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Moul, Judd Wendell

Overview:

Dr Judd Moul joined the Duke faculty in mid 2004 after a career in the US Army Medical Corps mainly at Walter Reed Army Medical Center.  He is a retired colonel and a noted researcher and clinician in the area of prostate cancer and is a urologic oncologist. He served as the division chief of Duke Division of Urology from 2004 to 2011 and was named the James H Semans MD Professor of surgery in 2009 becoming Duke's first named endowed chair for urology.  He was awarded the Gold Cystoscope Award from the American Urologic Association as well as Castle Connelly Physician of the year for Clinical Medicine in 2009.  He has performed more than 1300 radical prostatectomies since joining the Duke faculty and is committed to outcomes research on this series and in other areas of prostate cancer.  He served as the Editor for Prostate Cancer and Prostatic Dissease, a Nature Medicine journal, for more than a decade and is a popular speaker and lecturer having been visiting professor and keynote speaker throughout the US and the World.  He is very committed to training residents and mentoring students and trainees.

Positions:

James H. Semans, M.D. Professor of Urologic Surgery, in the School of Medicine

Surgery, Urology
School of Medicine

Professor of Surgery

Surgery, Urology
School of Medicine

Professor in Anesthesiology

Anesthesiology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Chief of the Division of Urology in the Department of Surgery

Surgery, Urology
School of Medicine

Education:

B.S. 1979

B.S. — Pennsylvania State University

M.D. 1982

M.D. — Thomas Jefferson University

Residency, Surgery

Walter Reed Army Medical Center

Residency, Urology

Walter Reed Army Medical Center

Fellowship, Urologic Oncology

Duke University

Grants:

Phase III Randomized Efficacy and Safety Study

Administered By
Surgery, Urology
AwardedBy
Medivation, Inc.
Role
Principal Investigator
Start Date
February 01, 2016
End Date
January 31, 2023

A Prospective Observational Cohort Study of Patients with Castration Resistant Prostate Cancer

Administered By
Surgery, Urology
AwardedBy
Astellas Pharma Global Development, Inc
Role
Principal Investigator
Start Date
September 07, 2015
End Date
December 31, 2020

Exercise Training, Erectile Dysfunction, and Prostate Cancer

Administered By
Radiation Oncology
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
April 01, 2009
End Date
March 31, 2013

IPA - Jens Dannull

Administered By
Surgery
AwardedBy
Veterans Administration Medical Center
Role
Principal Investigator
Start Date
July 01, 2007
End Date
June 30, 2008

Prostate Cancer Recovery Enhancement (PROCARE) for African American Men

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
September 27, 2007
End Date
January 31, 2008

IPA Agreement - Jens Dannull

Administered By
Surgery
AwardedBy
Veterans Administration Medical Center
Role
Principal Investigator
Start Date
September 01, 2006
End Date
June 30, 2007

Expression Analysis of Prostate Cancer's Clinical Behavior

Administered By
Institutes and Centers
AwardedBy
National Institutes of Health
Role
Sponsor
Start Date
July 16, 2001
End Date
December 31, 2006
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Awards:

National Physician of the Year Clinician Award. Castle Connelly.

Type
National
Awarded By
Castle Connelly
Date
March 01, 2009

US Army Surgeon General "A" Designator Award. US Army Office of the Surgeon General.

Type
National
Awarded By
US Army Office of the Surgeon General
Date
January 01, 2001

Gold Cystoscope Award. American Urological Association.

Type
National
Awarded By
American Urological Association
Date
May 01, 1997

Publications:

Comparison of DRE and PSA in the Detection of Prostate Cancer.

Authors
Moul, JW
MLA Citation
Moul, JW. "Comparison of DRE and PSA in the Detection of Prostate Cancer." The Journal of urology 197.2S (February 2017): S208-S209.
PMID
28010975
Source
epmc
Published In
The Journal of Urology
Volume
197
Issue
2S
Publish Date
2017
Start Page
S208
End Page
S209
DOI
10.1016/j.juro.2016.11.031

Polymer-delivered subcutaneous leuprolide acetate formulations achieve and maintain castrate concentrations of testosterone in four open-label studies in patients with advanced prostate cancer

Authors
Shore, ND; Chu, F; Moul, J; Saltzstein, D; Concepcion, R; McLane, JA; Atkinson, S; Yang, A; Crawford, ED
MLA Citation
Shore, ND, Chu, F, Moul, J, Saltzstein, D, Concepcion, R, McLane, JA, Atkinson, S, Yang, A, and Crawford, ED. "Polymer-delivered subcutaneous leuprolide acetate formulations achieve and maintain castrate concentrations of testosterone in four open-label studies in patients with advanced prostate cancer." BJU International 119.2 (February 2017): 239-244.
Source
crossref
Published In
Bju International
Volume
119
Issue
2
Publish Date
2017
Start Page
239
End Page
244
DOI
10.1111/bju.13482

Editorial Comment.

Authors
Moul, JW
MLA Citation
Moul, JW. "Editorial Comment." Urology 99 (January 2017): 74-.
PMID
27839903
Source
epmc
Published In
Urology
Volume
99
Publish Date
2017
Start Page
74
DOI
10.1016/j.urology.2016.09.047

Role of salvage lymph node dissection in prostate cancer.

Oligometastatic prostate cancer (PCA) has increasingly been detected in the era of modern imaging studies such as choline-specific and prostate-specific membrane antigen (PSMA)-positron emission tomography and X-ray computed tomography (PET/CT). Recent evidence suggests that durable control is attainable with local treatment modalities such as salvage metastasectomy or stereotactic radiation therapy targeting oligometastases, either with or without the use of systemic therapy. The purpose of this article is to critically review the current findings on the indication, extent, and oncologic outcome of salvage lymphadenectomy (SLAD).Oligometastatic PCA is defined by three or less to five metastatic lesions, no rapid spread to more sites, and feasibility of targeted treatment of all metastatic lesions with surgery or radiation therapy. Ga-PSMA-PET/CT or C-choline PET/CT represents the imaging study of choice to identify patients with potential lymph node metastases, and both studies should be performed at prostate-specific antigen serum levels around 1 ng/ml in order to achieve optimal results. If available, Ga-PSMA-PET/CT should be preferred because of higher sensitivity, specificity, and accuracy. With regard to pelvic SLAD, only data of retrospective studies with a total of more than 400 patients and an evidence level III-IV are available. SLAD should always be performed in terms of an extended lymph node dissection. Five-year biochemical-free survival ranges between 19 and 25%, 5-year cancer-specific survival varies between 75 and 90%. The median time to systemic treatment is in the range of 20-30 months. Patients with retroperitoneal metastases have a poorer prognosis with less than 10% responding.SLAD in oligometastatic PCA represents an individual approach with the major goal to prolong progression-free survival and time until systemic therapy is started. It is currently unclear whether SLAD will have an impact on long-term survival. Prospective randomized trials targeting this issue are on their way.

Authors
Heidenreich, A; Moul, JW; Shariat, S; Karnes, RJ
MLA Citation
Heidenreich, A, Moul, JW, Shariat, S, and Karnes, RJ. "Role of salvage lymph node dissection in prostate cancer." Current opinion in urology 26.6 (November 2016): 581-589.
PMID
27584024
Source
epmc
Published In
Current Opinion in Urology
Volume
26
Issue
6
Publish Date
2016
Start Page
581
End Page
589
DOI
10.1097/mou.0000000000000343

Rising PSA level in an anxious postprostatectomy patient

Authors
Qi, R; Moul, JW
MLA Citation
Qi, R, and Moul, JW. "Rising PSA level in an anxious postprostatectomy patient." ONCOLOGY (United States) 30.9 (September 15, 2016).
Source
scopus
Published In
Oncology
Volume
30
Issue
9
Publish Date
2016

Serial Anatomical Prostate Ultrasound during Prostate Cancer Active Surveillance EDITORIAL COMMENTS

Authors
Moul, JW
MLA Citation
Moul, JW. "Serial Anatomical Prostate Ultrasound during Prostate Cancer Active Surveillance EDITORIAL COMMENTS." JOURNAL OF UROLOGY 196.3 (September 2016): 732-732.
Source
wos-lite
Published In
The Journal of Urology
Volume
196
Issue
3
Publish Date
2016
Start Page
732
End Page
732

Cáncer de próstata resistente a la castración: ¿por qué les debe importar a los urólogos?

Authors
Moul, JW
MLA Citation
Moul, JW. "Cáncer de próstata resistente a la castración: ¿por qué les debe importar a los urólogos?." Urología Colombiana 25.3 (September 2016): 195-197.
Source
crossref
Volume
25
Issue
3
Publish Date
2016
Start Page
195
End Page
197
DOI
10.1016/j.uroco.2016.07.001

Castration-resistant prostate cancer: Why should urologists care?

Authors
Moul, JW
MLA Citation
Moul, JW. "Castration-resistant prostate cancer: Why should urologists care?." Urología Colombiana 25.3 (September 2016): 198-200.
Source
crossref
Volume
25
Issue
3
Publish Date
2016
Start Page
198
End Page
200
DOI
10.1016/j.uroco.2016.07.002

Editorial Comment.

Authors
Moul, JW
MLA Citation
Moul, JW. "Editorial Comment." The Journal of urology 196.3 (September 2016): 732-.
PMID
27264352
Source
epmc
Published In
The Journal of Urology
Volume
196
Issue
3
Publish Date
2016
Start Page
732
DOI
10.1016/j.juro.2016.03.185

Determining optimal prostate-specific antigen thresholds to identify an increased 4-year risk of prostate cancer development: an analysis within the Veterans Affairs Health Care System.

To assess the prostate-specific antigen (PSA) threshold value that optimally predicts future risk of prostate cancer (overall and by race) for a dispersed US population.This was a retrospective analysis of men in the Veterans Affairs (VA) Health Care System database. Men ≥ 40 years with a baseline PSA ≤ 4.0 ng/mL, not receiving 5-alpha reductase inhibitors, and without a prostate cancer diagnosis prior to baseline PSA date were included and followed for 4 years. Patients diagnosed with prostate cancer within 6 months of baseline were excluded. The optimal PSA threshold value for future 4-year prostate cancer risk was determined by maximizing Youden's index.The eligible population for the final analysis included 41,250 Caucasian (n = 24,518; 59.4 %) and African American (n = 16,732; 40.6 %) patients. The 4-year prostate cancer rate was 3.08 % overall, and race-specific rates were 3.02 and 3.17 % for Caucasian and African American men, respectively. Mean time to prostate cancer diagnosis was 2.01 years across all patients. Race-specific PSA thresholds that optimally predicted future prostate cancer were 2.5 ng/mL [area under the curve (AUC) = 80.3 %] in Caucasians and a 1.9 ng/mL (AUC = 85.4 %) in African Americans; across all patients, a 2.4 ng/mL threshold was optimal (AUC = 82.5 %).In the VA population, a relatively low PSA threshold of ~2.5 ng/mL was optimal in predicting prostate cancer within 4 years overall and for Caucasian men, but an even lower threshold of 1.9 ng/mL was applicable for African American men.

Authors
Sutton, SS; Crawford, ED; Moul, JW; Hardin, JW; Kruep, E
MLA Citation
Sutton, SS, Crawford, ED, Moul, JW, Hardin, JW, and Kruep, E. "Determining optimal prostate-specific antigen thresholds to identify an increased 4-year risk of prostate cancer development: an analysis within the Veterans Affairs Health Care System." World journal of urology 34.8 (August 2016): 1107-1113.
PMID
26753559
Source
epmc
Published In
World Journal of Urology
Volume
34
Issue
8
Publish Date
2016
Start Page
1107
End Page
1113
DOI
10.1007/s00345-015-1754-6

Screening for familial and hereditary prostate cancer.

Prostate cancer (PC) has the highest degree of genetic transmission of any form of malignancy. In some families, the hereditary pattern is so strong as to mimic an autosomal dominance trait. We reviewed the known predisposing genetic markers to assess possible strategies for screening of families at risk. We carried out a systematic literature search using the Pubmed service of the National Center for Biotechnology Information (NCBI) and several gene libraries, including the NCBI SNP Library, the Online Mendelian Inheritance in Man® Catalog of Human Genes and Genetic Disorders (OMIM) and SNPedia to obtain known gene loci, SNPs and satellite markers associated with PC. We further cross referenced information on identified loci comparing data from different articles and gene reference sites. Whenever possible, we recorded the odds ratio (OR) for the allele associated with PC. In multiple different linkage studies, many independent PC associated loci have been identified on separate chromosomes. Genome-wide association studies have added many more markers to the set derived from linkage investigations. A subset of the alleles is associated with early onset and aggressive cancer. Due to the great heterogeneity, the OR for any one allele predicting future development of this malignancy is low. The strongest predictors are the BRCA2 mutations, and the highly penetrant G84E mutation in HOXB13. The presence of multiple risk alleles is more highly predictive than a single allele. Technical limitations on screening large panels of alleles are being overcome. It is appropriate to begin supplementing prostate specific antigen testing with alleles, such as BRCA2 and HOXB13, disclosed by targeted genomic analysis in families with an unfavorable family cancer history. Future population studies of PC should include genomic sequencing protocols, particularly in families with a history of PC and other malignancies.

Authors
Lynch, HT; Kosoko-Lasaki, O; Leslie, SW; Rendell, M; Shaw, T; Snyder, C; D'Amico, AV; Buxbaum, S; Isaacs, WB; Loeb, S; Moul, JW; Powell, I
MLA Citation
Lynch, HT, Kosoko-Lasaki, O, Leslie, SW, Rendell, M, Shaw, T, Snyder, C, D'Amico, AV, Buxbaum, S, Isaacs, WB, Loeb, S, Moul, JW, and Powell, I. "Screening for familial and hereditary prostate cancer." International journal of cancer 138.11 (June 2016): 2579-2591. (Review)
PMID
26638190
Source
epmc
Published In
International Journal of Cancer
Volume
138
Issue
11
Publish Date
2016
Start Page
2579
End Page
2591
DOI
10.1002/ijc.29949

A phase 2 multimodality trial of docetaxel/prednisone with sunitinib followed by salvage radiation therapy in men with PSA recurrent prostate cancer after radical prostatectomy.

In men with high Gleason PC and rapid PSA progression after surgery, failure rates remain unacceptably high despite salvage radiation. We explored a novel multimodality approach of docetaxel with anti-angiogenic therapy before salvage radiotherapy (RT).This was a phase 2 single-arm prospective open-label trial with historic controls. Eligible men had a rising PSA of 0.1-3.0 ng ml(-1) within 4 years of radical prostatectomy, no metastases except resected nodal disease, no prior androgen-deprivation therapy (ADT) and Gleason 7-10. Men received four cycles of docetaxel 70 mg m(-2) every 3 weeks with low dose prednisone and sunitinib 37.5 mg daily for 14/21 days each cycle, with no ADT. Salvage prostate bed RT (66 Gy) started at day 100. The primary end point was progression-free survival (PFS) rate at 24 months. Safety data, quality of life (QOL) and dose-limiting toxicities (DLTs) were measured over time.Thirty-four men accrued in this multi-institutional clinical trial: 24% of men were node positive, 47% were Gleason 8-10, median PSA at entry was 0.54. The trial was terminated prematurely owing to excess DLTs (nine) including grade 3 hand-foot syndrome (n=4), neutropenic fever (n=2), AST increase (n=1), fatigue (n=1) and vomiting with diarrhea (n=1). PFS rate at 24 months was 51% (95% CI: 33, 67%) with a median PFS of 26.2 months (95% CI: 12.5, -). Six men (17.6%) had an undetectable PSA at 2 years.Sunitinib and docetaxel/prednisone followed by salvage RT resulted in excess pre-specified DLTs. Although nearly half of the men experienced durable disease control, efficacy was not greater than expected with radiation alone. The use of the intermediate end point of PFS in this salvage setting permitted an early decision on further development of this combination.

Authors
Armstrong, AJ; Halabi, S; Healy, P; Lee, WR; Koontz, BF; Moul, JW; Mundy, K; Creel, P; Wood, S; Davis, K; Carducci, MA; Stein, M; Hobbs, C; Reimer, B; Nguyen, M; Anand, M; Bratt, L; Kim, S; Tran, PT; George, DJ
MLA Citation
Armstrong, AJ, Halabi, S, Healy, P, Lee, WR, Koontz, BF, Moul, JW, Mundy, K, Creel, P, Wood, S, Davis, K, Carducci, MA, Stein, M, Hobbs, C, Reimer, B, Nguyen, M, Anand, M, Bratt, L, Kim, S, Tran, PT, and George, DJ. "A phase 2 multimodality trial of docetaxel/prednisone with sunitinib followed by salvage radiation therapy in men with PSA recurrent prostate cancer after radical prostatectomy." March 2016.
PMID
26754260
Source
epmc
Published In
Prostate Cancer and Prostatic Diseases
Volume
19
Issue
1
Publish Date
2016
Start Page
100
End Page
106
DOI
10.1038/pcan.2015.59

A phase 2 multimodality trial of docetaxel/prednisone with sunitinib followed by salvage radiation therapy in men with PSA recurrent prostate cancer after radical prostatectomy

Authors
Armstrong, AJ; Halabi, S; Healy, P; Lee, WR; Koontz, BF; Moul, JW; Mundy, K; Creel, P; Wood, S; Davis, K; Carducci, MA; Stein, M; Hobbs, C; Reimer, B; Nguyen, M; Anand, M; Bratt, L; Kim, S; Tran, PT; George, DJ; Tr, DDPCC
MLA Citation
Armstrong, AJ, Halabi, S, Healy, P, Lee, WR, Koontz, BF, Moul, JW, Mundy, K, Creel, P, Wood, S, Davis, K, Carducci, MA, Stein, M, Hobbs, C, Reimer, B, Nguyen, M, Anand, M, Bratt, L, Kim, S, Tran, PT, George, DJ, and Tr, DDPCC. "A phase 2 multimodality trial of docetaxel/prednisone with sunitinib followed by salvage radiation therapy in men with PSA recurrent prostate cancer after radical prostatectomy." PROSTATE CANCER AND PROSTATIC DISEASES 19.1 (March 2016): 100-106.
Source
wos-lite
Published In
Prostate Cancer and Prostatic Diseases
Volume
19
Issue
1
Publish Date
2016
Start Page
100
End Page
106
DOI
10.1038/pcan.2015.59

Management of Prostate Cancer in the Elderly.

The impact of localized prostate cancer in the elderly depends on disease aggressiveness and life expectancy. In men with localized prostate cancer, those with low-risk disease or a shorter life expectancy should be managed expectantly, whereas those with long life expectancy or more aggressive disease may benefit from curative treatment. Comorbidity and quality-of-life concerns are key considerations during the selection of therapeutic modalities in the elderly in localized and metastatic settings. A variety of new agents have changed the therapeutic landscape in castrate-resistant prostate cancer, but their benefits need to be considered alongside their side effects and cost.

Authors
Tay, KJ; Moul, JW; Armstrong, AJ
MLA Citation
Tay, KJ, Moul, JW, and Armstrong, AJ. "Management of Prostate Cancer in the Elderly." Clinics in geriatric medicine 32.1 (February 2016): 113-132. (Review)
PMID
26614864
Source
epmc
Published In
Clinics in Geriatric Medicine
Volume
32
Issue
1
Publish Date
2016
Start Page
113
End Page
132
DOI
10.1016/j.cger.2015.08.001

Prostate cancer in men of African origin.

Men of African origin are disproportionately affected by prostate cancer: prostate cancer incidence is highest among men of African origin in the USA, prostate cancer mortality is highest among men of African origin in the Caribbean, and tumour stage and grade at diagnosis are highest among men in sub-Saharan Africa. Socioeconomic, educational, cultural, and genetic factors, as well as variations in care delivery and treatment selection, contribute to this cancer disparity. Emerging data on single-nucleotide-polymorphism patterns, epigenetic changes, and variations in fusion-gene products among men of African origin add to the understanding of genetic differences underlying this disease. On the diagnosis of prostate cancer, when all treatment options are available, men of African origin are more likely to choose radiation therapy or to receive no definitive treatment than white men. Among men of African origin undergoing surgery, increased rates of biochemical recurrence have been identified. Understanding differences in the cancer-survivorship experience and quality-of-life outcomes among men of African origin are critical to appropriately counsel patients and improve cultural sensitivity. Efforts to curtail prostate cancer screening will likely affect men of African origin disproportionately and widen the racial disparity of disease.

Authors
McGinley, KF; Tay, KJ; Moul, JW
MLA Citation
McGinley, KF, Tay, KJ, and Moul, JW. "Prostate cancer in men of African origin." Nature reviews. Urology 13.2 (February 2016): 99-107. (Review)
PMID
26718455
Source
epmc
Published In
Nature Reviews: Urology
Volume
13
Issue
2
Publish Date
2016
Start Page
99
End Page
107
DOI
10.1038/nrurol.2015.298

Application of active surveillance threshold to series of samples submitted for commercial testing.

Authors
Scardino, PT; Cuzick, JM; Stone, S; Evans, B; Jorgensen, MR; Eastham, JA; Keane, TE; Davis, JW; Lin, DW; Moul, JW; Brawer, MK; Crawford, ED
MLA Citation
Scardino, PT, Cuzick, JM, Stone, S, Evans, B, Jorgensen, MR, Eastham, JA, Keane, TE, Davis, JW, Lin, DW, Moul, JW, Brawer, MK, and Crawford, ED. "Application of active surveillance threshold to series of samples submitted for commercial testing." January 10, 2016.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
34
Issue
2
Publish Date
2016

Navigating MRI-TRUS fusion biopsy: optimizing the process and avoiding technical pitfalls.

Multi-parametric MRI (mpMRI) is widely used in the detection and characterization of clinically- significant prostate cancer. MRI-TRUS (trans-rectal ultrasound) fusion biopsy is an in-office procedure that promises to empower urologists to successfully target these MRI-visible lesions for histological confirmation. We describe the moving parts in the process and discuss methods to optimize biopsy outcomes. mpMRI is highly technical and reader-dependent. The acquisition of US images to generate a valid 3D US model and subsequent registration and fusion requires the urologist to attain equilibrium of probe position and pressure to achieve maximum registration accuracy. Environmental, medical and engineering measures can be undertaken to improve targeting accuracy. The art and skill of 'hitting' a visual target involves real-time recognition and adjustment for potential errors/ mis-registration in the fusion guide. A multi-disciplinary team effort is critical to improve all steps of the procedure.

Authors
Tay, KJ; Gupta, RT; Rastinehad, AR; Tsivian, E; Freedland, SJ; Moul, JW; Polascik, TJ
MLA Citation
Tay, KJ, Gupta, RT, Rastinehad, AR, Tsivian, E, Freedland, SJ, Moul, JW, and Polascik, TJ. "Navigating MRI-TRUS fusion biopsy: optimizing the process and avoiding technical pitfalls." Expert review of anticancer therapy 16.3 (January 2016): 303-311.
PMID
26653079
Source
epmc
Published In
Expert Review of Anticancer Therapy
Volume
16
Issue
3
Publish Date
2016
Start Page
303
End Page
311
DOI
10.1586/14737140.2016.1131155

Editorial comment.

Authors
Moul, JW
MLA Citation
Moul, JW. "Editorial comment." Urology 87 (January 2016): 131-132.
PMID
27243084
Source
epmc
Published In
Urology
Volume
87
Publish Date
2016
Start Page
131
End Page
132

Preface

Authors
Dunlap, C
MLA Citation
Dunlap, C. "Preface." (2016).
Source
c-inst-1
Publish Date
2016

Keeping an Open Mind About Novel Concepts for Management of Prostate Cancer.

Authors
Polascik, TJ; Tay, KJ; Moul, JW
MLA Citation
Polascik, TJ, Tay, KJ, and Moul, JW. "Keeping an Open Mind About Novel Concepts for Management of Prostate Cancer." European urology 68.6 (December 2015): 937-938.
PMID
25770483
Source
epmc
Published In
European Urology
Volume
68
Issue
6
Publish Date
2015
Start Page
937
End Page
938
DOI
10.1016/j.eururo.2015.02.024

Hormone naïve prostate cancer: predicting and maximizing response intervals.

Hormone naïve advanced prostate cancer is subdivided into two disease states: biochemical recurrence and traditional M1 (metastatic) prostate cancer and characterized by no prior hormonal therapy or androgen deprivation therapy (ADT). In biochemical recurrence/prostate-specific antigen (PSA) recurrence, men should be risk-stratified based on their PSA doubling time, the Gleason score and the timing of the recurrence. In general, only men who are at high risk should be considered for early/immediate ADT although this is best done using shared decision with the patient. The type of ADT to be used in biochemical recurrence ranging from oral-only peripheral blockade (peripheral androgen deprivation) to complete hormonal therapy (combined androgen blockade [CAB]) remains in debate owing to lack of randomized controlled trials (RCT). However, there is good RCT support for use of intermittent hormonal therapy (IHT). There is also limited research on biomarker response (PSA and testosterone decline) to predict prognosis. On the other hand, in the setting of M1 hormone naïve prostate cancer, there are many more RCT's to inform our decisions. CAB and gonadotrophin-releasing hormone antagonists perhaps provide a slight efficacy advantage while IHT may be slightly inferior with minimal M1 disease. The PSA nadir at 7 months after starting ADT is a powerful prognostic tool for M1 patients. There is growing recognition that serum testosterone (T) control while on ADT is linked to the development of castrate-resistant prostate cancer. Especially for a M1 patient, maintaining a serum T below 20-30 ng dl-1 prolongs the response to ADT. Novel oral agents (abiraterone and enzalutamide) may soon find use in hormone naïve disease and may alter the treatment landscape. Despite over 75 years of experience with ADT, many questions remain, and the field continues to evolve.

Authors
Moul, JW
MLA Citation
Moul, JW. "Hormone naïve prostate cancer: predicting and maximizing response intervals." Asian journal of andrology 17.6 (November 2015): 929-933. (Review)
PMID
26112479
Source
epmc
Published In
Asian journal of andrology
Volume
17
Issue
6
Publish Date
2015
Start Page
929
End Page
933
DOI
10.4103/1008-682x.152821

Hot topic of cancer survivorship and the 'seven deadly sins'.

Authors
Moul, JW
MLA Citation
Moul, JW. "Hot topic of cancer survivorship and the 'seven deadly sins'." BJU international 116.3 (September 2015): 310-311.
PMID
26260419
Source
epmc
Published In
Bju International
Volume
116
Issue
3
Publish Date
2015
Start Page
310
End Page
311
DOI
10.1111/bju.13115

Optimizing the efficiency and quality of sipuleucel-T delivery in an academic institution.

Sipuleucel-T, an autologous cellular immunotherapy, is approved for the treatment of certain patients with metastatic castration-resistant prostate cancer (mCRPC). Sipuleucel-T is the first personalized treatment for prostate cancer to be manufactured using the immune system of each individual patient. Patient preparation and compliance are critical because patients undergo serial leukapheresis and reinfusion procedures within a relatively short time period, which may result in transient reactions.The study aims to identify patients best suited for sipuleucel-T treatment, provide an overview of treatment, and encourage infusion sites to consider a primary contact model for the efficient coordination of care.Treatment experiences were evaluated from 124 patients with mCRPC who received sipuleucel-T from January 2010 to August 2013 according to current best practices. Feedback was collected from reflective interdisciplinary discussion within the sipuleucel-T delivery team (nurses, advanced practice providers, urologists, and medical oncologists).Early patient identification and education on treatment rationale, delivery, and expectations help ensure a successful sipuleucel-T treatment experience. A multidisciplinary coordinated-care process can facilitate proficient sipuleucel-T delivery, and the selection of a primary contact for care coordination offers benefits, such as clear and efficient education.

Authors
Davis, K; Wood, S; Dill, E; Fesko, Y; Bitting, RL; Harrison, MR; Armstrong, AJ; Moul, JW; George, DJ
MLA Citation
Davis, K, Wood, S, Dill, E, Fesko, Y, Bitting, RL, Harrison, MR, Armstrong, AJ, Moul, JW, and George, DJ. "Optimizing the efficiency and quality of sipuleucel-T delivery in an academic institution." Clinical journal of oncology nursing 19.3 (June 2015): 297-303.
PMID
26000580
Source
epmc
Published In
Clinical Journal of Oncology Nursing
Volume
19
Issue
3
Publish Date
2015
Start Page
297
End Page
303
DOI
10.1188/15.cjon.297-303

Randomized head-to-head prospective study of pharmacokinetic and pharmacodynamic properties of leuprolide acetate formulations: 7.5 mg single depot subcutaneous vs 7.5 mg intramuscular microsphere.

Authors
Saltzstein, DR; Moul, JW; de la Motte, S; McLane, JA; Osborne, DW; Yang, A; Concepcion, RS
MLA Citation
Saltzstein, DR, Moul, JW, de la Motte, S, McLane, JA, Osborne, DW, Yang, A, and Concepcion, RS. "Randomized head-to-head prospective study of pharmacokinetic and pharmacodynamic properties of leuprolide acetate formulations: 7.5 mg single depot subcutaneous vs 7.5 mg intramuscular microsphere." May 20, 2015.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
33
Issue
15
Publish Date
2015

Active surveillance for prostate cancer: can we modernize contemporary protocols to improve patient selection and outcomes in the focal therapy era?

In the absence of whole gland treatment for prostate cancer, both active surveillance and focal therapy share the common need of requiring a more thorough, detailed and precise analysis of the biological threats within the prostatic parenchyma if one chooses to monitor or selectively eradicate only specific neoplastic targets. In addition, focal therapy utilizes active surveillance post-treatment to monitor the untreated sectors of the prostate. We aim to evaluate the current modalities available to modernize active surveillance protocols in order to distinguish patients who may be safely observed from those who require intervention.Traditional active surveillance protocols by today's standards are rudimentary given the rapidly evolving technologies now available to clinicians. There is growing evidence for the adoption and use of multiparametric MRI and MRI-targeted biopsy to identify and localize prostate cancers of higher stage and grade. In addition, serum markers and prostate tissue DNA, RNA and methylation markers provide novel information that extends beyond Gleason grade to better characterize and define prostate cancer prognosis. Current active surveillance protocols should incorporate these modalities to improve patient stratification to surveillance, focal or whole gland interventions.Active surveillance protocols should be modernized to include cancer localization modalities and molecular prognostic markers to improve tumour characterization and better stratify men to surveillance, focal or radical intervention.

Authors
Tay, KJ; Mendez, M; Moul, JW; Polascik, TJ
MLA Citation
Tay, KJ, Mendez, M, Moul, JW, and Polascik, TJ. "Active surveillance for prostate cancer: can we modernize contemporary protocols to improve patient selection and outcomes in the focal therapy era?." Current opinion in urology 25.3 (May 2015): 185-190.
PMID
25768694
Source
epmc
Published In
Current Opinion in Urology
Volume
25
Issue
3
Publish Date
2015
Start Page
185
End Page
190
DOI
10.1097/mou.0000000000000168

High-risk prostate cancer and radical prostatectomy in the setting and context of multidisciplinary care.

Authors
Moul, JW
MLA Citation
Moul, JW. "High-risk prostate cancer and radical prostatectomy in the setting and context of multidisciplinary care." Urologic oncology 33.5 (May 2015): 206-207.
PMID
25851744
Source
epmc
Published In
Urologic Oncology: Seminars and Original Investigations
Volume
33
Issue
5
Publish Date
2015
Start Page
206
End Page
207
DOI
10.1016/j.urolonc.2015.03.004

Editorial comment.

Authors
Peterson, AC
MLA Citation
Peterson, AC. "Editorial comment." Urology 85.5 (May 2015): 1199-.
PMID
25819625
Source
epmc
Published In
Urology
Volume
85
Issue
5
Publish Date
2015
Start Page
1199
DOI
10.1016/j.urology.2014.12.048

Disparate results between proliferation rates of surgically excised prostate tumors and an in vitro bioassay using sera from a positive randomized controlled trial.

In vitro bioassay has been used extensively to test the effects of culturing cancer cells in sera from humans participating in dietary interventions, i.e, studies of modified intake of nutrients for the purpose of reducing cancer risk or progression. It has been hypothesized that cell proliferation rates determined by the in vitro bioassay indicate whether modification of dietary intake could decrease cancer cell growth in vivo. It has been suggested, however, that the in vitro bioassay may not correlate with tumor cell proliferation rates in prostate cancer. We investigated the concordance of cell proliferation rates from surgically excised prostate tumor tissue with the in vitro bioassay using sera from matched patients. We used samples from an earlier randomized clinical trial that showed that supplementation with flaxseed significantly inhibited prostate cancer cell proliferation rates in vivo as indicated by Ki67 staining in tumor specimens. Proliferation rates of LNCaP, DU145 and PC3 cell lines cultured in 10% human sera from participants in the flaxseed trial were determined using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Spearman's Rho correlation coefficients (ρ) indicated no association between Ki67 staining in prostate tumors and the in vitro bioassay for the three cell lines. These disparate findings suggest that the in vitro bioassay may not provide an accurate assessment of the environment in vivo.

Authors
Azrad, M; Vollmer, RT; Madden, J; Polascik, TJ; Snyder, DC; Ruffin, MT; Moul, JW; Brenner, D; He, X; Demark-Wahnefried, W
MLA Citation
Azrad, M, Vollmer, RT, Madden, J, Polascik, TJ, Snyder, DC, Ruffin, MT, Moul, JW, Brenner, D, He, X, and Demark-Wahnefried, W. "Disparate results between proliferation rates of surgically excised prostate tumors and an in vitro bioassay using sera from a positive randomized controlled trial." Biotechnic & histochemistry : official publication of the Biological Stain Commission 90.3 (April 2015): 184-189.
PMID
25434394
Source
epmc
Published In
Biotechnic & Histochemistry
Volume
90
Issue
3
Publish Date
2015
Start Page
184
End Page
189
DOI
10.3109/10520295.2014.976840

Editorial Comment

Authors
Moul, JW; Semans, JH
MLA Citation
Moul, JW, and Semans, JH. "Editorial Comment." Urology 85.1 (January 2015): 90-90.
Source
crossref
Published In
Urology
Volume
85
Issue
1
Publish Date
2015
Start Page
90
End Page
90
DOI
10.1016/j.urology.2014.07.073

ADT risks and side effects in advanced prostate cancer: cardiovascular and acute renal injury.

Androgen deprivation therapy (ADT) is key to the treatment of men with advanced prostate cancer. ADT can consist of surgical (bilateral orchiectomy) or medical strategies (eg, luteinizing hormone-releasing hormone agonists or gonadotropin-releasing hormone [GnRH] antagonists). The substantial reduction of testosterone levels achieved with ADT is associated with numerous well-characterized side effects, the management of which are key to patients' quality of life. More recently, a group of metabolic changes (dyslipidemia, hyperglycemia, others) that carry an increased risk of diabetes and cardiovascular disease have been reported in men receiving ADT. We review recent evidence suggesting an increased risk of pneumonia, cardiovascular disease, and acute kidney injury in men treated with ADT and consider whether the incidence of such events differs with the treatment modality. We discuss possible mechanisms by which such events might be mediated, including the roles of testosterone and the GnRH receptor, and consider current guidelines in light of these data.

Authors
Crawford, ED; Moul, JW
MLA Citation
Crawford, ED, and Moul, JW. "ADT risks and side effects in advanced prostate cancer: cardiovascular and acute renal injury." Oncology (Williston Park, N.Y.) 29.1 (January 2015): 55-66.
PMID
25592210
Source
epmc
Published In
Oncology
Volume
29
Issue
1
Publish Date
2015
Start Page
55
End Page
66

Extended release, 6-month formulations of leuprolide acetate for the treatment of advanced prostate cancer: achieving testosterone levels below 20 ng/dl.

Luteinizing hormone-releasing hormone agonists such as leuprolide acetate (LA) are the most frequently utilized treatment of advanced prostate cancer as the regimen for achieving androgen deprivation therapy (ADT). The efficacy of LA is determined by extent of testosterone (T) suppression in prostate cancer patients. Although, the historical castrate T suppression target has been defined as < 50 ng/dl, this level may not be as low as required to deliver equivalent suppression as achieved by surgical castration. Recent studies have demonstrated that a T level as low as 20 ng/dl may produce improved clinical outcomes.LA is available in long-acting formulations that deliver active drug over the course of 1-6 months from a single-dose administration. The technologies utilized to provide sustained drug delivery differ: one mode of administration uses microspheres, which encapsulate the drug and are injected as a suspension intramuscularly; another mode of administration uses a liquid polymer that creates a single, solid depot after injection subcutaneously. This article will review the safety and efficacy of both 6-month LA formulations, as well as their impact in prostate cancer treatment.As the understanding of optimal T castrate level evolves and may be refined pending new data from contemporaneous trials, achievement and maintenance of T levels well below 50 ng/dl may be important in evaluating potential differences in ADT regimens.

Authors
Crawford, ED; Moul, JW; Sartor, O; Shore, ND
MLA Citation
Crawford, ED, Moul, JW, Sartor, O, and Shore, ND. "Extended release, 6-month formulations of leuprolide acetate for the treatment of advanced prostate cancer: achieving testosterone levels below 20 ng/dl." Expert opinion on drug metabolism & toxicology 11.9 (January 2015): 1465-1474. (Review)
PMID
26293510
Source
epmc
Published In
Expert Opinion on Drug Metabolism & Toxicology
Volume
11
Issue
9
Publish Date
2015
Start Page
1465
End Page
1474
DOI
10.1517/17425255.2015.1073711

High-Risk Prostate Cancer: Role of Radical Prostatectomy and Radiation Therapy.

Up to 12% of European men aged 55-69 years diagnosed with prostate cancer have high-risk disease and thus are at increased risk of mortality. There remains a lack of consensus on definitive treatment for prostate cancer, although both radiation therapy and radical prostatectomy are frequently utilized. Furthermore, the different types of radiation and surgical options also increase the complexity of deciding on a single treatment, as does the use of multimodal treatment plans. Here, we provide an overview of radiation therapy and radical prostatectomy in treating high-risk prostate cancer.

Authors
Qi, R; Moul, J
MLA Citation
Qi, R, and Moul, J. "High-Risk Prostate Cancer: Role of Radical Prostatectomy and Radiation Therapy." Oncology research and treatment 38.12 (January 2015): 639-644.
PMID
26633298
Source
epmc
Published In
Oncology Research and Treatment
Volume
38
Issue
12
Publish Date
2015
Start Page
639
End Page
644
DOI
10.1159/000441736

Editorial comment.

Authors
Moul, JW; Semans, JH
MLA Citation
Moul, JW, and Semans, JH. "Editorial comment." Urology 85.1 (January 2015): 90-.
PMID
25530369
Source
epmc
Published In
Urology
Volume
85
Issue
1
Publish Date
2015
Start Page
90
DOI
10.1016/j.urology.2014.07.073

Editorial.

Authors
Leong, KW
MLA Citation
Leong, KW. "Editorial." Biomaterials 36 (January 2015): 5-.
PMID
25443403
Source
epmc
Published In
Biomaterials
Volume
36
Publish Date
2015
Start Page
5
DOI
10.1016/j.biomaterials.2014.10.047

ADT risks and side effects in advanced prostate cancer: cardiovascular and acute renal injury

Androgen deprivation therapy (ADT) is key to the treatment of men with advanced prostate cancer. ADT can consist of surgical (bilateral orchiectomy) or medical strategies (eg, luteinizing hormone-releasing hormone agonists or gonadotropin-releasing hormone [GnRH] antagonists). The substantial reduction of testosterone levels achieved with ADT is associated with numerous well-characterized side effects, the management of which are key to patients' quality of life. More recently, a group of metabolic changes (dyslipidemia, hyperglycemia, others) that carry an increased risk of diabetes and cardiovascular disease have been reported in men receiving ADT. We review recent evidence suggesting an increased risk of pneumonia, cardiovascular disease, and acute kidney injury in men treated with ADT and consider whether the incidence of such events differs with the treatment modality. We discuss possible mechanisms by which such events might be mediated, including the roles of testosterone and the GnRH receptor, and consider current guidelines in light of these data.

Authors
Crawford, ED; Moul, JW
MLA Citation
Crawford, ED, and Moul, JW. "ADT risks and side effects in advanced prostate cancer: cardiovascular and acute renal injury." Oncology (Williston Park, N.Y.) 29.1 (2015): 55-66.
Source
scival
Published In
Oncology
Volume
29
Issue
1
Publish Date
2015
Start Page
55
End Page
66

Editorial Comment

Authors
Moul, JW
MLA Citation
Moul, JW. "Editorial Comment." Urology 86.4 (2015): 788--.
Source
scival
Published In
Urology
Volume
86
Issue
4
Publish Date
2015
Start Page
788-
DOI
10.1016/j.urology.2015.05.035

Conclusion

Authors
Wiener, J; Balleisen, E; Bennear, L; Krawiec, K
MLA Citation
Wiener, J, Balleisen, E, Bennear, L, and Krawiec, K. "Conclusion (Accepted)." (2015).
PMID
22054922
Source
c-inst-1
Publish Date
2015

Does the multidisciplinary approach improve oncological outcomes in men undergoing surgical treatment for prostate cancer?

OBJECTIVES: To determine whether oncological outcomes are improved in prostate cancer patients by using a multidisciplinary strategy as compared with a standard clinic paradigm, and whether time to treatment is delayed when using a multidisciplinary approach. METHODS: We retrospectively analyzed patients who were evaluated and pursued radical prostatectomy as primary treatment, by the same surgeons, in the prostate cancer multidisciplinary clinic (n = 194) and standard urology clinic (n = 741) at Duke University Medical Center from 2005 to 2009. Comparisons of baseline characteristics were examined using rank sum and χ(2) -tests. Differences in time to radical prostatectomy and oncological outcomes were evaluated using multivariate linear and Cox regression, respectively. RESULTS: A greater proportion of high-risk patients (D'Amico criteria) were evaluated at the multidisciplinary clinic compared with the urology clinic (23.2% vs 15.6%, P = 0.014). Mean-adjusted time from biopsy to radical prostatectomy was shorter for multidisciplinary clinic patients (85.6 vs 96.8 days, P = 0.006). After a median follow up of 21 months, no significant difference was found between the multidisciplinary clinic and urology clinic in the risk of biochemical recurrence after radical prostatectomy, whether controlling for clinical (hazard ratio 0.71, P = 0.249) or pathological variables (hazard ratio 0.75, P = 0.349). CONCLUSIONS: Despite higher-risk disease, men evaluated using the multidisciplinary approach have similar oncological outcomes compared with men undergoing standard evaluation. Furthermore, time to radical prostatectomy is not delayed by the multidisciplinary management of these patients.

Authors
Stewart, SB; Moul, JW; Polascik, TJ; Koontz, BF; Robertson, CN; Freedland, SJ; George, DJ; Lee, WR; Armstrong, AJ; Bañez, LL
MLA Citation
Stewart, SB, Moul, JW, Polascik, TJ, Koontz, BF, Robertson, CN, Freedland, SJ, George, DJ, Lee, WR, Armstrong, AJ, and Bañez, LL. "Does the multidisciplinary approach improve oncological outcomes in men undergoing surgical treatment for prostate cancer?." International journal of urology : official journal of the Japanese Urological Association 21.12 (December 2014): 1215-1219.
PMID
25041422
Source
epmc
Published In
International Journal of Urology
Volume
21
Issue
12
Publish Date
2014
Start Page
1215
End Page
1219
DOI
10.1111/iju.12561

NADiA ProsVue prostate-specific antigen slope, CAPRA-S, and prostate cancer--specific survival after radical prostatectomy.

OBJECTIVE: To assess whether NADiA ProsVue prostate-specific antigen slope, a prognostic biomarker for identifying men at a reduced risk of clinically recurrent prostate cancer after radical prostatectomy, is prognostic for prostate cancer--specific mortality (PCSM) and other outcomes. MATERIALS AND METHODS: We examined long-term outcome in the cohort of 304 men selected for the ProsVue 510(k) clinical trial. We assessed the prognostic value of a ProsVue result ≤ 2.0 pg/mL/mo and pathologic risk stratified by the Cancer of the Prostate Risk Assessment Postsurgical nomogram for a reduced risk of prostate cancer--specific survival. We also assessed its value for predicting clinical outcome in men given salvage treatment for biochemical recurrence. Efficacy was assessed using univariate and multivariate Cox regression and the Kaplan-Meier analyses. RESULTS: Median (interquartile range) overall survival for the groups of men with a ProsVue slope result ≤ 2.0 and >2.0 pg/mL/mo were 11.0 (9.4-12.9) and 9.2 (4.9-11.6) years, respectively. The ProsVue univariate hazard ratio (95% confidence interval) for PCSM was 20.6 (6.8-62.7), with P <.0001 for a ProsVue result >2.0 pg/mL/mo vs a result ≤ 2.0 pg/mL/mo. The multivariate hazard ratio of ProsVue adjusted by Cancer of the Prostate Risk Assessment Postsurgical nomogram remained significant (16.7 [4.7-58.6]; P <.0001). The inverse of the hazard ratio translates to a 94.0% risk reduction for PCSM for men with a ProsVue result ≤ 2.0 pg/mL/mo. Salvage treatment for biochemical recurrence did not significantly reduce the hazard of clinical recurrence or PCSM; however, this is based on only 18 events. CONCLUSION: A NADiA ProsVue slope result ≤ 2.0 pg/mL/mo was prognostic for a reduced risk of PCSM in men after radical prostatectomy.

Authors
Moul, JW; Sarno, MJ; McDermed, JE; Triebell, MT; Reynolds, MA
MLA Citation
Moul, JW, Sarno, MJ, McDermed, JE, Triebell, MT, and Reynolds, MA. "NADiA ProsVue prostate-specific antigen slope, CAPRA-S, and prostate cancer--specific survival after radical prostatectomy." Urology 84.6 (December 2014): 1427-1432.
PMID
25432832
Source
epmc
Published In
Urology
Volume
84
Issue
6
Publish Date
2014
Start Page
1427
End Page
1432
DOI
10.1016/j.urology.2014.07.059

Reply: To PMID 25432832.

Authors
Moul, J
MLA Citation
Moul, J. "Reply: To PMID 25432832." Urology 84.6 (December 2014): 1433-.
PMID
25432834
Source
epmc
Published In
Urology
Volume
84
Issue
6
Publish Date
2014
Start Page
1433
DOI
10.1016/j.urology.2014.07.063

Editorial comment.

Authors
Moul, J
MLA Citation
Moul, J. "Editorial comment." Urology 84.5 (November 2014): 1178-1179.
PMID
25443929
Source
epmc
Published In
Urology
Volume
84
Issue
5
Publish Date
2014
Start Page
1178
End Page
1179
DOI
10.1016/j.urology.2014.05.075

Impact of NADiA ProsVue PSA slope on secondary treatment decisions after radical prostatectomy.

BACKGROUND: Selecting appropriate candidates for postprostatectomy radiotherapy is challenging, because adverse pathological features cannot accurately predict clinical recurrence. Biomarkers that identify residual disease activity may assist clinicians when counseling patients on the risks, benefits and costs of secondary treatment. NADiA ProsVue PSA slope results ≤2.0 pg ml(-1) month(-1) are predictive of a reduced risk of clinical recurrence; however, its clinical utility has not yet been studied. METHODS: We prospectively enrolled men treated by radical prostatectomy in a multicenter, institutional review board-approved clinical trial. At postsurgical follow-up, investigators (N=17) stratified men into low-, intermediate- or high-risk groups for prostate cancer recurrence based on clinicopathological findings and other factors. Investigators documented their initial treatment plan for each subject and serially collected three serum samples for ProsVue testing. After the ProsVue result was reported, investigators recorded whether or not the initial treatment plan was changed. The proportion of cases referred for secondary treatment before and after ProsVue was reported, and the significance of the difference determined. RESULTS: Complete assessments were reported for 225 men, 128 (56.9%) of whom were stratified into intermediate- and high-risk groups. Investigators reported that they would have referred 41/128 (32.0%) at-risk men for secondary treatment. However, after results were known, they referred only 15/128 (11.7%) men. The difference in proportions (-20.3%, 95% confidence interval (CI) -29.9 to -10.3%) is significant (P<0.0001). Odds of a referral was significantly reduced after results were reported (odds ratio 0.28, 95% CI 0.15-0.54, P<0.0001). CONCLUSIONS: Knowledge of a ProsVue result had significant impact on the final treatment plan. A ProsVue result ⩽2.0 pg ml(-1) month(-1) significantly reduced the proportion of men at risk of recurrence who otherwise would have been referred for secondary treatment.

Authors
Moul, JW; Chen, DYT; Trabulsi, EJ; Warlick, CA; Ruckle, HC; Porter, JR; Yoshida, JS; Adams, GW; Kella, N; Matsunaga, GS; Bans, LL; Sarno, MJ; McDermed, JE; Triebell, MT; Reynolds, MA
MLA Citation
Moul, JW, Chen, DYT, Trabulsi, EJ, Warlick, CA, Ruckle, HC, Porter, JR, Yoshida, JS, Adams, GW, Kella, N, Matsunaga, GS, Bans, LL, Sarno, MJ, McDermed, JE, Triebell, MT, and Reynolds, MA. "Impact of NADiA ProsVue PSA slope on secondary treatment decisions after radical prostatectomy." Prostate cancer and prostatic diseases 17.3 (September 2014): 280-285.
PMID
25027863
Source
epmc
Published In
Prostate Cancer and Prostatic Diseases
Volume
17
Issue
3
Publish Date
2014
Start Page
280
End Page
285
DOI
10.1038/pcan.2014.25

The urology perspective on expanding androgen-targeted treatments for men with castration-resistant prostate cancer.

Authors
Moul, JW
MLA Citation
Moul, JW. "The urology perspective on expanding androgen-targeted treatments for men with castration-resistant prostate cancer." Oncology (Williston Park, N.Y.) 28.8 (August 2014): 702-722.
PMID
25140628
Source
epmc
Published In
Oncology
Volume
28
Issue
8
Publish Date
2014
Start Page
702
End Page
722

A framework to evaluate the cost-effectiveness of the NADiA ProsVue slope to guide adjuvant radiotherapy among men with high-risk characteristics following prostatectomy for prostate cancer.

OBJECTIVES: The NADiA ProsVue is a prognostic system that measures prostate-specific antigen slope to identify men at lower risk of clinical recurrence of prostate cancer after radical prostatectomy. We developed a decision-modeling framework to evaluate its cost-effectiveness to guide the use of adjuvant radiotherapy (ART). METHODS: We populated the model using patient-level data and external sources. Patients were classified as intermediate risk or high risk on the basis of Cancer of the Prostate Risk Assessment-Postsurgical (CAPRA-S) nomogram and then stratified by the ProsVue slope (≤2 pg/mL/mo; >2 pg/mL/mo) and receipt of ART. In sensitivity analyses, we varied the effect of the ProsVue slope on the use of ART and other model parameters. RESULTS: The cost-effectiveness of the ProsVue-guided strategy varied widely because of small differences in quality-adjusted life-years (QALYs) at 10 years. In the intermediate-risk group, when the use of ART decreased from 20% (standard care) to 7.5% among patients with a ProsVue slope value of 2 pg/mL/mo or less, the incremental cost-effectiveness ratio was $25,160/QALY. In the high-risk group, the use of ART would have to decrease from 40% (standard care) to 11.5% among those with a ProsVue slope value of 2 pg/mL/mo or less to obtain a ratio of $50,000/QALY. The cost-effectiveness ratios were sensitive to varying benefits of salvage therapy, quality of life, and costs of ART and ProsVue testing. CONCLUSIONS: The effect of the ProsVue system on costs will be dependent on the extent to which ART decreases among men identified as having a low risk of recurrence. Its effect on QALYs will remain conditional on uncertain clinical and quality-of-life benefits associated with ART.

Authors
Reed, SD; Stewart, SB; Scales, CD; Moul, JW
MLA Citation
Reed, SD, Stewart, SB, Scales, CD, and Moul, JW. "A framework to evaluate the cost-effectiveness of the NADiA ProsVue slope to guide adjuvant radiotherapy among men with high-risk characteristics following prostatectomy for prostate cancer." Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research 17.5 (July 2014): 545-554.
PMID
25128047
Source
epmc
Published In
Value in Health
Volume
17
Issue
5
Publish Date
2014
Start Page
545
End Page
554
DOI
10.1016/j.jval.2014.04.010

Awareness, concern, and communication between physicians and patients on bone health in cancer.

PURPOSE: This study aims to explore physician-patient communications about bone metastases and cancer treatment-induced bone loss (CTIBL). METHODS: The study utilizes online survey of patients with breast cancer, prostate cancer, and multiple myeloma, and the physicians who treat them. RESULTS: Even though 69 and 48 % of patients with nonmetastatic breast and prostate cancer aware of treatment-induced bone loss, only 39 and 23 %, respectively, were concerned about bone loss. Yet, 62 and 71 % of oncologists treating breast and prostate cancer felt that their patients were concerned. Among patients with metastatic breast and prostate cancer, two thirds had not discussed treatment for bone metastases with their doctor; when discussed, 88 and 91 % of discussions were initiated by the doctor, usually prior to initiating treatment. Most myeloma patients (77 %) had discussed treatment options with their physicians; 99 % of hematologists reported discussing treatment of bone disease with patients. CONCLUSIONS: Physicians are primary sources of information to patients regarding bone health. There is a gap between what physicians assume their patients know about bone health and the patients' perceptions, presenting a need for systematic awareness and education.

Authors
Tripathy, D; Durie, BGM; Mautner, B; Ferenz, KS; Moul, JW
MLA Citation
Tripathy, D, Durie, BGM, Mautner, B, Ferenz, KS, and Moul, JW. "Awareness, concern, and communication between physicians and patients on bone health in cancer." Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 22.6 (June 2014): 1601-1610.
PMID
24477326
Source
epmc
Published In
Supportive Care in Cancer
Volume
22
Issue
6
Publish Date
2014
Start Page
1601
End Page
1610
DOI
10.1007/s00520-014-2127-1

Low central venous pressure versus acute normovolemic hemodilution versus conventional fluid management for reducing blood loss in radical retropubic prostatectomy: a randomized controlled trial.

OBJECTIVE: To compare acute normovolemic hemodilution versus low central venous pressure strategy versus conventional fluid management in reducing intraoperative estimated blood loss, hematocrit drop and need for blood transfusion in patients undergoing radical retropubic prostatectomy under general anesthesia. RESEARCH DESIGN AND METHODS: Patients undergoing radical retropubic prostatectomy under general anesthesia were randomized to conventional fluid management, acute normovolemic hemodilution or low central venous pressure (≤5 mmHg). Treatment effects on estimated blood loss and hematocrit change were tested in multivariable regression models accounting for surgeon, prostate size, and all two-way interactions. RESULTS: Ninety-two patients completed the study. Estimated blood loss (mean ± SD) was significantly lower with low central venous pressure (706 ± 362 ml) compared to acute normovolemic hemodilution (1103 ± 635 ml) and conventional (1051 ± 714 ml) groups (p = 0.0134). There was no difference between the groups in need for blood transfusion, or hematocrit drop from preoperative values. The multivariate model predicting estimated blood loss showed a significant effect of treatment (p = 0.0028) and prostate size (p = 0.0323), accounting for surgeon (p = 0.0013). In the model predicting hematocrit change, accounting for surgeon difference (p = 0.0037), the treatment effect depended on prostate size (p = 0.0007) with the slope of low central venous pressure differing from the other two groups. Hematocrit was predicted to drop more with increased prostate size in acute normovolemic hemodilution and conventional groups but not with low central venous pressure. KEY LIMITATIONS: Limitations include the inability to blind providers to group assignment, possible variability between providers in estimation of blood loss, and the relatively small sample size that was not powered to detect differences between the groups in need for blood transfusion. CONCLUSIONS: Maintaining low central venous pressure reduced estimated blood loss compared to conventional fluid management and acute normovolemic hemodilution in patients undergoing radical retropubic prostatectomy but there was no difference in allogeneic blood transfusion between the groups.

Authors
Habib, AS; Moul, JW; Polascik, TJ; Robertson, CN; Roche, AM; White, WD; Hill, SE; Nosnick, I; Gan, TJ; Duke Perioperative Outcome Study Group,
MLA Citation
Habib, AS, Moul, JW, Polascik, TJ, Robertson, CN, Roche, AM, White, WD, Hill, SE, Nosnick, I, Gan, TJ, and Duke Perioperative Outcome Study Group, . "Low central venous pressure versus acute normovolemic hemodilution versus conventional fluid management for reducing blood loss in radical retropubic prostatectomy: a randomized controlled trial." Curr Med Res Opin 30.5 (May 2014): 937-943.
PMID
24351100
Source
pubmed
Published In
Current Medical Research and Opinion
Volume
30
Issue
5
Publish Date
2014
Start Page
937
End Page
943
DOI
10.1185/03007995.2013.877436

Long-term tolerability and efficacy of degarelix: 5-year results from a phase III extension trial with a 1-arm crossover from leuprolide to degarelix.

OBJECTIVE: To demonstrate the safety and efficacy of up to 5 years of degarelix treatment and the effects of crossing over from leuprolide to degarelix in the extension phase of a phase III pivotal 1-year trial. METHODS: Patients receiving degarelix who completed the 1-year trial continued on 80 mg (n = 125) or 160 mg (n = 126) maintenance doses. Patients who received leuprolide were rerandomized to degarelix 240/80 mg (n = 69) or 240/160 mg (n = 65). Safety and tolerability were assessed (primary end point), as well as testosterone and prostate-specific antigen levels and prostate-specific antigen progression-free survival (secondary end points). RESULTS: Adverse event frequency was similar between both the groups. Adverse events included initial injection site reactions, hot flushes, and increased weight. Testosterone and prostate-specific antigen values during the extension study were similar to those seen during the 1-year trial in patients who continued on degarelix or crossed over from leuprolide. The prostate-specific antigen progression-free survival hazard rate was decreased significantly after the crossover in the leuprolide to degarelix group (from 0.20 to 0.09; P = .002), whereas in patients who continued on degarelix, the rate did not change significantly. In patients with baseline prostate-specific antigen >20 ng/mL, the same hazard rate change pattern was observed on crossover (from 0.38 to 0.19; P = .019). CONCLUSION: Degarelix was well tolerated; no safety concerns were identified. The significant prostate-specific antigen progression-free survival benefit established for degarelix over leuprolide during year 1 remained consistent at 5 years.

Authors
Crawford, ED; Shore, ND; Moul, JW; Tombal, B; Schröder, FH; Miller, K; Boccon-Gibod, L; Malmberg, A; Olesen, TK; Persson, B-E; Klotz, L
MLA Citation
Crawford, ED, Shore, ND, Moul, JW, Tombal, B, Schröder, FH, Miller, K, Boccon-Gibod, L, Malmberg, A, Olesen, TK, Persson, B-E, and Klotz, L. "Long-term tolerability and efficacy of degarelix: 5-year results from a phase III extension trial with a 1-arm crossover from leuprolide to degarelix." Urology 83.5 (May 2014): 1122-1128.
PMID
24661333
Source
epmc
Published In
Urology
Volume
83
Issue
5
Publish Date
2014
Start Page
1122
End Page
1128
DOI
10.1016/j.urology.2014.01.013

USE OF PSA SLOPE TO GUIDE ADJUVANT RADIOTHERAPY IN POST-PROSTATECTOMY PROSTATE CANCER HAS POTENTIAL TO BE COST EFFECTIVE

Authors
Reed, SD; Stewart, BS; Scales, CD; Moul, JW
MLA Citation
Reed, SD, Stewart, BS, Scales, CD, and Moul, JW. "USE OF PSA SLOPE TO GUIDE ADJUVANT RADIOTHERAPY IN POST-PROSTATECTOMY PROSTATE CANCER HAS POTENTIAL TO BE COST EFFECTIVE." May 2014.
Source
wos-lite
Published In
Value in Health
Volume
17
Issue
3
Publish Date
2014
Start Page
A86
End Page
A86

NADIA (R) PSA SLOPE IMPACTS UROLOGISTS' RECOMMENDATIONS FOR ADJUVANT RADIOTHERAPY FOR PROSTATE CANCER PATIENTS WITH HIGH-RISK PATHOLOGY FOLLOWING RADICAL PROSTATECTOMY

Authors
Reynolds, MA; Moul, JW; McDermed, J
MLA Citation
Reynolds, MA, Moul, JW, and McDermed, J. "NADIA (R) PSA SLOPE IMPACTS UROLOGISTS' RECOMMENDATIONS FOR ADJUVANT RADIOTHERAPY FOR PROSTATE CANCER PATIENTS WITH HIGH-RISK PATHOLOGY FOLLOWING RADICAL PROSTATECTOMY." May 2014.
Source
wos-lite
Published In
Value in Health
Volume
17
Issue
3
Publish Date
2014
Start Page
A101
End Page
A101

Utility of LHRH antagonists for advanced prostate cancer.

INTRODUCTION: Androgen deprivation therapy (ADT) is the lynchpin of treatment for advanced prostate cancer. Prescribing physicians and patients have a choice between orchiectomy, luteinizing hormone releasing hormone (LHRH) agonists, combined androgen deprivation (CAD) or LHRH antagonists. MATERIALS AND METHODS: Literature relating to the use of LHRH antagonists in the management of prostate cancer was reviewed. RESULTS: Abarelix was the first-in-class LHRH pure antagonist that was Food and Drug Administration (FDA) approved in 2003. Due to a variety of concerns including hypersensitivity reactions it was withdrawn from the United States (U.S.) market in 2005. The only currently commercially available LHRH antagonist in the U.S. is degarelix available as a once-a-month depot injection. The potential clinical advantage of degarelix compared to the LHRH agonists is the very rapid and sustained testosterone suppression with no identifiable physiological or clinical testosterone surge or flare. The main disadvantage of degarelix compared to the LHRH agonists is the monthly dosing and the inconvenience for some patients and practices. Recent studies tout improved disease control for degarelix compared to monthly leuprolide acetate; however, these results remain controversial. CONCLUSIONS: The rapid T-suppression achieved with degarelix may provide a clinical benefit for various groups of men with advanced or locally advanced disease.

Authors
Moul, JW
MLA Citation
Moul, JW. "Utility of LHRH antagonists for advanced prostate cancer." The Canadian journal of urology 21.2 Supp 1 (April 2014): 22-27.
PMID
24775720
Source
epmc
Published In
Canadian Journal of Urology
Volume
21
Issue
2 Supp 1
Publish Date
2014
Start Page
22
End Page
27

Updated prognostic model for predicting overall survival in first-line chemotherapy for patients with metastatic castration-resistant prostate cancer.

Prognostic models for overall survival (OS) for patients with metastatic castration-resistant prostate cancer (mCRPC) are dated and do not reflect significant advances in treatment options available for these patients. This work developed and validated an updated prognostic model to predict OS in patients receiving first-line chemotherapy.Data from a phase III trial of 1,050 patients with mCRPC were used (Cancer and Leukemia Group B CALGB-90401 [Alliance]). The data were randomly split into training and testing sets. A separate phase III trial served as an independent validation set. Adaptive least absolute shrinkage and selection operator selected eight factors prognostic for OS. A predictive score was computed from the regression coefficients and used to classify patients into low- and high-risk groups. The model was assessed for its predictive accuracy using the time-dependent area under the curve (tAUC).The model included Eastern Cooperative Oncology Group performance status, disease site, lactate dehydrogenase, opioid analgesic use, albumin, hemoglobin, prostate-specific antigen, and alkaline phosphatase. Median OS values in the high- and low-risk groups, respectively, in the testing set were 17 and 30 months (hazard ratio [HR], 2.2; P < .001); in the validation set they were 14 and 26 months (HR, 2.9; P < .001). The tAUCs were 0.73 (95% CI, 0.70 to 0.73) and 0.76 (95% CI, 0.72 to 0.76) in the testing and validation sets, respectively.An updated prognostic model for OS in patients with mCRPC receiving first-line chemotherapy was developed and validated on an external set. This model can be used to predict OS, as well as to better select patients to participate in trials on the basis of their prognosis.

Authors
Halabi, S; Lin, C-Y; Kelly, WK; Fizazi, KS; Moul, JW; Kaplan, EB; Morris, MJ; Small, EJ
MLA Citation
Halabi, S, Lin, C-Y, Kelly, WK, Fizazi, KS, Moul, JW, Kaplan, EB, Morris, MJ, and Small, EJ. "Updated prognostic model for predicting overall survival in first-line chemotherapy for patients with metastatic castration-resistant prostate cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 32.7 (March 2014): 671-677.
PMID
24449231
Source
epmc
Published In
Journal of Clinical Oncology
Volume
32
Issue
7
Publish Date
2014
Start Page
671
End Page
677
DOI
10.1200/jco.2013.52.3696

Will the future of health care lead to the end of the robotic golden years?

Authors
Biehn Stewart, S; Reed, SD; Moul, JW
MLA Citation
Biehn Stewart, S, Reed, SD, and Moul, JW. "Will the future of health care lead to the end of the robotic golden years?." Eur Urol 65.2 (February 2014): 325-327.
PMID
23116656
Source
pubmed
Published In
European Urology
Volume
65
Issue
2
Publish Date
2014
Start Page
325
End Page
327
DOI
10.1016/j.eururo.2012.10.019

The role of magnetic resonance imaging (MRI) in focal therapy for prostate cancer: recommendations from a consensus panel.

OBJECTIVE: To establish a consensus on the utility of multiparametric magnetic resonance imaging (mpMRI) to identify patients for focal therapy. METHODS: Urological surgeons, radiologists, and basic researchers, from Europe and North America participated in a consensus meeting about the use of mpMRI in focal therapy of prostate cancer. The consensus process was face-to-face and specific clinical issues were raised and discussed with agreement sought when possible. All participants are listed among the authors. Topics specifically did not include staging of prostate cancer, but rather identifying the optimal requirements for performing MRI, and the current status of optimally performed mpMRI to (i) determine focality of prostate cancer (e.g. localising small target lesions of ≥0.5 mL), (ii) to monitor and assess the outcome of focal ablation therapies, and (iii) to identify the diagnostic advantages of new MRI methods. In addition, the need for transperineal template saturation biopsies in selecting patients for focal therapy was discussed, if a high quality mpMRI is available. In other words, can mpMRI replace the role of transperineal saturation biopsies in patient selection for focal therapy? RESULTS: Consensus was reached on most key aspects of the meeting; however, on definition of the optimal requirements for mpMRI, there was one dissenting voice. mpMRI is the optimum approach to achieve the objectives needed for focal therapy, if made on a high quality machine (3T with/without endorectal coil or 1.5T with endorectal coil) and judged by an experienced radiologist. Structured and standardised reporting of prostate MRI is paramount. State of the art mpMRI is capable of localising small tumours for focal therapy. State of the art mpMRI is the technique of choice for follow-up of focal ablation. CONCLUSIONS: The present evidence for MRI in focal therapy is limited. mpMRI is not accurate enough to consistently grade tumour aggressiveness. Template-guided saturation biopsies are no longer necessary when a high quality state of the art mpMRI is available; however, suspicious lesions should always be confirmed by (targeted) biopsy.

Authors
Muller, BG; Fütterer, JJ; Gupta, RT; Katz, A; Kirkham, A; Kurhanewicz, J; Moul, JW; Pinto, PA; Rastinehad, AR; Robertson, C; de la Rosette, J; Sanchez-Salas, R; Jones, JS; Ukimura, O; Verma, S; Wijkstra, H; Marberger, M
MLA Citation
Muller, BG, Fütterer, JJ, Gupta, RT, Katz, A, Kirkham, A, Kurhanewicz, J, Moul, JW, Pinto, PA, Rastinehad, AR, Robertson, C, de la Rosette, J, Sanchez-Salas, R, Jones, JS, Ukimura, O, Verma, S, Wijkstra, H, and Marberger, M. "The role of magnetic resonance imaging (MRI) in focal therapy for prostate cancer: recommendations from a consensus panel." BJU Int 113.2 (February 2014): 218-227.
PMID
24215670
Source
pubmed
Published In
Bju International
Volume
113
Issue
2
Publish Date
2014
Start Page
218
End Page
227
DOI
10.1111/bju.12243

Effects of nonlinear aerobic training on erectile dysfunction and cardiovascular function following radical prostatectomy for clinically localized prostate cancer

Erectile dysfunction (ED) is a major adverse effect of radical prostatectomy (RP). We conducted a randomized controlled trial to examine the efficacy of aerobic training (AT) compared with usual care (UC) on ED prevalence in 50 men (n = 25 per group) after RP. AT consisted of five walking sessions per week at 55-100% of peak oxygen uptake (VO2peak) for 30-60 min per session following a nonlinear prescription. The primary outcome was change in the prevalence of ED, as measured by the International Index of Erectile Function (IIEF), from baseline to 6 mo. Secondary outcomes were brachial artery flow-mediated dilation (FMD), VO2peak, cardiovascular (CV) risk profile (eg, lipid profile, body composition), and patient-reported outcomes (PROs). The prevalence of ED (IIEF score ≤21) decreased by 20% in the AT group and by 24% in the UC group (difference: p = 0.406). There were no significant between-group differences in any erectile function subscale (p > 0.05). Significant between-group differences were observed for changes in FMD and VO2peak, favoring AT. There were no group differences in other markers of CV risk profile or PROs. In summary, nonlinear AT does not improve ED in men with localized prostate cancer in the acute period following RP. Trial registration Clinicaltrials.gov identifier NCT00620932. © 2013 European Association of Urology.

Authors
Jones, LW; Hornsby, WE; Freedland, SJ; Lane, A; West, MJ; Moul, JW; Ferrandino, MN; Allen, JD; Kenjale, AA; Thomas, SM; Herndon, JE; Koontz, BF; Chan, JM; Khouri, MG; Douglas, PS; Eves, ND
MLA Citation
Jones, LW, Hornsby, WE, Freedland, SJ, Lane, A, West, MJ, Moul, JW, Ferrandino, MN, Allen, JD, Kenjale, AA, Thomas, SM, Herndon, JE, Koontz, BF, Chan, JM, Khouri, MG, Douglas, PS, and Eves, ND. "Effects of nonlinear aerobic training on erectile dysfunction and cardiovascular function following radical prostatectomy for clinically localized prostate cancer." European Urology 65.5 (January 1, 2014): 852-855.
Source
scopus
Published In
European Urology
Volume
65
Issue
5
Publish Date
2014
Start Page
852
End Page
855
DOI
10.1016/j.eururo.2013.11.009

Active surveillance for African-American men with prostate cancer: of course! Pro.

Authors
Moul, JW
MLA Citation
Moul, JW. "Active surveillance for African-American men with prostate cancer: of course! Pro." Oncology (Williston Park, N.Y.) 28.1 (January 1, 2014): 82-85.
Source
scopus
Published In
Oncology
Volume
28
Issue
1
Publish Date
2014
Start Page
82
End Page
85

Active surveillance for African-American men with prostate cancer: of course! Pro.

Authors
Moul, JW
MLA Citation
Moul, JW. "Active surveillance for African-American men with prostate cancer: of course! Pro." Oncology (Williston Park, N.Y.) 28.1 (January 2014): 82-85.
PMID
24683724
Source
epmc
Published In
Oncology
Volume
28
Issue
1
Publish Date
2014
Start Page
82
End Page
85

A guide for clinicians in the evaluation of emerging molecular diagnostics for newly diagnosed prostate cancer.

Prostate-specific antigen (PSA) screening is associated with a decline in prostate cancer-related mortality. However, screening has also led to overdiagnosis and overtreatment of clinically insignificant tumors. Recently, certain national guidelines (eg, US Preventive Services Task Force) have recommended against PSA screening, which may lead to a reverse-stage migration. Although many prostate tumors are indolent at presentation, others are aggressive and are appropriate targets for treatment interventions. Utilization of molecular markers may improve our ability to measure tumor biology and allow better discrimination of indolent and aggressive tumors at diagnosis. Many emerging commercial molecular diagnostic assays have been designed to provide more accurate risk stratification for newly diagnosed prostate cancer. Unfamiliarity with molecular diagnostics may make it challenging for some clinicians to navigate and interpret the medical literature to ascertain whether particular assays are appropriately developed and validated for clinical use. Herein, the authors provide a framework for practitioners to use when assessing new tissue-based molecular assays. This review outlines aspects of assay development, clinical and analytic validation and clinical utility studies, and regulatory issues, which collectively determine whether tests (1) are actionable for specific clinical indications, (2) measurably influence treatment decisions, and (3) are sufficiently validated to warrant incorporation into clinical practice.

Authors
Canfield, SE; Kibel, AS; Kemeter, MJ; Febbo, PG; Lawrence, HJ; Moul, JW
MLA Citation
Canfield, SE, Kibel, AS, Kemeter, MJ, Febbo, PG, Lawrence, HJ, and Moul, JW. "A guide for clinicians in the evaluation of emerging molecular diagnostics for newly diagnosed prostate cancer." Reviews in urology 16.4 (January 2014): 172-180.
PMID
25548544
Source
epmc
Published In
Reviews in Urology
Volume
16
Issue
4
Publish Date
2014
Start Page
172
End Page
180

Differences in self-reported outcomes of open prostatectomy patients and robotic prostatectomy patients in an international web-based survey.

OBJECTIVES: To compare patient reported outcomes between robotic assisted surgery and non-robotic assisted surgery. METHODS: This was an international web-based survey based on a qualitative research and literature review, an internet-based questionnaire was developed with approximately 70 items. The questionnaire included both closed and open-ended questions. RESULTS: Responses were received from 193 men of whom 86 had received either open (OP) or robotic (RALP) surgery. A statistically significant (p=0.027), ranked analysis of covariance was found demonstrating higher recent distress in the robotic (RALP) surgery group. Although not statistically significant, there was a pattern of men having robotic (RALP) surgery reporting fewer urinary and bowel problems, but having a greater rate of sexual dysfunction. CONCLUSIONS: Men who opt for robotic surgery may have higher expectations for robotic (RALP) surgery, when these expectations are not fully met they may be less likely to accept the consequences of this major cancer surgery. Information regarding surgical choice needs to be tailored to ensure that men diagnosed with prostate cancer are fully informed of not only short term surgical and physical outcomes such as erectile dysfunction and incontinence, but also of potential issues with regards to masculinity, lifestyle and sexual health.

Authors
O'Shaughnessy, PK; Laws, TA; Pinnock, C; Moul, JW; Esterman, A
MLA Citation
O'Shaughnessy, PK, Laws, TA, Pinnock, C, Moul, JW, and Esterman, A. "Differences in self-reported outcomes of open prostatectomy patients and robotic prostatectomy patients in an international web-based survey." Eur J Oncol Nurs 17.6 (December 2013): 775-780.
PMID
23643697
Source
pubmed
Published In
European Journal of Oncology Nursing (EJON)
Volume
17
Issue
6
Publish Date
2013
Start Page
775
End Page
780
DOI
10.1016/j.ejon.2013.03.010

Management of biochemical recurrence after primary treatment of prostate cancer: a systematic review of the literature.

CONTEXT: Despite excellent cancer control with the treatment of localized prostate cancer (PCa), some men will experience a recurrence of disease. The optimal management of recurrent disease remains uncertain. OBJECTIVE: To systematically review recent literature regarding management of biochemical recurrence after primary treatment for localized PCa. EVIDENCE ACQUISITION: A comprehensive systematic review of the literature was performed from 2000 to 2012 to identify articles pertaining to management after recurrent PCa. Search terms included prostate cancer recurrence, salvage therapy, radiorecurrent prostate cancer, post HIFU, post cryoablation, postradiation, and postprostatectomy salvage. Studies were selected according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines and required to provide a comprehensive description of primary and secondary treatments along with outcomes. EVIDENCE SYNTHESIS: The data from 32 original publications were reviewed. The most common option for local salvage therapy after radical prostatectomy (RP) was radiation. Options for local salvage therapy after primary radiation included RP, brachytherapy, and cryotherapy. Different definitions of recurrence and risk profiles among patients make comparative assessment among salvage treatment modalities difficult. Triggers for intervention and factors predicting response to salvage therapy vary. CONCLUSIONS: Radiation therapy (RT) after RP can provide durable prostate-specific antigen (PSA) responses in a sizeable percentage of men, especially when given early (ie, PSA <1 ng/ml). Though a few studies suggest improvements in mortality, prospective randomized trials are needed and underway. The role of salvage treatment after RT is less clear.

Authors
Punnen, S; Cooperberg, MR; D'Amico, AV; Karakiewicz, PI; Moul, JW; Scher, HI; Schlomm, T; Freedland, SJ
MLA Citation
Punnen, S, Cooperberg, MR, D'Amico, AV, Karakiewicz, PI, Moul, JW, Scher, HI, Schlomm, T, and Freedland, SJ. "Management of biochemical recurrence after primary treatment of prostate cancer: a systematic review of the literature." Eur Urol 64.6 (December 2013): 905-915. (Review)
PMID
23721958
Source
pubmed
Published In
European Urology
Volume
64
Issue
6
Publish Date
2013
Start Page
905
End Page
915
DOI
10.1016/j.eururo.2013.05.025

Long-term oncological outcomes of men undergoing radical prostatectomy with preoperative prostate-specific antigen <2.5 ng/ml and 2.5-4 ng/ml.

OBJECTIVES: Prostate-specific antigen (PSA) screening has increased the detection of small, organ-confined tumors, and studies suggest that these patients may have favorable outcomes following radical prostatectomy (RP). To date, there are limited data available on the outcomes of patients diagnosed with low PSA (≤ 4 ng/ml) who underwent RP. This study aimed to evaluate long-term oncological outcomes of patients undergoing RP with preoperative PSA <2.5 and 2.5-4 ng/ml compared with PSA 4.1-10 ng/ml. MATERIALS AND METHODS: Data were analyzed from 3,621 men who underwent RP between 1988 and 2010 at our institution. Patients were stratified into 3 PSA groups: <2.5 ng/ml (n = 280), 2.5-4 ng/ml (n = 563), and 4.1-10 ng/ml (n = 2,778). Patient and disease characteristics were compared. Overall, biochemical disease-free (bDFS), and PCa-specific survivals were analyzed and compared between the groups. Multivariable analyses were conducted using proportional hazards model. RESULTS: Compared with the 4.1-10 ng/ml PSA group, Gleason score >7, extracapsular extension, and non-organ-confined disease were less common in patients with PSA ≤ 4 ng/ml (all P < 0.001). The incidence of organ-confined disease was similar between the PSA < 2.5 and 2.5-4 ng/ml groups while perineural invasion (P = 0.050) and Gleason score ≥ 7 (P = 0.026) were more common in the 2.5-4 ng/ml PSA group. Estimated 10-year overall and PCa-specific survivals were comparable across all PSA groups, whereas bDFS was significantly lower in PSA 4.1-10 group (P < 0.001). bDFS was not statistically different between PSA <2.5 and 2.5-4 groups (P = 0.300). 10-year bDFS were 59.0%, 70.1%, and 76.4% in PSA 4.1-10, 2.5-4, and <2.5, respectively. For the PSA ≤ 4 ng/ml groups, age, race, margin status, pathologic stage, but not PSA were independent predictors of bDFS, whereas age, pathologic Gleason, and biochemical recurrence were associated with overall survival. CONCLUSIONS: Long-term oncological outcomes (overall, bDFS, PCa-specific survivals) of patients presenting with low PSA (≤ 4 ng/ml) were excellent in this study. Compared with PSA 4.1-10 ng/ml, patients presenting with PSA ≤ 4 ng/ml had better bDFS outcomes. However, there was no difference in long-term outcomes between PSA <2.5 and 2.5-4 ng/ml.

