bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of men with ductal prostate cancer undergoing definitive therapy for localized disease.
Authors: Ranasinghe Weranja Kalana Bodhisiri , Shapiro Daniel D. , Reichard Chad A. , Elsheshtawi Mohamed A , Nyame Yaw , Sundi Debasish , Tosoian Jeffrey J. , Wilkins Lamont , Alam Ridwan , Bathala Tharakeswara , Tang Chad , Aparicio Ana , Tu Shi-Ming , Navone Nora , Pisters Louis L. , Stephenson Andrew J. , Klein Eric A. , Allaf Mohamad E. , Chapin Brian Francis , Davis John W. 
Published: February 2020

350 Background: Ductal prostate adenocarcinoma (DAC) is an aggressive variant of prostate cancer (PC). We aimed to assess the outcomes of men with localized DAC undergoing radical prostatectomy (RP) or external beam radiotherapy (RTx) compared to acinar adenocarcinoma of the prostate (PAC) and investigate any difference between these treatment modalities. Methods: All patients presenting to our institution with localized DAC from January 2005 - November 2018 were compared to a pooled cohort of patients from 3 tertiary referral centers who underwent RP for Gleason 8 PC and a cohort of high risk PC patients who underwent RTx for PAC. Patient, tumor characteristics and outcome data were analyzed. Results: 257 men with DAC were identified and compared to 803 with PAC. 203 men with DAC and 729 men with PAC underwent RP while 54 men with DAC and 74 men with PAC underwent RTx. Men with DAC were older (65 vs 63 years and 70.5 vs 66 years) and had higher cT3/T4 stage (43% vs 2.8% and 44.5% vs 31.1%) in both groups, respectively (all p <0.05). The median follow-up for men undergoing RP was 34 (range 0.9 to 177) months and 73.4 (range 0.6 – 224.2) months for men having RTx. Presence of DAC was an independent risk factor for metastases (HR 2.5 (95% CI 1.4- 4.8); p<0.01) and death (HR 2.3 (95% CI 1.1 – 4.7); p=0.02) following RP. The 3- year overall survival (OS) rates for DAC and PAC in men undergoing RP were 93.3% vs 99.3% (p<0.01). On adjusting for Gleason score, clinical T stage, PSA and age, DAC was also an independent risk factor for death (HR 6.1 (95% CI 1.7-22.2); p<0.01) in men undergoing RTx with 5-year OS rates of 100% and 81.6% for DAC and PAC, respectively. There was no difference in the OS of men with DAC between RP and RTx. Conclusions: Men undergoing RP or RTx for localized DAC had worse outcomes compared to PAC, but no survival difference was seen between these treatment modalities. DAC behaves clinically differently than PAC. Further evaluation of the underlying biology and potential for specific targeted multimodality therapies in DAC is needed.
Assessing focality of dominant tumor on serial biopsy in an active surveillance cohort: Implications for focal therapy.
