1
|
Schenk JM, Liu M, Neuhouser ML, Newcomb LF, Zheng Y, Zhu K, Brooks JD, Carroll PR, Dash A, Ellis WJ, Filson CP, Gleave ME, Liss M, Martin FM, Morgan TM, Wagner AA, Lin DW. Dietary Patterns and Risk of Gleason Grade Progression among Men on Active Surveillance for Prostate Cancer: Results from the Canary Prostate Active Surveillance Study. Nutr Cancer 2022; 75:618-626. [PMID: 36343223 PMCID: PMC9974882 DOI: 10.1080/01635581.2022.2143537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/28/2022] [Indexed: 11/09/2022]
Abstract
Modifiable lifestyle factors, such as following a healthy dietary pattern may delay or prevent prostate cancer (PCa) progression. However, few studies have evaluated whether following specific dietary patterns after PCa diagnosis impacts risk of disease progression among men with localized PCa managed by active surveillance (AS). 564 men enrolled in the Canary Prostate Active Surveillance Study, a protocol-driven AS study utilizing a pre-specified prostate-specific antigen monitoring and surveillance biopsy regimen, completed a food frequency questionnaire (FFQ) at enrollment and had ≥ 1 surveillance biopsy during follow-up. FFQs were used to evaluate adherence to the Dietary Guidelines for Americans (Healthy Eating index (HEI))-2015, alternative Mediterranean Diet (aMED), and Dietary Approaches to Stop Hypertension (DASH) dietary patterns. Multivariable-adjusted hazards ratios (HRs) and 95% confidence intervals were estimated using Cox proportional hazards models. During a median follow-up of 7.8 years, 237 men experienced an increase in Gleason score on subsequent biopsy (grade reclassification). Higher HEI-2015, aMED or DASH diet scores after diagnosis were not associated with significant reductions in the risk of grade reclassification during AS. However, these dietary patterns have well-established protective effects on chronic diseases and mortality and remain a prudent choice for men with prostate cancer managed by AS.
Collapse
Affiliation(s)
- Jeannette M. Schenk
- Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Center, Seattle WA
| | - Menghan Liu
- Biostatistics Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle WA
| | - Marian L. Neuhouser
- Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Center, Seattle WA
| | - Lisa F Newcomb
- Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Center, Seattle WA
- Department of Urology, University of Washington, Seattle WA
| | - Yingye Zheng
- Biostatistics Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle WA
| | - Kehao Zhu
- Biostatistics Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle WA
| | | | - Peter R. Carroll
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco CA
| | | | | | - Christopher P. Filson
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
- Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia, USA
| | - Martin E. Gleave
- Department of Urologic Sciences, University of British Columbia, Vancouver BC
| | - Michael Liss
- University of Texas Health Sciences Center, San Antonio TX
| | - Frances M. Martin
- Department of Urology, Eastern Virginia Medical School, Virginia Beach VA
| | - Todd M. Morgan
- Department of Urology, University of Michigan, Ann Arbor MI
| | - Andrew A. Wagner
- Division of Urology, Beth Israel Deaconess Medical Center, Boston MA
| | - Daniel W. Lin
- Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Center, Seattle WA
- Department of Urology, University of Washington, Seattle WA
| |
Collapse
|
2
|
Filson CP, Zhu K, Huang Y, Zheng Y, Newcomb LF, Williams S, Brooks JD, Carroll PR, Dash A, Ellis WJ, Gleave ME, Liss MA, Martin F, McKenney JK, Morgan TM, Wagner AA, Sokoll LJ, Sanda MG, Chan DW, Lin DW. Impact of Prostate Health Index Results for Prediction of Biopsy Grade Reclassification During Active Surveillance. J Urol 2022; 208:1037-1045. [PMID: 35830553 PMCID: PMC10189606 DOI: 10.1097/ju.0000000000002852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 06/23/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE We assessed whether Prostate Health Index results improve prediction of grade reclassification for men on active surveillance. METHODS AND MATERIALS We identified men in Canary Prostate Active Surveillance Study with Grade Group 1 cancer. Outcome was grade reclassification to Grade Group 2+ cancer. We considered decision rules to maximize specificity with sensitivity set at 95%. We derived rules based on clinical data (R1) vs clinical data+Prostate Health Index (R3). We considered an "or"-logic rule combining clinical score and Prostate Health Index (R4), and a "2-step" rule using clinical data followed by risk stratification based on Prostate Health Index (R2). Rules were applied to a validation set, where values of R2-R4 vs R1 for specificity and sensitivity were evaluated. RESULTS We included 1,532 biopsies (n = 610 discovery; n = 922 validation) among 1,142 men. Grade reclassification was seen in 27% of biopsies (23% discovery, 29% validation). Among the discovery set, at 95% sensitivity, R2 yielded highest specificity at 27% vs 17% for R1. In the validation set, R3 had best performance vs R1 with Δsensitivity = -4% and Δspecificity = +6%. There was slight improvement for R3 vs R1 for confirmatory biopsy (AUC 0.745 vs R1 0.724, ΔAUC 0.021, 95% CI 0.002-0.041) but not for subsequent biopsies (ΔAUC -0.012, 95% CI -0.031-0.006). R3 did not have better discrimination vs R1 among the biopsy cohort overall (ΔAUC 0.007, 95% CI -0.007-0.020). CONCLUSIONS Among active surveillance patients, using Prostate Health Index with clinical data modestly improved prediction of grade reclassification on confirmatory biopsy and did not improve prediction on subsequent biopsies.
Collapse
Affiliation(s)
- Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
- Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia
| | - Kehao Zhu
- Biostatistics Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Yijian Huang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Yingye Zheng
- Biostatistics Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Lisa F Newcomb
- Department of Urology, University of Washington, Seattle, Washington
- Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Sierra Williams
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - James D Brooks
- Department of Urology, Stanford University, Stanford, California
| | - Peter R Carroll
- Department of Urology, University of California, San Francisco, California
| | - Atreya Dash
- VA Puget Sound Health Care Systems, Seattle, Washington
| | - William J Ellis
- Department of Urology, University of Washington, Seattle, Washington
| | - Martin E Gleave
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael A Liss
- Department of Urology, University of Texas Health Sciences Center, San Antonio, Texas
| | - Frances Martin
- Department of Urology, Eastern Virginia Medical School, Virginia Beach, Virginia
| | - Jesse K McKenney
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Andrew A Wagner
- Division of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Lori J Sokoll
- Department of Pathology, Urology, and Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Martin G Sanda
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
- Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia
| | - Daniel W Chan
- Department of Pathology, Urology, and Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel W Lin
- Department of Urology, University of Washington, Seattle, Washington
- Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| |
Collapse
|
3
|
Gulhane A, Talukder R, Dash A, Ellis WJ, Schade G, Chen JJ, Weg ES, Cheng HH, Grivas P, Hawley J, Lee JK, Montgomery RB, Nelson PS, Schweizer MT, Yezefski T, Yu EY, Lin DW, Chen DL. Clinical impact of PSMA PET in patients with biochemically recurrent prostate cancer after locoregional definitive therapy. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e17009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17009 Background: [68Ga]-PSMA-11 positron emission tomography (PSMA PET) detects sites of biochemically recurrent prostate cancer (BCR) at higher rates than conventional imaging. We hypothesized that PSMA PET would lead to high change in management (CIM) rates in this setting. Methods: We prospectively recruited patients (pts) with BCR, defined as confirmed PSA > 0.2 ng/mL > 6 weeks post-surgery or PSA ≥2 ng/mL above nadir post-radiation therapy, to undergo Ga-68 PSMA-11 PET. Some also had equivocal lesions on CT, MRI, bone scan, or fluciclovine PET obtained prior to PSMA PET. Pre-PET intended treatment, PSA (ng/mL), and PSA doubling time (PSAdt, months) from most recent 3 values were recorded prior to imaging. Post-PET treatment (intended or actual) was collected from medical record. CIM was categorized as major (change in or addition of treatment modality) vs minor (change within treatment modality, such as altered radiation field). Any lesion with uptake above blood pool was interpreted as positive for prostate cancer by an experienced PET reader (DLC). All values were represented as the median [interquartile range, IQR]. Kruskal Wallis analysis tested for significant differences among groups. Results: 44 pts with BCR age 71 [10] with Gleason scores (GS) at diagnosis of 6 (N = 2), 7 (N = 23), 8 (N = 5), and 9 (N = 13) enrolled, 14/44 with equivocal lesions on conventional imaging. 42 had post-PSMA PET treatment decisions available in medical records for CIM analysis. Time from PSA nadir to PSA at time of PSMA PET was 5 [7.25] months. PSMA PET was positive in 33 (8/33 with equivocal lesions on prior imaging; 7 local disease only; 11 regional nodal metastases, 2/11 also with local disease; and 15 with distant metastases, 4/15 also with local disease, 9/15 with regional nodal metastases), negative in 6, and equivocal in 5 pts. Of those with distant metastases, 8 had oligometastases, defined as 3 or fewer distinct sites (1 site = single nodal region or single bone lesion), 4 in bones and 4 in distant nodes. CIM rate was 71% (30/42) overall, 65.5% (16/29 major, 3/29 minor) in pts with BCR and negative conventional imaging; 84.6% (11/13, all major) in pts with equivocal lesions on conventional imaging. Of the patients with major CIM, a treatment modality was added in 21/27, modality switched in 3/27, and a modality removed in 3/27. PSA was significantly lower (p = 0.04) for those with negative or equivocal PSMA PET (0.5 [2.7]) than those with localized disease (4.1 [2.8]), regional nodal (1.1 [3.4]) or distant metastases (3.8 [5.3]), but not PSAdt (p = 0.2, negative/equivocal PET 5 [6.5], localized 15 [36], regional nodal metastases 11 [13], distant metastases 6 [6]). Conclusions: PSMA PET may impact decision making in pts with BCR after treatment of localized prostate cancer, particularly for those with equivocal findings on conventional imaging, regardless of clinical risk at diagnosis. Clinical trial information: NCT04777071.
Collapse
Affiliation(s)
| | | | - Atreya Dash
- Department of Urology, University of Washington Medical Center, Seattle, WA
| | | | | | | | | | | | - Petros Grivas
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Brady L, Newcomb LF, Zhu K, Zheng Y, Boyer H, Sarkar ND, McKenney JK, Brooks JD, Carroll PR, Dash A, Ellis WJ, Filson CP, Gleave ME, Liss MA, Martin F, Morgan TM, Thompson IM, Wagner AA, Pritchard CC, Lin DW, Nelson PS. Germline mutations in penetrant cancer predisposition genes are rare in men with prostate cancer selecting active surveillance. Cancer Med 2022; 11:4332-4340. [PMID: 35467778 DOI: 10.1002/cam4.4778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/08/2022] [Accepted: 02/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pathogenic germline mutations in several rare penetrant cancer predisposition genes are associated with an increased risk of aggressive prostate cancer (PC). Our objectives were to determine the prevalence of pathogenic germline mutations in men with low-risk PC on active surveillance, and assess whether pathogenic germline mutations associate with grade reclassification or adverse pathology, recurrence, or metastases, in men treated after initial surveillance. METHODS Men prospectively enrolled in the Canary Prostate Active Surveillance Study (PASS) were retrospectively sampled for the study. Germline DNA was sequenced utilizing a hereditary cancer gene panel. Mutations were classified according to the American College of Clinical Genetics and Genomics' guidelines. The association of pathogenic germline mutations with grade reclassification and adverse characteristics was evaluated by weighted Cox proportional hazards modeling and conditional logistic regression, respectively. RESULTS Overall, 29 of 437 (6.6%) study participants harbored a pathogenic germline mutation of which 19 occurred in a gene involved in DNA repair (4.3%). Eight participants (1.8%) had pathogenic germline mutations in three genes associated with aggressive PC: ATM, BRCA1, and BRCA2. The presence of pathogenic germline mutations in DNA repair genes did not associate with adverse characteristics (univariate analysis HR = 0.87, 95% CI: 0.36-2.06, p = 0.7). The carrier rates of pathogenic germline mutations in ATM, BRCA1, and BRCA2did not differ in men with or without grade reclassification (1.9% vs. 1.8%). CONCLUSION The frequency of pathogenic germline mutations in penetrant cancer predisposition genes is extremely low in men with PC undergoing active surveillance and pathogenic germline mutations had no apparent association with grade reclassification or adverse characteristics.
Collapse
Affiliation(s)
- Lauren Brady
- Division of Human Biology, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Lisa F Newcomb
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA.,Department of Urology, University of Washington, Seattle, Washington, USA
| | - Kehao Zhu
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Yingye Zheng
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Hilary Boyer
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA.,Department of Urology, University of Washington, Seattle, Washington, USA
| | - Navonil De Sarkar
- Division of Human Biology, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Jesse K McKenney
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - James D Brooks
- Department of Urology, Stanford University, Stanford, California, USA
| | - Peter R Carroll
- Department of Urology, University of California, San Francisco, California, USA
| | - Atreya Dash
- VA Puget Sound Health Care Systems, Seattle, WA, USA
| | - William J Ellis
- Department of Urology, University of Washington, Seattle, Washington, USA
| | - Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia, USA
| | - Martin E Gleave
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael A Liss
- Department of Urology, University of Texas Health Sciences Center, San Antonio, Texas, USA
| | - Frances Martin
- Department of Urology, Eastern Virginia Medical School, Virginia Beach, Virginia, USA
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ian M Thompson
- CHRISTUS Medical Center Hospital, San Antonio, Texas, USA
| | - Andrew A Wagner
- Division of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Colin C Pritchard
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Daniel W Lin
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA.,Department of Urology, University of Washington, Seattle, Washington, USA
| | - Peter S Nelson
- Division of Human Biology, Fred Hutchinson Cancer Center, Seattle, Washington, USA.,Department of Urology, University of Washington, Seattle, Washington, USA
| |
Collapse
|
5
|
Schweizer MT, Gulati R, Liu Y, Hakansson AK, Davicioni E, True L, Ellis WJ, Schade G, Montgomery RB, Wadhera S, Nega K, Pienta KJ, Nelson P, Wright JL, Lin DW. Transcriptomic discriminators of response to apalutamide in patients with prostate cancer (PC) on active surveillance (AS). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
267 Background: We previously reported the results of a Phase 2 study showing that a high proportion (59%) of men with PC being followed on AS will have a negative post-treatment biopsy after 90 days of apalutamide (Schweizer, et al. SUO Annual Meeting 2020). In order to identify candidate biomarkers for response, we conducted transcriptional profiling of tumor tissue obtained from men enrolled to the aforementioned trial. Methods: We analyzed FFPE tissue obtained from men enrolled to a Phase II study testing 90-days of apalutamide. Transcript profiles were assessed using Affymetrix Microarrays (Decipher Biosciences, Inc). Differences in signaling pathways were assessed between samples at baseline, day (D) 91 (post-treatment) and at D365. We also assessed differences in signaling pathways between patients that did vs. did not have a response (i.e. negative vs. persistent cancer on surveillance biopsy) at D91, which was the primary endpoint of the study. All comparisons were made using a Wilcoxon signed rank test unless otherwise indicated. Results: Samples from 22 subjects who completed 3-months of apalutamide and subsequently underwent post-treatment biopsy were available for analysis. From 19 Baseline and 15 post-treatment tissue samples, 25 passed pathology quality control (N = 12 at baseline, N = 8 at D91 and N = 5 at D365). Principal component analysis revealed distinct transcriptional profiles between tumor samples analyzed at baseline vs. D91. Surprisingly, D365 specimens still demonstrated a distinct profile compared to both baseline and D91 samples. Pathway analysis revealed up-regulation of angiogenesis signaling at D91 (P < 0.01) and D365 (P = 0.03) compared to baseline. As expected, estrogen (P < 0.01) and androgen receptor (P = 0.02) signaling were significantly lower at D91; however, only estrogen signaling was persistently suppressed at D365 (P = 0.03). Basal pathway signatures and markers associated with inflammatory response were also significantly upregulated at D91. There were no significant differences in Gleason grade group (GG) between responders and non-responders: 8/15 (53%) with GG1 vs. 5/7 (71%) with GG2 (Fisher’s exact P = 0.648). Decipher (P = 0.01) and Cuzick (P = 0.03) risk classifiers revealed an enrichment for responses in those with higher risk disease at baseline. There was also an enrichment for responses in those with higher nucleotide excision repair signature (P = 0.03) and those with signatures associated with TP53 mutations (P = 0.02). Conclusions: We observed significant transcriptional changes following 90 days of apalutamide, with evidence of persistent differences up to one year after enrollment. Higher baseline risk score was associated with improved responses to apalutamide treatment. Prospective studies evaluating the benefit of apalutamide in men on AS with higher risk transcriptional profiles are warranted. Clinical trial information: NCT02721979.