Authors
Qi, P; Tsivian, M; Abern, MR; Bañez, LL; Tang, P; Moul, JW; Polascik, TJ
MLA Citation
Qi, P, Tsivian, M, Abern, MR, Bañez, LL, Tang, P, Moul, JW, and Polascik, TJ. "Long-term oncological outcomes of men undergoing radical prostatectomy with preoperative prostate-specific antigen <2.5 ng/ml and 2.5-4 ng/ml." Urol Oncol 31.8 (November 2013): 1527-1532.
PMID
22795501
Source
pubmed
Published In
Urologic Oncology: seminars and original investigations
Volume
31
Issue
8
Publish Date
2013
Start Page
1527
End Page
1532
DOI
10.1016/j.urolonc.2012.06.003

Image Guidance Affects Biochemical Outcome for Postprostatectomy Radiation Therapy

Authors
Koontz, BF; Kalman, NS; Banez, LL; Livengood, KP; Anscher, MS; Moul, JW; Lee, WR
MLA Citation
Koontz, BF, Kalman, NS, Banez, LL, Livengood, KP, Anscher, MS, Moul, JW, and Lee, WR. "Image Guidance Affects Biochemical Outcome for Postprostatectomy Radiation Therapy." October 1, 2013.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
87
Issue
2
Publish Date
2013
Start Page
S362
End Page
S363

Identifying appropriate patients for early salvage radiotherapy after prostatectomy.

PURPOSE: It remains unclear whether relapsed prostate specific antigen at postprostatectomy salvage radiotherapy impacts outcomes as long it is 1.0 ng/ml or less. MATERIALS AND METHODS: We performed a retrospective cohort study of 197 patients treated with salvage radiotherapy in the setting of detectable relapsed prostate specific antigen 1.0 ng/ml or less. Patients were excluded from analysis if they had lymph node involvement or received androgen deprivation therapy. Freedom from prostate specific antigen progression after salvage radiotherapy was analyzed by a Cox regression model. RESULTS: Median relapsed prostate specific antigen was 0.33 ng/ml (range 0.07 to 1.0). There was 86% freedom from prostate specific antigen progression at a median followup of 52 months. Relapsed prostate specific antigen (HR 1.9, p = 0.004), Gleason score 8-10 (HR 5.2, p <0.001) and negative margin status (HR 2.0, p = 0.02) were independently associated with an increased risk of prostate specific antigen progression after salvage radiotherapy. We identified interaction between relapsed prostate specific antigen and Gleason score (p = 0.04) but not margin status. A significant association was noted between higher relapsed prostate specific antigen and prostate specific antigen progression after salvage radiotherapy in patients with Gleason score 8-10 but not 7 or less. In patients with Gleason score 8-10 the rate of freedom from prostate specific antigen progression at 53 months was 77% vs 26% when salvage radiotherapy was initiated at a relapsed prostate specific antigen of 0.33 or less vs 0.34 to 1.0 ng/ml (log rank p = 0.003). CONCLUSIONS: Different relapsed prostate specific antigen thresholds for unsuccessful salvage radiotherapy may exist based on Gleason score. These data suggest that patients with Gleason score 8-10 should be offered salvage radiotherapy at the earliest detectable relapsed prostate specific antigen, even 0.33 ng/ml or less. Those with Gleason score 7 or less may have the opportunity to be followed with serial prostate specific antigen measurements to improve risk stratification, and delay and/or avoid the potential toxicity of salvage radiotherapy.

Authors
Karlin, JD; Koontz, BF; Freedland, SJ; Moul, JW; Grob, BM; Wan, W; Hagan, MP; Anscher, MS; Moghanaki, D
MLA Citation
Karlin, JD, Koontz, BF, Freedland, SJ, Moul, JW, Grob, BM, Wan, W, Hagan, MP, Anscher, MS, and Moghanaki, D. "Identifying appropriate patients for early salvage radiotherapy after prostatectomy." J Urol 190.4 (October 2013): 1410-1415.
PMID
23648223
Source
pubmed
Published In
The Journal of Urology
Volume
190
Issue
4
Publish Date
2013
Start Page
1410
End Page
1415
DOI
10.1016/j.juro.2013.04.078

Phase 1 trial of neoadjuvant radiation therapy before prostatectomy for high-risk prostate cancer.

PURPOSE: To evaluate, in a phase 1 study, the safety of neoadjuvant whole-pelvis radiation therapy (RT) administered immediately before radical prostatectomy in men with high-risk prostate cancer. METHODS AND MATERIALS: Twelve men enrolled and completed a phase 1 single-institution trial between 2006 and 2010. Eligibility required a previously untreated diagnosis of localized but high-risk prostate cancer. Median follow-up was 46 months (range, 14-74 months). Radiation therapy was dose-escalated in a 3 × 3 design with dose levels of 39.6, 45, 50.4, and 54 Gy. The pelvic lymph nodes were treated up to 45 Gy with any additional dose given to the prostate and seminal vesicles. Radical prostatectomy was performed 4-8 weeks after RT completion. Primary outcome measure was intraoperative and postoperative day-30 morbidity. Secondary measures included late morbidity and oncologic outcomes. RESULTS: No intraoperative morbidity was seen. Chronic urinary grade 2+ toxicity occurred in 42%; 2 patients (17%) developed a symptomatic urethral stricture requiring dilation. Two-year actuarial biochemical recurrence-free survival was 67% (95% confidence interval 34%-86%). Patients with pT3 or positive surgical margin treated with neoadjuvant RT had a trend for improved biochemical recurrence-free survival compared with a historical cohort with similar adverse factors. CONCLUSIONS: Neoadjuvant RT is feasible with moderate urinary morbidity. However, oncologic outcomes do not seem to be substantially different from those with selective postoperative RT. If this multimodal approach is further evaluated in a phase 2 setting, 54 Gy should be used in combination with neoadjuvant androgen deprivation therapy to improve biochemical outcomes.

Authors
Koontz, BF; Quaranta, BP; Pura, JA; Lee, WR; Vujaskovic, Z; Gerber, L; Haake, M; Anscher, MS; Robertson, CN; Polascik, TJ; Moul, JW
MLA Citation
Koontz, BF, Quaranta, BP, Pura, JA, Lee, WR, Vujaskovic, Z, Gerber, L, Haake, M, Anscher, MS, Robertson, CN, Polascik, TJ, and Moul, JW. "Phase 1 trial of neoadjuvant radiation therapy before prostatectomy for high-risk prostate cancer." Int J Radiat Oncol Biol Phys 87.1 (September 1, 2013): 88-93.
PMID
23790772
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
87
Issue
1
Publish Date
2013
Start Page
88
End Page
93
DOI
10.1016/j.ijrobp.2013.05.014

A validated prognostic model for predicting overall survival in patients with metastatic chemotherapy naive castrate-resistant prostate cancer

Authors
Halabi, S; Lin, CY; Kelly, WK; Fizazi, K; Moul, JW; Kaplan, E; Morris, MJ; Small, EJ
MLA Citation
Halabi, S, Lin, CY, Kelly, WK, Fizazi, K, Moul, JW, Kaplan, E, Morris, MJ, and Small, EJ. "A validated prognostic model for predicting overall survival in patients with metastatic chemotherapy naive castrate-resistant prostate cancer." September 2013.
Source
wos-lite
Published In
European Journal of Cancer
Volume
49
Publish Date
2013
Start Page
S679
End Page
S679

Re: Early detection of prostate cancer: AUA guideline: H. B. Carter, P. C. Albertsen, M. J. Barry, R. Etzioni, S. J. Freedland, K. L. Greene, L. Holmberg, P. Kantoff, B. R. Konety, M. H. Murad, D. F. Penson and A. L. Zietman J Urol 2013; 190: 419-426.

Authors
Moul, JW; Walsh, PC; Rendell, MS; Lynch, HT; Leslie, SW; Kosoko-Lasaki, O; Fitzgibbons, WP; Powell, I; D'Amico, AV; Catalona, WJ
MLA Citation
Moul, JW, Walsh, PC, Rendell, MS, Lynch, HT, Leslie, SW, Kosoko-Lasaki, O, Fitzgibbons, WP, Powell, I, D'Amico, AV, and Catalona, WJ. "Re: Early detection of prostate cancer: AUA guideline: H. B. Carter, P. C. Albertsen, M. J. Barry, R. Etzioni, S. J. Freedland, K. L. Greene, L. Holmberg, P. Kantoff, B. R. Konety, M. H. Murad, D. F. Penson and A. L. Zietman J Urol 2013; 190: 419-426." J Urol 190.3 (September 2013): 1134-1137. (Letter)
PMID
23871525
Source
pubmed
Published In
The Journal of Urology
Volume
190
Issue
3
Publish Date
2013
Start Page
1134
End Page
1137
DOI
10.1016/j.juro.2013.07.002

A phase 3, placebo controlled study of the safety and efficacy of avanafil for the treatment of erectile dysfunction after nerve sparing radical prostatectomy.

PURPOSE: We evaluated the safety and efficacy of 100 and 200 mg avanafil for the treatment of adult males with erectile dysfunction after bilateral nerve sparing radical prostatectomy. MATERIALS AND METHODS: This was a double-blind, placebo controlled, parallel group, phase 3 study in males age 18 to 70 years with a history of erectile dysfunction of 6 months or more after bilateral nerve sparing radical prostatectomy. Patients were randomized to 100 or 200 mg avanafil or placebo (taken 30 minutes before sexual activity) for 12 weeks. Primary end points included successful vaginal insertion (Sexual Encounter Profile [SEP] question 2), successful intercourse (SEP3) and change in score on the erectile function domain of the International Index of Erectile Function (IIEF-EF) questionnaire. RESULTS: A total of 298 patients were randomized and 84.6% completed the study. At baseline 16.1% were age 65 years or older and 71.5% had severe erectile dysfunction (mean overall IIEF-EF domain score 9.2). After 12 weeks there were significantly greater increases in SEP2 and SEP3 and change in mean IIEF-EF domain score with 100 and 200 mg avanafil vs placebo (p <0.01). Following dosing with avanafil 36.4% (28 of 77) of sexual attempts (SEP3) at 15 minutes or less were successful vs 4.5% (2 of 44) for placebo (p <0.01). Avanafil was generally well tolerated. No serious adverse events were reported and fewer than 2% of patients discontinued the study due to an adverse event. CONCLUSIONS: Avanafil in 100 and 200 mg doses was effective and well tolerated in improving erectile function after prostatectomy. Results suggest a rapid onset of action and sustained duration of effect, with all 3 primary end points being achieved at both dose levels.

Authors
Mulhall, JP; Burnett, AL; Wang, R; McVary, KT; Moul, JW; Bowden, CH; DiDonato, K; Shih, W; Day, WW
MLA Citation
Mulhall, JP, Burnett, AL, Wang, R, McVary, KT, Moul, JW, Bowden, CH, DiDonato, K, Shih, W, and Day, WW. "A phase 3, placebo controlled study of the safety and efficacy of avanafil for the treatment of erectile dysfunction after nerve sparing radical prostatectomy." J Urol 189.6 (June 2013): 2229-2236.
PMID
23219537
Source
pubmed
Published In
The Journal of Urology
Volume
189
Issue
6
Publish Date
2013
Start Page
2229
End Page
2236
DOI
10.1016/j.juro.2012.11.177

Phase III, randomized, placebo-controlled study of once-daily oral zibotentan (ZD4054) in patients with non-metastatic castration-resistant prostate cancer.

BACKGROUND: Standard treatment options are limited for the management of non-metastatic castration-resistant prostate cancer (CRPC). This study, part of the ENTHUSE (EndoTHelin A USE) phase III programme, evaluated the efficacy and safety of the oral specific endothelin (ET)A receptor antagonist zibotentan vs placebo in patients with non-metastatic CRPC (non-mCRPC). METHODS: This was a multicentre, randomized, double-blind, phase III study. Patients (n=1421) with non-mCRPC and biochemical progression (determined by rising serum PSA levels) were randomized to receive zibotentan 10 mg or placebo once daily. Based on the lack of efficacy signal in another ENTHUSE phase III study, an interim analysis was performed to determine whether the study was likely to achieve the co-primary objectives of improved overall survival (OS) and progression-free survival (PFS). RESULTS: Criteria for continuation of this study were not met. A total of 79 deaths and 293 progression events were recorded at final data cutoff. Zibotentan-treated patients did not significantly differ from placebo-treated patients for OS (hazard ratio (HR): 1.13; 95% confidence interval (CI): 0.73-1.76, P=0.589) or PFS (HR: 0.89; 95% CI: 0.71-1.12, P=0.330). The most commonly reported adverse events in zibotentan-treated patients were peripheral oedema (37.7%), headache (26.2%) and nasal congestion (24.9%); each occurred with >15% higher incidence than in the placebo group. CONCLUSIONS: This trial was terminated early because of failure at interim analysis of the efficacy data to meet the defined criteria for continuation. Owing to the absence of demonstrable survival benefits in the ENTHUSE clinical studies, zibotentan is no longer under investigation as a potential treatment for prostate cancer.

Authors
Miller, K; Moul, JW; Gleave, M; Fizazi, K; Nelson, JB; Morris, T; Nathan, FE; McIntosh, S; Pemberton, K; Higano, CS
MLA Citation
Miller, K, Moul, JW, Gleave, M, Fizazi, K, Nelson, JB, Morris, T, Nathan, FE, McIntosh, S, Pemberton, K, and Higano, CS. "Phase III, randomized, placebo-controlled study of once-daily oral zibotentan (ZD4054) in patients with non-metastatic castration-resistant prostate cancer." Prostate Cancer Prostatic Dis 16.2 (June 2013): 187-192.
PMID
23381694
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
16
Issue
2
Publish Date
2013
Start Page
187
End Page
192
DOI
10.1038/pcan.2013.2

Prostate cancer: active surveillance in African American men.

Authors
Moul, JW
MLA Citation
Moul, JW. "Prostate cancer: active surveillance in African American men." Nat Rev Urol 10.6 (June 2013): 311-312.
PMID
23649288
Source
pubmed
Published In
Nature Reviews Urology
Volume
10
Issue
6
Publish Date
2013
Start Page
311
End Page
312
DOI
10.1038/nrurol.2013.97

Phase III, randomized, placebo-controlled study of docetaxel in combination with zibotentan in patients with metastatic castration-resistant prostate cancer.

PURPOSE As part of the ENTHUSE (Endothelin A Use) program, the efficacy and safety of zibotentan (ZD4054), an oral specific endothelin A receptor antagonist, has been investigated in combination with docetaxel in patients with metastatic castration-resistant prostate cancer (CRPC). PATIENTS AND METHODS In this randomized, double-blind, placebo-controlled, phase III study, patients received intravenous docetaxel 75 mg/m(2) on day 1 of 21-day cycles plus oral zibotentan 10 mg or placebo once daily. The primary end point was overall survival (OS). Secondary end points included time to pain and prostate-specific antigen (PSA) progression, pain and PSA response, progression-free survival, health-related quality of life, and safety. Results A total of 1,052 patients received study treatment (docetaxel-zibotentan, n = 524; docetaxel-placebo, n = 528). At the time of data cutoff, there had been 277 and 280 deaths, respectively. There was no difference in OS for patients receiving docetaxel-zibotentan compared with those receiving docetaxel-placebo (hazard ratio, 1.00; 95% CI, 0.84 to 1.18; P = .963). No significant differences were observed on secondary end points, including time to pain progression (median 9.3 v 10.0 months, respectively) or pain response (odds ratio, 0.84; 95% CI, 0.61 to 1.16; P = .283). The median time to death was 20.0 and 19.2 months for the zibotentan and placebo groups, respectively. The most commonly reported adverse events in zibotentan-treated patients were peripheral edema (52.7%), diarrhea (35.4%), alopecia (33.9%), and nausea (33.3%). CONCLUSION Docetaxel plus zibotentan 10 mg/d did not result in a significant improvement in OS compared with docetaxel plus placebo in patients with metastatic CRPC.

Authors
Fizazi, K; Higano, CS; Nelson, JB; Gleave, M; Miller, K; Morris, T; Nathan, FE; McIntosh, S; Pemberton, K; Moul, JW
MLA Citation
Fizazi, K, Higano, CS, Nelson, JB, Gleave, M, Miller, K, Morris, T, Nathan, FE, McIntosh, S, Pemberton, K, and Moul, JW. "Phase III, randomized, placebo-controlled study of docetaxel in combination with zibotentan in patients with metastatic castration-resistant prostate cancer." J Clin Oncol 31.14 (May 10, 2013): 1740-1747.
PMID
23569308
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
31
Issue
14
Publish Date
2013
Start Page
1740
End Page
1747
DOI
10.1200/JCO.2012.46.4149

Flaxseed-derived enterolactone is inversely associated with tumor cell proliferation in men with localized prostate cancer.

Enterolactone and enterodiol, mammalian lignans derived from dietary sources such as flaxseed, sesame seeds, kale, broccoli, and apricots, may impede tumor proliferation by inhibiting activation of nuclear factor kappa B (NFκB) and vascular endothelial growth factor (VEGF). We examined the associations between urinary enterolactone and enterodiol with prostatic tumor expression of NFκB, VEGF, and Ki67 among 147 patients with prostate cancer who participated in a presurgical trial of flaxseed supplementation (30 g/day) for ~30 days. Urinary enterolignans and tissue biomarkers were determined by high-performance liquid chromatography and immunohistochemistry, respectively. After supplementation, we observed significant correlations between intakes of plant lignan and urinary concentrations of total enterolignans (ρ=0.677, P<.0001), enterolactone (ρ=0.676, P<.0001), and enterodiol (ρ=0.628, P<.0001). Importantly, we observed that total urinary enterolignans and enterolactone were significantly and inversely correlated with Ki67 in the tumor tissue (ρ=-0.217, P=.011, and ρ=-0.230, P=.007, respectively), and a near-significant inverse association was observed for enterodiol (ρ=-0.159, P=.064). An inverse association was observed between enterolactone and VEGF (ρ=-0.143, P=.141), although this did not reach statistical significance. We did not observe an association between enterolignans and NFκB. In conclusion, flaxseed-derived enterolignans may hinder cancer cell proliferation via VEGF-associated pathways.

Authors
Azrad, M; Vollmer, RT; Madden, J; Dewhirst, M; Polascik, TJ; Snyder, DC; Ruffin, MT; Moul, JW; Brenner, DE; Demark-Wahnefried, W
MLA Citation
Azrad, M, Vollmer, RT, Madden, J, Dewhirst, M, Polascik, TJ, Snyder, DC, Ruffin, MT, Moul, JW, Brenner, DE, and Demark-Wahnefried, W. "Flaxseed-derived enterolactone is inversely associated with tumor cell proliferation in men with localized prostate cancer." J Med Food 16.4 (April 2013): 357-360.
PMID
23566060
Source
pubmed
Published In
Journal of Medicinal Food
Volume
16
Issue
4
Publish Date
2013
Start Page
357
End Page
360
DOI
10.1089/jmf.2012.0159

Race is associated with discontinuation of active surveillance of low-risk prostate cancer: results from the Duke Prostate Center.

BACKGROUND: Active surveillance (AS) is increasingly utilized in low-risk prostate cancer (PC) patients. Although black race has traditionally been associated with adverse PC characteristics, its prognostic value for patients managed with AS is unclear. METHODS: A retrospective review identified 145 patients managed with AS at the Duke Prostate Center from January 2005 to September 2011. Race was patient-reported and categorized as black, white or other. Inclusion criteria included PSA <10 ng ml(-1), Gleason sum ≤ 6, and ≤ 33% of cores with cancer on diagnostic biopsy. The primary outcome was discontinuation of AS for treatment due to PC progression. In men who proceeded to treatment after AS, the trigger for treatment, follow-up PSA and biopsy characteristics were analyzed. Time to treatment was analyzed with univariable and multivariable Cox proportional hazards models and also stratified by race. RESULTS: In our AS cohort, 105 (72%) were white, 32 (22%) black and 8 (6%) another race. Median follow-up was 23.0 months, during which 23% percent of men proceeded to treatment. The demographic, clinical and follow-up characteristics did not differ by race. There was a trend toward more uninsured black men (15.6% black, 3.8% white, 0% other, P = 0.06). Black race was associated with treatment (hazard ratio (HR) 2.93, P = 0.01) as compared with white. When the analysis was adjusted for socioeconomic and clinical parameters at the time of PC diagnosis, black race remained the sole predictor of treatment (HR 3.08, P = 0.01). Among men undergoing treatment, the trigger was less often patient driven in black men (8 black, 33 white, 67% other, P = 0.05). CONCLUSIONS: Black race was associated with discontinuation of AS for treatment. This relationship persisted when adjusted for socioeconomic and clinical parameters.

Authors
Abern, MR; Bassett, MR; Tsivian, M; Bañez, LL; Polascik, TJ; Ferrandino, MN; Robertson, CN; Freedland, SJ; Moul, JW
MLA Citation
Abern, MR, Bassett, MR, Tsivian, M, Bañez, LL, Polascik, TJ, Ferrandino, MN, Robertson, CN, Freedland, SJ, and Moul, JW. "Race is associated with discontinuation of active surveillance of low-risk prostate cancer: results from the Duke Prostate Center." Prostate Cancer Prostatic Dis 16.1 (March 2013): 85-90.
PMID
23069729
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
16
Issue
1
Publish Date
2013
Start Page
85
End Page
90
DOI
10.1038/pcan.2012.38

Preoperative predictors of pathologic stage T2a and pathologic Gleason score ≤ 6 in men with clinical low-risk prostate cancer treated with radical prostatectomy: reference for active surveillance.

To assess preoperative parameters that may be predictive of pathologic stage T2a (pT2a) and pathologic Gleason score (pGS) ≤ 6 disease in low-risk prostate cancer patients considering active surveillance. A cohort of 1,495 men with low-risk prostate cancer between 1993 and 2009 was utilized. Preoperative assessment focused on patient age, race, diagnostic PSA level, clinical stage, diagnostic biopsy Gleason score, and prostate cancer laterality. Kaplan-Meier curves and a Cox regression model were used for analysis of PSA recurrence. Preoperative parameters were analyzed by univariate and multivariate logistic regression methods. Of 1,495 patients, 187 (12.5 %) were identified with pT2a and pGS ≤ 6 disease. Of the 187 men with pT2a and pGS ≤ 6 disease, only 6 (3.2 %) cases had PSA recurrence. Kaplan-Meier PSA recurrence-free survival curves identified a difference between prostate cancers with pT2a and pGS ≤ 6 and prostate cancers with >pT2a or pGS ≥ 7 disease (p = 0.002). Only biopsy tumor unilaterality (OR, 10.452; p ≤ 0.001) and low diagnostic PSA levels (OR, 0.887; p = 0.003) were independent predictors of prostate cancers with pT2a and pGS ≤ 6 disease on univariate and multivariate logistic regression. Biopsy tumor unilaterality and low diagnostic PSA levels are the independent predictors of pT2a and pGS ≤ 6 disease in low-risk prostate cancer patients. Unilateral cancer by prostate biopsy and low diagnostic PSA level may be the reference to improving the selection of appropriate candidates for active surveillance within a low-risk prostate cancer cohort.

Authors
Fu, Q; Moul, JW; Bañez, L; Sun, L; Mouraviev, V; Xie, D; Polascik, TJ
MLA Citation
Fu, Q, Moul, JW, Bañez, L, Sun, L, Mouraviev, V, Xie, D, and Polascik, TJ. "Preoperative predictors of pathologic stage T2a and pathologic Gleason score ≤ 6 in men with clinical low-risk prostate cancer treated with radical prostatectomy: reference for active surveillance." Med Oncol 30.1 (March 2013): 326-.
PMID
23263824
Source
pubmed
Published In
Medical Oncology
Volume
30
Issue
1
Publish Date
2013
Start Page
326
DOI
10.1007/s12032-012-0326-5

African-American men with low-grade prostate cancer have higher tumor burdens: results from the Duke Prostate Center.

BACKGROUND: To investigate racial differences in tumor burden (cancer volume, cancer percentage and cancer to PSA ratios) in a large cohort of men undergoing radical prostatectomy (RP). METHODS: Demographic, clinical and pathological data of patients undergoing RP between 1993-2010 were reviewed and compared between African-American (AA) and non African-American (nAA) men. Further assessments of pathological tumor burden (estimated tumor volume, percent of cancer involvement, and estimated tumor volume/PSA ratios) were performed across Gleason score categories. RESULTS: Of 4157 patients in the analysis, 604 (14.5%) were AA. Overall, AA patients were younger, had higher Gleason scores, PSA levels and incidence of palpable disease (all P < 0.001). Despite comparable prostate weights (39.4 vs. 39.6 g), AA men had higher percent cancer involvement and estimated tumor volume (all P < 0.001) but similar estimated tumor volume/PSA ratios ( P> 0.05). When stratified by Gleason scores, prostate weights were comparable; however, estimated tumor volume, percent cancer involvement and estimated tumor volume/PSA ratios were higher in AA men with low grade (≤ 6) prostate cancer (PCa), similar in intermediate grade (7-8) and lower in high grade (9-10) PCa compared to nAA men. CONCLUSIONS: In this large series, AA patients had higher disease burden (estimated tumor volume, percent cancer involvement, estimated tumor volume/PSA ratios) compared to nAA but this association was especially pronounced in low grade (Gleason ≤ 6) cancers. These data depict a complex picture of relations between race and tumor burden across the spectrum of PCa aggressiveness. Further investigation is warranted to understand the mechanisms of racial disparities in PCa.

Authors
Tsivian, M; Bañez, LL; Keto, CJ; Abern, MR; Qi, P; Gerber, L; Moul, JW; Polascik, TJ
MLA Citation
Tsivian, M, Bañez, LL, Keto, CJ, Abern, MR, Qi, P, Gerber, L, Moul, JW, and Polascik, TJ. "African-American men with low-grade prostate cancer have higher tumor burdens: results from the Duke Prostate Center." Prostate Cancer Prostatic Dis 16.1 (March 2013): 91-94.
PMID
23032361
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
16
Issue
1
Publish Date
2013
Start Page
91
End Page
94
DOI
10.1038/pcan.2012.39

Sexual bother and function after radical prostatectomy: predictors of sexual bother recovery in men despite persistent post-operative sexual dysfunction.

Changes in sexual bother (SB) following radical prostatectomy (RP) negatively affect health-related quality of life (HRQoL) of prostate cancer survivors. However, post-operative SB tends to be neglected whereas sexual function (SF) is thoroughly assessed in clinical practice and few studies have focused on and evaluated patients' SB. We retrospectively reviewed 2 345 consecutive patients who underwent RP between 2001 and 2009 at a single institution. SF and SB were assessed using Expanded Prostate Cancer Index Composite (EPIC) questionnaires. We stratified our cohort by SB recovery and post-operative SF status, including a subset of men who recovered SB despite persistent post-RP sexual dysfunction. Multivariable logistic regression analyses were conducted to identify factors for men who have SB recovery. Of 319 eligible patients, 133 (41.7%) recovered their SB at a mean of 20 months after RP. Among the 133 men who demonstrated SB recovery, 109 had post-operative sexual dysfunction. Patients with SB recovery despite post-RP sexual dysfunction were more likely to be old (p = 0.004), to have higher clinical T stage (p < 0.001), to have more non-nerve-sparing RP (p < 0.001), to have lower pre-operative EPIC-SF/SB scores (p < 0.001), to have more extracapsular extension (p = 0.031) and to be PDE5i non-users after surgery (p < 0.001). In multivariable analysis, predictors for this subset were lower comorbidity (OR 0.62, p = 0.043), higher clinical cancer stage (OR 2.35, p = 0.026), worse pre-operative SF (OR 0.98, p = 0.010), SB (OR 0.98, p < 0.010) and no PDE5i use (OR 0.37, p = 0.002); age was not related (OR 0.99, p = 0.555). As SB can influence patients' overall HRQoL, expectations of SB recovery should be provided to patients in the same way that SF recovery is presented. This study may help clinicians to discuss SB with patients and assess their potential for SB recovery following RP.

Authors
Kimura, M; Bañez, LL; Polascik, TJ; Bernal, RM; Gerber, L; Robertson, CN; Donatucci, CF; Moul, JW
MLA Citation
Kimura, M, Bañez, LL, Polascik, TJ, Bernal, RM, Gerber, L, Robertson, CN, Donatucci, CF, and Moul, JW. "Sexual bother and function after radical prostatectomy: predictors of sexual bother recovery in men despite persistent post-operative sexual dysfunction." Andrology 1.2 (March 2013): 256-261.
PMID
23413138
Source
pubmed
Published In
Andrology
Volume
1
Issue
2
Publish Date
2013
Start Page
256
End Page
261
DOI
10.1111/j.2047-2927.2012.00036.x

Image guidance for post-prostatectomy radiotherapy: Are we missing the mark?

Authors
Kalman, NS; Banez, LL; Gerber, L; Moul, JW; Anscher, MS; Lee, WR; Koontz, BF
MLA Citation
Kalman, NS, Banez, LL, Gerber, L, Moul, JW, Anscher, MS, Lee, WR, and Koontz, BF. "Image guidance for post-prostatectomy radiotherapy: Are we missing the mark?." February 20, 2013.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
31
Issue
6
Publish Date
2013

Value of NADiA ProsVue on the CAPRA-S nomogram for predicting postprostatectomy clinical recurrence

Authors
Moul, JW; Lilja, H; Lance, R; Vessella, R; McDermed, JE; Sarno, MJ; Adams, TH
MLA Citation
Moul, JW, Lilja, H, Lance, R, Vessella, R, McDermed, JE, Sarno, MJ, and Adams, TH. "Value of NADiA ProsVue on the CAPRA-S nomogram for predicting postprostatectomy clinical recurrence." February 20, 2013.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
31
Issue
6
Publish Date
2013

Image guidance for post-prostatectomy radiotherapy: Are we missing the mark?

56 Background: Image-guided radiation therapy (IGRT) has been widely adopted for both definitive and post-operative prostate radiotherapy. In the postoperative setting, numerous studies of prostate bed motion have recommended tight planning margins (<10mm) if IGRT is used daily. The purpose of this analysis is to determine the effect of IGRT on the efficacy and toxicity of post-operative prostate radiotherapy.Between 1998 and 2010, 286 patients received radiation therapy after prostatectomy at Duke. Recurrent disease following radiation therapy was defined as PSA >0.2 ng/ml and rising or initiation of salvage ADT. CTCAE v 4.0 and the RTOG/LENT late morbidity scores were used to grade acute and late toxicities. Risk for biochemical failure and late Grade 2+ GI toxicity were compared between IGRT (N = 113) and non-IGRT (N = 173) patients using multivariable adjusted Cox regression controlling for age, treatment technique (3D vs IMRT), radiation dose, androgen suppression, pathologic Gleason Score, margin status, pathologic stage, and pre-radiotherapy PSA level.The median margin size for patients with IGRT was 7mm (IQR 6-10mm) and 15mm (IQR 7-15mm) for those without IGRT (p < 0.001). Median follow up was 21 months (IQR 15-33 mo) for patients with IGRT and 49 months (IQR 30-73 mo) for those without IGRT (p < 0.001). On multivariate analysis, patients treated with IGRT had a greater risk of progression versus non-daily imaging (HR = 2.51, p < 0.001), as did patients who received salvage versus adjuvant radiotherapy (HR = 2.41, p = 0.005). Higher pathologic Gleason Score (HR = 1.96, p = 0.026) and pathologic stage (HR = 1.93, p = 0.003) conferred increased risk of progression, while positive margin status was protective (HR = 0.53, p = 0.002). Age, radiation dose, androgen suppression, and treatment technique did not affect biochemical outcome (p > 0.1). There were no differences in acute or late GI toxicity according to treatment technique or use of IGRT (both p > 0.1).The use of IGRT was associated with increased biochemical recurrence for patients receiving post-operative prostate radiotherapy. For these patients, we recommend using treatment margins of at least 10mm to address subclinical disease and organ motion.

Authors
Banez, LL; Gerber, L; Moul, JW; Anscher, MS; Lee, WR; Koontz, BF
MLA Citation
Banez, LL, Gerber, L, Moul, JW, Anscher, MS, Lee, WR, and Koontz, BF. "Image guidance for post-prostatectomy radiotherapy: Are we missing the mark?." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 31.6_suppl (February 2013): 56-.
PMID
28137048
Source
epmc
Published In
Journal of Clinical Oncology
Volume
31
Issue
6_suppl
Publish Date
2013
Start Page
56

Race is associated with discontinuation of active surveillance of low-risk prostate cancer: Results from the Duke Prostate Center

Background:Active surveillance (AS) is increasingly utilized in low-risk prostate cancer (PC) patients. Although black race has traditionally been associated with adverse PC characteristics, its prognostic value for patients managed with AS is unclear.Methods:A retrospective review identified 145 patients managed with AS at the Duke Prostate Center from January 2005 to September 2011. Race was patient-reported and categorized as black, white or other. Inclusion criteria included PSA <10 ng ml -1, Gleason sum ≤6, and ≤33% of cores with cancer on diagnostic biopsy. The primary outcome was discontinuation of AS for treatment due to PC progression. In men who proceeded to treatment after AS, the trigger for treatment, follow-up PSA and biopsy characteristics were analyzed. Time to treatment was analyzed with univariable and multivariable Cox proportional hazards models and also stratified by race.Results:In our AS cohort, 105 (72%) were white, 32 (22%) black and 8 (6%) another race. Median follow-up was 23.0 months, during which 23% percent of men proceeded to treatment. The demographic, clinical and follow-up characteristics did not differ by race. There was a trend toward more uninsured black men (15.6% black, 3.8% white, 0% other, P=0.06). Black race was associated with treatment (hazard ratio (HR) 2.93, P=0.01) as compared with white. When the analysis was adjusted for socioeconomic and clinical parameters at the time of PC diagnosis, black race remained the sole predictor of treatment (HR 3.08, P=0.01). Among men undergoing treatment, the trigger was less often patient driven in black men (8 black, 33 white, 67% other, P=0.05).Conclusions:Black race was associated with discontinuation of AS for treatment. This relationship persisted when adjusted for socioeconomic and clinical parameters. © 2013 Macmillan Publishers Limited. All rights reserved.

Authors
Abern, MR; Bassett, MR; Tsivian, M; Bañez, LL; Polascik, TJ; Ferrandino, MN; Robertson, CN; Freedland, SJ; Moul, JW
MLA Citation
Abern, MR, Bassett, MR, Tsivian, M, Bañez, LL, Polascik, TJ, Ferrandino, MN, Robertson, CN, Freedland, SJ, and Moul, JW. "Race is associated with discontinuation of active surveillance of low-risk prostate cancer: Results from the Duke Prostate Center." Prostate Cancer and Prostatic Diseases 16.1 (2013): 84-89.
Source
scival
Published In
Prostate Cancer and Prostatic Diseases
Volume
16
Issue
1
Publish Date
2013
Start Page
84
End Page
89
DOI
10.1038/pcan.2012.38

Preoperative predictors of pathologic stage T2a and pathologic Gleason score ≤ 6 in men with clinical low-risk prostate cancer treated with radical prostatectomy: reference for active surveillance.

To assess preoperative parameters that may be predictive of pathologic stage T2a (pT2a) and pathologic Gleason score (pGS) ≤ 6 disease in low-risk prostate cancer patients considering active surveillance. A cohort of 1,495 men with low-risk prostate cancer between 1993 and 2009 was utilized. Preoperative assessment focused on patient age, race, diagnostic PSA level, clinical stage, diagnostic biopsy Gleason score, and prostate cancer laterality. Kaplan-Meier curves and a Cox regression model were used for analysis of PSA recurrence. Preoperative parameters were analyzed by univariate and multivariate logistic regression methods. Of 1,495 patients, 187 (12.5 %) were identified with pT2a and pGS ≤ 6 disease. Of the 187 men with pT2a and pGS ≤ 6 disease, only 6 (3.2 %) cases had PSA recurrence. Kaplan-Meier PSA recurrence-free survival curves identified a difference between prostate cancers with pT2a and pGS ≤ 6 and prostate cancers with >pT2a or pGS ≥ 7 disease (p = 0.002). Only biopsy tumor unilaterality (OR, 10.452; p ≤ 0.001) and low diagnostic PSA levels (OR, 0.887; p = 0.003) were independent predictors of prostate cancers with pT2a and pGS ≤ 6 disease on univariate and multivariate logistic regression. Biopsy tumor unilaterality and low diagnostic PSA levels are the independent predictors of pT2a and pGS ≤ 6 disease in low-risk prostate cancer patients. Unilateral cancer by prostate biopsy and low diagnostic PSA level may be the reference to improving the selection of appropriate candidates for active surveillance within a low-risk prostate cancer cohort.

Authors
Fu, Q; Moul, JW; Bañez, L; Sun, L; Mouraviev, V; Xie, D; Polascik, TJ
MLA Citation
Fu, Q, Moul, JW, Bañez, L, Sun, L, Mouraviev, V, Xie, D, and Polascik, TJ. "Preoperative predictors of pathologic stage T2a and pathologic Gleason score ≤ 6 in men with clinical low-risk prostate cancer treated with radical prostatectomy: reference for active surveillance." Medical oncology (Northwood, London, England) 30.1 (2013): 326--.
Source
scival
Published In
Medical Oncology
Volume
30
Issue
1
Publish Date
2013
Start Page
326-
DOI
10.1007/s12032-012-0326-5

Oncologist roundtable: Is the Zaltrap pricing reversal a 'watershed moment'?

Authors
Moul, JW; Moore, MJ; III, HAB
MLA Citation
Moul, JW, Moore, MJ, and III, HAB. "Oncologist roundtable: Is the Zaltrap pricing reversal a 'watershed moment'?." Oncology Report JAN (2013): 9--.
Source
scival
Published In
Oncology Report
Issue
JAN
Publish Date
2013
Start Page
9-

Predicting participation in and successful outcome of a penile rehabilitation programme using a phosphodiesterase type 5 inhibitor with a vacuum erection device after radical prostatectomy.

UNLABELLED: Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? The role of the vacuum erection device (VED) has increased with its use in combined therapy with a phosphodiesterase type 5 inhibitor (PDE5i) for penile rehabilitation after radical prostatectomy (RP) and radiotherapy. The advantages of the VED are non-invasive, cost-effective, and a possibility of preventing shrinkage of penis length. Albeit current widespread use of penile rehabilitation programmes for post-RP erectile dysfunction, independent predictors for the rehabilitation participants, as well as for its treatment success have not been fully investigated. In the present study, we have added several new predictors for rehabilitation participation, e.g. African-Americans and higher preoperative sexual function. Conversely, higher preoperative PSA concentrations and the presence of positive surgical margins were predictors for avoidance of rehabilitation. Notably, there was a primary surgeon difference, which had a trend for predicting outcome of the rehabilitation among the participants, implying their surgical technique and follow-up might influence success of the rehabilitation. OBJECTIVES: • To investigate baseline demographic and clinicopathological characteristics of men who participate in our penile rehabilitation programme after radical prostatectomy (RP). • To determine predictors for participation in rehabilitation, as well as successful rehabilitation outcome using multivariable logistic regression analyses. PATIENTS AND METHODS: • We analysed data on 2345 consecutive patients who underwent RP between 2001 and 2009 in our institution. • The decision to participate in penile rehabilitation using phosphodiesterase type 5 inhibitor (PDE5i) with a vacuum erection device (VED) was based on the patient's choice after post-RP discussions. • Rehabilitation success was defined using the following criteria: (i) patients who continued the penile rehabilitation programme and did not switch treatment from PDE5i to other erectile aids, (ii) success was noted in men who had an Expanded Prostate Cancer Index Composite (EPIC) sexual function (SF) score of >75% of the patient's baseline EPIC score, and (iii) patients who answered that they achieved adequate erections with a PDE5i. • Logistic regression analysis was used to identify factors associated with treatment participation and its success. RESULTS: • Of 676 patients, 354 (53.2%) men participated in a penile rehabilitation programme. Among 329 rehabilitation participants with available data, 96 (29.2%) had treatment success. • In multivariable regression analysis, African-Americans (odds ratio [OR] 3.47, P < 0.001), and higher preoperative SF (OR 1.02, P < 0.001) were associated with participation in rehabilitation. • Higher preoperative PSA concentration (OR 0.50, P = 0.004) and presence of positive surgical margins (OR 0.68, P = 0.042) were found to be independent predictors for non-participation in the rehabilitation. • For rehabilitation outcomes, being older at surgery (OR 0.93, P = 0.001) and adjuvant therapy (OR 0.34, P = 0.047) had a negative association with successful outcome. • There was a trend in the relationship between primary surgeon and rehabilitation success (OR 1.05, P = 0.053) CONCLUSIONS: • Those patients who have risk factors, e.g. adverse prostate cancer features, need to be carefully counselled and encouraged to participate in the penile rehabilitation programme. • Clinicians could lead patients toward successful outcomes if appropriate surgical techniques and rehabilitation are provided.

Authors
Kimura, M; Caso, JR; Bañez, LL; Koontz, BF; Gerber, L; Senocak, C; Donatucci, CF; Vujaskovic, Z; Moul, JW; Polascik, TJ
MLA Citation
Kimura, M, Caso, JR, Bañez, LL, Koontz, BF, Gerber, L, Senocak, C, Donatucci, CF, Vujaskovic, Z, Moul, JW, and Polascik, TJ. "Predicting participation in and successful outcome of a penile rehabilitation programme using a phosphodiesterase type 5 inhibitor with a vacuum erection device after radical prostatectomy." BJU Int 110.11 Pt C (December 2012): E931-E938.
PMID
22520165
Source
pubmed
Published In
Bju International
Volume
110
Issue
11 Pt C
Publish Date
2012
Start Page
E931
End Page
E938
DOI
10.1111/j.1464-410X.2012.11168.x

NADiA ProsVue prostate-specific antigen slope is an independent prognostic marker for identifying men at reduced risk of clinical recurrence of prostate cancer after radical prostatectomy.

OBJECTIVE: To validate the hypothesis that men displaying serum prostate-specific antigen (PSA) slopes ≤ 2.0 pg/mL/mo after prostatectomy, measured using a new immuno-polymerase chain reaction diagnostic test (NADiA ProsVue), have a reduced risk of clinical recurrence as determined by positive biopsy, imaging findings, or death from prostate cancer. MATERIALS AND METHODS: From 4 clinical sites, we selected a cohort of 304 men who had been followed up for 17.6 years after prostatectomy for clinical recurrence. We assessed the prognostic value of a PSA slope cutpoint of 2.0 pg/mL/mo against established risk factors to identify men at low risk of clinical recurrence using uni- and multivariate Cox proportional hazards regression and Kaplan-Meier analyses. RESULTS: The univariate hazard ratio of a PSA slope >2.0 pg/mL/mo was 18.3 (95% confidence interval 10.6-31.8) compared with a slope ≤ 2.0 pg/mL/mo (P <.0001). The median disease-free survival interval was 4.8 years vs >10 years in the 2 groups (P <.0001). The multivariate hazard ratio for PSA slope with the covariates of preprostatectomy PSA, pathologic stage, and Gleason score was 9.8 (95% confidence interval 5.4-17.8), an 89.8% risk reduction for men with PSA slopes ≤ 2.0 pg/mL/mo (P <.0001). The Gleason score (<7 vs ≥ 7) was the only other significant predictor (hazard ratio 5.4, 95% confidence interval 2.1-13.8, P = .0004). CONCLUSION: Clinical recurrence after radical prostatectomy is difficult to predict using established risk factors. We have demonstrated that a NADiA ProsVue PSA slope of ≤ 2.0 pg/mL/mo after prostatectomy is prognostic for a reduced risk of prostate cancer recurrence and adds predictive power to the established risk factors.

Authors
Moul, JW; Lilja, H; Semmes, OJ; Lance, RS; Vessella, RL; Fleisher, M; Mazzola, C; Sarno, MJ; Stevens, B; Klem, RE; McDermed, JE; Triebell, MT; Adams, TH
MLA Citation
Moul, JW, Lilja, H, Semmes, OJ, Lance, RS, Vessella, RL, Fleisher, M, Mazzola, C, Sarno, MJ, Stevens, B, Klem, RE, McDermed, JE, Triebell, MT, and Adams, TH. "NADiA ProsVue prostate-specific antigen slope is an independent prognostic marker for identifying men at reduced risk of clinical recurrence of prostate cancer after radical prostatectomy." Urology 80.6 (December 2012): 1319-1325.
PMID
23107099
Source
pubmed
Published In
Urology
Volume
80
Issue
6
Publish Date
2012
Start Page
1319
End Page
1325
DOI
10.1016/j.urology.2012.06.080

Does variation in either age at start of therapy or duration of therapy make chemoprevention with finasteride cost-effective?

BACKGROUND: Incremental cost-effectiveness ratios (ICERs) of finasteride for prostate cancer prevention are consistent with estimates beyond $100 000 per quality-adjusted life-year (QALY). The majority of these analyses are based on chemoprevention starting in men aged 50-55 years. We sought to evaluate the impact of varying both age at commencement of therapy and length of therapy on the cost-effectiveness of finasteride. METHODS: A probabilistic Markov model was designed to estimate lifetime prostate health-related costs and quality-adjusted survival for men receiving or not receiving chemoprevention with finasteride. ICERs across scenarios varying age at start of therapy and duration of chemoprevention were compared. RESULTS: The ICER for men starting chemoprevention at age 50 and continuing to age 75 was $88 800 per QALY when assuming finasteride causes a constant risk reduction across all tumor grades (base case 1) and $142 300 per QALY when assuming a differential treatment effect according to Gleason score (base case 2). When starting age is increased, the ICERs trend downward and nadir at 65 years to $64 700 per QALY (base case 1) and $118 600 per QALY (base case 2). Altering duration of therapy had minimal impact. Patient-level experiences with finasteride and BPH significantly influenced the cost-effectiveness of chemoprevention. CONCLUSIONS: Initiating chemoprevention at ages when prostate cancer incidence is higher improves its cost-effectiveness profile. Only when assuming a constant risk reduction for all tumor grades, did finasteride fall below $100 000 per QALY, but this finding was not upheld when accounting for side effects associated with the drug.

Authors
Stewart, SB; Scales, CD; Moul, JW; Reed, SD
MLA Citation
Stewart, SB, Scales, CD, Moul, JW, and Reed, SD. "Does variation in either age at start of therapy or duration of therapy make chemoprevention with finasteride cost-effective?." Prostate Cancer Prostatic Dis 15.4 (December 2012): 380-385.
PMID
22777393
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
15
Issue
4
Publish Date
2012
Start Page
380
End Page
385
DOI
10.1038/pcan.2012.26

Association between percentage of tumor involvement and Gleason score upgrading in low-risk prostate cancer.

To find the predictors of Gleason score upgrading in a cohort of low-risk prostate cancer patients, data were analyzed comprising 1,632 consecutive men with low-risk prostate cancer who underwent radical prostatectomy between 1993 and 2009. Assessment focused on preoperative parameters including patient age, race, diagnostic prostate-specific antigen (PSA) levels, clinical stage and biopsy Gleason score, along with pathological parameters including percentage of tumor involvement (PTI), tumor laterality, pathological stage, extra-capsular extension, seminal vesicle invasion, and surgical margins. These parameters were analyzed using univariate and multivariate methods. Kaplan-Meier curves compared differences in biochemical disease-free survival in men having cancers with and without Gleason score upgrading. Cases involving pathological Gleason score upgrading were identified in 723 (44.3 %) of 1,632 patients. Kaplan-Meier PSA recurrence-free survival curves showed a difference in outcome between men with and without Gleason score upgrading (p < 0.001). Of Gleason score upgraded patients, 35 (4.8 %) men had PTI of <5 %, 237 (32.8 %) had PTI of 5-9.9 %, 177 (24.5 %) had PTI of 10-14.9 %, and 274 (37.9 %) had PTI ≥ 15 % (p < 0.001). PTI (p < 0.001) along with diagnostic PSA, patient age, diagnostic biopsy Gleason score, pathologic stage, and surgical margin status were independent predictors of pathological Gleason score upgrading on multivariate logistic regression. PTI correlates closely with Gleason score upgrading in a low-risk prostate cancer cohort. Low-risk prostate cancer patients with clinical findings suggestive of high PTI or large volume cancers should not benefit from active surveillance strategies.

Authors
Fu, Q; Moul, JW; Bañez, LL; Sun, L; Mouraviev, V; Xie, D; Polascik, TJ
MLA Citation
Fu, Q, Moul, JW, Bañez, LL, Sun, L, Mouraviev, V, Xie, D, and Polascik, TJ. "Association between percentage of tumor involvement and Gleason score upgrading in low-risk prostate cancer." Med Oncol 29.5 (December 2012): 3339-3344.
PMID
22688447
Source
pubmed
Published In
Medical Oncology
Volume
29
Issue
5
Publish Date
2012
Start Page
3339
End Page
3344
DOI
10.1007/s12032-012-0270-4

Phase 3, randomized, placebo-controlled study of zibotentan (ZD4054) in patients with castration-resistant prostate cancer metastatic to bone.

BACKGROUND: Endothelin-1 and the endothelin A (ET(A) ) receptor have been implicated in prostate cancer progression in bone. This study aimed to determine whether the specific ET(A) receptor antagonist, zibotentan, prolonged overall survival (OS) in patients with castration-resistant prostate cancer and bone metastases who were pain-free or mildly symptomatic for pain. METHODS: Patients were randomized 1:1 to zibotentan 10 mg/day or placebo, plus standard prostate cancer treatment. The primary endpoint was OS. Secondary endpoints included times to pain progression, chemotherapy use, new bone metastases, and safety. Efficacy endpoints were analyzed using a log-rank test. RESULTS: A total of 594 patients were randomized (zibotentan, n = 299; placebo, n = 295). Median OS was 24.5 months in zibotentan-treated patients versus 22.5 months for placebo, but the difference did not reach statistical significance (hazard ratio, 0.87; 95.2% confidence interval, 0.69-1.10; P = .240). No statistically significant differences were observed for any secondary efficacy endpoints. Peripheral edema (44%) and headache (31%) were the most commonly reported adverse events in the zibotentan group. Cardiac failure events were higher in the zibotentan group than placebo (any grade, 5.7% and 1.7%; Common Terminology Criteria for Adverse Events grade ≥3, 3.0% and 1.0%, respectively); these were manageable and reversible. CONCLUSIONS: In this large, randomized, placebo-controlled phase 3 trial, treatment with zibotentan 10 mg/day did not lead to a statistically significant improvement in OS in this patient population. Zibotentan had an acceptable safety profile.

Authors
Nelson, JB; Fizazi, K; Miller, K; Higano, C; Moul, JW; Akaza, H; Morris, T; McIntosh, S; Pemberton, K; Gleave, M
MLA Citation
Nelson, JB, Fizazi, K, Miller, K, Higano, C, Moul, JW, Akaza, H, Morris, T, McIntosh, S, Pemberton, K, and Gleave, M. "Phase 3, randomized, placebo-controlled study of zibotentan (ZD4054) in patients with castration-resistant prostate cancer metastatic to bone." Cancer 118.22 (November 15, 2012): 5709-5718.
PMID
22786751
Source
pubmed
Published In
Cancer
Volume
118
Issue
22
Publish Date
2012
Start Page
5709
End Page
5718
DOI
10.1002/cncr.27674

Radical prostatectomy vs radiation therapy and androgen-suppression therapy in high-risk prostate cancer.

UNLABELLED: What's known on the subject? and What does the study add? Prostate cancer is generally considered to be high risk when the prostate-specific antigen (PSA) concentration is >20 ng/mL, the Gleason score is ≥8 or the American Joint Commission on Cancer (AJCC) tumour (T) category is ≥2c. There is no consensus on the best treatment for men with prostate cancer that includes these high-risk features. Options include external beam radiation therapy (EBRT) with androgen suppression therapy (AST), treatment with a combination of brachytherapy, EBRT and AST termed combined-modality therapy (CMT) or radical prostatectomy (RP) followed by adjuvant RT in cases where there are unfavourable pathological features, e.g. positive surgical margin, extracapsular extension and seminal vesicle invasion. While outcomes for both approaches have been published independently these treatments have not been compared in the setting of a prospective RCT where confounding factors related to patient selection for RP or CMT would be minimised. These factors include age, known prostate cancer prognostic factors and comorbidity. RCTs that compare RP to radiation-based regimens have been attempted but failed to accrue. OBJECTIVE: To assess the risk of prostate cancer-specific mortality after therapy with radical prostatectomy (RP) or combined-modality therapy (CMT) with brachytherapy, external beam radiation therapy (EBRT) and androgen-suppression therapy (AST) in men with Gleason score 8-10 prostate cancer. PATIENTS AND METHODS: Men with localised high-risk prostate cancer based on a Gleason score of 8-10 were selected for study from Duke University (285 men), treated between January 1988 and October 2008 with RP or from the Chicago Prostate Cancer Center or within the 21st Century Oncology establishment (372) treated between August 1991 and November 2005 with CMT. Fine and Gray multivariable regression was used to assess whether the risk of prostate cancer-specific mortality differed after RP as compared with CMT adjusting for age, cardiac comorbidity and year of treatment, and known prostate cancer prognostic factors. RESULTS: As of January 2009, with a median (interquartile range) follow-up of 4.62 (2.4-8.2) years, there were 21 prostate cancer-specific deaths. Treatment with RP was not associated with an increased risk of prostate cancer-specific mortality compared with CMT (adjusted hazard ratio [HR] 1.8, 95% confidence interval [CI] 0.6-5.6, P = 0.3). Factors associated with an increased risk of prostate cancer-specific mortality were a PSA concentration of <4 ng/mL (adjusted HR 6.1, 95% CI 2.3-16, P < 0.001) as compared with ≥4 ng/mL, and clinical category T2b, c (adjusted HR 2.9; 95% CI 1.1-7.2; P = 0.03) as compared with T1c, 2a. CONCLUSION: Initial treatment with RP as compared with CMT was not associated with an increased risk of prostate cancer-specific mortality in men with Gleason score 8-10 prostate cancer.

Authors
Westover, K; Chen, M-H; Moul, J; Robertson, C; Polascik, T; Dosoretz, D; Katin, M; Salenius, S; D'Amico, AV
MLA Citation
Westover, K, Chen, M-H, Moul, J, Robertson, C, Polascik, T, Dosoretz, D, Katin, M, Salenius, S, and D'Amico, AV. "Radical prostatectomy vs radiation therapy and androgen-suppression therapy in high-risk prostate cancer." BJU Int 110.8 (October 2012): 1116-1121.
PMID
22540922
Source
pubmed
Published In
Bju International
Volume
110
Issue
8
Publish Date
2012
Start Page
1116
End Page
1121
DOI
10.1111/j.1464-410X.2012.11012.x

Masculinity beliefs predict psychosocial functioning in African American prostate cancer survivors.

Research examining psychosocial functioning in African American prostate cancer survivors has been limited, in spite of documented higher mortality from prostate cancer and worse long-term physical and emotional outcomes from prostate cancer treatment reported by this group of survivors. In addition, the role of masculinity in psychosocial adjustment among prostate cancer survivors is not well understood. In this study, 59 African American prostate cancer survivors completed a questionnaire assessing masculinity beliefs related to self-reliance, emotional control, and dominance, as well as measures of psychosocial functioning (i.e., symptom distress, negative mood, and functional and social well-being). Results of regression analyses indicated that masculinity beliefs predicted negative mood, functional well-being, and social well-being, controlling for age, income, and medical comorbidities. The findings reported here, although preliminary, suggest that masculinity beliefs could be important therapeutic targets for improving the efficacy of cognitive-behavioral interventions for men adjusting to prostate cancer survivorship.

Authors
Campbell, LC; Keefe, FJ; McKee, DC; Waters, SJ; Moul, JW
MLA Citation
Campbell, LC, Keefe, FJ, McKee, DC, Waters, SJ, and Moul, JW. "Masculinity beliefs predict psychosocial functioning in African American prostate cancer survivors." Am J Mens Health 6.5 (September 2012): 400-408.
PMID
22691305
Source
pubmed
Published In
American Journal of Men's Health
Volume
6
Issue
5
Publish Date
2012
Start Page
400
End Page
408
DOI
10.1177/1557988312450185

When should we pull the trigger for post-radical prostatectomy radiotherapy?

Authors
Moul, JW
MLA Citation
Moul, JW. "When should we pull the trigger for post-radical prostatectomy radiotherapy?." Eur Urol 62.3 (September 2012): 488-490.
PMID
22695240
Source
pubmed
Published In
European Urology
Volume
62
Issue
3
Publish Date
2012
Start Page
488
End Page
490
DOI
10.1016/j.eururo.2012.05.066

What the U.S. Preventive Services Task Force missed in its prostate cancer screening recommendation.

Authors
Catalona, WJ; D'Amico, AV; Fitzgibbons, WF; Kosoko-Lasaki, O; Leslie, SW; Lynch, HT; Moul, JW; Rendell, MS; Walsh, PC
MLA Citation
Catalona, WJ, D'Amico, AV, Fitzgibbons, WF, Kosoko-Lasaki, O, Leslie, SW, Lynch, HT, Moul, JW, Rendell, MS, and Walsh, PC. "What the U.S. Preventive Services Task Force missed in its prostate cancer screening recommendation." Annals of internal medicine 157.2 (July 17, 2012): 137-138.
Source
scopus
Published In
Annals of internal medicine
Volume
157
Issue
2
Publish Date
2012
Start Page
137
End Page
138

What the U.S. Preventive Services Task Force missed in its prostate cancer screening recommendation.

Authors
Catalona, WJ; D'Amico, AV; Fitzgibbons, WF; Kosoko-Lasaki, O; Leslie, SW; Lynch, HT; Moul, JW; Rendell, MS; Walsh, PC
MLA Citation
Catalona, WJ, D'Amico, AV, Fitzgibbons, WF, Kosoko-Lasaki, O, Leslie, SW, Lynch, HT, Moul, JW, Rendell, MS, and Walsh, PC. "What the U.S. Preventive Services Task Force missed in its prostate cancer screening recommendation." Ann Intern Med 157.2 (July 17, 2012): 137-138.
PMID
22801676
Source
pubmed
Published In
Annals of internal medicine
Volume
157
Issue
2
Publish Date
2012
Start Page
137
End Page
138
DOI
10.7326/0003-4819-157-2-201207170-00463

Detection of previously unidentified metastatic disease as a leading cause of screening failure in a phase III trial of zibotentan versus placebo in patients with nonmetastatic, castration resistant prostate cancer.

PURPOSE: Understanding the extent of disease in asymptomatic patients with castration resistant prostate cancer is important when making treatment decisions and designing clinical trials. The ENTHUSE M0 (ENdoTHelin A USE) trial (NCT00626548) was a large phase III study comparing the endothelin A receptor antagonist zibotentan with placebo in patients with nonmetastatic, castration resistant prostate cancer. The study was stopped prematurely after early efficacy review indicated that it was unlikely to meet its co-primary objectives of improved overall and progression-free survival vs placebo. Screening failed in an unexpectedly high number of patients. We investigated this screening failure rate to promote better classification of patients thought to have nonmetastatic castration resistant prostate cancer and inform the design of future clinical trials in this setting. MATERIALS AND METHODS: The number of patients enrolled in and subsequently excluded from study was analyzed by geographic region and by the specialty of the investigating clinician (oncology or urology) who enrolled the study patients. RESULTS: Of 2,577 patients enrolled in a total of 350 hospital based centers in 39 countries screening failed in 1,155 (45%). The most common reason for screening failure was the detection of metastatic disease in 32% of all screened patients and in 71% of those in whom screening failed. The leading reasons for failed screening did not differ between investigator specialties overall or by geographic region. CONCLUSIONS: The high frequency of asymptomatic metastasis in men thought to have nonmetastatic, castration resistant prostate cancer highlights the importance of periodic staging assessments for the condition. Optimal treatment modalities may differ for metastatic and nonmetastatic disease.

Authors
Yu, EY; Miller, K; Nelson, J; Gleave, M; Fizazi, K; Moul, JW; Nathan, FE; Higano, CS
MLA Citation
Yu, EY, Miller, K, Nelson, J, Gleave, M, Fizazi, K, Moul, JW, Nathan, FE, and Higano, CS. "Detection of previously unidentified metastatic disease as a leading cause of screening failure in a phase III trial of zibotentan versus placebo in patients with nonmetastatic, castration resistant prostate cancer." J Urol 188.1 (July 2012): 103-109.
PMID
22583636
Source
pubmed
Published In
The Journal of Urology
Volume
188
Issue
1
Publish Date
2012
Start Page
103
End Page
109
DOI
10.1016/j.juro.2012.03.008

Minimally invasive open retropubic prostatectomy: in experienced hands--still the gold standard.

Authors
Moul, JW
MLA Citation
Moul, JW. "Minimally invasive open retropubic prostatectomy: in experienced hands--still the gold standard." Oncology (Williston Park) 26.7 (July 2012): 610-615.
PMID
22888559
Source
pubmed
Published In
Oncology
Volume
26
Issue
7
Publish Date
2012
Start Page
610
End Page
615

Role of oxidative stress in a rat model of radiation-induced erectile dysfunction.

INTRODUCTION: Chronic oxidative stress is one of the major factors playing an important role in radiation-induced normal tissue injury. However, the role of oxidative stress in radiation-induced erectile dysfunction (ED) has not been fully investigated. Aims.  To investigate role of oxidative stress after prostate-confined irradiation in a rat model of radiation-induced ED. METHODS: Fifty-four young adult male rats (10-12 weeks of age) were divided into age-matched sham radiotherapy (RT) and RT groups. Irradiated animals received prostate-confined radiation in a single 20 Gy fraction. MAIN OUTCOME MEASURES: Intracavernous pressure (ICP) measurements with cavernous nerve electrical stimulation were conducted at 2, 4, and 9 weeks following RT. The protein expression of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase subunits (Nox4 and gp91(phox)), markers of oxidative DNA damage (8-hydroxy-2'-deoxyguanosine [8-OHdG]), lipid peroxidation (4-hydroxynonenal [4HNE]), and inflammatory response including inducible nitric oxide synthase, macrophage activation (ED-1), and nitrotyrosine, and endogenous antioxidant defense by nuclear factor erythroid 2-related factor (Nrf2) were evaluated in irradiated prostate tissue and corpora cavernosa (CC). In addition, we investigated the relationships between results of ICP/mean arterial pressure (MAP) ratios and expression level of oxidative stress markers. RESULTS: In the RT group, hemodynamic functional studies demonstrated a significant time-dependent decrease in ICP. Increased expression of Nox4, gp91(phox), 8-OHdG, and 4HNE were observed in the prostate and CC after RT. Similarly, expressions of inflammatory markers were significantly increased. There was a trend for increased Nrf2 after 4 weeks. ICP/MAP ratio negatively correlated with higher expression level of oxidative markers. CONCLUSION: NADPH oxidase activation and chronic oxidative stress were observed in irradiated prostate tissue and CC, which correlated with lower ICP/MAP ratio. Persistent inflammatory responses were also found in both tissues after RT. These findings suggest that oxidative stress plays a crucial role in the development of radiation-induced ED.

Authors
Kimura, M; Rabbani, ZN; Zodda, AR; Yan, H; Jackson, IL; Polascik, TJ; Donatucci, CF; Moul, JW; Vujaskovic, Z; Koontz, BF
MLA Citation
Kimura, M, Rabbani, ZN, Zodda, AR, Yan, H, Jackson, IL, Polascik, TJ, Donatucci, CF, Moul, JW, Vujaskovic, Z, and Koontz, BF. "Role of oxidative stress in a rat model of radiation-induced erectile dysfunction." J Sex Med 9.6 (June 2012): 1535-1549.
PMID
22489731
Source
pubmed
Published In
The Journal of Sexual Medicine
Volume
9
Issue
6
Publish Date
2012
Start Page
1535
End Page
1549
DOI
10.1111/j.1743-6109.2012.02716.x

African American race to predict for earlier failure of active surveillance: Results from the Duke Prostate Center

Authors
Bassett, M; Abern, M; Banez, LL; Ferrandino, M; Robertson, CN; Inman, BA; Polascik, T; Freedland, SJ; Walther, PJ; Moul, JW
MLA Citation
Bassett, M, Abern, M, Banez, LL, Ferrandino, M, Robertson, CN, Inman, BA, Polascik, T, Freedland, SJ, Walther, PJ, and Moul, JW. "African American race to predict for earlier failure of active surveillance: Results from the Duke Prostate Center." May 20, 2012.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
30
Issue
15
Publish Date
2012

Post-prostatectomy PSA slope (ProsVue) in Gleason score >= 7 disease

Authors
Moul, JW; Lilja, H; Semmes, OJ; Vessella, R; McDermed, JE; Sarno, MJ; Klem, RE
MLA Citation
Moul, JW, Lilja, H, Semmes, OJ, Vessella, R, McDermed, JE, Sarno, MJ, and Klem, RE. "Post-prostatectomy PSA slope (ProsVue) in Gleason score >= 7 disease." May 20, 2012.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
30
Issue
15
Publish Date
2012

The number of high-risk factors and the risk of prostate cancer-specific mortality after brachytherapy: implications for treatment selection.

PURPOSE: To determine whether an increasing number of high-risk factors is associated with higher prostate cancer-specific mortality (PCSM) among men treated with brachytherapy (BT)-based treatment, and whether supplemental therapy has an impact on this risk. METHODS AND MATERIALS: We analyzed the cases of 2234 men with localized prostate cancer treated between 1991 and 2007 with low-dose rate BT monotherapy (n = 457) or BT with supplemental external-beam radiotherapy (EBRT, n = 229), androgen suppression therapy (AST, n = 424), or both (n = 1124). All men had at least one high-risk factor (prostate-specific antigen >20 ng/mL, biopsy Gleason score 8-10, or clinical stage ≥T2c). Competing-risks multivariable regressions were performed to determine whether the presence of at least two high-risk factors was associated with an increased risk of PCSM, with adjustment for age, comorbidity, and the type of supplemental treatment. RESULTS: The median follow-up time was 4.3 years. The number of men with at least two high-risk factors was highest in the group treated with BT, EBRT, and AST (21%), followed by BT plus EBRT or AST (13%), and BT alone (8%) (p(trend) < 0.001). The adjusted hazard ratio (AHR) for PCSM for those with at least two high-risk factors (as compared with one) was 4.8 (95% confidence interval [CI], 2.8-8.0; p < 0.001). The use of both supplemental EBRT and AST was associated with a decreased risk of PCSM (AHR 0.5; 95% CI, 0.2-0.9; p = 0.03) compared with BT alone. When the high-risk factors were analyzed separately, Gleason score 8-10 was most significantly associated with increased PCSM (AHR 6.2; 95% CI, 3.5-11.2; p < 0.001). CONCLUSIONS: Men with high-risk prostate adenocarcinoma treated with BT have decreased PCSM if they receive trimodailty therapy that includes EBRT and AST. This benefit is likely most important in men with multiple determinants of high risk.

Authors
Wattson, DA; Chen, M-H; Moran, BJ; Dosoretz, DE; Braccioforte, MH; Salenius, SA; D'Amico, AV
MLA Citation
Wattson, DA, Chen, M-H, Moran, BJ, Dosoretz, DE, Braccioforte, MH, Salenius, SA, and D'Amico, AV. "The number of high-risk factors and the risk of prostate cancer-specific mortality after brachytherapy: implications for treatment selection." Int J Radiat Oncol Biol Phys 82.5 (April 1, 2012): e773-e779.
PMID
22300573
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
82
Issue
5
Publish Date
2012
Start Page
e773
End Page
e779
DOI
10.1016/j.ijrobp.2011.11.023

A critical analysis of the long-term impact of radical prostatectomy on cancer control and function outcomes.

CONTEXT: The optimal management strategy for men with newly diagnosed clinically localized prostate cancer remains a matter of debate. Numerous series have reported cancer control and quality-of-life (QoL) outcomes following treatment with radical prostatectomy (RP). OBJECTIVE: Critically review published oncologic and functional outcomes after RP, and evaluate factors associated with these outcome measures. EVIDENCE ACQUISITION: A review of the literature was performed using the Medline and Web of Sciences databases. Relevant reports published between 1980 and 2011 identified using the keywords prostate cancer, radical prostatectomy, prostate-specific antigen, biochemical recurrence, incontinence, and erectile dysfunction were reviewed and summarized. EVIDENCE SYNTHESIS: Cancer control rates following RP largely depend on the definition of treatment efficacy. While up to 40% of men have been reported to experience postoperative biochemical recurrence on long-term follow-up, death from prostate cancer has been noted in <10% of men at 15 yr after surgery in contemporary series. For men with high-risk disease, surgery affords pathologic staging, thereby facilitating the selective application of secondary therapies, and has been associated with decreased mortality risk versus radiation in retrospective series. Reported functional outcomes after surgery, particularly urinary continence and erectile dysfunction, have varied greatly to date. These assessments have been limited by nonstandardized reporting methodology. The use of robot-assisted radical prostatectomy has increased in recent years, and while follow-up is thus far short, available data do not suggest the superiority of either approach in terms of functional or oncologic outcomes. CONCLUSIONS: RP is associated with excellent long-term cancer control. Continued efforts to conduct prospective assessments of postoperative functional outcomes are necessary using validated QoL instruments. The importance of surgical approach will also require further study, incorporating comparative oncologic, functional, and economic data.

Authors
Boorjian, SA; Eastham, JA; Graefen, M; Guillonneau, B; Karnes, RJ; Moul, JW; Schaeffer, EM; Stief, C; Zorn, KC
MLA Citation
Boorjian, SA, Eastham, JA, Graefen, M, Guillonneau, B, Karnes, RJ, Moul, JW, Schaeffer, EM, Stief, C, and Zorn, KC. "A critical analysis of the long-term impact of radical prostatectomy on cancer control and function outcomes." Eur Urol 61.4 (April 2012): 664-675. (Review)
PMID
22169079
Source
pubmed
Published In
European Urology
Volume
61
Issue
4
Publish Date
2012
Start Page
664
End Page
675
DOI
10.1016/j.eururo.2011.11.053

Association between preoperative erectile dysfunction and prostate cancer features--an analysis from the Duke Prostate Center Database.

INTRODUCTION: Erectile dysfunction (ED) is related to several co-morbidities including obesity, metabolic syndrome, cigarette smoking, and low testosterone, all of which have been reported to be associated with adverse prostate cancer features. AIM: To examine whether preoperative ED has a relationship with adverse prostate cancer features in patients who underwent radical prostatectomy (RP). METHODS: We analyzed data from our institution on 676 patients who underwent RP between 2001 and 2010. Crude and adjusted logistic regression models were used to investigate the association between preoperative ED and several pathological parameters. The log-rank test and multivariate proportional hazards model were conducted to determine the association of preoperative ED with biochemical recurrence (BCR). MAIN OUTCOME MEASURES: The expanded prostate cancer index composite (EPIC) instrument was used to evaluate preoperative erectile function (EF). Preoperative normal EF was defined as EPIC-SF ≥ 60 points while ED was defined as preoperative EPIC-SF lower than 60 points. RESULTS: Preoperatively, a total of 343 (50.7%) men had normal EF and 333 (49.3%) men had ED. After adjusting for covariates, preoperative ED was identified a risk factor for positive extracapsular extension (OR 1.57; P = 0.029) and high percentage of tumor involvement (OR 1.56; P = 0.047). In a Kaplan-Meier curve, a trend was identified that patients with ED had higher incidence of BCR than men with normal EF (P = 0.091). Moreover, using a multivariate Cox model, higher preoperative EF was negatively associated with BCR (HR 0.99; P = 0.014). CONCLUSIONS: These results suggest that the likelihood for adverse pathological outcomes as well as BCR following prostatectomy is higher among men with preoperative ED, though these results require validation in larger datasets. The present study indicates that preoperative ED might be a surrogate for adverse prostate cancer outcomes following RP.

Authors
Kimura, M; Bañez, LL; Gerber, L; Qi, J; Tsivian, M; Freedland, SJ; Satoh, T; Polascik, TJ; Baba, S; Moul, JW
MLA Citation
Kimura, M, Bañez, LL, Gerber, L, Qi, J, Tsivian, M, Freedland, SJ, Satoh, T, Polascik, TJ, Baba, S, and Moul, JW. "Association between preoperative erectile dysfunction and prostate cancer features--an analysis from the Duke Prostate Center Database." J Sex Med 9.4 (April 2012): 1174-1181.
PMID
22188861
Source
pubmed
Published In
The Journal of Sexual Medicine
Volume
9
Issue
4
Publish Date
2012
Start Page
1174
End Page
1181
DOI
10.1111/j.1743-6109.2011.02547.x

Pretreatment expectations of patients undergoing robotic assisted laparoscopic or open retropubic radical prostatectomy.

PURPOSE: We previously found that patients undergoing robotic assisted laparoscopic radical prostatectomy vs radical retropubic prostatectomy had a higher likelihood of not being satisfied, independent of side effect profile. We hypothesized that differential preoperative expectations might contribute to this finding. In the current study we compared expectations of patients undergoing robotic assisted laparoscopic radical prostatectomy vs radical retropubic prostatectomy. MATERIALS AND METHODS: A questionnaire on expectations regarding recovery was administered to 171 patients electing to undergo robotic assisted laparoscopic radical prostatectomy or radical retropubic prostatectomy from 2008 to 2010. We prospectively collected data on patient expectations before surgery. Differences between patients undergoing robotic assisted laparoscopic radical prostatectomy vs radical retropubic prostatectomy were assessed with adjusted proportional odds models. RESULTS: Patients who underwent robotic assisted laparoscopic radical prostatectomy (97) did not differ significantly from those treated with radical retropubic prostatectomy (74) in age, race, income, time between survey and surgery, and prostate specific antigen (p ≥0.4). Patients who underwent radical retropubic prostatectomy had significantly higher clinical stage and Gleason grade disease (p ≤0.007). After adjusting for socioeconomic factors, clinical stage and grade on multivariate analysis, patients who underwent robotic assisted laparoscopic radical prostatectomy expected a significantly shorter length of stay (OR 0.07, p <0.001) and earlier return to physical activity (OR 0.36, p = 0.005). The choice of robotic assisted laparoscopic radical prostatectomy (OR 0.41, p = 0.012), younger age (OR 0.49, p = 0.001) and higher preoperative International Index of Erectile Function-5-item version score (OR 0.60, p = 0.017) were independently associated with the expectation of earlier return of erections but not of continence on multivariate analysis. CONCLUSIONS: The body of evidence surrounding robotic assisted laparoscopic radical prostatectomy supports shorter hospitalization but there is no conclusive evidence that the robotic approach results in earlier return to physical activity or improved disease specific outcomes. Nonetheless we found that patients who underwent robotic assisted laparoscopic radical prostatectomy had higher expectations regarding these outcomes, particularly that of erectile function recovery, than did their radical retropubic prostatectomy counterparts.

Authors
Schroeck, FR; Krupski, TL; Stewart, SB; Bañez, LL; Gerber, L; Albala, DM; Moul, JW
MLA Citation
Schroeck, FR, Krupski, TL, Stewart, SB, Bañez, LL, Gerber, L, Albala, DM, and Moul, JW. "Pretreatment expectations of patients undergoing robotic assisted laparoscopic or open retropubic radical prostatectomy." J Urol 187.3 (March 2012): 894-898.
PMID
22245326
Source
pubmed
Published In
The Journal of Urology
Volume
187
Issue
3
Publish Date
2012
Start Page
894
End Page
898
DOI
10.1016/j.juro.2011.10.135

Postoperative radiation therapy for pathologically advanced prostate cancer after radical prostatectomy.

CONTEXT: Approximately 15-25% of men who undergo radical prostatectomy for localized prostate cancer (PCa) will experience recurrence of their cancer; men with poorly differentiated cancer, non-organ-confined disease, and positive surgical margins are at the highest risk. OBJECTIVE: Review accumulating evidence indicating that postoperative radiotherapy (RT) to the prostate bed favorably influences the course of disease in men with adverse pathologic features. EVIDENCE ACQUISITION: Three phase 3 randomized trials of adjuvant RT versus observation have reported improved freedom from biochemical recurrence (BCR) and local control: Southwest Oncology Group (SWOG) 8794, European Organization for Research and Treatment of Cancer (EORTC) 22911, and the German Cancer Society (ARO 96-02). EVIDENCE SYNTHESIS: Conflicting evidence from these trials suggests that adjuvant RT can have a favorable impact on systemic progression, PCa-specific mortality, or overall survival. Observational studies have reported durable responses to salvage RT in a substantial proportion of high-risk patients (provided that it is administered at the earliest evidence of BCR) and reduced PCa-specific mortality. There is consensus that the outcome of patients receiving postoperative RT is best when the prostate-specific antigen (PSA) level is the lowest. However, it is unclear if better outcomes will be achieved administering adjuvant RT to all patients at increased risk for recurrent PCa who have an undetectable postoperative PSA level compared to close observation and timely salvage RT at the earliest indications of BCR. CONCLUSIONS: Given the absence of data from randomized trials demonstrating superiority of one approach over the other in terms of quantity and quality of life, we advocate multidisciplinary input and shared and informed decision making among patients, urologists, and radiation oncologists based on the relative advantages and disadvantages of each approach.

