bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical outcomes following biochemical recurrence among patients with Gleason score 9-10 prostate adenocarcinoma.
Authors: Sandler Kiri A , Chu Fang-I , Ciezki Jay P. , Stock Richard , Merrick Gregory Stephen , Demanes David Jeffrey , Spratt Daniel Eidelberg , Abu-Isa Eyad I. , Pomerantz Mark , Ross Ashley , Tran Phuoc T. , Nguyen Paul L. , Wedde Trude Baastad , Lilleby Wolfgang , Krauss Daniel , Alam Ridwan , Steinberg Michael L. , Horwitz Eric M. , King Christopher R. , Kishan Amar Upadhyaya 
Published: February 2018

102 Background: Patients with Gleason score (GS) 9-10 prostate cancer (PCa) have a high risk of early biochemical recurrence (BCR). Salvage therapy options differ depending on the upfront management strategy. Patients who received upfront surgery (RP) may be curable with salvage external beam radiation therapy (EBRT). However those who underwent EBRT or EBRT with a brachytherapy boost (EBRT+BT) are less likely to receive local salvage therapy and are commonly treated with androgen deprivation therapy (ADT). In this study, we examine the risk of distant metastases (DM) and prostate-cancer specific mortality (PCSM) among patients with GS 9-10 PCa who had BCR following RP, EBRT, or EBRT+BT. Methods: 712 patients with GS 9-10 PCa treated between 2000-2013 at 12 institutions who had BCR were included (346 RP, 282 EBRT, 84 EBRT+BT). Time to DM and PCSM were compared between groups using Cox proportional hazards models with propensity score adjustment. Propensity scores were calculated using age, T-stage, PSA, and GS. Results: In patients who had a BCR, incidence rates of DM and PCSM after RP were 40% and 28%. Rates after EBRT were 60% and 46% and after EBRT+BT were 49% and 31%. Median times to DM and PCSM were 3.5 and 4.9 years after RP, 3.7 and 5.1 years after EBRT, and 3.3 and 6.8 years after EBRT+BT. The rates of local salvage RT and systemic salvage therapy among RP patients were 38% and 59%, respectively. Local and systemic salvage rates were 5% and 31% for EBRT patients and 5% and 28% for EBRT+BT patients. EBRT patients had a shorter time interval to DM compared with RP (HR 1.4, p = .02) and EBRT+BT (HR 1.9, p < .01). EBRT patients also had a shorter time interval to PCSM compared with RP (HR 1.5, p = .02). Conclusions: Among patients with GS 9-10 PCa who experience BCR after definitive management, those treated with EBRT have a shorter time interval to DM and PCSM compared with RP and EBRT+BT. While this analysis is confounded by the differential thresholds for diagnosing a BCR after different modalities, it does suggest that outcomes following BCR after EBRT+BT and RP are similar. It also suggests that extreme dose escalation delays the onset of DM and PCSM even after BCR, when compared with conventionally-dosed EBRT alone.
Shared decision making for prostate cancer screening: Reality or farce?
Authors: Pucheril Daniel , Fletcher Sean A. , Zlatev Dimitar V. , Mossanen Matthew , Ingham Matthew D. , Chang Steven Lee , Kibel Adam S. , Trinh Quoc-Dien 
Published: February 2018

