bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparative study of RARP and carbon ion radiotherapy sexual functional changes for prostate cancer using the propensity score matching method.
Authors: Miyazawa Yoshiyuki , Oka Daisuke , Koike Hidekazu , Kawamura Hidemasa , Miyasaka Yuhei , Syuto Takahiro , Arai Seiji , Sekine Yoshitaka , Matsui Hiroshi , Ohno Tatsuya , Suzuki Kazuhiro 
Published: February 2022

236 Background: We mainly perform Robotic-Assisted laparoscopic Radical Prostatectomy (RARP) and Carbon Ion Radiotherapy (CIRT) as curative treatment for prostate cancer. Several factors such as cancer control and quality of life after treatment are considered to be important, but there are few reports comparing sexual function changes before and after treatment between RARP and CIRT. We performed retrospective study comparing the evaluation of sexual function after RARP and CIRT cases using the propensity score matching method. Methods: 127 patients treated by RARP from 2014 to 2018 and 190 patients treated by CIRT monotherapy from 2010 to 2019 were evaluated. We evaluated Expanded Prostate Cancer Index Composite (EPIC) score before and after treatment. The EPIC was compared before, 12 months, and 24 months after treatment. Propensity score matching was performed using the age at treatment, PSA value, T stage, and pretreatment EPIC comprehensive score of sexual function as covariates. A cohort of 101 patients in each group was prepared and examined. This study was approved by the Institutional Review Board of Gunma University Hospital (No. IRB2020-050, 1839). Results: The mean ± standard deviation of each of the RARP and CIRT groups were age; 65.1 ± 5.9, 65.3 ± 6.5 years, PSA value; 6.31 ± 2.07, 6.34 ± 2.46 ng/ ml, pretreatment EPIC sexual function overall score; 46.4 ± 15.6, 48.2 ± 16.2. In both groups, T1N0M0 was 16%, T2N0M0 was 83%, and T3N0M0 was 1%. The total EPIC sexual function scores before, 12 months, and 24 months after treatment were 46.4, 27.9, 28.2 in the RARP group, and 48.2, 41.4, 41.6 in the CIRT group, respectively. In both groups, there was a significant decrease in score after 12 months and 24 months compared to before treatment (p < 0.05). At 12 and 24 months, the total EPIC sexual function score in the CIRT group was significantly higher than RARP group (p < 0.001). Conclusions: In prostate cancer cases adjusted by propensity score matching, the decrease in EPIC sexual function score was significantly smaller in the CIRT group than RARP group. The results of this study seemed to be useful information for decision making with patients.
Prostate specific antigen dynamics and prostate cancer risk: A population-based study.
Authors: Hird Amanda Elizabeth , Saskin Refik , Del Giudice Lisa , Kulkarni Girish S. , Nam Robert 
Published: February 2022

239 Background: Baseline prostate specific antigen (PSA) is a strong predictor of clinically significant prostate cancer. In a large cohort of patients undergoing opportunistic testing, our objective was to assess the association between first serum PSA in combination with other PSA predictors and risk of prostate cancer. Methods: This was a retrospective, population-based study in Ontario, Canada between 2010-2019. Men 40-75 years of age who underwent incident PSA testing with at least two PSA tests during the study period were included. Among men who underwent PSA testing, the PSA levels of patients who were diagnosed with prostate cancer were compared to patients who were not. Univariable and multivariable logistic regression analysis was used to compare any prostate cancer and clinically significant prostate cancer diagnosis (International Society of Urological Pathology [ISUP] grade group 2-5) between groups. Results: A total of 508,238 patients were included in our cohort (12,444 cases and 495,794 controls). The median follow-up time was 8.2 years (IQR: 7.0-9.1). Patients who were diagnosed with prostate cancer were older (median age 62 [IQR: 56-67] versus 56 years [IQR:50-63], standardized difference [SD]:0.61) and had a higher first PSA than patients who were not (median 4.79 [IQR:3.29-6.96] versus 0.96 ng/mL [IQR:0.58-1.69], SD:1.93). Fewer than 0.1% (248/261,463) of patients with a first PSA less than 1.0 ng/mL were diagnosed with prostate cancer during the study period. Our final multivariable model revealed that a first PSA above 2.0 ng/mL (adjusted odds ratio [OR] 6.64, 95%CI: 6.13-7.20, p < 0.001), a final PSA between 4.0 to 9.9 ng/mL and 10.0 to 20.0 ng/mL (adjusted OR 22.09, 95%CI: 20.58-23.71, p < 0.001 and adjusted OR 47.46, 95%CI: 43.28-52.05, p < 0.001, respectively) and change from first to final PSA per 365 days of 20.0 to 99.9% (adjusted OR 3.40, 95%CI: 3.21-3.60, p < 0.001) and more than 100% (adjusted OR 6.91, 95%CI: 6.29-7.59, p < 0.001) were strongly associated with the diagnosis of prostate cancer. The model performed well when predicting any prostate cancer, clinically significant prostate cancer, and when stratified by age. Conclusions: This study suggests that first PSA in combination with final PSA and rate of change can be used to predict prostate cancer diagnosis. Future studies will be conducted to determine the association with metastatic and lethal prostate cancer.
