bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utilization of pelvic lymph node dissection for low-risk prostate cancer.
Authors: Modi Parth K. , Bock Megan , Kim Sinae , Singer Eric A. , Parikh Rahul 
Published: March 2017

86 Background: National guidelines suggest against pelvic lymph node dissection (PLND) for patients with low-risk prostate cancer (PCa). However, the actuarial rate of PLND in this population is unknown. This study aimed to characterize the use of PLND in contemporary cohort of men with low-risk PCa undergoing robotic assisted radical prostatectomy (RARP). Methods: The National Cancer Database was queried for PCa patients who underwent RARP from 2010 to 2013. Patients who underwent PLND were identified and patient clinicodemographic and hospital characteristics were abstracted. The primary outcome measure was receipt of PLND. Secondary outcome measures included number of lymph nodes evaluated and number of lymph nodes positive for cancer. Unadjusted and multivariate regression analyses were conducted to identify predictors of receipt of PLND. Analysis of clustered data was employed to account for hospital-level correlation in utilization. Results: Of 51,971 patients with low-risk PCa who underwent RARP, 19,059 (36.7%) received PLND. Lymph node positivity was identified in 0.4% of low-risk patients and 4.6% of intermediate/high risk patients. Predictors of PLND in low-risk patients included rural residence (OR 1.157), treatment at academic institutions (OR 1.492) or high-volume (OR 1.327) facilities. Mean number of lymph nodes obtained in low-risk patients was lower than in intermediate- or high-risk patients (4.74 vs 5.86, P < 0.0001). In multivariate analysis, black race was associated with significantly fewer lymph nodes retrieved. Intermediate or high risk PCa; rural residence; and treatment at an academic, high-volume, or West region facility were independently associated with a higher yield of retrieved lymph nodes. Conclusions: PLND is performed for greater than one-third of low-risk PCa patients undergoing RARP in this large hospital-based data set. Our study demonstrated a low likelihood (0.4%) of detecting nodal metastasis in this population, thus validating the national recommendations against PLND. Rural residence and treatment at high-volume and academic centers are associated with receipt of PLND. Reasons for the variation in practice patterns should be investigated to improve the quality of PCa care.
Prospectively collected baseline erectile function (EF) in 1,173 consecutive newly diagnosed prostate cancer patients referred for radiotherapy.
Authors: Nicholson Jill , Kelly Paul J. 
Published: March 2017

89 Background: Preservation of EF is a goal of care for many men with newly diagnosed prostate cancer. In order to accurately counsel patients regarding their likely treatment outcome, an assessment of baseline EF, and screening for known risk factors, should form part of the assessment of all prostate cancer patients. Methods: We performed a retrospective review of prospectively-collected data regarding baseline EF in men with prostate cancer referred for a radiotherapy opinion. 1173 consecutive patients referred over a 5.5 year period from 2011-16 were included. All patients were offered the opportunity to complete the International Index of Erectile Function (IIEF-5) questionnaire in privacy. Information on known risk factors such as age, vascular comorbidity, smoking and alcohol history, and cardiovascular risk factors was recorded. Results: Of the 1173 patients, 233 were excluded due to metastatic disease at referral. Of the remaining 940 with localised disease, 812 (86%) completed the questionnaire. 561 (69%) successfully filled the questionnaire yielding a score. A further 251 (31%) commented on the questionnaire without completing the score (see table). Median age was 66years (IQR 62-71). 574(61%) had known risk factors for erectile dysfunction such as hypertension or diabetes. 173 (18.5%) had a history of peripheral, cardiovascular, or cerebrovascular disease. Smoking and alcohol history was available for 645 patients, 353(60%) had a smoking history, and 450(70%) had a history of alcohol use. Conclusions: In this population, there is a high prevalence of baseline erectile dysfunction (IIEF-5 ≤16), 242/561 (43%). Additionally, significant numbers of patients were sexually inactive or unconcerned regarding ED. Known risk factors for erectile dysfunction were common in this population, many of which are modifiable. [Table: see text]
Population based PSA screening in Mexico City.
Authors: Herrera-Caceres Jaime Omar , Gonzalez-Cuenca Eduardo , Manzanera Andrea G. , Aguilar Laura K. , Aguilar-Cordova Estuardo , Castillejos-Molina Ricardo Alonso , Feria Bernal Guillermo 
Published: March 2017

