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Peter R Carroll - One of the best experts on this subject based on the ideXlab platform.
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minimal impact of clinical stage on prostate cancer prognosis among contemporary patients with clinically Localized Disease
The Journal of Urology, 2010Co-Authors: Adam C Reese, Matthew R Cooperberg, Peter R CarrollAbstract:Purpose: Clinical staging criteria for prostate cancer were established before the advent of widespread prostate specific antigen screening and extended biopsy templates. However, clinical stage remains commonly used in the modern era to predict prostate cancer outcomes. We hypothesize that in the context of data available from a contemporary biopsy, clinical stage no longer offers meaningful independent prognostic information for clinically Localized prostate cancer.Materials and Methods: We performed an analysis of men in the CaPSURE™ database with Localized (clinical stage T1 or T2) prostate cancer who underwent radical prostatectomy. The usefulness of clinical stage and other clinical parameters (prostate specific antigen, biopsy Gleason score, percent of positive biopsy cores) to predict pathological outcomes and biochemical recurrence after radical prostatectomy was assessed using univariate and multivariable analyses.Results: Of the 4,899 men in the study cohort 51.9% were classified as having T1 d...
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the independent value of tumour volume in a contemporary cohort of men treated with radical prostatectomy for clinically Localized Disease
BJUI, 2010Co-Authors: Sima P Porten, Matthew R Cooperberg, Peter R CarrollAbstract:Study Type – Prognosis (case series) Level of Evidence 4 OBJECTIVE To determine if prostate tumour volume is an independent prognostic factor in a contemporary cohort of men who had a radical prostatectomy (RP) for clinically Localized Disease, as the effect of tumour volume on prostate cancer outcomes has not been consistently shown in the era of widespread screening with prostate-specific antigen (PSA). PATIENTS AND METHODS The study included 856 men who had RP from 1998 to 2007 for Localized prostate cancer. Tumour volume based on pathology was analysed as a continuous and categorized ( 4.00 mL) variable using Cox proportional hazards regression and Kaplan-Meier analysis. A multivariable analysis was also conducted controlling for PSA level, Gleason grade, surgical margins, and pathological stage. RESULTS Tumour volume had a positive association with grade and stage, but did not correlate with biochemical recurrence-free survival on univariate analysis as a continuous variable (hazard ratio 1.00, P = 0.09), and was only statistically significant for volumes of >4 mL as a categorical variable. No tumour volume was an independent predictor of prostate cancer recurrence on multivariate analysis. There was no difference between tumour volume and time to cancer recurrence for organ-confined tumours using Kaplan-Meier analysis. In low-risk patients (PSA level <10 ng/mL, Gleason score ≤6, clinical stage T1c/T2a) tumour volume did not correlate with biochemical recurrence-free survival in univariate or multivariable analysis. CONCLUSIONS There is no evidence that tumour volume is an independent predictor of prostate cancer outcome and it should not be considered as a marker of tumour risk, behaviour or prognosis.
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national practice patterns and time trends in androgen ablation for Localized prostate cancer
Journal of the National Cancer Institute, 2003Co-Authors: Matthew R Cooperberg, Gary D Grossfeld, Deborah P Lubeck, Peter R CarrollAbstract:Background Recent reports have suggested that growing numbers of patients with Localized prostate cancer are receiving androgen deprivation therapy as primary or neoadjuvant treatment, yet sparse clinical evidence supports the use of such treatment in some contexts. We describe national trends in the use of androgen deprivation therapy for Localized Disease and identify sociodemographic variables that are associated with its use.
Shannon L Stott - One of the best experts on this subject based on the ideXlab platform.
