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Fu Q, Luo L, Hong R, Zhou H, Xu X, Feng Y, Huang K, Wan Y, Li Y, Gong J, Le X, Liu X, Wang N, Yuan J, Li F. Radiogenomic analysis of ultrasound phenotypic features coupled to proteomes predicts metastatic risk in primary prostate cancer. BMC Cancer 2024; 24:290. [PMID: 38438956 PMCID: PMC10913270 DOI: 10.1186/s12885-024-12028-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/20/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Primary prostate cancer with metastasis has a poor prognosis, so assessing its risk of metastasis is essential. METHODS This study combined comprehensive ultrasound features with tissue proteomic analysis to obtain biomarkers and practical diagnostic image features that signify prostate cancer metastasis. RESULTS In this study, 17 ultrasound image features of benign prostatic hyperplasia (BPH), primary prostate cancer without metastasis (PPCWOM), and primary prostate cancer with metastasis (PPCWM) were comprehensively analyzed and combined with the corresponding tissue proteome data to perform weighted gene co-expression network analysis (WGCNA), which resulted in two modules highly correlated with the ultrasound phenotype. We screened proteins with temporal expression trends based on the progression of the disease from BPH to PPCWOM and ultimately to PPCWM from two modules and obtained a protein that can promote prostate cancer metastasis. Subsequently, four ultrasound image features significantly associated with the metastatic biomarker HNRNPC (Heterogeneous nuclear ribonucleoprotein C) were identified by analyzing the correlation between the protein and ultrasound image features. The biomarker HNRNPC showed a significant difference in the five-year survival rate of prostate cancer patients (p < 0.0053). On the other hand, we validated the diagnostic efficiency of the four ultrasound image features in clinical data from 112 patients with PPCWOM and 150 patients with PPCWM, obtaining a combined diagnostic AUC of 0.904. In summary, using ultrasound imaging features for predicting whether prostate cancer is metastatic has many applications. CONCLUSION The above study reveals noninvasive ultrasound image biomarkers and their underlying biological significance, which provide a basis for early diagnosis, treatment, and prognosis of primary prostate cancer with metastasis.
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Affiliation(s)
- Qihuan Fu
- Department of Ultrasound, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC) , Chongqing University Cancer Hospital, 400030, Chongqing, China
| | - Li Luo
- Department of Ultrasound, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC) , Chongqing University Cancer Hospital, 400030, Chongqing, China
| | - Ruixia Hong
- Department of Ultrasound, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC) , Chongqing University Cancer Hospital, 400030, Chongqing, China
| | - Hang Zhou
- Department of Ultrasound, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC) , Chongqing University Cancer Hospital, 400030, Chongqing, China
| | - Xinzhi Xu
- Department of Ultrasound, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC) , Chongqing University Cancer Hospital, 400030, Chongqing, China
| | - Yujie Feng
- Department of Ultrasound, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC) , Chongqing University Cancer Hospital, 400030, Chongqing, China
| | - Kaifeng Huang
- Department of Ultrasound, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC) , Chongqing University Cancer Hospital, 400030, Chongqing, China
| | - Yujie Wan
- Department of Ultrasound, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC) , Chongqing University Cancer Hospital, 400030, Chongqing, China
| | - Ying Li
- Department of Ultrasound, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC) , Chongqing University Cancer Hospital, 400030, Chongqing, China
| | - Jiaqi Gong
- Department of Ultrasound, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC) , Chongqing University Cancer Hospital, 400030, Chongqing, China
| | - Xingyan Le
- Department of Ultrasound, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC) , Chongqing University Cancer Hospital, 400030, Chongqing, China
| | - Xiu Liu
- Department of Ultrasound, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC) , Chongqing University Cancer Hospital, 400030, Chongqing, China
| | - Na Wang
- Department of Ultrasound, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC) , Chongqing University Cancer Hospital, 400030, Chongqing, China
| | - Jiangbei Yuan
- Department of Infection, Zhejiang Provincial People's Hospital, 310014, Hangzhou, China.
| | - Fang Li
- Department of Ultrasound, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC) , Chongqing University Cancer Hospital, 400030, Chongqing, China.
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Fu Q, Hong R, Zhou H, Li Y, Liu X, Gong J, Wang X, Chen J, Ran H, Wang L, Li F, Yuan J. Proteomics reveals MRPL4 as a high-risk factor and a potential diagnostic biomarker for prostate cancer. Proteomics 2022; 22:e2200081. [PMID: 36059095 DOI: 10.1002/pmic.202200081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 12/29/2022]
Abstract
Through digital rectal examinations (DRE) and routine prostate-specific antigen (PSA) screening, early prostate cancer (PC) treatment has become possible. However, PC is a complex and heterogeneous disease. In vivo, cancer cells can invade adjacent tissues and metastasize to other tissues resulting in hard cures. Therefore, the key to improving PC patients' survival time is preventing cancer cells' metastasis. We used mass spectrometry to profile primary PC in patients with versus without metastatic PC. We named these two groups of PC patients as high-risk primary PC (n = 11) and low-risk primary PC (n = 7), respectively. At the same time, patients with benign prostatic hyperplasia (BPH, n = 6) were used as controls to explore the possible factors driving PC metastasis. Based on comprehensive mass spectrometry analysis and biological validation, we found significant upregulation of MRPL4 expression in high-risk primary PC relative to low-risk primary PC and BPH. Further, through research of the extensive clinical cohort data in the database, we discovered that MRPL4 could be a high-risk factor for PC and serve as a potential diagnostic biomarker. The MRPL4 might be used as an auxiliary indicator for clinical status/stage of primary PC to predict patient survival time.
