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Tosoian JJ, Zhang Y, Xiao L, Xie C, Samora NL, Niknafs YS, Chopra Z, Siddiqui J, Zheng H, Herron G, Vaishampayan N, Robinson HS, Arivoli K, Trock BJ, Ross AE, Morgan TM, Palapattu GS, Salami SS, Kunju LP, Tomlins SA, Sokoll LJ, Chan DW, Srivastava S, Feng Z, Sanda MG, Zheng Y, Wei JT, Chinnaiyan AM. Development and Validation of an 18-Gene Urine Test for High-Grade Prostate Cancer. JAMA Oncol 2024:2817657. [PMID: 38635241 DOI: 10.1001/jamaoncol.2024.0455] [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: 04/19/2024]
Abstract
Importance Benefits of prostate cancer (PCa) screening with prostate-specific antigen (PSA) alone are largely offset by excess negative biopsies and overdetection of indolent cancers resulting from the poor specificity of PSA for high-grade PCa (ie, grade group [GG] 2 or greater). Objective To develop a multiplex urinary panel for high-grade PCa and validate its external performance relative to current guideline-endorsed biomarkers. Design, Setting, and Participants RNA sequencing analysis of 58 724 genes identified 54 markers of PCa, including 17 markers uniquely overexpressed by high-grade cancers. Gene expression and clinical factors were modeled in a new urinary test for high-grade PCa (MyProstateScore 2.0 [MPS2]). Optimal models were developed in parallel without prostate volume (MPS2) and with prostate volume (MPS2+). The locked models underwent blinded external validation in a prospective National Cancer Institute trial cohort. Data were collected from January 2008 to December 2020, and data were analyzed from November 2022 to November 2023. Exposure Protocolized blood and urine collection and transrectal ultrasound-guided systematic prostate biopsy. Main Outcomes and Measures Multiple biomarker tests were assessed in the validation cohort, including serum PSA alone, the Prostate Cancer Prevention Trial risk calculator, and the Prostate Health Index (PHI) as well as derived multiplex 2-gene and 3-gene models, the original 2-gene MPS test, and the 18-gene MPS2 models. Under a testing approach with 95% sensitivity for PCa of GG 2 or greater, measures of diagnostic accuracy and clinical consequences of testing were calculated. Cancers of GG 3 or greater were assessed secondarily. Results Of 761 men included in the development cohort, the median (IQR) age was 63 (58-68) years, and the median (IQR) PSA level was 5.6 (4.6-7.2) ng/mL; of 743 men included in the validation cohort, the median (IQR) age was 62 (57-68) years, and the median (IQR) PSA level was 5.6 (4.1-8.0) ng/mL. In the validation cohort, 151 (20.3%) had high-grade PCa on biopsy. Area under the receiver operating characteristic curve values were 0.60 using PSA alone, 0.66 using the risk calculator, 0.77 using PHI, 0.76 using the derived multiplex 2-gene model, 0.72 using the derived multiplex 3-gene model, and 0.74 using the original MPS model compared with 0.81 using the MPS2 model and 0.82 using the MPS2+ model. At 95% sensitivity, the MPS2 model would have reduced unnecessary biopsies performed in the initial biopsy population (range for other tests, 15% to 30%; range for MPS2, 35% to 42%) and repeat biopsy population (range for other tests, 9% to 21%; range for MPS2, 46% to 51%). Across pertinent subgroups, the MPS2 models had negative predictive values of 95% to 99% for cancers of GG 2 or greater and of 99% for cancers of GG 3 or greater. Conclusions and Relevance In this study, a new 18-gene PCa test had higher diagnostic accuracy for high-grade PCa relative to existing biomarker tests. Clinically, use of this test would have meaningfully reduced unnecessary biopsies performed while maintaining highly sensitive detection of high-grade cancers. These data support use of this new PCa biomarker test in patients with elevated PSA levels to reduce the potential harms of PCa screening while preserving its long-term benefits.
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Affiliation(s)
- Jeffrey J Tosoian
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Yuping Zhang
- Department of Pathology, University of Michigan, Ann Arbor
| | - Lanbo Xiao
- Department of Pathology, University of Michigan, Ann Arbor
| | - Cassie Xie
- Department of Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Nathan L Samora
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Zoey Chopra
- Department of Pathology, University of Michigan, Ann Arbor
| | - Javed Siddiqui
- Department of Pathology, University of Michigan, Ann Arbor
| | - Heng Zheng
- Department of Pathology, University of Michigan, Ann Arbor
| | - Grace Herron
- Department of Pathology, University of Michigan, Ann Arbor
| | | | - Hunter S Robinson
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Bruce J Trock
- Departments of Pathology and Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ashley E Ross
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor
| | | | - Simpa S Salami
- Department of Urology, University of Michigan, Ann Arbor
| | | | - Scott A Tomlins
- Department of Urology, University of Michigan, Ann Arbor
- Strata Oncology, Ann Arbor, Michigan
| | - Lori J Sokoll
- Departments of Pathology and Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel W Chan
- Departments of Pathology and Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sudhir Srivastava
- Division of Cancer Prevention, National Institutes of Health, Bethesda, Maryland
| | - Ziding Feng
- Department of Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Martin G Sanda
- Department of Urology, Emory University, Atlanta, Georgia
| | - Yingye Zheng
- Department of Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - John T Wei
- Department of Urology, University of Michigan, Ann Arbor
| | - Arul M Chinnaiyan
- Department of Pathology, University of Michigan, Ann Arbor
- Department of Urology, University of Michigan, Ann Arbor
- Howard Hughes Medical Institute, Chevy Chase, Maryland
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Singhal U, Hollenbeck BK, Kaffenberger SD, Salami SS, George AK, Skolarus TA, Montgomery JS, Wittmann DA, Miller DC, Wei JT, Palapattu GS, Montie JE, Dunn RL, Morgan TM. Comparing Patient-reported Functional Outcomes After Radical Prostatectomy in Historical and Contemporary Practice. J Urol 2023; 210:771-777. [PMID: 37566643 DOI: 10.1097/ju.0000000000003646] [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: 03/16/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE Modifications to surgical technique, particularly the widespread adoption of robotic surgery, have been proposed to improve functional recovery after prostate cancer surgery. However, rigorous comparison of men in historical vs contemporary practice to evaluate the cumulative effect of these changes on urinary and sexual function after radical prostatectomy is lacking. MATERIALS AND METHODS We compared prospectively collected patient-reported urinary and sexual function from historical (PROSTQA [Prostate Cancer Outcomes and Satisfaction With Treatment Quality Assessment study], n=235) and contemporary (MUSIC-PRO [Michigan Urological Surgery Improvement Collaborative Patient Reported Outcome] registry, n=1,215) cohorts at the University of Michigan to understand whether modern techniques have resulted in functional improvements for men undergoing prostate cancer surgery. RESULTS We found significant differences in baseline function, with better urinary (median [IQR]; 100 [93.8-100] vs 93.8 [85.5-100], P < .001) and sexual scores (median [IQR]; 83.3 [66.7-100] vs 74.4 [44.2-87.5], P < .001) prior to treatment in PROSTQA compared to MUSIC-PRO patients, respectively. There was no statistically significant difference in the pattern of urinary incontinence recovery after surgery from 6-24 months between groups (P = .14). However, men in the contemporary MUSIC-PRO group did have significantly better recovery of sexual function compared to men in the historical PROSTQA group (P < .0001). Further, we found that contemporary practice consists of men with more unfavorable demographic and clinical characteristics compared to historical practice. CONCLUSIONS Our results demonstrate that the widespread alterations in prostate cancer surgery over the past 2 decades have yielded improvements in sexual, but not urinary, function recovery.
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Affiliation(s)
- Udit Singhal
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Brent K Hollenbeck
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Samuel D Kaffenberger
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Simpa S Salami
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Arvin K George
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
- James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ted A Skolarus
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Jeffrey S Montgomery
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Daniela A Wittmann
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - David C Miller
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - John T Wei
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Ganesh S Palapattu
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - James E Montie
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Rodney L Dunn
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Todd M Morgan
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
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3
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Tosoian JJ, Sessine MS, Trock BJ, Ross AE, Xie C, Zheng Y, Samora NL, Siddiqui J, Niknafs Y, Chopra Z, Tomlins S, Kunju LP, Palapattu GS, Morgan TM, Wei JT, Salami SS, Chinnaiyan AM. MyProstateScore in men considering repeat biopsy: validation of a simple testing approach. Prostate Cancer Prostatic Dis 2023; 26:563-567. [PMID: 36585434 PMCID: PMC10310885 DOI: 10.1038/s41391-022-00633-3] [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: 06/05/2022] [Revised: 11/16/2022] [Accepted: 12/09/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Men with persistent risk of Grade Group (GG) ≥ 2 cancer after a negative biopsy present a unique clinical challenge. The validated MyProstateScore test is clinically-available for pre-biopsy risk stratification. In biopsy-naïve patients, we recently validated a straightforward testing approach to rule-out GG ≥ 2 cancer with 98% negative predictive value (NPV) and 97% sensitivity. In the current study, we established a practical MPS-based testing approach in men with a previous negative biopsy being considered for repeat biopsy. METHODS Patients provided post-digital rectal examination urine prior to repeat biopsy. MyProstateScore was calculated using the validated, locked model including urinary PCA3 and TMPRSS2:ERG scores with serum PSA. In a clinically-appropriate primary (i.e., training) cohort, we identified a lower (rule-out) threshold approximating 90% sensitivity and an upper (rule-in) threshold approximating 80% specificity for GG ≥ 2 cancer. These thresholds were applied to an external validation cohort, and performance measures and clinical outcomes associated with their use were calculated. RESULTS MyProstateScore thresholds of 15 and 40 met pre-defined performance criteria in the primary cohort (422 patients; median PSA 6.4, IQR 4.3-9.1). In the 268-patient validation cohort, 25 men (9.3%) had GG ≥ 2 cancer on repeat biopsy. The rule-out threshold of 15 provided 100% NPV and sensitivity for GG ≥ 2 cancer and would have prevented 23% of unnecessary biopsies. Use of MyProstateScore >40 to rule-in biopsy would have prevented 67% of biopsies while maintaining 95% NPV. In the validation cohort, the prevalence of GG ≥ 2 cancer was 0% for MyProstateScore 0-15, 6.5% for MyProstateScore 15-40, and 19% for MyProstateScore >40. CONCLUSIONS In patients who previously underwent a negative prostate biopsy, the MyProstateScore values of 15 and 40 yielded clinically-actionable rule-in and rule-out risk groups. Using this straightforward testing approach, MyProstateScore can meaningfully inform patients and physicians weighing the need for repeat biopsy.
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Affiliation(s)
- Jeffrey J Tosoian
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA.
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA.
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA.
| | - Michael S Sessine
- Department of Urology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Bruce J Trock
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ashley E Ross
- Department of Urology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Cassie Xie
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Yingye Zheng
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Nathan L Samora
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Javed Siddiqui
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Yashar Niknafs
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Zoey Chopra
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Scott Tomlins
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Lakshmi P Kunju
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Ganesh S Palapattu
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - John T Wei
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Simpa S Salami
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Arul M Chinnaiyan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
- Howard Hughes Medical Institute, University of Michigan, Ann Arbor, MI, USA
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4
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Wei JT, Barocas D, Carlsson S, Coakley F, Eggener S, Etzioni R, Fine SW, Han M, Kim SK, Kirkby E, Konety BR, Miner M, Moses K, Nissenberg MG, Pinto PA, Salami SS, Souter L, Thompson IM, Lin DW. Early Detection of Prostate Cancer: AUA/SUO Guideline Part II: Considerations for a Prostate Biopsy. J Urol 2023; 210:54-63. [PMID: 37096575 DOI: 10.1097/ju.0000000000003492] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE The summary presented herein covers recommendations on the early detection of prostate cancer and provides a framework to facilitate clinical decision-making in the implementation of prostate cancer screening, biopsy, and follow-up. This is Part II of a two-part series focusing on initial and repeat biopsies, and biopsy technique. Please refer to Part I for discussion of initial prostate cancer screening recommendations. MATERIALS AND METHODS The systematic review utilized to inform this guideline was conducted by an independent methodological consultant. The systematic review was based on searches in Ovid MEDLINE and Embase and Cochrane Database of Systematic Reviews (January 1, 2000-November 21, 2022). Searches were supplemented by reviewing reference lists of relevant articles. RESULTS The Early Detection of Prostate Cancer Panel developed evidence- and consensus-based guideline statements to provide guidance in prostate cancer screening, initial and repeat biopsies, and biopsy technique. CONCLUSIONS The evaluation of prostate cancer risk should be focused on the detection of clinically significant prostate cancer (Grade Group 2 or higher [GG2+]). The use of laboratory biomarkers, prostate MRI, and biopsy techniques described herein may improve detection and safety when a prostate biopsy is deemed necessary following prostate cancer screening.
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Affiliation(s)
- John T Wei
- University of Michigan, Ann Arbor, Michigan
| | | | | | | | | | - Ruth Etzioni
- Fred Hutchinson Cancer Center, Seattle, Washington
| | - Samson W Fine
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Misop Han
- Johns Hopkins University, Baltimore, Maryland
| | - Sennett K Kim
- American Urological Association, Linthicum, Maryland
| | - Erin Kirkby
- American Urological Association, Linthicum, Maryland
| | | | | | | | - Merel G Nissenberg
- National Alliance of State Prostate Cancer Coalitions, Los Angeles, California
| | | | | | - Lesley Souter
- Nomadic EBM Methodology, Smithville, Ontario, Canada
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5
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Wei JT, Barocas D, Carlsson S, Coakley F, Eggener S, Etzioni R, Fine SW, Han M, Kim SK, Kirkby E, Konety BR, Miner M, Moses K, Nissenberg MG, Pinto PA, Salami SS, Souter L, Thompson IM, Lin DW. Early Detection of Prostate Cancer: AUA/SUO Guideline Part I: Prostate Cancer Screening. J Urol 2023; 210:46-53. [PMID: 37096582 PMCID: PMC11060750 DOI: 10.1097/ju.0000000000003491] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [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: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE The summary presented herein covers recommendations on the early detection of prostate cancer and provides a framework to facilitate clinical decision-making in the implementation of prostate cancer screening, biopsy, and follow-up. This is Part I of a two-part series that focuses on prostate cancer screening. Please refer to Part II for discussion of initial and repeat biopsies as well as biopsy technique. MATERIALS AND METHODS The systematic review utilized to inform this guideline was conducted by an independent methodological consultant. The systematic review was based on searches in Ovid MEDLINE and Embase and Cochrane Database of Systematic Reviews (January 1, 2000-November 21, 2022). Searches were supplemented by reviewing reference lists of relevant articles. RESULTS The Early Detection of Prostate Cancer Panel developed evidence- and consensus-based guideline statements to provide guidance in prostate cancer screening, initial and repeat biopsy, and biopsy technique. CONCLUSIONS Prostate-specific antigen (PSA)-based prostate cancer screening in combination with shared decision-making (SDM) is recommended. Current data regarding risk from population-based cohorts provide a basis for longer screening intervals and tailored screening, and the use of available online risk calculators is encouraged.
