bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identifying patient profiles and mapping the patient journey across three countries in a large-scale, fully digital survey of patients with prostate cancer.
Authors: Morgans Alicia K. , Lehmann Reiner , Heidenreich Axel , Allen Stephen , Carl Ernst-Günther , Wolinsky Howard , Poschenrieder Andreas , Mirante Osvaldo , O'Sullivan Joe M. 
Published: February 2022

16 Background: A survey of patients with prostate cancer (PCa) was conducted to map their experiences, expectations and attitudes, and to identify challenges and unmet needs in diagnosis, therapy patterns, care teams, quality of life (QoL), patient organizations and resources. Here, we describe the initial survey results and explore differences in diagnosis and therapy patterns between 3 countries. Methods: Don’tBePatient Intelligence conducted a large survey in patients with non-metastatic (M−) and metastatic (M+) PCa in Germany (DE), the UK and the US from Feb 9–Apr 10, 2021 in collaboration with patient organizations and medical experts. Recruitment was through social media advertising and patient organizations. Data were evaluated using descriptive and advanced statistics. Results: Of 33,882 survey starters, 15,824 completed, split 50.1%/49.9% in rural/urban areas. In DE/US, diagnosis through healthcare screening was more frequent than in the UK (M−/M+: DE 77%/58%; UK 42%/21%; US 77%/63%) where a higher percentage of symptomatic diagnosis was recorded (M−/M+: DE 18%/39%; UK 49%/75%; US 12%/31%). Prostatectomy was the predominant therapy in M− PCa in DE/US (71%/57%). In the UK, radiotherapy was slightly more frequent than prostatectomy (48% vs. 41%) and active surveillance was more common than in DE/US (14% vs. 6%/9%). Hormone therapy was the most common therapy in M+ PCa in all countries (DE 65%; UK 77%; US 73%). Chemotherapy was received by < 2% of patients with M− PCa in all countries but was more frequent in M+ PCa in the UK than DE/US (38% vs. 21%/27%; table). Satisfaction levels were generally high (> 80%) for all therapies in all countries. Conclusions: To our knowledge this is the largest digital survey conducted in patients with PCa, allowing identification of unmet needs in the patient journey. Preliminary data suggest that rates of screening are lower in the UK than DE/US; this may correlate with the higher rate of symptomatic and potentially later-stage diagnosis, highlighting the role of routine screening. Relatively low active surveillance rates in DE/US may reflect a lower likelihood of men with M− versus M+ PCa to respond to the survey. Further analyses will include impact of differences in patient journey, trust in healthcare professionals, access to information, involvement with patient advocacy groups and QoL. [Table: see text]
Financial toxicity and its effect on screening for prostate and colon cancer.
Authors: Herriges Michael Joseph , Shenhav-Goldberg Rachel , Peck Juliet Irene , Shapiro Oleg , Jacob Joseph M , Basnet Alina , Bratslavsky Gennady , Goldberg Hanan 
Published: February 2022

21 Background: The term ‘financial toxicity’ or ‘hardship’ is used to describe the financial problems patients experience due to high out-of-pocket costs for their healthcare. Financial toxicity in the context of cancer treatment is an area of recent study due to the significant costs associated with these treatments, but little is known about the effect of financial toxicity on cancer prevention. We examined the effects of financial toxicity on the utilization of screening tests for prevalent cancers, including prostate and colon cancer, using a US nationally representative survey-based data source. We hypothesized that patients with more financial hardship would show an association with decreased prevalence of prostate and colon cancer screening. Methods: This cross-sectional survey-based US study included men and women aged 18+ from the National Health Interview Survey (NHIS) database from January – December 2018. A financial hardship score between 0 and 1 was formulated by summarizing the responses from ten financial toxicity questions including if in the past 12 months one was unable to afford prescription medication or healthcare; or if one had to skip or take less medicine to save money. A higher score was associated with a worse financial hardship score. The primary outcomes of the study were self-reported occurrence of PSA blood testing for prostate cancer screening, and occurrence of colonoscopy for colon cancer screening. Results: As shown in table, a higher financial hardship score was associated with a decreased odds ratio for having a PSA test of 0.916 (95% CI 0.867-0.967, p=0.002) and colonoscopy of 0.969 (95% CI 0.941-0.998, p=0.039). Conclusions: Worse financial hardship is associated with a decreased probability of having PSA or colonoscopy screening tests. Awareness of this specific toxicity needs to be raised, examining the association of financial toxicity and screening of prostate, colon, and other additional cancers. [Table: see text]
Racial disparity in survival of African-American (AA) patients diagnosed with metastatic prostate cancer: Analysis of surveillance epidemiology and end results program.
Authors: Farooq Muhammad Zain , Shrivastava Trilok , Sarfraz Humaira , Ba Aqeel Sheeba Habeeb , Fu Pingfu , Mangla Ankit 
Published: February 2022

