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1. Risk of progression following a negative biopsy in prostate cancer active surveillance

Author

Beckmann, Kerri, Santaolalla, Aida, Sugimoto, Mikio, Carroll, Peter, Rubio, Jose, Villers, Arnauld, Bjartell, Anders, Morgan, Todd, Dasgupta, Prokar, Van Hemelrijck, Mieke, and Elhage, Oussama

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Oncology and Carcinogenesis, Aging, Clinical Research, Cancer, Prostate Cancer, Urologic Diseases, Prevention, Male, Humans, Prostatic Neoplasms, Watchful Waiting, Neoplasm Grading, Biopsy, Logistic Models, Prostate-Specific Antigen, Movember Foundation’s Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium, Urology & Nephrology, Clinical sciences, Oncology and carcinogenesis
Abstract

BackgroundCurrently, follow-up protocols are applied equally to men on active surveillance (AS) for prostate cancer (PCa) regardless of findings at their initial follow-up biopsy. To determine whether less intensive follow-up is suitable following negative biopsy findings, we assessed the risk of converting to active treatment, any subsequent upgrading, volume progression (>33% positive cores), and serious upgrading (grade group >2) for negative compared with positive findings on initial follow-up biopsy.Methods13,161 men from 24 centres participating in the Global Action Plan Active Surveillance Prostate Cancer [GAP3] consortium database, with baseline grade group ≤2, PSA ≤ 20 ng/mL, cT-stage 1-2, diagnosed after 1995, and ≥1 follow-up biopsy, were included in this study. Risk of converting to treatment was assessed using multivariable mixed-effects survival regression. Odds of volume progression, any upgrading and serious upgrading were assessed using mix-effects binary logistic regression for men with ≥2 surveillance biopsies.Results27% of the cohort (n = 3590) had no evidence of PCa at their initial biopsy. Over 50% of subsequent biopsies in this group were also negative. A negative initial biopsy was associated with lower risk of conversion (adjusted hazard ratio: 0.45; 95% confidence interval [CI]: 0.42-0.49), subsequent upgrading (adjusted odds ratio [OR]: 0.52; 95%CI: 0.45-0.62) and serious upgrading (OR: 0.74; 95%CI: 0.59-92). Radiological progression was not assessed due to limited imaging data.ConclusionDespite heterogeneity in follow-up schedules, findings from this global study indicated reduced risk of converting to treatment, volume progression, any upgrading and serious upgrading among men whose initial biopsy findings were negative compared with positive. Given the low risk of progression and high likelihood of further negative biopsy findings, consideration should be given to decreasing follow-up intensity for this group to reduce unnecessary invasive biopsies.

Published
2023

2. Comparison of outcomes of different biopsy schedules among men on active surveillance for prostate cancer: An analysis of the G.A.P.3 global consortium database

Author

Beckmann, Kerri R, Bangma, Chris H, Helleman, Jozien, Bjartell, Anders, Carroll, Peter R, Morgan, Todd, Nieboer, Daan, Santaolalla, Aida, Trock, Bruce J, Valdagni, Riccardo, Roobol, Monique J, Trock, Bruce, Ehdaie, Behfar, Carroll, Peter, Filson, Christopher, Logothetis, Christopher, Klotz, Laurence, Pickles, Tom, Hyndman, Eric, Moore, Caroline, Gnanapragasam, Vincent, Van Hemelrijck, Mieke, Dasgupta, Prokar, Bangma, Chris, Roobol, Monique, Villers, Arnauld, Robert, Grégoire, Semjonow, Axel, Rannikko, Antti, Perry, Antoinette, Hugosson, Jonas, Rubio‐Briones, Jose, Hefermehl, Lukas, Shiong, Lee Lui, Frydenberg, Mark, Stricker, Phillip, Sugimoto, Mikio, Chung, Byung Ha, van der Kwast, Theo, van der Linden, Wim, Hulsen, Tim, Ruwe, Boris, van Hooft, Peter, Steyerberg, Ewout, Beckmann, Kerri, Denton, Brian, Hayen, Andrew, Boutros, Paul, Guo, Wei, Benfante, Nicole, Cowan, Janet, Patil, Dattatraya, Park, Lauren, Ferrante, Stephanie, Mamedov, Alexandre, LaPointe, Vincent, Crump, Trafford, Stavrinides, Vasilis, Kimberly‐Duffell, Jenna, Olivier, Jonathan, Rancati, Tiziana, Ahlgren, Helén, Mascarós, Juanma, Löfgren, Annica, Lehmann, Kurt, Lin, Catherine Han, Cusick, Thomas, Hirama, Hiromi, Lee, Kwang Suk, Jenster, Guido, Auvinen, Anssi, Haider, Masoom, van Bochove, Kees, Kouspou, Michelle, and Paich, Kellie

