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General medicine: MRI and MRI-targeted biopsy take precedence over systematic biopsy in primary prostatecancer diagnosis MRI and MRI-targeted biopsy take precedence over systematic biopsy in primary prostatecancer diagnosis | BMJ Evidence-Based Medicine Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? Search for this keyword Search for this keyword Main menu Log in using your username (...) and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? You are here MRI and MRI-targeted biopsy take precedence over systematic biopsy in primary prostatecancer diagnosis Article Text Commentary General medicine MRI and MRI-targeted biopsy take precedence over systematic biopsy in primary prostatecancer diagnosis Ivo G Schoots 1 , 2 , Olivier Rouvière 3 , 4 Statistics from Altmetric.com Commentary on : Kasivisvanathan V, Rannikko
Radical Prostatectomy or Watchful Waiting in ProstateCancer - 29-Year Follow-up. Radical prostatectomy reduces mortality among men with clinically detected localized prostatecancer, but evidence from randomized trials with long-term follow-up is sparse.We randomly assigned 695 men with localized prostatecancer to watchful waiting or radical prostatectomy from October 1989 through February 1999 and collected follow-up data through 2017. Cumulative incidence and relative risks with 95 (...) % confidence intervals for death from any cause, death from prostatecancer, and metastasis were estimated in intention-to-treat and per-protocol analyses, and numbers of years of life gained were estimated. We evaluated the prognostic value of histopathological measures with a Cox proportional-hazards model.By December 31, 2017, a total of 261 of the 347 men in the radical-prostatectomy group and 292 of the 348 men in the watchful-waiting group had died; 71 deaths in the radical-prostatectomy group
users and nonusers using an age-adjusted Cox regression model.Screening increased the detection of Gleason 6 (hazard ratio [HR] 1.59, 95% confidence interval [CI] 1.47-1.72 and HR 1.39, 95% CI 1.26-1.54) and localized prostatetumors (HR 1.25, 95% CI 1.18-1.32 and HR 1.11, 95% CI 1.03-1.20) more among baseline NSAID nonusers than among users, respectively (p for interaction <0.04 for both). This difference was observed in all three screening rounds. Detection of metastatic prostatecancer (...) was similar in both NSAID users and nonusers. Screening decreased prostatecancer mortality among men using NSAIDs at FinRSPC randomization (HR 0.66, 95% CI 0.49-0.90) but not among nonusers (HR 0.95, 95% CI 0.81-1.12); p for interaction=0.04.Screening detected fewer well-differentiated localized tumors among NSAID users than among nonusers. This suggests that PSA screening may cause less overdiagnosis within this subgroup, whereas mortality benefit may be greater among NSAID users.Prostate cancer
Sequence of hormonal therapy and radiotherapy field size in unfavourable, localised prostatecancer (NRG/RTOG 9413): long-term results of a randomised, phase 3 trial The NRG/RTOG 9413 study showed that whole pelvic radiotherapy (WPRT) plus neoadjuvant hormonal therapy (NHT) improved progression-free survival in patients with intermediate-risk or high-risk localised prostatecancer compared with prostate only radiotherapy (PORT) plus NHT, WPRT plus adjuvant hormonal therapy (AHT), and PORT plus (...) in the NHT plus WPRT group, 17 (5%) of 313 in the NHT plus PORT group, 22 (7%) of 317 in the WPRT plus AHT group, and 14 (4%) of 315 in the PORT plus AHT group. Late grade 3 or worse gastrointestinal adverse events occurred in 22 (7%) of 316 patients in the NHT plus WPRT group, five (2%) of 313 in the NHT plus PORT group, ten (3%) of 317 in the WPRT plus AHT group, and seven (2%) of 315 in the PORT plus AHT group.In this cohort of patients with intermediate-risk and high-risk localised prostatecancer
in a large cohort of men with prostatecancer highly enriched in an AA patient population.Patients were diagnosed with clinically localized adenocarcinoma of the prostate and treated at The Ochsner Clinic (New Orleans, LA, USA) from January 2006 to December 2011. CCP scores were derived from archival formalin-fixed, paraffin-embedded biopsy tissue. CCR scores were calculated as the combination of molecular (CCP score) and clinical (Cancer of the Prostate Risk Assessment [CAPRA] score) components.Active (...) Comparison of the Prognostic Utility of the Cell Cycle Progression Score for Predicting Clinical Outcomes in African American and Non-African American Men with Localized ProstateCancer Better prostatecancer risk stratification is necessary to inform medical management, especially for African American (AA) men, for whom outcomes are particularly uncertain.To evaluate the utility of both a cell cycle progression (CCP) score and a clinical cell-cycle risk (CCR) score to predict clinical outcomes