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Affiliation(s)
- Qihuan Fu
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Ruixia Hong
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Hang Zhou
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Ying Li
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Xiu Liu
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Jiaqi Gong
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Xiaoyang Wang
- Biomedical Analysis Center, Army Medical University, Chongqing, China
| | - Jiajia Chen
- Biomedical Analysis Center, Army Medical University, Chongqing, China
| | - Haiying Ran
- Biomedical Analysis Center, Army Medical University, Chongqing, China
| | - Liting Wang
- Biomedical Analysis Center, Army Medical University, Chongqing, China
| | - Fang Li
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Jiangbei Yuan
- Hepato-Pancreato-Biliary Surgery, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Guangdong province, China
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[On the practice of therapy decision in locally limited prostate cancer: surgery vs. radiation-who benefits? : Allocation and results of a monocentric, cumulative long-term study]. Urologe A 2021; 61:282-291. [PMID: 34338813 DOI: 10.1007/s00120-021-01601-w] [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: 06/21/2021] [Indexed: 10/20/2022]
Abstract
AIM The goal of this two-armed observational study was to map the clinical therapy effectiveness of radical prostatovesiculectomy (RPVE) and external beam radiation therapy (EBRT) in locally limited prostate cancer (PCA) in direct comparison over 20 years under clinical conditions. Retrospectively, the various variables and predictors for the individual therapy decision were identified, and the preference was to compared with studies on survival and recurrence characteristics. The presentation of toxicity was not the focus of this work. METHODOLOGY In all, 743 patients from a single center were enrolled according to biopsy/staging chronologically in the sequence of the initial consultation after clarification and informed consent: 494 patients were in the RPVE arm and 249 patients in the EBRT arm. We used retrospective data analysis with univariate and multivariate comparisons in the alternative therapy arms. Multivariate logical regression models were developed to objectify the allocation process. Univariate processing of survival analyses, the comparison of tumor- and comorbidity-specific mortality rates was co-founded. RESULTS Predictive variables for RPVE vs. EBRT therapy decision are significantly age, Gleason score, D'Amico index, Charlson index, prostate-specific antigen (PSA), and prostate volume. There was no significance level for the biopsy score. The age gap was in the median 67 (RPVE) and 73 (EBRT) years. Overall survival (n = 734, 20 years, all risks) in the RPVE arm was 56.8% (95% confidence interval [CI] 45.1-67.0%) and in the EBRT arm 19.2% (95%CI 9.2-31.8%). Comorbid risk was highly significantly (p < 0.0001) different (27.1% [95%CI 18.0-36.1%] in the RPVE arm, and 60.4% [95%CI 47.3-73.5%] in the EBRT arm). The risk of tumor-specific death at 16.2% (95%CI 8.1-24.4%) after RPVE and 20.5% (95%CI 11.7-29.3%) after EBRT was not significantly different (p = 0.2122, overlapping 95%CI). After stratification, a clear advantage can be demonstrated for the high-risk tumors after allocation to the RPVE arm. CONCLUSIONS The complexity of the predictive variables of the PCA further complicates the individual therapy decision. According to our data, the higher D'Amico score, the rather low Charlson index, a high Gleason score and a higher organ volume speak for a valid therapy for RPVE.
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Soerensen SJC, Thomas IC, Schmidt B, Daskivich TJ, Skolarus TA, Jackson C, Osborne TF, Chertow GM, Brooks JD, Rehkopf DH, Leppert JT. Using an Automated Electronic Health Record Score To Estimate Life Expectancy In Men Diagnosed With Prostate Cancer In The Veterans Health Administration. Urology 2021; 155:70-76. [PMID: 34139251 DOI: 10.1016/j.urology.2021.05.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/11/2021] [Accepted: 05/09/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine if an automatically calculated electronic health record score can estimate intermediate-term life expectancy in men with prostate cancer to provide guideline concordant care. METHODS We identified all men (n = 36,591) diagnosed with prostate cancer in 2013-2015 in the VHA. Of the 36,591, 35,364 (96.6%) had an available Care Assessment Needs (CAN) score (range: 0-99) automatically calculated in the 30 days prior to the date of diagnosis. It was designed to estimate short-term risks of hospitalization and mortality. We fit unadjusted and multivariable Cox proportional hazards regression models to determine the association between the CAN score and overall survival among men with prostate cancer. We compared CAN score performance to two established comorbidity measures: The Charlson Comorbidity Index and Prostate Cancer Comorbidity Index (PCCI). RESULTS Among 35,364 men, the CAN score correlated with overall stage, with mean scores of 46.5 ( ± 22.4), 58.0 ( ± 24.4), and 68.1 ( ± 24.3) in localized, locally advanced, and metastatic disease, respectively. In both unadjusted and adjusted models for prostate cancer risk, the CAN score was independently associated with survival (HR = 1.23 95%CI 1.22-1.24 & adjusted HR = 1.17 95%CI 1.16-1.18 per 5-unit change, respectively). The CAN score (overall C-Index 0.74) yielded better discrimination (AUC = 0.76) than PCCI (AUC = 0.65) or Charlson Comorbidity Index (AUC = 0.66) for 5-year survival. CONCLUSION The CAN score is strongly associated with intermediate-term survival following a prostate cancer diagnosis. The CAN score is an example of how learning health care systems can implement multi-dimensional tools to provide fully automated life expectancy estimates to facilitate patient-centered cancer care.
