Prostate cancer in the British Asian population: A case-control study

Objectives: To study demographic and disease variables at presentation, diagnosis and treatment of prostate cancer in British South Asian (SA) men and compare with their Caucasian counterparts. Methods: A retrospective review of prostate cancer cases between 2010 and 2015 identified patients of SA descent who were matched for age, residential location and year of diagnosis with two Caucasian patients. Disease characteristics, treatment and short-term outcomes were recorded and compared. Results: A total of 1274 patients were diagnosed, of which 50 (3.9%) were SA. SA patients had less screen-detected prostate cancer (12% versus 31%, p=0.02), more co-morbidity and more high-risk disease (57% versus 37%, p=0.03). Active surveillance was the preferred treatment option (32%) with 2% having surgery compared with 22% ( p=0.003) from the Caucasian cohort. Logistic regression showed these disparities to be related to the different presentations. Conclusion: SA men with prostate cancer are less likely to be diagnosed following asymptomatic screening and the majority have high-risk disease at presentation. These differences lead to SA men preferring active surveillance to radical surgery. Given the increasing British Asian population, the findings demonstrate a need for research and public health interventions to better understand and address the differences noted between these groups.

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Disease Characteristics of Minority Patient Populations with Polycythemia Vera: An Analysis from the Reveal Study

Blood ◽

10.1182/blood-2018-99-112530 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 4735-4735 ◽

Cited By ~ 1

Author(s):

Ivy Altomare ◽

Philomena Colucci ◽

Shreekant Parasuraman ◽

Dilan Chamikara Paranagama ◽

Anas Al-Janadi

Keyword(s):

United States ◽

High Risk ◽

The United States ◽

Low Risk ◽

Employment Equity ◽

Disease Characteristics ◽

Reveal Study ◽

High Risk Disease ◽

Caucasian Patients ◽

Equity Ownership

Abstract Introduction: Polycythemia vera (PV) is associated with increased blood cell counts, risk of thrombosis, and symptoms including fatigue and pruritus. Few studies have examined the presence or absence of racial/ethnic disparities among patients with PV. The objective of this analysis is to describe differences in disease characteristics, diagnosis, treatment, and quality of life (QOL) among Caucasian and non-Caucasian patients with PV in the United States enrolled in the prospective, observational REVEAL study. Methods: The ongoing REVEAL study (ClinicalTrials.gov ID, NCT02252159) is a prospective, multicenter, observational study of adult patients with PV in the United States. Patients were observed during a 36-month period, during which clinical data were collected from usual care visits. This analysis compared demographics, disease and clinical characteristics, disease management, comorbidities, and QOL between Caucasian and non-Caucasian patients with PV at enrollment. QOL was measured by the European Organisation for Research and Treatment of Cancer Questionnaire C30 (EORTC QLQ-C30) and Myeloproliferative Neoplasm Symptom Assessment Form Total Symptom Score (MPN-SAF TSS). Results are summarized with descriptive statistics. Results: Of the 2,510 patients enrolled in REVEAL, 2,237 were Caucasian (89.1%); 199 (7.9%) were non-Caucasian, comprised of African American (5.7%), Asian (1.5%), Native American Indian (0.2%), Pacific Islander (0.1%), and other patients (0.4%); no information was provided regarding race or ethnicity for 74 patients (2.9%). Baseline disease characteristics were similar for Caucasian and non-Caucasian groups with respect to gender and disease duration. There were no differences in method of diagnosis, laboratory values, or overall history of thrombosis between groups (Figure 1A). Mean age was higher among Caucasian patients compared to non-Caucasian patients (66.6 vs 63.8 years, respectively). The proportion of patients from rural areas was higher among Caucasian vs non-Caucasian patients (28.8% vs 12.6%); similarly, the proportion of patients from urban areas was lower among Caucasian vs non-Caucasian patients (23.1% vs 46.7%). The proportion of patients with some college or higher level of education was higher among Caucasian vs non-Caucasian patients (64.1% vs 50.3%). A higher proportion of Caucasian vs non-Caucasian patients were retired (52.0% vs 43.2%); a higher proportion of non-Caucasian patients reported being unable to work or were disabled (3.8% vs 10.1%). More Caucasian patients had high-risk disease (78.0%) compared with non-Caucasian patients (71.4%), and patients with high-risk disease were managed similarly between groups. However, Caucasian patients with low-risk disease received more phlebotomies (56.6%) than non-Caucasian patients with low-risk disease (40.4%), and over twice as many non-Caucasian patients received hydroxyurea (38.6%) than Caucasian patients (15.6%) (Figure 1B). MPN-SAF TSSs were higher for non-Caucasian patients compared with Caucasian patients, suggesting a worse symptom burden. Similarly, non-Caucasian patients reported lower functional and symptom outcomes on the EORTC QLQ-C30, including a disparity in financial difficulties, compared to Caucasian patients (Figure 1C). Conclusions: This analysis evaluated a cohort of racial/ethnic minority patients with PV treated in the United States. As in other cancer-related trials, there is a risk that racial and ethnic minorities may be underrepresented in REVEAL. With this limitation in mind, in this analysis, differences were not observed among Caucasian and non-Caucasian patients with respect to method of diagnosis, duration of disease, thrombosis rates, or management of high-risk disease. Non-Caucasian patients demonstrated higher rates of low-risk disease and cytoreductive therapy for low-risk disease yet had worse symptom burden, lower functional scores, and greater disability. This study underscores the importance of symptom assessment and ancillary resource availability for patients with PV Disclosures Altomare: Bayer: Consultancy; Genentech: Consultancy; Ipsen: Other: Advisory Board Member; Celgene: Other: Advisory Board Member; Incyte: Consultancy; Novartis: Consultancy; Amgen: Consultancy. Colucci:Incyte: Employment, Equity Ownership. Parasuraman:Incyte: Employment, Equity Ownership. Paranagama:Incyte: Employment, Equity Ownership.

