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Filson CP, Richards TB, Ekwueme DU, Howard DH. Patterns of Care for Medicare Beneficiaries With Metastatic Prostate Cancer. Urol Pract 2024; 11:489-497. [PMID: 38640419 DOI: 10.1097/upj.0000000000000557] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/22/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Therapeutic options for men with metastatic prostate cancer have increased in the past decade. We studied recent treatment patterns for men with metastatic prostate cancer and how treatment patterns have changed over time. METHODS Using the Surveillance, Epidemiology, and End Results‒Medicare database, we identified fee-for-service Medicare beneficiaries who either were diagnosed with metastatic prostate cancer or developed metastases following diagnosis, as indicated by the presence of claims with diagnoses codes for metastatic disease, between 2007 and 2017. We evaluated treatment patterns using claims. RESULTS We identified 29,800 men with metastatic disease, of whom 4721 (18.8%) had metastatic disease at their initial diagnosis. The mean age was 77 years, and 77.9% of patients were non-Hispanic White. The proportion receiving antineoplastic agents within 3 years of the index date increased over time (from 9.7% in 2007 to 25.9% in 2017; P < .001). Opioid use within 3 years of prostate cancer diagnosis was stable during 2007 to 2013 (around 73%) but decreased through 2017 to 65.5% (P < .001). Patients diagnosed during 2015 to 2017 had longer median survival (32.6 months) compared to those diagnosed during 2007 to 2010 (26.6 months; P < .001). CONCLUSIONS Most metastatic prostate cancer patients do not receive life-prolonging antineoplastic therapies. Improved adoption of effective cancer therapies when appropriate may increase length and quality of survival among metastatic prostate cancer patients.
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Affiliation(s)
- Christopher P Filson
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Thomas B Richards
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Donatus U Ekwueme
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David H Howard
- Department of Health Policy and Management, Winship Cancer Institute, Emory University, Atlanta, Georgia
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Joyce DD, Filson CP, Herrel LA. Point of View: What Are We Doing? The Incredible Expense and Uncertain Value of Localized Prostate Cancer Diagnostic and Therapeutic "Advances". J Urol 2024; 211:320-321. [PMID: 38010944 DOI: 10.1097/ju.0000000000003798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Daniel D Joyce
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
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Horný M, Yabroff KR, Filson CP, Zheng Z, Ekwueme DU, Richards TB, Howard DH. The cost burden of metastatic prostate cancer in the US populations covered by employer-sponsored health insurance. Cancer 2023; 129:3252-3262. [PMID: 37329254 PMCID: PMC10527879 DOI: 10.1002/cncr.34905] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/30/2023] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Recent advancements in the clinical management of metastatic prostate cancer include several costly therapies and diagnostic tests. The objective of this study was to provide updated information on the cost to payers attributable to metastatic prostate cancer among men aged 18 to 64 years with employer-sponsored health plans and men aged 18 years or older covered by employer-sponsored Medicare supplement insurance. METHODS By using Merative MarketScan commercial and Medicare supplemental data for 2009-2019, the authors calculated differences in spending between men with metastatic prostate cancer and their matched, prostate cancer-free controls, adjusting for age, enrollment length, comorbidities, and inflation to 2019 US dollars. RESULTS The authors compared 9011 patients who had metastatic prostate cancer and were covered by commercial insurance plans with a group of 44,934 matched controls and also compared 17,899 patients who had metastatic prostate cancer and were covered by employer-sponsored Medicare supplement plans with a group of 87,884 matched controls. The mean age of patients with metastatic prostate cancer was 58.5 years in the commercial samples and 77.8 years in the Medicare supplement samples. Annual spending attributable to metastatic prostate cancer was $55,949 per person-year (95% confidence interval [CI], $54,074-$57,825 per person-year) in the commercial population and $43,682 per person-year (95% CI, $42,022-$45,342 per person-year) in the population covered by Medicare supplement plans, both in 2019 US dollars. CONCLUSIONS The cost burden attributable to metastatic prostate cancer exceeds $55,000 per person-year among men with employer-sponsored health insurance and $43,000 among those covered by employer-sponsored Medicare supplement plans. These estimates can improve the precision of value assessments of clinical and policy approaches to the prevention, screening, and treatment of prostate cancer in the United States.
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Affiliation(s)
- Michal Horný
- School of Medicine, Emory University, Atlanta, Georgia, USA
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - K. Robin Yabroff
- Health Services Research, and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Christopher P. Filson
- School of Medicine, Emory University, Atlanta, Georgia, USA
- Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia, USA
- Urology Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
| | - Zhiyuan Zheng
- Health Services Research, and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Donatus U. Ekwueme
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - David H. Howard
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Corriher TJ, Janopaul-Naylor J, Liu Y, Dhere VR, Sebastian N, Weiss A, Hershatter B, Filson CP, Patel SA. Utilization of Radical Prostatectomy vs. Radiation Therapy for Gleason Grade Group 5 Prostate Cancer before and after USPSTF Grade D Recommendation against Prostate-Specific Antigen Screening in 2012. Int J Radiat Oncol Biol Phys 2023; 117:e374. [PMID: 37785273 DOI: 10.1016/j.ijrobp.2023.06.2478] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The 2012 United States Preventive Services Task Force (USPSTF) Grade D recommendation against prostate-specific antigen (PSA) screening has resulted in a shift to higher-stage prostate cancer (PC) at diagnosis. While incidence of low-risk prostate cancer has declined, more men are diagnosed with high-risk disease, and multimodal treatment is often required. The impact of this epidemiologic shift on practice patterns, specifically radical prostatectomy (RP) versus definitive radiation therapy (RT), for men with localized PC at high risk of recurrence is unknown. Herein, we evaluate the utilization of RP versus RT in the United States for Gleason grade group 5 (GG5) prostate cancer before and after 2012. MATERIALS/METHODS We identified 34,011 men with localized GG5 PC treated with (1) RP or (2) RT plus androgen deprivation therapy (ADT) between 2004 and 2017 in the National Cancer Database. We excluded those who were clinically node-positive, had metastatic disease, or received chemotherapy or palliative-intent treatment. Chi-square was used to compare the relative use of RP and RT before versus after January 1, 2012, corresponding to the year of USPSTF recommendation against PSA screening. Annual use of RP versus RT from 2004 to 2017 was compared in academic and non-academic centers using Cochran-Armitage test for trend. Joinpoint regression assessed if 2012 was significant for inflection of crude rates of RP. Finally, we modeled the effect of treatment year (i.e., 2012-2017 versus 2004-2011) on use of RP using multivariable logistic regression. Sensitivity analysis tested an interaction term for facility type (i.e., academic versus community). Tests were two-sided with a 0.05 level of significance. RESULTS Of the eligible men, 10,745 (31.6%) had T3-T4 disease. Between 2004 and 2011, 36.5% (n = 5,483) underwent RP; between 2012 and 2017, 42.3% (n = 8,034) underwent RP (p = .02). Across all centers, use of RP increased from 31% to 41% (p for trend <.001). In academic centers, use of RP increased from 32% to 44% (p for trend <.001); in community centers, use of RP increased from 30% to 39% (p for trend <.001). 2012 was associated with significant inflection for increase in RP use in all centers. On multivariable analysis, there was an increased odds of receiving RP after 2012 (adjusted OR 1.34, 95% CI 1.28-1.40, p<.001). No differential effect by facility type was observed (p = .15). CONCLUSION Utilization of RP for GG5 PC has significantly increased in the United States over the past decade, particularly after the USPSTF Grade D recommendation against PSA screening in 2012. It remains unknown whether oncologic or functional outcomes may be compromised in this group of high-risk men, many of whom require post-prostatectomy RT and/or ADT. While historically rare, prospective comparison of RP versus RT+ADT for GG5 PC may be helpful given the evolving epidemiology of localized PC.
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Affiliation(s)
- T J Corriher
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - J Janopaul-Naylor
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Y Liu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - V R Dhere
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - N Sebastian
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - A Weiss
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - B Hershatter
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - C P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - S A Patel
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
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Janopaul-Naylor J, Corriher TJ, Switchenko J, Hanasoge S, Esdaille A, Mahal BA, Filson CP, Patel SA. Disparities in Time to Prostate Cancer Treatment Initiation before and after the Affordable Care Act. Int J Radiat Oncol Biol Phys 2023; 117:e28. [PMID: 37785048 DOI: 10.1016/j.ijrobp.2023.06.709] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Delayed access to care may contribute to disparities in prostate cancer (PCa). The Affordable Care Act (ACA) aimed at increasing access and reducing healthcare disparities, but its impact on timely treatment initiation for men with PCa is unknown. MATERIALS/METHODS Men with intermediate- and high-risk PCa diagnosed 2010-2016 and treated with curative surgery or radiotherapy were identified in the National Cancer Database. Multivariable logistic regression modeled the effect of race and insurance type on treatment delay >180 days after diagnosis to start of surgery, radiotherapy, or hormonal therapy. Cochran-Armitage test measured annual trends in delays, and join point regression assessed if 2014, the year the ACA became fully operationalized, was significant for inflection in crude rates of major delays. RESULTS Of 422,506 eligible men, 18,720 (4.4%) experienced >180-day delay in treatment initiation. Compared to White patients, Black (OR 1.79, 95% CI 1.72-1.87, p<.001) and Hispanic (OR 1.37, 95% CI 1.28-1.48, p<.001) patients had higher odds of delay. These disparities persisted when analyzing only patients treated after 2014 or for patients who had Medicare or Private insurance. Compared to uninsured patients, those with Medicaid had no difference in odds of delay (OR 0.94, 95% CI 0.84-1.06, p = .31), while those with private insurance (OR 0.57, 95% CI 0.52-0.63, p<.001) or Medicare (OR 0.64, 95% CI 0.58-0.70, p<.001) had lower odds of delay. These disparities persisted when analyzing only patients treated after 2014. Mean time to treatment significantly increased from 2010 to 2016 across all racial/ethnic groups (trend p<.001); 2014 was associated with a significant inflection for increase in rates of major delays. CONCLUSION The impact of race and insurance status were independently associated with longer delays to PCa treatment in the US. These disparities were unaffected by implementation of the ACA. In fact, implementation of ACA was associated with increased delays in treatment initiation for all men, regardless of race. As the epidemiology of newly diagnosed prostate cancer in the United States continues to shift due to tempered screening and the COVID pandemic, further work will be needed to increase equity in prostate cancer care.
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Affiliation(s)
- J Janopaul-Naylor
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - T J Corriher
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | | | - S Hanasoge
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - A Esdaille
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - B A Mahal
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
| | - C P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - S A Patel
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
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Janopaul‐Naylor JR, Corriher TJ, Switchenko J, Hanasoge S, Esdaille A, Mahal BA, Filson CP, Patel SA. Disparities in time to prostate cancer treatment initiation before and after the Affordable Care Act. Cancer Med 2023; 12:18258-18268. [PMID: 37537835 PMCID: PMC10523962 DOI: 10.1002/cam4.6419] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/19/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Delayed access to care may contribute to disparities in prostate cancer (PCa). The Affordable Care Act (ACA) aimed at increasing access and reducing healthcare disparities, but its impact on timely treatment initiation for PCa men is unknown. METHODS Men with intermediate- and high-risk PCa diagnosed 2010-2016 and treated with curative surgery or radiotherapy were identified in the National Cancer Database. Multivariable logistic regression modeled the effect of race and insurance type on treatment delay >180 days after diagnosis. Cochran-Armitage test measured annual trends in delays, and joinpoint regression assessed if 2014, the year the ACA became fully operationalized, was significant for inflection in crude rates of major delays. RESULTS Of 422,506 eligible men, 18,720 (4.4%) experienced >180-day delay in treatment initiation. Compared to White patients, Black (OR 1.79, 95% CI 1.72-1.87, p < 0.001) and Hispanic (OR 1.37, 95% CI 1.28-1.48, p < 0.001) patients had higher odds of delay. Compared to uninsured, those with Medicaid had no difference in odds of delay (OR 0.94, 95% CI 0.84-1.06, p = 0.31), while those with private insurance (OR 0.57, 95% CI 0.52-0.63, p < 0.001) or Medicare (OR 0.64, 95% CI 0.58-0.70, p < 0.001) had lower odds of delay. Mean time to treatment significantly increased from 2010 to 2016 across all racial/ethnic groups (trend p < 0.001); 2014 was associated with a significant inflection for increase in rates of major delays. CONCLUSIONS Non-White and Medicaid-insured men with localized PCa are at risk of treatment delays in the United States. Treatment delays have been consistently rising, particularly after implementation of the ACA.
