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Nieuwkamer B, Vrouwe J, Willemse P, Nicolai M, Bevers R, Pelger R, Hamdy N, Osanto S. Quantitative ultrasound of the calcaneus (QUS): A valuable tool in the identification of patients with non-metastatic prostate cancer requiring screening for osteoporosis. Bone Rep 2023; 18:101679. [PMID: 37425192 PMCID: PMC10323220 DOI: 10.1016/j.bonr.2023.101679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 07/11/2023] Open
Abstract
Non-metastatic prostate cancer (PCa) patients are at increased risk for osteoporosis and fractures mainly due to androgen deprivation therapy (ADT)-associated hypogonadism, but this remains largely underdiagnosed and untreated. In this study, we examine the value of pre-screening calcaneal QUS in identifying patients who should be referred for screening for osteoporosis using dual-energy X-Ray absorptiometry (DXA). In a single-center retrospective cross-sectional cohort study, we analysed data on DXA and calcaneal QUS measurements systematically collected between 2011 and 2013 in all non-metastatic PCa patients attending our Uro-Oncological Clinic at the Leiden University Medical Center. Receiver operating characteristic curves were used to assess the positive (PPV) and negative (NPV) predictive values of QUS T-scores of 0, -1.0, and - 1.8 in identifying DXA-diagnosed osteoporosis (T-scores ≤ - 2.5 and ≤ -2) at lumbar spine and/or femoral neck. Complete sets of data were available in 256 patients, median age 70.9 (53.6-89.5) years; 93.0 % had received local treatment, 84.4 % with additional ADT. Prevalence of osteoporosis and osteopenia was respectively 10.5 % and 53 %. Mean QUS T-score was -0.54 ± 1.58. Whereas PPV at any QUS T-score was <25 %, precluding the use of QUS as surrogate for DXA in screening for osteoporosis, QUS T-scores of -1.0 to 0.0 had a NPV of ≥94.5 % for DXA T-scores ≤ 2.5 and ≤ -2 at any site, confidently identifying patients least likely to have osteoporosis, thereby significantly reducing the number of patients requiring DXA screening for diagnosing osteoporosis by up to two-third. Osteoporosis screening is a significant unmet need in non-metastatic prostate cancer patients treated with ADT, and QUS may represent a valuable alternative pre-screening strategy to overcome logistics, time demands, and economic barriers encountered with current strategies for osteoporosis screening in these patients. Summary Osteoporosis and associated increased fracture risk are common in non-metastatic prostate carcinoma, mainly due to androgen deprivation therapy, but these often remain underdiagnosed and untreated. We demonstrate that QUS is a safe, less costly pre-screen tool that reduces by up to two-third the number of patients requiring referral for DXA for osteoporosis screening.
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Affiliation(s)
- B.B. Nieuwkamer
- Department of Medical Oncology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, the Netherlands
- Department of Urology, Reinier de Graaf Hospital (RdGG), Reinier de Graafweg 5, 2625 AD Delft, the Netherlands
| | - J.P.M. Vrouwe
- Department of Medical Oncology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, the Netherlands
- Centre for Human Drug Research (CHDR), Zernikedreef 8, 2333 CL Leiden, the Netherlands
| | - P.M. Willemse
- Department of Urology, University Medical Center Utrecht (UMCU), Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - M.P.J. Nicolai
- Department of Urology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, the Netherlands
- Department of Urology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - R.F.M. Bevers
- Department of Urology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - R.C.M. Pelger
- Department of Urology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - N.A.T. Hamdy
- Department of Medicine, Division of Endocrinology and Center for Bone Quality, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - S. Osanto
- Department of Medical Oncology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, the Netherlands
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Pharmacoepidemiology for oncology clinical practice: Foundations, state of the art and perspectives. Therapie 2022; 77:229-240. [DOI: 10.1016/j.therap.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/23/2021] [Indexed: 11/20/2022]
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Moussa M, Papatsoris A, Sryropoulou D, Chakra MA, Dellis A, Tzelves L. A pharmacoeconomic evaluation of pharmaceutical treatment options for prostate cancer. Expert Opin Pharmacother 2021; 22:1685-1728. [PMID: 34076542 DOI: 10.1080/14656566.2021.1925647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Prostate cancer is one of the most common neoplasms in men. For many years the mainstay of treatment was androgen deprivation therapy, but during last decade many novel agents have emerged, accompanied by increased costs for healthcare systems. AREAS COVERED In this literature review, the authors provide a pharmacoeconomic review of several pharmaceutical agents used in several disease stages, by summarizing evidence from cost-analysis, cost-effectiveness, cost-utility, cost-saving, cost-benefit and budgetary impact analysis studies. EXPERT OPINION The rapid development of therapeutic agents for prostate cancer has put a great budgetary burden on healthcare systems, since these drugs are prolonging survival and improving quality of life . Since existing data are now mature enough from a number of clinical trials with long-term follow-up, policy makers should propose not only the most clinically effective but also the most cost-effective agents, in order for every patient to gain access at least to some of these therapies. Docetaxel addition seems to be a cost-effective option, when compared to both abiraterone and enzalutamide (due to costs related to acquisition and side effects). Cabazitaxel is a strong candidate after docetaxel failure, while both denosumab and bisphosphonates are cost-effective for reducing skeletal-related events in metastatic disease.