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Assessment of 2,000 patients presenting to a multidisciplinary prostate cancer clinic in the United Kingdom.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.5077 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 5077-5077

Author(s):

Pandora Rudd ◽

John Hines ◽

Eleanor Watkins ◽

Thomas Powles ◽

Karen Tipples

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Disease Severity ◽

Active Surveillance ◽

Group Treatment ◽

Treatment Decision ◽

Treatment Decisions ◽

Treatment Choice ◽

Low Risk ◽

High Risk Disease

5077 Background: Multidisciplinary clinics (MDCs) involving both oncologists and urologists are recommended for managing radical prostate cancer patients. The effectiveness of MDCs in arriving at best treatment decisions is unknown. We analysed patient characteristics and management decisions over 8 years in a MDC at Bart’s Hospital, London. Methods: Clinical data were collected in real time and analysed retrospectively, including demographics, tumour stage and grade, D’amico risk group, treatment choice and first clinician seen. We compared variables in 1000 consecutive patients presenting between 2011-2015 (cohort A) to 1000 patients presenting 2016-18 (cohort B) to investigate trends over time. Results: 2000 patients were included, age 65.2 ± 8.6 years and 65.9 ± 9.1 years (p=0.08), with presenting PSA 9.0 (6.3-14.4) and 9.2 (6.4-15.0) ng/ml (p=0.36), in cohort A and B respectively. Disease severity and initial treatment decision are shown in the table. In low risk disease, 126 (75%) patients had active surveillance in cohort A, and 158 (90%) in cohort B (p=0.0003). In high risk disease, 202 (59%) patients had radiotherapy compared to 194 (50%) in cohort B (p=0.011). In cohort B, 127 (39%) patients seeing oncology first had radiotherapy compared to 143 (25%) patients who saw urology first (p<0.0001). 76 (23%) and 154 (27%) patients had surgery, that saw oncology and urology first, respectively (p=0.11). Conclusions: In 2000 patients presenting to a prostate MDC over 8 years, active surveillance in low risk disease increased, radiotherapy in high risk disease reduced, and the proportion undergoing surgery was unchanged. The initial clinician seen influenced treatment choice; having both specialists in the same consultation may improve consistency of treatment decisions. Disease severity and treatment choice before and after 2016. [Table: see text]

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Predictive factors for short-term biochemical recurrence-free survival after robot-assisted laparoscopic radical prostatectomy in high-risk prostate cancer patients

International Journal of Clinical Oncology ◽

10.1007/s10147-019-01445-7 ◽

2019 ◽

Vol 24 (9) ◽

pp. 1099-1104 ◽

Cited By ~ 3

Author(s):