Collapse
Affiliation(s)
| | - Roman Gulati
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Yang Liu
- GenomeDx Biosciences Inc., San Diego, CA
| | | | | | | | | | | | | | | | | | - Kenneth J. Pienta
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Peter Nelson
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jonathan L. Wright
- Department of Urology, University of Washington Medical Center, Seattle, WA
| | | |
Collapse
|
6
|
Kirk PS, Zhu K, Zheng Y, Newcomb LF, Schenk JM, Brooks JD, Carroll PR, Dash A, Ellis WJ, Filson CP, Gleave ME, Liss M, Martin F, McKenney JK, Morgan TM, Nelson PS, Thompson IM, Wagner AA, Lin DW, Gore JL. Treatment in the absence of disease reclassification among men on active surveillance for prostate cancer. Cancer 2022; 128:269-274. [PMID: 34516660 PMCID: PMC8738121 DOI: 10.1002/cncr.33911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Maintaining men on active surveillance for prostate cancer can be challenging. Although most men who eventually undergo treatment have experienced clinical progression, a smaller subset elects treatment in the absence of disease reclassification. This study sought to understand factors associated with treatment in a large, contemporary, prospective cohort. METHODS This study identified 1789 men in the Canary Prostate Cancer Active Surveillance Study cohort enrolled as of 2020 with a median follow-up of 5.6 years. Clinical and demographic data as well as information on patient-reported quality of life and urinary symptoms were used in multivariable Cox proportional hazards regression models to identify factors associated with the time to treatment RESULTS: Within 4 years of their diagnosis, 33% of men (95% confidence interval [CI], 30%-35%) underwent treatment, and 10% (95% CI, 9%-12%) were treated in the absence of reclassification. The most significant factor associated with any treatment was an increasing Gleason grade group (adjusted hazard ratio [aHR], 14.5; 95% CI, 11.7-17.9). Urinary quality-of-life scores were associated with treatment without reclassification (aHR comparing "mostly dissatisfied/terrible" with "pleased/mixed," 2.65; 95% CI, 1.54-4.59). In a subset analysis (n = 692), married men, compared with single men, were more likely to undergo treatment in the absence of reclassification (aHR, 2.63; 95% CI, 1.04-6.66). CONCLUSIONS A substantial number of men with prostate cancer undergo treatment in the absence of clinical changes in their cancers, and quality-of-life changes and marital status may be important factors in these decisions. LAY SUMMARY This analysis of men on active surveillance for prostate cancer shows that approximately 1 in 10 men will decide to be treated within 4 years of their diagnosis even if their cancer is stable. These choices may be related in part to quality-or-life or spousal concerns.
Collapse
Affiliation(s)
- Peter S. Kirk
- Department of Urology, University of Washington, Seattle, WA
| | - Kehao Zhu
- Biostatistics Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Yingye Zheng
- Biostatistics Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Lisa F. Newcomb
- Department of Urology, University of Washington, Seattle, WA
- Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jeannette M. Schenk
- Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Peter R. Carroll
- Department of Urology, University of California, San Francisco, CA
| | - Atreya Dash
- VA Puget Sound Health Care Systems, Seattle, WA
| | | | | | - Martin E. Gleave
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | - Michael Liss
- Department of Urology, University of Texas Health Sciences Center, San Antonio, TX
| | - Frances Martin
- Department of Urology, Eastern Virginia Medical School, Virginia Beach, VA
| | - Jesse K. McKenney
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Todd M. Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Peter S. Nelson
- Division of Human Biology and Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Andrew A. Wagner
- Division of Urology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Daniel W. Lin
- Department of Urology, University of Washington, Seattle, WA
- Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - John L. Gore
- Department of Urology, University of Washington, Seattle, WA
| |
Collapse
|
7
|
Graham LS, True LD, Gulati R, Schade GR, Wright J, Grivas P, Yezefski T, Nega K, Alexander K, Hou WM, Yu EY, Montgomery B, Mostaghel EA, Matsumoto AA, Marck B, Sharifi N, Ellis WJ, Reder NP, Lin DW, Nelson PS, Schweizer MT. Targeting backdoor androgen synthesis through AKR1C3 inhibition: A presurgical hormonal ablative neoadjuvant trial in high-risk localized prostate cancer. Prostate 2021; 81:418-426. [PMID: 33755225 PMCID: PMC8044035 DOI: 10.1002/pros.24118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/27/2021] [Accepted: 03/09/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Localized prostate cancers (PCs) may resist neoadjuvant androgen receptor (AR)-targeted therapies as a result of persistent intraprostatic androgens arising through upregulation of steroidogenic enzymes. Therefore, we sought to evaluate clinical effects of neoadjuvant indomethacin (Indo), which inhibits the steroidogenic enzyme AKR1C3, in addition to combinatorial anti-androgen blockade, in men with high-risk PC undergoing radical prostatectomy (RP). METHODS This was an open label, single-site, Phase II neoadjuvant trial in men with high to very-high-risk PC, as defined by NCCN criteria. Patients received 12 weeks of apalutamide (Apa), abiraterone acetate plus prednisone (AAP), degarelix, and Indo followed by RP. Primary objective was to determine the pathologic complete response (pCR) rate. Secondary objectives included minimal residual disease (MRD) rate, defined as residual cancer burden (RCB) ≤ 0.25cm3 (tumor volume multiplied by tumor cellularity) and elucidation of molecular features of resistance. RESULTS Twenty patients were evaluable for the primary endpoint. Baseline median prostate-specific antigen (PSA) was 10.1 ng/ml, 4 (20%) patients had Gleason grade group (GG) 4 disease and 16 had GG 5 disease. At RP, 1 (5%) patient had pCR and 6 (30%) had MRD. Therapy was well tolerated. Over a median follow-up of 23.8 months, 1 of 7 (14%) men with pathologic response and 6 of 13 (46%) men without pathologic response had a PSA relapse. There was no association between prostate hormone levels or HSD3B1 genotype with pathologic response. CONCLUSIONS In men with high-risk PC, pCR rates remained low even with combinatorial AR-directed therapy, although rates of MRD were higher. Ongoing follow-up is needed to validate clinical outcomes of men who achieve MRD.
Collapse
Affiliation(s)
- Laura S Graham
- Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Lawrence D True
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Roman Gulati
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - George R Schade
- Department of Urology, University of Washington, Seattle, Washington, USA
| | - Jonathan Wright
- Department of Urology, University of Washington, Seattle, Washington, USA
| | - Petros Grivas
- Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Todd Yezefski
- Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Katie Nega
- Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Katerina Alexander
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Wen-Min Hou
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Evan Y Yu
- Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Bruce Montgomery
- Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Geriatric Research Education and Clinical Care, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Elahe A Mostaghel
- Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Geriatric Research Education and Clinical Care, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Alvin A Matsumoto
- Geriatric Research Education and Clinical Care, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Brett Marck
- Geriatric Research Education and Clinical Care, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Nima Sharifi
- Genitourinary Malignancies Research Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - William J Ellis
- Department of Urology, University of Washington, Seattle, Washington, USA
| | - Nicholas P Reder
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Daniel W Lin
- Department of Urology, University of Washington, Seattle, Washington, USA
| | - Peter S Nelson
- Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Michael T Schweizer
- Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| |
Collapse
|
8
|
Dinh TKT, Lee HJ, Macomber MW, Apisarnthanarax S, Zeng J, Laramore GE, Rengan R, Russell KJ, Chen JJ, Ellis WJ, Schade GR, Liao JJ. Rectal Hydrogel Spacer Improves Late Gastrointestinal Toxicity Compared to Rectal Balloon Immobilization After Proton Beam Radiation Therapy for Localized Prostate Cancer: A Retrospective Observational Study. Int J Radiat Oncol Biol Phys 2020; 108:635-643. [DOI: 10.1016/j.ijrobp.2020.01.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/10/2020] [Accepted: 01/21/2020] [Indexed: 12/19/2022]
|
9
|
Nayak JG, Scalzo N, Chu A, Shiff B, Kearns JT, Dy GW, Macleod LC, Mossanen M, Ellis WJ, Lin DW, Wright JL, True LD, Gore JL. The development and comparative effectiveness of a patient-centered prostate biopsy report: a prospective, randomized study. Prostate Cancer Prostatic Dis 2020; 23:144-150. [PMID: 31462701 PMCID: PMC10896697 DOI: 10.1038/s41391-019-0169-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/29/2019] [Accepted: 08/01/2019] [Indexed: 02/01/2023]
Abstract
PURPOSE The prostate biopsy pathology report represents a critical document used for decision-making in patients diagnosed with prostate cancer, yet the content exceeds the health literacy of most patients. We sought to create and compare the effectiveness of a patient-centered prostate biopsy report compared with standard reports. MATERIALS AND METHODS Using a modified Delphi approach, prostate cancer experts identified critical components of a prostate biopsy report. Patient focus groups provided input for syntax and formatting of patient-centered pathology reports. Ninety-four patients with recent prostate biopsies were block randomized to the standard report with or without the patient-centered report. We evaluated patient activation, self-efficacy, provider communication skills, and prostate cancer knowledge. RESULTS Experts selected primary and secondary Gleason score and the number of positive scores as the most important elements of the report. Patients prioritized a narrative design, non-threatening language and information on risk classification. Initial assessments were completed by 87% (40/46) in the standard report group and 81% (39/48) in the patient-centered report group. There were no differences in patient activation, self-efficacy, or provider communication skills between groups. Patients who received the patient-centered report had significantly improved ability to recall their Gleason score (100% vs. 85%, p = 0.026) and number of positive cores (90% vs. 65%, p = 0.014). In total, 86% of patients who received the patient-centered report felt that it helped them better understand their results and should always be provided. CONCLUSIONS Patient-centered pathology reports are associated with significantly higher knowledge about a prostate cancer diagnosis. These important health information documents may improve patient-provider communication and help facilitate shared decision-making among patients diagnosed with prostate cancer.
Collapse
Affiliation(s)
- Jasmir G Nayak
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Nicholas Scalzo
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Alice Chu
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Benjamin Shiff
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - James T Kearns
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Geolani W Dy
- Department of Urology, New York University, New York, NY, USA
| | - Liam C Macleod
- Department of Urology, University of Pittsburgh Medical Center, Hermitage, PA, USA
| | - Matthew Mossanen
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - William J Ellis
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Daniel W Lin
- Department of Urology, University of Washington, Seattle, WA, USA
| | | | - Lawrence D True
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - John L Gore
- Department of Urology, University of Washington, Seattle, WA, USA.
| |
Collapse
|
10
|
Graham L, Reder N, Gulati R, Grivas P, Wright JL, Yu EY, Hou W, Nega K, Yezefski T, Montgomery RB, Mostaghel EA, Ellis WJ, True LD, Lin DW, Nelson P, Schweizer MT. Targeting backdoor androgen synthesis through AKR1C3 inhibition: A presurgical hormonal ablative trial in high risk localized prostate cancer (PC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.5081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5081 Background: Studies have shown that localized PCs may resist neoadjuvant androgen receptor (AR)-targeted therapies as a result of persistent intraprostatic androgens, likely arising through upregulation of steroidogenic enzymes. Therefore, we sought to evaluate clinical effects of combinatorial AR-targeted therapy, including indomethacin (Indo) to inhibit the steroidogenic enzyme AKR1C3, in men with high risk PC undergoing radical prostatectomy (RP). Methods: This was an open label, single-site, Phase II neoadjuvant trial in men with localized high to very-high risk PC, as defined by NCCN criteria. Patients received 12 weeks of neoadjuvant apalutamide (Apa), abiraterone (Abi) plus prednisone, degarelix, and Indo at their respective FDA-approved doses followed by RP. The primary objective was to determine the pathologic complete response (pCR) rate. Secondary objectives included assessing for minimal residual disease (MRD) (i.e. ≤0.25 cm3 tumor volume corrected for cellularity), measuring intraprostatic androgens and assessing molecular features associated with drug resistance. Twenty evaluable patients provided 91% power (one-sided alpha = 7.5%) to detect a difference in pCR rate of 5% (H0) vs. 25% (H1). Results: Twenty-two patients enrolled and 20 were evaluable for the primary endpoint (1 patient came off to pursue stereotactic radiosurgery; 1 was removed after developing grade 2 transaminitis). At baseline, the median PSA was 10.1 ng/mL (4.4-159.4), 4 (20%) patients had Gleason grade group (GG) 4 disease and 16 had GG 5 disease. At RP, 1 (5%) patient had a pCR, 6 (30%) had MRD, 18 (90%) had ypT3 disease and 7 (35%) had lymph node (LN) metastases. Treatment was generally well tolerated and adverse events were consistent with each individual drug’s known safety profile. Additional follow up data and correlative work will be presented at the meeting. Conclusions: In our cohort of men with high-risk PC, pCR rates remained low even with combinatorial AR-directed therapy. Ongoing pharmacodynamic studies aimed at determining if Indo effectively inhibited AKR1C3 will provide important insights regarding the utility of targeting this steroidogenic enzyme. Clinical trial information: NCT02849990.
