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Desmond C, Kaul S, Fleishman A, Korets R, Chang P, Wagner A, Kim SP, Aghdam N, Olumi AF, Gershman B. The association of patient and disease characteristics with the overtreatment of low-risk prostate cancer from 2010 to 2016. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00822-2. [PMID: 38555410 DOI: 10.1038/s41391-024-00822-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 03/05/2024] [Accepted: 03/18/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Although active surveillance is the preferred management for low-risk prostate cancer (PCa), some men remain at risk of overtreatment with definitive local therapy. We hypothesized that baseline characteristics may be associated with overtreatment and represent a potential source of health disparities. We therefore examined the associations of patient and disease characteristics with the surgical overtreatment of low-risk PCa. METHODS We identified men aged 45-75 years with cT1 cN0 cM0 prostate adenocarcinoma with biopsy Gleason score 6 and PSA < 10 ng/ml from 2010-2016 in the National Cancer Database (NCDB) and who underwent radical prostatectomy (RP). We evaluated the associations of baseline characteristics with clinically insignificant PCa (iPCa) at RP (i.e., "overtreatment"), defined as organ-confined (i.e., pT2) Gleason 3 + 3 disease, using multivariable logistic regression. RESULTS We identified 36,088 men with low-risk PCa who underwent RP. The unadjusted rate of iPCa decreased during the study period, from 54.7% in 2010 to 40.0% in 2016. In multivariable analyses adjusting for baseline characteristics, older age (OR 0.98, 95% CI 0.97-0.98), later year of diagnosis (OR 0.62, 95% CI 0.57-0.67 for 2016 vs. 2010), Black race (OR 0.85, 95% CI 0.79-0.91), treatment at an academic/research program (OR 0.82, 95% CI 0.73-0.91), higher PSA (OR 0.91, 95% CI 0.90-0.92), and higher number of positive biopsy cores (OR 0.87, 95% CI 0.86-0.88) were independently associated with a lower risk of overtreatment (iPCa) at RP. Conversely, a greater number of biopsy cores sampled (OR 1.01, 95% CI 1.01-1.02) was independently associated with an increased risk of overtreatment (iPCa) at RP. CONCLUSIONS We observed an ~27% reduction in rates of overtreatment of men with low-risk PCa over the study period. Several patient, disease, and structural characteristics are associated with detection of iPCa at RP and can inform the management of men with low-risk PCa to reduce potential overtreatment.
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Affiliation(s)
| | - Sumedh Kaul
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Aaron Fleishman
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ruslan Korets
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Peter Chang
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Andrew Wagner
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Simon P Kim
- Division of Urology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Nima Aghdam
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Aria F Olumi
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Boris Gershman
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Wang S, Ji Y, Ma J, Du P, Cao Y, Yang X, Yu Z, Yang Y. Role of inflammatory factors in prediction of Gleason score and its upgrading in localized prostate cancer patients after radical prostatectomy. Front Oncol 2023; 12:1079622. [PMID: 36713540 PMCID: PMC9878388 DOI: 10.3389/fonc.2022.1079622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/22/2022] [Indexed: 01/15/2023] Open
Abstract
Purpose To investigate the role of inflammatory factors including systemic immune-inflammation index (SII) and neutrophil to lymphocyte ratio (NLR) in predicting Gleason Score (GS) and Gleason Score upgrading (GSU) in localized prostate cancer (PCa) after radical prostatectomy (RP). Methods The data of 297 patients who underwent prostate biopsy and RP in our center from January 2014 to March 2020 were retrospectively analyzed. Preoperative clinical characteristics including age, values of tPSA, total prostate volume (TPV), f/t PSA ratio, body mass index (BMI), biopsy GS and inflammatory factors including SII, NLR, lymphocyte to monocyte (LMR), neutrophil ratio (NR), platelet to lymphocyte ratio (PLR), lymphocyte ratio (LR), mean platelet volume (MPV) and red cell distribution (RDW) as well as pathological T (pT) stage were collected and compared according to the grades of RP GS (GS ≤ 6 and GS≥7), respectively. ROC curve analysis was used to confirm the discriminative ability of inflammatory factors including SII, NLR and their combination with tPSA for predicting GS and GSU. By using univariate and multivariate logistic regression analysis, the association between significant inflammatory markers and grades of GS were evaluated. Results Patients enrolled were divided into low (GS ≤ 6) and high (GS≥7) groups by the grades of GS. The median values of clinical factors were 66.08 ± 6.04 years for age, 36.62 ± 23.15 mL for TPV, 26.16 ± 33.59 ng/mL for tPSA and 0.15 ± 0.25 for f/t PSA ratio, 22.34 ± 3.14 kg/m2 for BMI, 15 (5.1%) were pT1, 116 (39.1%) were pT2 and 166 (55.9%) were pT3. According to the student's t test, patients in high GS group had a greater proportion of patients with pT3 (P<0.001), and higher NLR (P=0.04), SII (P=0.037) and tPSA (P=0.015) compared with low GS group, the distribution of age, TPV, f/t PSA ratio, BMI, LMR, NR, PLR, LR, MPV and RDW did not show any significantly statistical differences. The AUC for SII, NLR and tPSA was 0.732 (P=0.007), 0.649 (P=0.045) and 0.711 (P=0.015), with threshold values of 51l.08, 2.3 and 10.31ng/mL, respectively. According to the multivariable logistic regression models, NLR ≥ 2.3 (OR, 2.463; 95% CI, 0.679-10.469, P=0.042), SII ≥ 511.08 (OR, 3.519; 95% CI 0.891-12.488; P=0.003) and tPSA ≥ 10.31 ng/mL (OR, 4.146; 95% CI, 1.12-15.35; P=0.033) were all independent risk factors associated with higher GS. The AUC for combination of SII, NLR with tPSA was 0.758 (P=0.003) and 0.756 (P=0.003), respectively. GSU was observed in a total of 48 patients with GS ≤ 6 (55.17%). Then patients were divided into 2 groups (high and low) according to the threshold value of SII, NLR, tPSA, SII+tPSA and NLR+tPSA, respectively, when the GSU rates were compared with regard to these factors, GSU rate in high level group was significantly higher than that in low level group, P=0.001, 0.044, 0.017, <0.001 and <0.001, respectively. Conclusion High SII, NLR and tPSA were associated with higher GS and higher GSU rate. SII was likely to be a more favorable biomarker for it had the largest AUC area compared with tPSA and NLR; the combination of SII or NLR with tPSA had greater values for predicting GS and GSU compared with NLR, SII or tPSA alone, since the AUC area of combination was much higher. SII, NLR were all useful inflammatory biomarkers for predicting GS and detecting GSU among localized PCa patients with biopsy GS ≤ 6.
