bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heterogeneity in early oncologic outcomes among men with NCCN intermediate-risk prostate cancer treated with radical prostatectomy.
Authors: Ghabili Kamyar , Nguyen Kevin , Lu Amanda , Hsiang Walter , Shuch Brian M. , Leapman Michael 
Published: February 2018

144 Background: The National Comprehensive Cancer Network (NCCN) risk classification scheme for prostate cancer (PCa) encompasses several definitions and has been shown to contain significant heterogeneity. Because patients possessing a single intermediate-risk (IR) feature may be regarded as ineligible for active surveillance (AS), we aimed to compare pathologic and early oncologic outcomes between those with low-risk (LR) and IR features based on the number of criteria met. Methods: We queried the National Cancer Database (NCDB) to identify men with NCCN LR (cT1-T2a, prostate-specific antigen [PSA] < 10 ng/mL, and Gleason score (GS)≤6) and IR PCa diagnosed from 2010-2014 who were treated with radical prostatectomy (RP). Patients with IR PCa were stratified based on a single factor: clinical stage (cT2b-T2c), PSA (10-20 ng/mL), GS 3+4, or GS 4+3 alone. The pathologic outcomes including any Gleason upgrade, and adverse pathology (primary Gleason 4 or ≥pT3 at RP), and receipt of adjuvant radiation therapy (RT) were compared between the LR and IR groups. Odds ratios for pathologic outcomes and receipt of adjuvant RT were computed using logistic regression analyses. Results: Of 181,847 men treated with RP, we identified 30.7% and 37.1% with LR and IR PCa, respectively. Of 67,623 with IR PCa, 4,075 (6%) were due to clinical stage alone, 5,004 (7.4%) by PSA, 43,409 (64.2%) by GS 3+4, and 15,135 (22.4%) by GS 4+3. Patients meeting IR by clinical stage alone had similar risks of adverse pathology as LR patients (OR 1.03, 95%CI 0.94-1.13, p = 0.49). In contrast, those meeting IR by PSA alone had higher risks of adverse pathology compared with LR individuals (OR 2.20, 95%CI 2.05-2.36, p < 0.001). Moreover, receipt of adjuvant RT was similar among LR and IR patients by clinical stage alone (p = 0.62), and higher among patients meeting IR by PSA alone (OR 2.99, 95% CI 2.43-3.69, p < 0.001). Conclusions: Based on national cancer registry data, early outcomes among men meeting the NCCN IR definition for PCa are heterogeneous. IR patients by clinical stage alone had similar rates of adverse pathology as did LR group. Broadened eligibility for AS should be considered to include those meeting favorable IR definitions.
Comparative effectiveness of a patient-centered prostate biopsy report in clinical prostate cancer practice.
Authors: Nayak Jasmir G. , Scalzo Nicholas , Chu Alice , Dy Geolani , Macleod Liam Connor , Kearns James T , Mossanen Matthew , Ellis William J. , Lin Daniel W. , True Lawrence D. , Gore John L. 
Published: February 2018

145 Background: The prostate biopsy pathology report is a critical decision-making document for men newly-diagnosed with prostate cancer, yet the content may be beyond the health literacy of most patients. We compare the effectiveness of a patient-centered prostate biopsy report developed through patient-centered outcomes research methods with standard synoptic reports. Methods: Using a modified Delphi approach, a multidisciplinary group of prostate cancer experts provided consensus for the critical components of a prostate biopsy report for treatment decision-making. Patient focus groups provided input for syntax and formatting to inform the design of a patient-centered pathology report. 94 patients with recent prostate biopsies were block randomized to receive the standard report with or without the patient-centered report. We evaluated patient self-efficacy, provider communication and empathy, and prostate cancer knowledge at pathology disclosure. We compared study groups with descriptive statistics. Results: Experts selected primary and secondary Gleason score and number of positive cores as the important elements of a prostate biopsy report. Patients prioritized a narrative word structure, clear language, a tabular format for histologic grade, and information on risk classification. Initial assessments were completed by 84% (79/94) of participants including 40/46 in the standard report group and 39/48 in the patient-centered report group. Patients who received the patient-centered report had significantly improved ability to recall their Gleason score (100% vs. 85%, p = 0.03) and number of positive cores (90% vs. 65%, p = 0.01). Provider communication and patient self-efficacy were uniformly high and did not differ between groups. 88% of patients who received the patient-centered report felt that it helped them better understand their pathology results. Conclusions: A patient-centered prostate biopsy pathology report is associated with significantly higher knowledge about a new prostate cancer diagnosis. These health information documents may help facilitate shared decision-making among patients newly diagnosed with prostate cancer.
Bladder filling during radiation therapy for prostate cancer treatment: Assessment via bladder ultrasound scanner.
Authors: Waddle Mark Raymond , Landy Robin , Ryan Karen , Tzou Katherine S. , Stross William C , Kaleem Tasneem , Miller Daniel , Trifiletti Daniel Michael , Herchko Steven , Serago Christopher , Buskirk Steven J. 
Published: February 2018

