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Gustavsen G, Taylor K, Cole D, Gullet L, Lewine N. Health economic impact of a biopsy-based cell cycle gene expression assay in localized prostate cancer. Future Oncol 2020; 16:3061-3074. [PMID: 32902306 DOI: 10.2217/fon-2020-0648] [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] [Indexed: 12/26/2022] Open
Abstract
Background: Prior studies have established that broader incorporation of active surveillance, guided by additional prognostic tools, may mitigate the growing economic burden of localized prostate cancer in the USA. This study sought to further explore the potential of a particular gene expression-based prognostic tool to address this unmet need. Materials & methods: A deterministic, decision-analytic model was developed to estimate the economic impact of the Prolaris® test on a US commercial health plan. Results & conclusion: When adopted in patients classified by the American Urological Association as low or intermediate risk, the assay was projected to reduce costs by $1894 and $2129 per patient over 3 and 10 years, respectively, largely through the increased use of active surveillance.
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Affiliation(s)
| | | | - Doria Cole
- Health Advances LLC, Newton, MA 02466, USA
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Gustavsen G, Gullet L, Cole D, Lewine N, Bishoff JT. Economic burden of illness associated with localized prostate cancer in the United States. Future Oncol 2019; 16:4265-4277. [PMID: 31802704 DOI: 10.2217/fon-2019-0639] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Aim: Prior studies have established the economic burden of prostate cancer on society. However, changes to screening, novel therapies and increased use of active surveillance (AS) create a need for an updated analysis. Methods: A deterministic, decision-analytic model was developed to estimate medical costs associated with localized prostate cancer over 10 years. Results: 10-year costs averaged $45,957, $99,445 and $188,928 for low-, intermediate- and high-risk patients, respectively. For low-risk patients, AS 10-year costs averaged $33,912/patient, whereas definitive treatment averaged $49,667/patient. Despite higher failure rates in intermediate-risk patients, AS remained less costly than definitive treatment, with 10-year costs averaging $90,614/patient and $99,394/patient, respectively. Conclusion: Broader incorporation of AS, guided by additional prognostic tools, may mitigate this growing economic burden.
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Affiliation(s)
| | | | - Doria Cole
- Health Advances LLC, Weston, MA 02493, USA
| | | | - Jay T Bishoff
- Intermountain Healthcare, Salt Lake City, UT 84103, USA
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Mohler JL, Halabi S, Ryan ST, Al-Daghmin A, Sokoloff MH, Steinberg GD, Sanford BL, Eastham JA, Walther PJ, Morris MJ, Small EJ. Management of recurrent prostate cancer after radiotherapy: long-term results from CALGB 9687 (Alliance), a prospective multi-institutional salvage prostatectomy series. Prostate Cancer Prostatic Dis 2018; 22:309-316. [PMID: 30385835 DOI: 10.1038/s41391-018-0106-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/09/2018] [Accepted: 09/29/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND To evaluate efficacy and morbidity prospectively in a contemporary multi-institutional salvage radical prostatectomy (SRP) series. METHODS Forty-one men were enrolled between 1997 and 2006, who suffered biopsy-proven recurrent prostate cancer (CaP) after receiving ≥ 60c Gy radiation as primary treatment for cT1-2NXM0 disease. Surgical morbidity, quality of life, biochemical progression-free survival (BPFS) and overall survival (OS) were evaluated. RESULTS Twenty-four men had undergone external beam radiotherapy, 11 brachytherapy, and six both. Median time between radiation and SRP was 64 months. Median age at SRP was 64 years. Pathologic staging revealed 44% pT2, 54% pT3, and 3% pT4. Surgical margins were positive in 17 and 88% were pN0. Twenty-two percent required intraoperative blood transfusion. Three rectal and one obturator nerve injuries occurred. Seventeen of 38 evaluable patients (45%) had urinary incontinence ( ≥ 3 pads/day) prior to SRP; 88% reported urinary incontinence at 6 months, 85% at 12 months, 63% at 24 months after SRP. Furthermore, 37% of men reported impotence prior to SRP; 78% reported impotence at 6 months, 82% at 12 months, and 44% at 24 months after SRP. The 2-, 5- and 10-year BPFS rates were 51, 39, and 33% respectively; the 2-, 5- and 10-year OS rates were 100, 89, and 52%, respectively, at median follow-up 91 months. CONCLUSIONS Modern surgical techniques continue to be associated with significant peri-operative complication rates. Nevertheless, SRP may benefit carefully selected patients through durable oncologic control.
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Affiliation(s)
- James L Mohler
- Roswell Park Cancer Institute, Buffalo, NY, CA59518, United States.