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Treatment patterns and rates of upgrading and upstaging in prostate cancer patients with single GGG1 positive biopsy core. Urol Oncol 2022; 40:407.e9-407.e19. [DOI: 10.1016/j.urolonc.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/29/2022] [Accepted: 06/02/2022] [Indexed: 11/23/2022]
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Xu J, Goodman M, Janisse J, Cher ML, Bock CH. Five-year follow-up study of a population-based prospective cohort of men with low-risk prostate cancer: the treatment options in prostate cancer study (TOPCS): study protocol. BMJ Open 2022; 12:e056675. [PMID: 35190441 PMCID: PMC8860062 DOI: 10.1136/bmjopen-2021-056675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Active surveillance (AS) is recommended for men with low-risk prostate cancer (LRPC) to reduce overtreatment and to maintain patients' quality of life (QOL). However, whether African American (AA) men can safely undergo AS is controversial due to concerns of more aggressive disease and lack of empirical data on the safety and effectiveness of AS in this population. Withholding of AS may lead to a lost opportunity for improving survivorship in AA men. In this study, peer-reviewed and funded by the US Department of Defense, we will assess whether AS is an equally effective and safe management option for AA as it is for White men with LRPC. METHODS AND ANALYSIS The project extends follow-up of a large contemporary population-based cohort of LRPC patients (n=1688) with a high proportion of AA men (~20%) and well-characterised baseline and 2-year follow-up data. The objectives are to (1) determine any racial differences in AS adherence, switch rate from AS to curative treatment and time to treatment over 5 years after diagnosis, (2) compare QOL among AS group and curative treatment group over time, overall and by race and (3) evaluate whether reasons for switching from AS to curative treatment differ by race. Validation of survey responses related to AS follow-up procedures is being conducted through medical record review. We expect to obtain 5-year survey from ~900 (~20% AA) men by the end of this study to have sufficient power. Descriptive and inferential statistical techniques will be used to examine racial differences in AS adherence, effectiveness and QOL. ETHICS AND DISSEMINATION The parent and current studies were approved by the Institutional Review Boards at Wayne State University and Emory University. Since it is an observational study, ethical or safety risks are low. We will disseminate our findings to relevant conferences and peer-reviewed journals.
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Affiliation(s)
- Jinping Xu
- Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Michael Goodman
- Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - James Janisse
- Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Michael L Cher
- Urology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Deka R, Parsons JK, Simpson DR, Riviere P, Nalawade V, Vitzthum LK, Kader AK, Kane CJ, Rock CS, Murphy JD, Rose BS. African-American men with low-risk prostate cancer treated with radical prostatectomy in an equal-access health care system: implications for active surveillance. Prostate Cancer Prostatic Dis 2020; 23:581-588. [PMID: 32327702 DOI: 10.1038/s41391-020-0230-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/24/2020] [Accepted: 03/31/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND There is concern that African-American men (AA) with low-risk prostate cancer may present with more aggressive disease and thus may not be candidates for active surveillance (AS). However, it is uncertain if poorer outcomes are due to disparities in access to medical care rather than true biological differences. METHODS Observational cohort study of patients diagnosed with low-risk PC-Gleason score ≤6, clinical tumor stage ≤2A, and prostate specific antigen (PSA) level ≤10-at US Department of Veterans Affairs between January 1, 2001 and October 31, 2015 and treated with radical prostatectomy. Outcomes included upgrading to Gleason Grade Group 2 (GG2), GG ≥ 3, PSA recurrence, pathologic tumor stage ≥3, positive surgical margins, and all-cause mortality. RESULTS A total of 2857 men (AA: 835 White: 2022) with a median follow-up of 7.1 years. Overall, there was no significant difference between AA and White men in upgrading to GG ≥ 3 (RR = 1.18, p = 0.43), tumor stage ≥3 (RR = 0.95, p = 0.74), positive surgical margins (RR = 1.14, p = 0.20), PSA recurrence (SHR = 1.26, p = 0.06), and all-cause mortality (SHR = 1.26, p = 0.16). However, there was a significant increase in upgrading for AA to GG2 (RR = 1.49, p < 0.01). CONCLUSIONS There was no significant difference in most adverse pathologic outcomes between AA and White patients. However, GG2 upgrading was more common in AA men. The implication is that AA may need to undergo additional evaluation, such as a biopsy MRI, before initiating AS. Whether the increase in GG2 upgrading will lead to poorer long-term clinical outcomes such as metastasis and PCSM also requires further investigation.