107 Background: A core tenant of major cancer society guidelines regarding prostate cancer screening (PSAS) is that providers discuss both the advantages and disadvantages of screening with eligible patients in a shared decision making (SDM) process. We sought to determine contemporary trends of SDM in regards to PSAS. Methods: Consistent with the AUA guidelines for PSAS, data was abstracted from the 2012-2016 Behavioral Risk Factor Surveillance System for men 55-69, without a personal history of prostate cancer, and having answered all questions within the PSAS module. PSAS occurred if a man had a PSA test within the last two years for reasons other than "a prostate problem” or “prostate cancer”. SDM occurred if the respondent was informed about both advantages and disadvantages of PSAS by a health professional. Descriptive statistics were generated for demographic covariates by year. The Chi-Square test was used to compare the distribution of covariate proportions amongst years. Separate multivariable regression models were built to identify independent predictors of both receipt of PSA screening and SDM. Results: A weighted estimate of 56.7 million men (n = 138,492) met inclusion criteria. Reported rates of PSAS decreased each year (56.7% in 2012 to 52.6% in 2014 to 49.1% in 2016, p < 000.1). There were no significant changes in rates of SDM (p = 0.82); in all three years, less than one-third of respondents reported SDM. After controlling for known confounders, possession of a personal physician (OR 2.24,95%CI 2.02-2.48), receipt of information regarding the advantages of PSAS (OR 3.93, 95%CI 3.63-4.26), and receiving a physician recommendation to undergo PSAS (OR 7.78, 95%CI 7.25-8.35) were most strongly associated with odds of undergoing PSAS. Odds of reporting participation in SDM were strongest amongst black respondents (2.09 95%CI 1.92-2.28) and those who received a physician recommendation to undergo PSAS (OR 4.64, 95%CI 4.32-4.99). Conclusions: Despite recommendations that physicians engage patients in a SDM process, our findings suggest that less than a third of patients are advised of both the advantages and disadvantages of PSAS. With the likely revision of the USPSTF PSAS recommendation to Grade C, a renewed effort towards SDM is needed.
Active surveillance of prostate cancer in African-Americans during the MRI era.
Authors: Bloom Jonathan , Gold Samuel , Hale Graham R. , Rayn Kareem , Valera Vladimir , Mehralivand Sherif , Wood Brad J. , Turkbey Baris , Parnes Howard L. , Pinto Peter A. 
Published: February 2018

108 Background: Many patients with low-risk prostate cancer are encouraged by their physicians to pursue active surveillance (AS). AS has increasingly been utilized, however there remains anxiety by patients and their physicians that more aggressive disease will be missed and allowed to progress. African-American (AA) patients may present with more aggressive disease and higher rates of upgrading at the time of radical prostatectomy. Due to these factors, physicians may be hesitant to recommend AS to AA patients. We examined the role of AS in these patients in the era of MRI targeted biopsies. Methods: A prospectively maintained database was queried for all patients who underwent an MRI guided fusion biopsy from 2007 to 2016 and chose AS as their primary management strategy. Patents with Gleason Group (GG) 1 or 2 were eligible. Patients were then followed with yearly PSA, exam, MRI and biopsy if warranted. MRI Fusion biopsies were reviewed to determine any GG progression. Results: A total of 19 AA and 143 non-AA patients were reviewed with median follow up times of 31.63 (15.42 -89.50) and 30.87 (3.45 – 99.85) months, respectively. AA and non-AA patients had similar baseline PSA values (6.08 ± 2.93 vs. 5.89 ± 4.23, p = 0.85), proportion of GG 1 (15.89% vs 21.68%, p = 0.55) and PSA density (0.103 ± 0.041 vs. 0.123 ± 0.041, p = 0.36. However, AA patients did present at an earlier age (58.89 ± 6.64 vs. 63.69 ± 6.64, p = 0.004). A total of 8/19 (42.1%) AA and 46/143 (32.2%) non-AA had GG upgrading while on AS, p = 0.34. The median time until progression for AA and non-AA patients was 60.76 and 77.42 months, p = 0.68. Conclusions: In our study, AA men did begin AS at an earlier age than non-AA men. While both groups had statistically similar rates of progression, the relative risk of progression was higher in the AA cohort during this time period. Therefore, in the era of MRI and fusion biopsies we are better able to detect upgrading and somewhat mitigate the the risks associated with upgrading during AS irrespective of race but larger studies are needed to determine whether there are meaningful differences in the rates of progression between AA and non-AA men. This research was supported by the Intramural Research Program of the National Cancer Institute, NIH.
Development of prostate-specific antigen (PSA) screening nomograms for 15-year prediction of prostate cancer diagnosis (PCDx), mortality (PCM), and all-cause mortality (ACM).
Authors: Brooks Michael Austin , Carlsson Sigrid V. , Zajichek Alexander , Chagin Kevin M. , Hugosson Jonas , Kattan Michael W. , Stephenson Andrew J. 
Published: February 2018

