1401
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Health technology assessment for PSMA-PET: striving towards a cost-effective management of prostate cancer. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00446-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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1402
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Petersen SE, Høyer M. Androgen Deprivation Therapy Combined With Particle Therapy for Prostate Cancer: A Systematic Review. Front Oncol 2021; 11:695647. [PMID: 34249753 PMCID: PMC8260995 DOI: 10.3389/fonc.2021.695647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/31/2021] [Indexed: 12/09/2022] Open
Abstract
Purpose There is high-level evidence for addition of androgen deprivation therapy to photon-based radiotherapy of the prostate in intermediate- and high-risk prostate cancer. Little is known about the value of ADT in particle therapy of prostate cancer. We are conducting a systematic review on biochemical disease-free survival, overall survival, and morbidity after combined particle therapy and ADT for prostate cancer. Methods A thorough search in PubMed, Embase, Scopus, and Web of Science databases were conducted, searching for relevant studies. Clinical studies on prostate cancer and the treatment combination of particle therapy and androgen deprivation therapy were included. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered on PROSPERO (CRD42021230801). Results A total of 298 papers were identified. Fifteen papers reporting on 7,202 patients after proton or carbon-ion therapy for localized prostate cancer where a fraction or all patients received ADT were selected for analysis. Three thousand five hundred and nineteen (49%) of the patients had received combined ADT and particle therapy. Primarily high-risk (87%), to a lesser extent intermediate-risk (34%) and low-risk patients (12%) received ADT. There were no comparative studies on the effect of ADT in patients treated with particles and no studies identified ADT as an independent prognostic factor related to survival outcomes. Conclusions The review found no evidence to support that the effects on biochemical disease-free survival and morbidity of combining ADT to particle therapy differs from the ADT effects in conventional photon based radiotherapy. The available data on the topic is limited.
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Affiliation(s)
| | - Morten Høyer
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
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1403
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Thomsen FB, Garmo H, Brasso K, Egevad L, Stattin P. Temporal changes in cause-specific death in men with localised prostate cancer treated with radical prostatectomy: a population-based, nationwide study. J Surg Oncol 2021; 124:867-875. [PMID: 34145588 PMCID: PMC8518635 DOI: 10.1002/jso.26579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/07/2021] [Indexed: 11/07/2022]
Abstract
Background and Objective Changes in diagnostic work‐up, histopathological assessment, and treatment of men with prostate cancer during the last 20 years have affected the prognosis. The objective was to investigate the risk of prostate cancer death in men with clinically localised prostate cancer treated with radical prostatectomy in Sweden in 2000–2010. Methods Population‐based, nationwide, study on men with clinically localised prostate cancer treated with radical prostatectomy in the period 2000–2010. Cox regression analyses were used to assess differences in risk of prostate cancer death according to calendar period for diagnosis and stratified on risk category. Results The study included 19 330 men with a median follow‐up of 12.4 years. Men diagnosed in 2007–2008 and 2009–2010 had a significantly lower risk of prostate cancer death compared to men diagnosed in 2000–2002. The reduced risk of prostate cancer death was restricted to men with intermediate‐risk prostate cancer with no differences observed in men with low‐ or high‐risk prostate cancer. Conclusion During the study period, the risk of prostate cancer death decreased in the total population of men with localised prostate cancer treated with radical prostatectomy. The decrease was restricted to men with intermediate‐risk prostate cancer.
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Affiliation(s)
- Frederik B Thomsen
- Department of Urology, Copenhagen University Hospital - Rigshospitalet, Copenhagen Prostate Cancer Center, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hans Garmo
- Regional Cancer Centre Uppsala Örebro, Uppsala University Hospital, Uppsala, Sweden.,Division of Cancer Studies, King's College London, School of Medicine, Cancer Epidemiology Group, London, UK
| | - Klaus Brasso
- Department of Urology, Copenhagen University Hospital - Rigshospitalet, Copenhagen Prostate Cancer Center, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Egevad
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.,Department of Surgical and Perioperative Sciences, Urology, and Andrology, Umeå University Hospital, Umeå, Sweden
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1404
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Moris L, Gandaglia G, Vilaseca A, Van den Broeck T, Briers E, De Santis M, Gillessen S, Grivas N, O'Hanlon S, Henry A, Lam TB, Lardas M, Mason M, Oprea-Lager D, Ploussard G, Rouviere O, Schoots IG, van der Poel H, Wiegel T, Willemse PP, Yuan CY, Grummet JP, Tilki D, van den Bergh RCN, Cornford P, Mottet N. Evaluation of Oncological Outcomes and Data Quality in Studies Assessing Nerve-sparing Versus Non-Nerve-sparing Radical Prostatectomy in Nonmetastatic Prostate Cancer: A Systematic Review. Eur Urol Focus 2021; 8:690-700. [PMID: 34147405 DOI: 10.1016/j.euf.2021.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/10/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Surgical techniques aimed at preserving the neurovascular bundles during radical prostatectomy (RP) have been proposed to improve functional outcomes. However, it remains unclear if nerve-sparing (NS) surgery adversely affects oncological metrics. OBJECTIVE To explore the oncological safety of NS versus non-NS (NNS) surgery and to identify factors affecting the oncological outcomes of NS surgery. EVIDENCE ACQUISITION Relevant databases were searched for English language articles published between January 1, 1990 and May 8, 2020. Comparative studies for patients with nonmetastatic prostate cancer (PCa) treated with primary RP were included. NS and NNS techniques were compared. The main outcomes were side-specific positive surgical margins (ssPSM) and biochemical recurrence (BCR). Risk of bias (RoB) and confounding assessments were performed. EVIDENCE SYNTHESIS Out of 1573 articles identified, 18 studies recruiting a total of 21 654 patients were included. The overall RoB and confounding were high across all domains. The most common selection criteria for NS RP identified were characteristic of low-risk disease, including low core-biopsy involvement. Seven studies evaluated the link with ssPSM and showed an increase in ssPSM after adjustment for side-specific confounders, with the relative risk for NS RP ranging from 1.50 to 1.53. Thirteen papers assessing BCR showed no difference in outcomes with at least 12 mo of follow-up. Lack of data prevented any subgroup analysis for potentially important variables. The definitions of NS were heterogeneous and poorly described in most studies. CONCLUSIONS Current data revealed an association between NS surgery and an increase in the risk of ssPSM. This did not translate into a negative impact on BCR, although follow-up was short and many men harbored low-risk PCa. There are significant knowledge gaps in terms of how various patient, disease, and surgical factors affect outcomes. Adequately powered and well-designed prospective trials and cohort studies accounting for these issues with long-term follow-up are recommended. PATIENT SUMMARY Neurovascular bundles (NVBs) are structures containing nerves and blood vessels. The NVBs close to the prostate are responsible for erections. We reviewed the literature to determine if a technique to preserve the NVBs during removal of the prostate causes worse cancer outcomes. We found that NVB preservation was poorly defined but, if applied, was associated with a higher risk of cancer at the margins of the tissue removed, even in patients with low-risk prostate cancer. The long-term importance of this finding for patients is unclear. More data are needed to provide recommendations.
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Affiliation(s)
- Lisa Moris
- Department of Urology, University Hospitals Leuven, Leuven, Belgium.
| | - Giorgio Gandaglia
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antoni Vilaseca
- Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | - Maria De Santis
- Department of Urology, Charité University Hospital Berlin, Berlin, Germany; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland
| | - Nikos Grivas
- Department of Urology, Hatzikosta General Hospital, Ioannina, Greece
| | - Shane O'Hanlon
- Medicine for Older People, Saint Vincent's University Hospital, Dublin, Ireland
| | - Ann Henry
- Leeds Cancer Centre, St. James's University Hospital and University of Leeds, Leeds, UK
| | - Thomas B Lam
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Michael Lardas
- Department of Urology, Metropolitan General Hospital, Athens, Greece
| | - Malcolm Mason
- Division of Cancer & Genetics, School of Medicine Cardiff University, UK
| | - Daniela Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands
| | | | - Olivier Rouviere
- Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Ivo G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Henk van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Peter-Paul Willemse
- Department of Oncological Urology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cathy Y Yuan
- Department of Medicine, Health Science Centre, McMaster University, Hamilton, ON, Canada
| | - Jeremy P Grummet
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Philip Cornford
- Department of Urology, Liverpool University Hospitals NHS Trust, Liverpool, UK
| | - Nicolas Mottet
- Department of Urology, University Hospital, St. Etienne, France
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1405
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Fukagawa E, Yamamoto S, Ohde S, Yoshitomi KK, Hamada K, Yoneoka Y, Fujiwara M, Fujiwara R, Oguchi T, Komai Y, Numao N, Yuasa T, Fukui I, Yonese J. External validation of the Briganti 2019 nomogram to identify candidates for extended pelvic lymph node dissection among patients with high-risk clinically localized prostate cancer. Int J Clin Oncol 2021; 26:1736-1744. [PMID: 34117947 PMCID: PMC8364898 DOI: 10.1007/s10147-021-01954-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/27/2021] [Indexed: 01/14/2023]
Abstract
Background We aimed to establish an external validation of the Briganti 2019 nomogram in a Japanese cohort to preoperatively evaluate the probability of lymph node invasion in patients with high-risk, clinically localized prostate cancer. Methods The cohort consisted of 278 patients with prostate cancer diagnosed using magnetic resonance imaging-targeted biopsy who underwent radical prostatectomy and extended pelvic lymph node dissection from 2012 to 2020. Patients were rated using the Briganti 2019 nomogram, which evaluates the probability of lymph node invasion. We used the area under curve of the receiver operating characteristic analysis to quantify the accuracy of the nomogram. Results Nineteen (6.8%) patients had lymph node invasion. The median number of lymph nodes removed was 18. The area under the curve for the Briganti 2019 was 0.71. When the cutoff was set at 7%, 84 (30.2%) patients with extended pelvic lymph node dissection could be omitted, and only 1 (1.2%) patient with lymph node invasion would be missed. Sensitivity, specificity, and negative predictive values at the 7% cutoff were 94.7, 32.0, and 98.8%, respectively. Conclusion This external validation showed that the Briganti 2019 nomogram was accurate, although there may still be scope for individual adjustments.
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Affiliation(s)
- Eri Fukagawa
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Shinya Yamamoto
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Sachiko Ohde
- Graduate School of Public Health, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
| | - Kasumi Kaneko Yoshitomi
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Kosuke Hamada
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yusuke Yoneoka
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Motohiro Fujiwara
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Ryo Fujiwara
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tomohiko Oguchi
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yoshinobu Komai
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Noboru Numao
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takeshi Yuasa
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Iwao Fukui
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Junji Yonese
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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1406
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Buckle T, Schilling C, Maurer T, Vidal-Sicart S. Image-guided surgery: from classical techniques to novel aspects and approaches. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2021; 65:187-189. [PMID: 34105340 DOI: 10.23736/s1824-4785.21.03388-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tessa Buckle
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands -
| | - Clare Schilling
- Head and Neck Academic Center, Department of Head and Neck Surgery, University College Hospital, London, UK
| | - Tobias Maurer
- Department of Urology, Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Sergi Vidal-Sicart
- Nuclear Medicine Department, Hospital Clínic Barcelona, Barcelona, Spain.,Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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1407
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Berrens AC, van Leeuwen PJ, Maurer T, Hadaschik BA, Krafft U. Implementation of radioguided surgery in prostate cancer. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2021; 65:202-214. [PMID: 34105337 DOI: 10.23736/s1824-4785.21.03348-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
With the development of new imaging technologies and tracers, the applications of radioguided surgery for prostate cancer are growing rapidly. The current paper aims to give an overview of the recent advances of radioguided surgery in the management of prostate cancer. We performed a literature search to give an overview of the current status of radioguided surgery for prostate cancer. Three modalities of radioguided surgery, the sentinel node procedure, Cerenkov Luminescence / beta-radio-guided surgery and radio-guided salvage surgery in recurrent prostate cancer, were reviewed in detail. Radioguided surgery for prostate cancer has shown promising value in the treatment of primary diagnosed prostate cancer and recurrent loco-regional lymph node positive prostate cancer. Advances have been made into minimal invasive (robot-assisted) laparoscopic surgery. The sentinel node procedure for prostate cancer has been further developed and is currently performed with high diagnostic sensitivity. Cerenkov luminescence imaging is a feasible and encouraging technique for intraoperative margin assessment in prostate cancer. Radioguided surgery in recurrent prostate cancer has shown to be feasible, yielding high sensitivity and specificity for detecting small local recurrences and metastases. With the availability of different new tracers, the road has been paved towards clinically feasible radioguided surgery for prostate cancer. Novel technologies now being developed for minimal invasive surgery are speeding up clinical research. Currently, none of the radioguided surgery techniques mentioned have been accepted as standard of care.
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Affiliation(s)
- Anne-Claire Berrens
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Pim J van Leeuwen
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Tobias Maurer
- Department of Urology, Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Boris A Hadaschik
- Department of Urology, West German Cancer Center, Essen University Hospital, Essen, Germany
| | - Ulrich Krafft
- Department of Urology, West German Cancer Center, Essen University Hospital, Essen, Germany -
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1408
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Forsvall A, Jönsson H, Wagenius M, Bratt O, Linder A. Rate and characteristics of infection after transrectal prostate biopsy: a retrospective observational study. Scand J Urol 2021; 55:317-323. [PMID: 34096449 DOI: 10.1080/21681805.2021.1933169] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of this study was to assess the incidence of infection after transrectal prostate biopsy (TRbx). Secondary objectives were to describe infection characteristics, antibiotic resistance patterns, ICD-10 coding, and costs. METHODS TRbx carried out at the hospitals of Ängelholm and Helsingborg, Scania, Sweden, between October 2017 and March 2019, were identified based on the NOMESCO Classification of Surgical Procedures code for TRbx, TKE00. All patients received per oral antibiotic prophylaxis, usually 750 mg ciprofloxacin at biopsy. Other preventative measures were not used. Medical care within 30 days of the biopsy was evaluated through a manual retrospective medical chart review. Data on patient and infection characteristics were collected. The costs of infections causing hospitalization were estimated. RESULTS After 36 (5.4%) of 670 biopsies, the patient developed post-biopsy infection within 30 days after TRbx. Twenty-six patients (3.9%) required hospitalization for an average of 6 days, at an estimated direct cost of USD 9174 (EUR 8031) per patient. Nine patients (1.3%) had a complicated infection leading to intensive care, multiple hospitalizations or emergency department visits. The inpatient care episodes for the 26 hospitalized patients were categorized with 15 different ICD-codes. In 6 episodes no ICD-code related to infection was used. CONCLUSIONS In this study, we found an infection rate of 5.4% after TRbx; 3.9% of the patients were hospitalized for a post-TRbx infection and 1.3% had complicated infections. A specific ICD code for post-TRbx infections would facilitate evaluation and monitoring of this common, costly, and sometimes serious complication.
