scholarly journals Diagnostic assessment program for prostate cancer: Lessons learned after 2 years and degree of compliance to Canadian guidelines

2021 ◽  
Vol 93 (4) ◽  
pp. 389-392
Author(s):  
Waleed Shabana ◽  
Ahmed Kotb ◽  
Daniel Tesolin ◽  
Mohammed F.K. Ibrahim ◽  
Kristi Dolcetti ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Waiting Time ◽  
Prostate Biopsy ◽  
External Beam Radiotherapy ◽  
Waiting Times ◽  
Lessons Learned ◽  
Diagnostic Assessment ◽  
Intermediate Risk ◽  
Assessment Program ◽  
Risk Patients

Background: In 2018, our Institute launched the Diagnostic Assessment Program (DAP) for prostate cancer. It enabled quick access to a urologist for patients presented to family physician with elevated PSA and allowed fast multidisciplinary patient care. We aim to document our data over 2 years in comparison to data before implementation of DAP and its impact on the degree of adherence to Canadian guidelines. Methods: From April 2016 to April 2020, 880 patients who were evaluated for prostate cancer at Thunder Bay Regional Health Sciences Centre (TBRHSC) were included in this study. Patients’ characteristics, clinical data, waiting times and line of treatment before and after implementation of DAP were calculated and statistically analysed. Results: The median waiting time to urology consultation was significantly reduced from 68 (IQR 27-168) days to 34 (23-44) days (p < 0.001). The time from patient’s referral to prostate biopsy decreased substantially from 34 (20-66) days to 18(11- 25) days after DAP (p < 0.001). After DAP, the percentage of Gleason 6 detected prostate cancers were significantly increased (19.7% to 30%) (p = 0.02). After DAP, rate for intermediate-risk patients elected for external beam radiotherapy (from 53.5% to 57.9%, p = 0.53) and radical prostatectomy (from 34.5% to 39.4%, p = 0.47) increased. More compliance to Canadian guidelines was observed in intermediate risk patients (88% vs 97.3%, p =.008). Conclusions: Implementation of DAP has led to a notable reduction of waiting time to urology consult and prostate biopsy. There is significant increase in Gleason 6 detected prostate cancer. Increased compliance to Canadian guidelines was detected in intermediate risk patients.

scholarly journals Comparison of Oncological Outcomes Between Radical Prostatectomy and Radiotherapy by Type of Radiotherapy in Elderly Prostate Cancer Patients

2021 ◽  
Vol 11 ◽  
Author(s):  
Xiao-Xiao Guo ◽  
Hao-Ran Xia ◽  
Hui-Min Hou ◽  
Ming Liu ◽  
Jian-Ye Wang
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
External Beam Radiotherapy ◽  
The Other ◽  
Oncologic Outcomes ◽  
Intermediate Risk ◽  
High Risk Patients ◽  
Significant Difference ◽  
Risk Patients

ObjectiveWe aimed compare the oncologic outcomes of radical prostatectomy (RP) with those of external beam radiotherapy (EBRT), brachytherapy (BT), or EBRT + BT (EBBT) in elderly patients with localised prostate cancer (PCa).MethodsLocalised PCa patients aged ≥70 years who underwent RP, EBRT, BT, or EBBT between 2004 and 2016 were identified from the Surveillance, Epidemiology, and End Results database. Multivariable competing risks survival analyses were used to estimate prostate cancer-specific mortality (CSM) and other-cause mortality (OCM). Subgroup analyses according to risk categories were also conducted.ResultsOverall, 14057, 37712, 8383, and 5244 patients aged ≥70 years and treated with RP, EBRT, BT, and EBBT, respectively, were identified. In low- to intermediate-risk patients, there was no significant difference in CSM risk between RP and the other three radiotherapy modalities (all P &gt; 0.05). The corresponding 10-year CSM rates for these patients were 1.2%, 2.3%, 2.0%, and 1.8%, respectively. In high-risk patients, EBRT was associated with a higher CSM than RP (P = 0.003), whereas there was no significant difference between RP and BT or RP and EBBT (all P &gt; 0.05). The 10-year CSM rates of high-risk patients in the RP, EBRT, BT, and EBBT groups were 7.5%, 10.2%, 8.3%, and 7.6%, respectively. Regarding OCM, the risk was generally lower in RP than in the other three radiotherapy modalities (all P &lt; 0.001).ConclusionsAmong men aged ≥70 years with localised PCa, EBRT, BT, and EBBT offer cancer-specific outcomes similar to those of RP for individuals with low- to intermediate-risk disease. In patients with high-risk disease, EBBT had outcomes equally favourable to those of RP, but RP is more beneficial than EBRT. More high-quality trials are warranted to confirm and expand the present findings.

