scholarly journals A Mixed Methods Investigation of Unmet Needs And Psychological Wellbeing During Active Surveillance For Prostate Cancer

2021 ◽  
Author(s):  
Megan McIntosh ◽  
Camille E Short ◽  
Michael O’Callaghan ◽  
Andrew D Vincent ◽  
Daniel A Galvão ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Mixed Methods ◽  
Patient Care ◽  
Active Surveillance ◽  
Cancer Progression ◽  
Rural Areas ◽  
Unmet Needs ◽  
Psychological Wellbeing ◽  
Anxiety And Depression ◽  
Care Needs

Abstract Purpose: While prostate cancer survivors experience unmet supportive care needs (USCNs) after definitive treatments, no study has measured USCNs during active surveillance (AS). This mixed-methods study aimed to identify and explore the USCNs and psychological wellbeing of AS patients.Methods: Patients 18+ years diagnosed with prostate cancer, who had been on AS for ≥6 months, were invited to complete a survey measuring USCNs, general and prostate cancer specific anxiety, and depression. A purposefully selected subset was also interviewed to explore USCNs and how needs during AS were addressed. Semi-structured interviews were transcribed verbatim and thematically analysed. Results: One hundred and three participants (n=47 currently on AS, n=54 on/had subsequent treatment, n=2 ceased all care) completed the survey, and 33 were also interviewed. Although most USCNs were considered low/moderate, 20% of participants reported high unmet informational needs around receiving information about monitoring and their test results. USCNs related to patient care (e.g., access to services in rural areas or after hours) and sexuality were also discussed in interviews. Anxiety, depression, and prostate cancer specific anxiety were generally very low. Fear of cancer progression/recurrence was the highest scoring prostate cancer specific worry and was frequently mentioned by interview participants.Conclusions: While unmet needs, anxiety and depression were generally low, one in five patients during AS experience unmet needs in psychological, physical, patient care, information, and sexual domains. Health professionals should be aware of common USCNs and offer appropriate support to address potential needs.

scholarly journals Comparative performance of MRI-derived PRECISE scores and delta-radiomics models for the prediction of prostate cancer progression in patients on active surveillance

2021 ◽  
Author(s):  
Nikita Sushentsev ◽  
Leonardo Rundo ◽  
Oleg Blyuss ◽  
Tatiana Nazarenko ◽  
Aleksandr Suvorov ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Cancer Progression ◽  
Predictive Value ◽  
Machine Learning Algorithms ◽  
Superior Performance ◽  
Control Group ◽  
P Value ◽  
Lasso Regression

Abstract Objectives To compare the performance of the PRECISE scoring system against several MRI-derived delta-radiomics models for predicting histopathological prostate cancer (PCa) progression in patients on active surveillance (AS). Methods The study included AS patients with biopsy-proven PCa with a minimum follow-up of 2 years and at least one repeat targeted biopsy. Histopathological progression was defined as grade group progression from diagnostic biopsy. The control group included patients with both radiologically and histopathologically stable disease. PRECISE scores were applied prospectively by four uro-radiologists with 5–16 years’ experience. T2WI- and ADC-derived delta-radiomics features were computed using baseline and latest available MRI scans, with the predictive modelling performed using the parenclitic networks (PN), least absolute shrinkage and selection operator (LASSO) logistic regression, and random forests (RF) algorithms. Standard measures of discrimination and areas under the ROC curve (AUCs) were calculated, with AUCs compared using DeLong’s test. Results The study included 64 patients (27 progressors and 37 non-progressors) with a median follow-up of 46 months. PRECISE scores had the highest specificity (94.7%) and positive predictive value (90.9%), whilst RF had the highest sensitivity (92.6%) and negative predictive value (92.6%) for predicting disease progression. The AUC for PRECISE (84.4%) was non-significantly higher than AUCs of 81.5%, 78.0%, and 80.9% for PN, LASSO regression, and RF, respectively (p = 0.64, 0.43, and 0.57, respectively). No significant differences were observed between AUCs of the three delta-radiomics models (p-value range 0.34–0.77). Conclusions PRECISE and delta-radiomics models achieved comparably good performance for predicting PCa progression in AS patients. Key Points • The observed high specificity and PPV of PRECISE are complemented by the high sensitivity and NPV of delta-radiomics, suggesting a possible synergy between the two image assessment approaches. • The comparable performance of delta-radiomics to PRECISE scores applied by expert readers highlights the prospective use of the former as an objective and standardisable quantitative tool for MRI-guided AS follow-up. • The marginally superior performance of parenclitic networks compared to conventional machine learning algorithms warrants its further use in radiomics research.

