bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contemporary management and pathologic outcomes of men with low- and very low-risk prostate cancer.
Authors: Ho Austin Y. , Li Eric , Bennett Richard , Aguiar Jonathan , Kumar Sai , Neill Clayton , Schaeffer Edward M. , Patel Hiten Dilip , Ross Ashley 
Published: January 2024

297 Background: The very-low risk (VLR) substratification of prostate cancer has been called into question with the 2022 American Urological Association (AUA) guidelines dropping this designation. Historical data suggested men with VLR disease have a reduced risk of disease progression compared to other low risk (LR) men. In this study, we evaluate contemporary initial management, disease progression, and predictors of upgrading for VLR and LR patients in a multi-centered hospital system. Methods: We retrospectively identified men diagnosed with VLR or LR prostate cancer across our eleven-hospital system (January 2018-September 2022). Active surveillance (AS) was defined as no treatment within 1 year of diagnosis. Adverse pathology at surgery was defined as Gleason Grade (GG) 3-5 or pT3b. Clinical variables were compared with appropriate statistical tests (Wilcoxon rank sum, Chi square, Fisher’s exact). A multivariable logistic regression model evaluated predictors of upgrading (≥GG2). Results: 566 patients (305 VLR, 261 LR) were included. AS was the initial management for 85% and 78% of VLR and LR patients, respectively (p=0.029). With a median follow up time of 26 months, VLR patients were less likely receive treatment versus LR patients (24% vs. 38%, p<0.001) or be reclassified to GG2-5 disease (24% vs. 39%, p<0.001). VLR patients had less volume of disease at diagnosis by percentage of positive cores (7% vs. 16%, p<0.001) and maximum core positivity (7% vs. 20%, p<0.001). On multivariable regression analysis, only pre-biopsy PI-RADS (OR 1.88 for PI-RADS 4 (p=0.030); OR 4.53 for PI-RADS 5 (p<0.001)) and percentage of positive cores (OR 1.02, p=0.039) were significant predictors of upgrading. Of men who receiving surgery, adverse pathology rates were similar for VLR and LR patients (14% vs. 19%, p=0.5). Conclusions: Men with VLR prostate cancer have lower treatment and upgrading rates than LR patients. VLR patients were more likely to be initially managed with AS and forgo definitive treatment, but rates of adverse pathology at surgery were similar. The findings support the AUA decision to drop the VLR substratification, but attention to high MRI PI-RADS and percentage of positive cores at diagnosis should be considered when evaluating risk of disease progression for men with GG1 prostate cancer.[Table: see text]
Real-world treatment patterns for patients with high-risk biochemically recurrent nonmetastatic castration-sensitive prostate cancer.
Authors: Freedland Stephen J. , Ribbands Amanda , Butcher Jake , Brown Tom , Russell David , Bland Christopher S , Touya Maelys , Ivanova Jasmina I. 
Published: January 2024

299 Background: Patients with biochemically recurrent (BCR) nonmetastatic castration-sensitive prostate cancer (nmCSPC) who are identified as high-risk of developing metastases may benefit from earlier treatment. This study analyzed treatment patterns in these patients. Methods: The Adelphi Real World nmCSPC retrospective survey was completed by urologists and radiation oncologists in the US. For this analysis, data from medical charts for patients diagnosed with high-risk BCR nmCSPC from Jan 2021–Jul 2023 were extracted; physicians completed a chart for their last 6–8 patients. Data were analyzed descriptively for first line (1L) treatment received (regardless of time) since high-risk BCR diagnosis for the total patient sample and subgroups of interest. Physicians documented those with no treatment as on observation. Results: Aggregated data were analyzed for 376 patients with high-risk BCR nmCSPC; 252 (67%) had prostate-specific antigen doubling time (PSADT) ≤9 months after BCR and initial definitive therapy of radiotherapy (RT) and/or radical prostatectomy (RP). Overall, 84% were treated by urologists and 16% by radiation oncologists. Median age was 70 years; 64% were White, 31% were Black/African American. Median PSA at high-risk BCR diagnosis was 5 ng/mL. Median follow-up after high-risk BCR diagnosis was 249 days. Median time between high-risk BCR diagnosis and initiation of 1L treatment was 17 days. Most common 1L treatments were androgen deprivation therapy (ADT) alone, salvage RT, novel hormonal therapy (NHT) + ADT, and observation alone. For patients on observation alone, median follow-up after high-risk BCR diagnosis was 181 days. Few numerical differences were seen in treatment patterns depending on how patients were determined as high-risk (Table). Patients treated by urologists rather than radiation oncologists had numerically higher proportions of 1L treatment with NHT + ADT (21% / 2%) and observation alone (17% / 8%), and numerically lower proportions of ADT alone (27% / 34%) and salvage RT (12% / 44%). Conclusions: First line treatments were typically initiated rapidly following high-risk BCR nmCSPC diagnosis, with only 15% of patients receiving observation alone during available follow-up. [Table: see text]
Endocrine and metabolic diseases among survivors of prostate cancer in a population-based cohort.