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Affiliation(s)
- Simon John Christoph Soerensen
- Department of Urology, Stanford University School of Medicine, Stanford, CA; Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - I-Chun Thomas
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Bogdana Schmidt
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | | | - Ted A Skolarus
- Department of Urology, Dow Division of Health Services Research, University of Michigan Medical School, VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Ann Arbor, MI
| | - Christian Jackson
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Thomas F Osborne
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Glenn M Chertow
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - James D Brooks
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - David H Rehkopf
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - John T Leppert
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA.
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Sohlberg EM, Thomas IC, Yang J, Kapphahn K, Velaer KN, Goldstein MK, Wagner TH, Chertow GM, Brooks JD, Patel CJ, Desai M, Leppert JT. Laboratory-wide association study of survival with prostate cancer. Cancer 2020; 127:1102-1113. [PMID: 33237577 DOI: 10.1002/cncr.33341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/27/2020] [Accepted: 10/13/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Estimates of overall patient health are essential to inform treatment decisions for patients diagnosed with cancer. The authors applied XWAS methods, herein referred to as "laboratory-wide association study (LWAS)", to evaluate associations between routinely collected laboratory tests and survival in veterans with prostate cancer. METHODS The authors identified 133,878 patients who were diagnosed with prostate cancer between 2000 and 2013 in the Veterans Health Administration using any laboratory tests collected within 6 months of diagnosis (3,345,083 results). Using the LWAS framework, the false-discovery rate was used to test the association between multiple laboratory tests and survival, and these results were validated using training, testing, and validation cohorts. RESULTS A total of 31 laboratory tests associated with survival met stringent LWAS criteria. LWAS confirmed markers of prostate cancer biology (prostate-specific antigen: hazard ratio [HR], 1.07 [95% confidence interval (95% CI), 1.06-1.08]; and alkaline phosphatase: HR, 1.22 [95% CI, 1.20-1.24]) as well laboratory tests of general health (eg, serum albumin: HR, 0.78 [95% CI, 0.76-0.80]; and creatinine: HR, 1.05 [95% CI, 1.03-1.07]) and inflammation (leukocyte count: HR, 1.23 [95% CI, 1.98-1.26]; and erythrocyte sedimentation rate: HR, 1.33 [95% CI, 1.09-1.61]). In addition, the authors derived and validated separate models for patients with localized and advanced disease, identifying 28 laboratory markers and 15 laboratory markers, respectively, in each cohort. CONCLUSIONS The authors identified routinely collected laboratory data associated with survival for patients with prostate cancer using LWAS methodologies, including markers of prostate cancer biology, overall health, and inflammation. Broadening consideration of determinants of survival beyond those related to cancer itself could help to inform the design of clinical trials and aid in shared decision making. LAY SUMMARY This article examined routine laboratory tests associated with survival among veterans with prostate cancer. Using laboratory-wide association studies, the authors identified 31 laboratory tests associated with survival that can be used to inform the design of clinical trials and aid patients in shared decision making.
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Affiliation(s)
- Ericka M Sohlberg
- Department of Urology, Stanford University School of Medicine, Stanford, California
| | - I-Chun Thomas
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Jaden Yang
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Kristopher Kapphahn
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Kyla N Velaer
- Department of Urology, Stanford University School of Medicine, Stanford, California
| | - Mary K Goldstein
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California.,Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Todd H Wagner
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California.,Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Glenn M Chertow
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - James D Brooks
- Department of Urology, Stanford University School of Medicine, Stanford, California
| | - Chirag J Patel
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Manisha Desai
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - John T Leppert
- Department of Urology, Stanford University School of Medicine, Stanford, California.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California.,Department of Medicine, Stanford University School of Medicine, Stanford, California
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Sohlberg EM, Thomas IC, Yang J, Kapphahn K, Daskivich TJ, Skolarus TA, Shelton JB, Makarov DV, Bergman J, Bang CK, Goldstein MK, Wagner TH, Brooks JD, Desai M, Leppert JT. Life expectancy estimates for patients diagnosed with prostate cancer in the Veterans Health Administration. Urol Oncol 2020; 38:734.e1-734.e10. [PMID: 32674954 DOI: 10.1016/j.urolonc.2020.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/28/2020] [Accepted: 05/11/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Accurate life expectancy estimates are required to inform prostate cancer treatment decisions. However, few models are specific to the population served or easily implemented in a clinical setting. We sought to create life expectancy estimates specific to Veterans diagnosed with prostate cancer. MATERIALS AND METHODS Using national Veterans Health Administration electronic health records, we identified Veterans diagnosed with prostate cancer between 2000 and 2015. We abstracted demographics, comorbidities, oncologic staging, and treatment information. We fit Cox Proportional Hazards models to determine the impact of age, comorbidity, cancer risk, and race on survival. We stratified life expectancy estimates by age, comorbidity and cancer stage. RESULTS Our analytic cohort included 145,678 patients. Survival modeling demonstrated the importance of age and comorbidity across all cancer risk categories. Life expectancy estimates generated from age and comorbidity data were predictive of overall survival (C-index 0.676, 95% CI 0.674-0.679) and visualized using Kaplan-Meier plots and heatmaps stratified by age and comorbidity. Separate life expectancy estimates were generated for patients with localized or advanced disease. These life expectancy estimates calibrate well across prostate cancer risk categories. CONCLUSIONS Life expectancy estimates are essential to providing patient-centered prostate cancer care. We developed accessible life expectancy estimation tools for Veterans diagnosed with prostate cancer that can be used in routine clinical practice to inform medical-decision making.
