The Impact of Follow-Up Educational Telephone Calls on Patients after Radical Prostatectomy: Finding Value in Low-Margin Activities

98 Background: Positive surgical margin (PSM) found following radical prostatectomy (RP) is known to affect subsequent recurrence and survival. The extent of PSM has been shown to impact clinical outcomes. We examined the effect of length of PSM, extent of disease at PSM and maximum Gleason score at PSM on oncologic outcomes. Methods: A retrospective review of 3971 patients undergoing RP for prostate cancer at our institution between1978-2009 revealed 1053 patients with PSM, out of whom 814 received no hormone therapy. The initial 175 patients were selected to maximize available follow-up, and their slides were re-reviewed for following parameters: length of PSM (mm), maximum Gleason score at PSM, and maximal extension of PSM (intraprostatic incision vs. extracapsular extension). Data was available in 107 patients who are the subject of this study. Multivariable Cox regression models were used to evaluate the impact of above features as well as age, preoperative PSA, pathologic Gleason score, stage and adjuvant radiotherapy on biochemical and clinical recurrence-free survival (RFS), and overall survival (OS). Results: Median follow-up was 17.6 years. Maximum extension of PSM was limited to intraprostatic incision in 63 (58.9%) and extracapsular in 44(41.1%) patients. Median length of PSM was 4 mm (range 1-55 mm); 41 (38.3%) with <3mm and 66 (61.7%) with >4mm. Maximum Gleason score at PSM was <6 in 70 (66.0%) and >7 in 36 (34%) patients. 10-yr PSA RFS, clinical RFS, and OS were 60.2%, 80.7%, and 60.2%, respectively. Multivariable Cox regression modeling showed the length of PSM >4mm and extracapsular extension as independent predictors of PSA RFS and clinical RFS. Age and extracapsular extension were independent predictors of OS. Conclusions: PSM >4mm and extracapsular extension have a higher risk of PSA and clinical recurrence after RP. These findings can help decision-making regarding adjuvant therapy in patients with PSM and should be reported by pathologists in addition to the presence of PSM. [Table: see text]

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Prospective randomized trial of genomic classifier impact on treatment decisions in patients at high risk of recurrence following radical prostatectomy (G-MINOR).

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.tps154 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. TPS154-TPS154 ◽

Cited By ~ 2

Author(s):

Todd Matthew Morgan ◽

David Christopher Miller ◽

Rodney Dunn ◽

Linsell Susan ◽

Linda Okoth ◽

...

Keyword(s):

High Risk ◽

Radical Prostatectomy ◽

Treatment Decisions ◽

Risk Of Recurrence ◽

Clinical Center ◽

Patient Reported ◽

Impact On Treatment ◽

The Impact

TPS154 Background: Approximately 30% of patients will have ≥pT3 disease and/or positive surgical margins at radical prostatectomy (RP), indicating a high risk of local recurrence. While current guidelines recommend consideration of adjuvant radiotherapy (aRT) in this setting, < 10% undergo aRT. The Decipher assay is a novel, tissue-based genomic classifier (GC) developed and validated in the post-RP setting as a predictor of metastasis. Current retrospective evidence suggests that patients with a high GC score may benefit from aRT, while observation may be safe for those with a lower GC score. However, there are no randomized prospective data evaluating the clinical utility of biomarkers in men with adverse features after RP. Here we see to determine the impact of GC test results on adjuvant treatment decisions for high-risk post-RP patients vs. clinical factors alone. Methods: Genomics in Michigan ImpactiNg Observation or Radiation (G-MINOR) is a 4-year (12-month enrollment, 3-year follow-up) prospective, cluster-crossover, unblinded, study of 350 subjects from twelve Urology practices in the Michigan Urological Surgery Improvement Collaborative (MUSIC). MUSIC is a physician-led quality improvement consortium nearly all academic and community urology practices within the state of Michigan. Each clinical center participating in this trial will be randomly assigned to either a Genomic Classifier (GC)-based strategy or control arm for a period of 3 months. Patients in both arms will receive a predicted risk of recurrence based on a validated clinical nomogram, the CAPRA-S score, enabling a head-to-head comparison of the Decipher assay with a freely-available validated prognostic tool. Random assignments will be generated centrally by a study statistician and provided to centers immediately before commencing enrollment in each 3-month period. Each center will have two GC and two UC enrollment periods, maintaining study-wide balance and blinding of assignments in subsequent periods. Patients will be followed for receipt of adjuvant therapy as well as oncologic (recurrence, metastasis, and death) and patient-reported quality of life. Clinical trial information: NCT02783950.

