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Eapen RS, Buteau JP, Jackson P, Mitchell C, Oon SF, Alghazo O, McIntosh L, Dhiantravan N, Scalzo MJ, O'Brien J, Sandhu S, Azad AA, Williams SG, Sharma G, Haskali MB, Bressel M, Chen K, Jenjitranant P, McVey A, Moon D, Lawrentschuk N, Neeson PJ, Murphy DG, Hofman MS. Administering [ 177Lu]Lu-PSMA-617 Prior to Radical Prostatectomy in Men with High-risk Localised Prostate Cancer (LuTectomy): A Single-centre, Single-arm, Phase 1/2 Study. Eur Urol 2024; 85:217-226. [PMID: 37891072 DOI: 10.1016/j.eururo.2023.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/16/2023] [Accepted: 08/29/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND High-risk localised prostate cancer (HRCaP) has high rates of biochemical recurrence; [177Lu]Lu-PSMA-617 is effective in men with advanced prostate cancer. OBJECTIVE To investigate the dosimetry, safety, and efficacy of upfront [177Lu]Lu-PSMA-617 in men with HRCaP prior to robotic radical prostatectomy (RP). DESIGN, SETTING, AND PARTICIPANTS In this single-arm, phase I/II trial, we recruited men with HRCaP (any of prostate-specific antigen [PSA] >20 ng/ml, International Society of Urological Pathology (ISUP) grade group [GG] 3-5, and ≥cT2c), with high tumour uptake on [68Ga]Ga-PSMA-11 positron emission tomography/computed tomography (PSMA PET/CT), and scheduled for RP. INTERVENTION Cohort A (n = 10) received one cycle and cohort B (n = 10) received two cycles of [177Lu]Lu-PSMA-617 (5 GBq) followed by surgery 6 weeks later. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was tumour radiation absorbed dose. Adverse events (AEs; Common Terminology Criteria for Adverse Events (CTCAE) version 5.0), surgical safety (Clavien-Dindo), imaging, and biochemical responses were evaluated (ClinicalTrials.gov: NCT04430192). RESULTS AND LIMITATIONS Between May 29, 2020 and April 28, 2022, 20 patients were enrolled. The median PSA was 18 ng/ml (interquartile range [IQR] 11-35), Eighteen (90%) had GG ≥3, and six (30%) had N1 disease. The median (IQR) highest tumour radiation absorbed dose after cycle 1 for all lesions was 35.5 Gy (19.5-50.1), with 19.6 Gy (11.3-48.4) delivered to the prostate. Five patients received radiation to lymph nodes. Nine (45%) patients achieved >50% PSA decline. The most common AEs related to [177Lu]Lu-PSMA-617 were grade 1 fatigue in eight (40%), nausea in seven (35%), dry mouth in six (30%), and thrombocytopenia in four (20%) patients. No grade 3/4 toxicities or Clavien 3-5 complications occurred. Limitations include small a sample size. CONCLUSIONS In men with HRCaP and high prostate-specific membrane antigen (PSMA) expression, [177Lu]Lu-PSMA-617 delivered high levels of targeted radiation doses with few toxicities and without compromising surgical safety. Further studies of [177Lu]Lu-PSMA-617 in this population are worthwhile to determine whether meaningful long-term oncological benefits can be demonstrated. PATIENT SUMMARY In this study, we demonstrate that up to two cycles of [177Lu]Lu-PSMA-617 given prior to radical prostatectomy in patients with high-risk localised prostate cancer are safe and deliver targeted doses of radiation to tumour-affected tissues. It is tolerated well with minimal treatment-related adverse events, and surgery is safe with a low rate of complications. Activity measured through PSA reduction, repeat PSMA PET/CT, and histological response is promising.
