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1. Impact of Community-Based Clinical Breast Examinations in Botswana

Author

Michael Dykstra, Brighid Malone, Onica Lekuntwane, Jason Efstathiou, Virginia Letsatsi, Shekinah Elmore, Cesar Castro, Neo Tapela, and Scott Dryden-Peterson

Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

PURPOSEWe evaluated a clinical breast examination (CBE) screening program to determine the prevalence of breast abnormalities, number examined per cancer diagnosis, and clinical resources required for these diagnoses in a middle-income African setting.METHODSWe performed a retrospective review of a CBE screening program (2015-2018) by Journey of Hope Botswana, a Botswana-based nongovernmental organization (NGO). Symptomatic and asymptomatic women were invited to attend. Screening events were held in communities throughout rural and periurban Botswana, with CBEs performed by volunteer nurses. Individuals who screened positive were referred to a private tertiary facility and were followed by the NGO. Data were obtained from NGO records.RESULTSOf 6,120 screened women (50 men excluded), 452 (7.4%) presented with a symptom and 357 (5.83%) were referred for further evaluation; 257 ultrasounds, 100 fine-needle aspirations (FNAs), 58 mammograms, and 31 biopsies were performed. In total, 6,031 were exonerated from cancer, 78 were lost to follow-up (67 for ≤ 50 years and 11 for > 50 years), and 11 were diagnosed with cancer (five for 41-50 years and six for > 50 years, 10 presented with symptoms). Overall breast cancer prevalence was calculated to be 18/10,000 (95% CI, 8 to 29/10,000). The number of women examined per breast cancer diagnosis was 237 (95% CI, 126 to 1910) for women of age 41-50 years and 196 (95% CI, 109 to 977) for women of age > 50 years. Median time to diagnosis for all women was 17.5 [1 to 32.5] days. CBE-detected tumors were not different than tumors presenting through standard care.CONCLUSIONIn a previously unscreened population, yield from community-based CBE screening was high, particularly among symptomatic women, and required modest diagnostic resources. This strategy has potential to reduce breast cancer mortality.

Published
2021
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2. Outcomes for Muscle-invasive Bladder Cancer with Radical Cystectomy or Trimodal Therapy in US Veterans

Author

Abhishek Kumar, Daniel R. Cherry, Patrick T. Courtney, Vinit Nalawade, Nikhil Kotha, Paul J. Riviere, Jason Efstathiou, Rana R. McKay, A. Karim Kader, Brent S. Rose, and Tyler F. Stewart

Subjects
Muscle-invasive bladder cancer, Radical cystectomy, Trimodal therapy, Bladder preservation, Chemoradiotherapy, Treatment, Diseases of the genitourinary system. Urology, RC870-923, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Background: Muscle-invasive bladder cancer (MIBC) remains undertreated despite multiple potentially curative options. Both radical cystectomy (RC) with or without neoadjuvant chemotherapy and trimodal therapy (TMT), including transurethral resection of bladder tumor followed by chemoradiotherapy, are standard treatments. Objective: To evaluate real-world clinical outcomes of RC with neoadjuvant chemotherapy (RC-NAC), RC without NAC, TMT with National Comprehensive Cancer Network guideline–preferred radiosensitizing chemotherapy including cisplatin or mitomycin-C and 5-fluorouracil (pTMT), and TMT with nonpreferred chemotherapy (npTMT). Design, setting, and participants: US veterans with nonmetastatic MIBC (T2-4aN0-3M0) were studied. Outcome measurements and statistical analysis: Overall mortality (OM) was evaluated with multivariable Cox proportional hazard model. Bladder cancer-specific mortality (BCSM) was evaluated with multivariable Fine-Gray regression. Salvage cystectomy rates were obtained by chart review. Results and limitations: Overall 2306 patients were included: 1472 (64%) with RC without NAC, 506 (22%) with RC-NAC, 163 (7%) with pTMT, and 165 (7%) with npTMT. On multivariable analysis, pTMT was associated with similar OM (hazard ratio [HR] 1.19; 95% confidence interval [CI] 0.94–1.50; p = 0.15) and BCSM (HR 1.34; 95% CI 0.99–1.83; p = 0.06) to RC-NAC; npTMT was associated with worse OM (HR 1.30; 95% CI 1.04–1.61; p = 0.02) and BCSM (HR 1.45; 95% CI 1.09–1.94; p = 0.01). RC without NAC was associated with similar OM (HR 1.08; 95% CI 0.95–1.24; p = 0.24) and BCSM (HR 1.02; 95% CI 0.86–1.21; p = 0.79). When stratified by age, among patients ≥65 yr of age, treatment with pTMT was associated with similar OM (HR 1.14; 95% CI 0.87–1.50; p = 0.35) and BCSM (HR 1.11; 95% CI 0.76–1.62; p = 0.60). Among patients

Published
2021
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3. HIV and Hodgkin Lymphoma Survival: A Prospective Study in Botswana

Author

Kaelo Moahi, Tlotlo Ralefala, Isaac Nkele, Scott Triedman, Aliyah Sohani, Zola Musimar, Jason Efstathiou, Philipe Armand, Shahin Lockman, and Scott Dryden-Peterson

Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

PURPOSEPeople living with HIV (PLWH) experience increased risk of Hodgkin lymphoma (HL) despite effective initiation of antiretroviral therapy (ART). In high-income countries, outcomes following HIV HL have been reported to be non-differential, or inferior for PLWH. We sought to assess the effect of HIV on HL survival in Botswana, an African country with a generalized HIV epidemic and high ART coverage, to describe a context more reflective of global HIV populations.PATIENTS AND METHODSIn the Thabatse Cancer Cohort, consenting participants initiating treatment for HL at one of four cancer centers in Botswana were enrolled from 2010 to 2020. Patients were followed quarterly for up to 5 years. The impact of HIV on survival following treatment initiation was assessed using an inverse probability–weighted Cox marginal structural model adjusted for age, performance status, and disease stage.RESULTSSeventy-eight new HL cases were enrolled, 47 (60%) were PLWH and 31 (40%) were HIV-uninfected. Baseline characteristics were similar between groups. The majority (61%) of patients presented with regional disease (stage I or II) with no statistically significant difference by HIV status (P = .38). Nearly all (87%) PLWH participants were on ART before their HL diagnosis (median ART duration 42 months), and median CD4 count was 413 cells/μL (interquartile range 253-691). Survival, in unadjusted analyses, was lower among patients without HIV compared with PLWH (log rank P = .021). In adjusted analysis, HIV infection was not significantly associated with survival in inverse probability–weighted Cox model (hazard ratio 0.43; 95% CI, 0.16 to 1.16; P = .094).CONCLUSIONIn this cohort of patients treated for HL in Botswana, survival in PLWH (87% on long-standing ART) was at least as good as in individuals without HIV.

Published
2022
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6. PD09-03 INVERSE PROBABILITY TREATMENT WEIGHTING COMPARISON OF RADICAL CYSTECTOMY TO TRIMODALITY THERAPY FOR CT2-CT4 MUSCLE INVASIVE BLADDER CANCER

Author

Alexandre Zlotta, Leslie Ballas, Andrzej Niemierko, Katherine Lajkosz, Cynthia Kuk, Gus Miranda, Michael Drumm, Andrea Mari, Ethan Thio, Neil Fleshner, Girish Kulkarni, Michael Jewett, Rob Bristow, Charles Catton, Padraig Warde, Alejandro Berlin, Srikala Sridhar, Anne Schuckman, Hooman Djaladat, Adam Feldman, Matthew Wszolek, Douglas Dahl, Richard Lee, Philip Saylor, Marc Michaelson, David Miyamoto, Anthony Zietman, William Shipley, Peter Chung, Sia Daneshmand, and Jason Efstathiou

Subjects
Urology
Published
2023

7. Management of Patients with Advanced Prostate Cancer. Part I: Intermediate-/High-risk and Locally Advanced Disease, Biochemical Relapse, and Side Effects of Hormonal Treatment: Report of the Advanced Prostate Cancer Consensus Conference 2022

Author

Silke Gillessen, Alberto Bossi, Ian D. Davis, Johann de Bono, Karim Fizazi, Nicholas D. James, Nicolas Mottet, Neal Shore, Eric Small, Matthew Smith, Christopher Sweeney, Bertrand Tombal, Emmanuel S. Antonarakis, Ana M. Aparicio, Andrew J. Armstrong, Gerhardt Attard, Tomasz M. Beer, Himisha Beltran, Anders Bjartell, Pierre Blanchard, Alberto Briganti, Rob G. Bristow, Muhammad Bulbul, Orazio Caffo, Daniel Castellano, Elena Castro, Heather H. Cheng, Kim N. Chi, Simon Chowdhury, Caroline S. Clarke, Noel Clarke, Gedske Daugaard, Maria De Santis, Ignacio Duran, Ros Eeles, Eleni Efstathiou, Jason Efstathiou, Onyeanunam Ngozi Ekeke, Christopher P. Evans, Stefano Fanti, Felix Y. Feng, Valerie Fonteyne, Nicola Fossati, Mark Frydenberg, Daniel George, Martin Gleave, Gwenaelle Gravis, Susan Halabi, Daniel Heinrich, Ken Herrmann, Celestia Higano, Michael S. Hofman, Lisa G. Horvath, Maha Hussain, Barbara Alicja Jereczek-Fossa, Robert Jones, Ravindran Kanesvaran, Pirkko-Liisa Kellokumpu-Lehtinen, Raja B. Khauli, Laurence Klotz, Gero Kramer, Raya Leibowitz, Christopher J. Logothetis, Brandon A. Mahal, Fernando Maluf, Joaquin Mateo, David Matheson, Niven Mehra, Axel Merseburger, Alicia K. Morgans, Michael J. Morris, Hind Mrabti, Deborah Mukherji, Declan G. Murphy, Vedang Murthy, Paul L. Nguyen, William K. Oh, Piet Ost, Joe M. O'Sullivan, Anwar R. Padhani, Carmel Pezaro, Darren M.C. Poon, Colin C. Pritchard, Danny M. Rabah, Dana Rathkopf, Robert E. Reiter, Mark. A. Rubin, Charles J. Ryan, Fred Saad, Juan Pablo Sade, Oliver A. Sartor, Howard I. Scher, Nima Sharifi, Iwona Skoneczna, Howard Soule, Daniel E. Spratt, Sandy Srinivas, Cora N. Sternberg, Thomas Steuber, Hiroyoshi Suzuki, Matthew R. Sydes, Mary-Ellen Taplin, Derya Tilki, Levent Türkeri, Fabio Turco, Hiroji Uemura, Hirotsugu Uemura, Yüksel Ürün, Claire L. Vale, Inge van Oort, Neha Vapiwala, Jochen Walz, Kosj Yamoah, Dingwei Ye, Evan Y. Yu, Almudena Zapatero, Thomas Zilli, Aurelius Omlin, Tampere University, Clinical Medicine, Tays Research Services, Institut Català de la Salut, [Gillessen S] Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland. Università della Svizzera Italiana, Lugano, Switzerland. [Bossi A] Genitourinary Oncology, Prostate Brachytherapy Unit, Gustave Roussy, Paris, France. [Davis ID] Monash University and Eastern Health, Victoria, Australia. [de Bono J] The Institute of Cancer Research, London, UK. Royal Marsden Hospital, London, UK. [Fizazi K] Institut Gustave Roussy, University of Paris Saclay, Villejuif, France. [James ND] The Institute of Cancer Research, London, UK. [Mateo J] Prostate Cancer Translational Research Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain. Servei d’Oncologia Mèdica, Vall d’Hebron Hospital Universitari, Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus

Subjects
Neoplasms::Neoplasms by Site::Urogenital Neoplasms::Genital Neoplasms, Male::Prostatic Neoplasms [DISEASES], Urology, 3122 Cancers, Medizin, Pròstata - Càncer - Diagnòstic, Salvage therapy, Behavior and Behavior Mechanisms::Psychology, Social::Group Processes::Consensus [PSYCHIATRY AND PSYCHOLOGY], conducta y mecanismos de la conducta::psicología social::procesos de grupo::consenso [PSIQUIATRÍA Y PSICOLOGÍA], Prostate-specific membrane antigen positron emission tomography imaging, Adjuvant therapy, Locally advanced prostate cancer, SDG 3 - Good Health and Well-being, Decisió, Presa de, Urological cancers Radboud Institute for Molecular Life Sciences [Radboudumc 15], Side effects, Otros calificadores::/terapia [Otros calificadores], Salvage radiation therapy, Prostate cancer, Next-generation imaging, Other subheadings::/therapy [Other subheadings], Pròstata - Càncer - Tractament, 3126 Surgery, anesthesiology, intensive care, radiology, 3142 Public health care science, environmental and occupational health, Biochemical recurrence, neoplasias::neoplasias por localización::neoplasias urogenitales::neoplasias de los genitales masculinos::neoplasias de la próstata [ENFERMEDADES], Urological cancers Radboud Institute for Health Sciences [Radboudumc 15], Hormonal treatment
Abstract

Contains fulltext : 291600.pdf (Publisher’s version ) (Open Access) BACKGROUND: Innovations in imaging and molecular characterisation and the evolution of new therapies have improved outcomes in advanced prostate cancer. Nonetheless, we continue to lack high-level evidence on a variety of clinical topics that greatly impact daily practice. To supplement evidence-based guidelines, the 2022 Advanced Prostate Cancer Consensus Conference (APCCC 2022) surveyed experts about key dilemmas in clinical management. OBJECTIVE: To present consensus voting results for select questions from APCCC 2022. DESIGN, SETTING, AND PARTICIPANTS: Before the conference, a panel of 117 international prostate cancer experts used a modified Delphi process to develop 198 multiple-choice consensus questions on (1) intermediate- and high-risk and locally advanced prostate cancer, (2) biochemical recurrence after local treatment, (3) side effects from hormonal therapies, (4) metastatic hormone-sensitive prostate cancer, (5) nonmetastatic castration-resistant prostate cancer, (6) metastatic castration-resistant prostate cancer, and (7) oligometastatic and oligoprogressive prostate cancer. Before the conference, these questions were administered via a web-based survey to the 105 physician panel members ("panellists") who directly engage in prostate cancer treatment decision-making. Herein, we present results for the 82 questions on topics 1-3. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Consensus was defined as ≥75% agreement, with strong consensus defined as ≥90% agreement. RESULTS AND LIMITATIONS: The voting results reveal varying degrees of consensus, as is discussed in this article and shown in the detailed results in the Supplementary material. The findings reflect the opinions of an international panel of experts and did not incorporate a formal literature review and meta-analysis. CONCLUSIONS: These voting results by a panel of international experts in advanced prostate cancer can help physicians and patients navigate controversial areas of clinical management for which high-level evidence is scant or conflicting. The findings can also help funders and policymakers prioritise areas for future research. Diagnostic and treatment decisions should always be individualised based on patient and cancer characteristics (disease extent and location, treatment history, comorbidities, and patient preferences) and should incorporate current and emerging clinical evidence, therapeutic guidelines, and logistic and economic factors. Enrolment in clinical trials is always strongly encouraged. Importantly, APCCC 2022 once again identified important gaps (areas of nonconsensus) that merit evaluation in specifically designed trials. PATIENT SUMMARY: The Advanced Prostate Cancer Consensus Conference (APCCC) provides a forum to discuss and debate current diagnostic and treatment options for patients with advanced prostate cancer. The conference aims to share the knowledge of international experts in prostate cancer with health care providers and patients worldwide. At each APCCC, a panel of physician experts vote in response to multiple-choice questions about their clinical opinions and approaches to managing advanced prostate cancer. This report presents voting results for the subset of questions pertaining to intermediate- and high-risk and locally advanced prostate cancer, biochemical relapse after definitive treatment, advanced (next-generation) imaging, and management of side effects caused by hormonal therapies. The results provide a practical guide to help clinicians and patients discuss treatment options as part of shared multidisciplinary decision-making. The findings may be especially useful when there is little or no high-level evidence to guide treatment decisions.