110 Background: Recommendations for PSA screening encourage shared decision making between patients and providers, rather than population-based screening. Nomograms provide individualized risk predictions potentially enhancing informed decisions to undergo screening. Our objective was to develop PSA screening nomograms using demographic and follow-up data from two large randomized screening trials: the Göteborg Screening Trial ( Lancet Oncol. 2010;11:725-32) and Prostate, Lung, Colon, and Ovarian (PLCO) Cancer Screening Trial ( N Engl J Med. 2009;360:1310-9). The endpoints of the models were PCDx, PCM, and ACM at 15 years. Methods: Patients with screening prior to trial entry were excluded, leaving 59,951 total subjects: 19,899 and 40,052 from Göteborg and PLCO, respectively. Demographic information including age, family history of PCDx, ethnicity, Charlson Comorbidity Index, marital status, education, and control vs. screening arm were used as predictive variables. If screened, baseline PSA was used as an additional continuous variable. Models for ACM were first developed, then models predicting PCDx and PCM using competing risk analysis. Predictive accuracy was assessed using the concordance index (c-index) and calibration plots. Results: On multivariable analysis, all variables were significant (P < 0.05) for predicting at least one outcome. Nomograms predicting PCDx, PCM, and ACM demonstrated reasonable discrimination: c-index 0.60, 0.65, 0.70, respectively. When a single baseline PSA was included, discriminative accuracy improved for PCDx and PCM, but remained the same for ACM: c-index 0.78, 0.74, 0.69, respectively. Estimates were well-calibrated for all endpoints. Conclusions: Using demographic information, we developed PSA screening nomograms, with good discrimination and calibration in predicting all three outcomes. A single baseline PSA improved nomogram discrimination substantially for PCDx and PCM. We will study the implementation of these nomograms into clinic practice to aid decisions for previously unscreened patients, or whether to continue PSA screening for patients with a known prior PSA.
Impact of decipher test on adjuvant and salvage treatments received following radical prostatectomy.
Authors: Gore John L. , Du Plessis Marguerite , Dai Darlene , Yousefi Kasra , Thompson Darby , Karsh Lawrence Ivan , Lane Brian R. , Franks Michael , Chen David , Bandyk Mark , Kibel Adam S. , Kim Hyung Lae , Lowrance William Thomas , Maroni Paul , Perrapato Scott David , Trabulsi Edouard John , Waterhouse Robert J. , Davicioni Elai , Lotan Yair , Lin Daniel W. 
Published: February 2018

112 Background: Prostate cancer (PC) patients and providers have tremendous uncertainty as they decide on intervention with adjuvant or salvage radiation therapy (ART, SRT) after radical prostatectomy (RP). We prospectively evaluated the impact of Decipher test, a genomic classifier which predicts metastasis post-RP, on providers’ decision-making for ART and SRT. Methods: 150 men considering ART and 115 men considering SRT from 19 sites across the US were enrolled. Participating providers submitted a management recommendation prior to processing the Decipher test and again after receiving test results. We then followed patients for 12 months to assess actual treatment received and patient reported decisional conflict scale (DCS) and a validated survey on PC-related anxiety. Results: Pre-Decipher, observation was recommended for 89% of adjuvant men and 58% of salvage men. Post-Decipher, 17% of treatment recommendations changed in the adjuvant arm and 30% of recommendations changed in the salvage arm. Among adjuvant men, 78% maintained their recommended management 12 months after Decipher; 76% of salvage men maintained their recommended treatment after Decipher. Among 21 adjuvant men who intensified their treatment (observation to ART or ART to ART plus androgen deprivation therapy), 5 (24%) experienced biochemical recurrence with detectable PSA. In adjuvant men, PC-specific anxiety decreased differently among Decipher risk categories (p-value = 0.045), most notably among Decipher high risk men (9.07 [7.87, 10.26] pre-Decipher, 5.61 [5.35,5.88] 12 months post-Decipher). In salvage men, PC-specific anxiety decreased differently among those whose treatment were concordant (10.28 [8.1,12.47] pre-Decipher, 7.18 [6.82,7.54] 12 months post-Decipher) and those whose treatment were intensified (p-value = 0.01), and decreased differently among low-risk and high-risk Decipher patients (p = 0.04). Conclusions: Use of the Decipher test changed treatment decisions that was consistent with the eventual treatment received in three-fourths of adjuvant and salvage men after RP. Several men that pursued ART experienced PSA progression. PC-specific anxiety decreased in both adjuvant and salvage men. Clinical trial information: NCT02080689.
Ability of multiparametric magnetic resonance imaging (MRI) to predict prostate tumor heterogeneity on targeted biopsy.
Authors: Gold Samuel , Bloom Jonathan , Hale Graham R. , Rayn Kareem , Mehralivand Sherif , Wood Brad J. , Turkbey Baris , Pinto Peter A. 
Published: February 2018

