Background: Pan-immune inflammation value (PIV) is a newly defined biomarker that includes whole cellular components that are indicators of systemic inflammation in complete blood count (CBC), easily accessible and has the potential to reflect both the body's immune response and systemic inflammation status. This study evaluated the pretreatment PIV for its prognostic impact on overall survival (OS) in patients with metastatic castration-resistant prostate cancer (mCRPC) treated with Lutetium-177 (177Lu)-PSMA-617.
Methods: The PIV was based on the earliest CBC obtained within 1 month before treatment initiation. Patients were categorized into low and high PIV groups based on the median pretreatment PIV, and the relationship between OS and PIV groups was assessed by multivariable analysis.
Results: A total of 43 patients with mCRPC treated with (177Lu)-PSMA-617 were included. The median OS was longer in the low PIV group (15.1 months [95% confidence interval [CI] 10.6-19.5]) than in the high PIV group (4.2 months [95% CI 1.7-6.6]) (p < 0.001). In multivariable analysis, high PIV (hazard ratio [HR]: 4.3, 95% CI 1.194-15.93, p = 0.026) and high Eastern Cooperative Oncology Group performance score (HR: 7.05, 95% CI 1.48-33.46, p = 0.014) were associated with shorter OS.
Conclusion: This study showed that pretreatment PIV might be a prognostic factor in patients with mCRPC treated with (177Lu)-PSMA-617.
背景:泛免疫炎症值(PIV)是一种新定义的生物标志物,它包括全血细胞计数(CBC)中作为全身炎症指标的全细胞成分,易于获得,并有可能同时反映机体的免疫反应和全身炎症状态。本研究评估了接受镥-177(177Lu)-PSMA-617 治疗的转移性去势抵抗性前列腺癌(mCRPC)患者治疗前的 PIV 对总生存期(OS)的预后影响:PIV基于治疗开始前1个月内最早获得的全血细胞计数。根据治疗前PIV的中位数将患者分为低PIV组和高PIV组,并通过多变量分析评估OS与PIV组之间的关系:共纳入43例接受(177Lu)-PSMA-617治疗的mCRPC患者。低PIV组的中位OS(15.1个月[95% 置信区间[CI] 10.6-19.5])长于高PIV组(4.2个月[95% CI 1.7-6.6]):本研究表明,对于接受(177Lu)-PSMA-617治疗的mCRPC患者来说,治疗前PIV可能是一个预后因素。
{"title":"The prognostic role of pan-immune inflammation value in patients with metastatic castration resistance prostate cancer treated with Lutetium-177 (<sup>177</sup>Lu)-PSMA-617.","authors":"Satı Coskun Yazgan, Emre Yekeduz, Mine Araz, Hatice Bolek, N Ozlem Kucuk, Yuksel Urun","doi":"10.1002/pros.24804","DOIUrl":"10.1002/pros.24804","url":null,"abstract":"<p><strong>Background: </strong>Pan-immune inflammation value (PIV) is a newly defined biomarker that includes whole cellular components that are indicators of systemic inflammation in complete blood count (CBC), easily accessible and has the potential to reflect both the body's immune response and systemic inflammation status. This study evaluated the pretreatment PIV for its prognostic impact on overall survival (OS) in patients with metastatic castration-resistant prostate cancer (mCRPC) treated with Lutetium-177 (<sup>177</sup>Lu)-PSMA-617.</p><p><strong>Methods: </strong>The PIV was based on the earliest CBC obtained within 1 month before treatment initiation. Patients were categorized into low and high PIV groups based on the median pretreatment PIV, and the relationship between OS and PIV groups was assessed by multivariable analysis.</p><p><strong>Results: </strong>A total of 43 patients with mCRPC treated with (<sup>177</sup>Lu)-PSMA-617 were included. The median OS was longer in the low PIV group (15.1 months [95% confidence interval [CI] 10.6-19.5]) than in the high PIV group (4.2 months [95% CI 1.7-6.6]) (p < 0.001). In multivariable analysis, high PIV (hazard ratio [HR]: 4.3, 95% CI 1.194-15.93, p = 0.026) and high Eastern Cooperative Oncology Group performance score (HR: 7.05, 95% CI 1.48-33.46, p = 0.014) were associated with shorter OS.</p><p><strong>Conclusion: </strong>This study showed that pretreatment PIV might be a prognostic factor in patients with mCRPC treated with (<sup>177</sup>Lu)-PSMA-617.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":"90-96"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-09-26DOI: 10.1002/pros.24800
Claudio Bovolenta Murta, José Pontes Júnior, Pedro Humberto Felix de Souza Filho, Paulo Cezar de Godoy Júnior, Felipe Guimarães Pugliesi, Kayann Reda El Hayek, Fábio Pescarmona Gallucci, Giuliano Betoni Guglielmetti, Joaquim Francisco de Almeida Claro
Introduction: Characterization of the index lesion of prostate cancer (PCa) has facilitated the development of focal therapy to reduce complications caused by radical treatments. In the present study, we sought to identify factors associated with the oncological results of focal therapy for PCa.
Methods: Between April 2017 and February 2020, 123 PCa patients received focal therapy performed with high-intensity focused ultrasound (HIFU). The patients presented unilateral localized disease, PSA < 20 ng/dl, clinical stage T1-T2, ISUP grade 1-3, and more than 10 years of life expectancy. Five certified surgeons with different levels of experience performed the procedures and were divided into groups #1 and #2 (>30 HIFUs performed) and #3 (10-15 HIFUs performed each). All patients were prospectively followed and underwent surveillance biopsy 1 year post-treatment. The primary endpoint was radical treatment, and secondary endpoints included focal therapy failure and in-field recurrence. Univariate and multivariate logistic regression were used to detect associations between clinical and procedure variables and the endpoints.
