bluuebunny/crossref_metadata_2025_split huggingface dataset:
Change in a 17-gene genomic prostate score over time in men with low- and intermediate-risk prostate cancer managed with active surveillance.
Authors: Leapman Michael S. , Cowan Janet E. , Nguyen Hao Gia , Cooperberg Matthew R. , Carroll Peter 
Published: February 2017

124 Background: A biopsy-based RT-PCR assay (Oncotype DX Prostate Assay) providing a Genomic Prostate Score (GPS) as a measure of tumor aggressiveness has been validated as a predictor of adverse pathologic and oncologic outcomes. We sought to evaluate the change in GPS results among men with favorable-risk prostate cancer (PCa) managed with active surveillance (AS). Methods: We identified men with low and intermediate-clinical risk PCa managed with AS at our institution receiving a minimum of two GPS tests on serial prostate biopsy. GPS ranges from 0 (least) to 100 (most aggressive disease). We described the change in assay results and clinical risk designation over time and reported the subsequent clinical outcome (definitive treatment versus continued AS). For men receiving treatment with radical prostatectomy (RP) the occurrence of adverse pathological findings was defined by the presence of high grade (Gleason pattern ≥ 4+3) or non-organ confined disease ( ≥ pT3a). Results: 31 men were identified who underwent serial GPS testing at a median of 12 months. The median change in GPS was an increase of 1 point (IQR -7, 13). Fourteen (45%) patients experienced an increase in NCCN risk classification, including 3 from very-low to intermediate and 11 from low to intermediate risk. Following serial GPS testing 7 patients (23%) underwent radical prostatectomy. Among surgically treated patients, 3 had adverse pathology due to pT3a disease and the mean change in GPS prior to treatment was an increase of 13 points (IQR -7, 18); all of whom were intermediate clinical risk at the time of surgery. This study was limited by the small sample size and the uncontrolled decision to pursue definitive therapy. Conclusions: Serial change in a tissue based gene expression assay on serial biopsy during AS was non-static. Magnitude of GPS change may identify men at risk for adverse pathological findings, although larger series are required to validate such an endpoint during AS.
Psychological state and trait correlates of quality of life prior to radiotherapy for prostate cancer.
Authors: Walker Sara J , Chen Yiyi , Paik Kyungjeen , Mirly Brandy , Fields Alexis K , Thomas Charles R. , Hung Arthur 
Published: February 2017

129 Background: Improvement in cancer treatment has increased need to focus on survivors’ quality of life (QOL). Survivors often experience psychological stress, with impact on QOL and disease-related mortality. Better understanding the heterogeneity in individuals’ psychological adjustment to cancer diagnosis and treatment may help identify the most valid screening practices and patients most in need of psychosocial support. The specific aim of the current study investigates correlates of psychological state and trait with QOL prior to radiotherapy for localized non-metastatic prostate cancer. We hypothesized 1) positive correlations with QOL and trait Extraversion, Openness, and Conscientiousness, and 2) negative correlations between QOL and state depression/anxiety and trait Neuroticism. Methods: The PHQ-9, GAD-7, and NEO-FFI-3 assessed depressive state, anxiety state, and personality traits, respectively. The FACT-P assessed physical, social, emotional, and functional well-being. Our sample (n=29) had median age of 68 (range 52-79) and education of 16 years (range 10-20). Race/ethnicity: 89% European-American, 4% African-American, 7% Other. Association between constructs was assessed by Pearson’s correlation coefficient. Results: Higher depression, anxiety, and Neuroticism were negatively associated with physical (p < 0.04), emotional (p < 0.01), and functional (p < 0.02) well-being, and well-being related to prostate cancer-specific concerns (p < 0.01). Trait Agreeableness was associated with emotional (p < 0.01) and functional (p < 0.01) well-being. Extraversion was associated with social (p < 0.05) and functional (p < 0.02) well-being. Openness was associated with functional well-being only (p < 0.03). Contrary to hypothesis, Conscientiousness did not significantly correlate with any measured aspect of QOL. Conclusions: Assessing psychological risk and protective factors prior to radiotherapy may help identify patients in most need of psychosocial supports, informing effective screening protocols and individualized treatment planning. Future directions include prospectively measuring predictive value of baseline risk and protective factors on post-treatment QOL.
Outcomes in patients with high-risk prostate cancer treated with definitive versus adjuvant radiation therapy.
Authors: Tumati Vasu , Jacobs Corbin , Ying James , Roehrborn Claus G , Lotan Yair , Margulis Vitaly , Pistenmaa David A. , Kim Dong W. , Hannan Raquibul 
Published: February 2017