Authors: Fasulo Vittorio , Cowan Janet E. , Washington Samuel L. , Nguyen Hao Gia , Shinohara Katsuto , Casale Paolo , Carroll Peter 
Published: February 2020

352 Background: Focal therapy (FT) has been proposed as an alternative to active surveillance (AS) for men with low/intermediate risk prostate cancer (PCa). We aim to understand progression within and outside the dominant tumor (DT) in terms of changes in focality, tumor volume and histologic grading on serial biopsy of the prostate (Bx) to identify reasonable candidates for FT. Methods: Men enrolled on AS at UCSF between 1996 and 2017 with low\intermediate risk PCa at diagnosis (PSA < 20ng\ml, stage cT1\2, Gleason score (GS) ≤3+4) and at least 1 Bx after diagnosis were included. All Bx were systematic. Changes in Bx laterality and/or grade were assessed over time. DT was defined as the tumor with highest GS and size on Bx confined to 1 or 2 contiguous sextants. Those with unifocal disease (Un), multifocal in contiguous sextants (Mc), or a small volume of GS 3+3 on the contralateral side were considered candidates for FT. Results: Among 1272 men, mean age was 62 years, median PSA was 5.42 ng\ml and median follow up was 78 months (IQR 46-108). Median number of Bx was 3 (min 2, max 12) and 18% had >5 Bx. At diagnosis 90% and 10% of patients had GS 3+3 and 3+4 disease respectively. At first surveillance Bx (fsBX) findings were negative in 20%, unchanged in 56% and upgraded in 24%. Findings were similar at the following 3 Bx. Across all biopsies 27% were negative and 7-year upgrade-free survival was 39%. At diagnosis, 88% of tumors were in locations viable for FT (50% Un and 38% Mc versus 12% multifocal in non-contiguous sextants (Mn-c)). At fsBX, 21% of Bx were negative and 85% of the remainder were viable for FT (29% Un and 56% Mc versus 15% Mn-c). Across all Bx DT remained stable in 592 (47%), changed prostate side or expanded to bilateral in 128 (10%), upgraded on the original dominant side in 407 (32%), and upgraded on the opposite side in 145 (11%). Of those upgraded on the non-dominant side, 74% were GS 3+4, 21% were GS 4+3 and 5% were GS ≥4+4. Conclusions: On serial biopsy, tumor location remains relatively stable and significant changes in grade and/or volume occur in the DT. A low percentage of patients show significant progression outside the DT. Such information is relevant when considering FT in this patient population.
Association of salvage cryoablation with decreased utilization of androgen deprivation therapy for recurrent prostate cancer after radiotherapy.
Authors: Parsons J Kellogg , Cotta Brittney , Rose Brent , Murphy James Don , Ryan Stephen T. 
Published: February 2020

358 Background: Cryoablation is an established treatment for recurrent prostate cancer after primary radiotherapy, but outcomes data are mostly limited to uncontrolled case series. We assessed salvage cryoablation efficacy with a comparative analysis in a large national cohort. Methods: Patients with clinically localized prostate cancer treated with primary radiotherapy from 2000 to 2015 were identified in the Veterans Affairs Informatics and Computing Infrastructure (VINCI) dataset. Prostate-specific antigen (PSA) recurrence was defined as nadir + 2 ng/mL. Inclusion criteria included availability of serial PSA measures for ≥ 3 years after completion of radiotherapy and PSA < 10 ng/mL at recurrence. Salvage cryotherapy was identified with procedure- and fee-based billing codes. Chi square and Wilcoxon analysis was utilized for descriptive statistics; and Kaplan Meier analyses for time to androgen deprivation therapy (ADT). Results: Among 35,502 patients who underwent primary radiotherapy, 4,391 (12.3%) developed biochemical recurrence a median (IQR) of 4.5 (2.7, 6.9) years after treatment. Of these, 3889 (88.9%) had PSA < 10 ng/mL at time of recurrence, of whom 95 (2.4%) underwent salvage cryoablation. Cryoablation patients were younger at initial diagnosis (60 years versus 65 years, p < 0.01); had a lower pre-treatment PSA (6.6 ng/mL versus 7.8 ng/mL, p < 0.01); and had a lower PSA nadir (0.04 ng/mL versus 0.19 ng/mL, p<0.01). There were no between-group differences for clinical stage at initial diagnosis (p = 0.22) or African American prevalence (34.7% versus 29%, p =0.27). After recurrence, median (IQR) follow-up for those who did and did not receive cryoablation was 9.1 (7.2, 9.11) and 8.1 (5.4, 10.9) years, respectively. Cryoablation patients were less likely to receive ADT (40% versus 55%, p < 0.01); and, among those who did, time to ADT from recurrence was significantly longer compared to those who did not receive cryoablation (15.5 months versus 5.8 months, p<0.01). Conclusions: Salvage cryoablation is associated with decreased utilization of ADT in patients with biochemical recurrence after radiation.
Physical activity assessment among men undergoing genetic counseling for inherited prostate cancer: A teachable moment.