Results: The median follow-up was 54.3 months, with a mean age of 64.4 years. The mean PSA was 6.6 ng/dl; 59.3% of patients had intermediate-risk disease, and the remaining had low-risk. During follow-up, 29 (23.6%) patients required radical treatment (external beam radiation therapy), 37 (30.1%) experienced treatment failure, and 26 (21.1%) had an in-field recurrence with an ISUP grade of ≥2. Radical treatment in the follow-up was associated with patients treated by surgeons in group #3 and with elevated post-HIFU PSA concentrations. Baseline PSA concentrations, group #3 surgeons, and post-HIFU PSA concentrations were associated with treatment failure. In-field positive biopsies were associated with baseline and post-HIFU PSA concentrations. Furthermore, patients treated by surgeons in group #3 were independently associated with radical treatment and focal therapy failure.
Conclusion: Focal therapy with HIFU has acceptable oncological outcomes in the medium term, and the surgeon's experience and technique are independently associated with the need for subsequent radical treatment and focal therapy failure.
{"title":"Prostate cancer focal therapy: surgeon experience influences oncological results.","authors":"Claudio Bovolenta Murta, José Pontes Júnior, Pedro Humberto Felix de Souza Filho, Paulo Cezar de Godoy Júnior, Felipe Guimarães Pugliesi, Kayann Reda El Hayek, Fábio Pescarmona Gallucci, Giuliano Betoni Guglielmetti, Joaquim Francisco de Almeida Claro","doi":"10.1002/pros.24800","DOIUrl":"10.1002/pros.24800","url":null,"abstract":"<p><strong>Introduction: </strong>Characterization of the index lesion of prostate cancer (PCa) has facilitated the development of focal therapy to reduce complications caused by radical treatments. In the present study, we sought to identify factors associated with the oncological results of focal therapy for PCa.</p><p><strong>Methods: </strong>Between April 2017 and February 2020, 123 PCa patients received focal therapy performed with high-intensity focused ultrasound (HIFU). The patients presented unilateral localized disease, PSA < 20 ng/dl, clinical stage T1-T2, ISUP grade 1-3, and more than 10 years of life expectancy. Five certified surgeons with different levels of experience performed the procedures and were divided into groups #1 and #2 (>30 HIFUs performed) and #3 (10-15 HIFUs performed each). All patients were prospectively followed and underwent surveillance biopsy 1 year post-treatment. The primary endpoint was radical treatment, and secondary endpoints included focal therapy failure and in-field recurrence. Univariate and multivariate logistic regression were used to detect associations between clinical and procedure variables and the endpoints.</p><p><strong>Results: </strong>The median follow-up was 54.3 months, with a mean age of 64.4 years. The mean PSA was 6.6 ng/dl; 59.3% of patients had intermediate-risk disease, and the remaining had low-risk. During follow-up, 29 (23.6%) patients required radical treatment (external beam radiation therapy), 37 (30.1%) experienced treatment failure, and 26 (21.1%) had an in-field recurrence with an ISUP grade of ≥2. Radical treatment in the follow-up was associated with patients treated by surgeons in group #3 and with elevated post-HIFU PSA concentrations. Baseline PSA concentrations, group #3 surgeons, and post-HIFU PSA concentrations were associated with treatment failure. In-field positive biopsies were associated with baseline and post-HIFU PSA concentrations. Furthermore, patients treated by surgeons in group #3 were independently associated with radical treatment and focal therapy failure.</p><p><strong>Conclusion: </strong>Focal therapy with HIFU has acceptable oncological outcomes in the medium term, and the surgeon's experience and technique are independently associated with the need for subsequent radical treatment and focal therapy failure.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":"58-64"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-10-09DOI: 10.1002/pros.24806
Fabian Falkenbach, Marie-Lena Schmalhofer, Zhe Tian, Giovanni Mazzucato, Pierre I Karakiewicz, Markus Graefen, Sophie Knipper, Lars Budäus, Daniel Koehler, Tobias Maurer
Background: To evaluate how prostate-specific antigen (PSA) levels decrease after removal of isolated prostate cancer (PCa) nodal metastases in relation to their diameter/volume ("PSA-density of PCa-metastases") and maximum standardized uptake value (SUVmax).
Methods: A total of 83 consecutive patients with solitary nodal recurrence after radical prostatectomy who underwent prostate-specific membrane antigen-radioguided salvage surgery were retrospectively analyzed. Using multivariable linear regression models, the PSA-decrease after removal of each PCa-metastases (=PSA-contribution of each PCa-metastases) was correlated with the long axis diameter/estimated volume and the SUVmax of each removed metastasis. Sizes were measured by imaging and histopathologic examination.
Results: A total of 83 patients were included with a median (interquartile range [IQR]) PSA-decrease of 0.56 [0.22, 1.31] ng/mL after salvage surgery. The median [IQR] long axis diameters in imaging and histopathological examination were 8.0 [6.0, 11.0] mm and 8.4 [5.5, 11.1] mm, respectively. The median [IQR] estimated volumes were 0.13 [0.05, 0.32] cc (imaging) and 0.05 [0.02, 0.17] cc (pathology). In multivariable linear regression analyses, the estimated PSA-contribution ([95% confidence interval [CI]) of each millimeter of long axis diameter was 0.09 [0.03, 0.14] ng/mL (imaging) or 0.08 [0.03, 0.12] ng/mL (histology). The minimum diameter for biochemical recurrence (PSA ≥ 0.2 ng/mL) was >2.2 mm (imaging) or >2.5 mm (histology). The estimated PSA-contribution [95% CI] of each cc cancer volume was 1.23 [0.51, 1.94] ng/mL (imaging) or 1.46 [0.40, 2.52] ng/mL (histology). SUVmax as surrogate parameter for tissue composition was associated with increased PSA-contribution of PCa-metastases (+0.03-0.05 ng/mL per unit increase).
Conclusions: The diameter/volume and SUVmax of metastatic tissue correlate with its contribution to PSA levels. Therefore, very small metastases may produce too little PSA for biochemical recurrence.
