1
|
Ogunsanya ME, Kaninjing E, Ellis TN, Morton DJ, McIntosh AG, Zhao J, Dickey SL, Kendzor DE, Dwyer K, Young ME, Odedina FT. Health-related quality of life in ethnically diverse Black prostate cancer survivors: a convergent parallel mixed-methods approach. Qual Life Res 2024:10.1007/s11136-024-03718-9. [PMID: 39008143 DOI: 10.1007/s11136-024-03718-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE This study examined the health-related quality of life (HRQoL) among ethnically diverse Black men (BM) with prostate cancer (CaP) in the United States. METHODS A convergent parallel mixed-methods design, employing both qualitative and quantitative research, involved recruiting Black CaP survivors through multiple channels. The target population was native-born BM (NBBM), African-born BM (ABBM), and Caribbean-born BM (CBBM). QoL for all men was assessed using The Functional Assessment Cancer Therapy-Prostate (FACT-P) measure, which includes five domains: physical- (PWB), emotional- (EWB), social-(SWB), and functional-wellbeing (FWB), and a CaP subscale (PCS). A subset of men completed qualitative interviews. Demographic and clinical characteristics were also collected. RESULTS Black CaP survivors aged 49-85 participated in the study (n = 108), with a subset (n = 31) completing a qualitative interview. Participants were mainly NBBM (72.2%) and treated with radiotherapy (51.9%). The FACT-P scale total mean score (± SD) was 114 ± 24.1 (theoretical range 0-156), with lower scores reported on the SWB, FWB, and EWB domains. The mixed-methods findings approach included meta-inferences derived from integrating the corresponding quantitative and qualitative data, covering all the domains within the FACT-P. CONCLUSION Black CaP survivors experienced significant burdens that impacted their overall HRQoL. The analysis revealed impacts on physical, social, and emotional well-being, with variations among ethnic groups suggesting the need for culturally tailored interventions. EWB was also profoundly impacted by CaP treatment, with universal emotional burdens emphasized across all groups. Healthcare providers must recognize and address these multifaceted needs to promote better outcomes and HRQoL for Black CaP survivors.
Collapse
Affiliation(s)
- Motolani E Ogunsanya
- Department of Pharmacy, Clinical & Administrative Sciences, College of Pharmacy, University of Oklahoma Health Sciences, Oklahoma City, OK, USA.
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences, Oklahoma City, OK, USA.
- Stephenson Cancer Center, University of Oklahoma Health Sciences, Oklahoma City, OK, USA.
- iCCaRE for Black Men Consortium, Jacksonville, FL, USA.
- Prostate Cancer Transatlantic Consortium (CaPTC), Jacksonville, FL, USA.
| | - Ernest Kaninjing
- School of Health and Human Performance, Georgia College & State University, Milledgeville, GA, USA
- iCCaRE for Black Men Consortium, Jacksonville, FL, USA
- Prostate Cancer Transatlantic Consortium (CaPTC), Jacksonville, FL, USA
| | - Tanara N Ellis
- Department of Pharmacy, Clinical & Administrative Sciences, College of Pharmacy, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
| | - Daniel J Morton
- Stephenson Cancer Center, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
- Department of Pediatrics, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
| | - Andrew G McIntosh
- Stephenson Cancer Center, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
- Department of Urology, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
| | - Jian Zhao
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
| | - Sabrina L Dickey
- College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Darla E Kendzor
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
- Stephenson Cancer Center, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
| | - Kathleen Dwyer
- Stephenson Cancer Center, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
- Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
| | - Mary Ellen Young
- Community Health Collaborative and Minority Health & Health Equity Research Support Services, Mayo Foundation for Medical Education and Research, Jacksonville, FL, USA
- iCCaRE for Black Men Consortium, Jacksonville, FL, USA
| | - Folakemi T Odedina
- iCCaRE for Black Men Consortium, Jacksonville, FL, USA
- Prostate Cancer Transatlantic Consortium (CaPTC), Jacksonville, FL, USA
- Prevention, Symptom Control and Survivorship, and Care Delivery Transformation (CPSD) Program, Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Jacksonville, USA
| |
Collapse
|
2
|
Hsieh TF, Chen HL, Hsia YF, Lin CC, Chiang HY, Wu MY, Chen SH, Hsieh PF, Wu HC, Chang H, Kuo CC. Age-specific percentile-based prostate-specific antigen cutoff values predict the risk of prostate cancer: A single hospital observation. Biomedicine (Taipei) 2023; 13:9-24. [PMID: 37937061 PMCID: PMC10627214 DOI: 10.37796/2211-8039.1415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/18/2023] [Accepted: 06/28/2023] [Indexed: 11/09/2023] Open
Abstract
Background Testing for prostate-specific antigen (PSA) is often recommended for men with a potential risk of prostate cancer (PCa) before requiring advanced examination. However, the best PSA cutoff value remains controversial. Object We compared the predictive performance of age-specific percentile-based PSA thresholds with a conventional cutoff of >4 ng/mL for the risk of PCa. Methods We included men who received PSA measurements between 2003 and 2017 in a medical center in Taiwan. Logistic regression modeling was used to assess the association between age-specific percentile-based PSA thresholds and PCa risk in age subgroups. We further applied C-statistic and decision curve analysis to compare the predictive performance of age-specific percentile-based PSA with that of a conventional cutoff PSA. Results We identified 626 patients with PCa and 40 836 patients without PCa. The slope of PSA in patients >60-year-old was almost 3 times that of those <60-year-old (0.713 vs 0.259). The risk effect sizes of the 75th percentile PSA cutoff (<60-year-old: 2.19; 60-70-year-old: 4.36; >70-year-old: 5.84 ng/mL) were comparable to those observed based on the conventional cutoff in all age groups. However, the discrimination performance of the 75th percentile PSA cutoff was better than that of the conventional cutoff among patients aged <60-year-old (C-statistic, 0.783 vs. 0.729, p < 0.05). The 75th percentile cutoffs also correctly identified an additional 2 patients with PCa for every 100 patients with PSA screening at the threshold probability of 20%. Conclusions Our data support the use of the 75th percentile PSA cutoff to facilitate individualized risk assessment, particularly for patients aged <60-year-old.
Collapse
Affiliation(s)
- Teng-Fu Hsieh
- Division of Urology, Department of Surgery, Taichung Tzu Chi Hospital, Taichung,
Taiwan
| | - Hung-Lin Chen
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
| | - Ying-Fang Hsia
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
| | - Che-Chen Lin
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
| | - Min-Yen Wu
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
| | - Sheng-Hsuan Chen
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
| | - Po-Fan Hsieh
- Department of Urology, China Medical University Hospital, Taichung,
Taiwan
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung,
Taiwan
- Department of Urology, China Medical University Beigang Hospital, Beigang, Yunlin,
Taiwan
| | - Hsi-Chin Wu
- Department of Urology, China Medical University Hospital, Taichung,
Taiwan
- Department of Urology, China Medical University Beigang Hospital, Beigang, Yunlin,
Taiwan
| | - Han Chang
- Department of Pathology, China Medical University Hospital, Taichung,
Taiwan
| | - Chin-Chi Kuo
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
- College of Medicine, China Medical University, Taichung,
Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung,
Taiwan
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung,
Taiwan
| |
Collapse
|
3
|
The role of the serum 25-OH vitamin D level on detecting prostate cancer in men with elevated prostate-specific antigen levels. Sci Rep 2022; 12:14089. [PMID: 35982094 PMCID: PMC9388499 DOI: 10.1038/s41598-022-17563-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 07/27/2022] [Indexed: 12/24/2022] Open
Abstract
We aimed to determine whether vitamin D levels before prostate biopsy have diagnostic value for clinically significant prostate cancer. The study cohort included patients who underwent prostate biopsy. A total of 224 patients were enrolled in our study and serum vitamin D levels were measured from February 2016 to December 2019 in routine laboratory tests. To determine the relationship between vitamin D levels and aggressiveness of prostate cancer, we used logistic multivariate analysis. Based on the histopathological results of patients who underwent radical prostatectomy, the serum vitamin D level was significantly lower with the large tumor volume group. In the univariate analysis, the prostate cancer diagnosis rate was associated with low vitamin D levels. Low vitamin D level is negatively correlated with clinically significant prostate cancer (biopsy Gleason score of 7 or higher) in the univariate (Odds ratio [OR], 0.955; P < 0.001) and multivariate (OR, 0.944; P = 0.027) analyses. In conclusion, we found that the incidence of clinically significant prostate cancer might related to low vitamin D level in the Asian population. In the future, a larger population and prospective study are needed.
Collapse
|
4
|
A Combined Radiomics and Machine Learning Approach to Distinguish Clinically Significant Prostate Lesions on a Publicly Available MRI Dataset. J Imaging 2021; 7:jimaging7100215. [PMID: 34677301 PMCID: PMC8540196 DOI: 10.3390/jimaging7100215] [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: 09/08/2021] [Revised: 10/01/2021] [Accepted: 10/13/2021] [Indexed: 12/14/2022] Open
Abstract
Although prostate cancer is one of the most common causes of mortality and morbidity in advancing-age males, early diagnosis improves prognosis and modifies the therapy of choice. The aim of this study was the evaluation of a combined radiomics and machine learning approach on a publicly available dataset in order to distinguish a clinically significant from a clinically non-significant prostate lesion. A total of 299 prostate lesions were included in the analysis. A univariate statistical analysis was performed to prove the goodness of the 60 extracted radiomic features in distinguishing prostate lesions. Then, a 10-fold cross-validation was used to train and test some models and the evaluation metrics were calculated; finally, a hold-out was performed and a wrapper feature selection was applied. The employed algorithms were Naïve bayes, K nearest neighbour and some tree-based ones. The tree-based algorithms achieved the highest evaluation metrics, with accuracies over 80%, and area-under-the-curve receiver-operating characteristics below 0.80. Combined machine learning algorithms and radiomics based on clinical, routine, multiparametric, magnetic-resonance imaging were demonstrated to be a useful tool in prostate cancer stratification.