Authors
Stephenson, AJ; Bolla, M; Briganti, A; Cozzarini, C; Moul, JW; Roach, M; van Poppel, H; Zietman, A
MLA Citation
Stephenson, AJ, Bolla, M, Briganti, A, Cozzarini, C, Moul, JW, Roach, M, van Poppel, H, and Zietman, A. "Postoperative radiation therapy for pathologically advanced prostate cancer after radical prostatectomy." Eur Urol 61.3 (March 2012): 443-451. (Review)
PMID
22036777
Source
pubmed
Published In
European Urology
Volume
61
Issue
3
Publish Date
2012
Start Page
443
End Page
451
DOI
10.1016/j.eururo.2011.10.010

Perineural versus lymphovascular invasion: Which is a better marker for unfavorable biochemical outcomes following prostatectomy? Results from the Duke Prostate Center Database

Authors
Singh, AA; Banez, LL; Gerber, L; Freedland, SJ; Robertson, CN; Ferrandino, M; Polascik, T; Walther, PJ; Moul, JW
MLA Citation
Singh, AA, Banez, LL, Gerber, L, Freedland, SJ, Robertson, CN, Ferrandino, M, Polascik, T, Walther, PJ, and Moul, JW. "Perineural versus lymphovascular invasion: Which is a better marker for unfavorable biochemical outcomes following prostatectomy? Results from the Duke Prostate Center Database." February 10, 2012.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
30
Issue
5
Publish Date
2012

Awareness, concern, and communication between physicians and patients on bone health in nonmetastatic prostate cancer

Authors
Moul, JW; Ferenz, KS; Mautner, BD
MLA Citation
Moul, JW, Ferenz, KS, and Mautner, BD. "Awareness, concern, and communication between physicians and patients on bone health in nonmetastatic prostate cancer." February 10, 2012.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
30
Issue
5
Publish Date
2012

Characteristics of baseline PSA and PSA velocity in young men without prostate cancer: Racial differences.

BACKGROUND: Baseline prostate specific antigen (PSA) and PSA velocity used to stratify subsequent prostate cancer risk in young men may not directly applicable to all populations. We sought to compare the baseline PSA and PSA velocity among ethnic groups. PATIENTS AND METHODS: Chinese, African-American (AA), and Caucasian-American (CA) men aged ≤50 years old without prostate cancer were used to identify baseline PSA and PSA velocity. The differences of baseline PSA and PSA velocity between races were assessed. The important cutoffs of baseline PSA and PSA velocity were used to stratify patients among races. RESULTS: Four thousand two hundred six Chinese, 997 AA, and 2,030 CA were included. The rates of baseline PSA of ≥1.0, ≥2.5, and ≥4.0 ng/ml was 24.4%, 4.2%, and 2.1% in Chinese, 30.7%, 5.2%, and 1.8% in AA, 29.7%, 5.3%, and 2.8% in CA, respectively. The rates of PSA velocity of ≥0.35, ≥0.75, and ≥1.0 ng/ml/year was 6.0%, 3.1%, and 2.6% in Chinese, 5.3%, 2.3%, and 1.7% in AA, 5.4%, 3.5%, and 3.3% in CA, respectively. Chinese had a lower baseline PSA and higher PSA velocity as compared to AA and CA. Baseline PSA and PSA velocity in AA had no statistical differences as compared to CA. CONCLUSIONS: The distributions of baseline PSA and PSA velocity in young men among Chinese, AA, and CA races are different. These characteristics shall be taken into account when using these variables to stratify risk of prostate cancer in young men.

Authors
Tang, P; Du, W; Xie, K; Fu, J; Chen, H; Yang, W; Moul, JW
MLA Citation
Tang, P, Du, W, Xie, K, Fu, J, Chen, H, Yang, W, and Moul, JW. "Characteristics of baseline PSA and PSA velocity in young men without prostate cancer: Racial differences." Prostate 72.2 (February 1, 2012): 173-180.
PMID
21538426
Source
pubmed
Published In
The Prostate
Volume
72
Issue
2
Publish Date
2012
Start Page
173
End Page
180
DOI
10.1002/pros.21418

Perineural versus lymphovascular invasion: Which is a better marker for unfavorable biochemical outcomes following prostatectomy? Results from the Duke Prostate Center Database.

34 Background: Despite a substantial effort to study the clinical significance of perineural invasion in prostate biopsies (PNIb) its prognostic significance remains controversial. The limited data on perineural invasion in radical prostatectomy (RP) specimens (PNIp) suggests that biopsy specimens inadequately represent whole gland pathology thus rendering investigation of PNIp even more clinically relevant. While lymphovascular invasion in pathology specimens (LVIp) has been more rigorously investigated, studies have shown conflicting results. More importantly, there has been minimal comparison of PNIp and LVIp in the same cohort to determine which marker is the superior prognostic factor.We retrospectively analyzed data from 1611 men who underwent RP from 1999 to 2010 from the Duke Prostate Center database. We evaluated PNIp and LVIp as predictors of time to BCR by comparing hazard ratios (HR) and 95% confidence intervals (CI) using crude and adjusted proportional hazards regression models that included both variables and controlled for demographic and clinico-pathological covariates.A total of 1304 (81%) men had PNIp while only 82 (5%) men had LVIp. On crude regression, both PNIp (HR=3.39; 95% CI=1.94-5.84; p<0.001) and LVIp (HR=2.33; 95% CI=1.49-3.64; p<0.001) were significant predictors of adverse BCR risk. After adjusting for clinico-pathological covariates, PNIp remained significantly associated with increased BCR risk (HR=1.85; 95%CI =1.04-3.31; p=0.04). Specifically, men with PNIp were 85% more likely to experience BCR relative to PNIp (-) men. In contrast, LVIp was not independently associated with BCR risk (p=0.23).In a cohort of men who underwent RP, PNIp is predictive of adverse BCR outcomes independent of clinicopathological parameters that include LVIp. Consequently, LVIp is a poor predictor of BCR risk. PNIp may thus provide additional prognostic information for men treated with RP and its inclusion in predictive nomograms requires study. Further analyses to determine if PNIp is likewise associated with metastasis and cancer-specific survival are warranted.

Authors
Singh, AA; Banez, LL; Gerber, L; Freedland, SJ; Robertson, CN; Ferrandino, M; Polascik, T; Walther, PJ; Moul, JW
MLA Citation
Singh, AA, Banez, LL, Gerber, L, Freedland, SJ, Robertson, CN, Ferrandino, M, Polascik, T, Walther, PJ, and Moul, JW. "Perineural versus lymphovascular invasion: Which is a better marker for unfavorable biochemical outcomes following prostatectomy? Results from the Duke Prostate Center Database." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 30.5_suppl (February 2012): 34-.
PMID
27967845
Source
epmc
Published In
Journal of Clinical Oncology
Volume
30
Issue
5_suppl
Publish Date
2012
Start Page
34

Awareness, concern, and communication between physicians and patients on bone health in nonmetastatic prostate cancer.

246 Background: Little is known about physicians' (MDs) and prostate cancer (PC) patients' (pts) levels of awareness or concern about bone health or how/when MDs discuss bone health with at-risk pts. An online survey was conducted to explore these issues and evaluate knowledge levels and attitudes about cancer treatment-induced bone loss (CTIBL).A total of 4,403 oncologists and 4,961 urologists randomly selected from the American Medical Association master physician list, 533 oncologists from the Harris Physician Panel, and 3,400 pts from Harris' Chronic Illness Panel were invited to participate in the survey. Surveys lasted on average 10 minutes; MD and pt surveys were weighted to be representative of the populations of interest. Descriptive statistical analyses were used.Of those invited, 113 urologists and 63 oncologists completed the survey. The 186 PC pts who answered the survey (median age, 74 yrs; median time since PC diagnosis, 88 mos.) included 96 pts with nonmetastatic disease. Current or prior ADT was reported by 96% of pts. Of these pts, 48% were aware of CTIBL, 23% of whom were concerned about it and 55% of whom had discussed it with their MD. As many as 46% of pts obtained information on bone health exclusively from their healthcare team, rather than seeking information from other sources. Both oncologists and urologists (98% and 90%) considered CTIBL to be a serious issue for their patients, however, more oncologists than urologists perceived that their pts were concerned about CTIBL (71% vs 36%). More oncologists than urologists expressed concern about fractures due to CTIBL (58% vs 46%), and indicated that treatment-induced fractures would require additional intervention (91% vs 76%), treatment interruption (61% vs 43%), or change in treatment (55% vs 42%).Bone health is considered a serious issue for patients with nonmetastatic PC treated with ADT by both oncologists and urologists. However, there remains a gap in physician-patient communication regarding CTIBL and its clinical consequences. As primary sources of information for pts, MDs should proactively educate pts on CTIBL, its consequences, appropriate monitoring, and treatment options.

Authors
Moul, JW; Ferenz, KS; Mautner, BD
MLA Citation
Moul, JW, Ferenz, KS, and Mautner, BD. "Awareness, concern, and communication between physicians and patients on bone health in nonmetastatic prostate cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 30.5_suppl (February 2012): 246-.
PMID
27968188
Source
epmc
Published In
Journal of Clinical Oncology
Volume
30
Issue
5_suppl
Publish Date
2012
Start Page
246

Perineural versus lymphovascular invasion: Which is a better marker for unfavorable biochemical outcomes following prostatectomy? Results from the Duke Prostate Center Database.

34 Background: Despite a substantial effort to study the clinical significance of perineural invasion in prostate biopsies (PNIb) its prognostic significance remains controversial. The limited data on perineural invasion in radical prostatectomy (RP) specimens (PNIp) suggests that biopsy specimens inadequately represent whole gland pathology thus rendering investigation of PNIp even more clinically relevant. While lymphovascular invasion in pathology specimens (LVIp) has been more rigorously investigated, studies have shown conflicting results. More importantly, there has been minimal comparison of PNIp and LVIp in the same cohort to determine which marker is the superior prognostic factor.We retrospectively analyzed data from 1611 men who underwent RP from 1999 to 2010 from the Duke Prostate Center database. We evaluated PNIp and LVIp as predictors of time to BCR by comparing hazard ratios (HR) and 95% confidence intervals (CI) using crude and adjusted proportional hazards regression models that included both variables and controlled for demographic and clinico-pathological covariates.A total of 1304 (81%) men had PNIp while only 82 (5%) men had LVIp. On crude regression, both PNIp (HR=3.39; 95% CI=1.94-5.84; p<0.001) and LVIp (HR=2.33; 95% CI=1.49-3.64; p<0.001) were significant predictors of adverse BCR risk. After adjusting for clinico-pathological covariates, PNIp remained significantly associated with increased BCR risk (HR=1.85; 95%CI =1.04-3.31; p=0.04). Specifically, men with PNIp were 85% more likely to experience BCR relative to PNIp (-) men. In contrast, LVIp was not independently associated with BCR risk (p=0.23).In a cohort of men who underwent RP, PNIp is predictive of adverse BCR outcomes independent of clinicopathological parameters that include LVIp. Consequently, LVIp is a poor predictor of BCR risk. PNIp may thus provide additional prognostic information for men treated with RP and its inclusion in predictive nomograms requires study. Further analyses to determine if PNIp is likewise associated with metastasis and cancer-specific survival are warranted.

Authors
Singh, AA; Banez, LL; Gerber, L; Freedland, SJ; Robertson, CN; Ferrandino, M; Polascik, T; Walther, PJ; Moul, JW
MLA Citation
Singh, AA, Banez, LL, Gerber, L, Freedland, SJ, Robertson, CN, Ferrandino, M, Polascik, T, Walther, PJ, and Moul, JW. "Perineural versus lymphovascular invasion: Which is a better marker for unfavorable biochemical outcomes following prostatectomy? Results from the Duke Prostate Center Database." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 30.5_suppl (February 2012): 34-.
PMID
28142904
Source
epmc
Published In
Journal of Clinical Oncology
Volume
30
Issue
5_suppl
Publish Date
2012
Start Page
34

Awareness, concern, and communication between physicians and patients on bone health in nonmetastatic prostate cancer.

246 Background: Little is known about physicians' (MDs) and prostate cancer (PC) patients' (pts) levels of awareness or concern about bone health or how/when MDs discuss bone health with at-risk pts. An online survey was conducted to explore these issues and evaluate knowledge levels and attitudes about cancer treatment-induced bone loss (CTIBL).A total of 4,403 oncologists and 4,961 urologists randomly selected from the American Medical Association master physician list, 533 oncologists from the Harris Physician Panel, and 3,400 pts from Harris' Chronic Illness Panel were invited to participate in the survey. Surveys lasted on average 10 minutes; MD and pt surveys were weighted to be representative of the populations of interest. Descriptive statistical analyses were used.Of those invited, 113 urologists and 63 oncologists completed the survey. The 186 PC pts who answered the survey (median age, 74 yrs; median time since PC diagnosis, 88 mos.) included 96 pts with nonmetastatic disease. Current or prior ADT was reported by 96% of pts. Of these pts, 48% were aware of CTIBL, 23% of whom were concerned about it and 55% of whom had discussed it with their MD. As many as 46% of pts obtained information on bone health exclusively from their healthcare team, rather than seeking information from other sources. Both oncologists and urologists (98% and 90%) considered CTIBL to be a serious issue for their patients, however, more oncologists than urologists perceived that their pts were concerned about CTIBL (71% vs 36%). More oncologists than urologists expressed concern about fractures due to CTIBL (58% vs 46%), and indicated that treatment-induced fractures would require additional intervention (91% vs 76%), treatment interruption (61% vs 43%), or change in treatment (55% vs 42%).Bone health is considered a serious issue for patients with nonmetastatic PC treated with ADT by both oncologists and urologists. However, there remains a gap in physician-patient communication regarding CTIBL and its clinical consequences. As primary sources of information for pts, MDs should proactively educate pts on CTIBL, its consequences, appropriate monitoring, and treatment options.

Authors
Moul, JW; Ferenz, KS; Mautner, BD
MLA Citation
Moul, JW, Ferenz, KS, and Mautner, BD. "Awareness, concern, and communication between physicians and patients on bone health in nonmetastatic prostate cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 30.5_suppl (February 2012): 246-.
PMID
28143245
Source
epmc
Published In
Journal of Clinical Oncology
Volume
30
Issue
5_suppl
Publish Date
2012
Start Page
246

Emerging treatment options for patients with castration-resistant prostate cancer.

BACKGROUND: Most prostate cancer-related deaths occur in patients with castration-resistant prostate cancer (CRPC). Recent preclinical and clinical studies have identified intracellular signaling pathways and changes in the tumor and bone microenvironment as potential key drivers of CRPC. This increased understanding of mechanisms associated with CRPC has driven the development of numerous new agents, many of which are poised to alter the current CRPC treatment landscape. METHODS: A review of literature was conducted to identify ongoing and planned phase III studies of novel agents to treat CRPC. RESULTS: Multiple studies were identified, including novel androgen biosynthesis inhibitors (abiraterone, TAK-700), androgen-receptor inhibitors (MDV3100), angiogenesis inhibitors (aflibercept, tasquinimod), endothelin antagonists (zibotentan, atrasentan), a Src tyrosine kinase inhibitor (dasatinib), a novel radiotherapy (radium-223), and new immunotherapies (ipilimumab and ProstVac). In addition, both sipuleucel-T (an immunotherapy) and cabazitaxel (third-generation taxane) and the RANK-L inhibitor, denosumab, have recently been approved by the US Food and Drug Administration. CONCLUSIONS: Various combinations of these agents could theoretically be used to treat future patients with CRPC by targeting multiple signaling pathways as well as aspects of the tumor and bone microenvironments. Additional research will be needed to understand how to best use these agents and individualize care to optimize CRPC patient outcomes.

Authors
George, D; Moul, JW
MLA Citation
George, D, and Moul, JW. "Emerging treatment options for patients with castration-resistant prostate cancer." Prostate 72.3 (February 2012): 338-349. (Review)
PMID
21748753
Source
pubmed
Published In
The Prostate
Volume
72
Issue
3
Publish Date
2012
Start Page
338
End Page
349
DOI
10.1002/pros.21435

Prostate cancer: making the switch from LHRH antagonist to LHRH agonist.

Authors
Moul, JW
MLA Citation
Moul, JW. "Prostate cancer: making the switch from LHRH antagonist to LHRH agonist. (Published online)" Nat Rev Urol 9.3 (January 31, 2012): 125-126.
PMID
22289702
Source
pubmed
Published In
Nature Reviews Urology
Volume
9
Issue
3
Publish Date
2012
Start Page
125
End Page
126
DOI
10.1038/nrurol.2012.5

Impact of primary Gleason grade on risk stratification for Gleason score 7 prostate cancers.

PURPOSE: To evaluate the primary Gleason grade (GG) in Gleason score (GS) 7 prostate cancers for risk of non-organ-confined disease with the goal of optimizing radiotherapy treatment option counseling. METHODS: One thousand three hundred thirty-three patients with pathologic GS7 were identified in the Duke Prostate Center research database. Clinical factors including age, race, clinical stage, prostate-specific antigen at diagnosis, and pathologic stage were obtained. Data were stratified by prostate-specific antigen and clinical stage at diagnosis into adapted D'Amico risk groups. Univariate and multivariate analyses were performed evaluating for association of primary GG with pathologic outcome. RESULTS: Nine hundred seventy-nine patients had primary GG3 and 354 had GG4. On univariate analyses, GG4 was associated with an increased risk of non-organ-confined disease. On multivariate analysis, GG4 was independently associated with seminal vesicle invasion (SVI) but not extracapsular extension. Patients with otherwise low-risk disease and primary GG3 had a very low risk of SVI (4%). CONCLUSIONS: Primary GG4 in GS7 cancers is associated with increased risk of SVI compared with primary GG3. Otherwise low-risk patients with GS 3+4 have a very low risk of SVI and may be candidates for prostate-only radiotherapy modalities.

Authors
Koontz, BF; Tsivian, M; Mouraviev, V; Sun, L; Vujaskovic, Z; Moul, J; Lee, WR
MLA Citation
Koontz, BF, Tsivian, M, Mouraviev, V, Sun, L, Vujaskovic, Z, Moul, J, and Lee, WR. "Impact of primary Gleason grade on risk stratification for Gleason score 7 prostate cancers." Int J Radiat Oncol Biol Phys 82.1 (January 1, 2012): 200-203.
PMID
21237582
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
82
Issue
1
Publish Date
2012
Start Page
200
End Page
203
DOI
10.1016/j.ijrobp.2010.11.023

Biopsy accuracy in identifying unilateral prostate cancer depends on prostate weight.

OBJECTIVE: To evaluate the association between prostate weight and the diagnostic performance of routine biopsy schemes in detecting unilateral prostate cancer (PCa) that may be amenable to focal therapy. METHODS AND MATERIALS: Retrospective analysis of patients undergoing radical prostatectomy at Duke University Medical Center from 1990 to 2007. The cohort was dichotomized according to prostate weight (≤40 and >40 g) and further divided by biopsy scheme: 6-9 (sextant) and 10-20 cores (extended). Diagnostic accuracy, sensitivity, specificity, and positive and negative predictive values were calculated within each prostate weight group and compared between biopsy schemes. RESULTS: A total of 859 patients were included in the study. Patients with prostates >40 g were generally older and had higher PSA levels (P < 0.0001 and P = 0.036, respectively). Unilateral disease was more common in prostates >40 g both on biopsy (69% vs. 60%, P = 0.009) and on final pathology (21% vs. 14%, P = 0.017) despite larger total tumor volume (6.1 vs. 4.8 cc, P < 0.001). Low grade PCa was also more common in larger glands (P = 0.003). Overall, extended biopsy schemes performed better than sextant but the benefit was statistically significant only in prostates >40 g. CONCLUSIONS: Despite having higher tumor volumes, men with prostate weight >40 g were more likely to have unilateral PCa than those with smaller prostates. In prostates >40 g, increasing the number of cores harvested at biopsy increased the diagnostic performance for detecting cancer laterality. Therefore, our results suggest that the benefit of more extensive tissue sampling may be higher in larger prostates compared with smaller ones when selecting candidates for prostate hemiablation.

Authors
Tsivian, M; Moreira, DM; Sun, L; Mouraviev, V; Kimura, M; Moul, JW; Polascik, TJ
MLA Citation
Tsivian, M, Moreira, DM, Sun, L, Mouraviev, V, Kimura, M, Moul, JW, and Polascik, TJ. "Biopsy accuracy in identifying unilateral prostate cancer depends on prostate weight." Urol Oncol 30.1 (January 2012): 21-25.
PMID
20056457
Source
pubmed
Published In
Urologic Oncology: seminars and original investigations
Volume
30
Issue
1
Publish Date
2012
Start Page
21
End Page
25
DOI
10.1016/j.urolonc.2009.11.001

Quality of life associated with treatment of castration-resistant prostate cancer: a review of the literature.

The development of new therapies for castration-resistant prostate cancer (CRPC) has increasingly focused on improving patient quality of life, mainly because of limited survival gains and continuing high morbidity burden from disease progression or the adverse effects of treatments. However, there is no generally accepted quality of life instrument for use with this patient group. This paper objectively reviews the existing literature and assesses the impact of CRPC treatments on patients' quality of life. The review also provides a narrative description of the evolving role of quality of life measures in clinical trials, and critiques the most widely used instruments.

Authors
Moul, JW; Dawson, N
MLA Citation
Moul, JW, and Dawson, N. "Quality of life associated with treatment of castration-resistant prostate cancer: a review of the literature." Cancer Invest 30.1 (January 2012): 1-12. (Review)
PMID
22236184
Source
pubmed
Published In
Cancer Investigation (Informa)
Volume
30
Issue
1
Publish Date
2012
Start Page
1
End Page
12
DOI
10.3109/07357907.2011.629381

Baseline prostate-specific antigen testing at a young age.

CONTEXT: Prostate cancer screening is highly controversial, including the age to begin prostate-specific antigen (PSA) testing. Several studies have evaluated the usefulness of baseline PSA measurements at a young age. OBJECTIVE: Review the literature on baseline PSA testing at a young age (≤60 yr) for the prediction of prostate cancer risk and prognosis. EVIDENCE ACQUISITION: PubMed was searched for English-language publications on baseline PSA and prostate cancer for the period ending April 2011. EVIDENCE SYNTHESIS: In most published series, median PSA levels in the general male population range from approximately 0.4 to 0.7 ng/ml in men in their 40s and from approximately 0.7 to 1.0 ng/ml in men in their 50s. Evidence from both nonscreening and screening populations has demonstrated the predictive value of a single baseline PSA measurement for prostate cancer risk assessment. Specifically, men with baseline PSA levels above the age-group-specific median have a greater risk of prostate cancer diagnosis during the next 20-25 yr. Additional studies confirmed that higher baseline PSA levels at a young age are also associated with a greater risk of aggressive disease, metastasis, and disease-specific mortality many years later. CONCLUSIONS: Baseline PSA measurements at a young age are significant predictors of later prostate cancer diagnosis and disease-specific outcomes. Thus baseline PSA testing may be used for risk stratification and to guide screening protocols.

Authors
Loeb, S; Carter, HB; Catalona, WJ; Moul, JW; Schroder, FH
MLA Citation
Loeb, S, Carter, HB, Catalona, WJ, Moul, JW, and Schroder, FH. "Baseline prostate-specific antigen testing at a young age." Eur Urol 61.1 (January 2012): 1-7. (Review)
PMID
21862205
Source
pubmed
Published In
European Urology
Volume
61
Issue
1
Publish Date
2012
Start Page
1
End Page
7
DOI
10.1016/j.eururo.2011.07.067

What to order from the prostate cancer treatment menu?

Authors
Armstrong, AJ; Moul, JW; George, DJ
MLA Citation
Armstrong, AJ, Moul, JW, and George, DJ. "What to order from the prostate cancer treatment menu?." Oncology (Williston Park) 26.1 (January 2012): 84-88.
PMID
22393801
Source
pubmed
Published In
Oncology
Volume
26
Issue
1
Publish Date
2012
Start Page
84
End Page
88

Utilization trends at a multidisciplinary prostate cancer clinic: initial 5-year experience from the Duke Prostate Center.

PURPOSE: The multidisciplinary approach is becoming increasingly encouraged but little is known about the multidisciplinary experience compared to routine care. For patients with prostate cancer the goal is to provide evaluations by urologists, medical and radiation oncologists at a single visit. Although additional resources are required, this strategy may enhance the overall health care experience. We compared utilization determinants between a multidisciplinary and a urology prostate cancer clinic at Duke University Medical Center and identified factors associated with pursuing treatment at the university medical center for multidisciplinary clinic patients. MATERIALS AND METHODS: We retrospectively analyzed data on patients referred for primary prostate cancer treatment evaluation at Duke University Medical Center from 2005 to 2009. Comparisons between 701 multidisciplinary clinic and 1,318 urology prostate cancer clinic patients were examined with the rank sum and chi-square tests. Predictive factors for pursuing treatment at the university medical center were assessed using multivariate adjusted logistic regression. RESULTS: Compared to patients at the urology prostate cancer clinic those at the multidisciplinary clinic were more likely to be younger and white, have a higher income and travel a longer distance for evaluation. Of multidisciplinary clinic patients 58% pursued primary treatment at the university medical center. They were more likely to be younger, black and physician referred, have a lower income and reside closer to the medical center. Factors predictive of pursuing treatment at the medical center included high risk disease and physician referral. Factors predictive of not receiving care at the university medical center were income greater than $40,000 and a distance traveled of greater than 100 miles. CONCLUSIONS: A different patient demographic is using the multidisciplinary approach. However, when treatment is pursued at the institution providing multidisciplinary services, the patient demographic resembles that of the treating institution.

Authors
Stewart, SB; Bañez, LL; Robertson, CN; Freedland, SJ; Polascik, TJ; Xie, D; Koontz, BF; Vujaskovic, Z; Lee, WR; Armstrong, AJ; Febbo, PG; George, DJ; Moul, JW
MLA Citation
Stewart, SB, Bañez, LL, Robertson, CN, Freedland, SJ, Polascik, TJ, Xie, D, Koontz, BF, Vujaskovic, Z, Lee, WR, Armstrong, AJ, Febbo, PG, George, DJ, and Moul, JW. "Utilization trends at a multidisciplinary prostate cancer clinic: initial 5-year experience from the Duke Prostate Center." J Urol 187.1 (January 2012): 103-108.
PMID
22088334
Source
pubmed
Published In
The Journal of Urology
Volume
187
Issue
1
Publish Date
2012
Start Page
103
End Page
108
DOI
10.1016/j.juro.2011.09.040

What to order from the prostate cancer treatment menu?

Authors
Armstrong, AJ; Moul, JW; George, DJ
MLA Citation
Armstrong, AJ, Moul, JW, and George, DJ. "What to order from the prostate cancer treatment menu?." Oncology 26.1 (2012).
Source
scival
Published In
Oncology
Volume
26
Issue
1
Publish Date
2012

Reply

Authors
Moul, JW; McDermed, JE
MLA Citation
Moul, JW, and McDermed, JE. "Reply." Urology 80.6 (2012): 1326-1327.
Source
scival
Published In
Urology
Volume
80
Issue
6
Publish Date
2012
Start Page
1326
End Page
1327
DOI
10.1016/j.urology.2012.06.082

Preoperative predictors of pathologic stage T2a in low-risk prostate cancer: implications for focal therapy.

OBJECTIVE: To assess preoperative parameters that may be predictive of pathologic stage T2a disease in low-risk prostate cancer patients. METHODS: Data from a cohort of 1,495 consecutive men with low-risk prostate cancer who underwent a radical prostatectomy between 1993 and 2009 were evaluated. Preoperative parameter assessment focused on age, race, clinical stage, diagnostic PSA level, biopsy tumor laterality and diagnostic Gleason score. Preoperative parameters were analyzed by univariate and multivariate methods. Kaplan-Meier method was used to evaluate the biochemical disease-free survival. RESULTS: Among the 1,495 men, 236 (15.8%) had pT2a disease. In univariate analysis, biopsy tumor unilaterality (p < 0.001), diagnostic PSA ≤ 4 ng/ml (p < 0.001) and non-African-American race (p = 0.009) were significant variables. In multivariate analysis, biopsy tumor laterality (OR 0.377; p < 0.001), diagnostic PSA ≤ 4 ng/ml (OR 0.621; p = 0.002) and race (OR 0.583; p = 0.029) were independent predictors. Low-risk patients with pT2a disease showed a better PSA recurrence-free survival rate, compared with men with >pT2a diseases (p = 0.012). CONCLUSIONS: Biopsy tumor unilaterality, diagnostic PSA ≤ 4 ng/ml and race are independent predictors of pT2a in low-risk prostate cancer. These three preclinical variables may be a useful reference to begin the selection process for focal therapy in men with low-risk prostate cancer.

Authors
Fu, Q; Moul, JW; Bañez, LL; Sun, L; Mouraviev, V; Xie, D; Polascik, TJ
MLA Citation
Fu, Q, Moul, JW, Bañez, LL, Sun, L, Mouraviev, V, Xie, D, and Polascik, TJ. "Preoperative predictors of pathologic stage T2a in low-risk prostate cancer: implications for focal therapy." Urol Int 89.3 (2012): 296-300.
PMID
22964539
Source
pubmed
Published In
Urologia internationalis
Volume
89
Issue
3
Publish Date
2012
Start Page
296
End Page
300
DOI
10.1159/000341556

Testosterone in prostate cancer: The Bethesda consensus

What's known on the subject? and What does the study add? Androgen stimulation of prostate cancer (PCa) cells has been the basis for extensive studies evaluating the role of androgen in PCa but the diagnostic measurement of androgen as well as androgen values that potentially influence prognosis are unclear in patients with PCa. The 50 ng/dL threshold has been questioned as a result of reports indicating worse outcomes for levels between 20 and 50 ng/dL. Instead, a 20 ng/dL threshold for serum testosterone after androgren deprivation therapy in patients with advanced PCa was recommended. OBJECTIVE Androgen stimulation of prostate cancer (PCa) cells has been extensively studied. The increasing trend of using serum testosterone as an absolute surrogate for castration state means that the diagnostic measurement of testosterone and the values potentially influencing prognosis must be better understood. This is especially important when PCa progresses from an endocrine to an intracrine status. PATIENTS AND METHODS We performed a literature review using the MEDLINE database for publications on: (i) hormonal changes with androgen deprivation therapy (ADT); (ii) monitoring hormonal therapy with testosterone measurement; (iii) the efficacy of intermittent androgen deprivation (IAD) compared with continuous androgen deprivation; (iv) the underlying mechanisms of castration-resistance; and (v) novel treatments for castration-resistant PCa (CRPCa). RESULTS The optimum serum castration levels to be achieved with ADT are still debated. Recently, the 50 ng/dL threshold has been questioned because of reports indicating worse outcomes when levels between 20 and 50 ng/dL were studied. Instead, a 20 ng/dL threshold for serum testosterone after ADT in patients with advanced prostate cancer was recommended. CONCLUSION Understanding the mechanisms of androgen biosynthesis relating to PCa as well as prognostic implications might achieve a consensus regarding the role of ADT for both the androgen-sensitive and -insensitive disease state. © 2011 BJU INTERNATIONAL.

Authors
Djavan, B; Eastham, J; Gomella, L; Tombal, B; Taneja, S; Dianat, SS; Kazzazi, A; Shore, N; Abrahamsson, P-A; Cheetham, P; Moul, J; Lepor, H; Crawford, ED
MLA Citation
Djavan, B, Eastham, J, Gomella, L, Tombal, B, Taneja, S, Dianat, SS, Kazzazi, A, Shore, N, Abrahamsson, P-A, Cheetham, P, Moul, J, Lepor, H, and Crawford, ED. "Testosterone in prostate cancer: The Bethesda consensus." BJU International 110.3 (2012): 344-352.
PMID
22129242
Source
scival
Published In
Bju International
Volume
110
Issue
3
Publish Date
2012
Start Page
344
End Page
352
DOI
10.1111/j.1464-410X.2011.10719.x

Radiotherapy comparison favors IMRT for prostate cancer: Commentary

Authors
Moul, JW
MLA Citation
Moul, JW. "Radiotherapy comparison favors IMRT for prostate cancer: Commentary." Oncology Report MAY (2012): 11--.
Source
scival
Published In
Oncology Report
Issue
MAY
Publish Date
2012
Start Page
11-

Men avoid therapy for sexual side effects of prostatectomy: Commentary

Authors
Moul, JW
MLA Citation
Moul, JW. "Men avoid therapy for sexual side effects of prostatectomy: Commentary." Oncology Report MAY (2012): 14--.
Source
scival
Published In
Oncology Report
Issue
MAY
Publish Date
2012
Start Page
14-

In the pipeline: Galeterone lowers PSA in CRPC study: Commentary

Authors
Moul, JW
MLA Citation
Moul, JW. "In the pipeline: Galeterone lowers PSA in CRPC study: Commentary." Oncology Report MAY (2012): 12--.
Source
scival
Published In
Oncology Report
Issue
MAY
Publish Date
2012
Start Page
12-

Comprehensive preoperative evaluation and repair of inguinal hernias at the time of open radical retropubic prostatectomy decreases risk of developing postprostatectomy hernia

Authors
Moul, J
MLA Citation
Moul, J. "Comprehensive preoperative evaluation and repair of inguinal hernias at the time of open radical retropubic prostatectomy decreases risk of developing postprostatectomy hernia." BJU International (2012).
PMID
22967003
Source
scival
Published In
Bju International
Publish Date
2012
DOI
10.1111/j.1464-410X.2012.11335.x

Reply from Authors re: Seth A. Strope, Gerald L. Andriole. Prostate-Specific Antigen-Based Risk Assessment in Younger Men. Eur Urol 2012;61:8-9

Authors
Loeb, S; Carter, HB; Catalona, WJ; Moul, J; Schroder, FH
MLA Citation
Loeb, S, Carter, HB, Catalona, WJ, Moul, J, and Schroder, FH. "Reply from Authors re: Seth A. Strope, Gerald L. Andriole. Prostate-Specific Antigen-Based Risk Assessment in Younger Men. Eur Urol 2012;61:8-9." European Urology 61.1 (2012): 9-10.
Source
scival
Published In
European Urology
Volume
61
Issue
1
Publish Date
2012
Start Page
9
End Page
10
DOI
10.1016/j.eururo.2011.09.023

Prostatic alpha-linolenic acid (ALA) is positively associated with aggressive prostate cancer: a relationship which may depend on genetic variation in ALA metabolism.

Previous observational studies have reported associations between prostate cancer and alpha-linolenic acid (ALA). However, few investigations have been able to study this relationship prospectively and in well-controlled settings. Moreover, no studies have determined whether single nucleotide polymorphisms (SNPs) that influence ALA metabolism are associated with this common cancer. The purpose of this study was to explore associations between prostatic levels of ALA, SNPs and prostate cancer-specific biomarkers in samples collected from a previous randomized clinical trial conducted using a presurgical model and which tested the effects of flaxseed supplementation, a rich source of ALA, prior to prostatectomy (n = 134). Serum prostate-specific antigen (PSA) was determined and immunohistochemistry was used to assess tumor proliferation rate (Ki67). Prostatic ALA was determined with gas chromatography. Seven previously identified SNPs associated with delta-6 desaturase activity (rs99780, rs174537, rs174545, rs174572, rs498793, rs3834458 and rs968567) were tested for associations with prostatic ALA, PSA and Ki67. Despite consuming seven times more ALA per day, men in the flaxseed arm had similar amounts of prostatic ALA relative to men not consuming flaxseed. In unadjusted analysis, there were significant positive associations between prostatic ALA and PSA (ρ = 0.191, p = 0.028) and Ki67 (ρ = 0.186, p = 0.037). After adjusting for covariates (flaxseed, age, race, BMI and statin-use) the association between ALA and PSA remained (p = 0.004) but was slightly attenuated for Ki67 (p = 0.051). We did not observe associations between any of the SNPs studied and prostatic ALA; however, in models for PSA there was a significant interaction between rs498793 and ALA and for Ki67 there were significant interactions with ALA and rs99780 and rs174545. Independent and inverse associations were observed between rs174572 and Ki67. This study provides evidence that prostatic ALA, independent of the amount of ALA consumed, is positively associated with biomarkers of aggressive prostate cancer and that genetic variation may modify this relationship.

Authors
Azrad, M; Zhang, K; Vollmer, RT; Madden, J; Polascik, TJ; Snyder, DC; Ruffin, MT; Moul, JW; Brenner, D; Hardy, RW; Demark-Wahnefried, W
MLA Citation
Azrad, M, Zhang, K, Vollmer, RT, Madden, J, Polascik, TJ, Snyder, DC, Ruffin, MT, Moul, JW, Brenner, D, Hardy, RW, and Demark-Wahnefried, W. "Prostatic alpha-linolenic acid (ALA) is positively associated with aggressive prostate cancer: a relationship which may depend on genetic variation in ALA metabolism." PLoS One 7.12 (2012): e53104-.
Website
http://hdl.handle.net/10161/11293
PMID
23285256
Source
pubmed
Published In
PloS one
Volume
7
Issue
12
Publish Date
2012
Start Page
e53104
DOI
10.1371/journal.pone.0053104

Minimally invasive open retropubic prostatectomy: In experienced HandsStill the gold standard

Authors
Moul, JW
MLA Citation
Moul, JW. "Minimally invasive open retropubic prostatectomy: In experienced HandsStill the gold standard." ONCOLOGY (United States) 26.7 (2012).
Source
scival
Published In
Oncology
Volume
26
Issue
7
Publish Date
2012

Comprehensive preoperative evaluation and repair of inguinal hernias at the time of open radical retropubic prostatectomy decreases risk of developing postprostatectomy hernia

Authors
Moul, J
MLA Citation
Moul, J. "Comprehensive preoperative evaluation and repair of inguinal hernias at the time of open radical retropubic prostatectomy decreases risk of developing postprostatectomy hernia." BJU International 110.11 B (2012): E607-.
Source
scival
Published In
Bju International
Volume
110
Issue
11 B
Publish Date
2012
Start Page
E607
DOI
10.1111/j.1464-410X.2012.11335.x

Association between percentage of tumor involvement and Gleason score upgrading in low-risk prostate cancer

To find the predictors of Gleason score upgrading in a cohort of low-risk prostate cancer patients, data were analyzed comprising 1,632 consecutive men with low-risk prostate cancer who underwent radical prostatectomy between 1993 and 2009. Assessment focused on preoperative parameters including patient age, race, diagnostic prostate-specific antigen (PSA) levels, clinical stage and biopsy Gleason score, along with pathological parameters including percentage of tumor involvement (PTI), tumor laterality, pathological stage, extra-capsular extension, seminal vesicle invasion, and surgical margins. These parameters were analyzed using univariate and multivariate methods. Kaplan-Meier curves compared differences in biochemical disease-free survival in men having cancers with and without Gleason score upgrading. Cases involving pathological Gleason score upgrading were identified in 723 (44.3 %) of 1,632 patients. Kaplan-Meier PSA recurrence-free survival curves showed a difference in outcome between men with and without Gleason score upgrading (p < 0.001). Of Gleason score upgraded patients, 35 (4.8 %) men had PTI of <5 %, 237 (32.8 %) had PTI of 5-9.9 %, 177 (24.5 %) had PTI of 10-14.9 %, and 274 (37.9 %) had PTI ≥ 15 % (p < 0.001). PTI (p < 0.001) along with diagnostic PSA, patient age, diagnostic biopsy Gleason score, pathologic stage, and surgical margin status were independent predictors of pathological Gleason score upgrading on multivariate logistic regression. PTI correlates closely with Gleason score upgrading in a low-risk prostate cancer cohort. Low-risk prostate cancer patients with clinical findings suggestive of high PTI or large volume cancers should not benefit from active surveillance strategies. © 2012 Springer Science+Business Media, LLC.

Authors
Fu, Q; Moul, JW; Bañez, LL; Sun, L; Mouraviev, V; Xie, D; Polascik, TJ
MLA Citation
Fu, Q, Moul, JW, Bañez, LL, Sun, L, Mouraviev, V, Xie, D, and Polascik, TJ. "Association between percentage of tumor involvement and Gleason score upgrading in low-risk prostate cancer." Medical Oncology 29.5 (2012): 3339-3344.
Source
scival
Published In
Medical Oncology
Volume
29
Issue
5
Publish Date
2012
Start Page
3339
End Page
3344
DOI
10.1007/s12032-012-0270-4

Predictive value of digital rectal examination for prostate cancer detection is modified by obesity.

The American Cancer Society's updated screening guidelines for prostate cancer (CaP) render digital rectal examination (DRE) optional. We investigated the impact of DRE on CaP detection among obese men. Data from 2794 men undergoing initial prostate biopsy at three centers were analyzed to assess CaP risk attributed to abnormal DRE across body mass index (BMI) categories. Predictive accuracies of a combination of PSA, age, race, center and biopsy year including or excluding DRE findings were compared by areas under the receiver-operating characteristics curves. In all cohorts, obese men were less likely to have abnormal DREs diagnosed than non-obese men. As BMI category increased, abnormal DREs became stronger predictors for overall CaP in individual (P-trends ≤ 0.05) and combined (P-trend<0.001) cohorts, and for high-grade CaP in the Italian (P-trend=0.03) and combined (P-trend=0.03) cohorts. DRE inclusion improved the predictive accuracy for overall and high-grade CaP detection among all obese men (P ≤ 0.032) but not normal-weight men (P ≥ 0.198). DRE inclusion also near-significantly improved overall CaP detection in obese men with PSA<4 ng ml(-1) (P=0.081). In conclusion, the predictive value of DRE is dependent on obesity and is significantly higher among obese men than normal-weight men.

Authors
Chu, DI; De Nunzio, C; Gerber, L; Thomas, J-A; Calloway, EE; Albisinni, S; Senocak, C; McKeever, MG; Moreira, DM; Tubaro, A; Moul, JW; Freedland, SJ; Bañez, LL
MLA Citation
Chu, DI, De Nunzio, C, Gerber, L, Thomas, J-A, Calloway, EE, Albisinni, S, Senocak, C, McKeever, MG, Moreira, DM, Tubaro, A, Moul, JW, Freedland, SJ, and Bañez, LL. "Predictive value of digital rectal examination for prostate cancer detection is modified by obesity." Prostate Cancer Prostatic Dis 14.4 (December 2011): 346-353.
PMID
21727906
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
14
Issue
4
Publish Date
2011
Start Page
346
End Page
353
DOI
10.1038/pcan.2011.31

Prostate-specific antigen 1.5-4.0 ng/mL: a diagnostic challenge and danger zone.

UNLABELLED: What's known on the subject? and What does the study add? Large population screening trials like the ERSPC, PCPT and PLCO have noted that men with seemingly low PSA (even as low as 0.5 ng/dL) still can have prostate cancer. Despite these findings, PSA is still predominantly used as a current indicator for possible presence of prostate cancer rather than also serving as a prognostic marker. This study examines a larger number of men in a diverse US population to determine the prognostic value of a man's baseline or first PSA. OBJECTIVES: • To assess the value of a PSA threshold of 1.5 ng/mL as a predictor of increased prostate cancer risk over a four-year period based on a man's first PSA test, including racial differences. • To review the risk of progression of benign prostatic hyperplasia (BPH) based on a similar PSA threshold. PATIENTS AND METHODS: • A retrospective review involving 21,502 men from a large Midwestern health system was performed. • Men at least 40 years old with baseline PSA values between 0 and 4.0 ng/mL and at least four years of follow-up after initial PSA test were included. • Optimal PSA threshold and predictive value of PSA for development of prostate cancer were calculated. RESULTS: • Prostate cancer rates were 15-fold higher in patients with PSA ≥1.5 ng/mL vs patients with PSA <1.5 ng/mL (7.85% vs 0.51%). • African American patients with baseline PSA <1.5 ng/mL faced prostate cancer rates similar to the whole study population (0.54% vs 0.51%, respectively), while African American patients with PSA 1.5-4.0 ng/mL faced a 19-fold increase in prostate cancer. CONCLUSION: • Both Caucasian and African American men with baseline PSA values between 1.5 and 4.0 ng/mL are at increased risk for future prostate cancer compared with those who have an initial PSA value below the 1.5 ng/mL threshold. • Based on a growing body of literature and this analysis, it is recommended that a first PSA test threshold of 1.5 ng/mL and above, or somewhere between 1.5 and 4.0 ng/mL, represent the Early-Warning PSA Zone (EWP Zone). • This should serve to inform patients and clinicians alike to future clinical activities with respect to prostate cancer and BPH.

Authors
Crawford, ED; Moul, JW; Rove, KO; Pettaway, CA; Lamerato, LE; Hughes, A
MLA Citation
Crawford, ED, Moul, JW, Rove, KO, Pettaway, CA, Lamerato, LE, and Hughes, A. "Prostate-specific antigen 1.5-4.0 ng/mL: a diagnostic challenge and danger zone." BJU Int 108.11 (December 2011): 1743-1749.
PMID
21711431
Source
pubmed
Published In
Bju International
Volume
108
Issue
11
Publish Date
2011
Start Page
1743
End Page
1749
DOI
10.1111/j.1464-410X.2011.10224.x

Indications and practice with androgen deprivation therapy.

The Cancer of the Prostate Strategic Urological Research Endeavor (CaPSURE) is an ongoing longitudinal observational study of current trends in prostate cancer staging and treatment across a spectrum of different treatment facilities in the United States. To date, the study has documented 2 principal findings: (a) a large variation exists in the treatment choices applied to similar patient presentations across the range of facility type, size, and geographic location in the United States; and (b) although it does not seem to make much difference in mortality outcomes which approach--hormonal therapy, radiotherapy, or surgery--is applied to men at low or intermediate risk, a survival benefit exists with surgery for men at high risk.

Authors
Moul, JW; Kibel, AS; Roach, M; Dreicer, R
MLA Citation
Moul, JW, Kibel, AS, Roach, M, and Dreicer, R. "Indications and practice with androgen deprivation therapy." Urology 78.5 Suppl (November 2011): S478-S481.
PMID
22054918
Source
pubmed
Published In
Urology
Volume
78
Issue
5 Suppl
Publish Date
2011
Start Page
S478
End Page
S481
DOI
10.1016/j.urology.2011.04.025

Traditional approaches to androgen deprivation therapy.

For most of the past 25 years, 1 of the favored approaches to treating prostate cancer has been the suppression of circulating testosterone with luteinizing hormone-releasing hormone (LHRH) agonists. LHRH agonists produce a downregulation of LHRH receptors and an uncoupling of the LHRH signal transduction mechanism. This leads to a marked reduction in the secretion of bioactive hormones stimulating testosterone production and eventual induction of a reversible, but transient and incomplete, state known as "selective medical hypophysectomy." The treatment with LHRH agonists has proved effective in many settings; however, the dosage and timing strategies depend critically on the patient's disease risk and progression. More recent investigations have suggested that a newer, quicker acting, pure gonadotropin-releasing hormone antagonist might be a preferable treatment approach. It remains a fundamental truth, however, that hormonal therapy is both overused and more toxic than generally appreciated. Therefore, a complete understanding of the indications and applications of this approach is essential for the practice of evidence-based medicine.

Authors
Moul, JW; Evans, CP; Gomella, LG; Roach, M; Dreicer, R
MLA Citation
Moul, JW, Evans, CP, Gomella, LG, Roach, M, and Dreicer, R. "Traditional approaches to androgen deprivation therapy." Urology 78.5 Suppl (November 2011): S485-S493.
PMID
22054920
Source
pubmed
Published In
Urology
Volume
78
Issue
5 Suppl
Publish Date
2011
Start Page
S485
End Page
S493
DOI
10.1016/j.urology.2011.05.051

Targeting the androgen receptor--theory and practice.

Intensive investigation during the past 2 decades has led to an improved knowledge of the biology of the androgen receptor and a better understanding of how to assess for disease progression and the apparent existence of castrate-resistant prostate cancer. The result has been the clinical development of a new generation of hormonal therapy agents for achieving the androgen deprivation necessary to achieve castrate levels of circulating testosterone. It has also resulted in the realization that it is probably time to move away from using terms such as "hormone-refractory" and "androgen-independent" prostate cancer, given the clear evidence that significant, effective, ongoing suppression of testosterone, using better drugs and better assays, will continue to be the standard of care.

Authors
Dreicer, R; Gleave, M; Kibel, AS; Thrasher, JB; Moul, JW
MLA Citation
Dreicer, R, Gleave, M, Kibel, AS, Thrasher, JB, and Moul, JW. "Targeting the androgen receptor--theory and practice." Urology 78.5 Suppl (November 2011): S482-S484.
PMID
22054919
Source
pubmed
Published In
Urology
Volume
78
Issue
5 Suppl
Publish Date
2011
Start Page
S482
End Page
S484
DOI
10.1016/j.urology.2011.05.052

New data, new paradigms for treating prostate cancer patients--VI: novel hormonal therapy approaches.

Until the 1980s, testosterone suppression for men with advanced prostate cancer was managed surgically, with bilateral orchiectomy, or medically, with diethylstilbestrol, a drug that was associated with a problematic side effect profile. Beginning in the mid-1980s, the U.S. Food and Drug Administration approved the first luteinizing hormone-releasing hormone agonists, which proved effective for suppressing circulating testosterone levels and led to a significant shift away from surgical castration to medical management during the past 25 years. The luteinizing hormone-releasing hormone agonists resulted in a periodic return of noncastrate testosterone levels once the receptor desensitization attenuated and the effect of androgen agonism resumed. Therefore, the introduction of an androgen receptor antagonist (gonadotropin-releasing hormone antagonist) appeared, conceptually at least, to be a preferable alternative. The first such agent, degarelix, has proved to provide rapid testosterone suppression without the initial testosterone surge associated with luteinizing hormone-releasing hormone agonists. Other new agents in early development include a selective and irreversible inhibitor of CYP17, abiraterone, which has shown success in patients with castration-resistant metastatic prostate cancer, and MDV3100, a novel small molecule that acts as an oral nonsteroidal antiandrogen agent. In sum, these latest agents might lead to a paradigm shift in the treatment of patients with advanced prostate cancer; however, additional studies are required to clarify the many questions that remain regarding the optimal use and sequence of these agents.

Authors
Dreicer, R; Bajorin, DF; McLeod, DG; Petrylak, DP; Moul, JW
MLA Citation
Dreicer, R, Bajorin, DF, McLeod, DG, Petrylak, DP, and Moul, JW. "New data, new paradigms for treating prostate cancer patients--VI: novel hormonal therapy approaches." Urology 78.5 Suppl (November 2011): S494-S498.
PMID
22054921
Source
pubmed
Published In
Urology
Volume
78
Issue
5 Suppl
Publish Date
2011
Start Page
S494
End Page
S498
DOI
10.1016/j.urology.2011.06.058

New data, new paradigms for treating patients with prostate cancer: introduction.

Authors
Moul, JW; Dreicer, R
MLA Citation
Moul, JW, and Dreicer, R. "New data, new paradigms for treating patients with prostate cancer: introduction." Urology 78.5 Suppl (November 2011): S475-.
PMID
22054916
Source
pubmed
Published In
Urology
Volume
78
Issue
5 Suppl
Publish Date
2011
Start Page
S475
DOI
10.1016/j.urology.2011.03.061

Focusing on testosterone.

Since Huggins and Hodges first established testosterone as the principal androgenic hormone responsible for the growth of prostate cancer in 1941, lowering the circulating testosterone to surgical castration levels (<50 ng/dL) has been a fundamental strategy for prostate cancer therapy. Until the 1980s, surgical castration (bilateral orchiectomy) and medical castration using estrogen (diethylstilbestrol) were the primary methods of testosterone suppression. However, during the past 30 years, newer agents that lower serum testosterone even more effectively have been approved and the indications for use of these newer agents re-evaluated.

Authors
Moul, JW; Dreicer, R
MLA Citation
Moul, JW, and Dreicer, R. "Focusing on testosterone." Urology 78.5 Suppl (November 2011): S476-S477.
PMID
22054917
Source
pubmed
Published In
Urology
Volume
78
Issue
5 Suppl
Publish Date
2011
Start Page
S476
End Page
S477
DOI
10.1016/j.urology.2011.06.004

Diagnosis, staging, and risk factors: SIU/ICUD Consensus Meeting on Germ Cell Tumors (GCT), Shanghai 2009.

Authors
Albers, P; Algaba, F; Cohn-Cedermark, G; DeSantis, M; Kliesch, S; Moul, JW
MLA Citation
Albers, P, Algaba, F, Cohn-Cedermark, G, DeSantis, M, Kliesch, S, and Moul, JW. "Diagnosis, staging, and risk factors: SIU/ICUD Consensus Meeting on Germ Cell Tumors (GCT), Shanghai 2009." Urology 78.4 Suppl (October 2011): S427-S434.
PMID
21986222
Source
pubmed
Published In
Urology
Volume
78
Issue
4 Suppl
Publish Date
2011
Start Page
S427
End Page
S434
DOI
10.1016/j.urology.2011.03.053

Factors predicting early and late phase decline of sexual health-related quality of life following radical prostatectomy.

INTRODUCTION: The association between early and late phase sexual health-related quality of life (HRQoL) following radical prostatectomy (RP) is unclear. Moreover, factors that predict either early or late sexual HRQoL decline have not been fully investigated. AIM: The aim of this study was to evaluate the correlation between early and late phase sexual HRQoL decline, and identify clinical parameters that predict substantial sexual HRQoL decline after surgery in the early phase (3 months) and late phase (20 months) following RP. METHODS: We analyzed data on 2,345 consecutive patients who underwent radical retropubic prostatectomy, radical perineal prostatectomy, or robotic-assisted laparoscopic prostatectomy between 2001 and 2009 from the Duke Prostate Center database. MAIN OUTCOME MEASURE: Sexual HRQoL was assessed using the Expanded Prostate Cancer Index Composite instrument at baseline, early and late phase after surgery. The Spearman rank test was used to calculate correlation coefficients between early and late phase sexual HRQoL decline. Logistic regression analysis was performed to identify factors associated with substantial sexual HRQoL decline during both phases. RESULTS: Of 406 men who met our criteria, 217 (53.5%) men had normal erectile function, whereas 189 (46.5%) men had erectile dysfunction at baseline. Declines of sexual HRQoL during early phase had a significant association with that of a decline during late phase (r = 0.48, P < 0.001). In logistic regression, older age at surgery (odds ratio [OR], 1.06; P = 0.007 and OR, 1.08; P = 0.001), African-American race (OR, 4.32; P = 0.001 and OR, 3.13; P = 0.017), and overall comorbidity (OR, 1.43; P = 0.072 and OR, 1.72; P = 0.010) were consistently associated with substantial decline of sexual HRQoL in both early and late phases. CONCLUSIONS: Sexual HRQoL at early and late phases after RP were strongly correlated. Additionally, several factors were identified to be a predictor for decline of sexual HRQoL. Our findings may be used to advise patients who possess aforementioned risk factors during both phases.

Authors
Kimura, M; Bañez, LL; Schroeck, FR; Gerber, L; Qi, J; Satoh, T; Baba, S; Robertson, CN; Walther, PJ; Donatucci, CF; Moul, JW; Polascik, TJ
MLA Citation
Kimura, M, Bañez, LL, Schroeck, FR, Gerber, L, Qi, J, Satoh, T, Baba, S, Robertson, CN, Walther, PJ, Donatucci, CF, Moul, JW, and Polascik, TJ. "Factors predicting early and late phase decline of sexual health-related quality of life following radical prostatectomy." J Sex Med 8.10 (October 2011): 2935-2943.
PMID
21771284
Source
pubmed
Published In
The Journal of Sexual Medicine
Volume
8
Issue
10
Publish Date
2011
Start Page
2935
End Page
2943
DOI
10.1111/j.1743-6109.2011.02387.x

Salvage radiation in men after prostate-specific antigen failure and the risk of death.

BACKGROUND: A survival benefit has been observed with salvage radiation therapy (RT) for prostate-specific antigen (PSA) failure after radical prostatectomy (RP) in men with rapid rises in PSA doubling time (DT, < 6 months). Whether such a benefit exits in men with a protracted PSA rise in DT (≥ 6 months) is unclear and was examined in the current study. METHODS: Of 4036 men who underwent RP at Duke University between 1988 and 2008, 519 experienced a PSA failure, had complete data, and were the subjects of this study. Univariate and multivariate Cox regression analyses were performed to evaluate whether salvage RT in men with either a rapid (< 6 months) or a protracted (≥ 6 months) PSA DT was associated with the risk of all-cause mortality adjusting for age at the time of PSA failure, known prostate cancer prognostic factors, and cardiac comorbidity. RESULTS: After a median follow-up of 11.3 years after PSA failure, 195 men died. Salvage RT was associated with a significant reduction in all-cause mortality for men with either a PSA DT of < 6 months (adjusted hazard ratio [AHR], 0.53; P = .02) or a PSA DT of ≥ 6 months (AHR, 0.52; P = .003). In a subset of patients with comorbidity data at the time of PSA failure, salvage RT remained associated with a significant reduction in all-cause mortality for both men with a PSA DT of < 6 months (AHR, 0.35; P = .042) or a PSA DT of ≥ 6 months (AHR, 0.60; P = .04). CONCLUSIONS: Salvage RT for PSA DTs less than or in excess of 6 months is associated with a decreased risk in all-cause mortality.

Authors
Cotter, SE; Chen, MH; Moul, JW; Lee, WR; Koontz, BF; Anscher, MS; Robertson, CN; Walther, PJ; Polascik, TJ; D'Amico, AV
MLA Citation
Cotter, SE, Chen, MH, Moul, JW, Lee, WR, Koontz, BF, Anscher, MS, Robertson, CN, Walther, PJ, Polascik, TJ, and D'Amico, AV. "Salvage radiation in men after prostate-specific antigen failure and the risk of death." Cancer 117.17 (September 1, 2011): 3925-3932.
PMID
21437885
Source
pubmed
Published In
Cancer
Volume
117
Issue
17
Publish Date
2011
Start Page
3925
End Page
3932
DOI
10.1002/cncr.25993

A phase III extension trial with a 1-arm crossover from leuprolide to degarelix: comparison of gonadotropin-releasing hormone agonist and antagonist effect on prostate cancer.

PURPOSE: We investigated the efficacy and safety of degarelix treatment and the effects of switching from leuprolide to degarelix in an ongoing extension study with a median 27.5-month followup of a pivotal 1-year prostate cancer trial. MATERIALS AND METHODS: Patients who completed a 1-year pivotal phase III trial continued on the same monthly degarelix maintenance dose (160 or 80 mg in 125 each), or were re-randomized from leuprolide 7.5 mg to degarelix 240/80 mg (69) or 240/160 mg (65). Data are shown on the approved degarelix 240/80 mg dose. The primary end point was safety/tolerability and the secondary end points were testosterone, prostate specific antigen, luteinizing hormone and follicle-stimulating hormone responses, and prostate specific antigen failure and progression-free survival. RESULTS: During followup testosterone and prostate specific antigen suppression were similar to those in the 1-year trial in patients who continued on degarelix or switched from leuprolide. The prostate specific antigen progression-free survival hazard rate was decreased significantly after the switch in the leuprolide/degarelix group while the rate in those who continued on degarelix was consistent with the rate in treatment year 1. The same hazard rate change pattern occurred in the group with baseline prostate specific antigen greater than 20 ng/ml. Adverse event frequency was similar between the groups and decreased with time. CONCLUSIONS: Data support the statistically significant prostate specific antigen progression-free survival benefit for degarelix over leuprolide seen during year 1 and the use of degarelix as first line androgen deprivation therapy as an alternative to a gonadotropin-releasing hormone agonist.

Authors
Crawford, ED; Tombal, B; Miller, K; Boccon-Gibod, L; Schröder, F; Shore, N; Moul, JW; Jensen, J-K; Olesen, TK; Persson, B-E
MLA Citation
Crawford, ED, Tombal, B, Miller, K, Boccon-Gibod, L, Schröder, F, Shore, N, Moul, JW, Jensen, J-K, Olesen, TK, and Persson, B-E. "A phase III extension trial with a 1-arm crossover from leuprolide to degarelix: comparison of gonadotropin-releasing hormone agonist and antagonist effect on prostate cancer." J Urol 186.3 (September 2011): 889-897.
PMID
21788033
Source
pubmed
Published In
The Journal of Urology
Volume
186
Issue
3
Publish Date
2011
Start Page
889
End Page
897
DOI
10.1016/j.juro.2011.04.083

Risk of death from prostate cancer after radical prostatectomy or brachytherapy in men with low or intermediate risk disease.

PURPOSE: Radical prostatectomy and brachytherapy are widely used treatments for favorable risk prostate cancer. We estimated the risk of prostate cancer specific mortality following radical prostatectomy or brachytherapy in men with low or intermediate risk prostate cancer using prospectively collected data. MATERIALS AND METHODS: The study cohort comprised 5,760 men with low risk prostate cancer (prostate specific antigen 10 ng/ml or less, clinical category T1c or 2a and Gleason score 6 or less), and 3,079 with intermediate risk prostate cancer (prostate specific antigen 10 to 20 ng/ml, clinical category T2b or T2c, or Gleason score 7). Competing risks multivariable regression was performed to assess the risk of prostate cancer specific mortality after radical prostatectomy or brachytherapy, adjusting for age, year of treatment, cardiovascular comorbidity and known prostate cancer prognostic factors. RESULTS: After a median followup of 4.2 years (IQR 2.0-7.4) for low risk and 4.8 years (IQR 2.2-8.1) for intermediate risk men, there was no significant difference in the risk of prostate cancer specific mortality among low risk (adjusted hazard ratio 1.62, 95% CI 0.59-4.45, p = 0.35) or intermediate risk men (AHR 2.30, 95% CI 0.95-5.58, p = 0.07) treated with brachytherapy compared with radical prostatectomy. The only factor associated with an increased risk of prostate cancer specific mortality (AHR 1.05, 95% CI 1.01-1.10, p = 0.03) was increasing age at treatment in intermediate risk men. CONCLUSIONS: The risk of prostate cancer specific mortality in men with low or intermediate risk prostate cancer was not significantly different following radical prostatectomy vs brachytherapy.

Authors
Arvold, ND; Chen, M-H; Moul, JW; Moran, BJ; Dosoretz, DE; Bañez, LL; Katin, MJ; Braccioforte, MH; D'Amico, AV
MLA Citation
Arvold, ND, Chen, M-H, Moul, JW, Moran, BJ, Dosoretz, DE, Bañez, LL, Katin, MJ, Braccioforte, MH, and D'Amico, AV. "Risk of death from prostate cancer after radical prostatectomy or brachytherapy in men with low or intermediate risk disease." J Urol 186.1 (July 2011): 91-96.
PMID
21571341
Source
pubmed
Published In
The Journal of Urology
Volume
186
Issue
1
Publish Date
2011
Start Page
91
End Page
96
DOI
10.1016/j.juro.2011.03.003

Prostate-specific antigen velocity based risk-adapted discontinuation of prostate cancer screening in elderly men.

OBJECTIVE: • To evaluate weather prostate-specific antigen (PSA) velocity could be used to stratify patients at risk of death from prostate cancer (PCa) and be useful in aiding decision making regarding PSA screening in elderly men, as previous studies have shown that PSA velocity can predict PCa risk. PATIENTS AND METHODS: • The cohort included 3,525 patients aged ≥ 75 years with two or more PSA tests before a diagnosis of PCa. Cox proportional hazard model was used to evaluate which variables at time of last PSA measurement were associated with death from PCa. • The rates of death from PCa after diagnosis in different PSA velocity groups were calculated. Kaplan-Meier and log rank test were used to assess the significant difference in death from PCa after diagnosis, stratified by PSA velocity cutoff. RESULTS: • On multivariate analysis, men with a PSA velocity of PSA velocity ≥ 0.45 ng/mL/year had a 4.8-fold higher risk of death from PCa as compared to men with a PSA velocity of < 0.45 ng/mL/year (p value = 0.013). After a median 6.5 (up to 16.9) years of follow-up from diagnosis, 1.4% of the men with a PSA velocity < 0.45 ng/mL/year had died of PCa as compared to 8.7% of those with a PSA velocity ≥ 0.45 ng/mL/year. • The cumulative rate of death from PCa after diagnosis, stratified by a PSA velocity of 0.45 ng/mL/year, was statistically different (log rank test, P < 0.001). CONCLUSION: • Men age ≥ 75 years old with a PSA velocity of <0.45 ng/mL/year are unlikely to die of PCa. It may be safe to discontinue PSA screening in these men.

Authors
Tang, P; Sun, L; Uhlman, MA; Robertson, CN; Polascik, TJ; Moul, JW
MLA Citation
Tang, P, Sun, L, Uhlman, MA, Robertson, CN, Polascik, TJ, and Moul, JW. "Prostate-specific antigen velocity based risk-adapted discontinuation of prostate cancer screening in elderly men." BJU Int 108.1 (July 2011): 44-48.
PMID
21050357
Source
pubmed
Published In
Bju International
Volume
108
Issue
1
Publish Date
2011
Start Page
44
End Page
48
DOI
10.1111/j.1464-410X.2010.09812.x

Investigator-initiated pilot study of sunitinib malate in patients with newly diagnosed prostate cancer prior to prostatectomy: A trial of the DoD/PCF Prostate Cancer Clinical Trials Consortium

Authors
George, DJ; Halabi, S; Zurita, AJ; Creel, P; Mundy, K; Turnbull, JD; Wood, SEY; Armstrong, AJ; Varley, RJ; Madden, J; Moul, JW
MLA Citation
George, DJ, Halabi, S, Zurita, AJ, Creel, P, Mundy, K, Turnbull, JD, Wood, SEY, Armstrong, AJ, Varley, RJ, Madden, J, and Moul, JW. "Investigator-initiated pilot study of sunitinib malate in patients with newly diagnosed prostate cancer prior to prostatectomy: A trial of the DoD/PCF Prostate Cancer Clinical Trials Consortium." May 20, 2011.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
29
Issue
15
Publish Date
2011

Assessment of current practices among physicians and awareness and concern among patients for bone health in cancer.

Authors
Tripathy, D; Moul, JW; Durie, BG; Mautner, BD
MLA Citation
Tripathy, D, Moul, JW, Durie, BG, and Mautner, BD. "Assessment of current practices among physicians and awareness and concern among patients for bone health in cancer." May 20, 2011.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
29
Issue
15
Publish Date
2011

Investigator-initiated pilot study of sunitinib malate in patients with newly diagnosed prostate cancer prior to prostatectomy: A trial of the DoD/PCF Prostate Cancer Clinical Trials Consortium.

4664 Background: Sunitinib malate (Sutent, Pfizer) is an oral multi-targeted tyrosine kinase inhibitor of VEGF/PDGF receptors that may function in part to inhibit prostate tumor growth via anti-angiogenic mechanisms.We conducted a multi-site study of sunitinib in patients with newly diagnosed, clinically localized prostate cancer prior to prostatectomy. After meeting eligibility requirements (intermediate to high risk, localized prostate cancer, adequate laboratory parameters, no prior treatment for prostate cancer), subjects received sunitinib 50mg PO for 28 days followed by a 1 week washout period followed by either radical retropubic or robot-assisted prostatectomy. Pathologic specimens (pretreatment biopsies and prostatectomy specimens) were evaluated for apoptotic (TUNEL) and proliferation (Ki-67) indices, microvessel density (MVD) and gene expression patterns.31 subjects were enrolled (median age 60 yrs; ECOG=0, biopsy Gleason 3+4=7). Data analysis is complete for 28 subjects. Most common toxicities (>30%) were diarrhea, fatigue, hypertension, mucositis, neutropenia, taste alterations, and thrombocytopenia. Most common grade 3-4 toxicities (> 5%) were hypertension, increased AST/ALT, and neutropenia. Median PSA decline was 13.6% (range -32% to 80%). Median change in Ki-67 was -34% (lower quartile -64% upper quartile +1.3%); median change in TUNEL was 4.5% (lower quartile -76%, upper quartile +286%); and median change in MVD (CD31) was +22% (lower quartile -23%, upper quartile +110%). Gene expression analysis is ongoing.Sunitinib given in the pre-prostastectomy setting appears safe and tolerable with a similar toxicity profile seen in patients with advanced cancer. Changes in proliferation and apoptosis suggest a treatment effect, while increases in MVD suggest a possible rebound effect off of sunitinib.

Authors
George, DJ; Halabi, S; Zurita, AJ; Creel, P; Mundy, K; Turnbull, JD; Yenser Wood, SE; Armstrong, AJ; Varley, RJ; Madden, J; Moul, JW
MLA Citation
George, DJ, Halabi, S, Zurita, AJ, Creel, P, Mundy, K, Turnbull, JD, Yenser Wood, SE, Armstrong, AJ, Varley, RJ, Madden, J, and Moul, JW. "Investigator-initiated pilot study of sunitinib malate in patients with newly diagnosed prostate cancer prior to prostatectomy: A trial of the DoD/PCF Prostate Cancer Clinical Trials Consortium." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 29.15_suppl (May 2011): 4664-.
PMID
28023877
Source
epmc
Published In
Journal of Clinical Oncology
Volume
29
Issue
15_suppl
Publish Date
2011
Start Page
4664

Assessment of current practices among physicians and awareness and concern among patients for bone health in cancer.

e19617 Background: Little is known about physicians' (MDs) and cancer patients' (pts) levels of awareness or concern about bone health or how/when MDs discuss bone health with at-risk patients. An online survey was conducted to explore these issues and evaluate knowledge levels and attitudes about bone metastases and cancer treatment-induced bone loss (CTIBL).MDs from the AMA master list recruited for the survey included urologists (n=113), medical oncologists (med oncs; n=204) and hematologist-oncologists (hem oncs; n=150). Breast (BC, n=212) and prostate (PC, n=186) cancer pts were recruited from Harris' Chronic Illness Panel; myeloma (MM, n=831) pts were recruited from members of the International Myeloma Foundation. Surveys lasted on average 10 minutes; MD, BC pt, and PC pt surveys were weighted to be representative of the populations of interest. Descriptive statistical analyses were used.More nonmetastatic BC than PC pts are familiar with the term "bone metastases" (50% vs 35%) and concerned about CTIBL (39% vs 24%). Of those aware of CTIBL, 79% of BC pts and 55% of PC pts had discussed it with their MD. Both med oncs and urologists consider CTIBL a serious issue for PC pts (98% vs. 90%), but more med oncs believe that pts are concerned about CTIBL (71% vs 37%). For metastatic (M) PC, more med oncs than urologists believe they are responsible for pts' bone health (100% vs 75%), but 68% of MPC pts had not discussed bone mets treatment with their doctor; when discussed, 91% of discussions were initiated by the doctor, usually prior to initiating treatment. In MBC, 66% had not discussed bone mets treatment, and if discussed, initiated by the doctor in 88% of cases, again usually prior to treatment initiation. Most MM pts recognized common symptoms of bone disease, and most had experienced them (85%) and discussed treatment options with their MDs (77%). Among hem oncs, 98% discussed treatment of bone disease with MM pts.Hem oncs and MM pts are knowledgeable and concerned about bone health. Urologists and med oncs are also concerned about bone health but tend not to initiate discussion until an event occurs. Pt and MD awareness/concern and MD discussion are not always concordant in bone health.

Authors
Tripathy, D; Moul, JW; Durie, BG; Mautner, BD
MLA Citation
Tripathy, D, Moul, JW, Durie, BG, and Mautner, BD. "Assessment of current practices among physicians and awareness and concern among patients for bone health in cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 29.15_suppl (May 2011): e19617-.
PMID
28022150
Source
epmc
Published In
Journal of Clinical Oncology
Volume
29
Issue
15_suppl
Publish Date
2011
Start Page
e19617

Maximizing outcomes in genitourinary cancers across the treatment continuum.

Key controversies concerning the management of genitourinary cancers across the treatment continua were discussed at the second annual Interactive Genitourinary Cancer Conference (IGUCC) held in February 2010 in Athens, Greece. Prostate cancer is the most common form of cancer among western men and prevention strategies are needed. Trials evaluating 5α-reductase inhibitors have reported beneficial and clinically meaningful results, but uptake remains low for primary prostate cancer prevention. Prostate cancer detection programmes are also important as curative treatments for advanced disease are unavailable. Two large landmark randomized controlled trials reported conflicting results concerning screening efficacy and uncovered high levels of over-diagnosis and potential over-treatment. Tailored management strategies after diagnosis are important and predictive markers that distinguish between aggressive and indolent tumours are needed. The majority of newly diagnosed cases of prostate cancer are clinically localized. Active surveillance of favourable risk patients may be beneficial in the intermediate term, while an integrated approach of multi-modality therapy in patients with adverse features is recommended. The benefits of new technologies such as high-intensity focused ultrasound (HIFU) and robotic prostatectomy have not been established in prospective randomized trials vs current standards of care. A multidisciplinary approach is essential to evolving the management of advanced prostate cancer into a chronic disease paradigm. Docetaxel plus prednisone is the standard first-line chemotherapy for patients with metastatic castration-resistant prostate cancer (mCRPC), but the optimal timing of chemotherapy initiation has not been addressed in randomized clinical trials. Retrospective analyses suggest that asymptomatic patients with adverse prognostic factors for survival may also benefit from receiving chemotherapy. Bladder cancer is a common malignancy and the most expensive cancer per patient. Non-muscle-invasive bladder cancer is a heterogenous disease that requires dynamic multidisciplinary management. Aggressive early intervention may be beneficial in some cases. Platinum-based therapies represent the first-line standard of care for advanced bladder cancer, but the maximum benefit may have been reached for conventional chemotherapies and new strategies are needed. Several ongoing clinical trials are assessing combination chemotherapy and targeted therapy.

Authors
Fitzpatrick, JM; Bellmunt, J; Dreicer, R; Fleshner, NE; Logothetis, CJ; Moul, JW; Tombal, B; Zlotta, A
MLA Citation
Fitzpatrick, JM, Bellmunt, J, Dreicer, R, Fleshner, NE, Logothetis, CJ, Moul, JW, Tombal, B, and Zlotta, A. "Maximizing outcomes in genitourinary cancers across the treatment continuum." BJU Int 107 Suppl 2 (April 2011): 1-12.
PMID
21382149
Source
pubmed
Published In
Bju International
Volume
107 Suppl 2
Publish Date
2011
Start Page
1
End Page
12
DOI
10.1111/j.1464-410X.2010.10035.x

Risk of death from prostate cancer after radical prostatectomy or brachytherapy in men with low-or intermediate-risk disease

Authors
Arvold, ND; Chen, M; Moul, JW; Moran, BJ; Dosoretz, DE; Banez, LL; Katin, MJ; Braccioforte, MH; D'Amico, AV
MLA Citation
Arvold, ND, Chen, M, Moul, JW, Moran, BJ, Dosoretz, DE, Banez, LL, Katin, MJ, Braccioforte, MH, and D'Amico, AV. "Risk of death from prostate cancer after radical prostatectomy or brachytherapy in men with low-or intermediate-risk disease." JOURNAL OF CLINICAL ONCOLOGY 29.7 (March 1, 2011).
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
29
Issue
7
Publish Date
2011

Prognostic impact of post-prostatectomy PSA slope determined with a novel nucleic acid detection immunoassay (NADIA ProsVue) for total PSA

Authors
Moul, JW; Semmes, OJ; Vessella, R; McDermed, JE; Lilja, H
MLA Citation
Moul, JW, Semmes, OJ, Vessella, R, McDermed, JE, and Lilja, H. "Prognostic impact of post-prostatectomy PSA slope determined with a novel nucleic acid detection immunoassay (NADIA ProsVue) for total PSA." March 1, 2011.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
29
Issue
7
Publish Date
2011

Phase III study of the efficacy and safety of zibotentan (ZD4054) in patients with bone metastatic castration-resistant prostate cancer (CRPC)

Authors
Nelson, JB; Fizazi, K; Miller, K; Higano, CS; Moul, JW; Morris, T; McIntosh, S; Pemberton, K; Gleave, ME
MLA Citation
Nelson, JB, Fizazi, K, Miller, K, Higano, CS, Moul, JW, Morris, T, McIntosh, S, Pemberton, K, and Gleave, ME. "Phase III study of the efficacy and safety of zibotentan (ZD4054) in patients with bone metastatic castration-resistant prostate cancer (CRPC)." March 1, 2011.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
29
Issue
7
Publish Date
2011

Prostate-specific antigen (PSA) progression-free survival (PFS): A comparison of degarelix versus leuprolide in patients with prostate cancer

Authors
Shore, ND; Moul, JW; Crawford, E; van der Meulen, E; Olesen, T; Persson, B
MLA Citation
Shore, ND, Moul, JW, Crawford, E, van der Meulen, E, Olesen, T, and Persson, B. "Prostate-specific antigen (PSA) progression-free survival (PFS): A comparison of degarelix versus leuprolide in patients with prostate cancer." March 1, 2011.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
29
Issue
7
Publish Date
2011

Phase III study of the efficacy and safety of zibotentan (ZD4054) in patients with bone metastatic castration-resistant prostate cancer (CRPC).

117 Background: Endothelin-1 and the endothelin A (ETA) receptor have been implicated in prostate cancer progression in bone. Zibotentan, a specific ETA receptor antagonist, had a promising signal for prolonged overall survival (OS) in a phase II study of patients with CRPC and bone metastases who were pain free or mildly symptomatic for pain. The aim of this phase III study was to confirm the efficacy and safety of zibotentan in a similar but larger population.Patients with CRPC and bone metastases were randomized 1:1 to zibotentan 10 mg/day po or placebo, plus standard of care including chemotherapy. The primary endpoint was OS. Secondary endpoints included times to pain progression, chemotherapy use, new bone metastases, and safety. Efficacy endpoints were analyzed using a log-rank test. At least 263 deaths were required for formal analysis. If the true hazard ratio (HR) for zibotentan versus placebo was 0.67, the analysis would have 90% power to demonstrate a statistically significant effect in OS at the 5% level.A total of 594 patients were randomized (299 to zibotentan; 295 to placebo). Baseline group demographics were similar. Mean age was ∼71 yrs, and 64% were Caucasian. Although median OS was longer in zibotentan-treated patients than those receiving placebo (median 24.5 vs 22.5 months), the difference did not reach significance (HR [95.2% confidence interval]; 0.87 [0.69-1.10]: P=0.240). No significant differences were observed for any secondary endpoints. The most commonly reported AEs in the zibotentan group, peripheral edema and headache, were consistent with the pharmacologic action of zibotentan as a vasodilator. Cardiac failure events, actively solicited following a phase II signal, were higher in the zibotentan group (any grade, 5.7%; Common Terminology Criteria for Adverse Events [CTCAE] grade ≥3, 3.0%) than placebo (any grade, 1.7%; CTCAE grade ≥3, 1.0%), but were manageable and reversible.In this placebo-controlled phase III trial treatment with zibotentan 10 mg/day did not lead to a significant improvement in OS in patients with CRPC and bone metastases. Zibotentan had an acceptable safety profile. [Table: see text].