{"title":"Size and SUV<sub>max</sub> define the contribution of nodal metastases to PSA in oligorecurrent prostate cancer.","authors":"Fabian Falkenbach, Marie-Lena Schmalhofer, Zhe Tian, Giovanni Mazzucato, Pierre I Karakiewicz, Markus Graefen, Sophie Knipper, Lars Budäus, Daniel Koehler, Tobias Maurer","doi":"10.1002/pros.24806","DOIUrl":"10.1002/pros.24806","url":null,"abstract":"<p><strong>Background: </strong>To evaluate how prostate-specific antigen (PSA) levels decrease after removal of isolated prostate cancer (PCa) nodal metastases in relation to their diameter/volume (\"PSA-density of PCa-metastases\") and maximum standardized uptake value (SUV<sub>max</sub>).</p><p><strong>Methods: </strong>A total of 83 consecutive patients with solitary nodal recurrence after radical prostatectomy who underwent prostate-specific membrane antigen-radioguided salvage surgery were retrospectively analyzed. Using multivariable linear regression models, the PSA-decrease after removal of each PCa-metastases (=PSA-contribution of each PCa-metastases) was correlated with the long axis diameter/estimated volume and the SUV<sub>max</sub> of each removed metastasis. Sizes were measured by imaging and histopathologic examination.</p><p><strong>Results: </strong>A total of 83 patients were included with a median (interquartile range [IQR]) PSA-decrease of 0.56 [0.22, 1.31] ng/mL after salvage surgery. The median [IQR] long axis diameters in imaging and histopathological examination were 8.0 [6.0, 11.0] mm and 8.4 [5.5, 11.1] mm, respectively. The median [IQR] estimated volumes were 0.13 [0.05, 0.32] cc (imaging) and 0.05 [0.02, 0.17] cc (pathology). In multivariable linear regression analyses, the estimated PSA-contribution ([95% confidence interval [CI]) of each millimeter of long axis diameter was 0.09 [0.03, 0.14] ng/mL (imaging) or 0.08 [0.03, 0.12] ng/mL (histology). The minimum diameter for biochemical recurrence (PSA ≥ 0.2 ng/mL) was >2.2 mm (imaging) or >2.5 mm (histology). The estimated PSA-contribution [95% CI] of each cc cancer volume was 1.23 [0.51, 1.94] ng/mL (imaging) or 1.46 [0.40, 2.52] ng/mL (histology). SUV<sub>max</sub> as surrogate parameter for tissue composition was associated with increased PSA-contribution of PCa-metastases (+0.03-0.05 ng/mL per unit increase).</p><p><strong>Conclusions: </strong>The diameter/volume and SUV<sub>max</sub> of metastatic tissue correlate with its contribution to PSA levels. Therefore, very small metastases may produce too little PSA for biochemical recurrence.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":"105-111"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11609951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: A head-to-head comparison between enzalutamide (ENZ) and abiraterone plus prednisolone (ABI) revealed similar survival benefits for castration-resistant prostate cancer (CRPC) in the ENABLE study for PCa. Considering that a dose reduction of ENZ and ABI has demonstrated sufficient inhibitory ability of androgen receptor (AR) signaling, we analyzed the efficacy of modified doses of these agents in the ENABLE study for PCa.
Methods: This investigator-initiated, multicenter, randomized controlled trial that was conducted in Japan analyzed the prespecified survival endpoints, prostate-specific antigen (PSA) response rate ( ≥50% decline from baseline), and safety profile in patients treated with modified doses (ENZ ≤ 120 mg/day, ABI ≤ 750 mg/day) compared with those treated with a standard dose (ENZ 160 mg/day, ABI 1000 mg/day) as a starting dose.
Results: In total, 92 patients in each arm were treated and analyzed; 16 patients were treated with a modified dose in both the ENZ and ABI arms, respectively. Moreover, 32 patients treated with modified doses showed a significantly better time to PSA progression (TTPP) and overall survival (OS) compared with the 152 patients treated with a standard dose (HR 0.47, 95%CI 0.27-0.83, p = 0.0379, and HR 0.35, 95%CI 0.19-0.63, p = 0.0162). Despite a significantly longer TTPP in the modified ABI group than in the standard ABI group (HR 0.29, 95%CI 0.14-0.62, p = 0.0248), no significant difference was observed in the TTPP between the modified and standard ENZ groups (p = 0.5366). Furthermore, similar adverse event rates and grades were observed in each treatment dose group.
Conclusions: The modified doses of ABI showed better TTPP than the standard dose of ABI and may be a potential treatment option for CRPC patients; however, its mechanism is still unclear, although its ability to suppress AR signaling is equivalent to that of a standard dose.
