bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of suicide-related deaths (SRD) among patients diagnosed with metastatic genitourinary (mGU) cancers: A retrospective cohort study.
Authors: Ayaz Ahsan , Naqvi Syed Arsalan Ahmed , Imran Manal , Saxena Akshat , Raina Ammad , Khakwani Kaneez Zahra Rubab , Cobran Ewan Kemar , Mir Sajid Ahmad , Singh Parminder , Bryce Alan Haruo , Riaz Irbaz Bin 
Published: January 2024

230 Background: Elevated suicide risk is established in cancer patients compared with the general population. We aim to investigate the risk of SRD among individuals diagnosed with mGU cancers. Methods: Surveillance, Epidemiology, and End Results (SEER) database (2004-2020) was queried to obtain data on suicide death in adults (>20 years of age) diagnosed with mGU cancers including bladder cancer (BC), kidney cancer (KC), and prostate cancer (PC). Standardized mortality ratios (SMRs) with 95% confidence interval (CI) were computed overall and by latency period of <1, 1-5, and >5 years (y) after the initial diagnosis of mGU cancers. SMR >1 indicated increased while <1 indicated decreased SRD. Stratification was done by age (<50y, 50-70y, >70y), race (White, Black, Asian, Native American), ethnicity (Hispanic, non-Hispanic), chemotherapy, radiotherapy, surgery, and marital. Results: This analysis included 87,357 mGU patients. In overall population, the risk of suicide-related deaths was highest <1y after diagnosis (SMR: 3.29, 95% CI: 2.47-4.29) followed by 1-5y (2.61, 2.0-3.35) and >5y (1.27, 0.61-2.34) after diagnosis. With respect to race, SRD was significantly higher in Whites (3.31, 2.46-4.36) but not in Blacks (2.58, 0.31-9.33), and Asians (2.03 (0.05-11.3). In ethnic subgroups, non-Hispanics were observed to have increased SRD (3.71, 2.77-4.86) but not Hispanics (0.83, 0.1-3.0). Patients who received chemotherapy (3.74, 2.10-6.18) or those who did not receive radiotherapy (3.66, 2.68-4.89) were more likely to die from suicide. In terms of marital status, single patients had a higher SRD (4.39, 2.94-6.30) compared to those who were married (2.54, 1.65-3.76). Detailed results are outlined in the Table. Conclusions: Patients with GU malignancies are at increased risk of SRD. Targeted and timely interventions in highest risk subgroups such as Non-Hispanic patients with a recent cancer diagnosis with no partner support, may reduce the risk of SRD in patients diagnosed with mGU cancers. [Table: see text]
Disparities in prostate cancer mortality and clinical trial availability across vulnerable populations.
Authors: Sekar Rishi , Morgan Todd Matthew , Wallner Lauren P. , Stensland Kristian , Herrel Lindsey A. 
Published: January 2024

24 Background: Clinical trials provide high-level evidence and test novel therapies that have significantly improved cancer outcomes. However, disparities in clinical trial participation and cancer mortality persist across race/ethnicity and vulnerable populations, notably in patients with prostate cancer (PCa). Adverse social determinants of health (SDOH) and systemic barriers may underlie these disparities. Identifying and overcoming these barriers may improve access to and representation in clinical trials, thereby promoting equitable advancement and applicability of science. For these reasons, we evaluate the association between clinical trial availability, cancer mortality, and population-level SDOH in PCa. Methods: Using custom data linkage from ClinicalTrials.gov, Surveillance Epidemiology and End Results (SEER) Registry, and the Centers for Disease Control and Prevention Social Vulnerability Index (SVI), we performed a cross-sectional analysis of county-level PCa clinical trial data, cancer incidence and mortality rates, and population-level SDOH. We included Phase 2 and Phase 3 interventional PCa clinical trials with start dates from 2007 to 2022. The total number of clinical trials over the study period was calculated per county and population-adjusted for 100,000 residents. Counties were stratified into quintiles based on SVI (i.e., least vulnerable to most vulnerable). Population-adjusted clinical trial availability, cancer incidence, and cancer mortality were compared across SVI quintiles. Multivariable logistic and linear regression analyses were performed to evaluate the association between SVI and clinical trial availability and cancer mortality, respectively. Results: The mean number of PCa trials per 100,000 residents was 25.6, with the most vulnerable counties having fewer clinical trials compared to the least vulnerable counties (mean 18.1 vs. 50.0, p<0.05). Further, the most vulnerable counties had a lower PCa incidence rate per 100,000 residents (mean 393.8 vs. 411.7, p<0.05), but a higher PCa mortality rate per 100,000 residents (mean 85.7 vs. 72.0, p<0.05). On multivariable regression analysis, the most vulnerable counties were associated with significantly decreased odds of having any PCa clinical trial (OR 0.3, 95% CI 0.2 – 0.4) and significantly increased PCa mortality (10.8, 95% CI 7.4 – 14.3), while the presence of any PCa clinical trial was associated with significantly decreased PCa mortality (-6.9, 95% CI -9.1 – -4.7). Conclusions: The most vulnerable counties were far less likely to have any PCa clinical trials despite having a significantly higher PCa mortality rate. The presence of a PCa clinical trial was associated with a reduction in PCa mortality. These vulnerable counties represent scientifically underserved populations that may benefit from equity-driven clinical trial enrollment and cancer care infrastructure expansion.
