1
|
Augostini A, Wattengel BA, Mergenhagen KA. An evaluation of antimicrobial prophylaxis for transrectal prostate biopsies: A potential stewardship target. Am J Infect Control 2024:S0196-6553(24)00503-0. [PMID: 38782210 DOI: 10.1016/j.ajic.2024.05.012] [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: 03/06/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Transrectal prostate biopsy (TRPB) is a common procedure used to obtain a prostate biopsy. Although generally safe, complications may occur including infection. Preprocedural antimicrobial prophylaxis is recommended to minimize risk of subsequent infection. METHODS This study is a retrospective chart review via the computerized patient record system from January 1, 2018 to February 28, 2022. The study included patients who underwent a TRPB at the Western New York, Syracuse, or Albany Stratton Veterans Affairs Healthcare Systems. RESULTS This study included a total of 932 patients who underwent TRPB. Postoperative infection occurred in 3.2% (n = 30) of patients within 14days of the TRPB. Of the 30 patients who developed an infection, 30% (n = 9) resulted in bacteremia. For the 932 patients evaluated, 24 different antibiotic regimens were used, none of which followed guideline recommendations. None of the regimens were found to have an impact on rates of subsequent infection. CONCLUSIONS The results of this study suggest a need for guideline adherence. There was no benefit to using the guideline-discordant regimens as they were not associated with a decreased risk of infection, and in many cases exposed patients to unnecessarily broad and prolonged antibiotic regimens.
Collapse
Affiliation(s)
- Anna Augostini
- Department of Pharmacy, Veterans Affairs Western New York Healthcare System, Buffalo, NY
| | - Bethany A Wattengel
- Department of Pharmacy, Veterans Affairs Western New York Healthcare System, Buffalo, NY
| | - Kari A Mergenhagen
- Department of Pharmacy, Veterans Affairs Western New York Healthcare System, Buffalo, NY.
| |
Collapse
|
2
|
Dariane C, Chierigo F, Ouellet V, Delvoye N, Jammal MP, Bégin LR, Paradis JB, Mes-Masson AM, Karakiewicz PI, Saad F. Analysis of active surveillance uptake for localized prostate cancer in Quebec in 2016: A Canadian bicentric study and comparison with 2010 data. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102544. [PMID: 37858379 DOI: 10.1016/j.purol.2023.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/28/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Active surveillance (AS) has emerged as a primary management strategy for low-risk prostate cancer (PC) patients. We aimed to assess AS uptake over a 1-year snapshot throughout Quebec and to compare it to 2010 multicentric Canadian data. METHODS A retrospective chart review and data collection was performed in 1 academic and 2 non-academic community centres from Quebec, among men identified in 2016 with localized T1c-T2c PC on biopsy, fulfilling NCCN criteria of low-risk (LR)-PC, including very-low-risk (VLR) and non-VLR-PC, and favourable-intermediate risk (FIR)-PC. AS adherence was defined when chosen as initial strategy, without any radical treatment within 6 months. RESULTS Overall, 259 patients fulfilled the inclusion criteria with 50.2% of VLR-PC patients. At 6 months, 81% patients in the LR group and 65% in the FIR group were considered as adherent to AS, in both centres, but with an increased use of AS in the community centres compared to 2010 data. The rates of AS maintenance decreased at 12 months to respectively 69% and 58%. Among the VLR group, the rate of initiation was 98% and decreased to 85% at 12 months. CONCLUSION Our data suggest that the majority of low-risk PC patients indeed initiated an AS in 2016, with even a greater proportion of VLR-PC patients compared to 2010. This ideal strategy should be encouraged and improved at 12 months, and assessed with recent data and longer follow-up. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- C Dariane
- Institut du cancer de Montréal, centre de recherche du centre hospitalier de l'université de Montréal (CRCHUM), Montréal, Canada; Department of Urology, hôpital européen Georges-Pompidou, Paris University, 20, rue Leblanc, 75015 Paris, France.
| | - F Chierigo
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Canada
| | - V Ouellet
- Institut du cancer de Montréal, centre de recherche du centre hospitalier de l'université de Montréal (CRCHUM), Montréal, Canada
| | - N Delvoye
- Institut du cancer de Montréal, centre de recherche du centre hospitalier de l'université de Montréal (CRCHUM), Montréal, Canada
| | - M-P Jammal
- Centre de santé et des services sociaux de Laval, Laval, QC, Canada
| | - L R Bégin
- Centre intégré de santé et des services sociaux des Laurentides, St-Eustache, QC, Canada
| | - J-B Paradis
- Centre de santé et des services sociaux de Chicoutimi, Chicoutimi, QC, Canada
| | - A-M Mes-Masson
- Institut du cancer de Montréal, centre de recherche du centre hospitalier de l'université de Montréal (CRCHUM), Montréal, Canada
| | - P I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Canada
| | - F Saad
- Institut du cancer de Montréal, centre de recherche du centre hospitalier de l'université de Montréal (CRCHUM), Montréal, Canada; Department of Surgery, Division of Urology, centre hospitalier de l'université de Montréal (CHUM), Montréal, Canada
| |
Collapse
|
3
|
de Oliveira RAR, Guimarães GC, Mourão TC, Favaretto RDL, Santana TBM, Lopes A, Zequi SDC. Prostate Cancer Screening in Brazil: a single center experience in the public health system. Int Braz J Urol 2021; 47:558-565. [PMID: 33621004 PMCID: PMC7993978 DOI: 10.1590/s1677-5538.ibju.2020.0392] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/10/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Incidence and mortality of prostate cancer (PCa) are still increasing in developing countries. Limited access to the health system or more aggressive disease are potential reasons for this. Ethnic and social differences in developed countries seem to make inappropriate to extrapolate data from other centers. We aim to report the epidemiological profile of a PSA-screened population from a cancer center in Brazil. MATERIALS AND METHODS We retrospectively selected 9.692 men enrolled in a PCa prevention program, comprising total PSA level and digital rectal examination at the first appointment, associated with complementary tests when necessary. Men aged over 40 years-old were included after shared decision-making process. Prostate biopsy (TRUS) was performed when clinically suspected for PCa. After the diagnosis, patients underwent appropriate treatment. RESULTS TRUS was performed in 5.5% of men and PCa incidence was 2.6%. Overall ratio between number of patients who needed to be screened in order to diagnose one cancer was 38.9 patients, with 2.1 biopsies performed to diagnose a cancer. Positive predictive value (PPV) of TRUS biopsy in this strategy was 47.2%, varying from 38.5% (<50 years-old) to 60% (>80 years-old). We evidenced 70 patients (27.9%) classified as low risk tumors, 74 (29.5%) as intermediate risk, and 107 (42.6%) as high-risk disease. CONCLUSIONS PSA-screening remains controversial in literature. In front of a huge miscegenated people and considering the big proportion of high-risk PCa, even in young men diagnosed with the disease, it is imperative to inform patients and health providers about these data particularities in Brazil.
Collapse
Affiliation(s)
- Renato Almeida Rosa de Oliveira
- Hospital Beneficência Portuguesa de São PauloDepartamento de Uro-OncologiaSão PauloSPBrasilDepartamento de Uro-Oncologia, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil
- AC Camargo Cancer CenterDivisão de UrologiaSão PauloSPBrasilDivisão de Urologia, AC Camargo Cancer Center, São Paulo, SP, Brasil
| | - Gustavo Cardoso Guimarães
- Hospital Beneficência Portuguesa de São PauloSão PauloSPBrasilServiço de Oncologia Cirúrgica, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil
| | - Thiago Camelo Mourão
- Hospital Beneficência Portuguesa de São PauloDepartamento de Uro-OncologiaSão PauloSPBrasilDepartamento de Uro-Oncologia, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil
| | - Ricardo de Lima Favaretto
- Hospital Beneficência Portuguesa de São PauloDepartamento de Uro-OncologiaSão PauloSPBrasilDepartamento de Uro-Oncologia, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil
| | - Thiago Borges Marques Santana
- Hospital Beneficência Portuguesa de São PauloDepartamento de Uro-OncologiaSão PauloSPBrasilDepartamento de Uro-Oncologia, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil
- AC Camargo Cancer CenterDivisão de UrologiaSão PauloSPBrasilDivisão de Urologia, AC Camargo Cancer Center, São Paulo, SP, Brasil
| | - Ademar Lopes
- AC Camargo Cancer CenterSão PauloSPBrasilServiço de Cirurgia Pélvica do AC Camargo Cancer Center, São Paulo, SP, Brasil
| | - Stenio de Cassio Zequi
- AC Camargo Cancer CenterDivisão de UrologiaSão PauloSPBrasilDivisão de Urologia, AC Camargo Cancer Center, São Paulo, SP, Brasil
- AC Camargo Cancer CenterSão PauloSPBrasilServiço de Cirurgia Pélvica do AC Camargo Cancer Center, São Paulo, SP, Brasil
| |
Collapse
|
4
|
Ajami T, Durruty J, Mercader C, Rodriguez L, Ribal MJ, Alcaraz A, Vilaseca A. Impact on prostate cancer clinical presentation after non-screening policies at a tertiary-care medical center- a retrospective study. BMC Urol 2021; 21:20. [PMID: 33557801 PMCID: PMC7871577 DOI: 10.1186/s12894-021-00784-w] [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: 09/24/2020] [Accepted: 01/22/2021] [Indexed: 12/30/2022] Open
Abstract
Background In May 2012 the US Preventive Task Force issued a ‘D’ recommendation against routine PSA-based early detection of prostate cancer. This recommendation was implemented progressively in our health system. The aim of this study is to define its impact on prostate cancer staging at a tertiary care institution. Methods A retrospective analysis was performed from 2012 until 2015 at a single center. We analyzed the total number of biopsies performed per year and the positive biopsy rate. For those patients with positive biopsies we recorded diagnostic PSA, clinical stage, ISUP grade group, nodal involvement and metastatic status at diagnosis. Results A total of 1686 biopsies were analyzed. The positive biopsy rate increased from 25% in 2012 to 40% in 2015 (p < 0.05). No change in median PSA was noticed (p = 0.627). The biopsies detected higher ISUP grades (p = 0.000). In addition, newly diagnosed prostate cancer presented a higher clinical stage (p = 0.005), higher metastatic rates (p = 0.03) and a tendency to higher lymph node involvement although not statistically significant (p = 0.09). Conclusion After the 2012 recommendation, patients presented a higher probability of a prostate cancer diagnosis, with a more adverse ISUP group, clinical stage and metastatic disease. These results should be taken into consideration to implement a risk adapted strategy for prostate cancer screening.
Collapse
Affiliation(s)
- Tarek Ajami
- Urology Department, Hospital Clínic de Barcelona, C/ Villarroel, 170, 08036, Barcelona, Spain
| | - Jaime Durruty
- Urology Department, Hospital Fuerza Aérea de Chile, Santiago, Chile
| | - Claudia Mercader
- Urology Department, Hospital Clínic de Barcelona, C/ Villarroel, 170, 08036, Barcelona, Spain
| | | | - Maria J Ribal
- Urology Department, Hospital Clínic de Barcelona, C/ Villarroel, 170, 08036, Barcelona, Spain
| | - Antonio Alcaraz
- Urology Department, Hospital Clínic de Barcelona, C/ Villarroel, 170, 08036, Barcelona, Spain
| | - Antoni Vilaseca
- Urology Department, Hospital Clínic de Barcelona, C/ Villarroel, 170, 08036, Barcelona, Spain.
| |
Collapse
|
5
|
Clements MB, Abdalla B, Culp SH, Costabile RA, Krupski TL. Prostate Cancer Characteristics in the US Preventive Services Task Force Grade D Era: A Single-Center Study and Meta-Analysis. Urol Int 2020; 104:692-698. [PMID: 32759606 DOI: 10.1159/000507656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 03/20/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND In May 2012, the US Preventive Services Task Force assigned prostate-specific antigen-based screening a grade D recommendation, advising against screening at any age. Our objective was to compare prostate cancer characteristics pre- and post-recommendation with an adjusted analysis of our data and a pooled analysis including other primary data sources. METHODS We identified all incident prostate cancer diagnoses at our institution from 2007 to 2016. Multivariable log binomial regression was used to determine the relative risk (RR) of metastasis at diagnosis, ≥Gleason Group 4, and high D'Amico risk disease pre- versus post-recommendation. The meta-analysis included primary data studies evaluating these outcomes. RESULTS At our institution, 287 (44.6%) and 224 (48.8%) patients were diagnosed in the pre- and post-cohorts. The RR of metastatic disease at diagnosis did not differ between groups (p = 0.224), nor did the risk of high D'Amico category disease (p = 0.089). The risk of ≥Gleason Group 4 was 1.58 times higher post-recommendation (p = 0.007). The pooled risk of ≥Gleason Group 4 disease was 1.5 (p < 0.001) post-recommendation and was 1.29 (p = 0.006) for high D'Amico risk disease. CONCLUSIONS While the number of metastatic cases did not differ after the recommendation, the risk of high-grade cancers increased at both a local and aggregated level.