Collapse
|
5
|
Presti J, Alexeeff S, Avins AL. Impact of 2012 Prostate Cancer Screening Statement. J Gen Intern Med 2021; 36:2854-2855. [PMID: 34258729 PMCID: PMC8390719 DOI: 10.1007/s11606-021-06996-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Joseph Presti
- Department of Urology, Kaiser Permanente Northern California, Oakland, CA, USA. .,Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
| | - Stacey Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Andrew L Avins
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.,Department of Medicine, Kaiser Permanente Northern California, Oakland, CA, USA
| |
Collapse
|
6
|
Emerging role of multiparametric magnetic resonance imaging in identifying clinically relevant localized prostate cancer. Curr Opin Oncol 2021; 33:244-251. [PMID: 33606404 DOI: 10.1097/cco.0000000000000717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW To explore the recent advances and utility of multiparametric magnetic resonance imaging (mpMRI) in the diagnosis and risk-stratification of prostate cancer. RECENT FINDINGS Low-risk, clinically insignificant prostate cancer has a decreased risk of morbidity or mortality. Meanwhile, patients with intermediate and high-risk prostate cancer may significantly benefit from interventions like radiation or surgery. To appropriately risk stratify these patients, MRI has emerged as the imaging modality in the last decade to assist in defining prostate cancer significance, location, and biologic aggressiveness. Traditional 12-core transrectal ultrasound-guided biopsy is associated with over-detection, and ultimately over-treatment of clinically insignificant disease, and the under-detection of clinically significant disease. Biopsy accuracy is improved with MRI-guided targeted biopsy and with the use of standardized risk stratification imaging score systems. Cancer detection accuracy is further improved with combined biopsy techniques that include both systematic and MRI-targeted biopsy that aid in detection of MRI-invisible lesions. SUMMARY mpMRI is an area of expanding innovation that continues to refine the diagnostic accuracy of prostate biopsies. As mpMRI-targeted biopsy in prostate cancer becomes more commonplace, advances like artificial intelligence and less invasive dynamic metabolic imaging will continue to improve the utility of MRI.
Collapse
|
7
|
Gulati R, Carlsson SV, Etzioni R. When to Discuss Prostate Cancer Screening With Average-Risk Men. Am J Prev Med 2021; 61:294-298. [PMID: 33966938 PMCID: PMC8319088 DOI: 10.1016/j.amepre.2021.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 11/21/2022]
Affiliation(s)
- Roman Gulati
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Sigrid V Carlsson
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| |
Collapse
|
8
|
[Intelligent early prostate cancer detection in 2021: more benefit than harm]. Urologe A 2021; 60:602-609. [PMID: 33881554 DOI: 10.1007/s00120-021-01519-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
Prostate-specific antigen (PSA) is used for early detection of prostate cancer which represents the most frequent cancer diagnosed in men in Germany and Europe. Results of the largest screening trials revealed that PSA testing reduces the incidence of locally advanced and metastatic prostate cancer and shows an effect on cancer-specific mortality. However, since early diagnosis also results in overdiagnosis and overtreatment of insignificant cancers with associated morbidities, there is a need for a more individualized and risk-tailored modern strategy. The PSA at baseline is an important part of this strategy although the German Federal Joint Committee declined its financial coverage by health insurances. Available validated instruments should accompany the baseline PSA to optimize detection of clinically significant prostate cancer.
Collapse
|
9
|
Hatakeyama S, Yoneyama T, Tobisawa Y, Yamamoto H, Ohyama C. Narrative review of urinary glycan biomarkers in prostate cancer. Transl Androl Urol 2021; 10:1850-1864. [PMID: 33968674 PMCID: PMC8100853 DOI: 10.21037/tau-20-964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Prostate cancer (PC) is the second most common cancer in men worldwide. The application of the prostate-specific antigen (PSA) test has improved the diagnosis and treatment of PC. However, the PSA test has become associated with overdiagnosis and overtreatment. Therefore, there is an unmet need for novel diagnostic, prognostic, and predictive biomarkers of PC. Urinary glycoproteins and exosomes are a potential source of PC glycan biomarkers. Urinary glycan profiling can provide noninvasive monitoring of tumor heterogeneity and aggressiveness throughout a treatment course. However, urinary glycan profiling is not popular due to technical disadvantages, such as complicated structural analysis that requires specialized expertise. The technological development of glycan analysis is a rapidly advancing field. A lectin-based microarray can detect aberrant glycoproteins in urine, including PSA glycoforms and exosomes. Glycan enrichment beads can enrich the concentration of N-linked glycans specifically. Capillary electrophoresis, liquid chromatography-tandem mass spectrometry, and matrix-assisted laser desorption/ionization-time of flight mass spectrometry can detect glycans directory. Many studies suggest potential of urinary glycoproteins, exosomes, and glycosyltransferases as a biomarker of PC. Although further technological challenges remain, urinary glycan analysis is one of the promising approaches for cancer biomarker discovery.
Collapse
Affiliation(s)
- Shingo Hatakeyama
- Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tohru Yoneyama
- Department of Glycotechnology, Center for Advanced Medical Research, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuki Tobisawa
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Chikara Ohyama
- Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Glycotechnology, Center for Advanced Medical Research, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
10
|
Cancer Screening Among Older Adults: a Geriatrician's Perspective on Breast, Cervical, Colon, Prostate, and Lung Cancer Screening. Curr Oncol Rep 2020; 22:108. [PMID: 32803486 DOI: 10.1007/s11912-020-00968-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW We summarize the evidence of benefits, harms, and tools to assist in individualized decisions among older adults in screening for breast, prostate, colon, lung, and cervical cancer. RECENT FINDINGS The benefits of cancer screening in older adults remain unclear due to minimal inclusion of adults > 75 years old in most randomized controlled trials. Indirect evidence suggests that the benefits of screening seen in younger adults (< 70 years old) can be extrapolated to older adults when they have an estimated life expectancy of at least 10 years. However, older adults, especially those with limited life expectancy, may be at increased risk for experiencing harms of screening, including overdiagnosis of clinically unimportant diseases, complications from diagnostic procedures, and distress after false positive test results. We provide a framework to integrate key factors such as health status, risks and benefits of specific tests, and patient preferences to guide clinicians in cancer screening decisions in older adults.
Collapse
|
11
|
Hiremath A, Shiradkar R, Merisaari H, Prasanna P, Ettala O, Taimen P, Aronen HJ, Boström PJ, Jambor I, Madabhushi A. Test-retest repeatability of a deep learning architecture in detecting and segmenting clinically significant prostate cancer on apparent diffusion coefficient (ADC) maps. Eur Radiol 2020; 31:379-391. [PMID: 32700021 DOI: 10.1007/s00330-020-07065-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/22/2020] [Accepted: 07/02/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To evaluate short-term test-retest repeatability of a deep learning architecture (U-Net) in slice- and lesion-level detection and segmentation of clinically significant prostate cancer (csPCa: Gleason grade group > 1) using diffusion-weighted imaging fitted with monoexponential function, ADCm. METHODS One hundred twelve patients with prostate cancer (PCa) underwent 2 prostate MRI examinations on the same day. PCa areas were annotated using whole mount prostatectomy sections. Two U-Net-based convolutional neural networks were trained on three different ADCm b value settings for (a) slice- and (b) lesion-level detection and (c) segmentation of csPCa. Short-term test-retest repeatability was estimated using intra-class correlation coefficient (ICC(3,1)), proportionate agreement, and dice similarity coefficient (DSC). A 3-fold cross-validation was performed on training set (N = 78 patients) and evaluated for performance and repeatability on testing data (N = 34 patients). RESULTS For the three ADCm b value settings, repeatability of mean ADCm of csPCa lesions was ICC(3,1) = 0.86-0.98. Two CNNs with U-Net-based architecture demonstrated ICC(3,1) in the range of 0.80-0.83, agreement of 66-72%, and DSC of 0.68-0.72 for slice- and lesion-level detection and segmentation of csPCa. Bland-Altman plots suggest that there is no systematic bias in agreement between inter-scan ground truth segmentation repeatability and segmentation repeatability of the networks. CONCLUSIONS For the three ADCm b value settings, two CNNs with U-Net-based architecture were repeatable for the problem of detection of csPCa at the slice-level. The network repeatability in segmenting csPCa lesions is affected by inter-scan variability and ground truth segmentation repeatability and may thus improve with better inter-scan reproducibility. KEY POINTS • For the three ADCm b value settings, two CNNs with U-Net-based architecture were repeatable for the problem of detection of csPCa at the slice-level. • The network repeatability in segmenting csPCa lesions is affected by inter-scan variability and ground truth segmentation repeatability and may thus improve with better inter-scan reproducibility.
