bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prostate biopsies using both gray scale and 3D color flow power doppler ultrasound (3DCFPDU).
Authors: Dattoli Michael J. , Sorace Richard A , Bravo Stephen M , Bostwick David G. 
Published: February 2017

103 Background: Historically, prostate cancer (CAP) is identified through random biopsies. Experts usually recommend 10-12 core transrectal ultrasound guided biopsies (TRUS). This often leads to sampling errors with missed diagnosis, delayed and repeated biopsies, understaging and finding indolent CAP leading to over treatment. Advances in 3DCFPD imaging suggest that selective biopsies may be superior to standard TRUS biopsies. Methods: 192 consecutive patients were biopsied (Feb. 2012 – July 2014) in the dorso-lithotomy position with local anesthesia. Median number of biopsies per patient = 8; total number of cores = 1,520. Only 3 patients had not been previously biopsied (median previous biopsies = 2). We studied tumor detection rate using combined gray scale and 3DCFPD with direct sampling of specific regions using the transperineal brachytherapy template guided method as a simple outpatient procedure. Inclusion criteria were abnormal DRE, PSA kinetics 0.75ng/mg/yr, PSA >10 and % free PSA <17. PSA density 0.27. Cores were stratified into 4 risk groups: 1) hypoechoic lesion (72 patients, 648 cores); 2) hypervascular lesion (26 patients, 182 cores); 3) hypoechogenic with hypervascular pulsatile vessels synchronous and coinciding with normal cardiac pulse (32 patients, 256 cores); and 4) hypoechogenic with hypervascular non-pulsatile vessels suggesting independent vascular flow consistent with neoplasm (62 patients, 434 cores). Isoechoic regions were not biopsied. Subgroups were analyzed using chi-square, student t-test, and logistic regression. Results: The diagnostic yield associated with Group 4 was statistically significantly higher compared to: 1.) 20% biopsy positive (p <0.5); 2.) 19% biopsy positive (p <0.3); 3.) 55% biopsy positive (p <0.1); 4.) 97% biopsy positive (p <0.1). Only Group 4 revealed a greater number of Gleason 7-10 CAP (p <0.1). Conclusions: Transperineal template guided biopsies with gray scale and 3DCFPD are highly effective and cost effective. This may lead to reducing the number of prostate biopsies performed, better staging and allowing for enhanced detection of serious CAP by targeting the most suspicious lesions. Additional research should study the diagnostic gain with 3DCFPD.
Is the apical margin real? An analysis of postprostatectomy PSA failure by site of involved margin.
Authors: Watkins John Morgan , Laszewski Michael , Rodacker Mark , Watkins Patricia L. , Russo James Kyle 
Published: February 2017

105 Background: Though an involved margin at prostatectomy has been associated with elevated rates of PSA relapse, there has been an absence of consensus regarding the risk of relapse specific to the site(s) of margin involvement. Specifically, the apical margin has been sometimes considered "lower risk," based upon historical series. The present study seeks to determine the rate of PSA relapse in patients who had undergone prostatectomy with involved surgical margin, without immediate post-operative (adjuvant) therapy, with comparison of relapse rates by site of involved margin. Methods: A retrospective database review was performed, including patients with clinically localized prostate cancer and pre-operative PSA <30, who had undergone prostatectomy, with site(s) of involved margin characterized. Slides were re-reviewed by a pathologist for verification of site of margin involvement. Patients were excluded if seminal vesicle invasion or lymph node involvement was noted in the surgical specimen, if any adjuvant therapy was delivered prior to relapse, or if post-operative follow-up with PSA was <12 months. Relapse was defined as >0.2 and rising after prostatectomy. Log-rank analysis was employed for comparison of disease control between groups; the Kaplan-Meier method was employed to construct survival curves and estimate 5-year disease control. Results: Between 2002 and 2010, 155 patients were identified for inclusion in the present analysis. Of these, 105, 37, and 7 patients had 1, 2, and >2 sites of margin involvement, respectively. The apex was the sole site of margin involvement for 70 patients. At a median follow-up of 68 months (range 22-145), 62 patients (40%) had experienced PSA relapse. There was no statistically significant difference in risk of PSA relapse by site of margin involvement or number of foci of margin involvement. The 5-year estimates for PSA relapse for margin involvement of the apex only, other site only, or both were 40.5%, 33%, and 49.1%, respectively. Conclusions: Involvement of the apical margin is associated with a high rate of early PSA relapse, similar to rates noted when other site(s) of margin involvement are noted.
Reducing decisional conflict in men making treatment decisions on newly diagnosed localized prostate cancer.
Authors: Johnson David C. , Wallen Eric , Smith Angela , Woods Michael , Pruthi Raj , Mueller Dana , Nielsen Matthew Edward 
Published: February 2017