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Affiliation(s)
- James R. Janopaul‐Naylor
- Department of Radiation OncologyWinship Cancer Institute at Emory UniversityAtlantaGeorgiaUSA
- Department of Radiation OncologyMemorial Sloan Kettering CancerNew YorkNew YorkUSA
| | - Taylor J. Corriher
- Department of Radiation OncologyWinship Cancer Institute at Emory UniversityAtlantaGeorgiaUSA
| | - Jeffrey Switchenko
- Department of Biostatistics and BioinformaticsRollins School of Public HealthAtlantaGeorgiaUSA
| | - Sheela Hanasoge
- Department of Radiation OncologyWinship Cancer Institute at Emory UniversityAtlantaGeorgiaUSA
| | - Ashanda Esdaille
- Department of UrologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Brandon A. Mahal
- Department of Radiation OncologyUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | | | - Sagar A. Patel
- Department of Radiation OncologyWinship Cancer Institute at Emory UniversityAtlantaGeorgiaUSA
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Zambrano IA, Hwang S, Basak R, Spratte BN, Filson CP, Jacobs BL, Tan HJ. Patterns of multispecialty care for low- and intermediate-risk prostate cancer in the use of active surveillance. Urol Oncol 2023; 41:388.e1-388.e8. [PMID: 37286404 DOI: 10.1016/j.urolonc.2023.04.024] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/20/2023] [Accepted: 04/24/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Multidisciplinary models of care have been advocated for prostate cancer (PC) to promote shared decision-making and facilitate quality care. Yet, how this model applies to low-risk disease where the preferred management is expectant remains unclear. Accordingly, we examined recent practice patterns in specialty visits for low/intermediate-risk PC and resultant use of active surveillance (AS). METHODS Using SEER-Medicare, we ascertained whether patients saw urology and radiation oncology (i.e., multispecialty care) versus urology alone, based on self-designated specialty codes, for newly diagnosed PC from 2010 to 2017. We also examined the association with AS, defined as the absence of treatment within 12 months of diagnosis. Time trends were analyzed using Cochran-Armitage test. Chi-squared and logistic regression analyses were applied to compare sociodemographic and clinicopathologic characteristics between these models of care. RESULTS The proportion of patients seeing both specialists was 35.5% and 46.5% for low- and intermediate-risk patients respectively. Trend analysis showed a decline in multispecialty care in low-risk patients (44.1% to 25.3% years 2010-2017; P < 0.001). Between 2010 and 2017, the use of AS increased 40.9% to 68.6% (P < 0.001) and 13.1% to 24.6% (P < 0.001) for patients seeing urology and those seeing both specialists respectively. Age, urban residence, higher education, SEER region, co-morbidities, frailty, Gleason score, predicted receipt of multispecialty care (all P < 0.02). CONCLUSIONS Uptake of AS among men with low-risk PC has occurred primarily under the purview of urologists. While selection is certainly at play, these data suggest that multispecialty care may not be required to promote the utilization of AS for men with low-risk PC.
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Affiliation(s)
- Ibardo A Zambrano
- Department of Urology, University of North Carolina, Chapel Hill, NC.
| | - Soohyun Hwang
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Ram Basak
- Department of Urology, University of North Carolina, Chapel Hill, NC
| | | | | | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh, Pittsburgh, PA
| | - Hung-Jui Tan
- Department of Urology, University of North Carolina, Chapel Hill, NC
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Spratte BN, Tan HJ, Zambrano IA, Basak RS, Filson CP, Jacobs BL, Hwang S. Use of expectant management based on prostate cancer risk and health status: How far are we from a risk-adapted approach? Urol Oncol 2023; 41:323.e17-323.e25. [PMID: 37149430 DOI: 10.1016/j.urolonc.2023.04.006] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 03/21/2023] [Accepted: 04/01/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVES While active surveillance, a form of expectant management (EM), is preferred for patients with low-risk prostate cancer (PCa), some favor a more risk-adapted approach that recognizes patient preferences and condition-specific factors. However, previous research has shown non-patient-related factors often drive PCa treatment. In this context, we characterized trends in AS with respect to disease risk and health status. METHODS AND MATERIALS Using SEER-Medicare data, we identified men 66 years and older diagnosed with localized low- and intermediate-risk PCa from 2008 to 2017 and examined receipt of EM, defined as the absence of treatment (i.e., surgery, cryotherapy, radiation, chemotherapy, and androgen deprivation therapies) within 1 year of diagnosis. We performed bivariable analysis to compare trends in use for EM vs. treatment, stratified by disease risk (i.e., Gleason 3+3, 3+4, 4+3; PSA<10, 10-20) and health status (i.e., NCI Comorbidity Index (NCI), frailty, life expectancy). We then ran a multivariable logistic regression model to examine determinants of EM. RESULTS Within this cohort, 26,364 (38%) were categorized as low-risk (i.e., Gleason 3+3 and PSA<10) and 43,520 (62%) as intermediate-risk (i.e., all others). Over the study period, use of EM significantly increased across all risk groups, except for Gleason 4+3 (P = 0.662), as well across all health status groups. However, linear trends did not differ significantly between frail vs. nonfrail patients for both those categorized as low-risk (P = 0.446) and intermediate-risk (P = 0.208). Trends also did not differ between NCI 0 vs. 1 vs. >1 for low-risk PCa (P = 0.395). In the multivariable models, EM was associated with increasing age and being frail for men with both low- and intermediate risk disease. Conversely, EM selection was negatively associated with higher comorbidity score. CONCLUSIONS EM increased significantly over time for patients with low- and favorable intermediate-risk disease, with the most notable differences based on age and Gleason score. In contrast, trends in uptake of EM did not differ substantively by health status, suggesting that physicians may not be effectively incorporating patient health into PCa treatment decisions. Additional work is needed to develop interventions that recognize health status as an essential component of a risk-adapted approach.
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Affiliation(s)
| | - Hung-Jui Tan
- Department of Urology, University of North Carolina, Chapel Hill, NC
| | - Ibardo A Zambrano
- Department of Urology, University of North Carolina, Chapel Hill, NC
| | - Ram Sankar Basak
- Department of Urology, University of North Carolina, Chapel Hill, NC
| | | | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Soohyun Hwang
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
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Modi PK, Ward KC, Filson CP. Characteristics of prostate cancer patients captured by facility-based versus geography-based cancer registries. Urol Oncol 2023; 41:324.e1-324.e7. [PMID: 37150737 DOI: 10.1016/j.urolonc.2023.04.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/15/2023] [Accepted: 04/09/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE We determined differences in demographics, tumor factors, and treatment patterns of prostate cancer patients in a geographic-based cancer registry based on eligibility for a facility-based cancer registry system. METHODS We identified prostate cancer patients captured by the Surveillance, Epidemiology, and End Results (SEER) database from 2018 to 2019. Our exposure was receipt of cancer care at a facility accredited by the American College of Surgeons' Commission on Cancer (CoC) providing eligibility for inclusion in the National Cancer Database (NCDB). Outcomes included patient demographics, tumor factors (e.g., biopsy grade), and treatment with radical prostatectomy. RESULTS We identified 113,733 prostate cancer patients of whom 65,708 (57%) were NCDB-eligible with an analytic abstract, and 11,010 (10%) were NCDB-eligible without an analytic abstract. NCDB-eligible men were younger (67.0 vs. 68.1 years, P < 0.001), less likely to be Hispanic/Latino (8.7% vs. 13.2%, P < 0.001), and more likely in a county with median income over $75,000 (40.9% vs. 30.0%, P < 0.001). NCDB eligibility varied widely by registry, from 95.9% in Connecticut to 42.6% in Utah. NCDB-ineligible patients were more likely to have unknown stage (17.2% vs. 2.9% NCDB-eligible) and missing PSA (22.9% vs 9.3% NCDB-eligible). NCDB-eligible men were less likely to have Grade Group 1 cancer on biopsy (28.2% vs. 39.2%, P < 0.001). Treatment with prostatectomy was more common among NCDB-eligible patients for low-risk (19.6% vs. 8.8%, adjusted OR 2.30, 95% CI 1.72-6.66) and high-risk tumors (43.5% vs. 26.0%, adjusted OR 1.95, 95% CI 1.33-2.86). CONCLUSION Compared NCDB-ineligible patients, those eligible for inclusion in the NCDB have important differences in demographics, eligibility for active surveillance, and treatment patterns. Generalizations related to epidemiologic trends, practice patterns, and outcomes for this select population should be interpreted with caution.
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Affiliation(s)
- Parth K Modi
- Department of Surgery, Section of Urology, University of Chicago, Chicago, IL
| | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Winship Cancer Institute, Emory Healthcare, Atlanta, GA
| | - Christopher P Filson
- Winship Cancer Institute, Emory Healthcare, Atlanta, GA; Department of Urology, Emory University School of Medicine, Atlanta, GA.
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10
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Croll B, Patil D, Mason M, Narayan VM, Master V, Filson CP, Joshi SS. Prolonged Opioid Use Following Bladder Tumor Resection for Opioid-Naïve Patients. Urology Practice 2023:101097UPJ0000000000000401. [PMID: 37103557 DOI: 10.1097/upj.0000000000000401] [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: 04/07/2023]
Abstract
PURPOSE Bladder cancer patients represent a high-risk group for opioid dependence due to the frequency of surgical procedures. Using MarketScan insurance commercial claims (CC) and Medicare-eligible (ME) databases, we sought to identify whether filling an opioid prescription following initial TURBT resulted in increased odds of prolonged opioid use. MATERIALS AND METHODS We analyzed 43,741 CC and 45,828 ME opioid-naïve patients with a new diagnosis of bladder cancer from 2009 to 2019. Multivariable analyses were completed to assess the odds of prolonged opioid use at 3-6 months based on initial exposure to opioids and initial opioid dose quartile. We performed subgroup analyses by sex and eventual treatment modality. RESULTS Those who filled an opioid prescription following initial TURBT had greater odds of persistent opioid use (CC: 27% vs 12%, OR 2.14, 95% CI (1.84-2.45), ME: 24% vs 12%, OR 1.95, 95% CI (1.70-2.22). Increasing dosage quartile of opioids was associated with increased odds of prolonged opioid use. Those going on to radical therapy had the highest rates of an initial opioid prescription (31% (CC) and 23% (ME)). Men and women had similar rates of initial prescriptions, but female sex was associated with higher odds of persistent opioid use at 3-6 months in the ME group: OR 1.08, 95% CI (1.01-1.16). CONCLUSIONS Opioids following initial TURBT increase the odds of continued use at 3-6 months, with the greatest odds in those prescribed the highest initial doses. These data suggest that short-term prescriptions have long-term effects, and additional research on opioid use and bladder cancer outcomes is merited.
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Affiliation(s)
- Benjamin Croll
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Misaki Mason
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Vikram M. Narayan
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Viraj Master
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Shreyas S. Joshi
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
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Schenk JM, Liu M, Neuhouser ML, Newcomb LF, Zheng Y, Zhu K, Brooks JD, Carroll PR, Dash A, Ellis WJ, Filson CP, Gleave ME, Liss M, Martin FM, Morgan TM, Wagner AA, Lin DW. Dietary Patterns and Risk of Gleason Grade Progression among Men on Active Surveillance for Prostate Cancer: Results from the Canary Prostate Active Surveillance Study. Nutr Cancer 2022; 75:618-626. [PMID: 36343223 PMCID: PMC9974882 DOI: 10.1080/01635581.2022.2143537] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/28/2022] [Indexed: 11/09/2022]
Abstract
Modifiable lifestyle factors, such as following a healthy dietary pattern may delay or prevent prostate cancer (PCa) progression. However, few studies have evaluated whether following specific dietary patterns after PCa diagnosis impacts risk of disease progression among men with localized PCa managed by active surveillance (AS). 564 men enrolled in the Canary Prostate Active Surveillance Study, a protocol-driven AS study utilizing a pre-specified prostate-specific antigen monitoring and surveillance biopsy regimen, completed a food frequency questionnaire (FFQ) at enrollment and had ≥ 1 surveillance biopsy during follow-up. FFQs were used to evaluate adherence to the Dietary Guidelines for Americans (Healthy Eating index (HEI))-2015, alternative Mediterranean Diet (aMED), and Dietary Approaches to Stop Hypertension (DASH) dietary patterns. Multivariable-adjusted hazards ratios (HRs) and 95% confidence intervals were estimated using Cox proportional hazards models. During a median follow-up of 7.8 years, 237 men experienced an increase in Gleason score on subsequent biopsy (grade reclassification). Higher HEI-2015, aMED or DASH diet scores after diagnosis were not associated with significant reductions in the risk of grade reclassification during AS. However, these dietary patterns have well-established protective effects on chronic diseases and mortality and remain a prudent choice for men with prostate cancer managed by AS.
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Affiliation(s)
- Jeannette M. Schenk
- Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Center, Seattle WA
| | - Menghan Liu
- Biostatistics Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle WA
| | - Marian L. Neuhouser
- Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Center, Seattle WA
| | - Lisa F Newcomb
- Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Center, Seattle WA
- Department of Urology, University of Washington, Seattle WA
| | - Yingye Zheng
- Biostatistics Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle WA
| | - Kehao Zhu
- Biostatistics Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle WA
| | | | - Peter R. Carroll
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco CA
| | | | | | - Christopher P. Filson
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
- Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia, USA
| | - Martin E. Gleave
- Department of Urologic Sciences, University of British Columbia, Vancouver BC
| | - Michael Liss
- University of Texas Health Sciences Center, San Antonio TX
| | - Frances M. Martin
- Department of Urology, Eastern Virginia Medical School, Virginia Beach VA
| | - Todd M. Morgan
- Department of Urology, University of Michigan, Ann Arbor MI
| | - Andrew A. Wagner
- Division of Urology, Beth Israel Deaconess Medical Center, Boston MA
| | - Daniel W. Lin
- Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Center, Seattle WA
- Department of Urology, University of Washington, Seattle WA
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12
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Filson CP, Zhu K, Huang Y, Zheng Y, Newcomb LF, Williams S, Brooks JD, Carroll PR, Dash A, Ellis WJ, Gleave ME, Liss MA, Martin F, McKenney JK, Morgan TM, Wagner AA, Sokoll LJ, Sanda MG, Chan DW, Lin DW. Impact of Prostate Health Index Results for Prediction of Biopsy Grade Reclassification During Active Surveillance. J Urol 2022; 208:1037-1045. [PMID: 35830553 PMCID: PMC10189606 DOI: 10.1097/ju.0000000000002852] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 06/23/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE We assessed whether Prostate Health Index results improve prediction of grade reclassification for men on active surveillance. METHODS AND MATERIALS We identified men in Canary Prostate Active Surveillance Study with Grade Group 1 cancer. Outcome was grade reclassification to Grade Group 2+ cancer. We considered decision rules to maximize specificity with sensitivity set at 95%. We derived rules based on clinical data (R1) vs clinical data+Prostate Health Index (R3). We considered an "or"-logic rule combining clinical score and Prostate Health Index (R4), and a "2-step" rule using clinical data followed by risk stratification based on Prostate Health Index (R2). Rules were applied to a validation set, where values of R2-R4 vs R1 for specificity and sensitivity were evaluated. RESULTS We included 1,532 biopsies (n = 610 discovery; n = 922 validation) among 1,142 men. Grade reclassification was seen in 27% of biopsies (23% discovery, 29% validation). Among the discovery set, at 95% sensitivity, R2 yielded highest specificity at 27% vs 17% for R1. In the validation set, R3 had best performance vs R1 with Δsensitivity = -4% and Δspecificity = +6%. There was slight improvement for R3 vs R1 for confirmatory biopsy (AUC 0.745 vs R1 0.724, ΔAUC 0.021, 95% CI 0.002-0.041) but not for subsequent biopsies (ΔAUC -0.012, 95% CI -0.031-0.006). R3 did not have better discrimination vs R1 among the biopsy cohort overall (ΔAUC 0.007, 95% CI -0.007-0.020). CONCLUSIONS Among active surveillance patients, using Prostate Health Index with clinical data modestly improved prediction of grade reclassification on confirmatory biopsy and did not improve prediction on subsequent biopsies.