Collapse
Affiliation(s)
- Matthew B Clements
- Department of Urology, University of Virginia, Charlottesville, Virginia, USA,
| | - Basil Abdalla
- Department of Urology, University of Virginia, Charlottesville, Virginia, USA
| | - Stephen H Culp
- Department of Urology, University of Virginia, Charlottesville, Virginia, USA
| | - Raymond A Costabile
- Department of Urology, University of Virginia, Charlottesville, Virginia, USA
| | - Tracey L Krupski
- Department of Urology, University of Virginia, Charlottesville, Virginia, USA
| |
Collapse
|
6
|
Leong JY, Chandrasekar T, Berlin A, Klaassen Z, Wallis CJ, Ahmad AE, Herrera-Caceres JO, Perlis N, Fleshner NE, Goldberg H. Predictors of prostate-specific antigen testing in men aged ≥55 years: A cross-sectional study based on patient-reported outcomes. Int J Urol 2020; 27:711-718. [PMID: 32476206 DOI: 10.1111/iju.14276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 04/29/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To examine the predictors of prostate-specific antigen discussion with a physician and prostate-specific antigen testing in men aged ≥55 years. METHODS Utilizing the USA Health Information National Trends Survey, 4th Ed., a cross-sectional study from 2011 to 2014 was carried out to analyze the factors predicting prostate-specific antigen testing and discussion in men ≥55 years. Associations between each covariate and prostate-specific antigen discussion/testing were determined. Multivariable logistic regression models were used to determine clinically relevant predictors of prostate-specific antigen discussion/testing. Due to multiple comparisons, the Bonferroni correction was used. RESULTS A total of 2731 men included in the Health Information National Trends Survey were analyzed. Several socioeconomic parameters were found to increase the likelihood of men aged ≥55 years to undergo prostate-specific antigen testing: living with a spouse, a higher level of education (college graduate or above), a higher income (>$50 000 annually) and previous history of any cancer. In contrast, current smokers were less likely to undergo prostate-specific antigen testing. Having a prostate-specific antigen discussion with a physician was more likely for men surveyed in 2014, for men who were living with a spouse, who had a higher annual income (>$50 000 annually) and those with a history of any cancer. CONCLUSIONS Significant inequalities in prostate-specific antigen testing and discussion exist among men in the USA, mainly driven by socioeconomic factors. Ideally, prostate-specific antigen testing and discussion should be based on relevant clinical factors with a shared decision-making approach for every man. Therefore, a better understanding of the socioeconomic factors influencing prostate-specific antigen testing/discussions can inform strategies to reduce existing gaps in care.
Collapse
Affiliation(s)
- Joon Yau Leong
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Thenappan Chandrasekar
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alejandro Berlin
- Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Zachary Klaassen
- Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA.,Georgia Cancer Center, Augusta, Georgia, USA
| | - Christopher Jd Wallis
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Ardalan E Ahmad
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Jaime O Herrera-Caceres
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Nathan Perlis
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Neil E Fleshner
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Hanan Goldberg
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada.,Department of Urology, SUNY Upstate Medical University, Syracuse, New York, USA
| |
Collapse
|
7
|
Changes in Prostate Cancer Presentation Following the 2012 USPSTF Screening Statement: Observational Study in a Multispecialty Group Practice. J Gen Intern Med 2020; 35:1368-1374. [PMID: 31820217 PMCID: PMC7210336 DOI: 10.1007/s11606-019-05561-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 07/19/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In 2012, the US Preventive Services Task Force (USPSTF) recommended against PSA-based screening for prostate cancer in men of all ages. Following this change, screening declined yet the complete impact on clinical presentation is not well defined in the screen-eligible population. OBJECTIVE To determine if the rates of PSA screening, prostate biopsy, incident prostate cancer detection, and stage IV at presentation in screen-eligible men in Kaiser Permanente Northern California changed following the 2012 USPSTF Prostate Cancer Screening recommendations. DESIGN Retrospective study spanning the years 2010 to 2015, in screen-eligible Kaiser Permanente Northern California members (African American men ages 45-69 and all other men ages 50-69) with no prior history of prostate cancer. Participants All screen-eligible, male members during 2010 (n = 403,931) to 2015 (n = 483,286) without a history of prostate cancer within all Kaiser Permanente Northern California facilities. MAIN MEASURES Annual rates of PSA testing, prostate biopsy, incident prostate cancer detection, and stage IV cancer at presentation were compared between the pre-guideline period, 2010 and 2011, and the post-guideline period, 2014 and 2015, in men under the age of 70. KEY RESULTS Following the 2012 USPSTF guideline change, screening rates declined 23.4% (95% CI 23.0-23.8%), biopsy rates declined 64.3% (95% CI 62.9-65.6%), and incident prostate cancer detection rates declined 53.5% (95% CI 50.1-56.7%) resulting in 1871 fewer incident cancers detected, and metastatic cancer rates increased 36.9% (95% CI 9.5-71.0%) resulting in 75 more stage IV cancers detected. CONCLUSION Less screening resulted in a large decrease in cancer detection, some of which may be beneficial as many cancers may be indolent, yet this decrease occurred at the expense of an increase in metastatic cancer rates. For every 25 fewer cancers detected, one metastatic cancer was diagnosed. This information may be valuable in the shared decision-making process around prostate cancer screening.
Collapse
|
8
|
Seetharam Bhat KR, Moschovas MC, Onol FF, Sandri M, Rogers T, Roof S, Rocco B, Patel VR. Trends in clinical and oncological outcomes of robot-assisted radical prostatectomy before and after the 2012 US Preventive Services Task Force recommendation against PSA screening: a decade of experience. BJU Int 2020; 125:884-892. [PMID: 32173990 DOI: 10.1111/bju.15051] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the influence of the 2012 US Preventive Services Task Force (USPSTF) recommendation against prostate-specific antigen (PSA)-based screening on oncological and functional outcomes following robot-assisted laparoscopic prostatectomy (RALP). MATERIALS AND METHODS We retrospectively analysed patients who underwent RALP between 2008 and 2018 with a minimum of 12-month follow-up from a prospectively collected institutional review board-approved database. The impact of the USPSTF recommendation against PSA screening on our surgical outcomes was assessed using a logistic regression model using two groups comprising patients treated before/after the USPSTF statement and indicating time trends for each successive year. RESULTS The mean preoperative PSA increased from 6.0 to 7.4 ng/mL after the USPSTF recommendation. We detected statistically significant time-trend changes after 2012, including an increase in the positive slope of Gleason ≥3 + 4 or ≥pT3 disease. We detected a fall in bilateral full nerve-sparing and an increase in partial nerve-sparing. The total positive surgical margin (PSM) rate increased after the USPSTF recommendation; however, PSM rates pertinent to each pathological stage did not change significantly after 2012. There was a significant negative trend change in the postoperative 12-month continence and potency rates, indicating a breakpoint in functional outcomes after 2012. We detected a 1.7-fold increase in 12-month biochemical recurrence (BCR) rates. The 12-month BCR, potency and continence rates were maintained in young (<55 years) patients with a Sexual Health Inventory for Men score >22 and low-volume disease. CONCLUSION Since the USPSTF's recommendation in 2012, we have seen a significant increase in the incidence of high-risk disease that has forced us to modify our approach to the procedure and the grade of nerve-sparing used, leading to a wider resection, in order to reduce PSMs. This has led to a decrease in postoperative functional recovery. Patients with favourable characteristics had good outcomes before and after the USPSTF's recommendation, implying that the quality of surgery did not change over time.
Collapse
Affiliation(s)
| | | | - Fikret F Onol
- Global Robotics Institute, Advent Health Celebration Health, Celebration, FL, USA
| | - Marco Sandri
- Data Methods and Systems Statistical Laboratory, University of Brescia, Brescia, Italy
| | - Travis Rogers
- Global Robotics Institute, Advent Health Celebration Health, Celebration, FL, USA
| | - Shannon Roof
- Global Robotics Institute, Advent Health Celebration Health, Celebration, FL, USA
| | - Bernardo Rocco
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Vipul R Patel
- Global Robotics Institute, Advent Health Celebration Health, Celebration, FL, USA
| |
Collapse
|
9
|
Roberts MJ, Papa N, Perera M, Joshi A, Scott S, Bolton D, Lawrentschuk N, Yaxley J. Declining use of radical prostatectomy and pelvic lymphadenectomy despite more robotics: National population data over 15 years. Asia Pac J Clin Oncol 2020; 16:e118-e124. [DOI: 10.1111/ajco.13158] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 04/22/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Matthew J. Roberts
- Faculty of MedicineThe University of Queensland Brisbane Australia
- Department of UrologyPrincess Alexandra Hospital Brisbane Australia
| | - Nathan Papa
- Cancer Epidemiology CentreCancer Council Victoria Melbourne Australia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global HealthThe University of Melbourne Melbourne Australia
- University of MelbourneDepartment of Surgery, Austin Health Melbourne Australia
| | - Marlon Perera
- Faculty of MedicineThe University of Queensland Brisbane Australia
- Department of UrologyPrincess Alexandra Hospital Brisbane Australia
- University of MelbourneDepartment of Surgery, Austin Health Melbourne Australia
| | - Andre Joshi
- Department of UrologyPrincess Alexandra Hospital Brisbane Australia
| | - Susan Scott
- Faculty of MedicineThe University of Queensland Brisbane Australia
| | - Damien Bolton
- University of MelbourneDepartment of Surgery, Austin Health Melbourne Australia
- EJ Whitten Prostate Cancer Research Centre at Epworth Healthcare Melbourne Australia
| | - Nathan Lawrentschuk
- University of MelbourneDepartment of Surgery, Austin Health Melbourne Australia
- EJ Whitten Prostate Cancer Research Centre at Epworth Healthcare Melbourne Australia
- Department of Surgical OncologyPeter MacCallum Cancer Institute Melbourne Australia
| | - John Yaxley
- Faculty of MedicineThe University of Queensland Brisbane Australia
- Department of UrologyRoyal Brisbane and Women's Hospital Brisbane Australia
| |
Collapse
|
10
|
Yamada Y, Sakamoto S, Amiya Y, Sasaki M, Shima T, Komiya A, Suzuki N, Akakura K, Ichikawa T, Nakatsu H. Treatment strategy for metastatic prostate cancer with extremely high PSA level: reconsidering the value of vintage therapy. Asian J Androl 2019; 20:432-437. [PMID: 29735818 PMCID: PMC6116678 DOI: 10.4103/aja.aja_24_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The prognostic significance of initial prostate-specific antigen (PSA) level for metastatic prostate cancer remains uncertain. We investigated the differences in prognosis and response to hormonal therapies of metastatic prostate cancer patients according to initial PSA levels. We analyzed 184 patients diagnosed with metastatic prostate cancer and divided them into three PSA level groups as follows: low (<100 ng ml−1), intermediate (100–999 ng ml−1), and high (≥1000 ng ml−1). All patients received androgen deprivation therapy (ADT) immediately. We investigated PSA progression-free survival (PFS) for first-line ADT and overall survival (OS) within each of the three groups. Furthermore, we analyzed response to antiandrogen withdrawal (AW) and alternative antiandrogen (AA) therapies after development of castration-resistant prostate cancer (CRPC). No significant differences in OS were observed among the three groups (P = 0.654). Patients with high PSA levels had significantly short PFS for first-line ADT (P = 0.037). Conversely, patients in the high PSA level group had significantly longer PFS when treated with AW than those in the low PSA level group (P = 0.047). Furthermore, patients with high PSA levels had significantly longer PFS when provided with AA therapy (P = 0.049). PSA responders to AW and AA therapies had significantly longer survival after CRPC development than nonresponders (P = 0.011 and P < 0.001, respectively). Thus, extremely high PSA level predicted favorable response to vintage sequential ADT and AW. The current data suggest a novel aspect of extremely high PSA value as a favorable prognostic marker after development of CRPC.
