bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of late Medicaid expansion on prostate cancer screening.
Authors: Pucheril Daniel , Zlatev Dimitar V. , Mossanen Matthew , Cole Alexander P , Ingham Matthew D. , Chang Steven Lee , Kibel Adam S. , Trinh Quoc-Dien 
Published: February 2018

141 Background: A key provision of the Affordable Care Act (ACA) was the expansion of Medicaid to childless adults living < 138% of the federal poverty level (FPL). Aside from a few early expansion states, the majority of states adopting the provision expanded coverage in January 2014, and are categorized as late expansion states (LES). Non-expansion states (NES) opposed expansion and did not adopt these broader provisions. Our objective was to determine the effects of this policy change on prostate cancer screening (PSAS) trends in LES and NES. Methods: The 2014 and 2016 Behavioral Risk Factor Surveillance System surveys reflect 2013 and 2015 health behaviors, and were queried for men 40-64, without history of prostate cancer, with a household income < 138% FPL, and residing in NES or LES. Descriptive statistics, stratified by expansion status and year, were generated for covariates. The Chi-Square test was used to compare proportions between years within state categories. Difference-in-differences (DID) analyses were employed to compare trends in men with health insurance, a personal physician, and undergoing PSAS. Within a multivariable logistic regression model, the interaction term year*state expansion status was used to determine the significance of DID estimates. Results: A weighted 8.8 million (n = 14,979) men met inclusion criteria. PSAS significantly declined from 2014 to 2016 in both NES (22.6% to 16.4%, p = 0.0006) and LES (20.5% to 15.8%, p = 0.003). In LES, the proportion of men with health insurance significantly increased from 2014 to 2016 (75.5% to 82.7%, p = 0.0002), however the proportion of insured men in NES was constant. Additionally, the proportion of respondents with a personal physician was unchanged from 2014 to 2016 in both NES and LES. DID analysis determined a significant difference in health insurance trends between 2014 and 2016 for LES compared to NES (+6.9%, p = 0.008). DID estimates were not significant for comparisons of trends for PSAS or access to a personal physician. Conclusions: The ACA’s Medicaid expansion provision has led to significant gains in insurance coverage for eligible persons in LES compared to NES, however, these gains have not translated into significantly different rates of access to a personal physician or PSAS.
Decipher test’s impact on the postoperative management of prostate cancer.
Authors: Calio Brian P. , Murphy Matt , Calvaresi Anne , Mark James Ryan , Mann Mark , Den Robert Benjamin , Gomella Leonard G. , Trabulsi Edouard John , Lallas Costas D. 
Published: February 2018

146 Background: The Decipher Prostate Cancer Test provides risk stratification for prostate cancer aggressiveness and predicts the probability of metastasis after surgery. We aim to determine the impact on clinical decision-making Decipher risk designation has had at our institution since its implementation. Methods: A prospectively maintained single institution database was analyzed for patients who underwent prostate biopsy and prostatectomy between 2006-2017. Patients with pathologic T3 cancer, Gleason ≥3+4, or positive surgical margins were considered for the study. In cohort 1, patients’ Decipher scores were available prior to postoperative decision-making, in cohort 2 patients’ scores were not available. Postoperative management was then compared between cohorts to determine if presence of Decipher score influenced the rate of adjuvant and salvage radiation administered. The EMR was queried for the words “adjuvant”, “RT”, “salvage”, “SRT”, to record rates of radiation given to each patient. Chi Square and Mann Whitney test was used to compare rates between cohorts and Decipher risk categories. Results: 454 patients were included in the study with median (IQR) age of 62.0 (7.0) years. Mean time of follow-up was 2.0 years and 8.2 years in cohorts 1 and 2, respectively. In the cohort that received Decipher scores, rate of adjuvant radiation administered was significantly higher than in patients who did not receive a Decipher score (27.0% vs. 6.8%, p<0.001), and higher Decipher risk was associated with higher rate of adjuvant administration (9% vs 27.8% vs 35.4% for low, average and high risk, respectively; p<0.001). Rate of salvage radiation given was not significantly different between the cohorts (5.2% vs 4.0%; p=0.228). Conclusions: The Decipher Prostate Cancer Test provides valuable data regarding risk stratification of disease. As demonstrated here, the availability of Decipher scores has lead to a demonstrable effect in the postoperative management of prostate cancer.
Changing trends in prostate brachytherapy practice for clinically localized prostate cancer: Results of a survey in UK and Ireland.
Authors: Corey Gemma , Mohamed Yoosuf Ahamed Badusha , Byrne Monica M. , Workman Geraldine , Mitchell Darren M. , Jain Suneil 
Published: February 2018