Randomized trial of transperineal versus transrectal prostate biopsy to prevent infection complications.
Authors: Hu Jim C. , Vickers Andrew , Allaf Mohamad E. , Ehdaie Behfar , Cohen Andrew J , Ristau Benjamin T , Green David , Han Misop , Rezaee Michael , Pavlovich Christian P. , Montgomery Jeffrey S. , Kowalczyk Keith , Ross Ashley , Kundu Shilajit , Patel Hiten D , Wang Gerald J , Graham John N , Assel Melissa , Schaeffer Anthony J , Schaeffer Edward M. ,   PREVENT INVESTIGATORS
Published: January 2024

261 Background: Transrectal prostate biopsy is the predominant approach to prostate cancer detection in the U.S. and worldwide. The transperineal approach is traditionally preformed under general anesthesia. Recent advances enable prostate biopsy to be performed through the skin of the perineum (transperineal) under local anesthesia. There are potential advantages to this clean, percutaneous approach over the inherently contaminated transrectal approach. However, comparative evidence is limited. Methods: In a multicenter, randomized trial, we used two-stage consent and assigned participants with suspicion for prostate cancer to undergo transperineal biopsy without antibiotic prophylaxis vs. transrectal biopsy with targeted prophylaxis. The primary outcome was post-biopsy infection, with secondary outcomes of urinary retention, significant bleeding, cancer detection, and a numerical rating scale (0-10) for biopsy-related pain and discomfort during 7-days post-biopsy. Results: Six-hundred fifty-eight participants underwent randomization, and 567 (86%) of participants were included in the intent to treat analysis. Seventy-nine men declined to participate. There were zero transperineal versus 4 (1.4%) transrectal biopsy infections (adjusted difference -1.4%; 95% confidence interval -3.2, 0.3; P=0.059). Rates of other complications were very low and similar by approach. Importantly, detection of clinically significant cancer was similar (53% transperineal vs. 50% transrectal, adjusted difference 2.0%; 95% CI -6.0, 10; p=0.6). Participants undergoing transperineal biopsy experienced worse periprocedural pain (0.6 adjusted difference [0-10 scale] 95% CI 0.2, 0.9; P=0.002), but the effect was small and resolved by 7-days. Conclusions: Office-based transperineal biopsy is tolerable, does not compromise cancer detection and likely reduces the risk of infection without antibiotic prophylaxis, thereby improving antibiotic stewardship. Altogether, our findings support office based transperineal prostate biopsy without antibiotic prophylaxis as the new standard of care for prostate cancer detection with per patient and population-based antibiotic stewardship and healthcare cost benefits. Finally, two-stage consent facilitates accrual for surgical randomized trials, as evidenced by the relatively low rate of participants declining and withdrawing from the trial. Clinical trial information: NCT04815876 .
Stockholm3 validation in a multi-ethnic cohort for prostate cancer (SEPTA) detection: A multicentered, prospective trial.