133 Background: 20% of men with prostate cancer (PCa) are diagnosed with high-risk disease. The optimal therapy for these patients, prostatectomy followed by adjuvant radiation therapy (ART) or definitive radiation with androgen deprivation (DRT), is still unclear. Previous randomized trials failed to accrue; therefore we sought to answer this using an IRB-approved retrospective cohort study. Methods: High-risk PCa was defined using NCCN criteria. Adjuvant radiation was defined as radiotherapy started within 6 months of prostatectomy. Biochemical progression-free survival (BPFS), castrate resistance-free survival (CRFS), distant metastasis-free survival (DMFS), prostate cancer-specific survival (PCSS), and overall survival (OS) were calculated using Kaplan-Meier estimates. Biochemical failure was defined using the AUA definition in the ART group and by the Phoenix definition in the DRT group. Castrate resistance was defined as ≥2 episodes of rising PSA with testosterone <50 ng/ml or rising PSA despite second line anti-androgen. Statistical analysis was performed using log rank and Cox testing. Results: 60 men with high-risk PCa treated between 1992-2011 were included in the ART group and 154 men were included in the DRT group. 58% of men in the ART group received short course of androgen depravation therapy (ADT). Nearly all men received 2 years of ADT in the DRT group. The median follow up for the ART group was 62 months and 55 months for the DRT group. Men in ART group were younger (p<0.0001) and had a lower pre-treatment PSA (p=0.0338). Log rank testing revealed the ART group had worse BPFS (5 year: 57% vs. 71%; p=0.008), but there was no difference in the other endpoints including CRFS (p=0.9693), DMFS (p=0.7345), PCSS (p=0.5481), or OS (p=0.2557). On multivariable analysis ADT use, ADT length, type of treatment, and stage were not predictive of BRFS whereas Gleason score was (p=.0001). Conclusions: This study suggests that for high-risk PCa patients there is no difference between DRT and ART with regards to BPFS, CRFS, DMFS, PCSS, or OS. Therefore, over a short follow-up period, there does not appear to be a difference between these approaches. Prospective trials are required to validate this finding.
Feasibility of robot-assisted radical prostatectomy in elderly patients: Comparative analysis of the peri-surgical/oncological outcomes with younger patients.
Authors: Iwata Takehiro , Saika Takashi , Edamura Kohei 
Published: February 2017

134 Background: Robot-assisted radical prostatectomy (RARP) has become one of standard treatments for localized prostate cancer. However, a feasibility of RARP in elderly patients has not been clear yet. We performed a comparative analysis of peri-surgical/oncological outcomes for younger and elderly patients underwent RARP. Methods: We reviewed and compared our initial 340 consecutive patients who underwent RARP from 9/2012 to 8/2015 for peri-surgical outcomes, including surgical times, blood loss, complications, pathological findings, continence recovery, and oncological outcomes stratified by age less than 70 and over 70 years. Results: In our cohort, 202 men were age less than 70 and 138 men were ≥70. Preoperative parameters (age, PSA, Gleason score) were similar in both younger and elder groups. Operative time (median: 167 vs. 171 minutes) and estimated blood loss were similar in both groups. One of elder patients (0.7%) needed transfusion. Peri/post-operative complications in both groups appeared to be minimal with no cases of intra-operative open conversion. One of younger patients needed a surgical settlement for port site herniation. Surgical positive margin rates in organ-confined (pT2) disease were also similar (5.6%, younger vs. 9.0%,elder). Continence at 3 months was 82% in elder patients as opposed to 87% in younger patients. Median follow-up period in in elder patients and younger patients were 15.2 and 15.3 months, respectively. Biochemical recurrence free survival rates in elder patients and younger patients were 89.9% and 93.6%, respectively (p=0.1026). Conclusions: In our study, RARP in elderly patients was relatively safe and yielded good oncologic results. RARP is feasible even in elderly patients.
Racial variation in the outcome of subsequent prostate biopsies in men with an initial diagnosis of atypical small acinar proliferation (ASAP).
Authors: Kramer Jordan J. , Libby Robert Scott , Feibus Allison H. , Haney Nora M. , McCaslin Ian R. , Moparty Krishnarao , Thomas Raju , Silberstein Jonathan L. , Sartor A. Oliver 
Published: February 2017