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Affiliation(s)
- John T Wei
- University of Michigan, Ann Arbor, Michigan
| | | | | | | | | | - Ruth Etzioni
- Fred Hutchinson Cancer Center, Seattle, Washington
| | - Samson W Fine
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Misop Han
- Johns Hopkins University, Baltimore, Maryland
| | - Sennett K Kim
- American Urological Association, Linthicum, Maryland
| | - Erin Kirkby
- American Urological Association, Linthicum, Maryland
| | | | | | | | - Merel G Nissenberg
- National Alliance of State Prostate Cancer Coalitions, Los Angeles, California
| | | | | | - Lesley Souter
- Nomadic EBM Methodology, Smithville, Ontario, Canada
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Dhir A, Ellimoottil CS, Qi J, Zhu A, Wang RS, Montgomery JS, Salami SS, Wei JT, Shankar PR, Davenport MS, Curci NE, Millet JD, Wu CY, Johnson A, Miller DC, George AK. Intra-practice Urologist-level Variation in Targeted Fusion Biopsy Outcomes. Urology 2023; 177:122-127. [PMID: 37121355 DOI: 10.1016/j.urology.2023.04.017] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To examine the extent to which the urologist performing biopsy contributes to variation in prostate cancer detection during fusion-guided prostate biopsy. METHODS All men in the Michigan Urological Surgery Improvement Collaborative (MUSIC) clinical registry who underwent fusion biopsy at Michigan Medicine from August 2017 to March 2019 were included. The primary outcomes were clinically significant cancer detection rate (defined as Gleason Grade ≥2) in targeted cores and clinically significant cancer detection on targeted cores stratified by PI-RADS score. Bivariate and multivariable logistic regression analyses were performed. RESULTS A total of 1133 fusion biopsies performed by 5 providers were included. When adjusting for patient age, PSA, race, family history, prostate volume, clinical stage, and PI-RADS score, there was no significant difference in targeted clinically significant cancer detection rates across providers (range = 38.5%-46.9%, adjusted P-value = .575). Clinically significant cancer detection rates ranged from 11.1% to 16.7% in PI-RADS 3 (unadjusted P = .838), from 24.6% to 43.4% in PI-RADS 4 (adjusted P = .003), and from 69.4% to 78.8% in PI-RADS 5 (adjusted P = .766) lesions. CONCLUSION There was a statistically significant difference in clinically significant prostate cancer detection in PI-RADS 4 lesions across providers. These findings suggest that even among experienced providers, variation at the urologist level may contribute to differences in clinically significant cancer detection rates within PI-RADS 4 lesions. However, the relative impact of biopsy technique, radiologist interpretation, and MR acquisition protocol requires further study.
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Affiliation(s)
- Apoorv Dhir
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Chad S Ellimoottil
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Ji Qi
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Alex Zhu
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Robert S Wang
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Jeffrey S Montgomery
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Simpa S Salami
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - John T Wei
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Prasad R Shankar
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Michigan Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Matthew S Davenport
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Nicole E Curci
- Michigan Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI
| | - John D Millet
- Michigan Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Chen-Yu Wu
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Anna Johnson
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - David C Miller
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Arvin K George
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
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7
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Yang XK, Zhang DL, He T, Zhang Y, Xu ZG, Wei JT, Li J, Liu MD. [Clinical experience of free superficial temporal fascia flap/anterolateral femoral fascial flap combined with skin grafting in repairing deep tissue defects of special parts of extremities]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2023; 39:507-511. [PMID: 37805764 DOI: 10.3760/cma.j.cn501225-20220915-00407] [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] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
The deep tissue defects of extremities are prone to cause the exposure of tendons, blood vessels, nerves, and bones, which are commonly repaired with free flaps in clinical practice. However, for special parts such as fingers, toes, posterior ankles, anterior tibias, and dorsum of feet, the appearances are usually bulky after being repaired with free flaps and need lipectomy operations, which bring great physiological, psychological, and economic burden to patients. As the fascia flap is soft and thin with reliable blood supply and strong anti-infection ability, the free fascia flap combined with skin grafting offers some advantages in repairing the above-mentioned wounds. However, its clinical application is severely limited due to the complexity of surgical operation and the difficulty in observing blood supply after operation. In recent years, our team has carried out a lot of work and accumulated rich experience in repairing deep tissue defects of special parts of extremities with free superficial temporal fascia flap/anterolateral femoral fascial flap combined with skin grafting. From the clinical perspective, this paper mainly introduces the anatomy and harvesting method of free superficial temporal fascia flap/anterolateral femoral fascial flap, as well as the advantages, difficulties, and precautions of clinical application, for reference of peers.
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Affiliation(s)
- X K Yang
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China
| | - D L Zhang
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China
| | - T He
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China
| | - Y Zhang
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China
| | - Z G Xu
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China
| | - J T Wei
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China
| | - J Li
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China
| | - M D Liu
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China
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Ni L, Lin WK, Kasputis A, Postiff D, Siddiqui J, Allaway MJ, Davenport MS, Wei JT, Guo JL, Morgan TM, Udager AM, Wang X, Xu G. Assessment of prostate cancer progression using a translational needle photoacoustic sensing probe: Preliminary study with intact human prostates ex-vivo. Photoacoustics 2022; 28:100418. [PMID: 36386297 PMCID: PMC9650056 DOI: 10.1016/j.pacs.2022.100418] [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] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/17/2022] [Accepted: 10/23/2022] [Indexed: 06/14/2023]
Abstract
In our previous studies, we demonstrated the ability of an interstitial all-optical needle photoacoustic (PA) sensing probe and PA spectral analysis (PASA) to assess the aggressiveness of prostate cancer. In this clinical translation investigation, we integrated the optical components of the needle PA sensing probe into a 18G steel needle. The translational needle PA sensing probe was evaluated using intact human prostates in a simulated ultrasound-guided transperineal prostate biopsy. PA signals were acquired at 1220 nm, 1370 nm, 800 nm and 266 nm at each interstitial measurement location and quantified by PASA within the frequency range of 8-28 MHz. The measurement locations were stained for establishing spatial correlations between the quantitative measurements and the histological diagnosing. Most of the quantitative PA assessments reveal statistically significant differences between the benign and cancerous regions. Multivariate analysis combining the PASA quantifications shows an accuracy close to 90% in differentiating the benign and cancerous regions in the prostates.
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Affiliation(s)
- Linyu Ni
- Department of Biomedical Engineering, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
| | - Wei-kuan Lin
- Department of Electrical Engineering and Computer Sciences, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
| | - Amy Kasputis
- Department of Urology, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
| | - Deborah Postiff
- Department of Pathology, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
| | - Javed Siddiqui
- Department of Pathology, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
| | | | - Matthew S. Davenport
- Department of Urology, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
- Department of Radiology, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
| | - John T. Wei
- Department of Urology, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
| | - Jay L. Guo
- Department of Electrical Engineering and Computer Sciences, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
| | - Todd M. Morgan
- Department of Urology, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
| | - Aaron M. Udager
- Michigan Center for Translational Pathology, Rogel Cancer Center, Department of Pathology, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
| | - Xueding Wang
- Department of Biomedical Engineering, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
- Department of Radiology, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
| | - Guan Xu
- Department of Biomedical Engineering, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
- Department of Ophthalmology and Visual Sciences, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
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9
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Delaney RK, Sisco-Taylor BL, Wang X, Scherr K, Ubel PA, Haaland B, Kahn VC, Hamstra D, Wei JT, Madanay F, Davis JK, Greeno TU, Fagerlin A. Two Specialists, Two Recommendations: Discordance Between Urologists' & Radiation Oncologists' Prostate Cancer Treatment Recommendations. Urology 2022; 169:156-161. [PMID: 35768027 PMCID: PMC10049001 DOI: 10.1016/j.urology.2022.06.009] [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: 03/16/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the treatment recommendation patterns among urologists and radiation oncologists, the level of concordance or discordance between physician recommendations, and the association between physician recommendations and the treatment that patients received. METHOD The study was a secondary analysis of data from a randomized clinical trial conducted November 2010 to April 2014 (NCT02053389). Eligible participants were patients from the trial who saw both specialists. The primary outcome was physician recommendations that were scored using an adapted version of the validated PhyReCS coding system. Secondary outcomes included concordance between physician recommendations and the treatment patients received. RESULTS Participants were 108 patients (Mean age 61.9 years; range 43-82; 87% non-Hispanic White). Urologists were more likely to recommend surgery (79% of recommendations) and radiation oncologists were more likely to recommend radiation (68% of recommendations). Recommendations from the urologists and radiation oncologists were concordant for only 33 patients (30.6%). Most patients received a treatment that both physicians recommended (59%); however, 35% received a treatment that only one of their physicians recommended. When discordant, urologists more often recommended surgery and radiation oncologists recommended radiation and surgery as equally appropriate options. CONCLUSION Urologists and radiation oncologists are more likely to differ than agree in their treatment recommendations for the same patients with clinically localized prostate cancer and more likely to favor treatment aligned with their specialty. Additional studies are needed to better understand how patients make decisions after meeting with two different specialists to inform the development of best practices within oncology clinics.
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Affiliation(s)
- Rebecca K Delaney
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Brittany L Sisco-Taylor
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Xuechen Wang
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Karen Scherr
- Department of Family Medicine and Community Health, Duke University
| | - Peter A Ubel
- Sanford School of Public Policy, Duke University
| | - Benjamin Haaland
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Valerie C Kahn
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI
| | - Daniel Hamstra
- Department of Radiation Oncology, Baylor College of Medicine, Houston, TX
| | - John T Wei
- Department of Urology, University of Michigan
| | | | | | | | - Angela Fagerlin
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah, Salt Lake City, UT; Salt Lake City VA Center for Informatics Decision Enhancement and Surveillance.
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10
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Cani AK, Hu K, Liu CJ, Siddiqui J, Zheng Y, Han S, Nallandhighal S, Hovelson DH, Xiao L, Pham T, Eyrich NW, Zheng H, Vince R, Tosoian JJ, Palapattu GS, Morgan TM, Wei JT, Udager AM, Chinnaiyan AM, Tomlins SA, Salami SS. Development of a Whole-urine, Multiplexed, Next-generation RNA-sequencing Assay for Early Detection of Aggressive Prostate Cancer. Eur Urol Oncol 2022; 5:430-439. [PMID: 33812851 DOI: 10.1016/j.euo.2021.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 11/27/2020] [Revised: 02/22/2021] [Accepted: 03/08/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite biomarker development advances, early detection of aggressive prostate cancer (PCa) remains challenging. We previously developed a clinical-grade urine test (Michigan Prostate Score [MiPS]) for individualized aggressive PCa risk prediction. MiPS combines serum prostate-specific antigen (PSA), the TMPRSS2:ERG (T2:ERG) gene fusion, and PCA3 lncRNA in whole urine after digital rectal examination (DRE). OBJECTIVE To improve on MiPS with a novel next-generation sequencing (NGS) multibiomarker urine assay for early detection of aggressive PCa. DESIGN, SETTING, AND PARTICIPANTS Preclinical development and validation of a post-DRE urine RNA NGS assay (Urine Prostate Seq [UPSeq]) assessing 84 PCa transcriptomic biomarkers, including T2:ERG, PCA3, additional PCa fusions/isoforms, mRNAs, lncRNAs, and expressed mutations. Our UPSeq model was trained on 73 patients and validated on a held-out set of 36 patients representing the spectrum of disease (benign to grade group [GG] 5 PCa). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The area under the receiver operating characteristic curve (AUC) of UPSeq was compared with PSA, MiPS, and other existing models/biomarkers for predicting GG ≥3 PCa. RESULTS AND LIMITATIONS UPSeq demonstrated high analytical accuracy and concordance with MiPS, and was able to detect expressed germline HOXB13 and somatic SPOP mutations. In an extreme design cohort (n = 109; benign/GG 1 vs GG ≥3 PCa, stratified to exclude GG 2 cancer in order to capture signal difference between extreme ends of disease), UPSeq showed differential expression for T2:ERG.T1E4 (1.2 vs 78.8 median normalized reads, p < 0.00001) and PCA3 (1024 vs 2521, p = 0.02), additional T2:ERG splice isoforms, and other candidate biomarkers. Using machine learning, we developed a 15-transcript model on the training set (n = 73) that outperformed serum PSA and sequencing-derived MiPS in predicting GG ≥3 PCa in the held-out validation set (n = 36; AUC 0.82 vs 0.69 and 0.69, respectively). CONCLUSIONS These results support the potential utility of our novel urine-based RNA NGS assay to supplement PSA for improved early detection of aggressive PCa. PATIENT SUMMARY We have developed a new urine-based test for the detection of aggressive prostate cancer, which promises improvement upon current biomarker tests.
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Affiliation(s)
- Andi K Cani
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Molecular and Cellular Pathology Graduate Program, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Kevin Hu
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Chia-Jen Liu
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Javed Siddiqui
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Yingye Zheng
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Sumin Han
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Daniel H Hovelson
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Lanbo Xiao
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Trinh Pham
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Nicholas W Eyrich
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Heng Zheng
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Randy Vince
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jeffrey J Tosoian
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA; Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ganesh S Palapattu
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA; Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Todd M Morgan
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA; Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - John T Wei
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Aaron M Udager
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Arul M Chinnaiyan
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Molecular and Cellular Pathology Graduate Program, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA; Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Scott A Tomlins
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Molecular and Cellular Pathology Graduate Program, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA; Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Simpa S Salami
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI, USA; Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA; Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA.
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11
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Tosoian JJ, Singhal U, Davenport MS, Wei JT, Montgomery JS, George AK, Salami SS, Mukundi SG, Siddiqui J, Kunju LP, Tooke BP, Ryder CY, Dugan SP, Chopra Z, Botbyl R, Feng Y, Sessine MS, Eyrich NW, Ross AE, Trock BJ, Tomlins SA, Palapattu GS, Chinnaiyan AM, Niknafs YS, Morgan TM. Urinary MyProstateScore (MPS) to Rule out Clinically-Significant Cancer in Men with Equivocal (PI-RADS 3) Multiparametric MRI: Addressing an Unmet Clinical Need. Urology 2022; 164:184-190. [PMID: 34906585 PMCID: PMC10171463 DOI: 10.1016/j.urology.2021.11.033] [Citation(s) in RCA: 2] [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: 05/17/2021] [Revised: 10/27/2021] [Accepted: 11/29/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the complementary value of urinary MyProstateScore (MPS) testing and multiparametric MRI (mpMRI) and assess outcomes in patients with equivocal mpMRI. MATERIALS AND METHODS Included patients underwent mpMRI followed by urine collection and prostate biopsy at the University of Michigan between 2015 -2019. MPS values were calculated from urine specimens using the validated model based on serum PSA, urinary PCA3, and urinary TMPRSS2:ERG. In the PI-RADS 3 population, the discriminative accuracy of PSA, PSAD, and MPS for GG≥2 cancer was quantified by the AUC curve. Decision curve analysis was used to assess net benefit of MPS relative to PSAD. RESULTS There were 540 patients that underwent mpMRI and biopsy with MPS available. The prevalence of GG≥2 cancer was 13% for PI-RADS 3, 56% for PI-RADS 4, and 87% for PI-RADS 5. MPS was significantly higher in men with GG≥2 cancer [median 44.9, IQR (29.4 -57.5)] than those with negative or GG1 biopsy [median 29.2, IQR (14.8 -44.2); P <.001] in the overall population and when stratified by PI-RADS score. In the PI-RADS 3 population (n = 121), the AUC for predicting GG≥2 cancer was 0.55 for PSA, 0.62 for PSAD, and 0.73 for MPS. MPS provided the highest net clinical benefit across all pertinent threshold probabilities. CONCLUSION In patients that underwent mpMRI and biopsy, MPS was significantly associated with GG≥2 cancer across all PI-RADS scores. In the PI-RADS 3 population, MPS significantly outperformed PSAD in ruling out GG≥2 cancer. These findings suggest a complementary role of MPS testing in patients that have undergone mpMRI.
