tbuckley/cabot-search huggingface dataset:
Influence of MRIs performed in a 6-week interval on the histopathological detection of prostate cancer with different PIRADS classifications: A real-world data analysis.
Authors: Tim Nestler, Justine Schoch, Viola Düring, Michael Wiedmann, Daniel Overhoff, Daniel Dillinger, Stephan Waldeck, Hans Schmelz
Journal: Journal of Clinical Oncology (2025)

334 Background: In the early phases of MRI-guided prostate biopsies, it was often necessary to perform an additional in-house multiparametric MRI after an external MRI to accurately assess lesions for biopsy. This study aims to evaluate the consistency of lesion identification and the associated clinical and histological outcomes at a high-volume tertiary care center performing over 500 biopsies annually. Methods: This analysis included real-world data from 111 patients treated between 2018 and 2022. Each patient underwent two multiparametric MRI scans of the prostate at different institutions, with a median interval of 42 days [32–52] between scans. An MRI-fused biopsy followed 7 days [4–10] after the second MRI. Data were analyzed using the Chi-square test. Results: The PIRADS scores for index lesions on the in-house MRI were as follows: PIRADS V in 33.3% (n=37), PIRADS IV in 49.5% (n=55), PIRADS III in 12.6% (n=14), and PIRADS II in 4.5% (n=5) (Table 1). Most lesions were located in the peripheral zone of the prostate (68.8%, n=75). Cancer detection rates for randomized and/or targeted biopsies were 91.9% (n=34) for PIRADS V, 65.5% (n=36) for PIRADS IV, 21.4% (n=3) for PIRADS III, and 20% (n=1) for PIRADS II. Clinically significant prostate cancer (ISUP &gt; 1) was detected in 91.9% (n=34) of PIRADS V, 60% (n=33) of PIRADS IV, and 21.4% (n=3) of PIRADS III lesions. Overall, malignant histology was found in 64.9% (n=72) of targeted lesions and 59.5% (n=66) of randomized biopsies. A median of 7 [5.5–8.5] biopsies were taken per lesion, with an additional 13 [11–15] randomized biopsies. In the initial external MRI, 18% (n=20) of patients were assigned a higher PIRADS category, while 10.8% (n=12) were had a lower score (p&lt;0.001). The biopsy plan was adjusted for 57 patients (51.4%) based on the findings of the second MRI. However, given the cancer detection rates in both targeted and randomized biopsies, it is likely that all cancers would have been detected regardless of these adjustments. Conclusions: Although PIRADS classifications varied slightly between the two MRI scans performed six weeks apart, and biopsy plans were adjusted in about half of the cases, all cancers would likely have been identified. The six-week interval between MRI scans does not appear to significantly affect biopsy accuracy. PIRADS classification comparison of internal and external MRI. External MRI PIRADS II PIRADS III PIRADS IV PIRADS V All Internal MRI PIRADS II 0 40% (2) 40% (2) 20% (1) 5 PIRADS III 0 28.6% (4) 57.1% (8) 14.3% (2) 14 PIRADS IV 0 9.1% (5) 81.8% (45) 9.1% (5) 55 PIRADS V 0 2.7% (1) 16.2% (6) 81.1% (30) 37 All 0 12 60 39
Determining an immunohistochemical profile to predict response to intravesical bacillus Calmette–Guérin (BCG) in patients with high-grade non-muscle invasive bladder cancer.