Collapse
Affiliation(s)
- Amogh Hiremath
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Rakesh Shiradkar
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Harri Merisaari
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.,Department of Diagnostic Radiology, University of Turku, Turku, Finland
| | - Prateek Prasanna
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.,Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA
| | - Otto Ettala
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Pekka Taimen
- Institute of Biomedicine, Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - Hannu J Aronen
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Peter J Boström
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Ivan Jambor
- Department of Diagnostic Radiology, University of Turku, Turku, Finland.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.,Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, Ohio, USA
| |
Collapse
|
12
|
Kodama H, Hatakeyama S, Momota M, Togashi K, Hamaya T, Hamano I, Fujita N, Kojima Y, Okamoto T, Yoneyama T, Yamamoto H, Yoshikawa K, Yoneyama T, Hashimoto Y, Ohyama C. Effect of frailty and comorbidity on surgical contraindication in patients with localized prostate cancer (FRART-PC Study). Urol Oncol 2020; 39:191.e1-191.e8. [PMID: 32684512 DOI: 10.1016/j.urolonc.2020.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/11/2020] [Accepted: 06/19/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To determine how frailty and comorbidities affect surgical contraindication in patients with localized prostate cancer (CaP). MATERIALS AND METHODS We evaluated the effects of frailty in 479 patients with localized CaP who were treated with robot-assisted radical prostatectomy (RARP), or radiotherapy (RT) eligible for surgery (RT-nonfrail), or those with RT ineligible for surgery due to frailty or comorbidity (RT-frail) from February 2017 to April 2020. We retrospectively compared the geriatric 8 screening (G8) scores between patients with surgical indications (RARP and RT-nonfrail groups) and those with surgical contraindications (RT-frail group). The effect of G8 score in the RT-frail groups was investigated using multivariate logistic regression analysis. We developed and validated a nomogram for surgical contraindication in patients with localized CaP. RESULTS The median age of patients was 70 years. There were 256, 60, and 163 patients in the RARP, RT-nonfrail, and RT-frail, respectively. The G8 score in the RARP and RT-nonfrail groups was significantly higher than in the RT-frail group (15 vs. 14, respectively, P < 0.001). Age, comorbidities (cerebrocardiovascular disease or chronic respiratory disease), and G8 score were significantly associated with the RT-frail group. The nomogram showed that the area under the curve was 0.872 and 0.923 in the training and validation sets, respectively. The cutoff for surgical contraindication was >39.5%. CONCLUSIONS The G8 score and comorbidities have a significant effect on surgical contraindication in patients with localized CaP.
Collapse
Affiliation(s)
- Hirotake Kodama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Masaki Momota
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kyo Togashi
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tomoko Hamaya
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Itsuto Hamano
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Naoki Fujita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuta Kojima
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Teppei Okamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tohru Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
13
|
Associations among statins, preventive care, and prostate cancer mortality. Prostate Cancer Prostatic Dis 2020; 23:475-485. [PMID: 32029930 DOI: 10.1038/s41391-020-0207-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/18/2019] [Accepted: 01/28/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Increasing evidence indicates an association between statins and reduced prostate cancer-specific mortality (PCSM). However, significant bias may exist in these studies. One particularly challenging bias to assess is the healthy user effect, which may be quantified by screening patterns. We aimed to evaluate the association between statin use, screening, and PCSM in a dataset with detailed longitudinal information. METHODS We used the Veterans Affairs Informatics and Computing Infrastructure to assemble a cohort of patients diagnosed with prostate cancer (PC) between 2000 and 2015. We collected patient-level demographic, comorbidity, and tumor data. We also assessed markers of preventive care utilization including cholesterol and prostate specific antigen (PSA) screening rates. Patients were considered prediagnosis statin users if they had at least one prescription one or more years prior to PC diagnosis. We evaluated PCSM using hierarchical Fine-Gray regression models and all-cause mortality (ACM) using a cox regression model. RESULTS The final cohort contained 68,432 men including 40,772 (59.6%) prediagnosis statin users and 27,660 (40.4%) nonusers. Prediagnosis statin users had higher screening rates than nonusers for cholesterol (90 vs. 69%, p < 0.001) and PSA (76 vs. 67%, p < 0.001). In the model which excluded screening, prediagnosis statin users had improved PCSM (SHR 0.90, 95% CI 0.84-0.97; p = 0.004) and ACM (HR 0.96, 95% CI 0.93-0.99; p = 0.02). However, after including cholesterol and PSA screening rates, prediagnosis statin users and nonusers showed no differences in PCSM (SHR 0.98, 95% CI 0.91-1.06; p = 0.59) or ACM (HR 1.02, 95% CI 0.98-1.05; p = 0.25). CONCLUSION We found that statin users tend to have more screening than nonusers. When we considered screening utilization, we observed no relationship between statin use before a prostate cancer diagnosis and prostate cancer mortality.
Collapse
|
14
|
González-San Segundo C, Gómez-Iturriaga A, Couñago F. Are all prostate cancer patients "fit" for salvage radiotherapy? World J Clin Oncol 2020; 11:1-10. [PMID: 31976305 PMCID: PMC6935690 DOI: 10.5306/wjco.v11.i1.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/13/2019] [Accepted: 11/19/2019] [Indexed: 02/06/2023] Open
Abstract
The indication for salvage radiotherapy (RT) (SRT) in patients with biochemically-recurrent prostate cancer after surgery is based on prostate-specific antigen (PSA) levels at the time of biochemical recurrence. Although there are clear criteria (pT3-pT4 disease and/or positive margins) for the use of adjuvant radiotherapy, no specific clinical or tumour-related criteria have yet been defined for SRT. In retrospective series, 5-year biochemical progression-free survival (PFS) ranges from 35%-85%, depending on the PSA level at the start of RT. Two phase 3 trials have compared SRT with and without androgen deprivation therapy (ADT), finding that combined treatment (SRT+ADT) improves both PFS and overall survival. Similar to adjuvant RT, the indication for ADT is based on tumour-related factors such as PSA levels, tumour stage, and surgical margins. The number of patients referred to radiation oncology departments for SRT continues to rise. In the present article, we define the clinical, therapeutic, and tumour-related factors that we believe should be evaluated before prescribing SRT. In addition, we propose a decision algorithm to determine whether the patient is fit for SRT. This algorithm will help to identify patients in whom radiotherapy is likely to improve survival without significantly worsening quality of life.
Collapse
Affiliation(s)
| | | | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Madrid 28003, Spain
| |
Collapse
|
15
|
Khan MFL, Soikkeli M, Routila E, Krannila S, Terävä J, Taimen P, Boström PJ, Pettersson K. Clinical Utility of Mutant Antibody-Based Assays for Determination of Internally Cleaved and Intact Forms of Free Prostate-Specific Antigen. J Appl Lab Med 2019; 3:1014-1021. [PMID: 31639692 DOI: 10.1373/jalm.2018.027797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 12/07/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Subforms of prostate-specific antigen (PSA) have been a subject of intensive research, and use of multikallikrein immunoassays can add clinical value to the early detection of prostate cancer, overcoming known limitations of PSA. In this study, we evaluated mutant 4D4 (L3-2) antibody-assisted assay constructs against reference wild-type (wt)-4D4-based assays for determination of intact PSA (iPSA) and nicked PSA (nPSA) in plasma samples. METHODS Perioperative plasma samples obtained from 105 men who underwent biopsy (73 cancer, 32 noncancer) were analyzed with sandwich immunoassays for total PSA (tPSA), free PSA (fPSA), iPSA (3 constructs), and measured nPSA (2 constructs). Calculated nPSA (CN) was obtained from total fPSA - iPSA. RESULTS Mutant-assisted iPSA assays measured lower concentrations than the reference in both patient groups. CN separated the 2 groups with the iPSA using the mutant for capture (I-MC) performing the best (P = 0.008). In prostate volume group > median, only measured nPSA provided significant discrimination [area under the curve (AUC), 0.71; P = 0.016] but equally using mutant and wt antibodies. In the whole cohort, all ratios to tPSA performed well (AUC, 0.819-0.870; P ≤ 0.0001) with CN based on I-MC scoring highest (AUC, 0.870). Importantly, in the ≤ median volume group, the I-MC/F and CN(I-MC)/T ratios stand out as the best performing parameters (AUC, 0.825 and 0.861; P = 0.001 and P = 0.0003, respectively). CONCLUSIONS The new assay construct using the mutant 4D4 (L3-2) as a capture provides clear improvement in separating cancer from noncancer in all subgroups analyzed but especially in patients with prostate volume ≤ median.Clinical Trial Registration: ClinicalTrials.gov Identifier NCT01864135.
Collapse
Affiliation(s)
- Md Ferdhos L Khan
- Departments of Biochemistry/Biotechnology, University of Turku, Turku, Finland;
| | - Minna Soikkeli
- Departments of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Erica Routila
- Departments of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Sandra Krannila
- Departments of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Joonas Terävä
- Departments of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Pekka Taimen
- Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - Peter J Boström
- Department of Urology, Turku University Hospital, Turku, Finland
| | - Kim Pettersson
- Departments of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| |
Collapse
|
16
|
Lopez AM, Hudson L, Vanderford NL, Vanderpool R, Griggs J, Schonberg M. Epidemiology and Implementation of Cancer Prevention in Disparate Populations and Settings. Am Soc Clin Oncol Educ Book 2019; 39:50-60. [PMID: 31099623 DOI: 10.1200/edbk_238965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Successful cancer prevention strategies must be tailored to support usability. In this article, we will focus on cancer prevention strategies in populations that differ by race and ethnicity, place and location, sexual orientation and gender identity, and age by providing examples of effective approaches. An individual may belong to none of these categories, to all of these categories, or to some. This intersectionality of belonging characterizes individuals and shapes their experiences. Even within a category, broad diversity exists. Effective cancer prevention strategies comprehensively engage the community at multiple levels of influence and may effectively include lay health workers and faith-based cancer education interventions. Health system efforts that integrate cancer health with other health promotion activities show promise. At the individual physician level, culturally literate approaches have demonstrated success. For example, when discussing cancer screening tests with older adults, clinicians should indicate whether any data suggest that the screening test improves quality or quantity of life and the lag time to benefit from the screening test. This will allow older adults to make an informed cancer screening decision based on a realistic understanding of the potential benefits and risks and their values and preferences. Addressing individual and health system bias remains a challenge. Quality improvement strategies can address gaps in quality of care with respect to timeliness of care, coordination of care, and patient experience. The time is ripe for research on effective and interdisciplinary prevention strategies that harness expertise from preventive medicine, behavioral medicine, implementation science, e-health, telemedicine, and other diverse fields of health promotion.
