Discussion of Treatment Options for Metastatic Hormone Sensitive Prostate Cancer Patients

279 Background: The PCSC Program was initiated in 2013 at the Vancouver Prostate Centre to provide a comprehensive program for patients and partners with prostate cancer. This program provides educational sessions (ES) and clinical services, including decision-making for primary therapy, sexual health, pelvic floor physiotherapy, hormone therapy, counseling, exercise, and nutrition for patients in BC, Canada. In 2016, the PCSC Program expanded to BC Cancer Victoria and in 2017 to other BC Cancer sites. In 2018, medical oncologists (MDs) in Victoria (JR, SP) developed an Education Module addressing treatment options for men with metastatic hormone sensitive (mHSPC) and metastatic castration resistant (mCRPC) disease. MDs delivered in-person ES in Victoria in 2018 and, in 2019, added a virtual platform (VP) option. From 3-5/2020, the ESs were on hold due to the COVID pandemic and parental leaves. In 6/2020, the ESs resumed only on VP, and the PCSC Oncology Nurse Practitioner (NP), NI, gave the presentations for the MDs on leave. In 10/2020, due to a changing standard of care for mHSPC, the PCSC team consolidated the two ESs into one. We report on the evolution of this Education Module in response to both the changing standard of care and the COVID pandemic. Methods: We prospectively collected attendance and patient characteristic metrics from all ES for men with mPC. We tracked presenter type (MD vs. NP) and prospectively collected anonymous patient satisfaction questionnaires. Results: From 1/2018 to 1/2021, 100 men registered for 27 ES; 81 men, 41 partners, and 2 family members actually attended. 48/75 (64%) men were white, 39/75 (52%) retired, and 56/75 (74.7%) married. 47 men attended 12 mHSPC ES, 13 men attended ten mCRPC ES, and 17 attended four consolidated ES. MDs presented 15 ES, and the NP presented 12 ES. Responses to questions on 70 satisfaction surveys were similar for MD vs. NP presenters. 9 responders to the recently added VP-specific questions said they agreed (4) or strongly agreed (5) that it was beneficial to watch the ES at home on a computer. The Table below shows attendance per site per year. Conclusions: The ESs for men with mPC were well-received. Although there was a VP option before COVID, attendance increased significantly after the lockdown as patients and providers became more familiar with VPs. Satisfaction surveys confirmed that an NP could deliver the ES rather than MD. Consolidation of the mHSPC and mCRPC ES reflected the changing standard of care and resulted in more efficient use of presenter time. Virtual delivery of the sessions provided greater access to those living in distant or remote areas of the province and those in lockdown during the COVID pandemic. [Table: see text]

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Oligometastatic Disease Detection with 68Ga-PSMA-11 PET/CT in Hormone-Sensitive Prostate Cancer Patients (HSPC) with Biochemical Recurrence after Radical Prostatectomy: Predictive Factors and Clinical Impact

Cancers ◽

10.3390/cancers13194982 ◽

2021 ◽

Vol 13 (19) ◽

pp. 4982

Author(s):

Carlos Artigas ◽

Romain Diamand ◽

Qaid Ahmed Shagera ◽

Nicolas Plouznikoff ◽

Fabrice Fokoue ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Cancer Patients ◽

Predictive Factors ◽

Clinical Management ◽

Biochemical Recurrence ◽

Oligometastatic Disease ◽

Psma Pet ◽

Pet Ct ◽

Hormone Sensitive

Metastasis-directed therapy (MDT) in oligometastatic prostate cancer has the potential of delaying the start of androgen deprivation therapy (ADT) and disease progression. We aimed to analyze the efficacy of PSMA-PET/CT in detecting oligometastatic disease (OMD), to look for predictive factors of OMD, and to evaluate the impact of PSMA-PET/CT findings on clinical management. We retrospectively analyzed a homogeneous population of 196 hormone-sensitive prostate cancer patients (HSPC), considered potential candidates for MDT, with a PSMA-PET/CT performed at biochemical recurrence (BCR) after radical prostatectomy (RP). Multivariable logistic regression analysis was performed based on several clinico-pathological factors. Changes in clinical management before and after PSMA-PET/CT were analyzed. The OMD detection rate was 44% for a total positivity rate of 60%. PSMA-PET/CT positivity was independently related to PSA (OR (95%CI), p) (1.7 (1.3–2.3), p < 0.0001) and PSAdt (0.4 (0.2–0.8), p = 0.013), and OMD detection was independently related to PSA (1.6 (1.2–2.2), p = 0.001) and no previous salvage therapy (0.3 (0.1–0.9), p = 0.038). A treatment change was observed in 58% of patients, mostly to perform MDT after OMD detection (60% of changes). This study showed that PSMA-PET/CT is an excellent imaging technique to detect OMD early in HSPC patients with BCR after RP, changing therapeutic management mostly into MDT.