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Affiliation(s)
- Jeffrey J Tosoian
- Department of Urology, Vanderbilt University, Nashville, TN; Vanderbilt-Ingram Cancer Center, Nashville, TN; Department of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI.
| | - Udit Singhal
- Department of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI; Department of Urology, Mayo Clinic, Rochester, MN
| | - Matthew S Davenport
- Department of Urology, University of Michigan, Ann Arbor, MI; Department of Radiology, University of Michigan, Ann Arbor, MI
| | - John T Wei
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Jeffrey S Montgomery
- Department of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | - Arvin K George
- Department of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | - Simpa S Salami
- Department of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | | | - Javed Siddiqui
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI
| | - Lakshmi P Kunju
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | | | | | - Sarah P Dugan
- University of Michigan Medical School, Ann Arbor, MI
| | - Zoey Chopra
- University of Michigan Medical School, Ann Arbor, MI
| | - Rachel Botbyl
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI
| | - Yilin Feng
- University of Michigan Medical School, Ann Arbor, MI
| | | | | | - Ashley E Ross
- Department of Urology, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Bruce J Trock
- Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Scott A Tomlins
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI; Department of Pathology, University of Michigan, Ann Arbor, MI
| | - Ganesh S Palapattu
- Department of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Arul M Chinnaiyan
- Department of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI; Department of Pathology, University of Michigan, Ann Arbor, MI; Howard Hughes Medical Institute, University of Michigan, Ann Arbor, MI
| | - Yashar S Niknafs
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI
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12
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Chang P, Wagner AA, Regan MM, Smith JA, Saigal CS, Litwin MS, Hu JC, Cooperberg MR, Carroll PR, Klein EA, Kibel AS, Andriole GL, Han M, Partin AW, Wood DP, Crociani CM, Greenfield TK, Patil D, Hembroff LA, Davis K, Stork L, Spratt DE, Wei JT, Sanda MG. Prospective Multicenter Comparison of Open and Robotic Radical Prostatectomy: The PROST-QA/RP2 Consortium. J Urol 2022; 207:127-136. [PMID: 34433304 PMCID: PMC8840795 DOI: 10.1097/ju.0000000000002176] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Our goal was to evaluate the comparative effectiveness of robot-assisted laparoscopic prostatectomy (RALP) and open radical prostatectomy (ORP) in a multicenter study. MATERIALS AND METHODS We evaluated men with localized prostate cancer at 11 high-volume academic medical centers in the United States from the PROST-QA (2003-2006) and the PROST-QA/RP2 cohorts (2010-2013) with a pre-specified goal of comparing RALP (549) and ORP (545). We measured longitudinal patient-reported health-related quality of life (HRQOL) at pre-treatment and at 2, 6, 12, and 24 months, and pathological and perioperative outcomes/complications. RESULTS Demographics, cancer characteristics, and margin status were similar between surgical approaches. ORP subjects were more likely to undergo lymphadenectomy (89% vs 47%; p <0.01) and nerve sparing (94% vs 89%; p <0.01). RALP vs ORP subjects experienced less mean intraoperative blood loss (192 vs 805 mL; p <0.01), shorter mean hospital stay (1.6 vs 2.1 days; p <0.01), and fewer blood transfusions (1% vs 4%; p <0.01), wound infections (2% vs 4%; p=0.02), other infections (1% vs 4%; p <0.01), deep venous thromboses (0.5% vs 2%; p=0.04), and bladder neck contractures requiring dilation (1.6% vs 8.3%; p <0.01). RALP subjects reported less pain (p=0.04), less activity interference (p <0.01) and higher incision satisfaction (p <0.01). Surgical approach (RALP vs ORP) was not a significant predictor of longitudinal HRQOL change in any HRQOL domain. CONCLUSIONS In high-volume academic centers, RALP and ORP patients may expect similar long-term HRQOL outcomes. Overall, RALP patients have less pain, shorter hospital stays, and fewer post-surgical complications such as blood transfusions, infections, deep venous thromboses, and bladder neck contractures.
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Affiliation(s)
- Peter Chang
- Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Andrew A. Wagner
- Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Meredith M. Regan
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute and Harvard Medical School, Boston
| | - Joseph A. Smith
- Department of Urological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Mark S. Litwin
- Departments of Urology, Health Policy and Management, UCLA Center for Health Sciences, Los Angeles
| | - Jim C. Hu
- Department of Urology, Weill Cornell Medicine, New York, NY
| | | | - Peter R. Carroll
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Eric A. Klein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Adam S. Kibel
- Division of Urology, Brigham and Women’s Hospital and Harvard Medical School
| | | | - Misop Han
- Johns Hopkins University and The Brady Urological Institute, Johns Hopkins University, Baltimore, MD
| | - Alan W. Partin
- Johns Hopkins University and The Brady Urological Institute, Johns Hopkins University, Baltimore, MD
| | | | - Catrina M. Crociani
- Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School
| | | | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Larry A. Hembroff
- Office for Survey Research, Institute for Public Policy and Social Research, Michigan State University, East Lansing, MI
| | - Kyle Davis
- Office for Survey Research, Institute for Public Policy and Social Research, Michigan State University, East Lansing, MI
| | - Linda Stork
- Office for Survey Research, Institute for Public Policy and Social Research, Michigan State University, East Lansing, MI
| | - Daniel E. Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - John T. Wei
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Martin G. Sanda
- Department of Urology, Emory University School of Medicine, Atlanta, GA
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13
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Eyrich NW, Wei JT, Niknafs YS, Siddiqui J, Ellimoottil C, Salami SS, Palapattu GS, Mehra R, Kunju LP, Tomlins SA, Chinnaiyan AM, Morgan TM, Tosoian JJ. Association of MyProstateScore (MPS) with prostate cancer grade in the radical prostatectomy specimen. Urol Oncol 2021; 40:4.e1-4.e7. [PMID: 34753659 DOI: 10.1016/j.urolonc.2021.09.007] [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: 01/23/2021] [Revised: 09/02/2021] [Accepted: 09/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND To evaluate the association between urinary MyProstateScore (MPS) and pathologic grade group (GG) at surgery in men diagnosed with GG1 prostate cancer (PCa) on biopsy. METHODS Using an institutional biospecimen protocol, we identified men with GG1 PCa on biopsy and PSA ≤10 ng/ml who underwent radical prostatectomy (RP) at the University of Michigan. MPS was retrospectively calculated using prospectively collected, post-DRE urine samples. The primary outcome was upgrading on RP pathology, defined as GG ≥ 2. The associations of MPS, PSA, and PSA density (PSAD) with upgrading were assessed on univariable logistic regression, and the predictive accuracy of each marker was estimated by the area under the receiver operating characteristic curve (AUC). RESULTS There were 52 men with urinary specimens available that met study criteria, based on biopsy Gleason Grade and specimen collection. At RP, 17 men (33%) had GG1 cancer and 35 (67%) had GG ≥ 2 cancer. Preoperative MPS was significantly higher in patients with GG ≥ 2 cancer at surgery (median 37.8 [IQR, 22.2-52.4]) as compared to GG1 (19.3 [IQR, 9.2-29.4]; P = 0.001). On univariable logistic regression, increasing MPS values were significantly associated with upgrading (odds ratio 1.07 per one-unit MPS increase, 95% confidence interval 1.02-1.12, P = 0.004), while PSA and PSAD were not significantly associated with upgrading. Similarly, the discriminative ability of the MPS model (AUC 0.78) for upgrading at RP was higher compared to models based on PSA (AUC 0.52) and PSAD (AUC 0.62). CONCLUSIONS In men diagnosed with GG1 PCa who underwent surgery, MPS was significantly associated with RP cancer grade. In this limited cohort of men, these findings suggest that MPS could help identify patients with undetected high-grade cancer. Additional studies are needed to better characterize this association.
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Affiliation(s)
- Nicholas W Eyrich
- Department of Urology, University of Michigan, Ann Arbor, MI; Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - John T Wei
- Department of Urology, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, University of Michigan, Ann Arbor, MI
| | - Yashar S Niknafs
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI
| | - Javed Siddiqui
- Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI
| | - Chad Ellimoottil
- Department of Urology, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Simpa S Salami
- Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | - Ganesh S Palapattu
- Department of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | - Rohit Mehra
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI; Department of Pathology, University of Michigan, Ann Arbor, MI
| | - Lakshmi P Kunju
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI; Department of Pathology, University of Michigan, Ann Arbor, MI
| | - Scott A Tomlins
- Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | - Arul M Chinnaiyan
- Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI; Department of Pathology, University of Michigan, Ann Arbor, MI; Howard Hughes Medical Institute, University of Michigan, Ann Arbor, MI
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | - Jeffrey J Tosoian
- Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI; Department of Urology, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt-Ingram Cancer Center, Nashville, TN.
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14
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Scherr K, Delaney RK, Ubel P, Kahn VC, Hamstra D, Wei JT, Fagerlin A. Preparing Patients with Early Stage Prostate Cancer to Participate in Clinical Appointments Using a Shared Decision Making Training Video. Med Decis Making 2021; 42:364-374. [PMID: 34617827 PMCID: PMC8918874 DOI: 10.1177/0272989x211028563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 11/16/2022]
Abstract
Background Rates of shared decision making (SDM) are relatively low in early stage prostate cancer decisions, as patients’ values are not well integrated into a preference-sensitive treatment decision. The study objectives were to develop a SDM training video, measure usability and satisfaction, and determine the effect of the intervention on preparing patients to participate in clinical appointments. Methods A randomized controlled trial was conducted to compare a plain-language decision aid (DA) to the DA plus a patient SDM training video. Patients with early stage prostate cancer completed survey measures at baseline and after reviewing the intervention materials. Survey items assessed patients’ knowledge, beliefs related to SDM, and perceived readiness/intention to participate in their upcoming clinical appointment. Results Of those randomized to the DA + SDM video group, most participants (91%) watched the video and 93% would recommend the video to others. Participants in the DA + SDM video group, compared to the DA-only group, reported an increased desire to participate in the decision (mean = 3.65 v. 3.39, P < 0.001), less decision urgency (mean = 2.82 v. 3.39, P < 0.001), and improved self-efficacy for communicating with physicians (mean = 4.69 v. 4.50, P = 0.05). These participants also reported increased intentions to seek a referral from a radiation oncologist (73% v. 51%, P = 0.004), to take notes (mean = 3.23 v. 2.86, P = 0.004), and to record their upcoming appointments (mean = 1.79 v. 1.43, P = 0.008). Conclusions A novel SDM training video was accepted by patients and changed several measures associated with SDM. This may be a scalable, cost-effective way to prepare patients with early stage prostate cancer to participate in their clinical appointments.
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Affiliation(s)
- Karen Scherr
- Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
| | - Rebecca K Delaney
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Peter Ubel
- Stanford School of Public Policy, Duke University, Durham, NC, USA
| | - Valerie C Kahn
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Hamstra
- Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, Auburn Hills, MI, USA
| | - John T Wei
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.,Salt Lake City VA Center for Informatics Decision Enhancement and Surveillance (IDEAS), Salt Lake City, UT, USA
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15
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Ni L, Siddiqui J, Udager AM, Jo J, Wei JT, Davenport MS, Carson PL, Fowlkes JB, Wang X, Xu G. Characterizing the aggressiveness of prostate cancer using an all-optical needle photoacoustic sensing probe: feasibility study. Biomed Opt Express 2021; 12:4873-4888. [PMID: 34513230 PMCID: PMC8407826 DOI: 10.1364/boe.430085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 06/13/2023]
Abstract
In our previous studies, we have developed a prototype interstitial needle sensing probe that can acquire broadband A-line photoacoustic (PA) signals encoding both tissue microarchitecture and histochemical information comparable to that accessible by histology. Paving the road toward clinical translation of this technology, we replaced the piezoelectric hydrophone in the needle PA probe with a fiber optic hydrophone that enabled both broader bandwidth and sufficient signal-to-noise ratio (SNR) for PA signal detection. Such an all-optical design also facilitated disposability and significantly reduced the footprint of the needle PA sensing probe. Experiments were performed on well-controlled phantoms and human prostate tissues. The microarchitectures in each sample were quantitatively evaluated by both the nonlinear spectral slope of the PA signal power spectrum and the generalized gamma (GG) parameter a by implementing envelope statistics to the PA signal. In the studies on phantoms containing optically absorbing microspheres with various sizes and concentrations, the nonlinear spectral slope showed a strong correlation of r=-0.80 with the microsphere dimensions, and a relatively weak correlation of r=-0.54 with the microsphere concentrations, while the GG parameter a showed a strong correlation with the microsphere dimensions (r=0.72) and a moderate correlation with the microsphere concentrations (r=0.63). In the studies on human prostate tissues containing progressive cancer stages, both the nonlinear spectral slope and the GG parameter a demonstrated a statistically significant difference between benign and nonaggressive cancer tissues (p<0.01), and between nonaggressive and aggressive cancer tissues (p<0.01). In addition, a multivariate analysis combining the two quantitative measurements demonstrated the boundaries among the different progressive stages of prostate cancer.
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Affiliation(s)
- Linyu Ni
- Department of Biomedical Engineering, University of Michigan, 500 S. State St., Ann Arbor, MI 48109, USA
| | - Javed Siddiqui
- Department of Pathology, University of Michigan, 500 S. State St., Ann Arbor, MI 48109, USA
| | - Aaron M Udager
- Michigan Center for Translational Pathology, Rogel Cancer Center, Department of Pathology, University of Michigan, 500 S. State St., Ann Arbor, MI 48109, USA
| | - Janggun Jo
- Department of Biomedical Engineering, University of Michigan, 500 S. State St., Ann Arbor, MI 48109, USA
| | - John T Wei
- Department of Urology, University of Michigan, 500 S. State St., Ann Arbor, MI 48109, USA
| | - Matthew S Davenport
- Department of Radiology, University of Michigan, 500 S. State St., Ann Arbor, MI 48109, USA
| | - Paul L Carson
- Department of Radiology, University of Michigan, 500 S. State St., Ann Arbor, MI 48109, USA
| | - J Brian Fowlkes
- Department of Radiology, University of Michigan, 500 S. State St., Ann Arbor, MI 48109, USA
| | - Xueding Wang
- Department of Biomedical Engineering, University of Michigan, 500 S. State St., Ann Arbor, MI 48109, USA
- Department of Radiology, University of Michigan, 500 S. State St., Ann Arbor, MI 48109, USA
| | - Guan Xu
- Department of Biomedical Engineering, University of Michigan, 500 S. State St., Ann Arbor, MI 48109, USA
- Department of Ophthalmology and Visual Sciences, Department of Biomedical Engineering, University of Michigan, 500 S. State St., Ann Arbor, MI 48109, USA
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16
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Tosoian JJ, Dunn RL, Niknafs YS, Saha A, Vince RA, St Sauver JL, Jacobson DJ, McGree ME, Siddiqui J, Groskopf J, Jacobsen SJ, Tomlins SA, Kunju LP, Morgan TM, Salami SS, Wei JT, Chinnaiyan AM, Sarma AV. Association of Urinary MyProstateScore, Age, and Prostate Volume in a Longitudinal Cohort of Healthy Men: Long-term Findings from the Olmsted County Study. EUR UROL SUPPL 2021; 29:30-35. [PMID: 34337531 PMCID: PMC8317796 DOI: 10.1016/j.euros.2021.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 11/02/2022] Open
Abstract
Background Serum prostate-specific antigen (PSA), used in prostate cancer screening, is nonspecific for cancer and is affected by age and prostate volume. More specific biomarkers could be more accurate for early detection of prostate cancer and reduce unnecessary prostate biopsies. Objective To evaluate the association of age and prostate volume with urinary MyProstateScore (MPS) in a screened, longitudinal cohort without evidence of prostate cancer. Design setting and participants The Olmsted County Study included men aged 40-79 yr who underwent biennial prostate cancer screening. PSA ≥4.0 ng/ml or abnormal rectal examination triggered prostate biopsy, and patients with cancer were excluded. The remaining men submitted urinary specimens for PCA3 and TMPRSS2:ERG testing. Outcome measurements and statistical analysis MPS was calculated using the validated, locked model for grade group ≥2 cancer that includes serum PSA, urinary PCA3, and urinary TMPRSS2:ERG. The associations of age and volume with biomarkers were assessed in multivariable regression models. The t statistic was used to quantify the strength of associations independent of the unit of measurement, and R 2 values were used to estimate the proportion of biomarker variance explained by each factor. Results and limitations The study included 314 screened men without evidence of cancer. In multivariable models including age and volume, PCA3 score was significantly associated with age (t = 7.51; p < 0.001), while T2:ERG score was not associated with age or volume. MPS was significantly associated with both age (t = 7.45; p < 0.001) and volume (t = 3.56; p < 0.001), but accounting for age alone explained the variability observed (R 2 = 0.29) in a similar way to the model including age and volume (R 2 = 0.31). The variability of PCA3, T2:ERG, and MPS was less dependent on age and volume than the variability for PSA (R 2 = 0.45). Conclusions In a cohort of longitudinally screened men without evidence of cancer, we found that MPS demonstrated less variability with noncancer factors (age, prostate volume) than PSA did. These findings support the biology of these markers as more cancer-specific than PSA and highlight their promise in reducing the morbidity associated with PSA-based screening. Patient summary In a group of men with no evidence of prostate cancer, we found that each of three urine-based markers of cancer-PCA3, T2:ERG, and the commercially available MyProstateScore test-showed less variability with noncancer factors (age and prostate volume) than serum PSA (prostate-specific antigen) did. These findings support their proposed use as noninvasive markers of prostate cancer that could improve the accuracy of early detection.