Mitsugu Kanehira ◽

Ryo Takata ◽

Shuhei Ishii ◽

Akito Ito ◽

Daiki Ikarashi ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Recurrence Free Survival ◽

Robot Assisted ◽

Short Term ◽

Free Survival ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer

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Prostate Cancer Disparities in Risk Group at Presentation and Access to Treatment for Asian Americans, Native Hawaiians, and Pacific Islanders: A Study With Disaggregated Ethnic Groups

JCO Oncology Practice ◽

10.1200/op.21.00412 ◽

2021 ◽

Author(s):

Bhav Jain ◽

Kenrick Ng ◽

Patricia Mae G. Santos ◽

Kekoa Taparra ◽

Vinayak Muralidhar ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Asian Indian ◽

Asian American ◽

Native Hawaiian ◽

Risk Group ◽

Pacific Islander ◽

Pacific Islanders ◽

Native Hawaiians ◽

High Risk Disease

PURPOSE We identified (1) differences in localized prostate cancer (PCa) risk group at presentation and (2) disparities in access to initial treatment for Asian American, Native Hawaiian, and Pacific Islander (AANHPI) men with PCa after controlling for sociodemographic factors. METHODS We assessed all patients in the National Cancer Database with localized PCa with low-, intermediate-, and high-risk disease who identified as Thai, White, Asian Indian, Chinese, Vietnamese, Korean, Japanese, Filipino, Hawaiian, Pacific Islander, Laotian, Pakistani, Kampuchean, and Hmong. Multivariable logistic regression defined adjusted odds ratios (AORs) with 95% CI of (1) presenting at progressively higher risk group and (2) receiving treatment or active surveillance with intermediate- or high-risk disease, adjusting for sociodemographic and clinical factors. RESULTS Among 980,889 men (median age 66 years), all AANHPI subgroups with the exception of Thai (AOR = 0.84 [95% CI, 0.58 to 1.21], P > .05), Asian Indian (AOR = 1.12 [95% CI, 1.00 to 1.25], P > .05), and Pakistani (AOR = 1.34 [95% CI, 0.98 to 1.83], P > .05) men had greater odds of presenting at a progressively higher PCa risk group compared with White patients (Chinese AOR = 1.18 [95% CI, 1.11 to 1.25], P < .001; Japanese AOR = 1.36 [95% CI, 1.26 to 1.47], P < .001; Filipino AOR = 1.37 [95% CI, 1.29 to 1.46], P < .001; Korean AOR = 1.32 [95% CI, 1.18 to 1.48], P < .001; Vietnamese AOR = 1.20 [95% CI, 1.07 to 1.35], P = .002; Laotian AOR = 1.60 [95% CI, 1.08 to 2.36], P = .018; Hmong AOR = 4.07 [95% CI, 1.54 to 10.81], P = .005; Kampuchean AOR = 1.55 [95% CI, 1.03 to 2.34], P = .036; Asian Indian or Pakistani AOR = 1.15 [95% CI, 1.07 to 1.24], P < .001; Native Hawaiians AOR = 1.58 [95% CI, 1.38 to 1.80], P < .001; and Pacific Islanders AOR = 1.58 [95% CI, 1.37 to 1.82], P < .001). Additionally, Japanese Americans (AOR = 1.46 [95% CI, 1.09 to 1.97], P = .013) were more likely to receive treatment compared with White patients. CONCLUSION Our findings suggest that there are differences in PCa risk group at presentation by race or ethnicity among Asian American, Native Hawaiian, and Pacific Islander subgroups and that there exist disparities in treatment patterns. Although AANHPI are often studied as a homogenous group, heterogeneity upon subgroup disaggregation underscores the importance of further study to assess and address barriers to PCa care.

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Use of the Prostate Health Index for the Detection of Aggressive Prostate Cancer at Radical Prostatectomy

Urologia Internationalis ◽

10.1159/000379758 ◽

2015 ◽

Vol 95 (4) ◽

pp. 390-399 ◽

Cited By ~ 5

Author(s):

Luigi Mearini ◽

Elisabetta Nunzi ◽

Carla Ferri ◽

Guido Bellezza ◽

Carolina Lolli ◽

...

