bluuebunny/crossref_metadata_2025_split huggingface dataset:
Screening for aggressive prostate cancer: A single-center experience using the 4Kscore and multiparametric MRI for the detection of Gleason 7 or higher prostate cancer.
Authors: Venkatramani Vivek , Nahar Bruno , Koru-Sengul Tulay , Soodana-Prakash Nachiketh , Gonzalgo Mark L. , Ritch Chad , Parekh Dipen , Punnen Sanoj 
Published: March 2017

84 Background: While non-invasive biomarkers and multi-parametric MRI (mpMRI) are routinely used for prostate cancer detection, few studies have assessed their performance together. We evaluated the performance of mpMRI and the 4Kscore for the detection of significant prostate cancer. Methods: We identified a consecutive series of men who underwent an mpMRI and 4Kscore for evaluation of prostate cancer at the University of Miami. We selected those who underwent a biopsy of the prostate. The primary outcome was the presence of Gleason 7 or higher cancer on biopsy. The 4Kscore was modeled as a continuous variable, but also categorized into low ( < 7.5%), intermediate (7.5-20%), and high ( > 20) risk scores. The mpMRI was categorized as being either negative or positive for a suspicion of cancer. We used logistic regression and Decision Curve Analysis to report the discrimination and clinical utility of using mpMRI and the 4Kscore for prostate cancer detection. Finally, we modeled the probability of harboring a Gleason 7 or higher prostate cancer based on various categories of the 4Kscore and mpMRI. Results: Among 235 men who underwent a 4Kscore and mpMRI, only 112 (52%) were referred for a biopsy, allowing a significant proportion of men to avoid a biopsy. Among those who had a biopsy, the AUC for using the 4Kscore and mpMRI together [0.81(0.72-0.90)] was superior to using the 4Kscore [0.71(0.61-0.81);p = 0.004] and mpMRI [0.74(0.65-0.83);p = 0.02] alone. Similarly, decision curve analysis revealed the highest net benefit for using both tests together, compared to either test alone. Finally, we found that having a positive mpMRI was a predictor of aggressive cancer in the higher two 4Kscores, but not in the lowest category, suggesting that men with a low 4Kscore may not benefit from getting an mpMRI, most likely due to the low likelihood of cancer and having a positive mpMRI. Conclusions: The 4Kscore and mpMRI provides independent, but complementary, information to enhance the prediction of aggressive prostate cancer. Prospective trials are required to confirm these findings.
Management of high-risk prostate cancer with 5-treatment stereotactic body radiotherapy: Long-term results.
Authors: Kang Josephine , Katz Alan J. 
Published: March 2017

94 Background: Stereotactic Body Radiotherapy (SBRT) is an emerging treatment modality with excellent control rates for low- and intermediate-risk prostate cancer. The role of SBRT for high-risk disease, however, is less studied. The standard treatment (RT) for high-risk prostate cancer entails 8-9 weeks of daily RT with long-term androgen deprivation therapy (ADT). In comparison to this, SBRT is completed in 5 sessions, and offers convenience, low toxicity, and equivalent biochemical disease control rates as standard RT in the low- and intermediate-risk setting. We now present long-term results for SBRT in a cohort of patients with high-risk disease. Methods: We evaluated patients treated from 2006-2010 with SBRT alone (n = 52) to dose of 35-36.25 Gy in 5 fractions, or pelvic radiation to 45 Gy followed by SBRT boost of 19-21 Gy in 3 fractions (n = 46). Androgen deprivation therapy was administered to 55% of patients. Quality of life and bladder/bowel toxicity was assessed using the Expanded Prostate Index Composite (EPIC) and RTOG toxicity scale at regular time intervals. Results: Median followup was 84 months. 8-year biochemical disease-free survival (bDFS) was 61.3%. On univariate analyses,PSA was significant for bDFS (p = 0.001), whereas pelvic radiation (p = 0.97), T-stage (p = 0.79), ADT (p = 0.77), Gleason score (p = 0.78) were not. On multivariate analysis, only PSA remained significant (p = 0.003) for bDFS. Overall toxicity was mild, with 5.1% Grade 2 urinary, 3% Grade 3 urinary and 7.1% Grade 2 bowel toxicity. Use of pelvic radiotherapy was associated with significantly higher bowel toxicity (p = .001). EPIC bowel and bladder scores declined for the first six months and then returned towards baseline. Conclusions: Five-treatment SBRT appears to be a safe and effective treatment for high-risk prostate carcinoma now with median 84 month follow up. The addition of pelvic radiation or ADT does not confer any bDFS benefit with this modality. Our data suggests that SBRT alone may be the optimal approach. SBRT may be a good treatment alternative to discuss particularly for patients unable to undergo ADT or unwilling to receive standard 8-9 week RT. Prospective studies are required to corroborate our results.
