| | - Andrew Loblaw
- Princess Margaret Hospital, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Greg Pond
- Department of Biostatistics, McMaster University, Hamilton, Canada
| | - Masoom A Haider
- Department of Medical Imaging, University Health Network, Toronto, Canada
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11
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Fleshner NE, Sayyid RK, Hansen AR, Chin JLK, Fernandes R, Winquist E, van der Kwast T, Sweet J, Lajkosz K, Kenk M, Hersey K, Veloso R, Berlin D, Herrera-Caceres JO, Sridhar S, Moussa M, Finelli A, Hamilton RJ, Kulkarni GS, Zlotta AR, Joshua AM. Neoadjuvant Cabazitaxel plus Abiraterone/Leuprolide Acetate in Patients with High-Risk Prostate Cancer: ACDC-RP Phase II Trial. Clin Cancer Res 2023; 29:3867-3874. [PMID: 37439809 DOI: 10.1158/1078-0432.ccr-23-0731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/15/2023] [Accepted: 07/11/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE Early treatment intensification with neoadjuvant therapy may improve outcomes in patients with high-risk, localized prostate cancer treated with radical prostatectomy. Our objective was to compare pathologic, oncologic, and safety outcomes of neoadjuvant abiraterone acetate plus leuprolide acetate with or without cabazitaxel prior to radical prostatectomy in patients with localized, high-risk prostate cancer. PATIENTS AND METHODS This open-label, multicenter, phase II trial randomized men with clinically localized, D'Amico high-risk prostate cancer to neoadjuvant abiraterone acetate (1,000 mg/day) and leuprolide acetate (22.5 mg every 3 months) with or without cabazitaxel (25 mg/m2) prior to radical prostatectomy. The primary outcome was pathologic complete response (pCR) or minimal residual disease (MRD). Secondary outcomes included surgical margins, lymph node involvement, pathologic stage, 12-month biochemical relapse-free survival (BRFS) rates, and safety profile. RESULTS The per-protocol population consisted of 70 patients [cabazitaxel arm (Arm A): 37, no cabazitaxel arm (Arm B): 33]. Median patient age and prostate-specific antigen levels were 63.5 years [interquartile range (IQR), 58.0-68.0] and 21.9 ng/mL (IQR, 14.6-42.8), respectively. pCR/MRD occurred in 16 (43.2%) versus 15 patients (45.5%) in arms A and B, respectively (P = 0.85). pCR occurred in two (5.4%) versus three patients (9.1%) in arms A and B, respectively (P = 0.66). Patients with ≤ 25% total biopsy cores positive had increased odds of pCR/MRD (P = 0.04). Patients with pCR/MRD had superior 12-month BRFS rates (96.0% vs. 62.0%, P = 0.03). Grade 3+ adverse events occurred in 42.5% and 23.7% of patients in arms A and B, respectively (P = 0.078). CONCLUSIONS Neoadjuvant cabazitaxel addition to abiraterone acetate/leuprolide acetate prior to radical prostatectomy did not improve pCR/MRD in clinically localized, high-risk prostate cancer.
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Affiliation(s)
- Neil E Fleshner
- Division of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Rashid K Sayyid
- Division of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Aaron R Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Joseph L K Chin
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
| | - Ricardo Fernandes
- Department of Oncology, Division of Medical Oncology, Schulich School of Medicine and Dentistry, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Eric Winquist
- Department of Oncology, Division of Medical Oncology, Schulich School of Medicine and Dentistry, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Theodorus van der Kwast
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Joan Sweet
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Katherine Lajkosz
- Department of Biostatistics, University of Toronto, Toronto, Ontario, Canada
| | - Miran Kenk
- Division of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Karen Hersey
- Division of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Rosette Veloso
- Division of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Doron Berlin
- Division of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jaime O Herrera-Caceres
- Division of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Srikala Sridhar
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Madeleine Moussa
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - Antonio Finelli
- Division of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Robert J Hamilton
- Division of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Girish S Kulkarni
- Division of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Alexandre R Zlotta
- Department of Surgery, Urology, Sinai Health System, Toronto, Ontario, Canada
| | - Anthony M Joshua
- Kinghorn Cancer Centre, St Vincent's Hospital, Garvan Institute of Medical Research, Sydney, Australia
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Baydoun A, Sun Y, Jia AY, Zaorsky NG, Shoag JE, Vince RA, Ponsky L, Barata P, Garcia J, Berlin A, Ramotar M, Finelli A, Wallis CJD, van der Kwast T, Spratt DE. Post-Prostatectomy Risk Stratification of Biochemical Recurrence Using Transfer Learning-Based Multi-Modal Artificial Intelligence. Int J Radiat Oncol Biol Phys 2023; 117:S83-S84. [PMID: 37784586 DOI: 10.1016/j.ijrobp.2023.06.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) For patients undergoing radical prostatectomy for prostate cancer (PCa), accurate risk stratification is essential to guide post-prostatectomy therapeutic decision making. Recently, there has been success in the use of multi-modal artificial intelligence models for men after prostate biopsy to aid in risk stratification. Herein, we trained and tested a TRansfer learning-based multi-modal Artificial InteLligence model (TRAIL) for biochemical recurrence (BCR) risk stratification following radical prostatectomy. MATERIALS/METHODS Patients contained within a prospective PCa registry at a single institution were utilized. Digital pathology slides from the diagnostic biopsies prior to radical prostatectomy for patients with clinically localized PCa were scanned at 20x resolution. Features were extracted for the TRAIL model from pathology slides via two transfer learning steps: (1) InceptionResNetv2 that first determines a heatmap of tumor areas, and (2) A ResNet18 that extracts representative features from the high tumor probability areas. Least Absolute Shrinkage and Selection Operator (LASSO) was used for feature selection from the pathology-extracted features. Finally, TRAIL combines the clinical and pathology-extracted features via a classification ensemble model based on weak tree learners to predict 2- and 5-year BCR defined as two consecutive serum PSA levels ≥0.2 ng/mL. TRAIL training was performed on 250 patients and was then locked and applied to the test set of 125 patients. Accuracy and the area under the curve (AUC) were calculated. Comparison to CAPRA-S and to clinical-only features were assessed. RESULTS A total of 818 digital whole pathology biopsy slides from 375 patients treated with subsequent radical prostatectomy were included. Surgical margins were positive in 29% of the patients, and 41% had extra-prostatic extension. The median follow-up was 48 months (Range: 1-132 months). The rates of 2-and 5-year BCR were 11% and 18% respectively. A total of 19 digital pathology-driven features were included in TRAIL. Clinical factors included age, ISUPG, Gleason score, PSA, pathological T and N stages, surgical margin involvement, and the presence of extra-prostatic extension. On the testing set, TRAIL achieved a 2-year BCR AUC of 0.76 and accuracy of 0.87, and was superior to CAPRA-S (AUC = 0.57) and clinical-only features (AUC 0.50, accuracy 0.14). For 5-year BCR, TRAIL achieved an AUC of 0.69 and accuracy of 0.78, and performed better than CAPRA-S (AUC = 0.58), and clinical only features (AUC = 0.50, accuracy = 0.23). CONCLUSION Through a combination of deep and ensemble learning, TRAIL incorporates clinical and histopathology features, enabling an improved BCR risk stratification post-prostatectomy when compared to the currently used clinicopathologic models. Future work with larger datasets with metastatic events is warranted to further optimize the model for clinical use.
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Affiliation(s)
- A Baydoun
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Y Sun
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - A Y Jia
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - N G Zaorsky
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - J E Shoag
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - R A Vince
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - L Ponsky
- Urology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - P Barata
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - J Garcia
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - A Berlin
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - M Ramotar
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - A Finelli
- Department of Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - C J D Wallis
- Mount Sinai Hospital, UHN, University of Toronto, Toronto, ON, Canada
| | | | - D E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
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Lemire F, Fergusson DA, Knoll G, Morash C, Lavallée LT, Mallick R, Finelli A, Kapoor A, Pouliot F, Izawa J, Rendon R, Cagiannos I, Breau RH. Estimated glomerular filtration rate from the renal hypothermia trial: clinical implications. BJU Int 2023; 132:452-460. [PMID: 37409827 DOI: 10.1111/bju.16114] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
OBJECTIVE To assess if estimated glomerular filtration rate (eGFR) can replace measured GFR (mGFR) in partial nephrectomy (PN) trials, using data from a randomised clinical trial. PATIENTS AND METHODS We conducted a post hoc analysis of the renal hypothermia trial. Patients underwent mGFR with diethylenetriaminepentaacetic acid (DTPA) plasma clearance preoperatively and 1 year after PN. The eGFR was calculated using the 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equations incorporating age and sex, with and without race: 2009 eGFRcr(ASR) and 2009 eGFRcr(AS), and the 2021 equation that only incorporates age and sex: 2021 eGFRcr(AS). Performance was evaluated by determining the median bias, precision (interquartile range [IQR] of median bias), and accuracy (percentage of eGFR within 30% of mGFR). RESULTS Overall, 183 patients were included. Pre- and postoperative median bias and precision were similar between the 2009 eGFRcr(ASR) (-0.2 mL/min/1.73 m2 , 95% confidence interval [CI] -2.2 to 1.7, IQR 18.8; and -2.9, 95% CI -5.1 to -1.5, IQR 15, respectively) and 2009 eGFRcr(AS) (-0.3 mL/min/1.73 m2 , 95% CI -2.4 to 1.5, IQR 18.8; and -3.0, 95% CI -5.7 to -1.7, IQR 15.0, respectively). Bias and precision were worse for the 2021 eGFRcr(AS) (-8.8 mL/min/1.73 m2 , 95% CI -10.9 to -6.3, IQR 24.7; and -12.0, 95% CI -15.8 to -8.9, IQR 23.5, respectively). Similarly, pre- and postoperative accuracy was >90% for the 2009 eGFRcr(ASR) and 2009 eGFRcr(AS) equations. Accuracy was 78.6% preoperatively and 66.5% postoperatively for 2021 eGFRcr(AS). CONCLUSION The 2009 eGFRcr(AS) can accurately estimate GFR in PN trials and could be used instead of mGFR to reduce cost and patient burden.
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Affiliation(s)
- Francis Lemire
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Greg Knoll
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Christopher Morash
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Luke T Lavallée
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Ranjeeta Mallick
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Antonio Finelli
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | | | - Jonathan Izawa
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Ricardo Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Ilias Cagiannos
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Rodney H Breau
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Cheung DC, Martin LJ, Komisarenko M, McAlpine K, Alibhai SMH, Finelli A. A Matched Analysis of Active Surveillance Versus Nephrectomy for T1a Small Renal Masses. Eur Urol Oncol 2023; 6:535-539. [PMID: 36746730 DOI: 10.1016/j.euo.2023.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/27/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 02/08/2023]
Abstract
While patients with a small renal mass (SRM) on active surveillance (AS) experience excellent metastasis-free survival (MFS) and cancer-specific survival (CSS), differences in overall survival (OS) observed may be explained by selection of older/comorbid patients for AS. Few studies have evaluated AS versus primary intervention in clinically balanced groups. We identified patients aged 55-75 yr with an SRM (≤4 cm, T1a) in our institutional database (2000-2020). Patients from AS and nephrectomy subgroups were matched exactly for age, sex, Eastern Cooperative Oncology Group (ECOG) performance status, biopsy status, and histology. The primary outcomes were OS and an event-free survival (EFS) composite that included OS, CSS, MFS, progression, or systemic therapy, which we tested in Cox proportional-hazards models. We identified 377 patients (205 AS, 172 nephrectomy). The cohort was balanced after matching (n = 110; mean age 64 yr, 77% male, and 75% ECOG score 0). In each arm, 47% were biopsied (predominantly clear-cell histology). The predicted 5-yr OS was 96% for the nephrectomy group and 95% for the AS group (hazard ratio for nephrectomy vs AS [HR] 0.83, 95% confidence interval [CI] 0.13-5.32; p = 0.8), with corresponding 5-yr EFS rates of 93% and 96% (HR 1.88, 95% CI 0.35-10.15; p = 0.5). Among SRM cases well matched for age and overall health status, we observed higher 5-yr OS and EFS rates for AS than previously reported; the rates were not significantly different from those after nephrectomy. The matched characteristics of our population are similar to those for treatment arms in contemporary cohorts and the results support the safety of AS in younger, healthier patients. PATIENT SUMMARY: While it has been shown that active surveillance for small kidney tumors is safe in older and more frail patients, its safety in younger, healthier patients has not been confirmed. We compared outcomes for patients aged 55-75 yr who were managed with surgery or active surveillance, and were similar in age and overall health. The probability of death after 5 years was low overall and not significantly different between the groups, suggesting that active surveillance is safe in routine clinical practice.
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Affiliation(s)
- Douglas C Cheung
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Lisa J Martin
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, Toronto, Canada
| | - Maria Komisarenko
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, Toronto, Canada
| | - Kristen McAlpine
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada; Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, Toronto, Canada.
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Misurka J, Lajkosz K, Kenk M, Finelli A, Fleshner NE. Quantitative and qualitative impact of physician assistants in a Canadian urology setting. Can Urol Assoc J 2023; 17:337-340. [PMID: 37494320 PMCID: PMC10581721 DOI: 10.5489/cuaj.8287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
INTRODUCTION Physician assistants (PAs) are healthcare professionals who act as physician extenders. PAs are being used more and more in a wide variety of clinic settings throughout Canada to increase access to healthcare and reduce cost. We set out to determine the impact of PAs on a tertiary care center urologic oncology practice. METHODS We reviewed Ontario Health Insurance Plan (OHIP) billing codes since the introduction of PAs for two attending urologists at Princess Margaret Cancer Centre. Data were grouped into early experience and established experience. In addition, questionnaires were electronically distributed among nurses, physicians, residents, and fellows who work with PAs in clinic. Patient visits conducted by PAs were tracked for one quarter to estimate the amount of annual patients seen by PAs. The costs associated with PAs are presented as recommendations for a new graduate PA hire. RESULTS On average, PAs increased clinic volume by 11.3 patient visits per day. Furthermore, they individually care for an average of 24 patients per day. PAs did not represent a financial burden on the urology practice plan (revenue gain of $16 800). Our questionnaire demonstrated that PAs were capable healthcare professionals, who decreased workload and contributed to resident/fellow education. CONCLUSIONS PAs in a Canadian urology practice allow for more patient visits, decrease in physician workload, and positively impact trainee education. PAs saw more patients in clinic than clinic growth, thereby decreasing physician, fellow, and resident workload. The offset of the increase in patient visits made the PAs a cost-neutral investment.