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Affiliation(s)
- Andreas Forsvall
- Division of Clinical Sciences,Department of Infection Medicine, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Urology, Helsingborg Hospital, Helsingborg, Sweden
| | - Hannah Jönsson
- Division of Clinical Sciences,Department of Infection Medicine, Faculty of Medicine, Lund University, Lund, Sweden
| | - Magnus Wagenius
- Division of Clinical Sciences,Department of Infection Medicine, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Urology, Helsingborg Hospital, Helsingborg, Sweden
| | - Ola Bratt
- Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Adam Linder
- Division of Clinical Sciences,Department of Infection Medicine, Faculty of Medicine, Lund University, Lund, Sweden
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1409
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Moussa M, Papatsoris A, Sryropoulou D, Chakra MA, Dellis A, Tzelves L. A pharmacoeconomic evaluation of pharmaceutical treatment options for prostate cancer. Expert Opin Pharmacother 2021; 22:1685-1728. [PMID: 34076542 DOI: 10.1080/14656566.2021.1925647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Prostate cancer is one of the most common neoplasms in men. For many years the mainstay of treatment was androgen deprivation therapy, but during last decade many novel agents have emerged, accompanied by increased costs for healthcare systems. AREAS COVERED In this literature review, the authors provide a pharmacoeconomic review of several pharmaceutical agents used in several disease stages, by summarizing evidence from cost-analysis, cost-effectiveness, cost-utility, cost-saving, cost-benefit and budgetary impact analysis studies. EXPERT OPINION The rapid development of therapeutic agents for prostate cancer has put a great budgetary burden on healthcare systems, since these drugs are prolonging survival and improving quality of life . Since existing data are now mature enough from a number of clinical trials with long-term follow-up, policy makers should propose not only the most clinically effective but also the most cost-effective agents, in order for every patient to gain access at least to some of these therapies. Docetaxel addition seems to be a cost-effective option, when compared to both abiraterone and enzalutamide (due to costs related to acquisition and side effects). Cabazitaxel is a strong candidate after docetaxel failure, while both denosumab and bisphosphonates are cost-effective for reducing skeletal-related events in metastatic disease.
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Affiliation(s)
- Mohamad Moussa
- Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Mohamed Abou Chakra
- Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon
| | - Athanasios Dellis
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Department of Surgery, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lazaros Tzelves
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
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1410
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Crump RT, Remmers S, Van Hemelrijck M, Helleman J, Nieboer D, Roobol MJ, Venderbos LDF, Trock B, Ehdaie B, Carroll P, Filson C, Logothetis C, Morgan T, Klotz L, Pickles T, Hyndman E, Moore C, Gnanapragasam V, Van Hemelrijck M, Dasgupta P, Bangma C, Roobol M, Villers A, Robert G, Semjonow A, Rannikko A, Valdagni R, Perry A, Hugosson J, Rubio-Briones J, Bjartell A, Hefermehl L, Shiong LL, Frydenberg M, Sugimoto M, Chung BH, van der Kwast T, Hulsen T, de Jonge C, van Hooft P, Kattan M, Xinge J, Muir K, Lophatananon A, Fahey M, Steyerberg E, Nieboer D, Zhang L, Steyerberg E, Nieboer D, Beckmann K, Denton B, Hayen A, Boutros P, Guo W, Benfante N, Cowan J, Patil D, Park L, Ferrante S, Mamedov A, LaPointe V, Crump T, Stavrinides V, Kimberly-Duffell J, Santaolalla A, Nieboer D, Olivier J, France B, Rancati T, Ahlgren H, Mascarós J, Löfgren A, Lehmann K, Lin CH, Cusick T, Hirama H, Lee KS, Jenster G, Auvinen A, Bjartell A, Haider M, van Bochove K, Buzza M, Kouspou M, Paich K, Bangma C, Roobol M, Helleman J. Using the Movember Foundation's GAP3 cohort to measure the effect of active surveillance on patient-reported urinary and sexual function-a retrospective study in low-risk prostate cancer patients. Transl Androl Urol 2021; 10:2719-2727. [PMID: 34295757 PMCID: PMC8261406 DOI: 10.21037/tau-20-1255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 04/29/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Active surveillance (AS) for low-risk prostate cancer (PCa) is intended to overcome potential side-effects of definitive treatment. Frequent prostate biopsies during AS may, however, impact erectile (EF) and urinary function (UF). The objective of this study was to test the influence of prostate biopsies on patient-reported EF and UF using multicenter data from the largest to-date AS-database. METHODS In this retrospective study, data analyses were performed using the Movember GAP3 database (v3.2), containing data from 21,169 AS participants from 27 AS-cohorts worldwide. Participants were included in the study if they had at least one follow-up prostate biopsy and completed at least one patient reported outcome measure (PROM) related to EF [Sexual Health Inventory for Men (SHIM)/five item International Index of Erectile Function (IIEF-5)] or UF [International Prostate Symptom Score (IPSS)] during follow-up. The longitudinal effect of the number of biopsies on either SHIM/IIEF-5 or IPSS were analyzed using linear mixed models to adjust for clustering at patient-level. Analyses were stratified by center; covariates included age and Gleason Grade group at diagnosis, and time on AS. RESULTS A total of 696 participants completed the SHIM/IIEF-5 3,175 times, with a median follow-up of 36 months [interquartile range (IQR) 20-55 months]. A total of 845 participants completed the IPSS 4,061 times, with a median follow-up of 35 months (IQR 19-56 months). The intraclass correlation (ICC) was 0.74 for the SHIM/IIEF-5 and 0.68 for the IPSS, indicating substantial differences between participants' PROMs. Limited heterogeneity between cohorts in the estimated effect of the number of biopsies on either PROM were observed. A significant association was observed between the number of biopsies and the SHIM/IIEF-5 score, but not for the IPSS score. Every biopsy was associated with a decrease in the SHIM/IIEF-5 score of an average 0.67 (95% CI, 0.47-0.88) points. CONCLUSIONS Repeated prostate biopsy as part of an AS protocol for men with low-risk PCa does not have a significant association with self-reported UF but does impact self-reported sexual function. Further research is, however, needed to understand whether the effect on sexual function implies a negative clinical impact on their quality of life and is meaningful from a patient's perspective. In the meantime, clinicians and patients should anticipate a potential decline in erectile function and hence consider incorporating the risk of this harm into their discussion about opting for AS and also when deciding on the stringency of follow-up biopsy schedules with long-term AS.
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Affiliation(s)
| | - Sebastiaan Remmers
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mieke Van Hemelrijck
- King’s College London, Faculty of Life Sciences and Medicine, Translational Oncology & Urology Research (TOUR), London, UK
| | - Jozien Helleman
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Monique J. Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
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1411
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Mendichovszky IA. Editorial for "Deep Learning Whole-Gland and Zonal Prostate Segmentation on a Public MRI Dataset". J Magn Reson Imaging 2021; 54:460-461. [PMID: 34056795 DOI: 10.1002/jmri.27748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 05/18/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Iosif A Mendichovszky
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust and University of Cambridge, Cambridge, UK
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1412
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Basourakos SP, Tzeng M, Lewicki PJ, Patel K, Al Hussein Al Awamlh B, Venkat S, Shoag JE, Gorin MA, Barbieri CE, Hu JC. Tissue-Based Biomarkers for the Risk Stratification of Men With Clinically Localized Prostate Cancer. Front Oncol 2021; 11:676716. [PMID: 34123846 PMCID: PMC8193839 DOI: 10.3389/fonc.2021.676716] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/21/2021] [Indexed: 01/09/2023] Open
Abstract
Risk stratification of men with clinically localized prostate cancer has historically relied on basic clinicopathologic parameters such as prostate specific antigen level, grade group, and clinical stage. However, prostate cancer often behaves in ways that cannot be accurately predicted by these parameters. Thus, recent efforts have focused on developing tissue-based genomic tests that provide greater insights into the risk of a given patient's disease. Multiple tests are now commercially available and provide additional prognostic information at various stages of the care pathway for prostate cancer. Indeed, early evidence suggests that these assays may have a significant impact on patient and physician decision-making. However, the impact of these tests on oncologic outcomes remains less clear. In this review, we highlight recent advances in the use of tissue-based biomarkers in the treatment of prostate cancer and identify the existing evidence supporting their clinical use.
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Affiliation(s)
- Spyridon P. Basourakos
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, United States
| | - Michael Tzeng
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, United States
| | - Patrick J. Lewicki
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, United States
| | - Krishnan Patel
- Radiation Oncology Branch, National Cancer Institute, Bethesda, MD, United States
| | | | - Siv Venkat
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, United States
| | - Jonathan E. Shoag
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, United States
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Michael A. Gorin
- Department of Urology, University of Pittsburg School of Medicine, Pittsburgh, PA, United States
- Urology Associates and UPMC Western Maryland, Cumberland, MD, United States
| | - Christopher E. Barbieri
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, United States
| | - Jim C. Hu
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, United States
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1413
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Suzuki K, Okamura Y, Hara T, Terakawa T, Furukawa J, Harada K, Hinata N, Fujisawa M. Prognostic impact of bone metastatic volume beyond vertebrae and pelvis in patients with metastatic hormone-sensitive prostate cancer. Int J Clin Oncol 2021; 26:1533-1540. [PMID: 34047889 DOI: 10.1007/s10147-021-01931-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although bone metastasis beyond the vertebrae and pelvis has been a key factor in prognostic models of metastatic hormone-sensitive prostate cancer (mHSPC), the clinical significance of it is still unclear. The present study evaluated the prognostic impact of the volume of bone metastasis beyond the vertebrae and pelvis on the outcomes of mHSPC and created an ideal risk classification based on it. METHODS We retrospectively reviewed 197 patients with mHSPC who were treated with combined androgen blockade as the initial treatment between June 2003 and October 2019. We calculated the bone scan index (BSI), including the BSI beyond the vertebrae and pelvis (bBSI), using BONENAVI, and investigated the association between the BSI and the overall survival (OS) of mHSPC. RESULTS According to the CHAARTED criteria, 91 and 106 patients were classified into the low- and high-volume groups, respectively. Of the 79 patients who did not have visceral metastasis in the high-volume group, those with a bBSI ≤ 0.27 (n = 16) showed a favorable OS, as did those in the low-volume group. The modified CHAARTED high-volume group (presence of visceral metastases or 4 bone lesions with a bBSI > 0.27) showed a significantly shorter OS than others, with a hazard ratio (HR) of 4.69 (p < 0.001), which was higher than that observed with the original CHAARTED criteria (HR = 4.33). CONCLUSIONS Our data suggested that considering the volume of bone metastasis beyond the vertebrae and pelvis may help to improve the accuracy of risk classification. Further large-scale prospective studies are needed to validate our findings.
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Affiliation(s)
- Kotaro Suzuki
- Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Yasuyoshi Okamura
- Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takuto Hara
- Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Tomoaki Terakawa
- Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Junya Furukawa
- Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Kenichi Harada
- Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Nobuyuki Hinata
- Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Masato Fujisawa
- Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
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1414
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Padhani AR, Rouvière O, Schoots IG. Magnetic Resonance Imaging for Tailoring the Need to Biopsy During Follow-up for Men on Active Surveillance for Prostate Cancer. Eur Urol 2021; 80:564-566. [PMID: 34053779 DOI: 10.1016/j.eururo.2021.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK.
| | - Olivier Rouvière
- Department of Urinary and Vascular Imaging, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France; Faculté de Médecine Lyon Est, Université de Lyon 1, Lyon, France
| | - Ivo G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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1415
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A Genomic-Clinicopathologic Nomogram for the Prediction of Lymph Node Invasion in Prostate Cancer. JOURNAL OF ONCOLOGY 2021; 2021:5554708. [PMID: 34122545 PMCID: PMC8172299 DOI: 10.1155/2021/5554708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/28/2021] [Accepted: 04/01/2021] [Indexed: 12/24/2022]
Abstract
Background Lymph node status is important for treatment decision making in prostate cancer (PCa). We aimed to develop a genomic-clinicopathologic nomogram for the prediction of lymph node invasion (LNI) in PCa. Methods Differentially expressed genes between LNI and non-LNI PCa samples were identified in the Cancer Genome Atlas database. Univariate Cox regression analysis and minimum redundancy maximum relevance were performed for gene selection. The synthetic minority oversampling technique (SMOTE) was conducted to balance the minority group (LNI group). Machine learning models were constructed in the training set and assessed in the validation set. Univariable logistic regression and multivariable logistic regression were applied to build a nomogram. Furthermore, the RNA-sequence data from our center were used to validate the expression levels of hub genes between five matched primary PCa and the corresponding LNI samples. Results The 37-gene-based support vector machine (SVM) model had the optimal synthesized performance in the SMOTE-balanced training (area under the curve (AUC): 0.947) and validation (AUC: 0.901) sets. Incorporating the SVM-based risk score and the Gleason grade, the genomic-clinicopathologic nomogram demonstrated good prediction and calibration both in the SMOTE-balanced training (AUC: 0.946) and validation (AUC: 0.910) sets. The dysregulated expression of hub genes between PCa and LNI samples was also validated. Conclusion The proposed nomogram combining the 37-gene-based SVM model with the Gleason grade had the potential to preoperatively predict LNI in PCa. Some of the hub genes should be prioritized for functional studies and mechanistic analyses.
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1416
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Deniffel D, Healy GM, Dong X, Ghai S, Salinas-Miranda E, Fleshner N, Hamilton R, Kulkarni G, Toi A, van der Kwast T, Zlotta A, Finelli A, Perlis N, Haider MA. Avoiding Unnecessary Biopsy: MRI-based Risk Models versus a PI-RADS and PSA Density Strategy for Clinically Significant Prostate Cancer. Radiology 2021; 300:369-379. [PMID: 34032510 DOI: 10.1148/radiol.2021204112] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background In validation studies, risk models for clinically significant prostate cancer (csPCa; Gleason score ≥3+4) combining multiparametric MRI and clinical factors have demonstrated poor calibration (over- and underprediction) and limited use in avoiding unnecessary prostate biopsies. Purpose MRI-based risk models following local recalibration were compared with a strategy that combined Prostate Imaging Data and Reporting System (PI-RADS; version 2) and prostate-specific antigen density (PSAd) to assess the potential reduction of unnecessary prostate biopsies. Materials and Methods This retrospective study included 385 patients without prostate cancer diagnosis who underwent multipara-metric MRI (PI-RADS category ≥3) and MRI-targeted biopsy between 2015 and 2019. Recalibration and selection of the best-performing MRI model (MRI-European Randomized Study of Screening for Prostate Cancer [ERSPC], van Leeuwen, Radtke, and Mehralivand models) were undertaken in cohort C1 (n = 242; 2015-2017). The impact on biopsy decisions was compared with an alternative strategy (no biopsy for PI-RADS category 3 plus PSAd < 0.1 ng/mL per milliliter) in cohort C2 (n = 143; 2018-2019). Discrimination, calibration, and clinical utility were assessed by using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis, respectively. Results The prevalence of csPCa was 38% (93 of 242 patients) and 45% (64 of 143 patients) in cohorts C1 and C2, respectively. Decision curve analysis demonstrated the highest net benefit for the van Leeuwen and Mehralivand models in C1. Used for biopsy decisions in C2, van Leeuwen (AUC, 0.84; 95% CI: 0.77, 0.9) and Mehralivand (AUC, 0.79; 95% CI: 0.72, 0.86) enabled no net benefit at a risk threshold of 10%. Up to a risk threshold of 15%, net benefit remained inferior to the PI-RADS plus PSAd strategy, which avoided biopsy in 63 per 1000 men, without missing csPCa. Without prior recalibration in C1, three of four models (MRIERSPC, Radtke, Mehralivand) were poorly calibrated and not clinically useful in C2. Conclusion The number of unnecessary prostate biopsies in men with positive MRI may be safely reduced by using a prostate-specific antigen density-based strategy. In a risk-averse scenario, this strategy enabled better biopsy decisions compared with MRI-based risk models. ©RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Dominik Deniffel
- From the Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (D.D.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Ave, Toronto, ON, Canada M5G 1X5 (D.D., G.M.H., X.D., E.S.M., A.Z., M.A.H.); Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada (D.D., G.M.H., S.G., E.S.M., A.T., M.A.H.); Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada (N.F., R.H., G.K., A.Z., A.F., N.P.); Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada (T.v.d.K.); and Department of Surgery, Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada (A.Z.)