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Affiliation(s)
- Renu S Eapen
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
| | - James P Buteau
- Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Price Jackson
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Catherine Mitchell
- Department of Anatomical Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sheng F Oon
- Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Omar Alghazo
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Lachlan McIntosh
- Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nattakorn Dhiantravan
- Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Mark J Scalzo
- Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jonathan O'Brien
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Shahneen Sandhu
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Arun A Azad
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Scott G Williams
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Gaurav Sharma
- Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Mohammad B Haskali
- Radiopharmaceutical Research Laboratory, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Mathias Bressel
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Kenneth Chen
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Aoife McVey
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Daniel Moon
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Paul J Neeson
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Michael S Hofman
- Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
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Sutherland DEK, Azad AA, Murphy DG, Eapen RS, Kostos L, Hofman MS. Role of FDG PET/CT in Management of Patients with Prostate Cancer. Semin Nucl Med 2024; 54:4-13. [PMID: 37400321 DOI: 10.1053/j.semnuclmed.2023.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 07/05/2023]
Abstract
Prostate cancer is the second most common cancer in men worldwide. [18F]FDG PET/CT imaging, a well-known and effective technique for detecting malignancies, has not been considered a useful tool for prostate cancer imaging by many because of its perceived low [18F]FDG uptake. Incidentally detected focal [18F]FDG uptake in the prostate is not uncommon, and typically benign. Imaging features that would increase concern for an underlying prostatic carcinoma, include focal uptake in the periphery near the gland margin without calcifications. [18F]FDG PET/CT imaging provides little value in the initial staging of prostate cancer, particularly in the era of prostate specific membrane antigen (PSMA) radiotracer. In cases of biochemical recurrence, the value of [18F]FDG PET/CT increases notably when Grade group 4 or 5 and elevated PSA levels are present. Active research is underway for theranostic approaches to prostate cancer, including [177Lu]Lu-PSMA therapy. Dual tracer staging using FDG and PSMA imaging significantly enhances the accuracy of disease site assessment. Specifically, the addition of [18F]FDG PET/CT imaging allows for the evaluation of discordant disease (PSMA negative/FDG positive). The maximal benefit from [177Lu]Lu-PSMA therapy relies on significant PSMA accumulation across all disease sites, and the identification of discordant disease suggests that these patients may derive less benefit from the treatment. The genuine value of [18F]FDG PET/CT imaging lies in advanced prostate cancer, PSMA-negative disease, as a prognostic biomarker, and the realm of new targeted theranostic agents.
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Affiliation(s)
- Duncan E K Sutherland
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Arun A Azad
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Declan G Murphy
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Renu S Eapen
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Louise Kostos
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael S Hofman
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.
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Holmes A, Kelly BD, Perera M, Eapen RS, Bolton DM, Lawrentschuk N. A systematic scoping review of multidisciplinary cancer team and decision-making in the management of men with advanced prostate cancer. World J Urol 2020; 39:297-306. [PMID: 32500304 DOI: 10.1007/s00345-020-03265-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/16/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The early diagnosis of prostate cancer and subsequent access to the treatment options helps to achieve optimal cancer outcomes. As the treatment options for patients with advanced prostate cancer continues to evolve, patients need to access a multidisciplinary team (MDT) meeting to receive best-practice care. METHODS In this paper a MEDLINE review was performed to assess clinical decision making in the context of MDT discussions for patients with advanced prostate cancer. RESULTS From 441 returned articles and abstracts, 50 articles were assessed for eligibility and 16 articles included for analysis. Sixteen articles were identified, 9 of the 16 articles used quantitative methodology including three retrospective analysis of clinical registry data, patient medical records and/or MDT meeting notes and three cross-sectional surveys. Other study designs included one observation study and one study using a combination of qualitative and quantitative methodologies and one mini-review. There were also four editorials included in the review and two consensus statements. CONCLUSION This paper highlights the important role the inter-disciplinary MDT has on shared decision making for men with advanced prostate cancer. The application of MDT care is a rapidly growing trend in uro-oncology and an efficient MDT service requires further research to assess its efficiency so that it may expand through all aspect of uro-oncology.
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Affiliation(s)
- A Holmes
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - B D Kelly
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - M Perera
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - R S Eapen
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - D M Bolton
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - N Lawrentschuk
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia. .,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. .,EJ Whitten Prostate Cancer Research Centre at Epworth Healthcare, Melbourne, Australia. .,Department of Urology, Royal Melbourne Hospital, Melbourne, Australia.