113 Background: Prostate cancer (PCa) can show heterogeneous histology within lesions. MRI-targeted biopsy (Tbx) of the prostate improves PCa detection, but sampling within lesions has yet to be standardized. Furthermore, Tbx results are often heterogeneous as evidenced by differing histologic grades of Tbx cores within the same lesion. This introduces potential variability in biopsy results, on which clinical decisions are made. Here we aim to characterize lesion heterogeneity and identify predictive multiparametric MRI (mpMRI) features. Methods: A cohort of men who underwent mpMRI and Tbx between 2014-2017 were selected for analysis from a prospectively maintained database. To characterize lesion heterogeneity, only men with ≥2 positive Tbx cores were included. Histologic grades were scored according to International Society of Urological Pathology (ISUP) grades. Lesion heterogeneity, reported as a heterogeneity index (HI), was calculated as the difference of the average ISUP grades of Tbx cores per lesion from the maximum sampled ISUP grade of that lesion. Statistical analyses identified associations between imaging features and lesion heterogeneity. Results: 157 lesions in 114 patients met inclusion criteria. Maximum ISUP grade ranged from 1 to 5, with a median ISUP grade of 2. Higher ISUP grades were associated with greater lesion heterogeneity, HI for ISUP grade ≥3 = 0.58±0.11 vs <3 = 0.29±0.08, p = 0.0001. In addition, increasing lesion size on mpMRI was associated with greater lesion heterogeneity, HI for ≥2cm = 0.52±0.14 vs <2cm = 0.32±0.08, p = 0.0096. Finally, higher mpMRI suspicion scores were associated with increased heterogeneity vs lower suspicion scores, p = 0.048. Conclusions: mpMRI aids in characterizing PCa lesion heterogeneity to predict variability of histologic grades on Tbx. This information can assist Tbx planning to potentially reduce risks of upgrading on final pathology. Future research will examine how lesion heterogeneity can impact risk stratification and clinical decision-making for patients and practitioners. This research was supported by the Intramural Research Program of the National Cancer Institute, NIH and NIH Medical Research Scholars Program.
Outcomes of serial MRI/ultrasound fusion targeted biopsy in men with very low-risk and low-risk prostate cancer managed with active surveillance.
Authors: Hsiang Walter , Ghabili Kamyar , Syed Jamil , Nguyen Kevin , Suarez-Sarmiento Alfredo , Leapman Michael , Sprenkle Preston 
Published: February 2018

114 Background: The utility of serial magnetic resonance imaging (MRI)/ultrasound (US) fusion targeted prostate biopsy in men with prostate cancer (PCa) on active surveillance (AS) have not been clearly defined. We sought to investigate the rate of Gleason upgrading both on sequential fusion targeted and systematic biopsies among men with low-risk PCa managed with AS. Methods: We retrospectively queried an institutional database of 800 patients undergoing MRI/US fusion biopsy to identify 209 patients on AS with at least two fusion biopsies between December 2013 and November 2016. Men with National Comprehensive Cancer Network (NCCN) very low-risk and low-risk criteria were included. Gleason upgrade was defined as detection of Gleason score >=3+4. The proportion of patients experiencing upgrade on systematic, fusion, or both biopsy techniques was tabulated. Associations of clinical, pathologic, and imaging factors with biopsy upgrade were analyzed by logistic regression. Results: Of 209 patients undergoing MRI/US fusion biopsy, 73 (35.0%) had at least two targeted biopsies (66% very low-risk and 34% low-risk PCa). The time between biopsies was 12.6 months (11.2-17.7). The median PSA and PSA density were 5.4 ng/mL (4.2-7.1) and 0.11 ng/mL/mL (0.07-0.18), respectively. 21 (29%) patients experienced Gleason upgrade on subsequent biopsy. Of those, 6 (8%), 5 (7%), and 10 (14%) had upgrade on systematic biopsy only, fusion biopsy only, and both systematic and fusion biopsy, respectively. Patients with upgrade on subsequent biopsy had higher PSA (p=0.02) and PSA density (p=0.02), and were among low-risk disease population (p=0.03). In logistic regression models, greater number of positive cores in systematic biopsy (OR 1.88; 95% CI 1.23-2.92; p=0.005) was associated with the total Gleason upgrade on repeated biopsy. Conclusions: In men with favorable risk prostate cancer managed with AS, Gleason upgrade was detected in a 29% of patients on a second MRI/US fusion biopsy including both targeted and systematic regions. These findings support the continued use of both MRI fusion and systematic biopsy during surveillance due to risks of reclassification over time.
Time-dependent dose distribution changes in prostate brachytherapy with iodine seeds.
Authors: Teyssier Charles , Quivrin Magali , Blanc Julie , Petitfils Aurelie , Bidault Fabienne , Cormier Luc , Chambade Damien , Martin Etienne , Crehange Gilles 
Published: February 2018