scholarly journals Exercise duRing Active Surveillance for prostatE cancer—the ERASE trial: a study protocol of a phase II randomised controlled trial

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e026438 ◽  
Author(s):  
Dong-Woo Kang ◽  
Adrian S Fairey ◽  
Normand G Boulé ◽  
Catherine J Field ◽  
Kerry S Courneya
Keyword(s):  
Prostate Cancer ◽  
Randomised Controlled Trial ◽  
Disease Progression ◽  
Active Surveillance ◽  
Cancer Progression ◽  
Phase Ii ◽  
Controlled Trial ◽  
Exercise Group ◽  
Fear Of Cancer ◽  
Randomised Controlled

IntroductionActive surveillance (AS) is the preferred primary treatment strategy for men with low-risk clinically localised prostate cancer (PCa); however, the majority of these men still receive radical treatment within 10 years due to disease progression and/or fear of cancer progression. Interventions designed to suppress tumour growth, mitigate fear of cancer progression and precondition men for impending radical treatments are an unmet clinical need. Exercise has been shown to delay the progression of prostate tumours in animal models, improve physical and functional health and manage psychological outcomes in cancer patients; however, these outcomes have not been demonstrated in PCa patients undergoing AS.Methods and analysisThis phase II randomised controlled trial will randomise 66 men undergoing AS to either an exercise group or a usual care group. The exercise group will perform a 12-week, supervised, high-intensity interval training programme, consisting of 3 sessions/week for 28–40 min/session. The primary outcome will be cardiorespiratory fitness. Secondary outcomes will include immunosurveillance and cancer-related biomarkers, psychosocial outcomes including fear of cancer progression and quality of life and physical function. Exploratory outcomes will include clinical indicators of disease progression. The trial has 80% power to detect a significant between-group difference in VO2peakof 3.5 mL/kg/min with a two-tailed alpha level <0.05 and a 10% dropout rate.Ethics and disseminationThe study has received full ethical approval from the Health Research Ethics Board of Alberta – Cancer Committee (Protocol Number: HREBA.CC-17–0248). The findings of the study will be disseminated through public and scientific channels.Trial registration numberNCT03203460; Pre-results.

scholarly journals 4284 Development of a Survey Instrument to Predict Uptake of and Adherence to Active Surveillance among Men with Low-Risk Prostate Cancer

2020 ◽  
Vol 4 (s1) ◽  
pp. 128-129
Author(s):  
Aaron T Seaman ◽  
Kathryn L. Taylor ◽  
Kimberly Davis ◽  
Kenneth G. Nepple ◽  
Michelle A. Mengeling ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Cancer Progression ◽  
Large Scale ◽  
Survey Instrument ◽  
Low Risk ◽  
Cognitive Interviews ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
Single Instrument

OBJECTIVES/GOALS: Active surveillance (AS) is a recognized strategy to manage low-risk prostate cancer (PCa) in the absence of cancer progression. Little prospective data exists on the decisional factors associated with selecting and adhering to AS in the absence of cancer progression. We developed a survey instrument to predict AS uptake and adherence. METHODS/STUDY POPULATION: We utilized a three-step process to develop and refine a survey instrument designed to predict AS uptake and adherence among men with low-risk PCa: 1) We identified relevant conceptual domains based on prior research and a literature review. 2) We conducted 21 semi-structured concept elicitation interviews to identify patient-perceived barriers and facilitators to AS uptake and adherence among men with a low-risk PCa who had been on AS for ≥1 year. The identified concepts became the basis of our draft survey instrument. 3) We conducted two rounds of cognitive interviews with men with low-risk PCa (n = 12; n = 6) to refine and initially validate the instrument. RESULTS/ANTICIPATED RESULTS: Relevant concepts identified from the initial interviews included the importance of patient: knowledge of their PCa risk, value in delaying treatment, trust in urologist and the AS surveillance protocol, and perceived social support. Initially, the survey was drafted as a single instrument to be administered after a patient had selected AS comprising sections on patient health, AS selection, and AS adherence. Based on the first round of cognitive interviews, we revised the single instrument into two surveys to track shifts in patient preference and experience. The first, administered at diagnosis, focuses on selection, and the second, a 6-month follow up, focuses on adherence. Following revisions, participants indicated the revised 2-part instrument was clear and not burdensome to complete. DISCUSSION/SIGNIFICANCE OF IMPACT: The instrument’s content validity was evaluated through cognitive interviews, which supported that the survey items’ intended and understood meanings were isomorphic. In the next phase, we plan to conduct a large-scale prospective cohort study to evaluate the predictive validity, after which it will be available for public research use.

