bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extension of bone marrow involvement and cytopenias in patients with metastatic castration-resistant prostate cancer (mCRPC).
Authors: Preto Daniel D Almeida , Soares Marcella de Oliveira Gonçalves Prince , Alves Wilson Eduardo Furlan Matos , de Lima Marcos Alves , Neif Joao Antonio Junior , Zucca Luis Eduardo Rosa , Carcano Flavio Mavignier 
Published: February 2020

222 Background: Most of bone metastatic castration-resistant prostate cancer (mCRPC) patients present variable extension of bone marrow involvement which in some cases may influence hematopoiesis. Cytopenias may hinder clinical practice, especially in decision making, regarding the use of myelotoxic drugs. The aim of this study was to assess whether the extension of bone marrow involvement in mCRPC patients is a prognostic factor for developing cytopenias. Methods: We retrospectively reviewed 1649 hemograms from 103 bone mCRPC cases. Patients were pooled in two groups, according to the extension of bone metastasis assessed by skeletal scintigraphy: ≤10 lesions (group A) and >10 lesions or superscan (group B). Time for cytopenia event (event-free survival) and overall survival (time from first cytopenia event until death) were calculated using the Kaplan-Meier method and differences between survivals were tested using the log-rank test. Univariable analysis were performed to determine any significant prognostic factor. Results: The median event-free survival (EFS) was longer in patients with ≤10 bone lesions (group A) on the margin of significance (41.9 vs 23.6 months; p=0.051). The exploratory analyses for severe cytopenia events (grade 3-4) also showed a longer EFS for group A (51.8 vs 31.7 months; p=0.050). When group B was stratified into two subgroups (11-20 bone lesions vs >20 or superscan), there was no significant difference in EFS (19.1 vs 24.2 months; p=0.14). The median overall survival (OS) was 3.3 (1.9-4.6) months, regardless the extension of bone involvement. Patients in the group with more bone lesions showed higher mean PSA levels (55.5 vs 40.3 ng/mL; p=0.01). ECOG, stage disease, Gleason score, visceral metastases, types of cytopenia event (anemia, neutropenia or thrombocytopenia), number of chemotherapy lines, and antialgic radiotherapy did not show difference between groups. Conclusions: The extension of bone metastasis in mCRPC seems to be a prognostic factor for developing cytopenias, but is not related to OS. Additional analyzes with a larger sample are needed to assess whether any clinical variables may be associated with cytopenia event.
Real-world utilization of radium-223 (Ra-223) for the treatment of metastatic castration-resistant prostate cancer (mCRPC): A U.S. tertiary oncology center analysis.
Authors: McKay Rana R. , Silver Rebecca , Bhak Rachel , Korves Caroline , Cheng Mu , Appukkuttan Sreevalsa , Simmons Stacey J. , Duh Mei Sheng , Taplin Mary-Ellen 
Published: February 2020

223 Background: Guidelines for optimal sequencing of approved mCRPC therapies do not exist. This study evaluated treatment patterns and overall survival (OS) among patients (pts) with mCRPC treated with Ra-223 in an academic clinical setting. Methods: A retrospective chart review study was conducted at Dana-Farber Cancer Institute of bone metastases-predominant mCRPC pts treated with Ra-223. Treatment patterns from 2013-2018 were evaluated including Ra-223 initiation pre- vs. post-chemotherapy (chemo). OS was examined using Kaplan-Meier medians and 95% confidence intervals (CIs). Results: 220 pts were treated with Ra-223 (64 pre-chemo, 83 post-chemo, 73 no chemo). Median Ra-223 injections per pt was 6.0 and 5.0 in the pre- vs. post-chemo cohorts, respectively (p<0.001). Mean chemo cycles received was 9.0 (pre-chemo) and 9.2 (post-chemo); on average, Ra-223 was given in the 3rd and 5th mCRPC line of therapy (pre- and post-chemo, p<0.001). 41.8% of pts were treated with Ra-223 in combination (combo) with another mCRPC therapy, commonly abiraterone acetate (37.0%) or enzalutamide (44.4%). The majority received combo therapy for the duration of Ra-223 treatment. 17.6% started another agent after Ra-223 initiation; 17.6% initiated Ra-223 while on an established therapy. Median OS from Ra-223 initiation was 12.4 months (95% CI 10.2, 13.9). Median OS from first mCRPC treatment was slightly longer for pts with Ra-223 pre- vs. post-chemo (by 2 months) and for pts with Ra-223 combo vs. monotherapy (by 3 months). Conclusions: Ra-223 improves OS in mCRPC, and longest OS was seen in those with Ra-223 pre-chemo. Retrospective analysis of 5 years of Ra-223 treatment data from an academic center demonstrates that pts treated pre-chemo on average obtained 1 additional cycle of Ra-223, subsequent chemo administration was not limited and OS measured from first mCRPC therapy was not significantly different.[Table: see text]
FDG and PSMA PET in metastatic castration-resistant prostate cancer (mCRPC).
Authors: Zukotynski Katherine A. , Jadvar Hossein , Cho Steve Y. , Kim Chun Ki , Cline Kathryn , Emmenegger Urban , Hotte Sebastien J. , Pond Gregory Russell , Winquist Eric 
Published: February 2020