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Affiliation(s)
- James Misurka
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - Katherine Lajkosz
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - Miran Kenk
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - Antonio Finelli
- University Health Network, University of Toronto, Toronto, ON, Canada
- Princess Margret Cancer Centre, Toronto, ON, Canada
| | - Neil E. Fleshner
- University Health Network, University of Toronto, Toronto, ON, Canada
- Princess Margret Cancer Centre, Toronto, ON, Canada
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16
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Cardenas LM, Ghosh S, Finelli A, Wood L, Kollmannsberger C, Basappa N, Graham J, Heng D, Bjarnason G, Soulières D, Bossé D, Castonguay V, Saleh R, Tanguay S, Bhindi B, Breau RH, Pouliot F, Lalani AKA. Trends of Utilization of Systemic Therapies for Metastatic Renal Cell Carcinoma in the Canadian Health Care System. JCO Glob Oncol 2023; 9:e2300271. [PMID: 37992270 PMCID: PMC10681568 DOI: 10.1200/go.23.00271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/28/2023] [Accepted: 10/17/2023] [Indexed: 11/24/2023] Open
Abstract
PURPOSE Standard-of-care therapies for metastatic renal cell carcinoma (mRCC) have greatly evolved. However, the availability of emerging options in global health care systems can vary. We sought to describe the integration and usage of systemic therapies for mRCC in Canada since 2011. METHODS We included patients with mRCC enrolled in the Canadian Kidney Cancer Information System, a prospective cohort of patients from 14 Canadian academic centers, who received systemic therapy from January 1, 2011, to December 31, 2021. Patients were stratified by treatment era (cohort 1: 2011-2015, cohort 2: 2016-2021). Stacked bar charts were used to present treatment proportions; Sankey diagrams were used to show the evolution of treatment sequencing between the two cohorts. RESULTS Four thousand one hundred seven patients were diagnosed with mRCC, of whom 2,752 (67%) received systemic therapy. Among these patients, mean age was 64 years, 74% were male, 75% had clear cell histology, and International Metastatic RCC Database Consortium risk classification was favorable, intermediate, and poor in 16%, 56%, and 28%, respectively. Utilization of immune checkpoint inhibition (ICI)-based treatments has increased in Canada and reflects global and local patterns of approval and adoption. The use of therapies after doublet ICI has mostly shifted toward vascular endothelial growth factor-tyrosine kinase inhibitors (VEGF-TKIs) that were previously used in first line with subsequent treatments reflecting approved and available agents after previous VEGF-TKI. Clinical trial participation among patients who received systemic therapy was 18% in first, 21% in second, and 24% in third line. CONCLUSION In Canada's publicly funded health care system, availability of standard mRCC therapies broadly reflects access from government-funded clinical trials and compassionate access program sources. In an evolving therapeutic landscape, ongoing advocacy is required to continue to facilitate patient access to efficacious therapies.
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Affiliation(s)
- Luisa M. Cardenas
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Sunita Ghosh
- Department of Medical Oncology, Faculty of Medicine and Dentistry, University of Alberta, AB, Canada
| | - Antonio Finelli
- Division of Urology, University Health Network, Toronto, ON, Canada
| | - Lori Wood
- Department of Medicine and Urology, Dalhousie University, Halifax, NS, Canada
| | | | - Naveen Basappa
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Jeffrey Graham
- Cancer Care Manitoba Research Institute, University of Manitoba, Winnipeg, MB, Canada
| | - Daniel Heng
- Department of Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Georg Bjarnason
- Department of Medical Oncology, Sunnybrook Health Sciences Centre—Odette Cancer Centre, Toronto, ON, Canada
| | - Denis Soulières
- Hematology-Oncology Department, CHUM—Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Dominick Bossé
- Medical Oncology Division, The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada
| | - Vincent Castonguay
- Hematology-Oncology Department, Centre Hospitalier Universitaire Pavillon l'Hôtel-Dieu de Quebec, Quebec City, QC, Canada
| | - Ramy Saleh
- Department of Medical Oncology, McGill University, Montreal, QC, Canada
| | - Simon Tanguay
- Division of Urology, McGill University and McGill University Health Centre, Montreal, QC, Canada
| | - Bimal Bhindi
- Department of Surgery, Section of Urology, University of Calgary, Calgary, AB, Canada
| | - Rodney H. Breau
- Department of Surgery, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Frederic Pouliot
- Department of Urology, CHU de Quebec, Université Laval, Quebec City, QC, Canada
| | - Aly-Khan A. Lalani
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
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17
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Feng G, Parthipan M, Breunis H, Timilshina N, Soto-Perez-de-Celis E, Mina DS, Emmenegger U, Finelli A, Krzyzanowska MK, Clarke H, Puts M, Alibhai SMH. Daily physical activity monitoring in older adults with metastatic prostate cancer on active treatment: Feasibility and associations with toxicity. J Geriatr Oncol 2023; 14:101576. [PMID: 37421787 DOI: 10.1016/j.jgo.2023.101576] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Abstract
INTRODUCTION Physical activity may be associated with cancer treatment toxicity, but generalizability to geriatric oncology is unclear. As many older adults have low levels of physical activity and technology use, this area needs further exploration. We evaluated the feasibility of daily step count monitoring and the association between step counts and treatment-emergent symptoms. MATERIALS AND METHODS Adults aged 65+ starting treatment (chemotherapy, enzalutamide/abiraterone, or radium-223) for metastatic prostate cancer were enrolled in a prospective cohort study. Participants reported step counts (measured via smartphone) and symptoms (Edmonton Symptom Assessment Scale) daily for one treatment cycle (i.e., 3-4 weeks). Embedded semi-structured interviews were performed upon completion of the study. The feasibility of daily monitoring was evaluated with descriptive statistics and thematic analysis. The predictive validity of a decline in daily steps (compared to pre-treatment baseline) for the emergence of symptoms was examined using sensitivity and positive predictive value (PPV). Associations between a 15% decline in steps and the emergence of moderate (4-6/10) to severe (7-10/10) symptoms and pain in the next 24 h were assessed using logistic regression. RESULTS Of 90 participants, 47 engaged in step count monitoring (median age = 75, range = 65-88; 52.2% participation rate). Daily physical activity monitoring was found to be feasible (94% retention rate; 90.5% median response rate) with multiple patient-reported benefits including increased self-awareness and motivation to engage in physical activity. During the first treatment cycle, instances of a 15% decline in steps were common (n = 37, 78.7%), as was the emergence of moderate to severe symptoms overall (n = 40, 85.1%) and pain (n = 26, 55.3%). The predictive validity of a 15% decline in steps on the emergence of moderate to severe symptoms was good (sensitivity = 81.8%, 95% confidence interval [CI] = 68.7-95.0; PPV = 73.0%, 95% CI = 58.7-87.3), although the PPV for pain was poor (sensitivity = 77.8%, 95% CI = 58.6-97.0; PPV = 37.8%, 95% CI = 22.2-53.5). In the regression models, changes in daily physical activity were not associated with symptoms or pain. DISCUSSION Changes in physical activity had modest ability to predict moderate to severe symptoms overall. Although participation was suboptimal, daily activity monitoring in older adults with cancer appears feasible and may have other uses such as improving physical activity levels. Further studies are warranted.
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Affiliation(s)
- Gregory Feng
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Milothy Parthipan
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Henriette Breunis
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Narhari Timilshina
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Salvador Zubirán National Institute of Medical Science and Nutrition, Mexico City, Mexico
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Urban Emmenegger
- Division of Medical Oncology, Odette Cancer Centre, Toronto, Ontario, Canada
| | - Antonio Finelli
- Division of Urology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Monika K Krzyzanowska
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Hance Clarke
- Department of Anesthesia, Toronto General Hospital, Toronto, Ontario, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Ontario, Canada.
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18
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Deniffel D, McAlpine K, Harder FN, Jain R, Lawson KA, Healy GM, Hui S, Zhang X, Salinas-Miranda E, van der Kwast T, Finelli A, Haider MA. Predicting the recurrence risk of renal cell carcinoma after nephrectomy: potential role of CT-radiomics for adjuvant treatment decisions. Eur Radiol 2023; 33:5840-5850. [PMID: 37074425 DOI: 10.1007/s00330-023-09551-x] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/09/2023] [Accepted: 02/12/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVES Previous trial results suggest that only a small number of patients with non-metastatic renal cell carcinoma (RCC) benefit from adjuvant therapy. We assessed whether the addition of CT-based radiomics to established clinico-pathological biomarkers improves recurrence risk prediction for adjuvant treatment decisions. METHODS This retrospective study included 453 patients with non-metastatic RCC undergoing nephrectomy. Cox models were trained to predict disease-free survival (DFS) using post-operative biomarkers (age, stage, tumor size and grade) with and without radiomics selected on pre-operative CT. Models were assessed using C-statistic, calibration, and decision curve analyses (repeated tenfold cross-validation). RESULTS At multivariable analysis, one of four selected radiomic features (wavelet-HHL_glcm_ClusterShade) was prognostic for DFS with an adjusted hazard ratio (HR) of 0.44 (p = 0.02), along with American Joint Committee on Cancer (AJCC) stage group (III versus I, HR 2.90; p = 0.002), grade 4 (versus grade 1, HR 8.90; p = 0.001), age (per 10 years HR 1.29; p = 0.03), and tumor size (per cm HR 1.13; p = 0.003). The discriminatory ability of the combined clinical-radiomic model (C = 0.80) was superior to that of the clinical model (C = 0.78; p < 0.001). Decision curve analysis revealed a net benefit of the combined model when used for adjuvant treatment decisions. At an exemplary threshold probability of ≥ 25% for disease recurrence within 5 years, using the combined versus the clinical model was equivalent to treating 9 additional patients (per 1000 assessed) who would recur without treatment (i.e., true-positive predictions) with no increase in false-positive predictions. CONCLUSION Adding CT-based radiomic features to established prognostic biomarkers improved post-operative recurrence risk assessment in our internal validation study and may help guide decisions regarding adjuvant therapy. KEY POINTS In patients with non-metastatic renal cell carcinoma undergoing nephrectomy, CT-based radiomics combined with established clinical and pathological biomarkers improved recurrence risk assessment. Compared to a clinical base model, the combined risk model enabled superior clinical utility if used to guide decisions on adjuvant treatment.
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Affiliation(s)
- Dominik Deniffel
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
- Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada
| | - Kristen McAlpine
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Felix N Harder
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
- Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada
| | - Rahi Jain
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Keith A Lawson
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Gerard M Healy
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
- Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - Shirley Hui
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Xiaoyu Zhang
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Emmanuel Salinas-Miranda
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
- Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada
| | - Theodorus van der Kwast
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Masoom A Haider
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
- Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada.
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19
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Berman DM, Lee AY, Lesurf R, Patel PG, Ebrahimizadeh W, Bayani J, Lee LA, Boufaied N, Selvarajah S, Jamaspishvili T, Guérard KP, Dion D, Kawashima A, Clarke GM, How N, Jackson CL, Scarlata E, Siddiqui K, Okello JBA, Aprikian AG, Moussa M, Finelli A, Chin J, Brimo F, Bauman G, Loblaw A, Venkateswaran V, Buttyan R, Chevalier S, Thomson A, Park PC, Siemens DR, Lapointe J, Boutros PC, Bartlett JMS. Multimodal Biomarkers That Predict the Presence of Gleason Pattern 4: Potential Impact for Active Surveillance. J Urol 2023; 210:257-271. [PMID: 37126232 DOI: 10.1097/ju.0000000000003507] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/20/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE Latent grade group ≥2 prostate cancer can impact the performance of active surveillance protocols. To date, molecular biomarkers for active surveillance have relied solely on RNA or protein. We trained and independently validated multimodal (mRNA abundance, DNA methylation, and/or DNA copy number) biomarkers that more accurately separate grade group 1 from grade group ≥2 cancers. MATERIALS AND METHODS Low- and intermediate-risk prostate cancer patients were assigned to training (n=333) and validation (n=202) cohorts. We profiled the abundance of 342 mRNAs, 100 DNA copy number alteration loci, and 14 hypermethylation sites at 2 locations per tumor. Using the training cohort with cross-validation, we evaluated methods for training classifiers of pathological grade group ≥2 in centrally reviewed radical prostatectomies. We trained 2 distinct classifiers, PRONTO-e and PRONTO-m, and validated them in an independent radical prostatectomy cohort. RESULTS PRONTO-e comprises 353 mRNA and copy number alteration features. PRONTO-m includes 94 clinical, mRNAs, copy number alterations, and methylation features at 14 and 12 loci, respectively. In independent validation, PRONTO-e and PRONTO-m predicted grade group ≥2 with respective true-positive rates of 0.81 and 0.76, and false-positive rates of 0.43 and 0.26. Both classifiers were resistant to sampling error and identified more upgrading cases than a well-validated presurgical risk calculator, CAPRA (Cancer of the Prostate Risk Assessment; P < .001). CONCLUSIONS Two grade group classifiers with superior accuracy were developed by incorporating RNA and DNA features and validated in an independent cohort. Upon further validation in biopsy samples, classifiers with these performance characteristics could refine selection of men for active surveillance, extending their treatment-free survival and intervals between surveillance.
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Affiliation(s)
- D M Berman
- Queen's University Cancer Research Institute, Kingston, Ontario, Canada
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - A Y Lee
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - R Lesurf
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Now with Hospital for Sick Children, Toronto, Ontario, Canada
| | - P G Patel
- Queen's University Cancer Research Institute, Kingston, Ontario, Canada
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
- Now with Hospital for Sick Children, Toronto, Ontario, Canada
| | - W Ebrahimizadeh
- Department of Surgery, McGill University and the Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Now with IMV Inc, Dartmouth, Nova Scotia, Canada
| | - J Bayani
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, Ontario, Canada
| | - L A Lee
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - N Boufaied
- Department of Surgery, McGill University and the Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - S Selvarajah
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
- Now with University Health Network, Toronto, Ontario, Canada
| | - T Jamaspishvili
- Queen's University Cancer Research Institute, Kingston, Ontario, Canada
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - K-P Guérard
- Department of Surgery, McGill University and the Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - D Dion
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - A Kawashima
- Queen's University Cancer Research Institute, Kingston, Ontario, Canada
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
- Now with Osaka University, Osaka, Japan
| | - G M Clarke
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - N How
- Queen's University Cancer Research Institute, Kingston, Ontario, Canada
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - C L Jackson
- Queen's University Cancer Research Institute, Kingston, Ontario, Canada
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - E Scarlata
- Department of Surgery, McGill University and the Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - K Siddiqui
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Now with Sultan Qaboos University Hospital, Seeb, Oman
| | - J B A Okello
- Queen's University Cancer Research Institute, Kingston, Ontario, Canada
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - A G Aprikian
- Department of Surgery, McGill University and the Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - M Moussa
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - A Finelli
- Princess Margaret Cancer Centre. Toronto, Ontario, Canada
- Departments of Surgery and Oncology, University of Toronto, Toronto, Ontario, Canada
| | - J Chin
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - F Brimo
- Department of Surgery, McGill University and the Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Department of Pathology, McGill University, Montreal, Quebec, Canada
| | - G Bauman
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - A Loblaw
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Departments of Radiation Oncology and Health Policy Management and Evaluation, University of Toronto, Toronto
| | - V Venkateswaran
- Departments of Surgery and Oncology, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - R Buttyan
- Vancouver Prostate Centre, Vancouver, British Columbia, Canada
- Departments of Experimental Medicine and Interdisciplinary Oncology, Vancouver, British Columbia, Canada
| | - S Chevalier
- Department of Surgery, McGill University and the Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - A Thomson
- Department of Surgery, McGill University and the Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Now with College of Science and Engineering Biology, University of Edinburgh, Edinburgh, United Kingdom
| | - P C Park
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
- Now with Department of Pathology, Shared Health, Winnipeg, Manitoba, Canada
| | - D R Siemens
- Queen's University Cancer Research Institute, Kingston, Ontario, Canada
- Departments of Urology, Oncology and Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - J Lapointe
- Department of Surgery, McGill University and the Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - P C Boutros
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Now with University of California, Los Angeles, Los Angeles, California, United States
| | - J M S Bartlett
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, Ontario, Canada
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom
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20
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Millan B, Breau RH, Mallick R, Wood L, Rendon R, Finelli A, So AI, Lavallée LT, Pouliot F, Bhindi B, Heng D, Drachenberg D, Tanguay S, Dean L, Basappa NS, Lattouf JB, Bjarnason G, Lalani AK, Kapoor A. Comparison of patients with renal cell carcinoma in adjuvant therapy trials to a real-world population. Urol Oncol 2023; 41:328.e15-328.e23. [PMID: 37202328 DOI: 10.1016/j.urolonc.2023.04.015] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/09/2023] [Accepted: 04/16/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE To compare characteristics and outcomes of patients included versus those not in adjuvant therapy trials post complete resection of renal cell carcinoma (RCC). METHODS Adult patients following complete resection for clear cell RCC between January 1, 2011, and March 31, 2021, were included. Patients had intermediate high, high risk nonmetastatic disease (modified UCLA Integrated Staging System) or fully resected metastatic (M1) disease as per the inclusion criteria of adjuvant studies. Demographic, clinical, and outcomes between trial and nontrial patients were compared. RESULTS Of 1,459 eligible patients, 63 (4.3%) participated in an adjuvant trial. Disease characteristics were similar between groups. Trial patients were younger (mean age 58.1 vs. 63.6 years; P < 0.0001) and had lower Charlson Comorbidity Index scores (mean 4.2 vs. 4.9; P = 0.009). Unadjusted disease-free survival (DFS) at 5 years for trial patients was 48.6% and 39.2% for nontrial patients (HR 0.71, 0.48-1.05, P = 0.08). Median DFS was higher for trial patients in comparison to nontrial patients (4.4 years, IQR 1.7- not reached; vs. 3.0 years, IQR 0.8-8.6; P = 0.08). Cancer specific survival (CSS) at 5 years for trial patients was 85.2% in comparison to 78.6% for nontrial patients (HR 0.45, 0.22-0.92, P = 0.03). Unadjusted estimated overall survival (OS) at 5 years was 80.8% for trial patients and 74.8% (HR 0.42, 0.18-0.94; P = 0.04) for nontrial patients. CONCLUSIONS Patients in adjuvant trials were younger and healthier with longer CSS and OS in comparison to those not included in adjuvant trials. These findings may have implications when we generalize trial results to real world patients.