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Associations between patient knowledge of others' experiences and treatment choice in men with localized prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.6578 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 6578-6578

Author(s):

Aaron J. Katz ◽

Ying Cao ◽

Xinglei Shen ◽

Deborah Usinger ◽

Sarah Walden ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

North Carolina ◽

Cancer Patients ◽

Treatment Options ◽

Population Based ◽

Treatment Choice ◽

Localized Prostate Cancer ◽

The North ◽

Patient Reported

6578 Background: Men with localized prostate cancer must select from multiple treatment options, without one clear best choice. Consequently, personal factors, such as knowing other prostate cancer patients who have undergone treatment, may influence patient decision-making. However, associations between knowledge about others’ experiences and treatment decision-making among localized prostate cancer patients has not been well characterized. We used data from a population-based cohort of localized prostate cancer patients to examine whether patient-reported knowledge of others’ experiences is associated with treatment choice. Methods: The North Carolina Prostate Cancer Comparative Effectiveness & Survivorship Study (NC ProCESS) is a population-based cohort of localized prostate cancer patients enrolled from 2011-2013 throughout the state of North Carolina in collaboration with the North Carolina Central Cancer Registry. All patients were enrolled prior to treatment and followed prospectively. Patient decision-making factors including knowledge of others’ experiences with prostate cancer treatment options were collected through patient report. Patient treatment choice was determined through medical record abstraction and cancer registry data. Results: Among 1,202 patients, 17% reported knowing someone who pursued active surveillance (AS) while 28%, 46%, and 59% reported knowing someone who received brachytherapy, external beam radiation (EBRT), or radical prostatectomy (RP), respectively; 26% underwent AS, 9% brachytherapy, 21% EBRT, and 39% RP as their initial treatment. In unadjusted analyses, patients with knowledge of others’ experiences with brachytherapy, EBRT or RP had more than twice the odds of receiving that treatment compared to patients who did not. Knowledge of others’ experience with AS was not associated with choice to undergo AS. Multivariable analysis adjusting for age, race, risk group, and patient-reported goals of care showed knowledge of others’ experiences with brachytherapy (OR 4.60, 95% confidence interval [CI] 2.76 to 7.68), EBRT (OR 2.38, 95% CI 1.69 to 3.34), or RP (OR 4.02, 95% CI 2.84 to 5.70) was significantly associated with odds of receiving that treatment. The odds of receiving a particular treatment option were further increased among patients who reported knowing someone who had a “good” experience with the treatment in question. Conclusions: This is the first population-based study to directly demonstrate the impact of a patient’s knowledge of others’ experiences on treatment choice in prostate cancer. These data provide a new consideration to clinicians in their counseling of patients with newly diagnosed prostate cancer, and also impacts research into the informed decision-making process for this disease.

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The Use of Ultrasound Imaging in the External Beam Radiotherapy Workflow of Prostate Cancer Patients

BioMed Research International ◽

10.1155/2018/7569590 ◽

2018 ◽

Vol 2018 ◽

pp. 1-16 ◽

Cited By ~ 11

Author(s):

Saskia M. Camps ◽

Davide Fontanarosa ◽

Peter H. N. de With ◽

Frank Verhaegen ◽

Ben G. L. Vanneste

Keyword(s):