Collapse
Affiliation(s)
| | | | - Roman Gulati
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Petros Grivas
- University of Washington, School of Medicine, Seattle, WA
| | - Jonathan L. Wright
- Department of Urology, University of Washington Medical Center, Seattle, WA
| | | | - Wendy Hou
- University of Washington, Seattle, WA
| | | | - Todd Yezefski
- University of Washington, School of Medicine, Seattle, WA
| | | | | | | | | | | | - Peter Nelson
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | |
Collapse
|
11
|
McKay RR, Ye H, Xie W, Lis R, Calagua C, Zhang Z, Trinh QD, Chang SL, Harshman LC, Ross AE, Pienta KJ, Lin DW, Ellis WJ, Montgomery B, Chang P, Wagner AA, Bubley GJ, Kibel AS, Taplin ME. Evaluation of Intense Androgen Deprivation Before Prostatectomy: A Randomized Phase II Trial of Enzalutamide and Leuprolide With or Without Abiraterone. J Clin Oncol 2019; 37:923-931. [PMID: 30811282 DOI: 10.1200/jco.18.01777] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Patients with locally advanced prostate cancer have an increased risk of cancer recurrence and mortality. In this phase II trial, we evaluate neoadjuvant enzalutamide and leuprolide (EL) with or without abiraterone and prednisone (ELAP) before radical prostatectomy (RP) in men with locally advanced prostate cancer. PATIENTS AND METHODS Eligible patients had a biopsy Gleason score of 4 + 3 = 7 or greater, prostate-specific antigen (PSA) greater than 20 ng/mL, or T3 disease (by prostate magnetic resonance imaging). Lymph nodes were required to be smaller than 20 mm. Patients were randomly assigned 2:1 to ELAP or EL for 24 weeks followed by RP. All specimens underwent central pathology review. The primary end point was pathologic complete response or minimal residual disease (residual tumor ≤ 5 mm). Secondary end points were PSA, surgical staging, positive margins, and safety. Biomarkers associated with pathologic outcomes were explored. RESULTS Seventy-five patients were enrolled at four centers. Most patients had high-risk disease by National Comprehensive Cancer Network criteria (n = 65; 87%). The pathologic complete response or minimal residual disease rate was 30% (n = 15 of 50) in ELAP-treated patients and 16% (n = four of 25) in EL-treated patients (two-sided P = .263). Rates of ypT3 disease, positive margins, and positive lymph nodes were similar between arms. Treatment was well-tolerated. Residual tumors in the two arms showed comparable levels of ERG, PTEN, androgen receptor PSA, and glucocorticoid receptor expression. Tumor ERG positivity and PTEN loss were associated with more extensive residual tumors at RP. CONCLUSION Neoadjuvant hormone therapy followed by RP in locally advanced prostate cancer resulted in favorable pathologic responses in some patients, with a trend toward improved pathologic outcomes with ELAP. Longer follow-up is necessary to evaluate the impact of therapy on recurrence rates. The potential association of ERG and PTEN alterations with worse outcomes warrants additional investigation.
Collapse
Affiliation(s)
- Rana R McKay
- 1 University of California, San Diego, San Diego, CA.,2 Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Huihui Ye
- 3 Beth Israel Deaconess Medical Center, Boston, MA
| | - Wanling Xie
- 2 Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Rosina Lis
- 2 Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | | | - Zhenwei Zhang
- 2 Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Quoc-Dien Trinh
- 2 Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Steven L Chang
- 2 Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Lauren C Harshman
- 2 Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | | | | | | | | | | | - Peter Chang
- 3 Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | - Adam S Kibel
- 2 Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Mary-Ellen Taplin
- 2 Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| |
Collapse
|
12
|
Kearns JT, Faino AV, Schenk JM, Newcomb LF, Brooks JD, Carroll PR, Dash A, Ellis WJ, Fabrizio M, Gleave ME, Morgan TM, Nelson PS, Thompson IM, Wagner A, Zheng Y, Lin DW. Continued 5α-Reductase Inhibitor Use after Prostate Cancer Diagnosis and the Risk of Reclassification and Adverse Pathological Outcomes in the PASS. J Urol 2019; 201:106-111. [PMID: 30076904 PMCID: PMC10958899 DOI: 10.1016/j.juro.2018.07.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Outcomes in patients who enroll in active surveillance programs for prostate cancer while receiving 5α-reductase inhibitors have not been well defined. We sought to determine the association of 5α-reductase inhibitor use with the risk of reclassification in the PASS (Canary Prostate Active Surveillance Study). MATERIALS AND METHODS Participants in the multicenter PASS were enrolled between 2008 and 2016. Study inclusion criteria were current or never 5α-reductase inhibitors use, Gleason score 3 + 4 or less prostate cancer at diagnosis, less than a 34% core involvement ratio at diagnosis and 1 or more surveillance biopsies. Included in study were 1,009 men, including 107 on 5α-reductase inhibitors and 902 who had never received 5α-reductase inhibitors. Reclassification was defined as increase in the Gleason score and/or an increase to 34% or greater in the ratio of biopsy cores positive for cancer. Adverse pathology at prostatectomy was defined as Gleason 4 + 3 or greater and/or nonorgan confined disease (pT3 or N1). RESULTS On multivariable analysis there was no difference in reclassification between men who had received and those who had never received 5α-reductase inhibitors (HR 0.81, p = 0.31). Patients who had received 5α-reductase inhibitors were less likely to undergo radical prostatectomy (8% vs 18%, p = 0.01) or any definitive treatment (19% vs 24%, p = 0.04). In the 167 participants who underwent radical prostatectomy there was no suggestion of a difference in the rate of adverse pathology findings at prostatectomy between 5α-reductase inhibitor users and nonusers. CONCLUSIONS Continued 5α-reductase inhibitor use after an initial diagnosis of prostate cancer was not associated with the risk of reclassification on active surveillance in men in the PASS cohort.
Collapse
Affiliation(s)
- James T. Kearns
- Department of Urology, University of Washington School of Medicine (JTK, AD, WJE) and Fred Hutchinson Cancer Research Center (AVF, JMS, PSN, YZ), Seattle (LFN, DWL), Washington, Stanford University (JDB), Stanford and University of California-San Francisco (PRC), San Francisco, California, Eastern Virginia Medical School (MF), Norfolk, Virginia, University of British Columbia (MEG), Vancouver, British Columbia, Canada, University of Michigan (TMM), Ann Arbor, Michigan, University of Texas Health Sciences Center at San Antonio (IMT), San Antonio, Texas, and Beth Israel Deaconess Medical Center (AW), Boston, Massachusetts
| | - Anna V. Faino
- Department of Urology, University of Washington School of Medicine (JTK, AD, WJE) and Fred Hutchinson Cancer Research Center (AVF, JMS, PSN, YZ), Seattle (LFN, DWL), Washington, Stanford University (JDB), Stanford and University of California-San Francisco (PRC), San Francisco, California, Eastern Virginia Medical School (MF), Norfolk, Virginia, University of British Columbia (MEG), Vancouver, British Columbia, Canada, University of Michigan (TMM), Ann Arbor, Michigan, University of Texas Health Sciences Center at San Antonio (IMT), San Antonio, Texas, and Beth Israel Deaconess Medical Center (AW), Boston, Massachusetts
| | - Jeanette M. Schenk
- Department of Urology, University of Washington School of Medicine (JTK, AD, WJE) and Fred Hutchinson Cancer Research Center (AVF, JMS, PSN, YZ), Seattle (LFN, DWL), Washington, Stanford University (JDB), Stanford and University of California-San Francisco (PRC), San Francisco, California, Eastern Virginia Medical School (MF), Norfolk, Virginia, University of British Columbia (MEG), Vancouver, British Columbia, Canada, University of Michigan (TMM), Ann Arbor, Michigan, University of Texas Health Sciences Center at San Antonio (IMT), San Antonio, Texas, and Beth Israel Deaconess Medical Center (AW), Boston, Massachusetts
| | - Lisa F. Newcomb
- Department of Urology, University of Washington School of Medicine (JTK, AD, WJE) and Fred Hutchinson Cancer Research Center (AVF, JMS, PSN, YZ), Seattle (LFN, DWL), Washington, Stanford University (JDB), Stanford and University of California-San Francisco (PRC), San Francisco, California, Eastern Virginia Medical School (MF), Norfolk, Virginia, University of British Columbia (MEG), Vancouver, British Columbia, Canada, University of Michigan (TMM), Ann Arbor, Michigan, University of Texas Health Sciences Center at San Antonio (IMT), San Antonio, Texas, and Beth Israel Deaconess Medical Center (AW), Boston, Massachusetts
| | - James D. Brooks
- Department of Urology, University of Washington School of Medicine (JTK, AD, WJE) and Fred Hutchinson Cancer Research Center (AVF, JMS, PSN, YZ), Seattle (LFN, DWL), Washington, Stanford University (JDB), Stanford and University of California-San Francisco (PRC), San Francisco, California, Eastern Virginia Medical School (MF), Norfolk, Virginia, University of British Columbia (MEG), Vancouver, British Columbia, Canada, University of Michigan (TMM), Ann Arbor, Michigan, University of Texas Health Sciences Center at San Antonio (IMT), San Antonio, Texas, and Beth Israel Deaconess Medical Center (AW), Boston, Massachusetts
| | - Peter R. Carroll
- Department of Urology, University of Washington School of Medicine (JTK, AD, WJE) and Fred Hutchinson Cancer Research Center (AVF, JMS, PSN, YZ), Seattle (LFN, DWL), Washington, Stanford University (JDB), Stanford and University of California-San Francisco (PRC), San Francisco, California, Eastern Virginia Medical School (MF), Norfolk, Virginia, University of British Columbia (MEG), Vancouver, British Columbia, Canada, University of Michigan (TMM), Ann Arbor, Michigan, University of Texas Health Sciences Center at San Antonio (IMT), San Antonio, Texas, and Beth Israel Deaconess Medical Center (AW), Boston, Massachusetts
| | - Atreya Dash
- Department of Urology, University of Washington School of Medicine (JTK, AD, WJE) and Fred Hutchinson Cancer Research Center (AVF, JMS, PSN, YZ), Seattle (LFN, DWL), Washington, Stanford University (JDB), Stanford and University of California-San Francisco (PRC), San Francisco, California, Eastern Virginia Medical School (MF), Norfolk, Virginia, University of British Columbia (MEG), Vancouver, British Columbia, Canada, University of Michigan (TMM), Ann Arbor, Michigan, University of Texas Health Sciences Center at San Antonio (IMT), San Antonio, Texas, and Beth Israel Deaconess Medical Center (AW), Boston, Massachusetts
| | - William J. Ellis
- Department of Urology, University of Washington School of Medicine (JTK, AD, WJE) and Fred Hutchinson Cancer Research Center (AVF, JMS, PSN, YZ), Seattle (LFN, DWL), Washington, Stanford University (JDB), Stanford and University of California-San Francisco (PRC), San Francisco, California, Eastern Virginia Medical School (MF), Norfolk, Virginia, University of British Columbia (MEG), Vancouver, British Columbia, Canada, University of Michigan (TMM), Ann Arbor, Michigan, University of Texas Health Sciences Center at San Antonio (IMT), San Antonio, Texas, and Beth Israel Deaconess Medical Center (AW), Boston, Massachusetts
| | - Michael Fabrizio
- Department of Urology, University of Washington School of Medicine (JTK, AD, WJE) and Fred Hutchinson Cancer Research Center (AVF, JMS, PSN, YZ), Seattle (LFN, DWL), Washington, Stanford University (JDB), Stanford and University of California-San Francisco (PRC), San Francisco, California, Eastern Virginia Medical School (MF), Norfolk, Virginia, University of British Columbia (MEG), Vancouver, British Columbia, Canada, University of Michigan (TMM), Ann Arbor, Michigan, University of Texas Health Sciences Center at San Antonio (IMT), San Antonio, Texas, and Beth Israel Deaconess Medical Center (AW), Boston, Massachusetts
| | - Martin E. Gleave
- Department of Urology, University of Washington School of Medicine (JTK, AD, WJE) and Fred Hutchinson Cancer Research Center (AVF, JMS, PSN, YZ), Seattle (LFN, DWL), Washington, Stanford University (JDB), Stanford and University of California-San Francisco (PRC), San Francisco, California, Eastern Virginia Medical School (MF), Norfolk, Virginia, University of British Columbia (MEG), Vancouver, British Columbia, Canada, University of Michigan (TMM), Ann Arbor, Michigan, University of Texas Health Sciences Center at San Antonio (IMT), San Antonio, Texas, and Beth Israel Deaconess Medical Center (AW), Boston, Massachusetts
| | - Todd M. Morgan
- Department of Urology, University of Washington School of Medicine (JTK, AD, WJE) and Fred Hutchinson Cancer Research Center (AVF, JMS, PSN, YZ), Seattle (LFN, DWL), Washington, Stanford University (JDB), Stanford and University of California-San Francisco (PRC), San Francisco, California, Eastern Virginia Medical School (MF), Norfolk, Virginia, University of British Columbia (MEG), Vancouver, British Columbia, Canada, University of Michigan (TMM), Ann Arbor, Michigan, University of Texas Health Sciences Center at San Antonio (IMT), San Antonio, Texas, and Beth Israel Deaconess Medical Center (AW), Boston, Massachusetts
| | - Peter S. Nelson
- Department of Urology, University of Washington School of Medicine (JTK, AD, WJE) and Fred Hutchinson Cancer Research Center (AVF, JMS, PSN, YZ), Seattle (LFN, DWL), Washington, Stanford University (JDB), Stanford and University of California-San Francisco (PRC), San Francisco, California, Eastern Virginia Medical School (MF), Norfolk, Virginia, University of British Columbia (MEG), Vancouver, British Columbia, Canada, University of Michigan (TMM), Ann Arbor, Michigan, University of Texas Health Sciences Center at San Antonio (IMT), San Antonio, Texas, and Beth Israel Deaconess Medical Center (AW), Boston, Massachusetts
| | - Ian M. Thompson
- Department of Urology, University of Washington School of Medicine (JTK, AD, WJE) and Fred Hutchinson Cancer Research Center (AVF, JMS, PSN, YZ), Seattle (LFN, DWL), Washington, Stanford University (JDB), Stanford and University of California-San Francisco (PRC), San Francisco, California, Eastern Virginia Medical School (MF), Norfolk, Virginia, University of British Columbia (MEG), Vancouver, British Columbia, Canada, University of Michigan (TMM), Ann Arbor, Michigan, University of Texas Health Sciences Center at San Antonio (IMT), San Antonio, Texas, and Beth Israel Deaconess Medical Center (AW), Boston, Massachusetts
| | - Andrew Wagner
- Department of Urology, University of Washington School of Medicine (JTK, AD, WJE) and Fred Hutchinson Cancer Research Center (AVF, JMS, PSN, YZ), Seattle (LFN, DWL), Washington, Stanford University (JDB), Stanford and University of California-San Francisco (PRC), San Francisco, California, Eastern Virginia Medical School (MF), Norfolk, Virginia, University of British Columbia (MEG), Vancouver, British Columbia, Canada, University of Michigan (TMM), Ann Arbor, Michigan, University of Texas Health Sciences Center at San Antonio (IMT), San Antonio, Texas, and Beth Israel Deaconess Medical Center (AW), Boston, Massachusetts
