Nationwide analysis: Changes in the natural history of low risk localized prostate cancer.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 12-12
Author(s):  
John Thomas Helgstrand ◽  
Nina Klemann ◽  
Birgitte Grønkaer Toft ◽  
Ben Vainer ◽  
Martin Andreas Røder ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Natural History ◽  
Lead Time ◽  
Specific Antigen ◽  
Tumor Burden ◽  
Low Risk ◽  
Stage Migration ◽  
History Of ◽  
The Difference ◽  
The Impact

12 Background: Increased use of prostate-specific antigen (PSA) has introduced an increase in PCa incidence and a lead time and stage migration at diagnosis, altering the natural history of PCa. Contemporary PCa patients are likely younger and have smaller tumor burden at diagnosis. We investigated if changes in the PCa landscape have altered the course of low-risk localized PCa. Methods: In the Danish Prostate Cancer Registry (DaPCaR), patients diagnosed from 1995 to 2011 with localized (T1-2, N0/X, M0) PCa with Gleason score ≤ 6 were identified. Patients were stratified into three periods of diagnosis; 1995-2000 (period 1), 2001-2005 (period 2) and 2006-2011 (period 3). Competing risk analysis treating PCa and other-cause death as competing events was performed. Results: Of the 5,660 patients identified, 35.9% had undergone radical prostatectomy (RP). From period 1 to period 3, the median age at diagnosis decreased from 72.2 to 66.0 years and the median PSA decreased from 16.2 to 8.6 ng/mL. From period 1 to period 3, the 5-year risk of PCa-death decreased from 14.3% (95% CI: 12.1-16.4%) to 1.3% (95% CI: 0.83-1.7%), p < .0.0001 and the risk of other cause death decreased from 18.1% (95% CI: 15.8-20.5%) to 7.2% (95% CI: 6.2-8.2), p = 0.0001. In patients undergoing RP, the 5-year risk of PCa-death decreased from 0.67% (95% CI: 0.67-2.0%) for patients diagnosed in period 1 to 0.45% (95% CI: 0.0055-0.84), for patients diagnosed in period 3, p = 0.92. For patients not undergoing RP, the 5-year risk of PCa death decreased from 16.6% (95% CI: 14.1-19.1) to 2.0% (95% CI: 1.2-2.7%), p < 0.0001. Conclusions: In a nationwide cohort of patients with low risk localized PCa, the 5-year risk of PCa-death significantly decreased when comparing patients diagnosed during 2006-2011 to those diagnosed during 1995-2000. This was mainly driven by patients not undergoing RP. In the most recently diagnosed group, the difference in 5-year PCa-death between patients undergoing RP and not undergoing RP was small (0.45% vs. 2.0%). Our data demonstrate that the impact of PSA induced lead-time and stage migration has diminished the absolute effect of RP on the risk of 5-year PCa-death because contemporary low-risk localized patients have a significantly better prognosis.

The national impact of the COVID-19 pandemic on U.S. prostate cancer community care.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 5061-5061
Author(s):  
Matthew R. Cooperberg ◽  
Paul Brendel ◽  
Daniel J. Lee ◽  
Rahul Doraiswami ◽  
Hariesh Rajasekar ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Language Processing ◽  
Care Delivery ◽  
Specific Antigen ◽  
Risk Groups ◽  
Low Risk ◽  
T Stage ◽  
Risk Stratum ◽  
The Impact

