Patient characteristics at time of prostate cancer diagnosis in different races at an academic center serving a diverse population.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 158-158
Author(s):  
Tejas Suresh ◽  
Qi Gao ◽  
Mimi Kim ◽  
Sanjay Goel ◽  
Benjamin Adam Gartrell
Keyword(s):  
Prostate Cancer ◽  
Gleason Score ◽  
Metastatic Disease ◽  
Death Rate ◽  
Age At Diagnosis ◽  
Categorical Variables ◽  
Racial Groups ◽  
Diverse Population ◽  
Academic Center ◽  
The Mean

158 Background: In the United States, prostate cancer (PCa) incidence and death rate differ among racial groups. Non-Hispanic Blacks (NHB) have a higher incidence and death rate than non-Hispanic Whites (NHW), whereas incidence and death rate are slightly lower in Hispanics (H) than in NHW. We sought to compare the socioeconomic, demographic and baseline prognostic factors at PCa diagnosis among different races at a large, urban academic center serving a diverse population. Methods: Following institutional review board approval, the Montefiore Medical Center Cancer Registry was used to generate a comprehensive list of patients diagnosed with PCa 2004 to 2013. Clinical Looking Glass (a searchable database of patient information) and individual patient chart review were used to obtain data including age at diagnosis, socioeconomic score (SES), Gleason score, stage at diagnosis and PSA at diagnosis. Patients were classified by self-identified race as H, NHB or NHW. For categorical variables the chi-square test was used, whereas the ANOVA or the Kruskal-Wallis tests were employed for continuous variables. Results: During the specified period 2352 patients were diagnosed with PCa among which 778 were self-classified as H, 1046 as NHB, 486 as NHW and 42 as other (O). The mean age at diagnosis differed between these groups (H 63.2, NHB 63.4, NHW 67, O 63.0, p < 0.0001). The proportion of men below the mean SES also differed between races (H 92.8%, NHB 91.3%, NHW 56.6%, O 75%, p < 0.0001). Median PSA (ng/ml) at diagnosis was similar (H 8.0, NHB 8.4 NHW 7.2, O 6.4, p = 0.0768) whereas Gleason score differed between racial groups (Gleason ≤ 6: H 42.8%, NHB 39.1%, NHW 52.2%, O 50%; Gleason 8-10: H 15.8%, NHB 17.6%, NHW 14.3%, O 16.7%, p = 0.0005). The proportion of men with metastatic disease at diagnosis also differed significantly in these groups (H 7.5%, NHB 9.0%, NHW 4.3%, O 9.5%, p = 0.0139). Conclusions: At our center, in patients with newly diagnosed PCa, there are significant differences among racial groups. These include age at diagnosis, SES, Gleason score and proportion with metastatic disease. Such differences at diagnosis suggest that minority patients are at risk for inferior PCa outcomes.

scholarly journals Evaluation of neutrophil-to-lymphocyte ratio prior to prostate biopsy to predict biopsy histology: Results of 1836 patients

2015 ◽  
Vol 9 (11-12) ◽  
pp. 761 ◽  
Author(s):  
Mehmet Ilker Gokce ◽  
Nurullah Hamidi ◽  
Evren Suer ◽  
Semih Tangal ◽  
Adil Huseynov ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Gleason Score ◽  
Prostate Biopsy ◽  
Specific Antigen ◽  
Categorical Variables ◽  
Chi Square ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Cancer Group ◽  
The Mean