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Affiliation(s)
- Jeffrey J Tosoian
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Rodney L Dunn
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Yashar S Niknafs
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Anjan Saha
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Randy A Vince
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | | | - Debra J Jacobson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Michaela E McGree
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Javed Siddiqui
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | | | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, CA, USA
| | - Scott A Tomlins
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Lakshmi P Kunju
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.,Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Simpa S Salami
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - John T Wei
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Arul M Chinnaiyan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA.,Department of Pathology, University of Michigan, Ann Arbor, MI, USA.,Howard Hughes Medical Institute, University of Michigan, Ann Arbor, MI, USA
| | - Aruna V Sarma
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.,Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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17
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Fagerlin A, Holmes-Rovner M, Hofer TP, Rovner D, Alexander SC, Knight SJ, Ling BS, A Tulsky J, Wei JT, Hafez K, Kahn VC, Connochie D, Gingrich J, Ubel PA. Head to head randomized trial of two decision aids for prostate cancer. BMC Med Inform Decis Mak 2021; 21:154. [PMID: 33980208 PMCID: PMC8117645 DOI: 10.1186/s12911-021-01505-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 04/26/2021] [Indexed: 11/20/2022] Open
Abstract
Background While many studies have tested the impact of a decision aid (DA) compared to not receiving any DA, far fewer have tested how different types of DAs affect key outcomes such as treatment choice, patient–provider communication, or decision process/satisfaction. This study tested the impact of a complex medical oriented DA compared to a more simplistic decision aid designed to encourage shared decision making in men with clinically localized prostate cancer.
Methods 1028 men at 4 VA hospitals were recruited after a scheduled prostate biopsy. Participants completed baseline measures and were randomized to receive either a simple or complex DA. Participants were men with clinically localized cancer (N = 285) by biopsy and who completed a baseline survey. Survey measures: baseline (biopsy); immediately prior to seeing the physician for biopsy results (pre- encounter); one week following the physician visit (post-encounter). Outcome measures included treatment preference and treatment received, knowledge, preference for shared decision making, decision making process, and patients’ use and satisfaction with the DA. Results Participants who received the simple DA had greater interest in shared decision making after reading the DA (p = 0.03), found the DA more helpful (p’s < 0.01) and were more likely to be considering watchful waiting (p = 0.03) compared to those receiving the complex DA at Time 2. While these differences were present before patients saw their urologists, there was no difference between groups in the treatment patients received.
Conclusions The simple DA led to increased desire for shared decision making and for less aggressive treatment. However, these differences disappeared following the physician visit, which appeared to change patients’ treatment preferences. Trial registration This trial was pre-registered prior to recruitment of participants. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01505-x.
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Affiliation(s)
- Angela Fagerlin
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA. .,Department of Population Health Sciences, University of Utah, 295 Chipeta Way Rm 1S105, Salt Lake City, UT, 84132, USA.
| | - Margaret Holmes-Rovner
- Center for Ethics and Department of Medicine, Michigan State University, East Lansing, MI, USA
| | - Timothy P Hofer
- Ann Arbor VA HSR&D Center for Practice Management and Outcomes Research, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - David Rovner
- Center for Ethics and Department of Medicine, Michigan State University, East Lansing, MI, USA
| | | | - Sara J Knight
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA.,Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Bruce S Ling
- Department of Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - John T Wei
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Khaled Hafez
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Valerie C Kahn
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, USA
| | - Daniel Connochie
- Ann Arbor VA HSR&D Center for Practice Management and Outcomes Research, Ann Arbor, MI, USA
| | - Jeffery Gingrich
- Division of Urology, Department of Surgery, Duke University, Durham, NC, USA
| | - Peter A Ubel
- Sanford School of Public Policy, Duke University, Durham, NC, USA.,Fuqua School of Business, Duke University, Durham, USA
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18
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Osawa T, Wei JT, Abe T, Honda M, Rew KT, Dunn R, Yamada S, Furumido J, Kikuchi H, Matsumoto R, Sato Y, Harabayashi T, Takada N, Minami K, Morita K, Kashiwagi A, Fukuhara S, Murai S, Ito YM, Ogasawara K, Shinohara N. Comparison of Health-Related Quality of Life Between Japanese and American Patients with Bladder Cancer as Measured by a Newly Developed Japanese Version of the Bladder Cancer Index. Bladder Cancer 2021. [DOI: 10.3233/blc-200359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION: The aim of this study is to characterize health related quality of life (HRQOL) in Japanese patients after bladder cancer surgery and to perform cross-cultural comparison between Japanese and American patients. METHODS: Firstly, we cross-sectionally assessed HRQOL of 371 patients in Japan using the Bladder Cancer Index (BCI-Japanese). HRQOL of the four groups of patients (native bladder without intravesical therapy, native bladder with intravesical therapy, cystectomy with ileal conduit, and cystectomy with neobladder) were assessed. Secondly, we compared the Japanese with the American cohort (n = 315) from the original BCI paper. After adjusting for age and gender, the differences in each BCI subdomain score was analyzed. RESULTS: Among Japanese patients, the urinary domain function score was significantly lower among the cystectomy with neobladder group, compared to the cystectomy with ileal conduit group (p < 0. 01). Despite this, the urinary bother was comparable between the two groups. Although there were apparent differences between Japanese and American patients, there were few differences in Urinary and Bowel HRQOL. In three of the four treatment groups (other than native bladder with intravesical therapy), Japanese patients were more likely than Americans to report poor sexual function (p < 0.05). However, Japanese patients were less likely than Americans to be bothered by their lower sexual function, regardless of treatment (p < 0.05). CONCLUSIONS: HRQOL outcomes following treatment of bladder cancer in Japan are comparable to those in the USA, except for sexual functioning and sexual bother. The BCI can be used for cross-cultural assessments of HRQOL in bladder cancer patients.
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Affiliation(s)
- Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - John T. Wei
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Michitaka Honda
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Karl T. Rew
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Rod Dunn
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Shuhei Yamada
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Jun Furumido
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroshi Kikuchi
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ryuji Matsumoto
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yasuyuki Sato
- Department of Urology, Keiyukai Hospital, Sapporo, Japan
| | | | - Norikata Takada
- Department of Urology, Hokkaido Cancer Center, Sapporo, Japan
| | - Keita Minami
- Department of Urology, Sapporo City General Hospital, Sapporo, Japan
| | - Ken Morita
- Department of Urology, Kushiro City General Hospital, Kushiro, Japan
| | - Akira Kashiwagi
- Department of Urology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Shunichi Fukuhara
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University, Kyoto, Japan
- Department of General Medicine, Shirakawa STAR, Fukushima Medical University, Fukushima, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yoichi M. Ito
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan
| | | | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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19
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Jo J, Siddiqui J, Zhu Y, Ni L, Kothapalli SR, Tomlins SA, Wei JT, Keller ET, Udager AM, Wang X, Xu G. Photoacoustic spectral analysis at ultraviolet wavelengths for characterizing the Gleason grades of prostate cancer. Opt Lett 2020; 45:6042-6045. [PMID: 33137064 PMCID: PMC7687867 DOI: 10.1364/ol.409249] [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] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/23/2020] [Indexed: 06/11/2023]
Abstract
The diagnosis of aggressive prostate cancer (PCa) has relied on microscopic architectures, namely Gleason patterns, of tissues extracted through core biopsies. Technology capable of assessing the tissue architecture without tissue extraction will reduce the invasiveness of PCa diagnosis and improve diagnostic accuracy by allowing for more sampling locations. Our recently developed photoacoustic spectral analysis (PASA) has achieved quantification of tissue architectural heterogeneity interstitially. Taking advantage of the unique optical absorption of cell nuclei at ultraviolet (UV) wavelengths, this study investigated PASA at 266 nm for quantifying the tissue architecture heterogeneity in prostates. The results have shown significant differences among the normal, early cancer, and late cancer stages in mouse prostates ex vivo and in vivo (n=20, p<0.05). The study with human samples ex vivo has shown a correlation of 0.80 (n=11, p<0.05) between PASA quantification and pathologic diagnosis.
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Affiliation(s)
- Janggun Jo
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | - Javed Siddiqui
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | - Yunhao Zhu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | - Linyu Ni
- Department of Biomedical Engineering, Pennsylvania State University, University Park, Pennsylvania, 16802, USA
| | | | - Scott A. Tomlins
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | - John T Wei
- Department of Urology, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | - Evan T. Keller
- Department of Urology, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | - Aaron M. Udager
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, 48109, USA
- Michigan Center for Translational Pathology, Ann Arbor, MI, 48109, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Xueding Wang
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | - Guan Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, 48109, USA
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, 48109, USA
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20
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Punjani N, Hayden RP, Cai PY, Wei JT, Siddiqui J, Dudley VL, Feliciano M, Goldstein M. PCA3 AND TMPRSS:ERG ASSESSMENT IN SEMEN: RESULTS OF A PHASE I STUDY. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.1143] [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: 10/23/2022]
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21
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Osawa T, Wei JT, Abe T, Honda M, Yamada S, Furumido J, Kikuchi H, Matsumoto R, Hirakawa K, Sato Y, Sasaki Y, Harabayashi T, Takada N, Minami K, Tanaka H, Morita K, Kashiwagi A, Miyajima N, Akino T, Murai S, Ito YM, Fukuhara S, Ogasawara K, Shinohara N. Health-related quality of life in Japanese patients with bladder cancer measured by a newly developed Japanese version of the Bladder Cancer Index. Int J Clin Oncol 2020; 25:2090-2098. [PMID: 32833102 PMCID: PMC7677272 DOI: 10.1007/s10147-020-01770-2] [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: 06/08/2020] [Accepted: 08/11/2020] [Indexed: 11/12/2022]
Abstract
Introduction We validated a Japanese version of the Bladder Cancer Index (BCI) as a tool for measuring health-related quality of life (HRQOL) in bladder cancer patients treated with various surgical procedures. Methods The reliability and validity of the Japanese BCI were examined in 397 Japanese patients with bladder cancer via cross-sectional analysis. The patients simultaneously completed the Short Form (SF)-12, EQ-5D, and the Functional Assessment of Cancer Therapy-General and Bladder (FACT-G and FACT-BL). The differences in BCI subscales among various treatment groups were analyzed. Results This study involved 397 patients (301 males and 96 females), with a mean age of 70 years and a median disease duration of 29 months (IQR: 12–66 months). Of these patients, 221 underwent transurethral resection of a bladder tumor, and 176 patients underwent radical cystectomy (ileal conduit: 101 patients, ileal neobladder: 49, and ureterostomy: 26). Cronbach’s alpha coefficient was ≥ 0.78 for all subscales, except the bowel bother subscale. Despite moderate correlations being detected between the function and bother score in urinary and bowel domains, the sexual function score was inversely correlated with the sexual bother score (r = − 0.19). A missing value percentage of > 15% was associated with old age (p < 0.05). The mean domain scores differed significantly among distinct clinically relevant treatment groups. Conclusions Although revisions are needed to make it easier for elderly patients to comprehend, we confirmed the reliability and validity of the Japanese BCI. The Japanese BCI could be used for cross-cultural assessments of HRQOL in bladder cancer patients. Electronic supplementary material The online version of this article (10.1007/s10147-020-01770-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - John T Wei
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Michitaka Honda
- Department Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Shuhei Yamada
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Jun Furumido
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroshi Kikuchi
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ryuji Matsumoto
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | - Yasuyuki Sato
- Department of Urology, Keiyukai Hospital, Sapporo, Japan
| | | | | | - Norikata Takada
- Department of Urology, Hokkaido Cancer Center, Sapporo, Japan
| | - Keita Minami
- Department of Urology, Sapporo City General Hospital, Sapporo, Japan
| | - Hiroshi Tanaka
- Department of Urology, Sapporo City General Hospital, Sapporo, Japan
| | - Ken Morita
- Department of Urology, Kushiro City General Hospital, Kushiro, Japan
| | - Akira Kashiwagi
- Department of Urology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Naoto Miyajima
- Department of Urology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Tomoshige Akino
- Department of Urology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yoichi M Ito
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan
| | - Shunichi Fukuhara
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University, Kyoto, Japan.,Department of General Medicine, Shirakawa STAR, Fukushima Medical University, Fukushima, Japan
| | | | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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22
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Lebastchi AH, Russell CM, Niknafs YS, Eyrich NW, Chopra Z, Botbyl R, Kabeer R, Osawa T, Siddiqui J, Siddiqui R, Davenport MS, Mehra R, Tomlins SA, Kunju LP, Chinnaiyan AM, Wei JT, Tosoian JJ, Morgan TM. Impact of the MyProstateScore (MPS) Test on the Clinical Decision to Undergo Prostate Biopsy: Results From a Contemporary Academic Practice. Urology 2020; 145:204-210. [PMID: 32777370 DOI: 10.1016/j.urology.2020.07.042] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/03/2020] [Accepted: 07/27/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate the association of the MyProstateScore (MPS) urine test on the decision to undergo biopsy in men referred for prostate biopsy in urology practice. METHODS MPS testing was offered as an alternative to immediate biopsy in men referred to the University of Michigan for prostate biopsy from October 2013 through October 2016. The primary endpoint was the decision to perform biopsy. The proportion of patients undergoing biopsy was compared to predicted risk scores from the Prostate Cancer Prevention Trial risk calculator (PCPTrc). Analyses were stratified by the use of multiparametric magnetic resonance imaging (mpMRI). The associations of PCPTrc, MPS, and mpMRI with the decision to undergo biopsy were explored in a multivariable logistic regression model. RESULTS Of 248 patients, 134 (54%) proceeded to prostate biopsy. MPS was significantly higher in biopsied patients (median 29 vs14, P < .001). The use of biopsy was strongly associated with MPS, with biopsy rates of 26%, 38%, 58%, 90%, and 85% in the first through fifth quintiles, respectively (P < .001). MPS association with biopsy persisted upon stratification by mpMRI. On multivariable analysis, MPS was strongly associated with the decision to undergo biopsy when modeled as both a continuous (odds ratio [OR] 1.05, 95%; confidence interval [CI] 1.04-1.08; <.001) and binary (OR 7.76, 95%; CI 4.14-14.5; P < .001) variable. CONCLUSION Many patients (46%) undergoing clinical MPS testing as an alternative to immediate prostate biopsy were able to avoid biopsy. Increasing MPS was strongly associated with biopsy rates. These findings were robust to use of mpMRI.
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Affiliation(s)
| | | | - Yashar S Niknafs
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI
| | | | - Zoey Chopra
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI
| | - Rachel Botbyl
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI
| | - Rana Kabeer
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Takahiro Osawa
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Javed Siddiqui
- Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI
| | - Rabia Siddiqui
- Department of Urology, University of Michigan, Ann Arbor, MI
| | | | - Rohit Mehra
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI; Department of Pathology, University of Michigan, Ann Arbor, MI
| | - Scott A Tomlins
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI; Department of Pathology, University of Michigan, Ann Arbor, MI
| | - Lakshimi P Kunju
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI; Department of Pathology, University of Michigan, Ann Arbor, MI
| | - Arul M Chinnaiyan
- Department of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI; Department of Pathology, University of Michigan, Ann Arbor, MI; Howard Hughes Medical Institute, University of Michigan, Ann Arbor, MI
| | - John T Wei
- Department of Urology, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, University of Michigan, Ann Arbor, MI
| | - Jeffrey J Tosoian
- Department of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI.