Authors
Nelson, JB; Fizazi, K; Miller, K; Higano, CS; Moul, JW; Morris, T; McIntosh, S; Pemberton, K; Gleave, ME
MLA Citation
Nelson, JB, Fizazi, K, Miller, K, Higano, CS, Moul, JW, Morris, T, McIntosh, S, Pemberton, K, and Gleave, ME. "Phase III study of the efficacy and safety of zibotentan (ZD4054) in patients with bone metastatic castration-resistant prostate cancer (CRPC)." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 29.7_suppl (March 2011): 117-.
PMID
27968672
Source
epmc
Published In
Journal of Clinical Oncology
Volume
29
Issue
7_suppl
Publish Date
2011
Start Page
117

Risk of death from prostate cancer after radical prostatectomy or brachytherapy in men with low- or intermediate-risk disease.

198 Background: Radical prostatectomy (RP) and brachytherapy (BT) are widely utilized treatments for favorable-risk prostate cancer (PC). We estimated the risk of PC-specific mortality (PCSM) following RP or BT in men with low- or intermediate-risk PC using prospectively collected data.The study cohort comprised 5,760 men with low-risk PC (prostate-specific antigen [PSA] level ≤ 10 ng/mL, clinical category T1c or 2a, and Gleason score ≤ 6), and 3,079 men with intermediate-risk PC (PSA level 10-20 ng/mL, clinical T2b or T2c, or Gleason score 7). Competing risks multivariable regression was performed to assess risk of PCSM after RP or BT, adjusting for age, treatment year, cardiovascular comorbidity, and known PC prognostic factors.There was no significant difference in the risk of PCSM among men with low-risk PC (11 vs. 6 deaths: adjusted hazard ratio [AHR], 1.62; 95% CI, 0.59-4.45; P = 0.35) who received BT compared to RP. However among men with intermediate-risk PC, despite significantly shorter median follow-up for men undergoing BT as compared to RP (4.1 vs. 7.2 years, P < 0.001), there was a trend toward an increased risk of PCSM (18 vs. 9 deaths: AHR, 2.30; 95% CI, 0.95-5.58; P = 0.07) for men treated with BT.The risk of PCSM among men with low-risk PC was not significantly different following RP or BT, however there may be a reduced risk of PCSM after RP as compared to BT in men with intermediate-risk PC. [Table: see text] No significant financial relationships to disclose.

Authors
Arvold, ND; Chen, M; Moul, JW; Moran, BJ; Dosoretz, DE; Banez, LL; Katin, MJ; Braccioforte, MH; D'Amico, AV
MLA Citation
Arvold, ND, Chen, M, Moul, JW, Moran, BJ, Dosoretz, DE, Banez, LL, Katin, MJ, Braccioforte, MH, and D'Amico, AV. "Risk of death from prostate cancer after radical prostatectomy or brachytherapy in men with low- or intermediate-risk disease." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 29.7_suppl (March 2011): 198-.
PMID
27968470
Source
epmc
Published In
Journal of Clinical Oncology
Volume
29
Issue
7_suppl
Publish Date
2011
Start Page
198

Prostate-specific antigen (PSA) progression-free survival (PFS): A comparison of degarelix versus leuprolide in patients with prostate cancer.

12 Background: Comparative effectiveness of the gonadotropin-releasing hormone (GnRH) blocker, degarelix, vs the GnRH agonist, leuprolide, was evaluated during a 1-year phase III trial (CS21); data have been presented. We now report long-term data from an ongoing 5-year extension study (CS21A).In CS21, patients with prostate cancer (all stages) were randomized to degarelix (240 mg for 1 month, then monthly maintenance doses of 80 mg [n=207] or 160 mg [n=202]), or leuprolide 7.5 mg/month (n=201). Leuprolide patients could receive bicalutamide. Of the 504 patients who completed the 1-year trial, 384 chose to continue in an extension study; those on leuprolide were re-randomized to degarelix 240/80 mg or 240/160 mg. PSA PFS was defined as time to first PSA failure (two consecutive increases in PSA of 50% and ≥5 ng/mL above nadir) or death. Time for 25% of patients to experience PSA PFS (TTP25%) was analyzed using Weibull estimates.Up to 1 year, the risk of PSA PFS was significantly lower with degarelix 240/80 mg vs leuprolide (p=0.05, log-rank). At 27.5 months' median follow-up, hazard rate of PSA PFS significantly decreased in leuprolide patients switched to degarelix compared with before the switch (0.20 vs 0.08; p=0.003). Similar improvements occurred in patients with baseline PSA >20 ng/mL. During the first year, TTP25% for patients with baseline PSA >20 ng/mL was numerically longer with degarelix vs leuprolide (407 vs 303 days; p=0.085); the difference was even greater when degarelix data were analyzed beyond 1 year (514 vs 303 days; p=0.01).Patients receiving degarelix had a significantly lower risk of PSA failure or death vs leuprolide during the first year of treatment. After switching to degarelix, patients who initially received leuprolide experienced a significantly lower rate of PSA failure or death. In patients with baseline PSA >20 ng/mL, TTP25% was significantly longer for degarelix patients. These data support the durability of the significant PSA PFS benefit of degarelix vs monthly leuprolide observed during the first year and the use of degarelix as first-line androgen deprivation therapy. [Table: see text].

Authors
Shore, ND; Moul, JW; Crawford, E; van der Meulen, E; Olesen, T; Persson, B
MLA Citation
Shore, ND, Moul, JW, Crawford, E, van der Meulen, E, Olesen, T, and Persson, B. "Prostate-specific antigen (PSA) progression-free survival (PFS): A comparison of degarelix versus leuprolide in patients with prostate cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 29.7_suppl (March 2011): 12-.
PMID
27968308
Source
epmc
Published In
Journal of Clinical Oncology
Volume
29
Issue
7_suppl
Publish Date
2011
Start Page
12

Prognostic impact of post-prostatectomy PSA slope determined with a novel, nucleic acid detection immunoassay (NADiA ProsVue) for total PSA.

47 Background: ProsVue is an investigational PSA immunoassay whose reporter antibody is labeled with a synthetic DNA sequence. RT-PCR detects the DNA signal indicating the PSA concentration. Pilot studies showed ProsVue slope (least-squares linear slope of 3 post-RP PSA values) to correctly classify prostate cancer (PC) patients (pts) with no evidence of disease (NED) and clinical progression (CP) using a 2 pg/mL/month (mo) decision threshold. In a retrospective, multicenter clinical trial, we evaluated potential prognostic value of ProsVue slope at this decision threshold.392 PC pts having RPs 11/1991 to 8/2001 were studied. Eligibility required first post-RP PSA <100 pg/mL, full pathologic and radiographic data and 3 frozen serum samples drawn 6 weeks to 19.4 mo post-RP. Adjuvant radiotherapy (RT) and/or hormone therapy (HT) was not allowed. CP was documented by positive imaging, biopsy results or PC-related death. Efficacy of ProsVue slope as a prognostic test for NED/CP at a 2 pg/mL/month decision threshold was determined and also examined with regards to Gleason score (GS), pre-RP PSA and final pathology stage.Median (range) of pre-RP PSA was 6.3 (0-60.6) ng/mL and post-RP GS was 7.0 (4-10). 73 pts received neoadjuvant HT. Pathologic stage was pT0-2 (228), pT3 (147), pT4 (17); 116 pts had positive margins and 8 had positive lymph nodes. The 3 PSA values were drawn after a median of 4.9, 8.6 and 12.8 mo and showed median values of 10.7, 23.0 and 50.7 pg/mL, respectively. Calculated sensitivity, specificity, PPV and NPV for a 2 pg/mL/mo ProsVue slope were 75.0%, 96.6%, 81.4% and 95.2%, respectively. Median follow-up (f/u) was 10.5 years. There were 40 deaths (14 from PC).ProsVue provides information previously unknown in post-RP pts. ProsVue slope ≤2pg/mL/mo in the first year is highly associated with NED over long-term f/u. Potential clinical utility may include predicting pts not requiring long-term oncologic f/u and predicting a need for post-RP adjuvant RT. ProsVue slope may become a new paradigm for identifying those patients at reduced risk for recurrence of prostate cancer post-RP. Further studies are planned to address these questions. [Table: see text].

Authors
Moul, JW; Semmes, OJ; Vessella, R; McDermed, JE; Lilja, H
MLA Citation
Moul, JW, Semmes, OJ, Vessella, R, McDermed, JE, and Lilja, H. "Prognostic impact of post-prostatectomy PSA slope determined with a novel, nucleic acid detection immunoassay (NADiA ProsVue) for total PSA." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 29.7_suppl (March 2011): 47-.
PMID
27968413
Source
epmc
Published In
Journal of Clinical Oncology
Volume
29
Issue
7_suppl
Publish Date
2011
Start Page
47

Effects of family history and genetic polymorphism on the cost-effectiveness of chemoprevention with finasteride for prostate cancer.

PURPOSE: Improvement in the cost-effectiveness of chemoprevention for prostate cancer could be realized through the identification of patients at higher risk. We estimated the cost-effectiveness of prostate cancer chemoprevention across risk groups defined by family history and number of risk alleles, and the cost-effectiveness of targeting chemoprevention to higher risk groups. MATERIALS AND METHODS: We developed a probabilistic Markov model to estimate costs, survival and quality adjusted survival across risk groups for patients receiving or not receiving chemoprevention with finasteride. The model uses data from national cancer registries, online sources and the medical literature. RESULTS: The incremental cost-effectiveness of 25 years of chemoprevention with finasteride in patients 50 years old was an estimated $89,300 per quality adjusted life-year (95% CI $58,800-$149,800), assuming finasteride decreased all grades of prostate cancer by 24.8%. Among patients with a positive family history (without genetic testing) chemoprevention provided 1 additional quality adjusted life-year at a cost of $64,200. Among patients with a negative family history at $400 per person tested, the cost-effectiveness of genetically targeted chemoprevention ranged from $98,100 per quality adjusted life-year when limiting finasteride to individuals with 14 or more risk alleles, to $103,200 per quality adjusted life-year when including those with 8 or more risk alleles. CONCLUSIONS: Although there are small differences in the cost-effectiveness of genetically targeted chemoprevention strategies in patients with a negative family history, genetic testing could reduce total expenditures if used to target chemoprevention for higher risk groups.

Authors
Reed, SD; Scales, CD; Stewart, SB; Sun, J; Moul, JW; Schulman, KA; Xu, J
MLA Citation
Reed, SD, Scales, CD, Stewart, SB, Sun, J, Moul, JW, Schulman, KA, and Xu, J. "Effects of family history and genetic polymorphism on the cost-effectiveness of chemoprevention with finasteride for prostate cancer." J Urol 185.3 (March 2011): 841-847.
PMID
21239023
Source
pubmed
Published In
The Journal of Urology
Volume
185
Issue
3
Publish Date
2011
Start Page
841
End Page
847
DOI
10.1016/j.juro.2010.10.078

Putting Provenge in perspective.

Authors
Moul, JW
MLA Citation
Moul, JW. "Putting Provenge in perspective." Oncology (Williston Park) 25.3 (March 2011): 255-258. (Review)
PMID
21548468
Source
pubmed
Published In
Oncology
Volume
25
Issue
3
Publish Date
2011
Start Page
255
End Page
258

Putting Provenge in Perspective THE GARCIA AND DREICER ARTICLE REVIEWED

Authors
Moul, JW
MLA Citation
Moul, JW. "Putting Provenge in Perspective THE GARCIA AND DREICER ARTICLE REVIEWED." ONCOLOGY-NEW YORK 25.3 (March 2011): 255-258.
Source
wos-lite
Published In
Oncology
Volume
25
Issue
3
Publish Date
2011
Start Page
255
End Page
258

Contemporary radical prostatectomy.

Purpose. Patients diagnosed with clinically localized prostate cancer have more surgical treatment options than in the past. This paper focuses on the procedures' oncological or functional outcomes and perioperative morbidities of radical retropubic prostatectomy, radical perineal prostatectomy, and robotic-assisted laparoscopic radical prostatectomy. Materials and Methods. A MEDLINE/PubMed search of the literature on radical prostatectomy and other new management options was performed. Results. Compared to the open procedures, robotic-assisted radical prostatectomy has no confirmed significant difference in most literatures besides less blood loss and blood transfusion. Nerve sparing is a safe means of preserving potency on well-selected patients undergoing radical prostatectomy. Positive surgical margin rates of radical prostatectomy affect the recurrence and survival of prostate cancer. The urinary and sexual function outcomes have been vastly improved. Neoadjuvant treatment only affects the rate of positive surgical margin. Adjuvant therapy can delay and reduce the risk of recurrence and improve the survival of the high risk prostate cancer. Conclusions. For the majority of patients with organ-confined prostate cancer, radical prostatectomy remains a most effective approach. Radical perineal prostatectomy remains a viable approach for patients with morbid obesity, prior pelvic surgery, or prior pelvic radiation. Robot-assisted laparoscopic prostatectomy (RALP) has become popular among surgeons but has not yet become the firmly established standard of care. Long-term data have confirmed the efficacy of radical retropubic prostatectomy with disease control rates and cancer-specific survival rates.

Authors
Fu, Q; Moul, JW; Sun, L
MLA Citation
Fu, Q, Moul, JW, and Sun, L. "Contemporary radical prostatectomy." Prostate Cancer 2011 (2011): 645030-.
Website
http://hdl.handle.net/10161/11292
PMID
22110994
Source
pubmed
Published In
Prostate Cancer
Volume
2011
Publish Date
2011
Start Page
645030
DOI
10.1155/2011/645030

Re: Salvage radiation in men after prostate-specific antigen failure and the risk of death

Authors
Cotter, SE; Chen, MH; Moul, JW; Lee, WR; Koontz, BF; Anscher, MS; Robertson, CN; Walther, PJ; Polascik, TJ; D'Amico, AV
MLA Citation
Cotter, SE, Chen, MH, Moul, JW, Lee, WR, Koontz, BF, Anscher, MS, Robertson, CN, Walther, PJ, Polascik, TJ, and D'Amico, AV. "Re: Salvage radiation in men after prostate-specific antigen failure and the risk of death." Journal of Urology 186.5 (2011): 1876--.
Source
scival
Published In
The Journal of Urology
Volume
186
Issue
5
Publish Date
2011
Start Page
1876-
DOI
10.1016/j.juro.2011.08.056

Conclusion

Authors
Dreicer, R; Moul, JW
MLA Citation
Dreicer, R, and Moul, JW. "Conclusion." Urology 78.5 SUPPL. (2011): S499-.
Source
scival
Published In
Urology
Volume
78
Issue
5 SUPPL.
Publish Date
2011
Start Page
S499
DOI
10.1016/j.urology.2011.03.060

Re: Prostate-specific antigen velocity based risk-adapted discontinuation of prostate cancer screening in elderly men

Authors
Tang, P; Sun, L; Uhlman, MA; Robertson, CN; Polascik, TJ; Moul, JW
MLA Citation
Tang, P, Sun, L, Uhlman, MA, Robertson, CN, Polascik, TJ, and Moul, JW. "Re: Prostate-specific antigen velocity based risk-adapted discontinuation of prostate cancer screening in elderly men." Journal of Urology 186.5 (2011): 1880-1881.
Source
scival
Published In
The Journal of Urology
Volume
186
Issue
5
Publish Date
2011
Start Page
1880
End Page
1881
DOI
10.1016/j.juro.2011.07.063

What matters young low-risk men present conundrum

Authors
Moul, JW
MLA Citation
Moul, JW. "What matters young low-risk men present conundrum." Oncology Report MAY (2011): 12--.
Source
scival
Published In
Oncology Report
Issue
MAY
Publish Date
2011
Start Page
12-

Preface

Authors
Bhaskar, R; Gkoulalas-Divanis, A; Kifer, D; Laxman, S; Singh, L; Wu, X; Clifton, C; Domingo-Ferrer, J; Hay, M; Kalnis, P; Kargupta, H; LeFevre, K; Liu, K; Loukides, G; MacHanavajjhala, A; McSherry, F; Miklau, G; Mokbel, M; Sayal, M; Saygin, Y; Slavkovic, A; Smith, A; Terrovitis, M; Truta, TM; Yu, PS; Vaidya, J; Li, X
MLA Citation
Bhaskar, R, Gkoulalas-Divanis, A, Kifer, D, Laxman, S, Singh, L, Wu, X, Clifton, C, Domingo-Ferrer, J, Hay, M, Kalnis, P, Kargupta, H, LeFevre, K, Liu, K, Loukides, G, MacHanavajjhala, A, McSherry, F, Miklau, G, Mokbel, M, Sayal, M, Saygin, Y, Slavkovic, A, Smith, A, Terrovitis, M, Truta, TM, Yu, PS, Vaidya, J, and Li, X. "Preface." Proceedings - IEEE International Conference on Data Mining, ICDM (2011): xxxviii-xxxix.
Source
scival
Published In
Proceedings / IEEE International Conference on Data Mining. IEEE International Conference on Data Mining
Publish Date
2011
Start Page
xxxviii
End Page
xxxix
DOI
10.1109/ICDMW.2011.196

3D Conformal and Intensity Modulated Radiotherapy to the Prostate Bed have Similar Biochemical Outcomes

Authors
Koontz, BF; Gerber, L; Banez, LL; Degirmenci, IT; Vujaskovic, Z; Anscher, MS; Robertson, CN; Polascik, TJ; Moul, JW; Lee, WR
MLA Citation
Koontz, BF, Gerber, L, Banez, LL, Degirmenci, IT, Vujaskovic, Z, Anscher, MS, Robertson, CN, Polascik, TJ, Moul, JW, and Lee, WR. "3D Conformal and Intensity Modulated Radiotherapy to the Prostate Bed have Similar Biochemical Outcomes." 2011.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
81
Issue
2
Publish Date
2011
Start Page
S406
End Page
S407

Neoadjuvant Radiotherapy plus Prostatectomy for High Risk Prostate Cancer

Authors
Koontz, BF; Lee, WR; Vujaskovic, Z; Carroll, M; Quaranta, BP; Anscher, MS; Robertson, CN; Polascik, TJ; Moul, JW
MLA Citation
Koontz, BF, Lee, WR, Vujaskovic, Z, Carroll, M, Quaranta, BP, Anscher, MS, Robertson, CN, Polascik, TJ, and Moul, JW. "Neoadjuvant Radiotherapy plus Prostatectomy for High Risk Prostate Cancer." 2011.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
81
Issue
2
Publish Date
2011
Start Page
S397
End Page
S397

The Number of High-Risk Factors and the Risk of Prostate Cancer-Specific Mortality Following Radical Prostatectomy or Brachytherapy

Authors
Wattson, DA; Chen, M; Moul, JW; Moran, BJ; Dosoretz, DE; Robertson, CN; Polascik, TJ; Braccioforte, MH; Salenius, SA; D'Amico, AV
MLA Citation
Wattson, DA, Chen, M, Moul, JW, Moran, BJ, Dosoretz, DE, Robertson, CN, Polascik, TJ, Braccioforte, MH, Salenius, SA, and D'Amico, AV. "The Number of High-Risk Factors and the Risk of Prostate Cancer-Specific Mortality Following Radical Prostatectomy or Brachytherapy." 2011.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
81
Issue
2
Publish Date
2011
Start Page
S434
End Page
S434

Pathological T2 sub-divisions as a prognostic factor in the biochemical recurrence of prostate cancer.

OBJECTIVE: To determine the adequacy of T2 prostate cancer (PCa) sub-staging as an independent Predictor of biochemical disease-free survival (bDFS) after radical prostatectomy. MATERIALS AND METHODS: The Duke Prostate Center database was queried for patients who underwent radical prostatectomy between 1988 and 2007 and had pT2 PCa, identifying 1990 cases. Prostate-specific antigen (PSA) recurrence was defined as a single value ≥0.2 ng/mL. Kaplan-Meier curves compared differences in bDFS between T2 sub-divisions. Multivariate analysis was performed, adjusting for age, pathological Gleason sum, surgical margin status, preoperative PSA, race, total tumour percentage and prostate weight on biochemical recurrence. RESULTS: The mean age at surgery was 62 years, and 16% of patients were African-American. Median prostate weight was 40 g [interquartile range (IQR) 31-52] and median preoperative PSA was 5.6 (IQR 4.2-7.8). Pathological Gleason score was ≤6 in 57%, 7 in 38%, and ≥8 in 5%; pathological T stage distribution was 18% T2a, 6% T2b, and 76% T2c; and percentage tumour involvement was ≤5% in 43%, between 5.1 and 10% in 24%, between 10.1 and 15% in 10%, and >15% in 19%. 366 (18.4%) patients had a biochemical recurrence after a median of 4.6 years (IQR 2.1-8.2) follow-up. bDFS was significantly (P= 0.006) higher for pT2a disease than for pT2b and pT2c, which were comparable. Adjusting for demographic and other pathological variables, T2 sub-divisions lost statistical significance. CONCLUSIONS: Pathological T2a prostate cancer has significantly higher bDFS than the pT2b or pT2c sub-groups in univariate but not multivariate analyses. Different pathological features should be explored to create more meaningfully predictive pathological T2 sub-divisions.

Authors
Caso, JR; Tsivian, M; Mouraviev, V; Polascik, TJ; Moul, JW
MLA Citation
Caso, JR, Tsivian, M, Mouraviev, V, Polascik, TJ, and Moul, JW. "Pathological T2 sub-divisions as a prognostic factor in the biochemical recurrence of prostate cancer." BJU Int 106.11 (December 2010): 1623-1627.
PMID
20553260
Source
pubmed
Published In
Bju International
Volume
106
Issue
11
Publish Date
2010
Start Page
1623
End Page
1627
DOI
10.1111/j.1464-410X.2010.09439.x

Adjuvant versus salvage radiation therapy for prostate cancer and the risk of death.

OBJECTIVE: To investigate whether salvage radiation therapy (RT) for prostate-specific antigen (PSA) failure can provide the same result as adjuvant RT, which decreases the risk of all-cause mortality (ACM) for men with positive margins (R1), or extra-capsular or seminal vesicle extension (pT3). METHODS: We studied 1638 men at Duke University who underwent radical prostatectomy for unfavourable-risk prostate cancer and whose postoperative PSA was undetectable. Cox regression was used to evaluate whether salvage vs adjuvant RT in men with a rapid (<10 months) or slow (≥10 months) PSA doubling time (DT) was associated with the risk of ACM, adjusting for adverse features (pT3, R1, Gleason score 8-10), age, preoperative PSA level, comorbidity and hormonal therapy use. RESULTS: Despite fewer men with two or more adverse features (61 vs 82%; P=0.016), salvage for a rapid PSA DT vs adjuvant RT increased the risk of ACM [adjusted hazard ratio (AHR)=3.42; 95% confidence interval (CI)=1.27-9.20; P=0.015]. There was no difference (AHR=1.39; 95% CI=0.50-3.90; P=0.53) in the risk of ACM among men who received salvage for a slow PSA DT or adjuvant RT. Nearly all (90%) men with a slow PSA DT had Gleason score ≤7 and the majority (59%) had at most pT3 or R1 disease. CONCLUSION: Radiation therapy after PSA failure as compared with adjuvant RT was not associated with an increased risk of ACM in men with Gleason score ≤7 and pT3R0 or pT2R1 disease.

Authors
D'Amico, AV; Chen, M-H; Sun, L; Lee, WR; Mouraviev, V; Robertson, CN; Walther, PJ; Polascik, TJ; Albala, DM; Moul, JW
MLA Citation
D'Amico, AV, Chen, M-H, Sun, L, Lee, WR, Mouraviev, V, Robertson, CN, Walther, PJ, Polascik, TJ, Albala, DM, and Moul, JW. "Adjuvant versus salvage radiation therapy for prostate cancer and the risk of death." BJU Int 106.11 (December 2010): 1618-1622.
PMID
20553253
Source
pubmed
Published In
Bju International
Volume
106
Issue
11
Publish Date
2010
Start Page
1618
End Page
1622
DOI
10.1111/j.1464-410X.2010.09447.x

Editorial comment. Which patients with undetectable PSA levels 5 years after radical prostatectomy are still at risk of recurrence?--Implications for a risk-adapted follow-up strategy.

Authors
Moul, JW
MLA Citation
Moul, JW. "Editorial comment. Which patients with undetectable PSA levels 5 years after radical prostatectomy are still at risk of recurrence?--Implications for a risk-adapted follow-up strategy." Urology 76.5 (November 2010): 1205-.
PMID
21056268
Source
pubmed
Published In
Urology
Volume
76
Issue
5
Publish Date
2010
Start Page
1205
DOI
10.1016/j.urology.2010.04.055

Postoperative prostate-specific antigen nadir improves accuracy for predicting biochemical recurrence after radical prostatectomy: Results from the Shared Equal Access Regional Cancer Hospital (SEARCH) and Duke Prostate Center databases.

OBJECTIVES: We previously showed that prostate-specific antigen (PSA) nadir after radical prostatectomy (RP) significantly predicts biochemical recurrence (BCR). Herein, we sought to explore the effect of including PSA nadir into commonly used models on their accuracy to predict BCR after RP. METHODS: This was a retrospective analysis of 943 and 1792 subjects from the Shared Equal Access Regional Cancer Hospital (SEARCH) and Duke Prostate Cancer (DPC) databases, respectively. The discrimination accuracy for BCR of seven previously published models was assessed using concordance index and compared with and without adding PSA nadir level in SEARCH. Using data from SEARCH, we developed a new nomogram incorporating PSA nadir to other known predictors (preoperative PSA, pathological Gleason score, PSA nadir level, surgical findings, prostate weight, body mass index and race) of BCR and externally validated it in the DPC. RESULTS: In SEARCH, the mean concordance index across all seven nomograms was 0.687. After the inclusion of PSA nadir, the concordance index increased by nearly 7% (mean=0.753). The concordance index of the new nomogram in SEARCH was 0.779 (bias-corrected=0.767), which was 5% better than the next best model. In DPC, the new nomogram yielded a concordance index of 0.778. CONCLUSION: The addition of postoperative PSA nadir to commonly used nomograms increased their accuracies by nearly 7%. Based upon this, we developed and externally validated a new nomogram, which was well calibrated and highly accurate, and is a potentially valuable tool for patients and physicians to predict BCR after RP.

Authors
Moreira, DM; Presti, JC; Aronson, WJ; Terris, MK; Kane, CJ; Amling, CL; Sun, LL; Moul, JW; Freedland, SJ
MLA Citation
Moreira, DM, Presti, JC, Aronson, WJ, Terris, MK, Kane, CJ, Amling, CL, Sun, LL, Moul, JW, and Freedland, SJ. "Postoperative prostate-specific antigen nadir improves accuracy for predicting biochemical recurrence after radical prostatectomy: Results from the Shared Equal Access Regional Cancer Hospital (SEARCH) and Duke Prostate Center databases." Int J Urol 17.11 (November 2010): 914-922.
PMID
20880361
Source
pubmed
Published In
International Journal of Urology
Volume
17
Issue
11
Publish Date
2010
Start Page
914
End Page
922
DOI
10.1111/j.1442-2042.2010.02631.x

Prostate-specific antigen-based risk-adapted discontinuation of prostate cancer screening in elderly African American and Caucasian American men.

OBJECTIVES: To evaluate the relationship between initial prostate-specific antigen (PSA) and prostate cancer (PCa) risk in elderly African American (AA) and Caucasian American (CA) men. METHODS: A total of 408 AA and 1720 CA men whose initial PSA measurement was performed between 75 and 80 years of age were retrieved from Duke Prostate Center database. Patients were stratified by race and initial PSA value. The relative risk (RR) of PCa detection was estimated. The rates of high risk PCa, and death from PCa stratified by initial PSA groups were compared using the chi-square test. RESULTS: The age-adjusted RR of PCa detection in CA men with PSA 3.0-5.9 ng/mL was 1.9-fold higher when compared with that of men with PSA 0.0-2.9 ng/mL (P < .001), but it did not change significantly in AA men (P = .270). PSA 6.0-9.9 ng/mL was associated with age-adjusted RR of PCa 9.3-fold in AA men and 4.1-fold in CA men (both P values < .001). A low rate of high-risk PCa and death from PCa was indicated with PSA < 6.0 ng/mL and < 3.0 ng/mL and follow-up of a maximum of 19.2 years and 17.6 years, respectively, in AA and CA men. CONCLUSIONS: AA men with initial PSA < 6.0 ng/mL and CA men with initial PSA < 3.0 ng/mL between 75 and 80 years of age are unlikely to be diagnosed with high risk PCa or death from PCa. It may be safe to discontinue PSA screening in these men.

Authors
Tang, P; Sun, L; Uhlman, MA; Robertson, CN; Polascik, TJ; Albala, DM; Donatucci, CF; Moul, JW
MLA Citation
Tang, P, Sun, L, Uhlman, MA, Robertson, CN, Polascik, TJ, Albala, DM, Donatucci, CF, and Moul, JW. "Prostate-specific antigen-based risk-adapted discontinuation of prostate cancer screening in elderly African American and Caucasian American men." Urology 76.5 (November 2010): 1058-1062.
PMID
20035982
Source
pubmed
Published In
Urology
Volume
76
Issue
5
Publish Date
2010
Start Page
1058
End Page
1062
DOI
10.1016/j.urology.2009.09.049

Baseline PSA as a predictor of prostate cancer-specific mortality over the past 2 decades: Duke University experience.

BACKGROUND: A diagnosis of prostate cancer is not often predictive of death from prostate cancer because of competing causes of mortality. Identification of the risk of death from prostate cancer and death from all causes using information available at the time of baseline prostate-specific antigen (PSA) measurement appears to be particularly pertinent. METHODS: The Duke Prostate Center database was used to identify men who had their PSA level measured over the past 20 years. The Cox proportional hazards model was used to assess whether baseline PSA, race, and age at baseline PSA could predict death from prostate cancer and death from all causes after baseline PSA measurement. The receiver operating characteristic (ROC) curve was performed to analyze the accuracy of baseline PSA as a continuous variable in predicting death from prostate cancer. RESULTS: A total of 4568 men diagnosed with prostate cancer after baseline PSA measurement were included. On multivariate analysis, baseline PSA levels of 4.0 to 9.9 ng/mL and ≥10 ng/mL were associated with significantly higher rates of death from prostate cancer compared with PSA levels <2.5 ng/mL. An advanced age at baseline PSA and African American race were associated with a higher death rate from prostate cancer and death from all causes. The area under the ROC curve for baseline PSA predicting death was 0.839. When a baseline PSA of 10 ng/mL was chosen to predict death from prostate cancer, the corresponding sensitivity and specificity were 77% and of 78%, respectively. CONCLUSIONS: Baseline PSA appears to be a reliable and independent predictor of death from prostate cancer. A baseline PSA of ≥4 ng/mL has been associated with higher risk of death from prostate cancer.

Authors
Tang, P; Sun, L; Uhlman, MA; Polascik, TJ; Freedland, SJ; Moul, JW
MLA Citation
Tang, P, Sun, L, Uhlman, MA, Polascik, TJ, Freedland, SJ, and Moul, JW. "Baseline PSA as a predictor of prostate cancer-specific mortality over the past 2 decades: Duke University experience." Cancer 116.20 (October 15, 2010): 4711-4717.
PMID
20589748
Source
pubmed
Published In
Cancer
Volume
116
Issue
20
Publish Date
2010
Start Page
4711
End Page
4717
DOI
10.1002/cncr.25447

Assessment of circulating tumor cells (CTCs) in prostate cancer patients with low-volume tumors.

The objective of this study was to assess the incidence of circulating tumor cells (CTCs) in prostate cancer patients with low-volume tumors (less than 0.5 cc) after radical prostatectomy (RP). Blood samples were collected from 64 RP patients to assess the incidence of CTCs following RP. The specimens were processed by whole-mount section. Clinicopathological data (e.g. patient age, race, specimen weight, tumor volume, grade, stage and surgical margin status) and follow-up PSA data were compared to CTC status. Of the 64 RP patients, nine had 'low-volume prostate cancer'. Seven of these patients had detectable levels of CTCs. In two of the seven patients with detectable CTCs, PSA elevation was also observed. Isolation and detection of circulating epithelial cells is possible in low-volume prostate cancer patients. In the setting of low-volume prostate cancer, CTCs may be associated with the presence of detectable PSA levels. However, the detection of CTCs did not predict PSA failure.

Authors
Ali, A; Furusato, B; Ts'o, POP; Lum, Z-P; Elsamanoudi, S; Mohamed, A; Srivastava, S; Moul, JW; Brassell, SA; Sesterhenn, IA; McLeod, DG
MLA Citation
Ali, A, Furusato, B, Ts'o, POP, Lum, Z-P, Elsamanoudi, S, Mohamed, A, Srivastava, S, Moul, JW, Brassell, SA, Sesterhenn, IA, and McLeod, DG. "Assessment of circulating tumor cells (CTCs) in prostate cancer patients with low-volume tumors." Pathol Int 60.10 (October 2010): 667-672.
PMID
20846264
Source
pubmed
Published In
Pathology International
Volume
60
Issue
10
Publish Date
2010
Start Page
667
End Page
672
DOI
10.1111/j.1440-1827.2010.02584.x

Obese African-Americans with prostate cancer (T1c and a prostate-specific antigen, PSA, level of <10 ng/mL) have higher-risk pathological features and a greater risk of PSA recurrence than non-African-Americans.

OBJECTIVE: to analyse the relationship between African American (AA) race and obesity in men with prostate cancer. PATIENTS AND METHODS: in all, 4196 patients who underwent radical prostatectomy from 1988 to 2008 were identified in the Duke Prostate Center database. A subset of 389 (AA 20.9% and non-AA 79.1%) patients with a body mass index (BMI) of ≥30 kg/m(2) , T1c disease and a prostate-specific antigen (PSA) level of <10 ng/mL were stratified by race and analysed. Age at surgery, race, surgical margin status, pathological tumour stage (pT2, pT3/4), pathological Gleason sum (<7, 3 + 4, 4 + 3, >7), extracapsular extension (ECE), seminal vesicle invasion and tumour percentage were assessed by univariate analysis followed by Cox regression analysis. RESULTS: in the entire cohort, 143 (38.1%) AA men were obese, compared to 509 (25.0%) of the non-AA men. AA men had a significantly higher tumour percentage (15% vs 10%, P= 0.002), and a greater proportion of pT3/4 disease (45.1% vs 26.2%, P= 0.039), pathological Gleason sum ≥ 7 (70.7% vs 50.5%, P= 0.003), positive ECE (37.8% vs 23.1%, P= 0.007), and positive surgical margin (52.4% vs 36.8%, P= 0.010) than non-AA men. AA men had a greater risk of PSA recurrence on Kaplan Meier (P= 0.004) and Cox regression analysis (P= 0.040, hazard ratio 1.72) CONCLUSION: a greater proportion of AA men was obese in this cohort. Obese AA with impalpable cancer and a PSA level of <10 ng/mL have a higher risk of pathological features than obese non-AA men, as well as a higher risk of PSA recurrence. Obesity might be responsible for the racial disparity seen in prostate cancer.

Authors
Caire, AA; Sun, L; Polascik, TJ; Albala, DM; Moul, JW
MLA Citation
Caire, AA, Sun, L, Polascik, TJ, Albala, DM, and Moul, JW. "Obese African-Americans with prostate cancer (T1c and a prostate-specific antigen, PSA, level of <10 ng/mL) have higher-risk pathological features and a greater risk of PSA recurrence than non-African-Americans." BJU Int 106.8 (October 2010): 1157-1160.
PMID
20367635
Source
pubmed
Published In
Bju International
Volume
106
Issue
8
Publish Date
2010
Start Page
1157
End Page
1160
DOI
10.1111/j.1464-410X.2010.09340.x

External validation of the SEARCH model for predicting aggressive recurrence after radical prostatectomy: results from the Duke Prostate Center Database.

OBJECTIVE: To validate a model previously developed using the Shared Equal Access Regional Cancer Hospital (SEARCH) database to predict the risk of aggressive recurrence after surgery, defined as a prostate-specific antigen (PSA) doubling time (DT) of <9 months, incorporating pathological stage, preoperative PSA level and pathological Gleason sum, that had an area under the curve (AUC) of 0.79 using a cohort of men from the Duke Prostate Center (DPC). PATIENTS AND METHODS: Data were included from 1989 men from the DPC database who underwent RP for node-negative prostate cancer between 1987 and 2003. Of these men, 100 had disease recurrence, with a PSADT of <9 months, while 1889 either did not have a recurrence but had > or =36 months of follow-up or had a recurrence with a PSADT of > or =9 months. We examined the ability of the SEARCH model to predict aggressive recurrence within the DPC cohort, and examined the correlation between the predicted risk of aggressive recurrence and the actual outcome within DPC. RESULTS: The SEARCH model predicted aggressive recurrence within DPC with an AUC of 0.82. There was a strong and significant correlation between the predicted risk of aggressive recurrence based on the SEARCH tables and the actual outcomes within DPC (r= 0.68, P < 0.001), although the model predictions tended to be slightly higher than the actual risk. CONCLUSIONS: The SEARCH model to predict aggressive recurrence after RP predicted aggressive recurrence in an external dataset with a high degree of accuracy. These tables, now validated, can be used to help select men for adjuvant therapy and clinical trials.

Authors
Teeter, AE; Sun, L; Moul, JW; Freedland, SJ
MLA Citation
Teeter, AE, Sun, L, Moul, JW, and Freedland, SJ. "External validation of the SEARCH model for predicting aggressive recurrence after radical prostatectomy: results from the Duke Prostate Center Database." BJU Int 106.6 (September 2010): 796-800.
PMID
20151967
Source
pubmed
Published In
Bju International
Volume
106
Issue
6
Publish Date
2010
Start Page
796
End Page
800
DOI
10.1111/j.1464-410X.2010.09214.x

Editorial comment.

Authors
Moul, JW
MLA Citation
Moul, JW. "Editorial comment." Urology 76.3 (September 2010): 727-.
PMID
20832639
Source
pubmed
Published In
Urology
Volume
76
Issue
3
Publish Date
2010
Start Page
727
DOI
10.1016/j.urology.2010.04.006

Predicting non-organ-confined prostate cancer in men diagnosed after 2000.

The objective of this study was to preoperatively predict non-organ-confined disease in patients considering radical prostatectomy. To account for the stage migration seen in prostate cancer, we included only those patients who underwent prostatectomy after the year 2000. Information on a cohort of 1895 patients who underwent radical prostatectomy from 2000 to 2008 was retrieved from the Duke Prostate Center database. Race (African American, non-African American), body mass index, age at surgery, PSA, biopsy Gleason sum (<7, 7 and >7) and clinical tumor stage (cT1, cT2/3) were analyzed by univariate analysis followed by logistic regression analysis. The Duke Interactive Clinical Equation for staging (DICE-S score) was calculated from the logistic regression model. The model was then internally validated using a bootstrapping technique. Biopsy Gleason sums 7 and >7 were more likely to have non-organ-confined disease compared with <7 (OR=2.97, Gleason sum=7; OR=3.25, Gleason sum>7). Clinical tumor stage, cT2/3, predicted non-organ-confined disease (OR=1.58). Older age was associated with non-organ-confined disease (OR=1.02), as was greater PSA (OR=1.12). DICE-S equation x=ln (p/1-p)=-3.627+0.019 (age)+0.109 (PSA)+1.087 (bGleason=7)+1.180 (bGleason >7)+0.459 (clinical T stage >T1), where p=(e(x))/(1+e(x)). A concordance index (prediction accuracy) of 0.73 was reached on internal validation. Using the DICE-S score, age, PSA, biopsy Gleason sum and clinical tumor stage, we can predict non-organ-confined disease in radical prostatectomy at an acceptable accuracy. Preoperative information on disease stage may aid in treatment decisions and surgical approach.

Authors
Caire, AA; Sun, L; Lack, BD; Lum, K; Tang, P; Stackhouse, DA; Robertson, CN; Mouraviev, V; Polascik, TJ; Albala, DM; Moul, JW
MLA Citation
Caire, AA, Sun, L, Lack, BD, Lum, K, Tang, P, Stackhouse, DA, Robertson, CN, Mouraviev, V, Polascik, TJ, Albala, DM, and Moul, JW. "Predicting non-organ-confined prostate cancer in men diagnosed after 2000." Prostate Cancer Prostatic Dis 13.3 (September 2010): 248-251.
PMID
20514082
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
13
Issue
3
Publish Date
2010
Start Page
248
End Page
251
DOI
10.1038/pcan.2010.15

Management of prostate cancer in older men: recommendations of a working group of the International Society of Geriatric Oncology.

Prostate cancer is the most prevalent cancer in men and predominantly affects older men (aged >or=70 years). The median age at diagnosis is 68 years; overall, two-thirds of prostate cancer-related deaths occur in men aged >or=75 years. With the exponential ageing of the population and the increasing life-expectancy in developed countries, the burden of prostate cancer is expected to increase dramatically in the future. To date, no specific guidelines on the management of prostate cancer in older men have been published. The International Society of Geriatric Oncology (SIOG) conducted a systematic bibliographic search based on screening, diagnostic procedures and treatment options for localized and advanced prostate cancer, to develop a proposal for recommendations that should provide the highest standard of care for older men with prostate cancer. The consensus of the SIOG Prostate Cancer Task Force is that older men with prostate cancer should be managed according to their individual health status, which is mainly driven by the severity of associated comorbid conditions, and not according to chronological age. Existing international recommendations (European Association of Urology, National Comprehensive Cancer Network, and American Urological Association) are the backbone for localized and advanced prostate cancer treatment, but need to be adapted to patient health status. Based on a rapid and simple evaluation, patients can be classified into four different groups: 1, 'Healthy' patients (controlled comorbidity, fully independent in daily living activities, no malnutrition) should receive the same treatment as younger patients; 2, 'Vulnerable' patients (reversible impairment) should receive standard treatment after medical intervention; 3, 'Frail' patients (irreversible impairment) should receive adapted treatment; 4, Patients who are 'too sick' with 'terminal illness' should receive only symptomatic palliative treatment.

Authors
Droz, J-P; Balducci, L; Bolla, M; Emberton, M; Fitzpatrick, JM; Joniau, S; Kattan, MW; Monfardini, S; Moul, JW; Naeim, A; van Poppel, H; Saad, F; Sternberg, CN
MLA Citation
Droz, J-P, Balducci, L, Bolla, M, Emberton, M, Fitzpatrick, JM, Joniau, S, Kattan, MW, Monfardini, S, Moul, JW, Naeim, A, van Poppel, H, Saad, F, and Sternberg, CN. "Management of prostate cancer in older men: recommendations of a working group of the International Society of Geriatric Oncology." BJU Int 106.4 (August 2010): 462-469. (Review)
Website
http://hdl.handle.net/10161/11295
PMID
20346033
Source
pubmed
Published In
Bju International
Volume
106
Issue
4
Publish Date
2010
Start Page
462
End Page
469
DOI
10.1111/j.1464-410X.2010.09334.x

Simultaneously detected bilateral testicular cancer of different histopathological origin--a challenging situation for the urologist.

BACKGROUND: A 36-year-old male with a history of cryptorchidism of the right side, treated with orchidopexy at the age of 4, presented with bilateral testicular swelling. INVESTIGATIONS: Investigations included laboratory workup, ultrasound of both testes, as well as CT-scan of the chest, abdomen, and pelvis. Initial treatment was bilateral orchiectomy. RESULTS: Scrotal examination revealed a mass on the left side and a small right testis with a hard mass at the lower pole. One markedly enlarged right inguinal lymph node was palpable. LDH, betaHCG, and AFP were significantly elevated. Scrotal ultrasound revealed a homogeneous hypoechoic right testis without a mass and a heterogeneous mass containing multiple inhomogeneous cystic areas on the left side. A hypoechoic mass was visualized in the right groin. CT evaluation revealed an enlarged retroperitoneal lymph node on the left side. DIAGNOSIS: Histopathological evaluation revealed seminoma of the right testis, nonseminomatous germ cell tumor of the left testis, and metastatic seminoma in the right groin postoperatively. CONCLUSIONS: Due to improved diagnostic tools as well as the establishment of various adjuvant treatment options, the mortality of testicular cancer generally decreased in the last decades. However, metastatic bilateral testicular cancer of different histology is a challenging situation for the urologist, which warrants further discussion. Adjuvant treatment as well as postoperative follow-up should be chosen carefully.

Authors
Hammerich, KH; Schroeck, FR; West, D; Moul, JW
MLA Citation
Hammerich, KH, Schroeck, FR, West, D, and Moul, JW. "Simultaneously detected bilateral testicular cancer of different histopathological origin--a challenging situation for the urologist." Oncology (Williston Park) 24.8 (July 2010): 757-760. (Review)
PMID
20718257
Source
pubmed
Published In
Oncology
Volume
24
Issue
8
Publish Date
2010
Start Page
757
End Page
760

Re-calibration and external validation of an existing nomogram to predict aggressive recurrences after radical prostatectomy.

OBJECTIVE: To re-calibrate the previously published Duke Prostate Center (DPC) nomogram for the prediction of biochemical recurrence (BCR) after radical prostatectomy (RP) to not only predict overall BCR but also the clinically more relevant endpoint of an aggressive recurrence (i.e. a BCR with a postoperative PSA doubling time (PSADT) of <9 months). PATIENTS AND METHODS: Using the established point-scale system based upon the previously published DPC nomogram, we re-calibrated this point system to predict not just BCR, but also aggressive BCR within 2599 men treated with RP from the DPC database. PSADT was computed on all patients meeting the recurrence definition who had a minimum of two PSA values, separated by at least 3 months, and < or =2 years after recurrence. External validation was performed using data from 1695 men treated with RP within the Shared Equal Access Regional Cancer Hospital (SEARCH) database by calculating the concordance index c and by plotting calibration curves. RESULTS: The median follow-up for patients with no BCR was 56 and 47 months for DPC and SEARCH, respectively. In the DPC modelling cohort and the SEARCH validation cohort, 645 (25%) and 557 (33%) men had BCR, while 83 (3.2%) and 71 (4.2%) patients had an aggressive recurrence. In external validation, predictive accuracy for an aggressive BCR was high (c = 0.83) and the nomogram showed good calibration. CONCLUSIONS: We re-calibrated an existing nomogram to not only predict overall BCR after RP but also aggressive recurrence after RP. Our new tool can provide valuable information for patient counselling and patient selection for adjuvant therapy trials.

Authors
Schroeck, FR; Kattan, MW; Moul, JW; Aronson, WJ; Presti, JC; Terris, MK; Kane, CJ; Amling, CL; Sun, L; Freedland, SJ
MLA Citation
Schroeck, FR, Kattan, MW, Moul, JW, Aronson, WJ, Presti, JC, Terris, MK, Kane, CJ, Amling, CL, Sun, L, and Freedland, SJ. "Re-calibration and external validation of an existing nomogram to predict aggressive recurrences after radical prostatectomy." BJU Int 105.12 (June 2010): 1654-1659.
PMID
19912203
Source
pubmed
Published In
Bju International
Volume
105
Issue
12
Publish Date
2010
Start Page
1654
End Page
1659
DOI
10.1111/j.1464-410X.2009.09060.x

Using prostate-specific antigen threshold to identify increased 4-year risk of prostate cancer.

Authors
Crawford, E; Sutton, SS; Moul, JW; Pettaway, CA; Hardin, JW; Poston, SA; Kruep, EJ
MLA Citation
Crawford, E, Sutton, SS, Moul, JW, Pettaway, CA, Hardin, JW, Poston, SA, and Kruep, EJ. "Using prostate-specific antigen threshold to identify increased 4-year risk of prostate cancer." May 20, 2010.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
28
Issue
15
Publish Date
2010

Long-term prostate-specific antigen (USA) control in prostate cancer (PCa) patients switched from leuprolide to degarelix or receiving continuous degarelix treatment

Authors
Shore, ND; Moul, JW; Crawford, E; Olesen, T; Persson, B
MLA Citation
Shore, ND, Moul, JW, Crawford, E, Olesen, T, and Persson, B. "Long-term prostate-specific antigen (USA) control in prostate cancer (PCa) patients switched from leuprolide to degarelix or receiving continuous degarelix treatment." May 20, 2010.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
28
Issue
15
Publish Date
2010

Downsides of robot-assisted laparoscopic radical prostatectomy: limitations and complications.

CONTEXT: Robot-assisted laparoscopic radical prostatectomy (RALP) using the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) is now in widespread use for the management of localised prostate cancer (PCa). Many reports of the safety and efficacy of this procedure have been published. However, there are few specific reports of the limitations and complications of RALP. OBJECTIVE: The primary purpose of this review is to ascertain the downsides of RALP by focusing on complications and limitations of this approach. EVIDENCE ACQUISITION: A Medline search of the English-language literature was performed to identify all papers published since 2001 relating to RALP. Papers providing data on technical failures, complications, learning curve, or other downsides of RALP were considered. Of 412 papers identified, 68 were selected for review based on their relevance to the objective of this paper. EVIDENCE SYNTHESIS: RALP has the following principal downsides: (1) device failure occurs in 0.2-0.4% of cases; (2) assessment of functional outcome is unsatisfactory because of nonstandardised assessment techniques; (3) overall complication rates of RALP are low, although higher rates are noted when complications are reported using a standardised system; (4) long-term oncologic data and data on high-risk PCa are limited; (5) a steep learning curve exists, and although acceptable operative times can be achieved in <20 cases, positive surgical margin (PSM) rates may require experience with >80 cases before a plateau is achieved; (6) robotic assistance does not reduce the difficulty associated with obese patients and those with large prostates, middle lobes, or previous surgery, in whom outcomes are less satisfactory than in patients without such factors; (7) economic barriers prevent uniform dissemination of robotic technology. CONCLUSIONS: Many of the downsides of RALP identified in this paper can be addressed with longer-term data and more widespread adoption of standardised reporting measures. The significant learning curve should not be understated, and the expense of this technology continues to restrict access for many patients.

Authors
Murphy, DG; Bjartell, A; Ficarra, V; Graefen, M; Haese, A; Montironi, R; Montorsi, F; Moul, JW; Novara, G; Sauter, G; Sulser, T; van der Poel, H
MLA Citation
Murphy, DG, Bjartell, A, Ficarra, V, Graefen, M, Haese, A, Montironi, R, Montorsi, F, Moul, JW, Novara, G, Sauter, G, Sulser, T, and van der Poel, H. "Downsides of robot-assisted laparoscopic radical prostatectomy: limitations and complications." Eur Urol 57.5 (May 2010): 735-746. (Review)
PMID
20036784
Source
pubmed
Published In
European Urology
Volume
57
Issue
5
Publish Date
2010
Start Page
735
End Page
746
DOI
10.1016/j.eururo.2009.12.021

Radiotherapy: Secondary malignancies after prostate cancer treatment.

Authors
Moul, JW
MLA Citation
Moul, JW. "Radiotherapy: Secondary malignancies after prostate cancer treatment." Nat Rev Clin Oncol 7.5 (May 2010): 249-250.
PMID
20428221
Source
pubmed
Published In
Nature Reviews Clinical Oncology
Volume
7
Issue
5
Publish Date
2010
Start Page
249
End Page
250
DOI
10.1038/nrclinonc.2010.59

Prostate cancer: an evolving paradigm.

Since at least the early 1990s, stage and risk migration have been seen in patients with prostate cancer, likely corresponding to the institution of prostate specific antigen (PSA) screening in health systems. Preoperative risk factors, including PSA level and clinical stage, have decreased significantly. These improved prognostic variables have led to a larger portion of men being stratified with low-risk disease, as per the classification of D'Amico and associates. This, in turn, has corresponded with more favorable postoperative variables, including decreased extraprostatic tumor extension and prolonged biochemical-free recurrence rates. The advent of focal therapy is bolstered by findings of increased unilateral disease with decreased tumor volume. Increasingly, targeted or delayed therapies may be possible within the current era of lower risk disease.

Authors
Caso, JR; Mouraviev, V; Tsivian, M; Polascik, TJ; Moul, JW
MLA Citation
Caso, JR, Mouraviev, V, Tsivian, M, Polascik, TJ, and Moul, JW. "Prostate cancer: an evolving paradigm." J Endourol 24.5 (May 2010): 805-809.
Website
http://hdl.handle.net/10161/3242
PMID
20367442
Source
pubmed
Published In
Journal of Endourology
Volume
24
Issue
5
Publish Date
2010
Start Page
805
End Page
809
DOI
10.1089/end.2009.0539

Public survey and survival data do not support recommendations to discontinue prostate-specific antigen screening in men at age 75.

OBJECTIVES: To evaluate the US Preventative Services Task Force (USPSTF) recommendation to discontinue prostate-specific antigen (PSA) screening at age 75. METHODS: Public survey: A cohort of 340 patients was surveyed at our PSA screening clinic and stratified by awareness of the recommendation and education level. Age (< 75, >or= 75), race, health insurance status, knowledge of prostate cancer, and opinion on screening discontinuation at age 75 was evaluated between groups. Disease risk and survival analysis: A cohort of 4196 men who underwent radical prostatectomy between 1988 and 2008 was stratified into age groups: < 65, 65-74, and >or= 75. Associations between clinicopathologic variables, disease risk, and survival were compared between age groups using univariate and multivariate analysis. RESULTS: Approximately 78% of men surveyed disagreed with the USPSTF recommendation. The number of men who disagreed was not significantly different between awareness groups (P = .962). Awareness of new screening guidelines showed a significant difference (P = .006) between education groups. Age >or= 75 years was predictive of high-risk disease based on D'Amico's criteria (odds ratio = 2.72, P = .003). Kaplan-Meier and Cox regression analyses showed an association of men aged >or= 75 years with higher rate of PSA recurrence, distant metastasis, and disease specific death compared with the age groups of < 65 and 65-74 (P <.05). CONCLUSIONS: Men presenting to our PSA screening clinic disagreed with discontinuation of screening at age 75. Men aged >or= 75 years had higher risk disease and poorer survival. The USPSTF recommendation was supported neither by public opinion nor disease risk and survival results.

Authors
Caire, AA; Sun, L; Robertson, CN; Polascik, TJ; Maloney, KE; George, DJ; Price, MM; Stackhouse, DA; Lack, BD; Albala, DM; Moul, JW
MLA Citation
Caire, AA, Sun, L, Robertson, CN, Polascik, TJ, Maloney, KE, George, DJ, Price, MM, Stackhouse, DA, Lack, BD, Albala, DM, and Moul, JW. "Public survey and survival data do not support recommendations to discontinue prostate-specific antigen screening in men at age 75." Urology 75.5 (May 2010): 1122-1127.
PMID
19815259
Source
pubmed
Published In
Urology
Volume
75
Issue
5
Publish Date
2010
Start Page
1122
End Page
1127
DOI
10.1016/j.urology.2009.06.091

Impact of postoperative prostate-specific antigen disease recurrence and the use of salvage therapy on the risk of death.

BACKGROUND: This report evaluated whether biochemical recurrence (BCR) as a time-dependent covariate (t) after radical prostatectomy (RP) for prostate cancer was associated with the risk of death and whether salvage therapy with radiotherapy (RT) and/or hormonal therapy (HT) can lessen this risk METHODS: This was a retrospective cohort study of 3071 men who underwent RP at Duke University between 1988 and 2008 and had complete follow-up data. A Cox regression multivariable analysis was used to determine whether BCR (t) was associated with the risk of death in men after adjusting for age, prostatectomy findings, and the use of salvage RT and/or HT. RESULTS: After a median follow-up of 7.4 years, 546 (17.8%) men experienced BCR and 454 (14.8%) died. The median follow-up after prostate-specific antigen (PSA) failure was 11.2 years (interquartile range, 5.8-16.0 years). BCR (t) was associated with an increased risk of death (adjusted hazards ratio [AHR], 1.03; 95% confidence interval [95% CI], 1.004-1.06 [P = .025]). In men who experienced BCR, a PSA doubling time <6 months was associated with an increased risk of death (AHR, 1.55; 95% CI, 1.15-2.1 [P = .004]); whereas a decrease in the risk of death was observed in men who received RT (AHR, 0.58; 95% CI, 0.40-0.58 [P = .002]) or HT (AHR, 0.56; 95% CI, 0.37-0.84 [P = .005]) after BCR. CONCLUSIONS: The occurrence of BCR was found to increase the risk of death in men undergoing RP for prostate cancer, and this risk appeared to increase as the time to BCR shortened. However, the addition of RT and/or HT in men with BCR significantly lowered this risk.

Authors
Choueiri, TK; Chen, M-H; D'Amico, AV; Sun, L; Nguyen, PL; Hayes, JH; Robertson, CN; Walther, PJ; Polascik, TJ; Albala, DM; Moul, JW
MLA Citation
Choueiri, TK, Chen, M-H, D'Amico, AV, Sun, L, Nguyen, PL, Hayes, JH, Robertson, CN, Walther, PJ, Polascik, TJ, Albala, DM, and Moul, JW. "Impact of postoperative prostate-specific antigen disease recurrence and the use of salvage therapy on the risk of death." Cancer 116.8 (April 15, 2010): 1887-1892.
PMID
20162710
Source
pubmed
Published In
Cancer
Volume
116
Issue
8
Publish Date
2010
Start Page
1887
End Page
1892
DOI
10.1002/cncr.25013

Editorial comment on: Development of a new method for monitoring prostate-specific antigen changes in men with localised prostate cancer: a comparison of observational cohorts.

Authors
Moul, JW; Tang, P; Sun, L
MLA Citation
Moul, JW, Tang, P, and Sun, L. "Editorial comment on: Development of a new method for monitoring prostate-specific antigen changes in men with localised prostate cancer: a comparison of observational cohorts." Eur Urol 57.3 (March 2010): 452-.
PMID
19303696
Source
pubmed
Published In
European Urology
Volume
57
Issue
3
Publish Date
2010
Start Page
452
DOI
10.1016/j.eururo.2009.03.024

The effect of race on the discriminatory accuracy of models to predict biochemical recurrence after radical prostatectomy: results from the Shared Equal Access Regional Cancer Hospital and Duke Prostate Center databases.

To evaluate whether race modifies the accuracy of nomograms to predict biochemical recurrence (BCR) after radical prostatectomy among subjects from the Shared Equal Access Regional Cancer Hospital (SEARCH) and Duke Prostate Center (DPC) databases. Retrospective analysis of 1721 and 4511 subjects from the SEARCH and DPC cohorts, respectively. The discrimination accuracy for BCR of seven previously published predictive models was assessed using concordance index and compared between African-American men (AAM) and Caucasian men (CM). AAM represented 44% of SEARCH and 14% of DPC. In both cohorts, AAM were more likely to experience BCR than CM (P<0.01). In SEARCH, the mean concordance index across all seven models was lower in AAM (0.678) than CM (0.715), though the mean difference between CM and AAM was modest (0.037; range 0.015-0.062). In DPC the overall mean concordance index for BCR across all seven nomograms was 0.686. In contrast to SEARCH, the mean concordance index in DPC was higher in AAM (0.717) than CM (0.681), though the mean differences between CM and AAM was modest (-0.036; range -0.078 to -0.004). Across all seven models for predicting BCR, the discriminatory accuracy was better among CM in SEARCH and better among AAM in DPC. The mean difference in discriminatory accuracy of all seven nomograms between AAM and CM was approximately 3-4%. This indicates that currently used predictive models have similar performances among CM and AAM. Therefore, nomograms represent a valid and accurate method to predict BCR regardless of race.

Authors
Moreira, DM; Presti, JC; Aronson, WJ; Terris, MK; Kane, CJ; Amling, CL; Sun, LL; Moul, JW; Freedland, SJ
MLA Citation
Moreira, DM, Presti, JC, Aronson, WJ, Terris, MK, Kane, CJ, Amling, CL, Sun, LL, Moul, JW, and Freedland, SJ. "The effect of race on the discriminatory accuracy of models to predict biochemical recurrence after radical prostatectomy: results from the Shared Equal Access Regional Cancer Hospital and Duke Prostate Center databases." Prostate Cancer Prostatic Dis 13.1 (March 2010): 87-93.
PMID
19918263
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
13
Issue
1
Publish Date
2010
Start Page
87
End Page
93
DOI
10.1038/pcan.2009.48

Report from Durham.

Authors
Moul, JW
MLA Citation
Moul, JW. "Report from Durham." Prostate Cancer Prostatic Dis 13.1 (March 2010): 1-.
PMID
20145629
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
13
Issue
1
Publish Date
2010
Start Page
1
DOI
10.1038/pcan.2009.65

Initial prostate specific antigen 1.5 ng/ml or greater in men 50 years old or younger predicts higher prostate cancer risk.

PURPOSE: Studies show that initial prostate specific antigen higher than the median in young men predicts a subsequent higher risk of prostate cancer. To our knowledge this relationship has not been studied in patients stratified by race. MATERIALS AND METHODS: A cohort of 3,530 black and 6,118 white men 50 years or younger with prostate specific antigen 4 ng/ml or less at the first prostate specific antigen screening was retrieved from the prostate center database at our institution. Patients were divided into groups based on initial prostate specific antigen 0.1 to 0.6, 0.7 to 1.4, 1.5 to 2.4 and 2.5 to 4.0 ng/ml. Univariate and age adjusted multivariate logistic regression was done to estimate the cancer RR in these prostate specific antigen groups. We calculated the prostate cancer rate at subsequent followups. RESULTS: Median prostate specific antigen in black and white men was 0.7 ng/ml at age 50 years or less. The prostate cancer rate was not significantly different in the groups with prostate specific antigen less than 0.6 and 0.7 to 1.4 ng/ml in black or white men. Black and white men with initial prostate specific antigen in the 1.5 to 2.4 ng/ml range had a 9.3 and 6.7-fold increase in the age adjusted prostate cancer RR, respectively. At up to 9 years of followup initial prostate specific antigen 1.5 ng/ml or greater was associated with gradually increased detection at followup in black and white men. CONCLUSIONS: An initial prostate specific antigen cutoff of 1.5 ng/ml may be better than median prostate specific antigen 0.7 ng/ml to determine the risk of prostate cancer in black and white men 50 years old or younger.

Authors
Tang, P; Sun, L; Uhlman, MA; Robertson, CN; Polascik, TJ; Albala, DM; Donatucci, CF; Moul, JW
MLA Citation
Tang, P, Sun, L, Uhlman, MA, Robertson, CN, Polascik, TJ, Albala, DM, Donatucci, CF, and Moul, JW. "Initial prostate specific antigen 1.5 ng/ml or greater in men 50 years old or younger predicts higher prostate cancer risk." J Urol 183.3 (March 2010): 946-950.
PMID
20083275
Source
pubmed
Published In
The Journal of Urology
Volume
183
Issue
3
Publish Date
2010
Start Page
946
End Page
950
DOI
10.1016/j.juro.2009.11.021

Tumor percent involvement predicts prostate specific antigen recurrence after radical prostatectomy only in men with smaller prostate.

PURPOSE: We determined the predictive power of tumor percent involvement on prostate specific antigen recurrence in patients when stratified by prostate weight. MATERIALS AND METHODS: Data on 3,057 patients who underwent radical prostatectomy between 1988 and 2008 was retrieved from our institutional prostate cancer database. Patients with data on tumor percent involvement, prostate volume and prostate specific antigen recurrence were included in analysis. Patients were divided into 3 groups based on prostate volume less than 35, 35 to 45 and greater than 45 cc. The variables tumor percent involvement, age at surgery, race, prostate specific antigen, pathological Gleason score, positive surgical margins, extraprostatic extension, seminal vesicle invasion and surgery year were analyzed using the chi-square and Mann-Whitney tests to determine individual effects on prostate specific antigen recurrence. Tumor percent involvement and prostate specific antigen were evaluated as continuous variables. Significant variables on univariate analysis were included in multivariate Cox regression analysis to compare their effects on prostate specific antigen recurrence. RESULTS: Tumor percent involvement significantly predicted prostate specific antigen recurrence in men with a small prostate (p = 0.006) but not in those with a prostate of greater than 35 cc. Black race was a marginally significant predictor of prostate specific antigen recurrence in men with a medium prostate (p = 0.055). Age at surgery was a predictor of prostate specific antigen recurrence in men with a larger prostate (p = 0.003). Prostate specific antigen, positive surgical margins, seminal vesicle invasion and pathological Gleason score 7 or greater predicted prostate specific antigen recurrence in men with all prostate sizes. CONCLUSIONS: In men with a prostate of less than 35 cc tumor percent involvement is an important variable when assessing the risk of prostate specific antigen recurrence. Tumor percent involvement and prostate volume should be considered when counseling patients and determining who may benefit from heightened surveillance after radical prostatectomy.

Authors
Uhlman, MA; Sun, L; Stackhouse, DA; Polascik, TJ; Mouraviev, V; Robertson, CN; Albala, DM; Moul, JW
MLA Citation
Uhlman, MA, Sun, L, Stackhouse, DA, Polascik, TJ, Mouraviev, V, Robertson, CN, Albala, DM, and Moul, JW. "Tumor percent involvement predicts prostate specific antigen recurrence after radical prostatectomy only in men with smaller prostate." J Urol 183.3 (March 2010): 997-1001.
PMID
20089281
Source
pubmed
Published In
The Journal of Urology
Volume
183
Issue
3
Publish Date
2010
Start Page
997
End Page
1001
DOI
10.1016/j.juro.2009.11.046

Editorial comment.

Authors
Moul, JW
MLA Citation
Moul, JW. "Editorial comment." Urology 75.2 (February 2010): 445-446.
PMID
20152507
Source
pubmed
Published In
Urology
Volume
75
Issue
2
Publish Date
2010
Start Page
445
End Page
446
DOI
10.1016/j.urology.2009.07.1249

Tumor volume, tumor percentage involvement, or prostate volume: which is predictive of prostate-specific antigen recurrence?

OBJECTIVES: To compare the effects of tumor volume (TV), tumor percentage involvement (TPI), and prostate volume (PV) on prostate-specific antigen (PSA) recurrence (PSAR) after radical prostatectomy (RP). METHODS: A cohort of 3528 patients receiving RP between 1988 and 2008 was retrieved from the Duke Prostate Center. Patients were stratified by TV (< 3, 3-6, > 6 cm(3)), TPI (< 10%, 10%-20%, > 20%), and PV (< 35, 35-45, > 45 cm(3)) and their effects on PSAR evaluated using Kaplan-Meier analysis. Clinicopathologic variables included in univariate analysis were age at surgery, race, year of surgery, PSA, pathologic Gleason score, pathologic tumor stage, margin status, extracapsular extension, and seminal vesicle invasion. The effects of TV, TPI, and PV (as continuous and categorical variables) on PSAR were compared using Cox analysis. RESULTS: TPI, TV, and PV were predictive of PSAR (P <.05) in Kaplan-Meier analysis. In multivariate analysis as continuous variables, TPI and PV were predictive of PSAR (hazard ratio [HR] = 1.16 and HR = 0.65, P <.05). As categorical variables, TPI > 20% and PV 10-35 cm(3) were predictive of PSAR (HR = 1.45 and OR = 1.25, P <.05). TV was not predictive of PSAR in either analysis. Pathologic Gleason score > or = 7, PSA, positive margins, seminal vesicle invasion, and tumor stage T3/T4 were found to be predictors of PSAR (P <.05). CONCLUSIONS: TV, TPI, and PV were predictive of PSAR in univariate analysis, but in multivariate analysis, only TPI and PV were predictive of PSAR. TPI and PV should be considered when evaluating, assessing, and counseling patients regarding PSAR risk.

Authors
Uhlman, MA; Sun, L; Stackhouse, DA; Caire, AA; Polascik, TJ; Robertson, CN; Madden, J; Vollmer, R; Albala, DM; Moul, JW
MLA Citation
Uhlman, MA, Sun, L, Stackhouse, DA, Caire, AA, Polascik, TJ, Robertson, CN, Madden, J, Vollmer, R, Albala, DM, and Moul, JW. "Tumor volume, tumor percentage involvement, or prostate volume: which is predictive of prostate-specific antigen recurrence?." Urology 75.2 (February 2010): 460-466.
PMID
19819532
Source
pubmed
Published In
Urology
Volume
75
Issue
2
Publish Date
2010
Start Page
460
End Page
466
DOI
10.1016/j.urology.2009.06.059

Tumor Volume, Tumor Percentage Involvement, or Prostate Volume: Which Is Predictive of Prostate-specific Antigen Recurrence?

Authors
Uhlman, MA; Sun, L; Stackhouse, DA; Caire, AA; Polascik, TJ; Robertson, CN; Madden, J; Vollmer, R; Albala, DM; Moul, JW
MLA Citation
Uhlman, MA, Sun, L, Stackhouse, DA, Caire, AA, Polascik, TJ, Robertson, CN, Madden, J, Vollmer, R, Albala, DM, and Moul, JW. "Tumor Volume, Tumor Percentage Involvement, or Prostate Volume: Which Is Predictive of Prostate-specific Antigen Recurrence?." UROLOGY 75.2 (February 2010): 460-466.
Source
wos-lite
Published In
Urology
Volume
75
Issue
2
Publish Date
2010
Start Page
460
End Page
466
DOI
10.1016/j.urology.2009.06.059

Background for the proposal of SIOG guidelines for the management of prostate cancer in senior adults.

BACKGROUND: The incidence of prostate cancer increases with age, with a median age at diagnosis of 68 years. Owing to increased life expectancy, the management of prostate cancer in senior adult men (i.e., aged 70 years or older) represents an important public health concern and a major challenge for the future. No specific guidelines have previously been published on the management of prostate cancer in older men. The SIOG has developed a proposal of recommendations in this setting. METHODS: A systematic bibliographical search focused on screening, diagnostic procedures, treatment options for localised, locally advanced and metastatic prostate cancer in senior adults was performed. Specific aspects of the geriatric approach were emphasised, including evaluation of health status (nutritional, cognitive, thymic, physical and psycho-social) and screening for vulnerability and frailty. Attention was drawn to the consequences of androgen deprivation and complications of local treatment, mainly incontinence. The collected material has been reviewed and discussed by a scientific panel including urologists, radiation oncologists, medical oncologists and geriatricians from both Europe and North America. RESULTS: The consensus is to use either European Association of Urology or National Comprehensive Cancer Network clinical recommendations for prostate cancer treatment and to adapt them to health status based on instrumental activities of daily living (IADL) and activities daily living (ADL), comorbidity evaluation by Cumulative Illness Scoring Rating-Geriatrics and screening for malnutrition. Patients in Group 1 (no abnormality) are 'fit' and should receive the same treatment as younger patients; patients in Group 2 (one impairment in IADL or one uncontrolled comorbidity or at risk of malnutrition) are 'vulnerable' and should receive standard treatment after medical intervention; patients in Group 3 (one impairment in ADL or more than one uncontrolled comorbidity or severe malnutrition) are 'frail' and should receive adapted treatment; patients in Group 4 (dependent) should receive only symptomatic palliative treatment. CONCLUSIONS: Treatment of prostate cancer in senior adults should be adapted to health status. Specific prospective studies in this setting are warranted.

Authors
Droz, J-P; Balducci, L; Bolla, M; Emberton, M; Fitzpatrick, JM; Joniau, S; Kattan, MW; Monfardini, S; Moul, JW; Naeim, A; van Poppel, H; Saad, F; Sternberg, CN
MLA Citation
Droz, J-P, Balducci, L, Bolla, M, Emberton, M, Fitzpatrick, JM, Joniau, S, Kattan, MW, Monfardini, S, Moul, JW, Naeim, A, van Poppel, H, Saad, F, and Sternberg, CN. "Background for the proposal of SIOG guidelines for the management of prostate cancer in senior adults." Crit Rev Oncol Hematol 73.1 (January 2010): 68-91. (Review)
PMID
19836968
Source
pubmed
Published In
Critical Reviews in Oncology Hematology
Volume
73
Issue
1
Publish Date
2010
Start Page
68
End Page
91
DOI
10.1016/j.critrevonc.2009.09.005

The Shared Equal Access Regional Cancer Hospital (SEARCH) nomogram for risk stratification in intermediate risk group of men with prostate cancer: validation in the Duke Prostate Center database.

OBJECTIVES: To validate the Shared Equal Access Regional Cancer Hospital (SEARCH) nomogram to better risk stratify men with intermediate-risk pathology after prostatectomy (positive surgical margins, PSM, and/or extracapsular disease, ECE, without seminal vesicle or lymph node involvement) in a tertiary referral centre (the Duke Prostate Center, DPC). PATIENTS AND METHODS: We retrospectively analysed 485 men in the DPC cohort with PSM and/or ECE but without seminal vesicle or lymph node involvement. The predicted risk of biochemical progression-free probability at 1, 3 and 5 years was estimated by the SEARCH and updated Kattan postoperative nomograms. Calibration plots were generated and accuracy assessed with the concordance index. RESULTS: The SEARCH nomogram appeared to be well calibrated, with the highest-risk quartile having a predicted <60% progression-free probability at 5 years, vs >80% for the lowest risk. In comparison, overall external calibration appeared to be similar for the updated Kattan nomogram, although there was less separation between the highest- and lowest-risk quartiles. The SEARCH model had an overall predictive accuracy of 0.65, which compared favourably with the updated Kattan nomogram (0.57). CONCLUSION: In an external dataset, the SEARCH nomogram to predict progression-free probability for men at intermediate risk after prostatectomy was well calibrated and performed better than the updated postoperative Kattan nomogram.

Authors
Jayachandran, J; Schroeck, F; Sun, L; Gerber, L; Moreira, DM; Moul, JW; Freedland, SJ
MLA Citation
Jayachandran, J, Schroeck, F, Sun, L, Gerber, L, Moreira, DM, Moul, JW, and Freedland, SJ. "The Shared Equal Access Regional Cancer Hospital (SEARCH) nomogram for risk stratification in intermediate risk group of men with prostate cancer: validation in the Duke Prostate Center database." BJU Int 105.2 (January 2010): 180-184.
PMID
19709074
Source
pubmed
Published In
Bju International
Volume
105
Issue
2
Publish Date
2010
Start Page
180
End Page
184
DOI
10.1111/j.1464-410X.2009.08728.x

Editorial comment

Authors
Moul, JW
MLA Citation
Moul, JW. "Editorial comment." Urology 76.5 (2010): 1205--.
Source
scival
Published In
Urology
Volume
76
Issue
5
Publish Date
2010
Start Page
1205-
DOI
10.1016/j.urology.2010.04.055

Low-risk men can delay prostatectomy until biopsy upgrade: Comment

Authors
Moul, JW
MLA Citation
Moul, JW. "Low-risk men can delay prostatectomy until biopsy upgrade: Comment." Oncology Report JULY-AUGUST (2010): 22--.
Source
scival
Published In
Oncology Report
Issue
JULY-AUGUST
Publish Date
2010
Start Page
22-

Radiation plus ADT improves overall, disease-free survival: Comment

Authors
Moul, JW
MLA Citation
Moul, JW. "Radiation plus ADT improves overall, disease-free survival: Comment." Oncology Report JULY-AUGUST (2010): 20--.
Source
scival
Published In
Oncology Report
Issue
JULY-AUGUST
Publish Date
2010
Start Page
20-

Changes in alkaline phosphatase levels in patients with prostate cancer receiving degarelix or leuprolide: Results from a 12-month, comparative, phase III study

OBJECTIVE To compare the activity of degarelix, a new gonadotrophin- releasing hormone (GnRH) blocker, with leuprolide depot 7.5 mg in the control of total serum alkaline phosphatase (S-ALP) levels in patients with prostate cancer. PATIENTS AND METHODS In the randomized, phase III trial (CS21), patients with histologically confirmed prostate cancer (all stages), were randomized to one of three regimens: degarelix subcutaneous 240 mg for 1 month followed by monthly maintenance doses of 80 mg or 160 mg, or intramuscular leuprolide 7.5 mg/month. Patients receiving leuprolide could also receive antiandrogens for flare protection. We report exploratory S-ALP analyses from CS21, focusing on the comparison of degarelix 240/80 mg with leuprolide 7.5 mg, in line with the recent approvals of this dose by the USA Food and Drug Administration and the European Medicines Agency. RESULTS Overall, 610 patients were included, with a median age of 73 years and median prostate-specific antigen (PSA) level of 19.0 ng/mL. Baseline S-ALP levels were high in metastatic patients and highest in patients with metastatic disease and a haemoglobin level of <13 g/dL. In metastatic disease, after initial peaks in both groups, S-ALP levels were suppressed below baseline with degarelix but were maintained around baseline with leuprolide. The late rise in S-ALP seen with leuprolide was not apparent with degarelix. The pattern of S-ALP response was similar in patients with a baseline PSA level of ≥50 ng/mL. Between-treatment differences in patients with metastatic disease and those with a PSA level of ≥50 ng/mL were significant at day 364 (P = 0.014 and 0.007, respectively). CONCLUSION Patients with metastatic disease or those with PSA levels of ≥50 ng/mL at baseline had greater reductions in S-ALP levels with degarelix than with leuprolide. Patients in the degarelix group maintained S-ALP suppression throughout the study, in contrast to those in the leuprolide group. This suggests that degarelix might offer better S-ALP control than leuprolide and might prolong control of skeletal metastases, compared with GnRH agonists, over a 1-year treatment period. © 2009 the Authors.