| | - Susan Halabi
- Department of Biostatistics and Bioinformatics and Alliance Statistics and Data Center, Duke University, Durham, NC, CA33601, United States
| | - Stephen T Ryan
- University of California San Diego, La Jolla, CA, United States
| | - Ali Al-Daghmin
- Roswell Park Cancer Institute, Buffalo, NY, CA59518, United States
| | | | | | - Ben L Sanford
- Alliance Statistics and Data Center, Duke University, Durham, NC, CA33601, United States
| | - James A Eastham
- Memorial Sloan Kettering Cancer Center, New York, NY, CA77651, United States
| | - Philip J Walther
- Duke University Medical Center, Durham, NC, CA47577, United States
| | - Michael J Morris
- Memorial Sloan Kettering Cancer Center, New York, NY, CA77651, United States
| | - Eric J Small
- University of California at San Francisco, San Francisco, CA, CA60138, United States
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Frozen section evaluation of margins in radical prostatectomy specimens: a contemporary study and literature review. Ann Diagn Pathol 2016; 24:11-8. [DOI: 10.1016/j.anndiagpath.2016.08.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 08/04/2016] [Indexed: 11/18/2022]
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Denkçeken T, Canpolat M, Baykara M, Başsorgun İ, Aktaş-Samur A. Diagnosis of pelvic lymph node metastasis in prostate cancer using single optical fiber probe. Int J Biol Macromol 2015; 90:63-7. [PMID: 26526175 DOI: 10.1016/j.ijbiomac.2015.10.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 09/09/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
Abstract
Elastic light single-scattering spectroscopy system (ELSSS) is a biomedical tool which is used for detection of cancerous tissues ex-vivo. ELSSS spectra depend primarily on the size of scatterers in the tissue and are not directly related to changes in the absorption which are caused by variations of the biological macromolecules. In the present study, we aimed to detect metastasis in the pelvic lymph node by using combination of Principal Components Analysis (PCA) and Linear Discriminant Analysis (LDA). Single-scattering spectra in the 450-750nm wavelength regions were obtained from the total of 83 reactive lymph node and 12 metastatic lymph node samples from 10 prostatic cancer patients. The ELSSS spectral data were compared against the "gold standard" histopathology results. Data analyses were done via using PCA, followed by LDA. Receiver Operating Characteristic (ROC) curve analysis was employed for differentiating performance. The classification based on discriminant score provided sensitivity of 100% and specificity of 96.4%, in differentiating non-metastatic (reactive) from metastatic pelvic lymph nodes, with a Positive Predictive Value (PPV) of 0.8, a Negative Predictive Value (NPV) of 0.99 and the area under the ROC curve (AUC) of 0.99, respectively. In this study, it was shown that ELSSS system can accurately distinguish reactive and metastatic pelvic lymph nodes of prostate cancer with high PPV and NPV. It can be concluded that diagnostic accuracy of ELSSS system allows detecting metastatic tissues during operation.
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Affiliation(s)
- Tuba Denkçeken
- Department of Biophysics, Faculty of Medicine, SANKO University, Gaziantep, Turkey.
| | - Murat Canpolat
- Biomedical Optics Research Unit, Department of Biophysics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Mehmet Baykara
- Department of Urology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - İbrahim Başsorgun
- Department of Pathology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Anıl Aktaş-Samur
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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Gakis G, Boorjian SA, Briganti A, Joniau S, Karazanashvili G, Karnes RJ, Mattei A, Shariat SF, Stenzl A, Wirth M, Stief CG. The role of radical prostatectomy and lymph node dissection in lymph node-positive prostate cancer: a systematic review of the literature. Eur Urol 2013; 66:191-9. [PMID: 23735200 DOI: 10.1016/j.eururo.2013.05.033] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 05/13/2013] [Indexed: 11/17/2022]
Abstract
CONTEXT Because pelvic lymph node (LN)-positive prostate cancer (PCa) is generally considered a regionally metastatic disease, surgery needs to be better defined. OBJECTIVE To review the impact of radical prostatectomy (RP) and pelvic lymph node dissection (PLND), possibly in conjunction with a multimodal approach using local radiotherapy and/or androgen-deprivation therapy (ADT), in LN-positive PCa. EVIDENCE ACQUISITION A systematic Medline search for studies reporting on treatment regimens and outcomes in patients with LN-positive PCa undergoing RP between 1993 and 2012 was performed. EVIDENCE SYNTHESIS RP can improve progression-free and overall survival in LN-positive PCa, although there is a lack of high-level evidence. Therefore, the former practice of aborting surgery in the presence of positive nodes might no longer be supported by current evidence, especially in those patients with a limited LN tumor burden. Current data demonstrate that the lymphatic spread takes an ascending pathway from the pelvis to the retroperitoneum, in which the internal and the common iliac nodes represent critical landmarks in the metastatic distribution. Sophisticated imaging technologies are still under investigation to improve the prediction of LN-positive PCa. Nonetheless, extended PLND including the common iliac arteries should be offered to intermediate- and high-risk patients to improve nodal staging with a possible benefit in prostate-specific antigen progression-free survival by removing significant metastatic load. Adjuvant ADT has the potential to improve overall survival after RP; the therapeutic role of a trimodal approach with adjuvant local radiotherapy awaits further elucidation. Age is a critical parameter for survival because cancer-specific mortality exceeds overall mortality in younger patients (<60 yr) with high-risk PCa and should be an impetus to treat as thoroughly as possible. CONCLUSIONS Increasing evidence suggests that RP and extended PLND improve survival in LN-positive PCa. Our understanding of surgery of the primary tumor in LN-positive PCa needs a conceptual change from a palliative option to the first step in a multimodal approach with a significant improvement of long-term survival and cure in selected patients.
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Affiliation(s)
- Georgios Gakis
- Department of Urology, University Hospital Tübingen, Eberhard-Karls University Tübingen, Germany.
| | | | - Alberto Briganti
- Department of Urology, Urological Research Institute, University Vita-Salute San Raffaele, Milan, Italy
| | - Steven Joniau
- Department of Urology, University Hospital K.U. Leuven, Leuven, Belgium
| | | | | | - Agostino Mattei
- Department of Urology, Kantonsspital Lucerne, Lucerne, Switzerland
| | | | - Arnulf Stenzl
- Department of Urology, University Hospital Tübingen, Eberhard-Karls University Tübingen, Germany
| | - Manfred Wirth
- Department of Urology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University, Munich-Grosshadern, Germany
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Drake R. Frozen section analysis—is it of value when performing radical prostatectomy? Nat Rev Urol 2010; 7:416. [DOI: 10.1038/nrurol.2010.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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