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Riveros C, Ranganathan S, Haque W, Huang E, Xu J, Kulkarni GS, Geng M, Anis M, Muhammad T, Chan KS, Farach A, Teh BS, Miles BJ, Klaassen Z, Sonpavde GP, Wallis CJ, Satkunasivam R. Comparative real-world survival outcomes of muscle-invasive bladder cancer treated with bladder-only vs. whole-pelvis concurrent chemoradiation. Can Urol Assoc J 2024; 18:17-24. [PMID: 37931278 PMCID: PMC10841558 DOI: 10.5489/cuaj.8386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Elective pelvic nodal irradiation for patients with muscle-invasive bladder cancer (MIBC) undergoing trimodal therapy (TMT ) is controversial. In patients with node-negative (N0) MIBC, the benefit of elective whole-pelvis concurrent chemoradiation (WP-CCR) compared to bladder-only (BO )-CCR has not been demonstrated. Using real-world data from the National Cancer Database (NCDB ), we sought to compare the overall survival (OS ) between BO-CCR and WP-CCR for MIBC. METHODS Using the 2020 NCDB Participant User File, we identified cases of MIBC diagnosed between 2017 and 2019. We selected patients with clinical T2-T4aN0M0 disease receiving CCR as first-line treatment. CCR was defined as transurethral resection of bladder tumor followed by ≥40 Gy radiation to the bladder with concurrent single- or multiple-agent chemotherapy. Based on elective nodal irradiation status, patients were stratified as having received BO-CCR vs. WP-CCR. OS analysis was performed using summary three-month conditional landmark, inverse probability treatment weighting (IPTW)-adjusted Kaplan-Meier estimates, and Cox regression. RESULTS A total of 604 patients receiving CCR for MIBC were identified: 367 (60.8%) BO-CCR and 237 (39.2%) WP-CCR. Before IPTW, the groups were imbalanced in terms of baseline characteristics. The median followup of the weighted population was 42.3 months (interquartile range 18.1-49.1 months). In IPTW-adjusted Cox proportional hazards regression analysis, WP-CCR was associated with a significant OS benefit compared to BO-CCR (adjusted hazard ratio 0.72, 95% confidence interval 0.54-0.96, p=0.026). CONCLUSIONS In the setting of CCR for N0 MIBC, this retrospective NCDB analysis revealed that WP-CCR was associated with a benefit in OS compared to BO-CCR.
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Affiliation(s)
- Carlos Riveros
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Sanjana Ranganathan
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Waqar Haque
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, United States
| | - Emily Huang
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Jiaqiong Xu
- Center for Health Data Science and Analytics, Houston Methodist Hospital, Houston, TX, United States
| | - Girish S. Kulkarni
- Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Michael Geng
- School of Engineering Medicine, Texas A&M University, Houston, TX, United States
| | - Maryam Anis
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Taliah Muhammad
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Keith Syson Chan
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
- Center for TME Spatial Profiling in GU Oncology, Houston Methodist Research Institute, Houston, TX, United States
| | - Andrew Farach
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, United States
| | - Bin S. Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, United States
| | - Brian J. Miles
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Zachary Klaassen
- Division of Urology, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Guru P. Sonpavde
- Genitourinary Oncology Program, AdventHealth Cancer Institute, Orlando, FL, United States
| | - Christopher J.D. Wallis
- Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
- Division of Urology, University of Toronto, Toronto, ON, Canada
- Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
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Ranganathan S, Riveros C, Xu J, Geng M, Huang E, Anis M, Muhammad T, Zhang J, Efstathiou E, Wallis CJ, Sonpavde GP, Satkunasivam R. Chemotherapy, immunotherapy, or combination first-line treatment for metastatic urothelial carcinoma of the bladder: A large real-world experience. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
477 Background: First-line therapy for metastatic urothelial carcinoma of the bladder (mUC) consists of platinum-based chemotherapy in most patients and PD1/L1 inhibitors in selected patients. Multiple combination chemo-immunotherapy trials failed to show a clear benefit over chemotherapy alone. We sought to use real-world data to evaluate clinical and sociodemographic factors associated with receipt of first-line chemotherapy, immunotherapy or combination chemo-immunotherapy treatment for metastatic bladder cancer and examined differences in overall survival (OS). Methods: We used the National Cancer Database to identify patients with stage IV UCB diagnosed between 2014 and 2018, who were treated with first-line immunotherapy, chemotherapy, or combination treatment. We performed multivariable logistic regression modeling to determine factors associated with treatment receipt. An extension of inverse probability treatment weighting (IPTW) obtained from multinomial logistic regression was used to balance clinical and sociodemographic differences between treatment groups. Adjusted Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression were used to evaluate the association between treatment and OS. Results: A total of 4,169 patients were identified in the cohort; 3,255 (78.1%) were treated with chemotherapy, 601 (14.4%) with immunotherapy, and 313 (7.5%) with combination treatment. Multivariable analysis identified increasing age (RRR: 1.07, 95% CI, 1.06-1.08), comorbidity burden (Charlson-Deyo 2, RRR: 1.65, 95% CI, 1.21-2.24 and Charlson-Deyo 3, RRR: 2.11; 95% CI, 1.51-2.93), and treatment at an academic facility (RRR: 1.26; 95% CI, 1.03-1.53) as independent predictors of receiving immunotherapy. Treatment at an academic facility (RRR: 1.29, 95% CI, 1.01-1.65) was associated with receipt of combination treatment. After IPTW, we found that combination therapy (hazard ratio [HR]: 0.72; 95% CI, 0.62-0.83), but not immunotherapy alone, was associated with improved survival compared to chemotherapy. These data are limited by inability to determine platinum eligibility, and residual confounding. Conclusions: Patients with older age and more comorbidities were more likely to receive immunotherapy than chemotherapy for first-line treatment of metastatic urothelial carcinoma of the bladder. Modest real-world utilization of chemo-immunotherapy was observed to be higher in academic centers and was associated with improved survival compared to chemotherapy. The study is limited by retrospective design; prospective data are necessary to identify patients who may benefit from combination chemo-immunotherapy.
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Affiliation(s)
| | - Carlos Riveros
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Jiaqiong Xu
- Center for Health Data Science and Analytics, Houston Methodist Hospital, Houston, TX
| | - Michael Geng
- Texas A&M University, College of Medicine, Houston, TX
| | | | - Maryam Anis
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Taliah Muhammad
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Jun Zhang
- Houston Methodist Cancer Center, Houston, TX
| | - Eleni Efstathiou
- Department of Medical Oncology, Houston Methodist Hospital, Houston, TX
| | | | | | - Raj Satkunasivam
- Department of Urology and Center for Outcomes Research, Houston Methodist Hospital, Houston, TX
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Roy S, Sun Y, Spratt DE, Morgan SC, Kim T, Malone J, Wallis CJ, Kishan AU, Saad F, Malone S. Radiographic progression-free survival (rPFS) and time to radiographic progression (TTrP) as surrogate endpoints in docetaxel-naïve metastatic castrate resistant prostate cancer (mCRPC): A pooled analysis of COU-AA-302 and ACIS. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
136 Background: rPFS is often used as an intermediate clinical endpoint (ICE) for overall survival (OS) in randomized trials in mCRPC. However, the current literature shows conflicting results on the surrogacy of rPFS for OS. Moreover, it remains unknown if TTrP, which does not consider death as an event, is an ICE for OS. We performed a combined analysis of COU-AA-302 and ACIS to determine if TTrP and rPFS can be used as ICE. Methods: In COU trial, docetaxel-naïve mCRPC patients were randomized to abiraterone (abi) versus placebo. In ACIS, a similar patient population was randomized to abi alone or abi with apalutamide (abi+apa). We applied weighted Cox regression models to evaluate the effect of treatment on TTrP and OS and used landmark analyses to determine the if the treatment effect on OS is mediated by that on radiographic progression. We estimated a semiparametric Spearman correlation between the ICE and OS at the patient level. We determined the trial level correlation of treatment effect on the ICE and OS in the 2 trials where each of them was subdivided into 9 pseudo-trial centers and then calculating the adjusted R2 between center level estimates of treatment effect for ICE and OS. The procedure of creating pseudo-trial centers was repeated 500 times and the presented R2 is the average across 500 repetitions after excluding those with negative association. Results: Overall, 2016 patients were eligible for this study – 1053 from COU and 963 from ACIS. Abi was associated with superior TTrP (HR 0.55 [95%CI 0.45-0.66]) and OS (HR 0.80 [0.70-0.92]). Similar results were seen with abi+apa (0.51 [0.41-0.64], 0.77 [0.65-0.91]). Radiographic progression was associated with significantly higher hazard of death in the state arrival extended Markov proportional hazard model (3.64 [1.54-8.62]) while longer TTrP was associated with reduced hazard of death (0.94 [0.93-0.95]). At the patient level, the correlation between TTrP & OS and rPFS & OS was 0.58 [0.54-0.63] and 0.68 [0.65-0.71], in the overall cohort. In the abi and abi+apa group, the correlation between TTrP and OS was 0.60 [0.53-0.66] and 0.73 [0.66-0.79] and that for rPFS and OS was 0.72 [0.67-0.75] and 0.79 [0.74-0.83], respectively. At the trial level, the treatment effect on rPFS & OS and TTrP & OS were correlated with average R2 of 0.84, 0.84, 0.85, and 0.86, respectively. The mean surrogate threshold effect over 500 permutations for HRrPFS and HRTTrP was 0.78 and 0.70 in ACIS and 0.54 and 0.45 in the COU-AA-302 trials, respectively. Conclusions: TTrP and rPFS were found to have significant association with OS in chemo-naïve mCRPC patients. We noted a modest to strong correlation between the treatment effect on both the ICE and OS at the trial level. Larger meta-analytic studies are needed to validate these findings.
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Affiliation(s)
| | - Yilun Sun
- Case Western Reserve University, Cleveland, OH
| | - Daniel Eidelberg Spratt
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Scott C. Morgan
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Thomas Kim
- Rush University Medical Center, Chicago, IL
| | - Julia Malone
- The Ottawa Health Research Institute, Ottawa, ON, Canada
| | | | | | - Fred Saad
- University of Montreal, Montreal, QC, Canada
| | - Shawn Malone
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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Huang E, Riveros C, Ranganathan S, Klaassen Z, Rini BI, Wallis CJ, Satkunasivam R. Adjuvant immunotherapy in renal cell carcinoma: A systematic review and meta-analysis of randomized clinical trials. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
671 Background: There has been interest in adjuvant immune checkpoint inhibition (ICI) following surgical resection in patients with high-risk renal cell carcinoma (RCC) given high recurrence rates and approvals of ICI in metastatic RCC. The primary objective of this analysis was to synthesize available data regarding the disease-free survival (DFS) benefit of adjuvant ICIs for patients with RCC. Methods: This systematic review was performed according to the PRISMA guidelines. The protocol was registered in PROSPERO (CRD42022361599). We searched PubMed, EMBASE, and relevant conference proceedings to identify phase III randomized controlled trials (RCTs) comparing adjuvant ICI versus placebo/observation. The primary outcome of interest was DFS. Results: Among the four included studies, one demonstrated a significant DFS benefit. There was considerable clinical and statistical heterogeneity (I2=64%) due to differences in inclusion criteria and interventions. While pooled results across the four studies did not demonstrate a significant benefit in DFS overall (HR 0.85, 95% CI 0.69-1.04), there was significant benefit among patients with positive PD-L1 expression (HR 0.72, 95% CI 0.55-0.94) or sarcomatoid features (HR 0.59, 95% CI 0.38-0.91). Conclusions: The evidence base to date regarding ICI as adjuvant therapy in RCC is mixed – conclusions are limited by considerable heterogeneity between studies. However, pooled analyses suggest that patients with positive PDL1 expression or sarcomatoid features are most likely to benefit from adjuvant immunotherapy.