Collapse
Affiliation(s)
- Ana Maria Lopez
- 1 Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Lauren Hudson
- 2 University of Kentucky Markey Cancer Center, Lexington, KY
| | | | | | | | - Mara Schonberg
- 4 Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| |
Collapse
|
17
|
The burden of prostate cancer is associated with human development index: evidence from 87 countries, 1990-2016. EPMA J 2019; 10:137-152. [PMID: 31258819 DOI: 10.1007/s13167-019-00169-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 04/26/2019] [Indexed: 01/04/2023]
Abstract
Aim To examine the temporal patterns of the prostate cancer burden and its association with human development. Subject and methods The estimates of the incidence and mortality of prostate cancer for 87 countries were obtained from the Global Burden of Disease 2016 study for the period 1990 to 2016. The human development level of a country was measured using its human development index (HDI): a summary indicator of health, education, and income. The association between the burden of prostate cancer and the human development index (HDI) was measured using pairwise correlation and bivariate regression. Mortality-to-incidence ratio (MIR) was employed as a proxy for the survival rate of prostate cancer. Results Globally, 1.4 million new cases of prostate cancer arose in 2016 claiming 380,916 lives which more than doubled from 579,457 incident cases and 191,687 deaths in 1990. In 2016, the age-standardised incidence rate (ASIR) was the highest in very high-HDI countries led by Australia with ASIR of 174.1/100,000 and showed a strong positive association with HDI (r = 0.66); the age-standardised mortality rate (ASMR), however, was higher in low-HDI countries led by Zimbabwe with ASMR of 78.2/100,000 in 2016. Global MIR decreased from 0.33 in 1990 to 0.26 in 2016. Mortality-to-incidence ratio (MIR) exhibited a negative gradient (r = - 0.91) with human development index with tenfold variation globally with seven countries recording MIR in excess of 1 with the USA recording the minimum MIR of 0.10. Conclusion The high mortality and lower survival rates in less-developed countries demand all-inclusive solutions ranging from cost-effective early screening and detection to cost-effective cancer treatment. In tackling the rising burden of prostate cancer predictive, preventive and personalised medicine (PPPM) can play a useful role through prevention strategies, predicting PCa more precisely and accurately using a multiomic approach and risk-stratifying patients to provide personalised medicine.
Collapse
|
18
|
Matoso A, Epstein JI. Defining clinically significant prostate cancer on the basis of pathological findings. Histopathology 2019; 74:135-145. [PMID: 30565298 DOI: 10.1111/his.13712] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 12/12/2022]
Abstract
The definition of clinically significant prostate cancer is a dynamic process that was initiated many decades ago, when there was already evidence that a great proportion of patients with prostate cancer diagnosed at autopsy never had any clinical symptoms. Autopsy studies led to examinations of radical prostatectomy (RP) specimens and the establishment of the definition of significant cancer at RP: tumour volume of 0.5 cm3 , Gleason grade 6 [Grade Group (GrG) 1], and organ-confined disease. RP studies were then used to develop prediction models for significant cancer by the use of needle biopsies. The first such model was used to delineate the first active surveillance (AS) criteria, known as the 'Epstein' criteria, in which patients with a cancer Gleason score of 3 + 3 = 6 (GrG1) involving fewer than two cores, and <50% of any given core, and a prostate-specific antigen density of <0.15 ng/ml per cm3 had a minimal risk of significant cancer at RP. These were adopted as components of the 'very-low-risk category' of the National Comprehensive Cancer Network guidelines, in which AS is supported as a management option. With the increase in the popularity of AS, much research has been carried out to better define significant/insignificant cancer, in order to be able to safely offer AS to a larger proportion of patients without the risk of undertreatment. Research has focused on allowing higher volume tumours, focal extraprostatic extension, and a limited amount of Gleason pattern 4, and the significance of different morphological patterns of Gleason 4. Other areas of research that will probably impact on the field but that are not covered in this review include the molecular classification of tumours and imaging techniques.
Collapse
Affiliation(s)
- Andres Matoso
- Departments of Pathology, Urology and Oncology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Jonathan I Epstein
- Departments of Pathology, Urology and Oncology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| |
Collapse
|
19
|
Stanciu MA, Morris C, Makin M, Watson E, Bulger J, Evans R, Hiscock J, Hoare Z, Edwards RT, Neal RD, Yeo ST, Wilkinson C. Trial of personalised care after treatment-Prostate cancer: A randomised feasibility trial of a nurse-led psycho-educational intervention. Eur J Cancer Care (Engl) 2018; 28:e12966. [PMID: 30478975 DOI: 10.1111/ecc.12966] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 10/21/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The present parallel randomised control trial evaluated the feasibility of a nurse-led psycho-educational intervention aimed at improving the self-management of prostate cancer survivors. METHODS We identified 305 eligible patients from a district general hospital, diagnosed 9-48 months previously, who completed radical treatment, or were monitored clinically (ineligible for treatment). Ninety-five patients were recruited by blinded selection and randomised to Intervention (N = 48) and Control (N = 47) groups. Participant allocation was revealed to patients and researchers after recruitment was completed. For 36 weeks, participants received augmented usual care (Control) or augmented usual care and additional nurse support (Intervention) provided in two community hospitals and a university clinic, or by telephone. RESULTS Data from 91 participants (Intervention, N = 45; Control, N = 46) were analysed. All feasibility metrics met predefined targets: recruitment rate (31.15%; 95% CI: 25.95%-36.35%), attrition rate (9.47%; 95% CI: 3.58%-15.36%) and outcome measures completion rates (77%-92%). Forty-five patients received the intervention, with no adverse events. The Extended Prostate Cancer Index Composite can inform the minimum sample size for a future effectiveness trial. The net intervention cost was £317 per patient. CONCLUSIONS The results supported the feasibility and acceptability of the intervention, suggesting that it should be evaluated in a fully powered trial to assess its effectiveness and cost-effectiveness.
Collapse
Affiliation(s)
| | | | - Matt Makin
- Betsi Cadwaladr University Health Board, Wrexham, UK
| | - Eila Watson
- Department of Clinical Health Care, Oxford Brookes University, Oxford, UK
| | - Jenna Bulger
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Richard Evans
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Julia Hiscock
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Zoë Hoare
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | | | - Richard D Neal
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Seow Tien Yeo
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Clare Wilkinson
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| |
Collapse
|
20
|
Alibhai SMH, Ritvo P, Santa Mina D, Sabiston C, Krahn M, Tomlinson G, Matthew A, Lukka H, Warde P, Durbano S, O’Neill M, Culos-Reed SN. Protocol for a phase III RCT and economic analysis of two exercise delivery methods in men with PC on ADT. BMC Cancer 2018; 18:1031. [PMID: 30352568 PMCID: PMC6199786 DOI: 10.1186/s12885-018-4937-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 10/10/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Androgen deprivation therapy (ADT) is commonly used to treat prostate cancer. However, side effects of ADT often lead to reduced quality of life and physical function. Existing evidence demonstrates that exercise can ameliorate multiple treatment-related side effects for men on ADT, yet adherence rates are often low. The method of exercise delivery (e.g., supervised group in-centre vs. individual home-based) may be important from clinical and economic perspectives; however, few studies have compared different delivery models. Additionally, long-term exercise adherence and an understanding of predictors of adherence are critical to achieving sustained benefits, but such data are lacking. The primary aim of this multi-centre phase III non-inferiority randomized controlled trial is to determine whether a home-based delivery model is non-inferior to a group-based delivery model in terms of benefits in fatigue and fitness in this population. Two other key aims include examining cost-effectiveness and long-term adherence. METHODS Men diagnosed with prostate cancer of any stage, starting or continuing on ADT for at least 6 months, fluent in English, and living close to a study centre are eligible. Participants complete five assessments over 12 months (baseline and every 3 months during the 6-month intervention and 6-month follow-up phases), including a fitness assessment and self-report questionnaires. Biological outcomes are collected at baseline, 6, and 12 months. A total of 200 participants will be randomized in a 1:1 fashion to supervised group training or home-based training supported by smartphones, health coaches, and Fitbit technology. Participants are asked to complete 4 to 5 exercise sessions per week, incorporating aerobic, resistance and flexibility training. Outcomes include fatigue, quality of life, fitness measures, body composition, biological outcomes, and program adherence. Cost information will be obtained using patient diary-based self-report and utilities via the EQ-5D. DISCUSSION To disseminate publicly funded exercise programs widely, clinical efficacy and cost-effectiveness have to be demonstrated. The goals of this trial are to provide these data along with an increased understanding of adherence to exercise among men with prostate cancer receiving ADT. TRIAL REGISTRATION The trial has been registered at clinicaltrials.gov (Registration # NCT02834416 ). Registration date was June 2, 2016.