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Oncology and Carcinogenesis, Urologic Diseases, Aging, Prevention, Cancer, Prostate Cancer, Clinical Research, Biopsy, Disease Progression, Humans, Male, Neoplasm Grading, Prostate, Prostate-Specific Antigen, Prostatic Neoplasms, Watchful Waiting, active surveillance, biopsy schedule, prostate cancer, treatment, upgrading, Global Action Plan Active Surveillance Prostate Cancer [G.A.P.3] Consortium, Paediatrics and Reproductive Medicine, Oncology & Carcinogenesis, Clinical sciences, Oncology and carcinogenesis
Abstract

BackgroundThe optimal interval for repeat biopsy during active surveillance (AS) for prostate cancer is yet to be defined. This study examined whether risk of upgrading (to grade group ≥ 2) or risk of converting to treatment varied according to intensity of repeat biopsy using data from the GAP3 consortium's global AS database.Materials and methodsIntensity of surveillance biopsy schedules was categorized according to centers' protocols: (a) Prostate Cancer Research International Active Surveillance project (PRIAS) protocols with biopsies at years 1, 4, and 7 (10 centers; 7532 men); (b) biennial biopsies, that is, every other year (8 centers; 4365 men); and (c) annual biopsy schedules (4 centers; 1602 men). Multivariable Cox regression was used to compare outcomes according to biopsy intensity.ResultsOut of the 13,508 eligible participants, 56% were managed according to PRIAS protocols (biopsies at years 1, 4, and 7), 32% via biennial biopsy, and 12% via annual biopsy. After adjusting for baseline characteristics, risk of converting to treatment was greater for those on annual compared with PRIAS biopsy schedules (hazard ratio [HR] = 1.66; 95% confidence interval [CI] = 1.51-1.83; p

Published
2022

5. Comparison of Characteristics, Follow-up and Outcomes of Active Surveillance for Prostate Cancer According to Ethnicity in the GAP3 Global Consortium Database.

Author

Beckmann, Kerri, Santaolalla, Aida, Helleman, Jozien, Carroll, Peter, Ha Chung, Byung, Shiong Lee, Lui, Perry, Antoinette, Rubio-Briones, Jose, Sugimoto, Mikio, Trock, Bruce, Valdagni, Riccardo, Dasgupta, Prokar, Van Hemelrijck, Mieke, Elhage, Oussama, and Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium

Subjects
Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium, Active surveillance, Ethnicity, Outcomes, Prostate cancer, Race, Clinical Research, Urologic Diseases, Prostate Cancer, Cancer, Aging, Prevention
Abstract

