bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of multiparametric magnetic resonance imaging findings with oncologic outcomes in non-palpable localized prostate cancer.
Authors: Kumar Abhishek , LaBella Dominic , Acklin-Wehnert Scarlett , Gupta Rajan T. , Salama Joseph Kamel , Boyer Matthew J 
Published: January 2024

281 Background: Multiparametric magnetic resonance imaging (mpMRI) is becoming increasingly integrated into the evaluation and medical decision making for localized prostate cancer. However, mpMRI findings have not been correlated with prostate cancer outcomes and therefore are not currently included in staging. The purpose of this study was to test the association between mpMRI detected extraprostatic extension with oncologic outcomes in patients with non-palpable prostate cancer. Methods: We used the Veterans Affairs Prostate Data Core to identify patients diagnosed with cT1N0M0 prostate cancer between 2000-2021 with an mpMRI prior to definitive treatment. We reviewed MRI reports to identify presence of extracapsular extension (MRI-T3a), seminal vesicle invasion (MRI-T3b), and adjacent organ invasion (MRI-T4). We assessed the impact of mpMRI findings on metastasis free survival with multivariable Fine-Gray competing-risks regression. Results: Overall, 3,142 veterans with cT1N0M0 prostate cancer were included. There were 1,411 (45%) Black patients. By clinical staging, 904 (29%) had low risk, 1,626 (52%) had intermediate risk, and 612 (19%) had high risk disease. The majority of patients were treated with radiation (N=2,267; 72%). There were 217 (7%) patients with MRI-T3a disease, 87 (3%) patients with MRI-T3b disease, and 26 (1%) patients with MRI-T4 disease. The median follow-up time was 5.4 years (90% CI, 1-13 years). The 5-year cumulative incidence of metastases for patients with low, intermediate, and high risk prostate cancer were 3% (95% CI, 2-4%), 7% (95% CI, 6-8%), and 15% (95% CI, 12-18%). The 5-year cumulative incidence of metastases for patients with MRI-T3a, MRI-T3b, and MRI-T4 disease were 15% (95% CI, 10-20%), 29% (95% CI, 29-39%), and 40% (95% CI, 13-66%). After controlling for age, race, risk stratification (which includes prostate specific antigen (PSA) and grade group), local therapy, and co-morbidities, the presence of MRI-T3a (HR 1.58, 95% CI 1.09-2.29, p=0.02), MRI-T3b (HR 3.38, 95% CI 2.31-4.95, p<0.0001), and MRI-T4 disease (HR 4.47, 95% CI 2.32-8.62, p<0.0001) were independently associated with worse metastasis free survival. Similar results were obtained with PSA and grade group as individual variables. Conclusions: Extraprostatic extension observed on mpMRI is independently prognostic of metastasis free survival in patients with non-palpable prostate cancer. mpMRI is a critical imaging modality that should be widely available for patients with prostate cancer, and studies are ongoing to define its role as a standard staging modality.
Interim analyses from the PROSPET-BX trial: [G8Ga]PSMA PET/CT vs. mpMRI in patients with suspicion of prostate cancer and previous negative biopsy.
Authors: Lopci Egesta , Lazzeri Massimo , Disconzi Luca , Colombo Piergiuseppe , Saita Alberto , Peschechera Roberto , Fasulo Vittorio , Maffei Davide , Zanca Roberta , Casale Paolo , Rodari Marcello , Guazzoni Giorgio Ferruccio , Balzarini Luca , Buffi Nicolo' , Lughezzani Giovanni 
Published: January 2024

282 Background: Herein we present the results of the interim analyses of our prospective trial (Identifier: NCT05297162), designed to compare [68Ga]PSMA PET/CT with mpMRI in men with a high suspicion of prostate cancer (PCa) after at least one previous negative biopsy. Methods: From April 2022 until September 2023, overall, 94 patients were screened, 78 were enrolled and 64 completed all study investigations. Inclusion criteria: PSA>4.0ng/ml; free-to-total PSA ratio <20%; progressive rise of PSA levels in two consecutive samples; at least one previous negative biopsy; negative digital rectal examination. [68Ga]PSMA PET/CT and 3T mpMRI were performed within one month, followed by TRUS-fusion prostate biopsy. Target lesions were defined based on PI-RADS v2.1 for mpMRI and Primary Score, SUVmax and SUVratio for [68Ga]PSMA PET/CT, then correlated to pathology findings. Results: Median age was 64 years (range 51-83) and median PSA 10.4 ng/ml (range 4.3-25,9). Most patients (76.6%) had one previous negative biopsy. According to