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI
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23
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Marchetti* KA, George A, Wei JT, Ferrante S, Hearn J, Spratt D, Herrel LA. PD30-11 INITIAL PATIENT REPORTED OUTCOMES FOR MEN WITH PROSTATE CANCER UNDERGOING RECTAL HYDROGEL SPACER PLACEMENT UNDER LOCAL ANESTHESIA. J Urol 2020. [DOI: 10.1097/ju.0000000000000894.011] [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: 11/25/2022]
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24
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Osawa T, Wei JT, Abe T, Kako Y, Murai S, Shinohara N. Development of the Japanese version of the health-related quality of life questionnaire for bladder cancer patients using the Bladder Cancer Index: A pilot study. Int J Urol 2019; 26:1016-1017. [PMID: 31311062 DOI: 10.1111/iju.14073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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)
- Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - John T Wei
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Yuki Kako
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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25
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Cani AK, Hu K, Siddiqui J, Han S, Hovelson DH, Liu CJ, Salami SS, Palapattu GS, Morgan TM, Wei JT, Chinnaiyan AM, Tomlins SA. Abstract 914: Development of a whole-urine, next-generation sequencing-based assay for early detection of aggressive prostate cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Despite advances in biomarker development, early detection of aggressive prostate cancer (PCa) remains challenging. Existing biomarkers show modest improvement over models based on serum prostate specific antigen (PSA). We have previously developed a clinical-grade laboratory-developed test, named MiProstate Score (MiPS), for individualized risk prediction of aggressive prostate cancer. It uses transcription-mediated amplification to quantify the gene-fusion TMPRSS2:ERG (T2:ERG) (T1E4 splice isoform) and the lncRNA PCA3 from whole-urine obtained after a digital rectal exam (DRE), combined with serum PSA. To improve MiPS, we describe here the pre-clinical development and validation of a targeted next generation sequencing assay (NGS-MiPS) using post-DRE urine RNA to asses ~90 PCa transcriptomic biomarkers. These include those in MiPS as well as many isoforms of common PCa gene fusions, mRNA, and lncRNA candidate biomarkers nominated by our large-scale PCa tissue RNAseq and other sources. We have obtained a 98% informative sample rate from 2.5 mL of urine and high technical reproducibility (Pearson r=0.99). Risk scores for having PCa [or high-grade PCa (Gleason Score >6)] on biopsy, as determined by clinical MiPS vs. the clinical MiPS model using NGS data, were highly concordant, Pearson’s r=0.74 (and r=0.81). Urine from patients with benign or Gleason 6 vs. Gleason ≥ 4+3=7 cancer on biopsy (extreme design) showed expected differences in the levels of T2:ERG T1E4 (p=0.00003) and PCA3 (p=0.07), with additional T2:ERG splice isoforms and other biomarkers also being significantly different between low vs. high grade cancer. Feature selection and logistic regression trained in an extreme design cohort (n=73) yielded a 29-transcript model that outperformed MiPS and serum PSA in two validation cohorts: 1. A held-out set from the extreme design cohort n=36, AUC 0.81 vs. 0.76 and 0.63 respectively; 2. A separate active surveillance cohort n=45, AUCs 0.66 vs. 0.56 and 0.53 respectively. These results support the potential utility of our urine based targeted NGS assay to supplement serum PSA for the early detection of aggressive prostate cancer.
Citation Format: Andi K. Cani, Kevin Hu, Javed Siddiqui, Sumin Han, Daniel H. Hovelson, Chia-Jen Liu, Simpa S. Salami, Ganesh S. Palapattu, Todd M. Morgan, John T. Wei, Arul M. Chinnaiyan, Scott A. Tomlins. Development of a whole-urine, next-generation sequencing-based assay for early detection of aggressive prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 914.
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Affiliation(s)
| | - Kevin Hu
- University of Michigan, Ann Arbor, MI
| | | | - Sumin Han
- University of Michigan, Ann Arbor, MI
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26
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MacKinnon N, Ge W, Han P, Siddiqui J, Wei JT, Raghunathan T, Chinnaiyan AM, Rajendiran TM, Ramamoorthy A. NMR-Based Metabolomic Profiling of Urine: Evaluation for Application in Prostate Cancer Detection. Nat Prod Commun 2019. [DOI: 10.1177/1934578x19849978] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Detection of prostate cancer (PCa) and distinguishing indolent versus aggressive forms of the disease is a critical clinical challenge. The current clinical test is circulating prostate-specific antigen levels, which faces particular challenges in cancer diagnosis in the range of 4 to 10 ng/mL. Thus, a concerted effort toward building a noninvasive biomarker panel has developed. In this report, the hypothesis that nuclear magnetic resonance (NMR)-derived metabolomic profiles measured in the urine of biopsy-negative versus biopsy-positive individuals would nominate a selection of potential biomarker signals was investigated. 1H NMR spectra of urine samples from 317 individuals (111 biopsy-negative, 206 biopsy-positive) were analyzed. A double cross-validation partial least squares-discriminant analysis modeling technique was utilized to nominate signals capable of distinguishing the two classes. It was observed that after variable selection protocols were applied, a subset of 29 variables produced an area under the curve (AUC) value of 0.94 after logistic regression analysis, whereas a “master list” of 18 variables produced a receiver operating characteristic ROC) AUC of 0.80. As proof of principle, this study demonstrates the utility of NMR-based metabolomic profiling of urine biospecimens in the nomination of PCa-specific biomarker signals and suggests that further investigation is certainly warranted.
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Affiliation(s)
- Neil MacKinnon
- Biophysics, University of Michigan, Ann Arbor, MI, USA
- Department of Chemistry, University of Michigan, Ann Arbor, MI, USA
| | - Wencheng Ge
- Department of Chemistry, University of Michigan, Ann Arbor, MI, USA
| | - Peisong Han
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Javed Siddiqui
- Michigan Center for Translational Pathology, Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - John T. Wei
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
- Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Trivellore Raghunathan
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Arul M. Chinnaiyan
- Michigan Center for Translational Pathology, Department of Pathology, University of Michigan, Ann Arbor, MI, USA
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
- Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI, USA
- Howard Hughes Medical Institute, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Thekkelnaycke M. Rajendiran
- Michigan Center for Translational Pathology, Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Ayyalusamy Ramamoorthy
- Biophysics, University of Michigan, Ann Arbor, MI, USA
- Department of Chemistry, University of Michigan, Ann Arbor, MI, USA
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27
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Kirk PS, Borza T, Dupree JM, Wei JT, Ellimoottil C, Caram MEV, Burkhardt M, Heidelbaugh JJ, Hollenbeck BK, Skolarus TA. Potential Savings in Medicare Part D for Common Urological Conditions. Urol Pract 2018; 5:351-359. [PMID: 30555855 DOI: 10.1016/j.urpr.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction Millions of patients take prescription medications each year for common urological conditions. Generic and brand-name drugs have widely divergent pricing despite similar therapeutic benefit and side effect profiles. We examined prescribing patterns across provider types for generic and brand-name drugs used to treat 3 common urological conditions, and estimated economic implications for Medicare Part D spending. Methods We extracted 2014 prescription claims and payments from Medicare Part D and categorized oral medications used to treat 3 urological conditions, namely benign prostatic hyperplasia, erectile dysfunction and overactive bladder. We examined claims and payments for each medication among urologists and nonurologists. Lastly, we estimated potential savings by selecting a low cost or generic drug as a cost comparator for each class. Results There were significant differences in prescribing patterns across these conditions, with urologists prescribing more brand-name and expensive medications (p <0.001). The total potential savings related to prescriptions of more expensive and nongeneric drugs in 2014 was $1 billion (benign prostatic hyperplasia $348,454,910, erectile dysfunction $10,211,914 and overactive bladder $698,130,833). These potential savings comprised 53% of the total spending for these medications in 2014. Conclusions Within Medicare Part D the potential savings associated with generic substitution for higher cost and nongeneric drugs for 3 common urological conditions surpassed $1 billion, with urologists more likely to prescribe brand-name and more expensive drugs. Increasing low cost and generic drug use where available evidence of efficacy is equivocal represents a promising policy target to optimize prescription drug spending.
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Affiliation(s)
- Peter S Kirk
- Dow Division of Health Services Research, Department of Urology, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Tudor Borza
- Dow Division of Health Services Research, Department of Urology, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - James M Dupree
- Dow Division of Health Services Research, Department of Urology, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - John T Wei
- Dow Division of Health Services Research, Department of Urology, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Chad Ellimoottil
- Dow Division of Health Services Research, Department of Urology, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Megan E V Caram
- Division of Hematology & Oncology, Department of Internal Medicine, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Mary Burkhardt
- University of Michigan Health System, Pharmacy Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Joel J Heidelbaugh
- Department of Family Medicine, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Brent K Hollenbeck
- Dow Division of Health Services Research, Department of Urology, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Ted A Skolarus
- Dow Division of Health Services Research, Department of Urology VA Ann Arbor Healthcare System, Ann Arbor, Michigan, VA Health Services Research & Development Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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28
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Huang S, Qin Y, Chen Y, Pan J, Xu C, Wu D, Chao WY, Wei JT, Tomlins SA, Wang X, Fowlkes JB, Carson PL, Cheng Q, Xu G. Interstitial assessment of aggressive prostate cancer by physio-chemical photoacoustics: An ex vivo study with intact human prostates. Med Phys 2018; 45:10.1002/mp.13061. [PMID: 29935081 PMCID: PMC6629517 DOI: 10.1002/mp.13061] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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] [Received: 09/28/2017] [Revised: 04/24/2018] [Accepted: 06/10/2018] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Transrectal ultrasound (TRUS)-guided biopsy is the standard procedure for evaluating the presence and aggressiveness of prostate cancer. TRUS biopsy involves tissue removal, and suffers from low core yield as well as high false negative rate. A less invasive and more accurate diagnostic procedure for prostate cancer is therefore highly desired. Combining the optical sensitivity and ultrasonic resolution to resolve the spatial distribution of the major molecular components in tissue, photoacoustic (PA) technology could be an alternative approach for the diagnosis of prostate cancer. The purpose of this study was to examine the feasibility of identifying aggressive prostate cancer using interstitial PA measurements. METHODS Seventeen patients with prebiopsy magnetic resonance imaging (MRI), TRUS biopsies, and planned prostatectomies were enrolled in this study. The interstitial PA measurements were achieved using our recently developed needle PA probe, which was inserted into the ex vivo prostates in the fashion of a biopsy needle. A total of 70 interstitial PA measurements were acquired. The PA measurements were quantified by a previously established PA physio-chemical analysis (PAPCA) method. The histology has confirmed the nonaggressive and aggressive cancerous conditions at the insertion locations. The diagnostic accuracy was also compared to that provided by the prebiopsy MRI. RESULTS The quantitative study shows significant differences between the individual parameters of the nonaggressive and the aggressive cancerous regions (P < 0.005). Multivariate analysis of the quantitative features achieved a diagnostic accuracy of 78.6% for differentiating nonaggressive and aggressive prostate cancer tissues. CONCLUSIONS The proposed procedure has shown promises in the diagnosis of aggressive prostate cancer.
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Affiliation(s)
- Shengsong Huang
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Yu Qin
- Institute of Acoustics, School of Physics Science and Engineering, Tongji University, Shanghai 200092, China
| | - Yingna Chen
- Institute of Acoustics, School of Physics Science and Engineering, Tongji University, Shanghai 200092, China
| | - Jing Pan
- Institute of Acoustics, School of Physics Science and Engineering, Tongji University, Shanghai 200092, China
| | - Chengdang Xu
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Denglong Wu
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Wan-Yu Chao
- Faculty of Science, University of Western Ontario, London, ON N6A 3K7, Canada
| | - John T. Wei
- Departement of Urology, University of Michigan, Ann Arbor, 48109, USA
| | - Scott A. Tomlins
- Departement of Pathology, University of Michigan, Ann Arbor, 48109, USA
| | - Xueding Wang
- Departement of Radiology, University of Michigan, Ann Arbor, 48109, USA
- Departement of Biomedical Engineering, University of Michigan, Ann Arbor, 48109, USA
| | - J. Brian Fowlkes
- Departement of Radiology, University of Michigan, Ann Arbor, 48109, USA
| | - Paul L. Carson
- Departement of Radiology, University of Michigan, Ann Arbor, 48109, USA
| | - Qian Cheng
- Institute of Acoustics, School of Physics Science and Engineering, Tongji University, Shanghai 200092, China
| | - Guan Xu
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
- Departement of Radiology, University of Michigan, Ann Arbor, 48109, USA
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29
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Zhang Y, Pitchiaya S, Cieślik M, Niknafs YS, Tien JCY, Hosono Y, Iyer MK, Yazdani S, Subramaniam S, Shukla SK, Jiang X, Wang L, Liu TY, Uhl M, Gawronski AR, Qiao Y, Xiao L, Dhanasekaran SM, Juckette KM, Kunju LP, Cao X, Patel U, Batish M, Shukla GC, Paulsen MT, Ljungman M, Jiang H, Mehra R, Backofen R, Sahinalp CS, Freier SM, Watt AT, Guo S, Wei JT, Feng FY, Malik R, Chinnaiyan AM. Analysis of the androgen receptor-regulated lncRNA landscape identifies a role for ARLNC1 in prostate cancer progression. Nat Genet 2018; 50:814-824. [PMID: 29808028 PMCID: PMC5980762 DOI: 10.1038/s41588-018-0120-1] [Citation(s) in RCA: 160] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/23/2018] [Indexed: 12/23/2022]
Abstract
The androgen receptor (AR) plays a critical role in the development of the normal prostate as well as prostate cancer. Using an integrative transcriptomic analysis of prostate cancer cell lines and tissues, we identified ARLNC1 (AR-regulated long non-coding RNA 1) as an important long non-coding RNA that is strongly associated with AR signaling in prostate cancer progression. Not only was ARLNC1 induced by AR protein, ARLNC1 stabilized the AR transcript via RNA-RNA interaction. ARLNC1 knockdown suppressed AR expression, global AR signaling, and prostate cancer growth in vitro and in vivo. Taken together, these data support a role for ARLNC1 in maintaining a positive feedback loop that potentiates AR signaling during prostate cancer progression, and identifies ARLNC1 as a novel therapeutic target.
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Affiliation(s)
- Yajia Zhang
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA.,Department of Pathology, University of Michigan, Ann Arbor, MI, USA.,Molecular and Cellular Pathology Program, University of Michigan, Ann Arbor, MI, USA.,Department of Computational Medicine and Bioinformatics, Ann Arbor, MI, USA
| | - Sethuramasundaram Pitchiaya
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA.,Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Marcin Cieślik
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA.,Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Yashar S Niknafs
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA.,Department of Cellular and Molecular Biology, University of Michigan, Ann Arbor, MI, USA
| | - Jean C-Y Tien
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA.,Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Yasuyuki Hosono
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Matthew K Iyer
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA.,Department of Computational Medicine and Bioinformatics, Ann Arbor, MI, USA
| | - Sahr Yazdani
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Shruthi Subramaniam
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Sudhanshu K Shukla
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA.,Department of Biosciences and Bioengineering, Indian Institute of Technology Dharwad, Dharwad, India
| | - Xia Jiang
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Lisha Wang
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Tzu-Ying Liu
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Michael Uhl
- Department of Computer Science and Centre for Biological Signaling Studies (BIOSS), University of Freiburg, Freiburg, Germany
| | - Alexander R Gawronski
- School of Computing Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Yuanyuan Qiao
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA.,Department of Pathology, University of Michigan, Ann Arbor, MI, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Lanbo Xiao
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Saravana M Dhanasekaran
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA.,Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Kristin M Juckette
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Lakshmi P Kunju
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA.,Department of Pathology, University of Michigan, Ann Arbor, MI, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Xuhong Cao
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA.,Howard Hughes Medical Institute, University of Michigan, Ann Arbor, MI, USA
| | - Utsav Patel
- New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Mona Batish
- New Jersey Medical School, Rutgers University, Newark, NJ, USA.,Department of Medical Laboratory Sciences, University of Delaware, Newark, DE, USA
| | - Girish C Shukla
- Department of Biological, Geological and Environmental Sciences, Center for Gene Regulation in Health and Disease, Cleveland State Univesity, Cleveland, OH, USA
| | - Michelle T Paulsen
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.,Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Mats Ljungman
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.,Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Hui Jiang
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Rohit Mehra
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.,Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Rolf Backofen
- Department of Computer Science and Centre for Biological Signaling Studies (BIOSS), University of Freiburg, Freiburg, Germany
| | - Cenk S Sahinalp
- School of Informatics and Computing, Indiana University, Bloomington, IN, USA.,Vancouver Prostate Centre, Vancouver, British Columbia, Canada
| | | | | | | | - John T Wei
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Felix Y Feng
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.,Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.,Breast Oncology Program, University of Michigan, Ann Arbor, MI, USA.,Departments of Radiation Oncology, Urology, and Medicine, Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, CA, USA
| | - Rohit Malik
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA.,Bristol-Myers Squibb, Princeton, NJ, USA
| | - Arul M Chinnaiyan
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA. .,Department of Pathology, University of Michigan, Ann Arbor, MI, USA. .,Department of Computational Medicine and Bioinformatics, Ann Arbor, MI, USA. .,Department of Cellular and Molecular Biology, University of Michigan, Ann Arbor, MI, USA. .,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA. .,Howard Hughes Medical Institute, University of Michigan, Ann Arbor, MI, USA. .,Department of Urology, University of Michigan, Ann Arbor, MI, USA.