28 Background: Amongst all cancers in men, prostate cancer (PCa) is the most common cancer, and the second leading cause of death. Racial disparities in PCa care in the United States (US) are known to exist. However, it is not clear if this disparity is also noted specifically in patients diagnosed with metastatic PCa (metaPCa). We analyzed the Surveillance Epidemiology and End results Program (SEER) 18 registry, to determine the racial disparity in survival of AA patients diagnosed with metaPCa compared to other races recorded in this registry. Methods: Cancer incidence data was obtained from the SEER 18 registry (2000-2018). The data was analyzed using StataMP 16 (StataCorp) software. Demographic and clinical outcomes were recorded from the registry. We performed univariate Cox regression using proportional hazard model and obtained Kaplan Meier curves to look at the difference in survival based on different age groups and race. Results: A total of 51,979 cases were identified with metaPCa, out of whom 75.8% were Whites. 40,579 deaths were recorded. Mean age group of patients with metaPCa were 70-74 years. Grade 3 poorly differentiated adenocarcinoma was noted in 54.6% patients. There was no statistically significant difference in survival of AA patients with metaPCa compared to Non-Hispanic Whites (NHW) (Hazard Ratio (HR): 0.99; 95%CI 0.96,1.03 p = 0.71) or Alaskan and American Natives (AIAN) with metaPCa (HR:1.048; 95%CI 0.91,1.21 p = 0.539). AA with metaPCa had a statistically better outcome compared to Asian and Pacific Islanders with metaPCa (HR:0.775; 95%CI 0.731,0.821 p = 0.00). Amongst patients with less than 65 years of age with metaPCa, AA patients had statistically better survival than NHW (HR: 0.94; 95% CI 0.89-0.98 p = 0.05). No statistically supported racial disparity in survival was observed in patients above 65 years with metaPCa (AA to NHW patients- HR: 0.99; 95% CI 0.96,1.03 p = 0.71). Conclusions: Although racial disparities exist in survival of all patients diagnosed with prostate cancer, when it comes to those with metaPCA, there is no statistically supported racial disparity amongst AA patients compared to NHW, except for those who are younger than 65 years where white patients have a worse outcome compared to AA diagnosed with metaPCa.
Dual-tracer PET/CT-targeted, mpMRI-targeted, systematic biopsy, and combined biopsy for the diagnosis of prostate cancer.
Authors: Qiu Dongxu , Li Jian , Zhang Jinwei , Chen Minfeng , Gao Xiaomei , Tang Yongxiang , Zhang Ye , Yi Xiaoping , Yin Hongling , Gan Yu , Wang Guilin , Zu Xiongbing , Hu Shuo , Cai Yi 
Published: February 2022

34 Background: Growing evidence proved the efficacy of multiparametric MRI (mpMRI) and prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT)-guided targeted biopsy (TB) in prostate cancer (PCa) diagnosis, but there is no direct comparison between mpMRI-TB and PSMA PET/CT-TB. Gastrin-releasing peptide receptor (GRPR) highly expressed in PCa, which can compensate for the unstable expression of PSMA in PCa. Therefore, we designed a study to compare the efficiency of mpMRI-TB, dual-Tracer (GRPR and PSMA) PET/CT-TB, systematic biopsy, and combined biopsy for the diagnosis of prostate cancer. Methods: 112 suspicious PCa patients were enrolled from September 2020 and June 2021 in this prospective and comparative effectiveness study. Patients with positive dual-tracer PET/CT or mpMRI results underwent TB and all enrolled patients underwent SB after TB. The primary outcome was the detection rates of PCa in different biopsy strategies. Secondary outcomes were the performance of three imaging methods, omission diagnostic rates, and upgrading and downgrading of biopsy samples relative to those of prostatectomy specimens in different biopsy strategies. Results: In 112 men, clinically significant PCa (grade group≥2) accounted for 34.82% (39/112) and nonclinically significant PCa (grade group = 1) accounted for 4.46% (5/112). 68Ga-PSMA PET/CT-TB achieved higher PCa detection rate (69.77%) and positive ratio of biopsy cores (0.44) compared with SB (39.29% and 0.12) and mpMRI-TB (36.14% and 0.23), respectively (P < 0.005). Dual-tracer PET/CT as a triage test avoided 52.67% (59/112) unnecessary biopsy, whereas dual-tracer PET/CT-TB plus SB achieved high detection rate (77.36%) without misdiagnosis of csPCa. Conclusions: Dual-tracer PET/CT could screen patients for avoiding unnecessary biopsy. Dual-tracer PET/CT-TB plus SB might be a more effective and promising strategy for definite diagnosis of clinically significant PCa than mpMRI-TB.
Piflufolastat F 18-PET/CT in prostate cancer patients: An analysis of OSPREY (Cohorts A and B) standardized uptake value (SUV) results stratified by PSA and gleason score.
Authors: Gorin Michael A. , Rowe Steven P. , Pienta Kenneth J. , Carroll Peter R. , Pouliot Frederic , Probst Stephan , Saperstein Lawrence , Preston Mark , Alva Ajjai Shivaram , Patnaik Akash , Stambler Nancy , Siegel Barry A. , Morris Michael J. 
Published: February 2022