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Affiliation(s)
- Braden Millan
- Division of Urology, McMaster Institute of Urology, McMaster University, Hamilton, Ontario, Canada.
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, Ontario, Canada
| | - Ranjeeta Mallick
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Lori Wood
- Division of Medical Oncology, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Ricardo Rendon
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Antonio Finelli
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Alan I So
- Department of Urologic Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Luke T Lavallée
- Division of Urology, University of Ottawa, Ottawa, Ontario, Canada
| | - Frédéric Pouliot
- Division of Urology, CHU of Québec and Laval University, Montreal, Quebec, Canada
| | - Bimal Bhindi
- Division of Urology, University of Calgary, Calgary, Alberta, Canada
| | - Daniel Heng
- Division of Medical Oncology, University of Calgary, Calgary, Alberta, Canada
| | | | - Simon Tanguay
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Lucas Dean
- Department of Surgery, Alberta Urology Institute Research Center, University of Alberta, Edmonton, Alberta, Canada
| | - Naveen S Basappa
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Alberta. Edmonton, Canada
| | | | - George Bjarnason
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Aly-Khan Lalani
- Division of Medical Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Anil Kapoor
- Division of Urology, McMaster Institute of Urology, McMaster University, Hamilton, Ontario, Canada
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21
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Kwong JCC, Khondker A, Meng E, Taylor N, Kuk C, Perlis N, Kulkarni GS, Hamilton RJ, Fleshner NE, Finelli A, van der Kwast TH, Ali A, Jamal M, Papanikolaou F, Short T, Srigley JR, Colinet V, Peltier A, Diamand R, Lefebvre Y, Mandoorah Q, Sanchez-Salas R, Macek P, Cathelineau X, Eklund M, Johnson AEW, Feifer A, Zlotta AR. Development, multi-institutional external validation, and algorithmic audit of an artificial intelligence-based Side-specific Extra-Prostatic Extension Risk Assessment tool (SEPERA) for patients undergoing radical prostatectomy: a retrospective cohort study. Lancet Digit Health 2023; 5:e435-e445. [PMID: 37211455 DOI: 10.1016/s2589-7500(23)00067-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 02/11/2023] [Accepted: 03/22/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Accurate prediction of side-specific extraprostatic extension (ssEPE) is essential for performing nerve-sparing surgery to mitigate treatment-related side-effects such as impotence and incontinence in patients with localised prostate cancer. Artificial intelligence (AI) might provide robust and personalised ssEPE predictions to better inform nerve-sparing strategy during radical prostatectomy. We aimed to develop, externally validate, and perform an algorithmic audit of an AI-based Side-specific Extra-Prostatic Extension Risk Assessment tool (SEPERA). METHODS Each prostatic lobe was treated as an individual case such that each patient contributed two cases to the overall cohort. SEPERA was trained on 1022 cases from a community hospital network (Trillium Health Partners; Mississauga, ON, Canada) between 2010 and 2020. Subsequently, SEPERA was externally validated on 3914 cases across three academic centres: Princess Margaret Cancer Centre (Toronto, ON, Canada) from 2008 to 2020; L'Institut Mutualiste Montsouris (Paris, France) from 2010 to 2020; and Jules Bordet Institute (Brussels, Belgium) from 2015 to 2020. Model performance was characterised by area under the receiver operating characteristic curve (AUROC), area under the precision recall curve (AUPRC), calibration, and net benefit. SEPERA was compared against contemporary nomograms (ie, Sayyid nomogram, Soeterik nomogram [non-MRI and MRI]), as well as a separate logistic regression model using the same variables included in SEPERA. An algorithmic audit was performed to assess model bias and identify common patient characteristics among predictive errors. FINDINGS Overall, 2468 patients comprising 4936 cases (ie, prostatic lobes) were included in this study. SEPERA was well calibrated and had the best performance across all validation cohorts (pooled AUROC of 0·77 [95% CI 0·75-0·78] and pooled AUPRC of 0·61 [0·58-0·63]). In patients with pathological ssEPE despite benign ipsilateral biopsies, SEPERA correctly predicted ssEPE in 72 (68%) of 106 cases compared with the other models (47 [44%] in the logistic regression model, none in the Sayyid model, 13 [12%] in the Soeterik non-MRI model, and five [5%] in the Soeterik MRI model). SEPERA had higher net benefit than the other models to predict ssEPE, enabling more patients to safely undergo nerve-sparing. In the algorithmic audit, no evidence of model bias was observed, with no significant difference in AUROC when stratified by race, biopsy year, age, biopsy type (systematic only vs systematic and MRI-targeted biopsy), biopsy location (academic vs community), and D'Amico risk group. According to the audit, the most common errors were false positives, particularly for older patients with high-risk disease. No aggressive tumours (ie, grade >2 or high-risk disease) were found among false negatives. INTERPRETATION We demonstrated the accuracy, safety, and generalisability of using SEPERA to personalise nerve-sparing approaches during radical prostatectomy. FUNDING None.
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Affiliation(s)
- Jethro C C Kwong
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Temerty Centre for AI Research and Education in Medicine, University of Toronto, Toronto, ON, Canada
| | - Adree Khondker
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Eric Meng
- Faculty of Medicine, Queen's University, Kingston, ON, Canada
| | - Nicholas Taylor
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Cynthia Kuk
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Nathan Perlis
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Girish S Kulkarni
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Temerty Centre for AI Research and Education in Medicine, University of Toronto, Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Neil E Fleshner
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Theodorus H van der Kwast
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Laboratory Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Amna Ali
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Munir Jamal
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Frank Papanikolaou
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Thomas Short
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - John R Srigley
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Valentin Colinet
- Division of Urology, Department of Surgery, Jules Bordet Institute, Brussels, Belgium
| | - Alexandre Peltier
- Division of Urology, Department of Surgery, Jules Bordet Institute, Brussels, Belgium
| | - Romain Diamand
- Division of Urology, Department of Surgery, Jules Bordet Institute, Brussels, Belgium
| | - Yolene Lefebvre
- Department of Medical Imagery, Jules Bordet Institute, Brussels, Belgium
| | - Qusay Mandoorah
- Division of Urology, Department of Surgery, L'Institut Mutualiste Montsouris, Paris, France
| | - Rafael Sanchez-Salas
- Division of Urology, Department of Surgery, L'Institut Mutualiste Montsouris, Paris, France
| | - Petr Macek
- Division of Urology, Department of Surgery, L'Institut Mutualiste Montsouris, Paris, France
| | - Xavier Cathelineau
- Division of Urology, Department of Surgery, L'Institut Mutualiste Montsouris, Paris, France
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Alistair E W Johnson
- Temerty Centre for AI Research and Education in Medicine, University of Toronto, Toronto, ON, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Vector Institute, Toronto, ON, Canada
| | - Andrew Feifer
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada; Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Alexandre R Zlotta
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Division of Urology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada.
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22
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Richard PO, Violette PD, Bhindi B, Breau RH, Gratton M, Jewett MAS, Kapoor A, Pouliot F, Leveridge M, So AI, Whelan TF, Rendon RA, Tanguay S, Finelli A. 2023 UPDATE - Canadian Urological Association guideline: Management of cystic renal lesions Prior to original publication (March 2017), this guideline underwent review by the CUA Guidelines Committee, CUA members at large, and the CUA Executive Board. The 2023 updates were app roved by the CUA Guidelines Committee and CUA Executive Board. Can Urol Assoc J 2023; 17:162-174. [PMID: 37310905 DOI: 10.5489/cuaj.8389] [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] [Indexed: 06/15/2023]
Affiliation(s)
- Patrick O Richard
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Bimal Bhindi
- Southern Alberta Institute of Urology, University of Calgary, Calgary, AB, Canada
| | - Rodney H Breau
- Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON , Canada
| | - Matthieu Gratton
- Division of Urology, Department of Surgery, Université Laval, Quebec, QC, Canada
| | - Michael A S Jewett
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON , Canada
| | - Anil Kapoor
- Division of Urology, Department of Surgery McMaster University, Hamilton, ON , Canada
| | - Frederic Pouliot
- Division of Urology, Department of Surgery, Université Laval, Quebec, QC, Canada
| | - Michael Leveridge
- Department of Urology, Queen's University, Kingston General Hospital, Kingston, ON , Canada
| | - Alan I So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Tom F Whelan
- Division of Urology, Department of Surgery, Saint John Regional Hospital, Dalhousie University, Saint John, NB, Canada
| | - Ricardo A Rendon
- Department of Urology, QEII Health Sciences Centre, Dalhousie University, Halifax, NS , Canada
| | - Simon Tanguay
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Antonio Finelli
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON , Canada
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23
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Alrumayyan M, Raveendran L, Lawson KA, Finelli A. Cystic Renal Masses: Old and New Paradigms. Urol Clin North Am 2023; 50:227-238. [PMID: 36948669 DOI: 10.1016/j.ucl.2023.01.003] [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] [Indexed: 02/22/2023]
Abstract
Cystic renal masses describe a spectrum of lesions with benign and/or malignant features. Cystic renal masses are most often identified incidentally with the Bosniak classification system stratifying their malignant potential. Solid enhancing components most often represent clear cell renal cell carcinoma yet display an indolent natural history relative to pure solid renal masses. This has led to an increased adoption of active surveillance as a management strategy in those who are poor surgical candidates. This article provides a contemporary overview of historical and emerging clinical paradigms in the diagnosis and management of this distinct clinical entity.
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Affiliation(s)
- Majed Alrumayyan
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Lucshman Raveendran
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Keith A Lawson
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
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24
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Fu R, Sutradhar R, Li Q, Hanna TP, Chan KKW, Irish JC, Coburn N, Hallet J, Dare A, Singh S, Parmar A, Earle CC, Lapointe-Shaw L, Krzyzanowska MK, Finelli A, Louie AV, Look Hong NJ, Witterick IJ, Mahar A, Urbach DR, McIsaac DI, Enepekides D, Eskander A. Association between the COVID-19 pandemic and first cancer treatment modality: a population-based cohort study. CMAJ Open 2023; 11:E426-E433. [PMID: 37160325 PMCID: PMC10174267 DOI: 10.9778/cmajo.20220102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Physicians were directed to prioritize using nonsurgical cancer treatment at the beginning of the COVID-19 pandemic. We sought to quantify the impact of this policy on the modality of first cancer treatment (surgery, chemotherapy, radiotherapy or no treatment). METHODS In this population-based study using Ontario data from linked administrative databases, we identified adults diagnosed with cancer from January 2016 to November 2020 and their first cancer treatment received within 1 year postdiagnosis. Segmented Poisson regressions were applied to each modality to estimate the change in mean 1-year recipient volume per thousand patients (rate) at the start of the pandemic (the week of Mar. 15, 2020) and change in the weekly trend in rate during the pandemic (Mar. 15, 2020, to Nov. 7, 2020) relative to before the pandemic (Jan. 3, 2016, to Mar. 14, 2020). RESULTS We included 321 535 people diagnosed with cancer. During the first week of the COVID-19 pandemic, the mean rate of receiving upfront surgery over the next year declined by 9% (rate ratio 0.91, 95% confidence interval [CI] 0.88-0.95), and chemotherapy and radiotherapy rates rose by 30% (rate ratio 1.30, 95% CI 1.23-1.36) and 13% (rate ratio 1.13, 95% CI 1.07-1.19), respectively. Subsequently, the 1-year rate of upfront surgery increased at 0.4% for each week (rate ratio 1.004, 95% CI 1.002-1.006), and chemotherapy and radiotherapy rates decreased by 0.9% (rate ratio 0.991, 95% CI 0.989-0.994) and 0.4% (rate ratio 0.996, 95% CI 0.994-0.998), respectively, per week. Rates of each modality resumed to prepandemic levels at 24-31 weeks into the pandemic. INTERPRETATION An immediate and sustained increase in use of nonsurgical therapy as the first cancer treatment occurred during the first 8 months of the COVID-19 pandemic in Ontario. Further research is needed to understand the consequences.
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Affiliation(s)
- Rui Fu
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Rinku Sutradhar
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Qing Li
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Timothy P Hanna
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Kelvin K W Chan
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Jonathan C Irish
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Natalie Coburn
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Julie Hallet
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Anna Dare
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Simron Singh
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Ambica Parmar
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Craig C Earle
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Lauren Lapointe-Shaw
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Monika K Krzyzanowska
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Antonio Finelli
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Alexander V Louie
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Nicole J Look Hong
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Ian J Witterick
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Alyson Mahar
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - David R Urbach
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Daniel I McIsaac
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Danny Enepekides
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Antoine Eskander
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont.
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Timilshina N, Finelli A, Tomlinson G, Sander B, Alibhai SMH. Applying Quality Indicators to Examine Quality of Care During Active Surveillance in Low-Risk Prostate Cancer: A Population-Based Study. J Natl Compr Canc Netw 2023; 21:465-472.e9. [PMID: 37156486 DOI: 10.6004/jnccn.2022.7256] [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: 06/29/2022] [Accepted: 12/21/2022] [Indexed: 05/10/2023]
Abstract
BACKGROUND Although a few studies have reported wide variations in quality of care in active surveillance (AS), there is a lack of research using validated quality indicators (QIs). The aim of this study was to apply evidence-based QIs to examine the quality of AS care at the population level. METHODS QIs were measured using a population-based retrospective cohort of patients with low-risk prostate cancer diagnosed between 2002 and 2014. We developed 20 QIs through a modified Delphi approach with clinicians targeting the quality of AS care at the population level. QIs included structure (n=1), process of care (n=13), and outcome indicators (n=6). Abstracted pathology data were linked to cancer registry and administrative databases in Ontario, Canada. A total of 17 of 20 QIs could be applied based on available information in administrative databases. Variations in QI performance were explored according to patient age, year of diagnosis, and physician volume. RESULTS The cohort included 33,454 men with low-risk prostate cancer, with a median age of 65 years (IQR, 59-71 years) and a median prostate-specific antigen level of 6.2 ng/mL. Compliance varied widely for 10 process QIs (range, 36.6%-100.0%, with 6 [60%] QIs >80%). Initial AS uptake was 36.6% and increased over time. Among outcome indicators, significant variations were observed by patient age group (10-year metastasis-free survival was 95.0% for age 65-74 years and 97.5% in age <55 years) and physician average annual AS volume (10-year metastasis-free survival was 94.5% for physicians with 1-2 patients with AS and 95.8% for those with ≥6 patients with AS annually). CONCLUSIONS This study establishes a foundation for quality-of-care assessments and monitoring during AS implementation at a population level. Considerable variations appeared with QIs related to process of care by physician volume and Qis related to outcome by patient age group. These findings may represent areas for targeted quality improvement initiatives.