{"title":"Dose modification in enzalutamide and abiraterone plus prednisolone for castration-resistant prostate cancer: A subanalysis from the ENABLE study for PCa.","authors":"Nobumichi Tanaka, Kouji Izumi, Yasushi Nakai, Takashi Shima, Yuki Kato, Koji Mita, Manabu Kamiyama, Shogo Inoue, Seiji Hoshi, Takehiko Okamura, Yuko Yoshio, Hideki Enokida, Ippei Chikazawa, Noriyasu Kawai, Kohei Hashimoto, Takashi Fukagai, Kazuyoshi Shigehara, Shizuko Takahara, Atsushi Mizokami","doi":"10.1002/pros.24796","DOIUrl":"10.1002/pros.24796","url":null,"abstract":"<p><strong>Background: </strong>A head-to-head comparison between enzalutamide (ENZ) and abiraterone plus prednisolone (ABI) revealed similar survival benefits for castration-resistant prostate cancer (CRPC) in the ENABLE study for PCa. Considering that a dose reduction of ENZ and ABI has demonstrated sufficient inhibitory ability of androgen receptor (AR) signaling, we analyzed the efficacy of modified doses of these agents in the ENABLE study for PCa.</p><p><strong>Methods: </strong>This investigator-initiated, multicenter, randomized controlled trial that was conducted in Japan analyzed the prespecified survival endpoints, prostate-specific antigen (PSA) response rate ( ≥50% decline from baseline), and safety profile in patients treated with modified doses (ENZ ≤ 120 mg/day, ABI ≤ 750 mg/day) compared with those treated with a standard dose (ENZ 160 mg/day, ABI 1000 mg/day) as a starting dose.</p><p><strong>Results: </strong>In total, 92 patients in each arm were treated and analyzed; 16 patients were treated with a modified dose in both the ENZ and ABI arms, respectively. Moreover, 32 patients treated with modified doses showed a significantly better time to PSA progression (TTPP) and overall survival (OS) compared with the 152 patients treated with a standard dose (HR 0.47, 95%CI 0.27-0.83, p = 0.0379, and HR 0.35, 95%CI 0.19-0.63, p = 0.0162). Despite a significantly longer TTPP in the modified ABI group than in the standard ABI group (HR 0.29, 95%CI 0.14-0.62, p = 0.0248), no significant difference was observed in the TTPP between the modified and standard ENZ groups (p = 0.5366). Furthermore, similar adverse event rates and grades were observed in each treatment dose group.</p><p><strong>Conclusions: </strong>The modified doses of ABI showed better TTPP than the standard dose of ABI and may be a potential treatment option for CRPC patients; however, its mechanism is still unclear, although its ability to suppress AR signaling is equivalent to that of a standard dose.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":"21-29"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-09-30DOI: 10.1002/pros.24799
Mustafa Dinckal, Kasim Emre Ergun, Mustafa Serdar Kalemci, Ezgi Guler, Recep Tokac, Süleyman Ordu, Nahit Ogut, Semiha Ozgul, Ozgur Sanli, Sait Sen, Burak Turna
Background: Accurate staging of prostate cancer (PCa) is essential for determining the appropriate treatment and predicting outcomes. This study is comparing the effectiveness of Gallium-68 Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography (Ga-68 PSMA PET/CT) and multiparametric MRI (mpMRI) in preoperative locoregional staging and localizing PCa.
Methods: A retrospective analysis was conducted on 78 patients who underwent both mpMRI and Ga-68 PSMA PET/CT scans before surgery. The imaging was reviewed by radiologists and nuclear medicine specialists and compared with the final histopathology, which was reviewed by an experienced uropathologist.
Results: mpMRI demonstrated higher sensitivity in detecting extraprostatic extension (EPE) and bladder neck invasion (BNI) compared to Ga-68 PSMA PET/CT (83% vs. 44% and 29% vs. 17%, respectively). Conversely, Ga-68 PSMA PET/CT showed higher sensitivity in detecting seminal vesicle invasion (SVI) and lymph node metastasis (LNM) (75% vs. 55% and 50% vs. 30%, respectively). When both methods were combined, sensitivity increased in detecting both EPE and SVI. The index tumor localization in mpMRI and Ga-68 PSMA PET/CT was found to be in complete agreement with histopathological findings at 36.4% and 41.8%, respectively. When both imaging methods were combined, the agreement with histopathology in predicting index tumor localization reached 72.1%.
Conclusion: Both mpMRI and Ga-68 PSMA PET/CT provide valuable and complementary information for tumor localization and locoregional staging. While mpMRI showed higher sensitivity in detecting EPE, Ga-68 PSMA PET/CT demonstrated superior performance in detecting LNM and SVI. The combined use of these imaging modalities enhance accuracy of index tumor localizations.
{"title":"Head-to-head comparison of GA-68 PSMA PET/CT and multiparametric MRI findings with postoperative results in preoperative locoregional staging and localization of prostate cancer.","authors":"Mustafa Dinckal, Kasim Emre Ergun, Mustafa Serdar Kalemci, Ezgi Guler, Recep Tokac, Süleyman Ordu, Nahit Ogut, Semiha Ozgul, Ozgur Sanli, Sait Sen, Burak Turna","doi":"10.1002/pros.24799","DOIUrl":"10.1002/pros.24799","url":null,"abstract":"<p><strong>Background: </strong>Accurate staging of prostate cancer (PCa) is essential for determining the appropriate treatment and predicting outcomes. This study is comparing the effectiveness of Gallium-68 Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography (Ga-68 PSMA PET/CT) and multiparametric MRI (mpMRI) in preoperative locoregional staging and localizing PCa.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 78 patients who underwent both mpMRI and Ga-68 PSMA PET/CT scans before surgery. The imaging was reviewed by radiologists and nuclear medicine specialists and compared with the final histopathology, which was reviewed by an experienced uropathologist.</p><p><strong>Results: </strong>mpMRI demonstrated higher sensitivity in detecting extraprostatic extension (EPE) and bladder neck invasion (BNI) compared to Ga-68 PSMA PET/CT (83% vs. 44% and 29% vs. 17%, respectively). Conversely, Ga-68 PSMA PET/CT showed higher sensitivity in detecting seminal vesicle invasion (SVI) and lymph node metastasis (LNM) (75% vs. 55% and 50% vs. 30%, respectively). When both methods were combined, sensitivity increased in detecting both EPE and SVI. The index tumor localization in mpMRI and Ga-68 PSMA PET/CT was found to be in complete agreement with histopathological findings at 36.4% and 41.8%, respectively. When both imaging methods were combined, the agreement with histopathology in predicting index tumor localization reached 72.1%.</p><p><strong>Conclusion: </strong>Both mpMRI and Ga-68 PSMA PET/CT provide valuable and complementary information for tumor localization and locoregional staging. While mpMRI showed higher sensitivity in detecting EPE, Ga-68 PSMA PET/CT demonstrated superior performance in detecting LNM and SVI. The combined use of these imaging modalities enhance accuracy of index tumor localizations.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":"48-57"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11609967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-10-13DOI: 10.1002/pros.24793
Hemal Semwal, Colton Ladbury, Ali Sabbagh, Osama Mohamad, Derya Tilki, Arya Amini, Jeffrey Wong, Yun Rose Li, Scott Glaser, Bertram Yuh, Savita Dandapani
Background: Though several nomograms exist, machine learning (ML) approaches might improve prediction of pathologic stage in patients with prostate cancer. To develop ML models to predict pathologic stage that outperform existing nomograms that use readily available clinicopathologic variables.