scholarly journals Waiting Times for Prostate Cancer Diagnosis in a Nigerian Population

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Olufunmilade A. Omisanjo ◽  
Olawale O. Ogunremi ◽  
Olufemi O. Akinola ◽  
Olaolu O. Adebayo ◽  
Olufemi Ojewuyi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Teaching Hospital ◽  
Cancer Diagnosis ◽  
Waiting Time ◽  
Prostate Biopsy ◽  
Waiting Times ◽  
Prostate Cancer Diagnosis ◽  
Nigerian Population ◽  
The Mean ◽  
Patient Presentation

Background. Prostate biopsy remains an important surgical procedure in the diagnostic pathway for prostate cancer, but access to prostate biopsy service is poorly studied in the Nigerian population. While there has been a well-documented delay in patient presentation with prostate cancer in Nigeria, little is however known about how long patients wait to have a histological diagnosis of prostate cancer and start treatment after presenting at Nigerian hospitals. Method. This was a descriptive retrospective study to document the specific duration of the various timelines in getting a diagnosis of prostate cancer at the Lagos State University Teaching Hospital, Ikeja, Nigeria. Results. There were 270 patients. The mean age was 69.50 ± 8.03   years (range 45-90). The mean PSA at presentation was 563.2 ± 1879.2   ng / ml (range 2.05-15400), and the median PSA was 49.3 ng/ml. The median waiting times were (i) 10 days from referral to presentation; (ii) 30 days from presentation to biopsy; (iii) 24 days from biopsy to review of histology; (iv) 1 day from histology review to discussion/planning of treatment. The median overall waiting time from referral to treatment was 103 days. The mean time from presentation to biopsy was significantly shorter for patients with PSA of ≥50 ng/ml compared to those with PSA < 50   ng / ml . p = 0.048 . Overall, the median time from biopsy to histology was significantly shorter for patients whose specimens were processed in private laboratories (17 days) compared to those whose specimens were processed at the teaching hospital laboratory (30 days), p ≤ 0.001 . Conclusion. There is a significant delay within the health care system in getting a prostate cancer diagnosis in the Nigerian population studied. The major points of the identified delay were the waiting time from patient presentation to having a biopsy done and the histology report waiting time.

Intraductal carcinoma and cribriform architecture as novel prognostic factors in patients with prostate cancer treated with dose-escalated radiotherapy.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 101-101
Author(s):  
Jure Murgic ◽  
Alejandro Berlin ◽  
Melvin Chua ◽  
Melania Pintilie ◽  
Robert G. Bristow ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Univariate Analysis ◽  
Intraductal Carcinoma ◽  
Prognostic Impact ◽  
Intermediate Risk ◽  
Free Survival ◽  
Risk Patients ◽  
Clinical Records ◽  
The Impact

101 Background: Intraductal carcinoma (IDC) and cribriform architecture (CA) represent distinct pathohistological variants of high-grade prostate cancer associated with aggressive disease and poor clinical outcome. We evaluated impact of IDC and/or CA (IDC/CA) as a prognostic marker in patients with prostate cancer who underwent contemporary image-guided, dose-escalated, intensity-modulated radiotherapy (IMRT). Methods: Radiotherapy and clinical records of 379 patients with localized prostate cancer treated from 2005 to 2012 with prostate IMRT with 78 Gy in 39 fractions were retrospectively reviewed. Original diagnostic prostate biopsy slides were centrally reviewed by an expert genitourinary pathologist and scored for presence of IDC/CA. The impact of IDC/CA and other pre-treatment and treatment-related factors on biochemical relapse-free survival (BRFS) was evaluated. Results: IDC/CA was present in 19.3% of patients. After median follow-up of 56 months, 39 (10.3%) and 10 (3.6%) patients experienced biochemical failure and distant metastasis, respectively. On univariate analysis, the presence of IDC/CA was associated with decreased BRFS (HR 4.1 (95% CI: 2.2-7.8), p < 0.0001) and metastasis-free survival (HR = 4.7 (95% CI: 1.4-15.6), p = 0.013). On multivariate analysis, IDC/CA was associated with decreased BRFS (HR = 2.3 (95% CI: 1.2-4.7), p = 0.02) together with NCCN risk group (overall p = 0.0004), Gleason score (overall p = 0.016) and percent of positive biopsy cores (HR = 5.78 (95% CI: 1.4-23.9), p = 0.015). Within intermediate risk patients, presence of IDC/CA was associated with decreased BRFS (HR = 3.3 (95%CI: 1.5-7.1), p = 0.031) and was able to further stratify GS 4+3 patients (HR = 4.5, (95% CI: 1.6-13.0), p = 0.0045). Conclusions: The presence of IDC/CA in the prostate biopsy has negative prognostic impact in patients treated with dose-escalated radiotherapy. Furthermore, the prognostic significance of IDC/CA, even among unfavorable intermediate-risk patients, suggests that these pathological features should be considered in existing risk stratification tools for this patient group.