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Affiliation(s)
- Narhari Timilshina
- 1Department of Medicine, University Health Network, Toronto, Ontario, Canada
- 2Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Antonio Finelli
- 2Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- 3Division of Urology and Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - George Tomlinson
- 1Department of Medicine, University Health Network, Toronto, Ontario, Canada
- 2Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Beate Sander
- 2Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- 4The Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada
- 5Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- 6Institute of Clinical Research Services, Toronto, Ontario, Canada
- 7Public Health Ontario, Toronto, Ontario, Canada
| | - Shabbir M H Alibhai
- 1Department of Medicine, University Health Network, Toronto, Ontario, Canada
- 2Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Sweeney CJ, Martin AJ, Stockler MR, Begbie S, Cheung L, Chi KN, Chowdhury S, Frydenberg M, Horvath LG, Joshua AM, Lawrence NJ, Marx G, McCaffrey J, McDermott R, McJannett M, North SA, Parnis F, Parulekar W, Pook DW, Reaume MN, Sandhu SK, Tan A, Tan TH, Thomson A, Vera-Badillo F, Williams SG, Winter D, Yip S, Zhang AY, Zielinski RR, Davis ID, Abdi E, Allan S, Bastick P, Begbie S, Blum R, Briscoe K, Brungs D, Bydder S, Chittajallu BR, Cronk M, Cuff K, Davis ID, Dowling A, Frydenberg M, George M, Horvath L, Hovey E, Joshua A, Karanth N, Kichenadasse G, Krieger L, Marx G, Mathlum M, Nott L, Otty Z, Parnis F, Pook D, Sandhu S, Sewak S, Stevanovic A, Stockler M, Suder A, Tan H, Torres J, Troon S, Underhill C, Weickhardt A, Zielinski R, Abbas T, Anan G, Booth C, Campbell H, Chi K, Chin J, Chouinard E, Donnelly B, Drachenberg D, Faghih A, Finelli A, Hotte S, Noonan K, North S, Rassouli M, Reaume N, Rendon R, Saad F, Sadikov E, Vigneault E, Zalewski P, McCaffrey J, McDermott R, Morris P, O'Connor M, Donnellan P, O'Donnell D, Edwards J, Fong P, Tan A, Chowdhury S, Crabb S, Khan O, Khoo V, Macdonald G, Payne H, Robinson A, Shamash J, Staffurth J, Thomas C, Thomson A, Sweeney CJ. Testosterone suppression plus enzalutamide versus testosterone suppression plus standard antiandrogen therapy for metastatic hormone-sensitive prostate cancer (ENZAMET): an international, open-label, randomised, phase 3 trial. Lancet Oncol 2023; 24:323-334. [PMID: 36990608 DOI: 10.1016/s1470-2045(23)00063-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND The interim analysis of the ENZAMET trial of testosterone suppression plus either enzalutamide or standard nonsteroidal antiandrogen therapy showed an early overall survival benefit with enzalutamide. Here, we report the planned primary overall survival analysis, with the aim of defining the benefit of enzalutamide treatment in different prognostic subgroups (synchronous and metachronous high-volume or low-volume disease) and in those who received concurrent docetaxel. METHODS ENZAMET is an international, open-label, randomised, phase 3 trial conducted at 83 sites (including clinics, hospitals, and university centres) in Australia, Canada, Ireland, New Zealand, the UK, and the USA. Eligible participants were males aged 18 years or older with metastatic, hormone-sensitive prostate adenocarcinoma evident on CT or bone scanning with 99mTc and an Eastern Cooperative Oncology Group performance status score of 0-2. Participants were randomly assigned (1:1), using a centralised web-based system and stratified by volume of disease, planned use of concurrent docetaxel and bone antiresorptive therapy, comorbidities, and study site, to receive testosterone suppression plus oral enzalutamide (160 mg once per day) or a weaker standard oral non-steroidal antiandrogen (bicalutamide, nilutamide, or flutamide; control group) until clinical disease progression or prohibitive toxicity. Testosterone suppression was allowed up to 12 weeks before randomisation and for up to 24 months as adjuvant therapy. Concurrent docetaxel (75 mg/m2 intravenously) was allowed for up to six cycles once every 3 weeks, at the discretion of participants and physicians. The primary endpoint was overall survival in the intention-to-treat population. This planned analysis was triggered by reaching 470 deaths. This study is registered with ClinicalTrials.gov, NCT02446405, ANZCTR, ACTRN12614000110684, and EudraCT, 2014-003190-42. FINDINGS Between March 31, 2014, and March 24, 2017, 1125 participants were randomly assigned to receive non-steroidal antiandrogen (n=562; control group) or enzalutamide (n=563). The median age was 69 years (IQR 63-74). This analysis was triggered on Jan 19, 2022, and an updated survival status identified a total of 476 (42%) deaths. After a median follow-up of 68 months (IQR 67-69), the median overall survival was not reached (hazard ratio 0·70 [95% CI 0·58-0·84]; p<0·0001), with 5-year overall survival of 57% (0·53-0·61) in the control group and 67% (0·63-0·70) in the enzalutamide group. Overall survival benefits with enzalutamide were consistent across predefined prognostic subgroups and planned use of concurrent docetaxel. The most common grade 3-4 adverse events were febrile neutropenia associated with docetaxel use (33 [6%] of 558 in the control group vs 37 [6%] of 563 in the enzalutamide group), fatigue (four [1%] vs 33 [6%]), and hypertension (31 [6%] vs 59 [10%]). The incidence of grade 1-3 memory impairment was 25 (4%) versus 75 (13%). No deaths were attributed to study treatment. INTERPRETATION The addition of enzalutamide to standard of care showed sustained improvement in overall survival for patients with metastatic hormone-sensitive prostate cancer and should be considered as a treatment option for eligible patients. FUNDING Astellas Pharma.
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McAlpine K, Lawson K, Saarela O, Chen B, Wilson B, Abouassaly R, Nayan M, Finelli A. Surgeon-level versus hospital-level quality variance in kidney cancer surgery. Urol Oncol 2023; 41:257.e7-257.e17. [PMID: 36966064 DOI: 10.1016/j.urolonc.2023.02.007] [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: 11/24/2022] [Revised: 01/27/2023] [Accepted: 02/27/2023] [Indexed: 03/27/2023]
Abstract
PURPOSE To determine whether variance in kidney cancer surgery quality indicators (QIs) is most impacted by surgeon-level or hospital-level factors in order to inform quality improvement initiatives. MATERIALS AND METHODS The ICES and Veterans Affairs (VA) databases were queried for patients undergoing surgery for localized kidney cancer. Kidney cancer surgery QIs were defined within each cohort. Quality of care was benchmarked at a surgeon- vs. hospital-level to identify statistical outliers, using available clinicopathological data to adjust for differences in case-mix. Variance between surgeons and hospitals was calculated for each QI using a random-effects model. RESULTS The QI with the greatest amount of variance explained by hospital and surgeon-level factors was proportion of cases performed with minimally invasive surgery (MIS). The majority of this variance was due to surgeon-level factors for both the VA and ICES cohorts. The proportion of cases performed using an MIS approach was also the QI with the greatest number of outlier hospitals and surgeons compared to the average performance. The proportion of partial nephrectomies performed for patients at risk of chronic kidney disease was the QI with the greatest amount of variance due to hospital-level factors for the ICES cohort. CONCLUSIONS The proportion of localized kidney cancer cases performed using an MIS approach is the QI requiring the greatest attention. Quality improvement initiatives should focus on surgeon-level factors to increase the number of MIS cases being performed for patients with localized renal masses.
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Affiliation(s)
- Kristen McAlpine
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Keith Lawson
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Olli Saarela
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Bo Chen
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Brigid Wilson
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH
| | - Robert Abouassaly
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH; Glickman Urology and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Madhur Nayan
- Department of Urology, NYU Grossman School of Medicine, New York, NY
| | - Antonio Finelli
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada.
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Feng G, Parthipan M, Breunis H, Puts M, Emmenegger U, Timilshina N, Hansen AR, Finelli A, Krzyzanowska MK, Matthew A, Clarke H, Mina DS, Soto-Perez-de-Celis E, Tomlinson G, Alibhai SMH. Feasibility and acceptability of remote symptom monitoring (RSM) in older adults during treatment for metastatic prostate cancer. J Geriatr Oncol 2023; 14:101469. [PMID: 36917921 DOI: 10.1016/j.jgo.2023.101469] [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: 11/21/2022] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION Emerging data support multiple benefits of remote symptom monitoring (RSM) during chemotherapy to improve outcomes. However, these studies have not focused on older adults and do not include treatments beyond chemotherapy. Although chemotherapy, androgen receptor axis-targeted therapies (ARATs), and radium-223 prolong survival, toxicities are substantial and increased in older adults with metastatic prostate cancer (mPC). We aimed to assess RSM feasibility among older adults receiving life-prolonging mPC treatments. MATERIALS AND METHODS Older adults aged 65+ starting chemotherapy, an ARAT, or radium-223 for mPC were enrolled in a multicentre prospective cohort study. As part of the RSM package, participants completed the Edmonton Symptom Assessment Scale (ESAS) daily and detailed questionnaires assessing mood, anxiety, fatigue, insomnia, and pain weekly online or by phone throughout one treatment cycle (3-4 weeks). Alerts were sent to the clinical oncology team for severe symptoms (ESAS ≥7). Participants also completed an end of study questionnaire that assessed study burden and satisfaction. Descriptive statistics were used to determine recruitment and retention rates, participant response rates to daily and weekly questionnaires, clinician responses to alerts, and participant satisfaction rates. An inductive descriptive approach was used to categorize open-ended responses about study benefits, challenges, and recommendations into relevant themes. RESULTS Ninety males were included (mean age 77 years, 48% ARAT, 38% chemotherapy, and 14% radium-223). Approximately 38% of patients preferred phone-based RSM. Patients provided RSM responses in 1216 out of 1311 daily questionnaires (93%). Over 93% of participants were satisfied (36%), very satisfied (43%), or extremely satisfied (16%) with RSM, although daily reporting was reported by several (8%) as burdensome. Nearly 45% of patients reported severe symptoms during RSM. Most symptom alerts sent to the oncology care team were acknowledged (97%) and 53% led to follow-ups with a nurse or physician for additional care. DISCUSSION RSM is feasible and acceptable to older adults with mPC, but accommodation needs to be made for phone-based RSM. The optimal frequency and duration of RSM also needs to be established.
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Affiliation(s)
- Gregory Feng
- Department of Medicine, University Health Network, Toronto, Canada.
| | | | | | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
| | - Urban Emmenegger
- Division of Medical Oncology, Odette Cancer Centre, Toronto, Canada.
| | | | - Aaron R Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada.
| | - Antonio Finelli
- Division of Urology, Princess Margaret Cancer Centre, Toronto, Canada.
| | - Monika K Krzyzanowska
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada.
| | - Andrew Matthew
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada.
| | - Hance Clarke
- Department of Anesthesia, Toronto General Hospital, Toronto, Canada.
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada.
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, Mexico.
| | - George Tomlinson
- Biostatistics Research Unit, University Health Network, Toronto, Canada.
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Canada; Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada.
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Tan GH, Deniffel D, Finelli A, Wettstein M, Ahmad A, Zlotta A, Fleshner N, Hamilton R, Kulkarni G, Nason G, Ajib K, Herrera-Caceres J, Chandrasekar T, Perlis N. Validating the total cancer location density metric for stratifying patients with low-risk localized prostate cancer at higher risk of grade group reclassification while on active surveillance. Urol Oncol 2023; 41:146.e23-146.e28. [PMID: 36639336 DOI: 10.1016/j.urolonc.2022.12.003] [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: 08/02/2022] [Revised: 11/07/2022] [Accepted: 12/08/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE To validate a previously proposed prognostic metric, Total Cancer Location (TCLo) density, in a contemporary cohort of men with grade group (GG) 1 prostate cancer (PCa) on active surveillance (AS). METHODS We evaluated 123 patients who entered AS with maximum GG1 PCa at diagnostic and/or confirmatory biopsy. TCLo was defined as the total number of PCa locations identified on both biopsy sessions. TCLo density was calculated as TCLo / prostate volume [ml]. Primary endpoint was progression-free survival (PFS), defined as time from confirmatory biopsy to grade group reclassification (GGR) on repeat biopsy or prostatectomy. Optimal cut-point for TCLo density was predefined in a previously reported cohort and applied to this contemporary cohort. Kaplan-Meier and multivariable Cox regression analysis were used to estimate the association of predictors with PFS. RESULTS During median follow-up of 7.8 years, (IQR 7.3-8.2) 34 men had GGR. Using previously defined cut-points, PFS at 5-years was 60% (95% CI: 44%-81%) vs. 89% (95% CI: 83%-96%) in men with high (≥0.06 ml-1) vs. low (<0.06 ml-1) TCLo density, and 63% (95% CI: 48%-82%) vs. 90% (95% CI: 83%-96%) in men with high (≥3) vs. low (≤2) TCLo (log-rank test: P < 0.0001, respectively). Adjusting for age, prostate volume, percent of positive cores and PSA, both higher TCLo density (HR [per 0.01 ml-1 increase]: 1.18, 95% CI: 1.05-1.33, P = 0.005) and TCLo (HR: 1.69, 95% CI: 1.20-2.38, P = 0.002) were associated with shorter PFS. CONCLUSION The previously suggested prognostic value of TCLo density was confirmed in this validation cohort. TCLo alone performed similarly well. Patients with high TCLo density (≥0.06 ml-1) or TCLo (>2) were at greater risk of GGR while on AS. With external validation, these metric may help guide risk-adapted surveillance protocols.
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Affiliation(s)
- Guan Hee Tan
- University Health Network, Sprott Department of Surgery, Division of Urology, University of Toronto, Toronto, Canada; Sunway Medical Centre, Bandar Sunway, Selangor, Malaysia
| | - Dominik Deniffel
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Germany; Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, ON, Canada
| | - Antonio Finelli
- University Health Network, Sprott Department of Surgery, Division of Urology, University of Toronto, Toronto, Canada
| | - Marian Wettstein
- University Health Network, Sprott Department of Surgery, Division of Urology, University of Toronto, Toronto, Canada
| | - Ardalan Ahmad
- University Health Network, Sprott Department of Surgery, Division of Urology, University of Toronto, Toronto, Canada
| | - Alexandre Zlotta
- University Health Network, Sprott Department of Surgery, Division of Urology, University of Toronto, Toronto, Canada; Division of Urology, Sinai Health System, Toronto, Canada
| | - Neil Fleshner
- University Health Network, Sprott Department of Surgery, Division of Urology, University of Toronto, Toronto, Canada
| | - Robert Hamilton
- University Health Network, Sprott Department of Surgery, Division of Urology, University of Toronto, Toronto, Canada
| | - Girish Kulkarni
- University Health Network, Sprott Department of Surgery, Division of Urology, University of Toronto, Toronto, Canada
| | - Gregory Nason
- University Health Network, Sprott Department of Surgery, Division of Urology, University of Toronto, Toronto, Canada
| | - Khaled Ajib
- University Health Network, Sprott Department of Surgery, Division of Urology, University of Toronto, Toronto, Canada
| | - Jaime Herrera-Caceres
- University Health Network, Sprott Department of Surgery, Division of Urology, University of Toronto, Toronto, Canada
| | | | - Nathan Perlis
- University Health Network, Sprott Department of Surgery, Division of Urology, University of Toronto, Toronto, Canada.