23 Background: We hypothesized 18F-DCFPyL (PSMA-based tracer) and/ or 18F-FDG (glucose metabolism-based tracer) PET/CT might provide different/complementary molecular imaging information in men with mCRPC treated with abiraterone (A) or enzalutamide (E). Methods: In this prospective cohort study (MISTER trial) mCRPC patients (pts) had conventional imaging and both PSMA and FDG PET/CT prior to standard treatment with A or E, repeated after ~10 weeks on treatment. The main objective was to compare changes in PET/CT findings with conventional imaging. Median of PET maximum standardized uptake value (SUVmax) was measured across all PET avid disease sites and change in SUVmax was evaluated in the 5 hottest sites per patient. Review of PET/CT was performed by 3 experts based on consensus. Results: 36 men were enrolled between 2/2017-12/2018, of whom 28 had treatment and followup imaging. To date, 13 cases have been reviewed: mean age 71.2 years, 7 (53.9%) were ECOG=0, median duration since diagnosis of initial cancer 7.5 months and 8 (61.5%) were stage II/III. PSMA detected more skeletal metastases, positive nodes and non-skeletal, non-nodal metastases in 5/5/3 (39%/39%/23%) men, while FDG detected more non-skeletal, non-nodal metastases in 1 man. Following treatment, new lesions were seen in 3 men on both PSMA and FDG, 3 with PSMA only, and 1 with FDG only. 12 men had baseline FDG-avid disease with median SUVmax 6.5 pre-treatment and 3.8 following therapy (all men had lower SUVmax post-treatment). All 13 men had PSMA-avid disease with median SUVmax 17.6 at baseline and 18.7 post-therapy. Following treatment, 8/12 men (67%) had SUV declines ≥30% (2 had new lesions), 4 had declines of 0-30% (2 had new lesions) using FDG; at followup, 1/13 men had PSMA SUVmax declines ≥30% or more, 6 had declines of 0-30% (2 had new lesions), 5 had SUV increases of 0-30% (4 had new lesions) and 1 had >30% increase. Conclusions: In early analyses, PSMA identified more disease burden in mCRPC pts and was more avid than FDG. SUVmax for FDG declined following treatment in all men, while PSMA changes were heterogeneous. Potential prognostic value of early PSMA and FDG imaging changes on clinical outcomes will be correlated with conventional imaging along with review of remaining cases. Clinical trial information: NCT02813226.
The impact of race and insurance status on survival of prostate cancer patients.
Authors: Matthews Hew Trevanne Rose , Hew Jason Desmond , Chhatrala Hardik Satish , Tfirn Ian , Kadakia Meet , Gautam Shiva , Pham Dat C. 
Published: February 2020

233 Background: While prostate cancer mortality has declined in the in the general population, it remains high in African Americans. The aim of our study is to determine whether race and insurance type affect treatment outcomes in prostate cancer patients at our institution. Methods: A retrospective chart analysis between 2012 and 2017 of 2763 prostate cancer patients was done at our institution. We collected data on age, race, stage, insurance, treatment history, date of diagnosis, Gleason score, date of death. The healthcare insurance information was categorized into Medicare with and without supplement, VA, Medicaid, no insurance/self- pay, City Contract and private. City Contract is the city sponsored health care access for person with low income living in the Duval County. Univariate and multivariate chi square analysis with odd ratio was performed, 95 % confident intervals were evaluated with P value < 0.05. Results: African Americans were 2.93 times more likely to experience death than Caucasians (Odds Ratio, OR, 1.79-4.78, 95 % CI). Both Private and VA insurance were more likely to have a lower stage of prostate cancer compared to City Contract (0.53 times, 0.30-0.93, and 0.411 times, OR 0.23-0.84 95 % CI respectively). African Americans were significantly more likely to have a more advanced cancer stage when compared to Caucasians (1.85 times, 1.49 -2.29 95 % CI). Every insurance type was significantly less likely to undergo surgery compared to City Contract. All except Medicaid, were more likely to undergo radiation compared to City Contract. African Americans are more likely to undergo surgery (2.68 times, 2.01-3.56, 95% CI) and were less likely to have radiation or chemotherapy when compared Caucasians (0.25 times, 0.20-0.31 95% CI). Conclusions: Disparities in race and insurance type can affect the stage at presentation, type of treatment received and survival.[Table: see text]
Effect of core needle biopsy number on intraductal carcinoma diagnosis in patients with metastatic castration-sensitive prostate cancer.
Authors: Kato Masashi , Tsuzuki Toyonori , Yamamoto Akiyuki , Fujita Takashi , Gotoh Momokazu 
Published: February 2020