Authors: Giri Veda N. , Milliron Brandy-Joe , Sinclair Elizabeth , Obeid Elias , Smaltz Christa , Butryn Meaghan , Bruneau Michael 
Published: February 2020

360 Background: Genetic counseling (GC) and genetic testing (GT) for prostate cancer (PCA) is growing rapidly for men with or at risk for PCA. GC provides opportunities to promote a healthy lifestyle and is understudied in men. To inform future lifestyle interventions, we assessed adherence to physical activity (PA) guidelines among a sample of men undergoing PCA GC/GT at two academic institutions. Methods: Participants enrolled in the Genetic Evaluation of Men study completed a structured lifestyle questionnaire to assess frequency of PA over the past year, including intensity of aerobic activity and strength-based activities. Data were evaluated as M±SD by PCA status, PCA aggressiveness (Gleason>7, T3, or metastatic disease), family history, and body mass index (BMI) with Chi-Square contingency analyses and adjusted residuals. Demographic characteristics predictive of PA adherence with current Department of Health and Human Services and American College of Sports Medicine PA guidelines were assessed using logistic regression analyses. Alpha levels were set a priori to p<.05. Results: Men with (n=158) or at risk (n=96) for PCA who underwent GC/GT were included; 84% were overweight or obese. Men with PCA had less adherence to engaging in moderate (p=.02) and vigorous (p=.01) PA than men without PCA. Men overall who reported engaging in strength-based PA did meet the recommended guideline of 2-3 days per week (p<.01). Lower BMI (p=.05) and higher education (p<.01) were found to be significant predictors for adherence to vigorous PA; older age (p=.02) and higher education (p<.01) were found to be significant predictors for adherence to strength-based PA; and, higher education (p=.02) was found to predict adherence to light and moderate PA (p<.05). Conclusions: High proportions of men undergoing PCA GC/GT were overweight/obese. Furthermore, men with PCA did not adhere to current PA guidelines. Age, BMI, and education were important predictors of PA engagement, which should be considered in intervention development. GC encounters represent “teachable moments” to promote healthy lifestyle among men, which may have additional benefit for survivorship and improved treatment experience.
Determinants of biochemical failure and distant metastases-free survival in high-risk prostate cancer patients treated with external beam radiotherapy.
Authors: Pilar Avinash , Bayley Andrew , Shehata Danny , Liu Zhihui (Amy) , Berlin Alejandro , Catton Charles N. , Kong Vickie , Rosewall Tara , Gospodarowicz Mary K. , Craig Tim , Helou Joelle , Warde Padraig Richard , Chung Peter W. M. 
Published: February 2020

371 Background: Objectives were to1) identify predictors of biochemical failure(BCF) -free survival (FFS) & distant metastases free-survival (DMFS) in high-risk prostate cancer (HRPC) patients treated with external beam radiotherapy (EBRT) with or without androgen deprivation therapy (ADT); 2) assess the impact of nodal irradiation & escalation of dose to the nodal volumes in HRPC. Methods: Between Feb 2000 & May 2011, 462 patients with HRPC were treated with EBRT +/- ADT. This spanned an era of technical development; prior to 2002 conventional dose radiotherapy was routinely delivered, between 2002-2008, dose escalation to the prostate & pelvic lymph nodes was undertaken in a phase II trial & subsequently all patients were treated with a dose-escalated protocol. The disease characteristics included, a median PSA of 20ng/ml (range: 1-563), T3-T4 in 33% (n=158), & Gleason grade group (GGG) 3-5 in 72% (n=331). The majority (n=405, 88%) received ADT with EBRT & median duration of ADT was 36 months (range: 0-197). Dose escalated EBRT was utilized in 52% (n=241) & nodal irradiation in 69% (n=317); escalation of dose to nodal volumes was performed in 20% (n=93). Results: The median follow-up was 8.7yrs (range: 0.9-18.9). Median nadir PSA was < 0.05ng/ml (range: <0.05-5.78) with median time to nadir (TTN) of 11 months (range: 2-130). Cumulative incidence rates of BCF at 5 and 10-yrs were 23% & 45%; corresponding rates for DM were 6.6% & 14%, respectively. The 5 & 10-yr FFS rates were 75% & 51%; corresponding DMFS rates were 91.5% & 80%, respectively. On multivariate analysis, T stage (p<0.001), GGG (p<0.001), ADT (p=0.002), dose escalation to prostate (P=0.012) & median nadir PSA (p<0.001) were independent predictors of FFS. The GGG (p=0.007), median nadir PSA (p=<0.001) & Nodal RT (p=0.03) were independent predictors of DMFS. PSA of 20 & TTN predicted neither FFS nor DMFS. Conclusions: Nadir PSA level was an independent predictor of FFS & DMFS. Undetectable PSA level was associated with prolonged FFS & DMFS. Dose escalation to prostate resulted in an improved FFS & Nodal irradiation in an improved DMFS. Further studies are required to identify subgroups that may benefit the most from nodal irradiation.