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Timilshina N, Alibhai SMH, Tomlinson G, Sander B, Cheung DC, Finelli A. Long-term Outcomes Following Active Surveillance of Low-grade Prostate Cancer: A Population-based Study Using a Landmark Approach. J Urol 2023; 209:540-548. [PMID: 36475730 DOI: 10.1097/ju.0000000000003097] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/20/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Active surveillance is widely used to manage low-risk prostate cancer, but population-level long-term outcomes are limited. Our objective was to determine long-term population-level oncological outcomes in active surveillance patients. A secondary objective examined the active surveillance discontinuation rate. MATERIALS AND METHODS In this retrospective, population-based study using linked administrative databases from Ontario, Canada, we identified low-grade prostate cancer patients managed with active surveillance or initial treatment between 2002-2014. The 10- and 15-year metastasis-free survival, overall survival, and cancer-specific survival were compared between active surveillance and initial treatment. A landmark of 24 months was selected for the primary analysis. Long-term outcomes were examined using multivariable proportional hazards models and a propensity-based approach. RESULTS The cohort consisted of 21,282 low-grade prostate cancer patients with a median follow-up of 9.8 years. At 10-year follow-up the survival rate of remaining on active surveillance was 39%, metastasis-free survival was 94.2%, overall survival 88.7%, and cancer-specific survival 98.1%. In adjusted models active surveillance was associated with higher risk of metastasis (HR 1.34, 95%CI 1.15-1.57), overall mortality (HR 1.12, 95%CI 1.01-1.24), and prostate cancer-specific mortality (HR 1.66, 95%CI 1.15-2.39) compared to initial treatment. Survival analysis using 7,525 propensity-matched pairs was consistent with the primary analysis for metastasis-free survival, overall survival and cancer-specific survival. CONCLUSIONS In this large population-based study of long-term outcomes in men with low-grade prostate cancer, active surveillance is associated with excellent long-term metastasis-free survival and overall survival. However, long-term cancer-specific survival was slightly inferior (1% worse at 10 years with active surveillance), and this must be balanced against known harms of overtreatment.
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Affiliation(s)
- N Timilshina
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - S M H Alibhai
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - G Tomlinson
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - B Sander
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - D C Cheung
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Division of Urology and Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - A Finelli
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Division of Urology and Surgical Oncology, University Health Network, Toronto, Ontario, Canada
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Bansal RK, Cassim R, Sun R, Mallick R, Finelli A, Tanguay S, Drachenberg DE, Pouliot F, Lavallee L, So AI, Rendon RA, Wood L, Kapoor A, Lalani AKA, Basappa NS, Bhindi B, Dean LW, Bjarnason GA, Breau RH. Outcomes of partial nephrectomy for non-metastatic cT2 renal tumors: Results from a Canadian multi-institutional collaborative. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
690 Background: The role of partial nephrectomy (PN) is not well defined for cT2 renal cell carcinoma (RCC) as compared to radical nephrectomy (RN). The aim of this study was to examine oncological outcomes of PN as compared to RN for non-metastatic cT2 RCC. Methods: The Canadian Kidney Cancer information system was used to define patients who underwent surgery for non-metastatic cT2 RCC from January 2011 to October 2022. Patients with clear-cell, papillary, and chromophobe RCC were included. Other histology, multiple tumours, and hereditary RCC syndrome patients were excluded. Each PN patient was individually matched to RN up to 1:4 depending on availability of patients based on tumor size (+/- 1cm), histology, grade (clear cell and papillary), and necrosis (clear cell). Matched patients were analyzed as clusters. Results: A total of 1523 patients were identified, and 50 PN patients met study criteria who were then matched to 185 RN patients. Both groups had similar age, gender, smoking status, BMI, Charlson comorbidity index score, symptoms at presentation, baseline eGFR, hemoglobin and pathological characteristics. PN patients had smaller tumors (7.6 cm [IQR 2] vs 8.4 [IQR 2.4], p=0.05), had higher likelihood of undergoing open surgery (72.9% vs 31.8%, p<0.0001) and less likely received adrenalectomy (2% vs 24.3%, p=0.0004). Positive surgical margin rates were similar in both groups (8.2% in PN vs 3.4% in RN, p=0.2). Median follow up was not significantly different in either group (3.6 yrs [IQR 4.7] in PN vs 3.3 [4.7] yrs in RN, p=0.9). During the follow up period, PN patients had higher risk of local recurrence (HR 3.0, 95%CI 1.08-8.37), lower risk of distant metastasis (HR 0.36, 95%CI 0.15-0.88), better cancer specific survival (HR 0.56, 95%CI 0.18-1.78) and overall survival (HR 0.36, 95%CI 0.11-1.19) and as compared to RN. At 6 months and beyond after surgery, PN patients had less decline in eGFR than RN patients (-16.6 [SD 21.1] vs -24.4[SD 16.2], p=0.0002). Complications rates between PN and RN were (18% vs 9%, p=0.057). Conclusions: In this multi-institutional Canadian cohort of patients with non-metastatic cT2 RCC undergoing surgery, PN compared to RN was associated with slightly higher risk of peri-operative complications, better preservation of renal function, and higher risk of local recurrence. The lower risk of distant metastasis and death was likely from residual confounding unaccounted for in the individual patient match. [Table: see text]
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Affiliation(s)
| | | | - Ryan Sun
- University of Manitoba, Winnipeg, MB, Canada
| | | | | | - Simon Tanguay
- McGill University Health Center, Montreal, QC, Canada
| | | | | | - Luke Lavallee
- Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Alan I. So
- Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | | | - Lori Wood
- Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Anil Kapoor
- St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | | | | | - Bimal Bhindi
- Southern Alberta Institute of Urology, Calgary, AB, Canada
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Kwong J, Khondker A, Meng E, Taylor N, Perlis N, Kulkarni G, Hamilton R, Fleshner N, Finelli A, Van Der Kwast T, Srigley J, Jamal M, Colinet V, Peltier A, Diamand R, Lefebvre Y, Mandoorah Q, Sanchez-Salas R, Macek P, Cathelineau X, Eklund M, Johnson A, Feifer A, Zlotta A. SEPERA – a novel artificial intelligence-based side-specific extra-prostatic extension risk assessment tool for patients undergoing radical prostatectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00527-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Klotz L, Chin J, Black P, Finelli A, Anidjar M, Kebabdjian M, Mittman N, Seung S. Multi-parametric MRI-targeted biopsy compared to systematic TRUS biopsy for biopsy-naïve men at risk for prostate cancer: 2 year follow up data and economic analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00217-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Walton J, Lawson K, Prinos P, Finelli A, Arrowsmith C, Ailles L. PBRM1, SETD2 and BAP1 - the trinity of 3p in clear cell renal cell carcinoma. Nat Rev Urol 2023; 20:96-115. [PMID: 36253570 DOI: 10.1038/s41585-022-00659-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 02/08/2023]
Abstract
Biallelic inactivation of the tumour suppressor gene Von Hippel-Lindau (VHL) occurs in the vast majority of clear cell renal cell carcinoma (ccRCC) instances, disrupting cellular oxygen-sensing mechanisms to yield a state of persistent pseudo-hypoxia, defined as a continued hypoxic response despite the presence of adequate oxygen levels. However, loss of VHL alone is often insufficient to drive oncogenesis. Results from genomic studies have shown that co-deletions of VHL with one (or more) of three genes encoding proteins involved in chromatin modification and remodelling, polybromo-1 gene (PBRM1), BRCA1-associated protein 1 (BAP1) and SET domain-containing 2 (SETD2), are common and important co-drivers of tumorigenesis. These genes are all located near VHL on chromosome 3p and are often altered following cytogenetic rearrangements that lead to 3p loss and precede the establishment of ccRCC. These three proteins have multiple roles in the regulation of crucial cancer-related pathways, including protection of genomic stability, antagonism of polycomb group (PcG) complexes to maintain a permissive transcriptional landscape in physiological conditions, and regulation of genes that mediate responses to immune checkpoint inhibitor therapy. An improved understanding of these mechanisms will bring new insights regarding cellular drivers of ccRCC growth and therapy response and, ultimately, will support the development of novel translational therapeutics.
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Affiliation(s)
- Joseph Walton
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Keith Lawson
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Panagiotis Prinos
- Structural Genomics Consortium, University of Toronto, Toronto, Ontario, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Cheryl Arrowsmith
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Structural Genomics Consortium, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Laurie Ailles
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
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Björklund J, Cheung DC, Martin LJ, Komisarenko M, Lajkosz K, Hamilton RJ, Zlotta AR, Finelli A. Low-volume grade group 2 prostate cancer candidates for active surveillance: a radical prostatectomy retrospective analysis. Scand J Urol 2023; 57:29-35. [PMID: 36683418 DOI: 10.1080/21681805.2023.2165709] [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] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Guidelines support considering selected men with ISUP grade group (GG) 2 prostate cancer for active surveillance (AS). We assessed the association of clinical variables with unfavorable pathology at radical prostatectomy in low-volume GG 2 prostate cancer on biopsy in a retrospective cohort. MATERIALS AND METHODS This was a retrospective analysis of 378 men with low-volume (≤ 2 cores) GG 2 localized prostate cancer who underwent prostatectomy at a single tertiary cancer center. Multivariable logistic regression of unfavorable pathology, upgrading to ≥ T3, or GG ≥ 3 was performed in relation to clinical factors, common variables used in AS in GG 1 and percentage Gleason 4 at biopsy. We compared the performance of potential variables with commonly used combined AS restrictions in GG 1 prostate cancer. RESULTS In total, 128/378 (34%) men had unfavorable pathology at radical prostatectomy. On multivariable analysis, > 5% Gleason pattern 4 was independently associated with an increased risk of GG ≥ 3. A maximum percentage core involvement > 50% was independently associated with an increased risk of pT-stage ≥ 3 and unfavorable pathology. Restriction to patients with ≤ 5% Gleason 4 decreased the upgrading of both unfavorable pathology (OR = 0.62, p = 0.041) and GG ≥ 3 (OR = 0.17, p = 0.0007) compared to the full cohort, while restriction to those with ≤ 50% of max core involvement did not. CONCLUSION In low-volume GG 2, the percentage of Gleason 4 of ≤ 5% was the strongest predictor in reducing upgrading at final pathology. This easily available pathological descriptor could be used to guide urologists and patients when considering AS in this setting.
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Affiliation(s)
- Johan Björklund
- Division of Urologic Oncology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada.,Department of Molecular Medicine and Surgery, Karolinska Institutet and Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Douglas C Cheung
- Division of Urologic Oncology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada
| | - Lisa J Martin
- Division of Urologic Oncology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada
| | - Maria Komisarenko
- Division of Urologic Oncology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada
| | - Katharine Lajkosz
- Division of Urologic Oncology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada
| | - Robert J Hamilton
- Division of Urologic Oncology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada
| | - Alexandre R Zlotta
- Division of Urologic Oncology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada
| | - Antonio Finelli
- Division of Urologic Oncology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada
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Chen B, McAlpine K, Lawson KA, Finelli A, Saarela O. Hierarchical causal variance decomposition for institution and provider comparisons in healthcare. Health Serv Outcomes Res Method 2023. [DOI: 10.1007/s10742-023-00301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Moore CM, King LE, Withington J, Amin MB, Andrews M, Briers E, Chen RC, Chinegwundoh FI, Cooperberg MR, Crowe J, Finelli A, Fitch MI, Frydenberg M, Giganti F, Haider MA, Freeman J, Gallo J, Gibbs S, Henry A, James N, Kinsella N, Lam TBL, Lichty M, Loeb S, Mahal BA, Mastris K, Mitra AV, Merriel SWD, van der Kwast T, Van Hemelrijck M, Palmer NR, Paterson CC, Roobol MJ, Segal P, Schraidt JA, Short CE, Siddiqui MM, Tempany CMC, Villers A, Wolinsky H, MacLennan S. Best Current Practice and Research Priorities in Active Surveillance for Prostate Cancer-A Report of a Movember International Consensus Meeting. Eur Urol Oncol 2023; 6:160-182. [PMID: 36710133 DOI: 10.1016/j.euo.2023.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [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: 07/22/2022] [Revised: 12/06/2022] [Accepted: 01/04/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Active surveillance (AS) is recommended for low-risk and some intermediate-risk prostate cancer. Uptake and practice of AS vary significantly across different settings, as does the experience of surveillance-from which tests are offered, and to the levels of psychological support. OBJECTIVE To explore the current best practice and determine the most important research priorities in AS for prostate cancer. DESIGN, SETTING, AND PARTICIPANTS A formal consensus process was followed, with an international expert panel of purposively sampled participants across a range of health care professionals and researchers, and those with lived experience of prostate cancer. Statements regarding the practice of AS and potential research priorities spanning the patient journey from surveillance to initiating treatment were developed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Panel members scored each statement on a Likert scale. The group median score and measure of consensus were presented to participants prior to discussion and rescoring at panel meetings. Current best practice and future research priorities were identified, agreed upon, and finally ranked by panel members. RESULTS AND LIMITATIONS There was consensus agreement that best practice includes the use of high-quality magnetic resonance imaging (MRI), which allows digital rectal examination (DRE) to be omitted, that repeat standard biopsy can be omitted when MRI and prostate-specific antigen (PSA) kinetics are stable, and that changes in PSA or DRE should prompt MRI ± biopsy rather than immediate active treatment. The highest ranked research priority was a dynamic, risk-adjusted AS approach, reducing testing for those at the least risk of progression. Improving the tests used in surveillance, ensuring equity of access and experience across different patients and settings, and improving information and communication between and within clinicians and patients were also high priorities. Limitations include the use of a limited number of panel members for practical reasons. CONCLUSIONS The current best practice in AS includes the use of high-quality MRI to avoid DRE and as the first assessment for changes in PSA, with omission of repeat standard biopsy when PSA and MRI are stable. Development of a robust, dynamic, risk-adapted approach to surveillance is the highest research priority in AS for prostate cancer. PATIENT SUMMARY A diverse group of experts in active surveillance, including a broad range of health care professionals and researchers and those with lived experience of prostate cancer, agreed that best practice includes the use of high-quality magnetic resonance imaging, which can allow digital rectal examination and some biopsies to be omitted. The highest research priority in active surveillance research was identified as the development of a dynamic, risk-adjusted approach.