Authors
Schröder, FH; Tombal, B; Miller, K; Boccon-Gibod, L; Shore, ND; Crawford, ED; Moul, J; Olesen, TK; Persson, B-E
MLA Citation
Schröder, FH, Tombal, B, Miller, K, Boccon-Gibod, L, Shore, ND, Crawford, ED, Moul, J, Olesen, TK, and Persson, B-E. "Changes in alkaline phosphatase levels in patients with prostate cancer receiving degarelix or leuprolide: Results from a 12-month, comparative, phase III study." BJU International 106.2 (2010): 182-187.
PMID
19912212
Source
scival
Published In
Bju International
Volume
106
Issue
2
Publish Date
2010
Start Page
182
End Page
187
DOI
10.1111/j.1464-410X.2009.08981.x

Reply

Authors
Moul, JW
MLA Citation
Moul, JW. "Reply." Urology 75.5 (2010): 1130--.
Source
scival
Published In
Urology
Volume
75
Issue
5
Publish Date
2010
Start Page
1130-
DOI
10.1016/j.urology.2009.12.006

Reply

Authors
Moul, JW
MLA Citation
Moul, JW. "Reply." Urology 75.5 (2010): 1128-1129.
Source
scival
Published In
Urology
Volume
75
Issue
5
Publish Date
2010
Start Page
1128
End Page
1129
DOI
10.1016/j.urology.2009.07.1247

Additional Analysis of the Secondary End Point of Biochemical Recurrence Rate in a Phase 3 Trial (CS21) Comparing Degarelix 80 mg Versus Leuprolide in Prostate Cancer Patients Segmented by Baseline Characteristics

Background: Recent data suggest prostate-specific antigen (PSA) progression may predict overall survival in prostate cancer patients. Objective: To compare the activity of degarelix and leuprolide regarding PSA recurrence-free survival. Design, setting, and participants: Phase 3, 1-yr, multicentre, randomised, open-label trial comparing the efficacy and safety of degarelix at 240 mg for 1 mo, and then 80 mg monthly (240/80 mg); degarelix at 240 mg for 1 mo, and then 160 mg monthly; and leuprolide at 7.5 mg/mo. Overall, 610 patients with histologically confirmed prostate cancer (all stages), for whom androgen deprivation therapy was indicated, were included. The primary end point of this trial has been reported previously; the protocolled and exploratory subgroup analyses reported in this paper focus on degarelix at 240/80 mg (dose approved by the US Food and Drug Administration and the European Medicine Evaluation Association for the treatment of patients with hormone-naive advanced prostate cancer). Measurements: PSA progression-free survival (two consecutive increases in PSA of 50% compared with nadir and ≥5 ng/ml on two consecutive measurements at least 2 wk apart or death) and change in PSA were reviewed. Effects of baseline disease stage (localised, locally advanced, and metastatic) and PSA level (<10, 10-20, >20-50, and >50 ng/ml) were analysed. Results and limitations: Patients receiving degarelix showed a significantly lower risk of PSA progression or death compared with leuprolide (p = 0.05). PSA recurrences occurred mainly in patients with advanced disease and exclusively in those with baseline PSA >20 ng/ml. Patients with PSA >20 ng/ml had a significantly longer time to PSA recurrence with degarelix (p = 0.04). The relatively low number of patients in each subgroup is a limitation of this study. Conclusions: These results generate the hypothesis that degarelix at 240/80 mg offers improved PSA control compared with leuprolide. PSA recurrences occurred almost exclusively in patients with metastatic prostate cancer or high baseline PSA during this 1-yr study. Further studies are warranted to confirm these findings. © 2009 European Association of Urology.

Authors
Tombal, B; Miller, K; Boccon-Gibod, L; Schröder, F; Shore, N; Crawford, ED; Moul, J; Jensen, J-K; Olesen, TK; Persson, B-E
MLA Citation
Tombal, B, Miller, K, Boccon-Gibod, L, Schröder, F, Shore, N, Crawford, ED, Moul, J, Jensen, J-K, Olesen, TK, and Persson, B-E. "Additional Analysis of the Secondary End Point of Biochemical Recurrence Rate in a Phase 3 Trial (CS21) Comparing Degarelix 80 mg Versus Leuprolide in Prostate Cancer Patients Segmented by Baseline Characteristics." European Urology 57.5 (2010): 836-842.
PMID
19962227
Source
scival
Published In
European Urology
Volume
57
Issue
5
Publish Date
2010
Start Page
836
End Page
842
DOI
10.1016/j.eururo.2009.11.029

Editorial: Report from Durham

Authors
Moul, JW
MLA Citation
Moul, JW. "Editorial: Report from Durham." Prostate Cancer and Prostatic Diseases 13.1 (2010): 1--.
Source
scival
Published In
Prostate Cancer and Prostatic Diseases
Volume
13
Issue
1
Publish Date
2010
Start Page
1-
DOI
10.1038/pcan.2009.65

Prostate cancer early detection: Clinical practice guidelines in oncology™

Since the early 1990s, many variants of the tPSA assay have been introduced to increase the sensitivity of screening programs (cancer detection) while maintaining specificity (elimination of unnecessary biopsies). Again, these guidelines recommend ways that individuals and their physicians can use these new techniques rationally for early detection of prostate cancer. These guidelines are not designed to provide an argument for using population screening programs for prostate cancer, but are meant to provide a vehicle for practicing early detection efforts in an evidence-based, systematic fashion in patients who choose to participate in these programs. Whether to treat a patient on diagnosis is beyond the scope of these guidelines (see NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer [in this issue; to view the most recent version of these guidelines, visit the NCCN Web site at www.NCCN.org]). These guidelines incorporate many new validated findings in addition to the DRE and tPSA test, including percent fPSA, PSAV, cPSA, biopsy pathology, and TRUS-guided biopsy techniques. The panel will re-examine the clinical efficacy of these new modalities annually, and the guidelines will be modified accordingly. In addition, future iterations of these guidelines may incorporate new serum markers currently undergoing clinical investigation. The goal of the NCCN and this guideline panel in updating these algorithms is to help men and clinicians choose a program for early detection of prostate cancer and make decisions about the need for prostate biopsy. Any clinician who uses these guidelines is expected to exercise independent medical judgment in the context of the individual clinical circumstances to determine each patient's need for prostate biopsy. These guidelines will continue to evolve as the field of prostate cancer advances. © Journal of the National Comprehensive Cancer Network.

Authors
Kawachi, MH; Bahnson, RR; Barry, M; Busby, JE; Carroll, PR; Carter, HB; Catalona, WJ; Cookson, MS; Epstein, JI; Etzioni, RB; Giri, VN; III, GPH; Howe, RJ; Lange, PH; Lilja, H; Loughlin, KR; Mohler, J; Moul, J; Nadler, RB; Patterson, SG; Presti, JC; Stroup, AM; Wake, R; Wei, JT
MLA Citation
Kawachi, MH, Bahnson, RR, Barry, M, Busby, JE, Carroll, PR, Carter, HB, Catalona, WJ, Cookson, MS, Epstein, JI, Etzioni, RB, Giri, VN, III, GPH, Howe, RJ, Lange, PH, Lilja, H, Loughlin, KR, Mohler, J, Moul, J, Nadler, RB, Patterson, SG, Presti, JC, Stroup, AM, Wake, R, and Wei, JT. "Prostate cancer early detection: Clinical practice guidelines in oncology™." JNCCN Journal of the National Comprehensive Cancer Network 8.2 (2010): 240-262.
PMID
20141680
Source
scival
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
8
Issue
2
Publish Date
2010
Start Page
240
End Page
262

Reliance on PSA triggers may lead to overtreatment: Commentary

Authors
Moul, JW
MLA Citation
Moul, JW. "Reliance on PSA triggers may lead to overtreatment: Commentary." Oncology Report MARCH-APRIL (2010): 23--.
Source
scival
Published In
Oncology Report
Issue
MARCH-APRIL
Publish Date
2010
Start Page
23-

Salvage Radiation in Men with PSA Failure following Radical Prostatectomy and the Risk of Death

Authors
Cotter, SE; Chen, M; Moul, JW; Lee, WR; Koontz, BF; Anscher, MS; D'Amico, AV
MLA Citation
Cotter, SE, Chen, M, Moul, JW, Lee, WR, Koontz, BF, Anscher, MS, and D'Amico, AV. "Salvage Radiation in Men with PSA Failure following Radical Prostatectomy and the Risk of Death." 2010.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
78
Issue
3
Publish Date
2010
Start Page
S149
End Page
S149

Health policy: Health-care implications of resident duty-hour restrictions.

Authors
Stewart, SB; Scales, CD; Moul, JW
MLA Citation
Stewart, SB, Scales, CD, and Moul, JW. "Health policy: Health-care implications of resident duty-hour restrictions." Nat Rev Urol 6.12 (December 2009): 635-636.
PMID
19956189
Source
pubmed
Published In
Nature Reviews Urology
Volume
6
Issue
12
Publish Date
2009
Start Page
635
End Page
636
DOI
10.1038/nrurol.2009.230

Changes in Gleason score grading and their effect in predicting outcome after radical prostatectomy.

OBJECTIVES: To compare Gleason scores (GS) originally assigned in the mid 1990s with the current pathologic evaluation of the same prostatectomy slides, and to assess the GS migration effect on outcome in patients undergoing surgical treatment of prostate cancer. METHODS: We reviewed medical charts of consecutive patients who underwent a radical prostatectomy for T2-T3 prostate cancer at our Medical Center between 1995 and 1997. Prostate specimen slides of 204 patients were reviewed and GS was reassigned in a blinded fashion by a single uropathologist in 2008. GS distributions were compared, and original and re-evaluated GS were assessed for predictive ability in survival regression models. RESULTS: GS distribution differed significantly between the mid 1990s and the current evaluation (P < .001), with the average reevaluated GS higher than the initial one (6.14 vs 6.39, P < .001). The GS was upgraded in 63 cases (30.9%) and downgraded in 25 (12.3%) at reevaluation. The initial GS was predictive (P = .002) of prostate-specific antigen recurrence (PSAR), whereas the newly assigned GS was not (P = .393). However, grouping reassigned GS into risk groups (low < 7, moderate = 7 and high > 7) yielded a better PSAR definition. Survival curves of initial GS could not distinguish between moderate- and high-risk groups, although reassigned GS curves showed statistically significant differences between all risk groups. CONCLUSIONS: These results suggest that interpretation of pathologists played a significant role in the GS shift and propose that the contemporary GS remains a useful prognostic factor of PSAR when stratified in risk categories, although the single GS value may not be as important.

Authors
Tsivian, M; Sun, L; Mouraviev, V; Madden, JF; Mayes, JM; Moul, JW; Polascik, TJ
MLA Citation
Tsivian, M, Sun, L, Mouraviev, V, Madden, JF, Mayes, JM, Moul, JW, and Polascik, TJ. "Changes in Gleason score grading and their effect in predicting outcome after radical prostatectomy." Urology 74.5 (November 2009): 1090-1093.
PMID
19616835
Source
pubmed
Published In
Urology
Volume
74
Issue
5
Publish Date
2009
Start Page
1090
End Page
1093
DOI
10.1016/j.urology.2009.03.043

Men older than 70 years have higher risk prostate cancer and poorer survival in the early and late prostate specific antigen eras.

PURPOSE: We clarified whether men older than 70 years have a higher risk of prostate cancer and poorer survival in the early and late prostate specific antigen eras. MATERIALS AND METHODS: A cohort of 4,561 men who underwent radical prostatectomy were stratified into 3 age groups (younger than 60, 60 to 70 and older than 70 years), and early and late prostate specific antigen eras based on the year of surgery (before 2000 and 2000 or later). Race, body mass index, prostate specific antigen, prostate weight, tumor volume, pathological Gleason sum, pathological tumor stage, extracapsular extension, seminal vesicle invasion and surgical margin status were submitted for univariate and multivariable analyses against the previously mentioned groups. Survivals (prostate specific antigen recurrence, distant metastasis and disease specific death) were compared among the 3 age groups using univariate and multivariable methods. RESULTS: Compared with younger age groups (younger than 60, 60 to 70 years) men older than 70 years had a higher proportion of pathological tumor stage 3/4 (33.0 vs 44.3 vs 52.1%, p <0.001), pathological Gleason sum greater than 7 (9.5% vs 13.4% vs 17.2%, p <0.001) and larger tumor volume (3.7 vs 4.7 vs 5.2 cc, p <0.001). Pathological Gleason sum in men older than 70 years did not differ between the early and late prostate specific antigen eras (p = 0.071). Men older than 70 years had a higher risk of prostate specific antigen recurrence, distant metastasis and disease specific death on univariate (p <0.05) but not multivariable analysis. CONCLUSIONS: Men older than 70 years had higher risk disease and poorer survival in the early and late prostate specific antigen eras. Pathological Gleason sums did not change between the 2 eras. Patient age was an important variable in prostate specific antigen screening, biopsy, treatment and prognosis.

Authors
Sun, L; Caire, AA; Robertson, CN; George, DJ; Polascik, TJ; Maloney, KE; Walther, PJ; Stackhouse, DA; Lack, BD; Albala, DM; Moul, JW
MLA Citation
Sun, L, Caire, AA, Robertson, CN, George, DJ, Polascik, TJ, Maloney, KE, Walther, PJ, Stackhouse, DA, Lack, BD, Albala, DM, and Moul, JW. "Men older than 70 years have higher risk prostate cancer and poorer survival in the early and late prostate specific antigen eras." J Urol 182.5 (November 2009): 2242-2248.
PMID
19758616
Source
pubmed
Published In
The Journal of Urology
Volume
182
Issue
5
Publish Date
2009
Start Page
2242
End Page
2248
DOI
10.1016/j.juro.2009.07.034

Robot-assisted laparoscopic prostatectomy is not associated with early postoperative radiation therapy.

OBJECTIVE: To compare open radical prostatectomy (RP) and robot-assisted laparoscopic prostatectomy (RALP), and to determine whether RALP is associated with a higher risk of features that determine recommendations for postoperative radiation therapy (RT). PATIENTS AND METHODS: Patients undergoing RP from 2003 to 2007 were stratified into two groups: open RP and RALP. Preoperative (PSA level, T stage and Gleason score), pathological factors (T stage, Gleason score, extracapsular extension [ECE] and the status of surgical margins and seminal vesicle invasion [SVI]) and early treatment with RT or referral for RT within 6 months were compared between the groups. Multivariate analysis was used to control for selection bias in the RALP group. RESULTS: In all, 904 patients were identified; 368 underwent RALP and 536 underwent open RP (retropubic or perineal). Patients undergoing open RP had a higher pathological stage with ECE present in 24.8% vs 19.3% in RALP (P = 0.05) and SVI in 10.3% vs 3.8% (P < 0.001). In the RALP vs open RP group, there were positive surgical margins in 31.5% vs 31.9% (P = 0.9) and there were postoperative PSA levels of (3) 0.2 ng/mL in 5.7% vs 6.3% (P = 0.7), respectively. On multivariate analysis to control for selection bias, RALP was not associated with indication for RT (odds ratio (OR) 1.10, P = 0.55), or referral for RT (OR 1.04, P = 0.86). CONCLUSION: RALP was not associated with an increase in either indication or referral for early postoperative RT.

Authors
Chino, J; Schroeck, FR; Sun, L; Lee, WR; Albala, DM; Moul, JW; Koontz, BF
MLA Citation
Chino, J, Schroeck, FR, Sun, L, Lee, WR, Albala, DM, Moul, JW, and Koontz, BF. "Robot-assisted laparoscopic prostatectomy is not associated with early postoperative radiation therapy." BJU Int 104.10 (November 2009): 1496-1500.
PMID
19388991
Source
pubmed
Published In
Bju International
Volume
104
Issue
10
Publish Date
2009
Start Page
1496
End Page
1500
DOI
10.1111/j.1464-410X.2009.08588.x

Innovations in urology from military medicine.

Authors
Moul, JW
MLA Citation
Moul, JW. "Innovations in urology from military medicine." Urol Oncol 27.5 (September 2009): 551-552.
PMID
19720301
Source
pubmed
Published In
Urologic Oncology: seminars and original investigations
Volume
27
Issue
5
Publish Date
2009
Start Page
551
End Page
552
DOI
10.1016/j.urolonc.2009.01.022

Risk stratification in the hormonal treatment of patients with prostate cancer.

Prostate cancer (PCa) is the most common type of cancer found in American men, other than skin cancer. The American Cancer Society estimates that there will be 186,320 new cases of prostate cancer in the United States in 2008. About 28,660 men will die of this disease this year and PCa remains the second-leading cause of cancer death in men. One in six men will get PCa during his lifetime and one in 35 will die of the disease. Today, more than 2 million men in the United States who have had PCa are still alive. The death rate for PCa continues to decline, chiefly due to early detection and treatment, and improved salvage therapy such as hormone therapy (HT). HT continues to be a mainstay for primary-recurrent PCa and locally-advanced PCa. However, HT is associated with many undesirable side effects including sexual dysfunction, osteoporosis and hot flashes, all of which can lead to decreased quality of life (QOL). These risks are seen in both long- and short-term HT regimens. Additionally, research in recent years has revealed trends related to clinico pathological variables and their predictive ability in HT outcomes. Awareness of the potential adverse effects, the risks associated with HT and the prognostic ability of clinical and pathological variables is important in determining optimal therapy for individual patients. A rigorous evaluation of the current scientific literature associated with HT was conducted with the goal of identifying the most favorable balance of benefits and risks associated with HT.

Authors
Uhlman, MA; Moul, JW; Tang, P; Stackhouse, DA; Sun, L
MLA Citation
Uhlman, MA, Moul, JW, Tang, P, Stackhouse, DA, and Sun, L. "Risk stratification in the hormonal treatment of patients with prostate cancer." Ther Adv Med Oncol 1.2 (September 2009): 79-94.
PMID
21789114
Source
pubmed
Published In
Therapeutic Advances in Medical Oncology
Volume
1
Issue
2
Publish Date
2009
Start Page
79
End Page
94
DOI
10.1177/1758834009340164

Delayed prostate-specific antigen recurrence after radical prostatectomy: how to identify and what are their clinical outcomes?

OBJECTIVES: To identify factors that predict delayed (> 5 years) prostate-specific antigen recurrence (PSAR) after radical prostatectomy (RP) and to analyze the associated clinical outcomes. METHODS: A cohort of 4561 men who underwent RP between 1988 and 2008 was retrieved from the Duke University Prostate Center database. Among them, 1207 (26.5%) had PSAR and were included in this study. The cohort was then divided into 2 groups; PSAR before 5 years (early PSAR) and PSAR after 5 years (delayed PSAR), and Kaplan Meier analysis was performed. Univariate and logistic regression analysis was carried out to determine significant predictors of delayed PSAR, using factors such as race, age, body mass index, PSA, surgical margin status, pathologic Gleason sum, pathologic tumor stage, and prostate weight. RESULTS: There was a marginal difference between the early and delayed PSAR groups with regard to metastasis-free survival (P = .062). A significant difference in disease-specific survival was found between the 2 groups (P = .025). Patients with pathologic Gleason sums < 7 were more likely to have delayed PSAR as compared to those with pathologic Gleason sums > 7 (OR = 2.38). Patients with a PSA < 10 ng/mL were more likely to have delayed PSAR in comparison to those with PSA > 20 ng/mL (OR = 2.38). CONCLUSIONS: Approximately 90% of PSAR occurred within 5 years after RP. Lower pathologic Gleason sums and lower PSA at diagnosis were associated with delayed PSAR. Patients with delayed PSAR have a disease-specific survival advantage as compared to men with early PSAR.

Authors
Caire, AA; Sun, L; Ode, O; Stackhouse, DA; Maloney, K; Donatucci, C; Mouraviev, V; Polascik, TJ; Robertson, CN; Albala, DM; Moul, JW
MLA Citation
Caire, AA, Sun, L, Ode, O, Stackhouse, DA, Maloney, K, Donatucci, C, Mouraviev, V, Polascik, TJ, Robertson, CN, Albala, DM, and Moul, JW. "Delayed prostate-specific antigen recurrence after radical prostatectomy: how to identify and what are their clinical outcomes?." Urology 74.3 (September 2009): 643-647.
PMID
19501891
Source
pubmed
Published In
Urology
Volume
74
Issue
3
Publish Date
2009
Start Page
643
End Page
647
DOI
10.1016/j.urology.2009.02.049

Effect of age and pathologic Gleason score on PSA recurrence: analysis of 2911 patients undergoing radical prostatectomy.

OBJECTIVES: To clarify the relationship between age and pathologic Gleason score and their effect on prostate-specific antigen recurrence (PSAR). METHODS: The data from a cohort of 2911 men who had undergone radical prostatectomy from 1988 to 2006 were retrieved from the Duke Prostate Center database. Patient age was divided into 3 groups: <60, 60-64, and >or=65 years. The pathologic Gleason score was divided into 5 groups: 7. PSAR was defined as the prostate-specific antigen level increasing to >0.2 ng/mL >30 days after radical prostatectomy. The associations between age and pathologic Gleason score on PSAR and the time to PSAR were analyzed using parametric, nonparametric, Kaplan-Meier, and Cox regression techniques. RESULTS: Patient age and interval to PSAR had no significant association (P > .05). Kaplan-Meier analysis demonstrated a significant difference in PSAR among age groups. The pathologic Gleason scores of 3 + 3, 3 + 4, 4 + 3, and >7 were significant in determining the incidence of PSAR. Age was not significant for PSAR in patients with a pathologic Gleason score of 7, a statistically significant difference was observed among the age groups. Men <60 years old with a pathologic Gleason score >7 had a lower incidence of PSAR than did older men with a similar pathologic Gleason score. A pathologic Gleason score of >or=6 was significant in predicting PSAR. CONCLUSIONS: Age alone was an independent factor in predicting PSAR, but not in predicting the interval to PSAR. The pathologic Gleason score remained a predictor of PSAR, and patient age should be considered in patients with a pathologic Gleason score >7.

Authors
Xu, DD; Sun, SD; Wang, F; Sun, L; Stackhouse, D; Polascik, T; Albala, DM; Moul, JW; Caire, A; Robertson, CN
MLA Citation
Xu, DD, Sun, SD, Wang, F, Sun, L, Stackhouse, D, Polascik, T, Albala, DM, Moul, JW, Caire, A, and Robertson, CN. "Effect of age and pathologic Gleason score on PSA recurrence: analysis of 2911 patients undergoing radical prostatectomy." Urology 74.3 (September 2009): 654-658.
PMID
19628263
Source
pubmed
Published In
Urology
Volume
74
Issue
3
Publish Date
2009
Start Page
654
End Page
658
DOI
10.1016/j.urology.2008.12.063

Twenty years of controversy surrounding combined androgen blockade for advanced prostate cancer.

Authors
Moul, JW
MLA Citation
Moul, JW. "Twenty years of controversy surrounding combined androgen blockade for advanced prostate cancer." Cancer 115.15 (August 1, 2009): 3376-3378.
PMID
19484788
Source
pubmed
Published In
Cancer
Volume
115
Issue
15
Publish Date
2009
Start Page
3376
End Page
3378
DOI
10.1002/cncr.24393

Body mass index and prostate specific antigen as predictors of adverse pathology and biochemical recurrence after prostatectomy.

PURPOSE: Preoperative prostate specific antigen is widely used to predict unfavorable pathological features and biochemical relapse after radical prostatectomy. Recent reports that hemodilution may be responsible for lower prostate specific antigen in obese men led to concerns that prostate specific antigen may be less effective for prognosticating in men with increased body mass index. We determined whether the clinical usefulness of prostate specific antigen is negatively impacted by obesity by examining its operating characteristics and predictive accuracy as a function of body mass index. MATERIALS AND METHODS: We performed a multicenter retrospective analysis of the records of 11,705 men who underwent radical prostatectomy from 1988 to 2007 from Veterans Affairs hospitals of the Shared Equal Access Regional Cancer Hospital Database, the Duke Prostate Center and Johns Hopkins Hospital. ROC curve analysis, the concordance index and the test for interaction were used to compare the ability of prostate specific antigen to predict unfavorable tumor characteristics and biochemical recurrence across body mass index categories. RESULTS: There were no significant differences in the area under ROC curves across increasing body mass index categories for prostate specific antigen to predict pathological Gleason sum (7 or greater, 7 [4 + 3] or greater, or 8 or greater), positive surgical margins, extracapsular extension or seminal vesicle invasion in all 3 cohorts. There was no significant difference in prostate specific antigen accuracy to predict biochemical failure across increasing body mass index categories. CONCLUSIONS: In 3 cohorts of men treated with radical prostatectomy the ability of preoperative prostate specific antigen to predict adverse pathological features and posttreatment biochemical recurrence is not significantly affected by obesity. However, adjusting for obesity related hemodilution may still be required to properly interpret prostate specific antigen results in men with increased body mass index.

Authors
Bañez, LL; Sun, L; Trock, BJ; Han, M; Partin, AW; Aronson, WJ; Terris, MK; Presti, JC; Kane, CJ; Amling, CL; Moul, JW; Freedland, SJ
MLA Citation
Bañez, LL, Sun, L, Trock, BJ, Han, M, Partin, AW, Aronson, WJ, Terris, MK, Presti, JC, Kane, CJ, Amling, CL, Moul, JW, and Freedland, SJ. "Body mass index and prostate specific antigen as predictors of adverse pathology and biochemical recurrence after prostatectomy." J Urol 182.2 (August 2009): 491-496.
PMID
19524974
Source
pubmed
Published In
The Journal of Urology
Volume
182
Issue
2
Publish Date
2009
Start Page
491
End Page
496
DOI
10.1016/j.juro.2009.04.007

Combined low-dose flutamide plus finasteride vs low-dose flutamide monotherapy for recurrent prostate cancer: a comparative analysis of two phase II trials with a long-term follow-up.

OBJECTIVE: To compare the efficacy and tolerability of peripheral androgen blockade using combined low-dose flutamide plus finasteride vs low-dose flutamide monotherapy for treating biochemical relapse after the definitive management of prostate adenocarcinoma. PATIENTS AND METHODS: Fifty-six men treated for biochemical relapse of prostate cancer were enrolled prospectively in a phase II trial at the Walter Reed Army Medical Center from 1997 to 2001. Thirty-six men were treated with flutamide (125 mg twice daily) and finasteride (5 mg twice daily), and 20 men received low-dose flutamide only after biochemical recurrence (prostate-specific antigen, PSA, level > or =0.4 ng/mL). Cox proportional hazards analyses were used to compare the risk of progression between the groups. RESULTS: Patients on combined and monotherapy had a median follow-up of 54 and 43.5 months, respectively. Seven men (19%) in the combined arm remain in the study with no progression, while five (25%) on monotherapy continue and are progression-free. Men on combined therapy had a greater decrease in their PSA level (P = 0.002). Multivariate analysis showed that men on combined therapy had significantly less risk of progression than men on monotherapy (hazard ratio 0.21, 95% confidence interval 0.07-0.63, P = 0.005). There was no significant difference in the frequency of side-effects between the groups. Toxicities were reported to be mild. CONCLUSIONS: Our analysis suggests the therapeutic value of low-dose flutamide alone or combined with finasteride as first-line agents in a possible graduated approach for treating PSA-only recurrent prostate cancer. Due to unwanted metabolic effects associated with traditional hormonal agents, phase III trials comparing both regimens with current therapies are warranted.

Authors
Bañez, LL; Blake, GW; McLeod, DG; Crawford, ED; Moul, JW
MLA Citation
Bañez, LL, Blake, GW, McLeod, DG, Crawford, ED, and Moul, JW. "Combined low-dose flutamide plus finasteride vs low-dose flutamide monotherapy for recurrent prostate cancer: a comparative analysis of two phase II trials with a long-term follow-up." BJU Int 104.3 (August 2009): 310-314.
PMID
19239458
Source
pubmed
Published In
Bju International
Volume
104
Issue
3
Publish Date
2009
Start Page
310
End Page
314
DOI
10.1111/j.1464-410X.2009.08400.x

A retrospective comparison of anesthetic management of robot-assisted laparoscopic radical prostatectomy versus radical retropubic prostatectomy.

STUDY OBJECTIVE: To compare anesthetic management and postoperative outcomes in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALP) and radical retropubic prostatectomy (RRP) with general anesthesia. DESIGN: Retrospective database study of RALP and RRP patients at Duke University Medical Center from 6/2003 to 6/2006. SETTING: University teaching hospital. PATIENTS: 541 ASA physical status I, II, and III men, 280 of whom were RRP patients and 256 RALP patients. MEASUREMENTS: Patient demographics, intraoperative fluids and blood products, hemodynamic parameters, pain scores in the Postanesthesia Care Unit (PACU), intraoperative and postoperative analgesic consumption, need for rescue antiemetics in the PACU, and intraoperative use of vasopressors and antihypertensives, were all recorded. Additional data included postoperative transfusion data; clinical status of the patient's cancer preoperatively and postoperatively; hematocrit, platelet count, and creatinine levels; and length of hospital stay. MAIN RESULTS: Estimated blood loss (EBL) was higher for RRP than RALP patients (mean +/- SD; 1,087 +/- 853 mL vs. 287 +/- 317 mL; P < 0.0001). Likewise, 24% of RRP patients received red blood cell (RBC) transfusions intraoperatively, compared with 0.4% RALP patients (P < 0.0001). Intraoperatively, RALP patients received more antihypertensive agents (37% vs. 21%; P < 0.0001), and fewer vasopressors (63% vs. 78%; P < 0.0001) than did RRP patients. The two groups had similar morphine-equivalent opioid use intraoperatively, but in the PACU, RALP patients required fewer morphine equivalents (mean +/- SD; 11.4 +/- 7.7 mg vs. 14.9 +/- 9.8 mg; P < 0.0001). The RALP patients had longer surgical times (mean +/- SD; 296 +/- 76 vs.193 +/- 69 min; P < 0.0001) but shorter PACU stays (mean +/- SD; 113 +/- 55 min vs. 143 +/- 58 min; P < 0.0001) and shorter hospital stays (mean +/- SD; 44 +/- 77 hrs vs. 56 +/- 26 hrs; P = 0.009). CONCLUSIONS: Duration of surgery was greater with RALP, but it was associated with less EBL, fewer transfusions of blood products, and shorter PACU and hospital stays.

Authors
D'Alonzo, RC; Gan, TJ; Moul, JW; Albala, DM; Polascik, TJ; Robertson, CN; Sun, L; Dahm, P; Habib, AS
MLA Citation
D'Alonzo, RC, Gan, TJ, Moul, JW, Albala, DM, Polascik, TJ, Robertson, CN, Sun, L, Dahm, P, and Habib, AS. "A retrospective comparison of anesthetic management of robot-assisted laparoscopic radical prostatectomy versus radical retropubic prostatectomy." J Clin Anesth 21.5 (August 2009): 322-328.
PMID
19700296
Source
pubmed
Published In
Journal of Clinical Anesthesia
Volume
21
Issue
5
Publish Date
2009
Start Page
322
End Page
328
DOI
10.1016/j.jclinane.2008.09.005

Factors predicting prostatic biopsy Gleason sum under grading.

PURPOSE: We determined clinical factors affecting the under grading of biopsy Gleason sum compared with prostatectomy pathology and developed a model predicting the probability of under grading. MATERIALS AND METHODS: We analyzed a cohort of 1,701 patients treated for prostate cancer at our institution between 1988 and 2007 with complete biopsy and pathological data available. Patients with a biopsy Gleason sum of 7 or less were included in our analysis. Cases were categorized as under graded or not under graded by comparing biopsy and radical prostatectomy Gleason sums. Logistic regression was used to determine the predictors of under grading based on clinical variables (race, age at diagnosis, body mass index, prostate weight, diagnostic prostate specific antigen, biopsy positive-to-total core ratio, maximal cancer percent in positive cores and time from diagnosis to surgery). A nomogram was developed to calculate the probability of under grading. Results were validated using bootstrapping. RESULTS: Under grading occurred in 46.6% of our cohort. Significant variables predicting under grading were age at diagnosis, biopsy Gleason sum, diagnostic prostate specific antigen, prostate weight, biopsy positive-to-total core ratio and maximal percent of cancer in cores (p <0.05). Nomogram predictive accuracy was 72.4%. CONCLUSIONS: The risk of Gleason sum under grading can be predicted to a satisfactory level using our nomogram. Predicting under grading would improve patient consulting and identify those who should consider repeat biopsy, ultimately enhancing the accuracy of prostate cancer diagnosis.

Authors
Stackhouse, DA; Sun, L; Schroeck, FR; Jayachandran, J; Caire, AA; Acholo, CO; Robertson, CN; Albala, DM; Polascik, TJ; Donatucci, CF; Maloney, KE; Moul, JW
MLA Citation
Stackhouse, DA, Sun, L, Schroeck, FR, Jayachandran, J, Caire, AA, Acholo, CO, Robertson, CN, Albala, DM, Polascik, TJ, Donatucci, CF, Maloney, KE, and Moul, JW. "Factors predicting prostatic biopsy Gleason sum under grading." J Urol 182.1 (July 2009): 118-122.
PMID
19447436
Source
pubmed
Published In
The Journal of Urology
Volume
182
Issue
1
Publish Date
2009
Start Page
118
End Page
122
DOI
10.1016/j.juro.2009.02.127

Will the global economic downturn affect prostate cancer care? Pelvic lymphadenectomy as an example.

Authors
Moul, JW
MLA Citation
Moul, JW. "Will the global economic downturn affect prostate cancer care? Pelvic lymphadenectomy as an example." Eur Urol 55.6 (June 2009): 1266-1268.
PMID
19349110
Source
pubmed
Published In
European Urology
Volume
55
Issue
6
Publish Date
2009
Start Page
1266
End Page
1268
DOI
10.1016/j.eururo.2009.03.062

Lidocaine patch for postoperative analgesia after radical retropubic prostatectomy.

In a prospective, double-blind, placebo-controlled study, patients undergoing radical retropubic prostatectomy under general anesthesia were randomly assigned to receive a lidocaine patch or placebo applied on each side of the wound at the end of surgery. Data were collected for 24 h after surgery. Seventy patients completed the study (36 lidocaine group, 34 placebo group). Demographics and postoperative morphine consumption were not different between the groups. However, the lidocaine patch group reported significantly less pain on coughing (19%-33% reduction) over all time periods (treatment vs placebo P < 0.0001, time x treatment P = 0.3056) and at rest (17%-32% reduction) for up to 6 h (treatment vs placebo P = 0.0003, time x treatment P = 0.0130).

Authors
Habib, AS; Polascik, TJ; Weizer, AZ; White, WD; Moul, JW; ElGasim, MA; Gan, TJ
MLA Citation
Habib, AS, Polascik, TJ, Weizer, AZ, White, WD, Moul, JW, ElGasim, MA, and Gan, TJ. "Lidocaine patch for postoperative analgesia after radical retropubic prostatectomy." Anesth Analg 108.6 (June 2009): 1950-1953.
PMID
19448228
Source
pubmed
Published In
Anesthesia and Analgesia
Volume
108
Issue
6
Publish Date
2009
Start Page
1950
End Page
1953
DOI
10.1213/ane.0b013e3181a21185

Patient selection for hemiablative focal therapy of prostate cancer: variables predictive of tumor unilaterality based upon radical prostatectomy.

BACKGROUND: The application of focal therapy for low-risk prostate cancer (PCa) depended on appropriate patient selection. No definitive criteria existed to characterize patients who may potentially benefit from an organ-sparing approach. We evaluated pretreatment clinical parameters that may predict unilateral PCa amenable to hemigland thermoablation. METHODS: In total, 538 patients with complete data from the Duke Prostate Center (DPC) Outcomes database with low- to low-intermediate-risk PCa (prostate-specific antigen<10 ng/mL, biopsy Gleason score < or =7, and clinical stage T1c-T2b) treated with radical prostatectomy (RP) were included in the dataset. Patients underwent diagnostic prostate biopsy (PBx) at Duke or community hospitals from 1996 to 2006. Clinical and biopsy parameters were assessed as to the ability to predict PCa unilaterality verified by RP pathology. RESULTS: The strongest predictor of pathologic unilaterality was PBx unilaterality. The sensitivity and specificity for biopsy unilaterality to predict pathologic unilaterality was 88.4% and 34%, with a positive predictive value of 28% and a negative predictive value of 91%. PBx unilaterality (odds ratio [OR] = 3.88; 95% confidence interval [CI], 2.14-7.05; P < .0005) and negative family history of PCa (OR = 1.83; 95% CI, 1.09-3.05; P = .21) was associated with a higher probability of unilateral disease by multivariate regression. CONCLUSIONS: Two pretreatment clinical variables were significantly predictive of unilateral PCa: negative family history of PCa and PBx unilaterality. These variables may be used to select men with low- to low-moderate-risk PCa for hemiablation. Further work is necessary to decrease the false-negative and false-positive rates associated with PBx to improve predictability for PCa laterality.

Authors
Polascik, TJ; Mayes, JM; Schroeck, FR; Sun, L; Madden, JF; Moul, JW; Mouraviev, V
MLA Citation
Polascik, TJ, Mayes, JM, Schroeck, FR, Sun, L, Madden, JF, Moul, JW, and Mouraviev, V. "Patient selection for hemiablative focal therapy of prostate cancer: variables predictive of tumor unilaterality based upon radical prostatectomy." Cancer 115.10 (May 15, 2009): 2104-2110.
PMID
19288576
Source
pubmed
Published In
Cancer
Volume
115
Issue
10
Publish Date
2009
Start Page
2104
End Page
2110
DOI
10.1002/cncr.24258

Utility of a 3-dimensional transrectal ultrasound-guided prostate biopsy system for prostate cancer detection.

The 3-D transrectal ultrasound (TRUS)-guided prostate biopsy system is a novel device that allows precise needle placement in a template fashion. We evaluate its utility for prostate cancer (PCa) detection. A retrospective analysis was performed evaluating 68 prospective patients at the Duke Prostate Center who underwent a prostate biopsy using a 3-D TRUS-guided system. After creation of a three-dimensional map of the prostate, a computer algorithm identified an ideal biopsy scheme based on the measured dimensions of the prostate. The system then used a fixed template that allowed prostate biopsy at specific locations with the ability to target the same region of the prostate in the future if needed. For all patients, a 12-core biopsy pattern was used to cover medial and lateral areas of the base, mid-gland, and apex. In total, 68 patients underwent 3-D TRUS-guided prostate biopsies between April 2006 and November 2007 for prostate cancer detection. The indication for prostate biopsy was PSA > or = 4.0 ng/ml in 47 (69%) patients, abnormal digital rectal examination (DRE) in 17 (25%), and atypia on previous biopsy in 4 (6%) patients. Prostate cancer was detected in 18 patients (26.5%) and 7 (10.3%) had atypical small acinar proliferation (ASAP). The highest frequency (55.5%) from all cases of cancer detected was identified when 3-D TRUS biopsy was used as the initial biopsy. This study demonstrates that a 3-D TRUS-guided biopsy system translates to a more frequent detection of prostate cancer among patients undergoing an initial prostate biopsy than a subsequent one. More comprehensive studies are warranted to corroborate and extend the results of this study.

Authors
Chen, VH; Mouraviev, V; Mayes, JM; Sun, L; Madden, JF; Moul, JW; Polascik, TJ
MLA Citation
Chen, VH, Mouraviev, V, Mayes, JM, Sun, L, Madden, JF, Moul, JW, and Polascik, TJ. "Utility of a 3-dimensional transrectal ultrasound-guided prostate biopsy system for prostate cancer detection." Technol Cancer Res Treat 8.2 (April 2009): 99-104.
PMID
19334790
Source
pubmed
Published In
Technology in cancer research & treatment
Volume
8
Issue
2
Publish Date
2009
Start Page
99
End Page
104
DOI
10.1177/153303460900800202

PHASE I TRIAL OF PROSTATECTOMY AFTER PLANNED PREOPERATIVE RADIOTHERAPY FOR HIGH RISK LOCALIZED PROSTATE CANCER: PRELIMINARY RESULTS

Authors
Koontz, BF; Quaranta, BP; Carroll, M; Vujaskovic, Z; Lee, WR; Robertson, CN; Polascik, TJ; Anscher, MS; Moul, JW
MLA Citation
Koontz, BF, Quaranta, BP, Carroll, M, Vujaskovic, Z, Lee, WR, Robertson, CN, Polascik, TJ, Anscher, MS, and Moul, JW. "PHASE I TRIAL OF PROSTATECTOMY AFTER PLANNED PREOPERATIVE RADIOTHERAPY FOR HIGH RISK LOCALIZED PROSTATE CANCER: PRELIMINARY RESULTS." April 2009.
Source
wos-lite
Published In
The Journal of Urology
Volume
181
Issue
4
Publish Date
2009
Start Page
713
End Page
713

BODY MASS INDEX AND PROSTATE-SPECIFIC ANTIGEN AS A PREDICTOR OF ADVERSE PATHOLOGY AND BIOCHEMICAL RECURRENCE FOLLOWING RADICAL PROSTATECTOMY

Authors
Banez, LL; Sun, L; Trock, BJ; Han, M; Partin, AW; Aronson, WJ; Terris, MK; Jr, PJC; Kane, CJ; Amling, CL; Moul, JW; Freedland, SJ
MLA Citation
Banez, LL, Sun, L, Trock, BJ, Han, M, Partin, AW, Aronson, WJ, Terris, MK, Jr, PJC, Kane, CJ, Amling, CL, Moul, JW, and Freedland, SJ. "BODY MASS INDEX AND PROSTATE-SPECIFIC ANTIGEN AS A PREDICTOR OF ADVERSE PATHOLOGY AND BIOCHEMICAL RECURRENCE FOLLOWING RADICAL PROSTATECTOMY." April 2009.
Source
wos-lite
Published In
The Journal of Urology
Volume
181
Issue
4
Publish Date
2009
Start Page
574
End Page
574

DOES PATHOLOGICAL GLEASON SCORE RE-REVIEW BY A MODERN PATHOLOGIST IMPROVE RISK STRATIFICATION RELATIVE TO HISTORICAL GLEASON SCORE?

Authors
II, TJA; Jayachandran, J; Banez, LL; Sun, L; Madden, JC; Vollmer, RT; Lark, AL; Gerber, L; Moul, JW; Freedland, SJ
MLA Citation
II, TJA, Jayachandran, J, Banez, LL, Sun, L, Madden, JC, Vollmer, RT, Lark, AL, Gerber, L, Moul, JW, and Freedland, SJ. "DOES PATHOLOGICAL GLEASON SCORE RE-REVIEW BY A MODERN PATHOLOGIST IMPROVE RISK STRATIFICATION RELATIVE TO HISTORICAL GLEASON SCORE?." April 2009.
Source
wos-lite
Published In
The Journal of Urology
Volume
181
Issue
4
Publish Date
2009
Start Page
57
End Page
57

PREDICTING NON-ORGAN CONFINED PROSTATE CANCER AFTER THE YEAR 2000

Authors
Caire, AA; Sun, L; Polascik, TJ; Robertson, CN; Maloney, KE; Donatucci, CF; Albala, DM; Moul, JW
MLA Citation
Caire, AA, Sun, L, Polascik, TJ, Robertson, CN, Maloney, KE, Donatucci, CF, Albala, DM, and Moul, JW. "PREDICTING NON-ORGAN CONFINED PROSTATE CANCER AFTER THE YEAR 2000." JOURNAL OF UROLOGY 181.4 (April 2009): 609-609.
Source
wos-lite
Published In
The Journal of Urology
Volume
181
Issue
4
Publish Date
2009
Start Page
609
End Page
609

PERINEAL RADICAL PROSTATECTOMY: WHAT ARE THE TEN YEAR OUTCOMES?

Authors
Stackhouse, DA; Sun, L; Dahm, P; Kavoussi, LR; Paulson, D; Donatucci, CF; Maloney, KE; Albala, DM; Polascik, TJ; Robertson, CN; Moul, JW
MLA Citation
Stackhouse, DA, Sun, L, Dahm, P, Kavoussi, LR, Paulson, D, Donatucci, CF, Maloney, KE, Albala, DM, Polascik, TJ, Robertson, CN, and Moul, JW. "PERINEAL RADICAL PROSTATECTOMY: WHAT ARE THE TEN YEAR OUTCOMES?." JOURNAL OF UROLOGY 181.4 (April 2009): 210-210.
Source
wos-lite
Published In
The Journal of Urology
Volume
181
Issue
4
Publish Date
2009
Start Page
210
End Page
210

WHO DOES NOT NEED FOLLOW UP TWO YEARS AFTER PROSTATECTOMY? AN ANALYSIS OF 1739 PATIENTS AT DUKE UNIVERSITY MEDICAL CENTER

Authors
Lack, BD; Sun, L; Caire, AA; Donatucci, CF; Robertson, CN; Mouraviev, V; Polascik, TJ; Albala, DM; Maloney, KE; Walther, PJ; Moul, JW
MLA Citation
Lack, BD, Sun, L, Caire, AA, Donatucci, CF, Robertson, CN, Mouraviev, V, Polascik, TJ, Albala, DM, Maloney, KE, Walther, PJ, and Moul, JW. "WHO DOES NOT NEED FOLLOW UP TWO YEARS AFTER PROSTATECTOMY? AN ANALYSIS OF 1739 PATIENTS AT DUKE UNIVERSITY MEDICAL CENTER." JOURNAL OF UROLOGY 181.4 (April 2009): 759-759.
Source
wos-lite
Published In
The Journal of Urology
Volume
181
Issue
4
Publish Date
2009
Start Page
759
End Page
759

SAY NO TO THE US PREVENTATIVE TASK FORCE RECOMMENDATION TO NO LONGER OFFER PROSTATE CANCER SCREENING AFTER AGE 75?

Authors
Moul, JW; Sun, L; Lack, BD; Robertson, CN; Polascik, TJ; Donatucci, CF; Maloney, KE; Price, M; Albala, DM; Caire, AA
MLA Citation
Moul, JW, Sun, L, Lack, BD, Robertson, CN, Polascik, TJ, Donatucci, CF, Maloney, KE, Price, M, Albala, DM, and Caire, AA. "SAY NO TO THE US PREVENTATIVE TASK FORCE RECOMMENDATION TO NO LONGER OFFER PROSTATE CANCER SCREENING AFTER AGE 75?." JOURNAL OF UROLOGY 181.4 (April 2009): 797-797.
Source
wos-lite
Published In
The Journal of Urology
Volume
181
Issue
4
Publish Date
2009
Start Page
797
End Page
797

DELAYED PSA RECURRENCE AFTER RADICAL PROSTATECTOMY: HOW TO IDENTIFY PATIENTS AT RISK AND THEIR CLINICAL OUTCOMES?

Authors
Lack, BD; Sun, L; Caire, AA; Ode, O; Stackhouse, DA; Malone, KE; Donatucci, CF; Mouraviev, V; Polascik, TJ; Robertson, CN; Albala, DM; Moul, JW
MLA Citation
Lack, BD, Sun, L, Caire, AA, Ode, O, Stackhouse, DA, Malone, KE, Donatucci, CF, Mouraviev, V, Polascik, TJ, Robertson, CN, Albala, DM, and Moul, JW. "DELAYED PSA RECURRENCE AFTER RADICAL PROSTATECTOMY: HOW TO IDENTIFY PATIENTS AT RISK AND THEIR CLINICAL OUTCOMES?." JOURNAL OF UROLOGY 181.4 (April 2009): 457-457.
Source
wos-lite
Published In
The Journal of Urology
Volume
181
Issue
4
Publish Date
2009
Start Page
457
End Page
457

RECALIBRATION AND EXTERNAL VALIDATION OF AN EXISTING NOMOGRAM TO PREDICT AGGRESSIVE RECURRENCES AFTER RADICAL PROSTATECTOMY (RP)

Authors
Schroeck, FR; Kaftan, MW; Moul, JW; Aronson, WJ; Jr, PJC; Terris, MK; Kane, CJ; Amling, CL; Sun, L; Freedland, SJ
MLA Citation
Schroeck, FR, Kaftan, MW, Moul, JW, Aronson, WJ, Jr, PJC, Terris, MK, Kane, CJ, Amling, CL, Sun, L, and Freedland, SJ. "RECALIBRATION AND EXTERNAL VALIDATION OF AN EXISTING NOMOGRAM TO PREDICT AGGRESSIVE RECURRENCES AFTER RADICAL PROSTATECTOMY (RP)." April 2009.
Source
wos-lite
Published In
The Journal of Urology
Volume
181
Issue
4
Publish Date
2009
Start Page
54
End Page
54

Predicting prostate cancer mortality among men with intermediate to high-risk disease and multiple unfavorable risk factors.

PURPOSE: To determine whether the number of unfavorable risk factors could be used to predict the risk of prostate cancer-specific mortality (PCSM) among men with intermediate- to high-risk prostate cancer. METHODS AND MATERIALS: We studied 1,063 men who underwent radical prostatectomy (n = 559), external beam radiotherapy (n = 288), or radiotherapy plus androgen suppression therapy (n = 116) for prostate cancer between 1965 and 2002. Fine and Gray's regression analysis was used to determine whether an increasing number of unfavorable risk factors (prostate-specific antigen level >10 ng/mL, Gleason score of >or=7, clinical Stage T2b or greater, or pretreatment prostate-specific antigen velocity >2.0 ng/mL/y) was associated with the interval to PCSM and all-cause mortality. RESULTS: Median follow-up was 5.6 years. Compared with those with one risk factor, the adjusted hazard ratio for PCSM was 2.3 (95% confidence interval 1.1-4.8; p = 0.03) for two risk factors, 5.4 (95% confidence interval 2.7-10.7; p < 0.0001) for three risk factors, and 13.6 (95% confidence interval 6.3-29.2; p < 0.0001) for all four risk factors. The 5-year cumulative incidence of PCSM was 2.4% for one factor, 2.4% for two factors, 7.0% for three factors, and 14.7% for all four factors. Prostate cancer deaths as a proportion of all deaths was 19% for one factor, 33% for two factors, 53% for three factors, and 80% for four factors. CONCLUSION: The number of unfavorable risk factors was significantly associated with PCSM. Prostate cancer was the major cause of death in men with at least three risk factors. Therefore, these men should be considered for clinical trials designed to assess whether survival is prolonged with the addition of novel agents to current standards of practice.

Authors
Nguyen, PL; Chen, M-H; Catalona, WJ; Moul, JW; Sun, L; D'Amico, AV
MLA Citation
Nguyen, PL, Chen, M-H, Catalona, WJ, Moul, JW, Sun, L, and D'Amico, AV. "Predicting prostate cancer mortality among men with intermediate to high-risk disease and multiple unfavorable risk factors." Int J Radiat Oncol Biol Phys 73.3 (March 1, 2009): 659-664.
PMID
18692327
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
73
Issue
3
Publish Date
2009
Start Page
659
End Page
664
DOI
10.1016/j.ijrobp.2008.05.009

Prostate cancer: the new landscape.

PURPOSE OF REVIEW: This review highlights current features of the changing landscape of the US population with newly diagnosed prostate cancer and discusses new treatment options utilizing noninvasive or minimally invasive management. RECENT FINDINGS: Recent evidence of significant changes in the current prostate cancer landscape is based on clinical data and pathological specimens after radical prostatectomy that suggest a further increase of the low-risk patient population that may require reconsideration of treatment options. For a select cohort of patients with low-risk features, based on the D'Amico definition, active surveillance or focal ablative therapy may be a rational alternative to surgical prostatectomy or whole-gland radiation therapy that still dominate as the main treatment approaches for localized prostate cancer. SUMMARY: As the prostate-specific antigen era continues to mature, we continue to witness stage migration. A growing segment of the localized prostate cancer patient population has very low-volume, low-grade disease. Although active surveillance may be an appropriate approach for a selected group of patients, the progression requiring whole-gland therapy remains a challenge. Organ-sparing focal therapy might ideally fill the gap between a surveillance strategy and whole-gland treatment providing a reasonable balance between cancer control and quality of life.

Authors
Moul, JW; Mouraviev, V; Sun, L; Schroeck, FR; Polascik, TJ
MLA Citation
Moul, JW, Mouraviev, V, Sun, L, Schroeck, FR, and Polascik, TJ. "Prostate cancer: the new landscape." Curr Opin Urol 19.2 (March 2009): 154-160. (Review)
PMID
19195129
Source
pubmed
Published In
Current Opinion in Urology
Volume
19
Issue
2
Publish Date
2009
Start Page
154
End Page
160

Satisfaction and Regret After Open Retropubic or Robot-Assisted Laparoscopic Radical Prostatectomy

Authors
Schroeck, FR; Krupski, TL; Sun, L; Albala, DM; Price, MM; Polascik, TJ; Robertson, CN; Tewari, AK; Moul, JW
MLA Citation
Schroeck, FR, Krupski, TL, Sun, L, Albala, DM, Price, MM, Polascik, TJ, Robertson, CN, Tewari, AK, and Moul, JW. "Satisfaction and Regret After Open Retropubic or Robot-Assisted Laparoscopic Radical Prostatectomy." JOURNAL OF UROLOGY 181.2 (February 2009): 635-636.
Source
wos-lite
Published In
The Journal of Urology
Volume
181
Issue
2
Publish Date
2009
Start Page
635
End Page
636

Prostate Cancer and Prostatic Diseases. Report from Durham.

Authors
Moul, J
MLA Citation
Moul, J. "Prostate Cancer and Prostatic Diseases. Report from Durham." Prostate cancer and prostatic diseases 12.1 (January 2009): 1-.
PMID
19204722
Source
epmc
Published In
Prostate Cancer and Prostatic Diseases
Volume
12
Issue
1
Publish Date
2009
Start Page
1
DOI
10.1038/pcan.2009.1

Post-radical prostatectomy management options for positive surgical margins: argument for observation.

The screening zeal for prostate cancer in the PSA era resulted in and continues to produce an unprecedented number of men who have clinically localized prostate cancer seeking radical prostatectomy. Even before the advent of robotic laparoscopic-assisted radical prostatectomy (RALP), the topic of positive margins was hot. However, now it is even more contested in the era of the "RALP learning curve", the era of "The role of the experienced surgeon," and the era of the "well-informed Internet-savvy patient." The typical modern-era man with localized prostate cancer has very high expectations. He may be a younger Baby-Boomer who has been used to getting things his way and has been raised in a consumer-driven society. He is diagnosed with prostate cancer and his knowledge-seeking behavior then may be analogous to "finding religion." He, and/or his family, seeks "the best" surgeon and "the best" method of surgery, and he is expecting the trifecta outcome of cure, continence, and potency. The first episode to potentially deflate his sails is when the surgical pathology report returns and shows a positive margin.

Authors
Moul, JW
MLA Citation
Moul, JW. "Post-radical prostatectomy management options for positive surgical margins: argument for observation." Urol Oncol 27.1 (January 2009): 92-96.
PMID
19111807
Source
pubmed
Published In
Urologic Oncology: Seminars and Original Investigations
Volume
27
Issue
1
Publish Date
2009
Start Page
92
End Page
96
DOI
10.1016/j.urolonc.2008.04.011

Twenty-five year evolution of medical hormonal therapy for prostate cancer.

Authors
Moul, JW
MLA Citation
Moul, JW. "Twenty-five year evolution of medical hormonal therapy for prostate cancer." BJU Int 103.2 (January 2009): 145-146.
PMID
19278531
Source
pubmed
Published In
Bju International
Volume
103
Issue
2
Publish Date
2009
Start Page
145
End Page
146
DOI
10.1111/j.1464-410X.2008.08271.x

Report from Durham.

Authors
Moul, JW
MLA Citation
Moul, JW. "Report from Durham." Prostate Cancer Prostatic Dis 12.3 (2009): 209-210.
PMID
19721468
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
12
Issue
3
Publish Date
2009
Start Page
209
End Page
210
DOI
10.1038/pcan.2009.34

Obese men have higher-grade and larger tumors: an analysis of the duke prostate center database.

Obesity is associated with increased risk of positive surgical margins and prostate specific antigen (PSA) recurrence among men undergoing radical prostatectomy. To what degree positive margins contribute to poorer outcome is unclear. Thus, we sought to examine the association between body mass index (BMI) and more objective measures of tumor aggressiveness, tumor grade and size. We carried out a retrospective analysis of 2302 patients treated with radical prostatectomy at the Duke Prostate Center from 1988-2007. Tumor volume was calculated by multiplying prostate weight by percent of specimen involved with cancer. Associations between BMI and tumor volume and high-grade disease (Gleason >or=4+3) independent of pre-operative clinical characteristics of age, race, PSA, clinical stage, biopsy Gleason sum, and year of surgery were assessed using linear and logistic regression, respectively. Mean and median BMI among all subjects was 28.1 and 27.6 kg m(-2), respectively. Increased BMI was significantly associated with younger age (P<0.001), black race (P<0.001), more recent year of surgery (P<0.001), and positive surgical margins (P<0.001). After adjusting for multiple clinical pre-operative characteristics, higher BMI was associated with a greater percent of the prostate involved with cancer (P=0.003), increased tumor volume (P<0.001), and high-grade disease (P=0.007). Men with a BMI >or=35 kg m(2) had nearly 40% larger mean tumor volumes than normal weight men (5.1 versus 3.7 cc), after adjustment for multiple clinical characteristics. In this study, obese men undergoing radical prostatectomy had higher-grade and larger tumors, providing further evidence that obese men undergoing radical prostatectomy have more aggressive prostate cancers.

Authors
Freedland, SJ; Bañez, LL; Sun, LL; Fitzsimons, NJ; Moul, JW
MLA Citation
Freedland, SJ, Bañez, LL, Sun, LL, Fitzsimons, NJ, and Moul, JW. "Obese men have higher-grade and larger tumors: an analysis of the duke prostate center database." Prostate Cancer Prostatic Dis 12.3 (2009): 259-263.
PMID
19581922
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
12
Issue
3
Publish Date
2009
Start Page
259
End Page
263
DOI
10.1038/pcan.2009.11

Hormone therapy for prostate cancer raises heart disease risk: Commentary

Authors
Moul, JW
MLA Citation
Moul, JW. "Hormone therapy for prostate cancer raises heart disease risk: Commentary." Oncology Report WINT (2009): 26--.
Source
scival
Published In
Oncology Report
Issue
WINT
Publish Date
2009
Start Page
26-

Four clinical risk factors predict survival surrogate: Commentary

Authors
Moul, JW
MLA Citation
Moul, JW. "Four clinical risk factors predict survival surrogate: Commentary." Oncology Report FALL (2009): 25--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2009
Start Page
25-

Adjuvant radiotherapy remains rare in prostate cancer care: Commentary

Authors
Moul, JW
MLA Citation
Moul, JW. "Adjuvant radiotherapy remains rare in prostate cancer care: Commentary." Oncology Report FALL (2009): 26--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2009
Start Page
26-

Sampling the spatial patterns of cancer: Optimized biopsy procedures for estimating prostate cancer volume and Gleason Score

Prostate biopsy is the current gold-standard procedure for prostate cancer diagnosis. Existing prostate biopsy procedures have been mostly focusing on detecting cancer presence. However, they often ignore the potential use of biopsy to estimate cancer volume (CV) and Gleason Score (GS, a cancer grade descriptor), the two surrogate markers for cancer aggressiveness and the two crucial factors for treatment planning. To fill up this vacancy, this paper assumes and demonstrates that, by optimally sampling the spatial patterns of cancer, biopsy procedures can be specifically designed for estimating CV and GS. Our approach combines image analysis and machine learning tools in an atlas-based population study that consists of three steps. First, the spatial distributions of cancer in a patient population are learned, by constructing statistical atlases from histological images of prostate specimens with known cancer ground truths. Then, the optimal biopsy locations are determined in a feature selection formulation, so that biopsy outcomes (either cancer presence or absence) at those locations could be used to differentiate, at the best rate, between the existing specimens having different (high vs. low) CV/GS values. Finally, the optimized biopsy locations are utilized to estimate whether a new-coming prostate cancer patient has high or low CV/GS values, based on a binary classification formulation. The estimation accuracy and the generalization ability are evaluated by the classification rates and the associated receiver-operating-characteristic (ROC) curves in cross validations. The optimized biopsy procedures are also designed to be robust to the almost inevitable needle displacement errors in clinical practice, and are found to be robust to variations in the optimization parameters as well as the training populations. © 2009 Elsevier B.V.

Authors
Ou, Y; Shen, D; Zeng, J; Sun, L; Moul, J; Davatzikos, C
MLA Citation
Ou, Y, Shen, D, Zeng, J, Sun, L, Moul, J, and Davatzikos, C. "Sampling the spatial patterns of cancer: Optimized biopsy procedures for estimating prostate cancer volume and Gleason Score." Medical Image Analysis 13.4 (2009): 609-620.
PMID
19524478
Source
scival
Published In
Medical Image Analysis
Volume
13
Issue
4
Publish Date
2009
Start Page
609
End Page
620
DOI
10.1016/j.media.2009.05.002

Prostate-specific antigen screening and prostate cancer mortality: Implications of a randomized European study

Over the past two decades, prostate-specific antigen has become the primary modality for prostate cancer screening and has led to earlier detection. However, the question remains as to whether earlier detection actually leads to reductions in prostate cancer-specific mortality, especially since prostate cancer treatment can be associated with significant quality-of-life issues, including impotence and incontinence. Recently, long-term studies from Europe and the USA have demonstrated conflicting results with regard to this question. The European study demonstrated a 20% reduction in prostate cancer-specific mortality in men receiving routine screening, but concluded that 1410 men would need screening and 48 men would need treatment for prostate cancer in order to prevent one death. These findings demonstrated that prostate-specific antigen screening reduces prostate cancer-specific mortality, but reconfirmed the association of screening with a significant rate of overdiagnosis. © 2009 Future Medicine Ltd.

Authors
Uhlman, MA; Moul, JW; Robertson, CN; Sun, L
MLA Citation
Uhlman, MA, Moul, JW, Robertson, CN, and Sun, L. "Prostate-specific antigen screening and prostate cancer mortality: Implications of a randomized European study." Aging Health 5.3 (2009): 281-286.
Source
scival
Published In
Aging health
Volume
5
Issue
3
Publish Date
2009
Start Page
281
End Page
286
DOI
10.2217/ahe.09.29

Prostate Cancer and Prostatic Diseases. Report from Durham.

Authors
Moul, J
MLA Citation
Moul, J. "Prostate Cancer and Prostatic Diseases. Report from Durham." Prostate cancer and prostatic diseases 12.1 (2009): 1--.
Source
scival
Published In
Prostate Cancer and Prostatic Diseases
Volume
12
Issue
1
Publish Date
2009
Start Page
1-
DOI
10.1038/pcan.2009.1

Report from Durham

Authors
Moul, J
MLA Citation
Moul, J. "Report from Durham." Prostate Cancer and Prostatic Diseases 12.1 (2009): 1--.
Source
scival
Published In
Prostate Cancer and Prostatic Diseases
Volume
12
Issue
1
Publish Date
2009
Start Page
1-
DOI
10.1038/pcan.2009.1

Are we overtreating prostate cancer?

Authors
Moul, JW
MLA Citation
Moul, JW. "Are we overtreating prostate cancer?." J Urol 180.6 (December 2008): 2299-2300.
PMID
18930259
Source
pubmed
Published In
The Journal of Urology
Volume
180
Issue
6
Publish Date
2008
Start Page
2299
End Page
2300
DOI
10.1016/j.juro.2008.09.067

Flaxseed supplementation (not dietary fat restriction) reduces prostate cancer proliferation rates in men presurgery.

BACKGROUND: Prostate cancer affects one of six men during their lifetime. Dietary factors are postulated to influence the development and progression of prostate cancer. Low-fat diets and flaxseed supplementation may offer potentially protective strategies. METHODS: We undertook a multisite, randomized controlled trial to test the effects of low-fat and/or flaxseed-supplemented diets on the biology of the prostate and other biomarkers. Prostate cancer patients (n = 161) scheduled at least 21 days before prostatectomy were randomly assigned to one of the following arms: (a) control (usual diet), (b) flaxseed-supplemented diet (30 g/d), (c) low-fat diet (<20% total energy), or (d) flaxseed-supplemented, low-fat diet. Blood was drawn at baseline and before surgery and analyzed for prostate-specific antigen, sex hormone-binding globulin, testosterone, insulin-like growth factor-I and binding protein-3, C-reactive protein, and total and low-density lipoprotein cholesterol. Tumors were assessed for proliferation (Ki-67, the primary endpoint) and apoptosis. RESULTS: Men were on protocol an average of 30 days. Proliferation rates were significantly lower (P < 0.002) among men assigned to the flaxseed arms. Median Ki-67-positive cells/total nuclei ratios (x100) were 1.66 (flaxseed-supplemented diet) and 1.50 (flaxseed-supplemented, low-fat diet) versus 3.23 (control) and 2.56 (low-fat diet). No differences were observed between arms with regard to side effects, apoptosis, and most serologic endpoints; however, men on low-fat diets experienced significant decreases in serum cholesterol (P = 0.048). CONCLUSIONS: Findings suggest that flaxseed is safe and associated with biological alterations that may be protective for prostate cancer. Data also further support low-fat diets to manage serum cholesterol.

Authors
Demark-Wahnefried, W; Polascik, TJ; George, SL; Switzer, BR; Madden, JF; Ruffin, MT; Snyder, DC; Owzar, K; Hars, V; Albala, DM; Walther, PJ; Robertson, CN; Moul, JW; Dunn, BK; Brenner, D; Minasian, L; Stella, P; Vollmer, RT
MLA Citation
Demark-Wahnefried, W, Polascik, TJ, George, SL, Switzer, BR, Madden, JF, Ruffin, MT, Snyder, DC, Owzar, K, Hars, V, Albala, DM, Walther, PJ, Robertson, CN, Moul, JW, Dunn, BK, Brenner, D, Minasian, L, Stella, P, and Vollmer, RT. "Flaxseed supplementation (not dietary fat restriction) reduces prostate cancer proliferation rates in men presurgery." Cancer Epidemiol Biomarkers Prev 17.12 (December 2008): 3577-3587.
PMID
19064574
Source
pubmed
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
17
Issue
12
Publish Date
2008
Start Page
3577
End Page
3587
DOI
10.1158/1055-9965.EPI-08-0008

Defining potency: a comparison of the International Index of Erectile Function short version and the Expanded Prostate Cancer Index Composite.

BACKGROUND: Both the 5-item short version of the International Index of Erectile Function (IIEF-5) and the Expanded Prostate Cancer Index Composite (EPIC) have been used to assess erectile function. In this study, the authors compared various definitions of potency according to the IIEF-5 and the EPIC. METHODS: Patients with prostate cancer who had completed the IIEF-5 and the EPIC within 7 days of each other were included. The Spearman correlation coefficient (rho) was calculated to assess the relation between IIEF-5 and EPIC sexual domain scores. Concordance of potency rates by IIEF-5 and EPIC was assessed in cross-tabulations. By calculating the area under the receiver operator characteristics (ROC) curve (AUC), the authors ascertained the discriminative ability of the IIEF-5 score to identify potent men as defined by the EPIC. RESULTS: Analyzing 102 questionnaire pairs, IIEF-5 and EPIC domain scores were found to be highly correlated (rho = 0.776). EPIC sexual domain scores > or =60 had high concordance with IIEF-5 scores > or =17 (98%) and with nearly all single-item definitions of potency (> or =71%). However, an EPIC sexual domain score > or =80 was a very strict definition of potency, and only 54% of patients with IIEF-5 scores > or =22 met this threshold. On the basis of ROC analysis (AUC = 0.90), an IIEF-5 score > or =20 was identified as the ideal cutoff for defining potency and corresponded with an EPIC sexual domain score > or =60. CONCLUSIONS: IIEF-5 and EPIC scores were highly correlated, but potency rates varied widely, depending on the definition of potency. The current results help with the interpretation of sexual function outcomes data in patients with prostate cancer.

Authors
Schroeck, FR; Donatucci, CF; Smathers, EC; Sun, L; Albala, DM; Polascik, TJ; Moul, JW; Krupski, TL
MLA Citation
Schroeck, FR, Donatucci, CF, Smathers, EC, Sun, L, Albala, DM, Polascik, TJ, Moul, JW, and Krupski, TL. "Defining potency: a comparison of the International Index of Erectile Function short version and the Expanded Prostate Cancer Index Composite." Cancer 113.10 (November 15, 2008): 2687-2694.
PMID
18816628
Source
pubmed
Published In
Cancer
Volume
113
Issue
10
Publish Date
2008
Start Page
2687
End Page
2694
DOI
10.1002/cncr.23887

Point: radical prostatectomy is the treatment of choice for high-risk prostate cancer patients.

Authors
Moul, JW
MLA Citation
Moul, JW. "Point: radical prostatectomy is the treatment of choice for high-risk prostate cancer patients." Brachytherapy 7.4 (October 2008): 277-279.
PMID
18928920
Source
pubmed
Published In
Brachytherapy
Volume
7
Issue
4
Publish Date
2008
Start Page
277
End Page
279
DOI
10.1016/j.brachy.2008.08.003

Significant discrepancies between diagnostic and pathologic Gleason sums in prostate cancer: the predictive role of age and prostate-specific antigen.

OBJECTIVES: To assess the discrepancies between diagnostic and pathologic Gleason sums and the predictive role of age and prostate-specific antigen (PSA) level on Gleason sum discrepancies. METHODS: A total of 2963 patients receiving radical prostatectomy at Duke University from 1988 to 2006 were divided into two groups according to year of diagnosis: 1988 to 1999 and 2000 to 2006. The Gleason sum discrepancies were evaluated in the above groups. The predictive roles of diagnostic age (less than 50, 50 to 60, 60.1 to 70, and greater than 70 years), PSA level (less than 10, 10 to 20, and greater than 20 ng/mL), race, body mass index, and prostate weight on the discrepancies were analyzed. RESULTS: Overall, 55.8% of diagnostic Gleason sums differed from those on final surgical pathology (58.6% in the 1988 to 1999 and 49.3% in the 2000 to 2006 groups). Diagnostic Gleason sums were undergraded in 41.2% of cases and overgraded in 12.8% of cases. Men older than 60 years were more likely to have their diagnostic Gleason sums undergraded than men younger than 50 (odds ratio in age groups less than 50, 50 to 60, 60.1 to 70, and greater than 70 years: 1.00, 2.30, 4.03, and 3.96, respectively). Biopsy Gleason sums in men with a high PSA level were more likely to be undergraded compared with the PSA group less than 10 ng/mL (odds ratio in PSA groups less than 10, 10 to 20, and greater than 20 ng/mL: 1.00, 2.11, and 3.64, respectively). CONCLUSIONS: Significant discrepancies between diagnostic and pathologic Gleason sums remain in recent years. The rate of diagnostic Gleason sum undergrading was 3.2-fold that of overgrading. Advanced age and high PSA level were predictive of diagnostic Gleason sum undergrading, and caution should be exercised when recommending active surveillance in older men.

Authors
Isariyawongse, BK; Sun, L; Bañez, LL; Robertson, C; Polascik, TJ; Maloney, K; Donatucci, C; Albala, D; Mouraviev, V; Madden, JF; Moul, JW
MLA Citation
Isariyawongse, BK, Sun, L, Bañez, LL, Robertson, C, Polascik, TJ, Maloney, K, Donatucci, C, Albala, D, Mouraviev, V, Madden, JF, and Moul, JW. "Significant discrepancies between diagnostic and pathologic Gleason sums in prostate cancer: the predictive role of age and prostate-specific antigen." Urology 72.4 (October 2008): 882-886.
PMID
18384857
Source
pubmed
Published In
Urology
Volume
72
Issue
4
Publish Date
2008
Start Page
882
End Page
886
DOI
10.1016/j.urology.2008.02.021

Satisfaction and regret after open retropubic or robot-assisted laparoscopic radical prostatectomy.

BACKGROUND: To counsel patients adequately, it is important to understand the variables influencing satisfaction and regret following prostatectomy. OBJECTIVE: To identify independent predictors for satisfaction and regret after radical prostatectomy. DESIGN, SETTING, AND PARTICIPANTS: Patients who had undergone retropubic radical prostatectomy (RRP) or robot-assisted laparoscopic radical prostatectomy (RALP) between 2000 and 2007 were mailed cross-sectional surveys composed of sociodemographic information, the Expanded Prostate Cancer Index Composite (EPIC), and questions regarding satisfaction and regret. MEASUREMENTS: Sociodemographic variables, perioperative complications, type of procedure, length of follow-up, and EPIC scores were evaluated as independent predictors of satisfaction and regret in multivariate logistic regression analysis. RESULTS AND LIMITATIONS: A total of 400 patients responded (response rate 61%) of whom 84% were satisfied and 19% regretted their treatment choice. In multivariate analysis, lower income (odds ratio [OR], 0.08; 95% confidence interval [CI], 0.03-0.23), shorter follow-up (OR, 0.63; 95% CI, 0.41-0.98), having undergone RRP versus RALP (OR, 4.45; 95% CI, 1.90-10.4)], urinary domain scores (OR, 2.70; 95% CI, 1.60-4.54), and hormonal domain scores (OR, 2.01; 95% CI, 1.30-3.12) were independently associated with satisfaction (p< or =0.039). In terms of regret, RALP versus RRP (OR, 3.02; 95% CI, 1.50-6.07), lower urinary domain scores (OR, 0.58; 95% CI, 0.37-0.91) and hormonal domain scores (OR, 0.67; 95% CI, 0.45-0.98), and years since surgery (OR, 1.63; 95% CI, 1.13-2.36) were again predictive (p< or =0.041). African American race (OR, 3.58; 95% CI, 1.52-8.43) and lower bowel domain scores (OR, 0.73; 95% CI, 0.55-0.97) were also independently associated with regret (p< or =0.028). CONCLUSIONS: Sociodemographic variables and quality of life were important variables associated with satisfaction and regret. Patients who underwent RALP were more likely to be regretful and dissatisfied, possibly because of higher expectation of an "innovative" procedure. We suggest that urologists carefully portray the risks and benefits of new technologies during preoperative counseling to minimize regret and maximize satisfaction.

Authors
Schroeck, FR; Krupski, TL; Sun, L; Albala, DM; Price, MM; Polascik, TJ; Robertson, CN; Tewari, AK; Moul, JW
MLA Citation
Schroeck, FR, Krupski, TL, Sun, L, Albala, DM, Price, MM, Polascik, TJ, Robertson, CN, Tewari, AK, and Moul, JW. "Satisfaction and regret after open retropubic or robot-assisted laparoscopic radical prostatectomy." Eur Urol 54.4 (October 2008): 785-793.
PMID
18585849
Source
pubmed
Published In
European Urology
Volume
54
Issue
4
Publish Date
2008
Start Page
785
End Page
793
DOI
10.1016/j.eururo.2008.06.063

Pathologic stage T2a and T2b prostate cancer in the recent prostate-specific antigen era: implications for unilateral ablative therapy.

BACKGROUND: Early detection of small volume prostate cancer (PCa) has led to the concept of focal therapy to treat in an organ-sparing manner. We evaluated trends in pathologic staging among patients with localized PCa undergoing radical prostatectomy (RP), defining the frequency of unilateral cancers during 1988-1995, 1996-2000 and 2001-2006. METHODS: Data were abstracted from the Duke Prostate Cancer Outcome database selecting 3,676 men with available pathology treated with RP. Based on surgical pathology, trends in as pathological T (pT) stage, pathological Gleason Score (pGS), and percent tumor involvement (PTI) were evaluated. RESULTS: pT2a increased from 2.8% of men undergoing RP in 1988-1995 to 13.0% during 2001-2006 (P < 0.0005). PTI analysis shifted towards low volume disease, e.g. PTI

Authors
Polascik, TJ; Mayes, JM; Sun, L; Madden, JF; Moul, JW; Mouraviev, V
MLA Citation
Polascik, TJ, Mayes, JM, Sun, L, Madden, JF, Moul, JW, and Mouraviev, V. "Pathologic stage T2a and T2b prostate cancer in the recent prostate-specific antigen era: implications for unilateral ablative therapy." Prostate 68.13 (September 15, 2008): 1380-1386.
PMID
18543281
Source
pubmed
Published In
The Prostate
Volume
68
Issue
13
Publish Date
2008
Start Page
1380
End Page
1386
DOI
10.1002/pros.20804

Prostate-specific antigen screening among young men in the United States.

BACKGROUND: Disagreement exists on the use of prostate-specific antigen (PSA) tests for cancer-risk stratification in young men in the United States. Little is known about the use of PSA testing in these men. To understand policy implications of risk stratification, the authors sought to characterize PSA use among young men. METHODS: The authors used the 2002 Behavioral Risk Factor Surveillance System to study prostate-cancer screening in a representative sample of men aged 40 years and older (n = 58,511). The primary outcome was self-report of a PSA test in the previous year. RESULTS: Among men aged 40 to 49 years, 22.5% (95% confidence interval [CI], 21.5-23.5) reported having had a PSA test in the previous year, compared with 53.7% (95% CI, 52.8-54.7; P < .001) of men aged >or=50 years. When sociodemographic characteristics were statistically controlled, young, black, non-Hispanic men were more likely than young, white, non-Hispanic men to report having had a PSA test in the previous year (odds ratio [OR], 2.42; 95% CI, 1.95-3.01; P < .001). In young men, annual household income >or=USD 35,000 (OR, 1.50; 95% CI, 1.26-1.78; P < .001) and an ongoing relationship with a physician (OR, 2.52; 95% CI, 2.06-3.07; P < .001) were associated with PSA testing. CONCLUSIONS: One-fifth of young men reported having had a PSA test within the previous year. Young, black, non-Hispanic men are more likely than young, white, non-Hispanic men to report having had a PSA test, although screening in this high-risk group remains suboptimal.

Authors
Scales, CD; Antonelli, J; Curtis, LH; Schulman, KA; Moul, JW
MLA Citation
Scales, CD, Antonelli, J, Curtis, LH, Schulman, KA, and Moul, JW. "Prostate-specific antigen screening among young men in the United States." Cancer 113.6 (September 15, 2008): 1315-1323.
PMID
18696715
Source
pubmed
Published In
Cancer
Volume
113
Issue
6
Publish Date
2008
Start Page
1315
End Page
1323
DOI
10.1002/cncr.23667

Transdermal nicotine for analgesia after radical retropubic prostatectomy.

BACKGROUND: Previous animal and human studies suggested that nicotine might have an antinociceptive effect. We hypothesized that the preoperative application of a 7 mg nicotine patch would result in reduced postoperative analgesic requirements in patients undergoing radical retropubic prostatectomy (RRP) under general anesthesia. METHODS: Nonsmokers undergoing RRP under general anesthesia were enrolled in this prospective, double-blind, placebo-controlled study. Patients were randomly assigned to receive a patch of 7 mg nicotine or placebo applied behind the ear 30-60 min before induction of anesthesia. The anesthetic technique was standardized. Postoperative analgesia was provided with a standardized morphine patient-controlled analgesia and 6 hourly ketorolac 15 mg IV. Data were collected in the postanesthesia care unit and at 6, 12, and 24 h after surgery. RESULTS: Ninety patients were included in the analysis: 44 in the nicotine group and 46 in the placebo group. The groups did not differ significantly with respect to age, height, weight, ASA class, length of surgery, or amounts of intraoperative fentanyl received. The nicotine group showed significantly lower cumulative morphine consumption at 24 h (mean +/- sd): 33.3 +/- 30.8 mg vs 44.7 +/- 26.4 mg (P = 0.0059, time x treatment P = 0.0031). However, the repeated measures tests found no difference in amount of pain reported on coughing or at rest, either as treatment effects or in interaction with time. In post hoc comparisons, there was no significant difference in amount of pain reported on coughing or at rest at any of the times assessed. There were also no significant differences between the groups in the incidence of postoperative nausea and vomiting or the need for rescue antiemetics. However, the maximum nausea verbal rating scale score was higher in the nicotine than in the placebo group (median, 25th to 75th percentiles = 4, 0-6 vs 0, 0-6, P = 0.0158). There was a significant negative correlation between the 24 h plasma nicotine levels and postoperative morphine consumption in the postanesthesia care unit (P = 0.049), as well as at 6, 12, and 24 h (P = 0.002). CONCLUSION: The preoperative application of a 7 mg nicotine patch resulted in a significant reduction in opioid consumption in patients undergoing RRP under general anesthesia. Despite this reduction in opioid use, there was no reduction in pain scores or postoperative nausea and vomiting with the use of transdermal nicotine.