techniques for prostatecancer are more accur New diagnostic techniques for prostatecancer are more accurate at identifying low- ate at identifying low- risk disease risk disease 3.1 NICE's clinical guideline on prostatecancer considers tumours to be low risk if the following criteria are met: serum prostate-specific antigen (PSA) no more than 10 ng/ml, a Gleason score no more than 6, and a clinical stage of T1 to T2a. (The Gleason Score is a grading system that rates the aggressiveness of the 2 (...) largest areas of prostatecancer cells in a tumour. Each area is scored on how healthy it looks, so healthy tissue scores 1 or 2 and abnormal tissue scores 3). The clinical experts explained that the techniques used to diagnose prostatecancer in the NHS are changing, for example, transrectal ultrasound (TRUS) guided biopsy is being replaced by multiparametric MRI. MRI techniques are more accurate at differentiating low-risk disease that does not need treatment, from disease that is likely to progress
cohort in phase II will be reported separately.EPI is a noninvasive, easy-to-use, gene expression urine assay, which has now been successfully validated in over 1000 patients across two prospective validation trials to stratify risk of ≥GG2 from GG1 cancer and benign disease. The test improves identification of patients with higher grade disease and would reduce the total number of unnecessary biopsies.It is challenging to predict which men are likely to have high-grade prostatecancer (PCa (...) A Prospective Adaptive Utility Trial to Validate Performance of a Novel Urine Exosome Gene Expression Assay to Predict High-grade ProstateCancer in Patients with Prostate-specific Antigen 2-10ng/ml at Initial Biopsy Discriminating indolent from clinically significant prostatecancer (PCa) in the initial biopsy setting remains an important issue. Prospectively evaluated diagnostic assays are necessary to ensure efficacy and clinical adoption.Performance and utility assessment of ExoDx Prostate
Hypofractionated Radiation Therapy for Localized ProstateCancer Hypofractionated Radiation Therapy for Localized ProstateCancer: An ASTRO, ASCO, and AUA Evidence-Based Guideline | Journal of Clinical Oncology Search in: Menu Article Tools ASCO SPECIAL ARTICLE Article Tools OPTIONS & TOOLS COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.18.01097 Journal of Clinical Oncology - published online before print October 11, 2018 Hypofractionated Radiation Therapy (...) for Localized ProstateCancer: An ASTRO, ASCO, and AUA Evidence-Based Guideline x Scott C. Morgan , x Karen Hoffman , x D. Andrew Loblaw , x Mark K. Buyyounouski , x Caroline Patton , x Daniel Barocas , x Soren Bentzen , x Michael Chang , x Jason Efstathiou , x Patrick Greany , x Per Halvorsen , x Bridget F. Koontz , x Colleen Lawton , x C. Marc Leyrer , x Daniel Lin , x Michael Ray , and x Howard Sandler Scott C. Morgan, The Ottawa Hospital and University of Ottawa, Ottawa; D. Andrew Loblaw, Odette Cancer
Radiotherapy to the primary tumour for newly diagnosed, metastatic prostatecancer (STAMPEDE): a randomised controlled phase 3 trial. Based on previous findings, we hypothesised that radiotherapy to the prostate would improve overall survival in men with metastatic prostatecancer, and that the benefit would be greatest in patients with a low metastatic burden. We aimed to compare standard of care for metastatic prostatecancer, with and without radiotherapy.We did a randomised controlled phase (...) 3 trial at 117 hospitals in Switzerland and the UK. Eligible patients had newly diagnosed metastatic prostatecancer. We randomly allocated patients open-label in a 1:1 ratio to standard of care (control group) or standard of care and radiotherapy (radiotherapy group). Randomisation was stratified by hospital, age at randomisation, nodal involvement, WHO performance status, planned androgen deprivation therapy, planned docetaxel use (from December, 2015), and regular aspirin or non-steroidal
2018LancetControlled trial quality: predicted high
allocation. The primary endpoint was investigator-assessed radiographic progression-free survival (rPFS; based on Response Evaluation Criteria in Solid Tumors version 1.1 and ProstateCancer Clinical Trials Working Group 2 criteria). Efficacy analyses were done in the intention-to-treat population, which included all randomly assigned patients, and safety analyses included all patients who received at least one dose of olaparib or placebo. This trial is registered with ClinicalTrials.gov, number (...) Olaparib combined with abiraterone in patients with metastatic castration-resistant prostatecancer: a randomised, double-blind, placebo-controlled, phase 2 trial Patients with metastatic castration-resistant prostatecancer and homologous recombination repair (HRR) mutations have a better response to treatment with the poly(ADP-ribose) polymerase inhibitor olaparib than patients without HRR mutations. Preclinical data suggest synergy between olaparib and androgen pathway inhibitors. We aimed