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Affiliation(s)
- Rishi Deka
- VA San Diego Health Care System, La Jolla, CA, USA.
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, CA, USA.
| | - J Kellogg Parsons
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Daniel R Simpson
- VA San Diego Health Care System, La Jolla, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Paul Riviere
- VA San Diego Health Care System, La Jolla, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Vinit Nalawade
- VA San Diego Health Care System, La Jolla, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Lucas K Vitzthum
- VA San Diego Health Care System, La Jolla, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - A Karim Kader
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Christopher J Kane
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Chelsea S Rock
- VA San Diego Health Care System, La Jolla, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - James D Murphy
- VA San Diego Health Care System, La Jolla, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Brent S Rose
- VA San Diego Health Care System, La Jolla, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, CA, USA
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
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Slezak JM, Van Den Eeden SK, Cannavale KL, Chien GW, Jacobsen SJ, Chao CR. Long-term follow-up of a racially and ethnically diverse population of men with localized prostate cancer who did not undergo initial active treatment. Cancer Med 2020; 9:8530-8539. [PMID: 32965775 PMCID: PMC7666755 DOI: 10.1002/cam4.3471] [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: 05/04/2020] [Revised: 06/23/2020] [Accepted: 08/23/2020] [Indexed: 11/28/2022] Open
Abstract
Background There is limited research on the racial/ethnic differences in long‐term outcomes for men with untreated, localized prostate cancer. Methods Men diagnosed with localized, Gleason ≤7 prostate cancer who were not treated within 1 year of diagnosis from 1997–2007 were identified. Cumulative incidence rates of the following events were calculated; treatment initiation, metastasis, death due to prostate cancer and all‐cause mortality, accounting for competing risks. The Cox model of all‐cause mortality and Fine‐Gray sub distribution model to account for competing risks were used to test for racial/ethnic differences in outcomes adjusted for clinical factors. Results There were 3925 men in the study, 749 Hispanic, 2415 non‐Hispanic white, 559 non‐Hispanic African American, and 202 non‐Hispanic Asian/Pacific Islander (API). Median follow‐up was 9.3 years. At 19 years, overall cumulative incidence of treatment, metastasis, death due to prostate cancer, and all‐cause mortality was 25.0%, 14.7%, 11.7%, and 67.8%, respectively. In adjusted models compared to non‐Hispanic whites, African Americans had higher rates of treatment (HR = 1.39, 95% CI = 1.15–1.68); they had an increased risk of metastasis beyond 10 years after diagnosis (HR = 4.70, 95% CI = 2.30–9.61); API and Hispanic had lower rates of all‐cause mortality (HR = 0.66, 95% CI = 0.52–0.84, and HR = 0.72, 95% CI = 0.62–0.85, respectively), and API had lower rates of prostate cancer mortality in the first 10 years after diagnosis (HR = 0.29, 95% CI = 0.09–0.90) and elevated risks beyond 10 years (HR = 5.41, 95% CI = 1.39–21.11). Conclusions Significant risks of metastasis and prostate cancer mortality exist in untreated men beyond 10 years after diagnosis, but are not equally distributed among racial/ethnic groups.
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Affiliation(s)
- Jeff M Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | - Kimberly L Cannavale
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Gary W Chien
- Department of Urology, Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles, CA, USA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Chun R Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
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7
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Bedolla RG, Shah DP, Huang SB, Reddick RL, Ghosh R, Kumar AP. Receptor tyrosine kinase recepteur d'origine nantais as predictive marker for aggressive prostate cancer in African Americans. Mol Carcinog 2019; 58:854-861. [PMID: 30859654 DOI: 10.1002/mc.23002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/14/2019] [Accepted: 02/21/2019] [Indexed: 12/11/2022]
Abstract
Published evidence shows a correlation between several molecular markers and prostate cancer (PCa) progression including in African Americans (AAs) who are disproportionately affected. Our early detection efforts led to the identification of elevated levels of antiapoptotic protein, c-FLIP and its upstream regulatory factors such as androgen receptor (AR), recepteur d'origine nantais (RON), a receptor tyrosine kinase in human prostate tumors. The primary objective of this study was to explore whether these markers play a role in racial disparities using immunohistochemistry in prostatectomy samples from a cohort of AA, Hispanic Whites (HWs), and non-Hispanic Whites (NHWs). Bivariable and multivariable logistic regression analyses were used to identify a statistical association between molecular markers, possible correlation with risk factors including race, obesity, prostate-specific antigen (PSA) and disease aggressiveness. Further, changes in the levels and expression of these molecular markers were also evaluated using human PCa cell lines. We found significantly elevated levels of RON ( P = 0.0082), AR ( P = 0.0001), c-FLIP ( P = 0.0071) in AAs compared with HWs or NHWs. Furthermore, a higher proportion of HW and NHWs had a high Gleason score (>6) but not PSA as compared to AAs ( P = 0.032). In summary, our findings suggest that PSA was important in predicting aggressive disease for the cohort overall; however, high levels of RON may play a role in predisposing AA men to develop aggressive disease. Future research is needed using large datasets to confirm these findings and to explore whether all or any of these markers could aid in race-specific stratification of patients for treatment.