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Russell CM, Ghani KR, Linsell S, Qi J, Wei JT. MP40-01 EVALUATION OF PRE-BIOPSY RECTAL SWABS, AUGMENTED ANTIBIOTICS, AND FORMALIN NEEDLE DISINFECTION ON RATES OF TRANSRECTAL PROSTATE BIOPSY COMPLICATIONS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lee M, Siddiqui J, Wei JT, Palapattu GS, Chinnaiyan AM, Tomlins SA, Salami SS. MP35-19 ASSOCIATION OF URINARY PCA3 AND TMPRSS2:ERG RISK GROUPS WITH DETECTION OF PROSTATE CANCER AT REPEAT BIOPSY IN MEN WITH AN INITIAL NEGATIVE PROSTATE BIOPSY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Schuster TG, Wei JT, Hendlin K, Jahnke R, Roberts WW. Histotripsy Treatment of Benign Prostatic Enlargement Using the Vortx R x System: Initial Human Safety and Efficacy Outcomes. Urology 2018; 114:184-187. [DOI: 10.1016/j.urology.2017.12.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/02/2017] [Accepted: 12/28/2017] [Indexed: 10/18/2022]
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Barnett CL, Davenport MS, Montgomery JS, Wei JT, Montie JE, Denton BT. Cost‐effectiveness of magnetic resonance imaging and targeted fusion biopsy for early detection of prostate cancer. BJU Int 2018; 122:50-58. [DOI: 10.1111/bju.14151] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Christine L. Barnett
- Department of Industrial and Operations Engineering University of Michigan Ann Arbor MI USA
| | | | | | - John T. Wei
- Department ofUrology University of Michigan Ann Arbor MI USA
| | - James E. Montie
- Department ofUrology University of Michigan Ann Arbor MI USA
| | - Brian T. Denton
- Department of Industrial and Operations Engineering University of Michigan Ann Arbor MI USA
- Department ofUrology University of Michigan Ann Arbor MI USA
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Golan R, Bernstein A, Sedrakyan A, Daskivich TJ, Du DT, Ehdaie B, Fisher B, Gorin MA, Grunberger I, Hunt B, Jiang HH, Kim HL, Marinac-Dabic D, Marks LS, McClure TD, Montgomery JS, Parekh DJ, Punnen S, Scionti S, Viviano CJ, Wei JT, Wenske S, Wysock JS, Rewcastle J, Carol M, Oczachowski M, Hu JC. Development of a Nationally Representative Coordinated Registry Network for Prostate Ablation Technologies. J Urol 2018; 199:1488-1493. [PMID: 29307684 DOI: 10.1016/j.juro.2017.12.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2016] [Indexed: 10/18/2022]
Abstract
PURPOSE The accumulation of data through a prospective, multicenter coordinated registry network is a practical way to gather real world evidence on the performance of novel prostate ablation technologies. Urological oncologists, targeted biopsy experts, industry representatives and representatives of the FDA (Food and Drug Administration) convened to discuss the role, feasibility and important data elements of a coordinated registry network to assess new and existing prostate ablation technologies. MATERIALS AND METHODS A multiround Delphi consensus approach was performed which included the opinion of 15 expert urologists, representatives of the FDA and leadership from high intensity focused ultrasound device manufacturers. Stakeholders provided input in 3 consecutive rounds with conference calls following each round to obtain consensus on remaining items. Participants agreed that these elements initially developed for high intensity focused ultrasound are compatible with other prostate ablation technologies. Coordinated registry network elements were reviewed and supplemented with data elements from the FDA common study metrics. RESULTS The working group reached consensus on capturing specific patient demographics, treatment details, oncologic outcomes, functional outcomes and complications. Validated health related quality of life questionnaires were selected to capture patient reported outcomes, including the IIEF-5 (International Index of Erectile Function-5), the I-PSS (International Prostate Symptom Score), the EPIC-26 (Expanded Prostate Cancer Index Composite-26) and the MSHQ-EjD (Male Sexual Health Questionnaire for Ejaculatory Dysfunction). Group consensus was to obtain followup multiparametric magnetic resonance imaging and prostate biopsy approximately 12 months after ablation with additional imaging or biopsy performed as clinically indicated. CONCLUSIONS A national prostate ablation coordinated registry network brings forth vital practice pattern and outcomes data for this emerging treatment paradigm in the United States. Our multiple stakeholder consensus identifies critical elements to evaluate new and existing energy modalities and devices.
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Affiliation(s)
- Ron Golan
- Department of Urology, New York Presbyterian-Weill Cornell Medical College, New York, New York
| | - Adrien Bernstein
- Department of Urology, New York Presbyterian-Weill Cornell Medical College, New York, New York
| | - Art Sedrakyan
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
| | | | - Dongyi T Du
- Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, Maryland
| | - Behfar Ehdaie
- Urology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Benjamin Fisher
- Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, Maryland
| | - Michael A Gorin
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ivan Grunberger
- Division of Urology, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York
| | - Bradley Hunt
- Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, Maryland
| | - Hongying H Jiang
- Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, Maryland
| | - Hyung L Kim
- Division of Urology, Cedars Sinai Medical Center, Los Angeles, California
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, Maryland
| | - Leonard S Marks
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Timothy D McClure
- Department of Urology, New York Presbyterian-Weill Cornell Medical College, New York, New York
| | | | - Dipen J Parekh
- Department of Urology, University of Miami, Miami, Florida
| | - Sanoj Punnen
- Department of Urology, University of Miami, Miami, Florida
| | | | - Charles J Viviano
- Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, Maryland
| | - John T Wei
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Sven Wenske
- Department of Urology, New York Presbyterian-Columbia University Medical Center, New York, New York
| | - James S Wysock
- Department of Urology, New York University Langone Medical Center, New York, New York
| | - John Rewcastle
- Department of Urology, University of Southern California, Los Angeles, California
| | - Mark Carol
- SonaCare Medical, Charlotte, North Carolina
| | | | - Jim C Hu
- Department of Urology, New York Presbyterian-Weill Cornell Medical College, New York, New York.
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Barnett CL, Auffenberg GB, Cheng Z, Yang F, Wang J, Wei JT, Miller DC, Montie JE, Mamawala M, Denton BT. Optimizing active surveillance strategies to balance the competing goals of early detection of grade progression and minimizing harm from biopsies. Cancer 2017; 124:698-705. [DOI: 10.1002/cncr.31101] [Citation(s) in RCA: 10] [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: 04/21/2017] [Revised: 09/26/2017] [Accepted: 10/02/2017] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Zian Cheng
- University of MichiganAnn Arbor Michigan
| | - Fan Yang
- University of MichiganAnn Arbor Michigan
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36
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Sanda MG, Feng Z, Howard DH, Tomlins SA, Sokoll LJ, Chan DW, Regan MM, Groskopf J, Chipman J, Patil DH, Salami SS, Scherr DS, Kagan J, Srivastava S, Thompson IM, Siddiqui J, Fan J, Joon AY, Bantis LE, Rubin MA, Chinnayian AM, Wei JT, Bidair M, Kibel A, Lin DW, Lotan Y, Partin A, Taneja S. Association Between Combined TMPRSS2:ERG and PCA3 RNA Urinary Testing and Detection of Aggressive Prostate Cancer. JAMA Oncol 2017; 3:1085-1093. [PMID: 28520829 DOI: 10.1001/jamaoncol.2017.0177] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Importance Potential survival benefits from treating aggressive (Gleason score, ≥7) early-stage prostate cancer are undermined by harms from unnecessary prostate biopsy and overdiagnosis of indolent disease. Objective To evaluate the a priori primary hypothesis that combined measurement of PCA3 and TMPRSS2:ERG (T2:ERG) RNA in the urine after digital rectal examination would improve specificity over measurement of prostate-specific antigen alone for detecting cancer with Gleason score of 7 or higher. As a secondary objective, to evaluate the potential effect of such urine RNA testing on health care costs. Design, Setting, and Participants Prospective, multicenter diagnostic evaluation and validation in academic and community-based ambulatory urology clinics. Participants were a referred sample of men presenting for first-time prostate biopsy without preexisting prostate cancer: 516 eligible participants from among 748 prospective cohort participants in the developmental cohort and 561 eligible participants from 928 in the validation cohort. Interventions/Exposures Urinary PCA3 and T2:ERG RNA measurement before prostate biopsy. Main Outcomes and Measures Presence of prostate cancer having Gleason score of 7 or higher on prostate biopsy. Pathology testing was blinded to urine assay results. In the developmental cohort, a multiplex decision algorithm was constructed using urine RNA assays to optimize specificity while maintaining 95% sensitivity for predicting aggressive prostate cancer at initial biopsy. Findings were validated in a separate multicenter cohort via prespecified analysis, blinded per prospective-specimen-collection, retrospective-blinded-evaluation (PRoBE) criteria. Cost effects of the urinary testing strategy were evaluated by modeling observed biopsy results and previously reported treatment outcomes. Results Among the 516 men in the developmental cohort (mean age, 62 years; range, 33-85 years) combining testing of urinary T2:ERG and PCA3 at thresholds that preserved 95% sensitivity for detecting aggressive prostate cancer improved specificity from 18% to 39%. Among the 561 men in the validation cohort (mean age, 62 years; range, 27-86 years), analysis confirmed improvement in specificity (from 17% to 33%; lower bound of 1-sided 95% CI, 0.73%; prespecified 1-sided P = .04), while high sensitivity (93%) was preserved for aggressive prostate cancer detection. Forty-two percent of unnecessary prostate biopsies would have been averted by using the urine assay results to select men for biopsy. Cost analysis suggested that this urinary testing algorithm to restrict prostate biopsy has greater potential cost-benefit in younger men. Conclusions and Relevance Combined urinary testing for T2:ERG and PCA3 can avert unnecessary biopsy while retaining robust sensitivity for detecting aggressive prostate cancer with consequent potential health care cost savings.
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Affiliation(s)
- Martin G Sanda
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Ziding Feng
- Department of Biostatistics, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - David H Howard
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Scott A Tomlins
- Department of Urology, University of Michigan, Ann Arbor, Michigan.,Michigan Center for Translational Pathology, Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Lori J Sokoll
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Daniel W Chan
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Meredith M Regan
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | | | - Jonathan Chipman
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Dattatraya H Patil
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Simpa S Salami
- Hofstra North Shore-LIJ School of Medicine, The Arthur Smith Institute for Urology, New Hyde Park, New York
| | - Douglas S Scherr
- Department of Urology, Weill-Cornell Medical Center, New York, New York
| | - Jacob Kagan
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Sudhir Srivastava
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Ian M Thompson
- University of Texas Health Sciences Center - San Antonio, Texas
| | - Javed Siddiqui
- Michigan Center for Translational Pathology, Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Jing Fan
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, California
| | - Aron Y Joon
- Department of Biostatistics, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Leonidas E Bantis
- Department of Biostatistics, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Mark A Rubin
- Department of Pathology, Weill-Cornell Medical Center, New York, New York
| | - Arul M Chinnayian
- Department of Urology, University of Michigan, Ann Arbor, Michigan.,Michigan Center for Translational Pathology, Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - John T Wei
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | | | | | - Adam Kibel
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Daniel W Lin
- University of Washington Medical Center, Seattle
| | - Yair Lotan
- University of Texas Southwestern Medical Center, Dallas
| | | | - Samir Taneja
- New York University School of Medicine, New York
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37
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Jackson WC, Dess RT, Litzenberg DW, Li P, Schipper M, Rosenthal SA, Chang GC, Horwitz EM, Price RA, Michalski JM, Gay HA, Wei JT, Feng M, Feng FY, Sandler HM, Wallace RE, Spratt DE, Hamstra DA. A multi-institutional phase 2 trial of prostate stereotactic body radiation therapy (SBRT) using continuous real-time evaluation of prostate motion with patient-reported quality of life. Pract Radiat Oncol 2017; 8:40-47. [PMID: 29304991 DOI: 10.1016/j.prro.2017.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The use of stereotactic body radiation therapy (SBRT) for prostate cancer has been reported predominantly from single institutional studies, although concerns for broader adoption exist. METHODS AND MATERIALS From 2011 through 2013, 66 men were accrued to a phase 2 trial at 5 centers. SBRT consisted of 5 fractions of 7.4 Gy to a total dose of 37 Gy using conventional linear accelerators. Electromagnetic transponders were used for motion management. Health-related quality of life (HRQOL) was evaluated via the Expanded Prostate Cancer Index Composite 26 questionnaire. Acute and late toxicities were collected according to Common Terminology Criteria for Adverse Events, version 4.0. Linear mixed modeling was performed to assess changes in HRQOL over time. RESULTS Median follow-up was 36 months. All men had low- or intermediate-risk disease. There have been 0 biochemical recurrences. No grade 3 urinary or bowel toxicity was reported. Twenty-three percent of patients had acute grade 2 urinary toxicity, with 9% late grade 2 urinary toxicity. Four percent and 5% experienced acute or late grade 2+ bowel toxicity, respectively. Urinary bother and bowel HRQOL transiently decreased during the first 6 to 12 months post-SBRT, and then returned to baseline. In men with good erectile function at baseline, sexual HRQOL declined during the first 6 months and stabilized thereafter. On linear mixed modeling, the strongest predictor of sustained bowel and sexual HRQOL was baseline HRQOL. CONCLUSIONS In this multi-institutional phase 2 clinical trial using continuous real-time evaluation of prostate motion, prostate SBRT has excellent intermediate-term tumor control with mild and expected treatment-related side effects.
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Affiliation(s)
- William C Jackson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Robert T Dess
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Dale W Litzenberg
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Pin Li
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Matthew Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Seth A Rosenthal
- Department of Radiation Oncology, Sutter Medical Group, Roseville, California
| | - Garrick C Chang
- Department of Radiation Oncology, Sutter Medical Group, Roseville, California
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Robert A Price
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jeff M Michalski
- Department of Radiation Oncology, Washington University in St. Louis, School of Medicine Siteman Cancer Center, St. Louis, Missouri
| | - Hiram A Gay
- Department of Radiation Oncology, Washington University in St. Louis, School of Medicine Siteman Cancer Center, St. Louis, Missouri
| | - John T Wei
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Mary Feng
- Department of Radiation Oncology, Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California
| | - Felix Y Feng
- Department of Radiation Oncology, Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California
| | - Howard M Sandler
- Department of Radiation Oncology, Cedars-Sinai, Los Angeles, California
| | - Robert E Wallace
- Department of Radiation Oncology, Cedars-Sinai, Los Angeles, California
| | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Daniel A Hamstra
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan.