Contemporary outcomes of a systematic prostate cancer active surveillance program: Results from the Niagara Health System, Ontario, Canada.
Authors: Mesci Aruz , Tsakiridis Nicole Niki , Gouran-Savadkoohi Mohammad , Faught Brent , Brown Ian , Tsakiridis Theodoros 
Published: February 2022

241 Background: Surgery and radiotherapy are standard therapies for patients with early-stage prostate cancer (PrCa). However, studies show that patients with low-risk localized PrCa (Gleason 6; Grade Group (GG) 1 and prostate-specific antigen (PSA) <10) could be safely monitored with active surveillance (AS), if intense patient follow up and re-biopsy schedules are utilized. Here, we reviewed clinical outcomes of AS of a program associated with the Niagara Health System (NHS) PrCa diagnostic program, which provides centralized diagnosis, systematic follow up, re-biopsy and multi-disciplinary consultation clinics for all patients in the Niagara region, Ontario, Canada. Methods: After receiving appropriate ethics approval, NHS databases were searched for patients that underwent more than one biopsy of the prostate in the period Jan. 2015 (program inception) to Dec. 2020. Cases were reviewed for clinical stage, biopsy results and treatment record data. Data were then codified for anonymity and analyzed. Criteria for inclusion into the analysis involved, i) a minimum of two PrCa biopsies before treatment and ii) detailed reporting of biopsy and clinical results (number of positive cores, % of core involvement, and PSA). Results: A total of 343 AS patient cases were identified in the initial search. Of those 52 cases did not meet inclusion criteria. The baseline GG score distribution in the 291 cases included in the analysis was, GG0: 27 (cases with negative biopsies but high PSA), GG1: 247 and GG2: 17 (patients refusing treatment). A total of 144 cases (49.5%) progressed at re-biopsy. Rates of progression to higher GG category in the three groups were 100%, has 46.5% and 50%, respectively. The average time to progression was 23.3+15.5 months. The rate of progression to treatment after entering AS was 39.17% (114/291). Average time from first biopsy to treatment was (28.4+14.5 months). Amongst those that received treatment the overall rate of progression to high-intermediate or high-risk PrCa, was 29.8%, with 20.8% of cases (30/144) progressing to GG>3 (Gleason Score 7: 4+3 or higher) and 9.0% (13/144) progressing to PSA > 20. Of the treated patients, 70 (61.4%) patients received radiotherapy, 42 (36.8%) combined radiotherapy and androgen deprivation therapy and (31.3%) underwent radical prostatectomy. Conclusions: This retrospective study provides contemporary real-world systematic AS outcomes from a Canadian program with unique features of systematic urological follow up and centralized diagnosis and multi-disciplinary patient assessment. We observe increased rates of disease progression and need for earlier utilization of treatment compared to those reported by other studies. Further analysis examines factors predicting increased risk for disease progression.
Outcomes and factors associated with reclassification in a multiethnic cohort enrolled in active surveillance for prostate cancer.