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671 The impact of sexual desire on sexual health related quality of life following radical prostatectomy: A 5-year follow up study in Japan

European Urology Supplements ◽

10.1016/s1569-9056(12)60668-x ◽

2012 ◽

Vol 11 (1) ◽

pp. e671-e671a ◽

Cited By ~ 6

Author(s):

S. Namiki ◽

S. Ishidoya ◽

A. Ito ◽

Y. Arai

Keyword(s):

Quality Of Life ◽

Radical Prostatectomy ◽

Sexual Desire ◽

Health Related Quality ◽

Follow Up Study ◽

Related Quality ◽

Health Related ◽

The Impact

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Prospective randomized trial of gene expression classifier utility following radical prostatectomy (G-MINOR).

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.6_suppl.15 ◽

2021 ◽

Vol 39 (6_suppl) ◽

pp. 15-15

Author(s):

Todd Matthew Morgan ◽

Linda A. Okoth ◽

Daniel Eidelberg Spratt ◽

Rodney Dunn ◽

Felix Y Feng ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Randomized Trial ◽

Adjuvant Treatment ◽

Controlled Trial ◽

Treatment Decisions ◽

Oncologic Outcomes ◽

Primary Analysis ◽

The Impact

15 Background: Decipher is a tissue-based genomic classifier (GC) developed and validated in the post-radical prostatectomy (RP) setting as a predictor of metastasis. We conducted the first prospective randomized controlled trial assessing the use of a prostate cancer GC, with a primary objective to determine the impact of test results on adjuvant treatment decisions. Methods: The Genomics in Michigan ImpactiNg Observation or Radiation (G-MINOR) randomized trial enrolled participants across 12 centers between January 2017-August 2018. Eligible patients had undergone RP within 9 months of enrollment, had pT3-4 disease and/or positive surgical margins, and a PSA < 0.1ng/mL. Patients were assigned to either the GC or Usual Care (UC) group using cluster-crossover block randomization. Patients and providers in both arms received a CAPRA-S recurrence risk score. Decipher scores were obtained on RP tissue of all patients, but patients and providers in the UC arm were blinded to the results. The primary endpoint was the impact of impact of GC test result on adjuvant treatment decisions compared to clinical factors alone within 18 months of RP. Results: 356 patients were randomized and 340 had at least 18 months of follow-up. Of these, all but 2 control (UC) patients had sufficient tissue to pass quality control for GC testing. Randomization resulted in 175 (51.5%) GC and 165 (48.5%) UC patients. There were no significant differences in clinical variables or Decipher scores between arms. At 18 months post-RP, 19 (10.9%) patients in the GC group and 12 (7.3%) patients in the UC group had received adjuvant treatment. In the primary analysis, availability of the GC score in the GC arm was significantly associated with adjuvant treatment in GC high-risk patients after controlling for CAPRA-S risk (OR 7.6, 95%CI 1.95-29.6, p = 0.009). In the GC arm, both GC score (OR 8.8, 95%CI 1.9-39.7, p = 0.005) and CAPRA-S score (OR 3.8, 95%CI 1.09-12.9, p = 0.04) were independently associated with adjuvant treatment in a multivariable logistic regression model. Conclusions: In the first ever randomized trial testing the impact of a prostate cancer genomic classifier on treatment decisions, the use of a GC post-RP impacted post-operative treatment in a manner concordant with classifier risk. Further follow-up will be necessary to assess the impact of GC testing on oncologic outcomes. Clinical trial information: NCT02783950. [Table: see text]

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Standardized follow-up program may reduce emergency room and urgent care visits for patients undergoing radical prostatectomy

Canadian Urological Association Journal ◽

10.5489/cuaj.1655 ◽

2014 ◽

Vol 8 (7-8) ◽

pp. 505 ◽

Cited By ~ 5

Author(s):

Ryan Kendrick Flannigan ◽

Geoffrey T. Gotto ◽

Bryan Donnelly ◽

Kevin V. Carlson

Keyword(s):

Radical Prostatectomy ◽

Urgent Care ◽

Additional Patient ◽

Readmission Rates ◽

Entire Cohort ◽

Number Of Patients ◽

Ed Visits ◽

Hospital Visits ◽

The Impact

Introduction: The objective of the current study was to determine the impact of a standardized follow-up program on the morbidity and rates of hospital visits following radical prostatectomy (RP) in a tertiary, non-teaching urologic centre.Methods: Patients who underwent a RP in 2008 were retrospectively evaluated in this study. Postoperative morbidity for the entire cohort was assessed using the Modified Clavien Scale (MCS). Those patients readmitted to hospital or who visited an urban or rural emergency department (ED) within 90 days of surgery were further evaluated to determine the reason for readmission.Results: At our centre, 321 patients underwent RP in 2008 by 11 surgeons. Of the 321 patients, 77 (24.0%) visited an ED within 90 days, and 14 were readmitted to hospital, with an additional patient readmitted directly (with a total 15 readmissions, 4.7% overall). No patients died within the study period. In 2009 we launched a pilot study wherein 115 RP patients received scheduled and on-demand follow-up care by a dedicated nurse between May and November. We found that 90-day readmission rates among this cohort dropped to 5% and 2.6% for ED visits and hospital readmission, respectively.Conclusions: At our tertiary non-teaching centre, a significant number of patients presented back to hospital within 90 days following RP. Most of these patients (80.8%) were managed entirely through an outpatient ED, and many visits were for routine postoperative care. Only 18.2% (4.7% of the 321 prostatectomy patients) were readmitted to hospital. These data point to a need for enhanced postoperative support of patients to reduce costly and often unnecessary visits to acute care EDs. This conclusion is supported by our early experience. Limitations include retrospective design, and variability in practice of surgeons in this study.