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McKiernan J, Donovan MJ, O'Neill V, Bentink S, Noerholm M, Belzer S, Skog J, Kattan MW, Partin A, Andriole G, Brown G, Wei JT, Thompson IM, Carroll P. A Novel Urine Exosome Gene Expression Assay to Predict High-grade Prostate Cancer at Initial Biopsy. JAMA Oncol 2017; 2:882-9. [PMID: 27032035 DOI: 10.1001/jamaoncol.2016.0097] [Citation(s) in RCA: 386] [Impact Index Per Article: 55.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
IMPORTANCE Overdiagnosis and overtreatment of indolent prostate cancer (PCA) is a serious health issue in most developed countries. There is an unmet clinical need for noninvasive, easy to administer, diagnostic assays to help assess whether a prostate biopsy is warranted. OBJECTIVE To determine the performance of a novel urine exosome gene expression assay (the ExoDx Prostate IntelliScore urine exosome assay) plus standard of care (SOC) (ie, prostate-specific antigen [PSA] level, age, race, and family history) vs SOC alone for discriminating between Gleason score (GS)7 and GS6 and benign disease on initial biopsy. DESIGN, SETTING, AND PARTICIPANTS In training, using reverse-transcriptase polymerase chain reaction (PCR), we compared the urine exosome gene expression assay with biopsy outcomes in 499 patients with prostate-specific antigen (PSA) levels of 2 to 20 ng/mL. The derived prognostic score was then validated in 1064 patients from 22 community practice and academic urology clinic sites in the United States. Eligible participants included PCA-free men, 50 years or older, scheduled for an initial or repeated prostate needle biopsy due to suspicious digital rectal examination (DRE) findings and/or PSA levels (limit range, 2.0-20.0 ng/mL). MAIN OUTCOMES AND MEASURES Evaluate the assay using the area under receiver operating characteristic curve (AUC) in discrimination of GS7 or greater from GS6 and benign disease on initial biopsy. RESULTS In 255 men in the training target population (median age 62 years and median PSA level 5.0 ng/mL, and initial biopsy), the urine exosome gene expression assay plus SOC was associated with improved discrimination between GS7 or greater and GS6 and benign disease: AUC 0.77 (95% CI, 0.71-0.83) vs SOC AUC 0.66 (95% CI, 0.58-0.72) (P < .001). Independent validation in 519 patients' urine exosome gene expression assay plus SOC AUC 0.73 (95% CI, 0.68-0.77) was superior to SOC AUC 0.63 (95% CI, 0.58-0.68) (P < .001). Using a predefined cut point, 138 of 519 (27%) biopsies would have been avoided, missing only 5% of patients with dominant pattern 4 high-risk GS7 disease. CONCLUSIONS AND RELEVANCE This urine exosome gene expression assay is a noninvasive, urinary 3-gene expression assay that discriminates high-grade (≥GS7) from low-grade (GS6) cancer and benign disease. In this study, the urine exosome gene expression assay was associated with improved identification of patients with higher-grade prostate cancer among men with elevated PSA levels and could reduce the total number of unnecessary biopsies.
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Affiliation(s)
- James McKiernan
- Department of Urology, Columbia University, New York, New York
| | - Michael J Donovan
- Department of Pathology, Icahn School of Medicine at Mt Sinai, New York, New York
| | | | | | | | | | - Johan Skog
- Exosome Diagnostics, Cambridge, Massachusetts
| | - Michael W Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Alan Partin
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gerald Andriole
- Division of Urologic Surgery, Washington University, St Louis, Missouri
| | | | - John T Wei
- Division of Urologic Surgery, University of Michigan, Ann Arbor
| | - Ian M Thompson
- The Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio
| | - Peter Carroll
- Department of Urology, University of California-San Francisco, San Francisco
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Loeb S, Shin SS, Broyles DL, Wei JT, Sanda M, Klee G, Partin AW, Sokoll L, Chan DW, Bangma CH, van Schaik RHN, Slawin KM, Marks LS, Catalona WJ. Prostate Health Index improves multivariable risk prediction of aggressive prostate cancer. BJU Int 2017; 120:61-68. [PMID: 27743489 PMCID: PMC5392379 DOI: 10.1111/bju.13676] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To examine the use of the Prostate Health Index (PHI) as a continuous variable in multivariable risk assessment for aggressive prostate cancer in a large multicentre US study. MATERIALS AND METHODS The study population included 728 men, with prostate-specific antigen (PSA) levels of 2-10 ng/mL and a negative digital rectal examination, enrolled in a prospective, multi-site early detection trial. The primary endpoint was aggressive prostate cancer, defined as biopsy Gleason score ≥7. First, we evaluated whether the addition of PHI improves the performance of currently available risk calculators (the Prostate Cancer Prevention Trial [PCPT] and European Randomised Study of Screening for Prostate Cancer [ERSPC] risk calculators). We also designed and internally validated a new PHI-based multivariable predictive model, and created a nomogram. RESULTS Of 728 men undergoing biopsy, 118 (16.2%) had aggressive prostate cancer. The PHI predicted the risk of aggressive prostate cancer across the spectrum of values. Adding PHI significantly improved the predictive accuracy of the PCPT and ERSPC risk calculators for aggressive disease. A new model was created using age, previous biopsy, prostate volume, PSA and PHI, with an area under the curve of 0.746. The bootstrap-corrected model showed good calibration with observed risk for aggressive prostate cancer and had net benefit on decision-curve analysis. CONCLUSION Using PHI as part of multivariable risk assessment leads to a significant improvement in the detection of aggressive prostate cancer, potentially reducing harms from unnecessary prostate biopsy and overdiagnosis.
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Affiliation(s)
- Stacy Loeb
- Department of Urology and Population Health, NYU Langone Medical Center, New York, NY, USA
| | | | | | - John T Wei
- Department of Urology, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Martin Sanda
- Department of Urology, Emory University and Emory Healthcare, Atlanta, GA, USA
| | - George Klee
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Alan W Partin
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lori Sokoll
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel W Chan
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chris H Bangma
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ron H N van Schaik
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kevin M Slawin
- Vanguard Urologic Institute and Texas Prostate Center, Houston, TX, USA
| | - Leonard S Marks
- Department of Urology, University of California Los Angeles, Los Angeles, CA, USA
| | - William J Catalona
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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40
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Barnett CL, Tomlins SA, Underwood DJ, Wei JT, Morgan TM, Montie JE, Denton BT. Two-Stage Biomarker Protocols for Improving the Precision of Early Detection of Prostate Cancer. Med Decis Making 2017; 37:815-826. [DOI: 10.1177/0272989x17696996] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. New cancer biomarkers are being discovered at a rapid pace; however, these tests vary in their predictive performance characteristics, and it is unclear how best to use them. Methods. We investigated 2-stage biomarker-based screening strategies in the context of prostate cancer using a partially observable Markov model to simulate patients’ progression through prostate cancer states to mortality from prostate cancer or other causes. Patients were screened every 2 years from ages 55 to 69. If the patient’s serum prostate-specific antigen (PSA) was over a specified threshold in the first stage, a second stage biomarker test was administered. We evaluated design characteristics for these 2-stage strategies using 7 newly discovered biomarkers as examples. Monte Carlo simulation was used to estimate the number of screening biopsies, prostate cancer deaths, and quality-adjusted life-years (QALYs) per 1000 men. Results. The all-cancer biomarkers significantly underperformed the high-grade cancer biomarkers in terms of QALYs. The screening strategy that used a PSA threshold of 2 ng/mL and a second biomarker test with high-grade sensitivity and specificity of 0.86 and 0.62, respectively, maximized QALYs. This strategy resulted in a prostate cancer death rate within 1% of using PSA alone with a threshold of 2 ng/mL, while reducing the number of biopsies by 20%. Sensitivity analysis suggests that the results are robust with respect to variation in model parameters. Conclusions. Two-stage biomarker screening strategies using new biomarkers with risk thresholds optimized for high-grade cancer detection may increase quality-adjusted survival and reduce unnecessary biopsies.
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Affiliation(s)
- Christine L. Barnett
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI (CLB, BTD)
- Department of Urology, University of Michigan, Ann Arbor, MI (SAT, JTW, TMM, JEM, BTD)
- Department of Pathology, University of Michigan, Ann Arbor, MI (SAT)
- Department of Industrial & Systems Engineering, North Carolina State University, Raleigh, NC (DJU)
| | - Scott A. Tomlins
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI (CLB, BTD)
- Department of Urology, University of Michigan, Ann Arbor, MI (SAT, JTW, TMM, JEM, BTD)
- Department of Pathology, University of Michigan, Ann Arbor, MI (SAT)
- Department of Industrial & Systems Engineering, North Carolina State University, Raleigh, NC (DJU)
| | - Daniel J. Underwood
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI (CLB, BTD)
- Department of Urology, University of Michigan, Ann Arbor, MI (SAT, JTW, TMM, JEM, BTD)
- Department of Pathology, University of Michigan, Ann Arbor, MI (SAT)
- Department of Industrial & Systems Engineering, North Carolina State University, Raleigh, NC (DJU)
| | - John T. Wei
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI (CLB, BTD)
- Department of Urology, University of Michigan, Ann Arbor, MI (SAT, JTW, TMM, JEM, BTD)
- Department of Pathology, University of Michigan, Ann Arbor, MI (SAT)
- Department of Industrial & Systems Engineering, North Carolina State University, Raleigh, NC (DJU)
| | - Todd M. Morgan
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI (CLB, BTD)
- Department of Urology, University of Michigan, Ann Arbor, MI (SAT, JTW, TMM, JEM, BTD)
- Department of Pathology, University of Michigan, Ann Arbor, MI (SAT)
- Department of Industrial & Systems Engineering, North Carolina State University, Raleigh, NC (DJU)
| | - James E. Montie
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI (CLB, BTD)
- Department of Urology, University of Michigan, Ann Arbor, MI (SAT, JTW, TMM, JEM, BTD)
- Department of Pathology, University of Michigan, Ann Arbor, MI (SAT)
- Department of Industrial & Systems Engineering, North Carolina State University, Raleigh, NC (DJU)
| | - Brian T. Denton
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI (CLB, BTD)
- Department of Urology, University of Michigan, Ann Arbor, MI (SAT, JTW, TMM, JEM, BTD)
- Department of Pathology, University of Michigan, Ann Arbor, MI (SAT)
- Department of Industrial & Systems Engineering, North Carolina State University, Raleigh, NC (DJU)
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Gay HA, Sanda MG, Liu J, Wu N, Hamstra DA, Wei JT, Dunn RL, Klein EA, Sandler HM, Saigal CS, Litwin MS, Kuban DA, Hembroff L, Regan MM, Chang P, Michalski JM. External Beam Radiation Therapy or Brachytherapy With or Without Short-course Neoadjuvant Androgen Deprivation Therapy: Results of a Multicenter, Prospective Study of Quality of Life. Int J Radiat Oncol Biol Phys 2017; 98:304-317. [PMID: 28463150 DOI: 10.1016/j.ijrobp.2017.02.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 02/07/2017] [Accepted: 02/13/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The long-term effects of neoadjuvant androgen deprivation therapy (NADT) with radiation therapy on participant-reported health-related quality of life (HRQOL) have not been characterized in prospective multicenter studies. We evaluated HRQOL for 2 years among participants undergoing radiation therapy (RT) with or without NADT for newly diagnosed, early-stage prostate cancer. METHODS AND MATERIALS We analyzed longitudinal cohort data from the Prostate Cancer Outcomes and Satisfaction with Treatment Quality Assessment Consortium to ascertain the HRQOL trajectory of men receiving NADT with external beam RT (EBRT) or brachytherapy. HRQOL was measured using the expanded prostate cancer index composite 26-item questionnaire at 2, 6, 12, and 24 months after the initiation of NADT. We used the χ2 or Fisher exact test to compare the shift in percentages between groups that did or did not receive NADT. Analyses were conducted at the 2-sided 5% significance level. RESULTS For subjects receiving EBRT, questions regarding the ability to have an erection, ability to reach an orgasm, quality of erections, frequency of erections, ability to function sexually, and lack of energy were in a significantly worse dichotomized category for the patients receiving NADT. Comparing the baseline versus 24-month outcomes, 24%, 23%, and 30% of participants receiving EBRT plus NADT shifted to the worse dichotomized category for the ability to reach an orgasm, quality of erections, and ability to function sexually compared with 14%, 13%, and 16% in the EBRT group, respectively. CONCLUSIONS Compared with baseline, at 2 years, participants receiving NADT plus EBRT compared with EBRT alone had worse HRQOL, as measured by the ability to reach orgasm, quality of erections, and ability to function sexually. However, no difference was found in the ability to have an erection, frequency of erections, overall sexual function, hot flashes, breast tenderness/enlargement, depression, lack of energy, or change in body weight. The improved survival in intermediate- and high-risk patients receiving NADT and EBRT necessitates pretreatment counseling of the HRQOL effect of NADT and EBRT.
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Affiliation(s)
- Hiram A Gay
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
| | - Martin G Sanda
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Jingxia Liu
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Ningying Wu
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri
| | | | - John T Wei
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Rodney L Dunn
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Eric A Klein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Howard M Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Christopher S Saigal
- Department of Urology, University of California at Los Angeles, Los Angeles, California
| | - Mark S Litwin
- Department of Urology, University of California at Los Angeles, Los Angeles, California; Health Policy and Management, University of California at Los Angeles, Los Angeles, California
| | - Deborah A Kuban
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Larry Hembroff
- Institute for Public Policy and Social Research, Michigan State University, East Lansing, Michigan
| | - Meredith M Regan
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Peter Chang
- Department of Surgery, Beth Israel-Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Jeff M Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
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Stoffel JT, Peterson AC, Sandhu JS, Suskind AM, Wei JT, Lightner DJ. AUA White Paper on Nonneurogenic Chronic Urinary Retention: Consensus Definition, Treatment Algorithm, and Outcome End Points. J Urol 2017; 198:153-160. [PMID: 28163030 DOI: 10.1016/j.juro.2017.01.075] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The AUA (American Urological Association) QIPS (Quality Improvement and Patient Safety) committee created a white paper on the diagnosis and management of nonneurogenic chronic urinary retention. MATERIALS AND METHODS Recommendations for the white paper were based on a review of the literature and consensus expert opinion from the workgroup. RESULTS The workgroup defined nonneurogenic chronic urinary retention as an elevated post-void residual of greater than 300 mL that persisted for at least 6 months and documented on 2 or more separate occasions. It is proposed that chronic urinary retention should be categorized by risk (high vs low) and symptomatology (symptomatic versus asymptomatic). High risk chronic urinary retention was defined as hydronephrosis on imaging, stage 3 chronic kidney disease or recurrent culture proven urinary tract infection or urosepsis. Symptomatic chronic urinary retention was defined as subjectively moderate to severe urinary symptoms impacting quality of life and/or a recent history of catheterization. A treatment algorithm was developed predicated on stratifying patients with chronic urinary retention first by risk and then by symptoms. The proposed 4 primary outcomes that should be assessed to determine effectiveness of retention treatment are 1) symptom improvement, 2) risk reduction, 3) successful trial of voiding without catheterization, and 4) stability of symptoms and risk over time. CONCLUSIONS Defining and categorizing nonneurogenic chronic urinary retention, creating a treatment algorithm and proposing treatment end points will hopefully spur comparative research that will ultimately lead to a better understanding of this challenging condition.
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Affiliation(s)
| | | | | | - Anne M Suskind
- University of Calfornia, San Francisco, San Francisco, California
| | - John T Wei
- University of Michigan, Ann Arbor, Michigan
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O'Malley PG, Nguyen DP, Al Hussein Al Awamlh B, Wu G, Thompson IM, Sanda M, Rubin M, Wei JT, Lee R, Christos P, Barbieri C, Scherr DS. Racial Variation in the Utility of Urinary Biomarkers PCA3 and T2ERG in a Large Multicenter Study. J Urol 2017; 198:42-49. [PMID: 28115190 DOI: 10.1016/j.juro.2017.01.058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE To our knowledge it is unknown whether urinary biomarkers for prostate cancer have added utility to clinical risk calculators in different racial groups. We examined the utility of urinary biomarkers added to clinical risk calculators for predicting prostate cancer in African American and nonAfrican American men. MATERIALS AND METHODS Demographics, PCPT (Prostate Cancer Prevention Trial) risk scores, data on the biomarkers data PCA3 (prostate cancer antigen 3) and T2ERG (transmembrane protease serine 2 and v-ets erythroblastosis virus E26 oncogene homolog gene fusion), and biopsy pathology features were prospectively collected on 718 men as part of EDRN (Early Detection Research Network). Utility was determined by generating ROC curves and comparing AUC values for the baseline multivariable PCPT model and for models containing biomarker scores. RESULTS PCA3 and T2ERG added utility for the prediction of prostate cancer and clinically significant prostate cancer when combined with the PCPT Risk Calculator. This utility was seen in nonAfrican American men only for PCA3 (AUC 0.64 increased to 0.75 for prostate cancer and to 0.69-0.77 for clinically significant prostate cancer, both p <0.001) and for T2ERG (AUC 0.64-0.74 for prostate cancer, p <0.001, and 0.69-0.73 for clinically significant prostate cancer, p = 0.029). African American men did not have an added benefit with the addition of biomarkers, including PCA3 (AUC 0.75-0.77, p = 0.64, and 0.65-0.66, p = 0.74) and T2ERG (AUC 0.75-0.74, p = 0.74, and 0.65-0.64, p = 0.88), for prostate cancer and clinically significant prostate cancer, respectively. Limitations include the small number of African American men (72). The post hoc subgroup analysis nature of the study limited findings to being hypothesis generating. CONCLUSIONS As novel biomarkers are discovered, clinical utility should be established across demographically diverse cohorts.