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Odisho AY, Bridge M, Webb M, Ameli N, Eapen RS, Stauf F, Cowan JE, Washington SL, Herlemann A, Carroll PR, Cooperberg MR. Automating the Capture of Structured Pathology Data for Prostate Cancer Clinical Care and Research. JCO Clin Cancer Inform 2019; 3:1-8. [PMID: 31314550 PMCID: PMC6874052 DOI: 10.1200/cci.18.00084] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Accepted: 05/17/2019] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Cancer pathology findings are critical for many aspects of care but are often locked away as unstructured free text. Our objective was to develop a natural language processing (NLP) system to extract prostate pathology details from postoperative pathology reports and a parallel structured data entry process for use by urologists during routine documentation care and compare accuracy when compared with manual abstraction and concordance between NLP and clinician-entered approaches. MATERIALS AND METHODS From February 2016, clinicians used note templates with custom structured data elements (SDEs) during routine clinical care for men with prostate cancer. We also developed an NLP algorithm to parse radical prostatectomy pathology reports and extract structured data. We compared accuracy of clinician-entered SDEs and NLP-parsed data to manual abstraction as a gold standard and compared concordance (Cohen's κ) between approaches assuming no gold standard. RESULTS There were 523 patients with NLP-extracted data, 319 with SDE data, and 555 with manually abstracted data. For Gleason scores, NLP and clinician SDE accuracy was 95.6% and 95.8%, respectively, compared with manual abstraction, with concordance of 0.93 (95% CI, 0.89 to 0.98). For margin status, extracapsular extension, and seminal vesicle invasion, stage, and lymph node status, NLP accuracy was 94.8% to 100%, SDE accuracy was 87.7% to 100%, and concordance between NLP and SDE ranged from 0.92 to 1.0. CONCLUSION We show that a real-world deployment of an NLP algorithm to extract pathology data and structured data entry by clinicians during routine clinical care in a busy clinical practice can generate accurate data when compared with manual abstraction for some, but not all, components of a prostate pathology report.
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Affiliation(s)
| | - Mark Bridge
- University of California, San Francisco, San Francisco, CA
| | - Mitchell Webb
- University of California, San Francisco Medical Center, San Francisco, CA
| | - Niloufar Ameli
- University of California, San Francisco, San Francisco, CA
| | - Renu S Eapen
- University of California, San Francisco, San Francisco, CA
| | - Frank Stauf
- University of California, San Francisco, San Francisco, CA
| | - Janet E Cowan
- University of California, San Francisco, San Francisco, CA
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Eapen RS, Nzenza TC, Murphy DG, Hofman MS, Cooperberg M, Lawrentschuk N. PSMA PET applications in the prostate cancer journey: from diagnosis to theranostics. World J Urol 2018; 37:1255-1261. [PMID: 30374609 DOI: 10.1007/s00345-018-2524-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 10/08/2018] [Indexed: 12/18/2022] Open
Abstract
The heterogeneity of prostate cancer has made imaging modalities of crucial importance in this disease. Accurate diagnosis and staging of the volume and extent of disease, especially in advanced and metastatic prostate cancer, can help to tailor the timing and modalities of treatment. While MRI has been effective in the detection of significant prostate cancer, its use in the identification and quantification of extraprostatic disease is limited. This gap is now being filled by PSMA PET. PSMA PET scans have now been shown to have a role in all stages in the prostate cancer journey. Emerging evidence has shown its promise in primary staging, restaging and theranostics. In this paper, we review the evidence for the use of PSMA PET in the various stages of prostate cancer, from initial diagnosis to advanced metastatic disease where other systemic treatments have failed.
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Affiliation(s)
- R S Eapen
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia. .,Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia. .,Olivia Newton-John Cancer Research Institute, Austin Hospital, Melbourne, Australia. .,Department of Urology, Austin Hospital, Melbourne, Australia.