| | - Gerard M Healy
- From the Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (D.D.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Ave, Toronto, ON, Canada M5G 1X5 (D.D., G.M.H., X.D., E.S.M., A.Z., M.A.H.); Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada (D.D., G.M.H., S.G., E.S.M., A.T., M.A.H.); Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada (N.F., R.H., G.K., A.Z., A.F., N.P.); Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada (T.v.d.K.); and Department of Surgery, Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada (A.Z.)
| | - Xin Dong
- From the Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (D.D.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Ave, Toronto, ON, Canada M5G 1X5 (D.D., G.M.H., X.D., E.S.M., A.Z., M.A.H.); Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada (D.D., G.M.H., S.G., E.S.M., A.T., M.A.H.); Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada (N.F., R.H., G.K., A.Z., A.F., N.P.); Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada (T.v.d.K.); and Department of Surgery, Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada (A.Z.)
| | - Sangeet Ghai
- From the Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (D.D.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Ave, Toronto, ON, Canada M5G 1X5 (D.D., G.M.H., X.D., E.S.M., A.Z., M.A.H.); Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada (D.D., G.M.H., S.G., E.S.M., A.T., M.A.H.); Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada (N.F., R.H., G.K., A.Z., A.F., N.P.); Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada (T.v.d.K.); and Department of Surgery, Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada (A.Z.)
| | - Emmanuel Salinas-Miranda
- From the Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (D.D.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Ave, Toronto, ON, Canada M5G 1X5 (D.D., G.M.H., X.D., E.S.M., A.Z., M.A.H.); Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada (D.D., G.M.H., S.G., E.S.M., A.T., M.A.H.); Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada (N.F., R.H., G.K., A.Z., A.F., N.P.); Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada (T.v.d.K.); and Department of Surgery, Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada (A.Z.)
| | - Neil Fleshner
- From the Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (D.D.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Ave, Toronto, ON, Canada M5G 1X5 (D.D., G.M.H., X.D., E.S.M., A.Z., M.A.H.); Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada (D.D., G.M.H., S.G., E.S.M., A.T., M.A.H.); Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada (N.F., R.H., G.K., A.Z., A.F., N.P.); Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada (T.v.d.K.); and Department of Surgery, Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada (A.Z.)
| | - Robert Hamilton
- From the Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (D.D.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Ave, Toronto, ON, Canada M5G 1X5 (D.D., G.M.H., X.D., E.S.M., A.Z., M.A.H.); Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada (D.D., G.M.H., S.G., E.S.M., A.T., M.A.H.); Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada (N.F., R.H., G.K., A.Z., A.F., N.P.); Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada (T.v.d.K.); and Department of Surgery, Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada (A.Z.)
| | - Girish Kulkarni
- From the Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (D.D.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Ave, Toronto, ON, Canada M5G 1X5 (D.D., G.M.H., X.D., E.S.M., A.Z., M.A.H.); Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada (D.D., G.M.H., S.G., E.S.M., A.T., M.A.H.); Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada (N.F., R.H., G.K., A.Z., A.F., N.P.); Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada (T.v.d.K.); and Department of Surgery, Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada (A.Z.)
| | - Ants Toi
- From the Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (D.D.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Ave, Toronto, ON, Canada M5G 1X5 (D.D., G.M.H., X.D., E.S.M., A.Z., M.A.H.); Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada (D.D., G.M.H., S.G., E.S.M., A.T., M.A.H.); Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada (N.F., R.H., G.K., A.Z., A.F., N.P.); Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada (T.v.d.K.); and Department of Surgery, Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada (A.Z.)
| | - Theodorus van der Kwast
- From the Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (D.D.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Ave, Toronto, ON, Canada M5G 1X5 (D.D., G.M.H., X.D., E.S.M., A.Z., M.A.H.); Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada (D.D., G.M.H., S.G., E.S.M., A.T., M.A.H.); Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada (N.F., R.H., G.K., A.Z., A.F., N.P.); Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada (T.v.d.K.); and Department of Surgery, Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada (A.Z.)
| | - Alexandre Zlotta
- From the Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (D.D.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Ave, Toronto, ON, Canada M5G 1X5 (D.D., G.M.H., X.D., E.S.M., A.Z., M.A.H.); Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada (D.D., G.M.H., S.G., E.S.M., A.T., M.A.H.); Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada (N.F., R.H., G.K., A.Z., A.F., N.P.); Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada (T.v.d.K.); and Department of Surgery, Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada (A.Z.)
| | - Antonio Finelli
- From the Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (D.D.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Ave, Toronto, ON, Canada M5G 1X5 (D.D., G.M.H., X.D., E.S.M., A.Z., M.A.H.); Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada (D.D., G.M.H., S.G., E.S.M., A.T., M.A.H.); Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada (N.F., R.H., G.K., A.Z., A.F., N.P.); Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada (T.v.d.K.); and Department of Surgery, Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada (A.Z.)
| | - Nathan Perlis
- From the Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (D.D.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Ave, Toronto, ON, Canada M5G 1X5 (D.D., G.M.H., X.D., E.S.M., A.Z., M.A.H.); Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada (D.D., G.M.H., S.G., E.S.M., A.T., M.A.H.); Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada (N.F., R.H., G.K., A.Z., A.F., N.P.); Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada (T.v.d.K.); and Department of Surgery, Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada (A.Z.)
| | - Masoom A Haider
- From the Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (D.D.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Ave, Toronto, ON, Canada M5G 1X5 (D.D., G.M.H., X.D., E.S.M., A.Z., M.A.H.); Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada (D.D., G.M.H., S.G., E.S.M., A.T., M.A.H.); Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada (N.F., R.H., G.K., A.Z., A.F., N.P.); Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada (T.v.d.K.); and Department of Surgery, Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada (A.Z.)
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1417
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Małkiewicz B, Ptaszkowski K, Knecht K, Gurwin A, Wilk K, Kiełb P, Dudek K, Zdrojowy R. External Validation of the Briganti Nomogram to Predict Lymph Node Invasion in Prostate Cancer-Setting a New Threshold Value. Life (Basel) 2021; 11:life11060479. [PMID: 34070313 PMCID: PMC8227656 DOI: 10.3390/life11060479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 12/26/2022] Open
Abstract
(1) Introduction: The study aimed to test and validate the performance of the 2012 Briganti nomogram as a predictor for pelvic lymph node invasion (LNI) in men who underwent radical prostatectomy (RP) with extended pelvic lymph node dissection (PLND) to examine their performance and to analyse the therapeutic impact of using a different nomogram cut-off. (2) Material and Methods: The study group consisted of 222 men with clinically localized prostate cancer (PCa) who underwent RP with ePLND between 01/2012 and 10/2018. Measurements included: preoperative PSA, clinical stage (CS), primary and secondary biopsy Gleason pattern, and the percentage of positive cores. The area under the curve (AUC) of the receiver operator characteristic analysis was appointed to quantify the accuracy of the primary nomogram model to predict LNI. The extent of estimation associated with the use of this model was graphically depicted using calibration plots. (3) Results: The median number of removed lymph nodes was 16 (IQR 12–21). A total of 53 of 222 patients (23.9%) had LNI. Preoperative clinical and biopsy characteristics differed significantly (all p < 0.005) between men with and without LNI. A nomogram-derived cut-off of 7% could lead to a reduction of 43% (95/222) of lymph node dissection while omitting 19% (10/53) of patients with LNI. The sensitivity, specificity, and negative predictive value associated with the 7% cut-off were 81.1%, 50.3%, and 96.3%, respectively. (4) Conclusions: The analysed nomogram demonstrated high accuracy for LNI prediction. A nomogram-derived cut-off of 7% confirmed good performance characteristics within the first external validation cohort from Poland.
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Affiliation(s)
- Bartosz Małkiewicz
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (A.G.); (K.W.); (P.K.); (R.Z.)
- Correspondence: ; Tel.: +48-506-158-136
| | - Kuba Ptaszkowski
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Faculty of Health Science, Wroclaw Medical University, Grunwaldzka 2, 50-355 Wroclaw, Poland;
| | - Klaudia Knecht
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (A.G.); (K.W.); (P.K.); (R.Z.)
| | - Adam Gurwin
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (A.G.); (K.W.); (P.K.); (R.Z.)
| | - Karol Wilk
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (A.G.); (K.W.); (P.K.); (R.Z.)
| | - Paweł Kiełb
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (A.G.); (K.W.); (P.K.); (R.Z.)
| | - Krzysztof Dudek
- Faculty of Mechanical Engineering, Wroclaw University of Science and Technology, 50-370 Wrocław, Poland;
| | - Romuald Zdrojowy
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (A.G.); (K.W.); (P.K.); (R.Z.)
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1418
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Cimadamore A, Cheng L, Massari F, Santoni M, Pepi L, Franzese C, Scarpelli M, Lopez-Beltran A, Galosi AB, Montironi R. Circulating Tumor DNA Testing for Homology Recombination Repair Genes in Prostate Cancer: From the Lab to the Clinic. Int J Mol Sci 2021; 22:5522. [PMID: 34073818 PMCID: PMC8197269 DOI: 10.3390/ijms22115522] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/24/2022] Open
Abstract
Approximately 23% of metastatic castration-resistant prostate cancers (mCRPC) harbor deleterious aberrations in DNA repair genes. Poly (ADP-ribose) polymerase (PARP) inhibitors (PARPi) therapy has shown improvements in overall survival in patients with mCRPC who harbor somatic and/or germline alterations of homology recombination repair (HRR) genes. Peripheral blood samples are typically used for the germline mutation analysis test using the DNA extracted from peripheral blood leucocytes. Somatic alterations can be assessed by extracting DNA from a tumor tissue sample or using circulating tumor DNA (ctDNA) extracted from a plasma sample. Each of these genetic tests has its own benefits and limitations. The main advantages compared to the tissue test are that liquid biopsy is a non-invasive and easily repeatable test with the value of better representing tumor heterogeneity than primary biopsy and of capturing changes and/or resistance mutations in the genetic tumor profile during disease progression. Furthermore, ctDNA can inform about mutation status and guide treatment options in patients with mCRPC. Clinical validation and test implementation into routine clinical practice are currently very limited. In this review, we discuss the state of the art of the ctDNA test in prostate cancer compared to blood and tissue testing. We also illustrate the ctDNA testing workflow, the available techniques for ctDNA extraction, sequencing, and analysis, describing advantages and limits of each techniques.
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Affiliation(s)
- Alessia Cimadamore
- Section of Pathological Anatomy, School of Medicine, Polytechnic University of the Marche Region, United Hospitals, 60126 Ancona, Italy; (A.C.); (L.P.); (M.S.)
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, School of Medicine, Indiana University, Indianapolis, IN 46202, USA;
| | - Francesco Massari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy;
| | - Matteo Santoni
- Oncology Unit, Macerata Hospital, 62100 Macerata, Italy;
| | - Laura Pepi
- Section of Pathological Anatomy, School of Medicine, Polytechnic University of the Marche Region, United Hospitals, 60126 Ancona, Italy; (A.C.); (L.P.); (M.S.)
| | - Carmine Franzese
- Department of Specialist Clinical Science and Odontostomatology, Urology Division, Polytechnic University of the Marche Region, United Hospitals, 60126 Ancona, Italy; (C.F.); (A.B.G.)
| | - Marina Scarpelli
- Section of Pathological Anatomy, School of Medicine, Polytechnic University of the Marche Region, United Hospitals, 60126 Ancona, Italy; (A.C.); (L.P.); (M.S.)
| | - Antonio Lopez-Beltran
- Department of Morphological Sciences, Cordoba University Medical School, 14071 Cordoba, Spain;
| | - Andrea Benedetto Galosi
- Department of Specialist Clinical Science and Odontostomatology, Urology Division, Polytechnic University of the Marche Region, United Hospitals, 60126 Ancona, Italy; (C.F.); (A.B.G.)
| | - Rodolfo Montironi
- Section of Pathological Anatomy, School of Medicine, Polytechnic University of the Marche Region, United Hospitals, 60126 Ancona, Italy; (A.C.); (L.P.); (M.S.)
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1419
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Hou Y, Zhang YH, Bao J, Bao ML, Yang G, Shi HB, Song Y, Zhang YD. Artificial intelligence is a promising prospect for the detection of prostate cancer extracapsular extension with mpMRI: a two-center comparative study. Eur J Nucl Med Mol Imaging 2021; 48:3805-3816. [PMID: 34018011 DOI: 10.1007/s00259-021-05381-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/25/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE A balance between preserving urinary continence as well as sexual potency and achieving negative surgical margins is of clinical relevance while implementary difficulty. Accurate detection of extracapsular extension (ECE) of prostate cancer (PCa) is thus crucial for determining appropriate treatment options. We aimed to develop and validate an artificial intelligence (AI)-based tool for detecting ECE of PCa using multiparametric magnetic resonance imaging (mpMRI). METHODS Eight hundred and forty nine consecutive PCa patients who underwent mpMRI and prostatectomy without previous radio- or hormonal therapy from two medical centers were retrospectively included. The AI tool was built on a ResNeXt network embedded with a spatial attention map of experts' prior knowledge (PAGNet) from 596 training patients. Model validation was performed in 150 internal and 103 external patients. Performance comparison was made between AI, two experts using a criteria-based ECE grading system, and expert-AI interaction. RESULTS An index PAGNet model using a single-slice image yielded the highest areas under the receiver operating characteristic curve (AUC) of 0.857 (95% confidence interval [CI], 0.827-0.884), 0.807 (95% CI, 0.735-0.867), and 0.728 (95% CI, 0.631-0.811) in training, internal, and external validation data, respectively. The performance of two experts (AUC, 0.632 to 0.741 vs 0.715 to 0.857) was lower (paired comparison, all p values < 0.05) than that of AI assessment. When experts' interpretations were adjusted by AI assessments, the performance of two experts was improved. CONCLUSION Our AI tool, showing improved accuracy, offers a promising alternative to human experts for ECE staging using mpMRI.
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Affiliation(s)
- Ying Hou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Yi-Hong Zhang
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, 3663 N. Zhongshan Rd., Shanghai, 200062, China
| | - Jie Bao
- Department of Radiology, The First Affiliated Hospital of Soochow University, 188#, Shizi Road, Jiangsu Province, 215006, Suzhou, China
| | - Mei-Ling Bao
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Jiangsu Province, 210029, Nanjing, China
| | - Guang Yang
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, 3663 N. Zhongshan Rd., Shanghai, 200062, China
| | - Hai-Bin Shi
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Yang Song
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, 3663 N. Zhongshan Rd., Shanghai, 200062, China.
| | - Yu-Dong Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China.