Collapse
Affiliation(s)
- Yasutaka Yamada
- Department of Urology, Asahi General Hospital, Asahi 289-2511, Japan.,Department of Urology, Chiba University Graduate School of Medicine, Chiba 260-8677, Japan
| | - Shinichi Sakamoto
- Department of Urology, Chiba University Graduate School of Medicine, Chiba 260-8677, Japan
| | - Yoshiyasu Amiya
- Department of Urology, Asahi General Hospital, Asahi 289-2511, Japan
| | - Makoto Sasaki
- Department of Urology, Asahi General Hospital, Asahi 289-2511, Japan
| | - Takayuki Shima
- Department of Urology, Asahi General Hospital, Asahi 289-2511, Japan
| | - Akira Komiya
- Department of Urology, Chiba University Graduate School of Medicine, Chiba 260-8677, Japan
| | - Noriyuki Suzuki
- Department of Urology, Asahi General Hospital, Asahi 289-2511, Japan
| | - Koichiro Akakura
- Department of Urology, Japan Community Healthcare Organization Tokyo Shinjuku Medical Center, Tokyo 162-8543, Japan
| | - Tomohiko Ichikawa
- Department of Urology, Chiba University Graduate School of Medicine, Chiba 260-8677, Japan
| | - Hiroomi Nakatsu
- Department of Urology, Asahi General Hospital, Asahi 289-2511, Japan
| |
Collapse
|
11
|
Abstract
The field of prostate cancer has been the subject of extensive research that has resulted in important discoveries and shaped our appreciation of this disease and its management. Advances in our understanding of the epidemiology, natural history, anatomy, detection, diagnosis, grading, staging, imaging, and management of prostate cancer have changed clinical practice and influenced guideline recommendations. The development of the Gleason score and subsequent modifications enabled accurate prediction of prognosis. Increased anatomical understanding and improved surgical techniques resulted in the development of nerve-sparing surgery for radical prostatectomy. The advent of active surveillance has changed the management of low-risk disease, and chemotherapy and hormonal therapy have improved the outcomes of patients with distant disease. Ongoing research and clinical trials are expected to yield more practice-changing results in the near future.
Collapse
|
12
|
Index tumor volume on MRI as a predictor of clinical and pathologic outcomes following radical prostatectomy. Int Urol Nephrol 2019; 51:1349-1355. [PMID: 31098818 DOI: 10.1007/s11255-019-02168-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/07/2019] [Indexed: 01/30/2023]
Abstract
PURPOSE Index tumor volume (ITV) measured on radical prostatectomy (RP) specimens has been shown to be associated with adverse pathologic and oncologic outcomes. We evaluate the value of ITV calculated from prostate multiparametric MRI (mpMRI) in predicting adverse clinical and pathologic outcomes. MATERIALS AND METHODS Data from a prospectively maintained, single-institution database were analyzed for patients who underwent mpMRI prior to RP (2007-2016). Index tumor was defined as a T2-visible lesion with the longest diameter. Adverse pathologic outcomes were extraprostatic extension (EPE), lymph node invasion (LNI), seminal vesicle invasion (SVI), and positive margins (PM). Logistic and Cox proportional hazard regression were used to assess associations with adverse pathology and biochemical recurrence (BCR), respectively. RESULTS Of the 455 patients included, EPE, LNI, SVI and PM were present in 23.5%, 6.2%, 5.5% and 15.7% patients, respectively. Patients with adverse pathologic outcomes had larger median ITV. ITV was found to be an independent predictor of EPE (OR 1.22, p = 0.010), LNI (OR 1.39, p = 0.001), and SVI (OR 1.28, p = 0.009), but not PM (OR 1.03, p = 0.522). Combination of ITV and PSA was found to have predictive ability comparable to that of modified Partin tables (EPE:ITV + PSAAUC = 0.71 vs. PartinAUC = 0.71; LNI:ITV + PSAAUC = 0.92 vs. PartinAUC = 0.90, SVI:ITV + PSAAUC = 0.78 vs. PartinAUC = 0.82). 5 year BCR-free survival (median follow-up 24.9 months) was higher for patients with ITV < 2 cc (84.1% vs. 58.5%, p = 0.001). However, ITV was not found to be an independent predictor of BCR (HR 1.69, p = 0.130). CONCLUSIONS We demonstrate that ITV measured on mpMRI is a predictor of adverse pathologic and clinical outcomes and can aid in preoperative risk assessment.
Collapse
|
13
|
Antonelli A, Francavilla S, Gallotta A, Da Pozzo LF, Ferretti S, Sigala S, Simeone C, Mirone V, Artibani W, Porreca A. Current evidence and future perspectives about the role of iXip® in the diagnosis of prostate cancer. MINERVA UROL NEFROL 2019; 71:201-204. [DOI: 10.23736/s0393-2249.19.03329-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
14
|
Leapman MS, Wang R, Park HS, Yu JB, Weinreb JC, Gross CP, Ma X. AUTHOR REPLY. Urology 2019; 124:106. [PMID: 30784707 DOI: 10.1016/j.urology.2018.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 06/24/2018] [Accepted: 07/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Michael S Leapman
- Department of Urology, Yale School of Medicine, New Haven, CT; Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - Rong Wang
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Henry S Park
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT; Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
| | - James B Yu
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT; Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
| | - Jeffrey C Weinreb
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
| | - Cary P Gross
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| |
Collapse
|
15
|
Zlotta AR, Kuk C. Further Evidence of Differences in Prostate Cancer Biomarkers Between Caucasian and Asian Men. Eur Urol 2019; 75:562-563. [PMID: 30642612 DOI: 10.1016/j.eururo.2018.12.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/20/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Alexandre R Zlotta
- Department of Surgery, Urology Division, Sinai Health System, Toronto, Canada; Department of Surgical Oncology, Urology Division, University Health Network, Toronto, Canada.
| | - Cynthia Kuk
- Department of Surgery, Urology Division, Sinai Health System, Toronto, Canada; Department of Surgical Oncology, Urology Division, University Health Network, Toronto, Canada
| |
Collapse
|
16
|
Gennaro KH, Porter KK, Gordetsky JB, Galgano SJ, Rais-Bahrami S. Imaging as a Personalized Biomarker for Prostate Cancer Risk Stratification. Diagnostics (Basel) 2018; 8:diagnostics8040080. [PMID: 30513602 PMCID: PMC6316045 DOI: 10.3390/diagnostics8040080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/13/2018] [Accepted: 11/15/2018] [Indexed: 02/07/2023] Open
Abstract
Biomarkers provide objective data to guide clinicians in disease management. Prostate-specific antigen serves as a biomarker for screening of prostate cancer but has come under scrutiny for detection of clinically indolent disease. Multiple imaging techniques demonstrate promising results for diagnosing, staging, and determining definitive management of prostate cancer. One such modality, multiparametric magnetic resonance imaging (mpMRI), detects more clinically significant disease while missing lower volume and clinically insignificant disease. It also provides valuable information regarding tumor characteristics such as location and extraprostatic extension to guide surgical planning. Information from mpMRI may also help patients avoid unnecessary biopsies in the future. It can also be incorporated into targeted biopsies as well as following patients on active surveillance. Other novel techniques have also been developed to detect metastatic disease with advantages over traditional computer tomography and magnetic resonance imaging, which primarily rely on defined size criteria. These new techniques take advantage of underlying biological changes in prostate cancer tissue to identify metastatic disease. The purpose of this review is to present literature on imaging as a personalized biomarker for prostate cancer risk stratification.
Collapse
Affiliation(s)
- Kyle H Gennaro
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Jennifer B Gordetsky
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Samuel J Galgano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| |
Collapse
|
17
|
Zhao F, Olkhov-Mitsel E, Kamdar S, Jeyapala R, Garcia J, Hurst R, Hanna MY, Mills R, Tuzova AV, O'Reilly E, Kelly S, Cooper C, Brewer D, Perry AS, Clark J, Fleshner N, Bapat B. A urine-based DNA methylation assay, ProCUrE, to identify clinically significant prostate cancer. Clin Epigenetics 2018; 10:147. [PMID: 30470249 PMCID: PMC6260648 DOI: 10.1186/s13148-018-0575-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/28/2018] [Indexed: 12/12/2022] Open
Abstract
Background Prevention of unnecessary biopsies and overtreatment of indolent disease remains a challenge in the management of prostate cancer. Novel non-invasive tests that can identify clinically significant (intermediate-risk and high-risk) diseases are needed to improve risk stratification and monitoring of prostate cancer patients. Here, we investigated a panel of six DNA methylation biomarkers in urine samples collected post-digital rectal exam from patients undergoing prostate biopsy, for their utility to guide decision making for diagnostic biopsy and early detection of aggressive prostate cancer. Results We recruited 408 patients in risk categories ranging from benign to low-, intermediate-, and high-risk prostate cancer from three international cohorts. Patients were separated into 2/3 training and 1/3 validation cohorts. Methylation biomarkers were analyzed in post-digital rectal exam urinary sediment DNA by quantitative MethyLight assay and investigated for their association with any or aggressive prostate cancers. We developed a Prostate Cancer Urinary Epigenetic (ProCUrE) assay based on an optimal two-gene (HOXD3 and GSTP1) LASSO model, derived from methylation values in the training cohort, and assessed ProCUrE’s diagnostic and prognostic ability for prostate cancer in both the training and validation cohorts. ProCUrE demonstrated improved prostate cancer diagnosis and identification of patients with clinically significant disease in both the training and validation cohorts. Using three different risk stratification criteria (Gleason score, D’Amico criteria, and CAPRA score), we found that the positive predictive value for ProCUrE was higher (59.4–78%) than prostate specific antigen (PSA) (38.2–72.1%) for all risk category comparisons. ProCUrE also demonstrated additive value to PSA in identifying GS ≥ 7 PCa compared to PSA alone (DeLong’s test p = 0.039), as well as additive value to the PCPT risk calculator for identifying any PCa and GS ≥ 7 PCa (DeLong’s test p = 0.011 and 0.022, respectively). Conclusions ProCUrE is a promising non-invasive urinary methylation assay for the early detection and prognostication of prostate cancer. ProCUrE has the potential to supplement PSA testing to identify patients with clinically significant prostate cancer. Electronic supplementary material The online version of this article (10.1186/s13148-018-0575-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Fang Zhao
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada.,Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Canada
| | - Ekaterina Olkhov-Mitsel
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada.,Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Canada
| | - Shivani Kamdar
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada.,Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Canada
| | - Renu Jeyapala
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Julia Garcia
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Rachel Hurst
- Schools of Medicine and Biological Sciences, University of East Anglia, Norwich, Norfolk, UK
| | | | - Robert Mills
- Schools of Medicine and Biological Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Alexandra V Tuzova
- Cancer Biology and Therapeutics Laboratory, School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin 4, Ireland
| | - Eve O'Reilly
- Cancer Biology and Therapeutics Laboratory, School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin 4, Ireland
| | - Sarah Kelly
- Cancer Biology and Therapeutics Laboratory, School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin 4, Ireland
| | - Colin Cooper
- Schools of Medicine and Biological Sciences, University of East Anglia, Norwich, Norfolk, UK
| | | | - Daniel Brewer
- Schools of Medicine and Biological Sciences, University of East Anglia, Norwich, Norfolk, UK.,The Earlham Institute, Norwich, Norfolk, UK
| | - Antoinette S Perry
- Cancer Biology and Therapeutics Laboratory, School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin 4, Ireland
| | - Jeremy Clark
- Schools of Medicine and Biological Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Neil Fleshner
- Division of Urology, University Health Network, University of Toronto, Toronto, Canada
| | - Bharati Bapat
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada. .,Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Canada. .,Division of Urology, University Health Network, University of Toronto, Toronto, Canada.