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Affiliation(s)
| | - Carlos Riveros
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | | | - Zachary Klaassen
- Division of Urology, Medical College of Georgia, Augusta University, Augusta, GA
| | - Brian I. Rini
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Christopher J.D. Wallis
- Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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Riveros C, Ranganathan S, Haque W, Xu J, Geng M, Anis M, Muhammad T, Farach AM, Teh BS, Wallis CJ, Sonpavde GP, Satkunasivam R. Comparative real-world survival outcomes of muscle-invasive bladder cancer treated with bladder-only vs. whole-pelvis concurrent chemoradiation. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
488 Background: Elective nodal irradiation for patients with muscle-invasive bladder cancer (MIBC) undergoing trimodal therapy (TMT) is controversial. In patients with node-negative (N0) MIBC, the benefit of elective whole-pelvis concurrent chemoradiotherapy (WP-CCRT) compared to bladder-only (BO)-CCRT has not been demonstrated. Currently, the National Comprehensive Cancer Network (NCCN) guidelines do not recommend whether to include pelvic nodes in the radiation field. Using real-world data from the National Cancer Database (NCDB), we sought to compare the overall survival (OS) between BO-CCRT and WP-CCRT for MIBC. Methods: Using the 2019 NCDB Participant User File, we identified cases of MIBC diagnosed between 2017 and 2018. We selected patients with clinical T2-T4N0M0 disease receiving TMT as first-line treatment. TMT was defined as transurethral resection of bladder tumor followed by CCRT: 60–65 Gy of RT delivered to the bladder with concurrent single- or multiple-agent chemotherapy. Patients were stratified into BO-CCRT vs. WP-CCRT. Overall survival (OS) analysis was performed using Kaplan-Meier estimates and multivariable Cox proportional hazards regression analysis. The variables included in the multivariable Cox regression model were age, sex, race, comorbidity burden (as per the Charlson-Deyo comorbidity index), facility type, insurance status, median income quartile, rurality, distance from facility, and clinical T stage. Results: A total of 605 patients receiving TMT for MIBC were identified: 162 (26.8%) BO-CCRT and 443 (73.2%) WP-CCRT. The median follow-up time was 25.6 months (interquartile range [IQR]: 4.8-42.6) and 28.7 months (IQR: 3.0-51.6) for BO-CCRT and WP-CCRT, respectively. The median OS was 32.9 months (95% confidence interval [CI] 30.8 – not reached) and 48.3 months (95% CI 39.6 – not reached) for BO-CCRT and WP-CCRT, respectively. However, multivariable Cox regression analysis failed to find an association between WP-CCRT (hazard ratio [HR] 1.08, 95% CI 0.76-1.54) and improved OS, compared to BO-CCRT. Conclusions: Elective nodal-irradiation (WP-CCRT) in the setting of TMT for MIBC was not associated with a benefit in OS compared to BO-CCRT.
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Affiliation(s)
- Carlos Riveros
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | | | - Waqar Haque
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX
| | - Jiaqiong Xu
- Center for Health Data Science and Analytics, Houston Methodist Hospital, Houston, TX
| | - Michael Geng
- Texas A&M University, College of Medicine, Houston, TX
| | - Maryam Anis
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Taliah Muhammad
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Andrew M. Farach
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX
| | - Bin S. Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX
| | - Christopher J.D. Wallis
- Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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Gotto GT, Yip SM, Shayegan B, O'Sullivan DE, Wallis CJ, Basappa NS, Cagiannos I, Hamilton RJ, Ferrario C, Fernandes R, Danielson B, Saad F, Hotte SJ, Brenner DR, Cheung WY, Boyne DJ, Chan K, Osborne B, Zardan A, Malone S. Practice patterns and predictors of treatment intensification in patients with metastatic castration-sensitive prostate cancer. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
76 Background: In recent years, treatment intensification beyond androgen deprivation therapy (ADT) with several novel therapies have shown survival benefit in patients with metastatic castration-sensitive prostate cancer (mCSPC). Given the rapidly evolving landscape in mCSPC treatment, there is a need to better understand how treatment strategies fit in real-world clinical practice and are combined/sequenced with other available therapies. Methods: Using electronic medical records and administrative data, a population-based retrospective cohort study was conducted. Patients aged ≥18 years of age who were newly diagnosed with de novo mCSPC and initiated ADT post-diagnosis between 2010 to 2020 in Alberta, Canada, were included. Treatment intensification was defined as the receipt of apalutamide, abiraterone acetate, enzalutamide, or chemotherapy (e.g. docetaxel) within 180 days of ADT initiation. Results: A total of 2,515 de novo mCSPC were identified during study period with 2,098 (83%) patients initiating ADT post-diagnosis. Of those, 525 (25%) received intensification beyond ADT. The percentage of patients who were intensified was 3% in 2010-2013 and gradually increased to 67% in 2020. Between 2014-2017, docetaxel was the most common therapy for intensification, but its use decreased considerably in 2018-2020 with abiraterone acetate, apalutamide and enzalutamide becoming increasingly available in the mCSPC setting. Upon progression, 46% and 22% in the intensified group versus 38% and 13% in the ADT-alone group initiated one and two-lines of subsequent therapies respectively. Abiraterone acetate and enzalutamide were the most common subsequent therapy for both the intensified (32% and 31% respectively) and the ADT-alone (56% and 38% respectively) groups. Docetaxel (24%) was used as subsequent therapy among mCSPC patients who were intensified with oral systemic agents. In multivariable logistic regression analyses of patients diagnosed in 2014-2020, significant predictors of intensification were younger age at diagnosis, lower Charlson comorbidity index, greater number of metastatic sites, shorter time to ADT initiation, referral to a specialists/cancer centres, surgery or radiation prior to ADT, and more recent year of diagnosis (all p<0.05). Conclusions: In Alberta, Canada, there has been a considerable increase in the utilization of ADT intensification therapies that correspond with the timing of clinical trial data and approvals of novel agents. Early referral to specialists/cancer centres is warranted to intensify mCSPC treatment beyond ADT and to improve patients’ outcomes. [Table: see text]
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Affiliation(s)
- Geoffrey T. Gotto
- Southern Alberta Institute of Urology, University of Calgary, Calgary, AB, Canada
| | - Steven M. Yip
- Tom Baker Cancer Center, University of Calgary, Calgary, AB, Canada
| | - Bobby Shayegan
- St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
| | | | | | | | - Ilias Cagiannos
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Ricardo Fernandes
- London Health Science Centre, Western University, London, ON, Canada
| | - Brita Danielson
- Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Fred Saad
- Centre Hospitalier de l’Université de Montréal, Université de Montréal, Montréal, QC, Canada
| | | | - Darren R. Brenner
- Oncology Outcomes Initiative, University of Calgary, Calgary, AB, Canada
| | - Winson Y. Cheung
- Oncology Outcomes Initiative, University of Calgary, Calgary, AB, Canada
| | - Devon J. Boyne
- Oncology Outcomes Initiative, University of Calgary, Calgary, AB, Canada
| | | | | | | | - Shawn Malone
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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Saad F, Bhindi B, Noonan K, Ong M, Castellano K, Kourkounakis A, Wallis CJ. Assessment of the epidemiological trends for prostate cancer using administrative data in Ontario. Can Urol Assoc J 2022; 17:85-91. [PMID: 36486175 PMCID: PMC10073519 DOI: 10.5489/cuaj.8099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Studies have shown fluctuations in prostate cancer (PCa) incidence and prevalence over time and by region. Less is known about the most recent epidemiological trends by PCa disease stage.
Methods: This study was a population-based, sequential, cross-sectional analysis that used administrative health data from Ontario, Canada. After inclusion, patients were classified into major PCa disease states: non-metastatic PCa and metastatic PCa. The primary study outcome was a description of temporal trends in the incidence and prevalence of PCa over the study period (2010–2019), stratified by disease state. Crude incidence and prevalence rates were estimated for each year in the study period.
Results: Overall, there were 131 718 men living with PCa in 2019. The incident cohort contained 86 123 patients with nmPCa (n=65 691, 76.3%), mPCa (n=8431, 9.8%), or unknown stage (n=12 001, 13.9%). The prevalence has increased from 216 to 253 per 10 000 men, between 2010 and 2019, respectively. Between 2011 and 2014, overall PCa incidence decreased from 20.9 to 15.4 per 10 000 men, followed by an increase to 18.8 per 10 000 in 2018. The nmPCa incidence rate was considerably higher compared with mPCa and followed a trend similar to the overall incidence. In contrast, the incidence rate for mPCa demonstrated a continuous increase from 1.5 per 10 000 in 2010 to 2.4 per 10 000 in 2018.
Conclusions: The overall prevalence of PCa has steadily risen over the last decade, despite fluctuations in nmPCa incidence. The concurrent rise in mPCa and nmPCa requires further study regarding the burden of localized and systemic treatment.
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De B, Pasalic D, Barocas DA, Wallis CJ, Huang LC, Zhao Z, Koyama T, Tang C, Conwill R, Goodman M, Hamilton AS, Wu XC, Paddock LE, Stroup A, Cooperberg MR, Hashibe M, O’Neil BB, Kaplan SH, Greenfield S, Penson DF, Hoffman KE. Patient-reported Outcomes After External Beam Radiotherapy With Low Dose Rate Brachytherapy Boost vs Radical Prostatectomy for Localized Prostate Cancer: Five-year Results From a Prospective Comparative Effectiveness Study. J Urol 2022; 208:1226-1239. [PMID: 36006050 PMCID: PMC9933910 DOI: 10.1097/ju.0000000000002902] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Data comparing radical prostatectomy and external beam radiation therapy with low dose rate brachytherapy boost are lacking. To better guide shared decision making regarding treatment, we compared patient reported outcomes through 5 years following radical prostatectomy or external beam radiation therapy with low dose rate brachytherapy boost for localized prostate cancer. MATERIALS AND METHODS From 2011-2012, men aged <80 years with localized prostate adenocarcinoma were enrolled and followed longitudinally. Patient reported outcomes included the Expanded Prostate Index Composite. Regression models adjusted for baseline scores and covariates were constructed. RESULTS The study population included 112 men treated with external beam radiation therapy with low dose rate brachytherapy boost and 1,553 treated with radical prostatectomy. Compared to radical prostatectomy, external beam radiation therapy with low dose rate brachytherapy boost was associated with clinically meaningful worse urinary irritative/obstructive (adjusted mean score difference [95% confidence interval]: 5.0 [-8.7, -1.3]; P = .008 at 5 years) and better urinary incontinence function (13.3 [7.7, 18.9]; P < .001 at 5 years) through 5 years. Urinary function bother was similar between groups (P > .4 at all timepoints). Treatment with external beam radiation therapy with low dose rate brachytherapy boost was associated with worse bowel function (-4.0 [-6.9, -1.1]; P = .006 at 5 years) through 5 years compared to radical prostatectomy. Treatment with external beam radiation therapy with low dose rate brachytherapy boost was associated with better sexual function at 1 year (12.0 [6.5, 17.5]; P < .001 at 1 year) compared to radical prostatectomy, but there was insufficient evidence to reject the supposition that no difference was seen at 3 or 5 years. CONCLUSIONS Compared to radical prostatectomy, external beam radiation therapy with low dose rate brachytherapy boost was associated with clinically meaningful worse urinary irritative/obstructive and bowel functions but better urinary incontinence function through 5 years after treatment. These patient-reported functional outcomes may clarify treatment expectations and help inform treatment choices for localized prostate cancer.