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Affiliation(s)
- Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
- Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia
| | - Kehao Zhu
- Biostatistics Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Yijian Huang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Yingye Zheng
- Biostatistics Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Lisa F Newcomb
- Department of Urology, University of Washington, Seattle, Washington
- Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Sierra Williams
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - James D Brooks
- Department of Urology, Stanford University, Stanford, California
| | - Peter R Carroll
- Department of Urology, University of California, San Francisco, California
| | - Atreya Dash
- VA Puget Sound Health Care Systems, Seattle, Washington
| | - William J Ellis
- Department of Urology, University of Washington, Seattle, Washington
| | - Martin E Gleave
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael A Liss
- Department of Urology, University of Texas Health Sciences Center, San Antonio, Texas
| | - Frances Martin
- Department of Urology, Eastern Virginia Medical School, Virginia Beach, Virginia
| | - Jesse K McKenney
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Andrew A Wagner
- Division of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Lori J Sokoll
- Department of Pathology, Urology, and Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Martin G Sanda
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
- Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia
| | - Daniel W Chan
- Department of Pathology, Urology, and Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel W Lin
- Department of Urology, University of Washington, Seattle, Washington
- Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
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13
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Li J, Patil D, Davies BJ, Filson CP. Trends in Urethral Suspension With Robotic Prostatectomy Procedures Following Medicare Payment Policy Changes. JAMA Netw Open 2022; 5:e2233636. [PMID: 36194414 PMCID: PMC9533184 DOI: 10.1001/jamanetworkopen.2022.33636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
IMPORTANCE In 2016, the Centers for Medicare and Medicaid Services cut payments for robotic prostatectomy performed for Medicare beneficiaries. Although regulations mandate that billing for urethral suspension is only acceptable for preexisting urinary incontinence, reductions in reimbursement may incentivize billing for the use of this procedure in other scenarios. OBJECTIVE To assess trends and geographic variations in payments for urethral suspension with robotic prostatectomy in the context of Medicare payment policy. DESIGN, SETTING, AND PARTICIPANTS This US population-based retrospective cohort study analyzed data from the IBM MarketScan Commercial Claims and Encounters and Medicare Supplemental Database for men with employer-based insurance (primary commercial or Medicare supplemental coverage) who underwent robotic prostatectomy (Current Procedural Terminology [CPT] code 55866) between 2009 and 2019. EXPOSURES Time period and metropolitan statistical area of patient residence. MAIN OUTCOMES AND MEASURES Payment for urethral suspension (CPT code 51990) with robotic prostatectomy. RESULTS We identified 87 774 men with prostate cancer treated with robotic prostatectomy; 3352 (3.8%) had undergone urethral suspension. The mean (SD) patient age was 59.7 (6.5) years; 16 870 patients (19.2%) had Medicare supplemental coverage. From 2015 to 2016, median payments for robotic prostatectomy changed by -$358 (-17.0%) for Medicare beneficiaries vs -$9 (0%) for commercially insured patients. With urethral suspension vs without, median (IQR) episode payments for robotic prostatectomy were higher for commercially insured men ($3678 [$3090-$4503] vs $3322 [$2601-$4306]) and Medicare beneficiaries ($2927 [$2450-$3909] vs $2379 [$2014-$3512]). Compared with men treated between 2013 and 2015, those treated between 2016 and 2017 were twice as likely to undergo urethral suspension (8.5% vs 4.1%; odds ratio, 2.17 [95% CI, 1.96-2.38]). The proportion of patients who underwent urethral suspension was stable for 2018 to 2019 and 2016 to 2017 (8.5% vs 9.0%; odds ratio, 1.06 [95% CI, 0.96-1.18]). From 2015 to 2019, the proportion of patients who underwent urethral suspension was highest in Charleston, South Carolina (92.0%), Knoxville, Tennessee (66.0%), and Columbia, South Carolina (58.0%). These regions neighbored high-volume areas without patients who underwent prostatectomy with urethral suspension (eg, 146 patients in Greenville, South Carolina, and 173 in Nashville, Tennessee). CONCLUSIONS AND RELEVANCE In this study, urethral suspension was associated with increased costs for patients with both commercial insurance and Medicare. Patients treated between 2016 and 2017 were more likely than those treated between 2013 and 2015 to undergo this procedure. Geographic variation in use exceeded what was expected for the preexisting condition for which billing is permitted for Medicare beneficiaries. Policy statements from professional societies highlighting appropriate billing for urethral suspension may have tempered, but not reversed, the broad adoption of this procedure.
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Affiliation(s)
- Jonathan Li
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Benjamin J. Davies
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Christopher P. Filson
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
- Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia
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14
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Fang AM, Shumaker LA, Martin KD, Jackson JC, Fan RE, Khajir G, Patel HD, Soodana-Prakash N, Vourganti S, Filson CP, Sonn GA, Sprenkle PC, Gupta GN, Punnen S, Rais-Bahrami S. Multi-institutional analysis of clinical and imaging risk factors for detecting clinically significant prostate cancer in men with PI-RADS 3 lesions. Cancer 2022; 128:3287-3296. [PMID: 35819253 DOI: 10.1002/cncr.34355] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Most Prostate Imaging-Reporting and Data System (PI-RADS) 3 lesions do not contain clinically significant prostate cancer (CSPCa; grade group ≥2). This study was aimed at identifying clinical and magnetic resonance imaging (MRI)-derived risk fac- tors that predict CSPCa in men with PI-RADS 3 lesions. METHODS This study analyzed the detection of CSPCa in men who underwent MRI-targeted biopsy for PI-RADS 3 lesions. Multivariable logistic regression models with goodness-of-fit testing were used to identify variables associated with CSPCa. Receiver operating curves and decision curve analyses were used to estimate the clinical utility of a predictive model. RESULTS Of the 1784 men reviewed, 1537 were included in the training cohort, and 247 were included in the validation cohort. The 309 men with CSPCa (17.3%) were older, had a higher prostate-specific antigen (PSA) density, and had a greater likelihood of an anteriorly located lesion than men without CSPCa (p < .01). Multivariable analysis revealed that PSA density (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.05-1.85; p < .01), age (OR, 1.05; 95% CI, 1.02-1.07; p < .01), and a biopsy-naive status (OR, 1.83; 95% CI, 1.38-2.44) were independently associated with CSPCa. A prior negative biopsy was negatively associated (OR, 0.35; 95% CI, 0.24-0.50; p < .01). The application of the model to the validation cohort resulted in an area under the curve of 0.78. A predicted risk threshold of 12% could have prevented 25% of biopsies while detecting almost 95% of CSPCas with a sensitivity of 94% and a specificity of 34%. CONCLUSIONS For PI-RADS 3 lesions, an elevated PSA density, older age, and a biopsy-naive status were associated with CSPCa, whereas a prior negative biopsy was negatively associated. A predictive model could prevent PI-RADS 3 biopsies while missing few CSPCas. LAY SUMMARY Among men with an equivocal lesion (Prostate Imaging-Reporting and Data System 3) on multiparametric magnetic resonance imaging (mpMRI), those who are older, those who have a higher prostate-specific antigen density, and those who have never had a biopsy before are at higher risk for having clinically significant prostate cancer (CSPCa) on subsequent biopsy. However, men with at least one negative biopsy have a lower risk of CSPCa. A new predictive model can greatly reduce the need to biopsy equivocal lesions noted on mpMRI while missing only a few cases of CSPCa.
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Affiliation(s)
- Andrew M Fang
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Luke A Shumaker
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kimberly D Martin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Richard E Fan
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Ghazal Khajir
- Department of Urology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Hiten D Patel
- Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA
| | | | | | - Christopher P Filson
- Department of Urology, Emory University, Atlanta, Georgia, USA
- Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia, USA
| | - Geoffrey A Sonn
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Preston C Sprenkle
- Department of Urology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Gopal N Gupta
- Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA
- Department of Radiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Sanoj Punnen
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
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15
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Pozzar RA, Xiong N, Hong F, Filson CP, Chang P, Halpenny B, Berry DL. Concordance between influential adverse treatment outcomes and localized prostate cancer treatment decisions. BMC Med Inform Decis Mak 2022; 22:223. [PMID: 36002847 PMCID: PMC9404592 DOI: 10.1186/s12911-022-01972-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background Although treatment decisions for localized prostate cancer (LPC) are preference-sensitive, the extent to which individuals with LPC receive preference-concordant treatment is unclear. In a sample of individuals with LPC, the purpose of this study was to (a) assess concordance between the influence of potential adverse treatment outcomes and treatment choice; (b) determine whether receipt of a decision aid predicts higher odds of concordance; and (c) identify predictors of concordance from a set of participant characteristics and influential personal factors. Methods Participants reported the influence of potential adverse treatment outcomes and personal factors on treatment decisions at baseline. Preference-concordant treatment was defined as (a) any treatment if risk of adverse outcomes did not have a lot of influence, (b) active surveillance if risk of adverse outcomes had a lot of influence, or (c) radical prostatectomy or active surveillance if risk of adverse bowel outcomes had a lot of influence and risk of other adverse outcomes did not have a lot of influence. Data were analyzed using descriptive statistics and logistic regression. Results Of 224 participants, 137 (61%) pursued treatment concordant with preferences related to adverse treatment outcomes. Receipt of a decision aid did not predict higher odds of concordance. Low tumor risk and age ≥ 60 years predicted higher odds of concordance, while attributing a lot of influence to the impact of treatment on recreation predicted lower odds of concordance. Conclusions Risk of potential adverse treatment outcomes may not be the foremost consideration of some patients with LPC. Assessment of the relative importance of patients’ stated values and preferences is warranted in the setting of LPC treatment decision making. Clinical trial registration: NCT01844999 (www.clinicaltrials.gov). Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01972-w.
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Affiliation(s)
- Rachel A Pozzar
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA.
| | - Niya Xiong
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | - Fangxin Hong
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | | | - Peter Chang
- Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Barbara Halpenny
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | - Donna L Berry
- University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
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16
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Brady L, Newcomb LF, Zhu K, Zheng Y, Boyer H, Sarkar ND, McKenney JK, Brooks JD, Carroll PR, Dash A, Ellis WJ, Filson CP, Gleave ME, Liss MA, Martin F, Morgan TM, Thompson IM, Wagner AA, Pritchard CC, Lin DW, Nelson PS. Germline mutations in penetrant cancer predisposition genes are rare in men with prostate cancer selecting active surveillance. Cancer Med 2022; 11:4332-4340. [PMID: 35467778 DOI: 10.1002/cam4.4778] [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: 11/29/2021] [Revised: 02/08/2022] [Accepted: 02/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pathogenic germline mutations in several rare penetrant cancer predisposition genes are associated with an increased risk of aggressive prostate cancer (PC). Our objectives were to determine the prevalence of pathogenic germline mutations in men with low-risk PC on active surveillance, and assess whether pathogenic germline mutations associate with grade reclassification or adverse pathology, recurrence, or metastases, in men treated after initial surveillance. METHODS Men prospectively enrolled in the Canary Prostate Active Surveillance Study (PASS) were retrospectively sampled for the study. Germline DNA was sequenced utilizing a hereditary cancer gene panel. Mutations were classified according to the American College of Clinical Genetics and Genomics' guidelines. The association of pathogenic germline mutations with grade reclassification and adverse characteristics was evaluated by weighted Cox proportional hazards modeling and conditional logistic regression, respectively. RESULTS Overall, 29 of 437 (6.6%) study participants harbored a pathogenic germline mutation of which 19 occurred in a gene involved in DNA repair (4.3%). Eight participants (1.8%) had pathogenic germline mutations in three genes associated with aggressive PC: ATM, BRCA1, and BRCA2. The presence of pathogenic germline mutations in DNA repair genes did not associate with adverse characteristics (univariate analysis HR = 0.87, 95% CI: 0.36-2.06, p = 0.7). The carrier rates of pathogenic germline mutations in ATM, BRCA1, and BRCA2did not differ in men with or without grade reclassification (1.9% vs. 1.8%). CONCLUSION The frequency of pathogenic germline mutations in penetrant cancer predisposition genes is extremely low in men with PC undergoing active surveillance and pathogenic germline mutations had no apparent association with grade reclassification or adverse characteristics.