35 Background: The OSPREY clinical trial was a phase 2/3 prospective study of prostate specific membrane antigen (PSMA) PET/CT using piflufolastat F 18. Piflufolastat F 18 (aka 18F-DCFPyL or PyL) is a novel PSMA-targeting radiopharmaceutical approved for imaging of PCa pts both at initial staging and for disease recurrence. Here we describe SUV results by biopsy status, baseline PSA levels, and Gleason score (GS). Methods: Piflufolastat F 18 -PET/CT was evaluated in men with NCCN high-risk PCa scheduled to undergo radical prostatectomy with pelvic lymphadenectomy (RP-PLND) (Cohort A) and men with radiologically suspected recurrent/metastatic PCa (Cohort B). A single IV dose of 9 mCi (333 MBq) of piflufolastat F 18 was administered followed by PET/CT acquisition 1-2 hours later. Piflufolastat F 18 uptake in various lesion locations as defined by maximum and peak SUV (SUVmax, SUVpeak) were determined by three blinded, independent central readers for each tissue (e.g., bone, lymph nodes (LN), soft tissue). To measure SUVs, the reader placed a volume of interest (VOI) on each identified lesion. SUVmax was defined as the maximum single-voxel SUV within the VOI. SUVpeak within the VOI was defined as the average SUV within a fixed-sized VOI (1 cm diameter sphere), representing the cluster with the highest average SUV. Results: 345 men underwent piflufolastat F 18-PET/CT. Cohort B (n = 93 evaluable) SUVmax and SUVpeak were significantly higher for biopsy positive (+) (one biopsy lesion/pt) when compared to biopsy negative (-) lesions from bone and LN. SUVpeak for biopsied bone and LN (Cohort B) appeared to increase with rising baseline PSA. In high-risk PCa pts, SUVpeak for prostate (Cohort A; n = 252 evaluable) increased with baseline PSA and were highest for GS 9-10 (Table). Conclusions: Piflufolastat F 18-PET/CT uptake was significantly higher in biopsy + lesions and increased with baseline PSA. Prostate SUVpeak was highest for GS 9-10. Clinical trial information: NCT02981368. [Table: see text]
68 Ga-PSMA PET/CT for preoperative lymph nosde staging of high-risk prostate cancer.
Authors: Heidenreich Axel , Schmautz Maximilian , Pfister David A. , Hartmann Florian 
Published: February 2022