141 Background: African Americans (AA) are known to have more aggressive prostate cancer (PCa) and a greater probability of death from PCa. We sought to determine predictors of subsequent detection and risk stratification of PCa in a racially diverse group of men who presented with atypical small acinar proliferation (ASAP) on initial prostate biopsy. Methods: Upon receiving IRB approval, a retrospective analysis was performed on men from the Southeast Louisiana Veterans Health Care System and Tulane University Medical Center who presented with ASAP on initial prostate biopsy and subsequently received confirmatory prostate biopsies from September 2000 through July 2015. Confirmatory biopsy with a greater than 3-year interval from the initial were excluded. Self-identified race, age, body mass index (BMI), transrectal ultrasound (TRUS) volume, serum prostate-specific antigen (PSA), PSA velocity (PSAV), PSA density (PSAD), and elapsed time between biopsies were evaluated to determine if they were predictors of subsequent PCa diagnosis in patients with an initial finding of ASAP. Results: Of the 106 men in the analysis cohort, 75 (71%) were AA and 31 (29%) were not African American (non-AA). AA had higher PSA, PSAV, and PSAD (all p < 0.05). Age, BMI and TRUS volume were not statistically different between AA and non-AA. PCa was diagnosed in subsequent biopsy in 42 (40%) patients without significant racial variation; 30 (40%) AA vs 12 (39%) non-AA. Of the 42 men with PCa, 25 (24%) met Epstein pathological criteria for significant disease, although without racial variation; 18 (24%) AA vs 7 (23%) Non-AA. Only 10 (9%) men, again without racial variation, had any component of Gleason 4; 7 (9%) AA vs 3 (10%) non-AA. On multivariate analysis, increasing age, PSA and PSAD were significant predictors of cancer on repeat biopsy while race, BMI, TRUS volume and number of cores with ASAP were not. Conclusions: AA diagnosed with ASAP on initial prostate biopsy do not have increased risk of PCa on confirmatory biopsy compared to non-AA. Regardless of race, most cancers were low grade and lower volume, and AA with ASAP should be managed in a similar manner to non-AA with ASAP.
Pathologic upgrading on confirmatory biopsy in a racially diverse group of men on active surveillance for prostate cancer.
Authors: Feibus Allison H. , Haney Nora M. , Boxberger John , Levy Justin , Libby Robert Scott , Kramer Jordan J. , Ledet Elisa M. , Moparty Krishnarao , Thomas Raju , Lewis Brian E. , Silberstein Jonathan L. , Sartor A. Oliver 
Published: February 2017

142 Background: To evaluate the clinical variables associated with upgrading at confirmatory biopsy among a racially-diverse group of men with prostate cancer (PCa) who elect Active Surveillance (AS). Methods: Following IRB approval, of the more than 260 men from our multi-institutional prospective AS database we identified 140 that had undergone at least 1 confirmatory biopsy since their initial diagnosis. Patients whose diagnosis was made on TURP, had any Gleason 4 on their initial biopsy or whose initial and confirmatory biopsy were more than 2 years apart were excluded. The analysis cohort included 121 men who had Gleason Score ≤ 6, clinical stage ≤ T2a and PSA ≤ 20 ng/mL. Disease upgrading on confirmatory biopsy was Gleason score ≥ 7. Multiple variables were examined as univariate and MV predictors of upgrading. Results: We identified 121 men who fit inclusion criteria, 55 (45%) African Americans (AA) and 66 non-AA (55%) with a median follow-up of 22 months. The median age was 66, median number of biopsy cores taken at diagnostic biopsy was 12 and median time interval between diagnostic and confirmatory biopsy was 12 months. On confirmatory biopsy, no evidence of disease was noted for 51 (42%) men (26 AA, 25 non-AA), 48 (40%) men (18, AA, 30 non-AA) had findings consistent with their initial biopsy and 22 men (11 AA, 11 non-AA) experienced upgrading at repeat biopsy. Of the 22 (18%) men who were upgraded, 18 (8 AA, 10 non-AA) upgraded to a Gleason score of 7, 3 (2 AA, 1 non-AA) were upgraded to a Gleason score of 8 and 1 (AA) had a Gleason score of 9. In univariate analysis AA race was associated with a greater number of positive cores (p = 0.04) and greater total prostate volume (p = 0.03) at confirmatory biopsy. Multivariate analysis was performed and none of the clinical variables examined (race, age, BMI, PSA, volume, PSAD, number of positive cores, total number of cores, percentage of positive cores, time between biopsies) were associated with upgrading on repeat biopsy. Conclusions: Our findings suggest that race is not associated with an increased risk of upgrading at confirmatory biopsy. AA with low-risk PCa are reasonable candidates for inclusion in most AS protocols and should not be excluded based on race alone.
Effect of androgen deprivation therapy on intraductal carcinoma of the prostate (IDC-P), a prognostic factor for prostate cancer.
Authors: Kato Masashi 
Published: February 2017

