bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of prostate bed nodule on MRI in patients with rising PSA after radical prostatectomy.
Authors: Nasser Nicola Joseph , Chernyak Victoria , Kalnicki Shalom , Klein Jonathan 
Published: March 2019

122 Background: Radical prostatectomy (RP) is a common treatment modality for localized prostate cancer. Biochemical failure after RP is usually evaluated with whole body imaging to rule out metastatic disease and pelvic MRI to detect local recurrence in the prostate bed. We analyzed disease characteristics and demographic data of patients with rising PSA after RP to determine correlation with MRI-detected cancer recurrence. Methods: Using Clinical Looking Glass, an institutional data registry query tool, we identified all MRI scans performed at our institution between January 2013 and January 2018 to evaluate for the presence of prostate cancer after RP due to rising prostate specific antigen (PSA) levels. Using Chi-square testing, we analyzed PSA levels, pathologic disease characteristics, time from surgery to biochemical failure, and patient demographic characteristics as predictors of local recurrence detected by pelvic MRI. Results: We identified 64 patients who underwent MRI for rising PSA and had complete clinical and pathological data available. A prostate bed nodule compatible with local recurrence was found in 17 patients (27%). Thirty-six patients (56%) had no evidence of tumor in the prostate bed or pelvis. Eleven patients (17%) had a suspicious lesion which could represent scarring, retained seminal vesicle or recurrent cancer. Patient race was associated with likelihood of detecting a prostate nodule on MRI (p = 0.04) with African-American patients having 82% lower chance of MRI-detected tumor recurrence compared with White patients (p = 0.045). No other characteristic was significantly associated with MRI-detected recurrence including prostate cancer risk group, Gleason score, extra-capsular extension, positive surgical margin, seminal vesicle involvement, perineural invasion, lymphovascular invasion, and PSA level before MRI. Conclusions: African-American patients with biochemical failure after RP are less likely to have MRI-detectable recurrence in the prostate bed compared with white patients. This data may support a higher propensity toward microscopic metastatic disease at the time of biochemical failure in this population.
Intraductal carcinoma of the prostate in prostate biopsy samples: Correlation with pathological features after radical prostatectomy and prognostic value in high-risk prostate cancer patients.
Authors: Zhu Sha 
Published: March 2019

123 Background: Intraductal carcinoma of the prostate (IDC-P) is a biologically aggressive form of prostate cancer. We investigated the correlation between IDC-P in prostate biopsy samples (Pbx) and several pathological features after radical prostatectomy (RP), also its prognostic value in high-risk prostate cancer patients. Methods: Totally, 455 patients diagnosed with PCa during 2010 to 2017 in West China Hospital were included in this study. Chi-squared test and binary logistic regression were used in discovering the correlation between IDC-P and post-RP pathological features. Kaplan Meier curve, log-rank test, Cox’s proportional hazards model and C-index were applied in the investigation of the prognostic value of IDC-P on 418 high-risk patients. Results: The detection rate of IDC-P in Pbx is 7.91%. IDC-P was an independent predictor of SVI ( p= 0.014), EPE ( p< 0.001), cT stage ( p= 0.001), PSM of urethra end ( p= 0.042). Patients with IDC-P in PBx specimens manifested poorer BFS than those without IDC-P ( p< 0.001), and IDC-P pattern 2 (HR: 4.429, p= 0.020) was associated with worse prognosis than IDC-P pattern 1 (HR: 3.225, p= 0.047). Further analyses also demonstrated that the addition of IDC-P in several nomograms could improve their C-index. Conclusions: IDC-P is associated with several post-RP pathological features after radical prostatectomy. Also, IDC-P can effectively predict the patients’ BFS, and the addition of it can increase the C-index of several nomograms.
Risk of recurrence in patients with positive surgical margin at apex only versus other locations after radical prostatectomy.
Authors: Kato Masashi , Yamamoto Akiyuki , Ishida Ryo , Kimura Tohru , Sano Tomoyasu , Owaki Takayuki , Sassa Naoto , Gotoh Momokazu , Tsuzuki Toyonori 
Published: March 2019