New frontiers ahead focal therapy postoperative follow-up: What is the real role of MRI in this setting?
Authors: Nunes-Silva Igor , Barret Eric , Baghdadi Mohammed , Srougi Victor , Barreras Silvia Garcia , Carneiro Arie , Capogrosso Paolo , Rembeyo Gregory , Sanchez-Salas Rafael , Rozet François , Galiano Marc , Cathelineau Xavier 
Published: March 2017

e539 Background: Magnetic resonance imaging (MRI) plays an important role as a treatment-monitoring tool along focal therapy (FT) follow-up. This is the first study to assess MRI ability to correctly predict prostate cancer (PCa) local T-stage in the FT postoperative scenario. We aimed to describe MRI effectiveness in predicting upstaging in two groups of men: 1) men who failure after primary FT and then underwent salvage robotic-assisted radical prostatectomy (S-RARP) and 2) men who underwent RARP as primary treatment (P-RARP). Methods: Prospective data of 2775 men underwent RARP for localized PCa from 2000 to 2016 were reviewed. Twenty-two men underwent S-RARP after FT failure (S-RARP group). Total 2750 underwent RARP as first treatment. Matched-pair 1:2 selection of 44 out of 2750 patients by age defined primary RARP group (P-RARP). All patients underwent MRI immediately before RARP. MRI findings were confronted with final surgical pathology. Primary endpoint: sensitivity, specificity, positive and negative predictive values; positive (+LR) and negative (-LR) likelihood ratio regarding upstaging analysis on S-RARP. Secondary endpoint: same effectiveness analysis on P-RARP. Results: Preoperative MRI failed in predicting upstaging in 80% versus 91.7% of patients (p = 0.515) that presented final pathological status ≥ pT3a on S-RARP and P-RARP groups, respectively. On the other hand, when final pathology described a localized disease T2a-T2c, MRI correctly predicted the final pathological status in 81.8% versus 95.2% of patients (p = 0.27) on S-RARP and P-RARP groups, respectively. Between-group analysis, showed sensitivity and specificity rates of 20% versus 8.33% and 81.8% versus 95.23%, respectively; Positive and negative predictive values of 33.33% versus 50% and 69.23% versus 64.51%, respectively; Positive (+LR) and negative (-LR) likelihood ratio of 1.1 versus 1.74 and 0.98 versus 0.96, respectively. Conclusions: MRI has shown to be a weak diagnostic tool for predicting extra-prostatic disease along FT follow-up. Urologists may be warned about the risk of underdiagnosis and undertreatment in patients presenting failure after FT.
A new technique of reporting prostate biopsy to predict prostatectomy outcome.
Authors: Olsson Carl A. , Shah Paras Hemant , Yaskiv Oksana , Kapoor Deepak A. 