5061 Background: We used data from a specialty-wide, community-based urology registry to determine trends in outpatient prostate cancer (PCa) care during the COVID-19 pandemic. Methods: 3,165 (̃ 25%) of US urology providers, representing 48 states and territories, participate in the American Urological Association Quality (AQUA) Registry, which collects data via automated extraction from electronic health record systems. We analyzed trends in PCa care delivery from 156 practices contributing data in 2019 and 2020. Risk stratification was based on prostate-specific antigen (PSA) at diagnosis, biopsy Gleason, and clinical T-stage, and we used a natural language processing algorithm to determine Gleason and T-stage from unstructured clinical notes. The primary outcome was mean weekly visit volume by PCa patients per practice (visits defined as all MD and mid-level visits, telehealth and face-to-face), and we compared each week in 2020 through week 44 (November 1) to the corresponding week in 2019. Results: There were 267,691 PCa patients in AQUA who received care between 2019 and 2020. From mid-March to early November, 2020 (week 10 – week 44) the magnitude of the decline and recovery varied by risk stratum, with the steepest drops for low-risk PCa (Table). For 2020, overall mean visits per day (averaged weekly) were similar to 2019 for the first 9 weeks (̃25). Visits declined to week 14 (18.19; a 31% drop from 2019), recovered to 2019 levels by week 23, and declined steadily to 11.89 (a 58% drop from 2019) as of week 44, the cut off of this analysis. Conclusions: Access to care for men with PCa was sharply curtailed by the COVID-19 pandemic, and while the impact was less for men with high-risk disease compared to those with low-risk disease, visits even for high-risk individuals were down nearly one-third and continued to fall through November. This study provides real-world evidence on the magnitude of decline in PCa care across risk groups. The impact of this decline on cancer outcomes should be followed closely.[Table: see text]

Population-based analysis: Changes in the natural history of low risk localized prostate cancer

2017 ◽  
Vol 16 (3) ◽  
pp. e1837-e1838
Author(s):  
J.T. Helgstrand ◽  
N. Klemann ◽  
B.G. Toft ◽  
B. Vainer ◽  
M. Røder ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Natural History ◽  
Population Based ◽  
Low Risk ◽  
Localized Prostate Cancer ◽  
History Of

Impact of the USPSTF recommendations on prostate cancer stage migration and de-novo metastatic prostate cancer.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 166-166 ◽  
Author(s):  
Yu-Wei Chen ◽  
Ruby Gupta ◽  
Moshe Chaim Ornstein ◽  
Brian I. Rini ◽  
Timothy D. Gilligan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Metastatic Disease ◽  
De Novo ◽  
Task Force ◽  
Specific Antigen ◽  
P Value ◽  
Stage Migration ◽  
Nodal Disease ◽  
Psa Screening ◽  
The Impact

166 Background: The US Preventive Services Task Force (USPSTF) recommended against prostate specific antigen (PSA) screening for men aged≥75 in 2008 and all men in 2012 in an effort to reduce overdiagnosis and overtreatment of men with prostate cancer (PCa). This recommendation may delay diagnosis of clinically significant PCa. Methods: The Surveillance, Epidemiology and End Results Program (SEER) was used to identify men diagnosed with PCa between 2004-2015. PCa stage was categorized as localized (N0M0), nodal (N1M0) and metastatic (NxM1). Trend analysis was stratified on age group (PSA screening eligible was defined as age 55-69 according to the 2018 updated USPSTF recommendation). Multivariable logistic regression was used to identify predictors for nodal and metastatic disease. Results: Between 2004-2015, there were 603,323 men with PCa identified. Metastatic disease accounted for 2.8% of PCa in 2004-2008, 3.7% in 2009-2012, and 6.1% in 2013-2015. In men eligible for PCa screening, metastatic disease increased from 1.9% in 2004-2008, to 2.6% in 2009-2012, to 4.2% in 2013-2015; nodal disease increased from 1.4% to 1.6% to 2.6%, respectively (both p-value for trend< 0.0001). This stage migration was also observed in non-screening eligible groups (age >70 and <55). Compared with PCa diagnosed in 2009-2012, PCa diagnosed in 2013-2015 had higher odds of metastatic disease (AOR: 1.70, p-value<0.0001) or nodal disease (AOR: 1.71, p-value<0.0001). Conclusions: Men diagnosed with PCa in 2013-2015 were more likely to have metastatic or nodal disease, suggesting PCa stage migration since PSA screening was recommended to be discontinued in 2012. Although the impact of PSA screening on PCa mortality remains debatable, the reduced quality of life with advanced Pca should not be overlooked. Future population studies are warranted to investigate the influence of the updated 2018 USPSTF recommendation. [Table: see text]

Natural history of an immediately detectable PSA following radical prostatectomy: A description of a contemporary cohort.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 356-356
Author(s):  
Peter Eoin Lonergan ◽  
Samuel L. Washington ◽  
Janet E. Cowan ◽  
Hao Nguyen ◽  
Matthew R. Cooperberg ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Natural History ◽  
Locally Advanced ◽  
Specific Antigen ◽  
Salvage Treatment ◽  
Post Surgery ◽  
History Of