Authors: Zhu Denzel , Loloi Justin , Shreck Evan , Abeshouse Marnie , Sankin Alexander , Watts Kara , Stern Joshua M. , Aboumohamed Ahmed A. , Kovac Evan 
Published: February 2022

242 Background: Active surveillance (AS) is the standard of care for low-risk prostate cancer (PCa). However, there is limited data exploring factors associated with reclassification among non-Hispanic Black (NHB) and Hispanic men enrolled in AS. In this study, we examined factors associated with reclassification among men enrolled in AS within a multiethnic population. Methods: We identified men enrolled in AS from 2005-2019 at our institution, and collected demographic/clinical data. We then compared characteristics among men who experienced pathologic reclassification while on AS vs men who did not. Reclassification was defined as either type 1 (Grade Group (GG) 1 to GG2) or type 2 (GG1 to ≥GG3). Our AS protocol generally consists of biannual prostate specific antigen (PSA) testing and prostate biopsy every 1-3 years. Prostate MRI is used to guide decisions on selective basis. Logistic regression was used to determine factors associated with reclassification. Results: Among 197 men enrolled into an AS protocol within our institution, 133 (67.5%) did not experience reclassification by the end of follow-up while 64 (32.5%) did (Table). Median follow-up time was 12 months (IQR: 7-20), and 2-year overall reclassification-free rates were 59.3% (95% CI: 59.2-59.4). 2-year deferred treatment rates were 26.4% (95% CI: 26.3-26.5) for radical prostatectomy (RP) and 16.9% (95% CI: 16.8-17.0) for radiation therapy (RT). NHB and Hispanic men composed 87 (44.2%) and 70 (35.5%) of our cohort, respectively. Higher PSA at diagnosis was associated with adverse reclassification (OR=1.02, 95% CI: 1.01-1.05, p=0.002), and there was a trend towards NHB men having higher odds of experiencing reclassification (OR=2.78, 95% CI: 0.85-9.10) although the result was not statistically significant (p=0.09). Conclusions: In a diverse, multiethnic cohort, rates of adverse reclassification on AS were relatively low. The only factor predictive of reclassification while on AS was higher median PSA at diagnosis; however, NHB men did have a trend towards a higher odds of reclassification. Our results suggest that men who are NHB or have higher PSA at diagnosis may benefit from increased surveillance intensity, as they are more likely to experience reclassification while on AS.[Table: see text]
Discordance of patient- and physician-reported toxicities in two prospective trials of stereotactic body radiotherapy (SBRT) for localized prostate cancer.
Authors: Patel Akshat , Badia Rohit R , Amini Armon , Kung Christopher , Kusin Samuel B. , Neufeld Sarah , Mannala Samantha , Garant Aurelie , Hannan Raquibul , Timmerman Robert D. , Zelefsky Michael J. , Folkert Michael Ryan , Desai Neil Bipinchandra 
Published: February 2022

245 Background: SBRT for localized prostate cancer (PCa) is the focus of several ongoing and reported high-impact trials, which often focus on physician-reported toxicity (P-Tox) when comparing regimens. Patient-reported quality of life (PR-QoL) may differ and provide a more sensitive comparative metric of treatment burden, especially with fewer provider interactions during SBRT than during protracted RT courses. We evaluated the concordance of prospective genitourinary (GU) and gastrointestinal (GI) P-Tox and PR-QOL in men receiving SBRT for PCa. Methods: Data from two concurrently-enrolled prospective trials of SBRT in high-risk (Phase I Safety Endpoint, NCT01896271) and low-intermediate risk (Phase II GI Toxicity Endpoint, NCT02353832) PCa were used. Matching standardized schedules of collected PR-QoL [Expanded Prostate Cancer Index Composite (EPIC)] and P-Tox (CTCAE v5.0) were analyzed over the first 18 months of follow up, where symptoms are most pronounced. We assessed concordance of Grade≥2 GU/GI physician reported toxicity with PR-QoL declines exceeding anchor based minimal clinically important difference (MCID) thresholds (-6 urinary and -5 bowel summary scores, respectively) for each patient at each time point. Patients without baseline PR-QoL data were excluded in full, while time points with missing PR-QoL or P-Tox were excluded individually without imputation. Concordance was evaluated by Cohen’s kappa statistic. Results: From 101 patients, there were 256 (64%) follow up observations through 18 months with both PR-QoL and P-Tox at the time point and baseline. Concordance of PR-QoL and P-Tox was low at all time points for both GU and GI toxicity domains (mean kappa 0.093; Table). MCID was more often reported by patients than Grade≥2 toxicity by physicians (38% vs 17% for GU and 44% vs 10% for GI). There was little overlap of PR-QoL and P-Tox reporting: Grade≥2 P-Tox reported in 17% of observations with MCID in PR-QoL, while MCID in PR-QoL reported in 54% of observations of Grade ≥2 P-Tox. Mean concordance was similarly low when analyzing sub-groups of trial, investigator, and an alternative 2xMCID threshold. Conclusions: P-Tox and PR-QoL differed dramatically in two prospective studies of SBRT despite toxicity primary endpoints. This may reflect subjective and varying intervention thresholds driving P-Tox reporting, rather than actual patient burden. These data strongly support use of PR-QoL rather than P-Tox for SBRT comparative study endpoints and guidelines in this rapidly evolving space. [Table: see text]
Late, persistent, substantial, treatment-related symptoms (LAPERS) following low-dose-rate brachytherapy for prostate cancer.