16 Background: High Dose Rate (HDR) and Low Dose Rate ( LDR) prostate brachytherapy (PBT) with or without external beam radiotherapy provide excellent biochemical outcomes with practice adapting to ongoing research and technological advances. We wished to document current PBT practice in the UK and Ireland (UK & I) and compare with previous published audit results. Methods: A link to an online survey was communicated to centres attending the UK & I PBT conference in 2017 (n = 25). Sixty-three questions were grouped into six themed sections which included current experience, staffing, implant numbers (last 3 years), LDR pre / post implant dosimetry and HDR technique. Descriptive analysis was performed. Results: 18 of 25 centres responded (11 LDR only, 6 HDR & LDR, 1 HDR only) with 13 and 3 centres having > 10yrs experience with LDR and HDR respectively. 13 centres have two or more oncologists and 15 centres have two or more medical physics experts (MPE). 61% of lead clinicians performed > 25 implants with 22% performing > 50 in the year 2016. In the preceding 3 years, 44% of centres reported the number of LDR monotherapy cases as stable while 44% noted a reduction in numbers. Similarly 40% of centres reported LDR boost cases as stable, 40% as reduced and 20% with increased cases. The number of centres using HDR treatment as boost, monotherapy and salvage therapy has increased, with increased cases in the year 2016 as compared to 2014. Comparison with the UK 2012 audit showed that post implant LDR dosimetry is more consistently performed and the majority of cases were achieving the 3 defined quality standards of D90, V100 and CT:USS volume ratio. Average post implant D90 was > 145Gy in 63% of centres in 2014 and 2015 compared to 70% in 2016. 50% of centres reported average D90’s of > 155Gy in all three years surveyed. Conclusions: This survey offers a review of PBT practice across UK and I with an apparent fall in LDR monotherapy and boost cases but increase in HDR numbers noted. Surveyed centres report dosimetrically good quality implants. Current research supports PBT as a definitive primary treatment which should be discussed with eligible men at diagnosis.
The FALCON trial: Impact of 18F-fluciclovine PET/CT on clinical management choices for men with biochemically recurrent prostate cancer.
Authors: Teoh Eugene Jueren , Bottomley David M. , Scarsbrook Andrew , Payne Heather , Afaq Asim , Bomanji Jamshed , Van As Nick , Chua Sue , Hoskin Peter , Chambers Anthony , Cook Gary J. , Warbey Victoria S. , Chau Albert , Ward Penelope , Miller Matthew P. , Stevens Daniel J. , Wilson Lynn , Gleeson Fergus V. 
Published: February 2018

165 Background: Detection of the extent of local recurrence and of metastases in biochemical recurrence (BCR) of prostate cancer facilitates selection of appropriate treatment. The FALCON trial (NCT02578940) assessed the impact of 18F-fluciclovine PET/CT on the clinical management of men with BCR of prostate cancer following initial radical therapy. Methods: Men being considered for curative-intent salvage therapy following first BCR were recruited at 6 UK sites. Management plans were documented prior to and following 18F-fluciclovine PET/CT imaging. Post-scan changes to treatment modality such as salvage radiotherapy [RT] to systemic therapy were classed as ‘major’, while changes within a modality (e.g. modified RT fields) were classed as ‘other’. A pre-planned interim analysis of the first 85 patients was conducted; recruitment was to be stopped for efficacy if the number of treatment changes was > 45 (52.9%; 97.5% CI: 40.3–62.3%), or for futility if ≤ 8 (9.4%, 97.5% CI: 3.6–18.9%). Results: The 85 enrolled patients were a mean 4.8 y post-initial diagnosis, with a median age of 67 y and median PSA of 0.63ng/mL. Twelve (14.1%) had a Gleason score ≤ 6, 60 (70.6%) had a score of 7 and 13 (15.3%) had a score ≥ 8. Most (56; 65.9%) had previously undergone radical prostatectomy (RP), with 27 having received RT (± other therapy). The majority of those imaged (52; 61.2%) had a change in management (CIM) post-scan (Table). Recruitment was subsequently stopped as the pre-specified condition defining overwhelming efficacy was met. Conclusions: This prospective trial shows 18F-fluciclovine PET/CT has substantial impact on clinical decisions for men with a first BCR of prostate cancer after curative-intent primary therapy. Clinical trial information: NCT02578940. [Table: see text]
Can free PSA be used as a biomarker in biochemical recurrence after surgery to predict castrate resistant prostate cancer?
Authors: Goldberg Hanan , Hoffman Ally , Woon Teck Sing , Klaassen Zachary William Abraham , Chandrasekar Thenappan , Cheung Douglas , Berlin Alejandro , Sayyid Rashid , Fleshner Neil Eric 
Published: February 2018