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Affiliation(s)
- Lauren Brady
- Division of Human Biology, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Lisa F Newcomb
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA.,Department of Urology, University of Washington, Seattle, Washington, USA
| | - Kehao Zhu
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Yingye Zheng
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Hilary Boyer
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA.,Department of Urology, University of Washington, Seattle, Washington, USA
| | - Navonil De Sarkar
- Division of Human Biology, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Jesse K McKenney
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - James D Brooks
- Department of Urology, Stanford University, Stanford, California, USA
| | - Peter R Carroll
- Department of Urology, University of California, San Francisco, California, USA
| | - Atreya Dash
- VA Puget Sound Health Care Systems, Seattle, WA, USA
| | - William J Ellis
- Department of Urology, University of Washington, Seattle, Washington, USA
| | - Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia, USA
| | - Martin E Gleave
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael A Liss
- Department of Urology, University of Texas Health Sciences Center, San Antonio, Texas, USA
| | - Frances Martin
- Department of Urology, Eastern Virginia Medical School, Virginia Beach, Virginia, USA
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ian M Thompson
- CHRISTUS Medical Center Hospital, San Antonio, Texas, USA
| | - Andrew A Wagner
- Division of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Colin C Pritchard
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Daniel W Lin
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA.,Department of Urology, University of Washington, Seattle, Washington, USA
| | - Peter S Nelson
- Division of Human Biology, Fred Hutchinson Cancer Center, Seattle, Washington, USA.,Department of Urology, University of Washington, Seattle, Washington, USA
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17
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Fischer-Valuck BW, Baumann BC, Brown SA, Filson CP, Weiss A, Mueller R, Liu Y, Brenneman RJ, Sanda M, Michalski JM, Gay HA, James Rao Y, Pattaras JG, Jani AB, Hershatter B, Patel SA. Treatment Patterns and Overall Survival Outcomes Among Patients Aged 80 yr or Older with High-risk Prostate Cancer. EUR UROL SUPPL 2022; 37:80-89. [PMID: 35243392 PMCID: PMC8883189 DOI: 10.1016/j.euros.2021.12.011] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Elderly patients diagnosed with high-risk prostate cancer (PCa) present a therapeutic dilemma of balancing treatment of a potentially lethal malignancy with overtreatment of a cancer that may not threaten life expectancy. OBJECTIVE To investigate treatment patterns and overall survival outcomes in this group of patients. DESIGN SETTING AND PARTICIPANTS A retrospective cohort study was conducted. We queried the National Cancer Database for high-risk PCa in patients aged 80 yr or older diagnosed during 2004-2016. INTERVENTION Eligible patients underwent no treatment following biopsy (ie, observation), androgen deprivation therapy (ADT) alone, radiation therapy (RT) alone, RT + ADT, or surgery. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Kaplan-Meier, log rank, and multivariate Cox proportional hazard regression was performed to compare overall survival (OS). RESULTS AND LIMITATIONS A total of 19 920 men were eligible for analysis, and the most common treatment approach was RT + ADT (7401 patients; 37.2%). Observation and ADT alone declined over time (59.3% in 2004 vs 47.5% in 2016). There was no observed difference in OS between observation and ADT alone (adjusted hazard ratio [HR] 1.04, 95% confidence interval [CI], 0.99-1.09; p = 0.105). Definitive local treatment was associated with improved OS compared with ADT alone (RT alone, HR 0.54, 95% CI, 0.50-0.59, p < 0.0001; ADT + RT, HR 0.48, 95% CI, 0.46-0.50, p < 0.0001; surgery, HR 0.50, 95% CI, 0.42-0.59, p < 0.0001). CONCLUSIONS This analysis demonstrates that the use of definitive local therapy, including surgery or RT ± ADT, is increasing and is associated with a 50% reduction in overall mortality compared with observation or ADT alone. While prospective validation is warranted, elderly men with high-risk disease eligible for definitive management should be counseled on the risks, including a possible compromise in OS, with deferring definitive management. PATIENT SUMMARY Elderly men are more often diagnosed with higher-risk prostate cancer but are less likely to receive curative treatment options than younger men. Our analysis demonstrates that for men ≥80 yr of age with high-risk prostate cancer, definitive local therapy, including surgery or radiation therapy and/or androgen deprivation therapy, is associated with a 50% reduction in overall mortality compared with observation or androgen deprivation therapy alone. We therefore recommend that life expectancy (ie, physiologic age) be taken into account, over chronologic age, and that elderly men with good life expectancy (eg, >5 yr; minimal comorbidity) should be offered definitive, life-prolonging therapy.
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Affiliation(s)
- Benjamin W Fischer-Valuck
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Radiation Oncology, Springfield Clinic, Springfield, IL, USA
| | - Brian C Baumann
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA
| | - Simon A Brown
- Department of Radiation Oncology, Springfield Clinic, Springfield, IL, USA
| | - Christopher P Filson
- Department of Urology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Aaron Weiss
- Department of Urology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Ryan Mueller
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA
| | - Yuan Liu
- Department of Biostatistics & Bioinformatics, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Randall J Brenneman
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA
| | - Martin Sanda
- Department of Urology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Jeff M Michalski
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA
| | - Hiram A Gay
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA
| | - Yuan James Rao
- Department of Radiation Oncology, George Washington University, Washington, DC, USA
| | - John G Pattaras
- Department of Urology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Ashesh B Jani
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Bruce Hershatter
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Sagar A Patel
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
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18
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Li J, Patil D, Sanda MG, Filson CP. Cancer-specific outcomes for prostate cancer patients who had prebiopsy prostate MRI. Urol Oncol 2022; 40:58.e9-58.e15. [PMID: 34353711 PMCID: PMC8807787 DOI: 10.1016/j.urolonc.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/24/2021] [Accepted: 07/04/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE We characterized population-level cancer-specific outcomes for prostate cancer patients based on use of prebiopsy prostate MRI. METHODS Using SEER-Medicare claims, we identified men diagnosed with localized prostate cancer from 2010-2015 and prostate-specific antigen (PSA) < 20 ng/mL. Primary exposure was prebiopsy prostate MRI prior to diagnosis (i.e., CPT 72197 linked to urology-specific diagnosis). Outcomes included diagnosis of Grade Group 2+ disease on biopsy and proportion treated with prostatectomy. We assessed those treated with prostatectomy and evaluated association with prebiopsy MRI and grade concordance between biopsy and prostatectomy. We estimated adjusted odds ratios with multivariable regression after accounting for other factors (e.g., age, year, PSA, race/ethnicity). RESULTS We identified 48,574 patients, where 915 (1.9%) underwent prebiopsy MRI. Patients with prebiopsy MRI had more GG>2 cancer on biopsy (70.0% MRI vs. 62.8% no MRI) but lost significance after adjustment (OR 1.12, 95% CI 0.96-1.30). Patients with prebiopsy MRI were more likely to have prostatectomy (39.2% vs. 28.5%, adjusted OR 1.51, 95%CI 1.31-1.76). Downgrading from biopsy GG 3-5 to final GG 1-2 was less common after prebiopsy MRI (21.3% vs. 28.2% no MRI, P = 0.05) but not significant after adjustment (OR 0.74, 95% CI 0.51 - 1.08). Among 14,027 men with prostatectomy, accurate risk classification was not more likely with a prebiopsy MRI (48.0% no MRI vs. 49.6% prebiopsy MRI, P = 0.56). CONCLUSION During initial adoption, men with prebiopsy prostate MRI had marginally increased detection of significant cancer on biopsy and were more likely to be treated with prostatectomy. For those treated with prostatectomy, use of prebiopsy MRI was not associated with a greater likelihood of accurate risk classification or grade concordance between biopsy and final pathology results.
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Affiliation(s)
- Jonathan Li
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Martin G Sanda
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory Healthcare, Atlanta, GA
| | - Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory Healthcare, Atlanta, GA; Assistant Professor, Department of Urology, Emory University School of Medicine Member, Winship Cancer Institute, Atlanta, GA.
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19
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Kirk PS, Zhu K, Zheng Y, Newcomb LF, Schenk JM, Brooks JD, Carroll PR, Dash A, Ellis WJ, Filson CP, Gleave ME, Liss M, Martin F, McKenney JK, Morgan TM, Nelson PS, Thompson IM, Wagner AA, Lin DW, Gore JL. Treatment in the absence of disease reclassification among men on active surveillance for prostate cancer. Cancer 2022; 128:269-274. [PMID: 34516660 PMCID: PMC8738121 DOI: 10.1002/cncr.33911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/14/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Maintaining men on active surveillance for prostate cancer can be challenging. Although most men who eventually undergo treatment have experienced clinical progression, a smaller subset elects treatment in the absence of disease reclassification. This study sought to understand factors associated with treatment in a large, contemporary, prospective cohort. METHODS This study identified 1789 men in the Canary Prostate Cancer Active Surveillance Study cohort enrolled as of 2020 with a median follow-up of 5.6 years. Clinical and demographic data as well as information on patient-reported quality of life and urinary symptoms were used in multivariable Cox proportional hazards regression models to identify factors associated with the time to treatment RESULTS: Within 4 years of their diagnosis, 33% of men (95% confidence interval [CI], 30%-35%) underwent treatment, and 10% (95% CI, 9%-12%) were treated in the absence of reclassification. The most significant factor associated with any treatment was an increasing Gleason grade group (adjusted hazard ratio [aHR], 14.5; 95% CI, 11.7-17.9). Urinary quality-of-life scores were associated with treatment without reclassification (aHR comparing "mostly dissatisfied/terrible" with "pleased/mixed," 2.65; 95% CI, 1.54-4.59). In a subset analysis (n = 692), married men, compared with single men, were more likely to undergo treatment in the absence of reclassification (aHR, 2.63; 95% CI, 1.04-6.66). CONCLUSIONS A substantial number of men with prostate cancer undergo treatment in the absence of clinical changes in their cancers, and quality-of-life changes and marital status may be important factors in these decisions. LAY SUMMARY This analysis of men on active surveillance for prostate cancer shows that approximately 1 in 10 men will decide to be treated within 4 years of their diagnosis even if their cancer is stable. These choices may be related in part to quality-or-life or spousal concerns.
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Affiliation(s)
- Peter S. Kirk
- Department of Urology, University of Washington, Seattle, WA
| | - Kehao Zhu
- Biostatistics Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Yingye Zheng
- Biostatistics Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Lisa F. Newcomb
- Department of Urology, University of Washington, Seattle, WA
- Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jeannette M. Schenk
- Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Peter R. Carroll
- Department of Urology, University of California, San Francisco, CA
| | - Atreya Dash
- VA Puget Sound Health Care Systems, Seattle, WA
| | | | | | - Martin E. Gleave
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | - Michael Liss
- Department of Urology, University of Texas Health Sciences Center, San Antonio, TX
| | - Frances Martin
- Department of Urology, Eastern Virginia Medical School, Virginia Beach, VA
| | - Jesse K. McKenney
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Todd M. Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Peter S. Nelson
- Division of Human Biology and Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Andrew A. Wagner
- Division of Urology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Daniel W. Lin
- Department of Urology, University of Washington, Seattle, WA
- Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - John L. Gore
- Department of Urology, University of Washington, Seattle, WA
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20
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Cooke IJ, Patil D, Bobrek K, Narayan V, Master V, Rapaport M, Filson CP, Joshi SS. Longitudinal impact of bladder cancer diagnosis on common psychiatric disorders. Cancer Med 2021; 10:8412-8420. [PMID: 34773389 PMCID: PMC8633250 DOI: 10.1002/cam4.4346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/13/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 11/30/2022] Open
Abstract
Background The presence of psychiatric disorders in patients with cancer is associated with increased morbidity and poorer outcomes. We sought to determine the impact of a new bladder cancer diagnosis on the incidence of depression and anxiety. Methods We used a database of billing claims (MarketScan®) to identify patients newly diagnosed with bladder cancer between 2009 and 2018. Patients with preexisting psychiatric disorders or use of anxiolytics/antidepressants were excluded. We matched cases to patients without a bladder cancer or psychiatric diagnosis. Our primary outcome was a new diagnosis of depression, anxiety, or use of anxiolytics/antidepressants. Other exposures of interest included gender and treatment received. We used multivariable regression to estimate odds ratios for these exposures. Results We identified 65,846 cases with a new diagnosis of bladder cancer (31,367 privately insured; 34,479 Medicare‐eligible). Compared to controls, bladder cancer patients were more likely to develop new‐onset depression/anxiety at 6 months (privately insured: 6.9% vs. 3.4%, p < 0.001; Medicare‐eligible: 5.7% vs. 3.4%, p < 0.001) and 36 months (privately insured: 19.2% vs. 13.5%, p < 0.001; Medicare‐eligible: 19.3% vs. 16.0%, p < 0.001). Women (vs. men, privately insured: OR 1.65, 95%CI 1.53–1.78; Medicare‐eligible: OR 1.63, 95%CI 1.50–1.76) and those receiving cystectomy and chemotherapy (vs. no treatment, privately insured: OR 4.94, 95%CI 4.13–5.90; Medicare‐eligible: OR 2.35, 95%CI 1.88–2.94) were more likely to develop significant depression/anxiety. Conclusion A new diagnosis of bladder cancer was associated with increased burden of significant depression/anxiety compared with matched controls. Women and patients receiving more radical treatments had higher rates of depression and anxiety.