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Affiliation(s)
- Ericka M Sohlberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - I-Chun Thomas
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Jaden Yang
- Quantitative Sciences Unit, Stanford University, Stanford, CA
| | | | | | - Ted A Skolarus
- Department of Urology, University of Michigan, VA Ann Arbor Healthcare System, Center for Clinical Management and Research, Ann Arbor, MI
| | - Jeremy B Shelton
- Department of Urology, UCLA; West Los Angeles VA Medical Center, LA County Department of Health Services, Los Angeles, CA
| | - Danil V Makarov
- Departments of Urology and Population Health, New York University Langone Medical Center, Veterans Affairs New York Harbor Healthcare System, New York, NY
| | - Jonathan Bergman
- Department of Urology, UCLA; West Los Angeles VA Medical Center, LA County Department of Health Services, Los Angeles, CA
| | - Christine Ko Bang
- Department of Radiation Oncology, VA Maryland Health Care System, Baltimore, MD
| | - Mary K Goldstein
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Todd H Wagner
- Department of Surgery, Stanford University School of Medicine, Stanford, CA; VA Center for Innovation to Implementation, Palo Alto, CA
| | - James D Brooks
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Manisha Desai
- Quantitative Sciences Unit, Stanford University, Stanford, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - John T Leppert
- Department of Urology, Stanford University School of Medicine, Stanford, CA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA; VA Center for Innovation to Implementation, Palo Alto, CA.
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Rakic N, Keeley J, Abdollah F. Re: Timothy J. Wilt, Tien N. Vo, Lisa Langsetmo, et al. Radical Prostatectomy or Observation for Clinically Localized Prostate Cancer: Extended Follow-up of the Prostate Cancer Intervention Versus Observation Trial (PIVOT). Eur Urol 2020;77:713-724: External Validity of the Updated Prostate Cancer Intervention Versus Observation Trial (PIVOT). Eur Urol Oncol 2020; 3:557-558. [PMID: 32546347 DOI: 10.1016/j.euo.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/13/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Nikola Rakic
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Jacob Keeley
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
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Vernooij RW, Lancee M, Cleves A, Dahm P, Bangma CH, Aben KK. Radical prostatectomy versus deferred treatment for localised prostate cancer. Cochrane Database Syst Rev 2020; 6:CD006590. [PMID: 32495338 PMCID: PMC7270852 DOI: 10.1002/14651858.cd006590.pub3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Prostate cancer is a common cancer but is oftentimes slow growing. When confined to the prostate, radical prostatectomy (RP), which involves removal of the prostate, offers potential cure that may come at the price of adverse events. Deferred treatment, involving observation and palliative treatment only (watchful waiting (WW)) or close monitoring and delayed local treatment with curative intent as needed in the setting of disease progression (active monitoring (AM)/surveillance (AS)) might be an alternative. This is an update of a Cochrane Review previously published in 2010. OBJECTIVES To assess effects of RP compared with deferred treatment for clinically localised prostate cancer. SEARCH METHODS We searched the Cochrane Library (including CDSR, CENTRAL, DARE, and HTA), MEDLINE, Embase, AMED, Web of Science, LILACS, Scopus, and OpenGrey. Additionally, we searched two trial registries and conference abstracts of three conferences (EAU, AUA, and ASCO) until 3 March 2020. SELECTION CRITERIA We included all randomised controlled trials (RCTs) that compared RP versus deferred treatment in patients with localised prostate cancer, defined as T1-2, N0, M0 prostate cancer. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of references and extracted data from included studies. The primary outcome was time to death from any cause; secondary outcomes were: time to death from prostate cancer; time to disease progression; time to metastatic disease; quality of life, including urinary and sexual function; and adverse events. We assessed the certainty of evidence per outcome using the GRADE approach. MAIN RESULTS: We included four studies with 2635 participants (average age between 60 to 70 years). Three multicentre RCTs, from Europe and USA, compared RP with WW (n = 1537), and one compared RP with AM (n = 1098). Radical prostatectomy versus watchful waiting RP probably reduces the risk of death from any cause (hazard ratio (HR) 0.79, 95% confidence interval (CI) 0.70-0.90; 3 studies with 1537 participants; moderate-certainty evidence). Based on overall mortality at 29 years, this corresponds to 764 deaths per 1000 men in the RP group compared to 839 deaths per 1000 men in the WW group. RP probably also lowers the risk of death from prostate cancer (HR 0.57, 95% CI 0.44-0.73; 2 studies with 1426 participants; moderate-certainty evidence). Based on prostate cancer-specific mortality at 29 years, this corresponds to 195 deaths from prostate cancer per 1000 men in the RP group compared with 316 deaths from prostate cancer per 1000 men in the WW group. RP may reduce the risk of progression (HR 0.43, 95% CI 0.35-0.54; 2 studies with 1426 participants; I² = 54%; low-certainty evidence); at 19.5 years, this corresponds to 391 progressions per 1000 men for the RP group compared with 684 progressions per 1000 men for the WW group) and probably reduces the risk of developing metastatic disease (HR 0.56, 95% CI 0.46-0.70; 2 studies with 1426 participants; I² = 0%; moderate-certainty evidence); at 29 years, this corresponds to 