Introduction: We evaluate the role of NLR prior to prostate biopsy to predict biopsy histology and Gleason score in patients with prostate cancer.Methods: In this retrospective study, we evaluated data of patients underwent prostate biopsy between May 2005 and March 2015. We collected the following data: age, prostate-specific antigen (PSA), biopsy histology, Gleason score (GS) in prostate cancer patients, neutrophil counts, and lymphocyte counts. Patients were grouped as benign prostatic hyperplasia (BPH), prostate cancer, and prostatitis. The Chi square test was used to compare categorical variables and analysis of variance (ANOVA) was applied for continuous variables.Results: Data of 1836 patients were investigated. The mean age, total PSA and neutrophil-lymphocyte ratio (NLR) of the population were 66.8 ± 8.17 years, 9.38 ± 4.7 ng/dL, and 3.11 ± 1.71, respectively. Patients were divided as follows: 625 in the group with BPH history, 600 in the prostatitis group, and 611 in the prostate cancer histology group. The mean NLR of the prostatitis group was higher compared to the prostate cancer and BPH groups (p = 0.0001). The mean NLR of the prostate cancer group was significantly higher compared to the BPH group (p = 0.002). The GS 8–10 group had a significantly higher mean NLR compared to GS 5–6 (3.64 vs. 2.54, p = 0.0001) and GS 7 (3.64 vs. 2.58, p = 0.0001) patients.Conclusions: NLR was found to differ with regard to histology of prostate biopsy and higher GS was associated with higher NLR in patients with prostate cancer. However prostatitis prevents the use of NLR in predicting prostate cancer before a prostate biopsy. Also, the retrospective nature and lack of multivariate analysis in this study somewhat limits the relevance of these results.

scholarly journals Kinetic analysis and optimisation of 18F-rhPSMA-7.3 PET imaging of prostate cancer

2021 ◽  
Author(s):  
Simona Malaspina ◽  
Vesa Oikonen ◽  
Anna Kuisma ◽  
Otto Ettala ◽  
Kalle Mattila ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Metastatic Disease ◽  
Uptake Kinetics ◽  
Whole Body ◽  
Target Area ◽  
Post Injection ◽  
The Mean ◽  
Pet Radiopharmaceutical ◽  
Time Frames ◽  
Over Time

Abstract Purpose This phase 1 open-label study evaluated the uptake kinetics of a novel theranostic PET radiopharmaceutical, 18F-rhPSMA-7.3, to optimise its use for imaging of prostate cancer. Methods Nine men, three with high-risk localised prostate cancer, three with treatment-naïve hormone-sensitive metastatic disease and three with castration-resistant metastatic disease, underwent dynamic 45-min PET scanning of a target area immediately post-injection of 300 MBq 18F-rhPSMA-7.3, followed by two whole-body PET/CT scans acquired from 60 and 90 min post-injection. Volumes of interest (VoIs) corresponding to prostate cancer lesions and reference tissues were recorded. Standardised uptake values (SUV) and lesion-to-reference ratios were calculated for 3 time frames: 35–45, 60–88 and 90–118 min. Net influx rates (Ki) were calculated using Patlak plots. Results Altogether, 44 lesions from the target area were identified. Optimal visual lesion detection started 60 min post-injection. The 18F-rhPSMA-7.3 signal from prostate cancer lesions increased over time, while reference tissue signals remained stable or decreased. The mean (SD) SUV (g/mL) at the 3 time frames were 8.4 (5.6), 10.1 (7) and 10.6 (7.5), respectively, for prostate lesions, 11.2 (4.3), 13 (4.8) and 14 (5.2) for lymph node metastases, and 4.6 (2.6), 5.7 (3.1) and 6.4 (3.5) for bone metastases. The mean (SD) lesion-to-reference ratio increases from the earliest to the 2 later time frames were 40% (10) and 59% (9), respectively, for the prostate, 65% (27) and 125% (47) for metastatic lymph nodes and 25% (19) and 32% (30) for bone lesions. Patlak plots from lesion VoIs signified almost irreversible uptake kinetics. Ki, SUV and lesion-to-reference ratio estimates showed good agreement. Conclusion 18F-rhPSMA-7.3 uptake in prostate cancer lesions was high. Lesion-to-background ratios increased over time, with optimal visual detection starting from 60 min post-injection. Thus, 18F-rhPSMA-7.3 emerges as a very promising PET radiopharmaceutical for diagnostic imaging of prostate cancer. Trial Registration NCT03995888 (24 June 2019).

scholarly journals Can mean ADC value and ADC ratio of benign prostate tissue to prostate cancer assist in the prediction of clinically significant prostate cancer within the PI-RADSv2 scoring system?