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Affiliation(s)
- Caroline M Moore
- Division of Surgical and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals Trust, London, UK.
| | | | - John Withington
- Division of Surgical and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals Trust, London, UK
| | - Mahul B Amin
- Department of Pathology and Lab Medicine, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Urology, USC Keck School of Medicine, Los Angeles, CA, USA
| | | | | | - Ronald C Chen
- Department of Radiation Oncology, University of Kansas Cancer Center, Kansas City, KS, USA
| | - Francis I Chinegwundoh
- Department of Urology, Barts Health NHS Trust, London, UK; City University of London, London, UK
| | - Matthew R Cooperberg
- Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA; Department of Urology, University of California at San Francisco, San Francisco, CA, USA
| | - Jane Crowe
- Australian Prostate Centre, North Melbourne, Victoria, Australia
| | - Antonio Finelli
- Department of Surgery (Urology), Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada; Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada; Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital, Toronto, ON, Canada
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Mark Frydenberg
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Department of Urology, Cabrini Institute, Cabrini Health, Melbourne, Victoria, Australia
| | - Francesco Giganti
- Division of Surgical and Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Masoom A Haider
- Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada; Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | | | - Joseph Gallo
- Active Surveillance Patients International, East Stroudsburg, PA, USA
| | | | | | - Nicholas James
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Netty Kinsella
- Translational Oncology and Urology Research, Faculty of Life Sciences and Medicine, King's College London, London, UK; Department of Urology, Royal Marsden Hospital, London, UK
| | - Thomas B L Lam
- Academic Urology Unit, Aberdeen University, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Mark Lichty
- Active Surveillance Patients International, East Stroudsburg, PA, USA
| | - Stacy Loeb
- Department of Urology, New York University, New York, NY, USA; Department of Population Health, New York University, New York, NY, USA; Manhattan Veterans Affairs Medical Center, New York, NY, USA
| | - Brandon A Mahal
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | | | - Anita V Mitra
- Cancer Services, University College London Hospitals, NHS, London, UK
| | - Samuel W D Merriel
- Exeter Collaboration for Academic Primary Care (APEx), University of Exeter, Exeter, UK; Centre for Primary Care & Health Services Research, University of Manchester, Manchester, UK
| | - Theodorus van der Kwast
- Department of Pathology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Nynikka R Palmer
- Department of Medicine, Zuckerberg San Francisco General Hospital. University of California San Francisco School of Medicine; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco; Department of Urology, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Catherine C Paterson
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia; Canberra Health Services and ACT Health, Synergy Nursing and Midwifery Research Centre, Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Monique J Roobol
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Phillip Segal
- Prostate Cancer Support Toronto, Toronto, ON, Canada
| | | | - Camille E Short
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia; Melbourne Centre for Behaviour Change, University of Melbourne, Melbourne, Victoria, Australia
| | - M Minhaj Siddiqui
- Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Clare M C Tempany
- Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Arnaud Villers
- Department of Urology Univ. Lille, CHU Lille, Department of Urology F-59000 Lille, France
| | - Howard Wolinsky
- Answer Cancer Foundation, Tumacacori, Arizona, USA; TheActiveSurveillor.com, Flossmoor, Illinois, USA
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Fu R, Sutradhar R, Li Q, Hanna TP, Chan KKW, Irish JC, Coburn N, Hallet J, Dare A, Singh S, Parmar A, Earle CC, Lapointe-Shaw L, Krzyzanowska MK, Finelli A, Louie AV, Hong NJL, Witterick IJ, Mahar A, Urbach DR, McIsaac DI, Enepekides D, Tinmouth J, Eskander A. Timeliness and Modality of Treatment for New Cancer Diagnoses During the COVID-19 Pandemic in Canada. JAMA Netw Open 2023; 6:e2250394. [PMID: 36626169 PMCID: PMC9856765 DOI: 10.1001/jamanetworkopen.2022.50394] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
IMPORTANCE The impact of COVID-19 on the modality and timeliness of first-line cancer treatment is unclear yet critical to the planning of subsequent care. OBJECTIVE To explore the association of the COVID-19 pandemic with modalities of and wait times for first cancer treatment. DESIGN, SETTING, AND PARTICIPANTS This retrospective population-based cohort study using administrative data was conducted in Ontario, Canada, among adults newly diagnosed with cancer between January 3, 2016, and November 7, 2020. Participants were followed up from date of diagnosis for 1 year, until death, or until June 26, 2021, whichever occurred first, to ensure a minimum of 6-month follow-up time. EXPOSURES Receiving a cancer diagnosis in the pandemic vs prepandemic period, using March 15, 2020, the date when elective hospital procedures were halted. MAIN OUTCOMES AND MEASURES The main outcome was a time-to-event variable describing number of days from date of diagnosis to date of receiving first cancer treatment (surgery, chemotherapy, or radiation) or to being censored. For each treatment modality, a multivariable competing-risk regression model was used to assess the association between time to treatment and COVID-19 period. A secondary continuous outcome was defined for patients who were treated 6 months after diagnosis as the waiting time from date of diagnosis to date of treatment. RESULTS Among 313 499 patients, the mean (SD) age was 66.4 (14.1) years and 153 679 (49.0%) were male patients. Those who were diagnosed during the pandemic were less likely to receive surgery first (subdistribution hazard ratio [sHR], 0.97; 95% CI, 0.95-0.99) but were more likely to receive chemotherapy (sHR, 1.26; 95% CI, 1.23-1.30) or radiotherapy (sHR, 1.16; 95% CI, 1.13-1.20) first. Among patients who received treatment within 6 months from diagnosis (228 755 [73.0%]), their mean (SD) waiting time decreased from 35.1 (37.2) days to 29.5 (33.6) days for surgery, from 43.7 (34.1) days to 38.4 (30.6) days for chemotherapy, and from 55.8 (41.8) days to 49.0 (40.1) days for radiotherapy. CONCLUSIONS AND RELEVANCE In this cohort study, the pandemic was significantly associated with greater use of nonsurgical therapy as initial cancer treatment. Wait times were shorter in the pandemic period for those treated within 6 months of diagnosis. Future work needs to examine how these changes may have affected patient outcomes to inform future pandemic guideline development.
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Affiliation(s)
- Rui Fu
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Qing Li
- ICES, Toronto, Ontario, Canada
| | - Timothy P. Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Kelvin K. W. Chan
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre–Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Ontario Health–Cancer Care Ontario, Toronto, Ontario, Canada
| | - Jonathan C. Irish
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology–Head & Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Natalie Coburn
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Ontario Health–Cancer Care Ontario, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Julie Hallet
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre–Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Anna Dare
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Simron Singh
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ambica Parmar
- ICES, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Craig C. Earle
- ICES, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Lapointe-Shaw
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Monika K. Krzyzanowska
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Antonio Finelli
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Alexander V. Louie
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Nicole J. Look Hong
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ian J. Witterick
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Ontario Health–Cancer Care Ontario, Toronto, Ontario, Canada
- Department of Otolaryngology–Head & Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Alyson Mahar
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
| | - David R. Urbach
- ICES, Toronto, Ontario, Canada
- Department of Surgery, Women’s College Hospital, Toronto, Ontario, Canada
| | - Daniel I. McIsaac
- ICES, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jill Tinmouth
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre–Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Ontario Health–Cancer Care Ontario, Toronto, Ontario, Canada
| | - Antoine Eskander
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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McEvoy CM, Murphy JM, Zhang L, Clotet-Freixas S, Mathews JA, An J, Karimzadeh M, Pouyabahar D, Su S, Zaslaver O, Röst H, Arambewela R, Liu LY, Zhang S, Lawson KA, Finelli A, Wang B, MacParland SA, Bader GD, Konvalinka A, Crome SQ. Single-cell profiling of healthy human kidney reveals features of sex-based transcriptional programs and tissue-specific immunity. Nat Commun 2022; 13:7634. [PMID: 36496458 PMCID: PMC9741629 DOI: 10.1038/s41467-022-35297-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 11/27/2022] [Indexed: 12/13/2022] Open
Abstract
Knowledge of the transcriptional programs underpinning the functions of human kidney cell populations at homeostasis is limited. We present a single-cell perspective of healthy human kidney from 19 living donors, with equal contribution from males and females, profiling the transcriptome of 27677 cells to map human kidney at high resolution. Sex-based differences in gene expression within proximal tubular cells were observed, specifically, increased anti-oxidant metallothionein genes in females and aerobic metabolism-related genes in males. Functional differences in metabolism were confirmed in proximal tubular cells, with male cells exhibiting higher oxidative phosphorylation and higher levels of energy precursor metabolites. We identified kidney-specific lymphocyte populations with unique transcriptional profiles indicative of kidney-adapted functions. Significant heterogeneity in myeloid cells was observed, with a MRC1+LYVE1+FOLR2+C1QC+ population representing a predominant population in healthy kidney. This study provides a detailed cellular map of healthy human kidney, and explores the complexity of parenchymal and kidney-resident immune cells.
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Affiliation(s)
- Caitriona M. McEvoy
- grid.231844.80000 0004 0474 0428Toronto General Hospital Research Institute, University Health Network, Toronto, ON Canada ,grid.231844.80000 0004 0474 0428Ajmera Transplant Centre, University Health Network, Toronto, ON Canada ,grid.231844.80000 0004 0474 0428Department of Medicine, Division of Nephrology, University Health Network, Toronto, ON Canada
| | - Julia M. Murphy
- grid.231844.80000 0004 0474 0428Toronto General Hospital Research Institute, University Health Network, Toronto, ON Canada ,grid.231844.80000 0004 0474 0428Ajmera Transplant Centre, University Health Network, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Immunology, University of Toronto, Toronto, ON Canada
| | - Lin Zhang
- grid.17063.330000 0001 2157 2938Department of Statistical Sciences, University of Toronto, Toronto, ON Canada ,grid.231844.80000 0004 0474 0428Peter Munk Cardiac Centre, University Health Network, Toronto, ON Canada
| | - Sergi Clotet-Freixas
- grid.231844.80000 0004 0474 0428Toronto General Hospital Research Institute, University Health Network, Toronto, ON Canada ,grid.231844.80000 0004 0474 0428Ajmera Transplant Centre, University Health Network, Toronto, ON Canada
| | - Jessica A. Mathews
- grid.231844.80000 0004 0474 0428Toronto General Hospital Research Institute, University Health Network, Toronto, ON Canada ,grid.231844.80000 0004 0474 0428Ajmera Transplant Centre, University Health Network, Toronto, ON Canada
| | - James An
- grid.231844.80000 0004 0474 0428Toronto General Hospital Research Institute, University Health Network, Toronto, ON Canada ,grid.231844.80000 0004 0474 0428Ajmera Transplant Centre, University Health Network, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Immunology, University of Toronto, Toronto, ON Canada
| | - Mehran Karimzadeh
- grid.231844.80000 0004 0474 0428Peter Munk Cardiac Centre, University Health Network, Toronto, ON Canada ,grid.494618.6Vector Institute, Toronto, ON Canada
| | - Delaram Pouyabahar
- grid.17063.330000 0001 2157 2938Department of Molecular Genetics, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938The Donnelly Centre, University of Toronto, Toronto, ON Canada
| | - Shenghui Su
- grid.231844.80000 0004 0474 0428Toronto General Hospital Research Institute, University Health Network, Toronto, ON Canada ,grid.231844.80000 0004 0474 0428Ajmera Transplant Centre, University Health Network, Toronto, ON Canada
| | - Olga Zaslaver
- grid.17063.330000 0001 2157 2938Department of Molecular Genetics, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938The Donnelly Centre, University of Toronto, Toronto, ON Canada
| | - Hannes Röst
- grid.17063.330000 0001 2157 2938Department of Molecular Genetics, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938The Donnelly Centre, University of Toronto, Toronto, ON Canada
| | - Rangi Arambewela
- grid.231844.80000 0004 0474 0428Toronto General Hospital Research Institute, University Health Network, Toronto, ON Canada ,grid.231844.80000 0004 0474 0428Ajmera Transplant Centre, University Health Network, Toronto, ON Canada
| | - Lewis Y. Liu
- grid.231844.80000 0004 0474 0428Toronto General Hospital Research Institute, University Health Network, Toronto, ON Canada ,grid.231844.80000 0004 0474 0428Ajmera Transplant Centre, University Health Network, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Immunology, University of Toronto, Toronto, ON Canada
| | - Sally Zhang
- grid.231844.80000 0004 0474 0428Division of Urology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON Canada
| | - Keith A. Lawson
- grid.231844.80000 0004 0474 0428Division of Urology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON Canada
| | - Antonio Finelli
- grid.231844.80000 0004 0474 0428Division of Urology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, University of Toronto, Toronto, ON Canada
| | - Bo Wang
- grid.231844.80000 0004 0474 0428Peter Munk Cardiac Centre, University Health Network, Toronto, ON Canada ,grid.494618.6Vector Institute, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Computer Science, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Sonya A. MacParland
- grid.231844.80000 0004 0474 0428Toronto General Hospital Research Institute, University Health Network, Toronto, ON Canada ,grid.231844.80000 0004 0474 0428Ajmera Transplant Centre, University Health Network, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Immunology, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Gary D. Bader
- grid.17063.330000 0001 2157 2938Department of Molecular Genetics, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938The Donnelly Centre, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Computer Science, University of Toronto, Toronto, ON Canada ,grid.231844.80000 0004 0474 0428Princess Margaret Cancer Centre, University Health Network, Toronto, ON Canada ,grid.416166.20000 0004 0473 9881The Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON Canada
| | - Ana Konvalinka
- grid.231844.80000 0004 0474 0428Toronto General Hospital Research Institute, University Health Network, Toronto, ON Canada ,grid.231844.80000 0004 0474 0428Ajmera Transplant Centre, University Health Network, Toronto, ON Canada ,grid.231844.80000 0004 0474 0428Department of Medicine, Division of Nephrology, University Health Network, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Sarah Q. Crome
- grid.231844.80000 0004 0474 0428Toronto General Hospital Research Institute, University Health Network, Toronto, ON Canada ,grid.231844.80000 0004 0474 0428Ajmera Transplant Centre, University Health Network, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Immunology, University of Toronto, Toronto, ON Canada
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Czajkowski S, Lajkosz K, Koziarz A, Carr D, Finelli A, Lee JY. The rising burden of acute urological disease at an urban, academic hospital network. Can Urol Assoc J 2022; 16:401-407. [PMID: 36656705 PMCID: PMC9851211 DOI: 10.5489/cuaj.7909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Urological presentations to the emergency department (ED) can represent a significant burden of disease. We aimed to evaluate trends in the incidence, management, and followup of urological presentations to the ED at an urban, academic, tertiarycare hospital network over a 10-year period. METHODS A retrospective cohort study was conducted to include all patients presenting with renal colic (RC), gross hematuria (GH), or acute urinary retention (AUR) to EDs in the University Health Network in 2008-2009 and 2018-2019. Patient demographics and outcomes were compared between these two periods and between urological presentations. Multilevel regression analyses identified predictors of in-patient admission, return to the ED, and clinic wait time. RESULTS A total of 2751 patients and 3510 ED visits were included (991 visits from 2008-09 and 2519 visits from 2018-19). Over time, increases were observed in all three presentations, largely driven by an almost five-fold increase in RC presentations. Multilevel regression analyses showed that older patients were more likely to be admitted from the ED, while age, 2018-19 era, and residence within the "downtown core" independently predicted return to the ED within 30 days of initial visit. Time to be seen in urology clinic increased over time for the entire cohort, and 14.4% of clinic visits were preceded by multiple ED visits. CONCLUSIONS The incidence of acute urological presentations increased significantly over a 10-year period at a tertiary-care hospital network. These findings demonstrate an increasing burden of acute urological disease that is outpacing population growth and straining available resources.