BackgroundStudies of active surveillance (AS) for prostate cancer (PCa) have focussed predominantly on Caucasian populations. Little is known about the experience of Asian men, while suitability for men of African descent has been questioned.ObjectiveTo compare baseline characteristics, follow-up, and outcomes for men on AS for PCa, according to ethnicity.Design setting and participantsThe study cohort included 13 centres from the GAP3 consortium that record ethnicity (categorised broadly as Caucasian/white, African/Afro-Caribbean/black, Asian, mixed/other, and unknown). Men with biopsy grade group >2, prostate-specific antigen (PSA) >20 ng/ml, T stage ≥cT3, or age >80 yr were excluded.Outcome measurements and statistical analysisClinical characteristics, follow-up schedules, outcome status, and reasons for discontinuation were compared across ethnic groups. Risk of upgrading, potential disease progression (grade group ≥3 or T stage ≥3), suspicious indications (any upgrading, number of positive cores >3, T stage ≥cT3, PSA >20 ng/ml, or PSA density >0.2 ng/ml/cc2), and conversion to treatment were assessed using mixed-effect regression models.Results and limitationsThe eligible cohort (n = 9158) comprised 83% Caucasian men, 6% men of African descent, 5% Asian men, 2% men of mixed/other ethnicity, and 4% men of unknown ethnicity. Risks of suspicious indicators (hazard ratio = 1.27; 95% confidence interval [CI] 1.12-1.45), upgrading (odds ratio [OR] = 1.40; 95% CI 1.14-1.71), and potential progression (OR = 1.46; 95% CI 1.06-2.01) were higher among African/black than among Caucasian/white men. Risk of transitioning to treatment did not differ by ethnicity. More Asian than Caucasian men converted without progression (42% vs 26%, p < 0.001). Heterogeneity in surveillance protocols and racial makeup limit interpretation.ConclusionsThis multinational study found differences in the risk of disease progression and transitioning to treatment without signs of progression between ethnic groups. Further research is required to determine whether differences are due to biology, sociocultural factors, and/or clinical practice.Patient summaryThis international study compared prostate cancer active surveillance outcomes by ethnicity. Risks of upgrading and disease progression were higher among African than among Caucasian men. Transitioning to treatment without progression was highest among Asian men. Understanding of these differences requires further investigation.

Published
2021

11. Reasons for Discontinuing Active Surveillance: Assessment of 21 Centres in 12 Countries in the Movember GAP3 Consortium

Author

Van Hemelrijck, Mieke, Ji, Xi, Helleman, Jozien, Roobol, Monique J, van der Linden, Wim, Nieboer, Daan, Bangma, Chris H, Frydenberg, Mark, Rannikko, Antti, Lee, Lui S, Gnanapragasam, Vincent J, Kattan, Mike W, Trock, Bruce, Ehdaie, Behfar, Carroll, Peter, Filson, Christopher, Kim, Jeri, Logothetis, Christopher, Morgan, Todd, Klotz, Laurence, Pickles, Tom, Hyndman, Eric, Moore, Caroline M, Gnanapragasam, Vincent, Dasgupta, Prokar, Bangma, Chris, Roobol, Monique, Villers, Arnauld, Valdagni, Riccardo, Perry, Antoinette, Hugosson, Jonas, Rubio-Briones, Jose, Bjartell, Anders, Hefermehl, Lukas, Shiong, Lee Lui, Kakehi, Yoshiyuki, Chung, Byung Ha, van der Kwast, Theo, Obbink, Henk, Hulsen, Tim, de Jonge, Cees, Kattan, Mike, Xinge, Ji, Muir, Kenneth, Lophatananon, Artitaya, Fahey, Michael, Steyerberg, Ewout, Zhang, Liying, Santa Olalla, Aida, Beckmann, Kerri, Denton, Brian, Hayen, Andrew, Boutros, Paul, Guo, Wei, Benfante, Nicole, Cowan, Janet, Patil, Dattatraya, Tolosa, Emily, Kim, Tae-Kyung, Mamedov, Alexandre, La Pointe, Vincent, Crump, Trafford, Kimberly-Duffell, Jenna, Santaolalla, Aida, Olivier, Jonathan, Rancati, Tiziana, Ahlgren, Helén, Mascarós, Juanma, Löfgren, Annica, Lehmann, Kurt, Lin, Catherine Han, Hirama, Hiromi, Lee, Kwang Suk, Jenster, Guido, Auvinen, Anssi, Haider, Masoom, van Bochove, Kees, Carter, Ballentine, Gledhill, Sam, Buzza, Mark, and Bruinsma, Sophie

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Oncology and Carcinogenesis, Prostate Cancer, Aging, Prevention, Urologic Diseases, Cancer, Good Health and Well Being, Aged, Asia, Australia, Biopsy, Cause of Death, Clinical Decision-Making, Databases, Factual, Disease Progression, Early Detection of Cancer, Europe, Humans, Kallikreins, Male, Middle Aged, North America, Patient Dropouts, Predictive Value of Tests, Prostate-Specific Antigen, Prostatic Neoplasms, Risk Assessment, Risk Factors, Time Factors, Watchful Waiting, Prostate cancer, Active surveillance, Discontinuation, Worldwide, Members of the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance GAP3 consortium, Urology & Nephrology, Clinical sciences
Abstract