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Samar Ramzy Ragheb ◽  
Reem Hassan Bassiouny
Keyword(s):  
Prostate Cancer ◽  
Sensitivity And Specificity ◽  
Gleason Score ◽  
Treatment Strategies ◽  
Serum Levels ◽  
Prostatic Tissue ◽  
Histopathological Analysis ◽  
Adc Value ◽  
The Mean ◽  
Clinically Significant

Abstract Background The aim of this study is to investigate whether quantitative DW metrics can provide additive value to the reliable categorization of lesions within existing PI-RADSv2 guidelines. Fifty-eight patients with clinically suspicious prostate cancer who underwent PR examination, PSA serum levels, sextant TRUS-guided biopsies, and bi-parametric MR imaging were included in the study. Results Sixty-six lesions were detected by histopathological analysis of surgical specimens. The mean ADC values were significantly lower in tumor than non-tumor tissue. The mean ADC value inversely correlated with Gleason score of tumors with a significant p value < 0.001.Conversely, a positive relationship was found between the ADC ratio (ADC of benign prostatic tissue to prostate cancer) and the pathologic Gleason score with a significant elevation of the ADC ratio along with an increase of the pathologic Gleason score (p < 0.001). ROC curves constructed for the tumor ADC and ADC ratio helped to distinguish pathologically aggressive (Gleason score ≥ 7) from non-aggressive (Gleason score ≤ 6) tumors and to correlate it with PIRADSv2 scoring to predict the presence of clinically significant PCA (PIRADSv2 DW ≥ 4). The ability of the tumor ADC and ADC ratio to predict highly aggressive tumors (GS> 7) was high (AUC for ADC and ADC ratio, 0.946 and 0.897; p = 0.014 and 0.039, respectively). The ADC cut-off value for GS ≥ 7 was < 0.7725 and for GS ≤ 6 was > 0.8620 with sensitivity and specificity 97 and 94%. The cutoff ADC ratio for predicting (GS > 7) was 1.42 and for GS ≤ 6 was > 1.320 with sensitivity and specificity 97 and 92%. By applying this ADC ratio cut-off value the sensitivity and specificity of reader 1 for correct categorization of PIRADSv2 DW > 4 increased from 90 and 68% to 95 and 90% and that of reader 2 increased from 94 and 88% to 97 and 92%, respectively. Conclusion Estimation of DW metrics (ADC and ADC ratio between benign prostatic tissue and prostate cancer) allow the non-invasive assessment of biological aggressiveness of prostate cancer and allow reliable application of the PIRADSv2 scoring to determine clinically significant cancer (DW score > 4) which may contribute in planning initial treatment strategies.

Prognostic risk factors to predict final pathohistology in patients undergoing radical salvage prostatectomy for locally recurrent prostate cancer after radiation therapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15544-15544
Author(s):  
D. Pfister ◽  
C. Ohlmann ◽  
D. Sahi ◽  
U. Engelmann ◽  
A. Heidenreich
Keyword(s):  
Prostate Cancer ◽  
Multivariate Analysis ◽  
Radiation Therapy ◽  
Gleason Score ◽  
Curative Intent ◽  
Ldr Brachytherapy ◽  
Pet Ct ◽  
The Mean ◽  
Locally Recurrent ◽  
Biopsy Gleason Score