Published
2023

8. What experts think about prostate cancer management during the COVID-19 pandemic: report from The Advanced Prostate Cancer Consensus Conference 2021

Author

Fabio Turco, Andrew Armstrong, Gerhardt Attard, Tomasz M. Beer, Himisha Beltran, Anders Bjartell, Alberto Bossi, Alberto Briganti, Rob G. Bristow, Muhammad Bulbul, Orazio Caffo, Kim N. Chi, Caroline Clarke, Noel Clarke, Ian D. Davis, Johann de Bono, Ignacio Duran, Ros Eeles, Eleni Efstathiou, Jason Efstathiou, Christopher P. Evans, Stefano Fanti, Felix Y. Feng, Karim Fizazi, Mark Frydenberg, Dan George, Martin Gleave, Susan Halabi, Daniel Heinrich, Celestia Higano, Michael S. Hofman, Maha Hussain, Nicholas James, Rob Jones, Ravindran Kanesvaran, Raja B. Khauli, Laurence Klotz, Raya Leibowitz, Christopher Logothetis, Fernando Maluf, Robin Millman, Alicia K. Morgans, Michael J. Morris, Nicolas Mottet, Hind Mrabti, Declan G. Murphy, Vedang Murthy, William K. Oh, Ngozi Ekeke Onyeanunam, Piet Ost, Joe M. O'Sullivan, Anwar R. Padhani, Christopher Parker, Darren M.C. Poon, Colin C. Pritchard, Danny M. Rabah, Dana Rathkopf, Robert E. Reiter, Mark Rubin, Charles J. Ryan, Fred Saad, Juan Pablo Sade, Oliver Sartor, Howard I. Scher, Neal Shore, Iwona Skoneczna, Eric Small, Matthew Smith, Howard Soule, Daniel Spratt, Cora N. Sternberg, Hiroyoshi Suzuki, Christopher Sweeney, Matthew Sydes, Mary-Ellen Taplin, Derya Tilki, Bertrand Tombal, Levent Türkeri, Hiroji Uemura, Hirotsugu Uemura, Inge van Oort, Kosj Yamoah, Dingwei Ye, Almudena Zapatero, Silke Gillessen, Aurelius Omlin, Tilki, Derya, Turco, F., Armstrong, A., Attard, G., Beer, T.M., Beltran, H., Bjartell, A., Bossi, A., Briganti, A., Bristow, R.G., Bulbul, M., Caffo, O., Chi, K.N., Clarke, C.S., Clarke, N., Davis, I.D., de Bono, J., Duran, I., Eeles, R., Efstathiou, E., Efstathiou, J., Evans, C.P., Fanti, S., Feng, F.Y., Fizazi, K., Frydenberg, M., George, D., Gleave, M., Halabi, S., Heinrich, D., Higano, C., Hofman, M.S., Hussain, M., James, N., Jones, R., Kanesvaran, R., Khauli, R.B., Klotz, L., Leibowitz, R., Logothetis, C., Maluf, F., Millman, R., Morgans, A.K., Morris, M.J., Mottet, N., Mrabti, H., Murphy, D.G., Murthy, V., Oh, W.K., Ekeke, O.N., Ost, P., O'Sullivan, J.M., Padhani, A.R., Parker, C., Poon, D.M.C., Pritchard, C.C., Rabah, D.M., Rathkopf, D., Reiter, R.E., Rubin, M., Ryan, C.J., Saad, F., Sade, J.P., Sartor, O., Scher, H.I., Shore, N., Skoneczna, I., Small, E., Smith, M., Soule, H., Spratt, D.E., Sternberg, C.N., Suzuki, H., Sweeney, C., Sydes, M.R., Taplin, M.-E., Tombal, B., Türkeri, L., Uemura, H., van Oort, I., Yamoah, K., Ye, D., Zapatero, A., Gillessen, S., Omlin, A., Koç University Hospital, School of Medicine, Acibadem University Dspace, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, and UCL - (SLuc) Service d'urologie

Subjects
Male, COVID-19 Vaccines, Prostate cancer, Urology, COVID-19 boost injection, COVID-19 pandemic, COVID-19 vaccine, Prostate cancer management, Telemedicine, COVID-19, Prostatic Neoplasms, Androgen Antagonists, 610 Medicine & health, Urology and nephrology, SDG 3 - Good Health and Well-being, Urological cancers Radboud Institute for Molecular Life Sciences [Radboudumc 15], Humans, Pandemics
Abstract

Patients with advanced prostate cancer (APC) may be at greater risk for severe illness, hospitalisation, or death from coronavirus disease 2019 (COVID-19) due to male gender, older age, potential immunosuppressive treatments, or comorbidities. Thus, the optimal management of APC patients during the COVID-19 pandemic is complex. In October 2021, during the Advanced Prostate Cancer Consensus Conference (APCCC) 2021, the 73 voting members of the panel members discussed and voted on 13 questions on this topic that could help clinicians make treatment choices during the pandemic. There was a consensus for full COVID-19 vaccination and booster injection in APC patients. Furthermore, the voting results indicate that the expert's treatment recommendations are influenced by the vaccination status: the COVID-19 pandemic altered management of APC patients for 70% of the panellists before the vaccination was available but only for 25% of panellists for fully vaccinated patients. Most experts (71%) were less likely to use docetaxel and abiraterone in unvaccinated patients with metastatic hormone-sensitive prostate cancer. For fully vaccinated patients with high-risk localised prostate cancer, there was a consensus (77%) to follow the usual treatment schedule, whereas in unvaccinated patients, 55% of the panel members voted for deferring radiation therapy. Finally, there was a strong consensus for the use of telemedicine for monitoring APC patients. Patient summary: In the Advanced Prostate Cancer Consensus Conference 2021, the panellists reached a consensus regarding the recommendation of the COVID-19 vaccine in prostate cancer patients and use of telemedicine for monitoring these patients., NA