124 Background: Some reported that positive surgical margin at radical prostatectomy (RP) was a prognostic factor of clinical recurrence and prostate cancer death, and others showed that was not necessarily true. The prostatic apex is most popular location of positive surgical margin at RP and the frequency of apex is reported to be about 20-40% of all positive cases. Prostatic apex is also reported to lack a well-defined capsule and to be hardly retracted during operation. In this study, we evaluated the effect of positive surgical margin at apex-only on prognosis after RP in a large cohort. Methods: We retrospectively evaluated 1019 patients with prostate cancer who underwent radical prostatectomy without neoadjuvant or adjuvant therapy at the hospitals that the authors were affiliated with between 2005 and 2013. The operative approach (open, laparoscopic, or robotic) was decided by each institution. All prostatectomy specimen slides were reviewed by a single genitourinary pathologist according to ISUP 2014 criteria. Recurrence following RP was defined according to AUA guidelines. Results: The median patient age was 67 (range, 45–80) years. The median initial PSA was 6.8 ng/ml (range, 0.4–82 ng/ml). The median follow-up period was 69 (range, 0.7–135) months. Pathological T stage was in 72.5% of pT2 (n = 739), 23.4% of pT3a (n = 238), and 4.1% of pT3b (n = 42). There were 163 Grade Group (GG) 1 cases, 502 GG 2, 217 GG 3, 39 GG 4, and 98 GG 5 cases. 372 cases had positive surgical margin. Details were 201 (54%) apex only, 57 (15%) anterior, 43 (12%) posterior, 76 (20%) lateral, 40 (11%) bladder. Some patients showed multiple positive surgical margin. The patients with positive surgical margin at apex-only showed significantly better prognosis than other locations (P = 0.0001). This result was confirmed in each operative approach (open; P = 0.008, laparoscopic; P = 0.001, robotic; P = 0.01). Conclusions: Among surgical margin positive patients after RP, those at prostatic apex-only showed lower biochemical recurrence than other locations regardless of operative approach. Physician should follow such a patient carefully without adjuvant therapy.
Increasing utilization of multi-parametric magnetic resonance imaging in prostate cancer active surveillance.
Authors: Maganty Avinash , Yu Michelle , Macleod Liam C , Yabes Jonathan G , Fam Mina M , Bandari Jathin , Turner Robert , Furlan Alessandro , Filson Christopher Paul , Davies Benjamin John , Jacobs Bruce Lee 
Published: March 2019

125 Background: Multi-parametric resonance imaging (mpMRI) has emerged as a tool that may improve risk-stratification and decrease repeated biopsies in men electing active surveillance. However, the extent to which mpMRI has been implemented in active surveillance has not been established. Therefore, we sought to characterize the use of multiparametric magnetic resonance imaging (mpMRI) in Medicare beneficiaries electing active surveillance for prostate cancer. Methods: SEER-Medicare claims data, we identified men with localized prostate cancer diagnosed between 2008-2013 and managed with active surveillance. We classified men into two treatment groups: active surveillance without mpMRI and active surveillance with mpMRI. We then fit a multivariable logistic regression models to examine changing mpMRI utilization over time, and factors associated with the receipt of mpMRI. Results: We identified 9,467 men on active surveillance. Of these, 8,178 (86%) did not receive mpMRI and 1,289 (14%) received mpMRI. The likelihood of receiving mpMRI over the entire study period increased by 3.7% (p = 0.004). On multivariable logistic regression, patients who were younger, white, had lower comorbidity burden, lived in the northeast and west, had higher incomes and lived in more urban areas had greater odds of receiving mpMRI (all p < 0.05). Conclusions: From 2008-2013, use of mpMRI in active surveillance increased gradually but significantly. Receipt of mpMRI among men on surveillance for prostate cancer varied significantly across demographic, geographic and socioeconomic strata. Going forward, studies should investigate causes for this variation and define ideal strategies for equitable, cost-effective dissemination of mpMRI technology.
Radiogenomic characterization of multifocal prostate cancer.
Authors: Salami Simpa Samuel , Kaplan Jeremy B , Nallandhighal Srinivas , Takhar Mandeep , Tosoian Jeffrey J. , Lee Matthew , Yoon Junhee , Hovelson Daniel H , Plouffe Komal R. , Kaffenberger Samuel D. , George Arvin Koruthu , Montgomery Jeffrey Scott , Davenport Matthew , You Sungyong , Tomlins Scott A. , Curci Nicole E , Kim Hyung Lae , Spratt Daniel Eidelberg , Udager Aaron M. , Palapattu Ganesh S. 
Published: March 2019

