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Prostate Articles Flashcards

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1
Q

PCa Lit

HOXB13 X285k variant

6

A
  • Codes for homeobox transcription factor
  • Absolute risk of 32.9% (vs 15.9%)
  • 2.4-fold increased odds of PCa
  • Greater risk of Gleason >8, stage T3/T4 and metastatic disease
  • Found only in West African decent
  • Other variants are found in Chinese and Japanese men

Darst BF, Hughley R, Pfennig A, Hazra U, Fan C, Wan P, Sheng X, Xia L, Andrews C, Chen F, Berndt SI, Kote-Jarai Z, Govindasami K, Bensen JT, Ingles SA, Rybicki BA, Nemesure B, John EM, Fowke JH, Huff CD, Strom SS, Isaacs WB, Park JY, Zheng W, Ostrander EA, Walsh PC, Carpten J, Sellers TA, Yamoah K, Murphy AB, Sanderson M, Crawford DC, Gapstur SM, Bush WS, Aldrich MC, Cussenot O, Petrovics G, Cullen J, Neslund-Dudas C, Kittles RA, Xu J, Stern MC, Chokkalingam AP, Multigner L, Parent ME, Menegaux F, Cancel-Tassin G, Kibel AS, Klein EA, Goodman PJ, Stanford JL, Drake BF, Hu JJ, Clark PE, Blanchet P, Casey G, Hennis AJM, Lubwama A, Thompson IM Jr, Leach RJ, Gundell SM, Pooler L, Mohler JL, Fontham ETH, Smith GJ, Taylor JA, Brureau L, Blot WJ, Biritwum R, Tay E, Truelove A, Niwa S, Tettey Y, Varma R, McKean-Cowdin R, Torres M, Jalloh M, Magueye Gueye S, Niang L, Ogunbiyi O, Oladimeji Idowu M, Popoola O, Adebiyi AO, Aisuodionoe-Shadrach OI, Nwegbu M, Adusei B, Mante S, Darkwa-Abrahams A, Yeboah ED, Mensah JE, Anthony Adjei A, Diop H, Cook MB, Chanock SJ, Watya S, Eeles RA, Chiang CWK, Lachance J, Rebbeck TR, Conti DV, Haiman CA. A Rare Germline HOXB13 Variant Contributes to Risk of Prostate Cancer in Men of African Ancestry. Eur Urol. 2022 May;81(5):458-462. doi: 10.1016/j.eururo.2021.12.023. Epub 2022 Jan 12. PMID: 35031163; PMCID: PMC9018520.

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2
Q

PCa Lit

Embark

5

A

1068 men with high-risk BCR (PSADT <9m)
Randomized to enzalutimide only, ADT only or combo (int ADT allowed)
5y Fup
1: MFS 2: safety, QoL, OS
Combination and Enzalutimide monotherapy were both better than lupron monotherapy

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3
Q

PCa Lit

PROMIS

6

A
  • MRI is significantly more sensitive than TRUS Bx for PCa
  • Prospective 576 men with PSA < 15
  • All got MRI followed by both TRUS Bx and template prostate mapping (saturation) Bx
  • TPM found 408 (71%) PCa and 230 (40%) CS PCa
  • MRI was more sensitive (93 vs 48%) and less specific (41 vs 91%) for CS PCa
  • suggest MRI could be used to triage before Bx

Lancet 2017

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4
Q

PCa Lit

PRECISION

4

A
  • Precise people don’t shoot without a target
  • RCT 5,000 men TRUS Bx vs MRI +/- biopsy for PIRADs 3
  • 28% of MRI group had neg MRI (avoided biopsy)
  • MRI group had more CS PCa (38 vs 26%) and less GG1 (9 vs 22%) and higher % positive cores (44 vs 18%)

NEJM 2018

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5
Q

PCa Lit

MRI-First

6

A
  • Pre-biopsy MRI+ Targeted detects more CS PCa but not well enough to abandon systemic PBx
  • Prospective 275 men with MRI before biopsy
  • If +MRI, targeted biopsy plus systemic
  • 13/94 (14%) were diagnosed by systemic biopsy only
  • 19/94 (20%) were diagnosed by targeted biopsy only
  • 62/94 (66%) were diagnosed by both

Lancet 2018

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6
Q

PCa Lit

MRI-Targeted, Systemic and Combined Biopsy for Prostate Cancer Diagnosis

5

A
  • In MRI+, targeted is better than systemic but both are best
  • Prospective. 2103 men with MRI+ lesions had targeted and systemic biopsy
  • Targeted was better for GG 3-5 and worse for GG1
  • Combined led to 10% more dx than either method alone and upgraded 22%
  • Combined lead to fewer upgrade after RP (4%) vs target (9%) or systemic (17%)

NEJM 2020

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7
Q

PCa Lit

STHLM3-MRI

6

A
  • MRI to triage men with elevated PSA reduces GG1 without compromising GG2+
  • RCT 1532 swedish men with PSA over 3
  • TRUS Bx group vs PIRDs 3+ only Bx group (target and systemic)
  • 36% of MRI group had +MRI
  • GG2+ was non-inferior to TRUS Bx group
  • Less GG1 (4 vs 12%)

NEJM 2021

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8
Q

PCa Lit

Messing Trial

4

A
  • Immdietate (p) vs Deferred ADT for pN1
  • RCT 100men with pN1 disease
  • Immediate lifelong ADT vs deferred until mets or symptoms
  • OS (64 vs 45%), DSS (85 vs 51%) and PFS (28 vs 12%)

Lancet Onc 2006

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9
Q

Pca Lit

ProtecT

5

A
  • PCa treatment ProtecTs against disease progression but not against death
  • RCT 1643 men (50-69)
  • Active monitoring (19% got Sx) vs Sx vs RT
  • No significant difference in OS (8AM, 5S, 4RT) or CSS
  • MFS (33AM, 13S, 16RT) and DFS was worse with AM

NEJM 2016

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10
Q

PCa Lit

PIVOT

4

A
  • We need to Pivot away from OR
  • RCT 731 men with PCa, Sx vs Observation
  • No statistically significant OS benefit
  • Int risk most likely to benefit from surgery

NEJM 2017

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11
Q

PCa Lit

SPCG-4

4

A
  • Surgery improved survival and decreased mets and ADT
  • Scandinavians 4 Prostatectomy trial
  • RCT 700 men surery vs watchful waiting
  • RP improved risk of dying from cancer by 11.7% and lived 2.9 years longer
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12
Q

Pca Lit

AA Race and AS in low risk PCa

4

A
  • DFS but not OS lower for AA men
  • Retrospective cohort (2280 AA vs 64446 white) with LR PCa
  • AA had higher progression (60% vs 48%) and treatment (55 vs 41%)
  • No difference in mets or DSS

JAMA 2020

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13
Q
A
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14
Q

PCLO

A

Screening increased detection rates
No change in survival

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