15544 Background: Radical salvage prostatectomy (sRPE) represents one local secondary treatment option with curative intent in patients failing radiation therapy for localized prostate cancer (PCA). Currently, there are very few studies correlating preoperative clinical and pathohistological variables with final pathohistology of sRPE specimens. It was the purpose of our study to identify prognosticators predicting organ confined and locally advanced PCA. Methods: 45 patients with biopsy-proven locally recurrent PCA underwent sRPE and extended pelvic lymphadenectomy (epLA) via a retropubic approach. Preoperative PSA, PSA doubling time, PSA prior to initial radiation therapy, biopsy Gleason score, number of positive biopsies, cT stage, 11choline PET/CT findings, type of radiation therapy, neoadjuvant androgen deprivation were correlated with the pathohistological stage by uni- and multivariate analysis. Results: A total of 45 patients underwent sRPE and epLA; 16 (35.5%), 12 (26.6%) and 17 (37.8%) patients had undergone external beam radiation (EBRT), HDR and LDR brachytherapy, resp. The mean preop. serum PSA was 7.8 (2–24) ng/ml; mean biopsy Gleason score was 5.6 (4–9). We did not encounter significant intraoperative compliations, the mean blood loss was 490 (200–950) ml. A mean of 19 (10 - 32) lymph nodes were removed. Pathohistology showed stage pT1–2pN0 in 27 (60%), stage pT3a/b and pTxpN1 PCA in 9 (20%) and 9 (20%) of patients, respectively. Positive surgical margins were identified in 5 (11%) patients. By multivariate analysis the parameters significantly associated with organ confined PCA sRPE are PSADT > 12 months, = 50% positive biopsy cores, biopsy Gleason score = 7 and previous LDR brachytherapy (pT1–2pN0R0 in all men); pre-radiation and preoperative PSA, PET/CT findings had no significant impact with final pTpN-stage. Conclusions: SRPE can be performed with a low morbidity in biopsy proven locally recurrent PCA after radiotherapy. The identified prognostic parameters will help to select patients most suitable for a local secondary surgical approach with curative intent. Especially in patients with local relapse following LDR brachytherapy sRPE represents a valuable treatment option. No significant financial relationships to disclose.

βIII-tubulin expression as a predictor of docetaxel resistance in metastatic castrate-resistant prostate cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15174-e15174
Author(s):  
Bertha E. Sanchez ◽  
Nilesh Gupta ◽  
Meredith Mahan ◽  
Evelyn R Barrack ◽  
Prem-veer Reddy ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Gleason Score ◽  
Clinical Decision Making ◽  
Performance Status ◽  
Ecog Performance Status ◽  
Docetaxel Resistance ◽  
Psa Response ◽  
Castrate Resistant Prostate Cancer ◽  
The Mean ◽  
Castrate Resistant

e15174 Background: Docetaxel is a tubulin-targeting cytotoxic that remains first-line therapy in metastatic castrate-resistant prostate cancer (mCRPC) patients (pts) even though half of pts are reported to be non-responders. A predictive marker to identify those who will benefit from docetaxel-therapy will assist clinical decision making. High βIII-tubulin (TUBB3) expression has previously been reported to correlate with lack of response to taxanes in other cancers. We evaluated TUBB3 expression as a predictor of docetaxel-resistance in mCRPC. Methods: mCRPC pts treated with at least 3 cycles of docetaxel between 1990 and 2011 were identified retrospectively. TUBB3 immunostaining was performed on archival formalin-fixed, paraffin-embedded tissue. Stain intensity was scored from 0 to 3; 2 and 3 were interpreted as positive. Rates of PSA response were compared between pts with positive (+) and negative (-) TUBB3 expression. Two definitions of PSA response were evaluated (any PSA decline and at least 50% decline). Overall survival (OS) distribution between TUBB3+ and TUBB3- pts was estimated by the Kaplan-Meier method. Results: Of 73 pts, 26 (35%) expressed TUBB3. At diagnosis, the mean age was 65.7 years and the median Gleason score was 8. At the time of docetaxel therapy, the mean age was 71.2 years, the median PSA level was 70.9 (range, 0.2-5253) and 76% had ECOG performance status ≤1. The median number of docetaxel cycles was 7 (range, 3-18). The total dose of docetaxel was not different between groups (p=0.705). The median OS was 19.2 mo. TUBB3 expression was not correlated with any clinical or pathological characteristic (age, Gleason score, stage, ECOG, PSA, LDH, alkaline phosphatase, hemoglobin, visceral disease or chemotherapy before docetaxel). 65% of TUBB3+ pts had any PSA decline compared to 89% of pts with TUBB3- (p=0.0267). 52% of TUBB3+ pts had a PSA decline of ≥ 50% compared to 70% of TUBB3- pts (p=0.0144). Median OS for TUBB3+ pts was 16.8 mo compared to 20.4 mo in TUBB3- pts (p=0.039). Conclusions: High TUBB3 expression was associated with shorter OS and lower PSA response rates in mCRPC pts treated with docetaxel. These findings need to be validated prospectively.