| | - Yingye Zheng
- Department of Urology, University of Washington School of Medicine (JTK, AD, WJE) and Fred Hutchinson Cancer Research Center (AVF, JMS, PSN, YZ), Seattle (LFN, DWL), Washington, Stanford University (JDB), Stanford and University of California-San Francisco (PRC), San Francisco, California, Eastern Virginia Medical School (MF), Norfolk, Virginia, University of British Columbia (MEG), Vancouver, British Columbia, Canada, University of Michigan (TMM), Ann Arbor, Michigan, University of Texas Health Sciences Center at San Antonio (IMT), San Antonio, Texas, and Beth Israel Deaconess Medical Center (AW), Boston, Massachusetts
| | - Daniel W. Lin
- Department of Urology, University of Washington School of Medicine (JTK, AD, WJE) and Fred Hutchinson Cancer Research Center (AVF, JMS, PSN, YZ), Seattle (LFN, DWL), Washington, Stanford University (JDB), Stanford and University of California-San Francisco (PRC), San Francisco, California, Eastern Virginia Medical School (MF), Norfolk, Virginia, University of British Columbia (MEG), Vancouver, British Columbia, Canada, University of Michigan (TMM), Ann Arbor, Michigan, University of Texas Health Sciences Center at San Antonio (IMT), San Antonio, Texas, and Beth Israel Deaconess Medical Center (AW), Boston, Massachusetts
| |
Collapse
|
13
|
Kearns JT, Faino AV, Newcomb LF, Brooks JD, Carroll PR, Dash A, Ellis WJ, Fabrizio M, Gleave ME, Morgan TM, Nelson PS, Thompson IM, Wagner AA, Zheng Y, Lin DW. Role of Surveillance Biopsy with No Cancer as a Prognostic Marker for Reclassification: Results from the Canary Prostate Active Surveillance Study. Eur Urol 2018; 73:706-712. [PMID: 29433973 PMCID: PMC6064187 DOI: 10.1016/j.eururo.2018.01.016] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 01/17/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Many patients who are on active surveillance (AS) for prostate cancer will have surveillance prostate needle biopsies (PNBs) without any cancer evident. OBJECTIVE To define the association between negative surveillance PNBs and risk of reclassification on AS. DESIGN, SETTING, AND PARTICIPANTS All men were enrolled in the Canary Prostate Active Surveillance Study (PASS) between 2008 and 2016. Men were included if they had Gleason ≤3+4 prostate cancer and <34% core involvement ratio at diagnosis. Men were prescribed surveillance PNBs at 12 and 24 mo after diagnosis and then every 24 mo. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Reclassification was defined as an increase in Gleason grade and/or an increase in the ratio of biopsy cores to cancer to ≥34%. PNB outcomes were defined as follows: (1) no cancer on biopsy, (2) cancer without reclassification, or (3) reclassification. Kaplan-Meier and Cox proportional hazard models were performed to assess the risk of reclassification. RESULTS AND LIMITATIONS A total of 657 men met inclusion criteria. On first surveillance PNB, 214 (32%) had no cancer, 282 (43%) had cancer but no reclassification, and 161 (25%) reclassified. Among those who did not reclassify, 313 had a second PNB. On second PNB, 120 (38%) had no cancer, 139 (44%) had cancer but no reclassification, and 54 (17%) reclassified. In a multivariable analysis, significant predictors of decreased future reclassification after the first PNB were no cancer on PNB (hazard ratio [HR]=0.50, p=0.008), lower serum prostate-specific antigen, larger prostate size, and lower body mass index. A finding of no cancer on the second PNB was also associated with significantly decreased future reclassification in a multivariable analysis (HR=0.15, p=0.003), regardless of the first PNB result. The major limitation of this study is a relatively small number of patients with long-term follow-up. CONCLUSIONS Men who have a surveillance PNB with no evidence of cancer are significantly less likely to reclassify on AS in the PASS cohort. These findings have implications for tailoring AS protocols. PATIENT SUMMARY Men on active surveillance for prostate cancer who have a biopsy showing no cancer are at a decreased risk of having worse disease in the future. This may have an impact on how frequently biopsies are required to be performed in the future.
Collapse
Affiliation(s)
- James T Kearns
- Department of Urology, University of Washington, Seattle, WA, USA.
| | - Anna V Faino
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lisa F Newcomb
- Department of Urology, University of Washington, Seattle, WA, USA; Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Atreya Dash
- Department of Urology, University of Washington, Seattle, WA, USA
| | - William J Ellis
- Department of Urology, University of Washington, Seattle, WA, USA
| | | | | | | | - Peter S Nelson
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ian M Thompson
- University of Texas Health Sciences Center at San Antonio, TX, USA
| | | | - Yingye Zheng
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Daniel W Lin
- Department of Urology, University of Washington, Seattle, WA, USA
| |
Collapse
|
14
|
McKay RR, Xie W, Lis R, Ye H, Zhang Z, Trinh QD, Chang SL, Harshman LC, Ross A, Pienta KJ, Lin DW, Ellis WJ, Montgomery RB, Chang P, Wagner A, Bubley G, Kibel AS, Taplin ME. Results of a phase II trial of neoadjuvant abiraterone + prednisone+ enzalutamide + leuprolide (APEL) versus enzalutamide + leuprolide (EL) for patients with high-risk localized prostate cancer (PC) undergoing radical prostatectomy (RP). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.79] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
79 Background: Patients with high-risk PC have an increased risk of recurrence and mortality despite therapy. Abiraterone, a CYP17 inhibitor, and enzalutamide, a next generation anti-androgen, have demonstrated improved overall survival in metastatic PC. In this multicenter randomized phase II trial, we evaluate the impact of second generation hormone therapy on RP pathologic outcomes. Methods: Eligible patients had biopsy Gleason score ≥4+3=7, PSA >20 ng/mL or cT3 disease (by prostate MRI). Lymph node were require to be <20 mm. Patients were randomized 2:1 to APE:EL for 6 cycles (24 weeks) followed by RP. All RPs underwent central pathology review. The primary endpoint was the rate of pathologic complete response (pCR) or minimum residual disease (MRD, tumor ≤5 mm). Secondary endpoints include PSA response, surgical staging at RP, positive margin rate, and safety. Results: 75 patients were enrolled at four sites: DFCI/BWH (n=55), BIDMC (n=11), UW (n=5), JHU (n=4). Median age was 62 years. Most patients had NCCN high-risk disease [n=66, 88%; cT3 n=21 (28%), Gleason 8-10 n=59 (79%), PSA >20 ng/mL n=17 (23%)]. All patients completed 6 cycles followed by RP. Median PSA nadir was 0.03 and 0.02 ng/mL and time to nadir was 3.7 and 4.6 months in the APEL and EL arms, respectively. The combined pCR or MRD rate was 30% (n=15/50) in the APEL arm and 16% (n=4/25) in the EL arm. The response difference was 14% (80% CI -3%-30%, p=0.263). 15 patients (14 in APEL; 1 in EL) had grade 3 adverse events (AEs). The most common grade 3 AEs were hypertension (n=7) and ALT increase (n=5). No grade 4-5 AEs occurred. Conclusions: Neoadjuvant hormone therapy plus RP in men with high-risk PC resulted in favorable pathologic responses (≤5 mm residual tumor) in 16-30% with a trend towards improved pathologic outcomes with APEL and acceptable safety profile. Follow-up is necessary to evaluate the impact of therapy on recurrence rates. Clinical trial information: NCT02268175. [Table: see text]
Collapse
Affiliation(s)
| | | | - Rosina Lis
- Dana-Farber Cancer Institute, Boston, MA
| | - Huihui Ye
- Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Quoc-Dien Trinh
- Brigham and Women's Hospital/ Harvard Medical School, Boston, MA
| | | | | | | | - Kenneth J. Pienta
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | - Peter Chang
- Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Glenn Bubley
- Beth Israel Deaconess Medical Center, Boston, MA
| | - Adam S. Kibel
- Brigham and Women’s Hospital/ Dana-Farber Cancer Center, Boston, MA
| | | |
Collapse
|
15
|
Nayak JG, Scalzo N, Chu A, Dy G, Macleod LC, Kearns JT, Mossanen M, Ellis WJ, Lin DW, True LD, Gore JL. Comparative effectiveness of a patient-centered prostate biopsy report in clinical prostate cancer practice. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
145 Background: The prostate biopsy pathology report is a critical decision-making document for men newly-diagnosed with prostate cancer, yet the content may be beyond the health literacy of most patients. We compare the effectiveness of a patient-centered prostate biopsy report developed through patient-centered outcomes research methods with standard synoptic reports. Methods: Using a modified Delphi approach, a multidisciplinary group of prostate cancer experts provided consensus for the critical components of a prostate biopsy report for treatment decision-making. Patient focus groups provided input for syntax and formatting to inform the design of a patient-centered pathology report. 94 patients with recent prostate biopsies were block randomized to receive the standard report with or without the patient-centered report. We evaluated patient self-efficacy, provider communication and empathy, and prostate cancer knowledge at pathology disclosure. We compared study groups with descriptive statistics. Results: Experts selected primary and secondary Gleason score and number of positive cores as the important elements of a prostate biopsy report. Patients prioritized a narrative word structure, clear language, a tabular format for histologic grade, and information on risk classification. Initial assessments were completed by 84% (79/94) of participants including 40/46 in the standard report group and 39/48 in the patient-centered report group. Patients who received the patient-centered report had significantly improved ability to recall their Gleason score (100% vs. 85%, p = 0.03) and number of positive cores (90% vs. 65%, p = 0.01). Provider communication and patient self-efficacy were uniformly high and did not differ between groups. 88% of patients who received the patient-centered report felt that it helped them better understand their pathology results. Conclusions: A patient-centered prostate biopsy pathology report is associated with significantly higher knowledge about a new prostate cancer diagnosis. These health information documents may help facilitate shared decision-making among patients newly diagnosed with prostate cancer.
Collapse
Affiliation(s)
| | | | - Alice Chu
- University of Washington Medical Center, Seattle, WA
| | | | | | | | | | | | | | | | - John L. Gore
- University of Washington School of Medicine, Seattle, WA
| |
Collapse
|
16
|
Montgomery RB, Russell KJ, Liao JJ, Ellis WJ, Cheng HH, Yu EY, Mostaghel EA. A phase II study of degarelix prior to radiation on prostatic tissue androgens. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
103 Background: Optimizing androgen suppression may provide better treatment outcomes for localized prostate cancer (PCa). Numerous trials have supported the benefit of combining androgen deprivation (ADT) with definitive radiotherapy in men with locally advanced or high-grade disease. LHRH agonist (LHRHa) is most commonly used. The LHRH antagonist degarelix may provide more robust androgen suppression. The impact on tissue androgens following use of degarelix prior to radiation has not been reported. We examined the impact on androgens in serum and tissue after 12 weeks of degarelix in this phase II study. Methods: A prospective, phase II study was conducted in men with localized PCa treated with 6 months of neoadjuvant and concurrent degarelix with radiation. Prostate biopsies were obtained at the time of fiducial placement before radiotherapy. Serum and tissue androgen levels were measured by liquid chromatography-tandem mass spectrometry. Needle biopsies from a separate analysis of untreated men or those receiving LHRHa prior to prostatectomy were used as tissue androgen level controls. Results: 16 men with intermediate (4) and high-risk (12) PCa received study therapy. 14 men completed degarelix and planned radiation to 77.4-81 Gy. Serum and tissue androgens after 12 weeks of therapy are compared to untreated control and LHRHa treated patients (12 weeks). Serum levels of dihydrotestosterone (DHT) and testosterone were similarly suppressed by LHRHa or degarelix compared to untreated controls, without statistically significant differences. Degarelix provided statistically greater reduction in androsterone than LHRHa. Conclusions: In this phase II study degarelix and LHRHa achieved similar serum and tissue androgen levels at 12 weeks; however, there was a greater suppression of tissue androsterone with degarelix. The clinical significance of this difference remains uncertain. Clinical trial information: NCT01731912. [Table: see text]
Collapse
Affiliation(s)
| | | | | | | | | | - Evan Y. Yu
- Seattle Cancer Care Alliance, Seattle, WA
| | | |
Collapse
|
17
|
Shi T, Quek SI, Gao Y, Nicora CD, Nie S, Fillmore TL, Liu T, Rodland KD, Smith RD, Leach RJ, Thompson IM, Vitello EA, Ellis WJ, Liu AY, Qian WJ. Multiplexed targeted mass spectrometry assays for prostate cancer-associated urinary proteins. Oncotarget 2017; 8:101887-101898. [PMID: 29254211 PMCID: PMC5731921 DOI: 10.18632/oncotarget.21710] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/04/2017] [Indexed: 02/07/2023] Open
Abstract
Biomarkers for effective early diagnosis and prognosis of prostate cancer are still lacking. Multiplexed assays for cancer-associated proteins could be useful for identifying biomarkers for cancer detection and stratification. Herein, we report the development of sensitive targeted mass spectrometry assays for simultaneous quantification of 10 prostate cancer-associated proteins in urine. The diagnostic utility of these markers was evaluated with an initial cohort of 20 clinical urine samples. Individual marker concentration was normalized against the measured urinary prostate-specific antigen level as a reference of prostate-specific secretion. The areas under the receiver-operating characteristic curves for the 10 proteins ranged from 0.75 for CXL14 to 0.87 for CEAM5. Furthermore, MMP9 level was found to be significantly higher in patients with high Gleason scores, suggesting a potential of MMP9 as a marker for risk level assessment. Taken together, our work illustrated the feasibility of accurate multiplexed measurements of low-abundance cancer-associated proteins in urine and provided a viable path forward for preclinical verification of candidate biomarkers for prostate cancer.