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1420
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Meijer D, van Leeuwen PJ, Roberts MJ, Siriwardana AR, Morton A, Yaxley JW, Samaratunga H, Emmett L, van de Ven PM, van der Poel HG, Donswijk ML, Boellaard TN, Schoots IG, Oprea-Lager DE, Coughlin GD, Vis AN. External Validation and Addition of Prostate-specific Membrane Antigen Positron Emission Tomography to the Most Frequently Used Nomograms for the Prediction of Pelvic Lymph-node Metastases: an International Multicenter Study. Eur Urol 2021; 80:234-242. [PMID: 34024652 DOI: 10.1016/j.eururo.2021.05.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/07/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Different nomograms exist for the preoperative prediction of pelvic lymph-node metastatic disease in individual patients with prostate cancer (PCa). These nomograms do not incorporate modern imaging techniques such as prostate-specific membrane antigen (PSMA) positron emission tomography (PET). OBJECTIVE To determine the predictive performance of the Briganti 2017, Memorial Sloan Kettering Cancer Center (MSKCC), and Briganti 2019 nomograms with the addition of PSMA-PET in an international, multicenter, present-day cohort of patients undergoing robot-assisted radical prostatectomy (RARP) and extended pelvic lymph-node dissection (ePLND) for localized PCa. DESIGN, SETTING, AND PARTICIPANTS All 757 eligible patients who underwent a PSMA-PET prior to RARP and ePLND in three reference centers for PCa surgery between January 2016 and November 2020 were included. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Performance of the three nomograms was assessed using the receiver operating characteristic curve-derived area under the curve (AUC), calibration plots, and decision curve analyses. Subsequently, recalibration and addition of PSMA-PET to the nomograms were performed. RESULTS AND LIMITATIONS Overall, 186/757 patients (25%) had pelvic lymph-node metastatic (pN1) disease on histopathological examination. AUCs of the Briganti 2017, MSKCC, and Briganti 2019 nomograms were 0.70 (95% confidence interval [95% CI]: 0.64-0.77), 0.71 (95% CI: 0.65-0.77), and 0.76 (95% CI: 0.71-0.82), respectively. PSMA-PET findings showed a significant association with pN1 disease when added to the nomograms (p < 0.001). Addition of PSMA-PET substantially improved the discriminative ability of the models yielding cross-validated AUCs of 0.76 (95% CI: 0.70-0.82), 0.77 (95% CI: 0.72-0.83), and 0.82 (95% CI: 0.76-0.87), respectively. In decision curve analyses, the addition of PSMA-PET to the three nomograms resulted in increased net benefits. CONCLUSIONS The addition of PSMA-PET to the previously developed nomograms showed substantially improved predictive performance, which suggests that PSMA-PET is a likely future candidate for a modern predictive nomogram. PATIENT SUMMARY Different tools have been developed to individualize the prediction of prostate cancer spread to lymph nodes before surgery. We found that the inclusion of modern imaging (prostate-specific membrane antigen positron emission tomography) improved substantially the overall performance of these prediction tools.
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Affiliation(s)
- Dennie Meijer
- Department of Urology, Prostate Cancer Network Netherlands, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands; Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands.
| | - Pim J van Leeuwen
- Department of Urology, Prostate Cancer Network Netherlands, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Matthew J Roberts
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia; University of Queensland Centre for Clinical Research, Herston, Australia; Department of Urology, Redcliffe Hospital, Brisbane, Australia
| | - Amila R Siriwardana
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Andrew Morton
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - John W Yaxley
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia; Department of Urology, Wesley Hospital, Brisbane, Australia
| | - Hemamali Samaratunga
- Faculty of Medicine, University of Queensland, Brisbane, Australia; Department of Pathology, Aquesta Uropathology, Brisbane, Australia
| | - Louise Emmett
- St. Vincent's Clinical School, University of New South Wales, Kensington, Australia; Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital Sydney, Darlinghurst, Australia
| | - Peter M van de Ven
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, Prostate Cancer Network Netherlands, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maarten L Donswijk
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thierry N Boellaard
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ivo G Schoots
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Daniela E Oprea-Lager
- Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands
| | - Geoffrey D Coughlin
- Faculty of Medicine, University of Queensland, Brisbane, Australia; Department of Urology, Wesley Hospital, Brisbane, Australia
| | - André N Vis
- Department of Urology, Prostate Cancer Network Netherlands, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands; Department of Urology, Prostate Cancer Network Netherlands, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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1421
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Rajwa P, Pradere B, Quhal F, Mori K, Laukhtina E, Huebner NA, D'Andrea D, Krzywon A, Shim SR, Baltzer PA, Renard-Penna R, Leapman MS, Shariat SF, Ploussard G. Reliability of Serial Prostate Magnetic Resonance Imaging to Detect Prostate Cancer Progression During Active Surveillance: A Systematic Review and Meta-analysis. Eur Urol 2021; 80:549-563. [PMID: 34020828 DOI: 10.1016/j.eururo.2021.05.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/04/2021] [Indexed: 12/20/2022]
Abstract
CONTEXT Although magnetic resonance imaging (MRI) is broadly implemented into active surveillance (AS) protocols, data on the reliability of serial MRI in order to help guide follow-up biopsy are inconclusive. OBJECTIVE To assess the diagnostic estimates of serial prostate MRI for prostate cancer (PCa) progression during AS. EVIDENCE ACQUISITION We systematically searched PubMed, Scopus, and Web of Science databases to select studies analyzing the association between changes on serial prostate MRI and PCa progression during AS. We included studies that provided data for MRI progression, which allowed us to calculate diagnostic estimates. We compared Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) accuracy with institution-specific definitions. EVIDENCE SYNTHESIS We included 15 studies with 2240 patients. Six used PRECISE criteria and nine institution-specific definitions of MRI progression. The pooled PCa progression rate, which included histological progression to Gleason grade ≥2, was 27%. The pooled sensitivity and specificity were 0.59 (95% confidence interval [CI] 0.44-0.73) and 0.75 (95% CI 0.66-0.84) respectively. There was significant heterogeneity between included studies. Depending on PCa progression prevalence, the pooled negative predictive value for serial prostate MRI ranged from 0.81 (95% CI 0.73-0.88) to 0.88 (95% CI 0.83-0.93) and the pooled positive predictive value ranged from 0.37 (95% CI 0.24-0.54) to 0.50 (95% CI 0.36-0.66). There were no significant differences in the pooled sensitivity (p = 0.37) and specificity (p = 0.74) of PRECISE and institution-specific schemes. CONCLUSIONS Serial MRI still should not be considered a sole factor for excluding PCa progression during AS, and changes on MRI are not accurate enough to indicate PCa progression. There was a nonsignificant trend toward improved diagnostic estimates of PRECISE recommendations. These findings highlight the need to further define the optimal triggers and timing of biopsy during AS, as well as the need for optimizing the quality, interpretation, and reporting of serial prostate MRI. PATIENT SUMMARY Our study suggests that serial prostate magnetic resonance imaging (MRI) alone in patients on active surveillance is not accurate enough to reliably rule out or rule in prostate cancer progression. Other clinical factors and biomarkers along with serial MRI are required to safely tailor the intensity of follow-up biopsies.
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Affiliation(s)
- Pawel Rajwa
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Benjamin Pradere
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Fahad Quhal
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Keiichiro Mori
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ekaterina Laukhtina
- Department of Urology, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Nicolai A Huebner
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Aleksandra Krzywon
- Department of Biostatistics and Bioinformatics, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Sung Ryul Shim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Pascal A Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Raphaële Renard-Penna
- Department of Radiology, Pitié-Salpétrière Hospital, Paris-Sorbonne University, Paris, France
| | | | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
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1422
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Forsvall A, Fisher J, Cardoso JFP, Wagenius M, Tverring J, Nilson B, Dahlin A, Bratt O, Linder A, Mohanty T. Evaluation of the Forsvall biopsy needle in an ex vivo model of transrectal prostate biopsy - a novel needle design with the objective to reduce the risk of post-biopsy infection. Scand J Urol 2021; 55:227-234. [PMID: 33999753 DOI: 10.1080/21681805.2021.1921023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Transrectal prostate biopsy (TRbx) transfers colonic bacteria into prostatic tissue, potentially causing infectious complications, including sepsis. Our objective was to determine whether biopsy needle shape, surface properties and sampling mechanism affect the number of bacteria transferred through the colon wall, and evaluate a novel needle with improved properties. METHODS The standard Tru-Cut biopsy needle used today was evaluated for mechanisms of bacterial transfer in a pilot study. A novel Tru-Cut needle (Forsvall needle prototype) was developed. TRbx was simulated using human colons ex-vivo. Four subtypes of the prototype needle were compared with a standard Tru-Cut needle (BARD 18 G). Prototype and standard needles were used to puncture 4 different colon specimens in 10 randomized sites per colon. Needles were submerged into culture media to capture translocated bacteria. The media was cultured on blood agar and then the total amount of transferred bacteria was calculated for each needle. The primary outcome measure was the percent reduction of bacteria translocated by the prototype needles relative to the standard needle. Secondary outcome measures were the effects of tip design and coating on the percent reduction of translocated bacteria. RESULTS Prototype needles reduced the number of translocated bacteria by, on average, 96.0% (95% confidence interval 93.0-97.7%; p < 0.001) relative to the standard needle. This percent reduction was not significantly affected by prototype needle tip style or surface coating. CONCLUSIONS The Forsvall needle significantly reduces colonic bacterial translocation, suggesting that it could reduce infectious complications in prostate biopsy. A clinical trial has been initiated.
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Affiliation(s)
- Andreas Forsvall
- Faculty of Medicine, Department of Clinical Sciences, Infection Medicine, Lund University, Lund, Sweden.,Department of Urology, Helsingborg Hospital, Helsingborg, Sweden
| | - Jane Fisher
- Faculty of Medicine, Department of Clinical Sciences, Infection Medicine, Lund University, Lund, Sweden
| | | | - Magnus Wagenius
- Faculty of Medicine, Department of Clinical Sciences, Infection Medicine, Lund University, Lund, Sweden.,Department of Urology, Helsingborg Hospital, Helsingborg, Sweden
| | - Jonas Tverring
- Faculty of Medicine, Department of Clinical Sciences, Infection Medicine, Lund University, Lund, Sweden.,Department of Infectious Diseases, Helsingborg Hospital, Helsingborg, Sweden
| | - Bo Nilson
- Department of Laboratory Medicine Lund, Section of Medical Microbiology, Lund University, Lund, Sweden.,Clinical Microbiology, Lund, Sweden
| | - Andreas Dahlin
- Department of Chemistry and Chemical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Ola Bratt
- Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg University, Sweden.,Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Adam Linder
- Faculty of Medicine, Department of Clinical Sciences, Infection Medicine, Lund University, Lund, Sweden
| | - Tirthankar Mohanty
- Faculty of Medicine, Department of Clinical Sciences, Infection Medicine, Lund University, Lund, Sweden
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1423
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Role of systemic immune-inflammation index in patients treated with salvage radical prostatectomy. World J Urol 2021; 39:3771-3779. [PMID: 33997919 PMCID: PMC8521581 DOI: 10.1007/s00345-021-03715-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/26/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To examine the predictive and prognostic value of preoperative Systemic Immune-inflammation Index (SII) in patients with radio-recurrent prostate cancer (PCa) treated with salvage radical prostatectomy (SRP). Materials and methods This multicenter retrospective study included 214 patients with radio-recurrent PCa, treated with SRP between 2007 and 2015. SII was measured preoperatively (neutrophils × platelets/lymphocytes) and the cohort was stratified using optimal cut-off. Uni- and multivariable logistic and Cox regression analyses were performed to evaluate the predictive and prognostic value of SII as a preoperative biomarker. Results A total of 81 patients had high preoperative SII (≥ 730). On multivariable logistic regression modeling, high SII was predictive for lymph node metastases (OR 3.32, 95% CI 1.45–7.90, p = 0.005), and non-organ confined disease (OR 2.55, 95% CI 1.33–4.97, p = 0.005). In preoperative regression analysis, high preoperative SII was an independent prognostic factor for cancer-specific survival (CSS; HR 10.7, 95% CI 1.12–103, p = 0.039) and overall survival (OS; HR 8.57, 95% CI 2.70–27.2, p < 0.001). Similarly, in postoperative multivariable models, SII was associated with worse CSS (HR 22.11, 95% CI 1.23–398.12, p = 0.036) and OS (HR 5.98, 95% CI 1.67–21.44, p = 0.006). Notably, the addition of SII to preoperative reference models improved the C-index for the prognosis of CSS (89.5 vs. 80.5) and OS (85.1 vs 77.1). Conclusions In radio-recurrent PCa patients, high SII was associated with adverse pathological features at SRP and survival after SRP. Preoperative SII could help identify patients who might benefit from novel imaging modalities, multimodal therapy or a closer posttreatment surveillance. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03715-4.
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1424
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Deng W, Jiang H, Liu X, Chen L, Liu W, Zhang C, Zhou X, Fu B, Wang G. Transvesical Retzius-Sparing Versus Standard Robot-Assisted Radical Prostatectomy: A Retrospective Propensity Score-Adjusted Analysis. Front Oncol 2021; 11:687010. [PMID: 34079768 PMCID: PMC8165391 DOI: 10.3389/fonc.2021.687010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 04/28/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives To estimate the safety and efficiency of transvesical Retzius-sparing robot-assisted radical prostatectomy (T-RARP) compared with standard robot-assisted radical prostatectomy (S-RARP) for localized prostate cancer (PCa). Materials and Methods 174 patients bearing localized PCa and undergoing T-RARP or S-RARP between October 2017 and January 2020 were retrospectively enrolled in our analysis. All potential baseline confounders were strictly restrained with propensity-score matching (PM) method (1: 1). Within the matched setting, the perioperative and functional outcomes were compared between the T-RARP and S-RARP groups, while the oncological results and functional recovery of the two arms were presented with Kaplan-Meier curves. Results Finally, 114 and 60 eligible patients harbouring localized PCa were identified in the S-RARP and T-RARP group, respectively. No significant differences between the two groups were found in all baseline characteristics after PM. Within the matched cohort, no case was converted to open surgery in either group. The T-RARP group was significantly related to a higher mean operative time (p = 0.001) and shorter median hospital stay length (p < 0.001). There were not significant differences in the median estimated blood loss and specimen Gleason score between the two arms. The proportions of transfusion, pT3a disease, postoperative complication, and positive surgical margin in the T-RARP group were also comparable to that in the S-RARP group. The mean prostate-specific antigen and median erectile functional scores did not differ significantly between the two groups at postoperative 3 months and last follow-up. T-RARP vs. S-RARP had significantly improved urinary continence (UC) rates at the removal of catheter (p < 0.001) and postoperative 3 months (p < 0.001), but the significant difference between the two groups in UC recovery disappeared at last follow-up (p = 0.119). No significant difference in biochemical recurrence-free survival was observed following the two surgeries (p = 0.727). Conclusions T-RARP by experienced hands was feasible for selected patients with clinically localized PCa, yielding significantly improved early return to UC and similar erectile functional preservation without compromising oncological control when compared with the standard approach.