Published
2022

9. Management of Patients with Advanced Prostate Cancer: Report from the Advanced Prostate Cancer Consensus Conference 2021

Author

Silke Gillessen, Andrew Armstrong, Gert Attard, Tomasz M. Beer, Himisha Beltran, Anders Bjartell, Alberto Bossi, Alberto Briganti, Robert G. Bristow, Muhammad Bulbul, Orazio Caffo, Kim N. Chi, Caroline S. Clarke, Noel Clarke, Ian D. Davis, Johann S. de Bono, Ignacio Duran, Ros Eeles, Eleni Efstathiou, Jason Efstathiou, Onyeanunam Ngozi Ekeke, Christopher P. Evans, Stefano Fanti, Felix Y. Feng, Karim Fizazi, Mark Frydenberg, Dan George, Martin Gleave, Susan Halabi, Daniel Heinrich, Celesta Higano, Michael S. Hofman, Maha Hussain, Nick James, Robert Jones, Ravindran Kanesvaran, Raja B. Khauli, Laurence Klotz, Raya Leibowitz, Chris Logothetis, Fernando Maluf, Robin Millman, Alicia K. Morgans, Michael J. Morris, Nicolas Mottet, Hind Mrabti, Declan G. Murphy, Vedang Murthy, William K. Oh, Piet Ost, Joe M. O'Sullivan, Anwar R. Padhani, Chris Parker, Darren M.C. Poon, Colin C. Pritchard, Danny M. Rabah, Dana Rathkopf, Rob E. Reiter, Mark Rubin, Charles J. Ryan, Fred Saad, Juan P. Sade, Oliver Sartor, Howard I. Scher, Neal Shore, Iwona Skoneczna, Eric Small, Matthew Smith, Howard Soule, Daniel E. Spratt, Cora N. Sternberg, Hiroyoshi Suzuki, Christopher Sweeney, Matthew R. Sydes, Mary-Ellen Taplin, Derya Tilki, Bertrand Tombal, Levent Türkeri, Hiroji Uemura, Hirotsugu Uemura, Inge van Oort, Kosj Yamoah, Dingwei Ye, Almudena Zapatero, Aurelius Omlin, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service d'urologie, Acibadem University Dspace, Gillessen, Silke, Armstrong, Andrew, Attard, Gert, Beer, Tomasz M, Beltran, Himisha, Bjartell, Ander, Bossi, Alberto, Briganti, Alberto, Bristow, Robert G, Bulbul, Muhammad, Caffo, Orazio, Chi, Kim N, Clarke, Caroline S, Clarke, Noel, Davis, Ian D, de Bono, Johann S, Duran, Ignacio, Eeles, Ro, Efstathiou, Eleni, Efstathiou, Jason, Ekeke, Onyeanunam Ngozi, Evans, Christopher P, Fanti, Stefano, Feng, Felix Y, Fizazi, Karim, Frydenberg, Mark, George, Dan, Gleave, Martin, Halabi, Susan, Heinrich, Daniel, Higano, Celesta, Hofman, Michael S, Hussain, Maha, James, Nick, Jones, Robert, Kanesvaran, Ravindran, Khauli, Raja B, Klotz, Laurence, Leibowitz, Raya, Logothetis, Chri, Maluf, Fernando, Millman, Robin, Morgans, Alicia K, Morris, Michael J, Mottet, Nicola, Mrabti, Hind, Murphy, Declan G, Murthy, Vedang, Oh, William K, Ost, Piet, O'Sullivan, Joe M, Padhani, Anwar R, Parker, Chri, Poon, Darren M C, Pritchard, Colin C, Rabah, Danny M, Rathkopf, Dana, Reiter, Rob E, Rubin, Mark, Ryan, Charles J, Saad, Fred, Sade, Juan P, Sartor, Oliver, Scher, Howard I, Shore, Neal, Skoneczna, Iwona, Small, Eric, Smith, Matthew, Soule, Howard, Spratt, Daniel E, Sternberg, Cora N, Suzuki, Hiroyoshi, Sweeney, Christopher, Sydes, Matthew R, Taplin, Mary-Ellen, Tilki, Derya, Tombal, Bertrand, Türkeri, Levent, Uemura, Hiroji, Uemura, Hirotsugu, van Oort, Inge, Yamoah, Kosj, Ye, Dingwei, Zapatero, Almudena, Omlin, Aurelius, Gillessen, S., Armstron, A., Attard, G., Beer, T.M., Beltran, H., Bjartell, A., Bossi, A., Briganti, A., Bristow, R.G., Bulbul, M., Caffo, O., Chi, K.N., Clarke, C.S., Clarke, N., Davis, I.D., de Bono, J.S., Duran, I., Eeles, R., Efstathiou, E., Efstathiou, J., Ekeke, O.N., Evans, C.P., Fanti, S., Feng, F.Y., Fizazi, K., Frydenberg, M., George, D., Gleave, M., Halabi, S., Heinrich, D., Higano, C., Hofman, M.S., Hussain, M., James, N., Jones, R., Kanesvaran, R., Khauli, R.B., Klotz, L., Leibowitz, R., Logothetis, C., Maluf, F., Millman, R., Morgans, A.K., Morris, M.J., Mottet, N., Mrabti, H., Murphy, D.G., Murthy, V., Oh, W.K., Ost, P., O'Sullivan, J.M., Padhani, A.R., Parker, C., Poon, D.M.C., Pritchard, C.C., Rabah, D.M., Rathkopf, D., Reiter, R.E., Rubin, M., Ryan, C.J., Saad, F., Sade, J.P., Sartor, O., Scher, H.I., Shore, N., Skoneczna, I., Small, E., Smith, M., Soule, H., Spratt, D.E., Sternberg, C.N., Suzuki, H., Sweeney, C., Sydes, M.R., Taplin, M.E., Tombal, B., Türkeri, L., Uemura, H., van Oort, I., Yamoah, K., Ye, D., Zapatero, A., Omlin, A., Koç University Hospital, and School of Medicine