| |
Collapse
|
18
|
Seniority of primary care physicians is associated with a decrease in PSA ordering habits in the years surrounding the United States Preventative Services Task Force recommendation against PSA screening. Urol Oncol 2018; 36:500.e21-500.e27. [DOI: 10.1016/j.urolonc.2018.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/25/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
|
19
|
Zakaria AS, Dragomir A, Brimo F, Kassouf W, Tanguay S, Aprikian A. Changes in the outcome of prostate biopsies after preventive task force recommendation against prostate-specific antigen screening. BMC Urol 2018; 18:69. [PMID: 30126402 PMCID: PMC6102901 DOI: 10.1186/s12894-018-0384-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/13/2018] [Indexed: 11/23/2022] Open
Abstract
Background The benefits of PSA-based screening for prostate cancer (PCa) are controversial. The Canadian and American Task Forces on Preventive Health Care (CTFPHC & USPSTF) have released recommendations against the use of routine PSA-based screening for any men. We thought to assess the impact of these recommendations on the outcomes and trends of prostate needle biopsies. Methods A complete chart review was conducted for all men who received prostate needle biopsies at McGill University Health Center between 2010 and 2016. Of those, we included 1425 patients diagnosed with PCa for analysis. We Compared 2 groups of patients (pre and post recommendations’ release date) using Welch’s t-tests and Chi-square test. A multivariate logistic regression model was used to analyze variables predicting worse pathological outcomes. Results When the release date of the USPSTF draft (October 2011) was used as a cut-off, we found an average annual decrease of 10.6% in the total number of biopsies. The median (IQR) baseline PSA levels were higher in post-recommendations group (n = 977) when compared to pre-recommendations group (n = 448) [8 ng/ml (5.7–12.9) versus 6.4 ng/ml (4.9–10.1), respectively. P = 0.0007]. Also, post-recommendations group’s patients had higher Gleason score (G7: 35.4% versus 28.4% and G8-G10: 31.2% versus 18.1%, respectively. P < 0.0001). Moreover, they had higher intermediate and high-risk PCa classification (36.4% versus 32.8% and 35.5% versus 22.1%, respectively. P < 0.0001). The recommendations release date was an independent variable associated with higher Gleason score in prostate biopsies (OR: 2.006, 95%CI: 1.477–2.725). Using the CTFPHC recommendations release date (October 2014) as a cut-off in further analysis, revealed similar results. Conclusions Our results revealed a reduction in the number of prostate needle biopsies performed over time after the recommendations of the preventive task forces. Furthermore, it showed a significant relative increase in the higher risk PCa diagnosis. The oncological outcomes associated with this trend need to be examined in further studies.
Collapse
Affiliation(s)
- Ahmed S Zakaria
- Department of Surgery, Division of Urology, McGill University, McGill University Health Centre, 1001 Boulevard Decarie, Montreal, Quebec, H4A 3J1, Canada
| | - Alice Dragomir
- Department of Surgery, Division of Urology, McGill University, McGill University Health Centre, 1001 Boulevard Decarie, Montreal, Quebec, H4A 3J1, Canada
| | - Fadi Brimo
- Department of Pathology, McGill University, Montreal, Quebec, Canada
| | - Wassim Kassouf
- Department of Surgery, Division of Urology, McGill University, McGill University Health Centre, 1001 Boulevard Decarie, Montreal, Quebec, H4A 3J1, Canada
| | - Simon Tanguay
- Department of Surgery, Division of Urology, McGill University, McGill University Health Centre, 1001 Boulevard Decarie, Montreal, Quebec, H4A 3J1, Canada
| | - Armen Aprikian
- Department of Surgery, Division of Urology, McGill University, McGill University Health Centre, 1001 Boulevard Decarie, Montreal, Quebec, H4A 3J1, Canada.
| |
Collapse
|
20
|
Wang LL, Begashaw K, Evans M, Earnest A, Evans SM, Millar JL, Murphy DG, Moon D. Patterns of care and outcomes for men diagnosed with prostate cancer in Victoria: an update. ANZ J Surg 2018; 88:1037-1042. [PMID: 30047208 DOI: 10.1111/ans.14722] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 04/09/2018] [Accepted: 05/09/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND To update patterns of care for men diagnosed with prostate cancer in Victoria, Australia between 2008 and 2015. METHODS From August 2008 to December 2015, 14 025 men diagnosed with prostate cancer were included. These data were obtained from the Prostate Cancer Outcome Registry - Victoria (PCOR-Vic). Frequencies were used to describe hospital and patient characteristics and treatment types. Comparisons were made between previous period of analysis (2008-2011) to the most recent period (2011-2015). Survival analysis using a stepwise Cox proportional hazards regression model was performed. RESULTS Mean age of diagnosis was 66.5 years and 44% of patients were diagnosed with Gleason 7 prostate cancer. Majority of notifications (63.6%) were received from a private institution and 70.2% of patients were diagnosed at a metropolitan institution. Most patients (95.3%) were diagnosed with clinically localized disease. Within 12 months of diagnosis, 55.9% of patients with low-risk disease received no active treatment. Radical prostatectomy was the most common primary treatment with curative intent (47%). When comparing of patterns of care between 2008-2011 and 2011-2015, the proportion of patients diagnosed with Gleason 9-10 disease increased, as has the proportion of patients diagnosed with metastatic disease. CONCLUSION With the PCOR-Vic, we were able to identify that increasing number of patients were diagnosed with high-risk and metastatic disease. There has been an overall decrease in radical treatment rates, likely due to active surveillance playing a significant role especially in patients with low-risk prostate cancer.
Collapse
Affiliation(s)
- Luke L Wang
- Australian Urology Associates, Melbourne, Victoria, Australia
| | | | - Melanie Evans
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sue M Evans
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeremy L Millar
- Radiation Oncology, Alfred Health, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Daniel Moon
- Australian Urology Associates, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| |
Collapse
|
21
|
Leyh-Bannurah SR, Karakiewicz PI, Pompe RS, Preisser F, Zaffuto E, Dell’Oglio P, Briganti A, Nafez O, Fisch M, Steuber T, Graefen M, Budäus L. Inverse stage migration patterns in North American patients undergoing local prostate cancer treatment: a contemporary population-based update in light of the 2012 USPSTF recommendations. World J Urol 2018; 37:469-479. [DOI: 10.1007/s00345-018-2396-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/28/2018] [Indexed: 12/19/2022] Open
|
22
|
Rovito MJ, Leone JE, Cavayero CT. "Off-Label" Usage of Testicular Self-Examination (TSE): Benefits Beyond Cancer Detection. Am J Mens Health 2018; 12:505-513. [PMID: 25990509 PMCID: PMC5987946 DOI: 10.1177/1557988315584942] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Testicular cancer (TCa) is the most common cancer among 15- to 34-year-old males. Treatments are highly effective, which help foster approximately 98% 5-year survival rate. There are very few known causal factors of the disease (e.g., cryptorchidism and family history), thus possibly limiting primary prevention methods. Secondary preventative measures, on the other hand, most notably testicular self-examination (TSE), are well-known and are promoted to help prevent late-stage diagnosis of TCa. However, debate ensues as to whether or not TSE provides any benefit. In light of a recent systematic review conducted by these authors assessing the effectiveness of TSE promotion interventions, we propose that the behavior can serve as a tool not just for detection of TCa, but other male-specific urogenital health concerns, including varicoceles, hydroceles, among others. Furthermore, we suggest that TSE can also help foster informed decision-making skills among males with regard to health concerns and treatment options. However, our advocacy is in direct conflict with U.S. Preventive Services Task Force's influential "D" rating of TSE and others who recommend against performing TSE. This article offers an overview of the dispute over TSE's purpose and net benefit. We conclude that TSE is a behavior that is beneficial beyond detecting cancer. These proposed "off-label" uses of the procedure make for an effectual means to promote testicular health, self-awareness, and wellness among males. Recommendations for future research and advocacy are presented to the academy.
Collapse
|
23
|
Patel NH, Bloom J, Hillelsohn J, Fullerton S, Allman D, Matthews G, Eshghi M, Phillips JL. Prostate Cancer Screening Trends After United States Preventative Services Task Force Guidelines in an Underserved Population. Health Equity 2018; 2:55-61. [PMID: 29806045 PMCID: PMC5963250 DOI: 10.1089/heq.2018.0004] [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: 11/17/2022] Open
Abstract
Purpose: Prostate cancer screening is a controversial topic. We examined trends in Prostate Specific Antigen (PSA) testing in an underserved population before and after the United States Preventative Services Task Force (USPSTF) recommendation against screening. Methods: Data were collected on all PSA and cholesterol screening tests from 2008 to 2014. We examined the trend of these tests and prostate biopsies while comparing this data to lipid panel data to adjust for changes in patient population. Results: A decrease in PSA screening was observed from 2010 through 2014, with the greatest decline in 2012. The age group most affected was patients aged 55–69 years. The amount of prostate biopsies during this period decreased as well. Conclusions: Decreased rates of PSA screening were observed in our urban hospital population that preceded the publication of the USPSTF guidelines. The incidence of prostate biopsies decreased in this timeframe. It now remains to be demonstrated whether decreased PSA screening rates impact the diagnosis of and ultimately the survival from prostate cancer.
Collapse
Affiliation(s)
- Neel H Patel
- Department of Urology, New York Medical College, Valhalla, New York
| | - Jonathan Bloom
- Urologic Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Joel Hillelsohn
- Department of Urology, New York Medical College, Valhalla, New York
| | - Sean Fullerton
- Department of Urology, New York Medical College, Valhalla, New York
| | - Denton Allman
- Department of Urology, New York Medical College, Valhalla, New York
| | - Gerald Matthews
- Department of Urology, New York Medical College, Valhalla, New York
| | - Majid Eshghi
- Department of Urology, New York Medical College, Valhalla, New York
| | - John L Phillips
- Department of Urology, New York Medical College, Valhalla, New York
| |
Collapse
|
24
|
Waterhouse RL, Van Neste L, Moses KA, Barnswell C, Silberstein JL, Jalkut M, Tutrone R, Sylora J, Anglade R, Murdock M, Shiffman Z, Vandenberg T, Shah N, Carter M, Krispin M, Groskopf J, Van Criekinge W. Evaluation of an Epigenetic Assay for Predicting Repeat Prostate Biopsy Outcome in African American Men. Urology 2018; 128:62-65. [PMID: 29660369 PMCID: PMC10182891 DOI: 10.1016/j.urology.2018.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/29/2018] [Accepted: 04/02/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate an epigenetic assay performed on tissue from negative prostate biopsies in a group of African American (AA) men undergoing repeat biopsy, and to compare accuracy for predicting repeat biopsy outcome to prior studies conducted in predominantly Caucasian populations. MATERIALS AND METHODS The study population consisted of 211 AA men from 7 urology centers across the United States; all of whom were undergoing 12-core transrectal ultrasound-guided repeat biopsy within 30 months from a negative index biopsy. All biopsy cores from the negative index biopsy were profiled for the epigenetic biomarkers GSTP1, APC, and RASSF1 using ConfirmMDx for Prostate Cancer (MDxHealth, Irvine, CA). RESULTS Upon repeat biopsy, 130 of 211 subjects (62%) had no prostate cancer (PCa) detected and 81 of 211 (38%) were diagnosed with PCa. Of the subjects with PCa, 54 (67%) were diagnosed with Gleason score (GS) ≤6 PCa and 27 (33%) with GS ≥7 disease. For detection of PCa at repeat biopsy, ConfirmMDx sensitivity was 74.1% and specificity was 60.0%, equivalent to prior studies (P = .235 and .697, respectively). For detection of GS ≥7 PCa, sensitivity was 78% and specificity was 53%. The negative predictive values for detection of all PCa and GS ≥7 PCa were 78.8% and 94.2%, respectively. CONCLUSION In this group of AA men, we successfully validated an epigenetic assay to assess the need for repeat biopsy. Results were consistent with previous studies from predominantly Caucasian populations. Therefore, the ConfirmMDx assay is a useful tool for risk stratification of AA men who had an initial negative biopsy.