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Affiliation(s)
- Brian De
- The University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, TX
| | - Dario Pasalic
- The University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, TX
| | - Daniel A. Barocas
- Vanderbilt University Medical Center, Department of Urology, Nashville, TN
| | - Christopher J.D. Wallis
- Mount Sinai Hospital, Division of Urology, Department of Surgery, University of Toronto, Toronto, ON
| | - Li-Ching Huang
- Vanderbilt University Medical Center, Department of Biostatistics, Nashville, TN
| | - Zhiguo Zhao
- Vanderbilt University Medical Center, Department of Biostatistics, Nashville, TN
| | - Tatsuki Koyama
- Vanderbilt University Medical Center, Department of Biostatistics, Nashville, TN
| | - Chad Tang
- The University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, TX
| | - Ralph Conwill
- Vanderbilt University Medical Center, Office of Patient and Community Education, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Nashville, TN
| | - Michael Goodman
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA
| | - Ann S. Hamilton
- Keck School of Medicine at the University of Southern California, Department of Preventative Medicine, Los Angeles, CA
| | - Xiao-Cheng Wu
- Louisiana State University New Orleans School of Public Health, Department of Epidemiology, New Orleans, LA
| | - Lisa E. Paddock
- Cancer Institute of New Jersey, Rutgers Health, Department of Epidemiology, New Brunswick, NJ
| | - Antoinette Stroup
- Cancer Institute of New Jersey, Rutgers Health, Department of Epidemiology, New Brunswick, NJ
| | | | - Mia Hashibe
- University of Utah School of Medicine, Department of Family and Preventative Medicine, Salt Lake City, UT
| | - Brock B. O’Neil
- University of Utah Health, Department of Urology, Salt Lake City, UT
| | | | | | - David F. Penson
- Vanderbilt University Medical Center, Department of Urology, Nashville, TN
- Geriatric Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN
| | - Karen E. Hoffman
- The University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, TX
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Morgans AK, Sweeney C, Wallis CJ, Halabi S, Armstrong AJ, Verholen F, Ortiz JA, Schmall A, Srinivasan S, Grimm MO. Progression patterns by types of metastatic spread, prostate-specific antigen (PSA), and clinical symptoms: Post-hoc analyses of ARAMIS. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5044 Background: Darolutamide (DARO), a highly potent and structurally distinct androgen receptor inhibitor, prolonged metastasis-free survival by nearly 2 years and reduced the risk of death by 31% vs placebo (PBO) with a favorable tolerability profile in patients (pts) with nonmetastatic castration-resistant prostate cancer (nmCRPC) in ARAMIS. We present post-hoc analyses of ARAMIS to evaluate the association between metastatic progression with prostate-specific antigen (PSA) and clinical progression and to describe the distribution of metastatic progression between groups. Methods: Pts with nmCRPC were randomized 2:1 to DARO (n=955) or PBO (n=554) while continuing androgen-deprivation therapy. Descriptive analyses were performed using the primary data cutoff (Sept 3, 2018) for the double-blind period. Post-baseline metastases were based on central review of conventional radiographic imaging every 16 weeks. PSA and pain progression were defined per primary analysis ( N Engl J Med. 2019;380:1235-46). Results: Metastatic progression was observed in 13.6% of DARO and 28.5% of PBO pts. Most pts had isolated progression as bone (DARO 46%, PBO 39%) or lymph node (32%; 40%) metastasis (Table). Pts with radiographic progression had shorter median time from initial diagnosis to study treatment (DARO 72.9, PBO 74.4 months) vs the overall ARAMIS population (86.2, 84.2 months). Of all pts with metastatic progression, baseline PSA levels (ng/mL) were similar in DARO (12.6) and PBO pts (15.1); DARO pts had lower median PSA before metastasis (16.7) vs PBO pts (48.0) and median absolute/relative PSA decrease from baseline of -0.7/-3.2% vs an increase for PBO pts of 29.5/181%. PSA progression before metastasis was observed in 55.6% (160/288) of pts, occurring in fewer DARO (45.4%) vs PBO pts (63.9%) (treatment difference 18.5%; nominal 95% CI 6.5%–30.6%). The median time between PSA progression and metastasis was 7.0 months with DARO vs 5.6 months with PBO. Pain progression before metastatic progression was rare and similar between groups (DARO 16.9%, PBO 17.7%). Conclusions: DARO significantly reduced risk of metastatic progression and improved overall survival vs PBO without changing the pattern of metastatic progression. Many pts with nmCRPC experienced metastatic progression without PSA progression, and pain progression was rare. These results support the use of imaging with PSA monitoring to properly identify disease progression in pts with nmCRPC. Clinical trial information: TBC. [Table: see text]
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Affiliation(s)
| | | | | | - Susan Halabi
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University School of Medicine, Durham, NC
| | - Andrew J. Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University School of Medicine, Durham, NC
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Shayegan B, Wallis CJ, Malone S, Cagiannos I, Hamilton RJ, Ferrario C, Gotto GT, Basappa NS, Morgan SC, Fernandes R, Morash C, Niazi T, Noonan KL, Rendon R, Osborne B, Park-Wyllie L, Chan KF, Hotte SJ, Saad F. Real-world use of systemic therapies in men with metastatic castration resistant prostate cancer (mCRPC) in Canada. Urol Oncol 2022; 40:192.e1-192.e9. [DOI: 10.1016/j.urolonc.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 01/11/2022] [Accepted: 01/15/2022] [Indexed: 11/27/2022]
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11
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Manogue CE, Chen W, Mazza A, Dang A, Lewis B, Wallis CJ, Layton J, Barata P, Sartor O, Harris KM. Embracing the Practical Aspects of Theranostics With Prostate-Specific Membrane Antigen–Targeted Lutetium-177. Pract Radiat Oncol 2022; 12:300-304. [DOI: 10.1016/j.prro.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/22/2022] [Accepted: 01/31/2022] [Indexed: 11/30/2022]
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12
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Malone S, Wallis CJ, Lee-Ying RM, Basappa NS, Cagiannos I, Hamilton RJ, Fernandes R, Ferrario C, Gotto G, Morgan SC, Morash C, Niazi T, Noonan K, Rendon RA, Hotte SJ, Saad F, Zardan A, Osborne B, Chan K, Shayegan B. Patterns of care for patients with non-metastatic castration-resistant prostate cancer: Population-based study in Ontario, Canada. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
53 Background: To describe patterns of practice of PSA testing and imaging for Ontario men receiving continuous androgen deprivation therapy (ADT) for the treatment of non-metastatic castration-resistant prostate cancer (nmCRPC). Methods: This was a retrospective, longitudinal, population-based study of administrative health data from 2008 to 2019. Men > 65 years old receiving continuous ADT with documented CRPC were included. An administrative proxy definition was applied to capture patients with nmCRPC patients and excluded those with metastatic disease. Patients were indexed upon progression to CRPC and were followed until death or end of study period to assess frequency of monitoring with PSA tests and conventional imaging. A 2-year look-back window was used to assess patterns of care leading up to CRPC, as well as baseline covariates. Results: At a median follow-up of 40 months, 944 patients with CRPC were identified. Their median time from initiation of ADT to CRPC was 26 months, 61% of patients had their PSA measured twice or fewer in the year prior to index and 71% patients did not receive any imaging in the year following progression to CRPC. Almost all patients (98%, n = 921/944) in the study progressed to high-risk CRPC (HR-CRPC) during the study period, of which more than half received fewer than 3 PSA tests in the year prior to progression to HR-CRPC, and 31% received no imaging in the subsequent year. Conclusions: PSA testing and imaging studies are under-utilized in a real-world setting for the management of nmCRPC, including those at high-risk of developing metastatic disease. Infrequent monitoring impedes proper risk stratification, disease staging, detection of treatment failure and/or metastases, likely delaying necessary treatment intensification with life-prolonging therapies. Adherence to guideline recommendations and the importance of timely staging should be reinforced to optimize patients’ outcome.
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Affiliation(s)
- Shawn Malone
- The Ottawa Hospital Cancer Center, Ottawa, ON, Canada
| | | | | | | | | | | | | | | | - Geoffrey Gotto
- Southern Alberta Institute of Urology, University of Calgary, Calgary, AB, Canada
| | | | - Chris Morash
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Tamim Niazi
- Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Krista Noonan
- BC Cancer Agency, University of British Columbia, Surrey, BC, Canada
| | - Ricardo A. Rendon
- Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | | | - Fred Saad
- Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
| | | | | | | | - Bobby Shayegan
- St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
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Wallis CJ, Huang LC, Zhao Z, Penson DF, Koyama T, Conwill R, Tallman JE, Goodman M, Hamilton AS, Wu XC, Paddock LE, Stroup A, Cooperberg MR, Hashibe M, O’Neil BB, Kaplan SH, Greenfield S, Barocas DA, Hoffman KE. Association between pelvic nodal radiotherapy and patient-reported functional outcomes through 5 years among men undergoing external-beam radiotherapy for prostate cancer: An assessment of the comparative effectiveness analysis of surgery and radiation (CEASAR) cohort. Urol Oncol 2022; 40:56.e1-56.e8. [PMID: 34154899 PMCID: PMC9933913 DOI: 10.1016/j.urolonc.2021.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/12/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The role of pelvic irradiation in men receiving external beam radiotherapy (EBRT) for prostate cancer is unclear, in part due to a lack of data on patient-reported outcomes. We sought to compare functional outcomes for men receiving prostate and pelvic versus prostate-only radiotherapy, longitudinally over 5 years. MATERIALS AND METHODS We performed a population-based, prospective cohort study of men with clinically-localized prostate cancer undergoing EBRT. We examined the effect of prostate and pelvic (n = 102) versus prostate-only (n = 485) radiotherapy on patient-reported disease-specific (using the Expanded Prostate Cancer Index Composite[EPIC]-26) and general health-related (using the SF-36) function, over 5 years. Regression models were adjusted for outcome-specific baseline function, clinicopathologic characteristics, and androgen deprivation therapy (ADT). RESULTS 587 men (median [quartiles] age 69 [64-73] years) met inclusion criteria and completed ≥1 post-treatment survey. More men treated with prostate and pelvic radiotherapy had high-risk disease (58% vs. 18%, P < 0.01) and received ADT (75% vs. 41%, P < 0.01). These men reported worse sexual (6 months-5 years), hormonal (at 6 months), and physical (6 months-5 years) function. Accounting for baseline function, patient and tumor characteristics, and use of ADT, pelvic irradiation was not associated with statistically or clinically significant differences in bowel function, urinary incontinence, irritative voiding symptoms or sexual function through 5-years (all P > 0.05). Marginally clinically important differences were noted in hormonal function at 3-years (adjusted mean difference 4.7, 95% confidence interval [1.2-8.3]; minimally clinically important difference (MCID) 4 to 6) and 5-years (4.2, [0.4-8.0]) following treatment. After adjustment, there was a transient statistically significant, but not clinically important, difference in emotional well-being at 6 months (3.0, [0.19-5.8]; MCID 6) that resolved by 1 year and no differences in physical functioning or energy and fatigue. CONCLUSION This prospective, population-based cohort study of men with localized prostate cancer treated with EBRT, showed no clinically important differences in disease-specific or general health-related quality of life with the addition of pelvic irradiation to prostate radiotherapy, supporting the use of pelvic radiotherapy when it may be of clinical benefit, such as men with increased risk of nodal involvement.
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Affiliation(s)
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University Medical Center
| | | | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center
| | - Ralph Conwill
- Office of Patient and Community Education, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center
| | | | - Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health
| | - Ann S. Hamilton
- Department of Preventative Medicine, Keck School of Medicine at the University of Southern California
| | - Xiao-Cheng Wu
- Department of Epidemiology, Louisiana State University New Orleans School of Public Health
| | - Lisa E. Paddock
- Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health
| | - Antoinette Stroup
- Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health
| | | | - Mia Hashibe
- Department of Family and Preventative Medicine, University of Utah School of Medicine
| | | | | | | | | | - Karen E. Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Center
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Wallis CJ, Poon SJ, Lai P, Podczerwinki L, Buntin MB. Trends in medicare spending across strata of resource utilization among older individuals in the United States. EClinicalMedicine 2021; 36:100873. [PMID: 34041457 PMCID: PMC8144657 DOI: 10.1016/j.eclinm.2021.100873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Health care spending is an increasing proportion of government expenditures in most Western countries. How this growth is distributed between individuals with minimal compared to high health care utilization is unknown. METHODS We examined total and per-capita government expenditure in an observational cohort of fee-for-service U.S. Medicare enrollees aged ≥65 years from 2007 to 2018. We categorized patients into annual resource utilization strata. We examined annualized changes in adjusted spending across resource utilization strata and the distribution of spending within and across strata for a variety of health care settings. FINDINGS Examining 314,593,489 beneficiary-years of coverage, the top 1% of beneficiaries accounted for 14.9% of all expenditures, the top 5% for 41.5%, the top 10% for 60.0%, the top 20% for 79.1%, and the top 50% for 95.7%. Annual expenditures remained relatively stable from 2007 to 2018, with annual mean change of 0.7% (standard deviation 1.1%; median 1.1%) and mean per capita change of 0.4% (standard deviation 1·6%; median 0·3%). Changes were similar across strata with mean increases <1% in all, save for the <50th percentile strata (mean annual growth=1·9%), a significant difference (p = 0.0002). The overall distribution of expenditures across health care settings remained consistent over time, with different distributions between expenditure strata. INTERPRETATION In the U.S. from 2007 to 2018, Medicare spending has a Pareto distribution in which 80% of the costs are attributable to 20% of beneficiaries. Despite low overall Medicare spending growth from 2007 to 2018, growth has been greatest among those in the lowest spending group. FUNDING The Commonwealth Fund (20,202,411).