BackgroundCareful assessment of the reasons for discontinuation of active surveillance (AS) is required for men with prostate cancer (PCa).ObjectiveUsing Movember's Global Action Plan Prostate Cancer Active Surveillance initiative (GAP3) database, we report on reasons for AS discontinuation.Design, setting, and participantsWe compared data from 10296 men on AS from 21 centres across 12 countries.Outcome measurements and statistical analysisCumulative incidence methods were used to estimate the cumulative incidence rates of AS discontinuation.Results and limitationsDuring 5-yr follow-up, 27.5% (95% confidence interval [CI]: 26.4-28.6%) men showed signs of disease progression, 12.8% (95% CI: 12.0-13.6%) converted to active treatment without evidence of progression, 1.7% (95% CI: 1.5-2.0%) continued to watchful waiting, and 1.7% (95% CI: 1.4-2.1%) died from other causes. Of the 7049 men who remained on AS, 2339 had follow-up for >5yr, 4561 had follow-up for

Published
2019

12. Active Surveillance for Men Younger than 60 Years or with Intermediate-risk Localized Prostate Cancer. Descriptive Analyses of Clinical Practice in the Movember GAP3 Initiative

Author

Trock, Bruce, Ehdaie, Behfar, Carroll, Peter, Filson, Christopher, Logothetis, Christopher, Morgan, Todd, Klotz, Laurence, Pickles, Tom, Hyndman, Eric, Moore, Caroline, Gnanapragasam, Vincent, Van Hemelrijck, Mieke, Dasgupta, Prokar, Bangma, Chris, Roobol, Monique, Villers, Arnauld, Robert, Grégoire, Semjonow, Axel, Rannikko, Antti, Valdagni, Riccardo, Perry, Antoinette, Hugosson, Jonas, Rubio-Briones, Jose, Bjartell, Anders, Hefermehl, Lukas, Lui Shiong, Lee, Frydenberg, Mark, Stricker, Phillip, Sugimoto, Mikio, Ha Chung, Byung, van der Kwast, Theo, van der Linden, Wim, Hulsen, Tim, Ruwe, Boris, Peter van Hooft, Steyerberg, Ewout, Nieboer, Daan, Beckmann, Kerri, Denton, Brian, Hayen, Andrew, Boutros, Paul, Guo, Wei, Benfante, Nicole, Cowan, Janet, Patil, Dattatraya, Park, Lauren, Ferrante, Stephanie, Mamedov, Alexandre, LaPointe, Vincent, Crump, Trafford, Stavrinides, Vasilis, Kimberly-Duffell, Jenna, Santaolalla, Aida, Olivier, Jonathan, Rancati, Tiziana, Ahlgren, Helén, Mascarós, Juanma, Löfgren, Annica, Lehmann, Kurt, Han Lin, Catherine, Cusick, Thomas, Hirama, Hiromi, Suk Lee, Kwang, Jenster, Guido, Auvinen, Anssi, Haider, Masoom, van Bochove, Kees, Kouspou, Michelle, Paich, Kellie, Helleman, Jozien, Remmers, Sebastiaan, Hyndman, Matthew E., Moore, Caroline M., Shiong Lee, Lui, Elhage, Oussama, Morgan, Todd M., Bangma, Chris H., and Roobol, Monique J.

Published
2022
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17. Comparison of Characteristics, Follow-up and Outcomes of Active Surveillance for Prostate Cancer According to Ethnicity in the GAP3 Global Consortium Database