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Affiliation(s)
- Roble G Bedolla
- Departments of Urology, The University of Texas Health, San Antonio, Texas
| | - Dimpy P Shah
- Departments of Epidemiology and Biostatistics, The University of Texas Health, San Antonio, Texas.,Departments of Molecular Medicine, The University of Texas Health, San Antonio, Texas.,Mays Cancer Center, The University of Texas Health, San Antonio, Texas
| | - Shih-Bo Huang
- Departments of Urology, The University of Texas Health, San Antonio, Texas
| | - Robert L Reddick
- Departments of Pathology, The University of Texas Health, San Antonio, Texas
| | - Rita Ghosh
- Departments of Urology, The University of Texas Health, San Antonio, Texas.,Departments of Molecular Medicine, The University of Texas Health, San Antonio, Texas.,Mays Cancer Center, The University of Texas Health, San Antonio, Texas.,Departments of Pharmacology, The University of Texas Health, San Antonio, Texas
| | - Addanki P Kumar
- Departments of Urology, The University of Texas Health, San Antonio, Texas.,Mays Cancer Center, The University of Texas Health, San Antonio, Texas.,Departments of Pathology, The University of Texas Health, San Antonio, Texas.,Departments of Pharmacology, The University of Texas Health, San Antonio, Texas.,Research Division, South Texas Veterans Health Care System, The University of Texas Health, San Antonio, Texas
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Kamel MH, Bimali M, Khalil MI, Eltahawy E, Su LJ, Bissada NK, Davis R. Regional trends in average years of potential life lost (AYPLL) secondary to prostate cancer deaths among Caucasians and African Americans treated by surgery or radiation. Int Urol Nephrol 2019; 51:561-569. [PMID: 30840195 DOI: 10.1007/s11255-019-02116-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/23/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE To study regional trends in average years of potential life lost (AYPLL) among Caucasians (CA) and African Americans (AA) with prostate cancer (Pca) who received radical prostatectomy or radiation therapy among four different regions in the US as well as across different tumor grades. Years of potential life lost is defined as the difference between a predetermined end-point age and the age at death for a death that occurred prior to that end age, hence the AYPLL is calculated by dividing the total YPLL by the total number of patients died. METHODS The surveillance epidemiology and end results (SEER) database was used to identify Pca patients who were CA or AA and who have received radical prostatectomy or radiation therapy. Study duration was divided into four decades; 1973-1982 (D1), 1983-1992 (D2), 1993-2002 (D3), 2003-2012 (D4). Examined regions were; North East (NE), North central (NC), South and West. Tumor grade was classified into; well/moderately differentiated (WD/MD) and poorly/undifferentiated (PD/UD) groups. Differences in AYPLL among CA and AA in each of these variables were compared. RESULTS Overall, compared to CA, AA were diagnosed and died earlier from Pca. AA had higher AYPLL to Pca than CA. In both tumor grade groups, progressive increase in AYPLL among AA compared to CA was noted over the last three decades. In the WD/MD group, except for the South region, the highest recorded difference in AYPLL between AA and CA was in D4. In the PD/UD group, a similar difference in AYPLL between AA and CA was noted in all regions. The difference in AYPLL was higher in the PD/UD group than the WD/MD group. CONCLUSIONS Racial disparity between AA and CA existed across the examined regions. It is more pronounced in advanced tumor grades. The differences were more significant in the last decade.
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Affiliation(s)
- Mohamed H Kamel
- Department of Urology, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA. .,Department of Urology, Ain Shams University, Cairo, Egypt.
| | - Milan Bimali
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mahmoud I Khalil
- Department of Urology, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA.,Department of Urology, Ain Shams University, Cairo, Egypt
| | - Ehab Eltahawy
- Department of Urology, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA.,Department of Urology, Ain Shams University, Cairo, Egypt
| | - LJoseph Su
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nabil K Bissada
- Department of Urology, Baylor School of Medicine and Michael E. De Bakey VA Medical center, Houston, TX, USA
| | - Rodney Davis
- Department of Urology, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA
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Leinwand GZ, Gabrielson AT, Krane LS, Silberstein JL. Rethinking active surveillance for prostate cancer in African American men. Transl Androl Urol 2018; 7:S397-S410. [PMID: 30363480 PMCID: PMC6178310 DOI: 10.21037/tau.2018.06.19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Active surveillance (AS) is a treatment modality for prostate cancer that aims to simultaneously avoid overtreatment and allow for the timely intervention of localized disease. AS has become the de facto standard of care for most men with low-risk prostate cancer. However, few African American (AA) men were included in the prospective observational cohorts that resulted in a paradigm shift in treatment recommendations from active intervention toward AS. It has been established that AA men have an increased prostate cancer incidence, higher baseline prostate-specific antigen (PSA) values, more aggressive prostate cancer features, greater frequency of biochemical recurrence after treatment, and higher overall cancer-specific mortality compared to their Caucasian counterparts. As such, this has given many physicians pause before initiating AS for AA patients. In the following manuscript, we will review the available literature regarding AS, with a particular focus on AA men. The preponderance of evidence demonstrates that AS is as viable a management method for AA with low-risk prostate cancer as it is with other racial groups.