Published: March 2017

e544 Background: Presently, the highest Gleason Grade Group (GGG) is the metric used to gauge the clinical aggressiveness of tumor and dictate treatment. However, the urologist is limited by lack of consideration of the entire biopsy using that single parameter alone. Intuitively we presumed that the biopsy showing multiple cores of cancer would represent more aggressive disease. Herein, we propose the Weighted Gleason Grade Group (WGGG), a novel scoring system that synthesizes histopathologic data and cancer volume into a single numeric value representing the entire biopsy that provides the urologist with the ability to more accurately predict adverse pathologic outcomes of prostatectomy. Methods: We studied 212 men who underwent radical prostatectomy after standard multi-core prostate biopsy. The highest Gleason score of each biopsy was converted to its final GGG. The WGGG was calculated by summing the Gleason score of each positive core and normalized for a 12 core total. Radical prostatectomy pathology was studied to determine adverse pathological outcomes, specifically, extraprostatic extension (EPE), positive surgical margins (PSM), lymphovascular invasion (LVI), seminal vesical invasion (SVI) and pathological upgrading. Logistic regression analysis was used to compare the ability of conventional GGG versus WGGG to predict the risk of these adverse features. Results: The odds ratio (OR) for predicting EPE, SVI and LVI for increasing GGG versus WGGG (in 10-point incremental increases) were 1.16 (95% CI 1.1-1.2, p < 0.001) versus 1.81 (95% CI 1.42-2.32, p < 0.001), versus 2.05 (95% CI 1.45-2.90, p < 0.001) and versus 3.46 (95% CI 1.99-6.04, p < 0.001), respectively. WGGG, but not GGG was significantly associated with PSM 1.07 (95% CI 1.029-1.104, p = 0.004) and pathologic upgrading 1.621 (95% CI 1.461- 1.837, p = 0.002) of the prostatectomy specimen. Conclusions: The WGGG, by providing a measurable value reflecting the entirety of the prostate biopsy, is more informative than conventional single GGG alone in reliably predicting adverse pathologic outcomes on radical prostatectomy specimens.
Trends and clinico-sociodemographic determinants of stereotactic body radiotherapy use for localized prostate cancer: A National Cancer Database study.
Authors: Mahal Brandon Arvin Virgil , Chen Yu-Wei , Muralidhar Vinayak , Yang David , Mahal Amandeep R. , Yu James B. , Orio Peter F. , Nguyen Paul L. 
Published: March 2017

e545 Background: Stereotactic body radiotherapy (SBRT) represents an emerging and cautiously guideline-approved definitive therapy option for prostate cancer, though long-term data on efficacy and toxicity is still pending. Herein, we sought to determine contemporary national SBRT trends and clinico-sociodemographic determinants associated with its use in prostate cancer. Methods: The National Cancer Data Base (NCDB) was queried to identify 181,544 patients diagnosed with localized prostate cancer from 2004-2012 who received external beam radiotherapy. Multivariable logistic regression adjusted for sociodemographic and clinical factors was used to identify independent determinants of SBRT use. Results: Rate of SBRT use for localized prostate cancer increased from 0.05% in 2004 to 4.87% in 2012 ( Ptrend< 0.001). SBRT was more likely to be delivered at academic centers, to patients with Medicare, and to patients who were white, younger, healthier, from wealthier and more educated zipcodes, and who had lower risk disease features (all P< 0.001). Relative to Whites, men from more affluent zipcodes, or men with low stage or grade prostate cancer, Blacks, Hispanics, and men from less affluent zipcodes and men with high stage or grade prostate cancer were less likely to receive SBRT after multivariable adjustment, with adjusted hazard ratios of 0.66, 0.35, 0.33, 0.07, and 0.21, respectively (all P< 0.001). Conclusions: The absolute national rate of SBRT use as definitive therapy for prostate cancer has increased nearly 100-fold over the last decade. Men who are White, younger, healthier, from more affluent zipcodes and with favorable disease characteristics are more likely to receive an emerging form of radiotherapy with unknown long-term efficacy and toxicity.