Collapse
Affiliation(s)
| | | | | | | | | | - Mark Jalkut
- Associated Urologists of North Carolina, Raleigh, NC
| | | | - James Sylora
- Associated Urological Specialists, Orland Park, IL
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Faiena I, Holden S, Cooperberg MR, Holden S, Soule HR, Simons JW, Morgan TM, Penson DF, Morgans AK, Hussain M. Prostate Cancer Screening and the Goldilocks Principle: How Much Is Just Right? J Clin Oncol 2018; 36:937-941. [PMID: 29401003 PMCID: PMC6804825 DOI: 10.1200/jco.2017.76.4050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Izak Faiena
- Izak Faiena and Stuart Holden, David Geffen School of Medicine at UCLA, Los Angeles, CA; Mathew R. Cooperberg, University of California, San Francisco, San Francisco, CA; Stuart Holden, Howard R. Soule, and Jonathan W. Simons, Prostate Cancer Foundation, Santa Monica, CA; Todd M. Morgan, University of Michigan, Ann Arbor, MI; David F. Penson, Vanderbilt University Medical Center, Nashville, TN; and Alicia K. Morgans and Maha Hussain, Northwestern University, Chicago, IL
| | - Stuart Holden
- Izak Faiena and Stuart Holden, David Geffen School of Medicine at UCLA, Los Angeles, CA; Mathew R. Cooperberg, University of California, San Francisco, San Francisco, CA; Stuart Holden, Howard R. Soule, and Jonathan W. Simons, Prostate Cancer Foundation, Santa Monica, CA; Todd M. Morgan, University of Michigan, Ann Arbor, MI; David F. Penson, Vanderbilt University Medical Center, Nashville, TN; and Alicia K. Morgans and Maha Hussain, Northwestern University, Chicago, IL
| | - Mathew R. Cooperberg
- Izak Faiena and Stuart Holden, David Geffen School of Medicine at UCLA, Los Angeles, CA; Mathew R. Cooperberg, University of California, San Francisco, San Francisco, CA; Stuart Holden, Howard R. Soule, and Jonathan W. Simons, Prostate Cancer Foundation, Santa Monica, CA; Todd M. Morgan, University of Michigan, Ann Arbor, MI; David F. Penson, Vanderbilt University Medical Center, Nashville, TN; and Alicia K. Morgans and Maha Hussain, Northwestern University, Chicago, IL
| | - Stuart Holden
- Izak Faiena and Stuart Holden, David Geffen School of Medicine at UCLA, Los Angeles, CA; Mathew R. Cooperberg, University of California, San Francisco, San Francisco, CA; Stuart Holden, Howard R. Soule, and Jonathan W. Simons, Prostate Cancer Foundation, Santa Monica, CA; Todd M. Morgan, University of Michigan, Ann Arbor, MI; David F. Penson, Vanderbilt University Medical Center, Nashville, TN; and Alicia K. Morgans and Maha Hussain, Northwestern University, Chicago, IL
| | - Howard R. Soule
- Izak Faiena and Stuart Holden, David Geffen School of Medicine at UCLA, Los Angeles, CA; Mathew R. Cooperberg, University of California, San Francisco, San Francisco, CA; Stuart Holden, Howard R. Soule, and Jonathan W. Simons, Prostate Cancer Foundation, Santa Monica, CA; Todd M. Morgan, University of Michigan, Ann Arbor, MI; David F. Penson, Vanderbilt University Medical Center, Nashville, TN; and Alicia K. Morgans and Maha Hussain, Northwestern University, Chicago, IL
| | - Jonathan W. Simons
- Izak Faiena and Stuart Holden, David Geffen School of Medicine at UCLA, Los Angeles, CA; Mathew R. Cooperberg, University of California, San Francisco, San Francisco, CA; Stuart Holden, Howard R. Soule, and Jonathan W. Simons, Prostate Cancer Foundation, Santa Monica, CA; Todd M. Morgan, University of Michigan, Ann Arbor, MI; David F. Penson, Vanderbilt University Medical Center, Nashville, TN; and Alicia K. Morgans and Maha Hussain, Northwestern University, Chicago, IL
| | - Todd M. Morgan
- Izak Faiena and Stuart Holden, David Geffen School of Medicine at UCLA, Los Angeles, CA; Mathew R. Cooperberg, University of California, San Francisco, San Francisco, CA; Stuart Holden, Howard R. Soule, and Jonathan W. Simons, Prostate Cancer Foundation, Santa Monica, CA; Todd M. Morgan, University of Michigan, Ann Arbor, MI; David F. Penson, Vanderbilt University Medical Center, Nashville, TN; and Alicia K. Morgans and Maha Hussain, Northwestern University, Chicago, IL
| | - David F. Penson
- Izak Faiena and Stuart Holden, David Geffen School of Medicine at UCLA, Los Angeles, CA; Mathew R. Cooperberg, University of California, San Francisco, San Francisco, CA; Stuart Holden, Howard R. Soule, and Jonathan W. Simons, Prostate Cancer Foundation, Santa Monica, CA; Todd M. Morgan, University of Michigan, Ann Arbor, MI; David F. Penson, Vanderbilt University Medical Center, Nashville, TN; and Alicia K. Morgans and Maha Hussain, Northwestern University, Chicago, IL
| | - Alicia K. Morgans
- Izak Faiena and Stuart Holden, David Geffen School of Medicine at UCLA, Los Angeles, CA; Mathew R. Cooperberg, University of California, San Francisco, San Francisco, CA; Stuart Holden, Howard R. Soule, and Jonathan W. Simons, Prostate Cancer Foundation, Santa Monica, CA; Todd M. Morgan, University of Michigan, Ann Arbor, MI; David F. Penson, Vanderbilt University Medical Center, Nashville, TN; and Alicia K. Morgans and Maha Hussain, Northwestern University, Chicago, IL
| | - Maha Hussain
- Izak Faiena and Stuart Holden, David Geffen School of Medicine at UCLA, Los Angeles, CA; Mathew R. Cooperberg, University of California, San Francisco, San Francisco, CA; Stuart Holden, Howard R. Soule, and Jonathan W. Simons, Prostate Cancer Foundation, Santa Monica, CA; Todd M. Morgan, University of Michigan, Ann Arbor, MI; David F. Penson, Vanderbilt University Medical Center, Nashville, TN; and Alicia K. Morgans and Maha Hussain, Northwestern University, Chicago, IL
| |
Collapse
|
26
|
Tumor characteristics, treatments, and oncological outcomes of prostate cancer in men aged ≤50 years: a population-based study. Prostate Cancer Prostatic Dis 2018; 21:71-77. [DOI: 10.1038/s41391-017-0006-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/09/2017] [Indexed: 12/19/2022]
|
27
|
Re: Evolution of Primary Care Referrals to Urology. Impact of a Protocol on Prostate Disease and Continuing Education. J Urol 2017; 198:1183-1184. [DOI: 10.1016/j.juro.2017.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
28
|
Akerman JP, Allard CB, Tajzler C, Kapoor A. Prostate cancer screening among family physicians in Ontario: An update on attitudes and current practice. Can Urol Assoc J 2017; 12:E53-E58. [PMID: 29381468 DOI: 10.5489/cuaj.4631] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION This study serves as an update of prostate cancer screening practices among family physicians in Ontario, Canada. Since this population was first surveyed in 2010, the Canadian Task Force on Preventive Health Care (CTFPHC) and the United States Preventive Services Task Force (USPSTF) released recommendations against prostate cancer screening. METHODS An online survey was developed through input from urologists and family practitioners. It was distributed via email to all members of the Ontario Medical Association's Section on General and Family practice (11 657 family physicians). A reminder email was sent at two weeks and the survey remained active for one month. RESULTS A total of 1880 family physicians completed surveys (response rate 16.1%). Overall, 80.4% offered prostate cancer screening compared to 91.7% when surveyed in 2010. Physicians new to practice (two years or less) were the most likely to not offer screening (24.6%). A combination of digital rectal exam (DRE) and prostate-specific antigen (PSA) remained the most common form of screening (58.3%). Following the release of the CTFPHC recommendations, 45.6% of respondents said they now screen fewer patients. Participants were less familiar with national urological society guidelines compared to task force recommendations. The majority (72.6%) of respondents feel PSA screening leads to overdiagnosis and treatment. Those surveyed remained split with respect to PSA utility. CONCLUSIONS Data suggest a decline in screening practices since 2010, with newer graduates less likely to offer screening. CFTPHC and USPSTF recommendations had the greatest impact on clinical practice. Those surveyed were divided with respect to PSA utility. Some additional considerations to PSA screening in the primary care setting, including patient-driven factors, were not captured by our concise survey.
Collapse
Affiliation(s)
- Jason Paul Akerman
- McMaster Institute of Urology, McMaster University, Hamilton, ON, Canada
| | | | - Camilla Tajzler
- McMaster Institute of Urology, McMaster University, Hamilton, ON, Canada
| | - Anil Kapoor
- McMaster Institute of Urology, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
29
|
Gejerman G, Ciccone P, Goldstein M, Lanteri V, Schlecker B, Sanzone J, Esposito M, Rome S, Ciccone M, Margolis E, Simon R, Guo Y, Pentakota SR, Sadeghi-Nejad H. US Preventive Services Task Force prostate-specific antigen screening guidelines result in higher Gleason score diagnoses. Investig Clin Urol 2017; 58:423-428. [PMID: 29124241 PMCID: PMC5671961 DOI: 10.4111/icu.2017.58.6.423] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/17/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the impact that the 2012 US Preventive Services Task Force (USPSTF) prostate-specific antigen (PSA) screening guidelines have had on the diagnosis of prostate cancer, we compared the incidence and distribution of new cases diagnosed in 2011-before the USPSTF PSA screening recommendations versus 2014 at which time the guidelines were widely adopted. Materials and Methods We identified all prostate biopsies performed by a large urology group practice utilizing a centralized pathology lab. We examined total biopsies performed, percentage of positive biopsies, and for those with positive biopsies examined for differences in patient age, PSA, and Gleason score. Results A total of 4,178 biopsies were identified - 2,513 in 2011 and 1,665 in 2014. The percentage of positive biopsies was 27% in 2011 versus 34% in 2014 (p<0.0001). Among patients with positive biopsies, we found statistically significant differences between the 2 cohorts in the median ages and Gleason scores. Patients were about 1 year younger in 2014 compared to 2011 (t-test; p=0.043). High Gleason scores (8-10) were diagnosed in 19% of the 2014 positive biopsies versus 9% in the 2011 positive biopsies (chi square; p<0.0001). Conclusions After the widespread implementation of the 2011 USPTF PSA screening guidelines, 34% fewer biopsies were performed with a 29% increase in positive biopsy rates. We found a significantly higher incidence of high grade disease in 2014 compared with 2011. The percentage of patients with positive biopsies having Gleason scores 8-10 more than doubled in 2014. The higher incidence of these more aggressive cancers must be part of the discussion regarding PSA screening.