Author

Trock, Bruce, Ehdaie, Behfar, Carroll, Peter, Filson, Christopher, Logothetis, Christopher, Morgan, Todd, Klotz, Laurence, Pickles, Tom, Hyndman, Eric, Moore, Caroline, Gnanapragasam, Vincent, Van Hemelrijck, Mieke, Dasgupta, Prokar, Bangma, Chris, Roobol, Monique, Villers, Arnauld, Robert, Grégoire, Semjonow, Axel, Rannikko, Antti, Valdagni, Riccardo, Perry, Antoinette, Hugosson, Jonas, Rubio-Briones, Jose, Bjartell, Anders, Hefermehl, Lukas, Lui Shiong, Lee, Frydenberg, Mark, Stricker, Phillip, Sugimoto, Mikio, Ha Chung, Byung, van der Kwast, Theo, van der Linden, Wim, Hulsen, Tim, Ruwe, Boris, van Hooft, Peter, Steyerberg, Ewout, Nieboer, Daan, Beckmann, Kerri, Denton, Brian, Hayen, Andrew, Boutros, Paul, Guo, Wei, Benfante, Nicole, Cowan, Janet, Patil, Dattatraya, Park, Lauren, Ferrante, Stephanie, Mamedov, Alexandre, LaPointe, Vincent, Crump, Trafford, Stavrinides, Vasilis, Kimberly-Duffell, Jenna, Santaolalla, Aida, Olivier, Jonathan, Rancati, Tiziana, Ahlgren, Helén, Mascarós, Juanma, Löfgren, Annica, Lehmann, Kurt, Han Lin, Catherine, Cusick, Thomas, Hirama, Hiromi, Suk Lee, Kwang, Jenster, Guido, Auvinen, Anssi, Haider, Masoom, van Bochove, Kees, Kouspou, Michelle, Paich, Kellie, Helleman, Jozien, Shiong Lee, Lui, and Elhage, Oussama

Published
2021
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19. Prostate Cancer Related Sexual Dysfunction and Barriers to Help Seeking: A Scoping Review.

Author

Charlick, Megan, Tiruye, Tenaw, Ettridge, Kerry, O'Callaghan, Michael, Sara, Sally, Jay, Alexander, and Beckmann, Kerri

Subjects
HUMAN sexuality, PROSTATE cancer patients, HELP-seeking behavior, MEDICAL personnel, SEXUAL dysfunction
Abstract

Objective: Despite available support, sexuality needs are the most frequently reported unmet need among men with prostate cancer, which may be due to low help‐seeking rates. Using the Ecological Systems Framework as a theoretical foundation, we conducted a scoping review of the available literature to understand what factors impact help‐seeking behaviour for sexual issues after prostate cancer treatment among men who had received treatment. Methods: Following PRISMA guidelines, a systematic search on Medline, PsychInfo, Embase, Emcare, and Scopus was conducted to identify studies of adult prostate cancer patients post‐treatment, which reported barriers and/or facilitators to help‐seeking for sexual health issues. Quality appraisals were conducted using Joanna Briggs Institute appraisal tools, and results were qualitatively synthesised. Results: Of the 3870 unique results, only 30 studies met inclusion criteria. In general, studies were considered moderate to good quality, though only six used standardised measures to assess help‐seeking behaviour. Barriers and facilitators for sexual help‐seeking were identified across all five levels of the Ecological Systems Framework, including age, treatment type, and previous help seeking experience (individual level), healthcare professional communication and partner support (microsystem), financial cost and accessibility of support (meso/exosystem), and finally embarrassment, masculinity, cultural norms, and sexuality minority (macrosystem). Conclusions: Addressing commonly reported barriers (and inversely, enhancing facilitators) to help‐seeking for sexual issues is essential to ensure patients are appropriately supported. Based on our results, we recommend healthcare professionals include sexual wellbeing discussions as standard care for all prostate cancer patients, regardless of treatment received, age, sexual orientation, and partnership status/involvement. [ABSTRACT FROM AUTHOR]

Published
2024
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20. Temporal trends in medication and service use patterns for mental health issues among men with prostate cancer.

Author

Tiruye, Tenaw, Hiwase, Mrunal, Charlick, Megan, O'Callaghan, Michael, Khalid, Ashna, Li, Ming, FitzGerald, Liesel M., Caughey, Gillian E., Ettridge, Kerry, Roder, David, and Beckmann, Kerri

Subjects
MEDICAL care use, MENTAL health screening, PROSTATE cancer, PROSTATE cancer patients, MENTAL health services, CANCER diagnosis, PSYCHIATRIC drugs
Abstract