Authors: Hu Siqi , Chang Chun-Pin , Dodson Mark W. , Deshmukh Vikrant , Newman Michael , Date Ankita , Sanchez Alejandro , Lloyd Shane , ONeil Brock , Hashibe Mia 
Published: January 2024

306 Background: Prostate cancer treatment has been widely associated with developing and/or worsening metabolic syndrome. While numerous studies have explored the interplay between prostate cancer and metabolism, there have been very few studies investigating endocrine and metabolic disease diagnoses among prostate cancer survivors with long term follow up. The aim of this study is to examine the incidence of endocrine and metabolic disease among prostate cancer survivors compared to a general population cohort. A secondary aim is to investigate risk factors for endocrine and metabolic disease among prostate cancer survivors. Methods: Cohorts of 18,134 cancer patients with prostate adenocarcinomas diagnosed between 2004 and 2017 and 73,470 men without cancer matched by age, birth state and follow up time from the general population were identified. Incidental endocrine and metabolic diseases diagnoses were identified from electronic medical records and statewide healthcare facilities data. Cox proportional hazard models were used to estimate hazard ratios (HRs). Results: Prostate cancer patients had increased risks of endocrine and metabolic diseases for the overall 16-year follow-up after cancer diagnosis (1-5 years: HR=1.26, 99%CI=1.22-1.31; 5-10 years: HR=1.21, 99%CI=1.16-1.26; 10-16 years: HR=1.20, 99%CI=1.12-1.28) compared to the general population. Elevated risks of thyroid disorder among prostate cancer patients were observed across follow-up periods (1-5 years: HR=1.19, 99%CI=1.11-1.28; 5-10 years: HR=1.12, 99%CI=1.03-1.22; 10-16 years: HR=1.17, 99%CI=1.02-1.35). Similarly, disorders of lipid metabolism risks were higher for all follow-up periods (1-5 years: HR=1.53, 99%CI=1.41-1.66; 5-10 years: HR=1.21, 99%CI=1.15-1.26; 10-16 years: HR=1.20, 99%CI=1.11-1.29). The risks of obesity and diabetes mellitus were also increased within 1-10 years and 1-5 years, respectively. Risk factors for endocrine and metabolic diseases among prostate cancer survivors included non-Hispanic ethnicity, unhealthy BMI, CCI≥1, family history of cancer, older age at diagnosis, and higher cancer stage throughout the overall follow-up periods after prostate cancer diagnosis. Significant risk factors for endocrine and metabolic diseases within 1-10 years after prostate cancer diagnosis included family history of prostate cancer, single marital status, government health insurance, high socioeconomic level, and high household incomes. Moreover, prostate cancer survivors with a diagnosis of endocrine and metabolic diseases faced a 13% increased risk of death. Conclusions: This study highlights a heightened risk of endocrine and metabolic diseases among prostate cancer survivors throughout the entire follow-up period after cancer diagnosis. It underscores the importance of multidisciplinary care to monitor and manage endocrine and metabolic diseases in this population of survivors.
Prostate Cancer Supportive Care (PCSC) Program: A model for meeting an unmet need for patients with PC.