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Affiliation(s)
- Gabriel Z Leinwand
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Andrew T Gabrielson
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Louis S Krane
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
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10
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Alkaline Phosphatase Kinetics Predict Metastasis among Prostate Cancer Patients Who Experience Relapse following Radical Prostatectomy. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4727089. [PMID: 30050933 PMCID: PMC6046170 DOI: 10.1155/2018/4727089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/06/2018] [Indexed: 11/28/2022]
Abstract
Introduction Metastasis prostate cancer (CaP) occurs in a small fraction of patients. Improved prognostication of disease progression is a critical challenge. This study examined alkaline phosphatase velocity (APV) in predicting distant metastasis-free survival (DMFS). Materials and Methods This retrospective cohort study examined CaP patients enrolled in the Center for Prostate Disease Research (CPDR) multicenter national database who underwent RP and experienced BCR (n=1783). BCR was defined as a PSA ≥ 0.2 ng/mL at ≥ 8 weeks post-RP, followed by at least one confirmatory PSA ≥ 0.2 ng/mL or initiation of salvage therapy. APV was computed as the slope of the linear regression line of all alkaline phosphatase (AP) values after BCR and prior to distant metastasis. APV values in the uppermost quartile were defined as “rapid” and compared to the lower three quartiles combined (“slower”). Unadjusted Kaplan Meier (KM) estimation curves and multivariable Cox proportional hazards analysis were used to examine predictors of DMFS. Results Of the 1783 eligible patients who experienced post-RP BCR, 701 (39.3%) had necessary AP data for APV calculation. PSA doubling time (PSADT) and APV were strongly associated (p=0.008). No differences in APV were observed across race. In KM analysis, significantly poorer DMFS was observed among the rapid versus slower APV group (Log-rank p=0.003). In multivariable analysis, a rapid APV was predictive of a twofold increased probability of DMFS (HR = 2.2; 95% CI = 1.2, 3.9; p = 0.008), controlling for key study covariates. Conclusions Building on previous work, this study found that rapid APV was a strong predictor of DMFS for a broader group of CaP patients, those who undergo post-RP BCR who were enrolled in a longitudinal cohort with long-term follow-up and equal health care access. APV is worth considering as a complementary clinical factor for predicting DMFS.
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11
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Jiang S, Narayan V, Warlick C. Racial disparities and considerations for active surveillance of prostate cancer. Transl Androl Urol 2018; 7:214-220. [PMID: 29732279 PMCID: PMC5911544 DOI: 10.21037/tau.2017.09.11] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Active surveillance (AS) for the management of low-risk prostate cancer has been increasing and in the general population appears safe, allowing for a reduction in the harms of prostate cancer screening such as overtreatment. African-American (AA) men have overall worse outcomes from prostate cancer compared to Caucasian-American (CA) men for a variety of socioeconomic, cultural and possibly biologic reasons, thus complicating the use of AS in this population. Strategies for optimizing care and mitigating risk in this population include pursuing close surveillance with steadfast patient compliance, the use of multiparametric MRI with targeted biopsies including the anterior prostate to reduce the risk of undersampling, as well as a judicious and thoughtful incorporation of novel molecular biomarkers for risk stratification. Currently, there exists no direct data to suggest that AS cannot be safely carried out in AA men following an informed discussion and after engaging in shared decision making. Physicians should have a low threshold for consideration of definitive therapy. Additional efforts should be made in increasing the engagement of minority participants in clinical trials, to gain an improved representation of underserved populations in future research.
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Affiliation(s)
- Song Jiang
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Vikram Narayan
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
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12
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Active Surveillance in African-Americans. Prostate Cancer 2018. [DOI: 10.1007/978-3-319-78646-9_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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13
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Abstract
PURPOSE OF REVIEW The purpose of this review is to examine prostate cancer racial disparities specific to the African-American population. RECENT FINDINGS African-American men are more likely to be diagnosed with prostate cancer, present at an earlier age; are more likely to have locally advanced or metastatic disease at diagnosis; and have suboptimal outcomes to standard treatments. Prostate cancer treatment requires a nuanced approach, particularly when applying screening, counseling, and management of African-American men. Oncological as well as functional outcomes may differ and are potentially due to a combination of genetic, molecular, behavioral, and socioeconomic factors.