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Affiliation(s)
- Christopher J.D. Wallis
- Fellow, Department of Urology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sabrina J. Poon
- Assistant Professor, Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Pikki Lai
- Health Policy Analyst, Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Liliana Podczerwinki
- Health Policy Analyst, Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Melinda Beeuwkes Buntin
- Chair, Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, United States
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15
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Malone S, Wallis CJ, Morgan SC, Hamilton RJ, Cagiannos I, Basappa NS, Ferrario C, Gotto G, Fernandes R, Noonan K, Niazi T, Hotte SJ, Saad F, Chan K, Hew H, Park-Wyllie L, Shayegan B. Prognostic association between common laboratory tests and overall survival in men with de novo metastatic castration-sensitive prostate cancer: A population-based study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
149 Background: Despite significant advancements in the treatment of metastatic prostate cancer, a validated prognostic tool for patients with de novo metastatic castration-sensitive prostate cancer (mCSPC) is still lacking. Using population-based data from Ontario, Canada, we sought to examine the prognostic association between common laboratory tests and survival for patients with mCSPC. Methods: A population-based cohort of men aged 66 years and older diagnosed with de novo metastatic prostate cancer between 2014-2019 were included. We assessed the association between laboratory tests at the time of cancer diagnosis and overall survival (OS). Utilizing a complete case analysis, we used Cox proportional hazards models to assess the association between these laboratory tests and OS while adjusting for patient and disease characteristics. Results: A total of 3,556 men with de novo mCSPC were included. On multivariable analysis, there were significant associations between OS and neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, albumin, hemoglobin, PSA decrease and PSA nadir <0.1 ng/mL (please see table). Conclusions: Commonly available laboratory tests provide important prognostic information for patients with newly diagnosed mCSPC given demonstrated associations to overall survival. Apart from PSA kinetics, none of these baseline tests were performed in more than 57% of patients indicating underutilization of these low-cost prognostic biomarkers. [Table: see text]
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Affiliation(s)
- Shawn Malone
- The Ottawa Hospital Cancer Center, Ottawa, ON, Canada
| | | | | | - Robert James Hamilton
- Division of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | | | | | | | - Ricardo Fernandes
- London Regional Cancer Program, Western University, London, ON, Canada
| | - Krista Noonan
- British Columbia Cancer Agency - Fraser Valley Centre, Surrey, BC, Canada
| | - Tamim Niazi
- Jewish General Hospital, McGill University, Montreal, QC, Canada
| | | | - Fred Saad
- Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | | | - Huong Hew
- Medical Affairs, Janssen Inc., Toronto, ON, Canada
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16
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Wallis CJ, Malone S, Cagiannos I, Morgan SC, Hamilton RJ, Basappa NS, Ferrario C, Gotto G, Fernandes R, Niazi T, Noonan K, Saad F, Hotte SJ, Hew H, Chan K, Park-Wyllie L, Shayegan B. Geographic variation in systemic therapy in men age 66 years and older with de novo metastatic castration-sensitive prostate cancer: A population-based study in a single payer health-system. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
50 Background: Significant developments in the standard of care for patients with de novo metastatic castration-sensitive prostate cancer (mCSPC) have been reported over the past decade. Treatment intensification with systemic therapies in addition to androgen deprivation therapy (ADT) alone is guideline recommended for most patients. We studied the geographic variation in the use of systemic therapy for de novo mCSPC in Ontario, Canada, a single-payer health system. Methods: We performed a population-based study of men aged 66 years and older diagnosed with de novo mCSPC between 2014-2019. We linked population-based healthcare databases, as administered at the level of Local Health Integration Networks (LHINs) in Ontario, to examine treatment patterns following diagnosis of de novo mCSPC. We categorized initial mCSPC treatments as those begun within 60 days preceding and 6 months following diagnosis and examined the proportion of patients receiving LHRH alone, first generation anti-androgen (AA) alone, combined androgen blockade (CAB; LHRH + 1st gen AA), ADT + abiraterone acetate + prednisone (AAP), and, ADT + docetaxel (D). In aggregate, we considered LHRH alone, AA alone and CAB as “standard ADT”, and ADT + AAP and ADT + D as “ADT-plus”. Multinomial logistic regression analyses were used to examine the association between receiving systemic treatment intensification (“ADT-plus”) or no prostate cancer pharmacotherapy relative to ADT across geographic regions, while adjusting for baseline patient and disease characteristics. Results: We identified 3,556 men over 66 with de novo mCSPC. Overall, 2794 (78.6%) received standard ADT, 311 (8.7%) did not receive prostate cancer-directed pharmacotherapy, and 451 patients (12.7%) of patients received “ADT-plus”. Utilization of AAP increased from 0.5% to 3% following the LATITUDE data release in 2017, while D decreased from 12% to 10%. There was significant variation in treatment strategies between geographic regions in use of “ADT-plus” ranging from 7 to 20% (p < 0.0001), a difference which persisted after accounting for patient demographics, comorbidity, rurality, and disease characteristics (p = 0.036). Conclusions: Despite proven survival benefits in randomized controlled trials, intensified treatment with docetaxel or abiraterone in addition to ADT was infrequently utilized in this population-based study of men age 66 years and over with mCSPC.
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Affiliation(s)
| | - Shawn Malone
- The Ottawa Hospital Cancer Center, Ottawa, ON, Canada
| | | | | | - Robert James Hamilton
- Division of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | | | | | - Ricardo Fernandes
- Division of Medical Oncology, London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Tamim Niazi
- Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Krista Noonan
- British Columbia Cancer Agency - Fraser Valley Centre, Surrey, BC, Canada
| | - Fred Saad
- Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | | | - Huong Hew
- Medical Affairs, Janssen Inc., Toronto, ON, Canada
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17
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Shayegan B, Wallis CJ, Hamilton RJ, Morgan SC, Cagiannos I, Basappa NS, Ferrario C, Gotto G, Fernandes R, Noonan K, Niazi T, Hotte SJ, Saad F, Hew H, Chan K, Park-Wyllie L, Malone S. Real-world utilization of docetaxel among men with de novo metastatic castration-sensitive prostate cancer: A population-based study in men aged 66 or older. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
47 Background: Docetaxel was the first agent, when added to androgen deprivation therapy (ADT), to demonstrate a survival benefit in men with metastatic castration-sensitive prostate cancer (mCSPC). It remains an important guideline recommendation approach in these men. However, real-world experience among patients with de novo metastatic disease is poorly understood. Using population-based data from Ontario Canada, we examined the real-world experience of using docetaxel in mCSPC. Methods: Men aged 66 years and older diagnosed with de novo metastatic prostate cancer between 2014-2019 were captured. The Cancer Activity Level Reporting system tracks information regarding the use of cancer treatments, including details of systemic therapy. We identified patients who received docetaxel intensification to ADT following diagnosis of de novo mCSPC and analyzed the proportion of patients who completed 6 cycles of treatment, required a dose decrease, and who visited the emergency department (ED) or were hospitalized for febrile neutropenia. Results: Over the 5-year study period, 399 men received docetaxel treatment among 3,556 identified with de novo mCSPC. The median age was 72 (IQR 68-76) and mean Charlson comorbidity index was 0.15 (SD +/- 0.72). Of the 399 men, 230 (58%), 202 (51%) and 175 (44%) patients completed at least 4, 5 and 6 cycles of docetaxel, respectively. Dose reduction during docetaxel treatment was required in 173 (43%) patients. Filgrastim was prescribed among 29 (7.3%) patients. Hospitalization or ED visit for febrile neutropenia was observed in 63 (16 %) of patients who received docetaxel. Conclusions: Among men age 66 years and over who received docetaxel and ADT for mCSPC, less than half were able to complete all six prescribed cycles. In addition, over two fifth required dose reductions and 16% experienced febrile neutropenia requiring hospitalization or ED visit. These data highlight the differences in expected outcomes between clinical trial populations (as reported in CHAARTED) and routine use.
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Affiliation(s)
| | | | - Robert James Hamilton
- Division of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | | | | | | | | | - Ricardo Fernandes
- Division of Medical Oncology, London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Krista Noonan
- British Columbia Cancer Agency - Fraser Valley Centre, Surrey, BC, Canada
| | - Tamim Niazi
- Jewish General Hospital, McGill University, Montreal, QC, Canada
| | | | - Fred Saad
- Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Huong Hew
- Medical Affairs, Janssen Inc., Toronto, ON, Canada
| | | | | | - Shawn Malone
- The Ottawa Hospital Cancer Center, Ottawa, ON, Canada
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18
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Sayyid RK, Magee D, Hird AE, Harper BT, Webb E, Fratino KL, Terris MK, Madi R, Satkunasivam R, Wallis CJ, Klaassen Z. Re-operation within 30 days of radical cystectomy: Identifying high-risk patients and complications using American College of Surgeons National Surgical Quality Improvement Program database. Can Urol Assoc J 2021; 15:E1-E5. [PMID: 32701439 PMCID: PMC7769521 DOI: 10.5489/cuaj.6490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Radical cystectomy (RC) is a highly morbid procedure, with 30-day complication rates approaching 31%. Our objective was to determine risk factors for re-operation within 30 days following a RC for non-metastatic bladder cancer. METHODS We included all patients who underwent a RC for non-metastatic bladder cancer using The American College of Surgeons National Surgical Quality Improvement Program database between January 1, 2007 and December 31, 2014. Logistic regression analyses were used to evaluate predictors of re-operation. RESULTS A total of 2608 patients were included; 5.8% of patients underwent re-operation within 30 days. On multivariable analysis, increasing body mass index (BMI) (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.01-1.07), African American race (vs. Caucasian OR 2.29, 95% CI 1.21-4.34), and history of chronic obstructive pulmonary disease (COPD) (OR 2.33, 95% CI 1.45-3.74) were significant predictors of re-operation within 30 days of RC. Urinary diversion type (ileal conduit vs. continent) and history of chemotherapy or radiotherapy within 30 days prior to RC were not. Patients who underwent re-operation within this timeframe had a significantly higher mortality rate (4.0% vs. 1.6%) and were more likely to experience cardiac (7.2% vs. 1.9%), pulmonary (23.0% vs. 3.0%), neurological (2.0% vs. 0.49%), and venous thromboembolic events (10.5% vs. 5.4%), as well as infectious complications (64.5% vs. 24.1%), with a significantly longer hospital length of stay (16.5 vs. 7.0 days). CONCLUSIONS Recognizing increasing BMI, COPD, and African American race as risk factors for re-operation within 30 days of RC will allow urologists to preoperatively identify such high-risk patients and prompt them to adopt more aggressive approaches to minimize postoperative surgical complications.