Regional variation in survival after metastatic prostate cancer diagnosis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4666-4666
Author(s):  
Darius Lakdawalla ◽  
Charu Gupta ◽  
Yesenia L Luna ◽  
Stephen F Thompson ◽  
Muralikrishna Tangirala ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Gleason Score ◽  
Regional Variation ◽  
Regional Differences ◽  
Metastatic Prostate Cancer ◽  
Survival Rates ◽  
Wald Test ◽  
Sensitivity Analyses ◽  
Base Case ◽  
The Mean

4666 Background: Survival after diagnosis of metastatic prostate cancer (mPC) averages 2-3 years. Substantial regional differences in survival have been documented for PC prior to 2000. We investigated the extent to which regional variation exists in survival for mPC patients during 2000-2007. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database linked to Medicare claims, we identified men (mean age, 77.6 years) continuously enrolled in Medicare Parts A/B who were diagnosed with mPC between 2000 and 2007 and not diagnosed with another malignancy. The base-case model was limited to hospital service areas with >50 patients. A Cox proportional hazards model was used to estimate hazard ratios (HR) for overall survival (OS), adjusting for year of diagnosis, age, marital status, poverty and education covariates, Gleason score, comorbidities, and region covariates. Sensitivity of results was tested by limiting the analysis to patients surviving at least 6 months after diagnosis and by removing regional sample size limits. We report HRs for covariates, results of a Wald test of joint significance for region effects, and percentage difference from the mean for each region’s HR for death. Results: A total of 2696 patients with mPC met the inclusion criteria. OS was 37% at 3 years and mean HR for death was 4.8 (sd 2.1). HRs for death were positively correlated with age (HR=1.96, 95% CI: 1.6-2.3 for >80 years), PC-specific comorbidity index (HR=1.2, 95% CI: 1.1-1.3), and Gleason score (HR=6.6, 95% CI: 2.4-17.8 for poorly differentiated). Year of diagnosis, race, and socioeconomic status were not significantly associated with mortality. Wald test of joint significance for survival across regions of P=.019 indicated significant differences in survival across regions and was robust in sensitivity analyses. Patients living in regions with the worst survival rates had HRs for death that were 20% higher than the mean (HR=5.8) and those living in regions with the best survival rates had HRs 30% lower than the mean (HR=3.4). Conclusions: There are significant regional differences in survival for mPC patients in the 2000s. Further research is needed to determine if treatment differences play a role in this disparity.