Methods: Patients with prostate adenocarcinoma who underwent surgery were identified in the National Cancer Database. Seven ML models were trained to predict organ-confined (OC) disease, extracapsular extension, seminal vesicle invasion (SVI), and lymph node involvement (LNI). Model performance was measured using area under the curve (AUC) on a holdout testing data set. Clinical utility was evaluated using decision curve analysis (DCA). Performance metrics were confirmed on an external validation data set.
Results: The ML-based extreme gradient boosted trees model achieved the best performance with an AUC of 0.744, 0.749, 0.816, 0.811 for the OC, ECE, SVI, and LNI models, respectively. The MSK nomograms achieved an AUC of 0.708, 0.742, 0.806, 0.802 for the OC, ECE, SVI, and LNI models, respectively. These models also performed the best on DCA. Findings were consistent on both a holdout internal validation data set as well as an external validation data set.
Conclusions: Our ML models better predicted pathologic stage relative to existing nomograms at predicting pathologic stage. Accurate prediction of pathologic stage can help oncologists and patients determine optimal definitive treatment options for patients with prostate cancer.
背景:尽管存在多种提名图,但机器学习(ML)方法可能会改善对前列腺癌患者病理分期的预测。目的:开发预测病理分期的 ML 模型,使其优于现有的使用现成临床病理变量的提名图:方法:从国家癌症数据库中找出接受手术的前列腺腺癌患者。我们训练了七个 ML 模型来预测器官封闭(OC)疾病、囊外扩展、精囊侵犯(SVI)和淋巴结受累(LNI)。模型的性能是通过保留测试数据集上的曲线下面积(AUC)来衡量的。临床实用性通过决策曲线分析(DCA)进行评估。在外部验证数据集上确认了性能指标:基于 ML 的极梯度增强树模型性能最佳,OC、ECE、SVI 和 LNI 模型的 AUC 分别为 0.744、0.749、0.816 和 0.811。MSK提名图的OC、ECE、SVI和LNI模型的AUC分别为0.708、0.742、0.806和0.802。这些模型在 DCA 上的表现也最好。这些结果在保留的内部验证数据集和外部验证数据集上都是一致的:结论:在预测病理分期方面,我们的 ML 模型比现有的提名图更能预测病理分期。准确预测病理分期有助于肿瘤学家和患者确定前列腺癌患者的最佳明确治疗方案。
{"title":"Machine learning and explainable artificial intelligence to predict pathologic stage in men with localized prostate cancer.","authors":"Hemal Semwal, Colton Ladbury, Ali Sabbagh, Osama Mohamad, Derya Tilki, Arya Amini, Jeffrey Wong, Yun Rose Li, Scott Glaser, Bertram Yuh, Savita Dandapani","doi":"10.1002/pros.24793","DOIUrl":"10.1002/pros.24793","url":null,"abstract":"<p><strong>Background: </strong>Though several nomograms exist, machine learning (ML) approaches might improve prediction of pathologic stage in patients with prostate cancer. To develop ML models to predict pathologic stage that outperform existing nomograms that use readily available clinicopathologic variables.</p><p><strong>Methods: </strong>Patients with prostate adenocarcinoma who underwent surgery were identified in the National Cancer Database. Seven ML models were trained to predict organ-confined (OC) disease, extracapsular extension, seminal vesicle invasion (SVI), and lymph node involvement (LNI). Model performance was measured using area under the curve (AUC) on a holdout testing data set. Clinical utility was evaluated using decision curve analysis (DCA). Performance metrics were confirmed on an external validation data set.</p><p><strong>Results: </strong>The ML-based extreme gradient boosted trees model achieved the best performance with an AUC of 0.744, 0.749, 0.816, 0.811 for the OC, ECE, SVI, and LNI models, respectively. The MSK nomograms achieved an AUC of 0.708, 0.742, 0.806, 0.802 for the OC, ECE, SVI, and LNI models, respectively. These models also performed the best on DCA. Findings were consistent on both a holdout internal validation data set as well as an external validation data set.</p><p><strong>Conclusions: </strong>Our ML models better predicted pathologic stage relative to existing nomograms at predicting pathologic stage. Accurate prediction of pathologic stage can help oncologists and patients determine optimal definitive treatment options for patients with prostate cancer.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":"3-12"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-10-14DOI: 10.1002/pros.24805
Cheuk-Yin Tang, Joshua J X Li, Ka Long Leung, Hei Yuet Ma, Joanna K M Ng, Ryan T L Yan, Jeremy Y Teoh, Christopher J VandenBussche, Gary M Tse
Introduction: Urine cytology is robust for the diagnosis of urothelial lesions, but data on the detection rates of prostatic adenocarcinoma in urine cytology is limited. In this study, a multicenter review was performed to define the clinical role of urine cytology in diagnosis of prostatic adenocarcinoma.
Methods: Cytologic diagnoses of lower tract urine cytology specimens with histology-proven prostatic adenocarcinoma from three institutions, from a period of over two decades, were reviewed. Clinicopathological parameters-tumor grade, stage, histologic features, and preanalytical factors-prostate-specific antigen (PSA) level and lesion size, were retrieved and compared with cytologic diagnoses.
Results: In total, 2115 urine cytology specimens from 1119 patients were retrieved. The atypia (or above/C3+) and suspicious (or above/C4+) rates were 19.48% and 3.36%. Bilobar and extracapsular involvement, lymphovascular invasion, Gleason score, and International Society of Urological Pathology grade were associated with a positive urine diagnosis (p < 0.05). The atypia (C3+) and suspicious (C4+) rates of urine cytology in patients with a PSA level of ≤4.0 ng/mL was paradoxically higher (p < 0.01), but PSA levels correlated positively with urine diagnosis at higher cutoffs (>10, >20, >50, >100 ng/mL). All these factors remained significant on multivariate analysis (p < 0.05), including a negative correlation with low-PSA (≤4.0 ng/mL, p = 0.001) and positive correlation with high-PSA (>20 ng/mL, p = 0.020). Lesion size and multifocality were not associated with urine cytology diagnosis (p > 0.05).