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Affiliation(s)
- Rashid K. Sayyid
- Section of Urology, Department of Surgery, Medical College of Georgia-Augusta University, Augusta, GA, United States
| | - Diana Magee
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Amanda E. Hird
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Benjamin T. Harper
- Section of Urology, Department of Surgery, Medical College of Georgia-Augusta University, Augusta, GA, United States
| | - Eric Webb
- Section of Urology, Department of Surgery, Medical College of Georgia-Augusta University, Augusta, GA, United States
| | - Katherine L. Fratino
- Section of Urology, Department of Surgery, Medical College of Georgia-Augusta University, Augusta, GA, United States
| | - Martha K. Terris
- Section of Urology, Department of Surgery, Medical College of Georgia-Augusta University, Augusta, GA, United States
- Georgia Cancer Center, Augusta, GA, United States
| | - Rabii Madi
- Section of Urology, Department of Surgery, Medical College of Georgia-Augusta University, Augusta, GA, United States
- Georgia Cancer Center, Augusta, GA, United States
| | - Raj Satkunasivam
- Department of Urology and Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
| | | | - Zachary Klaassen
- Section of Urology, Department of Surgery, Medical College of Georgia-Augusta University, Augusta, GA, United States
- Georgia Cancer Center, Augusta, GA, United States
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Hird AE, Magee DE, Bhindi B, Ye XY, Chandrasekar T, Goldberg H, Klotz L, Fleshner N, Satkunasivam R, Klaassen Z, Wallis CJ. A Systematic Review and Network Meta-analysis of Novel Androgen Receptor Inhibitors in Non-metastatic Castration-resistant Prostate Cancer. Clin Genitourin Cancer 2020; 18:343-350. [DOI: 10.1016/j.clgc.2020.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/27/2020] [Accepted: 02/02/2020] [Indexed: 12/22/2022]
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Larcher A, Wallis CJ, Pavan N, Porpiglia F, Takagi T, Tanabe K, Rha KH, Raheem AA, Yang B, Zang C, Perdonà S, Quarto G, Maurer T, Amiel T, Schips L, Castellucci R, Crivellaro S, Dobbs R, Baiamonte G, Celia A, De Concilio B, Furlan M, Lima E, Linares E, Micali S, Amparore D, De Naeyer G, Trombetta C, Hampton LJ, Tracey A, Bindayi A, Antonelli A, Derweesh I, Mir C, Montorsi F, Mottrie A, Autorino R, Capitanio U. Outcomes of minimally invasive partial nephrectomy among very elderly patients: report from the RESURGE collaborative international database. Cent European J Urol 2020; 73:273-279. [PMID: 33133653 PMCID: PMC7587491 DOI: 10.5173/ceju.2020.0179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 01/20/2023] Open
Abstract
The aim of the study was to perform a comprehensive investigation of clinical outcomes of robot-assisted partial nephrectomy (RAPN) or laparoscopic partial nephrectomy (LPN) in elderly patients presenting with a renal mass. The REnal SURGery in Elderly (RESURGE) collaborative database was queried to identify patients aged 75 or older diagnosed with cT1-2 renal mass and treated with RAPN or LPN. Study outcomes were: overall complications (OC); warm ischemia time (WIT) and 6-month estimated glomerular filtration rate (eGFR); positive surgical margins (PSM), disease recurrence (REC), cancer-specific mortality (CSM) and other-cause mortality (OCM). Descriptive statistics, Kaplan-Meier, smoothed Poisson plots and logistic and linear regression models (MVA) were used. Overall, 216 patients were included in this analysis. OC rate was 34%, most of them being of low Clavien grade. Median WIT was 17 minutes and median 6-month eGFR was 54 ml/min/1.73 m2. PSM rate was 5%. After a median follow-up of 20 months, the 5-year rates of REC, CSM and OCM were 4, 4 and 5%, respectively. At MVA predicting perioperative morbidity, RAPN relative to LPN (odds ratio [OR] 0.33; p <0.0001) was associated with lower OC rate. At MVA predicting functional outcomes, RAPN relative to LPN was associated with shorter WIT (estimate [EST] -4.09; p <0.0001), and with higher 6-month eGFR (EST 6.03; p = 0.01). In appropriately selected patients with small renal masses, minimally-invasive PN is associated with acceptable perioperative outcomes. The use of a robotic approach over a standard laparoscopic approach can be advantageous with respect to clinically relevant outcomes, and it should be preferred when available.
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Affiliation(s)
- Alessandro Larcher
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Urology, OLV Hospital, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | | | - Nicola Pavan
- Department of Urology, University of Trieste, Trieste, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Toshio Takagi
- Department of Urology, Women's Medical University, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Women's Medical University, Tokyo, Japan
| | - Koon H. Rha
- Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ali Abdel Raheem
- Department of Urology, Tanta University, Tanta, Egypt; Department of Urology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Bo Yang
- Department of Urology, Changhai Hospital, Shanghai, China
| | - Chao Zang
- Department of Urology, Changhai Hospital, Shanghai, China
| | - Sisto Perdonà
- Division of Urology, IRCCS Fondazione G.Pascale, Naples, Italy
| | - Giuseppe Quarto
- Division of Urology, IRCCS Fondazione G.Pascale, Naples, Italy
| | - Tobias Maurer
- Department of Urology, Technical University, Munich, Germany
| | - Thomas Amiel
- Department of Urology, Technical University, Munich, Germany
| | - Luigi Schips
- Department Of Urology, Annunziata Hospital, G. D’Annunzio University, Chieti, Italy
| | - Roberto Castellucci
- Department Of Urology, Annunziata Hospital, G. D’Annunzio University, Chieti, Italy
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Ryan Dobbs
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Gianfranco Baiamonte
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | | | - Maria Furlan
- Department of Urology, Spedali Civili Hospital University of Brescia, Brescia, Italy
| | - Estevão Lima
- Department of CUF Urology and Service of Urology, Hospital of Braga, Braga, Portugal
| | | | - Salvatore Micali
- University of Modena and Reggio Emilia, Department of Urology, Modena, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | | | - Carlo Trombetta
- Department of Urology, University of Trieste, Trieste, Italy
| | | | | | - Ahmet Bindayi
- Department of Urology, UCSD Health System, La Jolla, CA, USA
| | - Alessandro Antonelli
- Department of Urology, Spedali Civili Hospital University of Brescia, Brescia, Italy
| | - Ithaar Derweesh
- Department of Urology, UCSD Health System, La Jolla, CA, USA
| | - Carme Mir
- Instituto Valenciano de Oncologia Foundation, Valencia, Spain
| | - Francesco Montorsi
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alexandre Mottrie
- Department of Urology, OLV Hospital, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | | | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
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Pathak R, Lopes G, Yu H, Ji W, Aryal M, Frumento KS, Wallis CJ, Klaassen ZWA, Park HSM, Goldberg SB. Comparative efficacy of chemoimmunotherapy versus immunotherapy alone in the front-line treatment of advanced non-small cell lung cancer: A systematic review and network meta-analysis. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.9552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9552 Background: Immune checkpoint inhibitors (ICI) and combination chemotherapy (chemo) plus ICI (Chemo-ICI) have been shown in RCTs to have improved OS compared to chemo in the 1L treatment of advanced NSCLC. However, the benefit of chemo-ICI compared with ICI alone is unknown. Methods: Systematic review using MEDLINE, Embase and Cochrane CENTRAL was done to identify relevant studies up to December 2019. Phase 3 RCTs that evaluated the efficacy of 1L ICI or chemo-ICI and reported outcomes stratified by PD-L1 status (<1%, 1-49%, ≥50%) were included. ICI was defined as single-agent PD-1 axis inhibitor or dual checkpoint blockade with PD-1 axis inhibitor plus CTLA-4 inhibitor. Comparison for PD-L1<1% included chemo-ICI vs ipi/nivo and for PD-L1 1-49% and PD-L1>50% included chemo-ICI vs ipi/nivo or single-agent ICI. OS, PFS, and ORR were extracted. Network meta-analysis (NMA) was done in Bayesian random-effects regression models. Results: Ten phase 3 RCTs (7971 screened) involving 7,218 patients assigned to ICI (pembro or atezo or ipi/nivo) or chemo-ICI (platinum-doublet + atezo, pembro, or nivo) were included. In PD-L1 <1% patients, NMA comparing chemo-ICI with ipi/nivo failed to show a statistically significant difference in OS, PFS or ORR. In PD-L1 1-49% patients, there was no significant difference between chemo-ICI vs ICI in OS or ORR; PFS could not be analyzed due to lack of available data. In PD-L1 >50% patients, chemo-ICI was associated with improved PFS and ORR compared to ICI alone, but without any OS difference (Table). Conclusions: Although the addition of chemo to ICI appears to improve ORR and PFS in PD-L1 ≥50% patients when compared to ICI alone, chemo-ICI does not confer an OS benefit in the 1L treatment of NSCLC patients regardless of PD-L1 status. Prospective trials comparing chemo-ICI, ICI monotherapy, and combination ICI are needed to confirm these findings. OS, PFS and ORR with chemo-ICI vs ICI. [Table: see text]
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Affiliation(s)
- Ranjan Pathak
- Section of Medical Oncology, Yale School of Medicine, New Haven, CT
| | | | - Han Yu
- Roswell Park Cancer Institute, Buffalo, NY
| | - Wenyan Ji
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Madan Aryal
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
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Goldberg H, Moshin F, Saskin R, Kulkarni GS, Berlin A, Kenk M, Wallis CJ, Chandrasekar T, Klaassen ZWA, Saarela O, Penn L, Alibhai SM, Fleshner NE. The deleterious association between proton pump inhibitors and prostate cancer specific death. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
309 Background: Proton pump inhibitors (PPIs) are a commonly prescribed class of medications. Although in-vitro and in-vivo data have shown PPIs to have anti-tumor effects, more recent studies suggest an increased cancer risk in several solid organs. Pantoprazole, a commonly prescribed PPI, has been shown to harbor a protective effect in human prostate cancer (PCa) cells. We aimed to investigate the effect of pantoprazole and other PPIs on PCa-specific death and additional PCa outcomes. Methods: In this retrospective, population-based cohort study, data were incorporated from the Institute for Clinical and Evaluative Sciences to identify all men aged 66 and above with a history of a single negative prostate biopsy between 1994 and 2016. We used multivariable Cox regression models with time-dependent covariates, to assess the effect of PPIs on PCa diagnosis, androgen deprivation therapy (ADT) use, and PCa-specific death. All models included other medications with a putative effect on PCa. All models were adjusted for age, rurality, comorbidity, and year of patient study inclusion. Results: Overall, 21,512 men were included, with a mean follow-up time of 8.06 years (SD 5.44 years). A total of 10,999 patients (51.1%) used a PPI. A total of 5,187 patients (24.1%) were diagnosed with PCa, 2,043 patients (9.5%) were treated with ADT, and 805 patients (3.7%) died from PCa. Pantoprazole was associated with a 3.0% (95% CI 0.3%-6,0%) increased rate of being treated with ADT for every six months of cumulative use, while any use of all other PPIs was associated with a 39.0% (95% CI 18.0%-64.0%) increased PCa-specific mortality. No significant association was found with PCa diagnosis. Conclusions: Upon validation of the potentially negative association of PPIs with PCa outcomes, the expansive use of PPIs may need to be reassessed, especially in PCa patients.
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Affiliation(s)
| | - Faizan Moshin
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Refik Saskin
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Girish S. Kulkarni
- Division of Urology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alejandro Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Miran Kenk
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Christopher J.D. Wallis
- Division of Urology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | | | | | - Linda Penn
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Neil Eric Fleshner
- Division of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Hird AE, Magee DE, Bhindi B, Ye XY, Chandrasekar T, Goldberg H, Klotz L, Fleshner N, Satkunasivam R, Klaassen ZWA, Wallis CJ. Novel androgen receptor inhibitors in nonmetastatic castration-resistant prostate cancer: A network meta-analysis. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
131 Background: Novel non-steroidal anti-androgens (NSAAs) including enzalutamide, apalutamide, and darolutamide with androgen deprivation therapy (ADT) have proven efficacy in men with high-risk non-metastatic castrate resistant prostate cancer (nmCRPC). However, in the absence of direct comparative trials, there is little evidence to guide therapeutic choice. Our objective was to perform a network meta-analysis to compare agents and perform a class-level meta-analysis of NSAAs with androgen deprivation therapy (ADT) versus ADT-alone. Methods: We performed a systematic review of phase III parallel-group RCTs in men ≥18 years of age with nmCRPC using EMBASE and MEDLINE, indexed as of March 8, 2019. Our primary outcome was metastasis free survival (MFS). Secondary outcomes included OS, PSA progression free survival (PFS), and rates of grade 3-4 adverse events (AEs). Three RCTs were identified. We performed a random effects meta-analysis of NSAA versus ADT-alone using the inverse variance technique for meta-analysis for efficacy outcomes and the Mantel-Haenszel method for meta-analysis of dichotomous data for AEs. We then performed a network meta-analysis to compare outcomes between NSAAs using fixed-effect models in a Bayesian framework. We estimated the relative ranking of the different treatments for each outcome. Results: Pooled MFS, PSA-PFS, and OS were significantly greater with NSAA versus placebo (HR:0.32,95%CI:0.25-0.41, HR:0.08,95%CI:0.05-0.13, and HR:0.74,95%CI:0.61-0.90, respectively). Apalutamide and enzalutamide had a 56% and 44% likelihood of maximizing MFS, respectively. There was a 44%, 41%, and 15% likelihood that apalutamide, darolutamide and enzalutamide offered the greatest OS benefit, respectively. There was a 61% chance that darolutamide was preferred with respect to AEs. Conclusions: NSAAs improve survival outcomes in patients with high-risk nmCRPC. Apalutamide and enzalutamide may offer improved oncological outcomes. Darolutamide may result in fewer adverse events. These differences, if confirmed, would be meaningful to patients and practitioners when selecting treatment.