Utility of PCA3 and TMPRSS2: ERG urinary biomarkers to predict pathologic outcomes in African American men undergoing radical prostatectomy.
Authors: Feibus Allison H. , Sartor Oliver , Ledet Elisa M. , Shaw Eric , Moparty Krishnarao , Thomas Raju , Silberstein Jonathan L. 
Published: March 2017

e547 Background: Tremendous disparity exists between preoperative characteristics and pathologic outcomes in men electing radical prostatectomy (RP) for localized prostate cancer (PCa). We sought to determine the performance characteristics of urinary PCA3 andTMPRSS2:ERG (T2:ERG) to predict pathologic outcomes in a racially diverse group of men undergoing RP. Methods: Following IRB approval, post digital rectal exam (DRE) urine was prospectively collected in consecutive patients with known PCa prior to RP. PCA3 and T2:ERG RNA copies were quantified and normalized to PSA mRNA copies using the Progensa assay (Hologic, San Diego, CA). Nonparametric Mann-Whitney U tests were performed to determine the ability of PCA3 and T2:ERG to predict higher risk PCa and notable disease features. Results: The cohort consisted of 214 men with PCa who underwent RP, and 89 men (42%) were African American (AA). The men in the cohort generally had higher risk disease, with 75% having AUA risk stratification of intermediate/high-risk PCa. PCA3 discriminated between biopsy low- and intermediate/high-grade Gleason Score (p = .005) and pathologic low- and intermediate/high-grade Gleason Score (p = 0.001). For men with low-risk PCa, PCA3 also predicted Gleason Score upgrading from biopsy to prostatectomy specimen (p = 0.003). PCA3 could not predict the presence of perineural invasion, lymph node positivity, seminal vesical invasion, positive surgical margins or extraprostatic extension. When stratified by race, within the AA cohort, T2:ERG did predict upgrading from Gleason 6 disease at the time of biopsy to higher grade pathology at RP (p = 0.016). However, T2:ERG was not predictive for the overall cohort, nor was it predictive for any of the disease features found to be significant with PCA3. Conclusions: In a racially-diverse group of men undergoing RP, PCA3 and T2:ERG urinary assays have limited ability to characterize aggressive pathologic features at the time of RP regardless of race.
Racial variations in upgraded gleason scores of active surveillance candidates.
Authors: Pandya Krishna , Feibus Allison H. , Sholl Andrew B. , Silberstein Jonathan L. 
Published: March 2017

e548 Background: Currently, active surveillance is an appropriate option for patients who have low risk PCa as determined by the NCCN as Gleason Score (GS) ≤ 6 and a PSA <10. Methods: Following IRB approval, we determined that 141 men from our database had low risk PCa and were eligible for AS, but underwent radical prostatectomy (RP). We performed a retrospective review of these patients examining GS upon RP. Disease upgrading on RP was considered Gleason score ≥ 7. A two-tailed t-test was performed to examine whether African American (AA) patients had greater incidence of upgrading on RP than non-African American patients. Results: Of the 141 patients identified (36 AA, 105 non-AA) there were no significant differences in age at RP (59 AA, 59 non-AA), median PSA (5.5 ng/dL AA, 5.4 ng/dL non-AA), and number of positive cores (3 AA, 3 non-AA) at biopsy when stratified by race. A total of 85 patients (19 AA, 66 non-AA) were found to have an upgraded GS at the time of RP; again without significant difference with respect to age (60 AA, 61 non-AA), serum PSA (5.3 AA, 5.35 non-AA), total cores taken at biopsy (12 AA, 12 non-AA) and median positive cores (3.5 AA, 3 non-AA). Of the 85 patients upgraded, 66 (12 AA, 54 non-AA) were 3+4 and the remainder were ≥ 4+3. There was no significant racial variation for patients upgraded to Gleason 3+4 (p>0.05). Next we reviewed the presence of tertiary pattern 5 within these 3+4 patients and found it present in 1 patient who was AA. For the 19 patients with ≥ 4+3 upgrading, with respect to race (7 AA, 12 non-AA, p = .08) there were no significant differences in age, serum PSA, median positive and total cores taken at biopsy. However, when comparing these 19 upgraded ≥ 4+3 patients to the total cohort, they had a higher median serum PSA (6.16 ng/dLvs 5.4 ng/dL) and higher positive cores (4 vs 3) on biopsy. For these 19 patients, upgrading resulted in reclassification from low to high-grade (GS ≥ 8) PCa in 7 patients. Conclusions: African American patients with low risk PCa have do not have an increased risk of significant upgrading at RP when compared with other races, and further investigation is needed to identify factors that contribute to upgrading.