Authors
Habib, AS; White, WD; El Gasim, MA; Saleh, G; Polascik, TJ; Moul, JW; Gan, TJ
MLA Citation
Habib, AS, White, WD, El Gasim, MA, Saleh, G, Polascik, TJ, Moul, JW, and Gan, TJ. "Transdermal nicotine for analgesia after radical retropubic prostatectomy." Anesth Analg 107.3 (September 2008): 999-1004.
PMID
18713920
Source
pubmed
Published In
Anesthesia and Analgesia
Volume
107
Issue
3
Publish Date
2008
Start Page
999
End Page
1004
DOI
10.1213/ane.0b013e31816f2616

Obesity and oncological outcome after radical prostatectomy: impact of prostate-specific antigen-based prostate cancer screening: results from the Shared Equal Access Regional Cancer Hospital and Duke Prostate Center databases.

OBJECTIVE: To indirectly test the hypothesis that prostate-specific antigen (PSA)-based screening is biased against obese men due to haemodilution of PSA, and thus results in delayed diagnosis and poorer outcome beyond the biological link between obesity and aggressive prostate cancer. PATIENTS AND METHODS: We sought to examine the association between body mass index (BMI) and the outcome of radical prostatectomy (RP) separately for men with PSA-detected cancers (cT1c) or with abnormal digital rectal examination (DRE) findings (cT2/T3), and stratified by year of treatment, using two large databases. We conducted a retrospective cohort study of 1375 and 2014 men treated by RP between 1988 and 2007 using the Shared Equal Access Regional Cancer Hospital (SEARCH) and Duke Prostate Center (DPC) databases. We evaluated the association between BMI and adverse pathological features and biochemical progression, using logistic regression and Cox proportional hazards models, adjusting for several clinical characteristics, respectively. Data were examined as a whole and as stratified by clinical stage (cT1c vs cT2/T3) and year of surgery (>or=2000 vs <2000). RESULTS: In both cohorts a higher BMI was associated with high-grade disease (P 0.3). Among men with T1c disease, the association between BMI and biochemical progression was limited to men treated in 2000 or later (P 0.4). CONCLUSIONS: Obese men with PSA-detected cancers and treated with RP since 2000 were at significantly greater risk of biochemical progression, while obese men treated before 2000 or diagnosed with an abnormal DRE were not at significantly greater risk of progression. These findings support the hypothesis that current PSA-based screening is less effective at finding cancers in obese men, leading to more aggressive tumours at diagnosis. Lowering the PSA threshold for biopsy among obese men might help to improve outcomes among this high-risk group.

Authors
Freedland, SJ; Sun, L; Kane, CJ; Presti, JC; Terris, MK; Amling, CL; Moul, JW; Aronson, WJ
MLA Citation
Freedland, SJ, Sun, L, Kane, CJ, Presti, JC, Terris, MK, Amling, CL, Moul, JW, and Aronson, WJ. "Obesity and oncological outcome after radical prostatectomy: impact of prostate-specific antigen-based prostate cancer screening: results from the Shared Equal Access Regional Cancer Hospital and Duke Prostate Center databases." BJU Int 102.8 (September 2008): 969-974.
PMID
18691175
Source
pubmed
Published In
Bju International
Volume
102
Issue
8
Publish Date
2008
Start Page
969
End Page
974
DOI
10.1111/j.1464-410X.2008.07934.x

Percent tumor involvement and risk of biochemical progression after radical prostatectomy.

PURPOSE: Percent tumor involvement has been associated with biochemical progression in organ confined disease, although its role in predicting outcome in men with more advanced disease pathology is unclear. We hypothesized percent tumor involvement may be a good correlate of outcome in all stages of prostate cancer. MATERIALS AND METHODS: We examined the association between percent tumor involvement in the radical prostatectomy specimen and the outcome measures of pathological stage and biochemical progression using multivariate logistic regression and Cox proportional hazards analysis, respectively, in 2,220 patients from the Duke Prostate Center radical prostatectomy database. RESULTS: On multivariate analysis, percent tumor involvement significantly predicted the risk of positive margins (p <0.001), extracapsular extension (p <0.001), seminal vesicle invasion (p <0.001) and biochemical progression (HR 1.16, 95% CI 1.01-1.33, p = 0.035). The percent tumor involvement cut points of 5% or less, 6% to 20%, 21% to 50% and greater than 50% significantly separated men in groups with differing biochemical progression risk (p <0.001). In addition, these cut points were further able to stratify men among those with organ confined margin negative disease (p <0.001), either positive margins or extracapsular extension (p <0.001), and those with seminal vesicle invasion (p = 0.02). CONCLUSIONS: Percent tumor involvement was a significant predictor of biochemical progression and was able to further stratify men who were already assigned to narrowly defined pathological groups. If confirmed in other studies, percent tumor involvement may enable the clinician to identify the high risk patient who stands to benefit the most from adjuvant therapy.

Authors
Rampersaud, EN; Sun, L; Moul, JW; Madden, J; Freedland, SJ
MLA Citation
Rampersaud, EN, Sun, L, Moul, JW, Madden, J, and Freedland, SJ. "Percent tumor involvement and risk of biochemical progression after radical prostatectomy." J Urol 180.2 (August 2008): 571-576.
PMID
18554662
Source
pubmed
Published In
The Journal of Urology
Volume
180
Issue
2
Publish Date
2008
Start Page
571
End Page
576
DOI
10.1016/j.juro.2008.04.017

Words of wisdom. Re: obesity-related plasma hemodilution and PSA concentration among men with prostate cancer.

Authors
Moul, JW
MLA Citation
Moul, JW. "Words of wisdom. Re: obesity-related plasma hemodilution and PSA concentration among men with prostate cancer." Eur Urol 54.1 (July 2008): 232-233.
PMID
18510952
Source
pubmed
Published In
European Urology
Volume
54
Issue
1
Publish Date
2008
Start Page
232
End Page
233
DOI
10.1016/j.eururo.2008.03.062

A decision aid for teaching limitations of prostate cancer screening.

There is minimal research regarding men's knowledge of the limitations of prostate cancer screening. This study measured knowledge of prostate cancer screening based on exposure to one of two decision aids that were related to prostate cancer screening (enhanced versus usual care). The sample consisted primarily of low income (54%) African-American men (81%) (n=230). The enhanced decision aid was compared against the usual care decision aid that was developed by the American Cancer Society. The enhanced decision aid was associated with higher post-test knowledge scores, but statistically significant differences were observed only in the men who reported having had a previous DRE (p = 0.013) in the multivariable analyses. All the men were screened, regardless of which decision aid they received. This study highlights the impact of previous screening on education of the limitations of prostate screening, and challenges the assumption that increased knowledge of the limitations of prostate cancer screening will lead to decreased screening.

Authors
Weinrich, SP; Seger, RE; Rao, GS; Chan, EC; Hamm, RM; Godley, PA; Moul, JW; Powell, IJ; Chodak, GW; Taylor, KL; Weinrich, MC
MLA Citation
Weinrich, SP, Seger, RE, Rao, GS, Chan, EC, Hamm, RM, Godley, PA, Moul, JW, Powell, IJ, Chodak, GW, Taylor, KL, and Weinrich, MC. "A decision aid for teaching limitations of prostate cancer screening." J Natl Black Nurses Assoc 19.1 (July 2008): 1-11.
PMID
18807773
Source
pubmed
Published In
Journal of National Black Nurses' Association
Volume
19
Issue
1
Publish Date
2008
Start Page
1
End Page
11

Comparison of prostate-specific antigen recurrence-free survival in a contemporary cohort of patients undergoing either radical retropubic or robot-assisted laparoscopic radical prostatectomy.

OBJECTIVES: To compare the prostate-specific antigen (PSA) recurrence (PSAR) rates in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALP) or radical retropubic prostatectomy (RRP). PATIENTS AND METHODS: Data from 797 consecutive patients who had RALP or RRP between August 2003 and January 2007 were retrieved from our database. Age, race, body mass index, PSA level, estimated blood loss (EBL), clinical and pathological stage, biopsy and pathological Gleason score, lymph node involvement, positive surgical margin (PSM) status, and prostate weight were compared between the groups. Multivariate analysis (logistic and Cox regression) was used to adjust for differences in clinical and pathological features when comparing the risk for PSM and PSAR. RESULTS: In all, 362 men had RALP and 435 had RRP; the mean follow-up was 1.09 and 1.37 years, respectively. RALP patients had a significantly lower clinical stage, Gleason score and EBL (P < 0.001). There was no significant difference in PSM between RALP and RRP in univariate (P = 0.701) and multivariate analyses (P = 0.095). The risk of PSAR for patients undergoing RALP or RRP was not significantly different after adjusting for clinical (hazard ratio 0.82, 95% confidence interval 0.48-1.38; P = 0.448) and pathological differences (0.94, 0.55-1.61; P = 0.824). CONCLUSIONS: Patients undergoing RALP had a lower EBL and lower-risk disease. After adjusting for differences in clinical and pathological features, there was no significant difference in early PSAR between patients undergoing RALP or RRP.

Authors
Schroeck, FR; Sun, L; Freedland, SJ; Albala, DM; Mouraviev, V; Polascik, TJ; Moul, JW
MLA Citation
Schroeck, FR, Sun, L, Freedland, SJ, Albala, DM, Mouraviev, V, Polascik, TJ, and Moul, JW. "Comparison of prostate-specific antigen recurrence-free survival in a contemporary cohort of patients undergoing either radical retropubic or robot-assisted laparoscopic radical prostatectomy." BJU Int 102.1 (July 2008): 28-32.
PMID
18384634
Source
pubmed
Published In
Bju International
Volume
102
Issue
1
Publish Date
2008
Start Page
28
End Page
32
DOI
10.1111/j.1464-410X.2008.07607.x

Use of local (111)in-capromab pendetide scan results to predict outcome after salvage radiotherapy for prostate cancer.

PURPOSE: The (111)In-capromab pendetide scan (ProstaScint; Cytogen Corp., Princeton NJ) is approved by the Food and Drug Administration to evaluate increasing prostate-specific antigen (PSA) levels after radical prostatectomy. This study evaluated the role of prostate bed (111)In-capromab pendetide scan findings to predict response to salvage radiotherapy (RT). METHODS AND MATERIALS: Forty patients who had PSA recurrence after radical prostatectomy and a (111)In-capromab pendetide scan immediately before salvage prostate bed RT (median, 66 Gy) were identified from the Duke Prostate Center database. Patients with distant uptake of capromab pendetide or long-term androgen deprivation therapy were excluded. Median follow-up after salvage RT was 2.7 years. Patient demographic, clinical, and pathologic characteristics; PSA values; and (111)In-capromab pendetide scan results were retrospectively analyzed. A PSA failure after salvage RT was defined as PSA level greater than 0.2 ng/ml. Data were combined with other published results in a secondary pooled analysis of 106 patients. RESULTS: (111)In-Capromab pendetide findings included 20 patients with negative scan results and 20 with locally positive scan results. Two-year progression-free survival rates were 60% for patients with a negative scan result and 74% for those with a locally positive scan result (p = 0.49). Combined analysis did not show a difference in outcome based on local (111)In-capromab pendetide scan result. CONCLUSION: For patients without distant signal detected by using (111)In-capromab pendetide scan, patients with locally positive scan findings did not have statistically different progression-free survival than those with a negative scan result, suggesting that salvage RT may be successful in patients with either a locally positive or negative (111)In-capromab pendetide scan result.

Authors
Koontz, BF; Mouraviev, V; Johnson, JL; Mayes, J; Chen, SH; Wong, TZ; Anscher, MS; Sun, L; Moul, J; Polascik, TJ
MLA Citation
Koontz, BF, Mouraviev, V, Johnson, JL, Mayes, J, Chen, SH, Wong, TZ, Anscher, MS, Sun, L, Moul, J, and Polascik, TJ. "Use of local (111)in-capromab pendetide scan results to predict outcome after salvage radiotherapy for prostate cancer." Int J Radiat Oncol Biol Phys 71.2 (June 1, 2008): 358-361.
PMID
18164863
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
71
Issue
2
Publish Date
2008
Start Page
358
End Page
361
DOI
10.1016/j.ijrobp.2007.10.020

Can prostate-specific antigen and prostate-specific antigen velocity be used for prostate cancer screening in men older than 70 years?

OBJECTIVES: We evaluated the lower threshold of prostate-specific antigen (PSA) and prostate-specific antigen velocity (PSAV) in a population of men over 70 years of age. METHODS: Between January 1988 and December 2005, 4038 men over 70 years of age including 605 African-American (AA) men and 3433 non-AA men from the Duke Prostate Center Outcomes database had determination of serum PSA and PSAV. We used receiver operating characteristic (ROC) curves to display the data graphically. RESULTS: The median age for all men on the study was 75 years. The area under the curve (AUC) for PSA in AA men and non-AA men was 0.84 and 0.76, respectively. For PSAV the AUC was 0.71 versus 0.54, respectively. The largest relative sensitivity and specificity in AA men was achieved at the established PSA cut-point of 4.0 ng/mL: 85% and 71%, respectively. The best cut-point in non-AA men was 3.4 ng/mL, which resulted in a sensitivity and specificity of 72% and 73%, respectively. The AUC of ROC curves within various age subgroups tends to be stable regardless of how the ages are grouped. In a multivariate logistic regression model age, PSA and PSAV were significant predictors of cancer status in the AA subset. Age and PSA were significant predictors in the non-AA subset. CONCLUSIONS: The AUC of ROC curves within various age subgroups tends to be stable; therefore, we are led to believe that a PSA or PSAV cutoff for safely commending discontinuation of PCa screening is not apparent from these data.

Authors
Mouraviev, V; Broadwater, G; Sun, L; Mayes, JM; Moul, JW; Polascik, TJ
MLA Citation
Mouraviev, V, Broadwater, G, Sun, L, Mayes, JM, Moul, JW, and Polascik, TJ. "Can prostate-specific antigen and prostate-specific antigen velocity be used for prostate cancer screening in men older than 70 years?." Urology 71.6 (June 2008): 1020-1023.
PMID
18267331
Source
pubmed
Published In
Urology
Volume
71
Issue
6
Publish Date
2008
Start Page
1020
End Page
1023
DOI
10.1016/j.urology.2007.11.016

The relationship between LHRH-agonist depot formulations and frequency of follow-up with health care providers in patients with prostate cancer

Authors
Moul, JW; Wiederkehr, D; Connolly, M; Sendersky, V; Onel, E
MLA Citation
Moul, JW, Wiederkehr, D, Connolly, M, Sendersky, V, and Onel, E. "The relationship between LHRH-agonist depot formulations and frequency of follow-up with health care providers in patients with prostate cancer." May 20, 2008.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
26
Issue
15
Publish Date
2008

The relationship between LHRH-agonist depot formulations and frequency of follow-up with health care providers in patients with prostate cancer.

16002 Background: Several formulations of Luteinizing Hormone-Releasing Hormone Agonists (LHRH-A) of varying duration are available for treatment of prostate cancer (PCa). Previous reports suggest that utilization of longer acting LHRH-A may reduce the number of healthcare visits, thereby reducing the costs of managing PCa patients. In this study we investigated the frequency of patient follow-up with respect to use of 1, 3 and 4 month depot formulations in a cohort of patients with PCa from a large healthcare system in the United States.Data from PCa patients identified in the Henry Ford Health System (HFHS) as International Classification of Diseases for Oncology (ICD-O) code C61.9 in the tumor registry were extracted. The following patients were included: full staging information at index and the same dosage of LHRH-A during the duration of the follow-up. Patients with prior primary tumor types were excluded.653 patients receiving the same depot of LHRH-A through the duration of agonist treatment were identified (44.1 % Caucasians, mean age 72±9.2, mean Gleason score 7.2, median PSA 10.5). There was no significant difference with depot switchers excluded from the analysis. Patients receiving 1, 3 and 4-month depot formulations had 25, 29 and 41 days between any PCa related visits. Patients on the 1-month depot had 51 days between visits to urologists, while patients on 3 and 4 month depots had 46 and 60 days between urologist visits, respectively. For patients receiving 1-month depot, there was no significant difference between the actual time between PCa related follow-up visits and expected time between follow-up visits (mean difference -5 days; p=0.1923). However, patients receiving 3-month (mean difference -61 days; p<0.0001) and 4-month (mean difference -79 days; p<0.0001) depot formulations had significantly less time than expected between PCa related follow-up visits.Although it was expected that the depot formulation would have a significant impact on the interval between PCa related visits, the data did not support this. The results of this study suggest that patients' frequency of follow- up with health care providers is not influenced by LHRH-A depot formulations. [Table: see text].

Authors
Moul, JW; Wiederkehr, D; Connolly, M; Sendersky, V; Onel, E
MLA Citation
Moul, JW, Wiederkehr, D, Connolly, M, Sendersky, V, and Onel, E. "The relationship between LHRH-agonist depot formulations and frequency of follow-up with health care providers in patients with prostate cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 26.15_suppl (May 2008): 16002-.
PMID
27947287
Source
epmc
Published In
Journal of Clinical Oncology
Volume
26
Issue
15_suppl
Publish Date
2008
Start Page
16002

Early versus delayed hormonal therapy for prostate specific antigen only recurrence of prostate cancer after radical prostatectomy.

PURPOSE: Hormonal therapy (HT) is the current mainstay of systemic treatment for prostate specific antigen (PSA) only recurrence (PSAR), however, there is virtually no published literature comparing HT to observation in the clinical setting. The goal of this study was to examine the Department of Defense Center for Prostate Disease Research observational database to compare clinical outcomes in men who experienced PSAR after radical prostatectomy by early versus delayed use of HT and by a risk stratified approach. MATERIALS AND METHODS: Of 5,382 men in the database who underwent primary radical prostatectomy (RP), 4,967 patients were treated in the PSA-era between 1988 and December 2002. Of those patients 1,352 men who had PSAR (PSA after surgery greater than 0.2 ng/ml) and had postoperative followup greater than 6 months were used as the study cohort. These patients were further divided into an early HT group in which patients (355) received HT after PSA only recurrence but before clinical metastasis and a late HT group for patients (997) who received no HT before clinical metastasis or by current followup. The primary end point was the development of clinical metastases. Of the 1,352 patients with PSAR clinical metastases developed in 103 (7.6%). Patients were also stratified by surgical Gleason sum, PSA doubling time and timing of recurrence. Univariate and multivariate Cox proportional hazard models were used to evaluate the effect of early and late HT on clinical outcome. RESULTS: Early HT was associated with delayed clinical metastasis in patients with a pathological Gleason sum greater than 7 or PSA doubling time of 12 months or less (Hazards ratio = 2.12, p = 0.01). However, in the overall cohort early HT did not impact clinical metastases. Race, age at RP and PSA at diagnosis had no effect on metastasis-free survival (p >0.05). CONCLUSIONS: The retrospective observational multicenter database analysis demonstrated that early HT administered for PSAR after prior RP was an independent predictor of delayed clinical metastases only for high-risk cases at the current followup. Further study with longer followup and randomized trials are needed to address this important issue.

Authors
Moul, JW; Wu, H; Sun, L; McLeod, DG; Amling, C; Donahue, T; Kusuda, L; Sexton, W; O'Reilly, K; Hernandez, J; Chung, A; Soderdahl, D
MLA Citation
Moul, JW, Wu, H, Sun, L, McLeod, DG, Amling, C, Donahue, T, Kusuda, L, Sexton, W, O'Reilly, K, Hernandez, J, Chung, A, and Soderdahl, D. "Early versus delayed hormonal therapy for prostate specific antigen only recurrence of prostate cancer after radical prostatectomy." J Urol 179.5 Suppl (May 2008): S53-S59.
PMID
18405753
Source
pubmed
Published In
The Journal of Urology
Volume
179
Issue
5 Suppl
Publish Date
2008
Start Page
S53
End Page
S59
DOI
10.1016/j.juro.2008.03.138

Trainees do not negatively impact the institutional learning curve for robotic prostatectomy as characterized by operative time, estimated blood loss, and positive surgical margin rate.

OBJECTIVES: We evaluated the learning curves and perioperative outcomes of an experienced laparoscopic surgeon and his trainees to assess our structured teaching program. METHODS: We retrieved 383 patients undergoing robot-assisted laparoscopic prostatectomy (RALP) from our database. Trainees completed a structured teaching program and were categorized as early (days 0 to 232), mid (days 566 to 797), and late (days 825 to 1218) according to the time period in which they were working with the mentor. We compared operative times, estimated blood loss (EBL), and positive surgical margin (PSM) rates between the trainees and the mentor (Mann-Whitney and Chi-square test). Association of EBL, body mass index (BMI), and prostate weight with operative time was evaluated in multivariate linear regression analysis. RESULTS: Median operative times of the early, mid, and late trainees (258, 220, and 200 minutes) significantly decreased and were similar to the corresponding senior surgeon's (254, 242, and 180 minutes). Operative times decreased with lower BMI, EBL, and prostate weight (P = 0.006, P <0.001, and P <0.001, respectively). Overall, EBL (150 mL vs. 150 mL, P = 0.215) and PSM rates (20% vs. 18.6%, P = 0.741) did not differ between the mentor and the trainees. CONCLUSIONS: A structured teaching program for RALP is effective and trainees are able to adopt the increased efficiency and skills of their mentor. Lower BMI, EBL, and prostate weight were associated with shorter operative times. Trainees performing the procedure did not negatively affect EBL and positive surgical margin rate.

Authors
Schroeck, FR; de Sousa, CAP; Kalman, RA; Kalia, MS; Pierre, SA; Haleblian, GE; Sun, L; Moul, JW; Albala, DM
MLA Citation
Schroeck, FR, de Sousa, CAP, Kalman, RA, Kalia, MS, Pierre, SA, Haleblian, GE, Sun, L, Moul, JW, and Albala, DM. "Trainees do not negatively impact the institutional learning curve for robotic prostatectomy as characterized by operative time, estimated blood loss, and positive surgical margin rate." Urology 71.4 (April 2008): 597-601.
PMID
18387389
Source
pubmed
Published In
Urology
Volume
71
Issue
4
Publish Date
2008
Start Page
597
End Page
601
DOI
10.1016/j.urology.2007.12.023

Siog (international society of geriatric oncology) localised prostate cancer guidelines proposals in senior adult men

Authors
Joniau, S; Balducci, L; Bella, M; Emberen, M; Fitzpatrick, J; Kaftan, M; Monfardini, S; Moul, JW; Naeim, A; Van Poppel, W; Saad, F; Sternberg, C; Droz, JP
MLA Citation
Joniau, S, Balducci, L, Bella, M, Emberen, M, Fitzpatrick, J, Kaftan, M, Monfardini, S, Moul, JW, Naeim, A, Van Poppel, W, Saad, F, Sternberg, C, and Droz, JP. "Siog (international society of geriatric oncology) localised prostate cancer guidelines proposals in senior adult men." March 2008.
Source
wos-lite
Published In
European Urology Supplements
Volume
7
Issue
3
Publish Date
2008
Start Page
300
End Page
300
DOI
10.1016/S1569-9056(08)60913-6

Significance of tertiary Gleason pattern 5 in Gleason score 7 radical prostatectomy specimens.

PURPOSE: The Gleason grading system in reporting prostate cancer accounts for the primary and secondary Gleason pattern. The clinical significance of a higher tertiary (third most prevalent) grade is largely unrecognized. MATERIALS AND METHODS: Radical prostatectomy specimens from 300 patients with Gleason score 7 (3 + 4 or 4 + 3) prostate cancer were pathologically reexamined for the presence of a tertiary grade 5 pattern as well as the association with pathological stage and biochemical recurrence-free survival. RESULTS: A total of 214 patients met study inclusion criteria. Patients with Gleason score 7 and tertiary grade 5 cancer had significantly higher pathological stage disease than patients with Gleason score 7 without tertiary grade 5 cancer (p <0.001). Gleason score 7 + tertiary pattern 5 tumors were significantly associated with adverse pathological features such as seminal vesicle invasion, extraprostatic extension and lymphovascular invasion compared to Gleason score 7 tumors (p <0.05). The relative effects of a tertiary grade 5 component on all pathological parameters analyzed was greater for Gleason score 7 tumors with a lower primary Gleason pattern 3 vs a higher primary Gleason pattern 4. Patients with Gleason score 7 + tertiary pattern 5 tumors had significantly decreased biochemical recurrence-free survival (54 months) compared to patients with Gleason score 7 tumors (121 months) (p = 0.0005). Preoperative prostate specific antigen, lymphovascular invasion and positive surgical margin status were shown to be independent predictors of prostate specific antigen recurrence on multivariate analysis. CONCLUSIONS: Small percentages of tertiary grade 5 patterns in Gleason score 7 radical prostatectomy specimens are associated with aggressive pathological features predictive of advanced pathological stage and biochemical recurrence-free survival.

Authors
Whittemore, DE; Hick, EJ; Carter, MR; Moul, JW; Miranda-Sousa, AJ; Sexton, WJ
MLA Citation
Whittemore, DE, Hick, EJ, Carter, MR, Moul, JW, Miranda-Sousa, AJ, and Sexton, WJ. "Significance of tertiary Gleason pattern 5 in Gleason score 7 radical prostatectomy specimens." J Urol 179.2 (February 2008): 516-522.
PMID
18076949
Source
pubmed
Published In
The Journal of Urology
Volume
179
Issue
2
Publish Date
2008
Start Page
516
End Page
522
DOI
10.1016/j.juro.2007.09.085

Neoadjuvant therapy followed by prostatectomy for clinically localized prostate cancer

Authors
Koontz, BF; Moul, J
MLA Citation
Koontz, BF, and Moul, J. "Neoadjuvant therapy followed by prostatectomy for clinically localized prostate cancer." Cancer 112.11 (2008): 2518-2519.
Source
scival
Published In
Cancer
Volume
112
Issue
11
Publish Date
2008
Start Page
2518
End Page
2519
DOI
10.1002/cncr.23464

Report from Durham.

Authors
Moul, JW
MLA Citation
Moul, JW. "Report from Durham." Prostate Cancer Prostatic Dis 11.3 (2008): 211-.
PMID
18711369
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
11
Issue
3
Publish Date
2008
Start Page
211
DOI
10.1038/pcan.2008.43

Report from Durham.

Authors
Moul, JW
MLA Citation
Moul, JW. "Report from Durham." Prostate Cancer Prostatic Dis 11.1 (2008): 1-.
PMID
18268507
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
11
Issue
1
Publish Date
2008
Start Page
1
DOI
10.1038/pcan.2008.8

Race and prostate weight as independent predictors for biochemical recurrence after radical prostatectomy.

We hypothesized that factors beyond pathological stage, grade, PSA and margin status would be important predictors of biochemical recurrence (BCR) after radical prostatectomy (RP). A cohort of 3194 patients who underwent RP between 1988 and 2007 and who had neither neoadjuvant therapy nor postoperative adjuvant hormonal therapy was retrieved from the Duke Prostate Center database. Age, prostate-specific antigen (PSA), pathological Gleason score (pG), lymph node status, seminal vesicle invasion (SVI), extracapsular extension (ECE), positive surgical margin (PSM) status, year of surgery, race, adjuvant radiation therapy (XRT), percent tumor involvement in the RP specimen and prostate weight were evaluated as possible predictors of BCR in multivariate Cox regression analysis. BCR was defined as a PSA of 0.2 ng ml(-1) or higher at least 30 days after surgery. A nomogram was developed from the Cox model. Predictive accuracy was obtained by calculating bias-corrected Harrell's c and by bootstrap calibration. In multivariate analysis, PSA (hazard ratio 1.39 (95% confidence interval 1.29-1.51)), ECE (1.22 (1.04-1.44)), pG score (1.38 (1.14-1.68), 2.23 (1.76-2.84), 2.69 (2.12-3.40) for pG 3+4, 4+3, >7, respectively), SVI (1.72 (1.40-2.12)), PSM (2.05 (1.73-2.42)), year of surgery (0.65 (0.54-0.77)), African-American race (1.37 (1.13-1.66)), adjuvant XRT (0.19 (0.11-0.34)) and prostate weight (0.83 (0.76-0.92)) were identified as independent predictors of BCR (P< or =0.018 for all factors). Predictive accuracy of the nomogram was 0.75. Race and prostate weight were independent predictors for BCR after RP. By incorporating these variables, we developed a nomogram, which provides a highly accurate means for estimating risk of BCR after RP.

Authors
Schroeck, FR; Sun, L; Freedland, SJ; Jayachandran, J; Robertson, CN; Moul, JW
MLA Citation
Schroeck, FR, Sun, L, Freedland, SJ, Jayachandran, J, Robertson, CN, and Moul, JW. "Race and prostate weight as independent predictors for biochemical recurrence after radical prostatectomy." Prostate Cancer Prostatic Dis 11.4 (2008): 371-376.
PMID
18427570
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
11
Issue
4
Publish Date
2008
Start Page
371
End Page
376
DOI
10.1038/pcan.2008.18

Primary androgen blockade is no better than watchful waiting: Commentary

Authors
Moul, JW
MLA Citation
Moul, JW. "Primary androgen blockade is no better than watchful waiting: Commentary." Oncology Report FALL (2008): 41--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2008
Start Page
41-

Sunitinib combination reduces PSA levels in metastatic HRPC: Commentary

Authors
Moul, JW
MLA Citation
Moul, JW. "Sunitinib combination reduces PSA levels in metastatic HRPC: Commentary." Oncology Report FALL (2008): 39--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2008
Start Page
39-

More leukemia diagnosed years after EBRT for prostate cancer: Commentary

Authors
Moul, JW
MLA Citation
Moul, JW. "More leukemia diagnosed years after EBRT for prostate cancer: Commentary." Oncology Report FALL (2008): 108--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2008
Start Page
108-

Rebuttal to Dr. Stock

Authors
Moul, JW
MLA Citation
Moul, JW. "Rebuttal to Dr. Stock." Brachytherapy 7.4 (2008): 283--.
Source
scival
Published In
Brachytherapy
Volume
7
Issue
4
Publish Date
2008
Start Page
283-
DOI
10.1016/j.brachy.2008.08.006

Optimizing treatment for men with advanced prostate cancer: Expert recommendations and the multidisciplinary approach

A multidisciplinary panel of 20 international experts, including urologists, radiation oncologists, and medical oncologists, convened during the Advanced Prostate Cancer Multidisciplinary Team meeting in Rome, Italy, in January 2007, to discuss the multidisciplinary team approach and current patterns of care for patients with hormone-refractory prostate cancer (HRPC). During the meeting, the experts discussed several definitions currently used in prostate cancer management, including those for senior adult patients. In addition, the panel reviewed a series of patient case studies in order to provide feedback on current treatment practices and to identify possible strategies for best practice. It was stressed that treatment decisions for senior adult patients should not be based solely on patient age. Additionally, although historically treatment decisions for advanced prostate cancer have focused on palliative care, given the survival benefit associated with docetaxel-based chemotherapy across patient subgroups, more men are likely to be offered chemotherapy for advanced-stage disease in the future. © 2008.

Authors
Fitzpatrick, JM; Anderson, J; Sternberg, CN; Fleshner, N; Fizazi, K; Rébillard, X; Dogliotti, L; Conti, G; Turesson, I; James, N; Heidenreich, A; Solsona, E; Guillem, V; Herchenhorn, D; Moul, J; Moorselaar, JV; Coetzee, LJE; Wilson, A; Bamias, A; Wit, RD; Chrisofos, M
MLA Citation
Fitzpatrick, JM, Anderson, J, Sternberg, CN, Fleshner, N, Fizazi, K, Rébillard, X, Dogliotti, L, Conti, G, Turesson, I, James, N, Heidenreich, A, Solsona, E, Guillem, V, Herchenhorn, D, Moul, J, Moorselaar, JV, Coetzee, LJE, Wilson, A, Bamias, A, Wit, RD, and Chrisofos, M. "Optimizing treatment for men with advanced prostate cancer: Expert recommendations and the multidisciplinary approach." Critical Reviews in Oncology/Hematology 68.1 SUPPL. (2008): S9-S22.
PMID
18723368
Source
scival
Published In
Critical Reviews in Oncology/Hematology
Volume
68
Issue
1 SUPPL.
Publish Date
2008
Start Page
S9
End Page
S22
DOI
10.1016/j.critrevonc.2008.07.019

Androgen deprivation ups diabetes risk, but not AMIs: Commentary

Authors
Moul, JW
MLA Citation
Moul, JW. "Androgen deprivation ups diabetes risk, but not AMIs: Commentary." Oncology Report FALL (2008): 42--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2008
Start Page
42-

Carboplatin matches radiation in stage I seminoma: Commentary

Authors
Moul, JW
MLA Citation
Moul, JW. "Carboplatin matches radiation in stage I seminoma: Commentary." Oncology Report FALL (2008): 45--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2008
Start Page
45-

Should elderly men be screened for prostate cancer?

Authors
Moul, JW; Mouraviev, V
MLA Citation
Moul, JW, and Mouraviev, V. "Should elderly men be screened for prostate cancer?." Aging Health 4.5 (2008): 443-446.
Source
scival
Published In
Aging health
Volume
4
Issue
5
Publish Date
2008
Start Page
443
End Page
446
DOI
10.2217/1745509X.4.5.443

Does robotic prostatectomy increase the need for adjuvant radiation therapy? The impact of choice of surgery and pretreatment disease characteristics on adjuvant indications

Authors
Chino, JP; Schroeck, FR; Sun, L; Lee, W; Albala, DM; Moul, JW; Koontz, BF
MLA Citation
Chino, JP, Schroeck, FR, Sun, L, Lee, W, Albala, DM, Moul, JW, and Koontz, BF. "Does robotic prostatectomy increase the need for adjuvant radiation therapy? The impact of choice of surgery and pretreatment disease characteristics on adjuvant indications." 2008.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
72
Issue
1
Publish Date
2008
Start Page
S304
End Page
S304
DOI
10.1016/j.ijrobp.2008.06.1065

What factors influence referral for postoperative radiation therapy for prostate cancer?

Authors
Koontz, BF; Chino, J; Schroeck, FR; Sun, L; Lee, WR; Moul, JW
MLA Citation
Koontz, BF, Chino, J, Schroeck, FR, Sun, L, Lee, WR, and Moul, JW. "What factors influence referral for postoperative radiation therapy for prostate cancer?." 2008.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
72
Issue
1
Publish Date
2008
Start Page
S137
End Page
S137
DOI
10.1016/j.ijrobp.2008.06.451

Prostate cancer in the Baby Boomer generation: results from CaPSURE.

OBJECTIVES: Baby Boomers (those born in 1946 to 1964) are thought to place a high value on quality of life, and have a higher propensity to consume healthcare services than previous generations. We sought to characterize prostate cancer (CaP) presentation among this group, and determine whether treatment patterns differ between Baby Boomers and the preceding generation. METHODS: We defined two birth cohorts: men born in 1927 to 1945 (pre-Boomers) and Baby Boomers. Our study cohort included men less than 65 years old, diagnosed with CaP between 1999 and 2003 (Baby Boomers, n = 812; pre-Boomers, n = 1843). We compared the two groups for clinical presentation, sociodemographics, and primary treatment, controlling for age effects. The primary endpoint was selection of radical prostatectomy as primary treatment. RESULTS: Most Baby Boomers were diagnosed with stage T1 disease (466, 61%), biopsy Gleason sums less than 7 (572, 73%), and prostate-specific antigen levels of 4.1 to 10.0 (509, 66%). This presentation was not clinically different from pre-Boomers. Baby Boomers had higher socioeconomic status than pre-Boomers. On multivariate analysis, Baby Boomers were more likely to undergo radical prostatectomy as primary therapy (odds ratio [OR] 1.63, 95% confidence interval [CI] 1.13 to 2.35). Controlling for age effects, however, there were no significant differences in treatment choice (OR 0.86, 95% CI 0.40 to 1.87) or sociodemographics between these groups. CONCLUSIONS: Differences in CaP presentation and treatment between Baby Boomers and pre-Boomers may be related to age at diagnosis rather than innate differences in behavior. As more Baby Boomers are diagnosed with CaP, further research will be required to characterize this generation's impact on CaP care.

Authors
Scales, CD; Moul, JW; Curtis, LH; Elkin, EP; Hughes, ME; Carroll, PR; CaPSURE Investigators,
MLA Citation
Scales, CD, Moul, JW, Curtis, LH, Elkin, EP, Hughes, ME, Carroll, PR, and CaPSURE Investigators, . "Prostate cancer in the Baby Boomer generation: results from CaPSURE." Urology 70.6 (December 2007): 1162-1167.
PMID
18158039
Source
pubmed
Published In
Urology
Volume
70
Issue
6
Publish Date
2007
Start Page
1162
End Page
1167
DOI
10.1016/j.urology.2007.08.011

A single-institution comparison between radical perineal and radical retropubic prostatectomy on perioperative and pathological outcomes for obese men: an analysis of the Duke Prostate Center database.

OBJECTIVES: To examine the association between body mass index (BMI) and operative time, estimated blood loss (EBL), and adverse pathologic features in patients undergoing either radical perineal prostatectomy (RPP) or radical retropubic prostatectomy (RRP). METHODS: We performed a retrospective analysis of 1006 patients treated with RPP or RRP at our institution from 1988 to 2005. Operative times and EBL were compared among BMI groups for both RPP and RRP. The odds ratio of positive surgical margins was estimated for the BMI categories using logistic regression after adjusting for preoperative and pathologic characteristics. RESULTS: Increased BMI was significantly associated with increased operative time and EBL for men treated with either RPP or RRP (all P < or = 0.03), though the associations were weak (all Spearman r < or = 0.19). After adjusting for multiple clinical preoperative characteristics, higher BMI was associated with positive surgical margins among all patients (P trend <0.001). The association between obesity and surgical margins remained after adjusting for pathologic characteristics (P trend = 0.001) with similar patterns among RRP (P trend = 0.03) and RPP (P trend = 0.01) patients. CONCLUSIONS: For mildly obese men, both RPP and RRP are associated with a similarly increased risk of higher EBL, longer operative time, and positive surgical margins. These data do not provide evidence to suggest that RPP should be preferred over RRP for mildly obese men. Further study is needed among men with a very high BMI.

Authors
Fitzsimons, NJ; Sun, LL; Dahm, P; Moul, JW; Madden, J; Gan, TJ; Freedland, SJ
MLA Citation
Fitzsimons, NJ, Sun, LL, Dahm, P, Moul, JW, Madden, J, Gan, TJ, and Freedland, SJ. "A single-institution comparison between radical perineal and radical retropubic prostatectomy on perioperative and pathological outcomes for obese men: an analysis of the Duke Prostate Center database." Urology 70.6 (December 2007): 1146-1151.
PMID
18158036
Source
pubmed
Published In
Urology
Volume
70
Issue
6
Publish Date
2007
Start Page
1146
End Page
1151
DOI
10.1016/j.urology.2007.07.065

Prostate cancer laterality does not predict prostate-specific antigen recurrence after radical prostatectomy.

OBJECTIVES: To evaluate biologic behaviors of unilateral cancers compared with bilateral cancers on prostate-specific antigen (PSA) recurrence after radical prostatectomy. METHODS: Analysis included demographic, clinical, and pathologic parameters of 1184 men who underwent RP for clinically localized prostate cancer at our institution between 2002 and 2006. Final pathologic assessment was performed with particular attention to laterality and percentage of tumor involvement, along with other routine parameters. On the basis of percentage of tumor involvement, all cancer foci were ranked as 5% or less, 5.01% to 10%, 10.01% to 15%, or greater than 15%. Statistical analysis was performed with univariate and multivariate methods. RESULTS: Overall, 19.2% of 1184 patients had completely unilateral cancers. Prostate-specific antigen recurrence was revealed in 164 of 1184 patients (13.9%) at a mean (+/- standard deviation) follow-up of 2.7 +/- 2.4 years. Among men who had recurrence, 26 of 227 (11.5%) had unilateral tumors and 138 of 957 (14.4%) had bilateral disease (P = 0.25). The most common characteristics associated with PSA recurrence of unilateral tumors in the Cox model were diagnostic PSA level, prostate weight, and pathologic Gleason score (P <0.05). CONCLUSIONS: Unilateral or bilateral prostate cancer did not predict PSA recurrence in men receiving radical prostatectomy. In contrast, baseline PSA level and pathologic Gleason score strongly predicted PSA recurrence.

Authors
Mouraviev, V; Sun, L; Madden, JF; Mayes, JM; Moul, JW; Polascik, TJ
MLA Citation
Mouraviev, V, Sun, L, Madden, JF, Mayes, JM, Moul, JW, and Polascik, TJ. "Prostate cancer laterality does not predict prostate-specific antigen recurrence after radical prostatectomy." Urology 70.6 (December 2007): 1141-1145.
PMID
18158035
Source
pubmed
Published In
Urology
Volume
70
Issue
6
Publish Date
2007
Start Page
1141
End Page
1145
DOI
10.1016/j.urology.2007.07.066

Obesity-related plasma hemodilution and PSA concentration among men with prostate cancer.

CONTEXT: Recent studies have suggested that obese men have lower serum prostate-specific antigen (PSA) concentrations than nonobese men. Because men with higher body mass index (BMI) have greater circulating plasma volumes, lower PSA concentrations among obese men may be due to hemodilution. OBJECTIVE: To determine the association between hemodilution and PSA concentration in obese men with prostate cancer. DESIGN, SETTING, AND PARTICIPANTS: Retrospective study of men who underwent radical prostatectomy for prostate adenocarcinoma from 1988 to 2006, using data from the databases of the Shared Equal Access Regional Cancer Hospital (n = 1373), Duke Prostate Center (n = 1974), and Johns Hopkins Hospital (n = 10 287). Multivariate linear regression models adjusting for clinicopathological characteristics were used to analyze the main outcome measures. MAIN OUTCOME MEASURES: Associations between BMI and mean adjusted PSA concentrations, mean plasma volume, and mean adjusted PSA mass (total circulating PSA protein, calculated as PSA concentration multiplied by plasma volume), assessed by determining P values for trend. RESULTS: After controlling for clinicopathological characteristics, higher BMI was significantly associated with higher plasma volume (P < .001 for trend) and lower PSA concentrations (P < or = .02 for trend) in all cohorts. In 2 of the 3 cohorts, PSA mass did not change significantly with increasing BMI. In the third cohort, higher BMI was associated with increased PSA mass (P < .001 for trend), but only between BMI category less than 25 and the other categories. CONCLUSIONS: In men undergoing radical prostatectomy, higher BMI was associated with higher plasma volume; hemodilution may therefore be responsible for the lower serum PSA concentrations among obese men with prostate cancer. Prospective studies are needed to evaluate this association in screened populations.

Authors
Bañez, LL; Hamilton, RJ; Partin, AW; Vollmer, RT; Sun, L; Rodriguez, C; Wang, Y; Terris, MK; Aronson, WJ; Presti, JC; Kane, CJ; Amling, CL; Moul, JW; Freedland, SJ
MLA Citation
Bañez, LL, Hamilton, RJ, Partin, AW, Vollmer, RT, Sun, L, Rodriguez, C, Wang, Y, Terris, MK, Aronson, WJ, Presti, JC, Kane, CJ, Amling, CL, Moul, JW, and Freedland, SJ. "Obesity-related plasma hemodilution and PSA concentration among men with prostate cancer." JAMA 298.19 (November 21, 2007): 2275-2280.
PMID
18029831
Source
pubmed
Published In
JAMA : the journal of the American Medical Association
Volume
298
Issue
19
Publish Date
2007
Start Page
2275
End Page
2280
DOI
10.1001/jama.298.19.2275

Rising PSA in nonmetastatic prostate cancer.

Rising prostate-specific antigen (PSA) in nonmetastatic prostate cancer occurs in two main clinical settings: (1) rising PSA to signal failed initial local therapy and (2) rising PSA in the setting of early hormone-refractory prostate cancer prior to documented clinical metastases. Most urologists and radiation oncologists are very familiar with the initial very common clinical scenario, commonly called "biochemical recurrence." In fact, up to 70,000 men each year will have a PSA-only recurrence after failed definitive therapy. The ideal salvage therapy for these men is not clear and includes salvage local therapies and systemic approaches, of which the mainstay is hormonal therapy. Treatment needs to be individualized based upon the patient's risk of progression and the likelihood of success and the risks involved with the therapy. It is unknown how many men per year progress with rising PSA while on hormonal therapy without documented metastases. This rising PSA disease state is sometimes called, "PSA-only hormone-refractory prostate cancer." As in the setting of initial biochemical recurrence, evidence-based treatment options are limited, and taking a risk-stratified approach is justified. In this article, we will explore these prostate cancer disease states with an emphasis on practical, clinically applicable approaches.

Authors
Moul, JW; Bañez, LL; Freedland, SJ
MLA Citation
Moul, JW, Bañez, LL, and Freedland, SJ. "Rising PSA in nonmetastatic prostate cancer." Oncology (Williston Park) 21.12 (November 2007): 1436-1445. (Review)
PMID
18077992
Source
pubmed
Published In
Oncology
Volume
21
Issue
12
Publish Date
2007
Start Page
1436
End Page
1445

Tumor laterality does not predict biochemical prostate cancer recurrence after radical prostatectomy

Authors
Mouraviev, V; Sun, L; Madden, JF; Mayes, JM; Moul, JW; George, DJ; Febbo, PG; Polascik, TJ
MLA Citation
Mouraviev, V, Sun, L, Madden, JF, Mayes, JM, Moul, JW, George, DJ, Febbo, PG, and Polascik, TJ. "Tumor laterality does not predict biochemical prostate cancer recurrence after radical prostatectomy." October 2007.
Source
wos-lite
Published In
Journal of Endourology
Volume
21
Publish Date
2007
Start Page
A216
End Page
A216

Open radical retropubic prostatectomy 2007: the true minimally invasive surgery for localized prostate cancer?

The introduction of robotic laparoscopic assisted prostatectomy at our institution and nationwide has been a great advancement and has caused us to focus and fine-tune our goal for improvements in prostate cancer outcomes whether the patient elects for robotic laparoscopic assisted prostatectomy or open minimally invasive radical retropubic prostatectomy. While these authors favor the open technique performed by highly skilled urologic surgical oncologists, the lessons we have learned to date suggest that it is the skill of the surgeon that determines outcome, regardless of whether or not the operation is performed by an open or robotic laparoscopic technique. The concepts we have articulated here are related to resection and avoidance of positive margins, limited intraoperative blood loss and pain control, which allow equivalence in these outcome areas, regardless of technique.

Authors
Nosnik, IP; Gan, TJ; Moul, JW
MLA Citation
Nosnik, IP, Gan, TJ, and Moul, JW. "Open radical retropubic prostatectomy 2007: the true minimally invasive surgery for localized prostate cancer?." Expert Rev Anticancer Ther 7.9 (September 2007): 1309-1317. (Review)
PMID
17892432
Source
pubmed
Published In
Expert Review of Anticancer Therapy
Volume
7
Issue
9
Publish Date
2007
Start Page
1309
End Page
1317
DOI
10.1586/14737140.7.9.1309

Prostate cancer laterality as a rationale of focal ablative therapy for the treatment of clinically localized prostate cancer.

BACKGROUND: Early detection of small-volume prostate cancer (PCa) has led to the concept of focal therapy to treat PCa as an organ-sparing, minimally invasive procedure. The authors sought to determine the frequency of unilateral cancers in the contemporary prostate-specific antigen (PSA) era to determine the percentage of patients who would be candidates for hemiablation of the prostate by using focal therapy while preserving the contralateral lobe. METHODS: Paraffin-embedded radical prostatectomy specimens (1184 specimens) from consecutive patients between 2002 and 2006 with pathologic organ confined PCa were analyzed. Pathologic assessment focused on tumor laterality and percentage of tumor involvement (PTI) along with other routine parameters such as pathological T-classification (pT), pathological Gleason Score (pGS), extracapsular extension (ECE), and surgical margins (SM). Clinical and pathologic parameters were analyzed by univariate and multivariate methods. RESULTS: Completely unilateral cancers were identified in 227 (19.2%) of 1184 patients. Of these patients, 164 (72.2%) had PTI of < or =5%, 40 (17.6%) had a PTI of 5.01%-10%, 9 (4.0%) had a PTI of 10.01%-15%, and 14 (6.2%) had a PTI of > 15%, respectively (P < .0005). African-American men had bilateral cancers more commonly that non-African-American men, eg, 90.8% versus 79.2%, respectively (P < .0005). Race, PTI, pGS, and SM were independent predictors by multivariate logistic regression (P < or = .05). CONCLUSIONS: This study suggests that 1 in 5 men diagnosed with PCa have small volume, completely unilateral cancers that may be amenable to hemiablation of the prostate. Further study is needed to develop predictive models to select candidates for focal therapy.

Authors
Mouraviev, V; Mayes, JM; Sun, L; Madden, JF; Moul, JW; Polascik, TJ
MLA Citation
Mouraviev, V, Mayes, JM, Sun, L, Madden, JF, Moul, JW, and Polascik, TJ. "Prostate cancer laterality as a rationale of focal ablative therapy for the treatment of clinically localized prostate cancer." Cancer 110.4 (August 15, 2007): 906-910.
PMID
17587207
Source
pubmed
Published In
Cancer
Volume
110
Issue
4
Publish Date
2007
Start Page
906
End Page
910
DOI
10.1002/cncr.22858

Erectile function outcome reporting after clinically localized prostate cancer treatment.

PURPOSE: In conjunction with the assignment to update the Guidelines for Management of Clinically Localized Prostate Cancer, the American Urological Association Prostate Cancer Guideline Update Panel performed a side analysis of the reporting of erectile function outcomes in this clinical context as published in the medical literature. MATERIALS AND METHODS: Four National Library of Medicine PubMed(R) Services literature searches targeting articles published from 1991 through early 2004 were done to derive outcome reporting (efficacy or side effects) for the treatment of clinical stage T1 or T2 N0M0 prostate cancer. A database was constructed containing descriptions relating to erectile function as well as numerical frequency rates of complete erectile dysfunction, and partial and intact erectile function for various treatments. A literature review was also done, consisting of a PubMed Services search of current measures and protocols used for assessing erectile function outcomes and a survey of consensus opinion sources on the management of male sexual dysfunctions. RESULTS: Based on inclusion criteria 436 articles were selected. Of these articles database extraction from 100 pertaining to radical prostatectomy garnered various characterizations of erectile function, including qualitative descriptions, generic terminology and rating systems. Database extraction from 31 articles, in which results for at least 50 patients were reported, yielded ranges of rates for complete erectile dysfunction, partial erectile function and intact erectile function that were 26% to 100%, 16% to 48% and 9% to 86% for radical prostatectomy, 8% to 85%, 21% to 47% and 36% to 63% for external beam radiation, and 14% to 61%, 21% and 18% for interstitial radiation, respectively. The literature review showed an evolution in standards for studying and reporting erectile function outcomes. CONCLUSIONS: Clinical studies reporting erectile function outcomes after localized prostate cancer treatment often demonstrate poorly interpretable and inconsistent manners of assessment as well as widely disparate rates of erectile dysfunction and erectile function. Future studies must apply scientifically rigorous methodology and standard outcomes measures to advance this field of study.

Authors
Burnett, AL; Aus, G; Canby-Hagino, ED; Cookson, MS; D'Amico, AV; Dmochowski, RR; Eton, DT; Forman, JD; Goldenberg, SL; Hernandez, J; Higano, CS; Kraus, S; Liebert, M; Moul, JW; Tangen, C; Thrasher, JB; Thompson, I; American Urological Association Prostate Cancer Guideline Update Panel,
MLA Citation
Burnett, AL, Aus, G, Canby-Hagino, ED, Cookson, MS, D'Amico, AV, Dmochowski, RR, Eton, DT, Forman, JD, Goldenberg, SL, Hernandez, J, Higano, CS, Kraus, S, Liebert, M, Moul, JW, Tangen, C, Thrasher, JB, Thompson, I, and American Urological Association Prostate Cancer Guideline Update Panel, . "Erectile function outcome reporting after clinically localized prostate cancer treatment." J Urol 178.2 (August 2007): 597-601. (Review)
PMID
17570435
Source
pubmed
Published In
The Journal of Urology
Volume
178
Issue
2
Publish Date
2007
Start Page
597
End Page
601
DOI
10.1016/j.juro.2007.03.140

Prostate cancer-specific mortality after radical prostatectomy or external beam radiation therapy in men with 1 or more high-risk factors.

BACKGROUND: Estimates of prostate cancer-specific mortality (PCSM) were determined after radical prostatectomy (RP) or radiation therapy (RT) in men with >or=1 high-risk factors. METHODS: The study cohort comprised 948 men who underwent RP (N = 660) or RT (N = 288) for localized prostate cancer between 1988 and 2004 and had at least 1 of the following high-risk factors: a prostate-specific antigen (PSA) velocity >2 ng/mL/year during the year before diagnosis, a biopsy Gleason score of >or=7, a PSA level of >or=10 ng/mL, or clinical category T2b or high disease. Grays regression was used to evaluate whether the number and type of high-risk factors were associated with time to PCSM. RESULTS: Multiple determinants of high risk were found to be significantly associated with a shorter time to PCSM after RP (P < .001) or RT (P 2 ng/mL/year was associated with an increased risk of PCSM after RP (hazards ratio [HR] of 7.3; 95% confidence interval [95% CI], 1.0-59 [P = .05]) or RT (HR of 12.1; 95% CI, 1.4-105 [P = .02]) when compared with men with any other single high-risk factor. CONCLUSIONS: Men with a PSA velocity >2 ng/mL/year had a significantly higher risk of PCSM compared with men who had any other single high-risk factor. These men should be considered for randomized trials evaluating the impact on PCSM from adding systemic agents to standards of care for men with high-risk PC.

Authors
D'Amico, AV; Chen, M-H; Catalona, WJ; Sun, L; Roehl, KA; Moul, JW
MLA Citation
D'Amico, AV, Chen, M-H, Catalona, WJ, Sun, L, Roehl, KA, and Moul, JW. "Prostate cancer-specific mortality after radical prostatectomy or external beam radiation therapy in men with 1 or more high-risk factors." Cancer 110.1 (July 1, 2007): 56-61.
PMID
17530618
Source
pubmed
Published In
Cancer
Volume
110
Issue
1
Publish Date
2007
Start Page
56
End Page
61
DOI
10.1002/cncr.22737

Guideline for the management of clinically localized prostate cancer: 2007 update.

Authors
Thompson, I; Thrasher, JB; Aus, G; Burnett, AL; Canby-Hagino, ED; Cookson, MS; D'Amico, AV; Dmochowski, RR; Eton, DT; Forman, JD; Goldenberg, SL; Hernandez, J; Higano, CS; Kraus, SR; Moul, JW; Tangen, CM; AUA Prostate Cancer Clinical Guideline Update Panel,
MLA Citation
Thompson, I, Thrasher, JB, Aus, G, Burnett, AL, Canby-Hagino, ED, Cookson, MS, D'Amico, AV, Dmochowski, RR, Eton, DT, Forman, JD, Goldenberg, SL, Hernandez, J, Higano, CS, Kraus, SR, Moul, JW, Tangen, CM, and AUA Prostate Cancer Clinical Guideline Update Panel, . "Guideline for the management of clinically localized prostate cancer: 2007 update." J Urol 177.6 (June 2007): 2106-2131.
PMID
17509297
Source
pubmed
Published In
The Journal of Urology
Volume
177
Issue
6
Publish Date
2007
Start Page
2106
End Page
2131
DOI
10.1016/j.juro.2007.03.003

Prostate specific antigen recurrence after definitive therapy.

PURPOSE: We estimate that approximately 70,000 men yearly have prostate specific antigen-only recurrence after failed definitive therapy. The ideal salvage therapy for these men is not clear. Treatment must be individualized based on the patient risk of progression, the likelihood of success and the risks involved with the therapy. However, to do so the risks and benefits of the various options must be known. Therefore, we provide a comprehensive overview of the natural history and treatment options for men with prostate specific antigen-only recurrence. MATERIALS AND METHODS: A literature review and overview of prostate specific antigen-only recurrence after failed definitive therapy was done. RESULTS: The natural history after prostate specific antigen-only recurrence is long but variable. Median time from prostate specific antigen-only recurrence after radical prostatectomy to prostate cancer death exceeds 16 years, although some men die within 1 year after PSA recurrence. Rapid prostate specific antigen doubling time is the best prognostic factor for poor outcome. Salvage radiation therapy after radical prostatectomy results in a 45% 4-year prostate specific antigen response rate, although long-term outcomes appear poor. To our knowledge the effect on survival is not known. Salvage radical prostatectomy is rarely performed but in the highly selected patient it may provide some benefit. There are no randomized studies of early vs late hormonal therapy for men with prostate specific antigen-only recurrence. A retrospective study suggested delayed metastasis when therapy was begun early but only in men at high risk. This mirrors other data suggesting that men at high risk may derive significant benefits from early hormonal therapy, whereas men at low risk are unlikely to benefit and may be harmed by hormonal therapy. CONCLUSIONS: Prostate specific antigen-only recurrence is the most common form of advanced prostate cancer. Optimal salvage treatments and timing of these treatments remain controversial.

Authors
Freedland, SJ; Moul, JW
MLA Citation
Freedland, SJ, and Moul, JW. "Prostate specific antigen recurrence after definitive therapy." J Urol 177.6 (June 2007): 1985-1991. (Review)
PMID
17509277
Source
pubmed
Published In
The Journal of Urology
Volume
177
Issue
6
Publish Date
2007
Start Page
1985
End Page
1991
DOI
10.1016/j.juro.2007.01.137

Novel techniques for the treatment of localized prostate cancer: evidence of efficacy?

Radical retropubic prostatectomy and radiation therapy remain the mainstay of treatment for localized prostate cancer. However, with the advent of the Internet, more patients are arriving in physicians' offices questioning novel techniques for their treatment that they otherwise would not have discovered. This paper discusses several of these techniques, including focal cryotherapy, high-intensity focused ultrasound, robotic-assisted laparoscopic prostatectomy, diets, supplements, and hormonal therapy. We also render our opinion on their efficacy for treatment based on the available published studies.

Authors
Robinson, MR; Moul, JW
MLA Citation
Robinson, MR, and Moul, JW. "Novel techniques for the treatment of localized prostate cancer: evidence of efficacy?." Curr Urol Rep 8.3 (May 2007): 203-210. (Review)
PMID
17459269
Source
pubmed
Published In
Current Urology Reports
Volume
8
Issue
3
Publish Date
2007
Start Page
203
End Page
210

Timely diagnosis of testicular cancer.

Early detection of testicular tumors has been touted as beneficial for more than 100 years. In earlier eras, early detection was virtually the only way to improve outcomes. According to statistics that have been tracked in the literature, however, the delay from initial symptoms to definitive diagnosis by radical orchiectomy has averaged 4 to 5 months. In the modern era of effective chemotherapy, the effects of a delayed diagnosis on survival can be overcome but at the cost of a more morbid treatment regimen. Although screening on a population basis is not currently recommended by the National Cancer Institute, teaching testicular self examination to young men, particularly those who have risk factors, is reasonable.

Authors
Moul, JW
MLA Citation
Moul, JW. "Timely diagnosis of testicular cancer." Urol Clin North Am 34.2 (May 2007): 109-117. (Review)
PMID
17484916
Source
pubmed
Published In
Urologic Clinics of North America
Volume
34
Issue
2
Publish Date
2007
Start Page
109
End Page
117
DOI
10.1016/j.ucl.2007.02.003

The role of early adopter bias for new technologies in robot assisted laparoscopic prostatectomy.

PURPOSE: We determined the potential influence of an early adopter bias in patients undergoing robot assisted laparoscopic prostatectomy. MATERIALS AND METHODS: We compared baseline demographic, clinical and health related quality of life characteristics of patients undergoing 3 different surgical procedures for clinically localized prostate cancer following the introduction of robot assisted laparoscopic prostatectomy at our institution. Patients included in this analysis were participating in a prospective health related quality of life study using the SF-12(R) and Expanded Prostate Cancer Index Composite validated questionnaires. RESULTS: Of 402 patients 159 (39%) underwent robot assisted laparoscopic, 144 (36%) underwent radical perineal and 99 (25%) underwent radical retropubic prostatectomy. There were no statistically significant associations between procedure type and patient age (p = 0.267), race (p = 0.725), number of medical comorbidities (p = 0.490), income (p = 0.056) and level of education (p = 0.495). Mean prostate specific antigen was 5.9 +/- 3.3, 7.3 +/- 5.5 and 5.7 +/- 5.0 ng/ml for robot assisted laparoscopic, radical perineal and radical retropubic prostatectomy, respectively (p = 0.030). The proportion of robot assisted laparoscopic, radical perineal and radical retropubic prostatectomy patients with a final Gleason score of 4-6 was 55%, 45% and 39%, respectively (p = 0.037). The proportion of robot assisted laparoscopic, radical perineal and radical retropubic prostatectomy patients with stage T2 disease was 91%, 68% and 80%, respectively (p = 0.001). Statistically significant associations of higher income and education with higher baseline health related quality of life scores were seen in the sexual and physical domains (each p <0.01). CONCLUSIONS: We failed to find evidence of an early adopter bias for patients undergoing robot assisted laparoscopic prostatectomy. Nevertheless, observational studies comparing robot assisted laparoscopic prostatectomy to radical perineal and radical retropubic prostatectomy should account carefully for patient baseline characteristics to allow meaningful comparisons of surgical outcomes.

Authors
Tseng, TY; Cancel, QV; Fesperman, SF; Kuebler, HR; Sun, L; Robertson, CN; Polascik, TJ; Moul, JW; Vieweg, J; Albala, DM; Dahm, P
MLA Citation
Tseng, TY, Cancel, QV, Fesperman, SF, Kuebler, HR, Sun, L, Robertson, CN, Polascik, TJ, Moul, JW, Vieweg, J, Albala, DM, and Dahm, P. "The role of early adopter bias for new technologies in robot assisted laparoscopic prostatectomy." J Urol 177.4 (April 2007): 1318-1323.
PMID
17382723
Source
pubmed
Published In
The Journal of Urology
Volume
177
Issue
4
Publish Date
2007
Start Page
1318
End Page
1323
DOI
10.1016/j.juro.2006.11.035

Prostate-specific antigen (PSA) and PSA velocity for prostate cancer detection in men aged <50 years.

OBJECTIVE: To identify threshold values of prostate-specific antigen (PSA) levels and PSA velocity (PSAV) to optimize the assessment of the risk of prostate cancer in young men, as prostate cancer is detected increasingly in men aged <50 years. PATIENTS AND METHODS: Data for a group of 12 078 men, including 1622 with prostate cancer, were retrieved from the Duke Prostate Center Database. Based on the latest date for a PSA assay, these men were divided into two age groups of <50 and >/= 50 years, with 904 and 11 174 men in each group, respectively. Receiver operating characteristic curves (ROC) of PSA and PSAV were calculated and the cancer risk was assessed. RESULTS: The prevalence of prostate cancer was 4.4% (40 men) for men aged <50 years and 14.2% (1582 men) for men aged >/= 50 years. For the group with cancer the median PSA in men aged <50 years was significantly lower than that in men aged >/= 50 (1.3 vs 6.3 ng/mL, P < 0.001). ROC curves of PSA and PSAV showed a breakpoint at a PSA level of 2.3 ng/mL and a PSAV of 0.60 ng/mL/year for men aged <50 years. Both the sensitivity and specificity in the younger group at a PSA level of 2.5 ng/mL were higher than in the older group. CONCLUSIONS: In men aged <50 years the operating characteristics of PSA are more sensitive and specific than in older men. Diagnostic PSA levels in men aged <50 years are significantly lower than suggested by guidelines. Using a 2.0-2.5 ng/mL PSA level threshold for biopsy in men aged <50 years and a PSAV threshold lower than the traditional 0.75 ng/mL/year is reasonable in contemporary practice. Further studies are warranted to validate these thresholds.

Authors
Sun, L; Moul, JW; Hotaling, JM; Rampersaud, E; Dahm, P; Robertson, C; Fitzsimons, N; Albala, D; Polascik, TJ
MLA Citation
Sun, L, Moul, JW, Hotaling, JM, Rampersaud, E, Dahm, P, Robertson, C, Fitzsimons, N, Albala, D, and Polascik, TJ. "Prostate-specific antigen (PSA) and PSA velocity for prostate cancer detection in men aged <50 years." BJU Int 99.4 (April 2007): 753-757.
PMID
17244286
Source
pubmed
Published In
Bju International
Volume
99
Issue
4
Publish Date
2007
Start Page
753
End Page
757
DOI
10.1111/j.1464-410X.2006.06682.x

Systemic strategies for prostate cancer.

Systemic therapy beyond hormonal therapy for advanced prostate cancer includes chemotherapy, antiangiogenic therapy, signal transduction inhibitors, immunomodulatory therapy, and other experimental therapeutics. This review will discuss the state of systemic therapy for advanced prostate cancer in 2007, with an emphasis on therapy in the neoadjuvant, adjuvant, and metastatic setting. As chemotherapy gains greater acceptance in the urologic oncology community for use in men with hormone-refractory disease, evaluating the role of systemic therapy in earlier disease states is essential given the success in other solid tumors for advancing cure rates. Current randomized phase III trials worldwide are addressing these questions in each disease state, and are anticipated to change the landscape of prostate cancer management for years to come. In this discussion, we will emphasize those agents that are currently being evaluated in phase II and III trials, with an emphasis on those trials that are likely to impact the standard of care in the near future. The collection of tumor or surrogate tissue is emphasized to define biomarkers that may predict for sensitivity to these systemic therapies.

Authors
Armstrong, AJ; Febbo, PG; George, DJ; Moul, J
MLA Citation
Armstrong, AJ, Febbo, PG, George, DJ, and Moul, J. "Systemic strategies for prostate cancer." Minerva Urol Nefrol 59.1 (March 2007): 11-25. (Review)
PMID
17431367
Source
pubmed
Published In
Minerva urologica e nefrologica = The Italian journal of urology and nephrology
Volume
59
Issue
1
Publish Date
2007
Start Page
11
End Page
25

Medical technologies for the diagnosis of prostate cancer.

Prostate cancer is an extremely prevalent problem, especially in our aging population. The prostate-specific antigen test has revolutionized prostate cancer screening. Significant advances have been made in the usage of prostate-specific antigen and its derivatives, biomarkers, diagnostic imaging techniques, biopsy strategy, biopsy needle design and anesthetic agents. Further improvement in prostate cancer detection hinges on the development of an imaging technique that is tumor specific and sensitive to biological aggressiveness.

Authors
Fitzsimons, NJ; Sun, L; Moul, JW
MLA Citation
Fitzsimons, NJ, Sun, L, and Moul, JW. "Medical technologies for the diagnosis of prostate cancer." Expert Rev Med Devices 4.2 (March 2007): 227-239. (Review)
PMID
17359227
Source
pubmed
Published In
Expert Review of Medical Devices
Volume
4
Issue
2
Publish Date
2007
Start Page
227
End Page
239
DOI
10.1586/17434440.4.2.227

Clinico-pathologic aspects of follow-up on small tumor volume prostate cancer after the radical prostatectomy at Walter reed army medical center

Authors
Furusato, R; Osborn, D; Rosner, I; Cullen, J; Davis, C; Moul, JW; Srivastava, S; McLeod, D; Sesterhenn, I; Allen, A
MLA Citation
Furusato, R, Osborn, D, Rosner, I, Cullen, J, Davis, C, Moul, JW, Srivastava, S, McLeod, D, Sesterhenn, I, and Allen, A. "Clinico-pathologic aspects of follow-up on small tumor volume prostate cancer after the radical prostatectomy at Walter reed army medical center." March 2007.
Source
wos-lite
Published In
Modern Pathology
Volume
20
Publish Date
2007
Start Page
147A
End Page
147A

Variation in the definition of biochemical recurrence in patients treated for localized prostate cancer: the American Urological Association Prostate Guidelines for Localized Prostate Cancer Update Panel report and recommendations for a standard in the reporting of surgical outcomes.

PURPOSE: The American Urological Association Prostate Guideline Update Panel was charged with updating the Guidelines for Clinically Localized Prostate Cancer. In assessing outcomes with treatment, it became apparent that a highly variable number of definitions exist with respect to biochemical recurrence. Herein, we review the variability in published definitions of biochemical recurrence and make recommendations directed toward improving this terminology by recommending a standard definition in patients treated with radical prostatectomy. MATERIALS AND METHODS: Four PubMed literature searches were performed between May 2001 and April, 2004 and covered articles published from 1991 through early 2004. The search terms included the MeSH major headings of prostate cancer and prostatic neoplasm. All potentially relevant articles were retrieved and a more detailed screen for relevance was performed. An article was considered relevant if it reported treatment outcomes of patients with clinical T1 or T2N0M0 prostate cancer. Data extractors recorded the definition of biochemical recurrence and definitions were then collapsed into categories representing the same criteria. The results of biochemical failure were subcategorized by initial treatment. RESULTS: Of 13,800 citations, a total of 436 articles were selected. Among these, a total of 145 articles contained 53 different definitions of biochemical recurrence for those treated with radical prostatectomy. Of these, the most common definition (35) was a prostate specific antigen of >0.2 ng/mL or a slight variation thereof. In addition, a total of 208 articles reported 99 different definitions of biochemical failure among those treated with radiation therapy. Of these, the American Society for Therapeutic Radiology and Oncology definition (70) and/or a variation thereof was the most commonly reported. In total, 166 different definitions of biochemical failure were identified. Following radical prostatectomy, the Panel recommends defining biochemical recurrence as an initial serum prostate specific antigen of > or =0.2 ng/mL, with a second confirmatory level of prostate specific antigen of >0.2 ng/mL. The Panel recommends the use of the American Society for Therapeutic Radiology and Oncology criteria for patients treated with radiation therapy and acknowledges that these criteria will soon be updated although not yet published. CONCLUSIONS: A high degree of variability in the definition of biochemical recurrence exists following treatment for localized prostate cancer. Strict definitions for biochemical recurrence are necessary to identify men at risk for disease progression and to allow meaningful comparisons among patients treated similarly. The Panel acknowledges the American Society for Therapeutic Radiology and Oncology criteria and future modifications thereof for those receiving radiation therapy and recommends the newly developed American Urological Association criteria for those treated with radical prostatectomy. The purpose for the establishment of this standard is for data reporting purposes and for comparison of similarly treated patients. It is not intended to represent a threshold value for which to initiate treatment. The Panel acknowledges that the clinical decision to initiate treatment will be dependent on multiple factors including patient and physician interaction rather than a specific prostate specific antigen threshold value.

Authors
Cookson, MS; Aus, G; Burnett, AL; Canby-Hagino, ED; D'Amico, AV; Dmochowski, RR; Eton, DT; Forman, JD; Goldenberg, SL; Hernandez, J; Higano, CS; Kraus, SR; Moul, JW; Tangen, C; Thrasher, JB; Thompson, I
MLA Citation
Cookson, MS, Aus, G, Burnett, AL, Canby-Hagino, ED, D'Amico, AV, Dmochowski, RR, Eton, DT, Forman, JD, Goldenberg, SL, Hernandez, J, Higano, CS, Kraus, SR, Moul, JW, Tangen, C, Thrasher, JB, and Thompson, I. "Variation in the definition of biochemical recurrence in patients treated for localized prostate cancer: the American Urological Association Prostate Guidelines for Localized Prostate Cancer Update Panel report and recommendations for a standard in the reporting of surgical outcomes." J Urol 177.2 (February 2007): 540-545. (Review)
PMID
17222629
Source
pubmed
Published In
The Journal of Urology
Volume
177
Issue
2
Publish Date
2007
Start Page
540
End Page
545
DOI
10.1016/j.juro.2006.10.097

Relationship between body mass index and prostate cancer screening in the United States.

PURPOSE: Obesity is associated with more advanced disease and worse outcomes in men with prostate cancer. To our knowledge the relationship between obesity and prostate cancer screening behavior in men 40 or older is unknown. Thus, we examined associations between body mass index and prostate cancer screening behavior. MATERIALS AND METHODS: We used the 2002 Behavioral Risk Factor Surveillance System to study prostate cancer screening in a representative sample of 57,827 men 40 years or older. Primary outcomes were the proportion of men ever screened and the proportion screened in the last year for prostate cancer. RESULTS: Obese men were more likely than normal weight men to have had a prostate specific antigen test (62.1% vs 56.1%, p <0.001) and to have had a prostate specific antigen test in the last year (44.2% vs 38.2%, p <0.001). After controlling for sociodemographic characteristics obese men remained more likely than normal weight men to have had a prostate specific antigen test (OR 1.46, 95% CI 1.33-1.61) and to have had a prostate specific antigen test in the last year (OR 1.42, 95% CI 1.30-1.55). Respondents reporting an ongoing relationship with a physician (OR 2.88, 95% CI 2.57-3.22) and black nonHispanic men vs white men (OR 1.58, 95% CI 1.38-1.81) were also more likely to have had a prostate specific antigen test in the last year. CONCLUSIONS: Obese men are more likely than normal weight men to be screened for prostate cancer. Associations between advanced stage, worse outcomes and obesity may not be explained by disparities in the screening of obese men for prostate cancer.

Authors
Scales, CD; Curtis, LH; Norris, RD; Schulman, KA; Dahm, P; Moul, JW
MLA Citation
Scales, CD, Curtis, LH, Norris, RD, Schulman, KA, Dahm, P, and Moul, JW. "Relationship between body mass index and prostate cancer screening in the United States." J Urol 177.2 (February 2007): 493-498.
PMID
17222617
Source
pubmed
Published In
The Journal of Urology
Volume
177
Issue
2
Publish Date
2007
Start Page
493
End Page
498
DOI
10.1016/j.juro.2006.09.059

Financial comparative analysis of minimally invasive surgery to open surgery for localized prostate cancer: a single-institution experience.

OBJECTIVES: To evaluate the financial implications of how the costs of new minimally invasive surgery such as laparoscopic robotic prostatectomy (LRP) and cryosurgical ablation of the prostate (CAP) technologies compare with those of conventional surgery. METHODS: From January 2002 to July 2005, 452 consecutive patients underwent surgical treatment for clinically localized (Stage T1-T2) prostate cancer. The distribution of patients among the surgical procedures was as follows: group 1, radical retropubic prostatectomy (RRP) (n = 197); group 2, radical perineal prostatectomy (RPP) (n = 60); group 3, LRP (n = 137); and group 4, CAP (n = 58). The total direct hospital costs and grand total hospital costs were analyzed for each type of surgery. RESULTS: The mean length of stay in the CAP group was significantly lower (0.16 +/- 0.14 days) than that for RRP (2.79 +/- 1.46 days), RPP (2.87 +/- 1.43 days), and LRP (2.15 +/- 1.48 days; P <0.0005). The direct surgical costs were less for the RRP (2471 dollars +/- 636 dollars) and RPP (2788 dollars +/- 762 dollars) groups than for the technology-dependent procedures: LRP (3441 dollars +/- 545 dollars) and CAP (5702 dollars +/- 1606 dollars; P <0.0005). The total hospital cost differences, including pathologic assessment costs, were less for LRP (10,047 dollars +/- 107 dollars, median 9343 dollars) and CAP (9195 dollars +/- 1511 dollars, median 8796 dollars) than for RRP (10,704 dollars +/- 3468 dollars, median 9724 dollars) or RPP (10,536 dollars +/- 3088 dollars, median 9251 dollars), with significant differences (P <0.05) between the minimally invasive technique and open surgery groups. CONCLUSIONS: In our study, despite the relatively increased surgical expense of CAP compared with conventional surgical prostatectomy (RRP or RPP) and LRP, the overall direct costs were offset by the significantly lower nonoperative hospital costs. The cost advantages associated with CAP included a shorter length of stay in the hospital and the absence of pathologic costs and the need for blood transfusion.

Authors
Mouraviev, V; Nosnik, I; Sun, L; Robertson, CN; Walther, P; Albala, D; Moul, JW; Polascik, TJ
MLA Citation
Mouraviev, V, Nosnik, I, Sun, L, Robertson, CN, Walther, P, Albala, D, Moul, JW, and Polascik, TJ. "Financial comparative analysis of minimally invasive surgery to open surgery for localized prostate cancer: a single-institution experience." Urology 69.2 (February 2007): 311-314.
PMID
17320670
Source
pubmed
Published In
Urology
Volume
69
Issue
2
Publish Date
2007
Start Page
311
End Page
314
DOI
10.1016/j.urology.2006.10.025

Age adjusted prostate specific antigen and prostate specific antigen velocity cut points in prostate cancer screening.

PURPOSE: We identified age adjusted prostate specific antigen and prostate specific antigen velocity cut points for prostate cancer biopsy. MATERIALS AND METHODS: A cohort of 33,643 men was retrieved from the Duke Prostate Center database. Of this group 11,861 men with 2 or more prostate specific antigen values within 2 years were analyzed for age adjusted prostate specific antigen and prostate specific antigen velocity performance in cancer risk assessment using a receiver operating characteristic curve. RESULTS: In the 11,861 men prostate cancer prevalence was 273 (8.0%), 659 (14.9%) and 722 (17.9%) in the groups of men 50 to 59 years old, 60 to 69 and 70 years old or older. In prostate cancer groups median prostate specific antigen and prostate specific antigen velocity in men 50 to 59 vs 70 years old or older were 5.6 vs 8.1 ng/ml and 1.37 vs 1.89 ng/ml per year (<0.0001). In men 50 to 59 years old the sensitivity and specificity were 82.1% and 80.7% at prostate specific antigen 2.5 ng/ml, and 84.3% and 72.4% at prostate specific antigen velocity 0.40 ng/ml per year, higher than those in men 70 years old or older at prostate specific antigen 4.0 ng/ml or prostate specific antigen velocity 0.75 ng/ml per year. Decreasing the prostate specific antigen cut point to 2.0 ng/ml and the prostate specific antigen velocity cut point to 0.40 ng/ml per year in men 50 to 59 years old improved the cancer detection rate but decreased the positive predictive value. CONCLUSIONS: Current biopsy guidelines (prostate specific antigen 4.0 ng/ml or greater, or prostate specific antigen velocity 0.75 ng/ml or greater per year) underestimated cancer risk in men 50 to 59 years old. Prostate specific antigen and prostate specific antigen velocity cut points should be age adjusted. In men 50 to 59 years old prostate specific antigen and prostate specific antigen velocity cut points could be decreased to 2.0 ng/ml and 0.40 ng/ml per year, respectively. Factors of age, sensitivity, specificity, positive predictive value and cancer prevalence are critical for obtaining the desired balance between cancer detection and negative biopsy.