147 Background: Prostate cancer patients treated with external beam radiation therapy are instructed to present daily with a full bladder to decrease small bowel and bladder toxicity and to increase reproducibility of treatment. However, older patients may have difficulty presenting with full bladders and variation of bladder volume with treatment is unknown. The objective of this study was to assess bladder filling at the time of radiation treatment (RT) using a bladder ultrasound in patients undergoing treatment for prostate cancer. Methods: Patients with prostate cancer were prospectively enrolled prior to CT simulation from January to August 2017. Bladder volume was recorded during CT simulation and daily immediately prior to RT. Patients were instructed to drink 8-12 ounces of water 30-60 minutes prior to RT. Three bladder volume measurements were recorded daily and averaged at the time of each treatment. Average bladder volume during treatment and the number of treatments with low bladder volumes ( < 50cc, < 60cc, and < 100cc) were reported using descriptive statistics. Results: A total of 13 patients completed a median of 42 days of RT during the study period, resulting in 550 daily bladder volumes. Ten patients were treated definitively and 3 with salvage radiation after prostatectomy. The median age of patients in the study was 72 years. Older patients were statistically more likely to present with low bladder volumes, with percentage of treatments with a bladder volume less than 50cc, 60cc, and 100cc being 29%, 42%, and 66% compared to only 4%, 7%, and 18% in patients aged < 70 (P < 0.01). The average bladder volume at the time of CT simulation was 176cc ± 57cc and the average volume during treatment was 140cc± 93cc, which was not statistically different (P = 0.28). The bladder volume did not significantly change over the course of treatment. Conclusions: Older patients (age 70+) with prostate cancer were more likely to present for RT with low bladder volumes in this prospective study. Our findings suggest that older patients should receive extra counseling about bladder filling and/or may require less bladder filling at the time of CT simulation to provide more accurate bowel dosimetry measurements.
Association of changes in functional status with radiation for prostate cancer in older veterans.
Authors: Ursem Carling Jade , Diaz-Ramirez L. Griselle , Lang-Brown Sean , Wei Xiao X. , Chen Ronald C. , Lee Sei 
Published: February 2018

148 Background: Although radiation therapy (RT) for prostate cancer is generally well tolerated, frail older adults with less functional reserve may experience more toxicity and loss of independence. Our objective was to determine trajectories of activities of daily living (ADL) for prostate cancer patients admitted to a nursing home for RT. Methods: We used the Veterans Affairs (VA) Minimum Data Set (MDS) to identify men age ≥65 with an ICD9 diagnosis of prostate cancer living in a VA nursing facility (CLC) 1/2005-12/2015, an MDS evaluation reporting RT and no ICD9 code for bone metastasis. Functional status was assessed using MDS-ADL score (range 0-28, higher scores = greater disability). A piecewise linear mixed effects model (nodes at months 1 and 3) modeled the relationship between baseline characteristics and MDS-ADL score. Results: 645 patients were identified, of whom 585 (90.7%) had not resided in a CLC prior to RT. Median age 74 (range 65-94), median baseline PSA 5.33 ng/mL (IQR 1-14.57), and median Charlson Comorbidity Index (CCI) 5 (30.5% CCl ≥8). Baseline median MDS-ADL score was 1 (range 0-28). Patients with CCI 2-3 did not have appreciable change in functional status in 6 months following start of RT, while patients with CCI 4-7 had an increase months 1-3, followed by improvement (Table). Compared to patients with CCI 2-3, those with CCl ≥8 had an increase in MDS-ADL score of 1.8 points/month months 1-3 after starting RT (p = 0.008), and increase in MDS-ADL score of 3 points/month from 3 months onward (p < 0.001). Older age and higher CCI were associated with increase in MDS-ADL score (p < 0.05). Conclusions: In a cohort of elderly prostate cancer patients with significant comorbidity, RT led to different functional trajectories depending on comorbidity burden. While patients with moderate comorbidity had an initial decline in functional status followed by improvement, patients with high comorbidity had continued functional decline. [Table: see text]
Association of low PTEN expression by fluorescence immunohistochemistry (F-IHC) and lethal disease in men with surgically-treated prostate cancer (PrCa).
Authors: Hamid Anis , Gray Kathryn P. , Huang Ying , Bowden Michaela , Loda Massimo , Pomerantz Mark , Sweeney Christopher 
Published: February 2018