356 Background: Radical prostatectomy (RP) can provide good long-term oncological outcomes in patients with localized and locally advanced prostate cancer (PCa). After RP, prostate specific antigen (PSA) represents the corner stone for follow-up of patients. A persistently detectable PSA immediately following RP is an unfavourable prognostic factor. We described the natural history of the management and outcomes in men with a detectable PSA in an academic cohort. Methods: A retrospective review of prospectively collected clinical and pathologic data from consecutive patients who underwent RP for non-metastatic PCa between 2000 and 2018 was performed. A detectable PSA was defined as PSA ≥ 0.05 ng/ml between 2-6 months post-surgery. Biochemical recurrence (BCR) was defined as two consecutive PSA values ≥ 0.2 ng/ml after 6 months post-surgery or any salvage treatment for a rising PSA. Second recurrence was defined as additional treatment after post-RP salvage treatment. Outcomes were defined as time to other cause mortality (OCM) or prostate cancer specific mortality (PCSM). Results: We identified 499 men with a detectable PSA within 6 months following RP. Median PSA at diagnosis was 7.95 ng/ml (IQR 5.57-12.97). Median CAPRA-S score was 5 (IQR 2-7). Median follow-up was 41 months (IQR 20-77). 296 (59%) underwent salvage treatment for a rising PSA at a median of 5 months. 33 (23%) of these men required further treatment (10 for bone metastases) at a median of 7 months. 203 (41%) of men with an immediately detectable PSA did not undergo any further treatment after RP. Treatment-free survival after post-RP salvage (31 on ADT and 2 underwent salvage RT) in men with a detectable vs undetectable PSA was 86% vs 92% at 1 year, 78% vs 89% at 3 years, 72% vs 86% at 5 years and 70% vs 76% at 10 years (Log-rank p =0.02). Prostate cancer specific survival in men with a detectable vs undetectable PSA was 100% vs 100% at 1 year, 99% vs 100% at 3 years, 96% vs 100% at 5 years and 91% vs 99% at 10 years (Log-rank p < 0.01). Conclusions: This report describes the natural history of the management and outcomes in men with a detectable PSA following RP. We demonstrate that men with a detectable PSA after RP may have excellent long-term outcomes.

MP14-02 THE NATURAL HISTORY OF MEN ON ACTIVE SURVEILLANCE WITH LOW-RISK PROSTATE CANCER AT A SAFETY-NET, COUNTY HOSPITAL

2017 ◽  
Vol 197 (4S) ◽  
Author(s):  
E. Charles Osterberg ◽  
Nynikka Palmer ◽  
Catherine Harris ◽  
Gregory Murphy ◽  
Sarah Blaschko ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Natural History ◽  
Active Surveillance ◽  
Safety Net ◽  
Low Risk ◽  
County Hospital ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
History Of

scholarly journals Detection of Recurrent Prostate Cancer With 18F-Fluciclovine PET/MRI

2020 ◽  
Vol 10 ◽  
Author(s):  
Kirsten Margrete Selnæs ◽  
Brage Krüger-Stokke ◽  
Mattijs Elschot ◽  
Håkon Johansen ◽  
Per Arvid Steen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Specific Antigen ◽  
Primary Treatment ◽  
Low Risk ◽  
Recurrent Prostate Cancer ◽  
Clinical Value ◽  
Detection Rates ◽  
Number Of Patients ◽  
The Impact ◽  
Mri Score