Conclusion: Urine cytology showed low sensitivity in detection of prostatic adenocarcinoma. Detection rates were largely positively correlated with PSA levels but not for lesion size nor multifocality, limiting its clinical utility.
{"title":"Is prostatic adenocarcinoma detectable by urine cytology-A multicenter retrospective review.","authors":"Cheuk-Yin Tang, Joshua J X Li, Ka Long Leung, Hei Yuet Ma, Joanna K M Ng, Ryan T L Yan, Jeremy Y Teoh, Christopher J VandenBussche, Gary M Tse","doi":"10.1002/pros.24805","DOIUrl":"10.1002/pros.24805","url":null,"abstract":"<p><strong>Introduction: </strong>Urine cytology is robust for the diagnosis of urothelial lesions, but data on the detection rates of prostatic adenocarcinoma in urine cytology is limited. In this study, a multicenter review was performed to define the clinical role of urine cytology in diagnosis of prostatic adenocarcinoma.</p><p><strong>Methods: </strong>Cytologic diagnoses of lower tract urine cytology specimens with histology-proven prostatic adenocarcinoma from three institutions, from a period of over two decades, were reviewed. Clinicopathological parameters-tumor grade, stage, histologic features, and preanalytical factors-prostate-specific antigen (PSA) level and lesion size, were retrieved and compared with cytologic diagnoses.</p><p><strong>Results: </strong>In total, 2115 urine cytology specimens from 1119 patients were retrieved. The atypia (or above/C3+) and suspicious (or above/C4+) rates were 19.48% and 3.36%. Bilobar and extracapsular involvement, lymphovascular invasion, Gleason score, and International Society of Urological Pathology grade were associated with a positive urine diagnosis (p < 0.05). The atypia (C3+) and suspicious (C4+) rates of urine cytology in patients with a PSA level of ≤4.0 ng/mL was paradoxically higher (p < 0.01), but PSA levels correlated positively with urine diagnosis at higher cutoffs (>10, >20, >50, >100 ng/mL). All these factors remained significant on multivariate analysis (p < 0.05), including a negative correlation with low-PSA (≤4.0 ng/mL, p = 0.001) and positive correlation with high-PSA (>20 ng/mL, p = 0.020). Lesion size and multifocality were not associated with urine cytology diagnosis (p > 0.05).</p><p><strong>Conclusion: </strong>Urine cytology showed low sensitivity in detection of prostatic adenocarcinoma. Detection rates were largely positively correlated with PSA levels but not for lesion size nor multifocality, limiting its clinical utility.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":"97-104"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11609891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: To develop and validate a prognostic risk model for high-risk metastatic hormone-sensitive prostate cancer (mHSPC) patients treated with upfront abiraterone acetate (ABI).
Methods: This retrospective multicenter study involved 233 high-risk mHSPC patients who received upfront ABI, developed by three academic centers. The model was externally validated with an independent cohort of 282 patients. To identify independent prognostic factors for second progression-free survival (PFS2) and develop the best-fitted model, Cox proportional hazards regression, followed by the Akaike information criterion, was used. Patients were categorized into three groups based on their risk scores. PFS2 and overall survival (OS) were evaluated according to the risk groups in the discovery and validation cohorts.
Results: The median age was 72 (range 51-89) years, with a median follow-up duration of 27 months. Independent factors linked to PFS2 included an Eastern Cooperative Oncology Group performance status ≥2, a primary Gleason score of 5, an extent of disease score of ≥3 or liver metastasis, and lactate dehydrogenase >220 U/L. Median PFS2 for favorable-, intermediate-, and poor-risk groups were not reached, 43 months, and 16 months, respectively. The median OS was 29 months in the poor-risk group, whereas it was not reached in the favorable- and intermediate-risk groups. The 2-year OS rates in the favorable-, intermediate- and poor-risk groups were 94.5%, 80.1%, and 60.3%, respectively. The validation cohort confirmed the risk model's relationship with PFS2 and OS. The median PFS2 and OS in the high-risk group were 21 months and 32 months, respectively.
Conclusions: Our prognostic model, including five clinical factors, is useful for patient care and treatment selection in high-risk mHSPC patients treated with ADT plus ABI. The developed model could provide more accurate information, guide treatment decisions, or classify patients in future clinical trials.