Gleason score upgrade among 10,282 men who underwent surgery as initial treatment in 2010: A population-based study.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 72-72
Author(s):  
Hong Zhang ◽  
Edward M. Messing ◽  
Hamza Ahmed ◽  
Yuhchyau Chen
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Gleason Score ◽  
Specific Antigen ◽  
Low Risk ◽  
Categorical Variables ◽  
Intermediate Risk ◽  
Time Of Surgery ◽  
Significant Difference ◽  
Risk Prostate Cancer

72 Background: Active surveillance is now accepted initial management for men who have localized prostate cancer with low risk of disease progression. Many criteria have been used for patient identification, including Gleason score (GS) obtained from prostate biopsy. Because of concerns of sampling error, some have recommended repeated biopsy before committing to active surveillance. However, there is limited information about the risk of missing high grade disease using the current standard biopsy approach. This study seeks to compare GS difference from biopsy and surgery to provide an estimated rate of GS upgrade. Methods: The Surveillance, Epidemiology, and End Results (SEER) program was used to identify men with American Joint Committee on Cancer stage T1-2cN0M0 prostate cancer diagnosed between January 2010 and December 2010. Patients who underwent prostatectomy were selected for further analysis. Based on prostate-specific antigen (PSA) levels and GS, cases were divided into low (PSA <=10 and GS <=6) and intermediate (10<PSA<=20 or GS=7) risk groups. The rates of GS upgrade were reported for each group. Chi-square tests were used to assess differences in categorical variables (e.g. age and race) between groups of GS upgrade and no change/downgrade. Results: A total of 10,282 men were evaluated, with 9.2% (n=942) having low-risk disease, and 90.8% (n=9340) having intermediate-risk disease. Among men with low-risk prostate cancer, 22.3% (n=210) had GS upgrade and 0.8% (n=8) had GS 8 disease. Among men with intermediate risk disease, 26.2% (n=2446) had GS upgrade and 2.3% (n=214) had GS 8 disease. There was no statistically significant difference in either age or race distribution among men who had GS upgrade versus no change or downgrade at the time of surgery. Conclusions: A substantial number of low- and intermediate-risk prostate cancer patients had GS upgrade at the time of surgery, but few had upgraded to GS 8 high risk disease. These observations suggest that repeat biopsy prior to active surveillance may not be necessary.

Evaluating the impact of African American ancestry among men with localized prostate cancer treated with radical prostatectomy.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 41-41
Author(s):  
Daniel Canter ◽  
Julia E. Reid ◽  
Maria Latsis ◽  
Margaret Variano ◽  
Shams Halat ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
African American ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Metastatic Disease ◽  
Proportional Hazards ◽  
Clinical Stage ◽  
Cox Proportional Hazards ◽  
Significant Difference ◽  
The Impact

41 Background: Prostate cancer (PC) is the most common male malignancy. Prior data has suggested that African American (AA) men present with more aggressive disease relative to men of other ancestries. Here, we examined the effects of ancestry on clinical and molecular measures of disease aggressiveness as well as pathologic outcomes in men treated with radical prostatectomy (RP) for localized PC. Methods: Data was collected from patients undergoing RP at the Ochsner Clinic from 2006 to 2011. Formalin−fixed paraffin embedded biopsy tissue was analyzed for the RNA expression of 31 cell cycle progression (CCP) genes and 15 housekeeping genes to obtain a CCP score (a validated molecular measure of PC aggressiveness). Cancer of the Prostate Risk Assessment (CAPRA) scores were also determined based on clinicopathologic features at the time of diagnosis. Clinical (Gleason score, tumor stage, CAPRA score) and molecular (CCP score) measures of disease aggressiveness were compared based on ancestry (AA versus non−AA). Cox proportional hazards models were used to test association of ancestry to biochemical recurrence (BCR) and progression to metastatic disease. Fisher’s exact and Wilcoxon rank sum tests were used to compare ancestries. Results: A total of 384 patients were treated with RP, including 133 (34.8%) AA men. At the time of diagnosis, the median age was 62 years (interquartile range (IQR) 56, 66) and PSA was 5.4 ng/mL (IQR 4.2, 7.6). When compared by ancestry, there were no significant differences in biopsy Gleason score (p = 0.26), clinical stage (p = 0.27), CAPRA score (p = 0.58), or CCP score (p = 0.87). In addition, there was no significant difference in the risk of BCR between ancestries (p = 0.55). Only non−AA men progressed to metastatic disease within the ten years of follow−up. Conclusions: Contrary to prior reports, these data appears to indicate that men of AA ancestry do not necessarily present with or develop a more biologically aggressive form of PC. Although these data represents only one institution’s experience, it contains a highly robust AA population compared to prior reports. Further research is required to account for the discrepancy in the previously published literature.