Authors: Higano Celestia S. , Sundar Monita , Zarowski Christine , Lui Meghan , Pratap Nicholas , Egilson Joy , Holmes Andrea , Ivanov Nikita , Dayan Marcy , Hudon-Kaide Anna , Griggs Paul , Maurice-Dror Corinne , Ho Rosalie , Sare Daniella , Hwang Angela , Flannigan Ryan 
Published: January 2024

308 Background: Prostate cancer (PC) patients (pts) face treatment-related sequelae that affect their quality of life. The PCSC Program was created in 2013 and is located in the Vancouver Prostate Centre’s urology clinic. It is a clinical, educational, and evidence-based program that addresses challenges experienced by PC pts from the time of diagnosis onward. The program consists of 8 “modules,” each designed to support a specific concern. Methods: We describe the operational details of the PCSC Program and its metrics. Results: The program consists of a Medical Director and Program Manager who articulate the mission, oversee the day-to-day operations, and hire and manage the allied health clinicians and administrative staff. Clinicians include two sexual health RNs (1.4 FTE), two pelvic floor physiotherapists, a nurse practitioner, a registered dietitian, two clinical exercise physiologists, and two clinical counselors (all 0.2 FTE). A sexual health urologist is in the clinic, and a medical oncologist delivers the metastatic disease module. As of 09/2023, 3562 pts registered for this no-cost program (Table). Pts choose modules relevant to their interests and needs. The program supports free language interpretation services to non-English speaking pts. Translation of education session recordings is currently underway. In 4/2020, in response to the COVID-19 pandemic, the real-time group education sessions and clinic appointments transitioned from in-person to hybrid delivery, with virtual options enabling the participation of pts from throughout British Columbia. PCSC maintains high patient satisfaction, as indicated by responses to patient satisfaction questionnaires. Conclusions: The need for PC supportive care is well recognized but may be challenging when the services are fragmented, costly, and time-consuming to orchestrate. All modules offered by the PCSC Program can be accessed with one registration and are conveniently housed in one location, which also facilitates clinician communications across disciplines. We attribute the success of our program and high patient satisfaction to this model and our team approach to the individual patient’s needs. [Table: see text]
Transperineal prostate biopsies without routine administration of perioperative antibiotics: A single-institution retrospective analysis.
Authors: Lichtbroun Benjamin , Patel Mann , Khizir Labeeqa , Said Munisa , Consalvo Alexis , Chien Austin , Chua Kevin J. , Srivastava Arnav , Pfail John , Elsamra Sammy , Jang Thomas L. , Ghodoussipour Saum 
Published: January 2024

310 Background: Infections are the most feared complication of transrectal prostate biopsy. Unfortunately, these complications are not infrequent. With antibiotic resistance becoming increasingly common, our institution has transitioned to a transperineal approach without use of perioperative antibiotics or bowel preparation. Given this significant change in practice pattern, we retrospectively analyzed these patients for rates of post-operative complications, 30-day hospital readmissions, and detection of prostate cancer. Methods: We retrospectively analyzed 146 patients who underwent a transperineal prostate biopsy at our institution in 2022. We recorded rates of complications including UTIs, sepsis, hematuria, and 30-day hospital readmissions. We also analyzed the percentage of patients found to have prostate cancer. Results: Of the 146 patients analyzed, 8 patients received peri-operative antibiotics (5.47%) - this was at the discretion of the surgeon performing the procedure. The reason 8 patients received peri-operative antibiotics was due to a prior infectious complication following a previous transrectal prostate biopsy. No patient received bowel preparation. Pre-procedure MRI was performed in 134 patients who had a MRI-ultrasound fusion biopsy. Hematuria was reported in 12 patients (8.21%) and there were zero infectious complications (UTI or sepsis). There were no 30-day readmissions amongst this cohort. Median procedure time was 24 minutes (Table). 86 patients were found to have adenocarcinoma (58.90) while 48 patients had benign pathology (32.87%). Conclusions: Despite a small percentage of patients receiving perioperative antibiotics, we had zero patients develop sepsis or an UTI. Our 30-day readmission rate was also 0%. With the high reported rates of infectious complications after transrectal prostate biopsy and antibiotic resistance becoming increasingly common, our data supports the notion that transperineal prostate biopsies are safe and can largely be done without the use of perioperative antibiotics.[Table: see text]
De novo financial toxicity in patients with prostate cancer following radical prostatectomy and its impact on health-related quality of life.
