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Men diagnosed with low-risk prostate cancer (PC) are increasingly electing active surveillance (AS) as their initial management strategy. While this may reduce the side effects of treatment for prostate cancer, many men on AS eventually convert to active treatment. PC is one of the most heritable cancers, and genetic factors that predispose to aggressive tumors may help distinguish men who are more likely to discontinue AS. To investigate this, we undertook a multi-institutional genome-wide association study (GWAS) of 5,222 PC patients and 1,139 other patients from replication cohorts, all of whom initially elected AS and were followed over time for the potential outcome of conversion from AS to active treatment. In the GWAS we detected 18 variants associated with conversion, 15 of which were not previously associated with PC risk. With a transcriptome-wide association study (TWAS), we found two genes associated with conversion (MAST3, p = 6.9×10-7 and GAB2, p = 2.0×10-6). Moreover, increasing values of a previously validated 269-variant genetic risk score (GRS) for PC was positively associated with conversion (e.g., comparing the highest to the two middle deciles gave a hazard ratio [HR] = 1.13; 95% Confidence Interval [CI]= 0.94-1.36); whereas, decreasing values of a 36-variant GRS for prostate-specific antigen (PSA) levels were positively associated with conversion (e.g., comparing the lowest to the two middle deciles gave a HR = 1.25; 95% CI, 1.04-1.50). These results suggest that germline genetics may help inform and individualize the decision of AS-or the intensity of monitoring on AS-versus treatment for the initial management of patients with low-risk PC.

BackgroundWith the advancement of imaging technology, focal therapy (FT) has been gaining acceptance for the treatment of select patients with localized prostate cancer (CaP). We aim to provide details of a formal physician consensus on the utilization of FT for patients with CaP who are discontinuing active surveillance (AS).MethodsA 3-stage Delphi consensus on CaP and FT was conducted. Consensus was defined as agreement by ≥80% of physicians. An in-person meeting was attended by 17 panelists to formulate the consensus statement.ResultsFifty-six respondents participated in this interdisciplinary consensus study (82% urologist, 16% radiologist, 2% radiation oncology). The participants confirmed that there is a role for FT in men discontinuing AS (48% strongly agree, 39% agree). The benefit of FT over radical therapy for men coming off AS is: less invasive (91%), has a greater likelihood to preserve erectile function (91%), has a greater likelihood to preserve urinary continence (91%), has fewer side effects (86%), and has early recovery post-treatment (80%). Patients will need to undergo mpMRI of the prostate and/or a saturation biopsy to determine if they are potential candidates for FT. Our limitations include respondent's biases and that the participants of this consensus may not represent the larger medical community.ConclusionsFT can be offered to men coming off AS between the age of 60 to 80 with grade group 2 localized cancer. This consensus from a multidisciplinary, multi-institutional, international expert panel provides a contemporary insight utilizing FT for CaP in select patients who are discontinuing AS.

Objective: To present a narrative review regarding the diagnostic accuracy of whole‐body magnetic resonance imaging (WBMRI) in staging patients with high‐risk prostate cancer (HRPCa) and compare it to established imaging modalities. Methods: A narrative review was carried out using PubMed using the following keywords: 'whole body', 'magnetic resonance imaging', 'MRI', 'prostate cancer', 'risk stratification', and 'staging'. Articles that evaluated WBMRI as the imaging modality to stage patients with HRPCa were included, while studies that solely assessed for biochemical recurrence or metastatic disease progression were excluded. Results: In the evaluation of lymphatic metastases, WBMRI has demonstrated a comparable, if not improved, sensitivity and specificity compared to conventional imaging of computed tomography (CT). Furthermore, WBMRI demonstrates improved sensitivity and specificity in detecting bone metastases compared to bone scintigraphy (BS). However, with advent of prostate‐specific membrane antigen (PSMA) radioligands for positron emission tomography (PET), the diagnostic performance of WBMRI to detect metastatic disease appears inferior. Conclusions: The diagnostic capabilities of WBMRI exceed that of conventional imaging of CT and BS in detecting metastatic disease in patients with HRPCa. However, WBMRI does not perform as well as PSMA PET/CT. Further study on cost comparisons between WBMRI and PSMA PET/CT are needed, as well as evaluations of combined PSMA PET/MRI are needed. [ABSTRACT FROM AUTHOR]