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Affiliation(s)
- Ian J Cooke
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Katherine Bobrek
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vikram Narayan
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute, Atlanta, Georgia, USA
| | - Viraj Master
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute, Atlanta, Georgia, USA
| | - Mark Rapaport
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute, Atlanta, Georgia, USA
| | - Shreyas S Joshi
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute, Atlanta, Georgia, USA
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21
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Quinn TP, Sanda MG, Howard DH, Patil D, Filson CP. Disparities in magnetic resonance imaging of the prostate for traditionally underserved patients with prostate cancer. Cancer 2021; 127:2974-2979. [PMID: 34139027 PMCID: PMC8319036 DOI: 10.1002/cncr.33518] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/29/2021] [Accepted: 02/09/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Prebiopsy magnetic resonance imaging (MRI) of the prostate improves detection of significant tumors, while decreasing detection of less-aggressive tumors. Therefore, its use has been increasing over time. In this study, the use of prebiopsy MRI among Medicare beneficiaries with prostate cancer was examined. It was hypothesized that patients of color and those in isolated areas would be less likely to undergo this approach for cancer detection. METHODS Using cancer registry data from the Surveillance, Epidemiology, and End Results (SEER) program linked to billing claims for fee-for-service Medicare beneficiaries, men with nonmetastatic prostate cancer were identified from 2010 through 2015 with prostate-specific antigen (PSA) <30 ng/mL. Outcome was prebiopsy MRI of the prostate performed within 6 months before diagnosis (ie, Current Procedural Terminology 72197). Exposures were patient race/ethnicity and rural/urban status. Multivariable regression estimated the odds of prebiopsy prostate MRI. Post hoc analyses examined associations with the registry-level proportion of non-Hispanic Black patients and MRI use, as well as disparities in MRI use in registries with data on more frequent use of prostate MRI. RESULTS There were 50,719 men identified with prostate cancer (mean age, 72.1 years). Overall, 964 men (1.9% of cohort) had a prebiopsy MRI. Eighty percent of patients with prebiopsy MRI lived in California, New Jersey, or Connecticut. Non-Hispanic Black men (0.6% vs 2.1% non-Hispanic White; odds ratio [OR], 0.28; 95% CI, 0.19-0.40) and men in less urban areas (1.1% vs 2.2% large metro; OR, 0.65; 95% CI, 0.44-0.97) were less likely to have prebiopsy MRI of the prostate. CONCLUSIONS Non-Hispanic Black patients with prostate cancer and those in less urban areas were less likely to have prebiopsy MRI of the prostate during its initial adoption as a tool for improving prostate cancer detection.
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Affiliation(s)
- Timothy P Quinn
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Martin G Sanda
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
- Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia
| | - David H Howard
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
- Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia
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22
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Howard DH, Quek RGW, Fox KM, Arondekar B, Filson CP. The value of new drugs for advanced prostate cancer. Cancer 2021; 127:3457-3465. [PMID: 34062620 DOI: 10.1002/cncr.33662] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/12/2021] [Accepted: 04/29/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND The US Food and Drug Administration has recently approved a number of new cancer drugs. The clinical trials that serve as the basis for new cancer drug approvals may not reflect how the drugs will perform in routine practice and do not measure the impact of the drugs on spending. The authors sought to evaluate the real-world effectiveness and value of drugs recently approved for advanced prostate cancer. METHODS Using Surveillance, Epidemiology, and End Results-Medicare data, the authors identified fee-for-service Medicare beneficiaries aged 65 years or older who began treatment with a drug approved for metastatic castration-resistant prostate cancer in 2007-2009, when only 1 drug was approved for metastatic castration-resistant prostate cancer, and in 2014-2016, when 5 additional drugs were approved. They calculated life expectancy and lifetime medical costs (ie, Medicare reimbursements) for each group. RESULTS Between 2007-2009 and 2014-2016, life expectancy increased by 12.6 months. Lifetime medical costs increased by $87,000. The incremental cost per life-year gained was $83,000. CONCLUSION The release of 5 new drugs coincided with increases in survival rates and spending. This study's estimates indicate that the new drugs collectively were cost-effective.
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Affiliation(s)
- David H Howard
- Department of Health Policy and Management, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia
| | | | - Kathleen M Fox
- Strategic Healthcare Solutions, LLC, Aiken, South Carolina
| | | | - Christopher P Filson
- Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia.,Department of Urology, Emory University, Atlanta, Georgia
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23
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Filson CP, Hong F, Xiong N, Pozzar R, Halpenny B, Berry DL. Reply to What is a good medical choice? Cancer 2021; 127:1935-1936. [PMID: 33544391 DOI: 10.1002/cncr.33442] [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] [Received: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia.,Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia.,Department of Urology, Atlanta VA Medical Center, Decatur, Georgia
| | - Fangxin Hong
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Niya Xiong
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rachel Pozzar
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Barbara Halpenny
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Donna L Berry
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington.,Department of Urology, University of Washington, Seattle, Washington
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24
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Xu KM, Liu Y, Gillespie TW, Osunkoya AO, Carthon B, Bilen MA, Filson CP, Ogan K, Patel PR, Shelton JW, Kucuk O, Joshi S, Jani AB. Small-Cell Carcinoma of the Prostate: Report of Outcomes of Localized Disease Using the National Cancer Database. Clin Genitourin Cancer 2021; 19:e193-e199. [PMID: 33582100 DOI: 10.1016/j.clgc.2021.01.002] [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: 09/07/2020] [Revised: 01/08/2021] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Small-cell carcinoma of the prostate (SCCP) is a rare but aggressive prostate cancer histology. We studied the reported comparative outcomes of the efficacy of radiotherapy (RT) versus surgery for nonmetastatic SCCP. METHODS The National Cancer Database (NCDB) was queried for nonmetastatic disease diagnosed from 2004 to 2015 as SCCP (defined as having a component of SCCP) receiving a single definitive local control modality (RT or surgery). RESULTS A total of 243 patients were included (177 RT and 66 surgery). A total of 142 patients received chemotherapy (CHT). Mean age was 68 years. One hundred forty patients had adenocarcinoma concurrently with the SCCP while 103 patients had pure histology. For pure histology, multivariable analysis (MVA) showed nonacademic facility, stage 4 disease, and poorly differentiated grade were associated with worse survival. On MVA, receipt of CHT (hazard ratio [HR] = 0.84, P = .644) or receipt of androgen deprivation therapy (HR = 0.88, P = .715) did not affect overall survival. Receipt of RT was nonsignificant compared to surgery (HR = 0.75, P = .475). For mixed histology, MVA showed receipt of CHT and prostate-specific antigen > 20 ng/mL were associated with worse survival. Receipt of androgen deprivation therapy (HR = 1.35, P = .414) did not affect overall survival. Receipt of RT was also nonsignificant compared to surgery (HR = 1.42, P = .344). CONCLUSION RT and surgery for nonmetastatic SCCP yield comparable options as local therapies.
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Affiliation(s)
- Karen M Xu
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA.
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute of Emory University, Atlanta, GA
| | | | - Adeboye O Osunkoya
- Departments of Pathology and Laboratory Medicine, and Urology, Emory University School of Medicine, Atlanta, GA
| | - Bradley Carthon
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Mehmet A Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | | | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Pretesh R Patel
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Joseph W Shelton
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Omer Kucuk
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Shreyas Joshi
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Ashesh B Jani
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
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25
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Berry DL, Hong F, Blonquist TM, Halpenny B, Xiong N, Filson CP, Master VA, Sanda MG, Chang P, Chien GW, Jones RA, Krupski TL, Wolpin S, Wilson L, Hayes JH, Trinh QD, Sokoloff M. Decision regret, adverse outcomes, and treatment choice in men with localized prostate cancer: Results from a multi-site randomized trial. Urol Oncol 2020; 39:493.e9-493.e15. [PMID: 33353864 DOI: 10.1016/j.urolonc.2020.11.038] [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: 09/07/2020] [Revised: 11/15/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Men diagnosed with localized prostate cancer must navigate a highly preference-sensitive decision between treatment options with varying adverse outcome profiles. We evaluated whether use of a decision support tool previously shown to decrease decisional conflict also impacted the secondary outcome of post-treatment decision regret. METHODS Participants were randomized to receive personalized decision support via the Personal Patient Profile-Prostate or usual care prior to a final treatment decision. Symptoms were measured just before randomization and 6 months later; decision regret was measured at 6 months along with records review to ascertain treatment choices. Regression modeling explored associations between baseline variables including race and D`Amico risk, study group, and 6-month variables regret, choice, and symptoms. RESULTS At 6 months, 287 of 392 (73%) men returned questionnaires of which 257 (89%) had made a treatment choice. Of that group, 201 of 257 (78%) completely answered the regret scale. Regret was not significantly different between participants randomized to the P3P intervention compared to the control group (P = 0.360). In univariate analyses, we found that Black men, men with hormonal symptoms, and men with bowel symptoms reported significantly higher decision regret (all P < 0.01). Significant interactions were detected between race and study group (intervention vs. usual care) in the multivariable model; use of the Personal Patient Profile-Prostate was associated with significantly decreased decisional regret among Black men (P = 0.037). Interactions between regret, symptoms and treatment revealed that (1) men choosing definitive treatment and reporting no hormonal symptoms reported lower regret compared to all others; and (2) men choosing active surveillance and reporting bowel symptoms had higher regret compared to all others. CONCLUSION The Personal Patient Profile-Prostate decision support tool may be most beneficial in minimizing decisional regret for Black men considering treatment options for newly-diagnosed prostate cancer. TRIAL REGISTRATION NCT01844999.
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Affiliation(s)
- Donna L Berry
- Dana-Farber Cancer Institute, Boston, MA; University of Washington School of Nursing, Seattle, WA.
| | | | | | | | - Niya Xiong
- Dana-Farber Cancer Institute, Boston, MA
| | - Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory Healthcare, Atlanta, GA; Atlanta VA Medical Center, Decatur, GA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory Healthcare, Atlanta, GA
| | - Martin G Sanda
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Peter Chang
- Beth Israel Deaconess Medical Center, Boston, MA
| | - Gary W Chien
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Randy A Jones
- University of Virginia School of Nursing, Charlottesville, VA
| | | | - Seth Wolpin
- University of Washington School of Nursing, Seattle, WA
| | - Leslie Wilson
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA
| | - Julia H Hayes
- Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, MA
| | - Quoc-Dien Trinh
- Department of Urology, Brigham and Women's Hospital, Boston, MA
| | - Mitchell Sokoloff
- Department of Urology, University of Massachusetts Medical Center, Worchester, MA
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26
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Filson CP, Hong F, Xiong N, Pozzar R, Halpenny B, Berry DL. Decision support for men with prostate cancer: Concordance between treatment choice and tumor risk. Cancer 2020; 127:203-208. [PMID: 33119142 DOI: 10.1002/cncr.33241] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Decision support tools improve decisional conflict and elicit patient preferences related to prostate cancer treatment. It was hypothesized that men using the Personal Patient Profile-Prostate (P3P) would be more likely to pursue guideline-concordant treatment. METHODS Men from a trial assessing the P3P decision support intervention were identified. The primary exposure was allocation to P3P (vs usual care), and the outcome was appropriate treatment per guidelines (eg, low risk = active surveillance). It was assessed whether providers recommended against any treatment options (ie, restricted). A multivariable model was fit for men with low-risk cancer that estimated the odds of the outcome of interest. RESULTS This study identified 295 men in the cohort: 113 (38%) had low-risk disease, 119 (40%) had favorable intermediate-risk disease, and 63 (21%) had unfavorable intermediate-risk disease. Among low-risk patients, more men pursued active surveillance after using P3P whether they were given unrestricted (62% vs 54% with usual care; P = .54) or restricted options (71% vs 59% with usual care; P = .34). After adjustments, only Black race (odds ratio [OR], 0.31; 95% CI, 0.11-0.89) and restricted options (OR, 0.23; 95% CI, 0.08-0.65) had an inverse association with the receipt of surveillance for patients with low-risk prostate cancer. An impact associated with P3P versus usual care (OR, 0.89; 95% CI, 0.36-2.20) was not observed. CONCLUSIONS Among men in a trial assessing a decision support tool, Black race and restricted treatment options were associated with less use of active surveillance for low-risk prostate cancer. Although the P3P instrument ameliorates decisional conflict, its use was not associated with more appropriate alignment of treatment with disease risk.
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Affiliation(s)
- Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia.,Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia.,Department of Urology, Atlanta VA Medical Center, Decatur, Georgia
| | - Fangxin Hong
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Niya Xiong
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rachel Pozzar
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Barbara Halpenny
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Donna L Berry
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington.,Department of Urology, University of Washington, Seattle, Washington
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27
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Abstract
IMPORTANCE The Patient Protection and Affordable Care Act broadened insurance coverage, partially through voluntary state-based Medicaid expansion. OBJECTIVE To determine whether patients with higher-risk prostate cancer residing in Medicaid expansion states were more likely to receive treatment after expansion compared with patients in states electing not to pursue Medicaid expansion. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included 15 332 patients diagnosed with higher-risk prostate cancer (ie, grade group >2; grade group 2 with prostate-specific antigen levels >10 ng/mL; or grade group 1 with prostate-specific antigen levels >20 ng/mL) from January 2010 to December 2016 aged 50 to 64 years who were candidates for definitive treatment. Patients residing in states that partially expanded Medicaid coverage before 2010 (ie, California and Connecticut) and those with diagnosis not confirmed by histology were excluded. Data were collected from the Surveillance, Epidemiology, and End Results Program. Data were analyzed between August and December 2019. EXPOSURE State-level Medicaid expansion status. MAIN OUTCOMES AND MEASURES Insurance status before and after expansion, treatment with prostatectomy or radiation therapy (including brachytherapy), treatment trends over time. RESULTS Of 15 332 patients, 7811 (50.9%) lived in expansion states (mean [SD] age, 59.1 [3.8] years; 5532 [71.9%] non-Hispanic White), and 7521 (49.1%) lived in nonexpansion states (mean [SD] age, 59.0 [3.9] years; 3912 [52.1%] non-Hispanic White). Residence in an expansion state was associated with higher pre-expansion levels of Medicaid coverage (292 [8.1%] vs 161 [3.8%]; odds ratio [OR], 2.12; 95% CI, 1.78 to 2.53) and lower likelihood of being uninsured (136 [3.2%] vs 38 [1.1%]; OR, 0.28; 95% CI, 0.15 to 0.54). After expansion, there was no difference in trends in treatment receipt between expansion and nonexpansion states (change, -0.39%; 95% CI, -0.11% to 0.28%; P = .25). Patients with private or Medicare coverage were more likely to receive treatment vs those with Medicaid or no coverage across racial/ethnic groups (eg, Black patients with coverage: OR, 2.30; 95% CI, 1.68 to 3.10; Black patients with no coverage: OR, 1.48; 95% CI, 1.09 to 2.00; P < .001). Medicaid patients were not more likely to be treated compared with those without insurance (737 [78.8%] vs 435 [79.5%]; OR, 0.97; 95% CI, 0.76 to 1.25). CONCLUSIONS AND RELEVANCE In this cohort study, state-level expansion of Medicaid was associated with increased Medicaid coverage for men with higher-risk prostate tumors but did not appear to affect treatment patterns at a population level. This may be related to the finding that Medicaid coverage was not associated with increased treatment rates compared with those without insurance.