Authors: Westhofen Thilo , Buchner Alexander , Eismann Lennert , Rodler Severin , Becker Armin , Stief Christian G. , Kretschmer Alexander 
Published: January 2024

318 Background: Financial toxicity (FT), a patient-reported outcome measure (PROM) is defined as the detrimental impact of financial burden caused by a cancer diagnosis on a patient’s well-being. FT is common among cancer patients, yet little is known about FT following radical prostatectomy (RP) for prostate cancer in countries with universal health coverage. We aimed to assess de novo FT and its impact on health-related quality of life (HRQOL) in a large prospective cohort of patients undergoing RP with a systematic follow-up of up to 10 yrs. Methods: 2254 consecutive patients who underwent RP at a large tertiary care center were analyzed. PROMs were prospectively assessed preoperatively, postoperatively at 3mo, then annually until a maximum follow-up of 120mo, applying the validated EORTC QLQ-C30- and the prostate cancer-specific QLQ-PR25 questionnaires. FT was assessed by the “financial toxicity subscale” (FTS) of the EORTC QLQ-C30. Based on previous reports, meaningful FT was defined as FTS ≥ 17. Multivariable regression analysis was used to identify predictors for the development of de novo FT. Separate modeling of longitudinal HRQOL was performed for patients with de novo FT (FT-cohort) and without FT (no-FT-cohort). General HRQOL was assessed by the global health status domain (GHS) of the EORTC QLQ-C30. Results: 298 patients reporting FT prior RP were excluded from further analysis. 20.3% (n=397) of the included patients reported de novo FT within 12 months after RP with a mean FTS-score of 47.3 (SD 21.9). Baseline clinicopathological characteristics did not differ between the FT-cohort and the no-FT-cohort (p-range .060-.173). Multivariable logistic regression analysis revealed subsequent therapies following RP (OR 1.981, 95%CI 1.11-3.53, p=.020), low preoperative emotional functioning (OR 0.990, 95%CI 0.92-0.99, p=.031) and low preoperative social functioning (OR 0.990, 95%CI 0.98-0.99, p=.035) to independently predict development of de novo FT after RP. In longitudinal analysis, significantly worse general HRQOL was observed for patients with de novo FT postoperatively and up to 48mo after RP (p-value each < .001). In the longer term, both cohorts reported no significant difference in general HRQOL up to 10yrs post RP (p-range: .90 - .91). Conclusions: The current study provides prospective data from a unique contemporary patient cohort, which reveals independent predictors for de novo FT in prostate cancer patients following RP. Furthermore, it displays the natural course of general HRQOL for patients who develop de novo FT.
Assessing the clinical utility of rapid post-therapy whole-body digital SPECT/CT in evaluating early treatment response of 177Lu-PSMA-617 treatment.
Authors: Song Hong , Leonio Maria Isabel , Ferri Valentina , Duan Heying , Shah Jagruti , Moradi Farshad , Mari Aparici Carina , Franc Benjamin Lewis , Davidzon Guido , Bergstrom Colin P , Fan Alice C. , Shah Sumit , Khaki Ali Raza , Srinivas Sandy , Iagaru Andrei 
Published: January 2024

32 Background: Multi-detector cadmium-zinc-telluride (CZT) based whole-body digital SPECT/CT is a new generation of imaging system. We aim to assess the clinical utility of rapid post-therapy whole-body SPECT/CT scan in evaluating early treatment response of 177Lu-PSMA-617 treatment. Methods: We retrospectively reviewed patients with progressive metastatic castration resistant prostate cancer (mCRPC) who were treated with at least two cycles of 177Lu-PSMA-617 at our institution from June 2022 to June 2023. Post-therapy whole-body digital SPECT/CT (GE StarGuide) was performed from vertex to mid-thigh at 1-2 hours after 177Lu-PSMA-617 infusion. Post-therapy SPECT/CT images were quantified with MIM software. Lu177-PSMA positive lesions were delineated with liver parenchyma uptake as cut-off. Lu-PSMA positive total tumor volume (Lu-TTV), tumor SUVmax and SUVmean were obtained. Post-therapy SPECT/CT image after cycle 1 was used as baseline for comparison with SPECT/CT after cycle 2 and 3. Overall survival, PSA progression free survival (PSA-PFS) as defined by PCWG3 and PSA decline > 50% from baseline (PSA50) at any time after treatment