Objective: Prostate cancer can significantly impact mental wellbeing, creating uncertainty and morbidity. This study described patterns of psychotropic medication and mental health service use, as a proxy measure for mental health problems, 5 years before and 5 years after prostate cancer diagnosis. Methods: Population‐based registry data were linked with Pharmaceutical Benefits Scheme and Medicare Benefits Schedule data for all prostate cancer patients diagnosed in South Australia between 2012 and 2020 (n = 13,693). We estimated the proportion and rates of psychotropic medication and mental health service use before and after diagnosis. Multivariable adjusted interrupted time series analyses (ITSA) were conducted to uncover temporal patterns. Results: Fifteen percent of men commenced psychotropic medications and 6.4% sought out mental health services for the first time after diagnosis. Psychotropic medication use rose from 34.5% 5 years before to 40.3% 5 years after diagnosis, including an increase in use of antidepressants (from 20.7% to 26.0%) and anxiolytics (from 11.3% to 12.8%). Mental health service use increased from 10.2% to 12.1%, with the increase mostly being general practice mental health visits (from 7.8% to 10.6%). Multivariable ITSA indicated a significant rise in medication and service utilisation immediately before and in the first 2 years following prostate cancer diagnosis. Conclusion: There is a clear increase in psychotropic medication use and mental health service use around the time of prostate cancer diagnosis. Mental health outcomes of men with prostate cancer may be improved with early mental health screening, particularly during the diagnosis process, to enable early intervention. [ABSTRACT FROM AUTHOR]

Published
2024
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21. Adherence to Active Surveillance Protocols for Low-risk Prostate Cancer: Results of the Movember Foundation’s Global Action Plan Prostate Cancer Active Surveillance Initiative

Author

Trock, Bruce, Ehdaie, Behfar, Carroll, Peter, Filson, Christopher, Kim, Jeri, Logothetis, Christopher, Morgan, Todd, Klotz, Laurence, Pickles, Tom, Hyndman, Eric, Moore, Caroline M., Gnanapragasam, Vincent, Van Hemelrijck, Mieke, Dasgupta, Prokar, Bangma, Chris, Roobol, Monique, Villers, Arnauld, Rannikko, Antti, Valdagni, Riccardo, Perry, Antoinette, Hugosson, Jonas, Rubio-Briones, Jose, Bjartell, Anders, Hefermehl, Lukas, Shiong, Lee Lui, Frydenberg, Mark, Kakehi, Yoshiyuki, Chung, Byung Ha, van der Kwast, Theo, Obbink, Henk, van der Linden, Wim, Hulsen, Tim, Jonge, Cees de, Kattan, Mike, Xinge, Ji, Muir, Kenneth, Lophatananon, Artitaya, Fahey, Michael, Steyerberg, Ewout, Nieboer, Daan, Zhang, Liying, Beckmann, Kerri, Denton, Brian, Hayen, Andrew, Boutros, Paul, Guo, Wei, Benfante, Nicole, Cowan, Janet, Patil, Dattatraya, Tolosa, Emily, Kim, Tae-Kyung, Mamedov, Alexandre, LaPointe, Vincent, Crump, Trafford, Kimberly-Duffell, Jenna, Santaolalla, Aida, Olivier, Jonathan, Rancati, Tiziana, Ahlgren, Helén, Mascarós, Juanma, Löfgren, Annica, Lehmann, Kurt, Lin, Catherine Han, Hirama, Hiromi, Lee, Kwang Suk, Jenster, Guido, Auvinen, Anssi, Haider, Masoom, van Bochove, Kees, Carter, Ballentine, Gledhill, Sam, Buzza, Mark, Bruinsma, Sophie, Helleman, Jozien, Kalapara, Arveen A., Verbeek, Jan F.M., Lee, Lui Shiong, Bangma, Chris H., Steyerberg, Ewout W., Harkin, Tim, and Roobol, Monique J.

Published
2020
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38. Margin status and survival outcomes after breast cancer conservation surgery: prospectively registered systematic review and meta-analysis

Author

Bundred, James R., Michael, Sarah, Stuart, Beth, Cutress, Ramsey I., Beckmann, Kerri, Holleczek, Bernd, Dahlstrom, Jane E., Gath, Jacqui, Dodwell, David, and Bundred, Nigel J.