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Affiliation(s)
- Wen Liu
- Department of Urology, NYU Langone School of Medicine, New York, New York
| | - Michael Goodman
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Christopher P. Filson
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
- Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia
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Elfatairy KK, Filson CP, Sanda MG, Osunkoya AO, Nour SG. In-Bore MRI-guided Prostate Biopsies in Patients with Prior Positive Transrectal US-guided Biopsy Results: Pathologic Outcomes and Predictors of Missed Cancers. Radiol Imaging Cancer 2020; 2:e190078. [PMID: 33033806 PMCID: PMC7523503 DOI: 10.1148/rycan.2020190078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 04/25/2020] [Accepted: 05/06/2020] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the role of confirmatory in-bore MRI-guided biopsy in patients with low- or intermediate-risk disease diagnosed at prior transrectal US-guided biopsy and to evaluate the rate and predictors for missed cancers. Materials and Methods A retrospective evaluation of 50 consecutive men who had previously undergone transrectal US-guided biopsy with positive results and who underwent subsequent in-bore MRI-guided biopsy at our university hospital (average time interval, 11 months) between 2012 and 2016 was performed. Ten men were excluded because of a history of treatment after transrectal US-guided biopsy. A total of 40 men (mean age, 63 years; range, 47-84 years) were included in this study. Multiparametric 3-T MRI (T2-weighted, diffusion-weighted, and dynamic contrast material-enhanced) and transrectal in-bore MRI-guided biopsy were performed. Cancer detection, disease-grade changes, and cancers missed at in-bore MRI-guided biopsy were evaluated. Descriptive statistics were used to report different rates. The Fisher exact test was used for categoric variables. The Mann-Whitney U test and independent Student t test were used for nonparametric and parametric data, respectively. The McNemar test was used for paired data. Results The overall cancer detection rate when using in-bore MRI-guided biopsy was 65% (26 of 40). In-bore MRI-guided biopsy detected 14 previously undiscovered cancerous lesions (clinically significant cancers [CSCs], 57.1% [eight of 14]). An overall disease upgrade by in-bore MRI-guided biopsy occurred in 40% (16 of 40) of cases (61.5% [16 of 26] of cases with positive results from in-bore MRI-guided biopsy). One case was downgraded from a Gleason score (GS) of 3 + 4 = 7 to a GS of 3 + 3 = 6. Out of 71 sextant biopsies with positive results detected by transrectal US-guided biopsy (from all 40 patients), 80% (57 of 71) were visible on MR images (in-bore MRI-guided biopsy results were positive in 52.6% [30 of 57]), and 20% (14 of 71) had no image correlates on MR images. In-bore MRI-guided biopsy upgraded 60% (18 of 30) and downgraded 3.3% (one of 30) of detected lesions. The false-negative rate was 35% (14.2% [two of 14] of patients had CSCs; GS ≥ 7), was higher in prostate volumes of greater than 40 mL, and was lower in the anterior gland location (P = .04 and .01, respectively). Conclusion Performing confirmatory in-bore MRI-guided biopsy following positive transrectal US-guided biopsy resulted in a high disease-upgrade incidence with subsequently improved disease-risk stratification, particularly when considering patients for active surveillance or focal therapy. Supplemental material is available for this article. © RSNA, 2020See also the commentary by Weiss and Solomon in this issue.
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Affiliation(s)
| | - Christopher P. Filson
- From the Department of Radiology and Imaging Sciences (K.K.E., S.G.N.), Interventional MRI Program (K.K.E., S.G.N.), Department of Urology (C.P.F., M.G.S., A.O.O.), and Department of Pathology (A.O.O.), School of Medicine, and Winship Cancer Institute (C.P.F., M.G.S., A.O.O., S.G.N.), Emory University, 1364 Clifton Rd NE, Room BG-42, Atlanta, GA 30322; Atlanta Veterans Affairs Medical Center, Decatur, Ga (C.P.F., M.G.S.); Department of Pathology, Veterans Affairs Medical Center, Atlanta, Ga (A.O.O.); and Department of Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt (K.K.E.)
| | - Martin G. Sanda
- From the Department of Radiology and Imaging Sciences (K.K.E., S.G.N.), Interventional MRI Program (K.K.E., S.G.N.), Department of Urology (C.P.F., M.G.S., A.O.O.), and Department of Pathology (A.O.O.), School of Medicine, and Winship Cancer Institute (C.P.F., M.G.S., A.O.O., S.G.N.), Emory University, 1364 Clifton Rd NE, Room BG-42, Atlanta, GA 30322; Atlanta Veterans Affairs Medical Center, Decatur, Ga (C.P.F., M.G.S.); Department of Pathology, Veterans Affairs Medical Center, Atlanta, Ga (A.O.O.); and Department of Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt (K.K.E.)
| | - Adeboye O. Osunkoya
- From the Department of Radiology and Imaging Sciences (K.K.E., S.G.N.), Interventional MRI Program (K.K.E., S.G.N.), Department of Urology (C.P.F., M.G.S., A.O.O.), and Department of Pathology (A.O.O.), School of Medicine, and Winship Cancer Institute (C.P.F., M.G.S., A.O.O., S.G.N.), Emory University, 1364 Clifton Rd NE, Room BG-42, Atlanta, GA 30322; Atlanta Veterans Affairs Medical Center, Decatur, Ga (C.P.F., M.G.S.); Department of Pathology, Veterans Affairs Medical Center, Atlanta, Ga (A.O.O.); and Department of Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt (K.K.E.)
| | - Sherif G. Nour
- From the Department of Radiology and Imaging Sciences (K.K.E., S.G.N.), Interventional MRI Program (K.K.E., S.G.N.), Department of Urology (C.P.F., M.G.S., A.O.O.), and Department of Pathology (A.O.O.), School of Medicine, and Winship Cancer Institute (C.P.F., M.G.S., A.O.O., S.G.N.), Emory University, 1364 Clifton Rd NE, Room BG-42, Atlanta, GA 30322; Atlanta Veterans Affairs Medical Center, Decatur, Ga (C.P.F., M.G.S.); Department of Pathology, Veterans Affairs Medical Center, Atlanta, Ga (A.O.O.); and Department of Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt (K.K.E.)
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Allen JD, Filson CP, Berry DL. Effect of a Prostate Cancer Screening Decision Aid for African-American Men in Primary Care Settings. Cancer Epidemiol Biomarkers Prev 2020; 29:2157-2164. [PMID: 32855264 DOI: 10.1158/1055-9965.epi-20-0454] [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] [Received: 03/25/2020] [Revised: 07/22/2020] [Accepted: 08/21/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND African-American men have an elevated risk of developing and dying from prostate cancer. Shared decision-making (SDM) about prostate cancer screening is recommended but does not always occur. METHODS We pilot-tested an online decision aid (DA) in primary care settings using a pre/postevaluation design among African-American men ages 45 to 70 years. Men completed surveys before and after using the DA, which had interactive segments (e.g., values clarification) and provided individualized assessment of prostate cancer risk. Primary outcomes included prostate cancer knowledge, confidence in ability to make informed decisions, decisional conflict, and satisfaction with the decision. Immediately after the clinical visit, patients reported the degree to which they were engaged by their provider in SDM. RESULTS Among this sample of men (n = 49), use of the DA was associated with increased knowledge about prostate cancer [mean = 55.3% vs. 71.2%; 95% confidence interval (CI), 9.8-22.1; P < 0.001], reduced decisional conflict (mean = 33.4 vs. 23.6; 95% CI, -18.1 to -1.6; P = 0.002) on a scale from 0 to 100, and a decreased preference to be screened (88% vs. 69%; 95% CI, 0.09-0.64; P = 0.01). Most (89%) reported that the DA prepared them well/very well for SDM with their provider. Following the clinical visit with providers, scores on perceived involvement in SDM were 68.1 (SD 29.1) on a 0 to 100 scale. CONCLUSIONS The DA improved men's knowledge, reduced decisional conflict, and promoted the perception of being prepared for SDM. IMPACT Findings suggest that use of an online DA to improve SDM outcomes warrants further testing in a future trial.
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Affiliation(s)
- Jennifer D Allen
- Department of Community Health, Tufts University, Medford, Massachusetts.
| | - Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia; Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia; Department of Surgical Services, Atlanta VA Medical Center, Atlanta, Georgia
| | - Donna L Berry
- Department of Behavioral Nursing and Health Informatics, University of Washington, School of Nursing, Seattle, Washington
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30
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Jiang J, Patil D, Traore EJ, Hammett J, Filson CP. Contemporary Patterns of Third-line Treatments for Privately Insured Individuals With Overactive Bladder in the United States. Urology 2020; 142:87-93. [DOI: 10.1016/j.urology.2020.04.102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 11/16/2022]
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31
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Joshi SS, Filson CP. Reply to Obesity and aggressive prostate cancer and the golden rule: Do not do to others what you do not want done to yourself. Cancer 2020; 126:2322-2323. [PMID: 32022901 DOI: 10.1002/cncr.32759] [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] [Received: 01/03/2020] [Accepted: 01/15/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Shreyas S Joshi
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
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32
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Patil D, Le TL, Bens KB, Alemozaffar M, Lay A, Pattaras J, Filson CP, Ogan K, Bilen MA, Master VA. Dynamic Evaluation of the Modified Glasgow Prognostic Scale in Patients With Resected, Localized Clear Cell Renal Cell Carcinoma. Urology 2020; 141:101-107. [PMID: 32294483 DOI: 10.1016/j.urology.2020.03.024] [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] [Received: 11/21/2019] [Revised: 03/17/2020] [Accepted: 03/22/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate the relationship between dynamic changes in the modified Glasgow Prognostic Scale (mGPS) and postnephrectomy survival among localized clear cell renal cell carcinoma (ccRCC) patients. METHODS We retrospectively identified patients who underwent nephrectomy for localized ccRCC with preoperative mGPS = 0 from 2005 to 2018. The primary exposure of interest was ΔmGPS between 2 points - 60 days prior to surgery and 1 year after surgery. We assessed the relationship between ΔmGPS and survival outcomes. Kaplan-Meier curves were generated to determine survival estimates and Cox proportional hazards models were fit to estimate hazard ratios (HRs). Multivariable models were constructed using both ΔmGPS and clinical variables known to be associated with differences in survival. RESULTS We identified 313 patients for our analytic cohort with a median follow-up time of 20.2 months. Thirty-seven (11.9%) patients died and 39 (12.54%) showed recurrence during follow-up. Two hundred sixty-three (84.6%) patients had unchanged mGPS before and after surgery, while 48 (15.4%) patients showed an increase in postoperative mGPS from preoperative mGPS. Compared to patients with unchanged mGPS, patients with a higher postoperative mGPS had an increased risk of death (HR = 3.05 [1.39-6.68], P = .005) and recurrence (HR = 2.98 [1.34-6.64], P = .008). CONCLUSION Patients with an increase in mGPS following nephrectomy for ccRCC were more likely to die and experience cancer recurrence. Assessing dynamic changes in this cheap, validated, and reproducible test may be useful in identifying patients at higher risk for more aggressive disease or for counseling patients regarding risk of cancer recurrence.
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Affiliation(s)
| | - Thien-Linh Le
- Department of Urology, Emory University, Atlanta, GA
| | | | - Mehrdad Alemozaffar
- Department of Urology, Emory University, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Aaron Lay
- Department of Urology, Emory University, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - John Pattaras
- Department of Urology, Emory University, Atlanta, GA
| | - Christopher P Filson
- Department of Urology, Emory University, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Kenneth Ogan
- Department of Urology, Emory University, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Mehmet A Bilen
- Winship Cancer Institute of Emory University, Atlanta, GA; Department of Hematology and Oncology, Emory University, Atlanta, GA
| | - Viraj A Master
- Department of Urology, Emory University, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA; Department of Hematology and Oncology, Emory University, Atlanta, GA.
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Jansen CS, Prokhnevska N, Master VA, Sanda MG, Carlisle JW, Bilen MA, Cardenas M, Wilkinson S, Lake R, Sowalsky AG, Valanparambil RM, Hudson WH, McGuire D, Melnick K, Khan AI, Kim K, Chang YM, Kim A, Filson CP, Alemozaffar M, Osunkoya AO, Mullane P, Ellis C, Akondy R, Im SJ, Kamphorst AO, Reyes A, Liu Y, Kissick H. An intra-tumoral niche maintains and differentiates stem-like CD8 T cells. Nature 2019; 576:465-470. [PMID: 31827286 DOI: 10.1038/s41586-019-1836-5] [Citation(s) in RCA: 442] [Impact Index Per Article: 88.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 11/13/2019] [Indexed: 02/07/2023]
Abstract
Tumour-infiltrating lymphocytes are associated with a survival benefit in several tumour types and with the response to immunotherapy1-8. However, the reason some tumours have high CD8 T cell infiltration while others do not remains unclear. Here we investigate the requirements for maintaining a CD8 T cell response against human cancer. We find that CD8 T cells within tumours consist of distinct populations of terminally differentiated and stem-like cells. On proliferation, stem-like CD8 T cells give rise to more terminally differentiated, effector-molecule-expressing daughter cells. For many T cells to infiltrate the tumour, it is critical that this effector differentiation process occur. In addition, we show that these stem-like T cells reside in dense antigen-presenting-cell niches within the tumour, and that tumours that fail to form these structures are not extensively infiltrated by T cells. Patients with progressive disease lack these immune niches, suggesting that niche breakdown may be a key mechanism of immune escape.