Does shared decision making for PSA screening empower patients?
Authors: Talcott James Austin , Bezuhly Maureen , Aharanoff Gina , Herzstein Jessica , Osborne Michael P. , Chadha Manjeet 
Published: March 2017

e549 Background: Participant characteristics affect shared decision making. In a randomized trial of physician (MD) educational interventions to improve cancer screening guideline compliance, we studied patient (PT) and MD recall of discussions and how PT characteristics affected recall. Methods: In a cluster-randomized trial of educational supports for MDs, we are enrolling an age- (30-89 years) and sex-stratified sample of 216 PTs who underwent a physical examination at two urban hospitals, 18 for each of 12 primary care MDs. Screening guideline formatting (color-coding) and academic detailing were randomly assigned in a 2x2 design. Immediate post-encounter surveys recorded PT and MD recall of screening discussions. Results: Of the first 174 participants, 92 were men. PTs were diverse (69% white) and well educated (73% college degree). When MDs reported a prostate specific antigen (PSA) screening discussion, 32% of PTs did not, and 26% of MDs disagreed when PTs reported the discussion occurred. Further, when the MD reported recommending screening, 26% of PTs disagreed, and 33% of MDs disagreed when their patients reported a recommendation. Overall, agreement between all PTs and MDs on whether screening was recommended was fair (kappa = 0.29) but there was no agreement for PTs over 70 years (kappa = -0.03). PTs reported more elements of shared decision making than MDs (data not shown). When both PT and MD or the MD alone reported that all elements of shared medical decision making had occurred, agreement on whether screening was recommended improved (kappa = 0.54 and 0.45, respectively). When PTs disagreed with their MD, they more often reported recommending for screening not against (11 vs. 4). Conclusions: In a highly educated, diverse PT population, PTs and MDs surveyed immediately after their encounter often disagreed on whether PSA screening was discussed and recommended. Disagreement was worse with older PT age but improved when both PT and MD or the MD alone reported all shared decision making elements. Clinical trial information: NCT02430948.
Permanent prostate brachytherapy and short-term androgen deprivation for favorable and unfavorable intermediate risk: Clinical results for median 5 year follow-up.