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Affiliation(s)
- Mohamad Moussa
- Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Mohamed Abou Chakra
- Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon
| | - Athanasios Dellis
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Department of Surgery, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lazaros Tzelves
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Dellis A, Zagouri F, Liontos M, Mitropoulos D, Bamias A, Papatsoris AG. Management of advanced prostate cancer: A systematic review of existing guidelines and recommendations. Cancer Treat Rev 2019; 73:54-61. [DOI: 10.1016/j.ctrv.2018.11.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
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Butler AM, Cetin K, Hernandez RK, Diane Reams B, Overman RA, I Kim J, Hirsch BR, Abernethy AP, Liede A, Alan Brookhart M. Treatment dynamics of bone-targeting agents among men with bone metastases from prostate cancer in the United States. Pharmacoepidemiol Drug Saf 2018; 27:229-238. [PMID: 29316026 DOI: 10.1002/pds.4360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/06/2017] [Accepted: 10/26/2017] [Indexed: 11/07/2022]
Abstract
PURPOSE To examine the dynamics of treatment with 2 bone-targeting agents (BTAs)-denosumab and zoledronic acid-among men with bone metastases from prostate cancer. METHODS Using electronic health record data from oncology practices across the US, we identified prostate cancer patients diagnosed with bone metastasis in 2012/2013 without evidence of BTA use within 6 months prior to diagnosis. We examined the risk and predictors of BTA initiation, interruption, and re-initiation. RESULTS Among 897 men diagnosed with prostate cancer, the cumulative incidence of BTA initiation after bone metastasis diagnosis was 34% (95% confidence interval [CI], 31-37%) at 30 days, 64% (95% CI, 61-68%) at 180 days, and 88% (95% CI, 85-91%) at 2 years. Denosumab was initiated more frequently than zoledronic acid. Men with diabetes, more bone lesions, history of androgen deprivation therapy, or no hospice enrollment were more likely to initiate treatment. Following initiation, the cumulative incidence of treatment interruption was 17% (95% CI, 14-19%) at 60 days and 70% (95% CI, 66-74%) at 2 years, with interruption more likely among patients receiving emerging therapies for prostate cancer or enrolling in hospice. The cumulative incidence of re-initiation following interruption was 36.3% (95% CI, 32.7-40.2%) at 15 days, 49.8% (95% CI, 45.9-54.1%) at 30 days, and 81.0% (95% CI, 77.5-84.7%) at 1 year. CONCLUSIONS Bone-targeting agent therapy is initiated by the majority of men living with bone metastases following a prostate cancer diagnosis; however, the timing of initiation is highly variable. Once on treatment, gaps or interruptions in therapy are common.
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Affiliation(s)
- Anne M Butler
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Karynsa Cetin
- Amgen, Inc., Thousand Oaks and South San Francisco, CA, USA
| | | | - B Diane Reams
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Robert A Overman
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Jung I Kim
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | | | | | | | - M Alan Brookhart
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
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Ramamurthy C, Doyle J, Uzzo RG, Kutikov A, Smaldone MC, Geynisman DM. Role of collaboration between urologists and medical oncologists in the advanced prostate cancer space. Urol Oncol 2017; 35:665-669. [DOI: 10.1016/j.urolonc.2017.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/06/2017] [Accepted: 06/13/2017] [Indexed: 11/26/2022]
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Cathomas R, Bajory Z, Bouzid M, El Ghoneimy A, Gillessen S, Goncalves F, Kacso G, Kramer G, Milecki P, Pacik D, Tantawy W, Lesniewski-Kmak K. Management of Bone Metastases in Patients with Castration-Resistant Prostate Cancer. Urol Int 2014; 92:377-86. [DOI: 10.1159/000358258] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Rizk R, Danse E, Aydin S, Tombal B, Machiels JP. Castrate-resistant prostate cancer with peritoneal metastases treated with docetaxel-based chemotherapy. Urol Int 2013; 93:49-54. [PMID: 24296400 DOI: 10.1159/000354396] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 07/15/2013] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To identify the risk factors, characteristics and prognosis of patients treated with docetaxel-based chemotherapy for peritoneal carcinomatosis due to metastatic castrate-resistant prostate cancer (mCRPC). METHODS We retrospectively reviewed our series of mCRPC patients with peritoneal metastases treated with docetaxel-based chemotherapy between 2004 and 2010. RESULTS Six patients were identified from our institutions' internal cancer registry. Three out of these patients had been treated with laparoscopic radical prostatectomy (LRP). In addition to peritoneal metastases, other metastatic sites were mainly visceral. Only 1 patient developed bone metastases. Peritoneal carcinomatosis occurred mainly in patients with a high Gleason (= or >6) score since 5 out of our 6 patients had a Gleason score ≥7. All 6 patients were treated with docetaxel-based chemotherapy when they developed castration resistance. Five patients benefitted from chemotherapy according to their PSA or RECIST responses. Median survival from the start of docetaxel was 24.5 months. CONCLUSIONS Our retrospective analysis suggests that peritoneal carcinomatosis occurs mainly in patients with a high Gleason score. It is also possible that tumor seeding occurs during LRP. Patients with peritoneal carcinomatosis resistant to castration seem to benefit from docetaxel-based chemotherapy.
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Affiliation(s)
- Rita Rizk
- Department of Medical Oncology, Cancer Center, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Akin Y, Yucel S, Baykara M. Distal phalangeal necrosis in the extremities as a paraneoplastic syndrome in prostate cancer: an extremely rare case. Urol Int 2013; 93:244-6. [PMID: 24281198 DOI: 10.1159/000354648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 07/25/2013] [Indexed: 11/19/2022]
Abstract
Paraneoplastic syndromes (PNSs) are rare disorders which are triggered by an altered immune system response to a neoplasm. Although prostate cancer (PCa) is the second most common urological malignancy associated with PNSs, literature is lacking in defining the cases representing different PNSs in PCa. Herein, we present a 50-year-old man with fulminant distal phalangeal necrosis in the lower extremities after a diagnosis of PCa. Additionally, we review the literature in light of this case.
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Affiliation(s)
- Yigit Akin
- Department of Urology, Erzincan University School of Medicine, Erzincan, Turkey
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