Authors: Vigneswaran Hari Thambiah , Eklund Martin , Discacciati Andrea , Nordström Tobias , Hubbard Rebecca A. , Perlis Nathan , Abern Michael , Moreira Daniel , Eggener Scott E. , Yonover Paul M. , Chow Alexander , Watts Kara , Liss Michael A. , Thoreson Gregory R , Abreu Andre Luis , Sonn Geoffrey A , Palsdottir Thorgerdur , Wiklund Fredrik , Gronberg Henrik , Murphy Adam B ,   SEPTA STHLM3 Study Group
Published: January 2024

262 Background: Stockholm3 is a multiparametric blood test incorporating germline risk, proteins and clinical data which improves prostate cancer (PC) risk stratification compared to PSA, however no validation exists in an ethnically diverse population. Methods: SEPTA is a prospective trial (NCT04583072) aimed to validate Stockholm3 in an ethnically diverse cohort of men referred for prostate biopsy at 17 North American sites from 2019 to 2023 (supplemented with bio-banked specimens 2008-2020). The trial had two prespecified primary aims when comparing Stockholm3 (≥15) compared to PSA (≥4 ng/ml): (1) Demonstrate non-inferior sensitivity in detecting clinically significant PC (csPC) (defined as ISUP Gleason Grade group ≥2) compared to PSA (non-inferiority margin of 20%). (2) Prove superior specificity thereby reducing the number of biopsies compared to PSA in men with benign or ISUP 1 biopsies. Both aims were assessed using a one-sided alpha of 0.025. A secondary aim was to evaluate Stockholm3 and PSA across ethnic subgroups. Statistical analysis plans were published before the analysis commenced. Results: The study involved 2,129 biopsied participants, categorized into self-identified groups: African American/Black (24%), White/Caucasian (46%), Hispanic/Latino (14%), and Asian (16%). Median participant age was 63 years. PSA and Stockholm3 median values were 6.1 ng/mL and 17, respectively. A total of 16% underwent MRI-targeted biopsies and 20% had a prior benign biopsy. On either systematic or targeted biopsy, csPC was found in 29%, 14% had ISUP 1 cancer, and 57% benign. The detection rate for csPC across groups were: African American/Black (37%), White/Caucasian (28%), Hispanic/Latino (29%), and Asian (21%). Overall, Stockholm3≥15 showed non-inferior sensitivity compared to PSA≥4 ng/ml (relative sensitivity: 0.95 [95% CI: 0.92-0.99]) and nearly 3 times superior specificity (relative specificity: 2.91 [95% CI: 2.63-3.22]). Results were consistent across ethnic subgroups: non-inferior sensitivity (0.91-0.98) and superior specificity (2.51-4.70). Stockholm3 ≥15 would have reduced benign and ISUP 1 biopsies by 45% overall and between 42-52% across ethnic subgroups compared to PSA ≥4 ng/ml. Stockholm3 exhibited higher AUC (0.82) compared to PSA (0.66), with similar trends in ethnic subgroups. Conclusions: In an ethnically diverse population, Stockholm3 would significantly reduce unnecessary prostate biopsies and diagnosis of ISUP 1 cancer at a similar sensitivity of PSA for detecting clinically significant cancer. Clinical trial information: NCT04583072 . [Table: see text]
The impact of perceived healthcare discrimination on health outcomes among patients with prostate cancer across racial and ethnic groups.
Authors: Sabater Minarim Daniel , Riviere Paul , Deshler Leah N. , Morgan Kylie M. , Duran Elizabeth A. , Banegas Matthew P. , Rose Brent S. 