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Affiliation(s)
- Amanda Elizabeth Hird
- Division of Urology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Diana E. Magee
- Division of Urology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Bimal Bhindi
- Division of Urology, University of Calgary, Calgary, AB, Canada
| | - Xiang Y. Ye
- MiCare Research Centre, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Hanan Goldberg
- Division of Urology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Laurence Klotz
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Neil Fleshner
- Division of Urology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Raj Satkunasivam
- Department of Urology and Center for Outcomes Research, Houston Methodist Hospital, Houston, TX
| | | | - Christopher J.D. Wallis
- Division of Urology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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Chandrasekar T, Goldberg H, Klaassen Z, Wallis CJ, Leong JY, Liem S, Teplitsky S, Noorani R, Loeb S. Twitter and academic Urology in the United States and Canada: a comprehensive assessment of the Twitterverse in 2019. BJU Int 2019; 125:173-181. [DOI: 10.1111/bju.14920] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Thenappan Chandrasekar
- Department of Urology Sidney Kimmel Cancer Center Thomas Jefferson University Philadelphia PA USA
| | - Hanan Goldberg
- Department of Urology State University of New York Upstate Medical University Syracuse NY USA
| | - Zachary Klaassen
- Division of Urology Department of Surgery Augusta University – Medical College of Georgia Augusta GA USA
- Georgia Cancer Center Augusta GA USA
| | - Christopher J.D. Wallis
- Division of Urology Department of Surgery University of Toronto Toronto ON Canada
- Department of Urology Vanderbilt University Medical Center Nashville TN USA
| | - Joon Yau Leong
- Department of Urology Sidney Kimmel Cancer Center Thomas Jefferson University Philadelphia PA USA
| | - Spencer Liem
- Department of Urology Sidney Kimmel Cancer Center Thomas Jefferson University Philadelphia PA USA
| | - Seth Teplitsky
- Department of Urology Sidney Kimmel Cancer Center Thomas Jefferson University Philadelphia PA USA
| | - Rodrigo Noorani
- Division of Urology Department of Surgery University of Toronto Toronto ON Canada
| | - Stacy Loeb
- Department of Urology and Population Health New York University and Manhattan Veterans Affairs New York NY USA
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Goldberg H, Moshin F, Klaassen ZWA, Chandrasekar T, Wallis CJ, Herrera Cáceres JO, Ahmed A, Alibhai SM, Berlin A, Saskin R, Hamilton RJ, Fleshner NE. IMPACT of putative chemopreventative agents on prostate cancer diagnosis. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e16553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16553 Background: Prostate cancer (PC) is the most common non-cutaneous cancer in men and the third most common cause of cancer death in males. Several studies have shown that use of commonly prescribed medications, is associated with improved survival in various malignancies, including PC. There has not been any large population-based study, examining the effects of these and other commonly prescribed medications, such as proton pump inhibitors (PPI), on the rate of PC diagnosis, PC advanced disease and PC-specific death. Methods: A retrospective population-based study using data from the institute of clinical evaluative sciences, including all male patients aged 65 and above in Ontario who have had a negative first prostate biopsy between 1994 and 2016. We assessed the impact of commonly prescribed medications on PC outcomes. The analyzed medications included Statins (hydrophilic and hydrophobic), most commonly used diabetes drugs (metformin, insulins, sulfonylureas, and thizolidinedions), PPIs, 5 alpha reductase inhibitors, and alpha blockers. Time dependent Cox regression proportional hazards models were performed to determine predictors of PC diagnosis, PC advanced disease (defined as usage of hormonal therapy), and PC-specific death. Medication exposure was time varying and modelled as “ever” vs. “never” use or as cumulative exposure. Results: A total of 21,562 men were analyzed over a mean (SD) follow-up time of 8.06 (5.44) years. Overall, 5,187 patients (24%) were diagnosed with PC, 7861 (36.5%) had died, and 647 (3%) died of PC. On multivariable analysis usage of hydrophilic statins modelled as “ever vs. never” was associated with a lower diagnosis rate (OR 0.832, 95% CI 0.732-0.946, p = 0.005) and a significantly decreased PC-specific death (OR 0.676, 95% CI 0.528-0.871, p = 0.0024). In contrast, Pantoprazole was associated with a higher rate of advanced PC disease when modelled as cumulative exposure of 6 months (OR 1.03, 95% CI 1.003-1.06, P = 0.031), and PC-specific death, when modeled as “ever vs. never” (OR 1.26, 95% CI 1.02-1.576, p = 0.031). Conclusions: Hydrophilic statins were associated with a clinically and statistically significant lower PC diagnosis and PC-specific death, while pantoprazole was associated with a higher rate of advanced PC disease and PC-specific death.
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Affiliation(s)
- Hanan Goldberg
- University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Faizan Moshin
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | - Ardalan Ahmed
- Princess Margaret Hospital, University Health Network, Toronto, ON, Canada
| | | | - Alejandro Berlin
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Refik Saskin
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | | | - Neil Eric Fleshner
- Department of Surgery, Division of Urology, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Klaassen Z, Wallis CJ, Chandrasekar T, Goldberg H, Sayyid RK, Williams SB, Moses KA, Terris MK, Nam RK, Urbach D, Austin PC, Kurdyak P, Kulkarni GS. Cancer diagnosis and risk of suicide after accounting for prediagnosis psychiatric care: A matched‐cohort study of patients with incident solid‐organ malignancies. Cancer 2019; 125:2886-2895. [PMID: 31021430 PMCID: PMC10182898 DOI: 10.1002/cncr.32146] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 03/09/2019] [Accepted: 03/14/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Previous studies have demonstrated an association between a diagnosis of cancer and the risk of suicide; however, they failed to account for psychiatric care before a cancer diagnosis, which may confound this relationship. The objective of this study was to assess the effect of a cancer diagnosis on the risk of suicide, accounting for prediagnosis psychiatric care utilization. METHODS All adult residents of Ontario, Canada who were diagnosed with cancer (1 of prostate, breast, colorectal, melanoma, lung, bladder, endometrial, thyroid, kidney, or oral cancer) between 1997 and 2014 were identified. Noncancer controls were matched 4:1 based on sociodemographics, including a psychiatric utilization gradient (PUG) score (with 0 indicating none; 1, outpatient; 2, emergency department; and 3, hospital admission). A marginal, cause-specific hazard model was used to assess the effect of cancer on the risk of suicidal death. RESULTS Among 676,470 patients with cancer and 2,152,682 matched noncancer controls, there were 8.2 and 11.4 suicides per 1000 person-years of follow-up, respectively. Patients with cancer had an overall higher risk of suicidal death compared with matched patients without cancer (hazard ratio, 1.34; 95% CI, 1.22-1.48). This effect was pronounced in the first 50 months after cancer diagnosis (hazard ratio, 1.60; 95% CI, 1.42-1.81); patients with cancer did not demonstrate an increased risk thereafter. Among individuals with a PUG score 0 or 1, those with cancer were significantly more likely to die of suicide compared with controls. There was no difference in suicide risk between patients with cancer and controls for those who had a PUG score of 2 or 3. CONCLUSIONS A cancer diagnosis is associated with increased risk of death from suicide compared with the general population even after accounting for precancer diagnosis psychiatric care utilization. The specific factors underlying the observed associations remain to be elucidated.
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Affiliation(s)
- Zachary Klaassen
- Department of Surgery, Division of Urology University of Toronto, University Health Network, Princess Margaret Cancer Center Toronto Ontario Canada
- Institute for Health Policy, Management, and Evaluation University of Toronto Toronto Ontario Canada
| | - Christopher J.D. Wallis
- Department of Surgery, Division of Urology University of Toronto, University Health Network, Princess Margaret Cancer Center Toronto Ontario Canada
| | - Thenappan Chandrasekar
- Department of Surgery, Division of Urology University of Toronto, University Health Network, Princess Margaret Cancer Center Toronto Ontario Canada
| | - Hanan Goldberg
- Department of Surgery, Division of Urology University of Toronto, University Health Network, Princess Margaret Cancer Center Toronto Ontario Canada
| | - Rashid K. Sayyid
- Division of Urology Medical College of Georgia‐Augusta University Augusta Georgia
| | - Stephen B. Williams
- Division of Urology The University of Texas Medical Branch at Galveston Galveston Texas
| | - Kelvin A. Moses
- Department of Urological Surgery Vanderbilt University Medical Center Nashville Tennessee
| | - Martha K. Terris
- Division of Urology Medical College of Georgia‐Augusta University Augusta Georgia
| | - Robert K. Nam
- Institute for Health Policy, Management, and Evaluation University of Toronto Toronto Ontario Canada
- Division of Urology Sunnybrook Health Sciences Center Toronto Ontario Canada
- Institute for Clinical Evaluative Sciences Toronto Ontario Canada
| | - David Urbach
- Institute for Health Policy, Management, and Evaluation University of Toronto Toronto Ontario Canada
- Institute for Clinical Evaluative Sciences Toronto Ontario Canada
- Department of Surgery University of Toronto, Women’s College Hospital Toronto Ontario Canada
| | - Peter C. Austin
- Institute for Health Policy, Management, and Evaluation University of Toronto Toronto Ontario Canada
- Institute for Clinical Evaluative Sciences Toronto Ontario Canada
| | - Paul Kurdyak
- Institute for Health Policy, Management, and Evaluation University of Toronto Toronto Ontario Canada
- Institute for Clinical Evaluative Sciences Toronto Ontario Canada
- Institute for Mental Health Policy Research Center for Addiction and Mental Health Toronto Ontario Canada
| | - Girish S. Kulkarni
- Department of Surgery, Division of Urology University of Toronto, University Health Network, Princess Margaret Cancer Center Toronto Ontario Canada
- Institute for Health Policy, Management, and Evaluation University of Toronto Toronto Ontario Canada
- Institute for Clinical Evaluative Sciences Toronto Ontario Canada
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27
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Goldberg H, Ramiz AH, Glicksman R, Salgado NS, Chandrasekar T, Klaassen Z, Wallis CJ, Hosni A, Moraes FY, Ghai S, Kulkarni GS, Hamilton RJ, Perlis N, Toi A, Chung P, Evans A, van der Kwast T, Finelli A, Fleshner N, Berlin A. Extraprostatic Extension in Core Biopsies Epitomizes High-risk but Locally Treatable Prostate Cancer. Eur Urol Oncol 2019; 2:88-96. [DOI: 10.1016/j.euo.2018.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/27/2018] [Accepted: 05/04/2018] [Indexed: 01/22/2023]
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28
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Matta R, Wallis CJ, Goldenberg MG, Hird AE, Klaassen Z, Kulkarni G, Kodama RT, Herschorn S, Nam RK. Variation and Trends in Antidepressant Prescribing for Men Undergoing Treatment for Nonmetastatic Prostate Cancer: A Population-based Cohort Study. Eur Urol 2019; 75:3-7. [DOI: 10.1016/j.eururo.2018.08.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
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29
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Klaassen Z, Sayyid RK, Wallis CJ. Lessons Learned from the Global Epidemiology of Kidney Cancer: A Refresher in Epidemiology 101. Eur Urol 2019; 75:85-87. [DOI: 10.1016/j.eururo.2018.09.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 09/18/2018] [Indexed: 01/08/2023]
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Radomski SB, Ruzhynsky V, Wallis CJ, Herschorn S. Complications and Interventions in Patients with an Artificial Urinary Sphincter: Long-Term Results. J Urol 2018; 200:1093-1098. [DOI: 10.1016/j.juro.2018.05.143] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Sidney B. Radomski
- Division of Urology and University of Toronto Research Program in Functional Urology, University of Toronto, Toronto, Ontario, Canada
| | - Vladimir Ruzhynsky
- Division of Urology and University of Toronto Research Program in Functional Urology, University of Toronto, Toronto, Ontario, Canada
| | - Christopher J.D. Wallis
- Division of Urology and University of Toronto Research Program in Functional Urology, University of Toronto, Toronto, Ontario, Canada
| | - Sender Herschorn
- Division of Urology and University of Toronto Research Program in Functional Urology, University of Toronto, Toronto, Ontario, Canada
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Wallis CJ, Klaassen Z. “Reverse Stage Migration”: What Can Population-based Data Tell Us About Trends in Prostate Cancer Presentation? Eur Urol Oncol 2018; 1:321-322. [DOI: 10.1016/j.euo.2018.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 06/15/2018] [Indexed: 11/28/2022]
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Klaassen Z, Goldberg H, Chandrasekar T, Arora K, Sayyid RK, Hamilton RJ, Fleshner NE, Williams SB, Wallis CJ, Kulkarni GS. Changing Trends for Suicidal Death in Patients With Bladder Cancer: A 40+ Year Population-level Analysis. Clin Genitourin Cancer 2018; 16:206-212.e1. [DOI: 10.1016/j.clgc.2017.12.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/27/2017] [Accepted: 12/29/2017] [Indexed: 11/30/2022]
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Klaassen ZWA, Wallis CJ, Goldberg H, Chandrasekar T, Sayyid RK, Fleshner NE, Finelli A, Nam R, Williams SB, Kurdyak P, Kulkarni GS. The impact of pre-cancer (Ca) diagnosis (Dx) psychiatric utilization (PU) on survival in patients with solid organ ca: A population analysis in Ontario, Canada. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e22144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Christopher J.D. Wallis
- Department of Surgery, Division of Urology, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Hanan Goldberg
- Department of Surgery, Division of Urology, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Thenappan Chandrasekar
- Department of Surgery, Division of Urology, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Rashid K. Sayyid
- Department of Surgery, Division of Urology, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Neil Eric Fleshner
- Department of Surgery, Division of Urology, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Antonio Finelli
- Department of Surgery, Division of Urology, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Robert Nam
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Girish S. Kulkarni
- Department of Surgery, Division of Urology, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Nam RK, Benatar T, Amemiya Y, Wallis CJ, Romero JM, Tsagaris M, Sherman C, Sugar L, Seth A. MicroRNA-652 induces NED in LNCaP and EMT in PC3 prostate cancer cells. Oncotarget 2018; 9:19159-19176. [PMID: 29721191 PMCID: PMC5922385 DOI: 10.18632/oncotarget.24937] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 03/06/2018] [Indexed: 12/17/2022] Open
Abstract
MicroRNAs (miRNAs) are small noncoding RNA molecules that post-transcriptionally regulate gene expression. Dysregulation of miRNAs is frequently associated with disease and, in particular, is involved in prostate cancer progression. Next generation miRNA sequencing identified a panel of five miRNAs associated with prostate cancer recurrence and metastasis. High expression of one of these five miRNAs, miR-652, correlated significantly with an increased rate of prostate cancer biochemical recurrence. Overexpression of miR-652 in prostate cancer cells, PC3 and LNCaP, resulted in increased growth, migration and invasion. Prostate cancer cell xenografts overexpressing miR-652 showed increased tumorigenicity and metastases. We found that miR-652 directly targets the B" regulatory subunit, PPP2R3A, of the tumor suppressor PP2A, inducing epithelial-mesenchymal transition (EMT) in PC3 cells and neuroendocrine-like differentiation (NED) in LNCaP cells. The mesenchymal marker N-cadherin increased and epithelial marker E-cadherin decreased in PC3 cells overexpressing miR-652. In LNCaP cells and xenografted tumors, overexpression of miR-652 increased markers of NED, including chromogranin A, neuron specific enolase, and synaptophysin. MiR-652 may contribute to prostate tumor progression by promoting NED through decreased PP2A function. MiR-652 expression could serve as a biomarker for aggressive prostate cancer, as well as provide an opportunity for novel therapy in prostate cancer.