re-biopsy results, 10 patients presented with clinically significant PCa (csPCa), 4 with GS 6, while the majority had a negative biopsy (78%). mpMRI results were: 40 patients with PI-RADS 2 (62.5%), 3 with PI-RADS 3 (4.7%), 15 with PI-RADS 4 (23.4%), and 6 with PI-RADS 5 (9.4%). Primary scores were: 45 score 1-2 (70%), and 19 score 3-5. PI-RADS and Primary scores were significantly correlated (P=0.0006). Median SUVmax and SUVratio were 3.7 and 1.35 for benign versus 8.9 and 3 for malignancy, respectively (P<0.001). ROC analyses identified optimal cut-off points for csPCA, with SUVmax>7.48 (AUC 0.756; 95%CI 0.633-0.855) and SUVratio>2.79 (AUC 0.748; 95%CI 0.624-0.848). PI-RADS, Primary score, SUVmax and SUVratio proved significantly associated to biopsy results. When combining [68Ga]PSMA PET/CT with mpMRI data, the detection rate was 90% for csPCa, and the combination of both modalities could spare 87.5% of unnecessary re-biopsies. Conclusions: In these interim results, [68Ga]PSMA PET/CT parameters predict biopsy results as mpMRI in patients who are candidates to re-biopsy; the combination of both modalities can spare most unnecessary re-biopsies, by granting a 90% detection rate for csPCa. Clinical trial information: NCT05297162 .
Detection and delineation of intraprostatic lesions (IPLs) using multiparametric magnetic resonance imaging (mpMRI) and prostate specific membrane antigen positron emission tomography (PSMA PET) for patients with prostate cancer: A systematic review and meta-analysis.
Authors: Dhar Aneesh , Mendez Lucas , Cendejas-Gomez Jose de Jesus , Boldt Gabriel , McArthur Eric , Zamboglou Constantinos , Bauman Glenn 
Published: January 2024

287 Background: External beam radiation therapy (EBRT) is a common treatment used for patients with prostate cancer, however, isolated local failures (ILFs) can occur in up to 13% of patients receiving EBRT. Most ILFs occur at the location of the previously known intraprostatic lesions (IPLs). The FLAME trial has shown improved cancer outcomes for patients treated with EBRT who receive a focal radiation boost to their IPL. Both mpMRI and PSMA PET can be used to localize IPL for these patients. Methods: A systematic review and meta-analysis was conducted for the use of mpMRI and PSMA PET for the detection and delineation of IPLs for patients with localized prostate cancer. Trials were included if patients received either mpMRI, PSMA PET, or both, prior to radical prostatectomy (RP). IPLs on RP specimens were used as the reference standard. The quality of the co-registration between imaging and histopathology was assessed as high or low for each study included in the systematic review. Outcomes that were recorded include sensitivity and specificity, among others. A meta-analysis was conducted using a bivariate model to determine the sensitivity, specificity, and area under the receiver operating curve (AUROC) of mpMRI, PSMA PET, and their combination. This systematic review was registered through PROSPERO (CRD42023389092). Results: After exclusions, 20 studies were incorporated into the bivariate meta-analysis. In total, there were 13 studies using mpMRI (n = 541 patients), 12 studies that used PSMA PET (n = 327), and 5 studies that used a combination (n = 180). The pooled sensitivity (95% CI), specificity (95% CI) and AUROC for mpMRI were 64.7% (50.2% – 76.9%), 86.4% (79.7% - 91.1%), and 0.852; the pooled outcomes for PSMA PET were 75.7% (64.0% - 84.5%), 87.1% (80.2% - 91.9%), and 0.889; for their combination, the pooled outcomes were 70.3% (64.1% - 75.9%), 81.9% (71.9% - 88.8%), and 0.796. When reviewing studies with a high-quality co-registration between imaging and histopathology, IPL delineation recommendations included using a 1-2 mm margin when delineating on mpMRI, using a SUV max threshold of 20-30% for PSMA PET, and using the union of mpMRI and PSMA PET when using both modalities. Conclusions: In this study, we conducted a meta-analysis of studies that used mpMRI, PSMA PET or their combination prior to RP for patients with localized prostate cancer. The pooled sensitivity and specificity for each modality had overlapping 95% confidence intervals, suggesting the modalities have similar accuracy in detecting IPLs on RP specimens. There were different delineation recommendations based on the imaging modalities used in studies with a high-quality co-registration of imaging and histopathology.