| | - T C Nzenza
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia.,Olivia Newton-John Cancer Research Institute, Austin Hospital, Melbourne, Australia.,Young Urology Researchers Organisation (YURO), Melbourne, Australia
| | - D G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - M S Hofman
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia.,Department of Molecular Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - M Cooperberg
- Department of Urology, Helen Diller Comprehensive Cancer Centre, University of California, San Francisco, USA
| | - N Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia.,Olivia Newton-John Cancer Research Institute, Austin Hospital, Melbourne, Australia
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Schmidt B, Eapen RS, Cowan JE, Broering JM, Greene KL, Carroll PR, Cooperberg MR. Practice patterns of primary EBRT with and without ADT in prostate cancer treatment. Prostate Cancer Prostatic Dis 2018; 22:117-124. [PMID: 30171230 DOI: 10.1038/s41391-018-0084-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/15/2018] [Accepted: 07/31/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) has been shown to improve survival for men with intermediate and high-risk prostate cancer undergoing external-beam radiation therapy (EBRT). Using data from a community-based prospective disease registry, we investigated usage of EBRT with or without neoadjuvant ADT. METHODS The CaPSURE database contains 14,863 men with prostate cancer, including 1337 men diagnosed between 1990 and 2014 with localized disease who received EBRT as primary treatment. Prostate cancer risk was calculated using the CAPRA score. Patient characteristics were compared using the Mantel-Haenszel chi-square test for trend and analysis of variance. RESULTS Between 1990 and 2014, 14,010 men were diagnosed with localized disease within the CaPSURE registry. Of those, 1337 underwent EBRT. Patients had a median age of 71 years. The use of ADT in addition to EBRT increased from 24% in 1990 to 60% in 1996 with a decrease seen to 47% in 2011. Men receiving ADT have differing clinical characteristics including higher PSA at diagnosis, higher Gleason grade, and higher CAPRA scores. Median ADT duration was 4 months. CONCLUSIONS The use of ADT in conjunction with primary EBRT has increased in frequency and duration since 1990. Men receiving ADT have higher risk characteristics than those receiving EBRT alone. There is substantial variability in use of ADT in clinical practice.
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Affiliation(s)
| | - Renu S Eapen
- Peter MacCallum Cancer Centre, Melbourne VIC, Australia
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Herlemann A, Washington SL, Eapen RS, Cooperberg MR. Whom to Treat: Postdiagnostic Risk Assessment with Gleason Score, Risk Models, and Genomic Classifier. Urol Clin North Am 2017; 44:547-555. [PMID: 29107271 DOI: 10.1016/j.ucl.2017.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Management of prostate cancer presents unique challenges because of the disease's variable natural history. Accurate risk stratification at the time of diagnosis in clinically localized disease is crucial in providing optimal counseling about management options. To accurately distinguish pathologically indolent tumors from aggressive disease, risk groups are no longer sufficient. Rather, multivariable prognostic models reflecting the complete information known at time of diagnosis offer improved accuracy and interpretability. After diagnosis, further testing with genomic assays or other biomarkers improves risk classification. These postdiagnostic risk assessment tools should not supplant shared decision making, but rather facilitate risk classification and enable more individualized care.
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Affiliation(s)
- Annika Herlemann
- Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, Box 0981, San Francisco, CA 94143-0981, USA; Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Samuel L Washington
- Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, Box 0981, San Francisco, CA 94143-0981, USA
| | - Renu S Eapen
- Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, Box 0981, San Francisco, CA 94143-0981, USA
| | - Matthew R Cooperberg
- Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, Box 0981, San Francisco, CA 94143-0981, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, 550 16th Street, San Francisco, CA 94143, USA.
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Abstract
Overactive bladder (OAB) is common in both men and women. It is a symptom complex that causes significant detriment to quality of life in patients. Although the prevalence of OAB is similar in both sexes, there are sex-specific differences in individual symptoms and the impact on quality of life. The coexistence of benign prostatic hyperplasia with OAB can worsen quality of life in men. This review examines the major studies that looked at the epidemiology of OAB as it relates to both sexes. It focuses on both the overall prevalence rates and the incidence of individual symptoms. This paper also addresses the level of bother and quality of life in men and women with OAB. In addition, the relationship between OAB and benign prostatic hyperplasia is reviewed.