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Affiliation(s)
- Simon Czajkowski
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Katherine Lajkosz
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Alex Koziarz
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - David Carr
- Department of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada,Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jason Y. Lee
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada,Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
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41
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Fu R, Sutradhar R, Li Q, Hanna TP, Chan KKW, Irish JC, Coburn N, Hallet J, Dare A, Singh S, Parmar A, Earle CC, Lapointe-Shaw L, Krzyzanowska MK, Finelli A, Louie AV, Look Hong NJ, Witterick IJ, Mahar A, Gomez D, McIsaac DI, Enepekides D, Urbach DR, Eskander A. Incident Cancer Detection During Multiple Waves of COVID-19: The Tsunami After the Earthquake. J Natl Compr Canc Netw 2022; 20:1190-1192. [PMID: 36351330 DOI: 10.6004/jnccn.2022.7075] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/15/2022] [Indexed: 11/11/2022]
Abstract
No population-based study exists to demonstrate the full-spectrum impact of COVID-19 on hindering incident cancer detection in a large cancer system. Building upon our previous publication in JNCCN, we conducted an updated analysis using 12 months of new data accrued in the pandemic era (extending the study period from September 26, 2020, to October 2, 2021) to demonstrate how multiple COVID-19 waves affected the weekly cancer incidence volume in Ontario, Canada, and if we have fully cleared the backlog at the end of each wave.
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Affiliation(s)
- Rui Fu
- 1ICES, Toronto, Ontario
- 2Institute of Health Policy, Management, and Evaluation, and
- 3Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto
| | - Rinku Sutradhar
- 1ICES, Toronto, Ontario
- 2Institute of Health Policy, Management, and Evaluation, and
| | | | - Timothy P Hanna
- 4Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston
- 5Ontario Institute for Cancer Research (OICR), Toronto
| | - Kelvin K W Chan
- 6Odette Cancer Centre-Sunnybrook Health Sciences Centre, Toronto
- 7Ontario Health-Cancer Care Ontario, Toronto
| | - Jonathan C Irish
- 2Institute of Health Policy, Management, and Evaluation, and
- 8Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto
| | - Natalie Coburn
- 1ICES, Toronto, Ontario
- 2Institute of Health Policy, Management, and Evaluation, and
- 7Ontario Health-Cancer Care Ontario, Toronto
- 9Department of Surgery
| | - Julie Hallet
- 1ICES, Toronto, Ontario
- 2Institute of Health Policy, Management, and Evaluation, and
- 6Odette Cancer Centre-Sunnybrook Health Sciences Centre, Toronto
- 9Department of Surgery
| | - Anna Dare
- 1ICES, Toronto, Ontario
- 2Institute of Health Policy, Management, and Evaluation, and
- 9Department of Surgery
| | - Simron Singh
- 1ICES, Toronto, Ontario
- 2Institute of Health Policy, Management, and Evaluation, and
- 10Department of Medicine, and
| | - Ambica Parmar
- 1ICES, Toronto, Ontario
- 10Department of Medicine, and
| | - Craig C Earle
- 1ICES, Toronto, Ontario
- 10Department of Medicine, and
| | - Lauren Lapointe-Shaw
- 1ICES, Toronto, Ontario
- 2Institute of Health Policy, Management, and Evaluation, and
- 10Department of Medicine, and
| | - Monika K Krzyzanowska
- 1ICES, Toronto, Ontario
- 2Institute of Health Policy, Management, and Evaluation, and
- 10Department of Medicine, and
| | - Antonio Finelli
- 1ICES, Toronto, Ontario
- 2Institute of Health Policy, Management, and Evaluation, and
- 9Department of Surgery
| | | | - Nicole J Look Hong
- 1ICES, Toronto, Ontario
- 2Institute of Health Policy, Management, and Evaluation, and
- 9Department of Surgery
| | - Ian J Witterick
- 3Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto
- 7Ontario Health-Cancer Care Ontario, Toronto
- 8Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto
| | - Alyson Mahar
- 12School of Nursing, Queen's University, Kingston
| | - David Gomez
- 1ICES, Toronto, Ontario
- 2Institute of Health Policy, Management, and Evaluation, and
- 9Department of Surgery
- 13Division of General Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto
| | - Daniel I McIsaac
- 1ICES, Toronto, Ontario
- 14Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa; and
| | - Danny Enepekides
- 3Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto
| | - David R Urbach
- 1ICES, Toronto, Ontario
- 15Department of Surgery, Women's College Hospital, Toronto, Ontario, Canada
| | - Antoine Eskander
- 1ICES, Toronto, Ontario
- 2Institute of Health Policy, Management, and Evaluation, and
- 3Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto
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42
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Yu Y, Lajkosz K, Finelli A, Fleshner N, van der Kwast TH, Downes MR. Impact of cribriform pattern 4 and intraductal prostatic carcinoma on National Comprehensive Cancer Network (NCCN) and Cancer of Prostate Risk Assessment (CAPRA) patient stratification. Mod Pathol 2022; 35:1695-1701. [PMID: 35676330 DOI: 10.1038/s41379-022-01111-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/09/2022] [Accepted: 05/12/2022] [Indexed: 11/09/2022]
Abstract
Pretreatment classification tools are used in prostate cancer to inform patient management. The effect of cribriform pattern 4 (CC) and intraductal carcinoma (IDC) on such nomograms is still underexplored. We analyzed the Cancer of Prostate Risk Assessment (CAPRA) and National Comprehensive Cancer Network (NCCN) risk scores in cases with and without CC/IDC to assess impact on biochemical recurrence (BCR) and metastases/death of prostate cancer (event free survival-EFS) after prostatectomy. A matched biopsy- prostatectomy cohort (2010-2017) was reviewed for CC/IDC. CAPRA and NCCN scores were calculated. CAPRA score 0-2 were deemed "low", 3-5 "intermediate" and 6-10 "high". NCCN scores 1-2 "very low/low", 3 "favorable intermediate", 4 "unfavorable intermediate", 5-6 "high/very high". Cases were stratified by presence of CC/IDC. BCR and EFS probabilities were estimated using the Kaplan-Meier method. Prognostic performance was evaluated using log-rank tests and Harrell's concordance index. 612 patients with mean age 63.1 years were included with mean follow up of 5.3 (range 0-10.8) years. CC/IDC was noted in 159/612 (26%) biopsies. There were 101 (17%) BCR and 36 (6%) events. CAPRA discriminated three distinct risk categories for BCR (p < 0.001) while only high risk separated significantly for EFS (p < 0.001). NCCN distinguished two prognostic groups for BCR (p < 0.0001) and three for EFS (p < 0.0001). Addition of CC/IDC to CAPRA impacted scores 3-5 for BCR and scores 3-5 and 6-10 for EFS and improved the overall concordance index (BCR: 0.66 vs. 0.71; EFS: 0.74 vs. 0.80). Addition of CC/IDC to NCCN impacted scores 4 and 5-6 and also improved the concordance index for BCR (0.62 vs. 0.68). Regarding EFS, NCCN scores 4 and 5-6 demonstrated markedly different outcomes with the addition of CC/IDC. The CAPRA nomogram allows better outcome stratification than NCCN. Addition of CC/IDC status particularly improves patient stratification for CAPRA scores 3-5, 6-10, and for NCCN scores 4 and 5-6.
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Affiliation(s)
- Yanhong Yu
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada. .,Anatomic Pathology, Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - Katherine Lajkosz
- Department of Biostatistics, Princess Margaret Hospital, Toronto, ON, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
| | - Neil Fleshner
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
| | - Theodorus H van der Kwast
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Laboratory Medicine Program, University Health Network and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Michelle R Downes
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Anatomic Pathology, Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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43
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Ghai S, Perlis N, Atallah C, Jokhu S, Corr K, Lajkosz K, Incze PF, Zlotta AR, Jain U, Fleming H, Finelli A, van der Kwast TH, Haider MA. Comparison of Micro-US and Multiparametric MRI for Prostate Cancer Detection in Biopsy-Naive Men. Radiology 2022; 305:390-398. [PMID: 35852425 DOI: 10.1148/radiol.212163] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Multiparametric MRI has led to increased detection of clinically significant prostate cancer (csPCa). Micro-US is being investigated for csPCa detection. Purpose To compare multiparametric MRI and micro-US in detecting csPCa (grade group ≥2) and to determine the proportion of MRI nodules visible at micro-US for real-time targeted biopsy. Materials and methods This prospective, single-center trial enrolled biopsy-naive men with suspected prostate cancer (PCa) between May 2019 and September 2020. All patients underwent multiparametric MRI followed by micro-US; findings at both were interpreted in a blinded fashion, followed by targeted biopsy and nontargeted systematic biopsy using micro-US. Proportions were compared using the exact McNemar test. The differences in proportions were calculated. Results Ninety-four men (median age, 61 years; IQR, 57-68 years) were included. MRI- and micro-US-targeted biopsy depicted csPCa in 37 (39%) and 33 (35%) of the 94 men, respectively (P = .22); clinically insignificant PCa in 14 (15%) and 15 (16%) (P > .99); and cribriform and/or intraductal PCa in 14 (15%) and 13 (14%) (P > .99). The MRI- plus micro-US-targeted biopsy pathway depicted csPCa in 38 of the 94 (40%) men. The addition of nontargeted systematic biopsy to MRI- plus micro-US-targeted biopsy did not enable identification of any additional men with csPCa but did help identify nine additional men with clinically insignificant PCa (P = .04). Biopsy was avoided in 32 of the 94 men (34%) with MRI and nine of the 94 men (10%) with micro-US (P < .001). Among 93 MRI targets, 62 (67%) were prospectively visible at micro-US. Conclusion MRI and micro-US showed similar rates of prostate cancer detection, but more biopsies were avoided with the MRI pathway than with micro-US, with no benefit of adding nontargeted systematic biopsy to the MRI- plus micro-US-targeted biopsy pathway. Most MRI lesions were prospectively visible at micro-US, allowing real-time targeted biopsy. ClinicalTrials.gov registration no.: NCT03938376 © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Sangeet Ghai
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
| | - Nathan Perlis
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
| | - Chantal Atallah
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
| | - Sarah Jokhu
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
| | - Kateri Corr
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
| | - Katherine Lajkosz
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
| | - Peter F Incze
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
| | - Alexandre R Zlotta
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
| | - Umesh Jain
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
| | - Hannah Fleming
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
| | - Antonio Finelli
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
| | - Theodorus H van der Kwast
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
| | - Masoom A Haider
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
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Dragomir A, Nazha S, Tanguay S, Breau RH, Bhindi B, Rendon RA, Kapoor A, Hotte SJ, Basappa N, Fairey A, So AI, Kollmannsberger C, Finelli A, Hansen A, Canil C, Heng D, Lattouf JB, Bjarnason G, Power N, Pouliot F, Wood LA. Outcomes of Cytoreductive Nephrectomy for Patients with Metastatic Renal Cell Carcinoma: Real World Data from Canadian Centers. Eur Urol Focus 2022; 8:1703-1710. [PMID: 34736870 DOI: 10.1016/j.euf.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/23/2021] [Revised: 09/10/2021] [Accepted: 10/05/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Treatment options for metastatic renal cell carcinoma (mRCC) include cytoreductive nephrectomy (CN) and systemic therapy (ST). Results from the CARMENA and SURTIME trials suggest that CN before ST may not be the optimal treatment strategy for mRCC. OBJECTIVE To use real-world data to evaluate and compare outcomes for patients with mRCC who underwent CN before, after, or without ST to those patients who only received ST. DESIGN, SETTING, AND PARTICIPANTS The Canadian Kidney Cancer information system (CKCis) database was used to identify patients diagnosed with mRCC between January 2011 and April 2020. Only patients with synchronous disease, treated within 12 mo from their initial RCC diagnosis, with International Metastatic Renal Cell Carcinoma Database Consortium intermediate/high risk, and confirmed RCC histology were included. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patients were classified into four groups according to the initial treatment received for mRCC. Inverse probability of treatment weighting using propensity scores was used to balance the treatment groups. Cox proportional hazards models were used to assess the impact of CN after adjusting for potential confounding variables in the weighted cohorts. RESULTS AND LIMITATIONS A total of 788 patients were included in the study cohort. Of these 383 patients underwent CN before ST, 73 underwent CN after ST, 80 underwent CN only, and 252 patients received ST only. The median patient age was 63 yr and 73% of the cohort were men. In weighted analysis, the groups undergoing CN before ST (hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.52-0.82) and CN after ST (HR 0.41, 95% CI 0.28-0.60) both had better survival compared to the ST only group. No survival benefit was observed for CN only compared to ST only, or for CN before ST compared to CN after ST. CONCLUSIONS We evaluated the association between different sequences of treatment with CN and survival in patients with mRCC using CKCis real world data. The results demonstrate that the selected patients who undergo CN, whether performed before or after ST, have an associated improvement in survival. PATIENT SUMMARY Two of the treatment options for metastatic kidney cancer are surgery and systemic therapy (chemotherapy or immunotherapy). We used data from the Canadian Kidney Cancer information system to determine whether there are differences in survival according to the sequencing of these treatments. Patients who had both surgery and systemic therapy, regardless of which treatment was first, had better survival than patients who only received systemic therapy.
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Affiliation(s)
| | | | | | | | - Bimal Bhindi
- Southern Alberta Institute of Urology, Alberta, Canada
| | | | - Anil Kapoor
- Juravinski Cancer Centre, McMaster University, Hamilton, Canada
| | | | - Naveen Basappa
- Cross Cancer Institute, University of Alberta, Edmonton, Canada
| | - Adrian Fairey
- Cross Cancer Institute, University of Alberta, Edmonton, Canada
| | - Alan I So
- British Columbia Cancer Agency, Vancouver Cancer Centre, Vancouver, Canada
| | | | - Antonio Finelli
- Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - Aaron Hansen
- Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | | | - Daniel Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, Canada
| | - Jean-Baptiste Lattouf
- Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Canada
| | - Georg Bjarnason
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | | | - Frédéric Pouliot
- Centre Hospitalier Universitaire de Québec, University of Laval, Quebec, Canada
| | - Lori A Wood
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
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45
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Saad F, Aprikian A, Finelli A, Fleshner NE, Gleave M, Kapoor A, Niazi T, North SA, Pouliot F, Rendon RA, Shayegan B, Sridhar SS, So AI, Usmani N, Vigneault E, Chi KN. 2022 Canadian Urological Association (CUA)-Canadian Uro Oncology Group (CUOG) guideline: Management of castration-resistant prostate cancer (CRPC). Can Urol Assoc J 2022; 16:E506-E515. [PMID: 36378572 PMCID: PMC9665314 DOI: 10.5489/cuaj.8161] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Affiliation(s)
- Fred Saad
- Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | | | - Antonio Finelli
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | | | - Martin Gleave
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Anil Kapoor
- Department of Surgery (Urology) and Oncology, McMaster University, Hamilton, ON, Canada
| | - Tamim Niazi
- Jewish General Hospital, Montreal, QC, Canada
| | - Scott A. North
- Department of Medical Oncology, University of Alberta, Edmonton, AB, Canada
| | | | | | - Bobby Shayegan
- Department of Surgery (Urology) and Oncology, McMaster University, Hamilton, ON, Canada
| | - Srikala S. Sridhar
- Division of Medical Oncology, University of Toronto, Toronto, ON, Canada
| | - Alan I. So
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Nawaid Usmani
- Department of Oncology, Division of Radiation Oncology, University of Alberta, Edmonton, AB, Canada
| | - Eric Vigneault
- Department of Radiation Oncology, CHU de Quebec, Université Laval, Quebec City, QC, Canada
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46
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Deniffel D, Perlis N, Ghai S, Girgis S, Healy GM, Fleshner N, Hamilton R, Kulkarni G, Toi A, van der Kwast T, Zlotta A, Finelli A, Haider MA. Prostate biopsy in the era of MRI-targeting: towards a judicious use of additional systematic biopsy. Eur Radiol 2022; 32:7544-7554. [PMID: 35507051 DOI: 10.1007/s00330-022-08822-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 01/16/2022] [Revised: 03/20/2022] [Accepted: 04/18/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We aimed to develop and compare strategies that help optimize current prostate biopsy practice by identifying patients who may forgo concurrent systematic biopsy (SBx) in favor of MRI-targeted (TBx) alone. METHODS Retrospective study on 745 patients who underwent combined MRI-TBx plus SBx. Primary outcome was the upgrade to clinically significant prostate cancer (csPCa; grade group ≥ 2) on SBx versus MRI-TBx. Variables (age, previous biopsy status, Prostate Imaging Reporting and Data System (PI-RADS) score, index lesion size/location, number of lesions, PSA, PSA density, prostate volume) associated with the primary outcome were identified by logistic regression and used for biopsy strategies. Clinical utility was assessed by decision curve analysis (DCA). RESULTS SBx detected 47 (6%) additional men with csPCa. The risk of detecting csPCa uniquely on SBx was significantly lower in men with PI-RADS 5 (versus PI-RADS 3: OR 0.30, p = 0.03; versus PI-RADS 4: OR 0.33, p = 0.01), and previous negative biopsy (versus previous positive biopsy: OR 0.40, p = 0.007), and increased with age (per 10 years: OR 1.64, p = 0.016). No significant association was observed for other variables. DCA identified the following strategies as most useful: (a) avoid SBx in men with PI-RADS 5 and (b) additionally in those with previous negative biopsy, resulting in avoiding SBx in 201 (27%) and 429 (58%), while missing csPCa in 5 (1%) and 15 (2%) patients, respectively. CONCLUSION Not all men benefit equally from the combination of SBx and MRI-TBx. SBx avoidance in men with PI-RADS 5 and/or previous negative biopsy may reduce the risk of excess biopsies with a low risk of missing csPCa. KEY POINTS • In men undergoing MRI-targeted biopsy, the risk of detecting clinically significant prostate cancer (csPCa) only on additional systematic biopsy (SBx) decreased in men with PI-RADS 5, previous negative biopsy, and younger age. • Using these variables may help select men who could avoid the risk of excess SBx. • If missing csPCa in 5% was acceptable, forgoing SBx in men with PI-RADS 5 and/or previous negative biopsy enabled the highest net reduction in SBx.