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Affiliation(s)
- Robert K. Nam
- 1 Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Tania Benatar
- 2 Platform Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Yutaka Amemiya
- 3 Genomics Facility, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Christopher J.D. Wallis
- 1 Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Joan Miguel Romero
- 2 Platform Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Melina Tsagaris
- 2 Platform Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Christopher Sherman
- 4 Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- 5 Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Linda Sugar
- 4 Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- 5 Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Arun Seth
- 2 Platform Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- 3 Genomics Facility, Sunnybrook Research Institute, Toronto, ON, Canada
- 4 Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- 5 Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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Matta R, Wallis CJ, Hird A, Dvorani E, Klaassen Z, Kulkarni G, Kodama RT, Herschorn S, Nam RK. MP21-20 ANTIDEPRESSANT USE BY MEN UNDERGOING TREATMENT FOR LOCALIZED PROSTATE CANCER: A POPULATION BASED COHORT STUDY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wallis CJ, Satkunasivam R, Herschorn S, Law C, Seth A, Kodama RT, Kulkarni GS, Nam RK. Association Between Primary Local Treatment and Non–prostate Cancer Mortality in Men With Nonmetastatic Prostate Cancer. Urology 2018; 114:147-154. [DOI: 10.1016/j.urology.2017.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 11/22/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
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Klaassen Z, Wallis CJ, Goldberg H, Chandrasekar T, Fleshner NE, Finelli A, Kulkarni GS, Satkunasivam R. MP57-02 THE ASSOCIATION BETWEEN PHYSICIAN TRUST AND PROSTATE SPECIFIC ANTIGEN SCREENING: IMPLICATIONS FOR SHARED DECISION MAKING. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Klaassen ZWA, Wallis CJ, Goldberg H, Chandrasekar T, Fleshner NE, Finelli A, Kulkarni GS, Satkunasivam R. The association between physician trust and prostate specific antigen screening: Implications for shared decision making. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
13 Background: Most cancer organizations recommend shared decision making for PSA screening, a process relying on a trusting relationship between patient and physician. The objective of this study was to assess the degree to which an individual’s trust in cancer information from their physician compared to internet-based information impacts the likelihood of receiving PSA-screening. Methods: This was a cross-sectional study (2011-2014) of the Health Information National Trends Survey (HINTS), a survey of people living in the US. The primary exposure was degree of trust in cancer information from participant’s physician (CIP). The secondary exposure was degree of trust in cancer information from the internet (CII). The primary outcome was patient-reported receipt of PSA-screening. The Cochran-Armitage test was used to identify significant trends in the primary outcome, across levels of trust. A multivariable logistic regression model assessed the association between CIP and CII with PSA-screening, adjusted for a priori covariates. Results: Among 5069 eligible respondents, 3,606 (71.1%) reported trusting CIP ‘a lot’, 1,186 (23.4%) ‘some’, 219 (4.3%) ‘a little’, and 58 (1.1%) ‘not at all’. 2,655 (52.4%) men received PSA-screening. The degree of trust in CIP was strongly associated with the likelihood of receiving PSA-screening: among men who reported ‘a lot’ of trust, 54.9% underwent screening, 48.6% ‘some’ trust, 38.4% ‘a little’ trust, and 27.6% among men ‘not at all’ trusting their physician (trend p < 0.0001). The degree to which men trusted CII was also associated with having received PSA-screening (p = 0.005), albeit with an insignificant trend (p = 0.07). After multivariable adjustment, these significant results persisted for degree of CIP trust (vs ‘a lot’: ‘some’ OR 0.80, 95%CI 0.66-0.97; ‘a little’ OR 0.61, 95%CI 0.41-0.90; ‘not at all’ OR 0.33, 95%CI 0.15-0.73), but not for trust in CII. Conclusions: The level of trust an individual has in their physician is strongly associated with undergoing PSA-screening. As rationale implementation of PSA screening requires shared decision-making, the level of physician trust has implications for dissemination of PSA-screening guidelines.
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Affiliation(s)
| | | | | | | | | | - Antonio Finelli
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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Wallis CJ, Peltz S, Byrne J, Kroft J, Karanicolas P, Coburn N, Nathens AB, Nam RK, Hallet J, Satkunasivam R. Peripheral Nerve Injury during Abdominal-Pelvic Surgery: Analysis of the National Surgical Quality Improvement Program Database. Am Surg 2017. [DOI: 10.1177/000313481708301122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Peripheral nerve injury (PNI) is a rare but preventable complication of surgery. We sought to assess whether the use of minimally invasive surgery (MIS) affects the occurrence of PNI. Using the American College of Surgeons National Surgical Quality Improvement Program database, we examined rates of PNI among patients undergoing appendectomy, hysterectomy, colectomy, or radical prostatectomy between 2005 and 2012. We assessed the effect of MIS, as compared with open surgery, on PNI occurrence using logistic regression. Among 297,532 patients, of whom 175,884 (59.1%) underwent MIS, the rate of PNI was 0.03 per cent. Forty-four patients treated using MIS had PNI (0.03%) as compared with 63 who underwent open surgery (0.05%; P = 0.0002). There was a significant decrease in the proportion of surgeries resulting in PNI (P < 0.0001) over time. In univariate analysis, MIS was associated with a decreased occurrence of PNI (odds ratio 0.48, 95% confidence interval 0.33–0.71), but this became nonsignificant on multivariable analysis (odds ratio 0.71, 95% confidence interval 0.47–1.09). Increased operative time and smoking status were the only factors independently associated with an increased risk of PNI on multivariable analysis. MIS techniques during common abdominal-pelvic surgeries do not appear to increase the risk of PNI. Prolonged operative time and smoking are independently associated with an increased risk of PNI. Quality improvement initiatives to increase awareness of PNI and identify patients at increased risk of this preventable complication should be considered.
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Affiliation(s)
| | - Sarah Peltz
- Division of Urology, Department of Surgery, University of Toronto, Ontario, Canada
| | - James Byrne
- Division of General Surgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Jamie Kroft
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Paul Karanicolas
- Division of General Surgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Natalie Coburn
- Division of General Surgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Avery B. Nathens
- Division of General Surgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Robert K. Nam
- Division of Urology, Department of Surgery, University of Toronto, Ontario, Canada
| | - Julie Hallet
- Division of General Surgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Raj Satkunasivam
- Division of Urology, Department of Surgery, University of Toronto, Ontario, Canada
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Wallis CJ, Garbens A, Chopra S, Gill IS, Satkunasivam R. Robotic Partial Nephrectomy: Expanding Utilization, Advancing Innovation. J Endourol 2017; 31:348-354. [DOI: 10.1089/end.2016.0639] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Christopher J.D. Wallis
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
| | - Alaina Garbens
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
| | - Sameer Chopra
- USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Inderbir S. Gill
- USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Raj Satkunasivam
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
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Nam R, Wallis CJ, Saskin R, Bansal S, Emmenegger U, Satkunasivam R. Population-based analysis of treatment toxicity among men with castration-resistant prostate cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
252 Background: There is little phase 4 data regarding the toxicity and effectiveness of contemporary metastatic castrate-resistant prostate cancer (mCRPC) treatments. We examined hospital admissions and emergency room (ER) visits and survival among patients in the Province of Ontario treated with abiraterone, enzalutamide, docetaxel, or cabazitaxel for mCRPC. Methods: We performed a population-based, retrospective cohort study of 2439 men over the age of 65 treated with abiraterone, enzalutamide, docetaxel, or cabazitaxel for mCRPC from 2003-2015 in Ontario, Canada. Outcomes were toxicity (hospitalizations and ER visits) and overall survival. We used multivariable Cox proportional hazards models with time-varying exposures to calculate hazard ratios (HR). Results: Among 2439 patients, cumulative exposure was greatest for docetaxel (n = 1886 (77.3%); 11,436 person-months), followed by abiraterone (n = 893 (36.6%); 5143 person-months), enzalutamide (n = 52 (2.1%); 351 person-months) and cabazitaxel (n = 18 (0.7%); 61 person-months). Abiraterone exposure was not significantly associated with any-cause (HR 0.88, 95% CI 0.72-1.07) or treatment-related (HR 1.09, 95% CI 0.87-1.37) hospitalizations or ER visits. Enzalutamide was not significantly associated with any-cause (HR 1.20, 95% CI 0.69-2.07) or treatment-related (HR 0.85, 95% CI 0.43-1.68) toxicity. Docetaxel exposure was associated with a significantly increased risk of any-cause (HR 1.29, 95% CI 1.15-1.44) and treatment-related (HR 1.52, 95% CI 1.33-1.74) toxicity. Cabazitaxel exposure was also associated with treatment-related (HR 5.94, 95% CI 1.87-18.92) but not any-cause (HR 2.37, 95% CI 0.59-9.63) toxicity. Patients who began CRPC treatment after the introduction of oral therapies had improved overall survival compared with those treated prior to their introduction (aHR 0.70, 95% CI 0.64-0.77). Conclusions: Among patients with metastatic CRPC, treatment with chemotherapy (docetaxel or cabazitaxel) is associated with an increased risk of hospitalizations and emergency room visits. We failed to show a significantly increased risk for patients treated with oral agents (abiraterone or enzalutamide).