Stereotactic radiotherapy +/- HDR boost for unfavorable-risk prostate cancer: Comparison of efficacy, survival, and late toxicity outcomes.
Authors: Loblaw Andrew , Cheung Patrick , Vesprini Danny , Liu Stanley K. , Chu William , Chung Hans T. , Morton Gerard , Musunuru Bindu , Deabreu Andrea , Davidson Melanie , Ravi Ananth , Helou Joelle , Ho Ling , Zhang Liying 
Published: February 2020

372 Background: The ASCO/CCO guidelines recommend brachytherapy boost for all eligible intermediate- or high-risk localized prostate cancer patients. Stereotactic body radiotherapy (SBRT) is an emerging treatment for prostate cancer but its use in high risk disease is limited. We compare efficacy, survival and late toxicity outcomes in patients treated on 2 prospective, phase 2 protocols that both use pelvic SBRT and androgen deprivation therapy (ADT). One used MR-guided HDR brachytherapy boost (SPARE) and the other uses a SBRT boost (SATURN). Methods: SPARE was a phase I/II study where intermediate (IR) or high-risk (HR) prostate cancer patients received HDR-BT 15Gy x 1 to the prostate and up to 22.5Gy to the MRI nodule and followed by gantry-based SBRT 25Gy in 5 weekly fractions delivered to pelvis. ADT was used for 6-18 months. SATURN was a phase II study where high risk patients received 40Gy to prostate and 25Gy to pelvis along in 5 weekly fractions with 12-18 months ADT. CTCAEv3 was used to assess toxicities and was captured q6months x 5 years. Biochemical failure (BF; nadir + 2 definition), nadir PSA, proportion of patients with PSA < 0.4 ng/ml at 4 years (4yPSARR), incidence of salvage therapy, cause specific survival were calculated. Day 0 was first day of RT for all time-to-event analyses. Results: Thirty-two patients (NCCN 3% favorable IR, 47% unfavorable IR (UIR), 50% HR) completed SPARE while 30 patients (7% UIR, 93% HR) completed SATURN. Median follow-up of 50 and 48 months, respectively. Actuarial 4-year BF was 11.5% and 0%. Median nPSA was 0.02 ng/ml for both studies. 4yPSARR was 69% and 93%. 4-year cause-specific survival was 96% and 100%. Toxicities are listed in Table. Conclusions: In the context of SBRT pelvis and ADT, SBRT boost provides similar efficacy for unfavorable risk prostate cancer with acceptable but worse toxicities compared to HDR boost. A randomized study is recommended to answer this question. Clinical trial information: 01953055. [Table: see text]
Clinical characteristics and treatment adherence among men with testicular germ cell tumors: Real-world data from a referral center in Mexico.