Hormone therapy (HT) to treat prostate cancer is reported to cause adverse changes in body composition. Clinically, interpatient body composition changes are heterogeneous, but the biological and clinical determinants of body composition toxicity are unknown. Herein, we test the hypothesis that inherited polymorphisms in steroidogenic genes are associated with differential changes in body composition after HT. Men with biochemically recurrent prostate cancer (BCR) who received 8 months of LHRH analog (LHRHa) +/- abiraterone acetate (AAP) were eligible if they had: i) CT imaging of L3 prior to and after treatment; and ii) nucleated cells collected. Cardiometabolic co-morbidities were retrospectively extracted. Body composition was measured using an AI-based segmentation tool. Germline DNA whole exome or genome sequencing was performed. In 162 men treated with 8 months of HT, median skeletal muscle mass (SMMi) loss was 6.6% and subcutaneous adipose gain was 12.3%. Men with type 2 diabetes had higher losses of SMMi after treatment (-11.1% vs -6.3%, P = 0.003). For the 150 men with germline NGS, SRD5A2 rs523349 genotype was associated with differential loss in skeletal muscle density after HT, (-1.3% vs -7.1%, P = 0.04). In addition, the HSD3B1 rs104703 genotype was associated with decreased baseline visceral adipose tissue (63.0 cm2/m2 vs 77.9, P = 0.05). In men with BCR, HT induced notable loss of skeletal muscle and increased subcutaneous adipose tissue. An inherited polymorphism in SRD5A2 and T2DM was associated with differential skeletal muscle toxicity. These findings suggest that inherited polymorphisms may contribute to the body composition toxicity observed with HT. [ABSTRACT FROM AUTHOR]

This study addresses equating issues with varying sample sizes using the Rasch model by examining how sample size affects the stability of item calibrations and person ability estimates. A resampling design was used to create 9 sample size conditions (200, 100, 50, 45, 40, 35, 30, 25, and 20), each replicated 10 times. Items were recalibrated using each of these 90 samples. The deviation of these calibrations from the full sample (N = 9,678) calibrations were then computed. The ability estimates for all 9,678 examinees were then recomputed 90 times using the item calibrations from each of the 90 different samples. The deviation of 90 sets of ability estimates from the original set of ability estimates was computed. This study found that less precision and item calibration instability occur with smaller sample sizes; however, the decreasing sample size has minimal effect on the person ability estimates.

Self-rubbing and social-rubbing (pectoral fin contact between dolphin pairs) were compared for observations conducted on three dolphin study groups: wild dolphin groups in The Bahamas and around Mikura Island, Japan, and a third group of captive dolphins at the Roatan Institute of Marine Sciences, Roatan, Honduras. A primary aim of this research was to determine whether self-rubbing and social pectoral fin rubbing served overlapping functions. Self-rubbing rates were nearly identical between the three study sites, suggesting that site-specific differences (e.g., environmental conditions, substrate, presence of rocks or coral, social grouping) do not affect the rates at which dolphins rub their bodies against non-dolphin objects. The function of self-rubbing is not entirely clear, and likely involves a combination of factors (e.g., play, pleasure), with functions such as hygiene possibly being shared by both self-rubbing and social-rubbing. Rubbing behavior in general (e.g., rates, body parts used) were similar at all three sites for all three species, suggesting that rubbing is an evolutionarily conserved behavior for delphinid species. Still, subtle and individually distinct differences were documented among our study groups with respect to how often and with whom dolphins exchanged pectoral fin contact or engaged in self-rubbing. Site-specific social pressures and predation risks, as well as individual personality might play a role with respect to the expression of an individual’s observed rubbing behavior.

Preliminary experimental evidence shows that it is possible for an eavesdropping dolphin to discern object information from the returning echoes generated by the echolocation signals of conspecifics. Researchers have offered suggestions as to how this proposed ability may affect the behavior of wild dolphin species. A review of early and contemporary ideas, hypotheses and experiments concerning eavesdropping in dolphins is presented here, resulting in the development of a formalized, modern version of the ‘echoic eavesdropping’ hypothesis. The ecological implications of eavesdropping behavior remain unknown; refinement of the hypothesis and clarification of underlying assumptions are vital to our understanding of how echoic eavesdropping behavior might manifest itself in the social behavior of wild odontocetes. Suggestions for future research involving both echoic eavesdropping and a novel, alternative hypothesis (multi-source echoic eavesdropping) are offered. With the potential to elucidate many of the mysteries concerning dolphin biosonar use and dolphin behavior in general, echoic eavesdropping is an idea that deserves future attention.