243 Background: The number of core needle biopsies performed to diagnose metastatic prostate cancer are sometimes reduced in daily clinical practice. Intraductal carcinoma of the prostate (IDC-P) is associated with adverse prognostic parameters and has recently received attention as a valuable indicator for the prediction of disease severity. Currently, the relationship between IDC-P diagnosis and the number of core prostate biopsies is unclear. In the present study, we analyzed the effect of core needle biopsy number on IDC-P diagnosis in patients with metastatic castration-sensitive prostate cancer. Methods: We retrospectively evaluated data from 150 patients diagnosed with metastatic prostate cancer at our hospital between 2002 and 2012. Percentage of the core involved with cancer and the maximum cancer occupancy were 100% in median of all the patients. Subjects were allocated to three groups according to the number of core biopsies performed: ≤5, 6–9, and ≥10. The study endpoints were the cancer-specific survival (CSS) and overall survival (OS) rates. Results: Twenty-seven (18%) patients had ≤5 core biopsies, 67 (45%) patients had 6–9 core biopsies, and 56 (37%) patients had ≥10 core biopsies. For patients who underwent ≥10 core biopsies, a significant difference on CSS was detected between with or without IDC-P ( p = 0.002). On the other hand, the difference decreased as the number of core biopsies became smaller (6–9; p = 0.322 and ≤5; p = 0.815). A similar trend was identified for the OS outcome. A significant difference on OS was also found between with or without IDC-P in patients who underwent ≥10 and 6–9 core needle biopsies ( p = 0.0002 and 0.015, respectively), but not in those who underwent ≤5 core biopsies ( p = 0.3407). IDC-P served as a stronger prognostic marker for CSS and OS than did the other factors included in the multivariate analysis. ( p = 0.0024, and p = 0.0014, respectively). Conclusions: Given the IDC-P detection and its value as a prognostic marker, we recommend the performance of ≥10 core biopsy procedures in patients diagnosed with metastatic prostate cancer. Sampling error effects the IDC-P value in smaller number of core needle biopsies.
Changes in conditional net survival and dynamic prognostic factors in patients with newly diagnosed metastatic prostate cancer.
Authors: Narita Shintaro , Nomura Kyoko , Hatakeyama Shingo , Takahashi Masahiro , Sakurai Toshihiko , Kawamura Sadafumi , Hoshi Senji , Ishida Masanori , Kawaguchi Toshiaki , Ishidoya Shigeto , Shimoda Jiro , Sato Hiromi , Mitsuzuka Koji , Tochigi Tatsuo , Tsuchiya Norihiko , Ohyama Chikara , Arai Yoichi , Nagashima Kengo , Habuchi Tomonori ,   Michinoku Japan Urological Cancer Study Group
Published: February 2020