177 Background: PSA produced from prostate cancer (PC) cells escapes proteolytic processing, resulting in a more complexed PSA and a lower %fPSA. Higher %fpsa correlates with lower PC risk. However, the role of fPSA in biochemical recurrence (BCR) after radical prostatectomy (RP) is unknown. Methods: All patients who had BCR after RP and at least one fPSA test, were included. Patients were stratified according to the %fPSA cut-off of 0.15. Multivariable logistic regression analysis was performed to predict covariates associated with a higher %fPSA. Results: A total of 81 men with BCR were found (Table 1). Interestingly, 20% (group 1) vs. 60% (groups 2) become castrate resistant (CRPC), p<0.0001 and the time to reach CRPC state was much shorter in group 2 (33.5 months) vs. group 1 (57.9 months), p=0.05. Additionally, 60% of group 2 patients vs. 32.5% of group 1 patients developed metastasis, p=0.014. Lastly, median survival of 193 months for group 2 patients with no median survival for group 1, Log Rank test p=0.023. Multivariable logistic regression analysis demonstrated that secondary Gleason score of 5 (compared to 3) and %fPSA>0.15 predicted CRPC status (OR 11.63, CI 95% 1.38-97.4, p=0.024, OR 7.99, CI 95% 2-31.95, p=0.003, respectively). Conclusions: %fPSA>0.15 in the setting of BCR confers a more aggressive disease, manifesting in a faster development of CRPC, metastasis and death. Our findings suggest a reversal in the significance of % fPSA values in BCR patients, and should be validated in larger cohorts. [Table: see text]
Radium-223 retreatment in an international, open-label, phase 1/2 study in patients with castration-resistant prostate cancer and bone metastases: 2-year follow-up.
Authors: Sartor A. Oliver , Heinrich Daniel , Mariados Neil , Méndez-Vidal María José , Keizman Daniel , Thellenberg Karlsson Camilla , Peer Avivit , Procopio Giuseppe , Frank Stephen Jay , Pulkkanen Kalevi , Rosenbaum Eli , Severi Stefano , Trigo Perez Jose Manuel , Trandafir Lucia , Wagner Volker Jean , Li Rui , Nordquist Luke T. 
Published: February 2018

178 Background: Radium-223 (Ra-223) treatment (tx) is indicated for patients (pts) with castration-resistant prostate cancer (CRPC) and symptomatic bone metastases (mets) (6 × 55 kBq/kg IV injections [inj]; 1 inj q4wk). Early results of an international, open-label, phase 1/2 study (NCT01934790) showed that re-treating pts with Ra-223 was well tolerated with favorable effects on disease progression. Here we report safety and efficacy findings from a 2-year follow-up. Methods: Pts with CRPC and bone mets who completed 6 initial Ra-223 inj with no disease progression in bone and later progressed were eligible for Ra-223 re-tx (6 additional Ra-223 inj), provided that hematologic parameters were adequate. No concomitant cytotoxic agents were allowed; other concomitant agents (eg, abiraterone, enzalutamide) were allowed at investigator discretion. The primary objective was safety. Exploratory objectives were time to radiographic bone progression, radiographic progression-free survival (rPFS), overall survival (OS), time to first symptomatic skeletal event (SSE), and SSE-free survival, all calculated from re-tx start. Pts will be followed for safety up to 7 years after last Ra-223 dose; an active 2-year follow-up evaluated exploratory objectives. Safety results from the active follow-up period and updated efficacy are reported. Results: 44 pts were re-treated with Ra-223; 29 (66%) completed all 6 inj (median number inj = 6). 34 (77%) of 44 pts entered active follow-up, during which no new safety concerns were noted. One new primary malignancy was reported (basal cell carcinoma). There were no serious drug-related adverse events. 19 (43%) of 44 pts had an rPFS event (radiographic progression or death); median rPFS was 9.9 months. Only 5 (11%) of 44 pts had radiographic bone progression; median time to radiographic bone progression was not reached. Median OS was 24.4 months. Median time to first SSE and SSE-free survival were 16.7 and 12.8 months, respectively. Conclusions: Re-treating with Ra-223 was well tolerated in this select pt population, led to minimal hematologic toxicity, and provided continued disease control in bone at 2-year follow-up. Clinical trial information: NCT01934790.
Independent validation of missense polymorphism in HSD3B1 in Japanese men treated with primary androgen-deprivation therapy for metastatic prostate cancer.
Authors: Shiota Masaki , Fujimoto Naohiro , Imada Kenjiro , Kashiwagi Eiji , Takeuchi Ario , Inokuchi Junichi , Tatsugami Katsunori , Kajioka Shunichi , Uchiumi Takeshi , Eto Masatoshi 
Published: February 2018