Subjects
Male, Consensus, Urology, education, Lu-177-PSMA therapy, Consensu, Hormone-sensitive prostate cancer, Imaging, SDG 3 - Good Health and Well-being, Genetic, Lu-PSMA therapy, Urological cancers Radboud Institute for Molecular Life Sciences [Radboudumc 15], Genetics, Humans, Castration-resistant prostate cancer, Tumour genomic profiling, Manchester Cancer Research Centre, Advanced prostate cancer, ResearchInstitutes_Networks_Beacons/mcrc, PARP inhibition, 177Lu-PSMA therapy, Next-generation sequencing, Prostate cancer treatment, Prostatic Neoplasms, Urology and nephrology, (177)Lu-PSMA therapy, Human
Abstract

Background: innovations in treatments, imaging, and molecular characterisation in advanced prostate cancer have improved outcomes, but various areas of management still lack high-level evidence to inform clinical practice. The 2021 Advanced Prostate Cancer Consensus Conference (APCCC) addressed some of these questions to supplement guidelines that are based on level 1 evidence. Objective: to present the voting results from APCCC 2021. Design, setting, and participants: the experts identified three major areas of controversy related to management of advanced prostate cancer: newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC), the use of prostate-specific membrane antigen ligands in diagnostics and therapy, and molecular characterisation of tissue and blood. A panel of 86 international prostate cancer experts developed the programme and the consensus questions. Outcome measurements and statistical analysis: The panel voted publicly but anonymously on 107 pre-defined questions, which were developed by both voting and non-voting panel members prior to the conference following a modified Delphi process. Results and limitations: the voting reflected the opinions of panellists and did not incorporate a standard literature review or formal meta-analysis. The answer options for the consensus questions received varying degrees of support from panellists, as reflected in this article and the detailed voting results reported in the Supplementary material. Conclusions: these voting results from a panel of experts in advanced prostate cancer can help clinicians and patients to navigate controversial areas of management for which high-level evidence is scant. However, diagnostic and treatment decisions should always be individualised according to patient characteristics, such as the extent and location of disease, prior treatment(s), comorbidities, patient preferences, and treatment recommendations, and should also incorporate current and emerging clinical evidence and logistic and economic constraints. Enrolment in clinical trials should be strongly encouraged. Importantly, APCCC 2021 once again identified salient questions that merit evaluation in specifically designed trials. Patient summary: the Advanced Prostate Cancer Consensus Conference is a forum for discussing current diagnosis and treatment options for patients with advanced prostate cancer. An expert panel votes on predefined questions focused on the most clinically relevant areas for treatment of advanced prostate cancer for which there are gaps in knowledge. The voting results provide a practical guide to help clinicians in discussing treatment options with patients as part of shared decision-making., National Health and Medical Research Council (NHMRC) Practitioner Fellowship; Prostate Cancer Foundation; Peter MacCallum Foundation; NHMRC Investigator Grant

Published
2022

10. Corrigendum to 'What Experts Think About Prostate Cancer Management During the COVID-19 Pandemic: Report from the Advanced Prostate Cancer Consensus Conference 2021' [Eur Urol 82(1):6–11]