{"title":"Prognostic model for second progression-free survival and overall survival in patients with high-risk metastatic hormone-sensitive prostate cancer treated with abiraterone acetate and androgen deprivation therapy.","authors":"Shintaro Narita, Takafumi Yanagisawa, Shingo Hatakeyama, Kenichi Hata, Kazutoshi Fujita, Takashi Ueda, Toshikazu Tanaka, Shinya Maita, Shuji Chiba, Hiromi Sato, Yuya Sekine, Mizuki Kobayashi, Soki Kashima, Ryohei Yamamoto, Kazuyuki Numakura, Mitsuru Saito, Koichiro Takayama, Katsumi Okane, Toshiya Ishida, Yohei Horikawa, Teruaki Kumazawa, Jiro Shimoda, Ikuya Iwabuchi, Takehiro Suzuki, Osamu Ukimura, Takahiro Kimura, Chikara Ohyama, Kyoko Nomura, Tomonori Habuchi","doi":"10.1002/pros.24802","DOIUrl":"10.1002/pros.24802","url":null,"abstract":"<p><strong>Background: </strong>To develop and validate a prognostic risk model for high-risk metastatic hormone-sensitive prostate cancer (mHSPC) patients treated with upfront abiraterone acetate (ABI).</p><p><strong>Methods: </strong>This retrospective multicenter study involved 233 high-risk mHSPC patients who received upfront ABI, developed by three academic centers. The model was externally validated with an independent cohort of 282 patients. To identify independent prognostic factors for second progression-free survival (PFS2) and develop the best-fitted model, Cox proportional hazards regression, followed by the Akaike information criterion, was used. Patients were categorized into three groups based on their risk scores. PFS2 and overall survival (OS) were evaluated according to the risk groups in the discovery and validation cohorts.</p><p><strong>Results: </strong>The median age was 72 (range 51-89) years, with a median follow-up duration of 27 months. Independent factors linked to PFS2 included an Eastern Cooperative Oncology Group performance status ≥2, a primary Gleason score of 5, an extent of disease score of ≥3 or liver metastasis, and lactate dehydrogenase >220 U/L. Median PFS2 for favorable-, intermediate-, and poor-risk groups were not reached, 43 months, and 16 months, respectively. The median OS was 29 months in the poor-risk group, whereas it was not reached in the favorable- and intermediate-risk groups. The 2-year OS rates in the favorable-, intermediate- and poor-risk groups were 94.5%, 80.1%, and 60.3%, respectively. The validation cohort confirmed the risk model's relationship with PFS2 and OS. The median PFS2 and OS in the high-risk group were 21 months and 32 months, respectively.</p><p><strong>Conclusions: </strong>Our prognostic model, including five clinical factors, is useful for patient care and treatment selection in high-risk mHSPC patients treated with ADT plus ABI. The developed model could provide more accurate information, guide treatment decisions, or classify patients in future clinical trials.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":"73-81"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-09-22DOI: 10.1002/pros.24798
Elizabeth U Tran, Eric Royz, Kyra Yamamoto, Samantha Marley, Alexander Song, Elizabeth Pan, Aaron M Lee, Daniel Herchenhorn, Sam Denmeade, Emmanuel S Antonarakis, Mark Markowski, Rana R McKay
Introduction: Advanced prostate cancer treatment has improved with androgen receptor signaling inhibitors (ARPI), yet many patients develop metastatic castration-resistant prostate cancer (mCRPC), characterized by sustained androgen receptor (AR) signaling. Bipolar androgen therapy (BAT) introduces supraphysiologic testosterone levels to inhibit tumor growth, offering novel treatment for mCRPC by exploiting AR-dependent mechanisms.
Case presentations: Case 1: A 53-year-old man with mCRPC, post multiple systemic therapies, initiated BAT and pembrolizumab, achieving PSA reduction and improved quality of life before progression. The patient exhibited AR amplification, which may have contributed to favorable response to BAT. Case 2: A 73-year-old man with recurrent prostate cancer, stable on ADT and abiraterone, experienced PSA decline with BAT to an undetectable level, maintaining stability post-therapy discontinuation. Case 3: A 73-year-old man with metastatic prostate cancer, initially resistant to enzalutamide, achieved clinical benefit and disease control with BAT, although he did not meet PSA response criteria, patient had remarkable response upon enzalutamide rechallenge. Case 4: A 90-year-old man with localized prostate cancer, refractory to multiple treatments, experienced symptom relief and PSA reduction with BAT before progression.
Conclusion: BAT represents a promising treatment strategy for mCRPC. This case series underscores BAT's potential to induce significant clinical and biochemical responses, resensitize tumors to ARPIs, and improve patients' quality of life. Despite eventual progression in some cases, BAT offers a period of disease control. Further research is needed to optimize patient selection and understand the molecular determinants of BAT responsiveness.
简介:雄激素受体信号转导抑制剂(ARPI)改善了晚期前列腺癌的治疗,但仍有许多患者发展为以持续雄激素受体(AR)信号转导为特征的转移性阉割耐药前列腺癌(mCRPC)。双极雄激素疗法(BAT)引入了超生理水平的睾酮来抑制肿瘤生长,通过利用AR依赖机制为mCRPC提供了新的治疗方法:病例 1:一名 53 岁的男性 mCRPC 患者在接受多种系统治疗后,开始接受 BAT 和 pembrolizumab 治疗,在病情恶化前实现了 PSA 降低并改善了生活质量。该患者表现出AR扩增,这可能是对BAT产生良好反应的原因之一。病例 2:一名 73 岁的男性前列腺癌复发患者,ADT 和阿比特龙治疗后病情稳定,BAT 治疗后 PSA 下降到检测不到的水平,停药后病情保持稳定。病例 3:一名 73 岁的转移性前列腺癌患者,起初对恩杂鲁胺耐药,使用 BAT 后取得了临床疗效并控制了病情,虽然未达到 PSA 反应标准,但患者在再次使用恩杂鲁胺后反应显著。病例 4:一名 90 岁的男性患者患有局部前列腺癌,对多种治疗方法均无效,在病情恶化前使用 BAT 后症状缓解,PSA 降低:结论:BAT 是治疗 mCRPC 的一种前景广阔的治疗策略。本系列病例强调了 BAT 在诱导显著的临床和生化反应、使肿瘤对 ARPIs 再敏感以及改善患者生活质量方面的潜力。尽管某些病例最终会出现进展,但 BAT 仍能使疾病得到一段时间的控制。要优化患者选择并了解 BAT 反应性的分子决定因素,还需要进一步的研究。