106 Background: Men with newly diagnosed localized prostate cancer (LPC) face a complex, preference-sensitive treatment decision. Low “decisional conflict” (DC), defined as uncertainty over treatment choice, is a key component of decision quality. Lower scores on the Decisional Conflict Scale (DCS) are associated with lower likelihood of delaying a decision and assessing blame to a physician for bad outcomes. We hypothesized that using a novel software application to measure and report patients’ preferences for LPC treatment outcomes as part of a pre-consultation intervention would improve decisional quality in men with LPC by reducing DC. Methods: Men with newly diagnosed LPC completed the online WiserCare (WiserCare, Inc) prostate cancer module prior to their initial consultation at the University of North Carolina, Chapel Hill Multi-disciplinary Urologic Oncology Clinic. WiserCare is a software application that provides education, preference assessment, and personalized decision analysis for patients. Preferences are measured using conjoint analysis. WiserCare then generates an individualized report ranking treatment options based on their “fit”(expected value) based on clinical prognostic factors and personal preferences. This report is used with their physician during counseling. We measured DCS scores before and after completion of the WiserCare module. Paired 2-tailed T-tests were to evaluate the changes in DCS scores. Results: 48 men completed the WiserCare module and DCS prior to their initial consultation for newly diagnosed LPC. Overall DCS score decreased by 38% (p<0.00001) after completion of the WiserCare module. Analysis of DCS subscales revealed improvements in all five, including feeling informed by 56% (p<0.00001), value clarity by 49% (p=0.001), feeling effective in decision making by 36% (p=0.0001), feeling supported by 31% (p=0.0037), and reduced uncertainty by 24% (p=0.0023). Conclusions: A pre-consultation web-based module integrating evidence-based information, individualized clinical data and personal preference data is a feasible and effective strategy to reduce decisional conflict in men making treatment choices for localized prostate cancer.
Outcome of hypofractionated biological optimized dose-painting radiotherapy for high-risk prostate cancer.
Authors: Syndikus Isabel , Onjukka Eva , Uzan Julien , Nahum Alan 
Published: February 2017

107 Background: Prostate dose-painting radiotherapy and hypo-fractionation both can improve biochemical contol in localised disease. We report toxicity and outcome for a cohort of high risk patients. Methods: We selected 28 patients with high-risk localised prostate cancer and 2 or 3 risk factors. Functional MRI’s were used to define boost volumes with a margin of 5 mm PTV. Neo-adjuvant hormone therapy was given for 3 months. Dose volume constraints, TCP and NTCP parameters were used for optimization of rotational IMRT treatment plans. We used fiducial markers, bowel and bladder preparation and daily IGRT. Results: Mean age was 66 years, mean PSA was 17.4 ng/ml (range 4.6-59.1), 20 patients had T3a and 10 had Gleason score ≥ 8. The mean dose to the prostate excluding the boost volume was 61.4 Gy (range 60.6-62.3) and the boost PTV 66.1 Gy (range 60.9-72.5). Mean NTCP for rectal bleeding was 4.7% (range 3.4-5.8), for faecal incontinence 3.5% (range 2.3-5) and mean TCP 75% (range 71-79) assuming a 71% biochemical control at 5 years for a standard plan. All patients completed radiotherapy, 16/28 patients had acute bladder toxicity grade 2 (RTOG score), but no grade 3 toxicity was observed. Worst acute bowel toxicity was grade 1 (4/28). Mean follow up was 15 months (range 8-25). For the 20 patients who had neo-adjuvant hormone therapy beyond 6months, the mean PSA was 0.33 ng/ml (range 0.2-0.8), 2 patients had relapsed at 12 month, 6 patients are still on hormone therapy. 4 patients had Grade 2 urinary late toxicities (CTCv4). Two patients developed grade 1 diarrhoea. Patient reported outcomes >6 month after completion of radiotherapy (EPIC QOL questionnaire) demonstrated similar scores to controls without prostate cancer for the bowel domains; reduction in the urinary domains was similar to other cohorts treated with external beam radiotherapy and hormone therapy. Conclusions: In this high risk group, dose escalation with hypo-fractionated dose painting radiotherapy achieved good biochemical control and urinary and bowel toxicity similar to standard dose radiotherapy during follow up.
External beam radiation therapy or high intensity-focused ultrasound for localized prostate cancer: A matched pair analysis in the prostate-specific antigen era.
Authors: Pasticier Gilles , Crouzet Sebastien , Pommier Pascal , Carrie Christian , Rouviere Olivier , Chapelon Jean-Yves , Rabilloud Muriel , Roche Laurent , Mege-Lechevallier Florence , Tonoli-Catez Helene , Martin Xavier , Gelet Albert 
Published: February 2017