271 metastatic diseases per 1000 men for RP compared with 431 metastatic diseases per 1000 men for WW. General quality of life at 12 years' follow-up is probably similar for both groups (risk ratio (RR) 1.0, 95% CI 0.85-1.16; low-certainty evidence), corresponding to 344 patients with high quality of life per 1000 men for the RP group compared with 344 patients with high quality of life per 1000 men for the WW group. Rates of urinary incontinence may be considerably higher (RR 3.97, 95% CI 2.34-6.74; low-certainty evidence), corresponding to 173 incontinent men per 1000 in the RP group compared with 44 incontinent men per 1000 in the WW group, as are rates of erectile dysfunction (RR 2.67, 95% CI 1.63-4.38; low-certainty evidence), corresponding to 389 erectile dysfunction events per 1000 for the RP group compared with 146 erectile dysfunction events per 1000 for the WW group, both at 10 years' follow-up. Radical prostatectomy versus active monitoring Based on one study including 1098 participants with 10 years' follow-up, there are probably no differences between RP and AM in time to death from any cause (HR 0.93, 95% CI 0.65-1.33; moderate-certainty evidence). Based on overall mortality at 10 years, this corresponds to 101 deaths per 1000 men in the RP group compared with 108 deaths per 1000 men in the AM group. Similarly, risk of death from prostate cancer probably is not different between the two groups (HR 0.63, 95% CI 0.21-1.89; moderate-certainty evidence). Based on prostate cancer-specific mortality at 10 years, this corresponds to nine prostate cancer deaths per 1000 men in the RP group compared with 15 prostate cancer deaths per 1000 men in the AM group. RP probably reduces the risk of progression (HR 0.39, 95% CI 0.27-0.56; moderate-certainty evidence; at 10 years, this corresponds to 86 progressions per 1000 men for RP compared with 206 progressions per 1000 men for AM) and the risk of developing metastatic disease (RR 0.39, 95% CI 0.21-0.73; moderate-certainty evidence; at 10 years, this corresponds to 24 metastatic diseases per 1000 men for the RP group compared with 61 metastatic diseases per 1000 men for the AM group).The general quality of life during follow-up was not different between the treatment groups. However, urinary function (mean difference (MD) 8.60 points lower, 95% CI 11.2-6.0 lower) and sexual function (MD 14.9 points lower, 95% CI 18.5-11.3 lower) on the Expanded Prostate Cancer Index Composite-26 (EPIC-26) instrument, were worse in the RP group. AUTHORS' CONCLUSIONS Based on long-term follow-up, RP compared with WW probably results in substantially improved oncological outcomes in men with localised prostate cancer but also markedly increases rates of urinary incontinence and erectile dysfunction. These findings are largely based on men diagnosed before widespread PSA screening, thereby limiting generalisability. Compared to AM, based on follow-up to 10 years, RP probably has similar outcomes with regard to overall and disease-specific survival yet probably reduces the risks of disease progression and metastatic disease. Urinary function and sexual function are probably decreased for the patients treated with RP.
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Affiliation(s)
- Robin Wm Vernooij
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
| | - Michelle Lancee
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
| | - Anne Cleves
- Velindre NHS Trust, Cardiff University Library Services, Cardiff, UK
| | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Chris H Bangma
- Department of Urology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Katja Kh Aben
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
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9
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Vuolukka K, Auvinen P, Palmgren JE, Aaltomaa S, Kataja V. Incidence of subsequent primary cancers and radiation-induced subsequent primary cancers after low dose-rate brachytherapy monotherapy for prostate cancer in long-term follow-up. BMC Cancer 2020; 20:453. [PMID: 32434560 PMCID: PMC7240976 DOI: 10.1186/s12885-020-06960-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 05/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As aging is the most significant risk factor for cancer development, long-term prostate cancer (PCa) survivors have an evident risk of developing subsequent primary cancers (SPCs). Radiotherapy itself is an additional risk factor for cancer development and the SPCs appearing beyond 5 years after radiotherapy in the original treatment field can be considered as radiation-induced subsequent primary cancers (RISPCs). METHODS During the years 1999-2008, 241 patients with localized PCa who underwent low dose-rate brachytherapy (LDR-BT) with I125 and were followed-up in Kuopio University Hospital, were included in this study. In this study the incidences and types of SPCs and RISPCs with a very long follow-up time after LDR-BT were evaluated. RESULTS During the median follow-up time of 11.4 years, a total of 34 (14.1%) patients developed a metachronous SPC. The most abundant SPCs were lung and colorectal cancers, each diagnosed in six patients (16.7% out of all SPCs). The crude incidence rate of RISPC was 1.7% (n = 4). Half of the SPC cases (50%) were diagnosed during the latter half of the follow-up time as the risk to develop an SPC continued throughout the whole follow-up time with the actuarial 10-year SPC rate of 7.0%. The crude death rates due to metachronous out-of-field SPCs and RISPCs were 50 and 50%, respectively. CONCLUSION The crude rate of SPC was in line with previously published data and the incidence of RISPC was very low. These results support the role of LDR-BT as a safe treatment option for patients with localized PCa.