15 Background: Loss of PTEN expression correlates with poorer clinical outcomes after definitive therapy for non-metastatic (M0) PrCa. While most studies have used biochemical-based end points, there is limited data regarding PTEN loss by IHC and risk of lethal disease after surgery. Methods: A retrospective cohort of patients who underwent radical prostatectomy (RP) was identified from the Dana-Farber Prostate Clinical Research Information Systems (CRIS) database. Formalin-fixed, paraffin-embedded RP specimens were used to construct tissue microarrays and F-IHC for PTEN was performed. Using multispectral imaging analysis, tumor-only PTEN expression was quantified. PTEN expression was analyzed continuously and dichotomously (low [ < lower quartile] vs other [≥lower quartile]). Kaplan-Meier method estimated the distribution of time from RP to metastatic disease and overall survival (OS). Cox model assessed association of PTEN status and the disease outcomes, with adjustment of age, Gleason score and pathological stage in multivariate analyses (MVA). Prognostic ability of PTEN was also explored using a logistic regression model. Results: The analysis cohort comprised 91 patients with either non-lethal (no metastatic or biochemical relapse) or lethal disease (metastasis post-RP). The median follow-up was 12.4 years. PTEN low was significantly associated with lethal disease as both a continuous (HR 1.82, 95% CI 1.35-2.44) and dichotomous (HR 2.94, 95% CI 1.52-5.56) variable. Significant association of PTEN-low expression and poorer OS was observed (cont: HR 2.22, 95% CI 1.54-3.23; low vs other: HR 4.00, 95% CI 1.89-8.33). MVA models yielded consistent results. A prognostic model assessing 10-year disease outcomes showed incremental prognostic improvement with PTEN status added to age/Gleason/stage (lethal disease: area under curve (AUC) 0.79 vs 0.84 [+PTEN status]; death: AUC 0.71 vs 0.76 [+PTEN status]). Conclusions: Low PTEN expression by F-IHC in primary prostate cancer is an independent prognostic biomarker of lethal disease and death after surgery. Quantitative F-IHC for PTEN is a viable diagnostic assay in this context.
Perioperative outcomes of aspirin use in radical prostatectomy.
Authors: Ingham Matthew D. , Krasnow Ross E , Mossanen Matthew , Wang Ye , Chang Steven Lee 
Published: February 2018

150 Background: Increasing cardiovascular disease has led to increases in the patient population on anti-platelet therapy who require urologic surgery. We sought to study perioperative outcomes for those undergoing radical prostatectomy (RP) while taking or not taking perioperative aspirin (pASA). Methods: A retrospective review of patients undergoing RP was performed on the Premier Hospital Database from 2003 to 2015, with survey projection weighting resulting in a cohort of 157,674 patients. Two groups were formed – those continued on pASA (group 1, n = 4400) and those with no pASA (group 2, n = 153,274). In-hospital complication rates were studied: major bleeding, overall transfusion, day-of-surgery transfusion, prolonged ( > 4 days) length of stay (LOS), and prolonged ( > 285 minutes) operative time. We also assessed 90-day rates of: cardiovascular catastrophe, readmission, major complication, and DVT/PE. Unadjusted rates were calculated for all RP patients and further subdivided into open and minimally invasive RP. Adjusted odds ratios (OR) were then calculated between groups 1 and 2. Results: Group 1 was older (51.5% vs 41.8% ≥65 years, p = 0.002) and less healthy (13.8% vs 5.3% with a CCI score ≥2, p < 0.0001) vs those in group 2. Group 1 patients were more likely to receive an open RP (42.3% vs 28.1%, p < 0.0001). For in-hospital outcomes for all RPs, no significant differences were noted regardless of surgical approach. For 90-day outcomes, those in group 1 were more likely to suffer a MI (OR 5.88, CI [3.4-10.18], p < 0.001), major complication (OR2.95, CI [1.58-5.5], p < 0.001), or be readmitted (OR 1.63, CI [1.18-2.26], p < 0.05). The disparity in both MI and major complication rates appeared to be largely driven by those undergoing minimally invasive RPs, with an OR of 7.92 and 4.02 noted, respectively. Conclusions: This large, retrospective, database review of both academic and community hospitals provides an important assessment of the impact pASA has on RP outcomes. In-hospital outcomes were equivalent between groups but those on pASA saw increased rates of MI, major complication, and readmission. Despite this, this study lends support to the belief that pASA should likely not be considered an absolute contraindication to RP.
Preliminary results of a study on focal low dose rate prostate brachytherapy using Cesium 131.
Authors: Moran Brian Joseph , Braccioforte Michelle H. 
Published: February 2018