Collapse
Affiliation(s)
- Glen Gejerman
- New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Patrick Ciccone
- New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Martin Goldstein
- New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Vincent Lanteri
- New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Burton Schlecker
- New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - John Sanzone
- New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Michael Esposito
- New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Sergey Rome
- New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Michael Ciccone
- New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Eric Margolis
- New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Robert Simon
- New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Yijun Guo
- New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Sri-Ram Pentakota
- Division of Urology, Rutgers New Jersey Medical School, Bloomfield, NJ, USA
| | | |
Collapse
|
30
|
Goldenberg MG, Skeldon SC, Nayan M, Suppiah Y, Chow L, Fryml E, Greenberg D, Singal RK, Goldenberg SL. Prostate-specific antigen testing for prostate cancer screening: A national survey of Canadian primary care physicians' opinions and practices. Can Urol Assoc J 2017; 11:396-403. [PMID: 29106358 DOI: 10.5489/cuaj.4486] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION In 2014, the Canadian Task Force on Preventive Health Care (CTFPHC) recommended against routine prostate cancer screening with the prostate-specific antigen (PSA) blood test. We surveyed Canadian primary care physicians (PCPs) to understand their opinions and attitudes towards prostate cancer screening in 2016. METHODS Twenty PCPs piloted the survey to assess its accessibility. We distributed a flyer to 19 633 PCPs as an insert in a large mailed package inviting them to attend a national meeting, and later promoted the survey at the meeting. Multinomial logistic regression models examined factors associated with agreement of key guideline statements and the overall benefit of PSA screening. RESULTS A total of 1254 PCPs responded (rate of 6.4%); 54.7% of physicians aware of the CTFPHC recommendations report screening less often as a result. Overall, 55.6% of PCPs feel that the risks of PSA screening outweigh the benefits. On multivariable analysis, physicians who did not read the guidelines, did not have an academic appointment, or were in practice for over 20 years were significantly more likely to disagree with the statement that men 55-69 years old should not be screened for prostate cancer with PSA. CONCLUSIONS Our national survey found that the prostate cancer screening practices of Canadian PCPs varies widely across physician demographic groups, with almost equal numbers for or against. This has significant ethical, medical, and legal implications. The poor response rate to highly incentivized survey request may suggest a reluctance or general apathy towards this subject because of the Task Force recommendations. Future efforts should provide physicians with objective guidance around PSA screening, incorporating input from all stakeholders, including PCPs, urologists, and patients.
Collapse
Affiliation(s)
| | - Sean C Skeldon
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Madhur Nayan
- Department of Surgery, Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Yegappan Suppiah
- Department of Surgery, Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Linda Chow
- Department of Surgery, Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Elise Fryml
- Department of Surgery, Division of Urology, University of Toronto, Toronto, ON, Canada
| | - David Greenberg
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Rajiv K Singal
- Department of Surgery, Division of Urology, University of Toronto, Toronto, ON, Canada
| | - S Larry Goldenberg
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
31
|
Rendon RA, Mason RJ, Marzouk K, Finelli A, Saad F, So A, Violette P, Breau RH. Recommandations de l'Association des urologues du Canada sur le dépistage et le diagnostic précoce du cancer de la prostate. Can Urol Assoc J 2017; 11:298-309. [PMID: 29381452 DOI: 10.5489/cuaj.4888] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ricardo A Rendon
- Département d'urologie, Université Dalhousie, Halifax, N.-É., Canada
| | - Ross J Mason
- Département d'urologie, Clinique Mayo, Rochester, Minn., États-Unis
| | - Karim Marzouk
- Division d'urologie, Centre de cancérologie Memorial Sloan Kettering, New York, NY, États-Unis
| | - Antonio Finelli
- Division d'urologie, Université de Toronto, Toronto, Ont., Canada
| | - Fred Saad
- Département de chirurgie (urologie), Université de Montréal, Montréal, Qc, Canada
| | - Alan So
- Département des sciences urologiques, Université de la Colombie-Britannique, Vancouver, C.-B., Canada
| | - Phillipe Violette
- Département de chirurgie, Université Western, London, Ont., Canada.,Départements de chirurgie et de méthodologie de recherche en santé, Données et répercussions, Université McMaster, Hamilton, Ont., Canada
| | - Rodney H Breau
- Division d'urologie, Université d'Ottawa, Ottawa, Ont., Canada
| |
Collapse
|
32
|
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.
Collapse
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
| |
Collapse
|
33
|
Webster TM, Lau E, Newell KJ. Implications of prostate-specific antigen screening guidelines on clinical practice at a Canadian regional community hospital. Can Urol Assoc J 2017; 11:283-286. [PMID: 28798833 DOI: 10.5489/cuaj.4140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Todd M Webster
- Department of Urology; Grey Bruce Health Services, Owen Sound, ON, Canada
| | - Erika Lau
- Department of Pathology; Grey Bruce Health Services, Owen Sound, ON, Canada
| | - Ken J Newell
- Department of Pathology; Grey Bruce Health Services, Owen Sound, ON, Canada
| |
Collapse
|
34
|
Bhindi B. Editorial Comment. J Urol 2017; 198:1052-1053. [PMID: 28780288 DOI: 10.1016/j.juro.2017.05.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
35
|
Bhindi B, Jiang H, Poyet C, Hermanns T, Hamilton RJ, Li K, Toi A, Finelli A, Zlotta AR, van der Kwast TH, Evans A, Fleshner NE, Kulkarni GS. Creation and internal validation of a biopsy avoidance prediction tool to aid in the choice of diagnostic approach in patients with prostate cancer suspicion. Urol Oncol 2017; 35:604.e17-604.e24. [PMID: 28781111 DOI: 10.1016/j.urolonc.2017.06.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 06/03/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION To reduce unnecessary prostate biopsies while using novel tests judiciously, we created a tool to predict the probability of clinically significant prostate cancer (CSPC) vs. low-risk prostate cancer or negative biopsy (i.e., when intervention is likely not needed) among men undergoing initial or repeat biopsy. METHODS Separate models were created for men undergoing initial and repeat biopsy, identified from our institutional biopsy database and the placebo arm of the REDUCE trial, respectively, to predict the presence of CSPC (Gleason≥7 or>33% of cores involved). Predictors considered included age, race, body mass index, family history of prostate cancer, digital rectal examination, prostate volume, prostate-specific antigen (PSA), free-to-total PSA, presence of high-grade prostatic intraepithelial neoplasia or atypical small acinar proliferation on prior biopsy, number of prior biopsies, and number of cores previously taken. Multivariable logistic regression models that minimized the Akaike Information Criterion and maximized out-of-sample area under the receiver operating characteristics curve (AUC) were selected. RESULTS Of 7,963 biopsies (initial = 2,042; repeat = 5,921), 1,138 had CSPC (initial = 870 [42.6%]; repeat = 268 [4.5%]). Age, race, body mass index, family history, digital rectal examination, and PSA were included in the initial biopsy model (out-of-sample AUC = 0.74). Age, prostate volume, PSA, free-to-total PSA, prior high-grade prostatic intraepithelial neoplasia, and number of prior biopsies were included in the repeat biopsy model (out-of-sample AUC = 0.81). CONCLUSION These prediction models may help guide clinicians in avoiding unnecessary initial and repeat biopsies in men unlikely to harbor CSPC. This tool may also allow for the more judicious use of novel tests only in patients in need of further risk stratification before deciding whether to biopsy.
Collapse
Affiliation(s)
- Bimal Bhindi
- Department of Surgery, University Health Network, University of Toronto, Toronto, Canada; Department of Urology, Mayo Clinic, Rochester, MN.
| | - Haiyan Jiang
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, Canada
| | - Cedric Poyet
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Robert J Hamilton
- Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Kathy Li
- Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Ants Toi
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada
| | - Antonio Finelli
- Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Alexandre R Zlotta
- Department of Surgery, University Health Network, University of Toronto, Toronto, Canada; Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | | | - Andrew Evans
- Institute for Clinical and Evaluative Sciences, University of Toronto, Toronto, Canada
| | - Neil E Fleshner
- Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Girish S Kulkarni
- Department of Surgery, University Health Network, University of Toronto, Toronto, Canada; Department of Pathology, University Health Network, University of Toronto, Toronto, Canada
| |
Collapse
|
36
|
Endt K, Goepfert J, Omlin A, Athanasiou A, Tennstedt P, Guenther A, Rainisio M, Engeler DS, Steuber T, Gillessen S, Joos T, Schiess R. Development and clinical testing of individual immunoassays for the quantification of serum glycoproteins to diagnose prostate cancer. PLoS One 2017; 12:e0181557. [PMID: 28767721 PMCID: PMC5540289 DOI: 10.1371/journal.pone.0181557] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/03/2017] [Indexed: 12/30/2022] Open
Abstract
Prostate Cancer (PCa) diagnosis is currently hampered by the high false-positive rate of PSA evaluations, which consequently may lead to overtreatment. Non-invasive methods with increased specificity and sensitivity are needed to improve diagnosis of significant PCa. We developed and technically validated four individual immunoassays for cathepsin D (CTSD), intercellular adhesion molecule 1 (ICAM1), olfactomedin 4 (OLFM4), and thrombospondin 1 (THBS1). These glycoproteins, previously identified by mass spectrometry using a Pten mouse model, were measured in clinical serum samples for testing the capability of discriminating PCa positive and negative samples. The development yielded 4 individual immunoassays with inter and intra-variability (CV) <15% and linearity on dilution of the analytes. In serum, ex vivo protein stability (<15% loss of analyte) was achieved for a duration of at least 24 hours at room temperature and 2 days at 4°C. The measurement of 359 serum samples from PCa positive (n = 167) and negative (n = 192) patients with elevated PSA (2-10 ng/ml) revealed a significantly improved accuracy (P <0.001) when two of the glycoproteins (CTSD and THBS1) were combined with %fPSA and age (AUC = 0.8109; P <0.0001; 95% CI = 0.7673-0.8545). Conclusively, the use of CTSD and THBS1 together with commonly used parameters for PCa diagnosis such as %fPSA and age has the potential to improve the diagnosis of PCa.
Collapse
|
37
|
Gaylis FD, Choi JE, Hamilton Z, Dato P, Cohen E, Calabrese R, Prime H, Rosenbaum A, Kader AK. Change in prostate cancer presentation coinciding with USPSTF screening recommendations at a community-based urology practice. Urol Oncol 2017; 35:663.e1-663.e7. [PMID: 28736250 DOI: 10.1016/j.urolonc.2017.06.059] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/19/2017] [Accepted: 06/25/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The benefits of prostate-specific antigen (PSA)-based prostate cancer screening are controversial. We sought to determine the change in prostate cancer presentation coinciding with the release of the United States Preventative Services Task Force recommendations against screening in a high-volume community-based urology practice. METHODS Characteristics of men presenting for an elevated PSA at a community urology practice from August 2011 to August 2015 were queried from a prospectively collected database. A retrospective analysis of presenting PSA, Gleason grade at biopsy, and prostatectomy as well as clinical and pathologic stage was performed. Kruskal-Wallis rank sum and chi-square tests were used for analysis. RESULTS Referrals for elevated PSA decreased from 933 in year 1 to 816 by year 4 (12.5% decrease) with a concomitant reduction in biopsies performed in newly referred men from 461 to 356 (22.8% decrease, P = 0.02). The proportion of men presenting with PSAs>10 increased from 28.1% to 36.8% (P = 0.009). First-time biopsy-positivity rate increased from 48.4% to 62.4% with a rise in the proportion having Gleason≥7 from 51.6% to 69.7% (P = 0.0001). Of the 578 men who underwent radical prostatectomy, there was a 19.4% increase in Gleason≥7 tumors (P = 0.01). CONCLUSIONS Our findings demonstrate a decrease in elevated PSA referrals, increase in PSA at the time of referral, decrease in detection of low-risk disease, and increase in detection of intermediate-/high-risk disease in a high-volume, multisite, community-based urology practice, coinciding with the United States Preventative Services Task Force recommendations against PSA screening.