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Affiliation(s)
- Zachary L Smith
- Department of Surgery, Section of Urology, The University of Chicago Medicine, 5841 S. Maryland Avenue, MC 6038, Chicago, IL, 60637, USA.
| | - Scott E Eggener
- Department of Surgery, Section of Urology, The University of Chicago Medicine, 5841 S. Maryland Avenue, MC 6038, Chicago, IL, 60637, USA
| | - Adam B Murphy
- Department of Urology, Northwestern University Feinberg School of Medicine, Tarry Building Room 16-703, 300 E. Superior Street, Chicago, IL, 60611, USA
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14
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Gökce MI, Sundi D, Schaeffer E, Pettaway C. Is active surveillance a suitable option for African American men with prostate cancer? A systemic literature review. Prostate Cancer Prostatic Dis 2017; 20:127-136. [DOI: 10.1038/pcan.2016.56] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 08/18/2016] [Accepted: 09/11/2016] [Indexed: 12/29/2022]
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15
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Shin T, Smyth TB, Ukimura O, Ahmadi N, de Castro Abreu AL, Oishi M, Mimata H, Gill IS. Detection of prostate cancer using magnetic resonance imaging/ultrasonography image-fusion targeted biopsy in African-American men. BJU Int 2017; 120:233-238. [PMID: 28111879 DOI: 10.1111/bju.13786] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the diagnostic yield of targeted prostate biopsy in African-American (A-A) men using image fusion of multi-parametric magnetic resonance imaging (mpMRI) with real-time transrectal ultrasonography (US). PATIENTS AND METHODS We retrospectively analysed 661 patients (117 A-A and 544 Caucasian) who had mpMRI before biopsy and then underwent MRI/US image-fusion targeted biopsy (FTB) between October 2012 and August 2015. The mpMRIs were reported on a 5-point Likert scale of suspicion. Clinically significant prostate cancer (CSPC) was defined as biopsy Gleason score ≥7. RESULTS After controlling for age, prostate-specific antigen level and prostate volume, there were no significant differences between A-A and Caucasian men in the detection rate of overall cancer (35.0% vs 34.2%, P = 0.9) and CSPC (18.8% vs 21.7%, P = 0.3) with MRI/US FTB. There were no significant differences between the races in the location of dominant lesions on mpMRI, and in the proportion of 5-point Likert scoring. In A-A men, MRI/US FTB from the grade 4-5 lesions outperformed random biopsy in the detection rate of overall cancer (70.6% vs 37.2%, P = 0.003) and CSPC (52.9% vs 12.4%, P < 0.001). MRI/US FTB outperformed random biopsy in cancer core length (5.0 vs 2.4 mm, P = 0.001), in cancer rate per core (24.9% vs 6.8%, P < 0.001), and in efficiency for detecting one patient with CSPC (mean number of cores needed 13.3 vs 81.9, P < 0.001), respectively. CONCLUSIONS Our key finding confirms a lack of racial difference in the detection rate of overall prostate cancers and CSPC with MRI/US FTB between A-A and Caucasian men. MRI/US FTB detected more CSPC using fewer cores compared with random biopsy.
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Affiliation(s)
- Toshitaka Shin
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Urology, Oita University, Oita, Japan
| | | | - Osamu Ukimura
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nariman Ahmadi
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andre Luis de Castro Abreu
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Masakatsu Oishi
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Inderbir S Gill
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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16
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Gokce MI, Tangal S, Hamidi N, Suer E, Ibis MA, Beduk Y. Role of neutrophil-to-lymphocyte ratio in prediction of Gleason score upgrading and disease upstaging in low-risk prostate cancer patients eligible for active surveillance. Can Urol Assoc J 2016; 10:E383-E387. [PMID: 28096923 DOI: 10.5489/cuaj.3550] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Active surveillance (AS) is an option for management of low-risk prostate cancer (PCa). However, grade and stage progression is an important consideration. Neutrophil-to-lymphocyte ratio (NLR) is a useful marker of cancer-related inflammation. In this study, we aimed to identify the roles of neutrophil count (NC), lymphocyte count (LC), and NLR to predict Gleason score (GS) upgrading, disease upstaging, and biochemical recurrence rates (BCR) in low-risk PCa patients. METHODS We retrospectively evaluated data of 210 low-risk PCa patients eligible for AS, but who underwent radical prostatectomy. The roles of NC, LC, and NLR on the GS upgrading, disease upstaging, and BCR rates were investigated. Univariate and multivariate models were used to determine the effect of these parameters. RESULTS There were 104 and 106 patients in the NLR <2.5 and NLR ≥2.5 groups, respectively. GS upgrading in the NLR ≥2.5 group was more common than in the NLR<2.5 group (p=0.04). The NLR ≥2.5 group had significantly higher GS (8-10; p=0.03). With regard to NLR, the groups were found to have similar rates of disease upstaging (9/104 in NLR <2.5 vs. 16/106 in NLR ≥2.5; p=0.200). BCR rates were also significantly different between groups (p=0.033). NC an LC were not found to be associated with GS upgrading, disease upstaging, or BCR. CONCLUSIONS NLR is a predictor of GS upgrading and BCR, but not disease upstaging in patients with low-risk PCa. Furthermore, higher NLR was found to be associated with higher GS PCa. NLR is a cost-effective and easily accessible tool that can be used in the decision-making process for treatment of low-risk PCa cases.