126 Background: Up to 20% of patients with negative multiparametric magnetic resonance imaging (MRI) harbor Gleason score ≥7 prostate cancer (PCa). We sought to elucidate the molecular basis of and determine the prognostic significance of PCa visibility on MRI. Methods: We identified a retrospective cohort of patients who underwent MRI prior to prostatectomy with both MRI visible (PIRADS 3 – 5) and invisible PCa. MRI for each patient was re-reviewed and co-registered with whole-mount histopathology. DNA and RNA were co-isolated from all tumor foci pre-identified on FFPE specimens. High depth, targeted DNA and RNA next generation sequencing was performed to characterize the molecular profile of each tumor focus using the Oncomine Comprehensive Panel (DNA) and a custom targeted RNAseq panel assessing PCa relevant alterations. A multigene RNAseq model was developed and validated in two independent cohorts to predict MRI visible PCa and to determine the prognostic significance of MRI visibility. Results: A total of 26 primary tumor foci from 10 patients were analyzed. Of the 14 (54%) invisible lesions on MRI, 5 (36%) were Gleason 3+4 = 7 and the remainder were Gleason 6. We detected high-confidence prioritized PCa relevant mutations in 54% (14/26) of tumor foci, 43% (6/14) of which were in MRI invisible lesions. Notable point mutations were in APC, AR, ARID1B, ATM, ATRX, BRCA2, FAT1, MAP3K1, NF1, SPEN, SPOP, and TP53. A 9-gene RNA signature, the majority of which were under-expressed cellular organization and structure genes, was developed to predict MRI visibility with an AUC of 0.89. Validation of this signature in an independent data set (n = 16) yielded an AUC of 0.88 with a specificity of 100% for predicting MRI visible tumors. Using this signature in a cohort of 375 patients with clinical follow up, we found that predicted MRI visibility status was not an independent predictor of biochemical recurrence, metastasis-free survival, or PCa specific mortality (all p > 0.05). Conclusions: We observed under-expression of cellular organization and structural genes in MRI visible tumors compared to MRI invisible cancer foci. Using our validated signature to predict MRI visibility status, we found that MRI visibility is not a significant predictor of oncological outcomes.
The value of transperineal prostate apical zone biopsy in predicting urethral or apical margin status after radical prostatectomy in prostate cancer.
Authors: Dai Jindong , Shen Pengfei 
Published: March 2019

127 Background: To investigate potential preoperative predictors of positive surgical margin (PSM) after radical prostatectomy, and how to reduce the possibility of urethral or apical PSM with positive biopsy cores in the apical zone of prostate (AZP). Methods: 531 patients who had radical prostatectomy during 2010-2017 in West China hospital was enrolled. The logistic regression was used to assess the preoperative factors associated with PSM. 399 patients with high/very high risk prostate cancer were recognized by National comprehensive cancer Network guidelines and 339 patients were reported positive biopsy cores in the AZP. Results: The overall PSM rate of all patients was about 30.1% (160/531) and 117 of them were reported urethral or apical PSM. The occurrence rate of urethral or apical PSM in patients with positive cores in AZP was obviously higher than that in total group (p = 0.022). We further found that the addition of positive AZP to a standard multivariable model could significantly increase the predictive value of urethral or apical PSM (p = 0.016) in different groups. The analysis also showed that neo-adjuvant hormone therapy was an independent protective factor for urethral or apical PSM in positive AZP patients, but not all patients. Conclusions: This is the first study to investigate the necessity of getting cores in the apical zone by transperineal prostate biopsy to predict the possibility of apical or urethral PSM. In clinical practice, neo-adjuvant hormone therapy should be given when patients with AZP(+) to reduce the presence of PSM, especially patients with high/very high risk prostate cancer.
Measurement science of the androgen receptor splice variant-7 protein in primary and castration-resistant prostate cancer tissue.
Authors: Sharp Adam , Coleman Ilsa , Welti Jon , Lambros Maryou B. , Yuan Wei , Nava Rodrigues Daniel , Sprenger Cynthia , Dolling David , Russo Joshua , Figueiredo Ines , Neeb Antje , Uo Takuma , Morrissey Colm , Carreira Suzanne , Nelson Peter S , Balk Steven P. , True Lawrence D. , Luo Jun , Plymate Stephen R , De Bono Johann S. 
Published: March 2019