115 Background: Prostate brachytherapy with iodine seeds has a lasting dose delivery due to a long half life of I125 (i.e. 2 months). To assess changes in dose metrics over time in low-dose rate prostate brachytherapy with iodine seeds and its relationship with rectal distension. Methods: One hundred and twenty-one post-implant CT scans performed every 2 weeks over 2 months after the treatment procedure were analyzed for dosimetry. Each CT-scan was performed without and with rectal enema. The following rectal parameters were collected to evaluate the influence of rectal distension over time: rectal volume, cross-sectional surface area (CSA) and relative CSA calculated from the first CT-scan chosen as reference (CTref). Results: Mean V150% and V200% of the prostate volume increased significantly over time (p < 0.0001) and were significantly higher on postimplant CT scan performed at day 45 (CT45) (p = 0.024 and p = 0.003, respectively) and CT scan performed at day 60 (CT60) (p = 0.0005 and p < 0.0001, respectively) compared with CTref. All dosimetric parameters for the rectum were significantly increased over time. No rectal parameters were significantly different after rectal enema and there was no difference in doses delivered to the prostate and the rectum after rectal emptying. Conclusions: Increased hot spots in the prostate and the rectum during the 2 months following the procedure with iodine seeds may be related to prostate shrinkage rather than rectal distension. We hypothesize that radioelements with shorter half-life (Pd103 or Cs131) or HDR may give less toxicity, as dose distribution is less time-dependent.
Prediction of adverse pathology after radical prostatectomy on MPMRI in the PIRADS v2 era.
Authors: Rayn Kareem , Bloom Jonathan , Gold Samuel , Hale Graham R. , Elnabawi Youssef A , Mehralivand Sherif , Wood Brad J. , Turkbey Baris , Pinto Peter A. 
Published: February 2018

121 Background: As the use of MRI in the diagnosis of prostate cancer (PCa) becomes more established, knowledge of its utility as a prognostic tool is needed to better counsel patients. Here, we aim to assess the ability of mpMRI to predict adverse pathologic factors, such as extraprostatic extension (EPE), seminal vesicle invasion (SVI) or lymph node involvement (LNI) on final pathology after radical prostatectomy (RP). Methods: A prospectively maintained database was queried for all men who underwent mpMRI with current PI-RADS v2 scoring system, MRI/TRUS fusion biopsy (FBx), and RP at our institution (n = 112). Patient demographics, clinical data, imaging and pathology were recorded. Patients were stratified by presence of adverse pathology (AP), defined as EPE, SVI or LNI. Statistical analyses were used to identify mpMRI characteristics predictive of AP using STATA 13. Results: Patients with adverse pathology were middle aged, predominantly caucasian, and significantly higher PSA at baseline (Table 1). Having a PI-RADS 5 lesion was positively associated with AP (adjusted OR = 4.37, 95% CI = 1.20-15.87, p = 0.02). Mean lesion diameter on mpMRI was greater in patients with AP (p < 0.01). However, number of lesions (p = 0.12) and prostate volume on mpMRI (p = 0.88) were not associated with AP. Conclusions: The results of this study demonstrate that features on mpMRI, particularly a PI-RADS score of 5 and large lesion diameter, are predictive of adverse pathology. This information will prove valuable in developing an imaging-based prognostic model in the era of MRI and FBx. This research was supported by the Intramural Research Program of the National Cancer Institute, NIH and NIH Medical Research Scholars Program[Table: see text]