92 Background: Since the U.S. Preventive Task Force recommended against PSA screening in 2012, the polemic between the benefit of early detection and the risk of early overtreatment, has been heightened. Furthermore, in countries where diagnosis is delayed even in symptomatic men and resources are limited for treating advanced disease, the impact of limiting PSA screening may be greater resulting in a shorter incidence/mortality ratio. In Mexico PSA screening is not widely used and many men are never diagnosed with PCa. Thus, the true incidence of PCa is unknown and yet it is the number one cause of cancer morbidity and mortality in men. The current study was designed to evaluate the incidence of PCa in a random population of men from Mexico City using PSA screening. Methods: Prospective enrollment of 3,837 men > 50 years old without previous history of PCa underwent PSA testing. Men with a PSA > 4ng/ml were selected for a second analysis and for completion of a questionnaire on prostate health history. Men with confirmed elevated PSA are being invited to further evaluation and possible biopsy by a urologist. Results: Median age was 59 years (interquartile range 56 to 63 years). In this cohort, 412 (10.8%) men had a total PSA > 4ng/ml (5% of those < 55 years vs. 26% of those > 70 years). From these men, 284 had a repeat PSA approximately 3 months after the first evaluation (median 98 days). A total of 229 men had a 2nd PSA above 4mg/ml, 25 had PSA > 20ng/ml. During evaluations, 309 men completed the questionnaire showing that 29% had previous PSA testing, 11% had a previous DRE, 4% had history of a previous biopsy and 2% identified having a family history of PCa. Conclusions: Greater than 10% (n = 412/3837) of men from a random screen in Mexico City were found to have elevated PSA ( > 4ng/ml). Of these, 12% (n = 48) and 6% (n = 25) had levels consistent with intermediate- and high-risk disease, respectively. Most of these ”high-PSA” patients did not have a previous PSA evaluation despite symptoms, representing a considerable number of patients in whom screening could be life-saving intervention. A low awareness of family history of PCa could be representative of both the lack of diagnosis of PCa and general ignorance regarding this disease. We continue evaluating and doing biopsies to patients with indication.
Pre-treatment PSA- progression as a negative prognostic factor in patients using 5-alpha-reductase inhibitors prior to radiotherapy for prostate cancer.
Authors: Taussky Daniel , Piotte Julie , Zorn Kevin , Zanaty Marc , Krishnan Vimal , Bahary Jean-Paul , Beauchemin Marie-Claude , Barkati Maroie , Menard Cynthia , Delouya Guila , Lambert Carole 
Published: March 2017

96 Background: To investigate the impact of 5-alpha-reductase inhibitors (5-ARIs) usage on radiotherapy outcomes for localized prostate cancer. Methods: From our institutional database of over 2500 patients, we identified 203 patients on a 5-ARI. They were all treated with either external beam radiotherapy (EBRT) or brachytherapy for localized prostate cancer. Patients receiving a 5-ARI were analyzed according to the following prostate cancer progression criteria: a) progression of Gleason score or increase in cancer volume on the biopsy, b) first biopsy positive for cancer after being treated for urinary symptoms with a 5-ARI, and c) prostate-specific antigen (PSA) progression with or without a previous cancer diagnosis. Biochemical failure (BF) was defined by the Phoenix definition. Log-rank test was used for survival analysis. Results: At a median follow-up of 36 months (interquartile range [IQR] 22-52 months), 10 (4.9%) patients experienced BF. 52% of men demonstrated none of the progression criteria, 37% showed only one prostate cancer progression criteria and 11% showed two. Using a univariate analysis, PSA progression (p = 0.004) and appearance of a positive biopsy (p < 0.001) but not Gleason progression (p = 0.3) were a significant predictive factor of BF. With separate multivariate analysis adjusted for the CAPRA score (HR 1.7, 95% CI 1.2-2.3, p = 0.003), a rising PSA (HR 5.7, 95% CI 1.1-28.8, p = 0.04) and the number of cancer progression factors (HR 2.9, 95%CI 1.2-7.0, p = 0.02) remained adverse risk factors. Both Gleason score progression (p = 0.4) and first biopsy positive for cancer (p = 0.13) failed to remain significant. Age and obesity were not significant factors in univariate or multivariate analysis. Conclusions: A PSA progression experienced while under 5-ARI treatment before EBRT or brachytherapy is predictive of worse biochemical outcome. Such details should be considered when counseling men prior to radiation therapy.
CANCAP02: A study into the pharmacodynamic biomarker effects of vistusertib (AZD2014), an mTORC1/2 inhibitor, given prior to radical prostatectomy (RP).
Authors: Pacey Simon , Garcia Corbacho Javier , Shah Nimish , Bratt Ola , Warren Anne , Baird Richard D. , Gnanapragasam Vincent , Stearn Sara , Ingle Susan , Bell Leanne K , Dott William , Qian Wendi , Zhao Wanfeng , Davies Barry , Harrington Elizabeth A. , Oelmann Elisabeth Maria , Hategan Mirela , Kumar Sanjeev 
Published: March 2017