Imaging predictive biomarkers of response in patients with prostate cancer undergoing high-intensity focused ultrasound (HIFU) focal therapy.
Authors: Lopci Egesta , Lughezzani Giovanni , Fasulo Vittorio , Maffei Davide , Saita Alberto , Casale Paolo , Peschechera Roberto , Hurle Rodolfo , Benetti Alessio , Pasini Luisa , Zandegiacomo Silvia , Rodari Marcello , Zanca Roberta , Balzarini Luca , Guazzoni Giorgio Ferruccio , Buffi Nicolo' , Lazzeri Massimo 
Published: January 2024

288 Background: The current study is designed to evaluate the role of PSMA PET/CT for response prediction in prostate cancer (PCa) patients who are candidates for High-Intensity Focused Ultrasound (HIFU) focal therapy (FT). Methods: BetweenOctober 2020 and June 2023, overall 65 patients have been enrolled in our prospective, single-center study. Inclusion criteria were: PSA<20ng/mL, radiological stage ≤T2bN0M0, ISUP grade 1-3, PSMA PET/CT at baseline and at response evaluation 6-12 months post-treatment. Follow up included: PSA at 3, 6 and 12 months. Post-treatment biopsies were scheduled per-protocol at 12 months or earlier if imaging suspicious. Biochemical response and treatment failure were correlated to mpMRI and PSMA PET data, comprising PI-RADS, Primary score, SUVmax, SUVratio, and their variations after HIFU FT. Results: Median age was 67 years (range 53-80), initial PSA (iPSA) was 6.56ng/mL (range 2.25-13.25) and prostate volume was 45mL (range 20-160). The majority of the patients presented with ISUP 1 (66%). mpMRI results were: 14 patients with PI-RADS 1-2 (21.5%) and 51 with PI-RADS 3-4. Baseline Primary scores were: 30 score 1-2 (45%), and 35 score 3-5. Median baseline SUVmax and SUVratio resulted 5.4 (range 1.5-33.2) and 1.43 (range 0.86-9.39), respectively. At 3 months post-HIFU, 23% of the patients obtained a PSA response ≥50%; whereas at 6 months and 12 months, PSA responses were 26% and 45%, respectively. Post-treatment PSMA PET/CT was available in 40 patients. Median SUVmax and SUVratio post-treatment resulted 3.4 (range 1.4-28.4) and 1.1 (range 0.64-10), respectively, with a median ΔSUVmax of 39% and ΔSUVratio of 42%. There was a moderate negative correlation between post-treatment SUVmax and SUVratio with PSA response at 12 months (rho=-0.504, p=0.0280, and rho=-0.521, p=0.0231, respectively), while a positive moderate correlation was confirmed for ΔSUVmax (rho=0.475, p=0.0383). PET parameters were also statistically significantly correlated to treatment failure at 12months (p=0.020, p=0.048 and p=0,04, respectively for SUVmax, SUVratio and Primary), with Primary scores confirmed as predictive on logistic regression (OR=10.5; 95%CI 1.12-98.9). Conclusions: PSMA PET/CT provides useful information for treatment monitoring in PCa patients undergoing HIFU FT. Baseline and post-treatment SUV parameters and Primary score can predict biochemical response and treatment failure at 12 months post-completion.
Association of aggressive prostate cancer features on whole-mount histopathology and quantitative measures on PSMA PET.