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Affiliation(s)
- Caroline S Jansen
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Martin G Sanda
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Jennifer W Carlisle
- Winship Cancer Institute of Emory University, Atlanta, GA, USA.,Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mehmet Asim Bilen
- Winship Cancer Institute of Emory University, Atlanta, GA, USA.,Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Maria Cardenas
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Scott Wilkinson
- Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, Bethesda, MD, USA
| | - Ross Lake
- Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, Bethesda, MD, USA
| | - Adam G Sowalsky
- Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, Bethesda, MD, USA
| | - Rajesh M Valanparambil
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA.,Emory Vaccine Centre, Emory University School of Medicine, Atlanta, GA, USA
| | - William H Hudson
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA.,Emory Vaccine Centre, Emory University School of Medicine, Atlanta, GA, USA
| | - Donald McGuire
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA.,Emory Vaccine Centre, Emory University School of Medicine, Atlanta, GA, USA
| | - Kevin Melnick
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Amir I Khan
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Kyu Kim
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Yun Min Chang
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA
| | - Alice Kim
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Mehrdad Alemozaffar
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Adeboye O Osunkoya
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA.,Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Patrick Mullane
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Carla Ellis
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Rama Akondy
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA.,Emory Vaccine Centre, Emory University School of Medicine, Atlanta, GA, USA
| | - Se Jin Im
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA.,Emory Vaccine Centre, Emory University School of Medicine, Atlanta, GA, USA
| | - Alice O Kamphorst
- Department of Oncological Sciences, Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Adriana Reyes
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Yuan Liu
- Winship Cancer Institute of Emory University, Atlanta, GA, USA.,Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Haydn Kissick
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA. .,Winship Cancer Institute of Emory University, Atlanta, GA, USA. .,Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA. .,Emory Vaccine Centre, Emory University School of Medicine, Atlanta, GA, USA.
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Joshi SS, Filson CP. Long‐term consequences of the USPSTF Grade D recommendation for prostate‐specific antigen screening. Cancer 2019; 126:694-696. [DOI: 10.1002/cncr.32605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/23/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Shreyas S. Joshi
- Department of Urology Emory University School of Medicine Atlanta Georgia
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35
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Elfatairy KK, Filson CP, Sanda MG, Osunkoya AO, Nour SG. In-Bore MRI-guided Prostate Biopsies: Retrospective Observational Study of Complementary Nontargeted Sampling of Normal-appearing Areas at Multiparametric MRI. Radiol Imaging Cancer 2019; 1:e190016. [PMID: 33778681 DOI: 10.1148/rycan.2019190016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/23/2019] [Accepted: 09/03/2019] [Indexed: 11/11/2022]
Abstract
Purpose To investigate the pathologic outcomes of additional random biopsies from areas with no visible MR targets in the setting of targeted in-bore MRI-guided biopsy and to assess the negative predictive value (NPV) of areas with no visible MR targets stratified according to patients' different biopsy statuses. Materials and Methods A retrospective analysis of patients who underwent in-bore MRI-guided biopsy with additional random biopsies in areas with no visible MR targets (Prostate Imaging-Reporting and Data System, version 2 category 1 or 2) was conducted in this study. Diagnostic scans and in-bore MRI-guided biopsy were performed with a 3-T MRI scanner. Areas with no visible MR targets were biopsied in a random fashion whenever a zone or side did not have a visible focal target. Clinically significant cancers (CSCs) were defined as a Gleason score of 7 or greater. NPVs were stratified based on patient's prior biopsy status. Descriptive analysis was performed. Results A total of 59 consecutive patients were included, with a median age of 65 years (interquartile range [IQR], 59-71 years). The median prostate-specific antigen level was 7 ng/mL (IQR, 4.9-10.8 ng/mL). Of the 59 patients, 16 (27.1%) were biopsy naive, 24 (40.7%) had prior negative transrectal US-guided biopsy findings, and 19 (32.2%) had prior positive transrectal US-guided biopsy findings. Forty-two (71.2%) biopsies revealed prostate cancer. A total of 112 areas with no visible MR targets were biopsied, of which 20 (17.9%) were cancers and 11 (9.8%) were CSCs. The NPV of areas with no visible MR targets was approximately 78% for all cancers and was 88.1% for CSCs. NPVs in biopsy-naive patients, patients with prior negative transrectal US-guided biopsy findings, and patients with prior positive transrectal US-guided biopsy findings were 62.5%, 83.3%, and 84.2%, respectively, for all cancers and 75.0%, 91.7%, and 94.7%, respectively, for CSCs. Conclusion Areas with no visible MR targets in patients with MR-suspicious foci may still harbor CSCs that may significantly affect management plans. Additional biopsies from areas with no visible MR targets are warranted in this population.Keywords: Biopsy/Needle Aspiration, Interventional-Body, MR-Imaging, Prostate, Urinary© RSNA, 2019.
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Affiliation(s)
- Kareem K Elfatairy
- Department of Radiology and Imaging Sciences (K.K.E., S.G.N.), Interventional MRI Program (K.K.E., S.G.N.), Department of Urology (C.P.F., M.G.S., A.O.O.), and Department of Pathology (A.O.O.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Atlanta Veterans Affairs Medical Center, Decatur, Ga (C.P.F., M.G.S.); Emory Winship Cancer Institute, Atlanta, Ga (C.P.F., M.G.S., A.O.O., S.G.N.); Department of Pathology, Veterans Affairs Medical Center, Atlanta, Ga (A.O.O.); and Department of Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt (K.K.E.)
| | - Christopher P Filson
- Department of Radiology and Imaging Sciences (K.K.E., S.G.N.), Interventional MRI Program (K.K.E., S.G.N.), Department of Urology (C.P.F., M.G.S., A.O.O.), and Department of Pathology (A.O.O.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Atlanta Veterans Affairs Medical Center, Decatur, Ga (C.P.F., M.G.S.); Emory Winship Cancer Institute, Atlanta, Ga (C.P.F., M.G.S., A.O.O., S.G.N.); Department of Pathology, Veterans Affairs Medical Center, Atlanta, Ga (A.O.O.); and Department of Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt (K.K.E.)
| | - Martin G Sanda
- Department of Radiology and Imaging Sciences (K.K.E., S.G.N.), Interventional MRI Program (K.K.E., S.G.N.), Department of Urology (C.P.F., M.G.S., A.O.O.), and Department of Pathology (A.O.O.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Atlanta Veterans Affairs Medical Center, Decatur, Ga (C.P.F., M.G.S.); Emory Winship Cancer Institute, Atlanta, Ga (C.P.F., M.G.S., A.O.O., S.G.N.); Department of Pathology, Veterans Affairs Medical Center, Atlanta, Ga (A.O.O.); and Department of Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt (K.K.E.)
| | - Adeboye O Osunkoya
- Department of Radiology and Imaging Sciences (K.K.E., S.G.N.), Interventional MRI Program (K.K.E., S.G.N.), Department of Urology (C.P.F., M.G.S., A.O.O.), and Department of Pathology (A.O.O.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Atlanta Veterans Affairs Medical Center, Decatur, Ga (C.P.F., M.G.S.); Emory Winship Cancer Institute, Atlanta, Ga (C.P.F., M.G.S., A.O.O., S.G.N.); Department of Pathology, Veterans Affairs Medical Center, Atlanta, Ga (A.O.O.); and Department of Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt (K.K.E.)
| | - Sherif G Nour
- Department of Radiology and Imaging Sciences (K.K.E., S.G.N.), Interventional MRI Program (K.K.E., S.G.N.), Department of Urology (C.P.F., M.G.S., A.O.O.), and Department of Pathology (A.O.O.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Atlanta Veterans Affairs Medical Center, Decatur, Ga (C.P.F., M.G.S.); Emory Winship Cancer Institute, Atlanta, Ga (C.P.F., M.G.S., A.O.O., S.G.N.); Department of Pathology, Veterans Affairs Medical Center, Atlanta, Ga (A.O.O.); and Department of Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt (K.K.E.)
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Alemozaffar M, Ogan K, Filson CP, Patil D, Lee G, Canter DJ, Hong G, Master VA. A randomized, controlled trial for transurethral treatment of bladder tumors using PlasmaButton vaporization electrode or monopolar loop electrocautery. Can J Urol 2019; 26:9908-9915. [PMID: 31629439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The use of an electrocautery device (monopolar loop) for patients undergoing transurethral resection of bladder tumors (TURBT) is standard of care. The aim of this study is to establish non-inferiority of complication rates for a bipolar energy device, the PK PlasmaButton (PK Button), when compared to the monopolar loop. MATERIALS AND METHODS Seventy-eight subjects (41 monopolar loop and 37 PK Button), were enrolled in a single-center, prospective, randomized study with cystoscopically detected bladder tumors that were judged endoscopically resectable with only one trip into the operating room. Intra and postoperative data on complication rates, operative time, catheterization time and disease recurrence rates at 3 month follow up were collected. RESULTS Overall complication rates after TURBT with the monopolar loop or PK Button were similar, (56% versus 38% respectively, p = 0.107), however there were more bladder perforations in the monopolar loop arm compared to the PK Button arm (12.2% versus 0%, respectively, p = 0.028). There was no difference in overall operative time (p = 0.170), catheterization time (p = 0.709) and disease recurrence (p = 0.199). CONCLUSION The results of this study demonstrated no difference between the monopolar loop and PK Button in regard to overall complications; however, there was a higher rate of bladder perforation with monopolar TURBT. PK Button vaporization for bladder tumors represents a promising alternative to traditional monopolar TURBT without compromising short term (3 month) cancer recurrence rates.
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Affiliation(s)
- Mehrdad Alemozaffar
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
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Nam CS, Mehta A, Hammett J, Kim FY, Filson CP. Variation in Practice Patterns and Reimbursements Between Female and Male Urologists for Medicare Beneficiaries. JAMA Netw Open 2019; 2:e198956. [PMID: 31397864 PMCID: PMC6692839 DOI: 10.1001/jamanetworkopen.2019.8956] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/20/2019] [Indexed: 12/02/2022] Open
Abstract
Importance Previous assessments of practice patterns and reimbursements for female urologists relied on surveys or board certification logs. A current evaluation of the geographic distribution and practice patterns by female urologists would reveal contemporary patterns of access for Medicare beneficiaries. Objective To characterize the variation in practice patterns and reimbursements by urologist sex and the regional deficiencies in care provided by female urologists. Design, Setting, and Participants This population-based cohort study used the publicly available Centers for Medicare & Medicaid Services Provider Payment database to evaluate payments for US urologists. The cohort (n = 8665) included urologists who provided and were paid for 11 or more services to Medicare beneficiaries in 2016. Data collection and analysis were performed from October 3, 2018, through June 19, 2019. Main Outcomes and Measures Proportion of female-specific services, payments per beneficiary, and payments per work relative value unit (wRVU) by urologist sex were assessed. Density of female urologists across hospital markets was also identified. Results Among the 8665 urologists who received payments in 2016, 7944 (91.7%) were men and 721 (8.3%) were women. Female urologists, compared with male urologists, saw a lower proportion of patients with cancer (mean [SD], 16.3% [9.2%] vs 22.7% [8.8%]; P < .001) and a greater proportion of female Medicare beneficiaries (mean [SD], 52.8% [23.2%] vs 24.4% [10.3%]; P < .001). Female urologists generated a greater proportion of wRVU from urodynamics (median [IQR], 2.88% [1.26%-4.84%] vs 1.07% [0.31%-2.26%]; P < .001) and gynecological operations (median [IQR], 0.68% [0.45%-1.07%] vs 0.41% [0.20%-0.81%]; P < .001) than male urologists. In addition, female urologists, compared with their male counterparts, received lower median payments per beneficiary seen ($70.12 [interquartile range (IQR), $60.00-$84.81] vs $72.37 [IQR, $59.63-$89.29]; P = .03) and lower payments per wRVU ($58.25 [IQR, $48.39-65.26] vs $60.04 [IQR, $51.93-$67.88]; P < .001). One-third (103 [33.7%]) of 306 hospital referral regions had 0 female urologists, and 80 (26.1%) had only 1 female urologist. Conclusions and Relevance Female urologists were more likely to provide care for female Medicare beneficiaries, to receive lower payments per wRVU generated and beneficiaries seen, and to be difficult to access in certain geographic areas; these findings have policy-related implications and highlight the regional deficiencies in urological care and reimbursement discrepancies according to urologist sex.