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Affiliation(s)
- Wen Deng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China.,Jiangxi Institute of Urology, Nanchang City, China
| | - Hao Jiang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China.,Jiangxi Institute of Urology, Nanchang City, China
| | - Xiaoqiang Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China
| | - Luyao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China
| | - Weipeng Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China.,Jiangxi Institute of Urology, Nanchang City, China
| | - Cheng Zhang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China
| | - Xiaochen Zhou
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China.,Jiangxi Institute of Urology, Nanchang City, China
| | - Gongxian Wang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China.,Jiangxi Institute of Urology, Nanchang City, China
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1425
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Hutten RJ, Parsons MW, Weil CR, Tward JD, Lloyd S, Sanchez A, Lester-Coll N, Johnson SB. Temporal Trends and Predictors in Diagnosing Pathologic Node-Positive Prostate Cancer in Clinically Node-Negative Patients. Clin Genitourin Cancer 2021; 19:e360-e366. [PMID: 34130915 DOI: 10.1016/j.clgc.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/14/2021] [Accepted: 05/03/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Managing pathologically node positive (pN+) prostate cancer (PCa) is controversial. We describe temporal patterns and predictors of pN+ PCa in men with initially surgically managed clinically node negative (cN-) PCa. MATERIALS AND METHODS This observational retrospective analysis of nonmetastatic, cN- PCa uses the National Cancer Database. Multivariable logistic regression was used to identify covariates associated with pN+ disease. Cox proportional hazards modeling and Kaplan-Meier analysis were used to evaluate survival patients undergoing radical prostatectomy with or without pelvic lymph node dissection (PLND). RESULTS The rates of radical prostatectomy in men with grade group (GG) 4 and GG5 increased from 47.6% to 53.1% and from 42.5% to 49.5%, respectively. The annual rate increased from 2.02% in 2010 to 5.12% in 2017 (P < .001). The annual rates of PLND increased from 54.3% to 71.7%. The most significant predictor of pN+ PCa was ISUP GG4 (odds ratio [OR] 12.5, P< .001) and GG 5 (OR 26.2, P < .001). Rates of pN+ identification increased from 5.5% to 9.4% in men with GG4 and from 13.4% to 19.5% in men with GG5 (P< .001). In GG4 and GG5, patients undergoing PLND had superior survival to those managed without PLND (P < .01). CONCLUSION Among patients with cN- PCa, the diagnosis of pN+ PCa has become more common over time. GG4 and GG5 are the strongest independent predictors of pN+ disease. Because incidental pN+ results in upstaging these data are useful for informing discussions before radical prostatectomy.
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Affiliation(s)
- Ryan J Hutten
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, Utah
| | - Matthew W Parsons
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, Utah
| | - Christopher R Weil
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, Utah
| | - Jonathan D Tward
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, Utah
| | - Shane Lloyd
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, Utah
| | - Alejandro Sanchez
- Division of Urology, Department of Surgery, Huntsman Cancer Hospital, University of Utah, Salt Lake City, Utah
| | - Nataniel Lester-Coll
- Division of Radiation Oncology, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Skyler B Johnson
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, Utah.
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1426
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Wenzel M, Preisser F, Wittler C, Hoeh B, Wild PJ, Tschäbunin A, Bodelle B, Würnschimmel C, Tilki D, Graefen M, Becker A, Karakiewicz PI, Chun FKH, Kluth LA, Köllermann J, Mandel P. Correlation of MRI-Lesion Targeted Biopsy vs. Systematic Biopsy Gleason Score with Final Pathological Gleason Score after Radical Prostatectomy. Diagnostics (Basel) 2021; 11:diagnostics11050882. [PMID: 34063557 PMCID: PMC8155831 DOI: 10.3390/diagnostics11050882] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 02/07/2023] Open
Abstract
Background: The impact of MRI-lesion targeted (TB) and systematic biopsy (SB) Gleason score (GS) as a predictor for final pathological GS still remains unclear. Methods: All patients with TB + SB, and subsequent radical prostatectomy (RP) between 01/2014-12/2020 were analyzed. Rank correlation coefficient predicted concordance with pathological GS for patients’ TB and SB GS, as well as for the combined effect of SB + TB. Results: Of 159 eligible patients, 77% were biopsy naïve. For SB taken in addition to TB, a Spearman’s correlation of +0.33 was observed regarding final GS. Rates of concordance, upgrading, and downgrading were 37.1, 37.1 and 25.8%, respectively. For TB, a +0.52 correlation was computed regarding final GS. Rates of concordance, upgrading and downgrading for TB biopsy GS were 45.9, 33.3, and 20.8%, respectively. For the combination of SB + TB, a correlation of +0.59 was observed. Rates of concordance, upgrading and downgrading were 49.7, 15.1 and 35.2%, respectively. The combined effect of SB + TB resulted in a lower upgrading rate, relative to TB and SB (both p < 0.001), but a higher downgrading rate, relative to TB (p < 0.01). Conclusions: GS obtained from TB provided higher concordance and lower upgrading and downgrading rates, relative to SB GS with regard to final pathology. The combined effect of SB + TB led to the highest concordance rate and the lowest upgrading rate.
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Affiliation(s)
- Mike Wenzel
- Department of Urology, University Hospital Frankfurt, University Frankfurt, 60590 Frankfurt, Germany; (F.P.); (C.W.); (B.H.); (A.B.); (F.K.H.C.); (L.A.K.); (P.M.)
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC H2X 3E4, Canada; (C.W.); (P.I.K.)
- Correspondence: ; Tel.: + 49-69-6301-83147; Fax: + 49-69-6301-80069
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, University Frankfurt, 60590 Frankfurt, Germany; (F.P.); (C.W.); (B.H.); (A.B.); (F.K.H.C.); (L.A.K.); (P.M.)
| | - Clarissa Wittler
- Department of Urology, University Hospital Frankfurt, University Frankfurt, 60590 Frankfurt, Germany; (F.P.); (C.W.); (B.H.); (A.B.); (F.K.H.C.); (L.A.K.); (P.M.)
| | - Benedikt Hoeh
- Department of Urology, University Hospital Frankfurt, University Frankfurt, 60590 Frankfurt, Germany; (F.P.); (C.W.); (B.H.); (A.B.); (F.K.H.C.); (L.A.K.); (P.M.)
| | - Peter J. Wild
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (P.J.W.); (A.T.); (J.K.)
- Frankfurt Institute for Advanced Studies (FIAS), 60590 Frankfurt, Germany
- Wildlab, University Hospital Frankfurt MVZ GmbH, 60590 Frankfurt, Germany
| | - Alexandra Tschäbunin
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (P.J.W.); (A.T.); (J.K.)
| | - Boris Bodelle
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany;
| | - Christoph Würnschimmel
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC H2X 3E4, Canada; (C.W.); (P.I.K.)
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany; (D.T.); (M.G.)
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany; (D.T.); (M.G.)
- Department of Urology, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany; (D.T.); (M.G.)
| | - Andreas Becker
- Department of Urology, University Hospital Frankfurt, University Frankfurt, 60590 Frankfurt, Germany; (F.P.); (C.W.); (B.H.); (A.B.); (F.K.H.C.); (L.A.K.); (P.M.)
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC H2X 3E4, Canada; (C.W.); (P.I.K.)
| | - Felix K. H. Chun
- Department of Urology, University Hospital Frankfurt, University Frankfurt, 60590 Frankfurt, Germany; (F.P.); (C.W.); (B.H.); (A.B.); (F.K.H.C.); (L.A.K.); (P.M.)
| | - Luis A Kluth
- Department of Urology, University Hospital Frankfurt, University Frankfurt, 60590 Frankfurt, Germany; (F.P.); (C.W.); (B.H.); (A.B.); (F.K.H.C.); (L.A.K.); (P.M.)
| | - Jens Köllermann
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (P.J.W.); (A.T.); (J.K.)
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, University Frankfurt, 60590 Frankfurt, Germany; (F.P.); (C.W.); (B.H.); (A.B.); (F.K.H.C.); (L.A.K.); (P.M.)
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1427
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Rosar F, Krause J, Bartholomä M, Maus S, Stemler T, Hierlmeier I, Linxweiler J, Ezziddin S, Khreish F. Efficacy and Safety of [ 225Ac]Ac-PSMA-617 Augmented [ 177Lu]Lu-PSMA-617 Radioligand Therapy in Patients with Highly Advanced mCRPC with Poor Prognosis. Pharmaceutics 2021; 13:pharmaceutics13050722. [PMID: 34069003 PMCID: PMC8156464 DOI: 10.3390/pharmaceutics13050722] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/26/2021] [Accepted: 05/07/2021] [Indexed: 01/07/2023] Open
Abstract
The use of 225Ac in prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT), either as monotherapy or in combination with 177Lu, is a promising therapy approach in patients with metastatic castration-resistant prostate carcinoma (mCRPC). In this study, we report the efficacy and safety of [225Ac]Ac-PSMA-617 augmented [177Lu]Lu-PSMA-617 RLT in 177Lu-naive mCRPC patients (n = 15) with poor prognosis (presence of visceral metastases, high total tumor burden with diffuse bone metastases or a short PSA doubling time of <2 months). Biochemical (by PSA serum value) and molecular imaging response (by [68Ga]Ga-PSMA-11 PET/CT) was assessed after two cycles of [177Lu]Lu-PSMA-617 RLT, with at least one [225Ac]Ac-PSMA-617 augmentation. In addition, PSA-based progression-free survival (PSA-PFS), overall survival (OS) and toxicity (according to CTCAE) were analyzed. We observed a biochemical- and molecular imaging-based partial remission in 53.3% (8/15) and 66.7% (10/15) of patients, respectively. The median PSA-PFS and OS was 9.1 and 14.8 months, respectively. No serious acute adverse events were recorded. Two out of fifteen patients experienced grade 3 anemia. No other grade 3/4 toxicities were observed. RLT-related xerostomia (grade 1/2) was recorded in 2/15 patients. Our data showed a high clinical efficacy with a favorable side effects profile of [225Ac]Ac-PSMA-617 augmented [177Lu]Lu-PSMA-617 RLT in this highly challenging patient cohort.
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Affiliation(s)
- Florian Rosar
- Department of Nuclear Medicine, Saarland University, 66421 Homburg, Germany; (F.R.); (J.K.); (M.B.); (S.M.); (T.S.); (I.H.); (S.E.)
| | - Jonas Krause
- Department of Nuclear Medicine, Saarland University, 66421 Homburg, Germany; (F.R.); (J.K.); (M.B.); (S.M.); (T.S.); (I.H.); (S.E.)
| | - Mark Bartholomä
- Department of Nuclear Medicine, Saarland University, 66421 Homburg, Germany; (F.R.); (J.K.); (M.B.); (S.M.); (T.S.); (I.H.); (S.E.)
| | - Stephan Maus
- Department of Nuclear Medicine, Saarland University, 66421 Homburg, Germany; (F.R.); (J.K.); (M.B.); (S.M.); (T.S.); (I.H.); (S.E.)
| | - Tobias Stemler
- Department of Nuclear Medicine, Saarland University, 66421 Homburg, Germany; (F.R.); (J.K.); (M.B.); (S.M.); (T.S.); (I.H.); (S.E.)
| | - Ina Hierlmeier
- Department of Nuclear Medicine, Saarland University, 66421 Homburg, Germany; (F.R.); (J.K.); (M.B.); (S.M.); (T.S.); (I.H.); (S.E.)
| | | | - Samer Ezziddin
- Department of Nuclear Medicine, Saarland University, 66421 Homburg, Germany; (F.R.); (J.K.); (M.B.); (S.M.); (T.S.); (I.H.); (S.E.)
| | - Fadi Khreish
- Department of Nuclear Medicine, Saarland University, 66421 Homburg, Germany; (F.R.); (J.K.); (M.B.); (S.M.); (T.S.); (I.H.); (S.E.)
- Correspondence: ; Tel.: +49-6841622201
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1428
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Doldi V, El Bezawy R, Zaffaroni N. MicroRNAs as Epigenetic Determinants of Treatment Response and Potential Therapeutic Targets in Prostate Cancer. Cancers (Basel) 2021; 13:2380. [PMID: 34069147 PMCID: PMC8156532 DOI: 10.3390/cancers13102380] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/07/2021] [Accepted: 05/13/2021] [Indexed: 12/15/2022] Open
Abstract
Prostate cancer (PCa) is the second most common tumor in men worldwide, and the fifth leading cause of male cancer-related deaths in western countries. PC is a very heterogeneous disease, meaning that optimal clinical management of individual patients is challenging. Depending on disease grade and stage, patients can be followed in active surveillance protocols or undergo surgery, radiotherapy, hormonal therapy, and chemotherapy. Although therapeutic advancements exist in both radiatiotherapy and chemotherapy, in a considerable proportion of patients, the treatment remains unsuccessful, mainly due to tumor poor responsiveness and/or recurrence and metastasis. microRNAs (miRNAs), small noncoding RNAs that epigenetically regulate gene expression, are essential actors in multiple tumor-related processes, including apoptosis, cell growth and proliferation, autophagy, epithelial-to-mesenchymal transition, invasion, and metastasis. Given that these processes are deeply involved in cell response to anti-cancer treatments, miRNAs have been considered as key determinants of tumor treatment response. In this review, we provide an overview on main PCa-related miRNAs and describe the biological mechanisms by which specific miRNAs concur to determine PCa response to radiation and drug therapy. Additionally, we illustrate whether miRNAs can be considered novel therapeutic targets or tools on the basis of the consequences of their expression modulation in PCa experimental models.
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Affiliation(s)
| | | | - Nadia Zaffaroni
- Molecular Pharmacology Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (V.D.); (R.E.B.)
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1429
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Moyad MA. Adult preventive vaccines with other synergistic lifestyle options: is it time to add these ancillary benefits to the overall AS management checklist? World J Urol 2021; 40:43-49. [PMID: 33963444 PMCID: PMC8104041 DOI: 10.1007/s00345-021-03709-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/19/2021] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To review the potential ancillary cardiovascular and other health impacts of compliance with general adult vaccination series in the prostate cancer active surveillance (AS) population. No previous review has been published in regard to this specific topic. METHODS Literature review of PubMed data up to December 2020 RESULTS: Compliance rates for adult vaccination are in the approximate anemic range of 25-50% with occasional higher rates of specific vaccines in the elderly population including annual influenza and pneumococcal prevention. Herpes zoster (HZ) and numerous other vaccine preventive illnesses are associated with an increased risk of cardiovascular events. Preliminary evidence suggests vaccine compliance could reduce overall morbidity and mortality, and adherence to heart healthy lifestyle changes and parameters could further improve vaccine efficacy and overall wellness. COVID-19 vaccine utilization and research should also continue to reinforce the direct and ancillary benefits of this entire preventive intervention category. CONCLUSIONS Multiple ancillary lifestyle change recommendations could be included in the AS criteria to potentially reduce morbidity and mortality in this population, and perhaps the most unsung intervention is to improve the inadequate rates of general adult vaccination compliance and other heart healthy behavioral changes that impact their efficacy. Heart health, prostate health, and immune system health are closely interlinked.
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Affiliation(s)
- Mark A Moyad
- Department of Urology, University of Michigan Medical Center, Ann Arbor, MI, 48109-5330, USA.