38 Background: The present study evaluates the potential role of 68Ga-PSMA PET/CT to detect pelvic lymph node metastases in newly diagnosed, treatment-naïve high risk prostate cancer (PCa) patients prior to radical prostatectomy and extended pelvic lymphadenectomy. Methods: A total of 165 men with newly diagnosed high risk PCa (ISUP grade 4/5, PSA > 20 ng/ml or ≥cT3a) were included in this retrospective analysis. All men had undergone a transperineal MR fusion biopsy and all men underwent RPE with epLND. Patients with neoadjuvant ADT, TRUS guided biopsies, previous radiation or surgeries in the small pelvis were excluded. Imaging findings and pathohistological findings were correlated and sensitivity, specificity, positive and negative predictive values were calculated. The correlation of clinical and biopsy characteristics with PSMA PET/CT. Results: The median PSA was 24.5 (6.7-185) ng/ml, the median number of dissected lymph nodes was 21-5 (14-45). A total of 68/165 (41,2%) patients had lymph node metastases (LNM) of which 43 (63.2%) were positive on PSMA-PET/CT whereas 25 (36.8%) LNM were negative on PSMA PET/CT. 97/165 (58.8%) pts had pN0 disease of whom 93 (95.9%) and 3 (4.1%) demonstrated negative and positive PSMA PE/CT findings, resp. n = 47 had positive PSMA PET/CT and 40 (85.1%) demonstrated LNM, 7 (14.9%) had pN0 disease. N = 118 had negative PSMA PET/CT of which 93 (78.8%) and 25 (21.2%) were true and false negative, resp. Sensitivity was 63.2%, specificity was 97.0%, and positive and negative predictive values were 93.5% and 78,8%, respectively. 3564 lymph nodes were resected, 149 (4.2%) had LNM. 88/149 (59.1%) were detected on PSMA PET/CT and 61 (40.9%) were undetected. On a per lymph node base, sensitivity and specificity were 40.4% and 94.5%, resp; positive and negative predictive values were 59.1% and 97.3%. Conclusions: PSMA-PET/CT has a high reliability to identify patients with high risk PCA and LNM. If a positive lesion is detected, epLND is mandatory due to high frequency of undetected small LNM. PSMA-PET/CT, is superior to standard imaging and it might replace CT/MRI of the small pelvis.
Do prostate MRI reports consider focal therapy when describing diagnostic findings? A descriptive review and analysis of concordance among prostate MRI reports and radical prostatectomy pathology reports.
Authors: Benidir Tarik , Hofmann Martin , Weight Christopher , Klein Eric A. , Purysko Andrei 
Published: February 2022

41 Background: Focal therapy (FT) for prostate cancer (PCa) is becoming an attractive option for men seeking treatments that minimize the morbidity of whole gland therapy. Prostate MRI reports should include lesion location, presence of bilateral extension and presence of multifocality as these radiographic features are essential in selecting appropriate candidacy. We aim to evaluate concordance of disease between MRI and final pathology reports. Methods: We conducted a retrospective review of pathology reports from radical prostatectomies (RP) performed at our institution between 2016-2019, in patients whom also underwent pre-operative prostate MRI’s. The number and locations of PI-RADS ≥ 3 lesions described in MRI reports were compared against the RP findings and assessed for disease concordance in terms of lesion location, extent (unilateral vs. bilateral extent) and/or the presence of tumor multifocality. Fischer’s exact test was used for statistical analysis. Results: A total of 1593 patients underwent RP, among which 416 (26.1%) had preoperative prostate MRI’s. A majority (65.3%) (n = 273/416) of MRI’s reported a single PI-RADS > 3 lesion, 51/416 (12.3%) had negative MRI’s and 22.1% (92/416) described >2 PI-RADS ≥ 3 lesions. A total of n = 388/416 (93.2%) had detailed descriptions of their MRI and path reports for comparative analysis. MRI and final path tumor concordance with respect to unifocal extent or multifocality was low at 37.2%. When a single PI-RADS > 3 lesion was described, concordance with final path was 37.6% as compared to 55.6% when >2 lesions were described (p = 0.006). Discordant findings at final path included the presence of tumor multifocality (80.7%) or the extent of a unifocal lesion (19.3%). Lesions crossing the midline were uncommonly reported on MRI (16%). When prostate midline assessment was included in the evaluation of lesion extent, the degree of concordance with final pathology improved from 33.3% to 64.2% (p = 0.038). Conclusions: Prostate MRI reports have a large discordance with RP reports. Tumor multifocality and/or unifocal disease crossing the midline may not hold significant meaning if the disease is ultimately organ confined and the treatment is aimed at the whole gland. However, in the context of focal therapy, these findings are of germane importance. Radiologists are encouraged to consider focal therapy as a treatment strategy when describing MRI findings and acknowledge the importance of tumor multifocality/bilaterality in this context.
Attainment of early, deep prostate-specific antigen response in metastatic castration-sensitive prostate cancer: A comparison of patients initiated on apalutamide or enzalutamide.
Authors: Lowentritt Benjamin , Pilon Dominic , Khilfeh Ibrahim , Rossi Carmine , Muser Erik , Kinkead Frederic , Waters Dexter , Ellis Lorie , Lefebvre Patrick 
Published: February 2022