Using longitudinal PSA values and machine learning for predicting progression of early stage prostate cancer in veterans.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17554-e17554
Author(s):  
Ioana Danciu ◽  
Samantha Erwin ◽  
Greeshma Agasthya ◽  
Tate Janet ◽  
Benjamin McMahon ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Machine Learning ◽  
Disease Progression ◽  
Gleason Score ◽  
Prediction Models ◽  
Early Stage ◽  
Treatment Plan ◽  
Specific Antigen ◽  
Machine Learning Algorithms ◽  
Age At Diagnosis

e17554 Background: The ability to understand and predict at the time of diagnosis the trajectories of prostate cancer patients is critical for deciding the appropriate treatment plan. Evidence-based approaches for outcome prediction include predictive machine learning algorithms that harness health record data. Methods: All our analyses used the Veterans Affairs Clinical Data Warehouse (CDW). We included all individuals with a non-metastatic (early stage) prostate cancer diagnosis between 2002 and 2017 as documented in the CDW cancer registry (N = 111351). Our predictors were demographics (age at diagnosis, race), disease staging parameters abstracted at diagnosis ( Stage grouping AJCC, Gleason score, SEER summary stage) and prostate specific antigen (PSA) laboratory values in the last 5 years prior to diagnosis (last value, the value before last, average, minimum, maximum, rate of the change of the last 2 PSAs and density). The predicted outcome was disease progression at 2 years (N = 3469) and 5 years (N = 6325) defined as metastasis - taking either Abiraterone, Sipuleucel-T, Enzalutamide or Radium 223, registry cancer related death or PSA > 50. We used 4 different machine learning classifiers to train prediction models: random forest, k-nearest neighbor, decision trees, and xgboost all with hyper parameter optimization. For testing, we used two approaches: (1) 20% sample held out at the beginning of the study, and (2) stratified test/train split on the remaining data. Results: The table below shows the performance of the best classifier, xgboost. The top five predictors of disease progression were the last PSA, Gleason Score, maximum PSA, age at diagnosis, and SEER summary stage. The last PSA had a significantly higher contribution than the other predictors. More than one PSA value is important for prediction, emphasizing the need for investigating the PSA trajectory in the period before diagnosis. The models are overall very robust going from outcome at 2 years compared to 5 years. Conclusions: A machine learning based xgboost classifier can be integrated in clinical decision support at diagnosis, to robustly predict disease progression at 2 and 5 years. [Table: see text]

scholarly journals Ar galima remiantis objektyviais ikioperaciniais veiksniais prognozuoti ankstyvą biocheminį atkrytį po radikalios prostatektomijos?

2005 ◽  
Vol 3 (4) ◽  
pp. 0-0
Author(s):  
Daimantas Milonas ◽  
Dainius Burinskas ◽  
Stasys Auškalnis ◽  
Mindaugas Jievaltas
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Gleason Score ◽  
Biochemical Recurrence ◽  
Specific Antigen ◽  
Biochemical Failure ◽  
Surgical Margins ◽  
Antigen Concentration ◽  
The Mean