Authors: Ong Wee Loon , Millar Jeremy Laurence 
Published: February 2022

246 Background: The late, persistent, substantial treatment-related symptoms (LAPERS) is a novel methodological approach to identify clinically relevant and long-lasting symptoms after treatment. It was first reported in a cohort of women with cervical cancer in the EMBRACE study. We applied the LAPERS methodology to report long-term outcomes following low-dose-rate brachytherapy (LDRBT) for prostate cancer (PCa). Methods: We studied a cohort of men with PCa treated with LDRBT in a single Australian institution, who completed the Expanded Prostate Cancer Index Composite short-from 26 (EPIC26) questionnaire before LDRBT, and at regular intervals after LDRBT. For LAPERS analyses, 1) we limited the analyses to men with baseline EPIC26, and at least 3 ‘late’ follow-up EPIC26 (from 6 months post-LDRBT onwards); 2) ‘substantial’ symptoms were defined as either ‘moderate’ (score 25) or ‘big problem’ (score 0) in EPIC26 urinary and bowel domain questions which assess the degree of symptom bother; 3) ‘persistent’ symptoms were defined as ‘substantial’ symptoms that present in at least half of the ‘late’ follow-up EPIC-26 assessments. This provides a binary (yes/no) LAPERS outcome. We estimated cumulative incidence of substantial symptom with the Kaplan-Meier methods. We reported on 1) proportion of men with LAPERS, 2) proportion with baseline-corrected LAPERS, 3) prevalence of substantial symptoms at specified timepoint, and 4) cumulative incidence of substantial symptoms. Results: 177 men were included in the study. The median follow-up was 60 months (IQR: 36-74 months). For overall urinary function, the proportion of men with LAPERS was 2.3% (baseline corrected LAPERS 2.3%). The prevalence of substantial urinary symptoms at 12, 24, 36, 48, and 60 months were 5.9%, 4.4%, 2.9%, 0.7%, 1.8%, and 5-year cumulative incidence was 17.8% (95%CI = 12.7-24.6%). For overall bowel function, the proportion of men with LAPERS was 2.3% (baseline-corrected LAPERS 1.7%). The prevalence of substantial bowel symptoms at 12, 24, 36, 48, 60 months were 7.6%, 3.0%, 3.6%, 3.6% and 2.2%, and 5-year cumulative incidence was 16.2% (95%CI = 11.3-23.2%). Conclusions: We observed considerable differences between LAPERS, prevalence and cumulative incidence of substantial symptoms in men with PCa treated with LDRBT. Cumulative incidence (‘time-to-first event’ analyses) may overestimate the burden of late toxicities as considerable proportion of patients do not experience persistent symptoms over time, and LAPERS is more reflective of ‘true’ late toxicities, taking into account the duration of symptoms.
Impact of rectal spacer on toxicity reduction in men treated with proton versus photon therapy.