Authors: Salazar-Mejía Carlos Eduardo , Zayas-Villanueva Omar , Gutiérrez Adriana González , Martinez Rolando Jacob , GUERRA CEPEDA ABRAHAM , Wimer-Castillo Blanca Otilia , Rodríguez-Calvillo Héctor Alejandro , Chapa-Montalvo Lourdes Paola , Samaniego-Sáenz Brenda Alejandra , Hernández-Barajas David , Vidal-Gutiérrez Oscar 
Published: February 2020

393 Background: Notwithstanding excellent oncological outcomes reported by pivotal trials in patients with testicular germ cell tumors (TGCT), adherence to medical treatment and follow-up remains a major issue in developing countries. Studies that describe the clinical characteristics and treatment adherence of Mexican men with TGCT are lacking. Methods: We performed a retrospective analysis of all men with newly diagnosed TGCT treated at an oncology referral center in Northeast Mexico from 2014 to 2018. Results: In the analysis, 195 patients were included. Median age at diagnosis was 28 years; median time from diagnosis to first evaluation by an oncologist was 26 days. Distribution according to the laterality of the primary tumor was right, 56%; left, 43%; and bilateral, 1%. There were 14 oncological emergencies at presentation; the most frequent was choriocarcinoma syndrome, described in 5 patients. Thirty-five percent of cases were seminomatous germ cell tumors (SGCT) and 65% nonseminomatous germ cell tumors (NSGCT). The clinical stages at diagnosis were I, 36%; IS, 8%; II, 18%; and III, 38%. After risk stratification according to the International Germ Cell Cancer Collaborative Group (IGCCCG), 90% of SGCT had a good risk and 10% an intermediate risk. In NSGCT, the risk distribution was 65, 10, and 25% for good, intermediate, and poor-risk disease, respectively. After proposing treatment, the adherence rate was 81%. Of the total, 58% were lost to medical follow-up with a median time of adherence of 11.5 months. Conclusions: Despite coverage by the Mexican public health insurance system “Seguro Popular”, treatment adherence and medical follow-up abandonment is a problem among men with TGCT, which could negatively impact their prognosis. Measures must be implemented to optimize adherence in this group of patients.
The use of DNA promoter methylation testing for prostate cancer diagnosis in the Department of Veterans Affairs.
Authors: Lee Kyung Min , Jones Jeffrey A. , Efimova Olga , DuVall Scott L. , Lynch Julie Ann 
Published: February 2020

394 Background: It is essential to study real-world evidence of novel molecular diagnostic tests to measure their impact on clinical decision-making and health outcomes. Studying test utilization within the Department of Veterans Affairs (VA) informs about clinical validity in a racially diverse population. This study analyzed the impact of DNA promoter methylation (ConfirmDx), on the diagnostic workup of Veterans. Methods: The VA Corporate Data Warehouse (CDW) was used to identify all incident prostate biopsies and cancers from 1/2014-10/2019. We captured patient clinical characteristics, including number and date of biopsies, date of cancer diagnosis, dates and values of PSA tests, comorbidities, demographics, whether the patient underwent DNA promoter methylation testing, and the results of that test. Results: Each year an average of 25,299 biopsies are conducted in the VA. Between 2014 and 2019, 151,794 biopsies were performed. 98,155 (70%) Veterans underwent first-time biopsies and 54,447 (55%) were positive for carcinoma. 8,062 (8.2%) underwent multiple biopsies, among whom 3,589 (44%) were subsequently diagnosed with cancer. 34 Veterans underwent 5 or more biopsies before being diagnosed. 33,878 (35%) did not undergo another biopsy in the study period. 328 (0.3%) of the 98,155 Veterans underwent the DNA promoter methylation test. 55 (17%) of these Veterans were eligible for Medicare coverage of the test. Of the 328 tested for DNA methylation, 217 (66%) were minorities. 132/328 (40%) tested positive for carcinoma and 168/328 (51%) were negative. Conclusions: Most Veterans referred for prostate biopsy have detectable cancer, and a large number are minorities with potential increased prostate cancer risk. DNA promoter methylation may improve care by reducing the need for multiple biopsies, limiting exposure to infection, and reducing time to diagnosis and treatment.
Do men want to perform testicular self-examination?