Collapse
Affiliation(s)
- Shabbir M. H. Alibhai
- University Health Network, Toronto, ON M5G 2C4 Canada
- University of Toronto, Toronto, ON M5S 2J7 Canada
- Toronto General Hospital, 200 Elizabeth St Room EN14-214, Toronto, ON M5G 2C4 Canada
| | - Paul Ritvo
- Cancer Care Ontario, Toronto, ON M5G 2L3 Canada
| | - Daniel Santa Mina
- University Health Network, Toronto, ON M5G 2C4 Canada
- University of Toronto, Toronto, ON M5S 2J7 Canada
| | | | - Murray Krahn
- University Health Network, Toronto, ON M5G 2C4 Canada
- University of Toronto, Toronto, ON M5S 2J7 Canada
| | - George Tomlinson
- University Health Network, Toronto, ON M5G 2C4 Canada
- University of Toronto, Toronto, ON M5S 2J7 Canada
| | | | - Himu Lukka
- The Juravinski Cancer Centre, Hamilton, ON L8V 5C2 Canada
| | - Padraig Warde
- University Health Network, Toronto, ON M5G 2C4 Canada
- University of Toronto, Toronto, ON M5S 2J7 Canada
- Cancer Care Ontario, Toronto, ON M5G 2L3 Canada
| | - Sara Durbano
- University Health Network, Toronto, ON M5G 2C4 Canada
| | | | | |
Collapse
|
21
|
Luh JY, Finkelstein SE, Michalski JM, Sandler H. Reconciling the Effects of Screening on Prostate Cancer Mortality in the ERSPC and PLCO Trials. Ann Intern Med 2018; 168:607-608. [PMID: 29677258 DOI: 10.7326/l17-0734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Join Y Luh
- Providence St. Joseph Health, Eureka, California (J.Y.L.)
| | - Steven E Finkelstein
- Bay Regional Cancer Center at Advanced Urology Institute, Panama City, Florida (S.E.F.)
| | | | - Howard Sandler
- Cedar Sinai Medical Center, Los Angeles, California (H.S.M.)
| |
Collapse
|
22
|
Kotwal AA, Schonberg MA. Cancer Screening in the Elderly: A Review of Breast, Colorectal, Lung, and Prostate Cancer Screening. Cancer J 2018; 23:246-253. [PMID: 28731949 PMCID: PMC5608027 DOI: 10.1097/ppo.0000000000000274] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There are relatively limited data on outcomes of screening older adults for cancer; therefore, the decision to screen older adults requires balancing the potential harms of screening and follow-up diagnostic tests with the possibility of benefit. Harms of screening can be amplified in older and frail adults and include discomfort from undergoing the test itself, anxiety, potential complications from diagnostic procedures resulting from a false-positive test, false reassurance from a false-negative test, and overdiagnosis of tumors that are of no threat and may result in overtreatment. In this paper, we review the evidence and guidelines on breast, colorectal, lung and prostate cancer as applied to older adults. We also provide a general framework for approaching cancer screening in older adults by incorporating evidence-based guidelines, patient preferences, and patient life expectancy estimates into shared screening decisions.
Collapse
Affiliation(s)
- Ashwin A. Kotwal
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Mara A. Schonberg
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| |
Collapse
|
23
|
Grubb RL. Prostate Cancer: Update on Early Detection and New Biomarkers. MISSOURI MEDICINE 2018; 115:132-134. [PMID: 30228704 PMCID: PMC6139871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Screening and early treatment of prostate cancer (PCa) has recently come under scrutiny due to the rates of overdiagnosis of low risk cancer. Randomized trials, including ERSPC and PLCO, have informed our understanding of the survival benefit provided by systematic PCa screening with serum prostate-specific antigen (PSA). To reduce the number of patients diagnosed with indolent disease, new adjuvant risk stratification tests have become available.
Collapse
Affiliation(s)
- Robert L Grubb
- Robert L. Grubb, III, MD, is Associate Professor, Urology, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
24
|
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
|
25
|
Cancer Screening in the Elderly: A Review of Breast, Colorectal, Lung, and Prostate Cancer Screening. Cancer J 2017. [DOI: 10.1097/00130404-201707000-00010] [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]
|
26
|
Curtis A, Ondracek RP, Murekeyisoni C, Kauffman E, Mohler J, Marshall J. Tobacco use and outcome in radical prostatectomy patients. Cancer Med 2017; 6:857-864. [PMID: 28317280 PMCID: PMC5387124 DOI: 10.1002/cam4.1041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 01/18/2017] [Accepted: 01/20/2017] [Indexed: 12/03/2022] Open
Abstract
Cigarette smoking has been consistently associated with increased risk of overall mortality, but the importance of smoking for patients with prostate cancer (CaP) who are candidates for curative radical prostatectomy (RP) has received less attention. This retrospectively designed cohort study investigated the association of smoking history at RP with subsequent CaP treatment outcomes and overall mortality. A total of 1981 patients who underwent RP at Roswell Park Cancer Institute (RPCI) between 1993 and 2014 were studied. Smoking history was considered as a risk factor for overall mortality as well as for currently accepted CaP treatment outcomes (biochemical failure, treatment failure, distant metastasis, and disease‐specific mortality). The associations of smoking status with these outcomes were tested by Cox proportional hazard analyses. A total of 153 (8%) patients died during follow‐up. Current smoking at diagnosis was a statistically significant predictor of overall mortality after RP (current smokers vs. former and never smokers, hazards ratio 2.07, 95% confidence interval [CI]: 1.36–3.14). This association persisted for overall mortality at 3, 5, and 10 years (odds ratios 2.07 [95% CI: 1.36–3.15], 2.05 [95% CI: 1.35–3.12], and 1.8 [95% CI: 1.18–2.74], respectively). Smoking was not associated with biochemical failure, treatment failure, distant metastasis, or CaP‐specific mortality, and the association of smoking with overall mortality did not appear to be functionally related to treatment or biochemical failure, or to distant metastasis. Smoking is a non‐negligible risk factor for death among CaP patients who undergo RP; patients who smoke are far more likely to die of causes other than CaP.
Collapse
Affiliation(s)
- Alexandra Curtis
- Department of Biostatistics, University of Iowa, Iowa City, Iowa.,Department of Cancer Prevention, Roswell Park Cancer Institute, Buffalo, New York.,Department of Biostatistics, University at Buffalo, Buffalo, New York
| | | | - Christine Murekeyisoni
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.,Center for Immunotherapy, Roswell Park Cancer Institute, Buffalo, New York
| | - Eric Kauffman
- Department of Urology and Department of Cancer Genetics, Roswell Park Cancer Institute, Buffalo, New York.,Department of Urology, State University of New York at Buffalo, Buffalo, New York
| | - James Mohler
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.,Department of Urology, State University of New York at Buffalo, Buffalo, New York
| | - James Marshall
- Department of Cancer Prevention, Roswell Park Cancer Institute, Buffalo, New York
| |
Collapse
|
27
|
Prognostic Significance of Digital Rectal Examination and Prostate Specific Antigen in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Arm. J Urol 2017; 197:363-368. [DOI: 10.1016/j.juro.2016.08.092] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2016] [Indexed: 11/20/2022]
|
28
|
Valerio M, Shah TT, Shah P, Mccartan N, Emberton M, Arya M, Ahmed HU. Magnetic resonance imaging-transrectal ultrasound fusion focal cryotherapy of the prostate: A prospective development study. Urol Oncol 2016; 35:150.e1-150.e7. [PMID: 27955940 DOI: 10.1016/j.urolonc.2016.11.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/27/2016] [Accepted: 11/09/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The use of software-based magnetic resonance-transrectal ultrasound fusion to deliver focal therapy may increase the precision of treatment. This is a prospective development study assessing the feasibility of Magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion focal cryotherapy. METHODS AND MATERIALS Consecutive patients undergoing focal cryotherapy were included in an academic registry (December 2013-June 2014). MRI-TRUS fusion focal cryotherapy was offered to men with visible clinically significant prostate cancer (Galil SeedNet system). Eligibility was determined by multiparametric MRI (mpMRI), and transperineal template mapping or targeted biopsies. A rigid fusion platform (Biojet) was used with the operator ensuring the ice ball covered at least the lesion. Adverse events were scored using the NCICTC V4. Genitourinary toxicity was assessed using patient-reported outcome measures (IPSS, IIEF-15, and UCLA-EPIC). Early contrast-enhanced MRI and mpMRI at 6 to 12 months were used to assess extent of lesion ablation. RESULTS Of 23 patients scheduled, 5 did not have image fusion owing to surgeon preference. Overall, 18 patients undergoing image-fusion cryotherapy had median age of 68 (interquartile range [IQR]: 65-73) years and median preoperative prostate-specific antigen = 9.54 (5.65-16)ng/ml. In all, 13 (72.2%) and 5 (27.8%) patients had intermediate and high-risk cancer, respectively. In total, 10 adverse events were reported with one of these as serious (grade 3) because of admission for hematuria requiring wash out only. There was no difference in the IIEF-15 between baseline and study end (P = 0.24). The IPSS remained stable (P = 0.12), whereas the UCLA-EPIC tended to improve (P = 0.065). The prostate-specific antigen level significantly decreased at 1.8 (1.04-2.93) ng/ml (P<0.001). Both early and late mpMRI showed no residual disease in the treated area. In 2 men, radiological progression of known contralateral disease was observed; both underwent focal high intensity focused ultrasound. CONCLUSION MRI-TRUS fusion focal cryotherapy is feasible in most patients and seems to accurately guide ablation demonstrated by posttreatment imaging. Additional studies are needed to determine efficacy using postcryotherapy biopsy.