Collapse
Affiliation(s)
- Tujin Shi
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA, USA
| | - Sue-Ing Quek
- Department of Urology, University of Washington, Seattle, WA, USA.,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, USA.,Present address: Singapore Polytechnic, Center for Biomedical and Life Sciences T11A-412 (level 4), Singapore
| | - Yuqian Gao
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA, USA
| | - Carrie D Nicora
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA, USA
| | - Song Nie
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA, USA
| | - Thomas L Fillmore
- Environmental Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland, WA, USA
| | - Tao Liu
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA, USA
| | - Karin D Rodland
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA, USA
| | - Richard D Smith
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA, USA
| | - Robin J Leach
- Department of Urology and the Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ian M Thompson
- Department of Urology and the Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Elizabeth A Vitello
- Department of Urology, University of Washington, Seattle, WA, USA.,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, USA
| | - William J Ellis
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Alvin Y Liu
- Department of Urology, University of Washington, Seattle, WA, USA.,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, USA
| | - Wei-Jun Qian
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA, USA
| |
Collapse
|
18
|
Kearns JT, Faino AV, Newcomb LF, Brooks JD, Carroll P, Dash A, Ellis WJ, Fabrizio M, Gleave M, Morgan TM, Nelson PS, Thompson IM, Wagner A, Zheng Y, Lin DW. The use of five-alpha reductase inhibitors and their association with reclassification and pathologic outcomes in the Canary Prostate Active Surveillance Study (PASS). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
22 Background: The outcomes of patients who enroll in active surveillance (AS) programs for prostate cancer (PCa) while currently taking five-alpha reductase inhibitors (5-ARIs) have not been well defined. Previous studies suggest that the initiation of 5-ARIs after enrolling in AS decreases the rate of reclassification and/or treatment for PCa, but there is still an FDA black box warning about the risk of grade risk prostate cancer while on 5-ARI. The objective of this study was to evaluate the safety of remaining on a 5-ARI after initiating AS for PCa. Methods: All men were enrolled in PASS. Inclusion criteria were current or never 5-ARI user, Gleason 3+3 or 3+4 PCa at diagnosis, ≤ 34% core ratio at diagnosis and ≥ 1 surveillance biopsy. Reclassification was defined as an increase in Gleason score and/or ratio of biopsy cores positive for cancer to ≥ 34%. Results: 1045 men were included in this study, 938 who had never used a 5-ARI and 107 5-ARI users. 5-ARI users had larger prostate volume (51 cc vs 40 cc, p < 0.01), a higher rate of BPH (77% vs 29%, p < 0.01) and older age (65 vs 62 years, p < 0.01). All other clinical parameters, including serum PSA, were statistically similar. Kaplan Meier analysis of any reclassification is shown in the figure. There was no significant difference in any reclassification (p = 0.12). The use of 5-ARI at diagnosis was significantly protective for reclassification in a proportional hazards model (HR 0.68, p = 0.03); this difference was not significant after accounting for serum PSA, BMI, prostate size and positive cores ratio at diagnosis (HR 0.78, p = 0.18). There was no significant effect on adjusted analysis when evaluating for disease upgrading. 171 patients underwent radical prostatectomy (RP), 158 never 5-ARI users and 13 5-ARI users. There were no statistically significant differences when evaluating for Gleason grade or adverse pathology. 5-ARI users had a longer median time to RP (3.6 vs 2.1 years, p = 0.045). Conclusions: There is no association between 5-ARI use at diagnosis and reclassification on AS for men in the Canary PASS cohort. 5-ARI users have a longer median time to RP and do not have more severe PCa at RP.
Collapse
Affiliation(s)
| | - Anna V Faino
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Lisa F Newcomb
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | | | - Peter Carroll
- Department of Urology, University of California at San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | | | | | | | - Martin Gleave
- Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | - Yingye Zheng
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | |
Collapse
|
19
|
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.
Collapse
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.
| |
Collapse
|
20
|
Winters BR, Wright JL, Holt SK, Lin DW, Ellis WJ, Dalkin BL, Schade GR. Extreme Gleason Upgrading From Biopsy to Radical Prostatectomy: A Population-based Analysis. Urology 2016; 96:148-155. [PMID: 27313123 DOI: 10.1016/j.urology.2016.04.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 01/28/2016] [Revised: 03/14/2016] [Accepted: 04/28/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the risk factors associated with the odds of extreme Gleason upgrading at radical prostatectomy (RP) (defined as a Gleason prognostic group score increase of ≥2), we utilized a large, population-based cancer registry. MATERIALS AND METHODS The Surveillance, Epidemiologic, and End Results database was queried (2010-2011) for all patients diagnosed with Gleason 3 + 3 or 3 + 4 on prostate needle biopsy. Available clinicopathologic factors and the odds of upgrading and extreme upgrading at RP were evaluated using multivariate logistic regression. RESULTS A total of 12,459 patients were identified, with a median age of 61 (interquartile range: 56-65) and a diagnostic prostate-specific antigen (PSA) of 5.5 ng/mL (interquartile range: 4.3-7.5). Upgrading was observed in 34% of men, including 44% of 7402 patients with Gleason 3 + 3 and 19% of 5057 patients with Gleason 3 + 4 disease. Age, clinical stage, diagnostic PSA, and % prostate needle biopsy cores positive were independently associated with odds of any upgrading at RP. In baseline Gleason 3 + 3 disease, extreme upgrading was observed in 6%, with increasing age, diagnostic PSA, and >50% core positivity associated with increased odds. In baseline Gleason 3 + 4 disease, extreme upgrading was observed in 4%, with diagnostic PSA and palpable disease remaining predictive. Positive surgical margins were significantly higher in patients with extreme upgrading at RP (P < .001). CONCLUSION Gleason upgrading at RP is common in this large population-based cohort, including extreme upgrading in a clinically significant portion.
Collapse
Affiliation(s)
- Brian R Winters
- Department of Urology, University of Washington School of Medicine, Seattle, WA.
| | - Jonathan L Wright
- Department of Urology, University of Washington School of Medicine, Seattle, WA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Sarah K Holt
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Daniel W Lin
- Department of Urology, University of Washington School of Medicine, Seattle, WA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - William J Ellis
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Bruce L Dalkin
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - George R Schade
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| |
Collapse
|
21
|
Tretiakova MS, Wei W, Boyer HD, Newcomb LF, Hawley S, Auman H, Vakar-Lopez F, McKenney JK, Fazli L, Simko J, Troyer DA, Hurtado-Coll A, Thompson IM, Carroll PR, Ellis WJ, Gleave ME, Nelson PS, Lin DW, True LD, Feng Z, Brooks JD. Prognostic value of Ki67 in localized prostate carcinoma: a multi-institutional study of >1000 prostatectomies. Prostate Cancer Prostatic Dis 2016; 19:264-70. [PMID: 27136741 DOI: 10.1038/pcan.2016.12] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/17/2016] [Accepted: 03/08/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Expanding interest in and use of active surveillance for early state prostate cancer (PC) has increased need for prognostic biomarkers. Using a multi-institutional tissue microarray resource including over 1000 radical prostatectomy samples, we sought to correlate Ki67 expression captured by an automated image analysis system with clinicopathological features and validate its utility as a clinical grade test in predicting cancer-specific outcomes. METHODS After immunostaining, the Ki67 proliferation index (PI) of tumor areas of each core (three cancer cores/case) was analyzed using a nuclear quantification algorithm (Aperio). We assessed whether Ki67 PI was associated with clinicopathological factors and recurrence-free survival (RFS) including biochemical recurrence, metastasis or PC death (7-year median follow-up). RESULTS In 1004 PCs (∼4000 tissue cores) Ki67 PI showed significantly higher inter-tumor (0.68) than intra-tumor variation (0.39). Ki67 PI was associated with stage (P<0.0001), seminal vesicle invasion (SVI, P=0.02), extracapsular extension (ECE, P<0.0001) and Gleason score (GS, P<0.0001). Ki67 PI as a continuous variable significantly correlated with recurrence-free, overall and disease-specific survival by multivariable Cox proportional hazard model (hazards ratio (HR)=1.04-1.1, P=0.02-0.0008). High Ki67 score (defined as ⩾5%) was significantly associated with worse RFS (HR=1.47, P=0.0007) and worse overall survival (HR=2.03, P=0.03). CONCLUSIONS In localized PC treated by radical prostatectomy, higher Ki67 PI assessed using a clinical grade automated algorithm is strongly associated with a higher GS, stage, SVI and ECE and greater probability of recurrence.
Collapse
Affiliation(s)
| | - W Wei
- MD Anderson Cancer Center, Houston, TX, USA
| | - H D Boyer
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - L F Newcomb
- University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - S Hawley
- Canary Foundation, Redwood City, CA, USA
| | - H Auman
- Canary Foundation, Redwood City, CA, USA
| | | | | | - L Fazli
- University of British Columbia, Vancouver, BC, Canada
| | - J Simko
- University of California at San Francisco, CA, USA
| | - D A Troyer
- Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - I M Thompson
- University of Texas Health Sciences Center at San Antonio, TX, USA
| | - P R Carroll
- University of California at San Francisco, CA, USA
| | - W J Ellis
- University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - M E Gleave
- University of British Columbia, Vancouver, BC, Canada
| | - P S Nelson
- University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - D W Lin
- University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - L D True
- University of Washington, Seattle, WA, USA
| | - Z Feng
- MD Anderson Cancer Center, Houston, TX, USA
| | | |
Collapse
|
22
|
Quek SI, Wong OM, Chen A, Borges GT, Ellis WJ, Salvanha DM, Vêncio RZN, Weaver B, Ench YM, Leach RJ, Thompson IM, Liu AY. Processing of voided urine for prostate cancer RNA biomarker analysis. Prostate 2015; 75:1886-95. [PMID: 26306723 DOI: 10.1002/pros.23066] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 08/06/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Voided urine samples have been shown to contain cells released from prostate tumors. Could good quality RNA from cells in urine be obtained from every donor for multimarker analysis? In addition, could urine donation be as simple as possible, a practical consideration for a lab test, without involving a prostate massage (as indicated for PCA3 testing), which precludes frequent collection; needing it done at a specific time of day (e.g., first or second urine); and requiring prompt processing of samples in clinics with limited molecular biology capability? METHODS Collected urine samples were pelleted, and the RNA isolated was processed for cDNA synthesis and in vitro transcription to generate amplified sense aRNA. The resultant aRNA was rigorously analyzed for possible introduced changes. DMSO was used as a cell preservative for frozen storage of urine samples. RESULTS Good quality aRNA was obtained for over 100 samples collected at two different institutions. The process of RNA amplification removed co-isolated DNA in some samples, which did not affect RNA amplification. Amplification did not amplify genes that were absent and produce other expression alterations. The sense aRNA could be used to generate urinary transcriptomes specific to individual patients. No chaotropic agents for RNA preservation were added to the urine samples so that the supernatant could be used for analysis of secreted protein biomarkers. The time of donation was not important since patients were seen during the entire day. DMSO was an effective cell preservative for freezing urine. CONCLUSIONS Urinary RNA can be readily isolated and amplified for prostate cancer biomarker analysis. Individual patients had unique set of transcripts derived from their tumor.
Collapse
Affiliation(s)
- Sue-Ing Quek
- Department of Urology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
| | - Olivia M Wong
- Department of Urology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
| | - Adeline Chen
- Department of Urology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
| | - Gisely T Borges
- Department of Urology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
| | - William J Ellis
- Department of Urology, University of Washington, Seattle, Washington
| | - Diego M Salvanha
- Department of Computation and Mathematics, University of São Paulo at Riberão Preto, Brazil
| | - Ricardo Z N Vêncio
- Department of Computation and Mathematics, University of São Paulo at Riberão Preto, Brazil
| | - Brandi Weaver
- Department of Urology and The Cancer Therapy and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Yasmin M Ench
- Department of Urology and The Cancer Therapy and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Robin J Leach
- Department of Urology and The Cancer Therapy and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Ian M Thompson
- Department of Urology and The Cancer Therapy and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Alvin Y Liu
- Department of Urology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
| |
Collapse
|
23
|
Ankerst DP, Xia J, Thompson IM, Hoefler J, Newcomb LF, Brooks JD, Carroll PR, Ellis WJ, Gleave ME, Lance RS, Nelson PS, Wagner AA, Wei JT, Etzioni R, Lin DW. Precision Medicine in Active Surveillance for Prostate Cancer: Development of the Canary-Early Detection Research Network Active Surveillance Biopsy Risk Calculator. Eur Urol 2015; 68:1083-8. [PMID: 25819722 PMCID: PMC4583313 DOI: 10.1016/j.eururo.2015.03.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [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] [Received: 01/11/2015] [Accepted: 03/06/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Men on active surveillance (AS) face repeated biopsies. Most biopsy specimens will not show disease progression or change management. Such biopsies do not contribute to patient management and are potentially morbid and costly. OBJECTIVE To use a contemporary AS prospective trial to develop a tool to predict AS biopsy outcomes. DESIGN, SETTING, AND PARTICIPANTS Biopsy samples (median: 2; range: 2-9 per patient) from 859 men participating in the Canary Prostate Active Surveillance Study and with Gleason 6 prostate cancer (median follow-up: 35.8 mo; range: 3.0-148.7 mo) were analyzed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Logistic regression was used to predict progression, defined as an increase in Gleason score from ≤6 to ≥7 or increase in percentage of cores positive for cancer from <34% to ≥34%. Fivefold internal cross-validation was performed to evaluate the area under the receiver operating characteristic curve (AUC). RESULTS AND LIMITATIONS Statistically significant risk factors for progression on biopsy were prostate-specific antigen (odds ratio [OR]: 1.045; 95% confidence interval [CI], 1.028-1.063), percentage of cores positive for cancer on most recent biopsy (OR: 1.401; 95% CI, 1.301-1.508), and history of at least one prior negative biopsy (OR: 0.524; 95% CI, 0.417-0.659). A multivariable predictive model incorporating these factors plus age and number of months since last biopsy achieved an AUC of 72.4%. CONCLUSIONS A combination of readily available clinical measures can stratify patients considering AS prostate biopsy. Risk of progression or upgrade can be estimated and incorporated into clinical practice. PATIENT SUMMARY The Canary-Early Detection Research Network Active Surveillance Biopsy Risk Calculator, an online tool, can be used to guide patient decision making regarding follow-up prostate biopsy.