Authors: Dason Shawn , Beebe Sarah , Scimeca Alicia , Posid Tasha 
Published: February 2020

395 Background: Early detection of testicular cancer (TC) may reduce the required burden of therapy. The long-term adverse effects of therapy in TC survivors are becoming increasingly recognized. The U.S. Preventive Services Task Force (USPSTF) currently recommends against testicular self-examinations (TSE) for TC screening due to a low incidence and lack of data to support a benefit. Our objective was to better understand the baseline knowledge and practices of men in the general population regarding TC/TSE in an effort to understand whether current screening guidelines reflect their viewpoint. Methods: This was a prospective survey study (51 questions). Participants (N=250; MAge=33 years, IQR: 28-39) were recruited via Amazon Mechanical Turk, a crowdsourcing platform used recruit minimally compensated participants. This platform has been extensively validated in US populations as being concordant with surveys conducted by other methods. Results: Most respondents were white (65.6%), had a college degree (76.4%), and did not work in a medical field (89.6%). Men rated themselves as “somewhat unknowledgeable” about testicular cancer, with no respondents considering themselves “very knowledgeable”. Only 26.4% of men knew that testicular cancer was curable most of the time. Despite 90.8% of men feeling that their doctor had at least some role in discussing TC/TSE, only 17.2% had actually discussed these topics with their doctor. Even after being informed of the rationale behind USPSTF recommendations, only 8% of men thought that potential false positives of TSE would be more important than the rare chance of finding early testicular cancer. Conclusions: Based on the largest survey of American men regarding testicular self-examination since the 2009 USPSTF recommendations, men don’t feel knowledgeable about testicular cancer, have a favorable attitude towards testicular self-examination, and want their doctor to discuss these topics. Shared decision making regarding testicular cancer screening is warranted given the low risk of harm and patient interest.
Tumor immune microenvironment alterations in penile squamous cell carcinoma using multiplex immunofluorescence and image analysis approaches.
Authors: Chahoud Jad , Netto Frederico , Lazcano Segura Rossana , Parra Cuentas Edwin Roger , Lu Xin , Rao Priya , Wistuba Ignacio Ivan , Pickering Curtis R. , Pettaway Curtis Alvin 
Published: February 2020

4 Background: Penile Squamous Cell Carcinoma (PSCC) is a rare but often fatal disease. In this study, we characterize the poorly understood immune microenvironment using multiplex immunofluorescence (mIF) and image analysis approaches in 54 patients with PSCC. Methods: Representative blocks of 54 PSCC patients were stained for six immune markers: CD3, CD8, CD68, PD-1, PD-L1, Pancytokeratin and DAPI. Two experienced pathologists using an image analysis system (InForm 2.2.4) divided them into the tumor and stroma compartment and assessed the different densities of cell phenotypes using R studio with results expressed as cells/mm2. The statistical correlations were performed using Fisher’s exact test, Pearson and Log-rank test for Kaplan Meyer plots. Results: 54 patients with confirmed diagnosis of PSCC had a median age of 62 (IQR 50-70). All samples were from the primary penile tumor with the majority of cases being HPV(–) (62%). We observed significantly higher stromal cytotoxic T cells in HPV(+) cases compared to HPV(–) ( P=0.04). Using the mean macrophage count as cutoff for positivity, high densities of total tumor macrophages CD68+ were associated with significantly improved estimated median cancer specific survival (CSS) (NA, P=0.04), median overall survival (OS) (68mos vs NA P=0.02) and lower risk of regional recurrence ( P=0.04). On the other hand, the high densities of stromal cytotoxic T cells antigen-experienced (CD3+CD8+PD-1+), was associated with significantly worse median OS (27 vs 102mos P=0.05) and median disease free survival (DFS) (18.2mos vs NA P= 0.07). Also, high densities of stromal T cells antigen-experienced (CD3+PDL-1+), were associated with significantly better CSS (NA, P=0.06) and better median OS (142.1 vs 68.8mos P=0.14). Conclusions: Using novel multiplex image analysis to assess the immune microenvironment in primary PSCC, we showed that high macrophage levels were associated with lower risk of recurrence and improved survival outcomes. Moreover, a low level of exhausted stromal cytotoxic PD-1+ T cells was associated with improved PSCC survival. Further characterization of T cell subsets in relation to tumor HPV status is ongoing.