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Affiliation(s)
- Mehmet Ilker Gokce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Semih Tangal
- Department of Urology, Ufuk University School of Medicine, Ankara, Turkey
| | - Nurullah Hamidi
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Evren Suer
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Muhammed Arif Ibis
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Yasar Beduk
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
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17
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Ammani A, Janane A, Bouzide B, Dehayni Y, Lezrek M, Ghadouane M, Ameur A, Abbar M, Qarro A, Alami M. Pathological outcomes and agressiveness of low-risk prostate cancer in Northern African men. Actas Urol Esp 2016; 40:556-563. [PMID: 27161090 DOI: 10.1016/j.acuro.2016.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 12/27/2015] [Accepted: 01/03/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Northern African (NAf) men show a high incidence of advanced prostate cancer (PCa) at diagnosis. Several studies suggested the existence of ethnic differences in the PCa aggressiveness and this has led to some concerns related to the inclusion of some ethnic groups into active surveillance protocols. OBJECTIVE To evaluate pathological outcomes and aggressiveness of low risk PCa treated by radical prostatectomy in a NAf ethnic group. SUBJECTS AND METHODS Data of 147 NAfs, who underwent radical prostatectomy for low risk PCa diagnosed via a 12-core biopsy in 2 academic centers between 2011 and 2015, were reviewed retrospectively to assess rates of worse pathological outcomes defined as: Gleason score upgrade to at least 3+4, upstage to pT3a or higher or pN1, and positive surgical margins. RESULTS Overall significant upstage and/or upgrade occurred in 20.2% and positive surgical margins occured in18.3%. In multivariate logistic regression analysis, independent variables that predicted for upstage and/or upgrade or positive surgical margins in the entire cohort were: NCCN risk group (low risk>very low risk), advanced age>60 years, PSA>6ng/ml, PSA density≥0.15, more than 2 positive cores in biopsy, more than 50% cancer involvement in positive cores, clinical stage (T2a>T1c) and UCSF-CAPRA-S score>3. CONCLUSIONS Our study found that, at least pathologically, NAf men do not have more aggressive disease than Caucasians and African Americans in both low and very low risk PCa. Thus, we think that active surveillance is a suitable approach for selected patients since there is no definitive data that show a more aggressive natural history of PCa in NAf men.
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Affiliation(s)
- A Ammani
- Department of Urology, Faculty of Medicine and Pharmacy, University Sidi Mohammed Ben Abdellah, Fez, Marruecos; Department of Urology, Universitary Military Hospital Moulay Ismail, Mequinez, Marruecos; Center of Doctoral Studies (PhD) of Life and Heath Sciences, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Marruecos.
| | - A Janane
- Department of Urology, Universitary Military Hospital Mohammed V, Rabat, Marruecos
| | - B Bouzide
- Department of Urology, Universitary Military Hospital Moulay Ismail, Mequinez, Marruecos
| | - Y Dehayni
- Department of Urology, Universitary Military Hospital Moulay Ismail, Mequinez, Marruecos
| | - M Lezrek
- Department of Urology, Universitary Military Hospital Moulay Ismail, Mequinez, Marruecos
| | - M Ghadouane
- Department of Urology, Universitary Military Hospital Mohammed V, Rabat, Marruecos
| | - A Ameur
- Department of Urology, Universitary Military Hospital Mohammed V, Rabat, Marruecos
| | - M Abbar
- Department of Urology, Universitary Military Hospital Mohammed V, Rabat, Marruecos
| | - A Qarro
- Department of Urology, Faculty of Medicine and Pharmacy, University Sidi Mohammed Ben Abdellah, Fez, Marruecos; Department of Urology, Universitary Military Hospital Moulay Ismail, Mequinez, Marruecos
| | - M Alami
- Department of Urology, Faculty of Medicine and Pharmacy, University Sidi Mohammed Ben Abdellah, Fez, Marruecos; Department of Urology, Universitary Military Hospital Moulay Ismail, Mequinez, Marruecos
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18
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Adamo MP, Boten JA, Coyle LM, Cronin KA, Lam CJK, Negoita S, Penberthy L, Stevens JL, Ward KC. Validation of prostate-specific antigen laboratory values recorded in Surveillance, Epidemiology, and End Results registries. Cancer 2016; 123:697-703. [PMID: 27783399 PMCID: PMC5293616 DOI: 10.1002/cncr.30401] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/22/2016] [Accepted: 09/26/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Researchers have used prostate‐specific antigen (PSA) values collected by central cancer registries to evaluate tumors for potential aggressive clinical disease. An independent study collecting PSA values suggested a high error rate (18%) related to implied decimal points. To evaluate the error rate in the Surveillance, Epidemiology, and End Results (SEER) program, a comprehensive review of PSA values recorded across all SEER registries was performed. METHODS Consolidated PSA values for eligible prostate cancer cases in SEER registries were reviewed and compared with text documentation from abstracted records. Four types of classification errors were identified: implied decimal point errors, abstraction or coding implementation errors, nonsignificant errors, and changes related to “unknown” values. RESULTS A total of 50,277 prostate cancer cases diagnosed in 2012 were reviewed. Approximately 94.15% of cases did not have meaningful changes (85.85% correct, 5.58% with a nonsignificant change of <1 ng/mL, and 2.80% with no clinical change). Approximately 5.70% of cases had meaningful changes (1.93% due to implied decimal point errors, 1.54% due to abstract or coding errors, and 2.23% due to errors related to unknown categories). Only 419 of the original 50,277 cases (0.83%) resulted in a change in disease stage due to a corrected PSA value. CONCLUSIONS The implied decimal error rate was only 1.93% of all cases in the current validation study, with a meaningful error rate of 5.81%. The reasons for the lower error rate in SEER are likely due to ongoing and rigorous quality control and visual editing processes by the central registries. The SEER program currently is reviewing and correcting PSA values back to 2004 and will re‐release these data in the public use research file. Cancer 2017;123:697–703. © 2016 American Cancer Society. Researchers have used prostate‐specific antigen (PSA) values collected by central cancer registries to evaluate tumors for potential aggressive clinical disease. The current study describes the comprehensive review of PSA laboratory values recorded across all Surveillance, Epidemiology, and End Results registries for 2012 prostate cancer cases and the proposed mechanism for reviewing and correcting PSA laboratory values.
