Prostate Age Gap: An MRI Surrogate Marker of Aging for Prostate Cancer Detection

BACKGROUND

Aging is the most important risk factor for prostate cancer (PC). Imaging techniques can be useful to measure age-related changes associated with the transition to diverse pathological states. However, biomarkers of aging from prostate magnetic resonance imaging (MRI) remain to be explored.

PURPOSE

To develop an aging biomarker from prostate MRI and to examine its relationship with clinically significant PC (csPC, Gleason score ≥7) risk occurrence.

STUDY TYPE

Retrospective.

POPULATION

Four hundred and sixty-eight (65.97 ± 6.91 years) biopsied males, contributing 7243 prostate MRI slices. A deep learning (DL) model was trained on 3223 MRI slices from 81 low-grade PC (Gleason score ≤6) and 131 negative patients, defined as non-csPC. The model was tested on 90 negative, 52 low-grade (142 non-csPC), and 114 csPC patients.

FIELD STRENGTH/SEQUENCE

3-T, axial T2-weighted spin sequence.

ASSESSMENT

Chronological age was defined as the age of the participant at the time of the visit. Prostate-specific antigen (PSA), prostate volume, Gleason, and Prostate Imaging-Reporting and Data System (PI-RADS) scores were also obtained. Manually annotated prostate masks were used to crop the MRI slices, and a DL model was trained with those from non-csPC patients to estimate the age of the patients. Following, we obtained the prostate age gap (PAG) on previously unseen csPC and non-csPC cropped MRI exams. PAG was defined as the estimated model age minus the patient's age. Finally, the relationship between PAG and csPC risk occurrence was assessed through an adjusted multivariate logistic regression by PSA levels, age, prostate volume, and PI-RADS ≥ 3 score.

STATISTICAL TESTS

T-test, Mann-Whitney U test, permutation test, receiver operating characteristics (ROC), area under the curve (AUC), and odds ratio (OR). A P value <0.05 was considered statistically significant.

RESULTS

After adjusting, there was a significant difference in the odds of csPC (OR = 3.78, 95% confidence interval [CI]: 2.32-6.16). Further, PAG showed a significantly larger bootstrapped AUC to discriminate between csPC and non-csPC than that of adjusted PI-RADS ≥ 3 (AUC = 0.981, 95% CI: 0.975-0.987).

DATA CONCLUSION

PAG may be associated with the risk of csPC and could outperform other PC risk factors.

LEVEL OF EVIDENCE

3 TECHNICAL EFFICACY: Stage 3.

Men's perception of information and psychological distress in the diagnostic phase of prostate cancer: a comparative mixed methods study

BACKGROUND

Previous studies indicate that men experience frustration and uncertainty when confronted with an elevated prostate specific antigen (PSA) test and during further diagnostics for prostate cancer. The novel Stockholm3 test is an algorithm-based test that combines plasma protein biomarkers, genetic markers and clinical variables in predicting the risk of PCa. The test was introduced in a western part of Norway as a new tool for detecting prostate cancer. This study aimed to explore and compare men's perception of information and possible experience of distress between a PSA group and a Stockholm3 group during the diagnostic phase of prostate cancer.

METHODS

This study is a part of the trailing research evaluating the impact of the change from PSA to Stockholm3. It is a multicenter study using a comparative mixed method design. Data were collected in a PSA group (n = 130) and a Stockholm3 group (n = 120) between 2017 and 2019. Quantitative data were collected using questionnaires and qualitative data were collected using semi-structured interviews (n = 20). The quantitative and qualitative data were analysed and compared separately and then merged in a side-by-side discussion. The study adheres to the GRAMMS guidelines for reporting mixed-methods research.

RESULTS

Compared with the PSA group, men in the Stockholm3 group reported that the information from the general practitioners was better. Similarly, men in the Stockholm3 group were more likely to indicate that they had received sufficient information regarding how examinations would be conducted. No differences were found between the groups regarding waiting time and distress. Three themes emerged from the qualitative analysis of the two groups: "Information affects the experience of comprehension", "Stepping into the world of the healthcare system", and "Periodically feelings of distress".

CONCLUSION

The Stockholm3 test may facilitate the provision of information to patients. However, some patients in both groups experienced distress and would benefit from more information and additional support from healthcare professionals. Routines that ensure sufficient information from the interdisciplinary healthcare team should be of priority during the diagnostic phase of prostate cancer in order to provide patients with predictability and to avoid unnecessary distress.

Men's perception of information and descriptions of emotional strain in the diagnostic phase of prostate cancer-a qualitative individual interview study

OBJECTIVE

To explore men`s perception of information and their possible emotional strain in the diagnostic phase of prostate cancer.

DESIGN, SETTING, PATIENTS

A qualitative explorative research design was employed. Data were collected from June to November 2017. The study was set at a urological outpatient clinic at a university hospital in Norway. Semi-structured interviews were conducted with ten men who had been examined for prostate cancer. Interviews were analyzed using Systematic Text Condensation (STC).

RESULTS

The analysis revealed three themes. The theme 'Different needs and perceptions of information' illustrated that information should be personalized. Despite different information needs, insufficient information about prostate cancer may prevent some men from being involved in decisions. The theme, 'A discovery of not being alone', indicated that a sense of affinity occurs when men realize the commonality of prostate cancer. Some men benefited from other men's experiences and knowledge about prostate cancer. The last theme 'Worries about cancer and mortality' showed that the emotional strain was affected by men's knowledge of cancer and the received information. Men expressed conflicting feelings toward prostate cancer that could be difficult to express.