Authors
Moul, JW; Sun, L; Hotaling, JM; Fitzsimons, NJ; Polascik, TJ; Robertson, CN; Dahm, P; Anscher, MS; Mouraviev, V; Pappas, PA; Albala, DM
MLA Citation
Moul, JW, Sun, L, Hotaling, JM, Fitzsimons, NJ, Polascik, TJ, Robertson, CN, Dahm, P, Anscher, MS, Mouraviev, V, Pappas, PA, and Albala, DM. "Age adjusted prostate specific antigen and prostate specific antigen velocity cut points in prostate cancer screening." J Urol 177.2 (February 2007): 499-503.
PMID
17222618
Source
pubmed
Published In
The Journal of Urology
Volume
177
Issue
2
Publish Date
2007
Start Page
499
End Page
503
DOI
10.1016/j.juro.2006.09.063

Choice of consultation specialist sways treatment decisions: Commentary

Authors
Moul, JW
MLA Citation
Moul, JW. "Choice of consultation specialist sways treatment decisions: Commentary." Oncology Report FALL (2007): 55--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2007
Start Page
55-

Erratum: Frequent overexpression of ETS-related gene-1 (ERG1) in prostate cancer transcriptome (Oncogene (2005) 24 (3847-3852) DOI:10.1038/sj.onc.1208518)

Authors
Petrovics, G; Liu, A; Shaheduzzaman, S; Furusato, B; Sun, C; Chen, Y; Nau, M; Ravindranath, L; Chen, Y; Dobi, A; Srikantan, V; Sesterhenn, IA; McLeod, DG; Vahey, M; Moul, JW; Srivastava, S
MLA Citation
Petrovics, G, Liu, A, Shaheduzzaman, S, Furusato, B, Sun, C, Chen, Y, Nau, M, Ravindranath, L, Chen, Y, Dobi, A, Srikantan, V, Sesterhenn, IA, McLeod, DG, Vahey, M, Moul, JW, and Srivastava, S. "Erratum: Frequent overexpression of ETS-related gene-1 (ERG1) in prostate cancer transcriptome (Oncogene (2005) 24 (3847-3852) DOI:10.1038/sj.onc.1208518)." Oncogene 26.46 (2007): 6684--.
Source
scival
Published In
Oncogene: Including Oncogene Reviews
Volume
26
Issue
46
Publish Date
2007
Start Page
6684-
DOI
10.1038/sj.onc.1210745

Stress management eases fear, aids postsurgical function: Commentary

Authors
Moul, JW
MLA Citation
Moul, JW. "Stress management eases fear, aids postsurgical function: Commentary." Oncology Report FALL (2007): 53--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2007
Start Page
53-

Circulating tumor cells may be better surrogate than PSA: Commentary

Authors
Moul, JW
MLA Citation
Moul, JW. "Circulating tumor cells may be better surrogate than PSA: Commentary." Oncology Report FALL (2007): 51--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2007
Start Page
51-

Better QOL with adjuvant chemotherapy than radiation: Commentary

Authors
Moul, JW
MLA Citation
Moul, JW. "Better QOL with adjuvant chemotherapy than radiation: Commentary." Oncology Report FALL (2007): 62--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2007
Start Page
62-

Report from Durham

Authors
Moul, JW
MLA Citation
Moul, JW. "Report from Durham." Prostate Cancer and Prostatic Diseases 10.3 (2007): 211--.
Source
scival
Published In
Prostate Cancer and Prostatic Diseases
Volume
10
Issue
3
Publish Date
2007
Start Page
211-
DOI
10.1038/sj.pcan.4500998

Flaxseed slows prostate cancer growth in randomized study: Commentary

Authors
Freedland, SJ; Moul, JW
MLA Citation
Freedland, SJ, and Moul, JW. "Flaxseed slows prostate cancer growth in randomized study: Commentary." Oncology Report FALL (2007): 52--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2007
Start Page
52-

PSA decline of 30% may be surrogate marker for overall survival: Commentary

Authors
Freedland, SJ; Moul, JW
MLA Citation
Freedland, SJ, and Moul, JW. "PSA decline of 30% may be surrogate marker for overall survival: Commentary." Oncology Report FALL (2007): 52-53.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2007
Start Page
52
End Page
53

Sunitinib active in bevacizumab-resistant kidney cancer: Commentary

Authors
Freedland, SJ; Moul, JW
MLA Citation
Freedland, SJ, and Moul, JW. "Sunitinib active in bevacizumab-resistant kidney cancer: Commentary." Oncology Report FALL (2007): 61--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2007
Start Page
61-

Postsurgical prognostic tools give inaccurate predictions: Commentary

Authors
Freedland, SJ; Moul, JW
MLA Citation
Freedland, SJ, and Moul, JW. "Postsurgical prognostic tools give inaccurate predictions: Commentary." Oncology Report FALL (2007): 50--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2007
Start Page
50-

More positive needle biopsies in African American men: Commentary

Authors
Freedland, SJ; Moul, JW
MLA Citation
Freedland, SJ, and Moul, JW. "More positive needle biopsies in African American men: Commentary." Oncology Report FALL (2007): 54--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2007
Start Page
54-

Bevacizumab plus interferon-α improves survival: Commentary

Authors
George, DJ; Moul, JW
MLA Citation
George, DJ, and Moul, JW. "Bevacizumab plus interferon-α improves survival: Commentary." Oncology Report FALL (2007): 57--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2007
Start Page
57-

Satraplatin boosts progression-free survival in SPARC: Commentary

Authors
George, DJ; Moul, JW
MLA Citation
George, DJ, and Moul, JW. "Satraplatin boosts progression-free survival in SPARC: Commentary." Oncology Report FALL (2007): 49--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2007
Start Page
49-

Adjuvant radiotherapy linked to better cause-specific survival: Commentary

Authors
Lee, WR; Moul, JW
MLA Citation
Lee, WR, and Moul, JW. "Adjuvant radiotherapy linked to better cause-specific survival: Commentary." Oncology Report FALL (2007): 62--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2007
Start Page
62-

Follow-up after EBRT falls short of guideline: Commentary

Authors
Lee, WR; Moul, JW
MLA Citation
Lee, WR, and Moul, JW. "Follow-up after EBRT falls short of guideline: Commentary." Oncology Report FALL (2007): 56--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2007
Start Page
56-

Adjuvant radiotherapy averts biochemical progression

Authors
Lee, WR; Moul, JW
MLA Citation
Lee, WR, and Moul, JW. "Adjuvant radiotherapy averts biochemical progression." Oncology Report FALL (2007): 51--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2007
Start Page
51-

Intermittent androgen suppression is safe alternative: Commentary

Authors
Moul, JW
MLA Citation
Moul, JW. "Intermittent androgen suppression is safe alternative: Commentary." Oncology Report FALL (2007): 50--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2007
Start Page
50-

Prostate cancer early detection

Since the early 1990s when the ACS developed guidelines for the early detection of prostate cancer, many variants of the tPSA assay have been introduced to increase the sensitivity of screening programs (cancer detection) while maintaining specificity (elimination of unnecessary biopsies). Again, the NCCN guidelines recommend how individuals and their physicians can use these new methods rationally for the early detection of prostate cancer. These guidelines are not designed to provide an argument for using early detection programs for prostate cancer, but are meant to provide a vehicle with which early detection efforts can be practiced in an evidence-based, systematic fashion in patients who choose to participate in these programs.56 These NCCN guidelines incorporate many new validated findings in addition to the DRE and tPSA test. These new factors include percent fPSA, PSAV, cPSA, biopsy pathology, and TRUS-guided biopsy techniques. The panel will re-examine the clinical usefulness of these new modalities annually, and the guidelines will be modified accordingly. In addition, future iterations of these guidelines may incorporate new serum markers currently undergoing clinical investigation. The goal of the NCCN and this guideline panel in updating these algorithms is to help men and clinicians choose a program of early detection of prostate cancer and make decisions about the need for prostate biopsy. Any clinician who uses these guidelines is expected to exercise independent medical judgment in the context of the individual clinical circumstances to determine each patient's need for prostate biopsy. These guidelines will continue to evolve as the field of prostate cancer advances. © Journal of the National Comprehensive Cancer Network.

Authors
Kawachi, MH; Bahnson, RR; Barry, M; Carroll, PR; Carter, HB; Catalona, WJ; Epstein, JI; Etzioni, RB; III, GPH; Howe, RJ; Kopin, JD; Lange, PH; Lilja, H; Mohler, J; Moul, J; Nadler, RB; Patterson, S; Pollack, A; Presti, JC; Stroup, AM; Urban, DA; Wake, R; Wei, JT
MLA Citation
Kawachi, MH, Bahnson, RR, Barry, M, Carroll, PR, Carter, HB, Catalona, WJ, Epstein, JI, Etzioni, RB, III, GPH, Howe, RJ, Kopin, JD, Lange, PH, Lilja, H, Mohler, J, Moul, J, Nadler, RB, Patterson, S, Pollack, A, Presti, JC, Stroup, AM, Urban, DA, Wake, R, and Wei, JT. "Prostate cancer early detection." JNCCN Journal of the National Comprehensive Cancer Network 5.7 (2007): 714-736.
PMID
17692177
Source
scival
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
5
Issue
7
Publish Date
2007
Start Page
714
End Page
736

Targeted prostate biopsy using statistical image analysis

In this paper, a method for maximizing the probability of prostate cancer detection via biopsy is presented, by combining image analysis and optimization techniques. This method consists of three major steps. First, a statistical atlas of the spatial distribution of prostate cancer is constructed from histological images obtained from radical prostatectomy specimen. Second, a probabilistic optimization framework is employed to optimize the biopsy strategy, so that the probability of cancer detection is maximized under needle placement uncertainties. Finally, the optimized biopsy strategy generated in the atlas space is mapped to a specific patient space using an automated segmentation and elastic registration method. Cross-validation experiments showed that the predictive power of the optimized biopsy strategy for cancer detection reached the 94%-96% levels for 6-7 biopsy cores, which is significantly better than standard random-systematic biopsy protocols, thereby encouraging further investigation of optimized biopsy strategies in prospective clinical studies. © 2007 IEEE.

Authors
Zhan, Y; Shen, D; Zeng, J; Sun, L; Fichtinger, G; Moul, J; Davatzikos, C
MLA Citation
Zhan, Y, Shen, D, Zeng, J, Sun, L, Fichtinger, G, Moul, J, and Davatzikos, C. "Targeted prostate biopsy using statistical image analysis." IEEE Transactions on Medical Imaging 26.6 (2007): 779-788.
PMID
17679329
Source
scival
Published In
IEEE Transactions on Medical Imaging
Volume
26
Issue
6
Publish Date
2007
Start Page
779
End Page
788
DOI
10.1109/TMI.2006.891497

Report from Durham

Authors
Moul, JW
MLA Citation
Moul, JW. "Report from Durham." Prostate Cancer and Prostatic Diseases 10.1 (2007): 1--.
Source
scival
Published In
Prostate Cancer and Prostatic Diseases
Volume
10
Issue
1
Publish Date
2007
Start Page
1-
DOI
10.1038/sj.pcan.4500945

Characterization of frequently deleted 6q locus in prostate cancer.

The long arm of chromosome 6 is frequently deleted in diverse human neoplasms. Our previous study showed a minimum deletion region between markers D6S1056 and D6S300 on chromosome 6q in primary prostate cancer (CaP). In this study, we further refined a 200-kb minimal region of deletion (6qTSG1) centered around D6S1013 marker. The 6qTSG1 transcripts contained complex multiple splicing variants with low or absent expression in CaP cells. None of the transcripts identified contained open reading frames that code for a protein in the NCBI database. The expression of 6qTSG transcripts revealed interesting hormonal regulation relevant to CaP biology. Expression of 6q TSG transcript was induced in LNCaP cells that were cultured in charcoal-stripped serum medium suggesting an upregulation of 6qTSG transcript by androgen ablation and cell growth inhibition/apoptosis. Induction of 6qTSG1 expression in response to androgen ablation was abrogated in androgen-independent derivatives of LNCaP cells. In summary, we have defined a candidate CaP suppressor locus on chromosome 6q16.1, and deletions of this locus are frequently associated with prostate tumorigenesis. In the light of emerging role of noncoding RNAs in cancer biology including CaP, future investigations of 6qTSG11 locus is warranted.

Authors
Sun, M; Srikantan, V; Ma, L; Li, J; Zhang, W; Petrovics, G; Makarem, M; Strovel, JW; Horrigan, SG; Augustus, M; Sesterhenn, IA; Moul, JW; Chandrasekharappa, S; Zou, Z; Srivastava, S
MLA Citation
Sun, M, Srikantan, V, Ma, L, Li, J, Zhang, W, Petrovics, G, Makarem, M, Strovel, JW, Horrigan, SG, Augustus, M, Sesterhenn, IA, Moul, JW, Chandrasekharappa, S, Zou, Z, and Srivastava, S. "Characterization of frequently deleted 6q locus in prostate cancer." DNA Cell Biol 25.11 (November 2006): 597-607.
PMID
17132090
Source
pubmed
Published In
DNA and Cell Biology
Volume
25
Issue
11
Publish Date
2006
Start Page
597
End Page
607
DOI
10.1089/dna.2006.25.597

Can prostate-specific antigen nadir predict prostate cancer outcomes following radiotherapy?

Authors
Lee, WR; Moul, JW
MLA Citation
Lee, WR, and Moul, JW. "Can prostate-specific antigen nadir predict prostate cancer outcomes following radiotherapy?." Nat Clin Pract Oncol 3.10 (October 2006): 534-535.
PMID
17019429
Source
pubmed
Published In
Nature Clinical Practice Oncology
Volume
3
Issue
10
Publish Date
2006
Start Page
534
End Page
535
DOI
10.1038/ncponc0612

Prostate-specific antigen-based serial screening may decrease prostate cancer-specific mortality.

OBJECTIVES: To compare the preoperative characteristics, postoperative prostate-specific antigen (PSA) doubling time (DT), and prostate cancer-specific mortality (PCSM) estimates after PSA failure in men diagnosed during a screening study versus a community referral population. A PSA-DT of less than 3 months is a surrogate endpoint for PCSM. METHODS: From 1988 to 2002, 1492 of 9637 patients with clinically localized prostate cancer underwent radical prostatectomy and experienced PSA failure. They were either participating in a screening study (n = 841) or attended 1 of 44 community-based practices (n = 611). The distributions of PSA, Gleason score, tumor stage, and PSA-DT were compared using chi-square metric. The estimates of PCSM after PSA failure were compared using Gray's P value. RESULTS: Compared with the community population, the annually screened men experiencing PSA failure had a lower PSA level at diagnosis (5.1 versus 9.5 ng/mL, P <0.0001), were less likely to have Gleason score 7 to 10 cancer (25.1% versus 42.1%, P <0.0001), and were more likely to have low-risk disease (64.5% versus 23.8%, P <0.0001). Furthermore, the screened cohort had a reduction (P <0.0001) in the proportion with a PSA-DT of less than 3, 3 to 5.99, and 6 to 11.99 months and a significant increase in the proportion with a PSA-DT of 12 months or longer. After a median follow-up of 4.5 and 4.1 years after PSA failure in the screened and community cohorts, respectively, the PCSM estimates were lower (P = 0.0002) in the screened cohort (10-year estimate 3.6% [95% confidence interval 1.3 to 5.8] versus 11.3% [95% confidence interval 5.9 to 17.4]). CONCLUSIONS: Patients diagnosed by annual prostate cancer screening appeared more likely to experience an indolent PSA recurrence and less likely to die of prostate cancer after PSA recurrence compared with patients referred from the community.

Authors
Efstathiou, JA; Chen, M-H; Catalona, WJ; McLeod, DG; Carroll, PR; Moul, JW; Roehl, KA; D'Amico, AV
MLA Citation
Efstathiou, JA, Chen, M-H, Catalona, WJ, McLeod, DG, Carroll, PR, Moul, JW, Roehl, KA, and D'Amico, AV. "Prostate-specific antigen-based serial screening may decrease prostate cancer-specific mortality." Urology 68.2 (August 2006): 342-347.
PMID
16904449
Source
pubmed
Published In
Urology
Volume
68
Issue
2
Publish Date
2006
Start Page
342
End Page
347
DOI
10.1016/j.urology.2006.02.030

Management of the patient with a rising PSA alone.

PSA-only recurrence after definitive RP or RT for PCA is an increasingly com-mon scenario. The very definition of advanced prostate cancer is changing. Multimodal therapy improves cancer-specific outcomes especially in men with high-risk disease. After RP, a detectable serum PSA has been considered suggestive of PCA recurrence. After RT, the ASTRO definition of BCR has been widely used to define BCR. Both of these definitions of BCR are subject to dispute. The kinetics of a rising PSA (PSA doubling time) appears to be the best surrogate marker for disease risk, clinical progression, and ultimately cancer-specific death. Therapeutic options include salvage RT after primary RP or systemic HT through surgical/chemical castration, antiandrogens, or nontraditional HT. Re-cent studies suggest that early HT can provide modest survival benefits, but at both an economic cost and decreased quality of life. The diminished side effects of an oral antiandrogen are appealing, and may be as efficacious as castration therapies in low-volume disease. More clinical trials are needed to determine the best treatments, alone and in combination. The potential opportunities for novel therapeutic agents with low associated morbidity are great.

Authors
Moul, JW; Ward, JF
MLA Citation
Moul, JW, and Ward, JF. "Management of the patient with a rising PSA alone." Hematol Oncol Clin North Am 20.4 (August 2006): 897-908. (Review)
PMID
16861121
Source
pubmed
Published In
Hematology/Oncology Clinics of North America
Volume
20
Issue
4
Publish Date
2006
Start Page
897
End Page
908
DOI
10.1016/j.hoc.2006.03.006

Prostate specific antigen testing in men older than 75 years in the United States.

PURPOSE: Although there is general agreement that men older than 75 years are unlikely to benefit from prostate specific antigen testing, patient reported testing rates in these patients exceed 30%. We examined physician reported PSA testing in elderly men, and physician and practice characteristics associated with testing. MATERIALS AND METHODS: Using the 1999 to 2002 National Ambulatory Medical Care Survey, a nationally representative sample of outpatient visits to nonfederal office based physicians, we measured rates of prostate specific antigen testing by age group in men without prostate cancer who were 40 years or older and who visited outpatient family medicine, internal medicine or urology clinics. RESULTS: An estimated 42.3 million prostate specific antigen tests were performed from 1999 to 2002, of which 5.91 million (14.0%) were performed in men older than 75 years. The population based testing rate was 6.1% in patients 40 to 49-year-old, 26.0% in patients 50 to 75-year-old and 27.8% in patients older than 75 years. Urologists performed 35.4% of prostate specific antigen tests in men older than 75 years. Controlling for sociodemographic variables physicians with a laboratory on site were more likely to perform a prostate specific antigen test (OR 1.35, 95% CI 1.07 to 1.71). In men older than 75 years the odds of prostate specific antigen testing were 1.58 times higher (95% CI 1.01 to 2.50) in practices with a laboratory on site. CONCLUSIONS: Up to a third of men older than 75 years undergo prostate specific antigen testing despite an average life expectancy of less than 10 years. Physician and practice characteristics are associated with prostate specific antigen PSA testing.

Authors
Scales, CD; Curtis, LH; Norris, RD; Schulman, KA; Albala, DM; Moul, JW
MLA Citation
Scales, CD, Curtis, LH, Norris, RD, Schulman, KA, Albala, DM, and Moul, JW. "Prostate specific antigen testing in men older than 75 years in the United States." J Urol 176.2 (August 2006): 511-514.
PMID
16813879
Source
pubmed
Published In
The Journal of Urology
Volume
176
Issue
2
Publish Date
2006
Start Page
511
End Page
514
DOI
10.1016/j.juro.2006.03.060

Activation of the PKB/Akt pathway in histological benign prostatic tissue adjacent to the primary malignant lesions.

In order to evaluate the molecular heterogeneity of prostate cancer, this study examined the expression of Akt-pathway related parameters within the cancerous prostate gland. PTEN, p-Akt and p27kip1 are known to be altered in prostate cancer. Tissue samples from malignant, tumor adjacent benign and benign areas of 25 whole mounted prostate cancer specimens were processed to 583 tissue microarray cores. Immunohistochemically determined biomarker expression was correlated to the different localizations. p-Akt and p27kip1 showed increased staining in malignant tissue compared to the respective benign tissue (p < 0.01 and p < 0.05). The adjacent but histologically benign tissue had increased levels (p < 0.05 and p < 0.01), whereas no significant difference was found between the adjacent and malignant regions. A highly significant correlation of p-Akt and p27kip1 in benign tissue (p < 0.001) was lost in the adjacent areas and in the malignant tissue (p = 0.054 and p = 0.12). In tendency, PTEN expression was decreased in the malignant regions and revealed the highest staining in the adjacent zone. According to the results obtained, the expression of p-Akt and p27kip1 was increased in both the adjacent microscopically benign tissue as well as the primary tumors when compared with the histologically benign tissue specimens that served as biological control. The increased expression of PTEN indicates its regulatory function in the initial steps of a deteriorated cell cycle control as well as uncontrolled cellular proliferation, for example, which seem to be present in the normal prostatic tissue surrounding the primary malignant lesion. The addition of molecular markers to a 'classical' histopathological approach might contribute to an enhanced sensitivity of analytical approaches aimed at the detection of malignant or premalignant lesions within prostatic biopsies.

Authors
Merseburger, AS; Hennenlotter, J; Simon, P; Müller, CC; Kühs, U; Knüchel-Clarke, R; Moul, JW; Stenzl, A; Kuczyk, MA
MLA Citation
Merseburger, AS, Hennenlotter, J, Simon, P, Müller, CC, Kühs, U, Knüchel-Clarke, R, Moul, JW, Stenzl, A, and Kuczyk, MA. "Activation of the PKB/Akt pathway in histological benign prostatic tissue adjacent to the primary malignant lesions." Oncol Rep 16.1 (July 2006): 79-83.
PMID
16786126
Source
pubmed
Published In
Oncology Reports: an international journal devoted to fundamental and applied research in oncology
Volume
16
Issue
1
Publish Date
2006
Start Page
79
End Page
83

The role of cytotoxic chemotherapy in prostate cancer - A critical reevaluation 20 years later - The Eisenberger/Sinibaldi article reviewed

Authors
Moul, JW
MLA Citation
Moul, JW. "The role of cytotoxic chemotherapy in prostate cancer - A critical reevaluation 20 years later - The Eisenberger/Sinibaldi article reviewed." ONCOLOGY-NEW YORK 20.8 (July 2006): 863-863.
Source
wos-lite
Published In
Oncology
Volume
20
Issue
8
Publish Date
2006
Start Page
863
End Page
863

Update on outcomes research databases in prostate cancer 2006.

PURPOSE OF REVIEW: The purpose of this review is to summarize single-institution prostate-cancer-outcomes databases (which are most commonly derived from large academic medical centers, Veterans Affairs medical centers, and military hospitals) to summarize the design and development of three well characterized outcomes databases that combine data from multiple sites (Carcinoma of the Prostate Strategic Urological Research Endeavor, Center for Prostate Disease Research, and the Shared Equal Access Regional Cancer Hospital database) and to use the examples of obesity and prostate-specific antigen changes over time to highlight the importance of these databases in prostate-cancer outcomes. RECENT FINDINGS: Multiple databases have demonstrated that obese men are at greater risk of biochemical progression following radical prostatectomy. In addition, objective data have shown that it is more difficult to operate on obese men leading to greater risk of positive surgical margins, which may contribute to poorer outcomes. Several databases have shown that a rapidly increasing prostate-specific antigen, measured either before diagnosis or after failed primary therapy, is associated with increased risk of prostate-cancer-specific mortality. SUMMARY: Outcomes databases are extremely useful tools. They have lead to dramatic improvements of our understanding of prostate cancer. The challenge is to use this information from past patients to help us better manage our current and future patients.

Authors
Freedland, SJ; Krupski, TL; Moul, JW
MLA Citation
Freedland, SJ, Krupski, TL, and Moul, JW. "Update on outcomes research databases in prostate cancer 2006." Curr Opin Urol 16.3 (May 2006): 168-172. (Review)
PMID
16679854
Source
pubmed
Published In
Current Opinion in Urology
Volume
16
Issue
3
Publish Date
2006
Start Page
168
End Page
172
DOI
10.1097/01.mou.0000193394.62221.e9

Treating the troops a model for battling health-care disparities

Authors
Moul, JW
MLA Citation
Moul, JW. "Treating the troops a model for battling health-care disparities." ONCOLOGY-NEW YORK 20.3 (March 2006): 318-318.
Source
wos-lite
Published In
Oncology
Volume
20
Issue
3
Publish Date
2006
Start Page
318
End Page
318

Treatment of PSA only recurrence of prostate cancer after prior local therapy.

Prostate cancer recurrence (after prior local treatment) that is detectable only by a rise in serum prostate specific antigen (PSA) level is a very common problem facing clinicians. Given that the majority of contemporary era men with PSA-only or biochemical recurrence are relatively young and otherwise healthy, treatment requires approaches that both improve clinical outcomes and preserve quality of life. Treatment is in one of two broad categories, additional local therapies, termed "salvage" local therapy and systemic therapies. For radical prostatectomy patients, salvage external beam radiotherapy to the prostate bed is commonly employed, being reserved for early biochemical recurrence in men with low risk at distant metastases. For primary radiation patients, salvage radical prostatectomy or cryotherapy can similarly be used for those men felt not to harbor distant metastases. Systemic therapy generally involves hormonal therapy. Traditional hormonal therapy (orchiectomy, luteinizing hormone-releasing hormone agonists or maximum androgen blockade) is the current mainstay of systemic treatment for biochemical recurrence, although non-traditional approaches, such as antiandrogen monotherapy, are increasingly being used. There is a critical need for new pharmaceutical agents to treat this growing stage of prostate cancer. However, it has been difficult to demonstrate efficacy due to the long natural history until death and the survival endpoint currently required by the U.S. Food and Drug Administration. New data show that PSA Doubling time (PSA-DT) during PSA recurrence may be a valid surrogate for death from the disease and may be used to accelerate drug approval. This monograph will attempt to provide a complete balanced discussion of the evaluation and treatment of biochemical recurrence of prostate cancer after prior primary local therapy.

Authors
Moul, JW
MLA Citation
Moul, JW. "Treatment of PSA only recurrence of prostate cancer after prior local therapy." Curr Pharm Des 12.7 (2006): 785-798. (Review)
PMID
16515495
Source
pubmed
Published In
Current Pharmaceutical Design
Volume
12
Issue
7
Publish Date
2006
Start Page
785
End Page
798

Prostatic carcinosarcoma 15 years after combined external beam radiation and brachytherapy for prostatic adenocarcinoma: a case report.

A 65-year-old man with a history of combined pelvic external beam radiation therapy (EBRT) and brachytherapy for prostatic adenocarcinoma 15 years prior underwent total pelvic exenteration for presumed rectal sarcoma with prostatic invasion. Pathology revealed carcinosarcoma of prostatic origin. This patient exhibited the longest reported interval between initial presentation with prostatic adenocarcinoma and development of carcinosarcoma. This case is also the first reported case of prostatic carcinosarcoma occurring after combined EBRT and brachytherapy. The increasing use of such combination high-dose radiation therapy may potentially lead to an increased incidence of secondary malignancies such as prostatic carcinosarcoma in the future.

Authors
Tseng, TY; Sevilla, DW; Moul, JW; Maloney, KE
MLA Citation
Tseng, TY, Sevilla, DW, Moul, JW, and Maloney, KE. "Prostatic carcinosarcoma 15 years after combined external beam radiation and brachytherapy for prostatic adenocarcinoma: a case report." Prostate Cancer Prostatic Dis 9.2 (2006): 195-197.
PMID
16568146
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
9
Issue
2
Publish Date
2006
Start Page
195
End Page
197
DOI
10.1038/sj.pcan.4500870

Quantitative expression profile of PSGR in prostate cancer.

PSGR is a novel member of the G-protein-coupled olfactory receptor family. Our initial report showed predominant expression of the PSGR in human prostate gland and significant alterations of PSGR expression in primary prostate cancer (CaP) specimens. The aim of this study was to provide in-depth evaluations of the expression profile of PSGR in prostatic epithelial cells of CaP patients and to evaluate the association of PSGR expression characteristics with clinico-pathologic features. In total, 220 RNA specimens, from laser capture microdissected paired benign and malignant prostatic epithelial cells of 110 CaP patients, were analyzed for PSGR expression by quantitative real-time PCR. The differential expression of PSGR between the prostatic epithelial cells of malignant and benign glands was statistically significant (P<0.0001). Comparison of PSGR expression between paired benign and tumor cells revealed prostate tumor cell-specific overexpression in 67.2% of tumor specimens (74 of 110), decreased expression in 20.9% of tumor specimens (23 of 110) and no difference of PSGR expression between tumor and normal cells in 11.8% of specimens (13 of 110). In representative cases, PSGR expression patterns were independently confirmed by in situ RNA hybridization. The PSGR overexpression associated with higher percentage of pathologic stage, pT3, and a higher level of preoperative serum PSA. CaP cells of African-American CaP patients exhibited about two-fold increase of PSGR expression in comparison to the Caucasian American CaP patients. Strikingly high-percentage CaP cells overexpress PSGR warrants further studies of PSGR expression alterations to define subsets of CaPs.

Authors
Xu, LL; Sun, C; Petrovics, G; Makarem, M; Furusato, B; Zhang, W; Sesterhenn, IA; McLeod, DG; Sun, L; Moul, JW; Srivastava, S
MLA Citation
Xu, LL, Sun, C, Petrovics, G, Makarem, M, Furusato, B, Zhang, W, Sesterhenn, IA, McLeod, DG, Sun, L, Moul, JW, and Srivastava, S. "Quantitative expression profile of PSGR in prostate cancer." Prostate Cancer Prostatic Dis 9.1 (2006): 56-61.
PMID
16231015
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
9
Issue
1
Publish Date
2006
Start Page
56
End Page
61
DOI
10.1038/sj.pcan.4500836

Timing and patterns of recurrences and deaths from prostate cancer following adjuvant pelvic radiotherapy for pathologic stage T3/4 adenocarcinoma of the prostate.

To determine the timing and patterns of late recurrence after radical prostatectomy (RP) alone or RP plus adjuvant radiotherapy (RT). Between 1970 and 1983, 159 patients underwent RP for newly diagnosed adenocarcinoma of the prostate and were found to have positive surgical margins, extracapsular extension and/or seminal vesicle invasion. Of these, 46 received adjuvant RT and 113 did not. The RT group generally received 45-50 Gy to the whole pelvis, then a boost to the prostate bed (total dose of 55-65 Gy). In the RP group, 62% received neoadjuvant/adjuvant androgen deprivation vs 17% in the RT group. Patients were analyzed with respect to timing and patterns of failure. Only one patient was lost to follow-up. The median follow-up for surviving patients was nearly 20 years. The median time to failure in the surgery group was 7.5 vs 14.7 years in the RT group (P=0.1). Late recurrences were less common in the surgery group than the RT group (9 and 1% at 10 and 15 years, respectively vs 17 and 9%). In contrast to recurrences, nearly half of deaths from prostate cancer occurred more than 10 years after treatment. Deaths from prostate cancer represented 55% of all deaths in these patients. Recurrences beyond 10 years after RP in this group of patients were relatively uncommon. Despite its long natural history, death from prostate cancer was the most common cause of mortality in this population with locally advanced tumors, reflecting the need for more effective therapy.

Authors
Anscher, MS; Clough, R; Robertson, CN; Prosnitz, LR; Dahm, P; Walther, P; Donatucci, CF; Albala, DM; Febbo, P; George, DJ; Sun, L; Moul, JW
MLA Citation
Anscher, MS, Clough, R, Robertson, CN, Prosnitz, LR, Dahm, P, Walther, P, Donatucci, CF, Albala, DM, Febbo, P, George, DJ, Sun, L, and Moul, JW. "Timing and patterns of recurrences and deaths from prostate cancer following adjuvant pelvic radiotherapy for pathologic stage T3/4 adenocarcinoma of the prostate." Prostate Cancer Prostatic Dis 9.3 (2006): 254-260.
PMID
16880828
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
9
Issue
3
Publish Date
2006
Start Page
254
End Page
260
DOI
10.1038/sj.pcan.4500903

Bicalutamide added to standard care reduces risk of bone metastasis: Comment

Authors
Freedland, SJ; Moul, JW
MLA Citation
Freedland, SJ, and Moul, JW. "Bicalutamide added to standard care reduces risk of bone metastasis: Comment." Oncology Report FALL (2006): 51--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2006
Start Page
51-

PSA doubling time key to reducing prostate cancer mortality: Comment

Authors
Moul, JW
MLA Citation
Moul, JW. "PSA doubling time key to reducing prostate cancer mortality: Comment." Oncology Report FALL (2006): 47-48.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2006
Start Page
47
End Page
48

Lower risk of recurrence with chemo than with lymph node dissection in stage I NSGCT: Comment

Authors
Moul, JW
MLA Citation
Moul, JW. "Lower risk of recurrence with chemo than with lymph node dissection in stage I NSGCT: Comment." Oncology Report FALL (2006): 57--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2006
Start Page
57-

Report from Durham

Authors
Moul, JW
MLA Citation
Moul, JW. "Report from Durham." Prostate Cancer and Prostatic Diseases 9.3 (2006): 199--.
Source
scival
Published In
Prostate Cancer and Prostatic Diseases
Volume
9
Issue
3
Publish Date
2006
Start Page
199-
DOI
10.1038/sj.pcan.4500908

Use of prostate-specific antigen in the follow-up of patients with localized prostate cancer: Results of a nationwide survey of urologists

Objectives: To perform a nationwide survey of urologists' opinions and behavior regarding the use of prostate-specific antigen (PSA) in prostate cancer follow-up and secondary treatment. Methods: A random sample of 300 urologists was interviewed. Content areas included defining recurrence in prostate cancer, factors that influence initiation of secondary treatment in this setting, and need for additional clinical trial information in recurrent prostate cancer. Results: Seventy-eight percent of urologists indicated that absolute PSA levels were of high or very high importance when making follow-up decisions. When defining a rising PSA level, 83% of urologists surveyed use the American Society for Therapeutic Radiology and Oncology definition of failure. An additional 78% use PSA doubling time. When asked about the importance of rapidly reducing PSA levels after recurrence, 61% said it was of high or very high importance to them, but 81% said it was of high or very high importance to their patients. Conclusions: Results from the current study indicate that urologists consider PSA failure to be an important outcome in patients with prostate cancer. Researchers and policy makers need to consider this outcome when designing studies of prostate cancer. © 2006 Elsevier Inc. All rights reserved.

Authors
Penson, D; Moul, J; Gandhi, S; Newling, D
MLA Citation
Penson, D, Moul, J, Gandhi, S, and Newling, D. "Use of prostate-specific antigen in the follow-up of patients with localized prostate cancer: Results of a nationwide survey of urologists." Urology 68.1 (2006): 80-84.
PMID
16777198
Source
scival
Published In
Urology
Volume
68
Issue
1
Publish Date
2006
Start Page
80
End Page
84
DOI
10.1016/j.urology.2006.01.028

Prostate cancer

Authors
Moul, JW
MLA Citation
Moul, JW. "Prostate cancer." Current Opinion in Urology 16.3 (2006): 121-122.
Source
scival
Published In
Current Opinion in Urology
Volume
16
Issue
3
Publish Date
2006
Start Page
121
End Page
122
DOI
10.1097/01.mou.0000193406.67166.83

Editorial introduction

Authors
Moul, JW
MLA Citation
Moul, JW. "Editorial introduction." Current Opinion in Urology 16.3 (2006): i-.
Source
scival
Published In
Current Opinion in Urology
Volume
16
Issue
3
Publish Date
2006
Start Page
i
DOI
10.1097/01.mou.0000193408.12909.56

Report from Durham

Authors
Moul, JW
MLA Citation
Moul, JW. "Report from Durham." Prostate Cancer and Prostatic Diseases 9.1 (2006): 1--.
Source
scival
Published In
Prostate Cancer and Prostatic Diseases
Volume
9
Issue
1
Publish Date
2006
Start Page
1-
DOI
10.1038/sj.pcan.4500863

PSA recurrence of prostate cancer: Update 2006

Prostaste-specific antigen (PSA) recurrence is the most common form of advanced prostate cancer. Salvage therapies may be effective even among some high-risk men, although long-term cancer control data are limited The natural history of PSA recurrence is long but variable. The postrecurrence PSA doubling time can identify men at high risk for progression and death. Early hormonal therapy, possibly via combined androgen blockade, may reduce the risk of prograssion and improve cancer-specific survival among men with high-risk recurrence. Men with low-risk recurrences likely receive minimal benefit from aggressive early hormonal therapy and may actually be harmed.

Authors
Freedland, SJ; Moul, JW; Ward, JF
MLA Citation
Freedland, SJ, Moul, JW, and Ward, JF. "PSA recurrence of prostate cancer: Update 2006." Consultant 46.14 (2006): 1613-1624.
Source
scival
Published In
Consultant
Volume
46
Issue
14
Publish Date
2006
Start Page
1613
End Page
1624

Intermittent maximum androgen blockade is a worthwhile option for metastatic disease: Comment

Authors
Freedland, SJ; Moul, JW
MLA Citation
Freedland, SJ, and Moul, JW. "Intermittent maximum androgen blockade is a worthwhile option for metastatic disease: Comment." Oncology Report FALL (2006): 50--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2006
Start Page
50-

Absolute PSA value is powerful predictor of survival after androgen deprivation: Comment

Authors
Freedland, SJ; Moul, JW
MLA Citation
Freedland, SJ, and Moul, JW. "Absolute PSA value is powerful predictor of survival after androgen deprivation: Comment." Oncology Report FALL (2006): 48-49.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2006
Start Page
48
End Page
49

Peripheral androgen blockage produces durable PSA responses in prostate cancer: Comment

Authors
Moul, JW; Freedland, SJ; George, DJ
MLA Citation
Moul, JW, Freedland, SJ, and George, DJ. "Peripheral androgen blockage produces durable PSA responses in prostate cancer: Comment." Oncology Report FALL (2006): 47--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2006
Start Page
47-

Zoledronic acid maintains BMD in GnRH agonist-treated men with prostate cancer: Comment

Authors
Freedland, SJ; George, DJ; Moul, JW
MLA Citation
Freedland, SJ, George, DJ, and Moul, JW. "Zoledronic acid maintains BMD in GnRH agonist-treated men with prostate cancer: Comment." Oncology Report FALL (2006): 51-52.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2006
Start Page
51
End Page
52

Sunitinib and temsirolimus: New standards of care for metastatic RCC? Comment

Authors
George, DJ; Moul, JW
MLA Citation
George, DJ, and Moul, JW. "Sunitinib and temsirolimus: New standards of care for metastatic RCC? Comment." Oncology Report FALL (2006): 53+57-.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2006
Start Page
53+57

Perioperative chemotherapy surprisingly underused for transitional cell carcinoma: Comment

Authors
George, DJ; Moul, JW
MLA Citation
George, DJ, and Moul, JW. "Perioperative chemotherapy surprisingly underused for transitional cell carcinoma: Comment." Oncology Report FALL (2006): 58-59.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2006
Start Page
58
End Page
59

Salvage chemotherapy yields high cure rate in recurrent germ cell tumors: Comment

Authors
George, DJ; Moul, JW
MLA Citation
George, DJ, and Moul, JW. "Salvage chemotherapy yields high cure rate in recurrent germ cell tumors: Comment." Oncology Report FALL (2006): 58--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2006
Start Page
58-

Prostate biopsy tumor extent but not location predicts recurrence after radical prostatectomy: Results from CaPSURE - Commentary

Authors
Moul, JW
MLA Citation
Moul, JW. "Prostate biopsy tumor extent but not location predicts recurrence after radical prostatectomy: Results from CaPSURE - Commentary." Journal of Urology 175.1 (2006): 129--.
Source
scival
Published In
The Journal of Urology
Volume
175
Issue
1
Publish Date
2006
Start Page
129-
DOI
10.1016/S0022-5347(05)00267-3

The Eisenberger/Sinibaldi article reviewed

Authors
Moul, JW
MLA Citation
Moul, JW. "The Eisenberger/Sinibaldi article reviewed." ONCOLOGY 20.8 (2006): 863--.
Source
scival
Published In
Oncology
Volume
20
Issue
8
Publish Date
2006
Start Page
863-

Prostate-specific antigen versus prostate-specific antigen density as predictor of tumor volume, margin status, pathologic stage, and biochemical recurrence of prostate cancer.

OBJECTIVES: To compare prostate-specific antigen (PSA) and PSA density (PSAD) calculated by transrectal ultrasound (TRUS) volume (TRUS PSAD), pathologic volume (Path PSAD), and weight (Weight PSAD) for their ability to predict pathologic characteristics and biochemical recurrence of prostate cancer. We also compared all PSAD derivatives to determine consistency. METHODS: Between 1993 and 2002, 306 patients were retrospectively identified who had had PSAD determined preoperatively by TRUS and subsequently underwent radical prostatectomy with whole mounting and close step sectioning. The determination of stage, margin status, tumor number, individual tumor volume, and total tumor volume was obtained from the pathologic evaluation. Clinical follow-up was available for 265 patients. RESULTS: The mean patient age was 62 years, the median Gleason score was 7, the median PSA level was 5.80 ng/mL, and the median TRUS PSAD was 0.16. The percentages of concordance for PSA, TRUS PSAD, Path PSAD, and Weight PSAD were similar in predicting margin status and extracapsular extension. Using linear regression analysis, PSA was more efficacious than TRUS PSAD, Path PSAD, or Weight PSAD in predicting the total tumor volume (R2 0.11, 0.08, 0.04, and 0.06, respectively). A significant positive correlation was found among TRUS PSAD, Path PSAD, and Weight PSAD. PSA was significantly better in predicting biochemical recurrence than TRUS, Path, or Weight PSAD (concordance 75.5%, 66.6%, 66.5%, and 70.4%, respectively). CONCLUSIONS: PSA and TRUS PSAD are significant and equivalent predictors of margin status and extracapsular extension. A marked difference may exist between PSA and TRUS PSAD in predicting the total tumor volume and biochemical recurrence.

Authors
Brassell, SA; Kao, T-C; Sun, L; Moul, JW
MLA Citation
Brassell, SA, Kao, T-C, Sun, L, and Moul, JW. "Prostate-specific antigen versus prostate-specific antigen density as predictor of tumor volume, margin status, pathologic stage, and biochemical recurrence of prostate cancer." Urology 66.6 (December 2005): 1229-1233.
PMID
16360448
Source
pubmed
Published In
Urology
Volume
66
Issue
6
Publish Date
2005
Start Page
1229
End Page
1233
DOI
10.1016/j.urology.2005.06.106

The changing face of prostate cancer.

Prostate cancer remains the most common noncutaneous human malignancy, and the second most lethal tumor among men. However, the natural history of the disease is often prolonged, and the survival benefits of local therapy for men with low-risk tumors may not be realized for a decade or more, as is increasingly well demonstrated in long-term observational cohorts in both the United States and Europe. A significant proportion of men with prostate cancer may be overdiagnosed, in the sense that diagnosis may not improve their lifespan or quality of life. However, the extent to which overdiagnosis represents a true problem relates to the consistency with which diagnosis leads invariably to active treatment. Prostate cancer is diagnosed at progressively earlier stages and with lower risk features; despite these trends, patients are less likely now than a decade ago to undergo a trial of active surveillance. Rates of brachytherapy and hormonal therapy use, in particular, have risen markedly. Important progress has been made in recent years in prostate cancer risk assessment. These advances, in combination with biomarkers in later stages of development, should be expected in the coming years to yield further improvements in clinicians' ability to diagnose prostate cancer early, and guide appropriately selected patients toward increasingly tailored treatment.

Authors
Cooperberg, MR; Moul, JW; Carroll, PR
MLA Citation
Cooperberg, MR, Moul, JW, and Carroll, PR. "The changing face of prostate cancer." J Clin Oncol 23.32 (November 10, 2005): 8146-8151. (Review)
PMID
16278465
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
23
Issue
32
Publish Date
2005
Start Page
8146
End Page
8151
DOI
10.1200/JCO.2005.02.9751

Screening for prostate cancer in military populations.

With the widespread use of the prostate-specific antigen (PSA) test, smaller cancers are being detected among younger men and 5-year, cancer-specific, survival rates are on the rise. Although this lead-time effect may not translate into long-term improvement, these changes are a necessary prerequisite to effective screening. For high-risk patients, i.e., men with a family history of the disease and African American men, a strategy consisting of annual PSA blood testing and digital rectal examination for men > or = 40 years of age appears prudent. Many low/average-risk men of age 40 to 49 also request testing, and it is reasonable to offer testing and risk assessment to them. The exact screening threshold for total PSA levels for these men is not known, but 95% have PSA levels of < or = 1.5 to 2.5 ng/mL. PSA velocity (< 20% per year), percentage of free PSA (> 18-25%), and complexed PSA levels may be used to help determine risk. More study of young men is needed.

Authors
Moul, JW
MLA Citation
Moul, JW. "Screening for prostate cancer in military populations." Mil Med 170.11 (November 2005): 905-914.
PMID
16450815
Source
pubmed
Published In
Military medicine
Volume
170
Issue
11
Publish Date
2005
Start Page
905
End Page
914

Predictors of prostate cancer-specific mortality after radical prostatectomy or radiation therapy.

PURPOSE: We evaluated predictors of prostate cancer-specific mortality (PCSM) after prostate-specific antigen (PSA) failure after radical prostatectomy (RP) or radiation therapy (RT). PATIENTS AND METHODS: A total of 1,159 men with clinically localized prostate cancer treated with RP (n = 498) or RT (n = 661) developed PSA failure, and they formed the study cohort. Competing risk regression analyses were used to evaluate whether previously identified predictors of time to metastasis, including post-treatment PSA doubling time (PSA-DT), Gleason score, and interval to PSA failure, could also predict time to PCSM after PSA failure. The cumulative incidence method was used to estimate PCSM after PSA failure. RESULTS: A post-RP PSA-DT of less than 3 months (hazard ratio [HR], 54.9; 95% CI, 16.7 to 180), a post-RT PSA-DT of less than 3 months (HR, 12.8; 95% CI, 7.0 to 23.1), and a biopsy Gleason score of 8 to 10 (HR, 6.1; 95% CI, 3.4 to 10.7) for patients treated with RT were significantly associated with PCSM. Post-RP estimated rates of PCSM 5 years after PSA failure were 31% (95% CI, 17% to 45%) v 1% (95% CI, 0% to 2%) for patients with PSA-DT of less than 3 months v > or = 3 months. Post-RT estimated rates of PCSM 5 years after PSA failure were 75% (95% CI, 59% to 92%) v 35% (95% CI, 24% to 47%) for patients with a biopsy Gleason score of > or = 8 v < or = 7, respectively, and PSA-DT of less than 3 months; these rates were 15% (95% CI, 0.8% to 28%) v 4% (95% CI, 1% to 6%), respectively, for patients with a PSA-DT > or = 3 months. CONCLUSION: Patients at high risk for PCSM after PSA failure can be identified based on post-RP PSA-DT or post-RT PSA-DT and biopsy Gleason score. These parameters may be useful in identifying patients for a randomized trial evaluating hormonal therapy with or without docetaxel.

Authors
Zhou, P; Chen, M-H; McLeod, D; Carroll, PR; Moul, JW; D'Amico, AV
MLA Citation
Zhou, P, Chen, M-H, McLeod, D, Carroll, PR, Moul, JW, and D'Amico, AV. "Predictors of prostate cancer-specific mortality after radical prostatectomy or radiation therapy." J Clin Oncol 23.28 (October 1, 2005): 6992-6998.
PMID
16192586
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
23
Issue
28
Publish Date
2005
Start Page
6992
End Page
6998
DOI
10.1200/JCO.2005.01.2906

Prostate-specific antigen nadir and cancer-specific mortality following hormonal therapy for prostate-specific antigen failure.

PURPOSE: For men receiving androgen-suppression therapy (AST) for a rising postoperative or postradiation prostate-specific antigen (PSA), we evaluated whether a PSA nadir of more than 0.2 ng/mL was significantly associated with prostate cancer-specific mortality (PCSM). PATIENTS AND METHODS: The study cohort comprised 747 men with rising PSA and negative bone scan after surgery (n = 486) or radiation therapy (n = 261) who were treated with AST. Cox regression was used to evaluate whether a significant association existed between the PSA nadir level after 8 months of AST and the time to PCSM, controlling for treatment and known prognostic factors. RESULTS: The post-AST PSA nadir (pCox < .0001), the pre-AST PSA doubling time (DT) (pCox = .002), PSA level (P = .0001), and Gleason eight to 10 cancers (pCox = .01) were significantly associated with time to PCSM. The adjusted hazard ratio for PCSM was 20 (95% CI, 7 to 61; pCox < .0001), for men with a PSA nadir of more than 0.2 ng/mL as compared with all others. A PSA DT of less than 3 months was observed in 30% (224 of 747) of the study cohort. Of the 28 observed prostate cancer deaths, 21 (75%) occurred in men whose PSA nadir was more than 0.2 ng/mL and who had a PSA DT of less than 3 months. CONCLUSION: A PSA nadir of more than 0.2 ng/mL after 8 months of AST given for postoperative or postradiation PSA failure is significantly associated with PCSM and is clinically significant because it accounted for 75% of the cancer deaths observed in this study.

Authors
Stewart, AJ; Scher, HI; Chen, M-H; McLeod, DG; Carroll, PR; Moul, JW; D'Amico, AV
MLA Citation
Stewart, AJ, Scher, HI, Chen, M-H, McLeod, DG, Carroll, PR, Moul, JW, and D'Amico, AV. "Prostate-specific antigen nadir and cancer-specific mortality following hormonal therapy for prostate-specific antigen failure." J Clin Oncol 23.27 (September 20, 2005): 6556-6560.
PMID
16170163
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
23
Issue
27
Publish Date
2005
Start Page
6556
End Page
6560
DOI
10.1200/JCO.2005.20.966

Radical perineal prostatectomy for the treatment of localized prostate cancer in morbidly obese patients.

PURPOSE: We assessed the feasibility of radical perineal prostatectomy (RPP) in morbidly obese patients with clinically organ confined prostate cancer. MATERIALS AND METHODS: Of 1,265 consecutive patients who underwent RPP at our institution from 1992 to 2003 we identified 18 with a body mass index (BMI) of 40 kg/m or greater. Demographic and clinical patient characteristics were obtained from the medical records, which were further reviewed to identify the perioperative incidence of surgical and anesthesia related complications. RESULTS: Median BMI was 41.7 kg/m (range 40.2 to 62.6). Five patients had a BMI of 45.0 kg/m or greater. No intraoperative or anesthesia related complication occurred. Mean operative time +/- SD was 188 +/- 32 minutes and estimated blood loss was 573 +/- 285 ml. None of the 18 patients received blood transfusions. During the immediate postoperative period 4 complications occurred in the form of lower extremity neuropraxia in 2 patients, local skin bleeding in 1 and early sepsis in 1 requiring rehospitalization for intravenous antibiotics. Mean operative time and estimated blood loss were significantly lower when surgery was performed by a highly experienced surgeon compared with experienced surgeons (174 +/- 21 vs 235 +/- 10 minutes and 485 +/- 258 vs 838 +/- 197 ml, p = 0.001 and 0.027, respectively). CONCLUSIONS: RPP in morbidly obese patients is feasible and it is associated with acceptable perioperative morbidity. The perineal approach should be considered in morbidly obese patients seeking surgical treatment for clinically localized prostate cancer.

Authors
Dahm, P; Yang, BK; Salmen, CR; Moul, JW; Gan, TJ
MLA Citation
Dahm, P, Yang, BK, Salmen, CR, Moul, JW, and Gan, TJ. "Radical perineal prostatectomy for the treatment of localized prostate cancer in morbidly obese patients." J Urol 174.1 (July 2005): 131-134.
PMID
15947597
Source
pubmed
Published In
The Journal of Urology
Volume
174
Issue
1
Publish Date
2005
Start Page
131
End Page
134
DOI
10.1097/01.ju.0000161593.29525.e2

Predictors of prostate cancer-specific mortality following radical prostatectomy or radiation therapy.

Authors
Zhou, P; Chen, MH; McLeod, D; Carroll, PR; Moul, JW; D'Amico, AV
MLA Citation
Zhou, P, Chen, MH, McLeod, D, Carroll, PR, Moul, JW, and D'Amico, AV. "Predictors of prostate cancer-specific mortality following radical prostatectomy or radiation therapy." June 1, 2005.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
23
Issue
16
Publish Date
2005
Start Page
389S
End Page
389S

Predictors of prostate cancer-specific mortality following radical prostatectomy or radiation therapy.

4548 Background: PSA-defined recurrence as far out as 10 years following radical prostatectomy (RP) or radiation therapy (RT) for men with clinically localized prostate cancer occurs in up to 30% of cases. Yet a minority of these men will experience prostate cancer-specific mortality (PCSM). This study was performed to define the predictors of PCSM following PSA failure.A total of 1159 men with clinically localized prostate cancer treated with RP (N = 498) or RT (N = 661) developed PSA failure and they formed the study cohort. The median follow-up was 5.9 and 5.2 years for the RP and RT groups, respectively. Cox regression analyses were used to evaluate whether previously identified predictors of time to metastasis including post-treatment PSA doubling time (PSA-DT), Gleason score, and interval to PSA failure could also predict time to PCSM following PSA failure. Cumulative incidence method was used to estimate PCSM following PSA failure.The post-treatment PSA-DT < 3 months after RP or RT and a biopsy Gleason score ≥ 8 in patients treated with RT were significantly associated with time to PCSM following PSA failure (Table). Postoperative estimates of PCSM (95% CI) 5 years following PSA failure were 31% (17-45%) versus 1% (0-2%) for patients with a PSA-DT < 3 months versus ≥ 3 months, respectively. Post-RT estimates of PCSM 5 years following PSA failure were 75% (59-92%) versus 35% (24-47%) for patients with a biopsy Gleason ≥ 8 versus ≤ 7 and a PSA-DT < 3 months; these estimates were 15% (0.8-28%) versus 4% (1-6%) for patients with a PSA-DT ≥ 3 months.Patients at high risk for PCSM following PSA failure can be identified based on the post-RP PSA-DT or the post-RT PSA-DT and biopsy Gleason score. These parameters identify the optimal patient selection for a randomized trial evaluating hormonal therapy with or without Taxotere. [Figure: see text] No significant financial relationships to disclose.

Authors
Zhou, P; Chen, MH; McLeod, D; Carroll, PR; Moul, JW; D'Amico, AV
MLA Citation
Zhou, P, Chen, MH, McLeod, D, Carroll, PR, Moul, JW, and D'Amico, AV. "Predictors of prostate cancer-specific mortality following radical prostatectomy or radiation therapy." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 23.16_suppl (June 2005): 4548-.
PMID
27946342
Source
epmc
Published In
Journal of Clinical Oncology
Volume
23
Issue
16_suppl
Publish Date
2005
Start Page
4548

Low-risk prostate cancer patient: active treatment.

We currently lack a prospective, randomized, multicenter trial, to reassure low-risk prostate cancer patients, especially younger ones, that watchful waiting is a legitimate treatment. To better manage these patients, we need to: first, confirm that the patient has low-risk prostate cancer; second, adapt the treatment to the risk (i.e., if therapy is chosen over watchful waiting, it should be monotherapy not multiple therapy); third, be aware of age migration; fourth, know that radical prostatectomy and radiation were shown to be very effective for these patients at 10-year follow-up; and lastly, make an effort to better define watchful waiting and embrace it more, to avoid overtreatment.

Authors
Moul, JW; Saad, F
MLA Citation
Moul, JW, and Saad, F. "Low-risk prostate cancer patient: active treatment." Can J Urol 12 Suppl 2 (June 2005): 25-27. (Review)
PMID
16018829
Source
pubmed
Published In
Canadian Journal of Urology
Volume
12 Suppl 2
Publish Date
2005
Start Page
25
End Page
27

Treating the biochemical recurrence of prostate cancer after definitive primary therapy.

As increasing numbers of men are living longer with prostate cancer, larger proportions will eventually present to our collective practices with increasing prostate-specific antigen (PSA) levels. Such PSA relapses, conservatively estimated to affect approximately 50,000 men each year, have become the most common form of advanced prostate cancer. Salvage radiation therapy and salvage prostatectomy have important roles in our therapeutic armamentarium and should be valid options for young, healthy men. Counseling patients regarding expectations for cancer control and treatment morbidity has become better because of reports from larger series of patients who have had salvage radiation therapy and surgery. Some patients may not be appropriate candidates for salvage local therapies. A growing body of evidence suggests early hormonal therapy improves progression-free survival (PFS) and could alter cancer-specific survival. This benefit seems to be greatest when hormonal therapy is initiated while PSA levels are low, before clinically measurable disease becomes apparent. However, there is a cost to be paid in side effects and health care dollars when androgen deprivation is administered over prolonged periods. The nonsteroidal antiandrogen agent bicalutamide could offer PFS equivalent to that seen with castration without the complications of androgen deprivation. Observational data seem to indicate that individuals at high risk could also receive benefit from therapy administered before PSA detection. The potential opportunities for novel therapeutic agents with low associated morbidity are great.

Authors
Ward, JF; Moul, JW
MLA Citation
Ward, JF, and Moul, JW. "Treating the biochemical recurrence of prostate cancer after definitive primary therapy." Clin Prostate Cancer 4.1 (June 2005): 38-44. (Review)
PMID
15992460
Source
pubmed
Published In
Clinical prostate cancer
Volume
4
Issue
1
Publish Date
2005
Start Page
38
End Page
44

Frequent overexpression of ETS-related gene-1 (ERG1) in prostate cancer transcriptome.

Transcription factors encoded by the ETS family of genes are central in integrating signals that regulate cell growth and differentiation, stress responses, and tumorigenesis. This study, analysing laser microdissected paired benign and malignant prostate epithelial cells from prostate cancer (CaP) patients (n=114; 228 specimen) by GeneChip and quantitative real-time RT-PCR, identifies ETS-related gene (ERG), a member of the ETS transcription factor family, as the most frequently overexpressed proto-oncogene in the transcriptome of malignant prostate epithelial cells. Combined quantitative expression analysis of ERG with two other genes commonly overexpressed in CaP, AMACR and DD3, revealed overexpression of at least one of these three genes in virtually all CaP specimen (54 of 55). Comprehensive evaluation of quantitative ERG1 expression with clinicopathological features also suggested that ERG1 expression level in prostate tumor cells relative to benign epithelial cells is indicator of disease-free survival after radical prostatectomy.

Authors
Petrovics, G; Liu, A; Shaheduzzaman, S; Furusato, B; Sun, C; Chen, Y; Nau, M; Ravindranath, L; Chen, Y; Dobi, A; Srikantan, V; Sesterhenn, IA; McLeod, DG; Vahey, M; Moul, JW; Srivastava, S
MLA Citation
Petrovics, G, Liu, A, Shaheduzzaman, S, Furusato, B, Sun, C, Chen, Y, Nau, M, Ravindranath, L, Chen, Y, Dobi, A, Srikantan, V, Sesterhenn, IA, McLeod, DG, Vahey, M, Moul, JW, and Srivastava, S. "Frequent overexpression of ETS-related gene-1 (ERG1) in prostate cancer transcriptome." Oncogene 24.23 (May 26, 2005): 3847-3852.
PMID
15750627
Source
pubmed
Published In
Oncogene: Including Oncogene Reviews
Volume
24
Issue
23
Publish Date
2005
Start Page
3847
End Page
3852
DOI
10.1038/sj.onc.1208518

Proteomics in prostate cancer.

PURPOSE OF REVIEW: State-of-the-art proteomics technologies are currently being assessed for utility in the study of prostatic malignancy. This review aims to provide background information on the current proteomics techniques employed in prostate cancer research, recent reports showing the potential application of proteomics in urological practice, and the future direction of proteomics in prostate cancer research and management. RECENT FINDINGS: Proteomic profiling of serum as a diagnostic tool and a platform for biomarker discovery in prostate cancer continues to draw favorable attention as well as close scrutiny as technological enhancements and multi-center study results are reported. In-vitro studies on prostate cell lines provide positive proof-of-principle results. The application of proteomics to query prostate tissue specimens yields novel prostate cancer biomarkers requiring further validation. The integration of proteomics with immunology also yields promising findings that may translate into clinically relevant biological assays. SUMMARY: The study of proteomics is an emerging research field, and current studies continue to display potential future usage in prostate cancer management. Succeeding scientific investigations will probably yield new diagnostic and prognostic tools for prostate cancer, provide insights into its underlying biology, and contribute to the development of novel treatment strategies.

Authors
Bañez, LL; Srivastava, S; Moul, JW
MLA Citation
Bañez, LL, Srivastava, S, and Moul, JW. "Proteomics in prostate cancer." Curr Opin Urol 15.3 (May 2005): 151-156. (Review)
PMID
15815190
Source
pubmed
Published In
Current Opinion in Urology
Volume
15
Issue
3
Publish Date
2005
Start Page
151
End Page
156

Biochemical recurrence after definitive prostate cancer therapy. Part II: treatment strategies for biochemical recurrence of prostate cancer.

PURPOSE OF REVIEW: Through the prostate-specific antigen era, the proportion of men less than 55 years old with newly diagnosed prostate cancer more than doubled to almost 15%. As increasing numbers of men are living longer with prostate cancer, larger proportions will eventually present to our collective practices with rising prostate-specific antigen levels. Such prostate-specific antigen relapses, conservatively estimated to affect approximately 50 000 men each year, have become the most common form of advanced prostate cancer in the current period. RECENT FINDINGS: Increasing evidence suggests that early hormonal therapy improves progression-free survival and may alter the cancer-specific survival. However, there is a cost to pay in side-effects when androgen deprivation is administered over prolonged periods. The non-steroidal anti-androgen bicalutamide may offer an equivalent progression-free survival to castration without the complications of androgen deprivation. Observational data seem to indicate that high-risk individuals (i.e. those with high-grade, high-stage disease or a prostate-specific antigen doubling time less than 12 months) may also receive benefit from early therapy. SUMMARY: The definition of advanced prostate cancer has changed. Multimodal therapy improves cancer-specific outcomes especially in men with high-risk disease. The potential opportunities for novel therapeutic agents with low associated morbidity are great.

Authors
Ward, JF; Moul, JW
MLA Citation
Ward, JF, and Moul, JW. "Biochemical recurrence after definitive prostate cancer therapy. Part II: treatment strategies for biochemical recurrence of prostate cancer." Curr Opin Urol 15.3 (May 2005): 187-195. (Review)
PMID
15815196
Source
pubmed
Published In
Current Opinion in Urology
Volume
15
Issue
3
Publish Date
2005
Start Page
187
End Page
195

Biochemical recurrence after definitive prostate cancer therapy. Part I: defining and localizing biochemical recurrence of prostate cancer.

PURPOSE OF REVIEW: The introduction of prostate-specific antigen into clinical practice heralded a dramatic shift in the epidemiology of prostate cancer. The diagnosis and treatment of lower stage disease in younger men with fewer competing co-morbidities has resulted in a longer period of post-treatment cancer surveillance and the potential for disease recurrence. Life-long periodic prostate-specific antigen testing for biochemical recurrence is standard of care; however, there is no single definition of biochemical recurrence that reliably predicts clinical recurrence. This review explores the complexities of biochemical recurrence, a thorough understanding of which is crucial to making appropriate treatment decisions after primary treatment. It also evaluates the array of diagnostic tests frequently employed when biochemical recurrence has occurred. RECENT FINDINGS: There is a disconnection between biochemical recurrence and progression to clinical disease. The definition of biochemical recurrence varies both by the prostate-specific antigen cut-point used and by the primary therapy employed. Furthermore, biochemical recurrence by itself appears not to be as reliable a predictor of eventual clinical recurrence as prostate-specific antigen doubling time. Current imaging modalities are rarely useful in localizing disease when biochemical recurrence is first detected. SUMMARY: The correct interpretation of biochemical recurrence is crucial to treatment decision-making. New data show that prostate-specific antigen doubling time during prostate-specific antigen recurrence may be a valid surrogate for death from the disease. The potential therefore exists for prostate-specific antigen doubling time to be accepted as a trial endpoint, which might accelerate drug approval by the United States Food and Drug Administration.

Authors
Ward, JF; Moul, JW
MLA Citation
Ward, JF, and Moul, JW. "Biochemical recurrence after definitive prostate cancer therapy. Part I: defining and localizing biochemical recurrence of prostate cancer." Curr Opin Urol 15.3 (May 2005): 181-186. (Review)
PMID
15815195
Source
pubmed
Published In
Current Opinion in Urology
Volume
15
Issue
3
Publish Date
2005
Start Page
181
End Page
186

Untitled

Authors
Moul, JW
MLA Citation
Moul, JW. "Untitled." CURRENT OPINION IN UROLOGY 15.3 (May 2005): I-I.
Source
wos-lite
Published In
Current Opinion in Urology
Volume
15
Issue
3
Publish Date
2005
Start Page
I
End Page
I

Rising prostate-specific antigen after primary prostate cancer therapy.

An estimated 20-40% of men experience a biochemical recurrence within 10 years of definitive prostate cancer treatment. No single prostate-specific antigen (PSA) value is invariably associated with clinical metastasis or cancer-specific survival; PSA kinetics might prove to be a more important predictor of eventual progression-free survival and cancer-specific survival than absolute PSA level alone. With only one-third of patients progressing from biochemical recurrence to clinical disease, therapeutic morbidity should not outpace risk of disease progression. Salvage radiation therapy following radical prostatectomy has widely variable long-term biochemical control rates (from 18 to 64% depending on the follow-up period). Early hormonal therapy delivered as castration or complete androgen blockade might delay clinical metastasis in patients with high-risk pathologic disease; however, the adverse effects and morbidity of long-term therapy must not be underestimated. Non-steroidal antiandrogens as monotherapy for early biochemical recurrence, particularly for younger men who wish to preserve their libido and sexual potency, have received considerable attention, but there are conflicting data on long-term outcomes. Because of their favorable adverse-effect profiles, non-traditional therapies that exert localized hormonal or cellular effects are receiving considerable attention for treatment of early, PSA-only recurrence. Data from animal models provide a rationale for the use of these therapies, but there is a lack of evidence to support prolongation of progression-free survival or cancer-specific survival.

Authors
Ward, JF; Moul, JW
MLA Citation
Ward, JF, and Moul, JW. "Rising prostate-specific antigen after primary prostate cancer therapy." Nat Clin Pract Urol 2.4 (April 2005): 174-182. (Review)
PMID
16474760
Source
pubmed
Published In
Nature Clinical Practice Urology
Volume
2
Issue
4
Publish Date
2005
Start Page
174
End Page
182
DOI
10.1038/ncpuro0145

Hormonal therapy options for prostate-specific antigen-only recurrence of prostate cancer after previous local therapy.

Authors
Moul, JW; Zlotta, AR
MLA Citation
Moul, JW, and Zlotta, AR. "Hormonal therapy options for prostate-specific antigen-only recurrence of prostate cancer after previous local therapy." BJU Int 95.3 (February 2005): 285-290. (Review)
PMID
15679779
Source
pubmed
Published In
Bju International
Volume
95
Issue
3
Publish Date
2005
Start Page
285
End Page
290
DOI
10.1111/j.1464-410X.2005.05284.x

Evaluation of serum protein profiling by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry for the detection of prostate cancer: I. Assessment of platform reproducibility.

BACKGROUND: Protein expression profiling for differences indicative of early cancer has promise for improving diagnostics. This report describes the first stage of a National Cancer Institute/Early Detection Research Network-sponsored multiinstitutional evaluation and validation of this approach for detection of prostate cancer. METHODS: Two sequential experimental phases were conducted to establish interlaboratory calibration and standardization of the surface-enhanced laser desorption (SELDI) instrumental and assay platform output. We first established whether the output from multiple calibrated Protein Biosystem II SELDI-ionization time-of-flight mass spectrometry (TOF-MS) instruments demonstrated acceptable interlaboratory reproducibility. This was determined by measuring mass accuracy, resolution, signal-to-noise ratio, and normalized intensity of three m/z "peaks" present in a standard pooled serum sample. We next evaluated the ability of the calibrated and standardized instrumentation to accurately differentiate between selected cases of prostate cancer and control by use of an algorithm developed from data derived from a single site 2 years earlier. RESULTS: When the described standard operating procedures were established at all laboratory sites, the across-laboratory measurements revealed a CV for mass accuracy of 0.1%, signal-to-noise ratio of approximately 40%, and normalized intensity of 15-36% for the three pooled serum peaks. This was comparable to the intralaboratory measurements of the same peaks. The instrument systems were then challenged with sera from a selected group of 14 cases and 14 controls. The classification agreement between each site and the established decision algorithm were examined by use of both raw peak intensity boosting and ranked peak intensity boosting. All six sites achieved perfect blinded classification for all samples when boosted alignment of raw intensities was used. Four of six sites achieved perfect blinded classification with ranked intensities, with one site passing the criteria of 26 of 28 correct and one site failing with 19 of 28 correct. CONCLUSIONS: These results demonstrate that "between-laboratory" reproducibility of SELDI-TOF-MS serum profiling approaches that of "within-laboratory" reproducibility as determined by measuring discrete m/z peaks over time and across laboratories.

Authors
Semmes, OJ; Feng, Z; Adam, B-L; Banez, LL; Bigbee, WL; Campos, D; Cazares, LH; Chan, DW; Grizzle, WE; Izbicka, E; Kagan, J; Malik, G; McLerran, D; Moul, JW; Partin, A; Prasanna, P; Rosenzweig, J; Sokoll, LJ; Srivastava, S; Srivastava, S; Thompson, I; Welsh, MJ; White, N; Winget, M; Yasui, Y; Zhang, Z; Zhu, L
MLA Citation
Semmes, OJ, Feng, Z, Adam, B-L, Banez, LL, Bigbee, WL, Campos, D, Cazares, LH, Chan, DW, Grizzle, WE, Izbicka, E, Kagan, J, Malik, G, McLerran, D, Moul, JW, Partin, A, Prasanna, P, Rosenzweig, J, Sokoll, LJ, Srivastava, S, Srivastava, S, Thompson, I, Welsh, MJ, White, N, Winget, M, Yasui, Y, Zhang, Z, and Zhu, L. "Evaluation of serum protein profiling by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry for the detection of prostate cancer: I. Assessment of platform reproducibility." Clin Chem 51.1 (January 2005): 102-112.
PMID
15613711
Source
pubmed
Published In
Clinical chemistry
Volume
51
Issue
1
Publish Date
2005
Start Page
102
End Page
112
DOI
10.1373/clinchem.2004.038950

Androgen and androgen receptor antagonist responsive primary African-American benign prostate epithelial cell line.

The generation of suitable in vitro models is critical for understanding the process associated with the development and progression of prostate cancer in high-risk African-American men. However, the generation of long-term human prostate epithelial cell lines derived from primary human prostate epithelium have been unsuccessful due to the absence of in vitro immortalization. We have successfully established an immortal human prostate epithelial cell line from primary benign tissues of African-American prostate cancer patients by using telomerase. The actively proliferating secondary African-American prostate epithelial RC-165N cells, derived from benign prostate tissue of a radical prostatectomy specimen, were transduced through infection with a retrovirus vector expressing the human telomerase catalytic subunit (hTERT). A high level of telomerase activity was detected in RC-165N/hTERT cells but not in RC-165N cells. RC-165N/hTERT cells are currently growing well at passage 50 whereas RC-165N cells senesced within passage 3. RC-165N/hTERT cells exhibit epithelial morphology. These immortalized cells showed no cell growth in soft agar, and no tumor formation in SCID mice. The RC-165N/hTERT cells express androgen-regulated prostate-specific homobox gene. NKX 3.1 and epithelial cell specific cytokeratin 8, androgen receptor (AR), prostate stem cell antigen and p16, but not PSA. AR protein was detected by Western blot analysis.

Authors
Gu, Y; Kim, K-H; Ko, D; Srivastava, S; Moul, JW; McLeod, DG; Rhim, JS
MLA Citation
Gu, Y, Kim, K-H, Ko, D, Srivastava, S, Moul, JW, McLeod, DG, and Rhim, JS. "Androgen and androgen receptor antagonist responsive primary African-American benign prostate epithelial cell line." Anticancer Res 25.1A (January 2005): 1-8.
PMID
15816512
Source
pubmed
Published In
Anticancer research
Volume
25
Issue
1A
Publish Date
2005
Start Page
1
End Page
8

Adjuvant RT reduces biochemical progression after radical prostatectomy. Comment

Authors
Moul, JW
MLA Citation
Moul, JW. "Adjuvant RT reduces biochemical progression after radical prostatectomy. Comment." Oncology Report FALL (2005): 55--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2005
Start Page
55-

Immunization with TG4010 appears biologically active in prostate cancer. Comment

Authors
Dahm, P; Moul, JW
MLA Citation
Dahm, P, and Moul, JW. "Immunization with TG4010 appears biologically active in prostate cancer. Comment." Oncology Report FALL (2005): 56--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2005
Start Page
56-

Report from Durham

Authors
Moul, J
MLA Citation
Moul, J. "Report from Durham." Prostate Cancer and Prostatic Diseases 8.1 (2005): 1--.
PMID
15775990
Source
scival
Published In
Prostate Cancer and Prostatic Diseases
Volume
8
Issue
1
Publish Date
2005
Start Page
1-
DOI
10.1038/sj.pcan.4500795

Treating invasive bladder cancer with TUR/chemotherapy feasible for selected patients

Authors
Moul, JW
MLA Citation
Moul, JW. "Treating invasive bladder cancer with TUR/chemotherapy feasible for selected patients." Oncology Report SPRING (2005): 58-59.
Source
scival
Published In
Oncology Report
Issue
SPRING
Publish Date
2005
Start Page
58
End Page
59

Radiation dose escalation for early-stage prostate cancer found safe and effective

Authors
Moul, JW
MLA Citation
Moul, JW. "Radiation dose escalation for early-stage prostate cancer found safe and effective." Oncology Report SPRING (2005): 52-53.
Source
scival
Published In
Oncology Report
Issue
SPRING
Publish Date
2005
Start Page
52
End Page
53

Report from Durham

Authors
Moul, JW
MLA Citation
Moul, JW. "Report from Durham." Prostate Cancer and Prostatic Diseases 8.3 (2005): 201--.
Source
scival
Published In
Prostate Cancer and Prostatic Diseases
Volume
8
Issue
3
Publish Date
2005
Start Page
201-
DOI
10.1038/sj.pcan.4500829

Bone complications in prostate cancer: Current and future role of bisphosphonates

Authors
Saad, F; Moul, J
MLA Citation
Saad, F, and Moul, J. "Bone complications in prostate cancer: Current and future role of bisphosphonates." Current Oncology 12.3 (2005): 71-75.
Source
scival
Published In
Current oncology (Toronto, Ont.)
Volume
12
Issue
3
Publish Date
2005
Start Page
71
End Page
75

High probability of metastases or death in untreated prostate cancer. Comment

Authors
Moul, JW
MLA Citation
Moul, JW. "High probability of metastases or death in untreated prostate cancer. Comment." Oncology Report FALL (2005): 58-59.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2005
Start Page
58
End Page
59

Favorable trends with DN-101 and docetaxel in androgen-independent prostate cancer. Comment

Authors
Moul, JW
MLA Citation
Moul, JW. "Favorable trends with DN-101 and docetaxel in androgen-independent prostate cancer. Comment." Oncology Report FALL (2005): 54--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2005
Start Page
54-

TICE chemotherapy achieves good response in germ cell tumors. Comment

Authors
Moul, JW; Dahm, P
MLA Citation
Moul, JW, and Dahm, P. "TICE chemotherapy achieves good response in germ cell tumors. Comment." Oncology Report FALL (2005): 60-61.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2005
Start Page
60
End Page
61

RT-PCR for PSA predicts time to disease progression in HR prostate cancer. Comment

Authors
Moul, JW
MLA Citation
Moul, JW. "RT-PCR for PSA predicts time to disease progression in HR prostate cancer. Comment." Oncology Report FALL (2005): 57--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2005
Start Page
57-

Prostate cancer

Authors
Moul, JW
MLA Citation
Moul, JW. "Prostate cancer." Current Opinion in Urology 15.3 (2005): 149-150.
Source
scival
Published In
Current Opinion in Urology
Volume
15
Issue
3
Publish Date
2005
Start Page
149
End Page
150

Surrogate end point for prostate cancer specific mortality in patients with nonmetastatic hormone refractory prostate cancer

Purpose: We determined whether prostate specific antigen (PSA) velocity can serve as surrogate end point for prostate cancer specific mortality (PCSM) in patients with nonmetastatic, hormone refractory prostate cancer. Materials and Methods: The study cohort comprised 919 men treated from 1988 to 2002 at 1 of 44 institutions with surgery (560) or radiation therapy (359) for clinical stages Tlc-4NxMo prostate cancer, followed by salvage hormonal therapy for PSA failure. All patients experienced PSA defined recurrence while on hormonal therapy. Prentice criteria require that the surrogate should be a prognostic factor and the treatment used did not alter time to PCSM following achievement of the surrogate end point. These criteria were tested using Cox regression. All statistical tests were 2-sided, Results: PSA velocity greater than 1.5 ng/ml yearly was statistically significantly associated with time to PCSM and all cause mortality following PSA defined recurrence while undergoing hormonal therapy (Cox p <0.0001). While initial treatment was statistically associated with time to PCSM and all cause mortality (Cox p = 0.001 and 0.01), this association became insignificant when PSA velocity and potential confounding variables were included in the Cox model (p = 0.22 and 0.93, respectively). The adjusted HR for PCSM in patients who experienced a greater than 1.5 ng/ml increase in PSA within 1 year while on hormonal therapy was 239 (95% CI 10 to 5,549). Conclusions: These data provide evidence to support PSA velocity greater than 1.5 ng/ml yearly as a surrogate end point for PCSM in patients with nonmetastatic, hormone refractory prostate cancer. Enrolling these men onto clinical trials evaluating the impact of chemotherapy on time to bone metastases and PCSM is warranted. Copyright © 2005 by American Urological Association.