were measured. Changes in post-therapy SPECT/CT were correlated with clinical outcomes to assess quantitative SPECT/CT as a tool for early treatment response. Analyses were performed with SPSS. Results: A total of 56 patients (76±8, mean ± SD, range 60-93 years old) who were imaged with at least 2 post-therapy SPECT/CT were included in the analysis. Post-therapy whole body SPECT/CT was acquired in ~12 mins. All scanned patients tolerated the rapid whole-body SPECT/CT very well. With median follow up of 10 months, median PSA-PFS was 5.0 months (range 1.0-15 months), 33 of 56 patients (58.9%) achieved PSA50 at any time after treatment, and 42 of 56 patients (75%) were alive at data cutoff. Quantitative analysis of SPECT/CT images showed that 36 of 56 patients (64%) had a >30% decrease in Lu-TTV on early follow-up post-therapy SPECT/CT after cycle 2 or 3. Kaplan-Meier survival analysis showed that a >30% decrease in Lu-TTV was associated with longer overall survival (median not reached vs 6 months, P = 0.008) and longer PSA-PFS (6 months vs 1 months, P < 0.001). Decrease in SUVmax or SUVmean, however, was not associated with PSA-PFS or overall survival. Conclusions: Rapid post-therapy whole-body digital SPECT/CT was well tolerated in post-therapy SPECT/CT imaging following 177Lu-PSMA-617 treatment. Quantitation of post-therapy SPECT/CT may be useful in evaluating early treatment response of 177Lu-PSMA-617. Prospective validation and larger patient cohorts are needed to further elucidate the role of post-therapy SPECT/CT imaging in guiding patient management in 177Lu-PSMA-617 therapy.
Long-term outcomes of a multicenter prospective observational study of active surveillance for early-stage prostate cancer: The PRIAS-JAPAN study.
Authors: Kato Takuma , Matsumoto Ryuji , Yokomizo Akira , Tohi Yoichiro , Mori Keiichiro , Fujii Yoichi , Fukuhara Hiroshi , Sato Takuma , Inokuchi Junichi , Hashine Katsuyoshi , Sakamoto Shinichi , Sugimoto Mikio , Kakehi Yoshiyuki ,   the PRIAS-JAPAN study group
Published: January 2024

322 Background: Japan is participating in the Prostate cancer Research International: Active Surveillance (PRIAS) study as PRIAS-JAPAN since 2010. This study’s aim is to report the long-term outcomes of the PRIAS-JAPAN study initiated in 2010. Methods: Basic patient eligibility criteria were clinical stage ≤T2, PSA ≤10, PSA density (PSAD) <0.2, number of positive cores ≤2, and Gleason score (GS) ≤6. Those have been revised progressively since then, and since January 2021, for patients who underwent MRI fusion biopsy at the time of initiation or follow-up biopsy, PSA ≤ 20, PSAD < 0.25, and the number of positive cores ≤ 2 for GS3+3, and ≤ 6 for GS3+4. For the number of positive cores, the eligibility criteria were expanded to no limit for GS3+3 and no more than half of the total number of cores for GS3+4. PSA test every 3 months, rectal examination every 6 months, biopsy at 1, 4, 7, and 10 years, and every 5 years thereafter, and recommendation for secondary treatment after confirming pathological deterioration. Reevaluation of MRI within 3 months after diagnosis and targeted biopsy of the same site if there is a lesion suspicious for cancer, and recommends annual MRI when PSA-DT < 10 years and annual systematic biopsy if MRI cannot be performed. Results: As of the end of February 2023, 1204 patients were enrolled. The eligibility criteria were met in 1173 patients. The median age, PSA, PSAD, and number of positive cores were 69 years, 5.3, 0.15, 1, 844, and 309, respectively, and the clinical stage was T1c in 1,019 and T2 in 154 patients. The acceptance rates of re-biopsy at 1, 4, 7, and 10 years were 83.0%, 63.5%, 39.0%, and 20.3%, respectively, and the pathological deterioration rate at each re-biopsy was 29.4%, 29.7%, and 35.6%, respectively. The pathological deterioration rate at the time of each biopsy was 29.4%, 29.7%, 35.6%, and 18.1%, respectively.467 patients selected subsequent therapy and prostatectomy was the most frequently chosen treatment option. Conclusions: Pathological deterioration was observed in about 30% of patients at the time of biopsy, but the rate of biopsy decreased over time. Adherence to biopsy was considered necessary for the safe implementation of active surveillance. Clinical trial information: 2021-211.[Table: see text]