109 Background: In the absence of randomised study data institutional series have shown High Intensity Focused Ultrasound (HIFU) to produce excellent overall and cancer specific survival rates in patients with localized prostate cancer (LPCa) compared with alternative curative treatments. The aim of this study was to evaluate the oncologic outcome of patients treated with HIFU versus conformal external beam radiation therapy (C-EBRT) without previous or associated androgen deprivation(AD).This study was designed to overcome limitations of case series studies by using a matched pair design in patients treated contemporaneously with HIFU and C- EBRT in two institutions in the same town. Methods: 256 eligible patients with intermediate risk prostate cancer (d’Amico classification) treated between 2000 and 2005 were prospectively followed and matched to a 1:1 basis following know prognostic variables: prostate-specific antigen (PSA) level and Gleason score.190 perfect matches of patients (95 in each group) were further analysed. Progression free survival rate were the primary endpoint. Other endpoints were secondary used of salvage therapy, and survival rate without salvage palliative androgen deprivation therapy (S-ADT).The progression free survival rates were calculated with Kaplan-Meier estimate. For progression free calculation, failure was defined using the Phoenix definition (nadir + 2ng/ml) or at the time of a salvage treatment for local relapse evidenced by control biopsy. Results: The seven years progression free survival rate was not significantly different after HIFU than after C-EBRT (47% versus 52%, p: 0.311) . The palliative androgen deprivation free rate at seven years was significantly different after HIFU than after C-EBRT (85% versus 58%, p: 0.002). Conclusions: The progression free survival rate was not significantly different after HIFU use than after C-EBRT but the rate of patients who need palliative S-ADT was significantly different after HIFU or C-EBRT: Higher rate of S-ADT was associated with C-EBRT use than with HIFU use.
Contemporary trends in receipt of local therapy for men with clinically localized high-risk prostate cancer.
Authors: Wang Lora S , Handorf Elizabeth , Murphy Colin T. , Haseebuddin Mohammed , Waingankar Nikhil , Uzzo Robert G. , Kutikov Alexander , Bekelman Justin E. , Horwitz Eric M. , Smaldone Marc C. 
Published: February 2017

111 Background: Level I evidence suggests local treatment results in improved survival as compared to androgen deprivation therapy (ADT) alone or watchful waiting for high risk prostate cancer (CaP), but contemporary trends in primary treatment for high risk CaP are poorly understood. Our aim is to examine local therapy utilization for patients with high risk CaP using a large national cancer registry. Methods: Using the National Cancer Database (NCDB), patients with clinically localized CaP meeting National Comprehensive Cancer Network high risk criteria were identified from 2004-2009. Men with node positive or metastatic disease were excluded. Adjusting for diagnosis year and demographic we examined the association between patient characteristics and local therapy, defined as radical prostatectomy (RP) or radiation (RT), in men with high risk CaP using logistic regression models. Results: A total of 132,369 men met inclusion criteria with 80% receiving local therapy and 12% receiving no treatment. There was a small but significant increase in local therapy utilization from 2004-2009 (79 to 81%, p<0.001) with the largest changes seen in increased use of RP alone (24 to 31%, p<0.001) and decreased use of RT+ADT (33 to 29%, p<0.001). In comparison, minor changes were noted in the rates of RT alone (14 to 13%, p=0.02), RP+RT (2.2 to 2.9%, p<0.001), RP+RT+ADT (1.6 to 1.9%, p=0.01), and ADT alone (8.9 to 7.0%, p<0.001). Following adjustment, patients with age >70 years (OR 0.27, CI 0.23-0.30) or Charlson morbidity count > 2 (OR 0.43, CI 0.39-0.46) were less likely to receive local therapy. Further, men of African American race (OR 0.7, CI 0.67-0.74) and Medicare (OR 0.82, CI 0.77-0.87) or Medicaid (OR 0.6, 0.53-0.68) insurance were less likely to receive primary treatment than Caucasian patients or those with private insurance. Conclusions: In the NCDB, 80% of men presenting with clinically localized high risk CaP undergo local therapy as part of multimodality treatment or as monotherapy, with RP overtaking RT+ADT as the primary local treatment of choice. Furthermore, racial and insurance disparities in the receipt of primary treatment are still evident, providing targets for emerging CaP quality of care initiatives.
Focal treatment of prostate cancer using Focal One device: Pilot study results.
Authors: Pasticier Gilles , Crouzet Sebastien , Rouviere Olivier , Chapelon Jean-Yves , Mege-Lechevallier Florence , Martin Xavier , Gelet Albert 
Published: February 2017