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The impact of bladder neck sparing on urinary continence during laparoscopic radical prostatectomy; Results from a high volume centre

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2017.3.186 ◽

2017 ◽

Vol 89 (3) ◽

pp. 186 ◽

Cited By ~ 3

Author(s):

Ali Serdar Gozen ◽

Yigit Akin ◽

Mutlu Ates ◽

Marcel Fiedler ◽

Jens Rassweiler

Keyword(s):

Radical Prostatectomy ◽

Bladder Neck ◽

Multivariate Analyses ◽

Laparoscopic Radical Prostatectomy ◽

Urinary Continence ◽

Neck Reconstruction ◽

Bladder Neck Reconstruction ◽

Group 3 ◽

The Impact

Objective: To evaluate the effects of bladder neck reconstruction techniques on early continence after laparoscopic radical prostatectomy (LRP). Materials and methods: This non-randomized retrospective study analyzed prospectively collected data concerning LRP. In total, 3107 patients underwent LRP between March 1999 and December 2016. Exclusion criteria were preoperative urinary incontinence, previous history of external beam radiotherapy, co-morbities which may affect urinary continence such as diabetes mellitus and/or neurogenic disorders, irregular followup, and follow-up shorter than 24 months. All patients were divided into one of three groups, posterior reconstruction being performed in Group 1 (n = 112), anterior reconstruction in Group 2 (n = 762), and bladder neck sparing (BNS) in Group 3 (n = 987). Demographic and pre-, peri-, and postoperative data were collected. Multivariate analyses were performed to determine factors affecting early continence after LRP. Results: 1861 patients were enrolled in the study. The mean follow-up period was 48.12 ± 29.8 months, and subjects’ mean age was 63.6 ± 6.2 years. There was no significant difference among the groups in terms of demographic or preoperative data. Postoperative data, including oncological outcomes, were similar among the groups. The level of early continence was higher in Group 3 than in the other groups (p < 0.001). Multivariate analyses identified BNS and age as parameters significantly affecting early continence levels after LRP (p < 0.001 and p < 0.001, respectively). Bladder neck reconstruction provided less earlier continence than BNS.

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Impact of advanced radiotherapy techniques and dose intensification on toxicity of salvage radiotherapy after radical prostatectomy

Scientific Reports ◽

10.1038/s41598-019-57056-9 ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 1

Author(s):

Natsuo Tomita ◽

Kaoru Uchiyama ◽

Tomoki Mizuno ◽

Mikiko Imai ◽

Chikao Sugie ◽

...

Keyword(s):

Radical Prostatectomy ◽

Intensity Modulated Radiotherapy ◽

Salvage Radiotherapy ◽

Dose Intensification ◽

Image Guided Radiotherapy ◽

Gu Toxicity ◽

Gi Toxicity ◽

Radiotherapy Techniques ◽

The Impact

AbstractThe safety and efficacy of dose-escalated radiotherapy with intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) remain unclear in salvage radiotherapy (SRT) after radical prostatectomy. We examined the impact of these advanced radiotherapy techniques and dose intensification on the toxicity of SRT. This multi-institutional retrospective study included 421 patients who underwent SRT at the median dose of 66 Gy in 2-Gy fractions. IMRT and IGRT were used for 225 (53%) and 321 (76%) patients, respectively. At the median follow-up of 50 months, the cumulative incidence of late grade 2 or higher gastrointestinal (GI) and genitourinary (GU) toxicities was 4.8% and 24%, respectively. Multivariate analysis revealed that the non-use of either IMRT or IGRT, or both (hazard ratio [HR] 3.1, 95% confidence interval [CI] 1.8–5.4, p < 0.001) and use of whole-pelvic radiotherapy (HR 7.6, CI 1.0–56, p = 0.048) were associated with late GI toxicity, whereas a higher dose ≥68 Gy was the only factor associated with GU toxicities (HR 3.1, CI 1.3–7.4, p = 0.012). This study suggested that the incidence of GI toxicities can be reduced by IMRT and IGRT in SRT, whereas dose intensification may increase GU toxicity even with these advanced techniques.

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