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Affiliation(s)
| | - Margaret Peggy Adamo
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Jessica A Boten
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Linda M Coyle
- Information Management Services Inc, Calverton, Maryland
| | - Kathleen A Cronin
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Clara J K Lam
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | | | - Lynne Penberthy
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | | | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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19
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Maurice MJ, Sundi D, Schaeffer EM, Abouassaly R. Risk of Pathological Upgrading and Up Staging among Men with Low Risk Prostate Cancer Varies by Race: Results from the National Cancer Database. J Urol 2016; 197:627-631. [PMID: 27582435 DOI: 10.1016/j.juro.2016.08.095] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE The impact of African-American race on oncologic outcomes for low risk prostate cancer is unclear due to conflicting data. We investigated the effect of African-American race on pathological upgrading and/or up staging at prostatectomy in men with clinically low risk prostate cancer. MATERIALS AND METHODS We queried the National Cancer Database for men with low risk prostate cancer (clinical stage T2a or less, Gleason score 6 or less, prostate specific antigen less than 10 ng/ml) treated with radical prostatectomy between 2010 and 2013. The outcomes were pathological upgrading to Gleason score greater than 6 (primary) or Gleason score greater than 3+4=7 (secondary) and/or up staging (pathological T3-4 or N1 disease). The association between race and the end points was assessed using multivariable logistic regression. To further adjust for potential confounders, stratification by urban residence and comorbidity score, and subgroup analyses were performed. RESULTS With adjustment for age, comorbidity, income, urban residence, T stage, prostate specific antigen and percentage of positive biopsy cores, African-American race conferred 1.2-fold higher odds of pathological upgrading to Gleason score greater than 6 and/or up staging (OR 1.2, 95% CI 1.1-1.3, p <0.01). African-American race also was an independent predictor of pathological upgrading to Gleason score greater than 3+4=7 and/or up staging (p=0.03). CONCLUSIONS African-American men with low risk prostate cancer are more likely to harbor higher risk disease, which may lead to adverse outcomes. This finding alone does not preclude active surveillance. However, race should be considered as men weigh the risks and benefits of active surveillance vs treatment.
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Affiliation(s)
- Matthew J Maurice
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Debasish Sundi
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Edward M Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert Abouassaly
- Department of Urology, University Hospitals Case Medical Center, Cleveland, Ohio.
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20
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Tosoian JJ, Carter HB, Lepor A, Loeb S. Active surveillance for prostate cancer: current evidence and contemporary state of practice. Nat Rev Urol 2016; 13:205-15. [PMID: 26954332 DOI: 10.1038/nrurol.2016.45] [Citation(s) in RCA: 166] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Prostate cancer remains one of the most commonly diagnosed malignancies worldwide. Early diagnosis and curative treatment seem to improve survival in men with unfavourable-risk cancers, but significant concerns exist regarding the overdiagnosis and overtreatment of men with lower-risk cancers. To this end, active surveillance (AS) has emerged as a primary management strategy in men with favourable-risk disease, and contemporary data suggest that use of AS has increased worldwide. Although published surveillance cohorts differ by protocol, reported rates of metastatic disease and prostate-cancer-specific mortality are exceedingly low in the intermediate term (5-10 years). Such outcomes seem to be closely associated with programme-specific criteria for selection, monitoring, and intervention, suggesting that AS--like other management strategies--could be individualized based on the level of risk acceptable to patients in light of their personal preferences. Additional data are needed to better establish the risks associated with AS and to identify patient-specific characteristics that could modify prognosis.
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Affiliation(s)
- Jeffrey J Tosoian
- Brady Urological Institute, Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Baltimore, Maryland 21287-2101, USA
| | - H Ballentine Carter
- Brady Urological Institute, Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Baltimore, Maryland 21287-2101, USA
| | - Abbey Lepor
- Department of Urology, New York University, 550 1st Avenue (VZ30 #612), New York, New York 10016, USA
| | - Stacy Loeb
- Department of Urology, New York University, 550 1st Avenue (VZ30 #612), New York, New York 10016, USA.,Depatment of Population Health, New York University. 550 1st Avenue (VZ30 #612), New York, New York 10016, USA.,The Laura &Isaac Perlmutter Cancer Center, New York University, 550 1st Avenue (VZ30 #612), New York, New York 10016, USA
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