Collapse
Affiliation(s)
- Donna P Ankerst
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Life Sciences Mathematics Unit, Technische Universitaet Muenchen, Munich, Germany.
| | - Jing Xia
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ian M Thompson
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Josef Hoefler
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Lisa F Newcomb
- Department of Urology, University of Washington, Seattle, WA, USA
| | - James D Brooks
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Peter R Carroll
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, CA, USA
| | - William J Ellis
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Martin E Gleave
- Department of Urologic Sciences, The Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raymond S Lance
- Departments of Microbiology and Molecular Cell Biology and Urology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Peter S Nelson
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Andrew A Wagner
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - John T Wei
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Daniel W Lin
- Department of Urology, University of Washington, Seattle, WA, USA
| |
Collapse
|
24
|
Ellis WJ. Should Clinicians Use Ultrasensitive Prostate Specific Antigen Measurements for Patient Evaluation? J Urol 2015; 195:243-4. [PMID: 26585681 DOI: 10.1016/j.juro.2015.11.016] [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] [Accepted: 11/09/2015] [Indexed: 10/22/2022]
Affiliation(s)
- William J Ellis
- Department of Urology, University of Washington, Seattle, Washington
| |
Collapse
|
25
|
Winters BR, Bremjit PJ, Gore JL, Lin DW, Ellis WJ, Dalkin BL, Porter MP, Harper JD, Wright JL. Preliminary Comparative Effectiveness of Robotic Versus Open Radical Cystectomy in Elderly Patients. J Endourol 2015; 30:212-7. [PMID: 26414964 DOI: 10.1089/end.2015.0457] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Treatment for muscle-invasive bladder cancer (MIBC) remains highly morbid despite improving surgical techniques. As the median age of diagnosis is 73, many patients are elderly at the time of cystectomy. We compare perioperative surgical outcomes in elderly patients undergoing robotic vs open radical cystectomy (RC). MATERIALS AND METHODS Patients >75 years at time of RC were identified. Demographic, clinicopathologic, and perioperative variables were examined. Estimated blood loss (EBL) and length of stay (LOS) data were collected with multivariate linear regression analysis performed to assess whether technique was independently associated with outcomes. RESULTS Eighty-seven patients >75 years of age underwent cystectomy for MIBC (58 open, 29 robotic). Mean age was 79.6 (±3.2) and 79.2 (±3.5) for open and robotic groups, respectively (p = 0.64). There were no significant differences in baseline comorbidities, clinical or pathologic stage, or use of neoadjuvant chemotherapy. The mean number of lymph nodes removed was similar (p = 0.08). Robotic cystectomy had significantly longer mean OR times (p < 0.001). On multivariate analyses, robotic surgery was associated with -389cc less EBL (95% CI -547 to -230, p < 0.001) and a -1.5-day-shortened LOS (95%CI -2.9 to -0.2, p = 0.02) compared with open surgery. There were no significant differences in surgical complications or 90-day readmission rates between the two groups. CONCLUSIONS Robotic cystectomy is safe and feasible in an elderly population. We observed longer OR times with robotic surgery, but with decreased EBL, shorter hospital stays, and comparable complication and readmission rates with open RC. Larger prospective studies are required to confirm these findings.
Collapse
Affiliation(s)
- Brian R Winters
- 1 Department of Urology, University of Washington School of Medicine , Seattle, Washington
| | | | - John L Gore
- 1 Department of Urology, University of Washington School of Medicine , Seattle, Washington
| | - Daniel W Lin
- 1 Department of Urology, University of Washington School of Medicine , Seattle, Washington.,3 Division of Public Health Sciences, Fred Hutchinson Cancer Research Center , Seattle, Washington
| | - William J Ellis
- 1 Department of Urology, University of Washington School of Medicine , Seattle, Washington
| | - Bruce L Dalkin
- 1 Department of Urology, University of Washington School of Medicine , Seattle, Washington
| | - Michael P Porter
- 1 Department of Urology, University of Washington School of Medicine , Seattle, Washington
| | - Jonathan D Harper
- 1 Department of Urology, University of Washington School of Medicine , Seattle, Washington
| | - Jonathan L Wright
- 1 Department of Urology, University of Washington School of Medicine , Seattle, Washington.,3 Division of Public Health Sciences, Fred Hutchinson Cancer Research Center , Seattle, Washington
| |
Collapse
|
26
|
Newcomb LF, Thompson IM, Boyer HD, Brooks JD, Carroll PR, Cooperberg MR, Dash A, Ellis WJ, Fazli L, Feng Z, Gleave ME, Kunju P, Lance RS, McKenney JK, Meng MV, Nicolas MM, Sanda MG, Simko J, So A, Tretiakova MS, Troyer DA, True LD, Vakar-Lopez F, Virgin J, Wagner AA, Wei JT, Zheng Y, Nelson PS, Lin DW. Outcomes of Active Surveillance for Clinically Localized Prostate Cancer in the Prospective, Multi-Institutional Canary PASS Cohort. J Urol 2015; 195:313-20. [PMID: 26327354 DOI: 10.1016/j.juro.2015.08.087] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE Active surveillance represents a strategy to address the overtreatment of prostate cancer, yet uncertainty regarding individual patient outcomes remains a concern. We evaluated outcomes in a prospective multicenter study of active surveillance. MATERIALS AND METHODS We studied 905 men in the prospective Canary PASS enrolled between 2008 and 2013. We collected clinical data at study entry and at prespecified intervals, and determined associations with adverse reclassification, defined as increased Gleason grade or greater cancer volume on followup biopsy. We also evaluated the relationships of clinical parameters with pathology findings in participants who underwent surgery after a period of active surveillance. RESULTS At a median followup of 28 months 24% of participants experienced adverse reclassification, of whom 53% underwent treatment while 31% continued on active surveillance. Overall 19% of participants received treatment, 68% with adverse reclassification, while 32% opted for treatment without disease reclassification. In multivariate Cox proportional hazards modeling the percent of biopsy cores with cancer, body mass index and prostate specific antigen density were associated with adverse reclassification (p=0.01, 0.04, 0.04, respectively). Of 103 participants subsequently treated with radical prostatectomy 34% had adverse pathology, defined as primary pattern 4-5 or nonorgan confined disease, including 2 with positive lymph nodes, with no significant relationship between risk category at diagnosis and findings at surgery (p=0.76). CONCLUSIONS Most men remain on active surveillance at 5 years without adverse reclassification or adverse pathology at surgery. However, clinical factors had only a modest association with disease reclassification, supporting the need for approaches that improve the prediction of this outcome.
Collapse
Affiliation(s)
- Lisa F Newcomb
- Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington, Seattle, Washington
| | - Ian M Thompson
- University of Texas Health Sciences Center at San Antonio, San Antonio, Texas
| | - Hilary D Boyer
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Peter R Carroll
- University of California San Francisco, San Francisco, California
| | | | - Atreya Dash
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | | | - Ladan Fazli
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Ziding Feng
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Martin E Gleave
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Maxwell V Meng
- University of California San Francisco, San Francisco, California
| | - Marlo M Nicolas
- University of Texas Health Sciences Center at San Antonio, San Antonio, Texas
| | - Martin G Sanda
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jeffry Simko
- University of California San Francisco, San Francisco, California
| | - Alan So
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Jeff Virgin
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | | | - John T Wei
- University of Michigan, Ann Arbor, Michigan
| | - Yingye Zheng
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Peter S Nelson
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Daniel W Lin
- Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington, Seattle, Washington; Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
| |
Collapse
|
27
|
Slawin KM, Tenke P, Joniau S, Ellis WJ, Alekseev BY, Buzogány I, Mishugin S, Klein EA, Stolz J, Student V, Matveev V, Karnes RJ, Jarrard DF, Yuh BE, Scherr D, Trabulsi EJ, Babich J, Stambler N, Armor T, Israel RJ. A phase 2 study of 99m Tc-trofolastat chloride (MIP-1404) SPECT/CT to identify and localize prostate cancer (PCa) in high-risk patients (pts) undergoing radical prostatectomy (RP) and extended pelvic lymph node (ePLN) dissection compared to histopathology: An interim analysis. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e16003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Peter Tenke
- Jahn Ferenc South Pest Hospital, Budapest, Hungary
| | - Steven Joniau
- Urology, Department of Development and Regeneration, University Hospitals Leuven, Leuven, Belgium
| | | | - Boris Y. Alekseev
- Federal State Institution, Moscow Research Oncological Institute, Moscow, Russia
| | | | | | | | - Josef Stolz
- University Hospital Motol, Prague, Czech Republic
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Schade GR, Holt SK, Ellis WJ, Dalkin BL, Wright JL, Lin DW. MP62-17 ASSESSMENT OF PREOPERATIVE 5-α REDUCTASE INHIBITOR USE AND PATHOLOGIC OUTCOMES AND BIOCHEMICAL RECURRENCE FREE SURVIVAL FOLLOWING RADICAL PROSTATECTOMY. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1974] [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: 11/25/2022]
|
29
|
Slawin KM, Ellis WJ, Tenke P, Joniau S, Alekseev BY, Buzogány I, Mishugin S, Klein EA, Karnes RJ, Scherr D, Yuh BE, Jarrard DF, Trabulsi EJ, Stolz J, Babich J, Youssoufian H, Stambler N, Armor T, Israel RJ. A phase II study of 99mTc-trofolastat (MIP-1404) SPECT/CT to identify and localize prostate cancer in high-risk patients undergoing radical prostatectomy (RP) and extended pelvic lymph node dissection (EPLND) compared to histopathology: An interim analysis. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.4_suppl.94] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
94 Background: Technetium (Tc99m) trofolastat (USANC) is a novel urea-based small molecule SPECT radiotracer with utility in imaging overexpression of PSMA in prostate cancer (PCa). Unlike earlier agents targeting PSMA, this ligand is rapidly internalized and retained in tumors. We conducted an open-label, multicenter phase 2 study in the US and Europe (NCT01667536). An interim analysis was performed at approximately 50% accrual. Methods: Patients (pts) with confirmed adenocarcinoma of the prostate scheduled for RP with EPLND at high risk for disease outside of the prostate gland were eligible. High risk pts were ≥cT3 or Kattan nomogram score ≥130. Within 30 days of screening, pts required a bone scan and pelvic MRI. After enrollment, pts received trofolastat followed by whole-body planar and SPECT/CT imaging 3 to 6 hrs later. Pts then underwent RP with EPLND within 21 days. SPECT/CT images were evaluated centrally by 3 readers blinded to clinical information and compared to on-site pathology assessments using a common scoring template. The primary endpoint was the ability of trofolastat to detect PCa within the gland. Secondary endpoints included detection of extent and location within the gland, pelvic lymph nodes and comparative performance against MRI. Results: 84 pts were enrolled to date from 16 centers. Interim data is available for 54 pts. A majority (≥2/3) of SPECT/CT readers correctly identified the presence or absence of primary PCa in 51/54 (94%, 85-98 95% CI) patients including 2 true-negative cases treated with neoadjuvant enzalutamide. Sensitivity and specificity were 94% (84-98 95% CI) and 100% (34-100 95% CI) respectively. Conclusions: Based on the interim data available, trofolastat has accurately detected primary prostate carcinoma within the gland with high sensitivity and specificity in high-risk pts prior to surgery. Updated results, analyses of secondary endpoints, pelvic lymph nodes, and comparative performance vs. MRI from this ongoing study will be presented. Clinical trial information: NCT01667536. [Table: see text]
Collapse
Affiliation(s)
| | | | - Peter Tenke
- Jahn Ferenc South Pest Hospital, Budapest, Hungary
| | - Steven Joniau
- Urology, Department of Development and Regeneration, University Hospitals Leuven, Leuven, Belgium
| | - Boris Y. Alekseev
- Federal State Institution, Moscow Research Oncological Institute, Moscow, Russia
| | | | | | - Eric A. Klein
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | | | | | | | - Edouard John Trabulsi
- Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Josef Stolz
- University Hospital Motol, Prague, Czech Republic
| | | | | | | | | | | |
Collapse
|
30
|
Ellis WJ. Treating prostate cancer: where do we draw the line? Oncology (Williston Park) 2014; 28:29-32. [PMID: 24683716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
31
|
Berry DL, Halpenny B, Hong F, Wolpin S, Lober WB, Russell KJ, Ellis WJ, Govindarajulu U, Bosco J, Davison BJ, Bennett G, Terris MK, Barsevick A, Lin DW, Yang CC, Swanson G. The Personal Patient Profile-Prostate decision support for men with localized prostate cancer: a multi-center randomized trial. Urol Oncol 2013; 31:1012-21. [PMID: 22153756 PMCID: PMC3349002 DOI: 10.1016/j.urolonc.2011.10.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 10/04/2011] [Accepted: 10/04/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The purpose of this trial was to compare usual patient education plus the Internet-based Personal Patient Profile-Prostate, vs. usual education alone, on conflict associated with decision making, plus explore time-to-treatment, and treatment choice. METHODS A randomized, multi-center clinical trial was conducted with measures at baseline, 1-, and 6 months. Men with newly diagnosed localized prostate cancer (CaP) who sought consultation at urology, radiation oncology, or multi-disciplinary clinics in 4 geographically-distinct American cities were recruited. Intervention group participants used the Personal Patient Profile-Prostate, a decision support system comprised of customized text and video coaching regarding potential outcomes, influential factors, and communication with care providers. The primary outcome, patient-reported decisional conflict, was evaluated over time using generalized estimating equations to fit generalized linear models. Additional outcomes, time-to-treatment, treatment choice, and program acceptability/usefulness, were explored. RESULTS A total of 494 eligible men were randomized (266 intervention; 228 control). The intervention reduced adjusted decisional conflict over time compared with the control group, for the uncertainty score (estimate -3.61; (confidence interval, -7.01, 0.22), and values clarity (estimate -3.57; confidence interval (-5.85,-1.30). Borderline effect was seen for the total decisional conflict score (estimate -1.75; confidence interval (-3.61,0.11). Time-to-treatment was comparable between groups, while undecided men in the intervention group chose brachytherapy more often than in the control group. Acceptability and usefulness were highly rated. CONCLUSION The Personal Patient Profile-Prostate is the first intervention to significantly reduce decisional conflict in a multi-center trial of American men with newly diagnosed localized CaP. Our findings support efficacy of P3P for addressing decision uncertainty and facilitating patient selection of a CaP treatment that is consistent with the patient values and preferences.
Collapse
Affiliation(s)
- Donna L Berry
- Dana-Farber Cancer Institute, Phyllis F. Cantor Center, Boston, MA 02215, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Dean JP, Sprenger CC, Wan J, Haugk K, Ellis WJ, Lin DW, Corman JM, Dalkin BL, Mostaghel E, Nelson PS, Cohen P, Montgomery B, Plymate SR. Response of the insulin-like growth factor (IGF) system to IGF-IR inhibition and androgen deprivation in a neoadjuvant prostate cancer trial: effects of obesity and androgen deprivation. J Clin Endocrinol Metab 2013; 98:E820-8. [PMID: 23533230 PMCID: PMC4430583 DOI: 10.1210/jc.2012-3856] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONTEXT Prostate cancer patients at increased risk for relapse after prostatectomy were treated in a neoadjuvant study with androgen deprivation therapy (ADT) in combination with cixutumumab, an inhibitory fully human monoclonal antibody against IGF receptor 1 (IGF-IR). OBJECTIVE A clinical trial with prospective collection of serum and tissue was designed to test the potential clinical efficacy of neoadjuvant IGF-IR blockade combined with ADT in these patients. The effect of body mass index (BMI) on response of IGF-IR/insulin components to IGF-IR blockade was also examined. DESIGN Eligibility for the trial required the presence of high-risk prostate adenocarcinoma. Treatment consisted of bicalutamide, goserelin, and cixutumumab for 13 weeks before prostatectomy. Here we report on an analysis of serum samples from 29 enrolled patients. Changes in IGF and glucose homeostasis pathways were compared to control samples from patients in a concurrent clinical trial of neoadjuvant ADT alone. RESULTS Significant increases were seen in GH (P = .001), IGF-I (P < .0001), IGF-II (P = .003), IGF binding protein (IGFBP)-3 (P < .0001), C-peptide (P = .0038), and insulin (P = .05) compared to patients treated with ADT alone. IGFBP-1 levels were significantly lower in the cixutumumab plus ADT cohort (P = .001). No significant changes in blood glucose were evident. Patients with BMIs in the normal range had significantly higher GH (P < .05) and IGFBP-1 (P < 0.5) levels compared to overweight and obese patients. CONCLUSIONS Patients with IGF-IR blockade in combination with ADT demonstrated significant changes in IGF and glucose homeostasis pathway factors compared to patients receiving ADT alone. In the patients receiving combination therapy, patients with normal BMI had serum levels of glucose homeostasis components similar to individuals in the ADT-alone cohort, whereas patients with overweight and obese BMIs had serum levels that differed from the ADT cohort.