Abstract

Objective: to determine if margin involvement is associated with distant recurrence and to determine the required margin to minimise both local recurrence and distant recurrence in early stage invasive breast cancer. Design: prospectively registered systematic review and meta-analysis of literature. Data sources: Medline (PubMed), Embase, and Proquest online databases. Unpublished data were sought from study authors. Eligibility criteria: eligible studies reported on patients undergoing breast conserving surgery (for stages I-III breast cancer), allowed an estimation of outcomes in relation to margin status, and followed up patients for a minimum of 60 months. Patients with ductal carcinoma in situ only or treated with neoadjuvant chemotherapy or by mastectomy were excluded. Where applicable, margins were categorised as tumour on ink (involved), close margins (no tumour on ink but Results: 68 studies from 1 January 1980 to 31 December 2021, comprising 112 140 patients with breast cancer, were included. Across all studies, 9.4% (95% confidence interval 6.8% to 12.8%) of patients had involved (tumour on ink) margins and 17.8% (13.0% to 23.9%) had tumour on ink or a close margin. The rate of distant recurrence was 25.4% (14.5% to 40.6%) in patients with tumour on ink, 8.4% (4.4% to 15.5%) in patients with tumour on ink or close, and 7.4% (3.9% to 13.6%) in patients with negative margins. Compared with negative margins, tumour on ink margins were associated with increased distant recurrence (hazard ratio 2.10, 95% confidence interval 1.65 to 2.69, PConclusions: involved or close pathological margins after breast conserving surgery for early stage, invasive breast cancer are associated with increased distant recurrence and local recurrence. Surgeons should aim to achieve a minimum clear margin of at least 1 mm. On the basis of current evidence, international guidelines should be revised. Systematic review registration: CRD42021232115.

Published
2022

43. Comparison of Characteristics, Follow-up and Outcomes of Active Surveillance for Prostate Cancer According to Ethnicity in the GAP3 Global Consortium Database

Author

Beckmann, Kerri, primary, Santaolalla, Aida, additional, Helleman, Jozien, additional, Carroll, Peter, additional, Ha Chung, Byung, additional, Shiong Lee, Lui, additional, Perry, Antoinette, additional, Rubio-Briones, Jose, additional, Sugimoto, Mikio, additional, Trock, Bruce, additional, Valdagni, Riccardo, additional, Dasgupta, Prokar, additional, Van Hemelrijck, Mieke, additional, Elhage, Oussama, additional, Ehdaie, Behfar, additional, Filson, Christopher, additional, Logothetis, Christopher, additional, Morgan, Todd, additional, Klotz, Laurence, additional, Pickles, Tom, additional, Hyndman, Eric, additional, Moore, Caroline, additional, Gnanapragasam, Vincent, additional, Bangma, Chris, additional, Roobol, Monique, additional, Villers, Arnauld, additional, Robert, Grégoire, additional, Semjonow, Axel, additional, Rannikko, Antti, additional, Hugosson, Jonas, additional, Bjartell, Anders, additional, Hefermehl, Lukas, additional, Lui Shiong, Lee, additional, Frydenberg, Mark, additional, Stricker, Phillip, additional, van der Kwast, Theo, additional, van der Linden, Wim, additional, Hulsen, Tim, additional, Ruwe, Boris, additional, van Hooft, Peter, additional, Steyerberg, Ewout, additional, Nieboer, Daan, additional, Beckmann, Kerri, additional, Denton, Brian, additional, Hayen, Andrew, additional, Boutros, Paul, additional, Guo, Wei, additional, Benfante, Nicole, additional, Cowan, Janet, additional, Patil, Dattatraya, additional, Park, Lauren, additional, Ferrante, Stephanie, additional, Mamedov, Alexandre, additional, LaPointe, Vincent, additional, Crump, Trafford, additional, Stavrinides, Vasilis, additional, Kimberly-Duffell, Jenna, additional, Olivier, Jonathan, additional, Rancati, Tiziana, additional, Ahlgren, Helén, additional, Mascarós, Juanma, additional, Löfgren, Annica, additional, Lehmann, Kurt, additional, Han Lin, Catherine, additional, Cusick, Thomas, additional, Hirama, Hiromi, additional, Suk Lee, Kwang, additional, Jenster, Guido, additional, Auvinen, Anssi, additional, Haider, Masoom, additional, van Bochove, Kees, additional, Kouspou, Michelle, additional, and Paich, Kellie, additional

Published
2021
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47. Comparison of outcomes of different biopsy schedules among men on active surveillance for prostate cancer:An analysis of the G.A.P.3 global consortium database

Author

Beckmann, Kerri R., Bangma, Chris H., Helleman, Jozien, Bjartell, Anders, Carroll, Peter R., Morgan, Todd, Nieboer, Daan, Santaolalla, Aida, Trock, Bruce J., Valdagni, Riccardo, Roobol, Monique J., Beckmann, Kerri R., Bangma, Chris H., Helleman, Jozien, Bjartell, Anders, Carroll, Peter R., Morgan, Todd, Nieboer, Daan, Santaolalla, Aida, Trock, Bruce J., Valdagni, Riccardo, and Roobol, Monique J.