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1430
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Wessels F, Schmitt M, Krieghoff-Henning E, Jutzi T, Worst TS, Waldbillig F, Neuberger M, Maron RC, Steeg M, Gaiser T, Hekler A, Utikal JS, von Kalle C, Fröhling S, Michel MS, Nuhn P, Brinker TJ. Deep learning approach to predict lymph node metastasis directly from primary tumour histology in prostate cancer. BJU Int 2021; 128:352-360. [PMID: 33706408 DOI: 10.1111/bju.15386] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To develop a new digital biomarker based on the analysis of primary tumour tissue by a convolutional neural network (CNN) to predict lymph node metastasis (LNM) in a cohort matched for already established risk factors. PATIENTS AND METHODS Haematoxylin and eosin (H&E) stained primary tumour slides from 218 patients (102 N+; 116 N0), matched for Gleason score, tumour size, venous invasion, perineural invasion and age, who underwent radical prostatectomy were selected to train a CNN and evaluate its ability to predict LN status. RESULTS With 10 models trained with the same data, a mean area under the receiver operating characteristic curve (AUROC) of 0.68 (95% confidence interval [CI] 0.678-0.682) and a mean balanced accuracy of 61.37% (95% CI 60.05-62.69%) was achieved. The mean sensitivity and specificity was 53.09% (95% CI 49.77-56.41%) and 69.65% (95% CI 68.21-71.1%), respectively. These results were confirmed via cross-validation. The probability score for LNM prediction was significantly higher on image sections from N+ samples (mean [SD] N+ probability score 0.58 [0.17] vs 0.47 [0.15] N0 probability score, P = 0.002). In multivariable analysis, the probability score of the CNN (odds ratio [OR] 1.04 per percentage probability, 95% CI 1.02-1.08; P = 0.04) and lymphovascular invasion (OR 11.73, 95% CI 3.96-35.7; P < 0.001) proved to be independent predictors for LNM. CONCLUSION In our present study, CNN-based image analyses showed promising results as a potential novel low-cost method to extract relevant prognostic information directly from H&E histology to predict the LN status of patients with prostate cancer. Our ubiquitously available technique might contribute to an improved LN status prediction.
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Affiliation(s)
- Frederik Wessels
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Urology and Urological Surgery, Medical Faculty Mannheim of Heidelberg University, University Medical Center Mannheim, Mannheim, Germany
| | - Max Schmitt
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eva Krieghoff-Henning
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tanja Jutzi
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas S Worst
- Department of Urology and Urological Surgery, Medical Faculty Mannheim of Heidelberg University, University Medical Center Mannheim, Mannheim, Germany
| | - Frank Waldbillig
- Department of Urology and Urological Surgery, Medical Faculty Mannheim of Heidelberg University, University Medical Center Mannheim, Mannheim, Germany
| | - Manuel Neuberger
- Department of Urology and Urological Surgery, Medical Faculty Mannheim of Heidelberg University, University Medical Center Mannheim, Mannheim, Germany
| | - Roman C Maron
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Matthias Steeg
- Institute of Pathology, Medical Faculty Mannheim of Heidelberg University, University Medical Center Mannheim, Mannheim, Germany
| | - Timo Gaiser
- Institute of Pathology, Medical Faculty Mannheim of Heidelberg University, University Medical Center Mannheim, Mannheim, Germany
| | - Achim Hekler
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jochen S Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Christof von Kalle
- Department of Clinical-Translational Sciences, Berlin Institute of Health (BIH), Charité University Medicine, Berlin, Germany
| | - Stefan Fröhling
- National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Maurice S Michel
- Department of Urology and Urological Surgery, Medical Faculty Mannheim of Heidelberg University, University Medical Center Mannheim, Mannheim, Germany
| | - Philipp Nuhn
- Department of Urology and Urological Surgery, Medical Faculty Mannheim of Heidelberg University, University Medical Center Mannheim, Mannheim, Germany
| | - Titus J Brinker
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
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1431
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Gao Z, Pang B, Li J, Gao N, Fan T, Li Y. Emerging Role of Exosomes in Liquid Biopsy for Monitoring Prostate Cancer Invasion and Metastasis. Front Cell Dev Biol 2021; 9:679527. [PMID: 34017837 PMCID: PMC8129505 DOI: 10.3389/fcell.2021.679527] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/06/2021] [Indexed: 12/12/2022] Open
Abstract
Prostate cancer (PCa) is the most common solid tumor in men. While patients with local PCa have better prognostic survival, patients with metastatic PCa have relatively high mortality rates. Existing diagnostic methods for PCa rely on tissue biopsy and blood prostate-specific antigen (PSA) detection; however, the PSA test does not detect aggressive PCa. Liquid biopsy is a promising technique to overcome tumor heterogeneity in diagnosis, provide more comprehensive information, and track tumor progression over time, allowing for the development of treatment options at all stages of PCa. Exosomes containing proteins and nucleic acids are potential sources of tumor biomarkers. Accumulating evidence indicates that exosomes play important roles in cell communication and tumor progression and are suitable for monitoring PCa progression and metastasis. In this review, we summarize recent advances in the use of exosomal proteins and miRNAs as biomarkers for monitoring PCa invasion and metastasis and discuss their feasibility in clinical diagnosis.
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Affiliation(s)
- Zhengfan Gao
- Department of Pharmacology, School of Basic Medicine, Zhengzhou University, Zhengzhou, China
| | - Bairen Pang
- Faculty of Medicine, St George and Sutherland Clinical School, St George Hospital, UNSW Sydney, Kensington, NSW, Australia
| | - Jing Li
- Department of Pharmacology, School of Basic Medicine, Zhengzhou University, Zhengzhou, China
| | - Na Gao
- Department of Pharmacology, School of Basic Medicine, Zhengzhou University, Zhengzhou, China
| | - Tianli Fan
- Department of Pharmacology, School of Basic Medicine, Zhengzhou University, Zhengzhou, China
| | - Yong Li
- Department of Pharmacology, School of Basic Medicine, Zhengzhou University, Zhengzhou, China.,Faculty of Medicine, St George and Sutherland Clinical School, St George Hospital, UNSW Sydney, Kensington, NSW, Australia
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1432
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Puterman C, Bjöersdorff M, Amidi J, Anand A, Soller W, Jiborn T, Kjölhede H, Trägårdh E, Bjartell A. A retrospective study assessing the accuracy of [18F]-fluorocholine PET/CT for primary staging of lymph node metastases in intermediate and high-risk prostate cancer patients undergoing robotic-assisted laparoscopic prostatectomy with extended lymph node dissection. Scand J Urol 2021; 55:293-297. [PMID: 33939583 DOI: 10.1080/21681805.2021.1914720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Previous studies have investigated [18F]-fluorocholine (FCH) positron emission tomography with computed tomography (PET/CT) in primary staging of men with intermediate or high-risk prostate cancer and have generally shown high specificity and poor sensitivity. FCH PET/CT is not recommended for the primary staging of metastases in the European guidelines for prostate cancer. However, it has been an option in the Swedish recommendations. Our aim was to assess PET/CT for primary staging of lymph node metastases before robotic-assisted laparoscopic prostatectomy (RALP) with extended pelvic lymph node dissection (ePLND) in patients with intermediate or high-risk prostate cancer. METHOD We identified all men with prostate cancer undergoing FCH PET/CT for initial staging followed by RALP and ePLND at Skåne University Hospital between 2015 and 2018. The result from PET/CT scan was compared with pathology report as the reference method for calculation of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS In total, 252 patients were included in the final analysis. Among 85 patients with a suspicion of regional lymph node metastases on FCH PET/CT only 31 had pathology-proven metastases. The sensitivity was 43% (95% CI 0.32-0.55) and the specificity 70% (95% CI 0.63-0.76) for PET/CT to predict lymph node metastases. PPV was 36% and NPV was 75%. Risk group analyses showed similar results. CONCLUSION Our study emphasizes the poor performance of FCH PET/CT to predict lymph node metastasis in intermediate and high-risk prostate cancer. The method should be replaced with newer radiopharmaceuticals, such as prostate-specific membrane antigen ligands.
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Affiliation(s)
| | - Mimmi Bjöersdorff
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Malmö, Sweden.,Wallenberg Centre for Molecular Medicine, Lund University, Malmö, Sweden
| | - Jennifer Amidi
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Aseem Anand
- Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Wolfgang Soller
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Thomas Jiborn
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Henrik Kjölhede
- Department of Urology, Sahlgrenska University Hospital, Region Västra Götaland, Göteborg, Sweden.,Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Elin Trägårdh
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Malmö, Sweden.,Wallenberg Centre for Molecular Medicine, Lund University, Malmö, Sweden
| | - Anders Bjartell
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
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1433
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Shi X, Fan J, Pei X, Wang Y, Guo G, Yang T, Wang X, He D, Li L. Inflammatory factor-based prognostic risk stratification for patients with metastatic castration-resistant prostate cancer treated with docetaxel. Andrologia 2021; 53:e14064. [PMID: 33900646 DOI: 10.1111/and.14064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/12/2021] [Accepted: 03/17/2021] [Indexed: 11/26/2022] Open
Abstract
To develop a simple inflammatory factor-based prognostic risk stratification system for patients with metastatic castration-resistant prostate cancer (mCRPC) receiving docetaxel as the initial treatment, we reviewed the data of 399 consecutive patients who received first-line docetaxel chemotherapy between January 2013 and June 2019 retrospectively. The optimal cut-off values for the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in terms of survival were calculated by ROC curves. Patients were stratified into favourable (lower NLR and lower PLR), intermediate (higher NLR and lower PLR, or lower NLR and higher PLR) and poor (higher NLR and higher PLR) groups. Kaplan-Meier curves were drawn to evaluate overall survival (OS) and progression-free survival (PFS). The ROC curve analysis determined the cut-offs for the NLR and PLR to be 2.355 and 104.275 respectively. Multivariate Cox regression analysis showed that being in the poor patient group (NLR ≥2.355 and PLR ≥104.275) was an independent prognostic risk factor and Kaplan-Meier curves analysis revealed that respondents with NLR <2.355 and PLR <104.275 had significantly longer OS and PFS. So it can be concluded that concurrently high NLR and PLR values are predictors for poor chemotherapy outcomes after androgen deprivation therapy failure in patients with mCRPC.
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Affiliation(s)
- Xinyu Shi
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Junjie Fan
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Urology, Baoji Center Hospital, Baoji, China
| | - Xinqi Pei
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuzhao Wang
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Guodong Guo
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Tao Yang
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xinyang Wang
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Dalin He
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lei Li
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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1434
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SelectMDx and Multiparametric Magnetic Resonance Imaging of the Prostate for Men Undergoing Primary Prostate Biopsy: A Prospective Assessment in a Multi-Institutional Study. Cancers (Basel) 2021; 13:cancers13092047. [PMID: 33922626 PMCID: PMC8122883 DOI: 10.3390/cancers13092047] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/15/2021] [Accepted: 04/20/2021] [Indexed: 01/04/2023] Open
Abstract
Prostate-specific antigen (PSA) testing as the sole indication for prostate biopsy lacks specificity, resulting in overdiagnosis of indolent prostate cancer (PCa) and missing clinically significant PCa (csPCa). SelectMDx is a biomarker-based risk score to assess urinary HOXC6 and DLX1 mRNA expression combined with traditional clinical risk factors. The aim of this prospective multi-institutional study was to evaluate the diagnostic accuracy of SelectMDx and its association with multiparametric magnetic resonance (mpMRI) when predicting PCa in prostate biopsies. Overall, 310 consecutive subjects were included. All patients underwent mpMRI and SelectMDx prior to prostate biopsy. SelectMDx and mpMRI showed sensitivity and specificity of 86.5% vs. 51.9%, and 73.8% vs. 88.3%, respectively, in predicting PCa at biopsy, and 87.1% vs. 61.3%, and 63.7% vs. 83.9%, respectively, in predicting csPCa at biopsy. SelectMDx was revealed to be a good predictor of PCa, while with regards to csPCa detection, it was demonstrated to be less effective, showing results similar to mpMRI. With analysis of strategies assessed to define the best diagnostic strategy to avoid unnecessary biopsy, SelectMDx appeared to be a reliable pathway after an initial negative mpMRI. Thus, biopsy could be proposed for all cases of mpMRI PI-RADS 4-5 score, and to those with Prostate Imaging-Reporting and Data System (PI-RADS) 1-3 score followed by a positive SelectMDx.
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1435
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Schoentgen N, Califano G, Manfredi C, Romero-Otero J, Chun FKH, Ouzaid I, Hermieu JF, Xylinas E, Verze P. Is it Worth Starting Sexual Rehabilitation Before Radical Prostatectomy? Results From a Systematic Review of the Literature. Front Surg 2021; 8:648345. [PMID: 33968975 PMCID: PMC8098976 DOI: 10.3389/fsurg.2021.648345] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Sexual dysfunction (SD) is a frequent side effect associated with radical prostatectomy (RP) for prostate cancer (PCa). Some studies have showed the benefit associated with preoperative sexual rehabilitation (prehabilitation) and Enhanced Recovery After Surgery (ERAS) for RP, but no clear clinical recommendations are available yet. Our aim was to conduct a systematic review on sexual prehabilitation prior to RP for patients with a localized PCa and analyze the impact on postoperative sexual health compared with the standard post-operative care. Methods: We performed a systematic review of the literature following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) recommendations. Results: Four randomized control trials and one retrospective comparative study were included in the analyses. Three of the five studies showed an improved EF recovery post-RP in the prehabilitation group compared to the standard of care represented by: higher International Index of Erectile Function 5 score (IIEF5) or IIEF score (p < 0.0001) and a higher percentage of patients reporting return of EF based on the Sexual Encounter Profile (SEP) (56 vs. 24%, p = 0.007). Self-confidence, therapeutic alliance, and adherence to treatment were stronger for patients with preoperative consultations (p < 0.05) and EF recovery was better in cases of a higher number of follow-up visits (OR 4-5 visits vs. 1:12.19, p = 0.002). Discussion: Despite heterogenous methods and high risks of bias in this systematic review, starting sexual rehabilitation prior to surgery seems to ensure better EF recovery. This prehabilitation should include information of both the patient and his or her partner, with a closer follow up and the use of a multimodal treatment approach that still remains to be defined and validated (oral medication, vacuum devices, pelvic floor muscle training, etc.).