Author

Fabio Turco, Andrew Armstrong, Gerhardt Attard, Tomasz M. Beer, Himisha Beltran, Anders Bjartell, Alberto Bossi, Alberto Briganti, Rob G. Bristow, Muhammad Bulbul, Orazio Caffo, Kim N. Chi, Caroline Clarke, Noel Clarke, Ian D. Davis, Johann de Bono, Ignacio Duran, Ros Eeles, Eleni Efstathiou, Jason Efstathiou, Christopher P. Evans, Stefano Fanti, Felix Y. Feng, Karim Fizazi, Mark Frydenberg, Dan George, Martin Gleave, Susan Halabi, Daniel Heinrich, Celestia Higano, Michael S. Hofman, Maha Hussain, Nicholas James, Rob Jones, Ravindran Kanesvaran, Raja B. Khauli, Laurence Klotz, Raya Leibowitz, Christopher Logothetis, Fernando Maluf, Robin Millman, Alicia K. Morgans, Michael J. Morris, Nicolas Mottet, Hind Mrabti, Declan G. Murphy, Vedang Murthy, William K. Oh, Onyeanunam Ngozi Ekeke, Piet Ost, Joe M. O'Sullivan, Anwar R. Padhani, Christopher Parker, Darren M.C. Poon, Colin C. Pritchard, Danny M. Rabah, Dana Rathkopf, Robert E. Reiter, Mark Rubin, Charles J. Ryan, Fred Saad, Juan Pablo Sade, Oliver Sartor, Howard I. Scher, Neal Shore, Iwona Skoneczna, Eric Small, Matthew Smith, Howard Soule, Daniel Spratt, Cora N. Sternberg, Hiroyoshi Suzuki, Christopher Sweeney, Matthew Sydes, Mary-Ellen Taplin, Derya Tilki, Bertrand Tombal, Levent Türkeri, Hiroji Uemura, Hirotsugu Uemura, Inge van Oort, Kosj Yamoah, Dingwei Ye, Almudena Zapatero, Silke Gillessen, Aurelius Omlin, Turco, Fabio, Armstrong, Andrew, Attard, Gerhardt, Beer, Tomasz M, Beltran, Himisha, Bjartell, Ander, Bossi, Alberto, Briganti, Alberto, Bristow, Rob G, Bulbul, Muhammad, Caffo, Orazio, Chi, Kim N, Clarke, Caroline, Clarke, Noel, Davis, Ian D, de Bono, Johann, Duran, Ignacio, Eeles, Ro, Efstathiou, Eleni, Efstathiou, Jason, Evans, Christopher P, Fanti, Stefano, Feng, Felix Y, Fizazi, Karim, Frydenberg, Mark, George, Dan, Gleave, Martin, Halabi, Susan, Heinrich, Daniel, Higano, Celestia, Hofman, Michael S, Hussain, Maha, James, Nichola, Jones, Rob, Kanesvaran, Ravindran, Khauli, Raja B, Klotz, Laurence, Leibowitz, Raya, Logothetis, Christopher, Maluf, Fernando, Millman, Robin, Morgans, Alicia K, Morris, Michael J, Mottet, Nicola, Mrabti, Hind, Murphy, Declan G, Murthy, Vedang, Oh, William K, Ekeke, Onyeanunam Ngozi, Ost, Piet, O'Sullivan, Joe M, Padhani, Anwar R, Parker, Christopher, Poon, Darren M C, Pritchard, Colin C, Rabah, Danny M, Rathkopf, Dana, Reiter, Robert E, Rubin, Mark, Ryan, Charles J, Saad, Fred, Sade, Juan Pablo, Sartor, Oliver, Scher, Howard I, Shore, Neal, Skoneczna, Iwona, Small, Eric, Smith, Matthew, Soule, Howard, Spratt, Daniel, Sternberg, Cora N, Suzuki, Hiroyoshi, Sweeney, Christopher, Sydes, Matthew, Taplin, Mary-Ellen, Tilki, Derya, Tombal, Bertrand, Türkeri, Levent, Uemura, Hiroji, Uemura, Hirotsugu, van Oort, Inge, Yamoah, Kosj, Ye, Dingwei, Zapatero, Almudena, Gillessen, Silke, and Omlin, Aurelius

Subjects
Urology, Prostate cancer Prostate cancer management COVID-19 pandemic COVID-19 vaccine COVID-19 boost injection Telemedicine
Abstract

Patients with advanced prostate cancer (APC) may be at greater risk for severe illness, hospitalisation, or death from coronavirus disease 2019 (COVID-19) due to male gender, older age, potential immunosuppressive treatments, or comorbidities. Thus, the optimal management of APC patients during the COVID-19 pandemic is complex. In October 2021, during the Advanced Prostate Cancer Consensus Conference (APCCC) 2021, the 73 voting members of the panel members discussed and voted on 13 questions on this topic that could help clinicians make treatment choices during the pandemic. There was a consensus for full COVID-19 vaccination and booster injection in APC patients. Furthermore, the voting results indicate that the expert’s treatment recommendations are influenced by the vaccination status: the COVID-19 pandemic altered management of APC patients for 70% of the panellists before the vaccination was available but only for 25% of panellists for fully vaccinated patients. Most experts (71%) were less likely to use docetaxel and abiraterone in unvaccinated patients with metastatic hormone-sensitive prostate cancer. For fully vaccinated patients with high-risk localised prostate cancer, there was a consensus (77%) to follow the usual treatment schedule, whereas in unvaccinated patients, 55% of the panel members voted for deferring radiation therapy. Finally, there was a strong consensus for the use of telemedicine for monitoring APC patients. Patient summary In the Advanced Prostate Cancer Consensus Conference 2021, the panellists reached a consensus regarding the recommendation of the COVID-19 vaccine in prostate cancer patients and use of telemedicine for monitoring these patients.

Published
2022

11. Radical cystectomy versus trimodality therapy for muscle-invasive urothelial carcinoma of the bladder

Author

Kenneth Softness, Sumedh Kaul, Aaron Fleishman, Jason Efstathiou, Joaquim Bellmunt, Simon P. Kim, Ruslan Korets, Peter Chang, Andrew Wagner, Aria F. Olumi, and Boris Gershman

Subjects
Male, Carcinoma, Transitional Cell, Muscles, Urology, Urinary Bladder, Cystectomy, Neoadjuvant Therapy, Treatment Outcome, Urinary Bladder Neoplasms, Oncology, Humans, Female, Neoplasm Invasiveness, Retrospective Studies
Abstract