Authors: Darren Lam, Gavin Wei, Mitchell G. Lawrence, Nicholas Choo, Renea Taylor, Nicholas Huntington, Beena Kumar, Steuart Rorke, Piero Nelva, Shivakumar Keerthikumar, Matthew Harper, Scott Donnellan, Weranja Ranasinghe
Journal: Journal of Clinical Oncology (2025)

847 Background: Intravesical Bacillus Calmette–Guérin (BCG) remains the gold standard for the management of high-grade non-muscle invasive bladder cancer (NMIBC). However, up to 70% of patients fail BCG therapy. We aimed to define potential mechanisms for BCG resistance and develop an immunohistochemical (IHC) panel to help identify patients likely to respond to intravesical BCG. Methods: Patients with NMIBC undergoing induction intravesical BCG at a tertiary institution were identified. Twelve BCG-responders and 13 non-responders were matched for patient and tumour factors. RNA sequencing was performed with hierarchical clustering and Gene Set Enrichment Analysis to identify response resistance mechanisms. Immune cell subsets were measured using pre and post-BCG therapy for CD4, CD8, T-Bet, GATA-3 and PD-1 antibodies. GATA-3 and T-Bet stains were used as surrogates for Th-2 and Th-1 cells, respectively. T-tests were used to assess differences. An integrated IHC panel using CD4, CD8, T-Bet, GATA and PD1 was developed and correlated with BCG response using Receiver Operator Characteristic (ROC) curves. Results: On hierarchical clustering, BCG-responders and non-responders had distinct gene expression profiles pre- and post-BCG. Prior to exposure to BCG, non-responders had enrichment for a pro-inflammatory gene signature with a higher CD4:CD8 ratio (2.94 vs 1.71, p=0.0003) and a higher Th-2/Th-1 (GATA/T-Bet) ratio (5.95 vs 2.97, p=0.0026) compared to BCG-responders, on IHC. However, on exposure to BCG, non-responders had no changes to the CD4:CD8 or Th-2/Th-1 ratios but had a 78% increase in the PD-1 expression (MD 20.83/5hpf, p=0.016) with BCG, indicating T cell exhaustion. In contrast, upon exposure to BCG, responders had an increase in the Th-2/Th-1 ratio (mean difference 0.9323, p=0.0228) with enrichment of the natural killer cell pathway compared to non-responders (p&lt;0.05). The area under the ROC curve using the integrated IHC panel to predict BCG response was 0.864 (95% CI: 0.663 to 1.000). Conclusions: BCG non-responders had a pro-inflammatory TME, which showed marked T cell exhaustion on exposure to BCG. In contrast, responders had a baseline TME with low CD4:CD8 and low Th-2/Th-1 ratios at baseline, which allowed activation of both humoral and adaptive responses to BCG. These immune changes can be utilised as an IHC panel to predict response to BCG therapy.
PET imaging for metastatic castration sensitive prostate cancer (mCSPC) for patients with PSA response after systemic therapy: A multicentric ambispective analysis.
Authors: Mathilde Beaufils, Lucie Meynard, Alice Bernard-Tessier, Isabelle Brenot-Rossi, Mathilde Guerin, Alban Tauty, Lorene Seguin, Naji Salem, Geraldine Pignot, Cecile Vicier, Jochen Walz, Guilhem Roubaud, Boughalem Elouen, Gwenaelle Gravis
Journal: Journal of Clinical Oncology (2025)

37 Background: PET imaging is not recommended for surveillance of mCSPC but it is used by some physicians. Little is known about surveillance for metastatic prostate cancer using PET imaging. The aim of this study was to assess the correlation between PSA response and PET imaging for mCSPC. Methods: An ambispective, multicentric, observational study, recorded PET imaging for patient’s treated with a minimum of 6 months of systemic therapy with androgen deprivation therapy (ADT) +/- androgen receptor pathway inhibitor (ARPI) +/- docetaxel for mCSPC with PSA &lt; 0.2 ng/ml, normal CT scan and non progressive disease in bone scan. All of them had baseline evaluation with standard imaging. Results: Between August 2022 and September 2024, 57 patients (pts) with mCSPC were included, in 4 centres in France. Baseline characteristics at the time of metastatic disease were: median age of 65 years (range: 45-84), ISUP ≥4 for 63%, median PSA 22.1 ng/ml (1.6-5000ng/ml) with T≥3 in 53%. The majority of pts had low volume disease 56%, with synchronous metastatic disease for 67% and ≥ 4 bone metastases in 44%. Only 5 pts had visceral metastases. Pts were treated, by ADT + ARPI in 81%, ADT + docetaxel in 7% and triplet