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Affiliation(s)
- Nadja Schoentgen
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France
| | - Gianluigi Califano
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France.,Department of Neurosciences, Reproductive Sciences, Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Celeste Manfredi
- Department of Neurosciences, Reproductive Sciences, Odontostomatology, University of Naples Federico II, Naples, Italy.,Department of Urology, Instituto de Investigation Sanitaria Hospital 12 de October (imas12), Hospital Universitario 12 October, Madrid, Spain
| | - Javier Romero-Otero
- Department of Urology, Instituto de Investigation Sanitaria Hospital 12 de October (imas12), Hospital Universitario 12 October, Madrid, Spain
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Idir Ouzaid
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France.,University of Paris, Paris, France
| | - Jean-François Hermieu
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France.,University of Paris, Paris, France
| | - Evanguelos Xylinas
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France.,University of Paris, Paris, France
| | - Paolo Verze
- Department of Medicine, Surgery, Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
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1436
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Saito K, Matsuoka Y, Toda K, Yoshida S, Yokoyama M, Yoshimura R, Kihara K, Fujii Y. Medium-term oncological and functional outcomes of hemi-gland brachytherapy using iodine-125 seeds for intermediate-risk unilateral prostate cancer. Brachytherapy 2021; 20:842-848. [PMID: 33883093 DOI: 10.1016/j.brachy.2021.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/24/2021] [Accepted: 03/07/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE To examine medium-term outcomes of hemi-gland low-dose-rate brachytherapy as a primary treatment for intermediate-risk prostate cancer. METHODS We recruited intermediate-risk unilateral prostate cancer patients for a prospective trial of hemi-gland brachytherapy. Twenty-four patients underwent hemi-gland iodine-125 seed implantation with a prescribed dose of 160 Gy. Serum prostate-specific antigen (PSA) was measured regularly and follow-up biopsy was scheduled after 2-3 years of treatment. When clinically needed afterward, for-cause biopsy was performed to confirm pathology. Treatment failure (TF)-free survival, which was defined as freedom from radical or systemic therapy, metastases, and cancer-specific mortality, was assessed, as was biochemical failure (BF)-free survival. Urinary and sexual functions were also evaluated. RESULTS Median follow-up duration was 61 months. Twenty-two patients (92%) exhibited a declining trend or decreased value of PSA for 12 months or longer after the treatment. Follow-up biopsy in the initial triennium and for-cause biopsy in the subsequent triennium were performed in 16 and four patients, respectively, and cancer was found from the treated lobe in one patient (4% of the cohort) and significant cancer was found from untreated lobes in four patients (17%) in total. Secondary treatments were performed in six patients successfully. Five-year freedom from BF, TF, and metastasis was 71%, 90%, and 100%, respectively. The International Prostate Symptom Score significantly deteriorated at 3 months and reversed itself afterward. The International Index of Erectile Function 5 had no significant decrease. CONCLUSIONS Hemi-gland low-dose-rate brachytherapy provides favorable medium-term oncological outcomes with genito-urinary functional preservation for men with intermediate-risk unilateral prostate cancer.
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Affiliation(s)
- Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
| | - Kazuma Toda
- Department of Radiology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Ryoichi Yoshimura
- Department of Radiology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Kazunori Kihara
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
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1437
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Céspedes MS, Radtke JP, Cathelineau X, Sanchez-Salas R. Prostate specific membrane antigen (PSMA) and Prostate Cancer Staging: is our current conventional staging obsolete? Int Braz J Urol 2021; 47:1243-1249. [PMID: 33861056 PMCID: PMC8486444 DOI: 10.1590/s1677-5538.ibju.2020.0997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/07/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
| | - Jan Philipp Radtke
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.,Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Xavier Cathelineau
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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1438
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Deng W, Zhang C, Jiang H, Li Y, Zhu K, Liu X, Chen L, Liu W, Guo J, Zhou X, Fu B, Wang G. Transvesical Versus Posterior Approach to Retzius-Sparing Robot-Assisted Radical Prostatectomy: A Retrospective Comparison With a 12-Month Follow-Up. Front Oncol 2021; 11:641887. [PMID: 33937043 PMCID: PMC8082308 DOI: 10.3389/fonc.2021.641887] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/24/2021] [Indexed: 12/16/2022] Open
Abstract
Objectives To assess the perioperative, functional, and oncological outcomes of transvesical robot-assisted radical prostatectomy (T-RARP) and posterior robot-assisted radical prostatectomy (P-RARP) for localized prostate cancer. Materials and Methods We analyzed the data of 96 patients who underwent T-RARP or P-RARP for localized prostate cancer between January 2017 and June 2019 in a retrospective fashion. Results No significant differences in the baseline characteristics existed between the T-RARP and P-RARP arms. Both interventions were successfully performed without open conversion in either group. T-RARP was associated with a slightly more operative time (135.3 vs. 127.3 min) and estimated blood loss (105.2 vs. 94.2 mL) than P-RARP, but the differences were not significant (both p > 0.05). The likelihood of transfusion, ≤Grade II, and >Grade II postoperative complications, pT3a disease and positive surgical margins in the T-RARP group was comparable with that in the P-RARP group. No significant differences were noted between these two arms in terms of UC at the removal of catheter and nocturia (p = 0.750 and p = 0.684, respectively), and all included patients recovered UC at 3 months postoperatively. The median International Index of Erectile Function-5 score in both groups remains comparable before and after RARP. The patients in the T-RARP and P-RARP groups had a similar biochemical recurrence-free survival (p = 0.387). Conclusions Both T-RARP and P-RARP by experienced hands are feasible for well-selected patients with prostate cancer, obtaining similar outcomes in terms of perioperative results, UC and erectile function, and oncological control within short-term follow-up.
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Affiliation(s)
- Wen Deng
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Cheng Zhang
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hao Jiang
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Yulei Li
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Ke Zhu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Xiaoqiang Liu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Luyao Chen
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Weipeng Liu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Ju Guo
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaochen Zhou
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bin Fu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Gongxian Wang
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
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1439
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MR-Guided Hypofractionated Radiotherapy: Current Emerging Data and Promising Perspectives for Localized Prostate Cancer. Cancers (Basel) 2021; 13:cancers13081791. [PMID: 33918650 PMCID: PMC8070332 DOI: 10.3390/cancers13081791] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary The biological features of prostate cancer as a tumor with a low alpha beta ratio have led clinicians to consider the use of higher doses per fraction, thus gaining an advantage both in terms of clinical outcomes and of logistic opportunities. To date, moderate hypofractionated schedules are supported by several international clinical guidelines. The subsequent step was represented by the adoption of extreme hypofractionated schedules, for which recent literature data report non-inferiority results for the five-fractions regimens. In this scenario, the recent introduction of MR-guided daily adaptive radiotherapy is a potential paradigm shift, given the ability to increase the resolution of the pelvis anatomy and to take into account of the daily variations in shape and size of the nearby healthy structures. Abstract In this review we summarize the currently available evidence about the role of hybrid machines for MR-guided radiotherapy for prostate stereotactic body radiotherapy. Given the novelty of this technology, to date few data are accessible, but they all report very promising results in terms of tolerability and preliminary clinical outcomes. Most of the studies highlight the favorable impact of on-board magnetic resonance imaging as a means to improve target and organs at risk identification with a consequent advantage in terms of dosimetric results, which is expected to relate to a more favorable toxicity pattern. Still, the longer treatment time per session may potentially affect the patient’s compliance to the treatment, although first quality of life assessment studies have reported substantial tolerability and no major impact on quality of life. Finally, in this review we hypothesize some future scenarios of further investigation, based on the possibility to explore the superior anatomy visualization and the role of daily adapted treatments provided by hybrid MR-Linacs.
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1440
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Zanoni L, Mei R, Bianchi L, Giunchi F, Maltoni L, Pultrone CV, Nanni C, Bossert I, Matti A, Schiavina R, Fiorentino M, Fonti C, Lodi F, D’Errico A, Brunocilla E, Fanti S. The Role of [ 18F]Fluciclovine PET/CT in the Characterization of High-Risk Primary Prostate Cancer: Comparison with [ 11C]Choline PET/CT and Histopathological Analysis. Cancers (Basel) 2021; 13:cancers13071575. [PMID: 33805543 PMCID: PMC8037300 DOI: 10.3390/cancers13071575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 12/23/2022] Open
Abstract
Simple Summary The role of [18F]Fluciclovine Positron Emission Tomography/Computed Tomography (PET/CT) in the characterization of intra-prostatic lesions was evaluated in high-risk primary PCa patients, scheduled for radical surgery, comparing investigational [18F]Fluciclovine and conventional [11C]Choline PET/CT results with the reference standard of pathologic surgical specimen. PET visual and semi-quantitative analyses were performed: for instance, patient-based, blinded to histopathology; subsequently lesion-based, unblinded, according to a pathology reference mapping. Among 19 pts, 45 malignant and 31 benign lesions were found. The highest SUVmax matched with the lobe of the index lesion in 89% of pts and a direct correlation between [18F]Fluciclovine uptake values and pISUP was demonstrated. Overall, the lesion-based performance of PET semiquantitative parameters (SUVmax, Target to background Ratio-TBRs) with either [18F]Fluciclovine or [11C]Choline, in detecting either malignant/ISUP2-5/ISUP4-5 PCa lesions, was moderate and similar (AUCs ≥ 0.70), but still inadequate (AUCs ≤ 0.81) as standalone staging procedure. TBRs (especially with threshold higher than bone marrow) may be complementary to implement malignancy targeting. Abstract The primary aim of the study was to evaluate the role of [18F]Fluciclovine PET/CT in the characterization of intra-prostatic lesions in high-risk primary PCa patients eligible for radical prostatectomy, in comparison with conventional [11C]Choline PET/CT and validated by prostatectomy pathologic examination. Secondary aims were to determine the performance of PET semi-quantitative parameters (SUVmax; target-to-background ratios [TBRs], using abdominal aorta, bone marrow and liver as backgrounds) for malignant lesion detection (and best cut-off values) and to search predictive factors of malignancy. A six sextants prostate template was created and used by PET readers and pathologists for data comparison and validation. PET visual and semi-quantitative analyses were performed: for instance, patient-based, blinded to histopathology; subsequently lesion-based, un-blinded, according to the pathology reference template. Among 19 patients included (mean age 63 years, 89% high and 11% very-high-risk, mean PSA 9.15 ng/mL), 45 malignant and 31 benign lesions were found and 19 healthy areas were selected (n = 95). For both tracers, the location of the “blinded” prostate SUVmax matched with the lobe of the lesion with the highest pGS in 17/19 cases (89%). There was direct correlation between [18F]Fluciclovine uptake values and pISUP. Overall, lesion-based (n = 95), the performance of PET semiquantitative parameters, with either [18F]Fluciclovine or [11C]Choline, in detecting either malignant/ISUP2-5/ISUP4-5 PCa lesions, was moderate and similar (AUCs ≥ 0.70) but still inadequate (AUCs ≤ 0.81) as a standalone staging procedure. A [18F]Fluciclovine TBR-L3 ≥ 1.5 would depict a clinical significant lesion with a sensitivity and specificity of 85% and 68% respectively; whereas a SUVmax cut-off value of 4 would be able to identify a ISUP 4-5 lesion in all cases (sensitivity 100%), although with low specificity (52%). TBRs (especially with threshold significantly higher than aorta and slightly higher than bone marrow), may be complementary to implement malignancy targeting.
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Affiliation(s)
- Lucia Zanoni
- Nuclear Medicine Unit, Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.N.); (F.L.); (S.F.)
- Correspondence: ; Tel.: +39-051-214-3959
| | - Riccardo Mei
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (R.M.); (M.F.)
| | - Lorenzo Bianchi
- Division of Urology, Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.B.); (C.V.P.); (R.S.); (E.B.)
- Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy;
| | - Francesca Giunchi
- Pathology, Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.G.); (A.D.)
| | - Lorenzo Maltoni
- Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy;
| | - Cristian Vincenzo Pultrone
- Division of Urology, Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.B.); (C.V.P.); (R.S.); (E.B.)
| | - Cristina Nanni
- Nuclear Medicine Unit, Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.N.); (F.L.); (S.F.)
| | - Irene Bossert
- Nuclear Medicine, Istituti Clinici Scientifici Maugeri, 27100 Pavia, Italy;
| | - Antonella Matti
- Nuclear Medicine, Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Ospedale Sacro Cuore-Don Calabria, 37024 Negrar di Valpolicella (VR), Italy;
| | - Riccardo Schiavina
- Division of Urology, Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.B.); (C.V.P.); (R.S.); (E.B.)
- Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy;
| | - Michelangelo Fiorentino
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (R.M.); (M.F.)
| | - Cristina Fonti
- Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy;
| | - Filippo Lodi
- Nuclear Medicine Unit, Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.N.); (F.L.); (S.F.)
| | - Antonietta D’Errico
- Pathology, Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.G.); (A.D.)
| | - Eugenio Brunocilla
- Division of Urology, Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.B.); (C.V.P.); (R.S.); (E.B.)
- Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy;
| | - Stefano Fanti
- Nuclear Medicine Unit, Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.N.); (F.L.); (S.F.)
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (R.M.); (M.F.)
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1441
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Degeling K, Pereira-Salgado A, Corcoran NM, Boutros PC, Kuhn P, IJzerman MJ. Health Economic Evidence for Liquid- and Tissue-based Molecular Tests that Inform Decisions on Prostate Biopsies and Treatment of Localised Prostate Cancer: A Systematic Review. EUR UROL SUPPL 2021; 27:77-87. [PMID: 34337517 PMCID: PMC8317795 DOI: 10.1016/j.euros.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2021] [Indexed: 11/16/2022] Open
Abstract
Context Several liquid- and tissue-based biomarker tests (LTBTs) are available to inform the need for prostate biopsies and treatment of localised prostate cancer (PCa) through risk stratification, but translation into routine practice requires evidence of their clinical utility and economic impact. Objective To review and summarise the health economic evidence on the ability of LTBTs to inform decisions on prostate biopsies and treatment of localised PCa through risk stratification. Evidence acquisition A systematic search was performed in the EMBASE, MEDLINE, Health Technology Assessment, and National Health Service Health Economic Evaluation databases. Eligible publications were those presenting health economic evaluations of an LTBT to select individuals for biopsy or risk-stratify PCa patients for treatment. Data on the study objectives, context, methodology, clinical utility, and outcomes were extracted and summarised. Evidence synthesis Of the 22 studies included, 14 were focused on test-informed biopsies and eight on treatment selection. Most studies performed cost-effectiveness analyses (n = 7), followed by costing (n = 4) or budget impact analyses (n = 3). Most (18 of 22) studies concluded that biomarker tests could decrease health care costs or would be cost-effective. However, downstream consequences and long-term outcomes were typically not included in studies that evaluated LTBT to inform biopsies. Long-term effectiveness was modelled by linking evidence from different sources instead of using data from prospective studies. Conclusions Although studies concluded that LTBTs would probably be cost-saving or -effective, the strength of this evidence is disputable because of concerns around the validity and transparency of the assumptions made. This warrants prospective interventional trials to inform health economic analyses to ensure collection of direct evidence of clinical outcomes based on LTBT use. Patient summary We reviewed studies that evaluated whether blood, urine, and tissue tests can reduce the health and economic burden of prostate cancer. Results indicate that these tests could be cost-effective, but clinical studies of long-term outcomes are needed to confirm the findings.