Published: January 2024

268 Background: Black men face a disproportionately higher risk of mortality from PC (prostate cancer), and disparities in healthcare access have been associated with these outcomes. Discrimination in healthcare settings can profoundly affect health outcomes, especially for populations with significant health conditions. This study examined the association between race/ethnicity and perceived healthcare discrimination among individuals diagnosed with PC. We hypothesized that (1) racial/ethnic minorities with PC would be more likely to perceive healthcare discrimination and that (2) such perceived discrimination is associated with self-reported poor health. Methods: Using the 'All of Us' database, we focused on patients diagnosed with PC. We analyzed variables related to perceptions of respect, courtesy, and service quality from healthcare providers, categorized by race. These perception variables were then grouped to form a composite measure of "perceived healthcare discrimination." Multivariable logistic regression was used to study the effects of race/ethnicity on perceived discrimination and its subsequent impact on self-reported health, adjusting for demographics. Results: In our PC patient cohort of 3,129 participants, the race breakdown was: White: 2665, Black or African American: 150, Hispanic/Latino: 98, Other: 171, Asian: 27, Multirace: 18; Gender: Male: 3008, Gender Diverse: 121. A substantial number of patients with PC reported experiencing discrimination in healthcare settings. According to updated data, Black or African American patients were more likely to perceive discrimination with an Odds Ratio (OR) of 5.20, p < 0.00. Hispanic/Latino patients had an OR of 1.53, p = 0.19, whereas Asians had an OR of 2.11, p = 0.17, and individuals of multiple races had an OR of 2.43, p = 0.16. In terms of health outcomes, patients who felt respected by their healthcare provider had an OR of 0.426 for reporting worse health, p < 0.01. Conversely, those who perceived a lack of respect had an OR of 2.346 for poor health, p < 0.01. Conclusions: Our findings enhance the understanding of the nuances of perceived healthcare discrimination among PC patients across racial and ethnic boundaries. Persistent racial differences underscore the need for systemic interventions in healthcare settings for PC patients. The identified negative experiences correlate with worsened health outcomes. Recognizing the instances of perceived healthcare discrimination in PC patients is paramount for elevating care quality and equity. Health systems are encouraged to take proactive measures in addressing these disparities, aiming for enhanced patient trust, improved communication, and superior outcomes.
Difference in high-risk prostate cancer detection between transrectal and transperineal fusion approaches.
Authors: Semko Sofiya , Heidenreich Axel , Paffenholz Pia , Pfister David A. , Pikul Maksym 
Published: January 2024

273 Background: Present study aimed to gain insight into whether patients with high-risk prostate cancer (defined as Gleason 8-10) are being more precisely diagnosed by MRI fusion technique compared to TRUS-guided biopsy. Methods: A special retrospective cohort study database analysis was planned and conducted by urological department of University clinic of Cologne. After the database cut off the group of 779 patients with prostate cancer that underwent biopsy and further surgical treatment (radical prostatectomy) was selected. it was split into 2 cohorts according to biopsy type: TRUS guided biopsy and transperineal Fusion Biopsy. Standard systemic approach included 12 cores in TRUS and 18 in MRI-guided cohorts. Additional 5-6 cores were taken from the region of interest in the Fusion group. All the patients during analysis were divided into risk groups: Gleason 6 (3+3) - low risk group, Gleason 7a (3+4) - intermediate risk group, favourable prognosis, Gleason 7b (4+3) - intermediate risk group, unfavourable prognosis, Gleason 8-10 – high group. Concordance of primary and postoperative pathology was estimated by using re-grading levels and migration from low\intermediate to high-risk group. Additionally, the presence of one or more risk factors (perineural and lymphovascular invasion, presence of cribriform pattern, etc.) in primary specimens was evaluated. Results: The groups were statistically equal by age (p = 0,16), PSA risk-groups (χ2= 1,36; p = 0,53), density division ( χ2= 0,58; p = 0,74), prostate volume (p = 0,23) and ECOG status (Me [25 %; 75 %] p = 0,17). There were no significant differences between groups in terms of final pathology – number of cases in low, intermediate and high risk groups (χ2= 1,37; p= 0,5). Difference was observed in lower rate of upgrading to high-risk group and higher detection of risk factors in favour of transperineal-targeted biopsy (Table). Exposure of targeted biopsy increased the probability of detecting high risk PCa by 39% compared to systemic cores (OR 1.39, 95% CI: 0.9 - 1.9; p = 0,06). Conclusions: Transperineal fusion biopsy can be characterised by a higher possibility of detecting high-risk prostate cancer compared to conventional transrectal methods. A higher probability of discovering risk factors after transperineal fusion biopsy might be an important tool for proper staging and risk-adapted treatment strategy.[Table: see text]
Diagnosis of prostate cancer and benign prostatic hyperplasia based on urinary cell-free DNA methylation characteristics.