Authors: Sonni Ida , Kim Daniel Hyeong Seok , Ter-Pogosyan Arthur , Grogan Tristan , Barroso Nashla , Ahuja Preeti , Soin Priti , Calais Jeremie , Reiter Robert Evan , Hsu William , Czernin Johannes , Sisk Anthony E , Raman Steven 
Published: January 2024

289 Background: The intraductal carcinoma (IDC) and the large cribriform growth pattern (LCP) are two architectural patterns of prostate cancer (PC) associated to more aggressive disease, high Gleason scores, advanced tumor stage, biochemical relapse, and distant metastasis. Predicting the presence of these pathology features could be of significant help in case whole-mount pathology (WMHP) is not available. The goal of this analysis was to assess the distribution of quantitative parameters from 68Ga-PSMA-11 PET/CT (PSMA PET) in lesions with and without LCP/IDC patterns on WMHP. We assessed the ability of pre-surgical PSMA PET imaging to predict the presence of aggressive pathology features. Methods: With IRB approval and HIPAA compliance, we derived a study cohort of PC patients who underwent PSMA PET prior to robotic radical prostatectomy (RALP). WMHP analysis described presence/absence of LCP and IDC patterns in each identified PC lesion. Board-certified physicians contoured all PC lesions on PSMA PET. Only lesions matching with WMHP were included in the analysis. PSMA PET metrics (SUVmax, SUVmean and PSMA-volume) were extracted. All lesions were categorized in sub-cohorts as LCP+/IDC+, LCP+/IDC-, LCP-/IDC-, and LCP-/IDC+. One way-ANOVA assessed significant differences among the imaging parameters in the sub-cohorts. The area under the curve (AUC) from ROC analysis was used to assess the ability of imaging metrics to predict the presence of aggressive PC features on WMHP. Results: The final cohort comprised 155 patients and 177 lesions. The median (IQR) PSA at time of RALP was 9.2 (5.55-15.05). 73/177 lesions (41.2%) were categorized as LCP+/IDC+, 63/177 (35.6%) as LCP-/IDC-, 37/177 (20.9%) as LCP+/IDC-, and 4 (2.3%) as LCP-/IDC-. SUVmax (p=0.007), SUVmean (p=0.048) and lesion size on PSMA PET (p=0.003) were significantly higher in lesions showing LCP, whereas only lesion size was significantly higher in lesions showing IDC (p=0.003). Lesions showing LCP+/IDC- had significantly higher SUVmax (p=0.002) and SUVmean (p=0.001) than lesions showing LCP-/IDC-. SUVmean was significantly higher in LCP+/IDC- than in LCP+/IDC+ (0.043). SUVmax and SUVmean were not significantly different among other sub-cohorts. Lesion size on PSMA PET was significantly higher in LCP+/IDC+ than in LCP-/IDC- (0.009). A logistic regression model analysis showed that PSMA PET quantitative measures predict the presence of LCP and/or IDC with moderate accuracy (AUC= 0.69; p=0.001). Conclusions: Higher SUVmax and SUVmean are found in lesions showing LCP, but not in those showing IDC. A linear regression model including SUVmax, SUVmean and PSMA PET lesion volume was able to predict with moderate accuracy the presence of pathology features of aggressive prostate cancer (AUC: 0.69).
Prospective evaluation of the Kaiser Permanente prostate cancer risk calculator in biopsy-naïve men with mild PSA elevations.
Authors: Presti Joseph , Horton Brandon , Alexeeff Stacey , Prausnitz Stephanie , Avins Andrew 
Published: January 2024

290 Background: To assess the impact on biopsy outcomes in biopsy-naïve men with mild PSA elevations (<10 ng/ml) when provided risk estimates using a novel prostate cancer risk calculator. Methods: This prospective study was conducted in urology departments in Kaiser Permanente Northern California in men with PSA elevations that were <10 ng/ml between March 2021 and March 2023. Patient variables (age, race, family history of prostate cancer, body mass index, and PSA level) were entered into our validated calculator. Risk estimates for high-grade cancer (Gleason score ≥7) and overall cancer were shared with the patient who accepted or declined the biopsy. We compared age, race, family history for prostate cancer, BMI, PSA level, predicted high-grade and overall cancer risks between those that accepted and those that declined biopsy. The outcomes of those who underwent biopsy were compared to historical data of biopsy-naïve men with PSA elevations <10 ng/ml who underwent biopsy in the three years prior to the Covid pandemic between January 2016 and December 2019 (n=5141). Results: After 24 months, the calculator was used to estimate risk for 1962 biopsy-naïve men with mild PSA elevations. 1455 (74%) accepted the biopsy. Those with a family history for prostate cancer were slightly more likely to accept biopsy. Age (continuous and categorical), and BMI (continuous and categorical) were not associated with decision for biopsy. Similarly, race/ethnicity when analyzed as four categories (White, Black, Asian, Hispanic) or as two categories (Black vs. all others) was not associated with decision for biopsy. The men who accepted the biopsy had higher predicted median high-grade cancer risks (24% [IQR 17-31%] vs. 20% [IQR 14-29%]; p<0.0001) and higher predicted median overall cancer risks (48% [IQR 40-56%] vs 45% [IQR 37-53%], respectively; p<0.0001) than those who declined the biopsy. Compared to the historical group, use of the risk calculator resulted in a biopsy population enriched with high-grade cancer: 29% vs 25%; similar rates of low-grade cancer: 24% vs 24%; and fewer negative biopsies: 47% vs. 51%, respectively; overall p=0.013. Conclusions: In biopsy-naïve men with mild PSA elevations, use of our risk calculator resulted in a biopsy population that had more high-grade cancer and fewer negative biopsies compared to a historical group. Only family history and higher predicted cancer risks by the calculator were associated with biopsy acceptance.