Collapse
|
33
|
Wayner EA, Quek SI, Ahmad R, Ho ME, Loprieno MA, Zhou Y, Ellis WJ, True LD, Liu AY. Development of an ELISA to detect the secreted prostate cancer biomarker AGR2 in voided urine. Prostate 2012; 72:1023-34. [PMID: 22072305 DOI: 10.1002/pros.21508] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 10/05/2011] [Indexed: 01/01/2023]
Abstract
BACKGROUND Comparative transcriptomics between sorted cells identified AGR2 as one of the highest up-regulated genes in cancer. Overexpression in primary tumors was verified by tissue microarray analysis. AGR2 encodes a 19-kDa secreted protein that might be found in urine. METHODS Monoclonal antibodies were generated against AGR2. One antibody pair, P1G4 (IgG1) to capture and P3A5 (IgG2a) to detect, showed good performance characteristics in a sandwich ELISA. This assay could detect AGR2 at sub ng/ml quantities. RESULTS AGR2 was detected in tissue digestion media of tumor specimens and culture media of AGR2-secreting prostate cancer cell lines. Additional testings involved frozen section immunohistochemistry, immunoprecipitation, and Western blot analysis. Voided urine samples were collected from pre-operative cancer patients, and urinary protein was desalted and concentrated by filtration. The amount of AGR2 detected was scored as pg/100 µg total protein, and then converted to pg/ml urine. The developed ELISA detected AGR2 protein, ranging from 3.6 to 181 pg/ml, in an initial cohort of samples. AGR2 was not detected in the urine of non-cancer and a bladder cancer patient. CONCLUSIONS For prostate cancer, an AGR2 urine test could be used for diagnosis. The data, although derived from a small number of samples assayed, showed that developing such a test for clinical application is viable because AGR2 is specific to cancer cells, and apparently secreted into urine.
Collapse
Affiliation(s)
- Elizabeth A Wayner
- Antibody Resource, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Mostaghel EA, Nelson P, Lange PH, Lin DW, Taplin ME, Balk SP, Ellis WJ, Penning T, Marck B, True LD, Vessella R, Montgomery RB. Neoadjuvant androgen pathway suppression prior to prostatectomy. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.4520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4520 Background: Optimizing tissue androgen suppression may provide better local and systemic control of prostate cancer (PCa). Standard androgen deprivation therapy (ADT) has limited effect on tissue androgens which remain in a range which supports tumor survival. We determined whether targeting androgen metabolism using CYP17 and 5a-reductase (SRD5A) inhibitors would more effectively suppress tissue androgens and tumor volume. Methods: Open label, multicenter neoadjuvant study in men with localized PCa treated for 3 months prior to prostatectomy with zoladex and 1) avodart 3.5 mg QD; 2) avodart and casodex 50 mg QD; or 3) casodex, avodart and ketoconazole 200 mg TID. Serum and tissue androgens were measured by LC/MS/MS. Data were compared to men treated with standard ADT (LHRH agonist plus Casodex), and untreated prostatectomy tissue. The primary outcome measure was suppression of tissue dihydrotestosterone (DHT). Results: 35 men with intermediate/high risk PCa were enrolled. Tissue DHT was suppressed 30 fold (> 95%) in all groups vs. LHRH agonist/Casodex (0.92 ± 0.20 pg/mg vs. 0.03± 0.03 for all groups combined, p<0.0001). Tissue testosterone was 3-4 fold higher (consistent with SRD5A inhibition) in all treatment groups vs. LHRH agonist/Casodex (0.33 vs. 0.07 pg/mg, p < 0.05). Differences in DHT/T between groups 1 through 3 were not statistically significant. There was no correlation between tissue and serum androgens, or tissue androgen and tumor volume (p> 0.05). In subset analysis, total serum DHEA declined significantly in group 3, with free DHEA unchanged, suggesting differential effect on free and total DHEA. Pathologic complete response (CR) was seen in 2 men, and an additional 8 men had <0.2 cc of tumor, with the largest number of CR or near CR in the cohort treated with ADT, CYP17 and SRD5A inhibitor, 4 of 12 men (33%). Due to small cohort size, differences were not statistically significant. Conclusions: Addition of high dose SRD5A inhibition (with and without CYP17 inhibition) achieves prostate DHT levels 30 fold below standard ADT. In this relatively high risk population, CR or near CR was seen in 10 of 35 men receiving protocol therapy. Further suppressing the androgen receptor signaling axis may provide better local and systemic control of PCa.
Collapse
Affiliation(s)
| | - Peter Nelson
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | | | | | | | | | | | | | - Robert Vessella
- Department of Urology, University of Washington, Seattle, WA
| | | |
Collapse
|
35
|
Izard JP, True LD, May PC, Ellis WJ, Lange PH, Lin DW, Wright JL. 1641 PROSTATE CANCER < 2 CELLS FROM THE SURGICAL MARGIN PREDICTS BIOCHEMICAL RECURRENCE. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1458] [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: 11/15/2022]
|
36
|
Berry DL, Halpenny B, Wolpin S, Davison BJ, Ellis WJ, Lober WB, McReynolds J, Wulff J. Development and evaluation of the personal patient profile-prostate (P3P), a Web-based decision support system for men newly diagnosed with localized prostate cancer. J Med Internet Res 2010; 12:e67. [PMID: 21169159 PMCID: PMC3056527 DOI: 10.2196/jmir.1576] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 06/22/2010] [Accepted: 11/03/2010] [Indexed: 11/18/2022] Open
Abstract
Background Given that no other disease with the high incidence of localized prostate cancer (LPC) has so many treatments with so few certainties related to outcomes, many men are faced with assuming some responsibility for the treatment decision along with guidance from clinicians. Men strongly consider their own personal characteristics and other personal factors as important and influential to the decision. Clinical researchers have not developed or comprehensively investigated interventions to facilitate the insight and prioritizing of personal factors along with medical factors that are required of a man in preparation for the treatment decision. Objectives The purpose of this pilot study was to develop and evaluate the feasibility and usability of a Web-based decision support technology, the Personal Patient Profile-Prostate (P3P), in men newly diagnosed with LPC. Methods Use cases were developed followed by infrastructure and content application. The program was provided on a personal desktop computer with a touch screen monitor. Participant responses to the query component of P3P determined the content of the multimedia educational and coaching intervention. The intervention was tailored to race, age, and personal factors reported as influencing the decision. Prepilot usability testing was conducted using a “think aloud” interview to identify navigation and content challenges. These issues were addressed prior to deployment in the clinic. A clinical pilot was conducted in an academic medical center where men sought consultation and treatment for LPC. Completion time, missing data, and acceptability were measured. Results Prepilot testing included 4 men with a past diagnosis of LPC who had completed therapy. Technical navigation issues were documented along with confusing content language. A total of 30 additional men with a recent diagnosis of LPC completed the P3P program in clinic prior to consulting with a urologist regarding treatment options. In a mean time of 46 minutes (SD 13 minutes), participants completed the P3P query and intervention components. Of a possible 4560 items for 30 participants, 22 (0.5%) were missing. Acceptability was reported as high overall. The sections of the intervention reported as most useful were the statistics graphs, priority information topics, and annotated external website links. Conclusions The P3P intervention is a feasible and usable program to facilitate treatment decision making by men with newly diagnosed LPC. Testing in a multisite randomized trial with a diverse sample is warranted.
Collapse
Affiliation(s)
- Donna L Berry
- Dana-Farber Cancer Institute, Boston, United States.
| | | | | | | | | | | | | | | |
Collapse
|
37
|
True LD, Zhang H, Ye M, Huang CY, Nelson PS, von Haller PD, Tjoelker LW, Kim JS, Qian WJ, Smith RD, Ellis WJ, Liebeskind ES, Liu AY. CD90/THY1 is overexpressed in prostate cancer-associated fibroblasts and could serve as a cancer biomarker. Mod Pathol 2010; 23:1346-56. [PMID: 20562849 PMCID: PMC2948633 DOI: 10.1038/modpathol.2010.122] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [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: 11/21/2022]
Abstract
A by-product in the processing of prostate tissue for cell sorting by collagenase digestion is the media supernatant that remains after the cells are harvested. These supernatants contain proteins made by the cells within the tissue. Quantitative proteomic analysis of N-glycosylated proteins detected an increased amount of CD90/THY1 in cancer supernatants compared with non-cancer supernatants. Immunohistochemistry showed that in all carcinomas, regardless of Gleason grade, a layer of CD90-positive stromal fibroblastic cells, ∼5 to 10 cells deep, was localized to tumor glands. In contrast, a no more than 1-cell wide girth of CD90-positive stromal cells was found around benign glands. The increased number of CD90-positive stromal cells in cancer correlated with overexpression of CD90 mRNA detected by gene expression analysis of stromal cells obtained by laser-capture microdissection. There is increasing evidence that cancer-associated stroma has a function in both tumor progression and carcinogenesis. Most experiments to identify cancer biomarkers have focused on the cancer cells. CD90, being a marker for prostate cancer-associated stroma, might be a potential biomarker for this cancer. A non-invasive test could be provided by a urine test. Proteomic analysis of urine from patients with prostate cancer identified CD90; conversely, CD90 was not detected in the urine of post-prostatectomy patients. Furthermore, this urinary CD90 protein was a variant CD90 protein not known to be expressed by such cells as lymphocytes that express CD90. These CD90 results were obtained from ∼90 cases consisting of proteomic analysis of tissue and urine, immunohistochemistry, western blot analysis of tissue media, flow cytometry of cells from digested tissue, and reverse transcriptase polymerase chain reaction analysis of isolated stromal cells.
Collapse
Affiliation(s)
- Lawrence D True
- Department of Pathology, University of Washington, Seattle, WA 98195-6100, USA.
| | - Hui Zhang
- Institute for Systems Biology, Seattle, Washington, USA
| | - Mingliang Ye
- Institute for Systems Biology, Seattle, Washington, USA
| | - Chung-Ying Huang
- Department of Genome Sciences, University of Washington, Seattle, USA
| | - Peter S Nelson
- Section of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | | | - Jong-Seo Kim
- Biological Science Division and Environmental Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland, Washington, USA
| | - Wei-Jun Qian
- Biological Science Division and Environmental Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland, Washington, USA
| | - Richard D Smith
- Biological Science Division and Environmental Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland, Washington, USA
| | - William J Ellis
- Department of Urology, University of Washington, Seattle, Washington, USA
| | - Emily S Liebeskind
- Department of Urology, University of Washington, Seattle, Washington, USA,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington, USA
| | - Alvin Y Liu
- Department of Urology, University of Washington, Seattle, Washington, USA,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington, USA
| |
Collapse
|
38
|
Wright JL, Dalkin BL, True LD, Ellis WJ, Stanford JL, Lange PH, Lin DW. 127 POSITIVE SURGICAL MARGINS AT RADICAL PROSTATECTOMY PREDICT PROSTATE CANCER-SPECIFIC MORTALITY: SUPPORT FOR OPTIMIZING SURGICAL TECHNIQUE AND PATHOLOGICAL EVALUATION AT RADICAL PROSTATECTOMY. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
39
|
Henrikson NB, Ellis WJ, Berry DL. "It's not like I can change my mind later": reversibility and decision timing in prostate cancer treatment decision-making. Patient Educ Couns 2009; 77:302-307. [PMID: 19386460 PMCID: PMC3509197 DOI: 10.1016/j.pec.2009.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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] [Received: 09/12/2008] [Revised: 03/09/2009] [Accepted: 03/10/2009] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To explore whether reversibility, decision timing, and uncertainty are relevant to men deciding on treatment for localized prostate cancer (LPC). DESIGN Secondary qualitative data analysis of unstructured interviews. METHODS Content analysis of previously collected qualitative data (31 individual interviews, 5 focus groups). We identified the frequency of references to reversibility, decision timing, and uncertainty and related sub-themes. RESULTS We identified eight themes: reversibility, timing of decision, number of options, "getting it over with," "the way I make decisions," uncertainty among experts, desire for certainty, and probability. Fifteen men mentioned reversibility in individual interviews; 13 mentioned the importance of the timing of their decision. Eleven mentioned the importance of the number of options; twelve "the way I make decisions." Eleven men mentioned the uncertainty of experts, fourteen the desire to "get it over with," and six a desire for certainty. CONCLUSION This study provides compelling preliminary data suggesting that men consider the reversibility, decision timing, and uncertainty in the prostate cancer treatment decision. PRACTICE IMPLICATION These findings may be helpful in enhancing support for men facing the treatment decision.