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Affiliation(s)
- Padraic G O'Malley
- Department of Urology, Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York.
| | | | | | - Guojiao Wu
- Department of Healthcare Policy and Research, Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York
| | - Ian M Thompson
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Martin Sanda
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Mark Rubin
- Department of Pathology, Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York
| | - John T Wei
- Department of Urology, University of Michigan, Livonia, Michigan
| | - Richard Lee
- Department of Urology, Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York
| | - Paul Christos
- Department of Healthcare Policy and Research, Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York
| | - Christopher Barbieri
- Department of Urology, Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York
| | - Douglas S Scherr
- Department of Urology, Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York
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Scherr KA, Fagerlin A, Wei JT, Williamson LD, Ubel PA. Treatment Availability Influences Physicians' Portrayal of Robotic Surgery During Clinical Appointments. Health Commun 2017; 32:119-125. [PMID: 27153051 PMCID: PMC5289122 DOI: 10.1080/10410236.2015.1099502] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In order to empower patients as decision makers, physicians must educate them about their treatment options in a factual, nonbiased manner. We propose that site-specific availability of treatment options may be a novel source of bias, whereby physicians describe treatments more positively when they are available. We performed a content analysis of physicians' descriptions of robotic prostatectomy within 252 appointments at four Veterans Affairs medical centers where robotic surgery was either available or unavailable. We coded how physicians portrayed robotic versus open prostatectomy across specific clinical categories and in the appointment overall. We found that physicians were more likely to describe robotic prostatectomy as superior when it was available [F(1, 42) = 8.65, p = .005]. We also provide initial qualitative evidence that physicians may be shaping their descriptions of robotic prostatectomy in an effort to manage patients' emotions and demand for the robotic technology. To our knowledge, this is the first study to provide empirical evidence that treatment availability influences how physicians describe the advantages and disadvantages of treatment alternatives to patients during clinical encounters, which has important practical implications for patient empowerment and patient satisfaction.
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Affiliation(s)
- Karen A Scherr
- a Fuqua School of Business and School of Medicine , Duke University
| | - Angela Fagerlin
- b Departments of Internal Medicine and Psychology , University of Michigan and Ann Arbor VA Center for Clinical Management Research
| | - John T Wei
- c Department of Urology , University of Michigan
| | | | - Peter A Ubel
- e Fuqua School of Business and Sanford School of Public Policy , Duke University
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Macleod LC, Ellis WJ, Newcomb LF, Zheng Y, Brooks JD, Carroll PR, Gleave ME, Lance RS, Nelson PS, Thompson IM, Wagner AA, Wei JT, Lin DW. Timing of Adverse Prostate Cancer Reclassification on First Surveillance Biopsy: Results from the Canary Prostate Cancer Active Surveillance Study. J Urol 2016; 197:1026-1033. [PMID: 27810448 DOI: 10.1016/j.juro.2016.10.090] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE During active surveillance for localized prostate cancer, the timing of the first surveillance biopsy varies. We analyzed the Canary PASS (Prostate Cancer Active Surveillance Study) to determine biopsy timing influence on rates of prostate cancer adverse reclassification at the first active surveillance biopsy. MATERIALS AND METHODS Of 1,085 participants in PASS, 421 had fewer than 34% of cores involved with cancer and Gleason sum 6 or less, and thereafter underwent on-study active surveillance biopsy. Reclassification was defined as an increase in Gleason sum and/or 34% or more of cores with prostate cancer. First active surveillance biopsy reclassification rates were categorized as less than 8, 8 to 13 and greater than 13 months after diagnosis. Multivariable logistic regression determined association between reclassification and first biopsy timing. RESULTS Of 421 men, 89 (21.1%) experienced reclassification at the first active surveillance biopsy. Median time from prostate cancer diagnosis to first active surveillance biopsy was 11 months (IQR 7.8-13.8). Reclassification rates at less than 8, 8 to 13 and greater than 13 months were 24%, 19% and 22% (p = 0.65). On multivariable analysis, compared to men biopsied at less than 8 months the OR of reclassification at 8 to 13 and greater than 13 months were 0.88 (95% CI 0.5,1.6) and 0.95 (95% CI 0.5,1.9), respectively. Prostate specific antigen density 0.15 or greater (referent less than 0.15, OR 1.9, 95% CI 1.1, 4.1) and body mass index 35 kg/m2 or greater (referent less than 25 kg/m2, OR 2.4, 95% CI 1.1,5.7) were associated with increased odds of reclassification. CONCLUSIONS Timing of the first active surveillance biopsy was not associated with increased adverse reclassification but prostate specific antigen density and body mass index were. In low risk patients on active surveillance, it may be reasonable to perform the first active surveillance biopsy at a later time, reducing the overall cost and morbidity of active surveillance.
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Affiliation(s)
- Liam C Macleod
- University of Washington School of Medicine, Seattle, Washington.
| | - William J Ellis
- University of Washington School of Medicine, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Lisa F Newcomb
- University of Washington School of Medicine, Seattle, Washington
| | - Yingye Zheng
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - James D Brooks
- Department of Urology, Stanford University School of Medicine, Stanford, California
| | - Peter R Carroll
- University of California-San Francisco School of Medicine, San Francisco, California
| | - Martin E Gleave
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Peter S Nelson
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ian M Thompson
- University of Texas Health Sciences Center at San Antonio, San Antonio, Texas
| | | | - John T Wei
- University of Michigan, Ann Arbor, Michigan
| | - Daniel W Lin
- University of Washington School of Medicine, Seattle, Washington; Seattle Puget Sound Health Care System, Veterans Affairs Hospital, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington.
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46
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Crowley SA, Foley SM, Wittmann D, Jagielski CH, Dunn RL, Clark PM, Griggs JJ, Peterson C, Leonard M, An LC, Wei JT, Montie JE, Janz NK. Sexual Health Concerns Among Cancer Survivors: Testing a Novel Information-Need Measure Among Breast and Prostate Cancer Patients. J Cancer Educ 2016; 31:588-94. [PMID: 26076657 DOI: 10.1007/s13187-015-0865-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
While it is recognized that cancer treatment can contribute to problems in sexual function, much less is currently known about the specific sexual health concerns and information needs of cancer survivors. This study tested a new instrument to measure cancer survivors' sexual health concerns and needs for sexual information after cancer treatment. The Information on Sexual Health: Your Needs after Cancer (InSYNC), developed by a multidisciplinary team of experts, is a novel 12-item questionnaire to measure sexual health concerns and information needs of cancer survivors. We tested the measure with a sample of breast and prostate cancer survivors. A convenience sample of 114 cancer survivors (58 breast, 56 prostate) was enrolled. Results of the InSYNC questionnaire showed high levels of sexual concern among cancer survivors. Areas of concern differed by cancer type. Prostate cancer survivors were most concerned about being able to satisfy their partners (57 %) while breast cancer survivors were most concerned with changes in how their bodies worked sexually (46 %). Approximately 35 % of all cancer survivors wanted more information about sexual health. Sexual health concerns and unmet information needs are common among breast and prostate cancer survivors, varying in some aspects by type of cancer. Routine screening for sexual health concerns should be included in comprehensive cancer survivorship care to appropriately address health care needs. The InSYNC questionnaire is one tool that may help clinicians identify concerns facing their patients.
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Affiliation(s)
- Sheila A Crowley
- Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Sallie M Foley
- School of Social Work, University of Michigan, Ann Arbor, MI, USA.
| | | | | | - Rodney L Dunn
- School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Patricia M Clark
- Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer J Griggs
- School of Medicine, University of Michigan, Ann Arbor, MI, USA
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Marcia Leonard
- Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Lawrence C An
- School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - John T Wei
- School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - James E Montie
- School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nancy K Janz
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Liss MA, Schenk JM, Faino AV, Newcomb LF, Boyer H, Brooks JD, Carroll PR, Dash A, Fabrizio MD, Gleave ME, Nelson PS, Neuhouser ML, Wei JT, Zheng Y, Wright JL, Lin DW, Thompson IM. A diagnosis of prostate cancer and pursuit of active surveillance is not followed by weight loss: potential for a teachable moment. Prostate Cancer Prostatic Dis 2016; 19:390-394. [PMID: 27431498 DOI: 10.1038/pcan.2016.28] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/12/2016] [Accepted: 06/07/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Obesity is a risk factor for incident prostate cancer (PC) as well as risk of disease progression and mortality. We hypothesized that men diagnosed with lower-risk PC and who elected active surveillance (AS) for their cancer management would likely initiate lifestyle changes that lead to weight loss. METHODS Patients were enrolled in the Prostate Active Surveillance Study (PASS), a multicenter prospective biomarker discovery and validation study of men who have chosen AS for their PC. Data from 442 men diagnosed with PC within 1 year of study entry who completed a standard of care 12-month follow-up visit were analyzed. We examined the change in weight and body mass index (BMI) over the first year of study participation. RESULTS After 1 year on AS, 7.5% (33/442) of patients had lost 5% or more of their on-study weight. The proportion of men who lost 5% or more weight was similar across categories of baseline BMI: normal/underweight (8%), overweight (6%) and obese (10%, χ2 test P=0.44). The results were similar for patients enrolled in the study 1 year or 6 months after diagnosis. By contrast, after 1 year, 7.7% (34/442) of patients had gained >5% of their weight. CONCLUSIONS Only 7.5% of men with low-risk PC enrolled in AS lost a modest (⩾5%) amount of weight after diagnosis. Given that obesity is related to PC progression and mortality, targeted lifestyle interventions may be effective at this 'teachable moment', as men begin AS for low-risk PC.
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Affiliation(s)
- M A Liss
- Department of Urology, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - J M Schenk
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - A V Faino
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - L F Newcomb
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - H Boyer
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | | | - P R Carroll
- University of California at San Francisco, San Francisco, CA, USA
| | - A Dash
- University of Washington, Seattle, WA, USA
| | - M D Fabrizio
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - M E Gleave
- University of British Columbia, Vancouver, BC, Canada
| | - P S Nelson
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - M L Neuhouser
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - J T Wei
- University of Michigan, Ann Arbor, MI, USA
| | - Y Zheng
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - J L Wright
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - D W Lin
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - I M Thompson
- Department of Urology, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
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48
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O'Malley P, Golombos DM, Lewicki P, Al Awamlh BAH, Christos PJ, Thompson IM, Sanda MG, Wei JT, Rubin MA, Barbieri CE, Scherr DS. MP21-12 PCA3 AND T2:ERG ADD FURTHER PREDICTIVE AND CLINICAL BENEFIT TO THE DETECTION OF PROSTATE CANCER IN MEN OF VARIOUS AGES IN THE EARLY DETECTION RESEARCH NETWORK (EDRN). J Urol 2016. [DOI: 10.1016/j.juro.2016.02.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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49
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Ellimoottil C, Ye Z, Chakrabarti AK, Englesbe MJ, Miller DC, Wei JT, Mathur AK. Understanding Inpatient Cost Variation in Kidney Transplantation: Implications for Payment Reforms. Urology 2016; 87:88-94. [PMID: 26383614 PMCID: PMC8236318 DOI: 10.1016/j.urology.2015.05.037] [Citation(s) in RCA: 12] [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: 02/17/2015] [Revised: 04/28/2015] [Accepted: 05/08/2015] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine the magnitude and sources of inpatient cost variation for kidney transplantation. METHODS We used the 2005-2009 Nationwide Inpatient Sample to identify patients who underwent kidney transplantation. We first calculated the patient-level cost of each transplantation admission and then aggregated costs to the hospital level. We fit hierarchical linear regression models to identify sources of cost variation and to estimate how much unexplained variation remained after adjusting for case-mix variables commonly found in administrative datasets. RESULTS We identified 8866 living donor (LDRT) and 5589 deceased donor (DDRT) renal transplantations. We found that higher costs were associated with the presence of complications (LDRT, 14%; P <.001; DDRT, 24%; P <.001), plasmapheresis (LDRT, 27%; P <.001; DDRT, 27%; P <.001), dialysis (LDRT, 4%; P <.001), and prolonged length of stay (LDRT, 84%; P <.001; DDRT, 82%; P <.001). Even after case-mix adjustment, a considerable amount of unexplained cost variation remained between transplant centers (DDRT, 52%; LDRT, 66%). CONCLUSION Although significant inpatient cost variation is present across transplant centers, much of the cost variation for kidney transplantation is not explained by commonly used risk-adjustment variables in administrative datasets. These findings suggest that although there is an opportunity to achieve savings through payment reforms for kidney transplantation, policymakers should seek alternative sources of information (eg, clinical registry data) to delineate sources of warranted and unwarranted cost variation.
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Affiliation(s)
- Chandy Ellimoottil
- Department of Urology, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI.
| | - Zaojun Ye
- Department of Urology, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI
| | - Apurba K Chakrabarti
- Department of Surgery, Section of Transplantation, University of Michigan, Ann Arbor, MI
| | - Michael J Englesbe
- Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI; Department of Surgery, Section of Transplantation, University of Michigan, Ann Arbor, MI
| | - David C Miller
- Department of Urology, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI
| | - John T Wei
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Amit K Mathur
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ; Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Phoenix, AZ
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50
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Xu G, Davis MC, Siddiqui J, Tomlins SA, Huang S, Kunju LP, Wei JT, Wang X. Quantifying Gleason scores with photoacoustic spectral analysis: feasibility study with human tissues. Biomed Opt Express 2015; 6:4781-9. [PMID: 26713193 PMCID: PMC4679253 DOI: 10.1364/boe.6.004781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 11/05/2015] [Indexed: 05/07/2023]
Abstract
Gleason score is a highly prognostic factor for prostate cancer describing the microscopic architecture of the tumor tissue. The standard procedure for evaluating Gleason scores, namely biopsy, is to remove prostate tissue for observation under microscope. Currently, biopsies are guided by transrectal ultrasound (TRUS). Due to the low sensitivity of TRUS to prostate cancer (PCa), non-guided and saturated biopsies are frequently employed, unavoidably causing pain, damage to the normal prostate tissues and other complications. More importantly, due to the limited number of biopsy cores, current procedure could either miss early stage small tumors or undersample aggressive cancers. Photoacoustic (PA) measurement has the unique capability of evaluating tissue microscopic architecture information at ultrasonic resolution. By frequency domain analysis of the broadband PA signal, namely PA spectral analysis (PASA), the microscopic architecture within the assessed tissue can be quantified. This study investigates the feasibility of evaluating Gleason scores by PASA. Simulations with the classic Gleason patterns and experiment measurements from human PCa tissues have demonstrated strong correlation between the PASA parameters and the Gleason scores.
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Affiliation(s)
- Guan Xu
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan 48109,
USA
| | - Mandy C. Davis
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan 48109,
USA
| | - Javed Siddiqui
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan 48109,
USA
| | - Scott A. Tomlins
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan 48109,
USA
| | - Shengsong Huang
- Department of Urology, Tongji Hospital of Tongji University, Putuo, Shanghai 200065,
China
| | - Lakshmi P. Kunju
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan 48109,
USA
| | - John T. Wei
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan 48109,
USA
| | - Xueding Wang
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan 48109,
USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109,
USA
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