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isolation and characterization of circulating tumor cells from patients with Localized and metastatic prostate cancer
Science Translational Medicine, 2010Co-Authors: Shannon L Stott, Richard J Lee, David Tomoaki Miyamoto, Lindsey Ulkus, Elizabeth J Inserra, Sunitha Nagrath, Min Yu, Matthew UlmanAbstract:Rarecirculatingtumorcells(CTCs)arepresentinthebloodofpatientswithmetastaticepithelialcancersbuthavebeen difficult to measure routinely. We report a quantitative automated imaging system for analysis of prostate CTCs, taking advantage of prostate-specific antigen (PSA), a unique prostate tumor–associated marker. The specificity of PSA staining enabled optimization of criteria for baseline image intensity, morphometric measurements, and integration of multiple signals in a three-dimensional microfluidic device. In a pilot analysis, we detected CTCs in prostate cancer patients with Localized Disease, before surgical tumor removal in 8 of 19 (42%) patients (range, 38 to 222 CTCs per milliliter). For 6 of the 8 patients with preoperative CTCs, a precipitous postoperative decline (<24 hours) suggests a short half-life for CTCs in the blood circulation. Other patients had persistent CTCs for up to 3 months after prostate removal, suggesting early but transient disseminated tumor deposits. In patients with metastatic prostate cancer, CTCs were detected in 23 of 36 (64%) cases (range, 14 to 5000 CTCs per milliliter). In previously untreated patients followed longitudinally, the numbers of CTCs declined after the initiation of effective therapy. The prostate cancer– specific TMPRSS2-ERG fusion was detectable in RNA extracted from CTCs from 9 of 20 (45%) patients with metastatic Disease, and dual staining of captured CTCs for PSA and the cell division marker Ki67 indicated a broad range for the proportion of proliferating cells among CTCs. This method for analysis of CTCs will facilitate the application of noninvasive tumor sampling to direct targeted therapies in advanced prostate cancer and warrants the initiation of longterm clinical studies to test the importance of CTCs in invasive Localized Disease.
Jeffrey J Tosoian - One of the best experts on this subject based on the ideXlab platform.
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prognostic significance of the risk of non Localized Disease on psma pet comparative performance of a novel psma pet derived risk stratification tool for high risk prostate cancer in a large multi institutional cohort
International Journal of Radiation Oncology Biology Physics, 2021Co-Authors: Ting Martin, Michael Xiang, Derya Tilki, R J Karnes, B J Stish, R Martinezmonge, Rahul D Tendulkar, E A Klein, Phuoc T Tran, Jeffrey J TosoianAbstract:Purpose/objective(s) Occult non-Localized Disease (N1 or M1) at the time of definitive treatment of high-risk prostate cancer (HR-PCa) underlies most treatment failures. We recently developed a nomogram tuned to the identification of non-Localized Disease on prostate specific membrane antigen PET/CT (PSMA PET/CT) in patients with cN0M0 HR-PCa by conventional imaging, which incorporates iPSA, percent positive core on biopsy, Gleason Grade and cT stage. We systematically compared the prognostic performance of the PSMA nomogram against other validated risk stratification tools for HR-PCa. Materials/methods We identified 5275 men from a multi-institutional database treated with radical prostatectomy (55%), external beam radiation therapy (EBRT, 31%), or EBRT and brachytherapy (14%). The prognostic performance of the PSMA nomogram was compared against the STAR-CAP score, the Cancer of the Prostate Risk Assessment (CAPRA) score, Cambridge Prognostic Groups (CPG) risk group, and Memorial Sloan Kettering Cancer Center (MSKCC) nomogram of 5-year recurrence probability. Accuracy was determined for 5- and 10-year distant metastasis (DM) and prostate cancer specific mortality (PCSM) using the concordance index (C-index). Results Median follow-up was 50.3 months (interquartile range 28.1-84.5 months). Overall, 16.1% developed DM, and 4.6% died from PCa. C-indices for the PSMA nomogram were 0.67 and 0.67 for 5- and 10-year DM, and 0.69 and 0.73 for 5- and 10-year PCSM, respectively. The PSMA nomogram outperformed CAPRA, CPG, and MSKCC for all endpoints, outperformed STAR-CAP for 10-year DM, and performed similarly to STAR-CAP for all other endpoints (see Table). The comparative performance between the tools was generally maintained at different follow-up times and in subgroup analyses stratified by primary treatment modalities. Conclusion A nomogram tuned to the detection of non-Localized Disease on PSMA/PET in HR-PCa patients is significantly prognostic of important clinical endpoints, with performance comparable to STAR-CAP and superior to other tools. These data strongly suggest that upstaging based on PSMA PET/CT provides clinically relevant information and warrant prospective validation.
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outcomes of men with ductal prostate cancer undergoing definitive therapy for Localized Disease
Journal of Clinical Oncology, 2020Co-Authors: Weranja Ranasinghe, Jeffrey J Tosoian, Daniel D Shapiro, Chad A Reichard, Mohamed A Elsheshtawi, Yaw A Nyame, Debasish Sundi, Lamont Wilkins, Ridwan Alam, Tharakeswara K BathalaAbstract:350Background: Ductal prostate adenocarcinoma (DAC) is an aggressive variant of prostate cancer (PC). We aimed to assess the outcomes of men with Localized DAC undergoing radical prostatectomy (RP)...