151 Background: Prostate cancer patients continue to seek out minimally invasive therapies with equal disease eradication, but with less morbidity, lower cost and multiple salvage options. Our objective was to evaluate PSA response and determine rate of prostate specific antigen (PSA) kinetics in patients undergoing permanent low dose rate (LDR) focal prostate brachytherapy at a single institution. Methods: Between 4/2015 – 1/2017, 52 patients, of which 25% of patients were diagnosed with prostate cancer using a stereotactic transperineal mapping biopsy approach, while 75% had a standard transrectal prostate biopsy, were treated with LDR focal prostate brachytherapy. Dose to target was 115 Gy using Cesium-131. 30 patients (57.7%) were considered low risk, 21 pts (40.4%) were intermediate, and 1 patient (1.9%) was high risk. Treatment was limited to the side of the gland where the cancer was diagnosed. Because there is no agreed upon standard regarding PSA control, we are choosing to call the percent change in PSA the “Impact PSA”. Results: Median pre-treatment prostate volume was 51.6 cm3 (range 18 – 129 cm3), while the median target volume was 17.8 cm3 (range 7.6 – 39.4 cm3). Additionally, the median prostate volume treated was 33.73% (range 17.6 – 95.3%). Our data demonstrates that patients in whom 25-50% of the gland treated, resulted in an Impact PSA of approximately 25% - 50% decrease in total PSA between 3 - 6 months, with continued decreases of 55% at 1 year, and 77% at 2 years. Conclusions: Focal therapy outcomes are highly variable and related to volume of ablation. For low volume disease, LDR focal brachytherapy may be a viable option for patients. Optimal outcome assessment after focal therapy is yet to be determined. Since there is untreated gland with the potential to produce PSA, perhaps stable patterns in PSA kinetics, rather than a nadir, is more valuable. We will continue to follow-up with this cohort to report long term results and closely study the Impact PSA.
Impact of USPSTF recommendations on utilization of PSA screening in Medicare beneficiaries.
Authors: Khairnar Rahul Ramesh , Mishra Mark , Onukwugha Ebere 
Published: February 2018

166 Background: Previous studies assessing the impact of the United States Preventive Services Task Force (USPSTF) recommendations on utilization of prostate-specific antigen (PSA) screening have not investigated longer-term impacts of the 2008 recommendations nor have they investigated the impact of the 2012 recommendations in the Medicare population. The study aim was to evaluate change in utilization of PSA screening, post USPSTF recommendations of 2008 and 2012, and to assess trends and determinants of receipt of PSA screening in the Medicare population. Methods: This retrospective study of male Medicare beneficiaries utilized Medicare Current Beneficiary Survey (MCBS) data and linked administrative claims from 2006-2013. Beneficiaries aged ≥65 years, with continuous enrollment in Parts A and B for each year they were surveyed were included in the study cohort. Beneficiaries with self-reported or claims-based diagnosis of prostate cancer were excluded. Beneficiaries with Medicare eligibility due to end stage renal disease or disability were also excluded. The primary outcome was receipt of PSA screening. Other measures include age groups (65-74 and ≥75), time periods (pre- and post-2008 and 2012 recommendations), and sociodemographic variables. Results: The study cohort consisted of 11,028 beneficiaries, who were predominantly white (87.56%), married (69.25%), and unemployed (84.4%); 52.21% beneficiaries were aged ≥75. Declining utilization trends for PSA screening were observed only in men aged ≥75 after 2008 recommendations and in both age groups after 2012 recommendations. The odds of receiving PSA screening declined by 17% percent in men aged ≥75 after the 2008 recommendations and by 29% in men aged ≥65 after the 2012 recommendations. Conclusions: The USPSTF recommendations of 2008 and 2012 against PSA screening were associated with declines in utilization of PSA screening during the study period. USPSTF recommendations play a significant role in affecting utilization patterns of health services. Future studies should evaluate if the proposed 2017 update to these recommendations advocating shared decision-making for PSA screening in men aged 55-69 increase utilization in this age-group.
Dose escalation with high-dose-3D-conformal/IMRT (HD-3D-CRT/IMRT) compared with low-dose 3D-conformal/IMRT plus HDR brachytherapy (LD-3D-CRT/IMRT+HDR-B) for intermediate- or high-risk prostate cancer: Disease control, survival, and toxicity.
Authors: Guix Ines , Bartrina Jose Maria , Tello Jose Ignacio , Garcia Ivan , Quinzaños Luis , Lacorte Teresa Maria , Guix Teresa , Guix Benjamin 
Published: February 2018