The comparative effectiveness of radical cystectomy (RC) and trimodality therapy (TMT) for muscle-invasive bladder cancer remains uncertain, as no randomized data exist. A phase 3 trial (SPARE) was attempted in the UK, however, was deemed infeasible and closed.To emulate the SPARE trial using observational data.We identified patients aged 40 to 79 with cT2-3cN0cM0 urothelial carcinoma of the bladder diagnosed from 2006 to 2015 who were treated with multiagent neoadjuvant chemotherapy + RC with lymphadenectomy (RC arm) or multiagent chemotherapy + 3D conformal radiotherapy to the bladder (TMT arm) in the National Cancer Database.The primary outcome was overall survival (OS). We fit a flexible logistic regression model for treatment to estimate the propensity score, and then used inverse probability of treatment weights to evaluate the associations of treatment group with OS.A total of 2,048 patients were included, of whom 1,812 underwent RC and 236 underwent TMT. Median follow-up was 29.0 months. After propensity score adjustment, compared to TMT, RC was not associated with a statistically significant difference in OS (HR 0.87; 95% CI 0.64-1.19; P = 0.40). When examining heterogeneity of treatment effects, RC appeared to be associated with improved OS only for patients with cT3 disease. Similar results were observed in sensitivity analyses. Our study is limited by the retrospective design and the lack of cancer-specific survival data.In observational analyses designed to emulate the SPARE trial, there was no statistically significant difference in OS between RC and TMT. Heterogeneity of treatment effects suggested improved survival with RC only for cT3 disease.

Published
2022

12. MP65-09 IMPACT OF PERIOPERATIVE CHEMOTHERAPY ON SURVIVAL IN PATIENTS WITH ADVANCED PRIMARY URETHRAL CANCER: RESULTS OF THE INTERNATIONAL COLLABORATION ON PRIMARY URETHRAL CARCINOMA

Author

Georgios Gakis, Todd Morgan, Siamak Daneshmand, Kirk Keegan, Harras Zaid, Jan Hrbacek, Bedeir Ali-El-Dein, Rebecca Clayman, Tilman Todenhöfer, Sigolene Galland, Kola Olugbade Jr., Michael Rink, Hans-Martin Fritsche, Maximillian Burger, Sam Chang, Marko Babjuk, George Thalmann, Arnulf Stenzl, and Jason Efstathiou

Subjects
Urology
Published
2015

13. Management of lymph node-positive prostate cancer: the role of surgery and radiation therapy

Author

Timur, Mitin, Michael, Blute, Richard, Lee, and Jason, Efstathiou

Subjects
Male, Lymphatic Metastasis, Humans, Prostatic Neoplasms, Androgen Antagonists, Combined Modality Therapy
Abstract

There is no clear consensus on how to manage a subset of patients with prostate cancer (PCa) who present with involved lymph nodes (LN+). Although outcomes for these patients are uniformly worse than those for patients with localized PCa, they are better than outcomes for patients with bone metastases, with more than 60% of patients alive at 10 years after the initial diagnosis. This article reviews the existing data on outcomes for patients treated with various combinations of systemic and local therapies. Current evidence suggests both a disease-control benefit and a survival benefit to multimodality therapy, which combines systemic androgen deprivation therapy (ADT) with local therapies, such as surgery and radiation, without evidence of excessive treatment-related toxicities.

Published
2013

14. Proton Therapy vs. IMRT for Low or Intermediate Risk Prostate Cancer (PARTIQoL)

Author

University of Pennsylvania, National Cancer Institute (NCI), Northwestern Medicine Chicago Proton Center, ProCure Proton Therapy Center, Washington University School of Medicine, University of Washington, Rutgers Cancer Institute of New Jersey, Provision Center for Proton Therapy, Mayo Clinic, University of Maryland Medical Center, University Hospitals Cleveland Medical Center, University of Florida Proton Therapy Institute, and Jason Efstathiou, Principal Investigator

Published
2023

17. Brachytherapy for Patients With Prostate Cancer: American Society of Clinical Oncology/Cancer Care Ontario Joint Guideline Update.

Author

Chin J, Rumble RB, Kollmeier M, Heath E, Efstathiou J, Dorff T, Berman B, Feifer A, Jacques A, and Loblaw DA

Subjects
Humans, Male, Randomized Controlled Trials as Topic, Brachytherapy methods, Brachytherapy standards, Prostatic Neoplasms radiotherapy
Abstract

Purpose To jointly update the Cancer Care Ontario guideline on brachytherapy for patients with prostate cancer to account for new evidence. Methods An Update Panel conducted a targeted systematic literature review and identified more recent randomized controlled trials comparing dose-escalated external beam radiation therapy (EBRT) with brachytherapy in men with prostate cancer. Results Five randomized controlled trials provided the evidence for this update. Recommendations For patients with low-risk prostate cancer who require or choose active treatment, low-dose rate brachytherapy (LDR) alone, EBRT alone, and/or radical prostatectomy (RP) should be offered to eligible patients. For patients with intermediate-risk prostate cancer choosing EBRT with or without androgen-deprivation therapy, brachytherapy boost (LDR or high-dose rate [HDR]) should be offered to eligible patients. For low-intermediate risk prostate cancer (Gleason 7, prostate-specific antigen < 10 ng/mL or Gleason 6, prostate-specific antigen, 10 to 20 ng/mL), LDR brachytherapy alone may be offered as monotherapy. For patients with high-risk prostate cancer receiving EBRT and androgen-deprivation therapy, brachytherapy boost (LDR or HDR) should be offered to eligible patients. Iodine-125 and palladium-103 are each reasonable isotope options for patients receiving LDR brachytherapy; no recommendation can be made for or against using cesium-131 or HDR monotherapy. Patients should be encouraged to participate in clinical trials to test novel or targeted approaches to this disease. Additional information is available at www.asco.org/Brachytherapy-guideline and www.asco.org/guidelineswiki .

Published
2017
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