Abstract

Background: The optimal interval for repeat biopsy during active surveillance (AS) for prostate cancer is yet to be defined. This study examined whether risk of upgrading (to grade group ≥ 2) or risk of converting to treatment varied according to intensity of repeat biopsy using data from the GAP3 consortium's global AS database. Materials and Methods: Intensity of surveillance biopsy schedules was categorized according to centers’ protocols: (a) Prostate Cancer Research International Active Surveillance project (PRIAS) protocols with biopsies at years 1, 4, and 7 (10 centers; 7532 men); (b) biennial biopsies, that is, every other year (8 centers; 4365 men); and (c) annual biopsy schedules (4 centers; 1602 men). Multivariable Cox regression was used to compare outcomes according to biopsy intensity. Results: Out of the 13,508 eligible participants, 56% were managed according to PRIAS protocols (biopsies at years 1, 4, and 7), 32% via biennial biopsy, and 12% via annual biopsy. After adjusting for baseline characteristics, risk of converting to treatment was greater for those on annual compared with PRIAS biopsy schedules (hazard ratio [HR] = 1.66; 95% confidence interval [CI] = 1.51–1.83; p < 0.001), while risk of upgrading did not differ (HR = 0.96; 95% CI = 0.84–1.10). Conclusion: Results suggest more frequent biopsy schedules may deter some men from continuing AS despite no evidence of grade progression.

Published
2022

48. Hormonal patterns in men with prediabetes and diabetes in NHANES III: possible links with prostate cancer

Author

Beckmann, Kerri; https://orcid.org/0000-0002-9798-1479, Crawley, Danielle, Nelson, William G, Platz, Elizabeth A, Selvin, Elizabeth, Van Hemelrijck, Mieke, Rohrmann, Sabine, Beckmann, Kerri; https://orcid.org/0000-0002-9798-1479, Crawley, Danielle, Nelson, William G, Platz, Elizabeth A, Selvin, Elizabeth, Van Hemelrijck, Mieke, and Rohrmann, Sabine

Abstract

PURPOSE Pathways involving sex hormones and insulin-like growth factors (IGFs) have been proposed to explain, in part, the lower risk of prostate cancer among men with diabetes. To gain insights into potential biological mechanisms we explored differences in serum concentrations of sex hormones and IGFs across the trajectory from normoglycemia to prediabetes to poorly controlled diabetes. METHODS Using cross-sectional data from the National Health and Nutrition Examination Survey III we examined differences in levels of circulating sex hormones, sex hormone-binding globulin (SHBG), IGF-1, and IFG-binding protein 3 (IGFBP-3), according to diabetes status: no diabetes [n = 648], prediabetes [n = 578], undiagnosed diabetes [n = 106], well-controlled diabetes [n = 42], and poorly controlled diabetes [n = 56]. Adjusted geometric mean concentrations were derived using multivariable linear regression, adjusted for age, race, and other lifestyle factors. RESULTS Total testosterone concentrations were lower among prediabetics (4.89 ng/mL, 95% confidence interval (CI) 4.95-5.21) than men without prediabetes/diabetes (5.29 ng/mL, 95% CI 5.06-5.53) but did not reduce further across diabetes groups. Concentrations of estradiol, estimated free testosterone, SHGB, IGF-1, and IGFBP-3 did not differ. While the ratio of IGF-1 to IGFBP-3 was lower among men with prediabetics and undiagnosed diabetes than men without prediabetes/diabetes, there was no trend across groups. A positive trend for the ratio of estradiol-to-testosterone levels was observed across groups (p trend = 0.045). CONCLUSION Our findings do not provide clear support for either an androgen driven or IGF-driven pathway for the inverse association between diabetes and prostate cancer risk.

Published
2022

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