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Affiliation(s)
- Kristiina Vuolukka
- Cancer Center, Kuopio University Hospital, PO Box 100, FI-70029, Kuopio, Finland.
| | - Päivi Auvinen
- Cancer Center, Kuopio University Hospital, PO Box 100, FI-70029, Kuopio, Finland.,University of Eastern Finland, Kuopio, Finland
| | - Jan-Erik Palmgren
- Cancer Center, Kuopio University Hospital, PO Box 100, FI-70029, Kuopio, Finland
| | - Sirpa Aaltomaa
- Department of Urology, Kuopio University Hospital, PO Box 100, FI-70029, Kuopio, Finland
| | - Vesa Kataja
- University of Eastern Finland, Kuopio, Finland.,Central Finland Health Care District, Central Finland Central Hospital, Adm Bldg 6/2, FI-40620, Jyväskylä, Finland
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10
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Halwani AS, Rasmussen KM, Patil V, Li CC, Yong CM, Burningham Z, Gupta S, Narayanan S, Lin SW, Carroll S, Mhatre SK, Graff JN, Dreicer R, Sauer BC. Real-world practice patterns in veterans with metastatic castration-resistant prostate cancer. Urol Oncol 2019; 38:1.e1-1.e10. [PMID: 31704142 DOI: 10.1016/j.urolonc.2019.09.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 09/25/2019] [Accepted: 09/28/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Metastatic castration-resistant prostate cancer (mCRPC) is incurable, with most patients surviving less than 3 years. However, many treatments that extend survival have been approved in the past decade. OBJECTIVE To describe the patient demographics, disease characteristics, treatment patterns, and outcomes in a cohort of Veterans diagnosed with mCRPC in the Veterans Health Administration. DESIGN We identified 3,637 Veterans diagnosed with prostate cancer between January 2006 and August 2015 with evidence of mCRPC through December 2016. We described the most commonly used systemic mCRPC treatments according to mCRPC diagnosis era: Epoch 1 (2006-2010) or Epoch 2 (2011-2016). Patient demographics, disease characteristics, and treatment patterns were examined using descriptive statistics. An unadjusted Kaplan-Meier method was used to estimate the median time to biochemical progression and overall survival (OS) with 95% confidence intervals. RESULTS The median age at initial prostate cancer diagnosis was 68 years. Approximately 67% of patients were non-Hispanic white, 29% were black, and 4% were other/unknown. A high-risk Gleason score (8-10) was reported in 748 (67%) of patients in Epoch 1 and 1578 (63%) of patients in Epoch 2, and the median prostate-specific antigen level at initial prostate cancer diagnosis was higher in Epoch 1 patients than in Epoch 2 patients (68 vs. 35 ng/ml). Following mCRPC diagnosis, the most common first-line therapies in Epoch 1 patients were docetaxel (83%) and abiraterone (9%), whereas Epoch 2 patients mainly received abiraterone (47%), docetaxel (36%), and enzalutamide (15%). In Epoch 1 and Epoch 2 patients, the median time to biochemical progression (unadjusted) was 9 and 13 months, respectively, and the median OS (unadjusted) was 15 and 23 months, respectively. CONCLUSIONS The introduction of new therapies has resulted in increased use of the noncytotoxic agents abiraterone and enzalutamide as first-line treatment in lieu of docetaxel. Our results suggest that more recently diagnosed patients (Epoch 2) have a delayed time to biochemical progression and longer OS (unadjusted) compared with patients diagnosed earlier (Epoch 1).
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Affiliation(s)
- Ahmad S Halwani
- George E. Wahlen Veterans Health Administration, Salt Lake City, UT; University of Utah, Salt Lake City, UT; Huntsman Cancer Institute, Salt Lake City, UT
| | - Kelli M Rasmussen
- George E. Wahlen Veterans Health Administration, Salt Lake City, UT; University of Utah, Salt Lake City, UT.
| | - Vikas Patil
- George E. Wahlen Veterans Health Administration, Salt Lake City, UT; University of Utah, Salt Lake City, UT
| | - Catherine C Li
- George E. Wahlen Veterans Health Administration, Salt Lake City, UT; University of Utah, Salt Lake City, UT
| | - Christina M Yong
- George E. Wahlen Veterans Health Administration, Salt Lake City, UT; University of Utah, Salt Lake City, UT
| | - Zachary Burningham
- George E. Wahlen Veterans Health Administration, Salt Lake City, UT; University of Utah, Salt Lake City, UT
| | - Sumati Gupta
- George E. Wahlen Veterans Health Administration, Salt Lake City, UT; University of Utah, Salt Lake City, UT; Huntsman Cancer Institute, Salt Lake City, UT
| | | | - Shih-Wen Lin
- Genentech, Inc, South San Francisco, California, FL
| | | | | | - Julie N Graff
- Oregon Health & Science University, Knight Cancer Center, Portland, OR
| | - Robert Dreicer
- University of Virginia Cancer Center, Charlottesville, VA
| | - Brian C Sauer
- George E. Wahlen Veterans Health Administration, Salt Lake City, UT; University of Utah, Salt Lake City, UT
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11
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Magnani CJ, Li K, Seto T, McDonald KM, Blayney DW, Brooks JD, Hernandez-Boussard T. PSA Testing Use and Prostate Cancer Diagnostic Stage After the 2012 U.S. Preventive Services Task Force Guideline Changes. J Natl Compr Canc Netw 2019; 17:795-803. [PMID: 31319390 PMCID: PMC7195904 DOI: 10.6004/jnccn.2018.7274] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 01/15/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Most patients with prostate cancer are diagnosed with low-grade, localized disease and may not require definitive treatment. In 2012, the U.S. Preventive Services Task Force (USPSTF) recommended against prostate cancer screening to address overdetection and overtreatment. This study sought to determine the effect of guideline changes on prostate-specific antigen (PSA) screening and initial diagnostic stage for prostate cancer. PATIENTS AND METHODS A difference-in-differences analysis was conducted to compare changes in PSA screening (exposure) relative to cholesterol testing (control) after the 2012 USPSTF guideline changes, and chi-square test was used to determine whether there was a subsequent decrease in early-stage, low-risk prostate cancer diagnoses. Data were derived from a tertiary academic medical center's electronic health records, a national commercial insurance database (OptumLabs), and the SEER database for men aged ≥35 years before (2008-2011) and after (2013-2016) the guideline changes. RESULTS In both the academic center and insurance databases, PSA testing significantly decreased for all men compared with the control. The greatest decrease was among men aged 55 to 74 years at the academic center and among those aged ≥75 years in the commercial database. The proportion of early-stage prostate cancer diagnoses ( CONCLUSIONS In primary care, PSA testing decreased significantly and fewer prostate cancers were diagnosed at an early stage, suggesting provider adherence to the 2012 USPSTF guideline changes. Long-term follow-up is needed to understand the effect of decreased screening on prostate cancer survival.