Prostate Cancer ◽

Cancer Patients ◽

Ultrasound Imaging ◽

Organs At Risk ◽

External Beam Radiotherapy ◽

Treatment Options ◽

Current Status ◽

Tumor Control ◽

External Beam ◽

Image Guided Radiotherapy

External beam radiotherapy (EBRT) is one of the curative treatment options for prostate cancer patients. The aim of this treatment option is to irradiate tumor tissue, while sparing normal tissue as much as possible. Frequent imaging during the course of the treatment (image guided radiotherapy) allows for determination of the location and shape of the prostate (target) and of the organs at risk. This information is used to increase accuracy in radiation dose delivery resulting in better tumor control and lower toxicity. Ultrasound imaging is harmless for the patient, it is cost-effective, and it allows for real-time volumetric organ tracking. For these reasons, it is an ideal technique for image guidance during EBRT workflows. Review papers have been published in which the use of ultrasound imaging in EBRT workflows for different cancer sites (prostate, breast, etc.) was extensively covered. This new review paper aims at providing the readers with an update on the current status for prostate cancer ultrasound guided EBRT treatments.

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Systemic treatment options for metastatic hormone-sensitive prostate cancer

Current Opinion in Urology ◽

10.1097/mou.0000000000000778 ◽

2020 ◽

Vol 30 (4) ◽

pp. 576-583 ◽

Cited By ~ 1

Author(s):

Catalin Baston ◽

Adrian Preda ◽

Silviu S. Guler-Margaritis ◽

Ioanel Sinescu ◽

Constantin Gingu

Keyword(s):

Prostate Cancer ◽

Systemic Treatment ◽

Treatment Options ◽

Hormone Sensitive

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Role of the urologist in whether locoregional prostate cancer patients consult with a radiation oncologist.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e16029 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e16029-e16029

Author(s):

Ruben G. W. Quek ◽

Kevin C. Ward ◽

Viraj A. Master ◽

Chun Chieh Lin ◽

Katherine S. Virgo ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Patients ◽

Clinical Judgment ◽

Treatment Options ◽

Critical Role ◽

Medical Schools ◽

Initial Therapy ◽

Radiation Oncologist ◽

Multilevel Regression ◽

Institutional Settings

e16029 Background: Multiple treatment options exist for prostate cancer patients, and therapeutic recommendations may differ depending on characteristics of the specialist consulted. The clinical judgment of specialists can play a critical role in the initial treatment choice, especially in cases where there is no professional consensus regarding the optimal treatment strategy. We examined the association between prostate cancer patients’ urologists’ practice affiliation with medical schools on the likelihood the patient would consult a radiation oncologist. Methods: Using the Surveillance, Epidemiology and End Results – Medicare linked database and the American Medical Association Physician Masterfile, we conducted a retrospective cohort study of 39,915 patients aged 66 years or older who were diagnosed between 2004 - 2007 with locoregional prostate cancer, and the 2,404 urologists who performed the diagnostic biopsies. Multilevel regression analysis was used to evaluate the influence of patients’ urologists’ practice affiliations with medical schools on the patients’ consultation with a radiation oncologist within 9 months of diagnosis. Results: Overall, 25,110 (62.9%) patients consulted with a radiation oncologist. After adjusting for patient, tumor and urologist characteristics, patients who saw urologists practicing within non-institutional settings were significantly more likely to consult with a radiation oncologist (odds ratio [OR], 1.19; 95% confidence interval [95% CI], 1.05-1.34, p = 0.006) when compared to those who saw urologists practicing within settings with a major medical school affiliation. In addition, patients who saw urologists ≥ 58 years old were significantly more likely to consult with a radiation oncologist (OR, 1.71; 95% CI, 1.16-2.50, p = 0.006) when compared to those who saw urologists < 43 years old. Conclusions: Locoregional prostate cancer patients who received their diagnostic biopsy by urologists practicing in non-institutional settings and those who saw older urologists were significantly more likely to eventually consult with a radiation oncologist. This may have implications on which patient eventually receives radiation as initial therapy.

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Evaluation of Quality of Life for Prostate Cancer Patients Who Have Undergone Radical Prostatectomy Surgery

American Journal of Men s Health ◽

10.1177/1557988306295024 ◽

2007 ◽

Vol 1 (4) ◽

pp. 284-293

Author(s):

Stephen F. Tomicich

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Radical Prostatectomy ◽

Sexual Function ◽

Cancer Patients ◽

Treatment Option ◽

Surgical Procedure ◽

Treatment Options ◽

Aging Men

Prostate cancer is an epidemic among aging men. It is essential that research be conducted with the purpose of determining the outcomes of various treatment options. For this study, a sample of radical prostatectomy patients completed a written questionnaire for the purpose of evaluating whether the radical prostatectomy for clinically localized prostate cancer has an effect on quality of life. In addition, demographic factors were examined to determine if they had an effect on quality of life after this surgical procedure. Data appeared to show that urinary, bowel, and sexual function are determinants of quality of life that are affected by having the radical prostatectomy procedure. Due to the numerous treatment options available for prostate cancer, more research regarding quality of life should be undertaken to determine the best possible treatment option for the patient.