247 Background: The treatment strategy for patients with newly diagnosed metastatic hormone naïve prostate cancer (mHNPC) has changed in recent years. Thus, an accurate assessment of prognosis is critical. Conditional net survival provides the more appropriate method of estimating survival from cancer. The purpose of this study was to identify predictive factors associated with conditional net survival in patients with mHNPC initially treated with androgen deprivation therapy (ADT). Methods: The medical records of 605 consecutive patients with mHNPC who initially received ADT were retrospectively reviewed. The Pohar Perme estimator was used to calculate conditional net cancer-specific survival (CSS) and overall survival (OS) for up to five years subsequent to the diagnosis. Using multiple imputation, proportional hazard ratios for conditional CSS and OS were calculated with adjusted Cox regression models. Results: During follow-up (median, 2.95 years), 208 patients died, 169 from progressive prostate cancer. At baseline, the 5-year CSS and OS rates were 65.5% and 58.2%, respectively. The overall conditional 5-yearnet OS rate at baseline was 0.582, and the overall conditional 5-year net OS rates for patients who survived for1, 2, 3, 4, and 5 years were 0.566 (−0.16), 0.615 (+3.3), 0.550 (−0.32), 0.702 (+1.2), and 0.811 (+2.29), respectively. Conditional 5-year net CSS and OS survival gradually increased for all the patients. In patients given a 5-year survivorship, the conditional 5-year net CSS and OS rates improved to 0.906 and 0.811, respectively. Only the extent of disease score (EOD) ≥2 remained a prognostic factor for CSS and OS up to 5 years; as survival time increased, other variables were no longer independent prognostic factors. Conclusions: The conditional 5-year net CSS and OS in patients with mHNPC gradually increased; thus, the risk of mortality decreased with increasing survival. The patient’s risk profile changed over time. EOD remained an independent prognostic factor for CSS and OS after 5-year follow-up. Conditional net survival can play a role in clinical decision-making, providing intriguing information for cancer survivors.
TMPRSS2: ERG expression in prostate cancer—Imaging and clinicopathological correlations.
Authors: Fasulo Vittorio , Lazzeri Massimo , Corbetta Marinella , Paciotti Marco , Maffei Davide , Soldà Giulia , Domanico Luigi , Frego Nicola , Regis Federica , Diana Pietro , Asselta Rosanna , Buffi Nicolo' , Casale Paolo , Saita Alberto , Chiereghin Chiara , Lughezzani Giovanni , Zuradelli Monica , Hurle Rodolfo , Duga Stefano , Guazzoni Giorgio Ferruccio 
Published: February 2020

284 Background: The TMPRSS2:ERG gene fusion (T:E) is found in up to 70% of prostate cancers (PCa) and results in androgen dependent overexpression of ERG, promoting tumor growth. The early identification of T:E may be helpful even in low-risk PCa. Although T:E can be non-invasively detected in urine, its correlation with new imaging tools (MRI and high-frequency ultrasound) and clinical outcome remains vague.This study investigates T:E expression in patients scheduled for random/software-assisted MRI or micro-ultrasound (29Mhz) fusion biopsy. Methods: This is a prospective cohort study in patients with suspected PCa enrolled between 2016 and 2019, approved by local authorities with Prot. N. 336/19, 14/05/2019. Patients underwent systematic US-guided biopsy, plus targeted biopsy if they had ³1 suspicious lesion (PI-RADS V.2 >2) at mpMRI or PRIMUS >2 at MICRO-US. For each patient, 1 prostatic core from the highest PI-RADS or PRIMUS lesion was collected for T:E analysis (a core from the right lobe in negative patients). Histological analyses were performed by experienced genitourinary pathologists. RNA was extracted from a dedicated fresh biopsy and RT-PCR was performed with different primer couples to detect the most frequent T:E fusions. All amplified products were checked by sequencing. Results: The cohort consists of 92 patients (median PSA 7.13 ng/ml, IQR 5.25-11.04 - average age 65ys), 81 with a diagnosis of PCa after biopsy. mpMRI was performed on 63 (68.5%) patients and was positive in 58 (92%), who underwent fusion biopsy. T:E fusion transcripts were detected in 23.5% of individuals with a diagnosis of PCa. Among patients positive for T:E, those analyzed by MRI were 100% positive (73% PI-RADS ≥4), those analyzed by MICRO-US were 83% positive. Sensitivity of the T:E assay for any PCa was 23.5%, specificity 100%, with negative and positive predicting values of 15% and 100%. There was no correlation between T:E and family history, PSA, PIRADS, PRI-MUS and Gleason score. Conclusions: Our finding showed a 100% of specificity making T:E an attractive tool for early cancer detection. In the future, identification of T:E in semen could represent a screening test for clinical stratification of patients with suspected PCa.
Characterization of PSMA and 18F-fluciclovine transporter gene expression in localized prostate cancer.
Authors: Chu Carissa , Alshalalfa Mohammed , Sjöström Martin , Zhao Shuang , Herlemann Annika , Chou Jonathan , Mahal Brandon Arvin Virgil , Kishan Amar Upadhyaya , Spratt Daniel Eidelberg , Karnes Jeffrey , Small Eric Jay , Wong Anthony C. , Porten Sima P. , Hope Thomas , Davicioni Elai , Nguyen Paul L. , Carroll Peter , Schaeffer Edward M. , Feng Felix Y , Cooperberg Matthew R. 
Published: February 2020