43 Background: Deep prostate-specific antigen (PSA) response, defined as a ≥90% decline in PSA (PSA90), is an important early prognostic factor for achieving radiographic progression free survival and overall survival in patients with metastatic castration-sensitive prostate cancer (mCSPC) treated with a next generation androgen receptor inhibitor (ARI) or androgen biosynthesis inhibitor. This study compared PSA90 responses among patients with mCSPC at first use of a next generation ARI. Methods: Clinical data from 69 community urology practices in the United States were evaluated. Patients with mCSPC were classified into treatment cohorts based on their first filled prescription (index date) for apalutamide (APA) or enzalutamide (ENZ) after 12/16/2019. Patients were followed from index date until the earliest of index regimen discontinuation, treatment switch, end of clinical activity or end of data availability (03/05/2021). Included patients had ≥12 months of clinical activity to assess baseline characteristics. Inverse probability of treatment weighting (IPTW) was used to reduce baseline confounding by controlling for age, race, index year, androgen deprivation therapy (ADT) use ≥6 months, first-generation antiandrogen use, most recent PSA level, most recent testosterone level, Gleason score, and time between metastasis and the index date. PSA90 was defined as the earliest attainment of ≥90% decline in PSA relative to baseline PSA (most recent value within 13 weeks pre-index). The proportion of patients achieving a PSA90 and the time to PSA90 was compared using a weighted Kaplan-Meier (KM) analysis and weighted Cox proportional hazards models. Results: A total of 186 APA patients and 165 ENZ patients met the study criteria. Patients’ characteristics were generally well balanced after IPTW (Table). By 6 months, 73.6% of APA and 69.5% of ENZ patients had a post index PSA measurement. At 6 months, significantly more mCSPC patients initiated on APA attained PSA90 response than patients initiated on ENZ (p=0.014; Table). This result continued to remain significant at 9 months and at the end of the follow-up (Table). The median time to PSA90 was 3.1 months for APA patients and 5.2 months for ENZ patients. Conclusions: This real-world study of mCSPC cohorts demonstrates that initiation of APA leads to significantly more patients achieving a deep PSA response more rapidly than patients initiating ENZ. [Table: see text]
Practice patterns in the management of metastatic castration-sensitive prostate cancer: A single-center survey-based study.
Authors: Lu Eric , Wang Xiaoyan , Shen John 
Published: February 2022

45 Background: Advanced hormonal therapies (abiraterone, enzalutamide, apalutamide) and docetaxel have demonstrated an overall survival benefit when added to androgen deprivation therapy (ADT) for metastatic castration-sensitive prostate cancer (mCSPC). There are no randomized controlled trials comparing these agents, resulting in heterogeneity in first-line therapy and sequencing of therapies. Methods: We surveyed practice patterns and underlying rationale behind first-line therapy selection for mCSPC among medical and urologic oncologists at a single center (academic and community-based practices). Responses were anonymous. We evaluated associations between responses using Friedman’s test with posthoc pair-wise comparison and Fisher exact test where appropriate. Results: From 6/2021-8/2021, we received 72/77 (94%) of distributed surveys. Of the 72 providers, 39 (31 med/onc, 8 uro/onc) reported treating mCSPC. For high-volume disease, most selected ADT plus docetaxel (41%) as first-line therapy. For low-volume disease, most selected ADT plus abiraterone (31%). There continues to be the use of bicalutamide in the treatment of low-volume mCSPC (18%). When asked to rank the most important factors when considering first-line therapy, clinical symptoms (skeletal event, bone pain, anorexia, weight loss, fatigue, visceral metastases) and disease volume were ranked higher than cost for both oncologists (p<0.01) and urologists (p = 0.03 for symptoms vs. cost and p<0.01 for disease volume vs. cost). When considering perceived barriers to selecting first-line therapy, 64% of providers identified out-of-pocket costs. Although uro/onc was less comfortable managing side effects of docetaxel compared to med/onc (0% vs. 100% comfortable, p<0.01), comfort levels with managing toxicities of hormonal therapies were comparable (100% vs. 97% comfortable, p=0.54). Conclusions: Given limitations of cross-trial comparison of efficacy from registration trials, the selection of front-line therapy for mCSPC often depends on shared decision-making. By this survey-based study, we observed docetaxel being favored for high-volume disease and abiraterone being favored for low-volume disease. Although cost did not factor into the selection of therapy, it was cited as the most common barrier faced by providers. [Table: see text]