CONCLUSIONS

The findings indicate that men in the diagnostic phase of prostate cancer are not a homogeneous group, but need personalized information. Some men may benefit from other men's experiences and support. Men's emotional strain can affect their communication about prostate cancer, which should be acknowledged. Procedures that identify patients' information needs early on should be an integrated part of the diagnostic phase of prostate cancer.KEY POINTSKnowledge about men's information needs and possible emotional strain in the diagnostic phase of prostate cancer are limited.Men with suspected prostate cancer have different preferences and information needs; however, insufficient information prevents men from participating in decisions.Men experience a sense of affinity with other men affected by prostate cancer, and some men benefit from exchanging experiences.Men consider prostate cancer as a less aggressive type of cancer but may experience emotional strain.

Supportive care needs of men with prostate cancer after hospital discharge: multi-stakeholder perspectives

PURPOSE

This study explored the supportive care needs of men with prostate cancer (PCa) after hospital discharge based on the perceptions of multiple stakeholders.

METHODS

Eight semi-structured focus groups and three individual interviews were conducted between September 2019 and January 2020, with 34 participants representing men with PCa, primary and secondary healthcare professionals, and cancer organizations in western Norway. Data was analysed using systematic text condensation.

RESULTS

Four categories emerged: 1) men with PCa have many information needs which should be optimally provided throughout the cancer care process; 2) various coordination efforts among stakeholders are needed to support men with PCa during follow-up; 3) supportive care resources supplement the healthcare services but knowledge about them is random; and 4) structured healthcare processes are needed to improve the services offered to men with PCa. Variations were described regarding priority, optimal mode and timeliness of supportive care needs, while alignment was concerned with establishing structures within and between stakeholders to improve patient care and coordination.

CONCLUSIONS

Despite alignment among stakeholders' regarding the necessity for standardization of information and coordination practices, the mixed prioritization of supportive care needs of men with PCa indicate the need for additional individualized and adapted measures.

Prostate cancer screening and socioeconomic disparities in Mexican older adults

[No disponible]

Average duration of treatment with antidepressants among concession card holders in Australia

OBJECTIVE

To analyse the average treatment duration with antidepressants that are reimbursed for concession card holders under the Pharmaceutical Benefits Scheme in Australia.

METHOD

This pharmacoepidemiological study was based on a representative 10% sample of patients receiving Pharmaceutical Benefits Scheme prescriptions. Antidepressants redeemed by concession card holders in the period from 2010 to 2013 were analysed. A 5-year baseline period was used to exclude prevalent users from incident users. Estimation of treatment duration was based on the epidemiological equation: prevalence/incidence = average duration. The mean value for prevalence and incidence over the studied period was used in the equation.

RESULTS

The number of prevalent and incident users increased from 90,475 to 103,305 and from 25,006 to 26,289, respectively. The epidemiological average treatment duration in the period was about 4 years. When considered by age-bands, average treatment duration was 2 years in patients under 24 years, 3 years in patients 35 to 44 years and up to 5 years in the 55 to 64 year age group. Of new users of antidepressants reimbursed under the Pharmaceutical Benefits Scheme, 86% received their first prescription from general practitioners, 4.3% from psychiatrists and 9.7% from other physicians.

CONCLUSION

While recommendations have underlined the importance of giving antidepressants for a sufficient period of time, the results from this study show that it is as important to remind general practitioners to review patients on antidepressant treatment regularly, and try to cease drug treatment when timely.

Prescriptions for ADHD medication, 2004-08

BACKGROUND

The use of medication for ADHD has increased significantly since the 1990 s. The objective of this study was to establish the prescription rate for such drugs in Norway, and to examine which doctors prescribe them.

MATERIAL AND METHOD

Data relating to all ADHD medication collected in the period 2004-08 was obtained from the Norwegian Prescription Database and linked to the GP database.

RESULTS

The number of people who collected at least one prescription annually for ADHD medication increased over the period, while the number of new drug users remained stable. In 2008, 3.6 % of the boys and 1.2 % of the girls aged 11-15 collected their prescriptions. Of the people who collected their prescriptions for the first time in 2005, 53 % continued to collect prescriptions every year throughout the period 2006-08. In 2008, extended-release methylphenidate constituted 51 % of the prescription volume for adults and 83 % for children and young people. GPs prescribed 17 % of the total volume collected in 2004 and 48 % in 2008.

INTERPRETATION

During childhood and the teenage years there are substantial differences between the sexes when it comes to the prescription pick-up rate for ADHD medication. This may suggest that girls who suffer from ADHD go through large parts of their statutory education before they are diagnosed and receive treatment. GPs play an important role in the treatment of ADHD.

Initial prescription of antipsychotics and antidepressants in general practice and specialist care in Norway

OBJECTIVE

To examine the incidence rates of antipsychotic (AP) and antidepressant (AD) drug treatment in Norway and the proportions initiated in general practice and specialist care respectively.

METHOD

Data on all prescriptions of APs and ADs dispensed to the general population in Norway from 1 January 2004 until 31 August 2009 were extracted from the Norwegian Prescription Database. This information was merged with data about general practitioners (GPs) from the Norwegian Regular General Practitioner Scheme.

RESULTS

One-year incidence rates per 1000 inhabitants were 3.4 for APs and 8.6 for ADs. GPs initiated 58% of APs and 73% of ADs, while psychiatrists initiated 15% and 6% respectively. Psychiatrists initiated treatment more often among younger patients, and they prescribed relatively newer drugs more commonly than GPs. A large share of incident users did not refill their prescriptions for APs (57%) or ADs (33%).

CONCLUSION

GPs have a key role as regards initiating treatment with APs and ADs in Norway, while psychiatrists' influence seems limited, particularly among older patients. Efforts for quality improvement of mental health care need to involve primary health care. In addition, an increased focus from psychiatrists towards the increasingly ageing part of the population seems requisite.