112 Background: To evaluate the efficacy of Focal One device for focal treatment of localized prostate cancer. Methods: Focal One is a device designed for the focal therapy of Prostate Cancer integrating the ability to visualize, target, treat and validate the focal treatment. Magnetic Resonnance Imaging (MRI) volumes are imported through the hospital’s network into the device so that an elastic fusion can be done between the real time ultrasonography and the MRI where the regions to treat have been previousy drawn, thus allowing to apply limited and targeted HIFU lesions. During the HIFU energy delivery process, the operator sees a live ultrasound image of what is being treated and, if necessary, can readjust the treatment planning. At the end of the treatment process, a Contrast-enhanced Ultrasound volume is acquired showing the de-vascularized areas. Ten patients with mono focal prostate cancer were treated between march 2013 and January 2014.HIFU treatment process was realized with the Focal One device using a 6 mm safety margin around the tumor. Contrast enhanced MRI is performed at day 2 after HIFU and Control biopsies guided with contrast-enhanced Ultrasound imaging were achieved one month after HIFU inside and in the rime of the treated area. Results: The mean age of patients was 65.8±5.5 years. The Clinical stage was T1for 9 patients and T2afor 1patient.The Gleason sum was 6 for 7 patients and 7(3+4) for 3 patients. The PSA value was 4.47± 3.7 ng/ml and the mean Prostate Volume was 50±23 cc .The mean treated volume was 14 cc (7.3-20.4) 28% of prostate gland. The mean nadir PSA value was 3.46±2 ng/ml. In all patients, targeted biopsies inside the treated area performed day 30 after the HIFU session demonstrated a complete destruction of the targeted tumor. No Incontinence was observed .A partial loss of potency (IIEF <17) occurred in 2 patients. Conclusions: Focal One device is able to achieve a complete destruction of small prostate cancer using an elastic magnetic resonance-ultrasound (MR-US) registration system for tumor location and HIFU treatment planning. Multicenter trial is in progress (30 patients).
Prostate cancer radiation therapy with reduced planning target volume (PTV) margins.
Authors: Sun Kelly , Brand Timothy , Tinnel Brent , Kathpal Madeera , Ninneman Stephanie , Hughs Grant , Halligan John B. , Brown Michael , Brooks Joseph P. , Macdonald Dusten 
Published: February 2017

124 Background: Electromagnetic tracking of the prostate during radiation therapy for prostate cancer allows decreased PTV margins which may reduce dose to nearby tissues. Sandler, et al. reported a reduction in patient-reported acute morbidity with this strategy (Sandler HM, et al. Urology, 2010 May;75 (5):1004-8). We conducted a similar prospective study and compare our results with Sandler’s Assessing Impact of Margin Reduction (AIM) study and with a group treated with radiation therapy without reduced PTV margins from the Sanda, et al. PROST-QA cohort (Sanda MG, et al. NEJM, 2008 Mar 20;358 (12):1250-61). Methods: 25 patients with low-to-intermediate risk prostate cancer were treated on a prospective study with definitive intensity-modulated radiation therapy with 3 mm circumferential PTV margins and daily electromagnetic localization. An EPIC quality of life questionnaire was completed prior to treatment and at the last treatment. Using data from the referenced publications, we performed a two-tailed t-test to compare EPIC scores from our cohort with the AIM and PROST-QA cohorts treated with external beam radiation therapy alone. Results: Table lists mean pre- and post-treatment EPIC scores and the differences between them. Conclusions: Our patients fared similarly to the PROST-QA cohort, but had a significantly greater mean decrement in the urinary irritation and sexual domains in comparison to the AIM cohort. Clinical trial information: NCT01589939. [Table: see text]
A retrospective case series looking at the effectiveness of hyperbaric oxygen in treating radiation cystitis.
Authors: Gorenstein Scott , Katz Aaron , Regan Kimberly , Hangan Donna 
Published: February 2017