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Affiliation(s)
- Catherine S. Nam
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Akanksha Mehta
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Jessica Hammett
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Frances Y. Kim
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Christopher P. Filson
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
- Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia
- Department of Urology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
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Macleod LC, Yabes JG, Fam MM, Bandari J, Yu M, Maganty A, Furlan A, Filson CP, Davies BJ, Jacobs BL. Multiparametric Magnetic Resonance Imaging Is Associated with Increased Medicare Spending in Prostate Cancer Active Surveillance. Eur Urol Focus 2019; 6:242-248. [PMID: 31031042 DOI: 10.1016/j.euf.2019.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/31/2019] [Revised: 03/22/2019] [Accepted: 04/10/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mpMRI) may improve prostate cancer risk stratification and decrease the need for repeat biopsies in men on prostate cancer active surveillance (AS). However, the impact of mpMRI on AS-related healthcare spending has not been established. OBJECTIVE To characterize the impact of mpMRI on AS-related Medicare expenditures. DESIGN, SETTING, AND PARTICIPANTS Using Surveillance, Epidemiology, and End Results (SEER)-Medicare files, we identified men ≥66 yr old with localized prostate cancer diagnosed during 2008-2013. OUTCOME MEASURES AND STATISTICAL ANALYSIS With a validated algorithm, we classified men into AS with and without mpMRI groups. We then determined Medicare spending on AS in each group using inflation-adjusted, price-standardized Medicare payments for AS-related procedures (ie, prostate-specific antigen [PSA] tests, prostate biopsies, biopsy complications, and mpMRI). Multivariable median regression compared Medicare spending on AS for men who received mpMRI and those who did not. RESULTS AND LIMITATIONS We identified 9081 men on AS with a median follow-up of 45 mo (interquartile range 29-64 mo). Thirteen percent (N = 1225) received mpMRI. On multivariable median regression, receipt of mpMRI was associated with an additional $447 (95% confidence interval $409-487) in Medicare spending per year. We observed greater frequency of AS-related procedures and higher spending for identical procedures (eg, PSA or prostate biopsy) in the mpMRI group than in the non-mpMRI group (all p < 0.001). CONCLUSIONS Among Medicare beneficiaries on AS, mpMRI is associated with additional annual Medicare spending. Future studies are needed to determine optimal use of mpMRI during AS to maximize value. PATIENT SUMMARY Prostate magnetic resonance imaging (MRI) helps physicians determine which prostate cancers are aggressive and which can be monitored safely. We studied whether using MRI during prostate cancer monitoring (also called active surveillance) resulted in increased healthcare spending. There was a modest increase in spending, but this may be worthwhile if the use of MRI allows physicians to monitor prostate cancer more accurately.
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Affiliation(s)
- Liam C Macleod
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Jonathan G Yabes
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mina M Fam
- Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Jathin Bandari
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michelle Yu
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Avinash Maganty
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alessandro Furlan
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Benjamin J Davies
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Fam MM, Yabes JG, Macleod LC, Bandari J, Turner RM, Lopa SH, Furlan A, Filson CP, Davies BJ, Jacobs BL. Increasing Utilization of Multiparametric Magnetic Resonance Imaging in Prostate Cancer Active Surveillance. Urology 2019; 130:99-105. [PMID: 30940480 DOI: 10.1016/j.urology.2019.02.037] [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: 11/11/2018] [Revised: 01/16/2019] [Accepted: 02/06/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To characterize the use of multiparametric magnetic resonance imaging (mpMRI) in male Medicare beneficiaries electing active surveillance for prostate cancer. mpMRI has emerged as a tool that may improve risk-stratification and decrease repeated biopsies in men electing active surveillance. However, the extent to which mpMRI has been implemented in active surveillance has not been established. METHODS Using Surveillance, Epidemiology, and End Results registry data linked to Medicare claims data, we identified men with localized prostate cancer diagnosed between 2008 and 2013 and managed with active surveillance. We classified men into 2 treatment groups: active surveillance without mpMRI and active surveillance with mpMRI. We then fit a multivariable logistic regression models to examine changing mpMRI utilization over time, and factors associated with the receipt of mpMRI. RESULTS We identified 9467 men on active surveillance. Of these, 8178 (86%) did not receive mpMRI and 1289 (14%) received mpMRI. The likelihood of receiving mpMRI over the entire study period increased by 3.7% (P = .004). On multivariable logistic regression, patients who were younger, white, had lower comorbidity burden, lived in the northeast and west, had higher incomes and lived in more urban areas had greater odds of receiving mpMRI (all P < .05). CONCLUSION From 2008 to 2013, use of mpMRI in active surveillance increased gradually but significantly. Receipt of mpMRI among men on surveillance for prostate cancer varied significantly across demographic, geographic, and socioeconomic strata. Going forward, studies should investigate causes for this variation and define ideal strategies for equitable, cost-effective dissemination of mpMRI technology.
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Affiliation(s)
- Mina M Fam
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jonathan G Yabes
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Liam C Macleod
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Jathin Bandari
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Robert M Turner
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Samia H Lopa
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Alessandro Furlan
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Benjamin J Davies
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
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Aliperti LA, Patil D, Filson CP, Hartsell LM, Carney KJ, Sanda MG, Mehta A. Genitourinary Prosthetic Use among Prostate Cancer Survivors Treated with Radical Prostatectomy. Urology Practice 2019. [DOI: 10.1016/j.urpr.2018.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Liu W, Patil D, Howard DH, Moore RH, Wang H, Sanda MG, Filson CP. Impact of prebiopsy magnetic resonance imaging of the prostate on cancer detection and treatment patterns. Urol Oncol 2019; 37:181.e15-181.e21. [DOI: 10.1016/j.urolonc.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/30/2018] [Accepted: 11/04/2018] [Indexed: 11/27/2022]
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Berry DL, Hong F, Halpenny B, Sanda MG, Master VA, Filson CP, Chang P, Chien GW, Underhill M, Fox E, McReynolds J, Wolpin S. Evaluating Clinical Implementation Approaches for Prostate Cancer Decision Support. Urol Pract 2019; 6:93-99. [PMID: 34350322 PMCID: PMC8330380 DOI: 10.1016/j.urpr.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)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Shared decision making is widely promoted for counseling men with localized prostate cancer. Results of randomized trials suggest decision aid efficacy. However, few practices or institutions have implemented decision support as standard practice. In this study we evaluated various implementation strategies for the decision aid P3P (Personal Patient Profile-Prostate) and analyzed feedback from clinical site staff and providers. METHODS A hybrid type 1 effectiveness-implementation trial was conducted. Primary data were collected in 6 urology clinics of 3 geographically distinct health networks. During the implementation phase site specific strategies were codesigned with site leaders. Referral and access metrics for men with localized prostate cancer were monitored for up to 7 months. Clinical staff reports of barriers and facilitators of implementation were evaluated in professionally facilitated focus groups. RESULTS Of 495 men with localized prostate cancer seen in the clinics 252 (51%, 95% CI 46-55) were informed of the program and of those men 107 (43%, 95% CI 36-49) accessed it. The highest access rates were observed with patient care coordinator e-mail and telephone contact (82%) or verbal physician instruction followed by e-mail and telephone invitations (87%). During focus groups physicians appraised the summaries as useful. Staff identified barriers included creating new workflows within heavy workloads and staff misunderstanding of context and resources. Promoters of successful implementation included an identified clinical lead and physician engagement. CONCLUSIONS Implementation success was realized when physicians engaged and staff provided followup contact. New practice changes to implement interventions require multimodal strategies for early success.
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Affiliation(s)
| | - Fangxin Hong
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Martin G. Sanda
- Department of Urology, Emory University School of Medicine, Atlanta
| | - Viraj A. Master
- Department of Urology, Emory University School of Medicine, Atlanta; Winship Cancer Institute, Emory Healthcare, Atlanta
| | - Christopher P. Filson
- Department of Urology, Emory University School of Medicine, Atlanta; Winship Cancer Institute, Emory Healthcare, Atlanta; Atlanta Veterans Administration Medical Center, Decatur, Georgia
| | - Peter Chang
- Department of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Gary W. Chien
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | | | - Erica Fox
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Justin McReynolds
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington
| | - Seth Wolpin
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington
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Wilson LS, Blonquist TM, Hong F, Halpenny B, Wolpin S, Chang P, Filson CP, Master VA, Sanda MG, Chien GW, Jones RA, Krupski TL, Berry DL. Assigning value to preparation for prostate cancer decision making: a willingness to pay analysis. BMC Med Inform Decis Mak 2019; 19:6. [PMID: 30626400 PMCID: PMC6327504 DOI: 10.1186/s12911-018-0725-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 12/17/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Personal Patient Profile-Prostate (P3P) is a web-based decision support system for men newly diagnosed with localized prostate cancer that has demonstrated efficacy in reducing decisional conflict. Our objective was to estimate willingness-to-pay (WTP) for men's decisional preparation activities. METHODS In a multicenter, randomized trial of P3P, usual care group participants received typical preparation for decision making plus referral to publicly-available, educational websites. Intervention group participants received the same, plus online P3P educational media specific to the user's personal preferences and values, and a communication coaching component tailored to race\ethnicity, age and language. WTP data were collected one week after physician consultation. An iterative bidding direct contingent valuation survey format was used, randomly assigning participants to high or low starting values (SV). Tobit models were used to explore associations between SV-adjusted WTP and age, education, marital and work-status, insurance, decision-control preference and decision-making stage. RESULTS Of 392 participants enrolled, 141 P3P and 107 usual care (UC) provided a WTP value. Men were willing to pay a median $25 (IQR $10-100) for P3P in addition to usual care preparation materials. In the final multivariable tobit regression model, SV, marital status, stage of decision making and income were significantly associated with WTP for P3P. Decision control preference was considered marginally significant (p = 0.11). Men were WTP a median $30 (IQR $10-$200) for usual care material alone. In the final multivariable model, SV, education, and stage of decision making were significantly associated with WTP in usual care. CONCLUSION WTP was similar for UC and for the addition of P3P to UC decision preparation. The WTP values were associated with demographic and preference variables. Findings can help focus decision support on future patients who would benefit most: those without strong support systems, at earlier stages of decision making, and open to a shared-decision style. TRIAL REGISTRATION NCT NCT01844999 . Registered May 3, 2013.
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Affiliation(s)
- Leslie S. Wilson
- University of California San Francisco, 2130 Fulton St, San Francisco, CA 94117 USA
| | - Traci M. Blonquist
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215 USA
| | - Fangxin Hong
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215 USA
| | - Barbara Halpenny
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215 USA
| | - Seth Wolpin
- University of Washington, 1959 NE Pacific St, Seattle, WA 98195 USA
| | - Peter Chang
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA
| | - Christopher P. Filson
- Emory University School of Medicine, 1365 Clifton Rd NE, Suite B1400, Atlanta, GA 30322 USA
| | - Viraj A. Master
- Emory University School of Medicine, 1365 Clifton Rd NE, Suite B1400, Atlanta, GA 30322 USA
| | - Martin G. Sanda
- Emory University School of Medicine, 1365 Clifton Rd NE, Suite B1400, Atlanta, GA 30322 USA
| | - Gary W. Chien
- Kaiser Permanente Medical Center, 4867 Sunset Blvd, Los Angeles, CA 90027 USA
| | - Randy A. Jones
- University of Virginia, 202 Jeanette Lancaster Way, Charlottesville, VA 22908 USA
| | - Tracey L. Krupski
- University of Virginia, 202 Jeanette Lancaster Way, Charlottesville, VA 22908 USA
| | - Donna L. Berry
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215 USA
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Henry M, Taylor M, Kim F, Pattaras JG, Alemozaffar M, Master V, Filson CP. Lymphadenectomy for High-Risk Prostate Cancer Patients: What Is Going on in Georgia? J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.579] [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: 11/28/2022]
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Melnick KR, Khan AI, Patil D, Kim F, Patel AP, Bilen MA, Kucuk O, Filson CP, Ogan K, Master V. New Preoperative Inflammatory Score Is an Independent and Significant Predictor of Overall Survival in Localized Clear Cell Renal Cell Carcinoma. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.663] [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: 10/28/2022]
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Safir IJ, Zholudev V, Laganosky D, Aliperti L, Al-Qassab U, Lindelow J, Filson CP, Issa MM. Patient Acceptance of Teleurology via Telephone vs Face-to-Face Clinic Visits for Hematuria Consultation at a Veterans Affairs Medical Center. Urology Practice 2018. [DOI: 10.1016/j.urpr.2017.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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]
Affiliation(s)
- Ilan J. Safir
- Department of Urology, Veterans Affairs Medical Center, Atlanta, Georgia
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Vitaly Zholudev
- Department of Urology, Veterans Affairs Medical Center, Atlanta, Georgia
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Dean Laganosky
- Department of Urology, Veterans Affairs Medical Center, Atlanta, Georgia
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Louis Aliperti
- Department of Urology, Veterans Affairs Medical Center, Atlanta, Georgia
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Usama Al-Qassab
- Department of Urology, Veterans Affairs Medical Center, Atlanta, Georgia
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Jennifer Lindelow
- Department of Urology, Veterans Affairs Medical Center, Atlanta, Georgia
| | - Christopher P. Filson
- Department of Urology, Veterans Affairs Medical Center, Atlanta, Georgia
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Muta M. Issa
- Department of Urology, Veterans Affairs Medical Center, Atlanta, Georgia
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
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Filson CP. Moving toward a more rational, evidence-based approach to PSA screening, diagnosis, and treatment of prostate cancer. Cancer 2018; 124:2684-2686. [DOI: 10.1002/cncr.31332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/09/2018] [Indexed: 11/10/2022]
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Abstract
The current health care climate mandates the delivery of high-value care for patients considering active surveillance for newly-diagnosed prostate cancer. Value is defined by increasing benefits (e.g., quality) for acceptable costs. This review discusses quality of care considerations for men contemplating active surveillance, and highlights cost implications at the patient, health-system, and societal level related to pursuit of non-interventional management of men diagnosed with localized prostate cancer. In general, most quality measures are focused on prostate cancer care in general, rather that active surveillance patients specifically. However, most prostate cancer quality measures are pertinent to men seeking close observation of their prostate tumors with active surveillance. These include accurate documentation of clinical stage, informed discussion of all treatment options, and appropriate use of imaging for less-aggressive prostate cancer. Furthermore, interventions that may help improve the quality of care for active surveillance patients are reviewed (e.g., quality collaboratives, judicious antibiotic use, etc.). Finally, the potential economic impact and benefits of broad acceptance of active surveillance strategies are highlighted.
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Affiliation(s)
- Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.,Atlanta Veterans Administration Medical Center, Decatur, GA, USA
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Affiliation(s)
- Mark A Henry
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
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