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Current Treatment Options for Metastatic Hormone-Sensitive Prostate Cancer.

Cancers ◽

10.3390/cancers11091355 ◽

2019 ◽

Vol 11 (9) ◽

pp. 1355 ◽

Cited By ~ 14

Author(s):

Cattrini ◽

Castro ◽

Lozano ◽

Zanardi ◽

Rubagotti ◽

...

Keyword(s):

Prostate Cancer ◽

Small Sample Size ◽

Treatment Options ◽

Current Treatment ◽

Abiraterone Acetate ◽

Small Sample ◽

Phase 3 ◽

Tumor Patient ◽

Randomized Controlled ◽

Hormone Sensitive

The possible treatments options for metastatic hormone-sensitive prostate cancer (mHSPC) have dramatically increased during the last years. The old backbone, which androgen-deprivation therapy (ADT) is the exclusive approach for hormone-naïve patients, has been disrupted. Despite the fact that several high-quality, randomized, controlled phase 3 trials have been conducted in this setting, no direct comparison is currently available among the different strategies. Inadequate power, absence of preplanning and small sample size frequently affect the subgroup analyses according to disease volume or patient’s risk. The choice between ADT alone and ADT combined with docetaxel, abiraterone acetate, enzalutamide, apalutamide or radiotherapy to the primary tumor remains challenging. Factors that are related to the tumor, patient or drug side effects, currently guide these clinical decisions. This comprehensive review aims to indirectly compare the phase 3 trials in the mHSPC setting, in order to extrapolate data useful for treatment selection, providing also perspectives on future biomarkers.

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Cancer testis antigen expression and immune responses by prostate cancer patients: Implications for prognosis and immunotherapy

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e16101 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e16101-e16101

Author(s):

L. von Boehmer ◽

P. Wild ◽

L. Keller ◽

T. Hermanns ◽

M. Provenzano ◽

...

Keyword(s):

Prostate Cancer ◽

Immune Responses ◽

Cancer Patients ◽

Late Stage ◽

Treatment Options ◽

Antigen Expression ◽

Castration Resistant Prostate Cancer ◽

Specific Antibodies ◽

Ct Antigens ◽

Cancer Testis

e16101 Background: Prostate cancer (PC) is the most frequent malignancy in men and it continues to be one of the most common fatal cancers. Treatment options in advanced castration-resistant prostate cancer (CRPC) are limited. Cancer testis (CT) antigens are expressed in a variety of human cancers, but not in normal tissues except for MHC deficient spermatogonia, and represent promising targets for immunotherapy. Little is known about CT antigen expression in relation to disease progression. The aim of this study was to investigate which CT antigens are expressed and immunogenic and hence represent promising targets for patients with prostate cancer and correlate these findings with clinicopathological characteristics. Methods: To determine the expression of 6 CT antigens in prostate cancer immunohistochemistry was performed on tissue micro arrays. We investigated 6 CT antigens (NY-ESO.1, MAGE-C1, MAGE-C2, GAGE, MAGE-A1 and MAGE-A4) in benign hyperplasia (n=45), early (n=388) and late stage (n=71) prostate cancer. To determine the occurrence of spontaneous antibodies against cancer testis antigens, ELISA and Western blot was performed for NY-ESO-1, MAGE-C1 and MAGE-C2 with sera from prostate cancer patients. Results: CT antigens are increasingly expressed in late stage prostate cancers. As an exception we found MAGE-C2 to be expressed early in the course of disease, frequently inducing MAGE-C2 specific antibodies. In later stage metastatic prostate cancer patients NY-ESO-1 is more often expressed, inducing NY-ESO-1 specific antibodies. Conclusions: Cancer testis (CT) antigens are prognostic markers, frequently inducing immune responses and may be suitable for immunotherapeutic intervention in patients with prostate cancer. No significant financial relationships to disclose.

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