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Affiliation(s)
- Koen Degeling
- Cancer Health Services Research, Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.,Cancer Health Services Research, Centre for Health Policy, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Amanda Pereira-Salgado
- Cancer Health Services Research, Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.,Cancer Health Services Research, Centre for Health Policy, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Niall M Corcoran
- Department of Urology, Frankston Hospital, Frankston, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Australia.,Division of Urology, Royal Melbourne Hospital, Melbourne, Australia
| | - Paul C Boutros
- Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California, Los Angeles, CA, USA.,Institute for Precision Health, University of California, Los Angeles, Los Angeles, CA, USA.,Jonsson Comprehensive Cancer Centre, University of California, Los Angeles, Los Angeles, CA, USA.,Departments of Human Genetics and Urology, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Peter Kuhn
- USC Michelson Center for Convergent Biosciences, University of Southern California, Los Angeles, CA, USA.,Department of Biological Sciences, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Maarten J IJzerman
- Cancer Health Services Research, Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.,Cancer Health Services Research, Centre for Health Policy, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.,Department of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia.,Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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1442
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Awenat S, Piccardo A, Carvoeiras P, Signore G, Giovanella L, Prior JO, Treglia G. Diagnostic Role of 18F-PSMA-1007 PET/CT in Prostate Cancer Staging: A Systematic Review. Diagnostics (Basel) 2021; 11:diagnostics11030552. [PMID: 33808825 PMCID: PMC8003688 DOI: 10.3390/diagnostics11030552] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 12/23/2022] Open
Abstract
Background: The use of prostate-specific membrane antigen (PSMA)-targeted agents for staging prostate cancer (PCa) patients using positron emission tomography/computed tomography (PET/CT) is increasing worldwide. We performed a systematic review on the role of 18F-PSMA-1007 PET/CT in PCa staging to provide evidence-based data in this setting. Methods: A comprehensive computer literature search of PubMed/MEDLINE and Cochrane Library databases for studies using 18F-PSMA-1007 PET/CT in PCa staging was performed until 31 December 2020. Eligible articles were selected and relevant information was extracted from the original articles by two authors independently. Results: Eight articles (369 patients) evaluating the role of 18F-PSMA-1007 PET/CT in PCa staging were selected. These studies were quite heterogeneous, but, overall, they demonstrated a good diagnostic accuracy of 18F-PSMA-1007 PET/CT in detecting PCa lesions at staging. Overall, higher primary PCa aggressiveness was associated with higher 18F-PSMA-1007 uptake. When compared with other radiological and scintigraphic imaging methods, 18F-PSMA-1007 PET/CT had superior sensitivity in detecting metastatic disease and the highest inter-reader agreement. 18F-PSMA-1007 PET/CT showed similar results in terms of diagnostic accuracy for PCa staging compared with PET/CT with other PSMA-targeted tracers. Dual imaging with multi-parametric magnetic resonance imaging and 18F-PSMA-1007 PET/CT may improve staging of primary PCa. Notably, 18F-PSMA-1007-PET/CT may detect metastatic disease in a significant number of patients with negative standard imaging. Conclusions: 18F-PSMA-1007 PET/CT demonstrated a good accuracy in PCa staging, with similar results compared with other PSMA-targeted radiopharmaceuticals. This method could substitute bone scintigraphy and conventional abdominal imaging for PCa staging. Prospective multicentric studies are needed to confirm these findings.
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Affiliation(s)
- Salam Awenat
- Institute for Radiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum, 44892 Bochum, Germany;
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, E.O. Ospedali Galliera, 16128 Genoa, Italy;
| | | | - Giovanni Signore
- Department of Medicine, Università degli studi della Campania “L. Vanvitelli”, 81100 Caserta, Italy;
| | - Luca Giovanella
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
- Department of Nuclear Medicine, University Hospital Zürich and University of Zürich, 8091 Zürich, Switzerland
| | - John O. Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, 1011 Lausanne, Switzerland;
- Faculty of Biology and Medicine, University of Lausanne, 1011 Lausanne, Switzerland
| | - Giorgio Treglia
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, 1011 Lausanne, Switzerland;
- Faculty of Biology and Medicine, University of Lausanne, 1011 Lausanne, Switzerland
- Academic Education, Research and Innovation Area, General Directorate, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera italiana, 6900 Lugano, Switzerland
- Correspondence: ; Tel.: +0041-918118919
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1443
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Wenzel M, Würnschimmel C, Nocera L, Collà Ruvolo C, Tian Z, Shariat SF, Saad F, Briganti A, Graefen M, Becker A, Kluth LA, Mandel P, Chun FKH, Karakiewicz PI. Salvage Radical Prostatectomy: Baseline Prostate Cancer Characteristics and Survival Across SEER Registries. Clin Genitourin Cancer 2021; 19:e255-e263. [PMID: 33849813 DOI: 10.1016/j.clgc.2021.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/09/2021] [Accepted: 03/13/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To test for baseline prostate cancer characteristics and survival differences after salvage radical prostatectomy (SRP) across 18 Surveillance, Epidemiology and End Results (SEER) registries from 2004 to 2016. METHODS We tabulated prostate-specific antigen (PSA), cT stage, age, and SRP rates across individual SEER registries. Kaplan-Meier and competing risks regression methodologies depicted cancer-specific mortality and other cause mortality. Finally, overall mortality was compared with predicted life expectancy. RESULTS Overall, 428 SRP patients (2004-2016) were identified in the SEER database. Median follow-up duration was 74 months (interquartile range [IQR], 31-114). The median age at diagnosis was 68 years (IQR, 61-73 years) with a median PSA at diagnosis of 8.8 ng/mL (IQR, 5.4-18.6 ng/mL) and 10% cT3-4 stage (0%-23.8%). Variability existed across individual SEER registries regarding age, PSA, cT stage, and annual number of SRPs (0-17), as well as cumulative numbers of SRPs (7-73) between 2004 and 2016. At 10 years, cancer-specific mortality was 23.2% vs. other cause mortality 19.3%. Finally, SRP patients exhibited higher 10-year overall mortality (43.3%) than predicted by life tables (31.8%). CONCLUSION SRP is rarely performed. In most SEER registries, SRP use is very occasional. More than 2 average annual SRPs were reported in only 5 of all registries. Nonetheless, across all registries, SRP patients showed marginal to moderate differences in PSA, cT stage, and age at diagnosis. However, at 10 years of follow-up, 1 of 5 SRP patients died of other causes and observed overall mortality was higher than expected (36%).
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Affiliation(s)
- Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
| | - Christoph Würnschimmel
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Luigi Nocera
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Claudia Collà Ruvolo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Departments of Urology, Weill Cornell Medical College, New York, NY; Department of Urology, University of Texas Southwestern, Dallas, Tx; Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Becker
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Luis A Kluth
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
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1444
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[Familial prostate cancer and genetic predisposition]. Urologe A 2021; 60:567-575. [PMID: 33721089 DOI: 10.1007/s00120-021-01491-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Twenty percent of all prostate cancer patients have a positive family history (at least 1 first-degree relative with prostate cancer) and a part of these patients have a genetic predisposition. OBJECTIVES A literature search and analysis of studies investigating incidence, diagnosis, and clinical course of familial compared to sporadic prostate cancer as well as genetic predisposition was performed using PubMed and Embase. RESULTS Risk of prostate cancer depends on number, degree of relationship, and age of onset of affected men in the family. The incidence of familial prostate cancer is higher and the age of diagnosis lower compared to sporadic cases. The clinical course of the disease is comparable, but in individuals with a germline mutation, more intensive therapy is needed due to a more aggressive disease. CONCLUSIONS Crucial for risk assessment is a detailed family history, including creation of a pedigree with cancer family history if necessary. In high-risk families, genetic counselling and annual prostate-specific antigen (PSA) screening beginning at the age of 40 should be performed. Verification of a germline mutation requires more intensive therapy due to more aggressive disease.
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1445
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Farolfi A, Calderoni L, Mattana F, Mei R, Telo S, Fanti S, Castellucci P. Current and Emerging Clinical Applications of PSMA PET Diagnostic Imaging for Prostate Cancer. J Nucl Med 2021; 62:596-604. [PMID: 33712536 DOI: 10.2967/jnumed.120.257238] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/01/2021] [Indexed: 12/20/2022] Open
Abstract
Prostate-specific membrane antigen (PSMA) is highly expressed on most prostate cancer (PCa) cells, and several PSMA ligands for PET imaging are now available worldwide. 68Ga-PSMA-11 has already received U.S. Food and Drug Administration and European Medicines Agency approval, and use of PSMA PET is currently suggested by several international guidelines for investigating PCa in different clinical settings. In primary PCa, PSMA PET has been shown to be superior to cross-sectional imaging for the detection of pelvic lymph nodes and distant metastases with subsequent clinical management changes. Additionally, it might also have a role in intraprostatic tumor localization, especially when combined with multiparametric MRI. In a setting of PCa recurrence, higher detection rates have been observed than for any other available imaging techniques, especially at low prostate-specific antigen values. Furthermore, PSMA PET consistently led to a shift in clinical management, thus increasing the proportion of radiotherapy, surgery, or other focal therapies at the expense of systemic options or no treatment. In oligometastatic disease after radical surgery, PSMA PET may be relevant in guiding a metastasis-directed therapy approach, as preliminary data seem to suggest a benefit in terms of progression-free survival after treatment of PSMA PET-positive lesions. As a staging and gatekeeping technique, PSMA PET represents a reliable whole-body imaging procedure in combination with second-line therapy of castration-resistant PCa, as well as being pivotal when assessing patients eligible for radioligand therapy such as 177Lu-PSMA. This critical review aims at providing a comprehensive overview of the latest literature on the current or emerging main indications, as well as a general outlook on the recommended interpretation criteria for PSMA PET imaging.
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Affiliation(s)
- Andrea Farolfi
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero, University of Bologna, Bologna, Italy
| | - Letizia Calderoni
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero, University of Bologna, Bologna, Italy
| | - Francesco Mattana
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero, University of Bologna, Bologna, Italy
| | - Riccardo Mei
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero, University of Bologna, Bologna, Italy
| | - Sivi Telo
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero, University of Bologna, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero, University of Bologna, Bologna, Italy
| | - Paolo Castellucci
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero, University of Bologna, Bologna, Italy
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1446
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Woo HH, Teh A. Clinically significant localised prostate cancer: deciding what will provide the best clinical outcomes. Med J Aust 2021; 214:264-265. [PMID: 33751574 DOI: 10.5694/mja2.50983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Henry H Woo
- Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, NSW.,Chris O'Brien Lifehouse, Sydney, NSW
| | - Amy Teh
- Icon Cancer Centre, Sydney, NSW
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1447
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Borkowetz A. [Localised prostate cancer: radical prostatectomy or deferred treatment strategy]. Urologe A 2021; 60:504-508. [PMID: 33666668 DOI: 10.1007/s00120-021-01482-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Angelika Borkowetz
- Klinik und Poliklinik für Urologie, Universitätsklinikum Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland. .,UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Deutschland.
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1448
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Evaluation of Fast Molecular Detection of Lymph Node Metastases in Prostate Cancer Patients Using One-Step Nucleic Acid Amplification (OSNA). Cancers (Basel) 2021; 13:cancers13051117. [PMID: 33807774 PMCID: PMC7961354 DOI: 10.3390/cancers13051117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/20/2021] [Accepted: 03/01/2021] [Indexed: 12/18/2022] Open
Abstract
Simple Summary Prostate cancer (PCa) is the second most common cancer and one of the highestcauses of cancer deaths among men. The presence of lymph node metastases (LNM) is the strongest prognostic factor. Histological detection of LNM is the gold standard for LN staging. In clinical practice, only fractions of LNs are examined histopathologically, resulting in missed (micro-)metastases. Biomolecular techniques can enhance the identification of LNM but are not routinely used because of high cost. One-step nucleic acid amplification (OSNA) analyzes the entire LN by detecting cytokeratin 19 mRNA as a surrogate for LNM requiring less effort and allowing intraoperative application. To verify the reliability of OSNA for the first time in PCa, we examined LNs of patients undergoing prostatectomy and sentinel lymphadenectomy. Results were compared with histopathological and immunohistochemistry findings. OSNA identified LNM equivalent to, or in cases of micrometastases, even better than enhanced histopathology, and might be useful in intraoperative decision-making in personalized LN surgery. Abstract Background: In clinical routine, only fractions of lymph nodes (LNs) are examined histopathologically, often resulting in missed (micro-)metastases and incorrect staging of prostate cancer (PCa). One-step nucleic acid amplification (OSNA) analyzes the entire LN by detecting cytokeratin 19 (CK19) mRNA as a surrogate for LN metastases requiring less effort than conventional biomolecular techniques. We aimed to evaluate performance of OSNA in detecting sentinel LN (SLN) metastases in PCa. Methods: SLNs (n = 534) of 64 intermediate- or high-risk PCa patients undergoing radical prostatectomy with extended and sentinel-guided lymphadenectomy were cut into slices and alternatingly assigned to OSNA and histopathology (hematoxylin-eosin staining, CK19, and CK AE1/AE3 immunohistochemistry). Sensitivity and specificity of OSNA and concordance and measure of agreement (Cohen’s kappa (κ)) between OSNA and histopathology were assessed. Results: Histopathology revealed metastases in 76 SLNs. Sensitivity and specificity of OSNA were 84.2% and 96.1%, respectively. Discordant results were recorded for 30 of 534 SLNs, revealing high concordance (94.4%). Twenty-four discordant cases were classified as micrometastases, indicating a possible allocation bias. In 18 cases, positive results were conferred only by OSNA resulting in seven LN-positive patients who were missed by histopathology. Overall, the level of agreement was high (κ = 0.78). Conclusions: OSNA provided a diagnosis that was as least as accurate as detailed histological examination and might improve LN staging in PCa.
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1449
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Are Multiparametric Magnetic Resonance Imaging and Guided Biopsies Needed in Men with Normal Digital Rectal Examination and Prostatic-specific Antigen >20 ng/ml? Eur Urol Oncol 2021; 4:334-335. [PMID: 33663960 DOI: 10.1016/j.euo.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/12/2021] [Indexed: 11/21/2022]
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1450
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Head-to-Head Comparison of Two Nomograms Predicting Probability of Lymph Node Invasion in Prostate Cancer and the Therapeutic Impact of Higher Nomogram Threshold. J Clin Med 2021; 10:jcm10050999. [PMID: 33801231 PMCID: PMC7957888 DOI: 10.3390/jcm10050999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction: The aim of the study was to compare the performance of the 2012 Briganti and Memorial Sloan Kettering Cancer Center (MSKCC) nomograms as a predictor for pelvic lymph node invasion (LNI) in men who underwent radical prostatectomy (RP) with pelvic lymph node dissection (PLND), to examine their performance and to analyse the therapeutic impact of using 7% nomogram cut-off. Materials and Methods: The study cohort consisted of 807 men with clinically localised prostate cancer (PCa) who underwent open RP with PLND between 2001 and 2019. The area under the curve (AUC) of the receiver operator characteristic analysis was used to quantify the accuracy of the 2012 Briganti and MSKCC nomograms to predict LNI. Calibration plots were used to visualise over or underestimation by the models and a decision curve analysis (DCA) was performed to evaluate the net benefit associated with the used nomograms. Results: A total of 97 of 807 patients had LNI (12%). The AUC of 2012 Briganti and MSKCC nomogram was 80.6 and 79.2, respectively. For the Briganti nomogram using the cut-off value of 7% would lead to reduce PLND in 47% (379/807), while missing 3.96% (15/379) cases with LNI. For the MSKCC nomogram using the cut-off value of 7% a PLND would be omitted in 44.5% (359/807), while missing 3.62% (13/359) of cases with LNI. Conclusions: Both analysed nomograms demonstrated high accuracy for prediction of LNI. Using a 7% nomogram cut-off would allow the avoidance up to 47% of PLNDs, while missing less than 4% of patients with LNI.
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