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Affiliation(s)
- Robert Nam
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Refik Saskin
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Symron Bansal
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Urban Emmenegger
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Abstract
288 Background: Cancer and immobility both contribute to the development of venous thromboembolic events (VTE), including pulmonary embolism and deep vein thrombosis. As such, patients undergoing radical cystectomy for bladder cancer are at elevated risk. We sought to assess the long-term incidence of VTE among all patients undergoing radical cystectomy in the province of Ontario. Methods: We conducted a population-based cohort study to examine the incidence of VTE, a composite of pulmonary embolism and deep vein thrombosis, among all patients treated with radical cystectomy for bladder cancer between 2002 and 2014 in Ontario, Canada. We estimated the cumulative incidence of VTE and used Fine and Grey competing risk survival analysis to assess risk factors for VTE while accounting for the risk of any cause mortality. Results: Among 3623 eligible patients, the 10 year cumulative incidence of VTE was 6.68% (Table 1). Among those who experienced VTE, the median time from surgery was 216 days (interquartile range 52-677 days; mean 527 days). However, VTE rates peaked much earlier with a mode of 20 days. Neither preoperative (HR 0.68, 95% CI 0.39-1.18) nor postoperative chemotherapy (HR 1.32, 95% CI 0.95-1.84) were significantly associated with VTE incidence. While patients with a prior history of VTE had increased risk of VTE after cystectomy (HR 5.1, 95% CI 2.2-12.0), age, gender, comorbidity score, rurality, diversion type (continent vs ileal conduit), treatment at an academic institution, or year of treatment were not significantly associated with the risk of VTE. Conclusions: Among patients undergoing cystectomy for bladder cancer, the cumulative incidence of VTE continues to rise long after the date of surgery indicating that previous studies may have underestimated these rates, but the highest rates occur at 20 days after surgery. Chemotherapy does not appear to increase the risk of VTE. [Table: see text]
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Affiliation(s)
| | - Diana Magee
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Robert Nam
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Wang LL, Wallis CJ, Sathianathen N, Lawrentschuk N, Murphy DG, Nam R, Moon D. ‘ProtecTion’ from overtreatment: does a randomized trial finally answer the key question in localized prostate cancer? BJU Int 2017; 119:513-514. [DOI: 10.1111/bju.13734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Luke L. Wang
- Australian Urology Associates; Malvern Vic. Australia
- Department of Surgery; Central Clinical School; Monash University; Melbourne Vic. Australia
| | - Christopher J.D. Wallis
- Division of Urology; Sunnybrook Health Sciences Centre; University of Toronto; Toronto ON Canada
| | - Niranjan Sathianathen
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; University of Melbourne; Melbourne Vic. Australia
| | - Nathan Lawrentschuk
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; University of Melbourne; Melbourne Vic. Australia
- Department of Surgery, Austin Health; University of Melbourne; Melbourne Vic. Australia
| | - Declan G. Murphy
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; University of Melbourne; Melbourne Vic. Australia
- Australian Prostate Cancer Research Centre; Epworth Healthcare; Richmond Vic. Australia
| | - Robert Nam
- Division of Urology; Sunnybrook Health Sciences Centre; University of Toronto; Toronto ON Canada
| | - Daniel Moon
- Australian Urology Associates; Malvern Vic. Australia
- Department of Surgery; Central Clinical School; Monash University; Melbourne Vic. Australia
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; University of Melbourne; Melbourne Vic. Australia
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Wallis CJ, Nam RK. Prostate Cancer Genetics: A Review. EJIFCC 2015; 26:79-91. [PMID: 27683484 PMCID: PMC4975354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Over the past decades, research has focussed on identifying the genetic underpinnings of prostate cancer. It has been recognized that a number of forms of genetic changes coupled with epigenetic and gene expression changes can increase the prediction to develop prostate cancer. This review outlines the role of somatic copy number alterations (SCNAs), structural rearrangements, point mutations, and single nucleotide polymorphisms (SNPs) as well as miRNAs. Identifying relevant genetic changes offers the ability to develop novel biomarkers to allow early and accurate detection of prostate cancer as well as provide risk stratification of patients following their diagnosis. The concept of personalized or individualized medicine has gained significant attention. Therefore, a better understanding of the genetic and metabolic pathways underlying prostate cancer development offers the opportunity to explore new therapeutic interventions with the possibility of offering patient-specific targeted therapy.
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Affiliation(s)
| | - Robert K. Nam
- 2075 Bayview Ave., Room MG-406 Toronto, ON M4N 3MS Canada 416-480-5075416-480-6121Robert.Nam(5)utoronto.ca
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Wallis CJ, English JC, Goldenberg SL. The role of resection of pulmonary metastases from prostate cancer: a case report and literature review. Can Urol Assoc J 2013. [DOI: 10.5489/cuaj.742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report a case of a 53-year-old man who presented with twonodules in the lower lobe and one nodule in the upper lobe of theright lung almost 7 years after radical prostatectomy for pT3aN0M0,Gleason 4+5 disease, without evidence of osseous or lymphaticspread. Surgical resection of the lower lung nodules confirmedmetastases, but prostate-specific antigen did not drop to undetectablelevels. Isolated pulmonary metastases from prostate cancerare rare with only 33 previously described cases in the Englishlanguageliterature, 18 of which were solitary metastases. Wereview the principles of management, including metastasectomyand long-term prognosis.
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Nelson HL, Wallis CJ, Pommerville PJ. Isolated Tuberculous Epididymitis: A Rare Complication after Intravesical Bacillus Calmette-Guerin Therapy. Curr Urol 2011. [DOI: 10.1159/000327461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
The effects of the dihydropyridine L-type calcium channel blockers nitrendipine and nimodipine on the pentylenetetrazol (PTZ) drug discrimination, an operant model of anxiety, were investigated. Male Long-Evans rats were trained to discriminate PTZ (16 mg/kg, i.p.) from saline. Both nitrendipine (5.0-25 mg/kg, i.p.) and nimodipine (5.0-25 mg/kg, i.p.) partially substituted for the PTZ discriminative stimulus. However, pretreatment with nitrendipine (25 mg/kg, i.p.) or nimodipine (25 mg/kg, i.p.) produced no change in the PTZ dose-effect function. Rats were given a nutritionally balanced liquid diet containing 6.5% ethanol for 10 days. Rats selected the PTZ drug lever during withdrawal. Subchronic coadministration of nitrendipine (1.25-5.0 mg/kg, i.p., b.i.d.) with ethanol failed to dose-dependently reduce PTZ-lever responding, but it did reverse withdrawal signs. Acute administration of nitrendipine (5, 10, and 20 mg/kg, i.p.) produced marked suppression of lever responding, but it failed to significantly reduce levels of PTZ-lever responding. Although calcium channel blockers reduce signs of ethanol withdrawal, they also markedly reduce rates of behavior and produce no clear effects on anxiety-like behaviors induced by ethanol withdrawal.
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Affiliation(s)
- M B Gatch
- Department of Pharmacology, University of North Texas Health Science Center, Fort Worth, TX 76107, USA.
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Abstract
This study investigated the effects of a benzodiazepine partial agonist, abecarnil, and a full agonist, alprazolam, on ethanol withdrawal-induced anxiety-like behaviors in rats. Anxiety was assessed in two models: elevated plus maze and pentylenetetrazol (GABA(A) antagonist) discrimination assay. Male rats received an ethanol-containing (4.5%) liquid diet for 7 to 10 days and were tested for withdrawal symptoms 12 h after termination of the diet. In the elevated plus maze, ethanol-withdrawn rats displayed less open arm activity and total arm entries than pair-fed rats. Abecarnil (0.08-0.32 mg/kg, IP) and alprazolam (0.08-1.25 mg/kg, IP) each produced a dose-dependent, full reversal of ethanol withdrawal-induced reduction of open arm activity, but only alprazolam increased the total arm entries. In the pentylenetetrazol assay, ethanol-withdrawn rats selected the pentylenetetrazol lever (100%) over the salin-lever. Abecarnil (0.04-0.32 mg/kg, IP) and alprazolam (0.08-0.32 mg/kg, IP) dose dependently reduced pentylenetetrazol-lever responding to control levels (10-20%). Alprazolam was more potent than abecarnil in reversing ethanol withdrawal-induced decrease in open arm activities, but showed comparable potency and efficacy to abecarnil in blocking the pentylenetetrazol-like ethanol withdrawal stimulus. These results suggest that abecarnil and alprazolam may have therapeutic potential for treatment of ethanol withdrawal-induced anxiety-like symptoms.
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Affiliation(s)
- M E Jung
- Department of Pharmacology, University of North Texas Health Science Center at Fort Worth, 3500 Camp Bowie Boulevard, Fort Worth, TX 76107-2699,
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49
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Abstract
This study investigated the ability of ritanserin, a 5-HT2 antagonist, to modify ethanol withdrawal (EW) symptoms in two animal models of anxiety: the elevated plus-maze (EPM) and the pentylenetetrazol (PTZ) discrimination assay. Long-Evans hooded rats were given a nutritionally balanced liquid diet containing 4.5% ethanol for 10 days. Twelve hours after removal of the ethanol diet, rats were tested in the EPM. A significant reduction in the open-arm activity and the number of total arm entries was observed, which is indicative of EW. Acute ritanserin (0.16-0.64 mg/kg, i.p., 60 min) had no effect on EW-induced anxiety-like behavior on the EPM. Ritanserin (0.08-0.64 mg/kg, i.p., b.i.d. 12 h) administered concurrently with the last 5 days of ethanol diet produced an increase in the time spent on the open arms of the EPM and reversed the EW-induced reduction in total arm entries. Rats trained to discriminate between saline and PTZ (an anxiogenic drug), selected the PTZ lever during EW. Chronic ritanserin (0.32 mg/kg, i.p., b.i.d. ) did not block PTZ lever responding during EW. On the rotorod, ritanserin (0.32 mg/kg, i.p.) increased the motor incoordination induced by ethanol. In conclusion, coadministration of ritanserin with ethanol prevented the development of EW-induced anxiety as measured by the EPM, but not in the PTZ drug discrimination.
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Affiliation(s)
- M B Gatch
- Department of Pharmacology, University of North Texas Health Science Center, Fort Worth 76107, USA.
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50
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Abstract
RATIONALE The serotonergic system plays a role in regulation of anxiety and ethanol withdrawal (EW). Nevertheless, few studies have assessed sex differences in serotonergic effects on EW. OBJECTIVES This study examined sex differences in the anxiogenic stimuli induced by a serotonin (5-HT)(1b,2) agonist, meta-chlorophenylpiperazine (mCPP), prior to ethanol and during EW. METHODS Gonadectomized or sham-operated adult male and female rats and 17beta-estradiol (2.5 mg, 21-day release, s.c.) -replaced ovariectomized (OVX) rats were trained to discriminate mCPP (1.2 mg/kg, i.p.) from saline in a two-lever choice task for food. Latency to the first lever press and mCPP lever selection were measured following mCPP (0-1.2 mg/kg). Rats then received chronic ethanol-containing liquid diet (6.5%) for 10 days and were tested for mCPP lever selection 12 h and 36 h after removal of ethanol. RESULTS Fewer sham female and beta-estradiol-replaced OVX rats selected the mCPP lever than male or OVX rats, and showed an increased initiation latency after mCPP injection. During EW (12 h and 36 h), fewer sham female and beta-estradiol-replaced OVX rats responded on the mCPP-lever after saline injection as well as after mCPP challenge than male or OVX rats. Castration did not alter any response of male rats to mCPP. CONCLUSIONS (1) mCPP discrimination is a useful measure of EW in male and female rats; and (2) sham female and beta-estradiol-replaced OVX rats are less sensitive to the discriminative stimulus prior to and during EW, but more sensitive to impaired behavioral initiation induced by mCPP than male or OVX rats.
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Affiliation(s)
- M E Jung
- Department of Pharmacology and Substance Abuse Institute of North Texas, University of North Texas Health Science Center at Fort Worth, 76107-2699, USA.
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