Celestia S Higano - One of the best experts on this subject based on the ideXlab platform.
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prostate cancer version 2 2019 nccn clinical practice guidelines in oncology
Journal of The National Comprehensive Cancer Network, 2019Co-Authors: James L Mohler, Emmanuel S Antonarakis, Andrew J Armstrong, Anthony V Damico, Brian J Davis, Tanya B Dorff, James A Eastham, Charles Arthur Enke, Thomas A Farrington, Celestia S HiganoAbstract:The NCCN Guidelines for Prostate Cancer include recommendations regarding diagnosis, risk stratification and workup, treatment options for Localized Disease, and management of recurrent and advanced Disease for clinicians who treat patients with prostate cancer. The portions of the guidelines included herein focus on the roles of germline and somatic genetic testing, risk stratification with nomograms and tumor multigene molecular testing, androgen deprivation therapy, secondary hormonal therapy, chemotherapy, and immunotherapy in patients with prostate cancer.
Matthew R Cooperberg - One of the best experts on this subject based on the ideXlab platform.
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minimal impact of clinical stage on prostate cancer prognosis among contemporary patients with clinically Localized Disease
The Journal of Urology, 2010Co-Authors: Adam C Reese, Matthew R Cooperberg, Peter R CarrollAbstract:Purpose: Clinical staging criteria for prostate cancer were established before the advent of widespread prostate specific antigen screening and extended biopsy templates. However, clinical stage remains commonly used in the modern era to predict prostate cancer outcomes. We hypothesize that in the context of data available from a contemporary biopsy, clinical stage no longer offers meaningful independent prognostic information for clinically Localized prostate cancer.Materials and Methods: We performed an analysis of men in the CaPSURE™ database with Localized (clinical stage T1 or T2) prostate cancer who underwent radical prostatectomy. The usefulness of clinical stage and other clinical parameters (prostate specific antigen, biopsy Gleason score, percent of positive biopsy cores) to predict pathological outcomes and biochemical recurrence after radical prostatectomy was assessed using univariate and multivariable analyses.Results: Of the 4,899 men in the study cohort 51.9% were classified as having T1 d...
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the independent value of tumour volume in a contemporary cohort of men treated with radical prostatectomy for clinically Localized Disease
BJUI, 2010Co-Authors: Sima P Porten, Matthew R Cooperberg, Peter R CarrollAbstract:Study Type – Prognosis (case series) Level of Evidence 4 OBJECTIVE To determine if prostate tumour volume is an independent prognostic factor in a contemporary cohort of men who had a radical prostatectomy (RP) for clinically Localized Disease, as the effect of tumour volume on prostate cancer outcomes has not been consistently shown in the era of widespread screening with prostate-specific antigen (PSA). PATIENTS AND METHODS The study included 856 men who had RP from 1998 to 2007 for Localized prostate cancer. Tumour volume based on pathology was analysed as a continuous and categorized ( 4.00 mL) variable using Cox proportional hazards regression and Kaplan-Meier analysis. A multivariable analysis was also conducted controlling for PSA level, Gleason grade, surgical margins, and pathological stage. RESULTS Tumour volume had a positive association with grade and stage, but did not correlate with biochemical recurrence-free survival on univariate analysis as a continuous variable (hazard ratio 1.00, P = 0.09), and was only statistically significant for volumes of >4 mL as a categorical variable. No tumour volume was an independent predictor of prostate cancer recurrence on multivariate analysis. There was no difference between tumour volume and time to cancer recurrence for organ-confined tumours using Kaplan-Meier analysis. In low-risk patients (PSA level <10 ng/mL, Gleason score ≤6, clinical stage T1c/T2a) tumour volume did not correlate with biochemical recurrence-free survival in univariate or multivariable analysis. CONCLUSIONS There is no evidence that tumour volume is an independent predictor of prostate cancer outcome and it should not be considered as a marker of tumour risk, behaviour or prognosis.
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national practice patterns and time trends in androgen ablation for Localized prostate cancer
Journal of the National Cancer Institute, 2003Co-Authors: Matthew R Cooperberg, Gary D Grossfeld, Deborah P Lubeck, Peter R CarrollAbstract:Background Recent reports have suggested that growing numbers of patients with Localized prostate cancer are receiving androgen deprivation therapy as primary or neoadjuvant treatment, yet sparse clinical evidence supports the use of such treatment in some contexts. We describe national trends in the use of androgen deprivation therapy for Localized Disease and identify sociodemographic variables that are associated with its use.