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Affiliation(s)
- Renu S Eapen
- Division of Urology, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, ON, Canada
| | - Sidney B Radomski
- Division of Urology, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, ON, Canada
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Eapen RS, Radomski SB. Gender differences in overactive bladder. Can J Urol 2016; 23:2-9. [PMID: 26924589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Overactive bladder (OAB) is a common condition in both women and men. Although prevalence's are similar in both genders, sex specific differences do exist in relation to individual OAB symptoms as well as degree of bother and quality of life. The added effect of prostatic enlargement in men leads to slightly different evaluation and treatment regimens in both genders. This review will examine the gender differences in OAB related to epidemiology, OAB evaluation, investigation and treatment. This information will assist the primary care physician in assessing and initiating treatment in patients with OAB. It will further the understanding of the spectrum of treatments available for OAB and assist in determining the appropriateness and timing of referral of such patients to a urologist.
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Affiliation(s)
- Renu S Eapen
- Division of Urology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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10
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McMahon CJ, Nagueh SF, Eapen RS, Dreyer WJ, Finkelshtyn I, Cao X, Eidem BW, Bezold LI, Denfield SW, Towbin JA, Pignatelli RH. Echocardiographic predictors of adverse clinical events in children with dilated cardiomyopathy: a prospective clinical study. Heart 2004; 90:908-15. [PMID: 15253966 PMCID: PMC1768368 DOI: 10.1136/hrt.2003.020966] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To compare tissue Doppler (TD) velocities between patients with dilated cardiomyopathy (DCM) and normal controls and to determine whether TD velocities, Tei index, right ventricular fractional area change, and left ventricular ejection fraction (LVEF) predict adverse clinical outcomes in children with DCM. METHODS Prospective evaluation of children with DCM. RESULTS 54 children with DCM and 54 age and sex matched control group participants were studied. Mitral inflow velocities were similar for both groups except for decreased mitral deceleration time in patients with DCM. Systolic and diastolic TD velocities at the mitral annulus (septal and lateral sides) and tricuspid annulus were significantly reduced in children with DCM compared with controls (p < 0.001 for each). By multivariate analysis, after adjustment for Tei index and right ventricular fractional area change, decreased LVEF and tricuspid velocity during early diastole (Ea) were predictors of the primary end point (PEP), a composite end point consisting of need for hospitalisation or the outcome transplantation or death. Tricuspid Ea velocity < 8.5 cm/s had 87% specificity and 60% sensitivity for reaching the PEP. LVEF < 30% had 68% specificity and 74% sensitivity for the PEP. Combined LVEF < 30% and tricuspid Ea < 11.5 cm/s had 100% specificity and 44% sensitivity for the PEP. CONCLUSIONS Children with DCM have significantly lower TD velocities than normal controls. In such cases, lower LVEF (< 30%) is more sensitive but less specific than lower tricuspid Ea velocities (< 8.5 cm/s) in predicting which patients are at risk of hospitalisation, transplantation, or death.
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Affiliation(s)
- C J McMahon
- Lillie Frank Abercrombie Division of Pediatric Cardiology, Texas Children's Hospital, 6621 Fannin, Houston, Texas 77030, USA.
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11
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Affiliation(s)
- R S Eapen
- University of Texas, Southwestern Medical, Dallas, TX 75235, USA
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12
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Abstract
We sought to determine the effect of prenatal diagnosis of congenital heart disease, specifically critical left heart obstructive (LHO) lesions, on postnatal morbidity and mortality. Several studies have found no significant improvement in mortality in infants with prenatally detected heart disease compared to infants diagnosed postnatally. Few reports have focused on the specific effects of prenatal diagnosis on the perinatal course. All newborns with LHO seen between July 1993 and July 1996 were identified and divided into two groups based on prenatal vs. postnatal diagnosis. Hospital records were reviewed for demographic and outcome variables. The outcome variables included degree of metabolic acidosis, hemodynamic instability, noncardiac organ dysfunction, delayed surgical intervention, and surgical mortality. Twenty-three fetuses were diagnosed with LHO lesions. Postnatally, 45 newborns presented with LHO anomalies. Prenatal diagnosis resulted in avoidance of hemodynamic compromise, reduced organ dysfunction, and reduced surgical delays. There was no significant difference in surgical mortality. Prenatal diagnosis significantly decreases postnatal morbidity in infants with LHO lesions. Although surgical results are similar, the reduced morbidity decreases surgical delays and potentially may impact on neurodevelopmental outcomes.
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Affiliation(s)
- R S Eapen
- Department of Pediatrics, The Ohio State University, Children's Hospital, Columbus 43205, USA
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