295 Background: While 18F-fluciclovine PET/CT is approved in the US and recommended by the NCCN, prostate-specific membrane antigen (PSMA) PET/CT is more common in Europe/Australia and recommended by the EAU. Less is known about the biology of lesions detected by either modality. 18F-fluciclovine PET relies on radiotracer uptake by amino acid transporters LAT1-4 and ASCT1-2. PSMA PET is dependent on surface expression of PSMA. We compared relative expression of PSMA and fluciclovine transporter genes in radical prostatectomy (RP) samples to determine their distribution across subtypes and correlation with outcomes. Methods: Gene expression data of 19,102 RP samples were analyzed using the Affymetrix Human Exon 1.0 ST microarray. 1,135 patients had long term follow up. Associations between expression of PSMA and fluciclovine transporter genes (LAT1-4 and ASCT1-2) and pathologic variables, molecular subtypes, and clinical outcomes were conducted. Results: All fluciclovine transporter genes (LAT 1-4, ASCT1-2) were expressed at lower levels than PSMA (p <0.0001). PSMA expression was positively correlated with genomic risk score and pathologic Gleason score (p<0.0001), but LAT2-3 and ASCT2 were inversely correlated with genomic risk in primary tumors (p<0.0001) and less expressed in GS 9-10 tumors (p<0.0001). PSMA expression was associated with worse metastasis-free survival (MFS) (HR 1.45, p=0.001) and lymph node involvement (HR 2.14, p<0.0001). Expression of LAT2, LAT3, ASCT2 expression was associated with better MFS (HR 0.85, 0.63, 0.74, p<0.0001-0.04). After multivariable adjustment, PSMA expression remained independently prognostic of poorer MFS (HR 1.3, p=0.028). Luminal B subtype was notable for PSMA overexpression; Luminal A was enriched in ASCT2 and LAT2 (p<0.0001). PSMA expression did not correlate with ERG fusion prostate cancers, but LAT2, ASCT1, and ASCT2 were overexpressed in ERG fusion negative tumors (p<0.0001). Conclusions: PSMA expression is associated with more aggressive disease and poorer clinical outcomes than fluciclovine transporter genes in localized prostate cancer. Molecular subtypes of prostate cancer vary in PSMA and fluciclovine transporter gene expression.
Disparities in receipt of molecular imaging in biochemical recurrent prostate cancer.
Authors: Borno Hala , Lin Tracy Kuo , Odisho Anobel Y. , Desai Arpita , Koshkin Vadim S , Werner Kalin , Legaspi Nichole , Bell Alexander , Hope Thomas 
Published: February 2020

297 Background: Molecular imaging with novel radiotracers is changing treatment landscape in prostate cancer (PCa). Currently, standard of care includes both conventional and molecular imaging, leaving uncertainty in prescription decision. This study evaluated the determinants of and disparities in utilization of molecular imaging for biochemical recurrent (BR) PCa. Methods: This is an observational, single institution, cohort study within the University of California, San Francisco (UCSF). Data were obtained on all men with BR PCa seen at UCSF from June 2018 to May 2019, regardless of histologic subtype. Multivariate logistic regression models were employed to analyze the primary outcome: receipt of molecular imaging (e.g. Fluciclovine PET, Prostate Specific Membrane Antigen PET) as part of diagnostic work-up for BR PCa. Multivariate linear regression models were used to analyze the secondary outcome: overall healthcare cost (hereafter cost) within a one-year time-frame. Results: The study sample included 245 patients; 88% non-Hispanic White (White), 2 % non-Hispanic Black (Black), 9% Asian/Pacific Islander (Asian), and 10% Other. The majority were 55 years or older (66%) and privately insured (73%). Analysis indicated that a one unit reduction in PSA is associated with 1.4 times higher likelihood of receiving molecular imaging (p<0.01). Analysis found that privately insured patients experienced approximately $500,000 more in cost (p<0.01) as compared to the publicly insured. Additionally, a one unit increase in PSA is associated with $5,075 increase in cost (p<0.05). Correlations between race and imaging type and having received radical prostatectomy (RP) and imaging type were identified but were not statistically significant (p<0.10). Conclusions: Higher PSA was associated with lower likelihood for molecular imaging and higher cost in a one year time-frame. Higher cost was also associated with private insurance, but there was no clear relationship between insurance type and imaging type. This study identified several factors – which may impact prescription pattern – that are worth exploring within a larger patient sample; namely, race/ ethnicity and RP as determinants for receipt of molecular imaging.