Multiparametric prostate MRI and MRI/ultrasound fusion biopsy as tools to follow prostate cancer progression for men on active surveillance.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 63-63 ◽  
Author(s):  
Nabeel Shakir ◽  
Annerleim Walton-Diaz ◽  
Soroush Rais-Bahrami ◽  
Baris Turkbey ◽  
Jason Rothwax ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Gleason Score ◽  
Cancer Progression ◽  
Predictive Value ◽  
Low Risk ◽  
Fusion Biopsy ◽  
Trus Biopsy ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

63 Background: Active surveillance (AS) is an option for patients with low risk prostate cancer (PCa); however, determining disease progression is challenging. At the NCI, multiparametric MRI (MP-MRI) with our biopsy protocol (MR-US fusion-guided plus 12 core extended sextant biopsy) has been used to confirm eligibility for AS. We evaluated the utility of these modalities in monitoring patients on AS. Methods: Patients who underwent MP-MRI of the prostate with biopsy per our protocol between 2007-2012 were reviewed. We selected a subset who met Johns Hopkins criteria for AS (Gleason score≤6, PSA density≤0.15, tumor involvement of ≤2 cores, and ≤50% of any single core) by outside 12−core TRUS biopsy. Patients with Gleason score≤6 confirmed at first NCI biopsy session were followed with annual MP-MRI and biopsy. MRI progression was defined as an increase in MP-MRI suspicion level, lesion diameter, or number of lesions. Pathologic progression was defined as an increase to Gleason score≥7 in either 12-core or MR-fusion biopsy. We determined the association between MRI and pathologic progression. Results: 129 patients met JHU criteria for AS by outside biopsy. Mean age was 61.6 years and mean PSA 5.16ng/mL. 28/129 (21.7%) patients had Gleason score ≥7 at first NCI biopsy session.31 patients had at least two biopsy sessions (mean follow up 18 months, range 12-54 months) of which 9/31 (29%) increased in Gleason score, all to 3+4=7. Fusion biopsy detected more pathologic progression than did standard biopsy (Table). The positive predictive value of MP-MRI for pathologic progression was 50%, while the negative predictive value was 84%. The sensitivity and specificity of MP-MRI for increase in Gleason score was 67% and 73%, respectively. Conclusions: Stable findings on MP-MRI are associated with Gleason score stability in patients with low-risk PCa choosing AS. The majority of patients who had pathologic progression were detected on fusion biopsy, which may suggest that random biopsies are unnecessary in this population. Larger studies are needed to validate these findings. [Table: see text]

Patient experiences of care in localized prostate cancer.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 215-215 ◽  
Author(s):  
Michelle Mollica ◽  
Lisa M Lines ◽  
Timothy S. McNeel ◽  
Serban Negoita ◽  
Sarah Gaillot ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Survivors ◽  
Patient Care ◽  
Active Surveillance ◽  
Watchful Waiting ◽  
Patient Experiences ◽  
Localized Prostate Cancer ◽  
Outcome Variable ◽  
Future Research ◽  
Prostate Cancer Survivors

215 Background: Over 161,000 new prostate cancer patients diagnosed annually, with 75% diagnosed at early stages. Limited evidence exists supporting choice of treatment (including radical prostatectomy, radiation therapy, hormonal therapy, active surveillance or watchful waiting) for localized prostate cancer. Treatments have varying side effects associated with impaired functional status and health-related quality of life. Patient care experiences are important quality indicators, but research examining patient experiences by prostate cancer treatment is limited. The purpose of this study was to examine the association between treatment received (surgery, radiation, or no treatment) and CAHPS ratings of overall care over the prior six months. Methods: This study used data from SEER-CAHPS, which links Surveillance, Epidemiology, and End Results (SEER) data with Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experience survey and Medicare claims data. Medicare Fee-for-Service beneficiaries ≥65 years with a National Comprehensive Cancer Network (NCCN) low- or intermediate-risk prostate cancer diagnosis were assigned to surgery only, radiation only, and no treatment received groups for analysis. The outcome variable was a CAHPS rating of overall care (0 = worst; 10 = best). The analysis adjusted for case mix and other cancer-specific variables. Results: The final cohort included 507 prostate cancer survivors (surgery n = 109 [21%]; radiation n = 197 [39%]; no treatment n = 201 [40%]). Respondents who received radiation rated their overall care higher than those not receiving treatment (adjusted mean 8.9 vs 8.3; p= 0.02). Ratings did not differ significantly between the surgery and no treatment groups. Conclusions: This study represents a first look at patient experiences among localized prostate cancer survivors receiving surgery, radiation, or no treatment. It is not clear whether those who did not receive treatment chose active surveillance or watchful waiting, or whether they did not have access to care, which could have affected results. Future research should explore associations between receipt of treatment and patient care experiences in an adequately powered sample to inform future interventions.

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