Randomized Trial of Hypofractionated, Dose-Escalated, Intensity-Modulated Radiation Therapy (IMRT) Versus Conventionally Fractionated IMRT for Localized ProstateCancer Hypofractionated radiotherapy delivers larger daily doses of radiation and may increase the biologically effective dose delivered to the prostate. We conducted a randomized trial testing the hypothesis that dose-escalated, moderately hypofractionated intensity-modulated radiation therapy (HIMRT) improves prostatecancer control (...) compared with conventionally fractionated IMRT (CIMRT) for men with localized prostate cancer.Men were randomly assigned to 75.6 Gy in 1.8-Gy fractions delivered over 8.4 weeks (CIMRT) or 72 Gy in 2.4 Gy fractions delivered over 6 weeks (HIMRT, biologically equivalent to 85 Gy in 1.8-Gy fractions assuming prostatecancer α-to-β ratio of 1.5). Failure was defined as prostate-specific antigen (PSA) failure (nadir plus 2 ng/mL) or initiation of salvage therapy. Modified Radiation Therapy Oncology Group
ASTRO/AUA Guideline on Hypofractionation for Localized ProstateCancer Supplemental Materials for Hypofractionated Radiation Therapy for Localized ProstateCancer: Executive Summary of an ASTRO, ASCO, and AUA Evidence-Based Guideline - Practical Radiation Oncology Email/Username: Password: Remember me Search Terms Search within Search Share this page: Volume 8, Issue 6, Pages 354–360 Hypofractionated Radiation Therapy for Localized ProstateCancer: Executive Summary of an ASTRO, ASCO, and AUA (...) period for guideline), Bayer (Joint Safety Review Committee; ended during disclosure period for guideline); Per Halvorsen: American College of Radiology Radiation Oncology Practice Accreditation program (honoraria, travel expenses); Karen Hoffman: Vanderbilt University (consultant); Patrick Greany: Department of Defense ProstateCancer Research Program (research funding, honoraria, travel expenses); Bridget Koontz: Janssen (research funding), Blue Earth Diagnostics (advisory board), American Society
and identifying optimal treatment, while considering such factors as disease stage, risk, volume, age, and performance status. The purpose of this American Society of Clinical Oncology (ASCO) guideline is to endorse the American Urological Association (AUA), American Society for Radiation Oncology (ASTRO), and Society of Urologic Oncology (SUO) guideline on Clinically Localized ProstateCancer by Sanda et al, , which was published online in 2017 (available at ) and in print in 2018. This ASCO endorsement (...) POPULATION Section: The Clinically Localized ProstateCancer guideline made recommendations according to shared decision making, cancer severity/risk group (very low– and low-risk disease, intermediate-risk disease, high-risk disease), recommended treatment approaches (active surveillance, prostatectomy, radiotherapy, cryosurgery, high intensity focal ultrasound/focal therapy), and outcome expectations and management (treatment-related adverse events and health-related quality of life, post-treatment
Early Detection of ProstateCancerProstateCancer: Early Detection Guideline - American Urological Association advertisement Toggle navigation About Us About the AUA Membership AUA Governance Industry Relations Education AUAUniversity Education Products & Resources Normal Histology and Important Histo-anatomic Structures Urinary Bladder Prostate Kidney Renovascular Diseases Andrenal Gland Testis Paratesticular Tumors Penis Retroperitoneum Cytology Online Learning For Medical Students Exams/LLL (...) and Quality of Care Accreditations and Reporting Patient Education Early Detection of ProstateCancer (2018) Published 2013; Reviewed and Validity Confirmed 2018 The clinical guideline on Early Detection of ProstateCancer discusses the detection of disease at an early, pre-symptomatic stage through the use of screening tools, such as PSA. Early detection allows for more conservative management, if needed, via means such as active surveillance and watchful waiting. [pdf] Panel Members H. Ballentine Carter