146 Background: The presence of intraductal carcinoma of the prostate (IDC-P) is reported to be an adverse prognostic factor for cancer-specific survival (CSS) in localized and metastatic prostate cancer patients. However, there is no data indicating whether the presence of IDC-P can be affected by ADT (androgen deprivation therapy). Methods: We retrospectively evaluated 152 high risk prostate cancer patients who underwent radical prostatectomy with neoadjuvant ADT. They were diagnosed and treated at author-affiliated hospitals between 1991 and 2005. All patient data was made available from slides prepared from prostate needle biopsy samples and prostatectomy specimens and each patient received ADT before operation. Slides were re-reviewed by a single genitourinary pathologist (T.T.) according to the 2005 International Society of Urological Pathology (ISUP) grading system and presence of IDC-P was defined using previously published diagnostic criteria. Results: Patient median age was 68 years (range 46-80 years). The median iPSA was 32.7 ng/ml (range 2.4-296). The median follow-up period was 109 months (range 11-257). Sixty-one patients (40%) were ≥cT3 and 113 cases (74%) had biopsy Gleason score ≥8. Preoperative median ADT period was 4 months (range 1–20 ). IDC-P component was detected in 54 patients (36%) in needle biopsy and 69 (45%) in prostatectomy. There were 28 patients who died of the disease and 12 patients who died of other causes during follow-up. They were divided in 4 groups according to with or without IDC-P in biopsy/prostatectomy (-/- 68cases ,-/+ 30, +/- 15, +/+ 39). Twenty eight per cent of IDC-P positive cases in biopsy showed disappearance of IDC-P in prostatectomy specimen. Prognosis was the worst in +/+ group and IDC-P disappearance cases (+/-) tended to have better survival than IDC-P existing cases (+/+) in CSS (p = 0.04). Conclusions: In a number of IDC-P-positive cases determined by needle biopsy, the disappearance of IDC-P in prostatectomy specimens after ADT indicates the possibility that part of IDC-P positive patients can occasionally respond to ADT.
First experience of prostate brachytherapy under hypnosedation.
Authors: Chapet Olivier , Rigal Edwige , Udrescu Corina , Hassouni Abdeslam , Ruffion Alain , Piriou Vincent 
Published: February 2017

149 Background: Hypnosedation is an alternative to general or spinal anesthesia and may reduce bleeding, postoperative recovery time, as well as potential side-effects of anesthesia. In our department, hypnosedation has been used for prostate brachytherapy (PBT). Levels of pain, comfort, anxiety and satisfaction were evaluated prospectively and are reported. Methods: Twenty-seven patients were treated with BT under hypnosedation. Anesthesia was limited to a perineal injection of 30cc of xylocaine. The same radiation-oncologist and the same anesthesiologist performed all the interventions and hypnosedations, respectively. A dose of 145Gy was delivered to the prostate using iodine-125 linked-seeds. In case of pain or discomfort during hypnosedation, the patient could ask to switch from hypnosedation to general anesthesia. Visual Analog Scales (VAS), from 0 to 10 points, were used to evaluated the lowest, mean and highest level of pain, comfort and anxiety. The VAS forms were completed by the patients in the same day (D1), before (anxiety and pain) and after the intervention (pain and comfort), and 8 weeks later (pain and comfort). Results: Only two patients had a general anesthesia, because they didn’t reach the hypnotic level and failed to follow the hypnosedation procedure. In the table below are presented the results (average and range) of the VAS scores for pain and comfort for the remaining 25 patients. Twenty-four (88.9%) patients would choose this approach again and recommend it to other patients. One patient would prefer a general anesthesia due to the discomfort of the position during the procedure (leg cramps). For all the patients, the short post-operative recovery time and their active participation to the treatment were two major advantages of the hypnosedation. Conclusions: To our knowledge, this is the first experience of brachytherapy under hypnosedation. Our first results demonstrate that hypnosedation is a feasible and comfortable alternative method to anesthesia, perfectly suitable for PBT. [Table: see text]
Patient characteristics at time of prostate cancer diagnosis in different races at an academic center serving a diverse population.
Authors: Suresh Tejas , Gao Qi , Kim Mimi , Goel Sanjay , Gartrell Benjamin Adam 
Published: February 2017