Authors: Luo Jindan , Dong Hang , Tang Haoran , Yi Jiahe , Du Pan , Jia Shidong , Xie Liping 
Published: January 2024

275 Background: Distinguishing between early-stage prostate cancer (PCa) and benign prostatic hyperplasia (BPH) has posed a persistent clinical challenge. Exploring the epigenetic characteristics of urinary cell-free DNA (ucfDNA) offers potential for improving diagnosis. In this preliminary study, we aimed to investigate the feasibility of utilizing of urinary cfDNA methylation features as a non-invasive way to detect PCa. Methods: Paired tissue, plasma, and urine samples were collected from 12 PCa patients, along with paired plasma and urine samples from 12 BPH patients, and urine samples from 24 healthy donors. PredicineEPIC, a whole genome-based DNA methylation assay, was implemented to profile methylation features in all these samples. Results: We discovered that the methylation patterns of ucfDNA more closely resembled those of tumor tissue compared to plasma cfDNA, suggesting that urine can serve as an effectual alternative to blood for detecting cancer related signals. We identified 369 differentially methylated regions that contained PCa-specific methylation signals. Subsequently, we employed feature selection and applied a machine learning regression algorithm to construct a classification model. Validation on an independent GEO dataset yielded an impressive AUC of 0.83 for distinguishing between PCa and benign prostatic hyperplasia (BPH). Conclusions: This study demonstrated the potential of ucfDNA-based methylation markers in the early detection of prostate cancer.
Assessing the mid-term impact of enhanced prostate cancer screening in Caucasian men with germline DNA repair pathogenic variants.
Authors: Lazzeri Massimo , Fasulo Vittorio , Buffi Nicolò Maria , Casale Paolo , Hurle Rodolfo , Saita Alberto , Paciotti Marco , Finocchiaro Alessio , Aljoulani Muhannad , Asselta Rosanna , Soldà Giulia , De Simone Ilaria , Colombo Piergiuseppe , Cieri Miriam , Maura Federica , Cavalli Pietro , Lughezzani Giovanni 
Published: January 2024

278 Background: Family history is a major prostate cancer (PCa) risk factor. Pathogenic gene variants (e.g., BRCA1/BRCA2) greatly increase PCa risk (2.5 to 8.6-fold for <65-year-olds) and affect outcomes. This study assesses an enhanced screening protocol's effectiveness and participant compliance. It combines PHI for familial cases and multiparametric MRI for those with pathogenic DNA repair gene (DRG) variants. Methods: This non-profit charity-funded study (AIRC - Fondazione AIRC project IG 2020 ID 25027) evaluates targeted screening for men at higher genetic risk of PCa due to PVs in a specific gene region (DRG). Conducted at a tertiary Hospital with collaboration from departments of Oncology, Breast Unit, Urology, Pathology, Radiology, Laboratory and Medical Genetics. It includes men aged 35-69 with documented deleterious DRG mutations who consent to planned screening. Exclusion criteria are prior prostate surgery, prostate cancer diagnosis, MRI contraindications, or variants of unknown significance (VUS). Results: Between 2020 and 2023, a total of 90 patients participated in this study. Their median age was 51.5 years (IQR 46.0-60.2). The median total PSA level was 0.9 (IQR 0.5-1.63), and the median PHI was 17 (IQR 12.3-23.8). Notably, 20.1% of patients had a family history of breast/ovarian cancer, while 79.9% had a family history of PCA. Most participants hailed from Northern Italy (69.4%). PVs were identified as follows: BRCA2 (55.7%), BRCA1 (17.8%), ATM (4.44%), PMS2 (3.33%), BRCA (3.33%), MSH2 (2.22%), TMPRSS2-ERG (2.22%), BRIP1 (1.11%), MLH1 (1.11%), MSH6 (1.11%), BRCA3 (1.11%), and 6.67% of patients reported mutations without specific details. In terms of screening compliance, 36 patients completed 1 visit, 31 completed 2 visits, 1 completed 3 visits, and 22 scheduled their first follow-up. Regarding PHI levels, 62.8% had PHI levels below 20, 33.5% fell in the 20-40 range, and 3.70% exceeded 40. For patients with PSA levels below 3 and PHI above 20 (n=17), only one exhibited a positive mpMRI result and is scheduled for a biopsy. Conversely, among patients with PSA levels above 3 and PHI below 20 (n=2), one underwent mpMRI, which yielded a negative result. Among the patients who underwent mpMRI, six underwent biopsy, and all resulted negatives. Conclusions: In summary, this study achieved high participant compliance with the screening method and underscores the importance of using PHI and multiparametric MRI, especially in those with genetic predispositions. These tools hold potential for enhancing prostate cancer detection accuracy and merit further exploration for early diagnosis in at-risk populations.