The risk of prostate cancer diagnosis in men with an elevated PSA but low IsoPSA.
Authors: Abdallah Nour , Benidir Tarik , Wood Andrew , Lone Zaeem M , Campbell Rebecca , Zhang Ao , Ergun Onuralp , Curry Caleb , Liao Ross , Michael Patrick , Haywood Samuel , Schwen Zeyad , Olivares Ruben , Kaouk Jihad , Abouassaly Robert , Klein Eric A. , Weight Christopher 
Published: January 2024

292 Background: IsoPSA is a structure-based serum assay. Initial studies demonstrated that it outperformed total and percent-free PSA in detecting clinically significant prostate cancer (csPCa) (i.e., grade group (GG) ≥2) on biopsy. This led to an overall reduction in invasive testing and magnetic resonance imaging (MRI). We sought to compare the risk of csPCa in patients with an initially normal or high IsoPSA, thus assessing IsoPSA’s prospective predictive ability of csPCa. Methods: We performed a single-center retrospective review of patients (n=1578) who underwent IsoPSA testing from November 2016 to August 2022. Data was dichotomized into patients with normal (≤6) and high IsoPSA (>6). We collected the outcomes of any follow-up IsoPSA, prostate biopsy, MRI, and diagnosis of prostate cancer. In the case of multiple follow-up tests, the most recent one was recorded. Results: The median follow-up time of 1578 patients who underwent IsoPSA testing was 24 months (IQR 16-29). Among 541 patients with an initial normal IsoPSA, 60 (11.1%) had a subsequent high IsoPSA, 23 (4.3%) had csPCa on a subsequent biopsy, and 48 (8.9%) had suspicious lesions on MRI (PI-RADS 4-5). Among 1037 patients with an initial high IsoPSA, 366 (35.3%) had csPCa on a subsequent biopsy and 342 (33%) had suspicious lesions on MRI. The sensitivity of IsoPSA to predict csPCa was 94.1%, and its negative predictive value was 89.3%. Conclusions: With 24-month follow-up, 4.3% of patients with normal IsoPSA developed csPCa, suggesting that a low baseline IsoPSA provides durable information about the 2-year risk of csPCa.[Table: see text]
Burnout among GU oncologists and associated factors: BUCARE survey.
Authors: Kahharov Alisher , Tsimafeyeu Ilya , Shatkovskaya Oxana , Kaidarova Dilyara , Polatova Jamila , Guliyev Fuad , Ongarbayev Bakytzhan , Mitin Timur 
Published: January 2024

293 Background: The growing number of patients with genitourinary (GU) cancers coupled with complexity of their treatments could create an increasing burden on GU oncologists. The Bureau for Cancer Research (BUCARE) assessed the prevalence of burnout among GU oncologists. Methods: This is a cross-sectional survey study conducted online among practicing surgical, medical and radiation oncologists from Kazakhstan, Russia, Uzbekistan, Azerbaijan, Georgia, Kyrgyzstan, Tajikistan, and Israel. The primary outcome is burnout experience assessed through the Maslach Burnout Inventory. Association between respondents’ characteristics and presence of burnout was tested using X-test. Results: From April to August 2023,a total of 674 GU oncologists completed the questionnaire. The characteristics of respondents are 50% female, 45% medical oncologists, 35% surgeons, 15% radiation oncologists, working in outpatient (35%) and inpatient (65%) departments. Ninety-two percent of responders are interested in their daily work and 83.7% have a great interest in further professional development. However, 71.5% (482 of 674) had symptoms of burnout (high emotional exhaustion and/or depersonalization scores) and 60.8% of respondents describe readiness to seek psychological support. 172 (25.5%) and 401 (59.5%) participants reported that they do not have enough time to communicate with their family at all or partially, respectively. Significant drivers of burnout identified in multivariable regression modeling include ≥20 patients per day (odds ratio [OR] = 15.1; P<0.001) and ≥10 working hours per day (OR=10.4; P<0.001). Male gender (OR=0.1; P<0.001) and specialization in radiation oncology (OR=0.19; P<0.01) are associated with lower odds of burnout. Conclusions: Two-thirds of surveyed GU oncologists met predefined standardized criteria for burnout. Expanding the staff of GU oncologists and reducing the daily workload may improve the emotional state of these physicians. Special attention must be paid to the work environment of female providers as well as surgical and medical oncologists to decrease the rate of burnout.