158 Background: In the United States, prostate cancer (PCa) incidence and death rate differ among racial groups. Non-Hispanic Blacks (NHB) have a higher incidence and death rate than non-Hispanic Whites (NHW), whereas incidence and death rate are slightly lower in Hispanics (H) than in NHW. We sought to compare the socioeconomic, demographic and baseline prognostic factors at PCa diagnosis among different races at a large, urban academic center serving a diverse population. Methods: Following institutional review board approval, the Montefiore Medical Center Cancer Registry was used to generate a comprehensive list of patients diagnosed with PCa 2004 to 2013. Clinical Looking Glass (a searchable database of patient information) and individual patient chart review were used to obtain data including age at diagnosis, socioeconomic score (SES), Gleason score, stage at diagnosis and PSA at diagnosis. Patients were classified by self-identified race as H, NHB or NHW. For categorical variables the chi-square test was used, whereas the ANOVA or the Kruskal-Wallis tests were employed for continuous variables. Results: During the specified period 2352 patients were diagnosed with PCa among which 778 were self-classified as H, 1046 as NHB, 486 as NHW and 42 as other (O). The mean age at diagnosis differed between these groups (H 63.2, NHB 63.4, NHW 67, O 63.0, p < 0.0001). The proportion of men below the mean SES also differed between races (H 92.8%, NHB 91.3%, NHW 56.6%, O 75%, p < 0.0001). Median PSA (ng/ml) at diagnosis was similar (H 8.0, NHB 8.4 NHW 7.2, O 6.4, p = 0.0768) whereas Gleason score differed between racial groups (Gleason ≤ 6: H 42.8%, NHB 39.1%, NHW 52.2%, O 50%; Gleason 8-10: H 15.8%, NHB 17.6%, NHW 14.3%, O 16.7%, p = 0.0005). The proportion of men with metastatic disease at diagnosis also differed significantly in these groups (H 7.5%, NHB 9.0%, NHW 4.3%, O 9.5%, p = 0.0139). Conclusions: At our center, in patients with newly diagnosed PCa, there are significant differences among racial groups. These include age at diagnosis, SES, Gleason score and proportion with metastatic disease. Such differences at diagnosis suggest that minority patients are at risk for inferior PCa outcomes.
Combined impact of diet and lifestyle after diagnosis on risk of prostate cancer death.
Authors: Kenfield Stacey A. 
Published: February 2017

159 Background: Several lifestyle factors have been independently associated with prostate cancer progression and mortality, but little is known about their combined effect.Our objective wasto develop scores based on post-diagnostic diet and lifestyle behaviors for the prevention of prostate cancer death. Methods: We developed four scores (food-only: range 0-5; food & drinks: range 0-8; lifestyle-only: range 0-3; food, drinks & lifestyle: range 0-11) among 3,583 men in the Health Professionals Follow-Up Study diagnosed with non-metastatic prostate cancer in 1986-2008 with follow-up through 2012. Potential factors and their cut-points were based on the literature. One point was given for each factor: not currently smoking or quit ≥ 10 years ago, BMI < 30 kg/m2, ≥ 3 h/wk vigorous activity or ≥ 7 h/wk brisk walking, ≥ 1 serv/d cruciferous vegetables, ≥ 3 serv/wk nuts or oil-based dressings, ≥ 4 cups/d coffee, ≥ 7 serv/wk wine, < 2 serv/wk processed meat, 0 serv/wk poultry with skin or poultry sandwiches, and < 140 ug/d of supplemental selenium. We used multivariable Cox proportional hazards regression. Results: We observed 240 prostate cancer deaths during a median of 11 years follow-up. A 1-unit increase in each score was associated with a similar reduction in risk of prostate cancer death: food-only (HR = 0.71; 95%CI = 0.60,0.85); food & drinks (HR = 0.71; 95%CI = 0.61,0.82); lifestyle-only (HR = 0.72; 95%CI = 0.56,0.92); and total diet & lifestyle (HR = 0.71; 95%CI = 0.63,0.81). Men with 3 vs 0-1 points for the lifestyle-only score had a 51% decreased risk of prostate cancer death (95%CI = 0.28,0.83); men with ≥ 5 vs 0-2 points on the food & drinks score had a 73% decreased risk of prostate cancer death (95%CI = 0.14,0.51); and men with 4-7 and 8-11 vs 0-3 points for the total diet & lifestyle score had a 48% (95%CI = 0.32,0.84) and 75% (95%CI = 0.09,0.69) decreased risk of prostate cancer death. Conclusions: Adhering toa lifestyle characterized by frequent vigorous activity; not smoking; a healthy weight; a diet rich in cruciferous vegetables, healthy fats from vegetable sources, coffee, and wine and low in processed meat and poultry with skin; and avoiding excess supplemental selenium after prostate cancer diagnosis may lower risk of prostate cancer death.