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Affiliation(s)
- Dominik Deniffel
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Avenue, M5G 1X5, Toronto, ON, Canada.,Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada
| | - Nathan Perlis
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada
| | | | - Gerard M Healy
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Avenue, M5G 1X5, Toronto, ON, Canada.,Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada
| | - Neil Fleshner
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Robert Hamilton
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Girish Kulkarni
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Ants Toi
- Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada
| | - Theodorus van der Kwast
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Alexandre Zlotta
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Surgery, Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Masoom A Haider
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Avenue, M5G 1X5, Toronto, ON, Canada. .,Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada.
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47
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Fu R, Sutradhar R, Dare A, Li Q, Hanna TP, Chan KKW, Irish JC, Coburn N, Hallet J, Singh S, Parmar A, Earle CC, Lapointe-Shaw L, Krzyzanowska MK, Finelli A, Louie AV, Witterick IJ, Mahar A, Urbach DR, McIsaac DI, Enepekides D, Look Hong NJ, Eskander A. Cancer Patients First Treated with Chemotherapy: Are They More Likely to Receive Surgery in the Pandemic? Curr Oncol 2022; 29:7732-7744. [PMID: 36290888 PMCID: PMC9600641 DOI: 10.3390/curroncol29100611] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/09/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
Due to the ramping down of cancer surgery in early pandemic, many newly diagnosed patients received other treatments first. We aimed to quantify the pandemic-related shift in rate of surgery following chemotherapy. This is a retrospective population-based cohort study involving adults diagnosed with cancer between 3 January 2016 and 7 November 2020 in Ontario, Canada who received chemotherapy as first treatment within 6-months of diagnosis. Competing-risks regression models with interaction effects were used to quantify the association between COVID-19 period (receiving a cancer diagnosis before or on/after 15 March 2020) and receipt of surgical reSection 9-months after first chemotherapy. Among 51,653 patients, 8.5% (n = 19,558) of them ultimately underwent surgery 9-months after chemotherapy initiation. Receipt of surgery was higher during the pandemic than before (sHR 1.07, 95% CI 1.02-1.13). Material deprivation was independently associated with lower receipt of surgery (least vs. most deprived quintile: sHR 1.11, 95% CI 1.04-1.17), but did not change with the pandemic. The surgical rate increase was most pronounced for breast cancer (sHR 1.13, 95% CI 1.06-1.20). These pandemic-related shifts in cancer treatment requires further evaluations to understand the long-term consequences. Persistent material deprivation-related inequity in cancer surgical access needs to be addressed.
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Affiliation(s)
- Rui Fu
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON M5G 1X5, Canada
| | - Rinku Sutradhar
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Anna Dare
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Qing Li
- ICES, Toronto, ON M4N 3M5, Canada
| | - Timothy P. Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON K7L 3N6, Canada
- Ontario Institute for Cancer Research (OICR), Toronto, ON M5G 0A3, Canada
| | - Kelvin K. W. Chan
- Odette Cancer Centre—Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Ontario Health—Cancer Care Ontario, Toronto, ON M5G 2L7, Canada
| | - Jonathan C. Irish
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Otolaryngology—Head & Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON M5G 1X5, Canada
| | - Natalie Coburn
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
- Ontario Health—Cancer Care Ontario, Toronto, ON M5G 2L7, Canada
| | - Julie Hallet
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
- Odette Cancer Centre—Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Simron Singh
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Ambica Parmar
- ICES, Toronto, ON M4N 3M5, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Craig C. Earle
- ICES, Toronto, ON M4N 3M5, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Lauren Lapointe-Shaw
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Monika K. Krzyzanowska
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Antonio Finelli
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Alexander V. Louie
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Ian J. Witterick
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON M5G 1X5, Canada
- Odette Cancer Centre—Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Ontario Health—Cancer Care Ontario, Toronto, ON M5G 2L7, Canada
| | - Alyson Mahar
- School of Nursing, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - David R. Urbach
- ICES, Toronto, ON M4N 3M5, Canada
- Department of Surgery, Women’s College Hospital, Toronto, ON M5S 1B2, Canada
| | - Daniel I. McIsaac
- ICES, Toronto, ON M4N 3M5, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
| | - Danny Enepekides
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON M5G 1X5, Canada
| | - Nicole J. Look Hong
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Antoine Eskander
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON M5G 1X5, Canada
- Correspondence: ; Tel.: +1-416-480-6705
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Parthipan M, Feng G, Toledano N, Donison V, Breunis H, Sudharshan A, Emmenegger U, Finelli A, Warde P, Soto-Perez-de-Celis E, Krzyzanowska M, Matthew A, Clarke H, Mina DS, Alibhai SM, Puts M. Symptom experiences of older adults during treatment for metastatic prostate cancer: A qualitative investigation. J Geriatr Oncol 2022; 14:101397. [PMID: 36988104 DOI: 10.1016/j.jgo.2022.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 09/23/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Exploring symptom experiences of older men during metastatic prostate cancer treatment can help clinicians identify unmet supportive care needs that, if addressed, could improve toxicity management and enhance patient wellbeing. Previous qualitative studies of older adults with advanced prostate cancer have focused on the psychological experience rather than the overall symptom experience. Therefore, the objective of this study was to understand the lived experience of symptoms and supportive care needs in older men undergoing treatment for metastatic prostate cancer. MATERIALS AND METHODS Semi-structured interviews were conducted with older adults (aged 65+) who completed their first cycle of chemotherapy, androgen-axis targeted therapies, or radium-223 for metastatic castrate-resistant and sensitive prostate cancer at the Princess Margaret Cancer Centre, Toronto, Canada. Six coders worked in pairs to review interview transcripts and conduct a thematic analysis. A consensus was reached through team discussions. Topics of interest included symptom experiences, the impact of symptoms on daily life, symptom management strategies, and suggestions for external support. RESULTS Thirty-six interviews were conducted with older adults (mean age: 76 years, 92% with metastatic castrate-resistant prostate cancer) who started chemotherapy (n = 11), androgen-axis targeted therapies (n = 19), or radium-223 (n = 6). The most common treatment-specific symptoms included: fatigue, pain, sleep disturbances, mood disturbances, and gastrointestinal symptoms. Four themes on the impact of symptoms on daily life emerged: resting more than usual, changes in mobility, changes in maintaining activities of daily living, and not feeling up to most things. It is important to note that participants who underwent chemotherapy have previously completed other lines of treatment and had more advanced disease, possibly contributing to higher prevalence of symptoms and greater impact on daily life. Four themes on symptom management strategies emerged: positive support systems, seeking help, interventions by healthcare providers, and self-management strategies. Suggestions for external support included building social support networks, improving health literacy, improving continuity of care, receiving support from healthcare providers, engaging in health-seeking behaviours, and addressing unmet supportive care needs. DISCUSSION Exploring symptom experiences of older men with metastatic prostate cancer provides valuable insights for developing supportive care programs and improving patient care.
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49
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Millan B, Breau RH, Bhindi B, Mallick R, Tanguay S, Finelli A, Lavallée LT, Pouliot F, Rendon R, So AI, Dean L, Lattouf JB, Basappa NS, Kapoor A. A Comparison of Percutaneous Ablation Therapy to Partial Nephrectomy for cT1a Renal Cancers: Results from the Canadian Kidney Cancer Information System. J Urol 2022; 208:804-812. [PMID: 35686812 DOI: 10.1097/ju.0000000000002798] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Percutaneous ablation therapy (AT) and partial nephrectomy (PN) are successful management strategies for T1a renal cancer. Our objective was to compare AT to PN with respect to recurrence-free survival (RFS) and overall survival (OS). MATERIALS AND METHODS Patients post-PN or -AT for cT1aN0M0 renal cancer from 2011 to 2021 were identified from the national Canadian Kidney Cancer information system. Inverse probability of treatment weighting (IPTW) using propensity score (PS) was used. The primary outcomes, RFS and OS, were compared using Kaplan-Meier log-rank test analyses and Cox proportional hazard regression models. RESULTS A total of 275 patients underwent AT and 2,001 underwent PN, with a median followup of 2.0 years (IQR 0.6-4.1). Covariates were well balanced between the AT and PN cohorts following PS matching. Two-year RFS following IPTW PS analysis for patients undergoing AT and PN was 88.1% and 97.4% (p <0.0001), respectively, while 2-year OS was 97.4% and 99.0% (p=0.7), respectively. Five-year RFS following IPTW PS analysis for patients undergoing AT and PN was 86.0% and 95.1%, respectively (p=0.003), while 5-year OS was 94.2% and 95.1%, respectively (p=0.9). Following IPTW PS analysis, treatment modality (PN vs AT) was a predictor of disease recurrence (HR 0.36, p=0.003) but not for OS (HR 0.96, p=0.9). CONCLUSIONS With short followup, PN offers better RFS than AT, although no significant difference in OS was detected following PS adjustments. Both modalities can be offered to appropriately selected patients while we await prospective randomized data.
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Affiliation(s)
- Braden Millan
- Division of Urology, McMaster Institute of Urology, McMaster University, Hamilton, Ontario, Canada
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, Ontario, Canada
| | - Bimal Bhindi
- Division of Urology, University of Calgary, Calgary, Alberta, Canada
| | - Ranjeeta Mallick
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Simon Tanguay
- Division of Urology, McGill University, Montreal, Quebec, Canada
| | - Antonio Finelli
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Luke T Lavallée
- Division of Urology, University of Ottawa, Ottawa, Ontario, Canada
| | - Frédéric Pouliot
- Department of Surgery, Division of Urology, Université Laval, Quebec City, Quebec, Canada
| | - Ricardo Rendon
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alan I So
- Department of Urologic Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Lucas Dean
- Department of Surgery, Alberta Urology Institute Research Center, University of Alberta, Edmonton, Alberta, Canada
| | | | - Naveen S Basappa
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Anil Kapoor
- Division of Urology, McMaster Institute of Urology, McMaster University, Hamilton, Ontario, Canada
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Glicksman RM, Ramotar M, Metser U, Chung PW, Liu Z, Vines D, Finelli A, Hamilton R, Fleshner NE, Perlis N, Zlotta AR, Bayley A, Helou J, Raman S, Kulkarni G, Catton C, Lam T, Chan R, Warde P, Gospodarowicz M, Jaffray DA, Berlin A. Extended Results and Independent Validation of a Phase 2 Trial of Metastasis Directed Therapy for Molecularly Defined Oligometastatic Prostate Cancer. Int J Radiat Oncol Biol Phys 2022; 114:693-704. [PMID: 36031465 DOI: 10.1016/j.ijrobp.2022.06.080] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/23/2022] [Accepted: 06/21/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE The role of metastasis-directed therapy (MDT) in molecularly defined oligorecurrent prostate cancer (PCa) remains irresolute. We present extended follow-up and an independent validation cohort of a prospective trial. METHODS AND MATERIALS This study consists of 2 sequential single-arm phase-2 trials of patients with biochemical recurrence (prostate specific antigen [PSA] 0.4-3.0 ng/mL) and negative conventional imaging after radical prostatectomy and postoperative radiation therapy. All patients underwent [18F]DCFPyL positron emission tomography/computed tomography. Patients with molecularly defined oligorecurrent prostate cancer underwent MDT with stereotactic body radiation therapy or surgery, without androgen deprivation therapy (ADT). The primary end point was biochemical response (≥50% PSA decline from baseline). Secondary end points included PSA progression-free survival and ADT-free survival. The sample size of 37 MDT patients was determined based on a Simon's 2-stage design with biochemical response rate >20%, and this design was also applied for the subsequent independent validation cohort. RESULTS Seventy-four patients underwent MDT: 37 each in the initial and validation cohorts. Both cohorts met the prespecified biochemical response rate and completed the planned 2-stages of accrual. For the pooled cohort, the median number of prostate specific membrane antigen positron emission tomography avid lesions was 2 and most (87%) recurrences were nodal. Sixty-four (87%) had stereotactic body radiation therapy and 10 (13%) had surgery. Median follow-up (interquartile range [IQR]) for the initial, validation and combined cohorts were 41 (35-46) months, 14 months (7-21), and 24 months (14-41), respectively. The biochemical response rates for the initial, validation and combined cohorts were 59%, 43%, and 51%, respectively. For the combined cohort, median biochemical progression-free survival was 21 months (95% confidence interval, 13-not reached), and median ADT-free survival was 45 months (95% confidence interval, 31-not reached). CONCLUSIONS Half of patients treated with MDT for molecularly defined-only oligorecurrent prostate cancer exhibited a biochemical response. This study provides necessary and validated evidence to support randomized trials aiming to determine whether MDT (alone or with systemic therapy) can affect clinically meaningful end points.
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Affiliation(s)
- Rachel M Glicksman
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Matthew Ramotar
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ur Metser
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Peter W Chung
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Zhihui Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Douglass Vines
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Antonio Finelli
- Department of Surgical Oncology, Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert Hamilton
- Department of Surgical Oncology, Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Neil E Fleshner
- Department of Surgical Oncology, Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Perlis
- Department of Surgical Oncology, Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Alexandre R Zlotta
- Department of Surgical Oncology, Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Bayley
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Joelle Helou
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Srinivas Raman
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Girish Kulkarni
- Department of Surgical Oncology, Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Charles Catton
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Tony Lam
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Rosanna Chan
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Padraig Warde
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Mary Gospodarowicz
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - David A Jaffray
- TECHNA Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Divisions of Radiation Oncology and Diagnostic Radiology, MD Anderson Cancer Centre, Houston, Texas
| | - Alejandro Berlin
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; TECHNA Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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