{"title":"Bipolar androgen therapy for treatment of metastatic castration-resistant prostate cancer: A case series.","authors":"Elizabeth U Tran, Eric Royz, Kyra Yamamoto, Samantha Marley, Alexander Song, Elizabeth Pan, Aaron M Lee, Daniel Herchenhorn, Sam Denmeade, Emmanuel S Antonarakis, Mark Markowski, Rana R McKay","doi":"10.1002/pros.24798","DOIUrl":"10.1002/pros.24798","url":null,"abstract":"<p><strong>Introduction: </strong>Advanced prostate cancer treatment has improved with androgen receptor signaling inhibitors (ARPI), yet many patients develop metastatic castration-resistant prostate cancer (mCRPC), characterized by sustained androgen receptor (AR) signaling. Bipolar androgen therapy (BAT) introduces supraphysiologic testosterone levels to inhibit tumor growth, offering novel treatment for mCRPC by exploiting AR-dependent mechanisms.</p><p><strong>Case presentations: </strong>Case 1: A 53-year-old man with mCRPC, post multiple systemic therapies, initiated BAT and pembrolizumab, achieving PSA reduction and improved quality of life before progression. The patient exhibited AR amplification, which may have contributed to favorable response to BAT. Case 2: A 73-year-old man with recurrent prostate cancer, stable on ADT and abiraterone, experienced PSA decline with BAT to an undetectable level, maintaining stability post-therapy discontinuation. Case 3: A 73-year-old man with metastatic prostate cancer, initially resistant to enzalutamide, achieved clinical benefit and disease control with BAT, although he did not meet PSA response criteria, patient had remarkable response upon enzalutamide rechallenge. Case 4: A 90-year-old man with localized prostate cancer, refractory to multiple treatments, experienced symptom relief and PSA reduction with BAT before progression.</p><p><strong>Conclusion: </strong>BAT represents a promising treatment strategy for mCRPC. This case series underscores BAT's potential to induce significant clinical and biochemical responses, resensitize tumors to ARPIs, and improve patients' quality of life. Despite eventual progression in some cases, BAT offers a period of disease control. Further research is needed to optimize patient selection and understand the molecular determinants of BAT responsiveness.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":"40-47"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-10-28DOI: 10.1002/pros.24803
Marco Finati, Chase Morrison, Alex Stephens, Giuseppe Chiarelli, Giuseppe Ottone Cirulli, Shane Tinsley, Matthew Davis, Akshay Sood, Nicolò Buffi, Giovanni Lughezzani, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Gian Maria Busetto, Carlo Bettocchi, Craig Rogers, Giuseppe Carrieri, Firas Abdollah
Background: Non-Hispanic Black (NHB) men are at higher risk both for incidence and mortality from prostate cancer (PCa) compared to Non-Hispanic White (NHW) men, but these findings arise from biopsy-detected PCa reports. We aimed to compare the incidence, subsequent management and cancer-specific mortality (CSM) of incidental PCa among NHB and NHW men, using two different North American cohorts.
Methods: The Surveillance, Epidemiology and End-Result (SEER: 2004-2017) and our institutional Henry Ford Health (HFH: 1995-2022) databases were queried to identify men diagnosed with incidental PCa. Cumulative incidence estimates were used to calculate CSM differences between NHB and NHW men. Competing-risk multivariable regression analysis tested the impact of race on CSM, after accounting for all available covariates.
Results: A total of 418 and 6,124 incidental PCa cases were recorded in HFH and SEER database respectively. No pathological differences were observed between NHB and NHW men in both the cohorts, except for prostate-specific antigen (PSA) value at diagnosis, which was higher in NHB men. At 10-years, the CSM rates were 5.5% vs 7.2% in our cohort and 8.6% vs 10.3% in the SEER cohort for NHW and NHB men, respectively (all Gray's test p-value > 0.05). At multivariable, race was not an independent predictor of CSM in our HFH cohort (HR: 1.46, 95% CI: 0.57-3.71, p = 0.6). In the SEER cohort, NHB men were 34% less likely to die from PCa from 1 year to the next (95% CI: 0.49-0.90, p = 0.008), when compared with NHW men.
Conclusions: In the comparison of incidental PCa findings between NHB and NHW men, both groups had similar pathological characteristic and survival outcomes. These findings are different from the 'conventional' screening-detected PCa and suggest that racial differences have minimal to no adverse effects on PCa-specific mortality after incidental diagnosis.
{"title":"Association of race with incidence, characteristics, and mortality from incidental prostate cancer: Analysis of two North American contemporary cohorts.","authors":"Marco Finati, Chase Morrison, Alex Stephens, Giuseppe Chiarelli, Giuseppe Ottone Cirulli, Shane Tinsley, Matthew Davis, Akshay Sood, Nicolò Buffi, Giovanni Lughezzani, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Gian Maria Busetto, Carlo Bettocchi, Craig Rogers, Giuseppe Carrieri, Firas Abdollah","doi":"10.1002/pros.24803","DOIUrl":"10.1002/pros.24803","url":null,"abstract":"<p><strong>Background: </strong>Non-Hispanic Black (NHB) men are at higher risk both for incidence and mortality from prostate cancer (PCa) compared to Non-Hispanic White (NHW) men, but these findings arise from biopsy-detected PCa reports. We aimed to compare the incidence, subsequent management and cancer-specific mortality (CSM) of incidental PCa among NHB and NHW men, using two different North American cohorts.</p><p><strong>Methods: </strong>The Surveillance, Epidemiology and End-Result (SEER: 2004-2017) and our institutional Henry Ford Health (HFH: 1995-2022) databases were queried to identify men diagnosed with incidental PCa. Cumulative incidence estimates were used to calculate CSM differences between NHB and NHW men. Competing-risk multivariable regression analysis tested the impact of race on CSM, after accounting for all available covariates.</p><p><strong>Results: </strong>A total of 418 and 6,124 incidental PCa cases were recorded in HFH and SEER database respectively. No pathological differences were observed between NHB and NHW men in both the cohorts, except for prostate-specific antigen (PSA) value at diagnosis, which was higher in NHB men. At 10-years, the CSM rates were 5.5% vs 7.2% in our cohort and 8.6% vs 10.3% in the SEER cohort for NHW and NHB men, respectively (all Gray's test p-value > 0.05). At multivariable, race was not an independent predictor of CSM in our HFH cohort (HR: 1.46, 95% CI: 0.57-3.71, p = 0.6). In the SEER cohort, NHB men were 34% less likely to die from PCa from 1 year to the next (95% CI: 0.49-0.90, p = 0.008), when compared with NHW men.</p><p><strong>Conclusions: </strong>In the comparison of incidental PCa findings between NHB and NHW men, both groups had similar pathological characteristic and survival outcomes. These findings are different from the 'conventional' screening-detected PCa and suggest that racial differences have minimal to no adverse effects on PCa-specific mortality after incidental diagnosis.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":"82-89"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}