Collapse
Affiliation(s)
- Massimo Valerio
- Division of Surgery and Interventional Science, University College London, London, United Kingdom; Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - Taimur Tariq Shah
- Division of Surgery and Interventional Science, University College London, London, United Kingdom; Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Paras Shah
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Neil Mccartan
- Division of Surgery and Interventional Science, University College London, London, United Kingdom; Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, United Kingdom; Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Manit Arya
- Division of Surgery and Interventional Science, University College London, London, United Kingdom; Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Hashim Uddin Ahmed
- Division of Surgery and Interventional Science, University College London, London, United Kingdom; Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
29
|
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]
|
30
|
Moyad MA, Vogelzang NJ. Heart healthy equals prostate healthy and statins, aspirin, and/or metformin (S.A.M.) are the ideal recommendations for prostate cancer prevention. Asian J Androl 2016; 17:783-91. [PMID: 25657084 PMCID: PMC4577591 DOI: 10.4103/1008-682x.148070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular disease (CVD) has been the number one cause of death in the U.S. for 114 of the last 115 years. Lifestyle factors that promote CVD also appear to increase prostate cancer risk and those that reduce CVD risk also appear to reduce the risk of prostate cancer. The largest randomized trials utilizing dietary supplements or pharmacologic agents for prostate cancer prevention (Selenium and Vitamin E Cancer Prevention Trial [SELECT]) have also shed light on the problems and future solutions in this area. Dietary supplements that have not been found to be CVD protective, such as selenium and Vitamin E have not been found to be prostate protective. In addition, over exposure to specific anti-oxidants in nutritionally replete populations may be encouraging cancer growth. Future trials of dietary supplements to prevent prostate cancer could be problematic because by the time a definitive trial is initiated the participants will no longer be “deficient” in the nutrient being tested, which arguably occurred in the SELECT trial. It is also interesting that statins, aspirin, and/or metformin (S.A.M.) are 3 generic, low-cost, heart healthy agents derived from natural sources with separate mechanism of actions, which all appear to have the best benefit to risk ratio compared to any other agent available for prostate cancer prevention, especially aggressive disease, or as an ancillary agent (s) to conventional cancer treatment. It is time to focus on the forest over the trees and recommend proven CVD protective measures for men concerned about their risk of prostate cancer.
Collapse
Affiliation(s)
- Mark A Moyad
- Department of Urology, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | | |
Collapse
|
31
|
|
32
|
Heart Healthy = Prostate Healthy and S.A.M. are the Ideal “Natural” Recommendations for Prostate Cancer. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00020-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
33
|
Jaiswal S, Sarmad R, Arora S, Dasaraju R, Sarmad K. Prostate Cancer for the Internist. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2015; 7:429-35. [PMID: 26713287 PMCID: PMC4677466 DOI: 10.4103/1947-2714.168660] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In the United States, approximately 240,000 men are diagnosed annually with prostate cancer. Although effective treatment options are available for clinically localized cancer, the potential burdensome co-morbidities and attendant healthcare costs from over diagnosis and over treatment have escalated the discussion and controversy regarding appropriate screening, diagnosis, and optimal management of prostate cancer. Although the lifetime risk of developing prostate cancer is approximately 1 in 6 (~16%), the risk of dying from the disease is only ~2%. The discrepancy between the cancer incidence and lethality has led to widespread scrutiny of prostate cancer patient management, particularly for low-grade, low-stage (indolent) disease. The vast majority of men diagnosed with clinically localized prostate cancer are treated with interventional therapies despite studies demonstrating that even without treatment, prostate cancer-specific mortality is low. A MedLine/PubMed search was performed using PICO format (Patient, Intervention, Comparison and Outcome) identifying all relevant articles. No restrictions were used for publication dates. The terms “Prostate Cancer”, “Screening”, “Mortality”, “Morbidity” yielded 307 results. “Diagnosis”, “Prognosis” and “Survival” yielded 1504 results. Further filters were applied to narrow down the results using keywords “Prostate cancer screening guidelines 2014”, “Beyond PSA”, “NCCN Guidelines prostate”, “MRI guided Prostate biopsy” yielding 72, 274, 54 and 568 results respectively. Of these, approximately 137 articles were found relevant and were reviewed. References from the reviewed articles were included in the final article.
Collapse
Affiliation(s)
- Shikha Jaiswal
- Department of Internal Medicine, University of Alabama at Birmingham, Montgomery Internal Medicine Residency Program, AL, 36116, USA
| | - Rehan Sarmad
- Department of Internal Medicine, University of Alabama at Birmingham, Montgomery Internal Medicine Residency Program, AL, 36116, USA
| | - Sumant Arora
- Department of Internal Medicine, University of Alabama at Birmingham, Montgomery Internal Medicine Residency Program, AL, 36116, USA
| | - Radhikha Dasaraju
- Department of Internal Medicine, University of Alabama at Birmingham, Montgomery Internal Medicine Residency Program, AL, 36116, USA
| | - Komal Sarmad
- PGY-2, Department of Internal Medicine, West Virginia University, Morgantown, West Virginia, 26505, USA
| |
Collapse
|
34
|
Rosenberg MT, Spring AC, David Crawford E. Prostate cancer and the PCP: the screening dilemma. Int J Clin Pract 2015; 69:1438-47. [PMID: 26459772 DOI: 10.1111/ijcp.12745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - A C Spring
- Mid Michigan Health Centers, Jackson, MI, USA
| | | |
Collapse
|
35
|
Rosenkrantz AB, Taneja SS. Prostate MRI can reduce overdiagnosis and overtreatment of prostate cancer. Acad Radiol 2015; 22:1000-6. [PMID: 25791578 DOI: 10.1016/j.acra.2015.02.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 02/05/2015] [Accepted: 02/06/2015] [Indexed: 10/23/2022]
Abstract
The contemporary management of prostate cancer (PCa) has been criticized as fostering overdetection and overtreatment of indolent disease. In particular, the historical inability to identify those men with an elevated PSA who truly warrant biopsy, and, for those needing biopsy, to localize aggressive tumors within the prostate, has contributed to suboptimal diagnosis and treatment strategies. This article describes how modern multi-parametric MRI of the prostate addresses such challenges and reduces both overdiagnosis and overtreatment. The central role of diffusion-weighted imaging (DWI) in contributing to MRI's current impact is described. Prostate MRI incorporating DWI achieves higher sensitivity than standard systematic biopsy for intermediate-to-high risk tumor, while having lower sensitivity for low-grade tumors that are unlikely to impact longevity. Particular applications of prostate MRI that are explored include selection of a subset of men with clinical suspicion of PCa to undergo biopsy as well as reliable confirmation of only low-risk disease in active surveillance patients. Various challenges to redefining the standard of care to incorporate solely MRI-targeted cores, without concomitant standard systematic cores, are identified. These include needs for further technical optimization of current systems for performing MRI-targeted biopsies, enhanced education and expertise in prostate MRI among radiologists, greater standardization in prostate MRI reporting across centers, and recognition of the roles of pre-biopsy MRI and MRI-targeted biopsy by payers. Ultimately, it is hoped that the medical community in the United States will embrace prostate MRI and MRI-targeted biopsy, allowing all patients with known or suspected prostate cancer to benefit from this approach.
Collapse
|
36
|
Stanciu MA, Morris C, Makin M, Watson E, Bulger J, Evans R, Hiscock J, Hoare Z, Edwards RT, Neal RD, Wilkinson C. A pilot randomised controlled trial of personalised care after treatment for prostate cancer (TOPCAT-P): nurse-led holistic-needs assessment and individualised psychoeducational intervention: study protocol. BMJ Open 2015; 5:e008470. [PMID: 26112224 PMCID: PMC4486944 DOI: 10.1136/bmjopen-2015-008470] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Prostate cancer is common and the incidence is increasing, but more men are living longer after diagnosis, and die with their disease rather than of it. Nonetheless, specific and substantial physical, sexual, emotional and mental health problems often lead to a poor quality of life. Urology services increasingly struggle to cope with the demands of follow-up care, and primary care is likely to play the central role in long-term follow-up. The present phase II trial will evaluate the feasibility and acceptability of a nurse-led, person-centred psychoeducational intervention, delivered in community or primary care settings. METHODS AND ANALYSIS Prostate cancer survivors diagnosed in the past 9-48 months and currently biochemically stable will be identified from hospital records by their treating clinician. Eligible men would have either completed radical treatment, or would be followed up with prostate specific antigen monitoring and symptom reporting. We will recruit 120 patients who will be randomised to receive either an augmented form of usual care, or an additional nurse-led intervention for a period of 36 weeks. Following the health policy in Wales, the intervention is offered by a key worker, is promoting prudent healthcare and is using a holistic needs assessment. Outcome measures will assess physical symptoms, psychological well-being, confidence in managing own health and quality of life. Healthcare service use will be measured over 36 weeks. Feedback interviews with patients and clinicians will further inform the acceptability of the intervention. Recruitment, attrition, questionnaire completion rates and outcome measures variability will be assessed, and results will inform the design of a future phase III trial and accompanying economic evaluation. ETHICS AND DISSEMINATION Ethics approval was granted by Bangor University and North Wales REC (13/WA/0291). Results will be reported in peer-reviewed publications, at scientific conferences, and directly through national cancer and primary care networks. TRIAL REGISTRATION NUMBER ISRCTN 34516019.