in 12% of cases. Patients had prostate radiotherapy (RxT) in 39% and RxT to metastatic bone lesion in 19%. The 8 months PSA was &lt;0.2 ng/ml in 89% of pts. PET imaging was choline in 86%, PSMA in 14%. Median time between treatment initiation and PET imaging was 17 months and delay between PSA &lt; 0.2 and PET imaging was 12 months (range: 0-32). A complete response was observed in 46 patients (81%). Non-complete responders (CR) were more frequently high volume disease (66%) and synchronous metastasis (100%), treated by ADT + ARPI alone (77%) or ADT + docetaxel (11%). Non CR were: 1 neuroendocrine progression, 1 lung cancer and 9 partial responders (2/9 progressed later). Conclusions: In patients with mCSPC, treated by ADT with ARPI and or docetaxel and with PSA &lt; 0.2 ng/ml, a complete response is observed in 81 % when using PET imaging. The information given by PET imaging could be and additional surrogate measure to PSA response for intensification or de intensification the systemic and local treatment for mCSPC.
Automated classification of treatment state of patients with prostate cancer from structured medical record data to help enhance care.
Authors: Richard Nishan Boyajian, Ashleigh Kowtoniuk, Sharon Hensley Alford, Tarun Kumar, Shilpa Mahatma, Pravin Solankar, Shrey Kumar, Paul L. Nguyen
Journal: Journal of Clinical Oncology (2025)

427 Background: The number of US prostate cancer (PCa) cases is projected to expand exponentially while the oncology workforce stagnates. The increase in clinic demand requires innovative technologic approaches for patient management. We are developing a process for automatically tracking patients across the care continuum which can flag patients overdue for follow-up, send alerts when patients recur, and thereby optimize clinic resources. In order to place patients into the correct care pathway, their disease status must be correctly classified, which is the focus of the current study. Methods: Clinician specialist input was used to define five mutually exclusive care states in PCa (newly diagnosed, active surveillance, active treatment, post-treatment surveillance, and metastatic). Using a variable set defined to classify each care state, decision tree modeling was applied to abstracted, de-identified data from 150 patients seen in the Dana-Farber/Brigham Cancer Center radiation oncology clinic between 5/14 and 8/14/2024 to validate model care state classification. Model output and a case summarization were presented in an interactive web-interface designed using user experience principles. Through a secure login, a provider accessed the data for each case and recorded if the care state assignment and case summary were accurate. Results: The concordance between the model classification and provider assignment was 100%. The model correctly sorted the care states of each of the patients, of which the distribution was 0% newly diagnosed, 1% active surveillance, 12% active treatment, 73% post-treatment surveillance, and 13% metastatic The interactive web interface included graphical and table views of PSA test values with automatic calculation of doubling time and velocity. In addition, treatment events (prostatectomy, radiation, hormone therapy) were overlaid on the PSA graph for easy clinical analysis. A treatment summary table provided a chronologic view for each patient. Conclusions: The care state assignment model was able to correctly classify the care state of all 150 patients in this cohort for which structured, provider abstracted data was available. The next steps in clinical implementation will be EMR integration, automatic record abstraction, and end-user testing. We have already begun work to automatically ingest and parse PCa records using natural language processing and expand the user interface to include a patient care journey map, generation of a pre-visit clinical note, and care optimization protocols. The goal is to provide a tool that will decrease time for case review and appointment preparation, give case prioritization alerts based on PSA testing results, and automatically monitor surveillance care compliance thus optimizing clinic resources while ensuring no patient is lost to follow-up.
Multivisceral surgery in patients with locally advanced castration-naïve and castration-resistant, symptomatic prostate cancer.