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Affiliation(s)
| | - Kevin Li
- School of Medicine, Stanford University
| | - Tina Seto
- Stanford University School of Medicine IRT Research Technology
| | | | - Douglas W. Blayney
- Department of Medicine, Stanford University
- Stanford Cancer Institute, Stanford University
| | | | - Tina Hernandez-Boussard
- Department of Medicine, Stanford University
- Department of Biomedical Data Science, Stanford University
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12
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Vuolukka K, Auvinen P, Palmgren JE, Voutilainen T, Aaltomaa S, Kataja V. Long-term efficacy and urological toxicity of low-dose-rate brachytherapy (LDR-BT) as monotherapy in localized prostate cancer. Brachytherapy 2019; 18:583-588. [PMID: 31227400 DOI: 10.1016/j.brachy.2019.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/16/2019] [Accepted: 05/20/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the incidence of late severe (≥Grade 3) urinary toxicity and the long-term efficacy after low-dose-rate brachytherapy (LDR-BT) in patients with localized prostate cancer (PCa). METHODS AND MATERIALS During the years 1999-2008, 241 patients with PCa who underwent LDR-BT with I125 and were followed up in Kuopio University Hospital were included to this analysis. The incidence of late severe (Grade 3) urinary toxicity and the long-term efficacy results were analyzed. RESULTS All D'Amico risk groups were represented, as 58.9%, 35.3%, and 5.8% of the patients were classified as low-, intermediate-, and high-risk patients, respectively. With a median followup of 11.4 years after implantation, the incidence of severe urinary toxicity increased throughout the followup period. The risk of Grade 3 urinary toxicity was highest among patients with higher Gleason scores (p = 0.016) and higher initial urine residual volumes (p = 0.017) and the cumulative incidence of severe urinary toxicity was 10.0%. The crude rate for transurethral prostatic resection was 5.8%. The relapse-free survival, the cause-specific survival, and the overall survival were 79.3%, 95.0%, and 66.4%, respectively. CONCLUSIONS The treatment was well tolerated as 90% of patients avoided any Grade 3 urinary toxicity. LDR-BT for localized PCa achieved high and durable efficacy. These results support the role of LDR-BT monotherapy as one of the valid primary treatment options for low-risk and favorable intermediate-risk patients.
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Affiliation(s)
- Kristiina Vuolukka
- Department of Oncology, Cancer Center, Kuopio University Hospital, Kuopio, Finland.
| | - Päivi Auvinen
- Department of Oncology, Cancer Center, Kuopio University Hospital, Kuopio, Finland; University of Eastern Finland, Kuopio, Finland
| | - Jan-Erik Palmgren
- Department of Oncology, Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | | | - Sirpa Aaltomaa
- Department of Urology, Kuopio University Hospital, Kuopio, Finland
| | - Vesa Kataja
- University of Eastern Finland, Kuopio, Finland; Central Finland Central Hospital, Jyväskylä, Finland
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13
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Sussman ES, Ho A, Pendharkar AV, Tharin S. Image-guided Percutaneous Polymethylmethacrylate-augmented Spondylodesis for Painful Metastasis in the Veteran Population. Cureus 2019; 11:e4509. [PMID: 31259118 PMCID: PMC6590854 DOI: 10.7759/cureus.4509] [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] [Indexed: 11/25/2022] Open
Abstract
The treatment of painful spinal metastases in patients with limited life-expectancy, significant perioperative risks, and poor bone quality poses a surgical challenge. Recent advances in minimal-access spine surgery allow for the surgical treatment of patients previously considered not to be operative candidates. The addition of fenestrated screws for cement augmentation to existing image-guided percutaneous pedicle screw fixation can enhance efficiency, decrease risk of hardware complications, and improve back pain in this patient population. The patient is a 70-year-old man with severe axial back pain due to metastatic prostate cancer and L5 pathologic fractures not amenable to kyphoplasty. In the setting of a 6-12-month life-expectancy, the primary goal of surgery was relief of back pain associated with instability with minimal operative morbidity and post-operative recovery time. This was achieved with an internal fixation construct including percutaneously placed cement-augmented fenestrated pedicle screws at L4 and S1. The patient was discharged to home on post-operative day 1 with substantial improvement of his low back pain. Image-guided, percutaneous placement of fenestrated, cement-augmented pedicle screws is an emerging treatment for back pain associated with metastasis. Fenestrated screws allow for integrated cement augmentation. The minimal associated blood loss and recovery time make this approach an option even for patients with limited life-expectancy. This is the first report of utilization of this technique for the veteran population.