Collapse
Affiliation(s)
- Nora B Henrikson
- University of Washington School of Public Health and Community Medicine, Institute for Public Health Genetics, Seattle, WA 98195, USA.
| | | | | |
Collapse
|
40
|
Morgan TM, Koreckij TD, Lin DW, Ellis WJ, Gallaher IS, Kinnunen M, Lakely B, Montgomery B, Lange PH, Vessella RL. EFFECT OF ANDROGEN DEPRIVATION THERAPY ON DISSEMINATED TUMOR CELLS IN MEN WITH PROSTATE CANCER. J Urol 2009. [DOI: 10.1016/s0022-5347(09)62158-3] [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: 10/21/2022]
|
41
|
Morgan TM, Lange PH, Porter MP, Lin DW, Ellis WJ, Gallaher IS, Vessella RL. Disseminated tumor cells in prostate cancer patients after radical prostatectomy and without evidence of disease predicts biochemical recurrence. Clin Cancer Res 2009; 15:677-83. [PMID: 19147774 PMCID: PMC3162324 DOI: 10.1158/1078-0432.ccr-08-1754] [Citation(s) in RCA: 176] [Impact Index Per Article: 11.7] [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: 02/05/2023]
Abstract
PURPOSE Men with apparently localized prostate cancer often relapse years after radical prostatectomy. We sought to determine if epithelial-like cells identified from bone marrow in patients after radical prostatectomy, commonly called disseminated tumor cells (DTC), were associated with biochemical recurrence. EXPERIMENTAL DESIGN We obtained bone marrow aspirates from 569 men prior to radical prostatectomy and from 34 healthy men with prostate-specific antigens <2.5 ng/mL to establish a comparison group. Additionally, an analytic cohort consisting of 98 patients with no evidence of disease (NED) after radical prostatectomy was established to evaluate the relationship between DTC and biochemical recurrence. Epithelial cells in the bone marrow were detected by magnetic bead enrichment with antibodies to CD45 and CD61 (negative selection) followed by antibodies to human epithelial antigen (positive selection) and confirmation with FITC-labeled anti-BerEP4 antibody. RESULTS DTC were present in 72% (408 of 569) of patients prior to radical prostatectomy. There was no correlation with pathologic stage, Gleason grade, or preoperative prostate-specific antigens. Three of 34 controls (8.8%) had DTC present. In patients with NED after radical prostatectomy, DTC were present in 56 of 98 (57%). DTC were detected in 12 of 14 (86%) NED patients after radical prostatectomy who subsequently suffered biochemical recurrence. The presence of DTC in NED patients was an independent predictor of recurrence (hazard ratio 6.9; 95% confidence interval, 1.03-45.9). CONCLUSIONS Approximately 70% of men undergoing radical prostatectomy had DTC detected in their bone marrow prior to surgery, suggesting that these cells escape early in the disease. Although preoperative DTC status does not correlate with pathologic risk factors, persistence of DTC after radical prostatectomy in NED patients was an independent predictor of recurrence.
Collapse
Affiliation(s)
- Todd M Morgan
- Department of Urology, University of Washington School of Medicine, 1959 NE Pacific, BB-1115, Box 356510, Seattle, WA 98195, USA.
| | | | | | | | | | | | | |
Collapse
|
42
|
Holcomb IN, Grove DI, Kinnunen M, Friedman CL, Gallaher IS, Morgan TM, Sather CL, Delrow JJ, Nelson PS, Lange PH, Ellis WJ, True LD, Young JM, Hsu L, Trask BJ, Vessella RL. Genomic alterations indicate tumor origin and varied metastatic potential of disseminated cells from prostate cancer patients. Cancer Res 2008; 68:5599-608. [PMID: 18632612 DOI: 10.1158/0008-5472.can-08-0812] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Disseminated epithelial cells can be isolated from the bone marrow of a far greater fraction of prostate-cancer patients than the fraction of patients who progress to metastatic disease. To provide a better understanding of these cells, we have characterized their genomic alterations. We first present an array comparative genomic hybridization method capable of detecting genomic changes in the small number of disseminated cells (10-20) that can typically be obtained from bone marrow aspirates of prostate-cancer patients. We show multiple regions of copy-number change, including alterations common in prostate cancer, such as 8p loss, 8q gain, and gain encompassing the androgen-receptor gene on Xq, in the disseminated cell pools from 11 metastatic patients. We found fewer and less striking genomic alterations in the 48 pools of disseminated cells from patients with organ-confined disease. However, we identify changes shared by these samples with their corresponding primary tumors and prostate-cancer alterations reported in the literature, evidence that these cells, like those in advanced disease, are disseminated tumor cells (DTC). We also show that DTCs from patients with advanced and localized disease share several abnormalities, including losses containing cell-adhesion genes and alterations reported to associate with progressive disease. These shared alterations might confer the capability to disseminate or establish secondary disease. Overall, the spectrum of genomic deviations is evidence for metastatic capacity in advanced-disease DTCs and for variation in that capacity in DTCs from localized disease. Our analysis lays the foundation for elucidation of the relationship between DTC genomic alterations and progressive prostate cancer.
Collapse
Affiliation(s)
- Ilona N Holcomb
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Sim HG, Telesca D, Culp SH, Ellis WJ, Lange PH, True LD, Lin DW. Tertiary Gleason Pattern 5 in Gleason 7 Prostate Cancer Predicts Pathological Stage and Biochemical Recurrence. J Urol 2008; 179:1775-9. [DOI: 10.1016/j.juro.2008.01.016] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2007] [Indexed: 11/24/2022]
Affiliation(s)
- Hong Gee Sim
- Department of Urology, University of Washington, Seattle, Washington
| | | | - Stephen H. Culp
- Department of Urology, University of Washington, Seattle, Washington
| | - William J. Ellis
- Department of Urology, University of Washington, Seattle, Washington
| | - Paul H. Lange
- Department of Urology, University of Washington, Seattle, Washington
| | - Lawrence D. True
- Department of Pathology, University of Washington, Seattle, Washington
- Department of Human Biology Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Daniel W. Lin
- Department of Urology, University of Washington, Seattle, Washington
- Department of Public Health Sciences, Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington
| |
Collapse
|
44
|
Pfitzenmaier J, Ellis WJ, Hawley S, Arfman EW, Klein JR, Lange PH, Vessella RL. The detection and isolation of viable prostate-specific antigen positive epithelial cells by enrichment: a comparison to standard prostate-specific antigen reverse transcriptase polymerase chain reaction and its clinical relevance in prostate cancer. Urol Oncol 2007; 25:214-20. [PMID: 17483018 DOI: 10.1016/j.urolonc.2006.09.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [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: 01/24/2006] [Revised: 09/06/2006] [Accepted: 09/07/2006] [Indexed: 11/22/2022]
Abstract
PURPOSE To isolate prostate epithelial cells from the peripheral blood and bone marrow, and compare prostate-specific antigen (PSA) reverse transcriptase polymerase chain reaction (RT-PCR) performed on unenriched or epithelial enriched peripheral blood and bone marrow samples. PATIENTS AND METHODS Peripheral blood samples from 371 patients with prostate cancer and 141 controls, and bone marrow samples from 292 patients with prostate cancer and 43 controls were obtained. One aliquot was assessed with PSA RT-PCR. Another was enriched for epithelial cells with paramagnetic immune microbeads and assessed for: (1) PSA immunohistochemistry, (2) PSA RT-PCR, and (3) immunofluorescent detection of epithelial cells. RESULTS In the bone marrow (P < 0.01), but not the peripheral blood (P = 0.62), we observed significantly higher detection rates of disseminated PSA expressing epithelial cells after enrichment. The presence of epithelial cells with or without evidence of PSA production was uncommon among controls both in peripheral blood (1% and 0%) and bone marrow (11% and 0%). In patients with active prostate cancer, 46% to 74% had epithelial cells in peripheral blood, and 20% to 64% had PSA expressing epithelial cells. In bone marrow, 55% to 92% had epithelial cells, and 43% to 83% had PSA expressing epithelial cells. Particularly in bone marrow, circulating cells were frequently detected in men without evidence of disease after prostatectomy. With limited follow-up, the detection of epithelial cells or PSA expressing epithelial cells in peripheral blood or bone marrow before radical prostatectomy does not define a population of patients that will have biochemical failure. CONCLUSIONS Immunomagnetic enrichment frequently detects epithelial, presumably malignant, cells in the peripheral blood and, especially, the bone marrow of patients with prostate cancer. Viable cells can be acquired for gene expression and phenotyping studies.
Collapse
Affiliation(s)
- Jesco Pfitzenmaier
- Department of Urology, Medical School, University of Washington, Seattle, WA 98195-6510, USA
| | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
Robotic-assisted laparoscopic radical prostatectomy is now one of the most common ways to treat prostate cancer. Although it is undoubtedly an outstanding procedure, in many contexts the advantages of the laparoscopic approach are overstated. The authors believe that open radical prostatectomy will continue to have an important role. For example, an extensive lymphadenectomy is more easily accomplished with the open technique and may be important in staging and possibly curing patients at high risk for prostate cancer. Also, tactile sensation is a valuable asset in assessing the extent of local tumor, and this cannot yet be replicated with a robotic approach. Furthermore, obese patients, those with a history of extensive prior surgical procedures, and men with extremely large prostates may experience advantages with the open technique. Finally, the open approach has a significant advantage in terms of hospital costs.
Collapse
Affiliation(s)
- William J Ellis
- Department of Urology, Washington University, Seattle, WA 98195, USA.
| | | |
Collapse
|
46
|
Berry DL, Ellis WJ, Russell KJ, Blasko JC, Bush N, Blumenstein B, Lange PH. Factors that predict treatment choice and satisfaction with the decision in men with localized prostate cancer. Clin Genitourin Cancer 2007; 5:219-26. [PMID: 17239276 DOI: 10.3816/cgc.2006.n.040] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [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] [Indexed: 11/20/2022]
Abstract
PURPOSE Men diagnosed with localized prostate cancer (LPC) often have the opportunity to participate in the treatment choice. The purpose of this study was to evaluate relationships between influential factors on treatment choice and the decision-related outcomes of decisional conflict and satisfaction. PATIENTS AND METHODS This report presents data from 260 men diagnosed with LPC who were identified by their clinicians as having a choice of treatments. Men completed questionnaires at home within 2 weeks of the informational clinic visit with the clinician, but before treatment. The respondent sample had a mean age of 63.2 years (standard deviation, 8.1 years); the majority were married/partnered (82.7%), working (51.5%), white (93.8%), and educated at the collegiate level (83.8%). Personal factors (information, influential people, and outcomes), treatment choice, and decisional conflict and satisfaction with the decision (SWD) were queried. Relationships between all variables and the outcomes, SWD, and treatment choice were explored using exhaustive chi(2) automatic interaction detector. RESULTS The strongest predictor partition variable for SWD was the subscale "factors contributing to uncertainty" (adjusted P < 0.0001) followed by the Trait Anxiety score (adjusted P = 0.0388). The strongest predictive partition for the actual treatment choice was age group (adjusted P < 0.0001), followed by interacting marital status (adjusted P = 0.0003), influence of the urologist (adjusted P = 0.0008), and use of the Internet (adjusted P = 0.0479). Men with LPC were more satisfied with their treatment choice when they reported fewer uncertainty factors; these are factors mainly relevant to information needed to understand the pros and cons and to make a decision. Consistent with this finding for treatment choice is the use of the Internet, though this factor interacted with age, the influence of their surgeon, and marital status. CONCLUSION This study suggests that personally meaningful information communicated between patients and clinicians is paramount.
Collapse
Affiliation(s)
- Donna L Berry
- University of Washington, Seattle, WA 98195-7266, USA.
| | | | | | | | | | | | | |
Collapse
|
47
|
Sim HG, Telesca D, Culp SH, Ellis WJ, Lange PH, True LD, Lin DW. 470: Tertiary Gleason Pattern 5 in Gleason 7 Prostate Cancer Predicts Pathologic Parameters and Biochemical Recurrence. J Urol 2007. [DOI: 10.1016/s0022-5347(18)30723-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
48
|
Yang CC, Sim HG, Kliot M, Lange PH, Ellis WJ, Takayama TK. 942: Two-Year Outcome of Unilateral Sural Nerve Interposition Graft after Radical Prostatectomy. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31170-4] [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: 10/17/2022]
|
49
|
Marks LS, Fradet Y, Deras IL, Blase A, Mathis J, Aubin SMJ, Cancio AT, Desaulniers M, Ellis WJ, Rittenhouse H, Groskopf J. PCA3 Molecular Urine Assay for Prostate Cancer in Men Undergoing Repeat Biopsy. Urology 2007; 69:532-5. [PMID: 17382159 DOI: 10.1016/j.urology.2006.12.014] [Citation(s) in RCA: 297] [Impact Index Per Article: 17.5] [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: 07/08/2006] [Revised: 09/18/2006] [Accepted: 12/12/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Men with elevated serum prostate-specific antigen (PSA) levels and negative prostate biopsy findings present a dilemma because of the lack of an accurate diagnostic test. We evaluated the potential utility of the investigational prostate cancer gene 3 (PCA3) urine assay to predict the repeat biopsy outcome. METHODS Urine was collected after digital rectal examination (three strokes per lobe) from 233 men with serum PSA levels persistently 2.5 ng/mL or greater and at least one previous negative biopsy. The specimens were collected from April 2004 to January 2006. The PCA3 scores were determined using a highly sensitive quantitative assay with transcription-mediated amplification. The ability of the PCA3 score to predict the biopsy outcome was assessed and compared with the serum PSA levels. RESULTS The RNA yield was adequate for analysis in the urine samples from 226 of 233 men (ie, the informative specimen rate was 97%). Repeat biopsy revealed prostate cancer in 60 (27%) of the of 226 remaining subjects. Receiver operating characteristic curve analysis yielded an area under the curve of 0.68 for the PCA3 score. In contrast, the area under the curve for serum PSA was 0.52. Using a PCA3 score cutoff of 35, the assay sensitivity was 58% and specificity 72%, with an odds ratio of 3.6. At PCA3 scores of less than 5, only 12% of men had prostate cancer on repeat biopsy; at PCA3 scores greater than 100, the risk of positive biopsy was 50%. CONCLUSIONS In men undergoing repeat prostate biopsy to rule out cancer, the urinary PCA3 score was superior to serum PSA determination for predicting the biopsy outcome. The high specificity and informative rate suggest that the PCA3 assay could have an important role in prostate cancer diagnosis.
Collapse
Affiliation(s)
- Leonard S Marks
- Urological Sciences Research Foundation, Los Angeles, California 90232, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Wright JL, Ellis WJ. Improved prostate cancer detection with anterior apical prostate biopsies. Urol Oncol 2007; 24:492-5. [PMID: 17138129 DOI: 10.1016/j.urolonc.2006.03.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [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: 11/07/2005] [Revised: 03/14/2006] [Accepted: 03/15/2006] [Indexed: 11/22/2022]
Abstract
PURPOSE Research to improve prostate cancer detection with transrectal ultrasound-guided prostate biopsies has focused on increasing the number of cores and the directing of biopsies laterally. In this study, we describe our experience with the addition of anterior apical biopsies. MATERIALS AND METHODS A total of 164 consecutive patients with an increased or increasing prostate-specific antigen and/or abnormal digital rectal examination underwent transrectal ultrasound and systematic biopsy. We performed our standard laterally directed sextant biopsies plus additional mid parasagittal plane biopsies at the base and mid-gland, and an anteriorly directed biopsy at the apex. Site-specific detection and tumor characteristics are reported. RESULTS Prostate cancer was detected in 71 patients (43.3%). The most commonly unique site was the anterior apex. Excluding these biopsies would have missed 17% of the cancers detected. The cancers limited to the anterior apex had tumor characteristics similar to all other cancers detected. CONCLUSION In our experience, the anterior apical biopsies increase the detection of prostate cancer on transrectal ultrasound-guided biopsies. Further study on incorporating this site into the biopsy scheme is indicated.
Collapse
Affiliation(s)
- Jonathan L Wright
- Department of Urology, University of Washington Medical Center, Seattle, WA 98195-6510, USA
| | | |
Collapse
|