97 Background: Additional systemic therapy given to unselected patients (pts) around RP has yet to improved pt survival. Further trials should use appropriate pt selection, i.e. men at highest risk of relapse, ideally biomarker stratified. Using novel drugs prior to RP allows direct study of effects in primary prostate cancer (PC) that may guide design of future trials. Altered PI3K/AKT/mTOR pathway signalling is associated with aggressive PC hence we have undertaken a study vistusertib, an oral, dual mTORC1/mTORC2 inhibitor prior to RP. Methods: Primary endpoint was to measure mTOR1/2 inhibition by immunohistochemistry (IHC). Secondary endpoints were feasibility, safety, tolerability and determining plasma concentrations of vistusertib. Exploratory objectives included measurement of anti-cancer effects. Men, due for RP, with high volume or aggressive PC consented and received vistusertib, 50mg bd, for 15 days prior to RP. Diagnostic biopsy and RP tissue were collected for IHC. Adverse events (AE) were graded according to CTCAE v4. Plasma was collected to determine vistusertib concentrations. Results: 21 men, median age 62 (range 50 – 69) included 11 intermediate and 10 high risk PC. 18/21 were evaluable for primary endpoint. On day of RP mean plasma vistusertib concentration at RP was 648 ng/mL (range 386-852) and 6-8 hr post dose 484 ng/mL (range 211-660). Majority of related AEs were Grade (Gr) 1, the most common being rash, thrombocytopenia, oral mucositis, diarrhoea, lymphopenia and fatigue. Six pts experienced Gr3 AEs (3 pt lymphopenia, 1 pt each rash, mucositis and ALT rise). Two pts discontinued due to AEs (mucositis, thrombocytopenia) and one withdrew consent. Surgery was delayed in one pt (Gr 1 thrombocytopenia). IHC confirmed at RP: 4EBP1 was reduced in 100% pt (75% no staining post vistusertib) and pS6 was reduced in 67%, not changed in 25% and increased in 8%. A fall in PSA occurred in 4/18 pts. Conclusions: 2 weeks of AZD2014 can be given prior to RP. Active plasma concentrations were achieved. mTOR pathway inhibition was confirmed on IHC and a PSA fall occurred in 22% of pt. Analysis is ongoing, to be informed by concomitant studies in a PTEN null PC model. Clinical trial information: NCT02064608.
Focal therapy for prostate cancer: Attitude and practice patterns.
Authors: Jain Amit L , Sidana Abhinav , Maruf Mahir , Sugano Dordaneh , Calio Brian P. , Wood Bradford J. , Pinto Peter A. 
Published: March 2017

e541 Background: Focal therapy (FT) for localized prostate cancer (PCa) has been shown to have encouraging short term oncological outcomes, excellent preservation of functional outcomes and is increasing in popularity in Urologic community. We aim to evaluate the preferences and practice trends among urologists regarding this upcoming treatment strategy. Methods: An anonymous online questionnaire was designed to collect information on urologists’ views and use of focal therapy. The survey was sent to members of the Endourological Society (ES) and American Urological Association (AUA). Multivariate logistic regression analysis was done to determine predictors for utilization of FT for localized prostate cancer. Results: A total of 383 responses were received [AUA: 342, ES: 41]. Mean age of respondents was 43(±11.2) years. Although about half of the respondents (51.4%) believed FT to be moderate to extremely beneficial in the treatment of PCa, only 23% (89) of the respondents currently utilize FT in their practice. While the most common setting for utilization of FT was in patients with unilateral intermediate risk (75.2%) PCa, a small percentage of respondents also used FT for patients with bilateral intermediate risk and unilateral high risk PCa (9% and 7% respectively). The most common FT modality was Cryoablation in 62% followed by High Intensity Focused Ultrasound in 44%. Most common reasons for not using focal therapy were the lack of belief in ‘index lesion theory’ (186) (63.2%) followed by the lack of experience (121) (41.1%). About 58.2% respondents would use FT often in an office or outpatient setting if they had access to reliable and cost effective options. Surgeon’s experience (practice for more than 15 years) (p = 0.035) was the only independent predictor for utilizing FT in localized PCa. Conclusions: Only a quarter of our respondents utilize FT in their practice with surgeon’s experience being the only independent predictor for utilizing FT. Majority of respondents though consider FT to be beneficial in prostate cancer management would use it more often if they provided more reliable and cost effective options. Over time experience and accessibility to reliable methods to perform FT may lead to further use of this novel treatment.
Efficacy of a neoadjuvant gonadotropin-releasing hormone antagonist plus low-dose estramustine phosphate in high-risk prostate cancer: A single-center study.
Authors: Hagiwara Kazuhisa , Koie Takuya , Tobisawa Yuki , Yamamoto Hayato , Imai Atsushi , Yoneyama Tohru , Hatakeyama Shingo , Yoneyama Takahiro , Hashimoto Yasuhiro , Ohyama Chikara 
Published: March 2017