Daimantas Milonas, Dainius Burinskas, Stasys Auškalnis, Mindaugas JievaltasKauno medicinos universiteto Urologijos klinika,Eivenių g. 2, LT-50009 KaunasEl paštas: [email protected] Tikslas Nustatyti objektyvius veiksnius, kurie leistų prognozuoti ankstyvą biocheminį atkrytį po radikalios prostatektomijos. Ligoniai ir metodai Į tyrimą įtraukti 142 prostatos vėžiu sergantys ligoniai, kuriems buvo atliktos radikalios prostatektomijos. Ankstyvas biocheminis atkrytis konstatuotas, kai prostatos specifinio antigeno koncentracija, praėjus 3 mėn. po operacijos, buvo >0,2 ng/ml. Neoadjuvantinė terapija (hormonų ar spindulių) buvo pagrindinis atmetimo kriterijus. Vertinta prostatos specifinio antigeno koncentracija, vėžio diferenciacijos laipsnis iki ir po operacijos, vėžio stadija, prostatos chirurginio šalinimo išlaidos. Rezultatai Galutinei analizei panaudoti 94 ligonų duomenys. Vidutinis jų amžius buvo 66,6 metų, prostatos specifinis antigenas iki operacijos – 9,87 ng/ml, Gleason diferenciacijos laipsnis iki operacijos – 5,87, diferenciacijos laipsnis po operacijos – 6,38, teigiami rezekciniai kraštai rasti 36 (38%), ankstyvas biocheminis atkrytis – 13 (14%) pacientų. Atlikus logistinę regresijos analizę nustatyta, jog ankstyvą biocheminį atkrytį galima patikimai prognozuoti, kai Gleason pooperacinis vėžio diferenciacijos laipsnis didesnis nei 7 (p = 0,02, tikimybių santykis – 7,8) ir vėžio stadija T3b (p = 0,012, tikimybių santykis – 6,76). Išvados Remiantis ikioperaciniais objektyviais veiksniais negalima patikimai prognozuoti ankstyvo biocheminio atkryčio. Prostatos vėžio išplitimas į sėklines pūsleles (T3b stadija) ir Gleasono pooperacinis vėžio diferenciacijos laipsnis > 7 leidžia reikšmingai prognozuoti ankstyvą biocheminį atkryti, po radikalios prostatektomijos, tokiems ligoniams indikuojamas ankstyvas adjuvantinis gydymas, nelaukiant biocheminio atkryčio požymių. Reikšminiai žodžiai: prostatos vėžys, radikali prostatektomija, ankstyvas biocheminis atkrytis Can objective preoperative parameters predict early biochemical recurrence after radical prostatectomy? Daimantas Milonas, Dainius Burinskas, Stasys Auškalnis, Mindaugas JievaltasClinic of Urology, Kaunas University of Medicine,Eivenių str. 2, LT-50009 Kaunas, LithuaniaE-mail: [email protected] Objective To estimate objective parameters which can be useful for predicting early biochemical recurrence after radical prostatectomy due to prostate cancer. Patients and methods The study embraced 142 patients that underwent radical retropubic prostatectomy. Early biochemical failure was defined as a prostate-specific antigen level 3 months after radical prostatectomy > 0.2 ng/ml. Neoadjuvant treatment (hormonal therapy or radiation) was the mane exclusion criteria. Preoperative antigen concentration, Gleason score at the biopsy, patients’ age, postoperative Gleason score, stage and surgical margins were investigated as possible predictors of early biochemical recurrence. Results Final analysis was done using data on 94 patients. The mean patients’ age was 66.6 years and mean preoperative prostate specific antigen concentration 9.87 (range 0.44–98.4) ng/ml. The mean Gleason score preoperatively was 5.87 (range 2–8) and postoperatively 6.38 (range 4–9). Positive surgical margins were in 36 (38%) and early biochemical failure was detected in 13 (14%) cases. Logistic regression analysis shows that postoperative Gleason score >7 (p = 0.02, OR-7.8) and stage pT3b (p = 0.012, OR-6.76) are powerful parameters for predicting early biochemical recurrence. Conclusions Preoperative parameters cannot predict early biochemical recurrence. Postoperative parameters such as Gleason score >7 and stage pT3b are useful in the prediction of early biochemical recurrence. In such patients early adjuvant treatment is advisable. Keywords: prostate cancer, radical prostatectomy, early biochemical recurrence

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