Collapse
Affiliation(s)
| | | | - Matt Makin
- Betsi Cadwaladr University Health Board, Wrexham, UK
| | - Eila Watson
- Department of Clinical Health Care, Oxford Brookes University, Oxford, UK
| | - Jenna Bulger
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Richard Evans
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Julia Hiscock
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Zoë Hoare
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | | | - Richard David Neal
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Clare Wilkinson
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| |
Collapse
|
37
|
Incidence, risk factors, and reasons for hospitalization among glioblastoma patients receiving chemoradiation. J Neurooncol 2015; 124:137-46. [PMID: 26033544 DOI: 10.1007/s11060-015-1820-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 05/22/2015] [Indexed: 12/21/2022]
Abstract
Despite a high symptom burden, little is known about the incidence or predictors of hospitalization among glioblastoma patients, including risks during chemoradiation (CRT). We studied 196 consecutive newly diagnosed glioblastoma patients treated at our institution from 2006-2010. Toxicity data were reviewed during and after the CRT phase, defined as the period between diagnosis and 6 weeks after radiotherapy completion. Logistic regression and proportional hazards modeling identified predictors of hospitalization and overall survival (OS). Median age was 59 years (range, 23-90) and 83 % had Karnofsky performance status (KPS) score ≥ 70. Twenty-six percent of patients underwent gross total resection, 77 % received ≥ 59.4 Gy of radiotherapy, and 89 % received concurrent temozolomide. Median OS was 15.6 months (IQR, 8.5-26.8 months). Forty-three percent of patients were hospitalized during the CRT phase; OS was 10.7 vs. 17.8 months for patients who were vs. were not hospitalized, respectively (P < .001). Nearly half of the hospitalizations were due to generalized weakness (17 % of hospitalizations), seizures (16 %), or venous thromboembolism (13 %). On multivariate analysis, age (odds ratio [OR], 1.03; 95 % CI, 1.002-1.060; P = .034) and KPS (OR, 0.95; 95 % CI, 0.93-0.97; P < .001) were associated with risk of hospitalization. Hospitalization during the CRT phase was associated with decreased OS (adjusted hazard ratio, 1.47; 95 % CI, 1.01-2.13; P = .043), after adjustment for known prognostic factors. Hospitalization during the CRT phase is common among glioblastoma patients in the temozolomide era and is associated with shorter overall survival.
Collapse
|
38
|
Sakai N, Taguri M, Kobayashi K, Noguchi S, Ikeda S, Koh H, Satomi Y, Furuhata A. Clinical outcomes of prostate cancer patients in Yokosuka City, Japan: A comparative study between cases detected by prostate-specific antigen-based screening in Yokosuka and those detected by other means. Int J Urol 2015; 22:747-52. [DOI: 10.1111/iju.12806] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 03/11/2015] [Accepted: 03/29/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Naoki Sakai
- Department of Urology; Yokosuka Kyosai Hospital; Yokosuka Kanagawa Japan
| | - Masataka Taguri
- Department of Biostatistics and Epidemiology, Graduate School of Medicine; Yokohama City University; Yokohama Kanagawa Japan
| | - Kazuki Kobayashi
- Department of Urology; Yokosuka Kyosai Hospital; Yokosuka Kanagawa Japan
| | - Sumio Noguchi
- Department of Urology; Yokosuka Kyosai Hospital; Yokosuka Kanagawa Japan
| | - Shigeru Ikeda
- Department of Urology; Kinugasa Hospital; Yokosuka Kanagawa Japan
| | - Hideshige Koh
- Department of Urology; Yokosuka City Uwamachi Hospital; Yokosuka Kanagawa Japan
| | - Yoshiaki Satomi
- Department of Urology; Satomi Jin-Hinyokika; Yokosuka Kanagawa Japan
| | - Akihiko Furuhata
- Department of Urology; Furuhata Hinyokika Clinic; Yokosuka Kanagawa Japan
| |
Collapse
|
39
|
Pron G. Prostate-Specific Antigen (PSA)-Based Population Screening for Prostate Cancer: An Evidence-Based Analysis. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2015; 15:1-64. [PMID: 26366236 PMCID: PMC4561549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Prostate cancer (PC) is the most commonly diagnosed non-cutaneous cancer in men and their second or third leading cause of cancer death. Prostate-specific antigen (PSA) testing for PC has been in common practice for more than 20 years. OBJECTIVES A systematic review of the scientific literature was conducted to determine the effectiveness of PSA-based population screening programs for PC to inform policy decisions in a publicly funded health care system. DATA SOURCES A systematic review of bibliographic databases was performed for systematic reviews or randomized controlled trials (RCT) of PSA-based population screening programs for PC. REVIEW METHODS A broad search strategy was employed to identify studies reporting on key outcomes of PC mortality and all-cause mortality. RESULTS The search identified 5 systematic reviews and 6 RCTs. None of the systematic reviews found a statistically significant reduction in relative risk (RR) of PC mortality or overall mortality with PSA-based screening. PC mortality reductions were found to vary by country, by screening program, and by age of men at study entry. The European Randomized Study of Screening for Prostate Cancer found a statistically significant reduction in RR in PC mortality at 11-year follow-up (0.79; 95% CI, 0.67-0.92), although the absolute risk reduction was small (1.0/10,000 person-years). However, the primary treatment for PCs differed significantly between countries and between trial arms. The American Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) found a statistically non-significant increase in RR for PC mortality with 13-year follow-up (1.09; 95% CI, 0.87-1.36). The degree of opportunistic screening in the control arm of the PLCO trial, however, was high. None of the RCTs found a reduction in all-cause mortality and all found a statistically significant increase in the detection of mainly low-risk, organ-confined PCs in the screening arm. CONCLUSIONS There was no evidence of a PC mortality reduction in the American PLCO trial, which investigated a screening program in a setting where opportunistic screening was already common practice. Given that opportunistic PSA screening practices in Canada are similar, it is unlikely that the introduction of a formal PSA screening program would reduce PC mortality.
Collapse
|
40
|
Vickers AJ. Four Flawed Arguments Against Prostate-specific Antigen Screening (and 1 Good One). Urology 2015; 85:491-4. [DOI: 10.1016/j.urology.2014.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 10/20/2014] [Accepted: 11/07/2014] [Indexed: 10/23/2022]
|
41
|
Deb S, Chin MY, Adomat H, Guns EST. Abiraterone inhibits 1α,25-dihydroxyvitamin D3 metabolism by CYP3A4 in human liver and intestine in vitro. J Steroid Biochem Mol Biol 2014; 144 Pt A:50-8. [PMID: 24269662 DOI: 10.1016/j.jsbmb.2013.10.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 10/02/2013] [Accepted: 10/17/2013] [Indexed: 01/08/2023]
Abstract
The chemopreventive and therapeutic effects of vitamin D3 are exerted through its dihydroxylated metabolite, 1α,25-dihydroxyvitamin D3 [1α,25(OH)2D3]. Inactivation of 1α,25(OH)2D3 by cytochrome P450 3A4 (CYP3A4) may be an important determinant of its serum and tissue levels. Abiraterone, a steroidogenesis inhibitor used in late stage prostate cancer treatment, is a CYP17A1 inhibitor. The purpose of this study was to assess the potential of abiraterone to block hepatic and intestinal inactivation of biologically active vitamin D3in vitro and to evaluate if abiraterone can alter CYP3A4 marker substrate activities. Biotransformation reactions were initiated with NADPH regenerating solutions following initial preincubation of pooled human hepatic or intestinal microsomal protein or human recombinant CYP3A4 supersomes with 1α,25(OH)2D3, midazolam or triazolam for 10min at 37°C. Formation of hydroxylated metabolites of 1α,25(OH)2D3, midazolam or triazolam was analyzed by liquid chromatography-mass spectrometry method. Co-incubation of 1α,25(OH)2D3 with abiraterone at varying concentrations (0.2-100μM) led to up to ∼85% inhibition of formation of hydroxylated metabolites of 1α,25(OH)2D3 thus preventing inactivation of active vitamin D3. The IC50 values for individual metabolites of 1α,25(OH)2D3 ranged from 0.4 to 2.2μM in human liver microsomes or human intestinal microsomes. The mechanism of CYP3A4-mediated inhibition of 1α,25(OH)2D3 by abiraterone was competitive (apparent Ki 2.8-4.3μM). Similar inhibitory effects were also observed upon inclusion of abiraterone into midazolam or triazolam hydroxylation assays. In summary, our results suggest that abiraterone inhibits the CYP3A4-mediated inactivation of active vitamin D3 in human liver and intestine, potentially providing additional anti-cancer benefits to prostate cancer patients. This article is part of a Special Issue entitled '16th Vitamin D Workshop'.
Collapse
Affiliation(s)
- Subrata Deb
- The Vancouver Prostate Centre at Vancouver General Hospital, 2660 Oak Street, Vancouver, BC, Canada V6H 3Z6
| | - Mei Yieng Chin
- The Vancouver Prostate Centre at Vancouver General Hospital, 2660 Oak Street, Vancouver, BC, Canada V6H 3Z6
| | - Hans Adomat
- The Vancouver Prostate Centre at Vancouver General Hospital, 2660 Oak Street, Vancouver, BC, Canada V6H 3Z6
| | - Emma S Tomlinson Guns
- The Vancouver Prostate Centre at Vancouver General Hospital, 2660 Oak Street, Vancouver, BC, Canada V6H 3Z6.
| |
Collapse
|
42
|
Hu JC, Williams SB, Carter SC, Eggener SE, Prasad S, Chamie K, Trinh QD, Sun M, Nguyen PL, Lipsitz SR. Population-based assessment of prostate-specific antigen testing for prostate cancer in the elderly. Urol Oncol 2014; 33:69.e29-34. [PMID: 25017694 DOI: 10.1016/j.urolonc.2014.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 06/03/2014] [Accepted: 06/05/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To perform a population-based analysis to characterize the effect of prostate-specific antigen (PSA) testing on oncologic outcomes in men diagnosed with prostate cancer. MATERIALS AND METHODS We used the Surveillance, Epidemiology, and End Results-Medicare-linked data to identify 98,883 men diagnosed with prostate cancer from 1996 to 2007. We stratified frequency of PSA testing as none, 1 to 2, 3 to 5, and≥6 tests in the 5 years before prostate cancer diagnosis. We used propensity scoring methods to assess the effect of frequency of PSA testing on likelihood of (1) metastases at diagnosis and (2) overall mortality and prostate cancer-specific mortality. RESULTS In adjusted analyses, the likelihood of being diagnosed with metastatic prostate cancer decreased with greater frequency of PSA testing (none, 10.6; 1-2, 8.3; 3-5, 3.7; and≥6, 2.5 events per 100 person years, P<0.001). Additionally, greater frequency of PSA testing was associated with improved overall survival and prostate cancer-specific survival (P<0.001 for both). CONCLUSIONS Greater frequency of PSA testing in men 70 years of age or older in the 5 years before prostate cancer diagnosis is associated with lower likelihood of being diagnosed with metastatic prostate cancer and improved overall and prostate cancer-specific survival.