e542 Background: The optimal treatment for high-risk prostate cancer (Pca) remains to be established. We previously reported favorable biochemical recurrence-free survival (BRFS) for high-risk Pca patients treated with neoadjuvant therapy comprising a luteinizing hormone-releasing hormone agonist plus low-dose estramustine (LHRH agonist + EMP) prior to radical prostatectomy (RP). In the present study, we evaluated the efficacy of neoadjuvant therapy comprising a gonadotropin-releasing hormone antagonist plus low-dose estramustine phosphate (GnRH antagonist + EMP) in patients with high-risk Pca. Methods: Between September 2005 and March 2016, we identified 406 high-risk Pca patients of whom 136 received neoadjuvant GnRH antagonist + EMP and 270 received LHRH agonist + EMP before RP. We retrospectively evaluated the clinical and pathological covariates between the two groups. The primary endpoint was the rate of pathological ≤ T2 status, and the secondary endpoint was BRFS. Results: The rates of pathological ≤ T2 status were 80.2% and 61.5% in the GnRH antagonist + EMP and LHRH agonist + EMP groups, respectively ( P < 0.001). The 3-year BRFS rates were 97.8% and 85.2% in the GnRH antagonist + EMP and LHRH agonist + EMP groups, respectively ( P = 0.021). Multivariate analysis revealed that biopsy Gleason score, GnRH antagonist + EMP, and clinical T stage were independent predictors of pathological ≤ T2 status in surgical specimens. Conclusions: Our findings suggest that neoadjuvant GnRH antagonist + EMP followed by RP may improve the pathological outcomes and reduce the risk of biochemical recurrence in patients with high-risk Pca. Further prospective studies to confirm these findings are warranted.
The impact of extended lymph node dissection versus neoadjuvant therapy with limited lymph node dissection on biochemical recurrence in high-risk prostate cancer patients treated with radical prostatectomy: A multi-institutional analysis.
Authors: Koie Takuya , Ookubo Teppei , Mitsuzuka Koji , Narita Shintaro , Inoue Takamitsu , Kawamura Sadafumi , Tochigi Tatsuo , Habuchi Tomonori , Arai Yoichi , Ohyama Chikara , Yoneyama Takahiro 
Published: March 2017

e543 Background: The optimal treatment for high-risk prostate cancer (Pca) remains to be established. We previously reported favorable biochemical recurrence-free survival (BRFS) in high-risk Pca patients treated with neoadjuvant therapy comprising a luteinizing-hormone-releasing hormone (LHRH) agonist plus low-dose estramustine phosphate (EMP) (LHRH+EMP) followed by radical prostatectomy (RP). The aim of this study was to assess whether neoadjuvant LHRH+EMP confers an oncological benefit for high-risk Pca compared to extended lymph node dissection (e-PLND). Methods: The Michinoku Urological Cancer Study Group database contained the data of 2403 consecutive Pca patients treated with RP at 4 institutes between March 2000 and December 2014. In the e-PLND group, we identified 238 high-risk Pca patients who underwent RP and e-PLND, with lymphatic tissue removal around the obturator and the external iliac regions, and hypogastric lymph node dissection. The neoadjuvant therapy with limited PLND (l-PLND) group included 280 high-risk Pca patients who underwent RP and removal of the obturator node chain between September 2005 and June 2014 at Hirosaki University. The neoadjuvant LHRH+EMP therapy included the administration of 280 mg/day of LHRH and EMP for 6 months before RP. The outcome measure was BRFS. Results: The 5-year BRFS rates for the neoadjuvant therapy with l-PLND group and e-PLND group were 84.9% and 54.7%, respectively ( P < 0.0001). The operative time was significantly longer in the e-PLND group compared to that of the neoadjuvant therapy with l-PLND group. Grade 3/4 surgery-related complications were not identified in both groups. Conclusions: Although the present study was not randomized, neoadjuvant LHRH+EMP therapy followed by RP might reduce the risk of biochemical recurrence.
Can frequency of prostate biopsy on active surveillance be reduced without significantly increasing risk?
Authors: Auffenberg Gregory , Barnett Christine , Cheng Zian , Yang Fan , Wang Jiachen , Miller David Christopher , Montie James E. , Mamawala Mufaddal , Denton Brian 
Published: March 2017