179 Background: Recently, genetic polymorphism in HSD3B1 has been shown to be associated with oncological outcome when treated with androgen-deprivation therapy (ADT) for prostate cancer. However, its impact on prognosis among different ethnicities remains unclear. Then, we aimed to investigate the significance of missense polymorphism in HSD3B1 gene encoding 3β-hydroxysteroid dehydrogenase among men treated with primary ADT for metastatic prostate cancer. Methods: This study included 104 Japanese patients with metastatic prostate cancer treated with primary ADT. The association of HSD3B1 (rs1047303, 1245C) with clinicopathological parameters and prognosis, including progression-free survival and overall survival, was examined. Results: Clinicopathological parameters were comparable between men with homozygous wild-type and men with heterozygous and homozygous variant types in HSD3B1 gene. Men carrying heterozygous and homozygous variant types in HSD3B1 gene showed higher progression risk [hazard ratio (95% confidence interval), 2.34 (1.08–4.49), P = 0.033], but not any-caused death risk [hazard ratio (95% confidence interval), 1.36 (0.52–2.92), P = 0.50], compared with men carrying homozygous wild-type. Conclusions: This study confirmed the finding that HSD3B1 genetic variation is associated with high risk of progression in Japanese men treated with primary ADT for metastatic prostate cancer, suggesting universal significance among different ethnicities.
Luminal and basal subtyping of metastatic castration-resistant prostate cancer (mCRPC) and its clinical implications.
Authors: Kim Won , Small Eric Jay , Aggarwal Rahul Raj , Den Robert Benjamin , Lehrer Jonathan , Zhang Li , Youngren Jack , Goldstein Theodore C , Alumkal Joshi J. , Gleave Martin , Rettig Matthew , Evans Christopher P. , Beer Tomasz M. , Reiter Robert Evan , Huang Jiaoti , Thomas George V. , Davicioni Elai , Ryan Charles J. , Spratt Daniel Eidelberg , Feng Felix Y 
Published: February 2018

197 Background: The PAM50 gene expression classifier (PAM50) identifies luminal and basal subtypes and predicts response to androgen deprivation therapy in localized prostate cancer. The clinical utility of using PAM50 to molecularly subtype mCRPC was evaluated. Methods: PAM50 was applied to RNA expression data from 86 metastatic tumor biopsies from the SU2C-AACR-PCF West Coast Prostate Cancer Dream Team (WCDT; NCT02432001). Overall survival (OS) differences between luminal A (LuA), luminal B (LuB), or basal patients (pts) were determined using Kaplan-Meier analyses. PAM50 was also applied to 15,136 prospectively collected radical prostatectomy (RP) samples from the Decipher GRiD database (NCT02609269). Drug response signatures (DRS) for 89 drugs were derived using publicly available data from the NCI60 cell line panel, and applied to gene expression data from the RP samples to predict patient-specific drug sensitivities. Differences in DRS as a function of PAM50 subtype were assessed using the Pearson’s chi-squared test. Results: The application of PAM50 to mCRPC transcriptional data segregated pts into LuA, LuB, and basal populations (43%, 14%, and 43%, respectively). The median OS for LuA, LuB, and basal pts was 20.6 months, 9.5 months, and 10.4 months, respectively (p=0.04), which was consistent with localized prostate cancer where LuB pts have the worst prognosis. DRS analyses revealed statistically significant differences in drug sensitivities, with LuA and LuB pts predicted to be markedly more sensitive to docetaxel than basal pts (p<0.00001), and basal pts predicted to be markedly more sensitive to platinums and etoposide than LuA and LuB pts (p<0.00001). Conclusions: PAM50 subtyping is prognostic in mCRPC, with LuA pts demonstrating the longest OS. Luminal and basal subtypes have distinct in silico drug response profiles that may be associated with response to mCRPC therapies. Prospective testing of DRS as a biomarker to guide treatment in mCRPC is warranted. Clinical trial information: NCT02432001, NCT02609269.
Genomic variations associated with prostate cancer in large cohort of African American men.
Authors: Walter Rayford , Jordan Jennifer , Takhar Mandeep , Alshalalfa Mohammed , Dai Darlene , Erho Nicholas , Greenberger Mark , Bradley Randy , Davicioni Elai 
Published: February 2018