Collapse
Affiliation(s)
- Franklin D Gaylis
- Genesis Healthcare Partners, San Diego, CA; Department of Urology, University of California, San Diego, CA
| | - Jae E Choi
- Department of Urology, University of California, San Diego, CA
| | | | - Paul Dato
- Genesis Healthcare Partners, San Diego, CA
| | | | | | | | | | | |
Collapse
|
38
|
Impact of Radical Prostatectomy on Long-Term Oncologic Outcomes in a Matched Cohort of Men with Pathological Node Positive Prostate Cancer Managed by Castration. J Urol 2017; 198:86-91. [DOI: 10.1016/j.juro.2017.01.063] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 11/23/2022]
|
39
|
Secular Trends in Prostate Biopsy Criteria and Outcomes: The Dartmouth Experience. Urology 2017; 107:178-183. [PMID: 28595934 DOI: 10.1016/j.urology.2017.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/12/2017] [Accepted: 04/17/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate trends in prostate biopsy and cancer diagnosis at a center with conservative screening practices in the pre- and post-2012 era. More restrictive prostate-specific antigen (PSA) screening guidelines have led to lower rates of screening, biopsy, and diagnosis of prostate cancer. It is not clear, however, how regions with low baseline screening rates (the Lebanon, New Hampshire hospital referral region centered on Dartmouth-Hitchcock Medical Center had the lowest rate of screening among Medicare patients in 2012) have responded to these guidelines. METHODS We retrospectively analyzed patients who underwent prostate biopsy from January 2011 to March 2016. Demographic and clinical characteristics were analyzed by time. Multivariable analysis assessed for factors associated with higher grade cancer. RESULTS There were 614 prostate biopsies were performed. PSA at biopsy increased with time (7.2 in 2011 vs 10.1 in 2015, P = .0085); age did not. There was a stable proportion of benign findings; proportions of low-grade disease decreased, whereas intermediate- and high-grade disease increased (2011 vs 2015: 21.1% vs 10.8% Gleason 3 + 3, 32.9% vs 43.3% ≥ Gleason 3 + 4, P = .0454). Factors predictive of higher grade disease included abnormal digital examination (odds ratio [OR] 2.19, P = .0076), higher PSA (OR 1.09, P = .0040), and later biopsy date (OR 1.01, P = .0469). CONCLUSION In an environment of conservative baseline screening practices, there has been a shift in prostate biopsy criteria and outcomes, namely a rising PSA threshold for biopsy and a 50% decrease in the diagnosis of low-grade disease. Additional study is needed to ensure these trends are favorably impacting the quality of care.
Collapse
|
40
|
Lee DJ, Mallin K, Graves AJ, Chang SS, Penson DF, Resnick MJ, Barocas DA. Recent Changes in Prostate Cancer Screening Practices and Epidemiology. J Urol 2017; 198:1230-1240. [PMID: 28552708 DOI: 10.1016/j.juro.2017.05.074] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE Prostate specific antigen based screening for prostate cancer has had a significant impact on the epidemiology of the disease. Its use has been associated with a significant decrease in prostate cancer mortality but has also resulted in the over diagnosis and overtreatment of indolent prostate cancer, exposing many men to the harms of treatment without benefit. The USPSTF (U.S. Preventive Services Task Force) in 2008 issued a recommendation against screening men older than 75 years, and in 2012 against routine screening for all men, indicating that in its interpretation the harms of screening outweigh the benefits. We review changes in the use of prostate specific antigen testing, performance of prostate biopsy, incidence of prostate cancer and stage of disease at presentation since 2012. MATERIALS AND METHODS An English language literature search was performed for terms that included "prostate specific antigen," "screening" and "United States Preventive Services Task Force" in various combinations. A total of 26 original studies had been published on the effects of the USPSTF recommendations on prostate specific antigen based screening or prostate cancer incidence in the United States as of December 1, 2016. RESULTS Review of the literature from 2012 through the end of 2016 indicates that there has been a decrease in prostate specific antigen testing and prostate biopsy. As a result, there has been a decline in the incidence of localized prostate cancer, including low, intermediate and high risk disease. The data regarding stage at presentation have yet to mature but there are some early signs of a shift toward higher burden of disease at presentation. CONCLUSIONS These findings raise concern about a reversal of the observed improvement in prostate cancer specific mortality during preceding decades. Alternative screening strategies would 1) incorporate patient preferences by allowing shared decision-making, 2) preserve the survival benefits associated with screening, 3) improve the specificity of screening to reduce unnecessary biopsies and detection of low risk disease, and 4) promote the use of active surveillance for low risk cancers if they are detected.
Collapse
Affiliation(s)
- Daniel J Lee
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.
| | | | - Amy J Graves
- Center for Surgical Quality and Outcomes Research, Nashville, Tennessee
| | - Sam S Chang
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Surgical Quality and Outcomes Research, Nashville, Tennessee; Geriatric Research, Education and Clinical Center, VA Tennessee Valley Health Care System, Nashville, Tennessee
| | - Matthew J Resnick
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Surgical Quality and Outcomes Research, Nashville, Tennessee; Geriatric Research, Education and Clinical Center, VA Tennessee Valley Health Care System, Nashville, Tennessee
| | - Daniel A Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
41
|
Cheng Z, Choi N, Wang R, Lee S, Moon KC, Yoon SY, Chen L, Choo J. Simultaneous Detection of Dual Prostate Specific Antigens Using Surface-Enhanced Raman Scattering-Based Immunoassay for Accurate Diagnosis of Prostate Cancer. ACS NANO 2017; 11:4926-4933. [PMID: 28441008 DOI: 10.1021/acsnano.7b01536] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Accurate analysis of specific biomarkers in clinical serum is essential for early diagnosis and treatment of cancer. Here, a surface-enhanced Raman scattering (SERS)-based immunoassay, using magnetic beads and SERS nano tags, was developed for the determination of free to total (f/t) prostate specific antigen (PSA) ratio to improve the diagnostic performance of prostate cancer. To assess the clinical applicability of the proposed method, SERS-based assays for the simultaneous detection of dual PSA markers, free PSA (f-PSA) and complexed PSA (c-PSA), were performed for clinical samples in the gray zone between 4.0 and 10.0 ng/mL. Our assay results for f/t PSA ratio showed a good linear correlation with those measured using the electrochemiluminescence (ECL) system installed in the clinical laboratory of the University Hospital. In addition, the simultaneous assay provided better precision than parallel assays for the detection of f-PSA and c-PSA in 13 clinical serum samples. Therefore, our SERS-based assay for simultaneous detection of dual PSA markers in clinical fluids has strong potential for application in the accurate diagnosis of prostate cancer.
Collapse
Affiliation(s)
- Ziyi Cheng
- Department of Bionano Technology, Hanyang University , Ansan 426-791, South Korea
| | - Namhyun Choi
- Department of Bionano Technology, Hanyang University , Ansan 426-791, South Korea
| | - Rui Wang
- Department of Bionano Technology, Hanyang University , Ansan 426-791, South Korea
| | - Sangyeop Lee
- Department of Bionano Technology, Hanyang University , Ansan 426-791, South Korea
| | - Kyung Chul Moon
- Department of Laboratory Medicine, Korea University College of Medicine , Seoul 152-854, South Korea
| | - Soo-Young Yoon
- Department of Laboratory Medicine, Korea University College of Medicine , Seoul 152-854, South Korea
| | - Lingxin Chen
- Key Laboratory of Coastal Environmental Processes and Ecological Remediation, Yantai Institute of Coastal Zone Research, Chinese Academy of Sciences , Yantai, Shandong 264003, China
| | - Jaebum Choo
- Department of Bionano Technology, Hanyang University , Ansan 426-791, South Korea
| |
Collapse
|
42
|
Taneja SS. Re: National Trends in Prostate Biopsy and Radical Prostatectomy Volumes following the US Preventive Services Task Force Guidelines against Prostate-Specific Antigen Screening. J Urol 2017; 197:1455-1457. [PMID: 28505897 DOI: 10.1016/j.juro.2017.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
43
|
Seminal plasma enables selection and monitoring of active surveillance candidates using nuclear magnetic resonance-based metabolomics: A preliminary investigation. Prostate Int 2017; 5:149-157. [PMID: 29188202 PMCID: PMC5693471 DOI: 10.1016/j.prnil.2017.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/14/2017] [Accepted: 03/16/2017] [Indexed: 01/15/2023] Open
Abstract
Background Diagnosis and monitoring of localized prostate cancer requires discovery and validation of noninvasive biomarkers. Nuclear magnetic resonance (NMR)-based metabolomics of seminal plasma reportedly improves diagnostic accuracy, but requires validation in a high-risk clinical cohort. Materials and methods Seminal plasma samples of 151 men being investigated for prostate cancer were analyzed with 1H-NMR spectroscopy. After adjustment for buffer (add-to-subtract) and endogenous enzyme influence on metabolites, metabolite profiling was performed with multivariate statistical analysis (principal components analysis, partial least squares) and targeted quantitation. Results Seminal plasma metabolites best predicted low- and intermediate-risk prostate cancer with differences observed between these groups and benign samples. Lipids/lipoproteins dominated spectra of high grade samples with less metabolite contributions. Overall prostate cancer prediction using previously described metabolites was not validated. Conclusion Metabolomics of seminal plasma in vitro may assist urologists with diagnosis and monitoring of either low or intermediate grade prostate cancer. Less clinical benefit may be observed for high-risk patients. Further investigation in active surveillance cohorts, and/or in combination with in vivo magnetic resonance spectroscopic imaging may further optimize localized prostate cancer outcomes.
Collapse
|
44
|
Yamada Y, Sakamoto S, Shimazaki J, Sugiura M, Amiya Y, Sasaki M, Shima T, Komiya A, Suzuki N, Akakura K, Ichikawa T, Nakatsu H. Significant prognostic difference between Grade Group 4 and 5 in the 2014 International Society of Urological Pathology Grading System for High Grade Prostate Cancer with Bone Metastasis. Prostate Int 2017; 5:143-148. [PMID: 29188201 PMCID: PMC5693457 DOI: 10.1016/j.prnil.2017.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 03/07/2017] [Indexed: 02/03/2023] Open
Abstract
Background To investigate prognostic difference between Gleason Score (GS) 8 and 9–10, as the 2014 International Society of Urological Pathology Gleason Grading Systems proposed, in patients with prostate cancer (PCa) with bone metastasis. Materials and methods We retrospectively reviewed data on 106 patients with GS 8–10 between 2006 and 2016. All patients received androgen deprivation therapy immediately. We validated biochemical recurrence, PCa-specific survival, and overall survival, and analyzed the predictive value for overall survival. Results Patients with GS 9–10 had significantly lower PCa-specific survival (50.5% vs. 83.4%, P = 0.01) and overall survival (38.8% vs. 66.3%, P = 0.04) at 5 years than those with GS 8, while biochemical recurrence rate was not significantly different (P = 0.26). Furthermore, these significant differences between GS 8 and 9–10 were also observed among high-risk groups proposed in Japan Cancer of the Prostate Risk Assessment Stratification (prostate cancer-specific survival: P = 0.03, overall survival: P = 0.04, respectively). Pathological GS 9–10 was an independent prognostic factor for overall survival (hazard ratio = 1.97, P = 0.04) in multivariable cox proportional hazard regression analysis. Among patients with GS 9–10, albumin level was an only prognostic factor for overall survival (hazard ratio = 0.33, P < 0.01). Conclusion Pathological GS 9–10 predicts significantly worse outcomes than GS 8 in Japanese PCa patients with bone metastasis. Our data indicated clinical significance of discriminating the 2014 International Society of Urological Pathology Gleason Grading Group 4 and 5 among high-risk PCa patients with bone metastasis.