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Affiliation(s)
- Eric S Sussman
- Neurosurgery, Stanford University School of Medicine, Stanford, USA
| | - Allen Ho
- Neurosurgery, Stanford University School of Medicine, Stanford, USA
| | | | - Suzanne Tharin
- Neurosurgery, Stanford University School of Medicine, Stanford, USA
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14
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Guo DP, Thomas IC, Mittakanti HR, Shelton JB, Makarov DV, Skolarus TA, Cooperberg MR, Sonn GA, Chung BI, Brooks JD, Leppert JT. The Research Implications of Prostate Specific Antigen Registry Errors: Data from the Veterans Health Administration. J Urol 2018; 200:541-548. [DOI: 10.1016/j.juro.2018.03.127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2018] [Indexed: 10/17/2022]
Affiliation(s)
- David P. Guo
- Department of Urology, Stanford University, Stanford, California
| | - I-Chun Thomas
- Department of Urology, Stanford University, Stanford, California
| | | | - Jeremy B. Shelton
- Department of Urology, University of California-Los Angeles, Los Angeles, California
- Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California
| | - Danil V. Makarov
- Departments of Urology and Population Health, New York University Langone Medical Center, New York, New York
- Veterans Affairs New York Harbor Healthcare System, New York, New York
| | - Ted A. Skolarus
- Division of Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
- Center for Clinical Management and Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Matthew R. Cooperberg
- Departments of Urology, and Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Geoffrey A. Sonn
- Department of Urology, Stanford University, Stanford, California
| | | | - James D. Brooks
- Department of Urology, Stanford University, Stanford, California
| | - John T. Leppert
- Department of Urology, Stanford University, Stanford, California
- Department of Medicine, Stanford University, Stanford, California
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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15
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Iglesias-Gato D, Thysell E, Tyanova S, Crnalic S, Santos A, Lima TS, Geiger T, Cox J, Widmark A, Bergh A, Mann M, Flores-Morales A, Wikström P. The Proteome of Prostate Cancer Bone Metastasis Reveals Heterogeneity with Prognostic Implications. Clin Cancer Res 2018; 24:5433-5444. [DOI: 10.1158/1078-0432.ccr-18-1229] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/13/2018] [Accepted: 07/18/2018] [Indexed: 11/16/2022]
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16
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Froehner M, Koch R, Hübler M, Renner T, Borkowetz A, Zastrow S, Wirth MP. Only <10% of Patients Selected for Radical Prostatectomy Reach the Competing Mortality Rate of the Prostate Cancer Intervention Versus Observation Trial (PIVOT). Eur Urol Focus 2018; 5:361-364. [PMID: 29426695 DOI: 10.1016/j.euf.2018.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/08/2018] [Accepted: 01/25/2018] [Indexed: 11/24/2022]
Abstract
In the Prostate Cancer Intervention Versus Observation Trial (PIVOT), surgery was not associated with lower mortality compared with observation. However, the high competing mortality rate of approximately 33% after 10 yr among the PIVOT study population has raised concerns on the generalizability of these results. We investigated 4282 patients who underwent radical prostatectomy at our institution between 1992 and 2010 to determine which subgroups harbored a competing (non-prostate cancer) mortality risk comparable to that of PIVOT and tested several combinations of higher age and comorbidities ("worst case scenarios") to identify subgroups reaching or even superseding the competing mortality rate of the PIVOT population. The competing mortality rate of PIVOT was not reached till an age-adjusted Charlson score of 5 or higher (corresponding to an age of 70-79 yr with diabetes with end-organ damage). Only 8.9% of patients belonged to this high-risk subgroup, and only small subgroups comprising 1-5% patients superseded the competing mortality rate among the PIVOT study population. This data underline that the results of PIVOT should be used with great caution to exclude candidates for radical prostatectomy with comorbidities from curative treatment. PATIENT SUMMARY: Only <10% of patients selected for radical prostatectomy reached the competing mortality rate of approximately 33% observed in the Prostate Cancer Intervention Versus Observation Trial (PIVOT). The results of PIVOT should be used with great caution to exclude patients with concomitant diseases who seem otherwise fit for radical prostatectomy from curative treatment.
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Affiliation(s)
- Michael Froehner
- Departments of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany.
| | - Rainer Koch
- Medical Statistics and Biometry, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Matthias Hübler
- Anesthesiology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Theresa Renner
- Departments of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Angelika Borkowetz
- Departments of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Stefan Zastrow
- Departments of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Manfred P Wirth
- Departments of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
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17
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Abdollah F, Dalela D, Menon M. Re: Follow-up of Prostatectomy Versus Observation for Early Prostate Cancer. Eur Urol 2018; 73:302-303. [DOI: 10.1016/j.eururo.2017.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022]
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18
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Affiliation(s)
- Timothy J Wilt
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN
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19
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Dalela D, Karabon P, Sammon J, Sood A, Löppenberg B, Trinh QD, Menon M, Abdollah F. Generalizability of the Prostate Cancer Intervention Versus Observation Trial (PIVOT) Results to Contemporary North American Men with Prostate Cancer. Eur Urol 2017; 71:511-514. [DOI: 10.1016/j.eururo.2016.08.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
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20
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Cole AP, Abdollah F, Trinh QD. Observational Studies to Contextualize Surgical Trials. Eur Urol 2016; 70:231-2. [PMID: 26992277 DOI: 10.1016/j.eururo.2016.02.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 02/26/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Alexander P Cole
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Firas Abdollah
- Henry Ford Hospital, Vattikuti Institute of Urology, Center for Outcomes Research, Analytics and Evaluation, Detroit, MI, USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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