151 Background: Liquid biopsies demonstrate the constitutively active androgen receptor splice variant-7 (AR-V7) associates with reduced benefit from endocrine therapies in castration resistant prostate cancer (CRPC). These studies provide little information pertaining to AR-V7 expression in PC tissue. Methods: AR-V7 protein expression was determined for 358 primary PC samples and 293 metastatic CRPC biopsies by immunohistochemistry. Associations with disease progression, full length AR (AR-FL) expression, response to therapy, gene expression, and circulating tumor cell (CTC) AR-V7 status were investigated. Results: AR-V7 protein is rarely expressed ( < 1% of 358 cases) in primary PC but is frequently detected (75% of 40 cases) following primary androgen deprivation therapy (ADT) alone (H-score 40; interquartile range 1.25-92.5), with a further significant (p = 0.020) increase following abiraterone or enzalutamide therapy (90; 20-150). In CRPC, AR-V7 expression is mainly nuclear (94% of 144 cases), correlates with AR-FL expression (p = < 0.001), and is homogeneous within single metastases (p = 0.997) but heterogeneous in different metastases from the same patient (p < 0.001). In addition, AR-V7 expression correlates with a 59-gene signature, including HOXB13, a co-regulator of AR-V7 function. Moreover, AR-V7 negative disease associates with better PSA response (p = 0.03) and overall survival (p = 0.02) from endocrine therapies. Finally, CTC+/AR-V7+ blood samples had significantly (p = 0.004) higher AR-V7 protein expression (100; 62.5-147.5) in paired tissue biopsy compared to CTC+/AR-V7- blood samples (15; 0.0-112.5), and AR-V7 protein expression is frequently detected (63% of 16 samples) in tissue of patients with CTC- blood samples. Conclusions: AR-V7 protein is not expressed until castration resistance and occurs after primary ADT alone. Levels of AR-V7 protein vary between metastases, and although AR-V7 associates with response to endocrine therapies, this suggests multiple resistance mechanisms exist in the same patient. If developed, agents targeting AR-V7 may be best explored earlier in the course of disease and in combination with other therapies.
Outcome, costs and dollar value of docetaxel and abiraterone in prostate cancer.
Authors: Guirgis Helmy M. 
Published: March 2019

155 Background: Questions have emerged on the role of diet, cost and value of Abiraterone (Abi) in prostate cancer. Abi improved the quality of life (QoL), in contrast to docetaxel (Doc) used > 6 cycles. We analyzed the data of 5 major clinical studies. Our objective was to weigh outcome, costs and dollar value of Abi and Doc in prostate cancer. Methods: Hazard ratios (HR) and company-posted prices were quoted. In hormone sensitive (HS), Doc costs x 6 cycles and Abi x 18-24 months were compared. Tests, follow-up and adverse events treatment costs (AEsTC) were computed separately. The probability of survival (PoS) was calculated as (1.0-HR) and dollar value as cost/PoS. Results: Doc costs x 6 cycles were $27,408 and AEsTC $1,450. In HS, at HR of 0.61 (Sweeney, 2015) and 0.73 (updated CHAARTED), Doc dollar value was $70,277 and $101,511 respectively. Abi costs x 2-years were $250,704, AEsTC $2,010, HR 0.73 (STAMPEDE) and value $928,533. In high risk HS (LATTITUDE), HR was 0.62 and value $659,747. At 18 months, Abi costs were $188,028. At an average HR of 0.73, value was $696,400. In comparison, in castrate-resistant (CR) chemo-naïve patients, Doc costs x 12 cycles were $54,816, AEsTC $4,840, HR 0.76 (Tannock, 2004) and value $228,400. Abi costs x one-year were $125,352 and AEsTC $1,050, HR 0.80 (COU-AA-302) and value $626,760. Conclusions: In HS, the results tend to suggest superior dollar value of Doc over Abi. In CR, the negative impact of Doc on QoL would undermine its dollar value.
Low incidence of microsurges with biodegradable polymer-delivered, subcutaneously-administered leuprolide acetate in prostate cancer patients.
Authors: Efstathiou Eleni , McLane John A. , Atkinson Stuart , Boldt-Houle Debbie , Sartor A. Oliver 
Published: March 2019