127 Background: A side effect of radiation therapy to treat genitourinary cancers is radiation-induced cystitis, which in its most severe form can be hemorrhagic cystitis (HC). Some studies have found the incidence of HC in radiation patients to range from 3% to 6.5% after radiation therapy and can develop anywhere from 6 months after radiation therapy to 10 years or more after the last treatment. The severity of symptoms, which includes hematuria, may drastically reduce quality of life. Recent studies have shown that hyperbaric oxygen therapy has improved symptoms of radiation cystitis in around 80% of patients. Methods: Sixty patients who received hyperbaric oxygen therapy (HBOT) for radiation-induced cystitis since 2010 at Winthrop University Hospital were identified. IRB approval was obtained for contacting these patients to gather outcome data. Patient reported outcomes were evaluated using a questionnaire that assessed the type and duration of radiation treatment, treatment other than HBOT for HC symptoms, surgical intervention, and patient perceived outcomes of HBOT. Results: 36 patients were consented. The average age of the patient was 71 with a range from 29-91. The majority of the patients 78% had prostate cancer with the Colon, Uterinem, Bladder and Testicular cancer also included The average time from completion of radiation to onset of symptoms was 3 years. The mean number of treatments was 35 with a range of 18-120 treatments. All treatments were for 90 minutes at 2.4 ATA. The majority of the patients (24) had external beam radiaiation and 12 patients had a urological procedure after completion of their therapy. 78 % of the patients reports either moderate improvement or complete resolution of symptoms. Conclusions: This case series seems to demonstrate that Hyperbaric Oxygen Therapy appears to be an effective treatment for radiation cystitis, however additional studies are necessary.
The impact of spatial distribution patterns of tumor foci on biochemical recurrence in prostate cancer.
Authors: Eminaga Okyaz , Hinkelammert Reemt , Semjonow Axel 
Published: February 2017

130 Background: The influence of spatial distribution patterns of organ-confined Prostate Cancer (PCa) on the biochemical recurrence (BCR) remains unclear. Therefore, we conducted a study investigating the association between distribution patterns and BCR-free rate in organ-confined PCa. Methods: The anatomical distribution of PCa in 743 men with pT1-pT3N0 and without neoadjuvant therapy was analyzed to determine 20 groups with similar distribution patterns of PCa. Then, 245 men with pT2N0R0 were considered for prognostic evaluation. Spatial distribution patterns of PCa were evaluated using a cMDX-based map model of the prostate. A comparison analysis including 552,049 compare operations was performed to assist the similarity levels of the distribution patterns. K-mean cluster analysis was applied to determine 20 groups with similar distribution patterns. A decision tree-Analysis was performed to divide these groups according to BCR. BCR-free survival was compared. Predictors of progression were investigated using a Cox proportional hazards model. Results: BCR was occurred in 8.2% men with pT2N0R0 PCa. In decision tree analysis, certain PCa distribution patterns revealed no BCR at a median follow-up of 60 mo. (IQR: 42.3-77.0) In univariate and multivariate analysis, the prostate volume, the distribution patterns were an independent predictor for BCR in univariate and multivariate, whereas tumor stage, Gleason score, PSA, relative tumor volume were not. When patients with pT2R0 were stratified according to PCa distribution patterns, the presence of BCR-negative PCa distribution patterns was significantly associated with no risk of BCR by comparison to BCR-associated PCa distribution patterns (P=0.001). Conclusions: PCa distribution patterns provide a prognostic value for BCR. Distribution patterns of PCa can be applied to create more meaningfully predictive pathological T2 sub-divisions than current pT2 prostate cancer sub-stages.