Authors: Dhere Vishal Ramesh , Jani Ashesh B. , Fischer-Valuck Benjamin Walker , Cooper Sherrie , Shelton Joseph W. , Hershatter Bruce Warren , Goyal Subir , Liu Yuan , Godette Karen D. , Patel Pretesh R. , Patel Sagar Anil 
Published: February 2022

247 Background: Dose escalation in prostate cancer (PCa) radiotherapy (RT) is limited by toxicity to surrounding tissue, including the rectum. Rectal spacers improve bowel toxicity in men treated with photons (i.e. IMRT). However, the relative benefit of rectal spacers in men treated with protons remains unknown. Further, proton therapy may result in high-dose exposure to the anterior rectal wall due to lateral penumbra with conventional opposed lateral beam arrangement. We hypothesize that rectal spacers will confer greater toxicity benefit in the setting of proton therapy compared with photon therapy. Methods: We conducted an IRB approved, single institution, retrospective review of patients receiving definitive conventional or moderate hypofractionated photon IMRT or pencil-beam scanning proton RT for localized PCa from 2018-2021. Four cohorts were compared: Photon with (Ph+RS) or without (Ph-RS) rectal spacer, and proton with (Pr+RS) or without (Pr-RS) rectal spacer. Rates of pelvic nodal treatment were equivalent between protons and photons within the +/- rectal spacer cohorts. Acute (<3 months) and late (≥ 3 month) toxicity was compared amongst the four cohorts. Cumulative incidence of physician-reported grade 1-2 gastrointestinal (GI) toxicity (CTCAE V5.0) was compared using Chi-square or Fisher’s exact test. Patient-reported bowel toxicity was evaluated using International Prostate Expanded Prostate Composite Index- Clinical Practice (EPIC-CP) and compared using linear mixed modeling. Results: 164 patients were eligible for analysis: 38 Ph-RS, 50 Ph+RS, 26 Pr-RS, & 50 Pr+RS. Median follow-up was 17.6 months. In men treated with protons, physician-reported acute G1-2 GI toxicity was significantly lower in men with versus without rectal spacer (6.12 vs 30.77%, Pr+RS vs Pr-RS, respectively; p=0.009) and there was a trend towards lower late G1-2 GI toxicity (8.51 vs 26.09%, Pr+RS vs Pr-RS, respectively; p=0.08). In men treated with photons, there were no significant differences in physician-reported acute or later GI toxicity with versus without rectal spacer. No significant differences in patient-reported outcomes were observed with versus without spacer in the proton or photon cohorts. Conclusions: Rectal spacer use was associated with a lower CTCAE grade 1-2 acute GI toxicity in men treated with protons, and this difference was not observed in men treated with photons. While this study is limited by low sample size, a relatively greater benefit of rectal spacer with proton vs. photon therapy was observed. Further prospective analyses in larger cohorts are ongoing to validate these hypothesis-generating findings.
Validation of the STAR-CAP clinical prognostic system for predicting biochemical recurrence after radical prostatectomy in a Japanese cohort.
Authors: Miura Noriyoshi , Miyauchi Yuki , Kikugawa Tadahiko , Oka Akihiro , Sawada Yuichiro , Tomida Ryotaro , Matsumura Masafumi , Hashine Katsuyoshi , Yanagihara Yutaka , Ninomiya Iku , Kan Masaharu , Yano Akira , Tacho Takatoshi , Yanagaki Takahiro , Takeda Hajime , Watanabe Yuichi , Saika Takashi 
Published: February 2022

253 Background: An international staging collaboration for cancer of the prostate (STAR-CAP) was recently established and used for predicting oncological outcomes for patients with prostate cancer. However, the validation of STAR-CAP has not yet been performed in the Japanese cohort. Our study aimed to assess the STAR-CAP prognostic model for Japanese patients with prostate cancer and compare it to the CAPRA score for the prediction of biochemical recurrence (BCR) after radical prostatectomy. Methods: We retrospectively analyzed data from a multi-institution database of 1,645 patients who underwent radical prostatectomy between 2010 and 2020. We excluded patients with inadequate follow-up duration ( < 1 year), missing or incomplete perioperative clinical parameters relevant for STAR-CAP, and patients who received neoadjuvant therapy. BCR was defined as two consecutive prostate-specific antigen values ≥ 0.2 ng/mL. The 3-year BCR-free survival was assessed by Kaplan-Meier analyses and log-rank test. The performance of both models to predict 3-year BCR-free survival was assessed using the area under the curve (AUC). Results: The 3-year BCR-free survival ranged from 47.3% (high risk) to 93.5% (low risk) in the STAR-CAP classification ( p< 0.001) and from 62.5% (high risk) to 94.6% (low risk) in the CAPRA classification ( p< 0.001). AUCs for the 3-year BCR prediction were 0.756 and 0.784 for STAR-CAP and CAPRA, respectively. Conclusions: In Japanese patients, both STAR-CAP and CAPRA prognostic systems provide sufficient stratification and their predictive ability for 3-year BCR-free survival is comparable, with a small advantage for CAPRA (2.8%).