Collapse
Affiliation(s)
- Yasutaka Yamada
- Department of Urology, Asahi General Hospital, Chiba, Japan.,Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shinichi Sakamoto
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Jun Shimazaki
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masahiro Sugiura
- Department of Urology, Asahi General Hospital, Chiba, Japan.,Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | | | - Makoto Sasaki
- Department of Urology, Asahi General Hospital, Chiba, Japan
| | - Takayuki Shima
- Department of Urology, Asahi General Hospital, Chiba, Japan
| | - Akira Komiya
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | | | - Koichiro Akakura
- Department of Urology, Japan Community Healthcare Organization, Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Tomohiko Ichikawa
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | | |
Collapse
|
45
|
Bhindi A, Bhindi B, Kulkarni GS, Hamilton RJ, Toi A, van der Kwast TH, Evans A, Zlotta AR, Finelli A, Fleshner NE. Modern-day prostate cancer is not meaningfully associated with lower urinary tract symptoms: Analysis of a propensity score-matched cohort. Can Urol Assoc J 2017; 11:41-46. [PMID: 28443144 DOI: 10.5489/cuaj.4031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION We sought to determine if prostate cancer (PCa) is associated with worse lower urinary tract symptoms (LUTS) than matched benign prostates, with attention to cancer characteristics, in a contemporary cohort. METHODS Using a single-institution database (January 1, 2009-June 30, 2013), men diagnosed with PCa on biopsy and controls with negative biopsies were matched 1:1 on age, prostate volume, and a propensity score predicting the probability of PCa diagnosis. International Prostate Symptom Score (IPSS) was compared between PCa cases and controls using paired statistics, stratifying on grade, cancer volume, stage, and D'Amico risk group. Sensitivity analyses were performed separately, repeating the match for high-grade, high-volume, and high-stage cancers only, and excluding users of benign prostatic hyperplasia medications. RESULTS In our cohort of 1330 men (665 with PCa), there were 284 (42.7%) Gleason 6 cancers (Grade Group 1), 315 (47.4%) Gleason 7 cancers (Grade Group 2-3), and 66 (9.9%) Gleason 8-10 cancers (Grade Group 4-5). There was no difference in IPSS between PCa cases (median 6.5, interquartile range [IQR] 3-12) and benign controls (median 7, IQR 3-13; p=0.34). Subgroup analyses based on cancer grade, volume, or stage, showed no significant differences in IPSS between men with and without PCa, except among men with cT2b-cT4 PC (median 9, IQR 5-16) vs. matched benign counterparts (median 8, IQR 3-12; p=0.03). Sensitivity analyses supported these findings. CONCLUSIONS Modern PCa does not appear to be associated with worse LUTS compared to benign prostates of the same size. Outlet obstruction is likely a late event in the natural history of PCa. This has implications for timely PCa detection, which should ideally be prior to the onset of LUTS.
Collapse
Affiliation(s)
- Amar Bhindi
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Bimal Bhindi
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Girish S Kulkarni
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ants Toi
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Andrew Evans
- Department of Pathology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alexandre R Zlotta
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Neil E Fleshner
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
46
|
Fleshner K, Carlsson SV, Roobol MJ. The effect of the USPSTF PSA screening recommendation on prostate cancer incidence patterns in the USA. Nat Rev Urol 2017; 14:26-37. [PMID: 27995937 PMCID: PMC5341610 DOI: 10.1038/nrurol.2016.251] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Guidelines regarding recommendations for PSA screening for early detection of prostate cancer are conflicting. In 2012, the United States Preventive Services Task Force (USPSTF) assigned a grade of D (recommending against screening) for men aged ≥75 years in 2008 and for men of all ages in 2012. Understanding temporal trends in rates of screening before and after the 2012 recommendation in terms of usage patterns in PSA screening, changes in prostate cancer incidence and biopsy patterns, and how the recommendation has influenced physician's and men's attitudes about PSA screening and subsequent ordering of other screening tests is essential within the scope of prostate cancer screening policy. Since the 2012 recommendation, rates of PSA screening decreased by 3-10% in all age groups and across most geographical regions of the USA. Rates of prostate biopsy and prostate cancer incidence have declined in unison, with a shift towards tumours being of higher grade and stage upon detection. Despite the recommendation, some physicians report ongoing willingness to screen appropriately selected men, and many men report intending to continue to ask for the PSA test from their physician. In the coming years, we expect to have an improved understanding of whether these decreased rates of screening will affect prostate cancer metastasis and mortality.
Collapse
Affiliation(s)
- Katherine Fleshner
- Schulich School of Medicine and Dentistry, University of
Western Ontario, Canada
| | - Sigrid V. Carlsson
- Department of Surgery; and Department of Epidemiology and
Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
- Institute of Clinical Sciences, Department of Urology,
Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Monique J. Roobol
- Department of Urology, Erasmus Medical Center, Rotterdam,
The Netherlands
| |
Collapse
|
47
|
Taneja SS. Re: Lethal Prostate Cancer in the PLCO Cancer Screening Trial. J Urol 2016; 196:1677. [DOI: 10.1016/j.juro.2016.09.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
48
|
Halpern JA, Sedrakyan A, Dinerman B, Hsu WC, Mao J, Hu JC. Indications, Utilization and Complications Following Prostate Biopsy: New York State Analysis. J Urol 2016; 197:1020-1025. [PMID: 27856226 DOI: 10.1016/j.juro.2016.11.081] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE Uptake of active surveillance and changes in prostate cancer care may affect the utilization of and complications following prostate needle biopsy. We characterized recent trends and risk factors for prostate needle biopsy complications using a statewide, all-payer cohort. MATERIALS AND METHODS We used SPARCS (New York Statewide Planning and Research Cooperative System) to identify prostate needle biopsies performed between 2011 and 2014 via the transrectal and the transperineal approach (9,472 and 421 patients, respectively). We characterized trends in utilization and complications using Poisson regression and the Cochrane-Armitage test. We applied logistic regression to examine predictors of complications within 30 days of prostate needle biopsy. RESULTS Ambulatory use of prostate needle biopsy decreased with time (p <0.01). The most common indication for prostate needle biopsy was elevated prostate specific antigen in 53.2% of patients, followed by active surveillance for cancer in 26.7%, abnormal digital rectal examination in 2.6% and atypia in 1.6%. The prostate needle biopsy associated infection rate increased from 2.6% to 3.5% during the study period (p = 0.02). Among the 777 repeat prostate needle biopsies, the complication rate was comparable to that of initial prostate needle biopsy. Preprocedural rectal swab was done in less than 1% of prostate needle biopsies. On multivariable analysis, patient race, procedure year, diabetes (OR 1.92, 95% CI 1.29-2.86, p <0.01), transrectal approach (OR 3.48, 95% CI 1.27-9.54, p = 0.02) and recent hospitalization (OR 2.03, 95% CI 1.43-2.89, p <0.01) were significantly associated with infection. The median total charge for infectious complications was $4,129 (IQR 711-19,185). CONCLUSIONS Across New York State, infectious complications after prostate needle biopsy have increased over time. With higher complications using the transrectal approach and minimal utilization of targeted antibiotic prophylaxis, further efforts should focus on the evaluation and implementation of these strategies to reduce post-prostate needle biopsy complications nationally.
Collapse
Affiliation(s)
- Joshua A Halpern
- Department of Urology, Weill Cornell Medical College, New York, New York; Department of Healthcare Policy and Research (AS, WCH), Weill Cornell Medical College, New York, New York
| | - Art Sedrakyan
- Department of Urology, Weill Cornell Medical College, New York, New York; Department of Healthcare Policy and Research (AS, WCH), Weill Cornell Medical College, New York, New York
| | - Brian Dinerman
- Department of Urology, Weill Cornell Medical College, New York, New York; Department of Healthcare Policy and Research (AS, WCH), Weill Cornell Medical College, New York, New York
| | - Wei-Chun Hsu
- Department of Urology, Weill Cornell Medical College, New York, New York; Department of Healthcare Policy and Research (AS, WCH), Weill Cornell Medical College, New York, New York
| | - Jialin Mao
- Department of Urology, Weill Cornell Medical College, New York, New York; Department of Healthcare Policy and Research (AS, WCH), Weill Cornell Medical College, New York, New York
| | - Jim C Hu
- Department of Urology, Weill Cornell Medical College, New York, New York; Department of Healthcare Policy and Research (AS, WCH), Weill Cornell Medical College, New York, New York.
| |
Collapse
|
49
|
Lavallée LT, Breau RH, Fergusson D, van Walraven C. Trends in prostate biopsy in Ontario, 1992-2014: a cohort study. CMAJ Open 2016; 4:E698-E705. [PMID: 28018884 PMCID: PMC5173466 DOI: 10.9778/cmajo.20160079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Prostate cancer is a substantial public health concern; however, in recent years, national guidelines have recommended against prostate cancer screening. We sought to determine if prostate biopsy incidence has changed over time in Ontario. We hypothesized that there has been a decrease in the incidence of prostate biopsy in recent years. METHODS This cohort study used population-based administrative databases from Ontario, Canada. We used a diagnostic code to identify if a patient received his first prostate biopsy between 1992 and 2012 (the last year for which records in the Ontario Cancer Registry were complete). Age-stratified and overall age-standardized incidences of prostate biopsy were determined. Changes over time in prostate biopsy incidence and the proportion of prostate biopsies that showed malignant disease were examined using negative binomial regression adjusting for patient age. RESULTS We identified 231 266 Ontario men aged 40 years and older who received their first prostate biopsy between 1992 and 2014. Up to 2007, biopsy incidence increased in younger men, but decreased in older men. After 2007, biopsy incidence decreased in all age groups, with the age-standardized overall biopsy incidence dropping from 480 per 100 000 in 2007 to 250 per 100 000 in 2014. A total of 84 149 (39%) incident biopsies showed malignant disease. The proportion of biopsies classified as showing malignant disease increased during the study period, from 25.6% in 1992 to 49.2% in 2010, and then decreased in all age groups. INTERPRETATION Previously increasing biopsy rates decreased significantly in recent years, suggesting that prostate cancer screening in Ontario may be changing.
Collapse
Affiliation(s)
- Luke T Lavallée
- Division of Urology (Lavallee), Department of Surgery, Ottawa Hospital Research Institute and Institute of Clinical Evaluative Sciences; Division of Urology (Breau), Department of Surgery, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute (Fergusson); and Department of Medicine (van Walraven), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Rodney H Breau
- Division of Urology (Lavallee), Department of Surgery, Ottawa Hospital Research Institute and Institute of Clinical Evaluative Sciences; Division of Urology (Breau), Department of Surgery, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute (Fergusson); and Department of Medicine (van Walraven), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Dean Fergusson
- Division of Urology (Lavallee), Department of Surgery, Ottawa Hospital Research Institute and Institute of Clinical Evaluative Sciences; Division of Urology (Breau), Department of Surgery, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute (Fergusson); and Department of Medicine (van Walraven), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Carl van Walraven
- Division of Urology (Lavallee), Department of Surgery, Ottawa Hospital Research Institute and Institute of Clinical Evaluative Sciences; Division of Urology (Breau), Department of Surgery, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute (Fergusson); and Department of Medicine (van Walraven), Ottawa Hospital Research Institute, Ottawa, Ont
| |
Collapse
|
50
|
Abascal Junquera JM, Fumadó Ciutat L, Francés Comalat A, Cecchini Rosell L. Análisis de las recomendaciones en contra del cribado con antígeno prostático específico en cáncer de próstata. Med Clin (Barc) 2016; 147:361-365. [DOI: 10.1016/j.medcli.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 11/16/2022]
|