Collapse
Affiliation(s)
- Jim C Hu
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
| | - Stephen B Williams
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stacey C Carter
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Sandip Prasad
- Department of Urology, Medical University of South Carolina, Charleston, SC
| | - Karim Chamie
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Quoc-Dien Trinh
- Department of Urology, Brigham and Women׳s Hospital, Boston, MA
| | - Maxine Sun
- Cancer Prognostics and Health Outcomes Unit, Centre Hospitalier de l׳Université de Montréal, Montreal, Canada
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women׳s Hospital, Boston, MA
| | - Stuart R Lipsitz
- Center for Surgery and Public Health, Brigham and Women׳s Hospital, Boston, MA
| |
Collapse
|
43
|
Valerio M, Emberton M, Barret E, Eberli D, Eggener SE, Ehdaie B, Jichlinski P, Ward JF, Ahmed HU. Health technology assessment in evolution - focal therapy in localised prostate cancer. Expert Rev Anticancer Ther 2014; 14:1359-67. [PMID: 24965212 DOI: 10.1586/14737140.2014.932692] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Focal therapy in prostate cancer aims to treat only the part of the gland harboring clinically significant disease while preserving the rest of the tissue. This approach may substantially reduce treatment-related toxicity without compromising disease control outcomes. Short- to medium-term functional and oncological results in prospective interventional studies are promising, but comparative effectiveness research against standard of care is required to incorporate focal therapy among standard options. In this review, we discuss the actual stage of assessment and results of sources of energy commonly used to deliver focal therapy. We also provide our viewpoint on how the field will evolve in the near future.
Collapse
Affiliation(s)
- Massimo Valerio
- Division of Surgery and Interventional Science, University College London, London, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
Low-risk prostate cancer, defined as Gleason Score 6 or less with PSA <10 ng/ml, is diagnosed in about half of men undergoing screening. Approximately 30% of men diagnosed with low-risk disease harbour high-grade cancer that is unrepresented on the biopsy. Moreover, a small percentage of low-grade cancers have molecular alterations that result in progression to aggressive disease. Favourable-risk prostate cancer should be managed with close follow up. Active surveillance is appropriate for most patients with low-risk disease, and radical treatment should be reserved for cases in which higher-risk disease is identified. In turn, focal therapy aims to preserve tissue and function in men who have been diagnosed with localized disease, and should be offered to men with higher risk disease at baseline, as an alternative to whole-gland radiation or surgery, or when the patient transitions from low-risk to higher-risk disease. The two strategies should be viewed as complementary elements of care that can be applied in a risk-stratified manner. In this Review, we discuss the rationale and current status of active surveillance-which constitutes a standard of care in most evidence-based guidelines-and comment on whether and when focal therapy should complement it in those men wishing to continue a tissue-preserving strategy.
Collapse
|
45
|
|
46
|
D'Amico AV. Stereotactic body radiation therapy versus intensity-modulated radiation therapy for prostate cancer: less cost at the expense of more genitourinary toxicity is a concerning but testable hypothesis. J Clin Oncol 2014; 32:1183-5. [PMID: 24616317 DOI: 10.1200/jco.2014.55.2380] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Anthony V D'Amico
- Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
| |
Collapse
|
47
|
Crook J, Ots AF. Prognostic factors for newly diagnosed prostate cancer and their role in treatment selection. Semin Radiat Oncol 2014; 23:165-72. [PMID: 23763882 DOI: 10.1016/j.semradonc.2013.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Adenocarcinoma of the prostate is extremely heterogeneous, ranging from an indolent chronic illness to an aggressive rapidly fatal systemic malignancy. The classic prognostic factors of tumor stage, prostate specific antigen level, and Gleason score have been used for over a decade to categorize patients at the time of diagnosis into broad risk groups that help to determine appropriate management. Although the grouping of patients into favorable, intermediate, and high-risk categories has become standard, and the categories continue to define distinct prognostic subgroups, considerable heterogeneity exists within each risk group. As a range of management options are available, additional prognostic factors can be considered when determining the treatment approach for an individual patient. We review these additional prognostic variables under the headings of patient-related, tumor-related, and treatment-related. The influence of each of these factors may vary depending on treatment factors such as dose, the radiation modality, or the use of concomitant androgen ablation.
Collapse
Affiliation(s)
- Juanita Crook
- Department of Radiation Oncology, British Columbia Cancer Agency, Center for the Southern Interior, Kelowna, British Columbia, Canada.
| | | |
Collapse
|
48
|
Huang KH, Carter SC, Hu JC. Does robotic prostatectomy meet its promise in the management of prostate cancer? Curr Urol Rep 2014; 14:184-91. [PMID: 23564268 DOI: 10.1007/s11934-013-0327-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Following Walsh's advances in pelvic anatomy and surgical technique to minimize intraoperative peri-prostatic trauma more than 30 years ago, open retropubic radical prostatectomy (RRP) evolved to become the gold standard treatment of localized prostate cancer, with excellent long-term survival outcomes [1•]. However, RRP is performed with great heterogeneity, even among high volume surgeons, and subtle differences in surgical technique result in clinically significant differences in recovery of urinary and sexual function. Since the initial description of robotic-assisted radical prostatectomy (RARP) in 2000 [2], and U.S. Food and Drug Administration approval shortly thereafter, RARP has been rapidly adopted and has overtaken RRP as the most popular surgical approach in the management of prostate cancer in the United States [3]. However, the surgical management of prostate cancer remains controversial. This is confounded by the idolatry of new technologies and aggressive marketing versus conservatism in embracing tradition. Herein, we review the literature to compare RRP to RARP in terms of perioperative, oncologic, and quality-of-life outcomes as well as healthcare costs. This is a particularly relevant, given the absence of randomized trials and long-term (more than 10-year) follow-up for RARP biochemical recurrence-free survival.
Collapse
Affiliation(s)
- Kuo-How Huang
- Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd, Suite 1000, Los Angeles, CA 90024, USA
| | | | | |
Collapse
|
49
|
Overdiagnosis and overtreatment of prostate cancer. Eur Urol 2014; 65:1046-55. [PMID: 24439788 DOI: 10.1016/j.eururo.2013.12.062] [Citation(s) in RCA: 637] [Impact Index Per Article: 63.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 12/27/2013] [Indexed: 12/16/2022]
Abstract
CONTEXT Although prostate cancer (PCa) screening reduces the incidence of advanced disease and mortality, trade-offs include overdiagnosis and resultant overtreatment. OBJECTIVE To review primary data on PCa overdiagnosis and overtreatment. EVIDENCE ACQUISITION Electronic searches were conducted in Cochrane Central Register of Controlled Trials, PubMed, and Embase from inception to July 2013 for original articles on PCa overdiagnosis and overtreatment. Supplemental articles were identified through hand searches. EVIDENCE SYNTHESIS The lead-time and excess-incidence approaches are the main ways used to estimate overdiagnosis in epidemiological studies, with estimates varying widely. The estimated number of PCa cases needed to be diagnosed to save a life has ranged from 48 down to 5 with increasing follow-up. In clinical studies, generally lower rates of overdiagnosis have been reported based on the frequency of low-grade minimal tumors at radical prostatectomy (1.7-46.8%). Autopsy studies have reported PCa in 18.5-38.5%, although not all are low grade or low volume. Factors influencing overdiagnosis include the study population, screening protocol, and background incidence, limiting generalizability between settings. Reported rates of overtreatment vary widely in the literature, although contemporary international studies suggest increasing use of conservative management. CONCLUSIONS Epidemiological, clinical, and autopsy studies have been used to examine PCa overdiagnosis, with estimates ranging widely from 1.7% to 67%. Correspondingly, estimates of overtreatment vary widely based on patient features and may be declining internationally. Careful patient selection for screening and reducing overtreatment are important to preserve the benefits and reduce the downstream harms of prostate-specific antigen testing. Because all of these estimates are extremely population and context specific, this must be considered when using these data to inform policy. PATIENT SUMMARY Screening reduces spread and death from prostate cancer (PCa) but overdiagnoses some low-risk tumors that may not have caused harm. Because treatment has potential side effects, it is critical that not all patients with PCa receive aggressive treatment.
Collapse
|
50
|
Mikropoulos C, Goh C, Leongamornlert D, Kote-Jarai Z, Eeles R. Translating genetic risk factors for prostate cancer to the clinic: 2013 and beyond. Future Oncol 2014; 10:1679-94. [PMID: 25145435 DOI: 10.2217/fon.14.72] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Prostate cancer (PrCa) is the most commonly diagnosed cancer in the male UK population, with over 40,000 new cases per year. PrCa has a complex, polygenic predisposition, due to rare variants such as BRCA and common variants such as single nucleotide polymorphisms (SNPs). With the introduction of genome-wide association studies, 78 susceptibility loci (SNPs) associated with PrCa risk have been identified. Genetic profiling could risk-stratify a population, leading to the discovery of a higher proportion of clinically significant disease and a reduction in the morbidity related to age-based prostate-specific antigen screening. Based on the combined risk of the 78 SNPs identified so far, the top 1% of the risk distribution has a 4.7-times higher risk of developing PrCa compared with the average of the general population.
Collapse
|