20 Background: Racial disparities in prostate cancer (PCa) incidence and mortality are well known. PCa is known to be more aggressive in African American men (AAM) in terms of higher incidence and mortality rates. Here we validate a tumor gene expression pan-cancer race model in men with PCa and further characterize genomic differences that may contribute to disparate clinical outcomes Methods: We obtained de-identified genome-wide expression profiles from clinical use of the Decipher RP test in 9,953 men from the GRID registry database. A subset of men (n = 313) had known race status. A pan-cancer race model, developed to predict patient AAM race from analysis of gene expression patterns in 4,162 tumors from retrospective cohorts with known race status was applied to the prospective cohort for race prediction. Gene expression data was used to define genomic differences. Results: The race model has an AUC of 0.98 discriminating EAM from AAM in independent PCa cohort. The model was then applied to the 9,640 GRID patients with unknown race status and classified 6,831 as EAM, 1,058 as AAM with 1,751 as having indeterminate race. Characterizing the molecular subtypes, we found known and predicted AAM to be enriched with SPINK1+ tumors (21% and 24%, respectively) compared to predicted EAM (8%). In contrast, while ERG+ was found 22% and 19% in known and predicted AAM, respectively compared to 46% in predicted EAM. Based on PAM50 prostate cancer classifier, 61% of AAM were classified as basal-like tumors, whereas 41% were basal-like in EAM. Similarly, 28% of AAM had low AR-A while only 11% of EAM had low AR-A. AAM tumors had higher levels of immune infiltration signatures as well as higher scores for inflammatory and interferon gamma responses, and Interleukin 6 (IL6) signaling activity scores. AAM had lower DNA repair and glycolysis pathway activity compared to EAM Conclusions: Known and predicted AAM, were enriched with SPINK1+ tumors, higher immune infiltration and activation but lower ERG+, DNA repair and AR activity tumors. Using such large GRID data with known race, we will further understand the underlying causes associated with prostate cancer racial disparities which could lead to personalized diagnosis and treatment.
Medical resource utilization (MRU) of abiraterone acetate plus prednisone (AAP) added to androgen deprivation therapy (ADT) in metastatic castration-naive prostate cancer: Results from LATITUDE.
Authors: Li Tracy , Franco-Villalobos Conrado , Proskorovsky Irina , Sorensen Sonja V , Tran Namphuong , Sulur Giri , Chi Kim N. 
Published: February 2018

201 Background: AAP + ADT demonstrated significant improvements in overall survival and disease progression in the LATITUDE trial. The objective of this analysis was to assess event-driven MRU from AAP + ADT vs ADT alone. Methods: MRU data from the LATITUDE trial were obtained and consisted of medical utilization other than that mandated by protocol while patients were on treatment. MRU types included overnight hospitalizations and length of stay (LOS), emergency room (ER) visits, radiotherapy, surgery, imaging, and specialist and general practitioner (GP) visits. Rates by treatment (per 100 person-years) and rate ratios were estimated using zero-inflated Poisson regression. Difference in average LOS between treatment arms was assessed using repeated measures regression. Results: A total of 1199 patients were evaluated. Statistically significantly lower rates (24% reduction) of hospitalizations were observed with AAP + ADT compared with ADT alone (Table). The most common hospitalization reasons were bladder/urethral symptoms and infections, lung infections, and musculoskeletal/connective tissue pain. Average LOS per hospitalization episode was similar. Statistically significantly lower rates of imaging (40% reduction) and radiotherapy were also observed for AAP + ADT vs ADT alone. Rates for specialist visits, surgery ER visits, and GP visits were not statistically different. Conclusions: Adding AAP to ADT does not increase MRU and leads to lower rates of hospitalization, imaging, and radiotherapy. This likely reflects the more favorable clinical outcomes with AAP + ADT therapy. Clinical trial information: NCT01715285. [Table: see text]