e546 Background: The goal of this investigation is to use longitudinal Active Surveillance (AS) data to identify whether biopsies could be eliminated from a 10-year AS plan calling for annual biopsy without substantially prolonging the time to detection of prostate cancer (CaP) grade progression. Methods: With data from 1,500 men with very-low or low-risk CaP enrolled in AS at Johns Hopkins, we developed a hidden Markov model to estimate probabilities of progression to Gleason 7 or higher. We then simulated all potential AS biopsy strategies where it was assumed biopsy would be performed no more often than annually and either would or would not be performed each year after diagnosis. For every strategy the model was used to predict the average time from occurrence to the detection of grade progression. Potential alternatives to annual biopsy were identified. Results: The estimated 10 year probability of grade progression was 40.0% and the annual probability was 4.0%. Simulation of an annual biopsy strategy estimated that for men who experience grade progression the mean time from occurrence to detection would be 14.1 months. Alternative strategies that reduced the number of biopsies received over 10 years increased the time to detecting grade progression; however several strategies eliminated biopsies with only small increases in the time to detecting grade progression (Table). For instance, a strategy calling for 6 biopsies over 10 years (biopsies in years 1-3,5,7, and 8) would only increase the average time to detecting grade progression by 4.6 months while eliminating 4 biopsies. Conclusions: While annual biopsy was associated with the shortest interval to detecting grade progression, several alternative strategies may allow for less frequent biopsy without sizable increases in time to detecting grade progression. [Table: see text]
Comparison of conventionally fractionated and hypofractionated schedule for post-prostatectomy salvage radiotherapy: Early results from non-randomized observational study.
Authors: Murgic Jure , Jaksic Blanka , Kruljac Ivan , Prpic Marin , Budanec Mirjana , Mrcela Iva , Gregov Marin , Prgomet Angela , Kust Davor , Mlinaric Mihaela , Spajic Borislav , Frobe Ana 
Published: March 2017

e551 Background: Data on hypofractionated radiotherapy in definitive treatment of prostate cancer are maturing; however, limited information is available for hypofractionated radiotherapy after prostatectomy. We aimed to compare hypofractionated and conventionally fractionated radiotherapy in salvage setting for biochemically recurrent prostate cancer. Methods: A retrospective analysis was performed in 106 patients with proven PSA recurrence treated to the prostate bed. Patients were non-randomly, in a alternating fashion, subjected to either 52.5 Gy in 20 fractions of 2.625 Gy over 4 weeks (N = 57, hypofractionated group) or 66 Gy in 33 fractions of 2 Gy over 6.5 weeks (N = 49, conventionally fractionated group). There was no statistically significant difference in pathologic T-stage and Gleason score distribution between the groups. In the conventionally fractionated group there were more patients with positive margins (p = 0.01), more prevalent concomitant hormonal therapy (50.9% vs 61.2%, p = 0.001), but less long-term hormonal therapy (21.4% vs 81%, p < 0.001), compared to hypofractionated group. Median follow-up was 20 months (range 6-36 months). Failure (PSA nadir+0.2) rates between the groups were compared using Cox proportional hazards model. Radiation-related side-effects were assessed using RTOG scoring scale. Results: At this early point, 13 patients (22.8%), and 6 patients (12.2%) experienced treatment failure in the hypofractionated group and conventionally fractionated group, respectively (HR 3.1, 95%CI (1.5-6.3)). More late grade 2 gastrointestinal and genitourinary side-effects were observed in conventionally fractionated group (4.1% vs 1.8%, and 2% vs 0%, p = 0.01, respectively). No grade 3 toxicities were observed. Conclusions: More initial biochemical failures were observed in hypofractionated group compared to conventionally fractionated group. However, baseline heterogeneity between the groups and short follow-up preclude any causal observation of differential efficacy between these two schedules. Randomized phase II trial is planned to prospectively compare these two regimens.