Authors: Guerif Stephane Gilles , Molina Sarah , Hugues Guillaume , Boissonnade Odile , Debaene Bertrand , Fromont Gaelle , Berger Antoine 
Published: March 2017

e554 Background: The option of prostate brachytherapy for intermediate risk is discuss. We present mature results of permanent prostate brachytherapy and short-term androgen deprivation for favourable and unfavourable intermediate risk. Methods: From 01/2006 through 12/2012, 707 patient were treated by real time iodine brachytherapy. 135 intermediate risk, 72% favourable and 28% unfavourable were include. Unfavourable was define as a gleason 7 (4+3) or > 50 % positive biopsy or 2 intermediate factors. Neoadjuvant with or without adjuvant androgen deprivation therapy was administered to 94% patients. 91 % of patients have a duration of hormone ≤ 6 mouths. 40% had vesicle seminal biopsy. 62 % had a lymph node dissection. 75 % had a bone scan. 95% had a MpMRI with tumour index in 72 %. All patients with DIL on MpMRI had a focused real time image guided brachytherapy. Tumour control was measure with phoenix definition and death with Kaplan-Meier method. The GU and GI toxicity were measure with IPSS and CTCAE V 3, IIEF-5. Results: The mean Number of seeds used was 63 ( SD, 13). Mean prostate volume was 27 cm3 (SD, 11) and 70cc maximum. Mean dose to 90% of the prostate was 188 Gy (SD, 9). Ud30 (mean, 189 Gy; SD, 10). RD2cc (mean, 105Gy; SD, 22). Mean duration of hormone was 5,6 mouths (SD,1,6). The biologic disease free survival at 5 and 8 years were 97,1 % and 94%. The global survival at 5 and 8 years were 98%. The urinary symptoms return to the baseline at 2 years with maximum toxicity at 1 month. 2 GU grade 3. GI grade 1 2 and 3 were 34%, 15% and 0%. 20% of patients with IIEF > 16 at baseline had sexual intercourse at Two years. Conclusions: Our single-institution study with a median 5-year follow-up showed that permanent prostate brachytherapy and short-term androgen deprivation risk was safe and effective for patients with favourable and unfavourable intermediate risk prostate cancer. However the association of hormone decrease the sexual function. The place of the hormone must be explore in selected intermediate risk treated by brachytherapy.
Three year results of a prospective study on focal salvage HDR prostate brachytherapy for local recurrence after external beam radiotherapy (XRT).
Authors: Chung Hans T. , D'alimonte Laura , Loblaw Andrew , Ravi Ananth , Davidson Melanie , Wronski Matthew , Haider Masoom A. , Morton Gerard 
Published: March 2017

e558 Background: Salvage options for those with local recurrence after XRT include surgery, brachytherapy, cryotherapy or high-frequency ultrasound. However, the risk of significant complications (e.g. fistula, incontinence, bladder neck contracture), is not insignificant. The sensitivity of multiparametric MRI in detecting viable cancer within the prostate is now more than 70%. The objectives of this pilot study are to explore the toxicities, QOL and efficacy of focal salvage HDR brachytherapy in patients with MRI-visible biopsy-confirmed local recurrence. Methods: Eligible patients included: multiparametric 3T MRI-visible biopsy-confirmed local recurrence > 30 months after XRT, negative metastatic workup, IPSS < 15, post-XRT PSA < 10ng/mL, prostate volume ≤ 50cc. The ultrasound-based HDR brachytherapy prescription dose was 27Gy divided over two implants separated by 1 week to the target volume (TV) with dose constraints to the urethra and rectum. Follow-up PSA, IPSS, EPIC QOL and CTCAE v4.0 toxicities were collected. Results: 15 patients (mean age 73 years) were enrolled in the study. Median follow up was 30 months (12-42). At initial presentation, there were 5, 8 and 2 low-, intermediate- and high-risk disease, and initial XRT dose was 70-78Gy. The Gleason score of the local recurrence was 6, 7 and 8-10 in 1, 7 and 6, respectively, and not classified in 1 patient. The pre-HDR median PSA was 4.13 (1.30 – 9.29). The median size of the recurrence on MRI was 9mm (7-20), TV 6.1cc (2.2-16.1), TV V100 96.3%, TV D90 110.9%, urethral D10 64.5% and rectal D10 36.0%. No acute/late GU/GI grade 3-5 toxicities, nor urinary retention, were observed. The most common acute toxicity was frequency and nocturia. Median IPSS at baseline, 1-, 3-, 6-, 12-, 18-, 24-months was 4, 8, 5, 5, 8 and 5 (p = 0.72). Three year PSA failure free rate was 71%. There was no significant change in EPIC domains. Conclusions: Early toxicity, QOL and PSA failure-freedata suggests that focal salvage HDR brachytherapy is well tolerated and effective. Clinical trial information: NCT01583920.