169 Background: To report early and late toxicity and biochemical outcome in a prospective series of 1,465 patients with intermediate- or high-risk clinically localized prostate cancer treated with either HD-3D-CRT/IMRT or with LD-3D-CRT/IMRT+HDR-B. Methods: Between 12/1999 and 10/2011, 1,465 pts (pts) with PSA›10, Gleason score›6 and/or T2b-T3 N0 M0 prostate cancer entered the study. Pts were prospectively assigned to one of the two treatment groups: 76 Gy HD-3D-CRT or IMRT to the prostate in 38 fractions (group 1; 733 pts) or 46 Gy LD-3D-CRT or IMRT followed by 16 Gy HDR-B given in 2 fractions of 8 Gy (group 2, 732 pts), limiting the maximum rectal dose to 85% of the prescribed dose. Both groups were well balanced taking into account patient’s as well as tumors’ characteristics. Toxicities were scored by the EORTC /RTOG morbidity grading scales. Special attention to local, regional or distant recurrence, survival, late effects, PSA and testosterone levels and quality of life was done. Results: All pts completed treatment. None pts included in the group 1 or 2 experienced grade 3 or more rectal toxicity. 94 pts of group 1 (12.8%) and 20 pts of group 2 (2.7%) developed grade 2 rectal toxicity (rectal bleeding or urgency). 49 pts in group 1 (6.7%) and 10 pts in group 2 (1.3%) developed grade 1 rectal bleeding (less than 2 times/week). With a mean follow-up of 102 months, the 10-year free-from-failure survival was 90.7% and 98.3% (p<0.002) in group 1 and 2 respectively; free-from-metastases survival 95.9% and 97.8% (p<0,006)for group 1 and 2 respectively; and cause-specific survival 97.1% and 98.2% (p<0.08). Conclusions: High-dose 3D-EBRT + HDR brachytherapy was a safe and effective method of escalating the dose to the prostate without increasing the risk of late effects. Acute as well as late rectal complications were significantly reduced with the combined treatment, compared with what was observed with high-dose conventional, 3D-conformal radiotherapy. Control rates were significantly better with in the HDR-boosted patients as expected by higher effective-dose.
The application of artificial intelligence and machine learning to automate Gleason grading: Novel tools to develop next generation risk assessment assays.
Authors: Donovan Michael Joseph , Scott Richard , Khan Faisal m , Zeineh Jack , Fernandez Gerardo 
Published: February 2018

170 Background: Postoperative risk assessment remains an important variable in the treatment of prostate cancer (PCA). Advances in genomic risk classifiers have aided clinical-decision making; however, clinical-pathologic variables such as Gleason grade and pathologic stage remain significant comparators for accurate prognostication. We aimed to standardize the descriptive pathology of PCA through automation of Gleason grading with artificial intelligence and image analysis feature selection Methods: Retrospective study using radical prostatectomy (RP) tissue microarrays from Henry Ford Hospital and Roswell Park Cancer Center with 8-year median follow-up. Samples were stained with a multiplex immunofluorescent assay: Androgen Receptor (AR), Ki67, Cytokeratin 18, Cytokeratin 5/6 and Alpha-methylacyl-CoA racemase); imaged with a CRI Nuance FX camera and then analyzed with proprietary software to generate a suite of morphometric - attributes that quantitatively characterize the Gleason spectrum. Derived features were univariately correlated with disease progression using the concordance index (CI) along with the hazards ratio and p-value. Results: Starting with a training cohort of 306 patients and a 15% event rate, MIF PCA images were subjected to a machine learning analysis program which incorporates a graph theory-based approach for characterization of gland / ring fusion and fragmentation of tumor architecture (TA) with biomarker quantitation (BQ) (i.e. AR and Ki67). 19 unique image features with 7 TA and 12 TA+BQ were identified, by univariate CI, all TA features were strongly associated with Gleason grading with CI’s reflecting degree of tumor differentiation (CI 0.29-.33, p-value = 0.005). Four TA+BQ features were selected in a training risk model and effectively replaced the clinical Gleason features. By comparison, dominant RP Gleason had a CI of 0.31. Conclusions: Image-based feature selection guided by principles of machine learning has the potential to automate and replace traditional Gleason grading. Such approaches provide the necessary foundation for next generation risk assessment assays.