Authors: Julian Heidenreich, David Pfister, Constantin Rieger, Axel Heidenreich
Journal: Journal of Clinical Oncology (2025)

176 Background: Local complications due to infiltration and compression of adjacent organs represent significant complications of locally advanced castration sensitive (CSPC) and castration resistant PCA (CRPC) despite the use of life prolonging agents. Methods: 139 patients with locally advanced CSPC/CRPC underwent palliative pelvic surgery: radical cystoprostatectomy in n=105 (75.5%), radical prostatectomy with continent vesicostomy in n=9 (6.5%) and anterior plus posterior exenteration in n=25 (17.6%). All patients underwent local staging via MRI of the small pelvis, cystoscopy and rectoscopy. Systemic staging was done with CT scans of the chest, abdomen, pelvis and bone scans. Perioperative complications were assessed according to Clavien-Dindo classification and symptom-free (SFS), cancer specific survival (CSS) were evaluated using the Kaplan-Meir method. Results: Indications for surgery were lower or upper urinary tract obstruction in 75 (54%) and 55 (39%), resp., hematuria and blood transfusions in 31 (22%), rectal infiltration with/without obstructive ileus in 23 (17%), refractory pelvic pain in 17 (12%). 96 (69%) pts had a combination of various symptoms. Clavien-Dindo grade 2, 3 and 4 complications developed in 32 (23%), 12 (8.6%) and 8 (5.7%), respectively. After a median follow-up of 42.5 (3 – 123) months, the SFS at 1 and 3 years was 90.3% and 66.9%. The median SFS was 27.9 months. CSS at 1 and 3 years was 92.2% and 43.7%, respectively. 78.6% of the patients were symptom-free during their remaining lifetime. Conclusions: Multivisceral prostate surgery is a technically feasible approach in well-selected patients resulting in symptom relief of &gt; 90% of patients which covered almost 80% of the remaining life-time. Adequate preoperative imaging studies, endoscopic evaluation and extensive surgical experience is mandatory to achieving a benefit for the individual patient with improvement of quality of life.
Clinical outcomes of lutetium-177-vipivotide tetraxetan in men with metastatic castration-resistant prostate cancer at a single academic center.
Authors: Adam Khorasanchi, Jinesh S. Gheeya, Timothy D. Gauntner, Menglin Xu, Elshad Hasanov, Katharine A. Collier, Lingbin Meng, Danielle Elise Zimmerman, Peng Wang, Edmund Folefac, Paul Monk, Amir Mortazavi, Steven K. Clinton, Yuanquan Yang
Journal: Journal of Clinical Oncology (2025)

84 Background: Lutetium-177-vipivotide tetraxetan ( 177 Lu) was approved in 2022 for PSMA-positive metastatic castration-resistant prostate cancer (mCRPC) patients (pts) treated with prior androgen receptor signaling inhibition (ARSI) and a taxane. The impact of 177 Lu in a non-trial setting is limited. Methods: We retrospectively reviewed records of mCRPC pts who received ≥1 dose of 177 Lu at The Ohio State University from 3/2022-3/2024. Demographics, tumor histology, metastasis sites (mets), treatment (Tx) history, standardized uptake value max (SUVm), and prostate-specific antigen (PSA), at baseline (BL) and post-Tx were collected. SUVm was defined as the highest SUV from a single lesion. Outcomes were PSA response, PSA50, radiographic progression-free (rPFS) by PCWG3, and overall survival (OS). Descriptive statistics, Mann-Whitney, Chi-square, and Cox regression model were used to assess impact. Results: A total of 152 pts were included with a median follow-up of 9 months (0.1-23 m). The median age was 70 years (46-92 y), with 39% having de novo metastatic disease, and 61% had Gleason grade group ≥4. The common mets were bone (91%), lymph node (68%), and visceral (34% with 17% liver and 8% lung). The majority received prior taxanes and ARSI, and 20% radium-223. The median lines of prior Tx was 5.The median BL PSA was 56.3 ng/mL, and the median BL SUVm was 30.4. Post-Tx, 64% showed a PSA response, and 46% achieved PSA50. Among the pts with available imaging, 17% had partial response, 12% stable disease, and 48% disease progression.Tx was discontinued in 62% for:radiographic progression (66%), PSA-only progression (7%), clinical decline (24%), and toxicity (3%). At the data cutoff, mortality was 50%. Median PFS and OS was 6.7 m, and 12.2 m respectively. BL SUVm was associated with improved PSA50 (p=0.01), rPFS (p&lt;0.01), and OS (p=0.01), and liver mets associated with worse OS (p&lt;0.01). Conclusions: In this retrospective study of 177 Lu, we see similar PSA and PSA50 responses to reported trials. However, PFS was shorter, and mortality was higher, likely related to the use of 177 Lu in heavily treated pts with few remaining options. Optimizing biomarkers to predict Tx benefit and resistance are needed.