scholarly journals Diagnosis, referral, and primary treatment decisions in newly diagnosed prostate cancer patients in a multidisciplinary diagnostic assessment program

2016 ◽  
Vol 10 (3-4) ◽  
pp. 120 ◽  
Author(s):  
David Guy ◽  
Gabriella Ghanem ◽  
Andrew Loblaw ◽  
Roger Buckley ◽  
Beverly Persaud ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Treatment Decisions ◽  
Diagnostic Assessment ◽  
Intermediate Risk ◽  
Newly Diagnosed ◽  
Electronic Patient Records ◽  
Management Decisions ◽  
Significant Treatment ◽  
Assessment Program ◽  
Over Time

<p><strong>Introduction:</strong> We aimed to report on data from the multidisciplinary diagnostic assessment program (DAP) at the Gale and Graham Wright Prostate Centre (GGWPC) at North York General Hospital (NYGH). We assessed referral, diagnosis, and treatment decisions for newly diagnosed prostate cancer (PCa) patients as seen over time, risk stratification, and clinic type to establish a deeper understanding of current decision-making trends.</p><p><strong>Methods:</strong> From June 2007 to April 2012, 1277 patients who were diagnosed with PCa at the GGWPC were included in this study. Data was collected and reviewed retrospectively using electronic patient records.</p><p><strong>Results:</strong> 1031 of 1260 patients (81.8%) were seen in a multidisciplinary clinic (MDC). Over time, a decrease in low-risk (LR) diagnoses and an increase intermediate-risk (IR) diagnoses was observed<br />(p&lt;0.0001). With respect to overall treatment decisions 474 (37.1%) of patients received primary radiotherapy, 340 (26.6%) received surgical therapy, and 426 (33.4%) had conservative management;<br />57% of patients who were candidates for active surveillance were managed this way. No significant treatment trends were observed over time (p=0.8440). Significantly, different management decisions<br />were made in those who attended the MDC compared to those who only saw a urologist (p&lt;0.0001).</p><p><strong>Conclusions:</strong> In our DAP, the vast majority of patients presented with screen-detected disease, but there was a gradual shift from low- to intermediate-risk disease over time. Timely multidisciplinary<br />consultation was achievable in over 80% of patients and was associated with different management decisions. We recommend that all patients at risk for prostate cancer be worked up in a multidisciplinary DAP.</p>

Magnetic resonance radiomics for prediction of extraprostatic extension in non-favorable intermediate- and high-risk prostate cancer patients

2020 ◽  
Vol 61 (11) ◽  
pp. 1570-1579 ◽  
Author(s):  
Are Losnegård ◽  
Lars A. R. Reisæter ◽  
Ole J. Halvorsen ◽  
Jakub Jurek ◽  
Jörg Assmus ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Magnetic Resonance ◽  
Diagnostic Performance ◽  
Prediction Models ◽  
Area Under The Curve ◽  
Intermediate Risk ◽  
High Risk Prostate Cancer ◽  
Risk Patients ◽  
Radiology Interpretation ◽  
Extraprostatic Extension

Background To investigate whether magnetic resonance (MR) radiomic features combined with machine learning may aid in predicting extraprostatic extension (EPE) in high- and non-favorable intermediate-risk patients with prostate cancer. Purpose To investigate the diagnostic performance of radiomics to detect EPE. Material and Methods MR radiomic features were extracted from 228 patients, of whom 86 were diagnosed with EPE, using prostate and lesion segmentations. Prediction models were built using Random Forest. Further, EPE was also predicted using a clinical nomogram and routine radiological interpretation and diagnostic performance was assessed for individual and combined models. Results The MR radiomic model with features extracted from the manually delineated lesions performed best among the radiomic models with an area under the curve (AUC) of 0.74. Radiology interpretation yielded an AUC of 0.75 and the clinical nomogram (MSKCC) an AUC of 0.67. A combination of the three prediction models gave the highest AUC of 0.79. Conclusion Radiomic analysis combined with radiology interpretation aid the MSKCC nomogram in predicting EPE in high- and non-favorable intermediate-risk patients.

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