Hypofractionated Radiation Therapy for Localized ProstateCancerProstateCancer: Hypofractionated Radiotherapy Guideline - American Urological Association advertisement Toggle navigation About Us About the AUA Membership AUA Governance Industry Relations Education AUAUniversity Education Products & Resources Normal Histology and Important Histo-anatomic Structures Urinary Bladder Prostate Kidney Renovascular Diseases Andrenal Gland Testis Paratesticular Tumors Penis Retroperitoneum Cytology (...) is considered low compared to most other neoplasms, with several estimates derived from large populations in the range of 100 to 200 cGy. 5-7 Unlike other solid tumors with higher alpha-beta ratios, the alpha-beta ratio of the adjacent dose-limiting normal structure, namely the rectum, has been estimated to be greater than that of prostatecancer itself. 8,9 An implication of this relationship is that hypofractionation - daily delivery of EBRT with fraction sizes >200 cGy - may further improve
Castration-Resistant ProstateCancerProstateCancer: Castration Resistant Guideline - American Urological Association advertisement Toggle navigation About Us About the AUA Membership AUA Governance Industry Relations Education AUAUniversity Education Products & Resources Normal Histology and Important Histo-anatomic Structures Urinary Bladder Prostate Kidney Renovascular Diseases Andrenal Gland Testis Paratesticular Tumors Penis Retroperitoneum Cytology Online Learning For Medical Students (...) and dangerous drug interactions. This document was amended in April 2014 and March 2015 to reflect literature that was released since the original publication of this guideline in May 2013. An additional amendment was conducted in 2018 to reflect new literature released related to the treatment of patients with non-metastatic castration-resistant prostatecancer. This document will continue to be periodically updated to reflect the growing body of literature related to this disease. Panel Members Michael S
5-year survival rate is around 100% for local- and regional-stage prostatecancer, and around 30% for distant-stage prostatecancer (based on data from 2007 to 2013). Definition A malignanttumour of glandular origin, situated in the prostate. It is most commonly seen in older men; between 2011 and 2015 the median age at diagnosis in the US was 66 years. National Cancer Institute; Surveillance, Epidemiology, and End Results program (SEER). SEER stat fact sheets: prostatecancer. 2018 [internet (...) is the principal investigator of an R-21 NIH research grant investigating the tumour-mediated immune responses in African-American men with prostatecancer. Professor Department of Radiation Oncology University of Texas MD Anderson Cancer Center Houston TX Disclosures MSA declares that he has no competing interests. Peer reviewers Clinical Oncology Registrar St Luke's Cancer Centre Royal Surrey Hospital Guildford Surrey UK Disclosures EA has received consultation fees from the following organisations during
Development, Evaluation, and Implementation of a Pan-African Cancer Research Network: Men of African Descent and Carcinoma of the ProstateCancer of the prostate (CaP) is the leading cancer among men in sub-Saharan Africa (SSA). A substantial proportion of these men with CaP are diagnosed at late (usually incurable) stages, yet little is known about the etiology of CaP in SSA.We established the Men of African Descent and Carcinoma of the Prostate Network, which includes seven SSA centers (...) and shipped it to the Center for Inherited Disease Research (Baltimore, MD) and the Centre for Proteomics and Genomics Research (Cape Town, South Africa), where genotypes were generated using the UK Biobank Axiom Array.We used common instruments for data collection and entered data into the shared database. Double-entered data from pilot participants showed a 95% to 98% concordance rate, suggesting that data can be collected, entered, and stored with a high degree of accuracy. Genotypes were obtained from
Effective Project Management of a Pan-African Cancer Research Network: Men of African Descent and Carcinoma of the Prostate (MADCaP) Health research in low- and middle-income countries can generate novel scientific knowledge and improve clinical care, fostering population health improvements to prevent premature death. Project management is a critical part of the success of this research, applying knowledge, skills, tools, and techniques to accomplish required goals. Here, we describe (...) the development and implementation of tools to support a multifaceted study of prostatecancer in Africa, focusing on building strategic and operational capacity.Applying a learning organizational framework, we developed and implemented a project management toolkit (PMT) that includes a management process flowchart, a cyclical center-specific schedule of activities, periodic reporting and communication, and center-specific monitoring and evaluation metrics.The PMT was successfully deployed during year one