Incidence of EMBARK and EAU high-risk biochemical recurrence and prostate cancer mortality: A real-life population-based study.
Authors: Ugo Giovanni Falagario, Francesco Pellegrino, Giuseppe Carrieri, Anna Lantz, Olof Akre, Peter Wiklund
Journal: Journal of Clinical Oncology (2025)

372 Background: The EMBARK trial proved the efficacy of enzalutamide plus leuprolide in patients with prostate cancer (PCa) who have had high-risk biochemical recurrence (BCR). Different criteria are currently used to define high-risk BCR. The aim of this study was to evaluate the incidence of several definitions of High-risk BCR after radical prostatectomy (RP) or radiotherapy (RT) and their association with PCa specific mortality (PCSM). Methods: Population-based study including 17,753 men undergoing RP (n=12,010) or RT (n=5743) with curative intent (cT1-3, cM0) and PSA follow-up in Stockholm between 2003 and 2021. Follow-up for all patients was until death, emigration, or end of the study period (December 31, 2021). Primary outcomes were the cumulative incidence of any BCR (RP: PSA≥ 0.2; RT: PSA≥ nadir+2) and high-risk BCR (according to EAU and Embark criteria) estimated using the Kaplan Mayer method and PCSM accounting for competing risk. Results: The 10-year cumulative incidences of any BCR, EAU, and Embark high-risk BCR were 25% (95% CI 24, 26), 10% (9, 11), 4% (3, 4) after RP and 20% (19, 22), 10% (9, 11) and 10% (9, 11) after RT. Median time from RP to high-risk BCR was 12.6 (5.8, 25.7) months for EAU criteria and 11.8 (5.1, 22.3) months for Embark criteria. Similarly median time from RT to high-risk BCR was 21.2 (11.3, 45.9) months for EAU criteria and 23.4 (14.3, 38.3) months for Embark criteria.After RP, the 10-year Cumulative incidences of PCSM were 11% (95% CI: 9, 13), 17% (14, 21) and 30% (24, 37) for any BCR, EAU and Embark high-risk BCR, respectively. After RT, the 10-year PCSM cumulative incidences were 39% (35, 44), 50% (45, 56) and 49% (42, 55), respectively. Conclusions: Incidence of High-Risk BCR vary according to the definition used and primary treatment. High risk BCR usually happen early after treatment and most patients with any PSA elevation will never experience High-risk BCR during the follow-up. Embark criteria currently represent the more stringent criteria with a very high risk of PCSM. Pattern of presentations of BCR, and high-risk BCR according to EAU and EMBARK criteria after radical prostatectomy or radiotherapy. Primary treatment Radical Prostatectomy Radiotherapy PSA&gt; 0.2 N=2501 EAU High Risk BCR N=1119 EMBARK High Risk BCR N=386 PSA&gt;Nadir + 2 N=836 EAU High Risk BCR N=427 EMBARK High Risk BCR N=456 Time frame, n (%) 0-1 year 660 (26.4%) 535 (47.8%) 199 (51.6%) 117 (14.0%) 117 (27.4%) 96 (21.1%) 1-3 years 757 (30.3%) 392 (35.0%) 139 (36.0%) 297 (35.5%) 171 (40.0%) 229 (50.2%) 3-5 years 463 (18.5%) 111 (9.9%) 29 (7.5%) 198 (23.7%) 79 (18.5%) 109 (23.9%) 5-7 years 286 (11.4%) 48 (4.3%) 10 (2.6%) 85 (10.2%) 23 (5.4%) 16 (3.5%) &gt;7 years 335 (13.4%) 33 (2.9%) 9 (2.3%) 139 (16.6%) 37 (8.7%) 6 (1.3%) Time to BCR, n (%) 29.7 (11.3, 59.6) 12.6 (5.8, 25.7) 11.8 (5.1, 22.3) 36.6 (18.6, 62.4) 21.2 (11.3, 45.9) 23.4 (14.3, 38.3)