ObjectiveSimultaneous PET/MRI combines soft-tissue contrast of MRI with high molecular sensitivity of PET in one session. The aim of this prospective study was to evaluate detection rates of recurrent prostate cancer by 18F-fluciclovine PET/MRI.MethodsPatients with biochemical recurrence (BCR) or persistently detectable prostate specific antigen (PSA), were examined with simultaneous 18F-fluciclovine PET/MRI. Multiparametric MRI (mpMRI) and PET/MRI were scored on a 3-point scale (1-negative, 2-equivocal, 3-recurrence/metastasis) and detection rates (number of patients with suspicious findings divided by total number of patients) were reported. Detection rates were further stratified based on PSA level, PSA doubling time (PSAdt), primary treatment and inclusion criteria (PSA persistence, European Association of Urology (EAU) Low-Risk BCR and EAU High-Risk BCR). A detailed investigation of lesions with discrepancy between mpMRI and PET/MRI scores was performed to evaluate the incremental value of PET/MRI to mpMRI. The impact of the added PET acquisition on further follow-up and treatment was evaluated retrospectively.ResultsAmong patients eligible for analysis (n=84), 54 lesions were detected in 38 patients by either mpMRI or PET/MRI. Detection rates were 41.7% for mpMRI and 39.3% for PET/MRI (score 2 and 3 considered positive). There were no significant differences in detection rates for mpMRI versus PET/MRI. Disease detection rates were higher in patients with PSA≥1ng/mL than in patients with lower PSA levels but did not differ between patients with PSAdt above versus below 6 months. Detection rates in patients with primary radiation therapy were higher than in patients with primary surgery. Patients categorized as EAU Low-Risk BCR had a detection rate of 0% both for mpMRI and PET/MRI. For 15 lesions (27.8% of all lesions) there was a discrepancy between mpMRI score and PET/MRI score. Of these, 10 lesions scored as 2-equivocal by mpMRI were changed to a more definite score (n=4 score 1 and n=6 score 3) based on the added PET acquisition. Furthermore, for 4 of 10 patients with discrepancy between mpMRI and PET/MRI scores, the added PET acquisition had affected the treatment choice.ConclusionCombined 18F-fluciclovine PET/MRI can detect lesions suspicious for recurrent prostate cancer in patients with a range of PSA levels. Combined PET/MRI may be useful to select patients for appropriate treatment, but is of limited use at low PSA values or in patients classified as EAU Low-Risk BCR, and the clinical value of 18F-fluciclovine PET/MRI in this study was too low to justify routine clinical use.

Increasing prostate-specific antigen profile following definitive radiation therapy for localized prostate cancer: clinical observations.

1997 ◽  
Vol 15 (1) ◽  
pp. 230-238 ◽  
Author(s):  
W R Lee ◽  
G E Hanks ◽  
A Hanlon
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Local Recurrence ◽  
Natural History ◽  
Short Interval ◽  
Specific Antigen ◽  
Distant Metastases ◽  
End Of Treatment ◽  
History Of ◽  
Cause Specific Survival

PURPOSE To examine the natural history of patients who have received definitive radiation therapy alone for clinically localized prostate cancer and have an increasing prostate-specific antigen (PSA) profile. PATIENTS AND METHODS One hundred fifty-one men with an increasing PSA profile after definitive radiotherapy were identified. The subsequent natural history of these men, including local recurrence, distant metastasis, and survival, was examined. In 119 men, posttreatment PSA doubling times (PSADT) were calculated using linear regression. Cox regression models were used to examine the effect of clinical and treatment variables on clinical failure and survival. RESULTS Patients with high pretreatment PSA values, high Gleason scores, and T3 tumors were more likely to develop a PSA elevation. The median calculated post-treatment PSADT was 13 months, and 95% of patients had posttreatment PSADT of less than 3 years. PSADT was correlated with tumor stage and Gleason score. Five years after PSA elevation, the estimated rate of clinical local recurrence is 26% and the estimated rate of distant metastases is 47%. Rapid PSADT (< 12 months) and a short interval from the end of treatment to PSA elevation (< 12 months) were significant independent predictors of distant metastases. The estimated rates of overall and cause-specific survival 5 years after PSA elevation are 65% and 76%, respectively. Gleason grade is the only significant independent predictor of overall and cause-specific survival after PSA elevation. CONCLUSION The natural history of men who have an increasing PSA profile following definitive radiotherapy is heterogeneous. In the absence of salvage therapy, at least three quarters of men will have clinical evidence of recurrent disease 5 years after a PSA elevation is detected. Men with a rapid posttreatment PSADT and a short interval from the end of treatment to an increasing PSA profile are at a very high risk of developing distant metastasis within 5 years of PSA elevation.

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