158 Background: Androgen deprivation therapy is a foundational treatment of advanced prostate cancer (PCa) with the primary objective of suppressing circulating androgens.Consistent drug delivery with long-acting leuprolide acetate (LA) formulations is important in providing continuous testosterone (T) suppression throughout the course of treatment without T rising above castrate level (T breakthrough). To assess subcutaneously-administered LA (SC-LA) maintenance of T levels in PCa patients, the incidence of microsurges was evaluated in 4 pivotal trials. Methods: In 4 open-label, fixed-dose, pivotal trials, 424 eugonadal prostate cancer patients (age 40-86) who achieved medical castration (T<50 ng/dL) while on the first administration of SC-LA 7.5, 22.5, 30, or 45 mg, lasting 1, 3, 4, or 6 months, respectively, were evaluated for microsurges. A microsurge was defined as an absolute increase in T level of at least 25 ng/dL during the 4 week period after the second study dose was administered. T was measured 2-4 times on day 0 and once on days 1, 2, 3, 7, and every week until the next dose through the end of the studies. Results: Across the individual studies, 8 patients out of 424 (range 0.9-3.4% by dose, pooled 1.9%) experienced a microsurge during the acute period after the second SC-LA dose (Table). 6 of these 8 patients remained below castrate level at the peak of the surge. Conclusions: SC-LA demonstrated a very low incidence of T breakthroughs and microsurges in PCa patients and only 2 of 424 patients experienced a T microsurge above castrate levels. Limiting the occurrence of T levels above castrate levels may have clinical implications with respect to prolonged progression-free survival. [Table: see text]
Second cancer following radical prostate cancer treatment.
Authors: Aksnessaether Bjorg Y , Solberg Arne , Myklebust Tor Åge , Hoff Solveig Roth , Skovlund Eva , Klepp Olbjørn , Lund Jo-Åsmund 
Published: March 2019

16 Background: We estimated second cancer (SC) risk following radical prostate cancer (PC) treatment and evaluated if the risk was influenced by treatment. Methods: We analyzed data from the Cancer Registry of Norway on all patients with PC (first cancer diagnosis) from 1997-2014. Standardized incidence ratios (SIRs) for SC were calculated. Subdistribution hazard ratios (SHRs) were estimated in treatment groups (prostatectomy (RP) reference). Results: Median follow-up in 24155 radically treated patients was 6 and 4 years in the external beam radiotherapy (EBRT) and RP-groups, respectively. SC-incidence was indifferent from that of the reference population in 24155 radically treated patients, higher following EBRT, SIR 1.06(1.01-1.12), and lower following RP, SIR 0.91(0.84-0.98). EBRT-patients had higher rectal and urinary bladder cancer incidences. Compared to RP, the EBRT-patients had a 38 % higher risk of any SC. Respective figures for rectal, urinary bladder and lung cancer: 72, 38, and 113%. Conclusions: EBRT-patients had a slightly higher SC-incidence than the general population. The rectal and urinary bladder cancer risk should be taken into account in follow-up after EBRT.[Table: see text]
A retrospective observational study assessing bone metastases (mets) detection and management of patients (pts) with castration-resistant prostate cancer (CRPC) in Canada.
Authors: Saad Fred , Kapoor Anil , Aprikian Armen G. , Casey Richard , Caveen Michele , Reiner Maureen , Gillesby Brad , Finelli Antonio 
Published: March 2019

161 Background: Canadian Urological Association guidelines outline the scheduling of imaging modalities based on prostate-specific antigen doubling time (PSADT) to screen for mets in pts with nonmetastatic (M0) CRPC and to manage pts with metastatic (M1) CRPC. Data describing guideline adoption and real-world timing of bone scans and treatment patterns in Canadian CRPC pts are limited. Methods: A retrospective chart review conducted at 13 Canadian urology practices included pts with CRPC (PSA ≥2 ng/mL despite androgen deprivation therapy) sequentially identified in reverse chronological order starting July 30, 2015. Pts had no mets at CRPC diagnosis (index date). Data were abstracted from the index date to the chart review date. Coprimary objectives were to describe CRPC management in terms of timing of the 1st and repeat bone scans in M0 and treatment patterns when pts became metastatic. Secondary objectives described nonbone imaging. Results: 232 pts enrolled. Over the observation period 109 remained nonmetastatic (M0 cohort); 123 developed mets (M1 cohort). Median index PSADT was ~1.5x greater for the M0 cohort than the M1 cohort. 68 pts (71.6%) in M0 and 117 pts (95.1%) in M1 had ≥1 bone scan. Median (95% CI) months from CRPC diagnosis to 1st bone scan was 7.5 (5.6–9.6) for pts in M1 and 15.7 (10.0–23.0) for pts in M0. Median (95% CI) months from identification of mets to start of treatment for the M1 cohort was 3.2 (2.3–5.7). The most common therapies were abiraterone (55%) and enzalutamide (42%), with respective median (95% CI) durations of 12.7 (8.7–23.3) and 15.7 months (10.4–NE). 25% of pts received a bone-targeted agent. Conclusions: In CRPC, time to first bone scan was shorter for pts who subsequently developed mets or had rapid PSADT. Abiraterone and enzalutamide were the most common therapies in pts with mets. [Table: see text]