Biomarker testing patterns among patients newly diagnosed with prostate cancer in a community oncology network.
Authors: Lisa Dwyer Orr, Siraje Mahmud, Vivian Jean M. Cline, Ayda Mirsalehi, Monica Lisi, Laura Ensley, Lorraine Brisbin, Roy Steven Paulson
Journal: Journal of Clinical Oncology (2025)

229 Background: Prostate cancer guidelines recommend that clinicians order biomarker testing for patients with metastatic prostate cancer. In addition, testing is recommended to determine patients’ eligibility for clinical trials and to identify potential actionable mutations that can inform appropriate treatment strategies. The aim of this study was to evaluate biomarker testing patterns among patients newly diagnosed with prostate cancer who received care in a large community oncology provider network. Methods: A retrospective database analysis, using several sources that include iKnowMed (EMR), Ellkay CareEvolve (Genetic HL7 interface), and the Molecular Data Warehouse and covers approximately 1.7 million distinct patients, was conducted on patients newly diagnosed with prostate cancer between Jan 1, 2018, and Jun 30, 2022, and receiving care in a large oncology network in West South-Central United States. Baseline demographics and clinical characteristics were analyzed descriptively and the proportion of patients who received biomarker testing was determined. Results: Data on 18,743 patients with prostate cancer (mean age at diagnosis, 71 years; 46% White, 13% Hispanic, 7% Black, 1% Asian, 33% other/unknown) were abstracted. The proportion of patients who received biomarker testing was 14% overall and 23% among those with Stage IV disease. Of all biomarker tests performed, roughly 6% was single gene testing, 49% was broad panel testing, 25% was both single gene testing with broad panel testing, and approximately 20% of the tests were unknown. The average time from first biomarker testing to disease diagnosis was approximately 5 months. Less than 10% of the patients who tested positive with an actionable mutation received targeted therapy. Hormone therapy (32%) was the most common treatment received, followed by supportive care (7%). Conclusions: These findings provide insights into the frequency of biomarker testing among patients newly diagnosed with prostate cancer who receive care in a large community practice setting. Advancement in targeted therapies is predicated on improved testing rates, and this study suggests opportunities exist for interventions and increased education among healthcare providers based on observed time to testing and the rate of testing. Biomarker testing patterns in patients with prostate cancer. Parameter Patients with prostate cancer(N=18,743) Received biomarker testing All patients, n (%) 2,585 (14) Patients with metastatic Stage IV disease, n/n (%) 941/4,168 (23) Received targeted therapy after positive biomarker testing indicating actionable mutation, n/n (%) 36/450 (8) Mean (standard deviation) days from ordering biomarker test to: Disease diagnosis 156 (545) Receiving results 52 (213) Treatment initiation 113 (525)