Keyword(s):

Prostate Cancer ◽

Lymph Node ◽

High Risk ◽

Radical Prostatectomy ◽

Gleason Score ◽

Health Index ◽

Final Pathology ◽

High Risk Disease ◽

Prostate Health Index ◽

Prostate Health

Introduction: In current study, we compared the accuracy of the PSA isoform p2PSA and its derivatives, the percentage of p2PSA to free PSA (%p2PSA) and the Prostate Health Index (PHI) in the detection of prostate cancer (PC) characteristics at the ﬁnal pathology with respect to reference standards. Materials and Methods: This was an observational prospective study evaluating 43 consecutive PC patients treated with laparoscopic/robotic radical prostatectomy (RP). Logistic regression models were ﬁtted to test the predictors of pT3 stage, pathologic Gleason score ≥8 or Gleason score upgrading, margin status, lymph node invasion, and the presence of high-risk disease (pT3 disease and/or Gleason score ≥8 and/or positive lymph node). The comparative base model included tPSA, clinical stage, biopsy Gleason score, and percentage of positive core. Results: Seventeen patients (39.5%) were affected by pT3 disease or had a pathologic Gleason score ≥8; positive margins were detected in 12 patients (27.9%), lymph node invasion was found in 2 patients (4.7%), and 15 patients (34.8%) harbored high-risk disease. In the univariate analysis, p2PSA, %p2PSA, and PHI were signiﬁcant predictors of pT3 disease, pathologic Gleason score, and the presence of high-risk disease (all p < 0.05), whereas only PHI was an independent predictor of pT3 disease, margin status, and presence of high-risk disease, increasing the accuracy of a base multivariable model by 6.3% (p < 0.05) and 4.2% (p < 0.05) for the prediction of pT3 and high-risk disease, respectively. Conclusions: p2PSA and its derivatives, primarily PHI, were signiﬁcant predictors of unfavorable PC characteristics as detected at the ﬁnal pathology, thus improving the clinical performance of standard prognostic factors for aggressive disease.

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Combined Androgen Blockade in Localized Prostate Cancer Treated With Definitive Radiation Therapy

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2019.7335 ◽

2019 ◽

Vol 17 (12) ◽

pp. 1497-1504

Author(s):

Lucas K. Vitzthum ◽

Chris Straka ◽

Reith R. Sarkar ◽

Rana McKay ◽

J. Michael Randall ◽

...

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

High Risk ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Short Term ◽

Combined Androgen Blockade ◽

Significant Difference ◽

Androgen Blockade

Background: The addition of androgen deprivation therapy to radiation therapy (RT) improves survival in patients with intermediate- and high-risk prostate cancer (PCa), but it is not known whether combined androgen blockade (CAB) with a gonadotropin-releasing hormone agonist (GnRH-A) and a nonsteroidal antiandrogen improves survival over GnRH-A monotherapy. Methods: This study evaluated patients with intermediate- and high-risk PCa diagnosed in 2001 through 2015 who underwent RT with either GnRH-A alone or CAB using the Veterans Affairs Informatics and Computing Infrastructure. Associations between CAB and prostate cancer–specific mortality (PCSM) and overall survival (OS) were determined using multivariable regression with Fine-Gray and multivariable Cox proportional hazards models, respectively. For a positive control, the effect of long-term versus short-term GnRH-A therapy was tested. Results: The cohort included 8,423 men (GnRH-A, 4,529; CAB, 3,894) with a median follow-up of 5.9 years. There were 1,861 deaths, including 349 resulting from PCa. The unadjusted cumulative incidences of PCSM at 10 years were 5.9% and 6.9% for those receiving GnRH-A and CAB, respectively (P=.16). Compared with GnRH-A alone, CAB was not associated with a significant difference in covariate-adjusted PCSM (subdistribution hazard ratio [SHR], 1.05; 95% CI, 0.85–1.30) or OS (hazard ratio, 1.02; 95% CI, 0.93–1.12). For high-risk patients, long-term versus short-term GnRH-A therapy was associated with improved PCSM (SHR, 0.74; 95% CI, 0.57–0.95) and OS (SHR, 0.82; 95% CI, 0.73–0.93). Conclusions: In men receiving definitive RT for intermediate- or high-risk PCa, CAB was not associated with improved PCSM or OS compared with GnRH alone.

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