Authors
D'Amico, AV; Moul, J; Carroll, PR; Sun, L; Lubeck, D; Chen, M-H
MLA Citation
D'Amico, AV, Moul, J, Carroll, PR, Sun, L, Lubeck, D, and Chen, M-H. "Surrogate end point for prostate cancer specific mortality in patients with nonmetastatic hormone refractory prostate cancer." Journal of Urology 173.5 (2005): 1572-1576.
PMID
15821488
Source
scival
Published In
Journal of Urology
Volume
173
Issue
5
Publish Date
2005
Start Page
1572
End Page
1576
DOI
10.1097/01.ju.0000157569.59229.72

Editorial introduction

Authors
Moul, JW
MLA Citation
Moul, JW. "Editorial introduction." Current Opinion in Urology 15.3 (2005): i-.
Source
scival
Published In
Current Opinion in Urology
Volume
15
Issue
3
Publish Date
2005
Start Page
i
DOI
10.1097/01.mou.0000165545.41298.9b

Promising phase II results for lenalidomide in metastatic renal cell cancer

Authors
Vieweg, J; Moul, JW
MLA Citation
Vieweg, J, and Moul, JW. "Promising phase II results for lenalidomide in metastatic renal cell cancer." Oncology Report SPRING (2005): 57-58.
Source
scival
Published In
Oncology Report
Issue
SPRING
Publish Date
2005
Start Page
57
End Page
58

Editorial comments

Authors
Moul, JW; Stamey, TA; Walsh, PC
MLA Citation
Moul, JW, Stamey, TA, and Walsh, PC. "Editorial comments." Journal of Urology 173.3 (2005): 750-751.
PMID
26324000
Source
scival
Published In
The Journal of Urology
Volume
173
Issue
3
Publish Date
2005
Start Page
750
End Page
751

In reply [2]

Authors
Moul, JW
MLA Citation
Moul, JW. "In reply [2]." Journal of Clinical Oncology 23.6 (2005): 1322-1323.
Source
scival
Published In
Journal of Clinical Oncology
Volume
23
Issue
6
Publish Date
2005
Start Page
1322
End Page
1323
DOI
10.1200/JCO.2005.05.460

Preclinical testing of a peptide-based, HER2/neu vaccine for prostate cancer.

The HER2/neu protein is over-expressed in multiple epithelial tumors and the source of immunogenic peptides currently under investigation in vaccine trials in ovarian and breast cancers. We sought to define the correlation between HER2/neu expression and risk for prostate cancer recurrence and then determine the potential efficacy of anti-HER2/neu vaccination in prostate cancer patients at risk for recurrence. The risk for prostate-specific antigen (PSA) recurrence in 95 patients undergoing prostatectomy at the Walter Reed Army Medical Center (WRAMC) was calculated and correlated to HER2/neu expression, as determined by immunohistochemical staining. Peripheral blood lymphocytes (PBL) were then isolated from six consecutive human leukocyte antigen (HLA) A2+ patients with HER2/neu+ prostate tumors. These PBL were grown in parallel cultures and stimulated either with no peptide, HER2/neu E75 peptide, or control peptide. The cultures were compared for stimulated proliferation, induced peptide-specific cytotoxicity and tumor-specific cytotoxicity. When assessed by risk group, 69% of the high risk patients' tumors over-expressed HER2/neu compared to 47% of the intermediate risk group (p<0.05). Evaluation of the in vitro immune response of PBL isolated from six consecutive prostate cancer patients revealed a statistically significant increase in E75-stimulated lymphocytic proliferation. E75-stimulated lymphocytes demonstrated an E75-specific cytolytic response in 6/6 prostate cancer patients that increased with successive stimulations. Moreover, these E75-specific lymphocytes also demonstrated tumor-specific lysis against HER2/neu-expressing prostate cancer cell lines. The majority of prostate cancer patients at high risk for recurrence have HER2/neu expressing tumors. Hence, HER2/neu is a viable target for immunotherapeutics such as preventative immunization strategies with HER2/neu peptide vaccines.

Authors
Woll, MM; Hueman, MT; Ryan, GB; Ioannides, CG; Henderson, CG; Sesterhan, IA; Shrivasta, S; McLeod, DG; Moul, JW; Peoples, GE
MLA Citation
Woll, MM, Hueman, MT, Ryan, GB, Ioannides, CG, Henderson, CG, Sesterhan, IA, Shrivasta, S, McLeod, DG, Moul, JW, and Peoples, GE. "Preclinical testing of a peptide-based, HER2/neu vaccine for prostate cancer." Int J Oncol 25.6 (December 2004): 1769-1780.
PMID
15547716
Source
pubmed
Published In
International journal of oncology
Volume
25
Issue
6
Publish Date
2004
Start Page
1769
End Page
1780

A telomerase-immortalized primary human prostate cancer clonal cell line with neoplastic phenotypes.

Understanding of molecular genetic mechanisms underlying prostate carcinogenesis would be greatly advanced by in vitro models of prostate tumors representing primary tumors. We have successfully established a neoplastic immortalized human prostate epithelial (HPE) clonal culture derived from a primary tumor of a prostate cancer patient (RC-58T) with hTERT, the catalytic subunit of telomerase. The early passage RC-58T cells derived from a radical prostatectomy specimen of a 52-year-old white male patient was transduced through infection with a retrovirus vector expressing the hTERT for the establishment of the RC-58T/hTERT cell line. One clonal line, soft-agar derived from the RC-58T/hTERT cell line, was isolated and further characterized phenotypically and genetically. These clonal (RC-58T/hTERT SA#4) cells are currently growing well at passage 70 and exhibit transformed morphology. The RC-58T/hTERT SA#4 line expressed a high level of telomerase activity and showed anchorage-independent growth in soft agar. The clonal line like the untransduced RC-58T cells (passage 3) expressed prostate specific antigen (PSA), androgen receptor (AR), prostate stem cell antigen (PSCA), and an androgen-regulated prostate specific gene NKX3.1, P16, and cytokeratin (CK) 8. Growth is slightly stimulated by dihydrotestosterone (DHT), and lyates are immunoreactive with AR antibody by Western blot analysis. More importantly, this clonal line produced adenocarcinomas when transplanted into SCID mice. A number of chromosome alterations were observed including the loss of chromosome Y, 1q, 2p, 3p, 4q, 8p, 11p, 14p, 17p and 18q. Our results demonstrate that this primary tumor-derived HPE cell line retained its neoplastic phenotypes and its prostate specific markers and should allow elucidating molecular and genetic alterations involved in prostate cancer. This is the first documented case of an AR and PSA expressing telomerase established human prostate cancer cell line with neoplastic phenotypes from a primary tumor of a prostate cancer patient.

Authors
Gu, Y; Kim, K-H; Ko, D; Nakamura, K; Yasunaga, Y; Moul, JW; Srivastava, S; Arnstein, P; Rhim, JS
MLA Citation
Gu, Y, Kim, K-H, Ko, D, Nakamura, K, Yasunaga, Y, Moul, JW, Srivastava, S, Arnstein, P, and Rhim, JS. "A telomerase-immortalized primary human prostate cancer clonal cell line with neoplastic phenotypes." Int J Oncol 25.4 (October 2004): 1057-1064.
PMID
15375556
Source
pubmed
Published In
International journal of oncology
Volume
25
Issue
4
Publish Date
2004
Start Page
1057
End Page
1064

Absence of a correlation of androgen receptor gene CAG repeat length and prostate cancer risk in an African-American population.

Shorter androgen receptor gene CAG repeat length has been associated with an increased risk of prostate cancer, an earlier age of onset, and more advanced stage of disease. Studies comparing the distribution of CAG repeat lengths within different populations have reported that racial groups with higher prostate cancer incidence also have shorter CAG repeat lengths. We evaluated CAG repeat length in 685 black men in Louisiana, South Carolina, and the District of Columbia who were participating in prostate cancer screening, comparing the 118 who were diagnosed with prostate cancer with 567 who had normal serum prostate-specific antigen levels and no evidence of cancer on digital rectal examination. The median CAG repeat length was 21 among cases and 19 among controls (P = 0.11). Cases were significantly older than controls, with a median age of 68 years compared with 54 years (P < 0.0001). After adjusting for age, we found no association between prostate cancer risk and CAG repeat length (odds ratio, 1.05; 95% CI, 0.98-1.13; P = 0.16). Dividing CAG repeat lengths into septiles and calculating the odds ratio for each revealed no specific repeat-length range with a significantly elevated or depressed risk of prostate cancer, but a trend test showed a significant association between longer CAG repeat lengths and an elevated risk of prostate cancer (P = 0.02). Neither grade nor stage was associated with CAG repeat length. This study confirms earlier reports that black men have shorter CAG repeat lengths than reported white and Asian populations. We did not find an increased risk of prostate cancer among black men with fewer CAG repeats.

Authors
Gilligan, T; Manola, J; Sartor, O; Weinrich, SP; Moul, JW; Kantoff, PW
MLA Citation
Gilligan, T, Manola, J, Sartor, O, Weinrich, SP, Moul, JW, and Kantoff, PW. "Absence of a correlation of androgen receptor gene CAG repeat length and prostate cancer risk in an African-American population." Clin Prostate Cancer 3.2 (September 2004): 98-103.
PMID
15479493
Source
pubmed
Published In
Clinical prostate cancer
Volume
3
Issue
2
Publish Date
2004
Start Page
98
End Page
103

Combination hormonal therapy: a reassessment within advanced prostate cancer.

Combination hormonal therapy, comprising a luteinising hormone-releasing hormone analogue (LHRHa) with an antiandrogen, is widely used in the treatment of advanced prostate cancer. There is ongoing debate regarding the use of combination hormonal therapy as opposed to LHRHa monotherapy. The pivotal consideration is whether there are adequate benefits with combination hormonal therapy in terms of increased survival and decreased disease progression to outweigh the increased risk of adverse events and additional cost. The most recent meta-analysis by the Prostate Cancer Trialists' Collaborative Group indicates a small but statistically significant survival benefit with combination hormonal therapy using nonsteroidal antiandrogens. It is, however, noteworthy that combined conclusions derived from such meta-analyses may not apply across each of the individual antiandrogens. Individual studies have reported differences between antiandrogens in terms of both tolerability and efficacy-for example, bicalutamide has been shown to be better tolerated than flutamide, and may be associated with improved survival. In addition, it is essential that treatment decisions are taken in consultation with the patient. Owing to an increasing proportion of cases presenting with early-stage disease, combination hormonal therapy is increasingly used in the neoadjuvant or adjuvant setting with radiotherapy and, in cases of prostate-specific antigen recurrence after prior localised therapy. Further data are awaited to optimise the use of combination hormonal therapy in these new settings.

Authors
Moul, JW; Chodak, G
MLA Citation
Moul, JW, and Chodak, G. "Combination hormonal therapy: a reassessment within advanced prostate cancer." Prostate Cancer Prostatic Dis 7 Suppl 1 (September 2004): S2-S7. (Review)
PMID
15365575
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
7 Suppl 1
Publish Date
2004
Start Page
S2
End Page
S7
DOI
10.1038/sj.pcan.4500741

Direct measurement of peptide-specific CD8+ T cells using HLA-A2:Ig dimer for monitoring the in vivo immune response to a HER2/neu vaccine in breast and prostate cancer patients.

HER2/neu is a proto-oncogene and a member of the epidermal growth factor receptor family of proteins that is overexpressed in numerous types of human cancer. We are currently conducting clinical trials with the HER2/neu E75 peptide vaccine in breast and prostate cancer patients. We have evaluated the use of HLA-A2 dimer molecule for the immunological monitoring of cancer patients receiving the E75 peptide vaccine. Peripheral blood samples from patients receiving the vaccine were stained with HLA-A2 dimers containing the vaccine peptide E75 or control peptides and analyzed by flow cytometry. We compared the HLA-A2 dimer assay to standard methods of immunologic monitoring (IFN-gamma release, lymphocyte proliferation, and cytotoxicity). The HLA-A2 dimer assay was also compared with the HLA-A2 tetramer assay. E75 peptide-specific CD8 T cells were detected directly in the peripheral blood of patients by staining with E75-HLA-A2 dimers and CD8 antibodies. T cell cultures generated by repeated stimulations using E75 peptide-pulsed dendritic cells showed increased staining with E75-peptide loaded HLA-A2 dimers. Simultaneously analysis by the dimer assay and standard immunologic assays demonstrated that the dimer-staining assay correlated well with these methods of immunologic monitoring. A direct comparison using E75-specific HLA-A2 tetramers and HLA-A2 dimers for the detection of E75-specific CD8 T cells in peripheral blood showed comparable results with the two assays. Our findings indicate that the HLA-A2 dimer is a powerful new tool for directly quantifying and monitoring immune responses of antigen-specific T cells in peptide vaccine clinical trials.

Authors
Woll, MM; Fisher, CM; Ryan, GB; Gurney, JM; Storrer, CE; Ioannides, CG; Shriver, CD; Moul, JW; McLeod, DG; Ponniah, S; Peoples, GE
MLA Citation
Woll, MM, Fisher, CM, Ryan, GB, Gurney, JM, Storrer, CE, Ioannides, CG, Shriver, CD, Moul, JW, McLeod, DG, Ponniah, S, and Peoples, GE. "Direct measurement of peptide-specific CD8+ T cells using HLA-A2:Ig dimer for monitoring the in vivo immune response to a HER2/neu vaccine in breast and prostate cancer patients." J Clin Immunol 24.4 (July 2004): 449-461.
PMID
15163902
Source
pubmed
Published In
Journal of Clinical Immunology
Volume
24
Issue
4
Publish Date
2004
Start Page
449
End Page
461
DOI
10.1023/B:JOCI.0000029117.10791.98

The economic burden of metastatic and prostate specific antigen progression in patients with prostate cancer: findings from a retrospective analysis of health plan data.

PURPOSE: We evaluated the economic burden of metastatic and prostate specific antigen (PSA) progression in patients with prostate cancer (CaP) using a cancer registry linked administrative database. MATERIALS AND METHODS: A retrospective cohort evaluation of 2056 patients with CaP was done at Henry Ford Health System from 1995 to 2000. Records were examined for metastatic progression via International Classification of Disease-9-CM codes for metastasis and for PSA progression using accepted definitions based on initial therapy type. Health care resource charges 6 months and 1 year before and after progression were compared using pairwise t tests. A generalized linear model determined the effect of progression on charges and compared initial care, continuing care and terminal care charges in the progressed and nonprogressed groups, while controlling for baseline covariates (stage and age). RESULTS: Patients with CaP had a mean age of 68 years, were mostly white (52%), had localized (88%) and moderately differentiated (66%) tumors, and a median baseline PSA of 7.0 ng/ml. Of patients 8.9% had metastatic progression at a mean followup of 3.6 years, while 16.1% had PSA progression at 4.5 years. After controlling for baseline covariates metastatic progression resulted in significant increases in charges (US dollars 92523 vs US dollars 58036, p < 0.0001). PSA progressed patients incurred significantly higher charges than nonprogressed patients (US dollars 69321 vs US dollars 58351, p = 0.0039), controlling for followup time, baseline stage, grade and treatment. CONCLUSIONS: In CaP cases metastatic and PSA progression pose a significant economic burden irrespective of baseline stage, grade and treatment. Treatments that slows or prevents meta-static and PSA progression could offset this cost.

Authors
Penson, DF; Moul, JW; Evans, CP; Doyle, JJ; Gandhi, S; Lamerato, L
MLA Citation
Penson, DF, Moul, JW, Evans, CP, Doyle, JJ, Gandhi, S, and Lamerato, L. "The economic burden of metastatic and prostate specific antigen progression in patients with prostate cancer: findings from a retrospective analysis of health plan data." J Urol 171.6 Pt 1 (June 2004): 2250-2254.
PMID
15126796
Source
pubmed
Published In
The Journal of Urology
Volume
171
Issue
6 Pt 1
Publish Date
2004
Start Page
2250
End Page
2254

Optimized prostate biopsy via a statistical atlas of cancer spatial distribution.

A methodology is presented for constructing a statistical atlas of spatial distribution of prostate cancer from a large patient cohort, and it is used for optimizing needle biopsy. An adaptive-focus deformable model is used for the spatial normalization and registration of 100 prostate histological samples, which were provided by the Center for Prostate Disease Research of the US Department of Defense, resulting in a statistical atlas of spatial distribution of prostate cancer. Based on this atlas, a statistical predictive model was developed to optimize the needle biopsy sites, by maximizing the probability of detecting cancer. Experimental results using cross-validation show that the proposed method can detect cancer with a 99% success rate using seven needles, in these samples.

Authors
Shen, D; Lao, Z; Zeng, J; Zhang, W; Sesterhenn, IA; Sun, L; Moul, JW; Herskovits, EH; Fichtinger, G; Davatzikos, C
MLA Citation
Shen, D, Lao, Z, Zeng, J, Zhang, W, Sesterhenn, IA, Sun, L, Moul, JW, Herskovits, EH, Fichtinger, G, and Davatzikos, C. "Optimized prostate biopsy via a statistical atlas of cancer spatial distribution." Med Image Anal 8.2 (June 2004): 139-150.
PMID
15063863
Source
pubmed
Published In
Medical Image Analysis
Volume
8
Issue
2
Publish Date
2004
Start Page
139
End Page
150
DOI
10.1016/j.media.2003.11.002

Intermediate end point for prostate cancer-specific mortality following salvage hormonal therapy for prostate-specific antigen failure.

BACKGROUND: Whether the prostate-specific antigen (PSA) response to salvage hormonal therapy can act as an intermediate end point for prostate cancer-specific mortality (PCSM) remains unclear. Therefore, we evaluated whether PSA response, defined as the absolute value of the ratio of the rate of PSA change after salvage hormonal therapy to the rate of PSA change before salvage therapy, is associated with the time to PCSM following salvage hormonal therapy. METHODS: A single-institution and two pooled multi-institution databases containing baseline, treatment, and follow-up information on men who received salvage hormonal therapy for PSA failure following surgery or radiation therapy from January 1, 1988, to January 1, 2002, formed the study (n = 199) and validation cohorts (n = 1255), respectively. The ability of PSA response and its constituents (i.e., pre-salvage hormonal therapy PSA slope and post-salvage hormonal therapy PSA slope) to predict time to PCSM following salvage hormonal therapy was assessed using Cox regression analysis. For illustrative purposes, PSA response was analyzed as a dichotomous variable with a breakpoint for the ratio of PSA response of 1. All statistical tests were two-sided. RESULTS: PSA response was statistically significantly associated with time to PCSM following salvage hormonal therapy in both the study (P(Cox) =.0014) and validation (P(Cox)<.001) cohorts; however, its constituents were not (pre-salvage hormonal therapy PSA slope: P(Cox-study) =.97, P(Cox-validation) =.57; post-salvage hormonal therapy PSA slope: P(Cox-study) =.27, P(Cox-validation) =.31). Patients with a PSA response that was less than or equal to 1 had a statistically significantly shorter time to PCSM than patients with a PSA response of greater than 1 in both the study (hazard ratio [HR] = 3.6, 95% confidence interval [CI] = 1.3 to 10.3; P(Cox) =.01) and validation (HR = 12.8, 95% CI = 6.2 to 26.3; P(Cox)<.001) cohorts. CONCLUSION: The PSA response to salvage hormonal therapy can serve as an intermediate end point for PCSM in patients with a rising PSA level following surgery or radiation therapy.

Authors
D'Amico, AV; Moul, JW; Carroll, PR; Cote, K; Sun, L; Lubeck, D; Renshaw, AA; Loffredo, M; Chen, M-H
MLA Citation
D'Amico, AV, Moul, JW, Carroll, PR, Cote, K, Sun, L, Lubeck, D, Renshaw, AA, Loffredo, M, and Chen, M-H. "Intermediate end point for prostate cancer-specific mortality following salvage hormonal therapy for prostate-specific antigen failure." J Natl Cancer Inst 96.7 (April 7, 2004): 509-515.
PMID
15069112
Source
pubmed
Published In
Journal of the National Cancer Institute
Volume
96
Issue
7
Publish Date
2004
Start Page
509
End Page
515

Early versus delayed hormonal therapy for prostate specific antigen only recurrence of prostate cancer after radical prostatectomy.

PURPOSE: Hormonal therapy (HT) is the current mainstay of systemic treatment for prostate specific antigen (PSA) only recurrence (PSAR), however, there is virtually no published literature comparing HT to observation in the clinical setting. The goal of this study was to examine the Department of Defense Center for Prostate Disease Research observational database to compare clinical outcomes in men who experienced PSAR after radical prostatectomy by early versus delayed use of HT and by a risk stratified approach. MATERIALS AND METHODS: Of 5382 men in the database who underwent primary radical prostatectomy (RP), 4967 patients were treated in the PSA-era between 1988 and December 2002. Of those patients 1352 men who had PSAR (PSA after surgery greater than 0.2 ng/ml) and had postoperative followup greater than 6 months were used as the study cohort. These patients were further divided into an early HT group in which patients (355) received HT after PSA only recurrence but before clinical metastasis and a late HT group for patients (997) who received no HT before clinical metastasis or by current followup. The primary end point was the development of clinical metastases. Of the 1352 patients with PSAR clinical metastases developed in 103 (7.6%). Patients were also stratified by surgical Gleason sum, PSA doubling time and timing of recurrence. Univariate and multivariate Cox proportional hazard models were used to evaluate the effect of early and late HT on clinical outcome. RESULTS: Early HT was associated with delayed clinical metastasis in patients with a pathological Gleason sum greater than 7 or PSA doubling time of 12 months or less (Hazards ratio = 2.12, p = 0.01). However, in the overall cohort early HT did not impact clinical metastases. Race, age at RP and PSA at diagnosis had no effect on metastasis-free survival (p >0.05). CONCLUSIONS: The retrospective observational multicenter database analysis demonstrated that early HT administered for PSAR after prior RP was an independent predictor of delayed clinical metastases only for high-risk cases at the current followup. Further study with longer followup and randomized trials are needed to address this important issue.

Authors
Moul, JW; Wu, H; Sun, L; McLeod, DG; Amling, C; Donahue, T; Kusuda, L; Sexton, W; O'Reilly, K; Hernandez, J; Chung, A; Soderdahl, D
MLA Citation
Moul, JW, Wu, H, Sun, L, McLeod, DG, Amling, C, Donahue, T, Kusuda, L, Sexton, W, O'Reilly, K, Hernandez, J, Chung, A, and Soderdahl, D. "Early versus delayed hormonal therapy for prostate specific antigen only recurrence of prostate cancer after radical prostatectomy." J Urol 171.3 (March 2004): 1141-1147.
PMID
14767288
Source
pubmed
Published In
The Journal of Urology
Volume
171
Issue
3
Publish Date
2004
Start Page
1141
End Page
1147
DOI
10.1097/01.ju.0000113794.34810.d0

Watchful waiting and factors predictive of secondary treatment of localized prostate cancer.

PURPOSE: Watchful waiting remains an important treatment option for some patients with localized prostate cancer. We defined the demographic, clinical and outcome features of men selecting watchful waiting as an initial treatment strategy, and determined factors predictive of eventual progression to secondary treatment. MATERIALS AND METHODS: Of 8390 patients diagnosed with prostate cancer from 1990 to 2001 in the Department of Defense Center for Prostate Disease Research Database, 1158 patients chose watchful waiting as initial treatment. The demographic and clinical differences between patients on watchful waiting and those choosing other initial treatments were compared using the chi-square test. Secondary treatment-free survival according to various prognostic factors was plotted using the Kaplan-Meier method and differences were tested using the log rank test. A multivariate Cox proportional hazards regression analysis was performed to determine which factors were independent predictors of secondary treatment. RESULTS: Compared to other patients, those selecting watchful waiting were older, had lower prostate specific antigen (PSA) at diagnosis, and were more likely to have lower stage (cT1) and lower grade (Gleason sum 7 or less) cancers. Age, PSA and clinical stage were all significant and independent predictors of secondary treatment. The relative risk of secondary treatment can be expressed as EXP (-0.034 x age at diagnosis + 0.284 x LOG (diagnostic PSA) + 0.271 x clinical stage T2 + 0.264 x clinical stage T3). CONCLUSIONS: Men who elect watchful waiting as initial management for prostate cancer are older with lower Gleason sums and serum PSA. In these men, age at diagnosis, serum PSA and clinical stage are the most significant predictors of requiring or selecting secondary treatment.

Authors
Wu, H; Sun, L; Moul, JW; Wu, HY; McLeod, DG; Amling, C; Lance, R; Kusuda, L; Donahue, T; Foley, J; Chung, A; Sexton, W; Soderdahl, D
MLA Citation
Wu, H, Sun, L, Moul, JW, Wu, HY, McLeod, DG, Amling, C, Lance, R, Kusuda, L, Donahue, T, Foley, J, Chung, A, Sexton, W, and Soderdahl, D. "Watchful waiting and factors predictive of secondary treatment of localized prostate cancer." J Urol 171.3 (March 2004): 1111-1116.
PMID
14767282
Source
pubmed
Published In
The Journal of Urology
Volume
171
Issue
3
Publish Date
2004
Start Page
1111
End Page
1116
DOI
10.1097/01.ju.0000113300.74132.8b

Pathologic variables and recurrence rates as related to obesity and race in men with prostate cancer undergoing radical prostatectomy.

PURPOSE: To determine if obesity is associated with higher prostate specific antigen recurrence rates after radical prostatectomy (RP), and to explore racial differences in body mass index (BMI) as a potential explanation for the disparity in outcome between black and white men. PATIENTS AND METHODS: A retrospective, multi-institutional pooled analysis of 3,162 men undergoing RP was conducted at nine US military medical centers between 1987 and 2002. Patients were initially categorized as obese (BMI > or = 30 kg/m(2)), overweight (BMI 25 to 30 kg/m(2)), or normal (BMI < or = 25 kg/m(2)). For analysis, normal and overweight groups were combined (BMI < 30 kg/m(2)) and compared with the obese group (BMI > or = 30 kg/m(2)) with regard to biochemical recurrence (prostate-specific antigen > or = 0.2 ng/mL) after RP. RESULTS: Of 3,162 patients, 600 (19.0%) were obese and 2,562 (81%) were not obese. BMI was an independent predictor of higher Gleason grade cancer (P <.001) and was associated with a higher risk of biochemical recurrence (P =.027). Blacks had higher BMI (P <.001) and higher recurrence rates (P =.003) than whites. Both BMI (P =.028) and black race (P =.002) predicted higher prostate specific antigen recurrence rates. In multivariate analysis of race, BMI, and pathologic factors, black race (P =.021) remained a significant independent predictor of recurrence. CONCLUSION: Obesity is associated with higher grade cancer and higher recurrence rates after RP. Black men have higher recurrence rates and greater BMI than white men. These findings support the hypothesis that obesity is associated with progression of latent to clinically significant prostate cancer (PC) and suggest that BMI may account, in part, for the racial variability in PC risk.

Authors
Amling, CL; Riffenburgh, RH; Sun, L; Moul, JW; Lance, RS; Kusuda, L; Sexton, WJ; Soderdahl, DW; Donahue, TF; Foley, JP; Chung, AK; McLeod, DG
MLA Citation
Amling, CL, Riffenburgh, RH, Sun, L, Moul, JW, Lance, RS, Kusuda, L, Sexton, WJ, Soderdahl, DW, Donahue, TF, Foley, JP, Chung, AK, and McLeod, DG. "Pathologic variables and recurrence rates as related to obesity and race in men with prostate cancer undergoing radical prostatectomy." J Clin Oncol 22.3 (February 1, 2004): 439-445.
PMID
14691120
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
22
Issue
3
Publish Date
2004
Start Page
439
End Page
445
DOI
10.1200/JCO.2004.03.132

Eligibility and outcomes reporting guidelines for clinical trials for patients in the state of a rising prostate-specific antigen: recommendations from the Prostate-Specific Antigen Working Group.

PURPOSE: To define methodology to show clinical benefit for patients in the state of a rising prostate-specific antigen (PSA). RESULTS: HYPOTHESIS: A clinical states framework was used to address the hypothesis that definitive phase III trials could not be conducted in this patient population. PATIENT POPULATION: The Group focused on men with systemic (nonlocalized) recurrence and a defined risk of developing clinically detectable metastases. Models to define systemic versus local recurrence, and risk of metastatic progression were discussed. INTERVENTION: Therapies that have shown favorable effects in more advanced clinical states; meaningful biologic surrogates of activity linked with efficacy in other tumor types; and/or effects on a target or pathway known to contribute to prostate cancer progression in this state can be considered for evaluation. OUTCOMES: An intervention-specific posttherapy PSA-based outcome definition that would justify further testing should be described at the outset. Reporting: Trial reports should include a table showing the number of patients who achieve a specific PSA-based outcome, the number who remain enrolled onto the trial, and the number who came off study at different time points. The term PSA response should be abandoned. TRIAL DESIGN: The phases of drug development for this state are optimizing dose and schedule, demonstration of a treatment effect, and clinical benefit. To move a drug forward should require a high bar that includes no rise in PSA in a defined proportion of patients for a specified period of time at a minimum. Agents that do not produce this effect can only be tested in combination. The preferred end point of clinical benefit is prostate cancer-specific survival; the time to development of metastatic disease is an alternative. CONCLUSION: Methodology to show that an intervention alters the natural history of prostate cancer is described. At each stage of development, only agents with sufficient activity should be moved forward.

Authors
Scher, HI; Eisenberger, M; D'Amico, AV; Halabi, S; Small, EJ; Morris, M; Kattan, MW; Roach, M; Kantoff, P; Pienta, KJ; Carducci, MA; Agus, D; Slovin, SF; Heller, G; Kelly, WK; Lange, PH; Petrylak, D; Berg, W; Higano, C; Wilding, G; Moul, JW; Partin, AN; Logothetis, C; Soule, HR
MLA Citation
Scher, HI, Eisenberger, M, D'Amico, AV, Halabi, S, Small, EJ, Morris, M, Kattan, MW, Roach, M, Kantoff, P, Pienta, KJ, Carducci, MA, Agus, D, Slovin, SF, Heller, G, Kelly, WK, Lange, PH, Petrylak, D, Berg, W, Higano, C, Wilding, G, Moul, JW, Partin, AN, Logothetis, C, and Soule, HR. "Eligibility and outcomes reporting guidelines for clinical trials for patients in the state of a rising prostate-specific antigen: recommendations from the Prostate-Specific Antigen Working Group." J Clin Oncol 22.3 (February 1, 2004): 537-556.
PMID
14752077
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
22
Issue
3
Publish Date
2004
Start Page
537
End Page
556
DOI
10.1200/JCO.2004.07.099

Race/ethnicity and the receipt of watchful waiting for the initial management of prostate cancer.

INTRODUCTION: Several recent studies have noted that African Americans disproportionately receive "watchful waiting" for the initial management of their prostate cancer. To determine whether racial/ethnic differences in the receipt of watchful waiting are explained by differences in clinical presentation and life expectancy at the time of diagnosis, we examined Surveillance, Epidemiology, and End Results (SEER)-Medicare data for men diagnosed with prostate cancer in 1994 to 1996. METHODS: Race/ethnicity, comorbidity, stage, grade, age, and expected lifespan and their association with the receipt of watchful waiting were examined in multivariate logistic regression analyses. Race-stratified logistic regression analyses were also used to examine racial/ethnic variation in the association of clinical and demographic factors with the receipt of watchful waiting among African-American, Hispanic, and non-Hispanic white men. RESULTS: African-American (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.3 to 1.6) and Hispanic men (OR, 1.3; 95% CI, 1.1 to 1.5) were significantly more likely than non-Hispanic white men to receive watchful waiting in a multivariate model adjusted for age, comorbidity, stage, grade, and life expectancy. Advanced stage and grade, lower life expectancy, older age, and high comorbidity indices were also significantly associated with an increase in the odds of receipt of watchful waiting in multivariate analyses. In general, the association between the receipt of watchful waiting and the clinical characteristics (i.e., stage, grade, and age) were similar for the three racial/ethnic groups. In race-stratified logistic regression analyses, life expectancy was associated with an increase in the odds of receiving watchful waiting but results were statistically significant for whites only. There was also a statistically significant increase in the odds of receiving watchful waiting for African-American and white men with high comorbidity indices but not Hispanic men. The odds of receiving watchful waiting were also higher for African-American and Hispanic men who resided in census tracts where a large percentage of residents had not completed high school than for white men who resided in similar census tracts. CONCLUSION: The disproportionate receipt of watchful waiting among African Americans and Hispanics is not completely explained by racial/ethnic variation in clinical characteristics or life expectancy as measured in this study. These data suggest that there are other factors that contribute to racial/ethnic differences in receipt of watchful waiting that warrant investigation.

Authors
Shavers, VL; Brown, ML; Potosky, AL; Klabunde, CN; Davis, WW; Moul, JW; Fahey, A
MLA Citation
Shavers, VL, Brown, ML, Potosky, AL, Klabunde, CN, Davis, WW, Moul, JW, and Fahey, A. "Race/ethnicity and the receipt of watchful waiting for the initial management of prostate cancer." J Gen Intern Med 19.2 (February 2004): 146-155.
PMID
15009794
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
19
Issue
2
Publish Date
2004
Start Page
146
End Page
155

Elevated expression of PCGEM1, a prostate-specific gene with cell growth-promoting function, is associated with high-risk prostate cancer patients.

PCGEM1 is a novel, highly prostate tissue-specific, androgen-regulated gene. Here, we demonstrate that PCGEM1 expression is significantly higher in prostate cancer (CaP) cells of African-American men than in Caucasian-American men (P=0.0002). Further, increased PCGEM1 expression associates with normal prostate epithelial cells of CaP patients with a family history of CaP (P=0.0400). PCGEM1 overexpression in LNCaP and in NIH3T3 cells promotes cell proliferation and a dramatic increase in colony formation, suggesting a biological role of PCGEM1 in cell growth regulation. Taken together, the cell proliferation/colony formation-promoting functions of PCGEM1 and the association of its increased expression with high-risk CaP patients suggest the potential roles of PCGEM1 in CaP onset/progression, especially in these high-risk groups.

Authors
Petrovics, G; Zhang, W; Makarem, M; Street, JP; Connelly, R; Sun, L; Sesterhenn, IA; Srikantan, V; Moul, JW; Srivastava, S
MLA Citation
Petrovics, G, Zhang, W, Makarem, M, Street, JP, Connelly, R, Sun, L, Sesterhenn, IA, Srikantan, V, Moul, JW, and Srivastava, S. "Elevated expression of PCGEM1, a prostate-specific gene with cell growth-promoting function, is associated with high-risk prostate cancer patients." Oncogene 23.2 (January 15, 2004): 605-611.
PMID
14724589
Source
pubmed
Published In
Oncogene: Including Oncogene Reviews
Volume
23
Issue
2
Publish Date
2004
Start Page
605
End Page
611
DOI
10.1038/sj.onc.1207069

Is the PSA test useless?

Authors
Kirby, R; Moul, JW
MLA Citation
Kirby, R, and Moul, JW. "Is the PSA test useless?." Prostate Cancer Prostatic Dis 7.4 (2004): 271-272.
PMID
15592438
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
7
Issue
4
Publish Date
2004
Start Page
271
End Page
272
DOI
10.1038/sj.pcan.4500777

External beam radiation therapy after radical prostatectomy: efficacy and impact on urinary continence.

INTRODUCTION AND OBJECTIVES: The efficacy of adjuvant and salvage external beam radiation (AXRT+SXRT) for prostate cancer after radical prostatectomy (RP) has been debated because of the inability to rule out systemic occult metastasis, uncertainty that radiation eradicates residual local disease and the potential of exacerbating impotency and incontinence. To characterize the effectiveness and treatment morbidity a retrospective review was performed. METHODS: In all, 38 patients received AXRT and 91 received SXRT. The SXRT group was stratified by PSA level, age, race, pathologic stage, margin status, worst Gleason sum, radiation dose and pelvic field. Complications evaluated were impotence and incontinence. Median follow-up was 60.2 months. RESULTS: The 5-y disease-free survival (DFS) rate was 61.3% for AXRT and 36.3% for SXRT. Multivariate analysis of the SXRT cohort showed Gleason score, pathologic stage and pre-XRT PSA to be predictors of disease recurrence. After XRT 26% had worsened continence. CONCLUSIONS: Patients who recur after RP whose pathologic stage is pT2 or pT3c, Gleason score of 8 or higher or pre-XRT PSA is >2.0 ng/dl may have microscopic metastatic disease and a decreased chance of cure with SXRT alone. Continence was further impaired after XRT.

Authors
Petroski, RA; Warlick, WB; Herring, J; Donahue, TF; Sun, L; Smith, CV; Connelly, RR; McLeod, DG; Moul, JW
MLA Citation
Petroski, RA, Warlick, WB, Herring, J, Donahue, TF, Sun, L, Smith, CV, Connelly, RR, McLeod, DG, and Moul, JW. "External beam radiation therapy after radical prostatectomy: efficacy and impact on urinary continence." Prostate Cancer Prostatic Dis 7.2 (2004): 170-177.
PMID
15136786
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
7
Issue
2
Publish Date
2004
Start Page
170
End Page
177
DOI
10.1038/sj.pcan.4500718

The evolving definition of advanced prostate cancer.

Each year more patients present with prostate cancer at increasingly younger ages and with earlier stage disease, resulting in the potential for longer survival time, longer-term hormonal therapy, and a heightened risk of developing biochemical recurrence after treatment. It seems clear that clinicians need to broaden the definition of "advanced" prostate cancer to include recent knowledge that will influence the form and timing of treatment as well as the monitoring of disease progression. A more contemporary definition should include patients with lower-grade disease and with an increased risk of progression and/or death from prostate cancer along with those with widely disseminated metastatic disease. Treatment alternatives for these patients should be evaluated based on a risk stratification equation toward a goal of the greatest efficacy and the least patient harm over time given that increasing numbers of these patients are entering treatment long before they develop widespread osteoblastic metastases.

Authors
Moul, JW
MLA Citation
Moul, JW. "The evolving definition of advanced prostate cancer." Rev Urol 6 Suppl 8 (2004): S10-S17.
PMID
16985915
Source
pubmed
Published In
Reviews in Urology
Volume
6 Suppl 8
Publish Date
2004
Start Page
S10
End Page
S17

Re: The economic burden of metastatic and prostate specific antigen progression in patients with prostate cancer: Findings from a retrospective analysis of health plan data [3]

Authors
Penson, DF; Moul, JW; Evans, CP; Doyle, JJ; Gandhi, S; Lamerato, L; Pitts, WR
MLA Citation
Penson, DF, Moul, JW, Evans, CP, Doyle, JJ, Gandhi, S, Lamerato, L, and Pitts, WR. "Re: The economic burden of metastatic and prostate specific antigen progression in patients with prostate cancer: Findings from a retrospective analysis of health plan data [3]." Journal of Urology 172.6 I (2004): 2484--.
PMID
15538302
Source
scival
Published In
Journal of Urology
Volume
172
Issue
6 I
Publish Date
2004
Start Page
2484-
DOI
10.1097/01.ju.0000145135.83351.cb

Prostate specific antigen doubling time as a surrogate end point for prostate cancer specific mortality following radical prostatectomy or radiation therapy

Purpose: A short posttreatment prostate specific antigen (PSA)-doubling time (DT) following radical prostatectomy or radiation therapy was evaluated as a surrogate end point for prostate cancer specific mortality (PCSM). Materials and Methods: Baseline, treatment and followup information was compiled on a cohort of 8,669 patients with prostate cancer treated with surgery (5,918) or radiation (2,751) from January 1, 1988 to January 1, 2002 for clinical stage T1c-4NxMo prostate cancer, forming the study cohort. Cox regression analysis was used to test whether Prentice criteria were violated in this cohort. Results: After PSA defined recurrence PSA-DT less than 3 months and the specific value of PSA-DT at 3 months or greater were statistically significantly associated with time to PCSM and with time to all cause mortality after PSA defined recurrence (each Cox p <0.001). Treatment received was not statistically significant associated with time to PCSM following PSA defined recurrence in patients with PSA-DT less than 3 months (Cox p = 0.90) and in patients with PSA-DT 3 months or greater (Cox p = 0.28). Furthermore, after PSA defined recurrence PSA-DT less than 3 months was statistically significantly associated with PCSM (HR 19.6, 95% CI 12.5 to 30.9). Conclusions: Posttreatment PSA-DT appears to be a surrogate end point for PCSM following surgery or radiation therapy. We recommend that consideration should be given to enrollment onto a clinical trial and/or initiating androgen suppression therapy at the time of PSA defined recurrence when PSA-DT is less than 3 months to delay the imminent sequelae of metastatic bone disease.

Authors
D'Amico, AV; Moul, J; Carroll, PR; Sun, L; Lubeck, D; Chen, M-H; Iversen, P; Gelmann, EP; Sellers, WR
MLA Citation
D'Amico, AV, Moul, J, Carroll, PR, Sun, L, Lubeck, D, Chen, M-H, Iversen, P, Gelmann, EP, and Sellers, WR. "Prostate specific antigen doubling time as a surrogate end point for prostate cancer specific mortality following radical prostatectomy or radiation therapy." Journal of Urology 172.5 II (2004): S42-S47.
PMID
15535442
Source
scival
Published In
Journal of Urology
Volume
172
Issue
5 II
Publish Date
2004
Start Page
S42
End Page
S47
DOI
10.1097/01.ju.0000141845.99899.12

The Cooperberg/Park/Carroll article reviewed

Authors
Moul, JW
MLA Citation
Moul, JW. "The Cooperberg/Park/Carroll article reviewed." ONCOLOGY 18.10 (2004): 1248-1256.
Source
scival
Published In
Oncology
Volume
18
Issue
10
Publish Date
2004
Start Page
1248
End Page
1256

Editorial

Authors
Moul, JW
MLA Citation
Moul, JW. "Editorial." Prostate Cancer and Prostatic Diseases 7.3 (2004): 179--.
Source
scival
Published In
Prostate Cancer and Prostatic Diseases
Volume
7
Issue
3
Publish Date
2004
Start Page
179-
DOI
10.1038/sj.pcan.4500759

Race/ethnicity and the intensity of medical monitoring under watchful waiting' for prostate cancer

Background: Previous studies have found that racial/ethnic minority patients with prostate cancer are more frequently managed with "watchful waiting." Little, however, is known about the medical care received among men managed with watchful waiting. We examine the type and intensity of medical monitoring received by African American, Hispanic, and white patients with prostate cancer managed with "watchful waiting" in fee-for-service systems. Methods: Surveillance Epidemiology and End Results-Medicare data for men diagnosed with prostate cancer 1994-1996 were used in this study. Men were determined to have initially received watchful waiting if they did not receive surgery, radiation, or hormone treatment within the first 7 months of diagnosis. Crosstabulations, multivariate logistic, and Cox regressions were used to examine the association between clinical and sociodemographic variables and the receipt of a primary care, urology visit, prostatespecific antigen test, or bone scan. Results: In general, Hispanic and African American men received less medical monitoring and had longer median times from diagnosis to receipt of a medical monitoring visit or procedure than white men. Furthermore, nearly 6% of African American, 5% of Hispanic, and 1% of white men did not have any medical monitoring visits or procedures during the 60-month follow-up period (P <0.001). Differences in observed clinical or sociodemographic characteristics did not explain variations in medical monitoring. Conclusion: Regular medical monitoring is considered by most medical authorities to be a necessary component of management with watchful waiting. The disproportionately low receipt of medical monitoring visits and procedures observed for African American and Hispanic men managed with watchful waiting in this study suggest that there are racial/ethnic disparities in the receipt of appropriate prostate cancer management. Copyright © 2004 by Lippincott Williams & Wilkins.

Authors
Shavers, VL; Brown, M; Klabunde, CN; Potosky, AL; Davis, W; Moul, J; Fahey, A
MLA Citation
Shavers, VL, Brown, M, Klabunde, CN, Potosky, AL, Davis, W, Moul, J, and Fahey, A. "Race/ethnicity and the intensity of medical monitoring under watchful waiting' for prostate cancer." Medical Care 42.3 (2004): 239-250.
PMID
15076823
Source
scival
Published In
Medical Care
Volume
42
Issue
3
Publish Date
2004
Start Page
239
End Page
250
DOI
10.1097/01.mlr.0000117361.61444.71

Editorial

Authors
Moul, JW; Kirby, RS
MLA Citation
Moul, JW, and Kirby, RS. "Editorial." Prostate Cancer and Prostatic Diseases 7.1 (2004): 1--.
Source
scival
Published In
Prostate Cancer and Prostatic Diseases
Volume
7
Issue
1
Publish Date
2004
Start Page
1-
DOI
10.1038/sj.pcan.4500711

Editorial

Authors
Kirby, RS; Moul, JW
MLA Citation
Kirby, RS, and Moul, JW. "Editorial." Prostate Cancer and Prostatic Diseases 7.2 (2004): 85-86.
Source
scival
Published In
Prostate Cancer and Prostatic Diseases
Volume
7
Issue
2
Publish Date
2004
Start Page
85
End Page
86
DOI
10.1038/sj.pcan.4500731

Evolution of therapeutic approaches with luteinizing hormone-releasing hormone agonists in 2003.

The role of hormone therapy in the current era of widespread testing for prostate-specific antigen (PSA) continues to evolve. Although still used in patients with metastatic disease, the most common uses of luteinizing hormone-releasing hormone (LHRH) agonist therapy are in the adjuvant and neoadjuvant settings with radiotherapy and sometimes with radical prostatectomy, as well as in the treatment of PSA-only recurrence. Immediate (adjuvant) hormone therapy after prostatectomy may provide a survival advantage relative to deferred treatment in high-risk patients, whereas the survival benefit of adjuvant therapy with radiation is clearer. Combined androgen blockade with an LHRH agonist and a nonsteroidal antiandrogen provides a very modest but statistically significant survival benefit relative to LHRH agonist monotherapy in patients with metastatic disease, but it has not been proved in those with less advanced disease. Intermittent hormone therapy appears to be effective in maintaining disease control for several years, but randomized studies are needed to determine if survival is at least equivalent to continuous therapy. Finally, LHRH agonist therapy is commonly used in the setting of biochemical or PSA-only recurrence. However, there are no randomized controlled trials to prove a survival benefit over observation. In summary, hormone therapy now plays a more important role at earlier stages of disease, consistent with the changing epidemiology of prostate cancer. Additional studies are needed, however, to define how to optimally use hormone therapy across various patient types.

Authors
Moul, JW; Fowler, JE
MLA Citation
Moul, JW, and Fowler, JE. "Evolution of therapeutic approaches with luteinizing hormone-releasing hormone agonists in 2003." Urology 62.6 Suppl 1 (December 22, 2003): 20-28.
PMID
14706505
Source
pubmed
Published In
Urology
Volume
62
Issue
6 Suppl 1
Publish Date
2003
Start Page
20
End Page
28

Temporarily deferred therapy (watchful waiting) for men younger than 70 years and with low-risk localized prostate cancer in the prostate-specific antigen era.

PURPOSE: Watchful waiting (WW) is an acceptable strategy for managing prostate cancer (PC) in older men. Prostate-specific antigen (PSA) testing has resulted in a stage migration, with diagnoses made in younger men. An analysis of the Department of Defense Center for Prostate Disease Research Database was undertaken to document younger men with low- or intermediate-grade PC who initially chose WW. PATIENTS AND METHODS: We identified men choosing WW who were diagnosed between January 1991 and January 2002, were 70 years or younger, had a Gleason score < or = 6 with no Gleason pattern 4, had no more than three positive cores on biopsy, and whose clinical stage was < or = T2 and PSA level was < or = 20. We analyzed their likelihood of remaining on WW, the factors associated with secondary treatment, and the influence of comorbidities. RESULTS: Three hundred thirteen men were identified. Median follow-up time was 3.8 years. Median age was 65.4 years (range, 41 to 70 years). Ninety-eight patients remained on WW; 215 proceeded to treatment. A total of 57.3% and 73.2% chose treatment within the first 2 and 4 years, respectively. Median PSA doubling time (DT) was 2.5 years for those who underwent therapy; those remaining on WW had a median DT of 25.8 years. The type of secondary treatment was associated with the number of patient's comorbidities (P =.012). CONCLUSION: Younger patients who choose WW seemed more likely to receive secondary treatment than older patients. PSA DTs often predict the use of secondary treatment. The number of comorbidities a patient has influences the type of secondary therapy chosen. The WW strategy may better be termed temporarily deferred therapy.

Authors
Carter, CA; Donahue, T; Sun, L; Wu, H; McLeod, DG; Amling, C; Lance, R; Foley, J; Sexton, W; Kusuda, L; Chung, A; Soderdahl, D; Jackmaan, S; Moul, JW
MLA Citation
Carter, CA, Donahue, T, Sun, L, Wu, H, McLeod, DG, Amling, C, Lance, R, Foley, J, Sexton, W, Kusuda, L, Chung, A, Soderdahl, D, Jackmaan, S, and Moul, JW. "Temporarily deferred therapy (watchful waiting) for men younger than 70 years and with low-risk localized prostate cancer in the prostate-specific antigen era." J Clin Oncol 21.21 (November 1, 2003): 4001-4008.
PMID
14581423
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
21
Issue
21
Publish Date
2003
Start Page
4001
End Page
4008
DOI
10.1200/JCO.2003.04.092

Combination of low-dose flutamide and finasteride for PSA-only recurrent prostate cancer after primary therapy.

OBJECTIVES: To evaluate the efficacy and tolerability of combined finasteride and low-dose flutamide for prostate-specific antigen (PSA)-only recurrence after definitive therapy and to determine the predictors of recurrence-free survival. METHODS: Seventy-one men with biochemical recurrence after primary therapy for prostate cancer were prospectively enrolled from 1996 to 1998. Forty-two patients had undergone radical retropubic prostatectomy and 29 had undergone external beam radiotherapy. Radionuclide bone scans and computed tomography of the abdomen and pelvis showed no metastasis. The initial treatment with finasteride (5 mg twice daily) and flutamide (125 mg twice daily) was continued unless participants were unable to tolerate the agents or experienced PSA progression. RESULTS: At a mean of 44.4 months (range 12 to 92) of follow-up, 54 (76%) of 71 patients were available for measurement of disease status and response to therapy. Three patients had died of unrelated causes; 5 men withdrew from the study because of side effects and 1 patient for protocol violation. Eight patients were lost to follow-up. Twenty-seven patients (38%) continued receiving therapy with no evidence of PSA progression (PSA level less than 0.4 ng/mL), 6 patients maintained a more than 50% reduction in their baseline PSA level at the time of analysis, and 21 (29%) had PSA progression (ie, elevated PSA level on three consecutive tests more than 4 weeks apart). Major side effects were breast tenderness (90%), gynecomastia (72%), gastrointestinal disturbances (22%), fatigue (10%), and decreased libido (4%). The side effects were mild and well tolerated by most patients. CONCLUSIONS: The combination of finasteride and flutamide showed a moderate efficacy in patients with PSA-only recurrence after definitive therapy. The efficacy appears to be greater in patients who can achieve a PSA nadir of 0.1 ng/mL or less after the start of treatment.

Authors
Barqawi, AB; Moul, JW; Ziada, A; Handel, L; Crawford, ED
MLA Citation
Barqawi, AB, Moul, JW, Ziada, A, Handel, L, and Crawford, ED. "Combination of low-dose flutamide and finasteride for PSA-only recurrent prostate cancer after primary therapy." Urology 62.5 (November 2003): 872-876.
PMID
14624911
Source
pubmed
Published In
Urology
Volume
62
Issue
5
Publish Date
2003
Start Page
872
End Page
876

Factors associated with blood loss during radical prostatectomy for localized prostate cancer in the prostate-specific antigen (PSA)-era: an overview of the Department of Defense (DOD) Center for Prostate Disease Research (CPDR) national database.

Radical Prostatectomy (RP) has been traditionally associated with significant operative blood loss and high risk of transfusion. However, over the last few years, centers of excellence have reported less bleeding and transfusion. To verify and document changes in the epidemiology of bleeding and transfusion of men electing RP, we undertook an analysis of such cases in the Department of Defense (DoD) Center for Prostate Disease Research (CPDR) Multicenter Research Database. Using the Department of Defense Center for Prostate Disease Research (CPDR) Multicenter National Research Database, a query of all RPs performed between January 1, 1985 and December 31, 2000 was conducted revealing 2918 cases with blood-loss data available for analysis from nine hospital sites. These cases were analyzed over time (calendar year) and changes in the characteristics of the patients, disease severity, and surgical results were compared with estimated blood loss (EBL) and transfusion data. Among the 2918 evaluable men, 2399 (82%) underwent a retropubic RP, 97% had clinical T1-2 disease, and 77% had a PSA level > or =10.0 ng/mL. Overall median operation time was 3.8 h, and EBL was 1000 cc. Examining trends over time, there was a dramatic decline in median operative time, EBL, and transfusion rate. In multiple linear regression analysis, operative time, operative approach, surgery year, lymphadenectomy status, and neoadjuvant hormonal therapy were significant predictor of EBL. Blood loss difference between retropubic and perineal RP became insignificant in the latter years. Radical prostatectomy is being performed more commonly on men with earlier stage disease in the PSA-Era. The operation is now performed more rapidly with less blood loss and fewer transfusion requirements. In a broad practice experience represented here, autologous blood donation would appear to be unnecessary for the majority of men and the blood loss advantage traditionally associated with perineal RP is no longer evident.

Authors
Moul, JW; Sun, L; Wu, H; McLeod, DG; Amling, C; Lance, R; Foley, J; Sexton, W; Kusuda, L; Chung, A; Soderdahl, D; Donahue, T
MLA Citation
Moul, JW, Sun, L, Wu, H, McLeod, DG, Amling, C, Lance, R, Foley, J, Sexton, W, Kusuda, L, Chung, A, Soderdahl, D, and Donahue, T. "Factors associated with blood loss during radical prostatectomy for localized prostate cancer in the prostate-specific antigen (PSA)-era: an overview of the Department of Defense (DOD) Center for Prostate Disease Research (CPDR) national database." Urol Oncol 21.6 (November 2003): 447-455.
PMID
14693271
Source
pubmed
Published In
Urologic Oncology: Seminars and Original Investigations
Volume
21
Issue
6
Publish Date
2003
Start Page
447
End Page
455

Surrogate end point for prostate cancer-specific mortality after radical prostatectomy or radiation therapy.

BACKGROUND: The relationship between prostate-specific antigen (PSA)-defined recurrence and prostate cancer-specific mortality remains unclear. Therefore, we evaluated the hypothesis that a short post-treatment PSA doubling time (PSA-DT) after radiation therapy is a surrogate end point for prostate cancer-specific mortality by analyzing two multi-institutional databases. METHODS: Baseline, treatment, and follow-up information was compiled on a cohort of 8669 patients with prostate cancer treated with surgery (5918 men) or radiation (2751 men) from January 1, 1988, through January 1, 2002, for localized or locally advanced, non-metastatic prostate cancer. We used a Cox regression analysis to test whether the post-treatment PSA-DT was a prognostic factor that was independent of treatment received. All statistical tests were two-sided. RESULTS: The post-treatment PSA-DT was statistically significantly associated with time to prostate cancer-specific mortality and with time to all-cause mortality (all P(Cox)<.001). However, the treatment received was not statistically significantly associated with time to prostate cancer-specific mortality after PSA-defined disease recurrence for patients with a PSA-DT of less than 3 months (P(Cox) =.90) and for patients with a PSA-DT of 3 months or more (P(Cox) =.28) when controlling for the specific value of the PSA-DT. Furthermore, after a PSA-defined recurrence, a PSA-DT of less than 3 months was statistically significantly associated with time to prostate cancer-specific mortality (median time = 6 years; hazard ratio = 19.6, 95% confidence interval = 12.5 to 30.9). CONCLUSION: A post-treatment PSA-DT of less than 3 months and the specific value of the post-treatment PSA-DT when it is 3 months or more appear to be surrogate end points for prostate cancer-specific mortality after surgery or radiation therapy. We recommend that consideration be given to initiating androgen suppression therapy at the time of a PSA-defined recurrence when the PSA-DT is less than 3 months to delay the imminent onset of metastatic bone disease.

Authors
D'Amico, AV; Moul, JW; Carroll, PR; Sun, L; Lubeck, D; Chen, M-H
MLA Citation
D'Amico, AV, Moul, JW, Carroll, PR, Sun, L, Lubeck, D, and Chen, M-H. "Surrogate end point for prostate cancer-specific mortality after radical prostatectomy or radiation therapy." J Natl Cancer Inst 95.18 (September 17, 2003): 1376-1383.
PMID
13130113
Source
pubmed
Published In
Journal of the National Cancer Institute
Volume
95
Issue
18
Publish Date
2003
Start Page
1376
End Page
1383

Population screening for prostate cancer and emerging concepts for young men.

Prostate cancer is the most common malignancy in American men, accounting for > 29% of all diagnosed cancers and approximately 13% of all cancer deaths. Nearly 1 of every 6 men will be diagnosed with the disease at some time in their lives. In 2003 alone, an estimated 221000 men in the United States will be diagnosed with prostate cancer and > 28000 will die of the disease. An elevated level of prostate-specific antigen (PSA) is correlated with the presence of prostate cancer, and since 1989 we have been living in the "PSA era," in which the PSA screening test is widely used in clinical practice. This article summarizes what has been learned about the use of PSA screening, including the intricacies of free PSA, PSA doubling time, and various factors that may affect PSA and confound screening in young men. Although population-based screening for prostate cancer has yet to be definitively proven to affect disease-specific mortality, PSA testing is detecting cancers in younger men and at earlier stages of disease progression and, partly as a result, 5-year cancer-specific survival is increasing. Even though this lead-time effect may not translate into long-term improvement, these changes are very promising and are a necessary prerequisite to effective screening. For patients at high risk with a family history of the disease and for black men, a strategy consisting of an annual PSA blood test and digital rectal examination for men >or=40 years of age appears to be prudent. Use of age- and race-specific reference ranges for PSA based on sensitivity, or maximal cancer detection, is the most appropriate approach in this high-risk group. Specifically among black men 40-49 years of age, those with a PSA value > 2.0 ng/mL should consider further evaluation. Many men at low/average risk aged 40-49 years also request testing and it is reasonable to offer testing and risk assessment to these young men. The exact screening threshold for total PSA in these men is unknown, but 95% of these men will have a PSA < 2.5 ng/mL. Prostate-specific antigen velocity, percentage of free PSA, and perhaps complexed PSA may be used to help determine risk, but further study of young men is needed. In the future, a risk-stratified approach using molecular biomarkers and/or proteomics in young men is anticipated.

Authors
Moul, JW
MLA Citation
Moul, JW. "Population screening for prostate cancer and emerging concepts for young men." Clin Prostate Cancer 2.2 (September 2003): 87-97. (Review)
PMID
15040869
Source
pubmed
Published In
Clinical prostate cancer
Volume
2
Issue
2
Publish Date
2003
Start Page
87
End Page
97

Early prostate cancer: prevention, treatment modalities, and quality of life issues.

Our understanding of the screening, prevention and treatment of early prostate cancer is improving. This is a result of new data from clinical trials and the incorporation of efficacy measures based on risk assessment and quality of life (QoL). This review aims to examine completed and ongoing clinical trials that address issues in early prostate cancer, including screening, prevention, treatment, and QoL. Prostate-specific antigen (PSA) testing has a crucial and evolving role in detecting primary prostate cancer, evaluating prevention interventions and assessing the effectiveness of treatment. Questions remain about the optimal PSA parameters appropriate for primary screening and for diagnosing relapse. Emerging and established data provide evidence that early intervention with hormone therapy, either as immediate or adjuvant therapy, delays progression in prostate cancer patients with intermediate or poor prognosis. The impact of therapeutic modality on QoL has become better characterized, as QoL instruments have been developed, validated and applied.

Authors
Moul, JW; Anderson, J; Penson, DF; Klotz, LH; Soloway, MS; Schulman, CC
MLA Citation
Moul, JW, Anderson, J, Penson, DF, Klotz, LH, Soloway, MS, and Schulman, CC. "Early prostate cancer: prevention, treatment modalities, and quality of life issues." Eur Urol 44.3 (September 2003): 283-293. (Review)
PMID
12932925
Source
pubmed
Published In
European Urology
Volume
44
Issue
3
Publish Date
2003
Start Page
283
End Page
293

Biochemical recurrence of prostate cancer.

Authors
Moul, JW
MLA Citation
Moul, JW. "Biochemical recurrence of prostate cancer." Curr Probl Cancer 27.5 (September 2003): 243-272. (Review)
PMID
12963877
Source
pubmed
Published In
Current Problems in Cancer
Volume
27
Issue
5
Publish Date
2003
Start Page
243
End Page
272

PMEPA1, an androgen-regulated NEDD4-binding protein, exhibits cell growth inhibitory function and decreased expression during prostate cancer progression.

PMEPA1 was originally identified as a highly androgen-induced gene by serial analysis of gene expression in androgen-treated LNCaP prostate cancer (CaP) cells. PMEPA1 expression is prostate abundant and restricted to prostatic epithelial cells. PMEPA1-encoded protein shows high sequence homology to a mouse N4wbp4-encoded protein that binds to Nedd4 protein, an E3 ubiquitin-protein ligase involved in ubiquitin-dependent, proteasome-mediated protein degradation. Studies from our and other laboratories have suggested the role of PMEPA1 in cell growth regulation as noted by androgen induction of PMEPA1 expression, elevated PMEPA1 expression in nontumorigenic revertants of tumor cell lines after chromosome 8p transfer, and PMEPA1 expression alterations (up- or down-regulation) in human tumors. Here, we demonstrate that PMEPA1 protein through its PY motifs interacts with WW domains of the human NEDD4 protein. Exogenous expression of PMEPA1, in widely used CaP cell lines DU145, PC3, LNCaP, and LNCaP sublines (C4, C4-2, and C4-2B), conferred cell growth inhibition, and at least one of the PY motifs of PMEPA1 may be involved in its cell growth inhibitory functions. Quantitative expression analysis of PMEPA1 in paired normal and tumor cells of 62 patients with primary CaP revealed tumor cells associated decreased expression in 40 of 62 patients that were significantly associated with higher pathologic stage and serum prostate-specific antigen. Taken together, PMEPA1 negatively regulates growth of androgen responsive or refractory CaP cells, and these functions may be mediated through the interaction of PMEPA1 with the NEDD4 protein involved in the ubiquitin-proteasome pathway. Loss or reduced PMEPA1 expression in CaP further suggests for its role in prostate tumorigenesis.

Authors
Xu, LL; Shi, Y; Petrovics, G; Sun, C; Makarem, M; Zhang, W; Sesterhenn, IA; McLeod, DG; Sun, L; Moul, JW; Srivastava, S
MLA Citation
Xu, LL, Shi, Y, Petrovics, G, Sun, C, Makarem, M, Zhang, W, Sesterhenn, IA, McLeod, DG, Sun, L, Moul, JW, and Srivastava, S. "PMEPA1, an androgen-regulated NEDD4-binding protein, exhibits cell growth inhibitory function and decreased expression during prostate cancer progression." Cancer Res 63.15 (August 1, 2003): 4299-4304.
PMID
12907594
Source
pubmed
Published In
Cancer Research
Volume
63
Issue
15
Publish Date
2003
Start Page
4299
End Page
4304

Diagnostic potential of serum proteomic patterns in prostate cancer.

PURPOSE: The serum prostate specific antigen test has been widely used in the last decade as an effective screening tool for prostate cancer (CaP). However, the high false-positive rate of the serum prostate specific antigen test necessitates the development of more accurate diagnostic and prognostic biomarkers for CaP. Promising diagnostic potential of serum protein patterns detected by surface enhanced laser desorption/ionization time of flight mass spectrometry for CaP has recently been reported. Independent evaluation of this new technology is warranted to realize its translational utility. We determined whether serum protein profiling by surface enhanced laser desorption/ionization time of flight mass spectrometry and a decision tree algorithm classification system could accurately discriminate between patients with CaP and unaffected individuals. MATERIALS AND METHODS: Proteomic spectra of crude serum were generated using the Ciphergen ProteinChip System and pattern detection was performed using Biomarker Patterns Software (Ciphergen Biosystems, Inc., Fremont, California). A total of 106 patients with CaP and 56 controls were randomly allocated to a training set and a test set. The training set, which consisted of 44 patients with cancer and 30 controls, was used to build a decision tree algorithm. The test set, which consisted of 62 patients with cancer and 26 controls, was used in blinded fashion to validate the decision tree. RESULTS: Accuracy of classification using the test set was 67% and 42% for the weak cation exchange array and the copper metal affinity capture array, respectively. Combined spectral data from the weak cation exchange and copper metal affinity capture arrays generated an algorithm that achieved 85% sensitivity and 85% specificity for the detection of CaP. CONCLUSIONS: These preliminary findings support recent observations that complex protein profiles have promising potential for the early detection of CaP and warrant future studies with streamlined technology. Furthermore, the combined effect of using 2 array types can greatly enhance the ability of protein profile patterns, suggesting the potential usefulness of alternative approaches to evaluate this new emerging technology.

Authors
Bañez, LL; Prasanna, P; Sun, L; Ali, A; Zou, Z; Adam, B-L; McLeod, DG; Moul, JW; Srivastava, S
MLA Citation
Bañez, LL, Prasanna, P, Sun, L, Ali, A, Zou, Z, Adam, B-L, McLeod, DG, Moul, JW, and Srivastava, S. "Diagnostic potential of serum proteomic patterns in prostate cancer." J Urol 170.2 Pt 1 (August 2003): 442-446.
PMID
12853795
Source
pubmed
Published In
The Journal of Urology
Volume
170
Issue
2 Pt 1
Publish Date
2003
Start Page
442
End Page
446
DOI
10.1097/01.ju.0000069431.95404.56

Population Screening for Prostate Cancer and Early Detection in High-risk African American Men

This chapter explores the changes in the prostate specific antigen (PSA) screening test and the prospects for targeted screening of certain groups of individuals who may be at particular risk of developing prostate cancer. Prostate cancer is the most common malignancy in American men, accounting for more than 29% of all diagnosed cancers and approximately 13% of all cancer deaths. To be of value, screening must lead to treatment that has a favorable impact on prognosis. Opponents of screening point to the potential for side effects from treatment, the possibility that some men will be treated unnecessarily, the economic burden on the health care system, and the lack of definitive scientific evidence that the screening will reduce overall disease-specific mortality. Although randomized clinical trials have yet to definitively prove or disprove the efficacy of prostate cancer population-based screening, emerging data in the PSA era arguably support PSA testing in the early diagnosis of prostate cancer. Specifically, with public awareness of the disease and widespread PSA testing, smaller cancers are being detected in younger men and survival rates are on the rise. Use of age- and race-specific reference ranges for PSA based on sensitivity, or maximal cancer detection, is a favorable approach in this high-risk group. © 2003 Elsevier Ltd. All rights reserved.

Authors
Moul, JW
MLA Citation
Moul, JW. "Population Screening for Prostate Cancer and Early Detection in High-risk African American Men." (July 1, 2003): 3-10. (Chapter)
Source
scopus
Publish Date
2003
Start Page
3
End Page
10
DOI
10.1016/B978-012286981-5/50003-3

Variables in predicting survival based on treating "PSA-only" relapse.

Prostate cancer recurrence (after prior local treatment) that is detectable only by a rise in serum prostate specific antigen (PSA) level is a very common problem facing clinicians. Given that the majority of contemporary era men with PSA-only or biochemical recurrence are relatively young and otherwise healthy, treatment requires approaches that both improve clinical outcomes and preserve quality of life. Treatment is in one of two broad categories, additional local therapies, termed "salvage" local therapy and systemic therapies. For radical prostatectomy patients, salvage external beam radiotherapy to the prostate bed is commonly employed, being reserved for early biochemical recurrence in men with low risk at distant metastases. For primary radiation patients, salvage radical prostatectomy or cryotherapy can similarly be used for those men felt not to harbor distant metastases. Systemic therapy generally involves hormonal therapy. Traditional hormonal therapy (orchiectomy, luteinizing hormone-releasing hormone agonists, or maximum androgen blockade) is the current mainstay of systemic treatment for biochemical recurrence, although nontraditional approaches, such as antiandrogen monotherapy, are increasingly being used. Variables in predicting survival based on treating PSA relapse is problematic. The condition of biochemical failure has only been recognized in the last decade and few "PSA-era" patients with biochemical recurrence have actually died of disease. Hence, the validation of prediction variables in this setting is just emerging. Early work would suggest that timing of recurrence, Gleason grade, and PSA velocity or doubling time during relapse are important prognostic factors. New data on PSA doubling time will be presented.

Authors
Moul, JW
MLA Citation
Moul, JW. "Variables in predicting survival based on treating "PSA-only" relapse." Urol Oncol 21.4 (July 2003): 292-304. (Review)
PMID
12954500
Source
pubmed
Published In
Urologic Oncology: Seminars and Original Investigations
Volume
21
Issue
4
Publish Date
2003
Start Page
292
End Page
304

Diagnostic potential of prostate-specific antigen expressing epithelial cells in blood of prostate cancer patients.

PURPOSE: Prostate-specific antigen (PSA) test has become a widely used screening test in prostate cancer (CaP). However, low specificity of serum PSA leads to many false-positive and false-negative results and clinical uncertainty. Development of CaP-specific diagnostic and prognostic markers is needed. Detection of circulating PSA-expressing cells (CPECs) in blood and bone marrow of CaP patients has potential in molecular diagnosis and prognosis. Our novel observations of the frequent presence of CPECs in CaP patients with organ-confined disease by reverse transcription (RT)-PCR-PSA assay in epithelial cells enriched from peripheral blood (ERT-PCR/PSA) have led us to test the hypothesis that CPECs have diagnostic potential for CaP. EXPERIMENTAL DESIGN: Epithelial cells from peripheral blood of radical prostatectomy patients or prostate biopsy patients were isolated using antiepithelial cell antibody, Ber-EP4-coated magnetic beads, and total RNA specimens from these cells were analyzed for PSA expression by RT-PCR. RESULTS: Peripheral blood specimens of 108 of 135 (80.0%) CaP patients were positive in ERT-PCR/PSA assay. Peripheral blood specimens from 45 control men were virtually negative (97.8%). In the blinded investigation, 84 patients who had biopsy for suspicion of CaP were evaluated by ERT-PCR/PSA assay. Eighteen of 22 (81.8%) patients with biopsy-proven CaP were positive, and 54 of 62 (87.1%) patients with biopsy negative for CaP were negative in this assay (P < 0.001). CONCLUSIONS: Our study provides intriguing novel results showing that the majority of patients with clinically organ-confined CaP contain CPECs. Strong concordance between the biopsy results and ERT-PCR/PSA assay (sensitivity 81.8%; specificity 87.1%) suggests a potentially new diagnostic application of this type of assay in CaP diagnosis.

Authors
Gao, C-L; Rawal, SK; Sun, L; Ali, A; Connelly, RR; Bañez, LL; Sesterhenn, IA; McLeod, DG; Moul, JW; Srivastava, S
MLA Citation
Gao, C-L, Rawal, SK, Sun, L, Ali, A, Connelly, RR, Bañez, LL, Sesterhenn, IA, McLeod, DG, Moul, JW, and Srivastava, S. "Diagnostic potential of prostate-specific antigen expressing epithelial cells in blood of prostate cancer patients." Clin Cancer Res 9.7 (July 2003): 2545-2550.
PMID
12855629
Source
pubmed
Published In
Clinical cancer research : an official journal of the American Association for Cancer Research
Volume
9
Issue
7
Publish Date
2003
Start Page
2545
End Page
2550

A novel neoplastic primary tumor-derived human prostate epithelial cell line.

Research into molecular and genetic mechanisms underlying prostate carcinogenesis would be greatly advanced by in vitro models of prostate tumors representing primary tumors. The generation of immortalized primary prostate cancer cells that will accurately reflect the in situ characteristics of malignant epithelium is greatly needed. We have successfully established a neoplastic immortalized human prostate epithelial (HPE) cell culture derived from a primary tumor. The RC-9 cells transduced through infection with a retrovirus vector expressing the E6 and E7 genes (E6E7) of human papilloma virus-16 (HPV-16) are currently growing well at passage 40, whereas RC-9 cells senesced at passage 7. RC-9/E6E7 cells exhibit epithelial morphology and high level of telomerase activity. More importantly, these immortalized cells produced tumors (SCID5038D) when inoculated into SCID mice. RC-9/E6E7 cells and SCID-5038D cells exhibit a high level of telomerase activity and androgen-responsiveness when treated with R1881. Expression of prostate specific antigen (PSA), androgen receptor (AR), prostate stem cell antigen (PSCA), an androgen-regulated prostate specific gene (NKX3.1), p16, cytokeratins 8, 15 and HPV-16 E6 gene was detected in both of these cells. RC-9/E6E7 and SCID5038D cells also showed growth inhibition when exposed to retinoic acid and transforming growth factor (TGF)-beta1, potent inhibitors of prostate epithelial cell growth. A number of chromosome alterations were observed including the loss of chromosomes 2p, 3p, 8p, 13, 14, 16, 17, 18, 21 and the gain of 7 and 20 in the tumor cell line (SCID5038D). These results demonstrate that this primary tumor-derived HPE cell line retained its neoplastic phenotypes and its prostate-specific markers and should allow studies to elucidate molecular and genetic alterations involved in prostate cancer. This is the first documented case of a malignant AR and PSA positive established human prostate cancer cell line from a primary tumor of a prostate cancer patient.

Authors
Ko, D; Gu, Y; Yasunaga, Y; Nakamura, K; Srivastava, S; Moul, JW; Sesterhenn, IA; McLeod, DG; Arnstein, P; Taylor, DO; Hukku, B; Rhim, JS
MLA Citation
Ko, D, Gu, Y, Yasunaga, Y, Nakamura, K, Srivastava, S, Moul, JW, Sesterhenn, IA, McLeod, DG, Arnstein, P, Taylor, DO, Hukku, B, and Rhim, JS. "A novel neoplastic primary tumor-derived human prostate epithelial cell line." Int J Oncol 22.6 (June 2003): 1311-1317.
PMID
12738999
Source
pubmed
Published In
International journal of oncology
Volume
22
Issue
6
Publish Date
2003
Start Page
1311
End Page
1317

Pretreatment total testosterone level predicts pathological stage in patients with localized prostate cancer treated with radical prostatectomy.

PURPOSE: In the last decade numerous groups have shown that low levels of pretreatment serum total testosterone consistently predict more aggressive disease, worse prognosis and worse treatment response in patients with metastatic prostate cancer. Prior studies have not demonstrated this same correlation in patients with known localized disease. We rigorously tested pretreatment total testosterone levels as a potential staging and prognostic marker in a large cohort of 879 patients with localized cancer treated with radical prostatectomy. MATERIALS AND METHODS: We retrospectively reviewed the clinical records of 879 patients treated with radical prostatectomy between January 1, 1986 and June 30, 2002 from 9 hospital sites. Nonparametric tests were used to compare the relationship of pretreatment testosterone to other variables. Multivariate logistic regression analysis was used to assess clinical predictors of extraprostatic disease. Kaplan-Meier survival methods and Cox regression analysis were used to assess predictors of biochemical recurrence. RESULTS: Patients with non-organ confined prostate cancer (pT3-T4) showed significantly lower pretreatment total testosterone levels than those with organ confined cancer (pT1-T2) (nonparametric p = 0.041). In multivariate analysis pretreatment total testosterone emerged as a significant independent predictor of extraprostatic disease (p = 0.046). Total testosterone was not a significant predictor of biochemical (prostate specific antigen) recurrence (p = 0.467). CONCLUSIONS: Pretreatment total testosterone was an independent predictor of extraprostatic disease in patients with localized prostate cancer. As testosterone decreases patients have an increased likelihood of non-organ confined disease. Low testosterone was not predictive of biochemical recurrence, although trends observed dictate study in larger cohorts with mature followup.

Authors
Massengill, JC; Sun, L; Moul, JW; Wu, H; McLeod, DG; Amling, C; Lance, R; Foley, J; Sexton, W; Kusuda, L; Chung, A; Soderdahl, D; Donahue, T
MLA Citation
Massengill, JC, Sun, L, Moul, JW, Wu, H, McLeod, DG, Amling, C, Lance, R, Foley, J, Sexton, W, Kusuda, L, Chung, A, Soderdahl, D, and Donahue, T. "Pretreatment total testosterone level predicts pathological stage in patients with localized prostate cancer treated with radical prostatectomy." J Urol 169.5 (May 2003): 1670-1675.
PMID
12686805
Source
pubmed
Published In
The Journal of Urology
Volume
169
Issue
5
Publish Date
2003
Start Page
1670
End Page
1675
DOI
10.1097/01.ju.0000062674.43964.d0

Methylation of TFPI-2 gene is not the sole cause of its silencing.

TFPI-2 (tissue factor pathway inhibitor-2) is a serine protease inhibitor that may suppress tumor cell invasion and metastasis. TFPI-2 expression is often lost in cells derived from tumors of diverse organs. We have examined whether aberrant hypermethylation of the 5' end of the TFPI-2 gene is associated with its loss of expression. After 5-azacytidine treatment of three cell lines lacking TFPI-2 expression (HT1080 fibrosarcoma cells, MCF-7 breast carcinoma cells, and LNCaP prostate carcinoma cells), TFPI-2 transcripts could be detected by RT-PCR. In these three cell lines, methylation of the 5' end of the TFPI-2 gene was detected, while two prostate carcinoma cell lines in which the TFPI-2 gene was expressed, PC-3 and DU-145, showed no methylation. However, all the three cell lines which lacked TFPI-2 expression also contained unmethylated TFPI-2 alleles. Furthermore, a transiently transfected TFPI-2 promoter was non-functional in the three cell lines, but function was attained following treatment with 5-azacytidine. Our results indicate that while methylation of the TFPI-2 gene is associated with its silencing, it is not the sole cause, and we suggest that one or more components of pathways regulating TFPI-2 expression have also undergone methylation-associated silencing in these cell lines.

Authors
Rao, CN; Segawa, T; Navari, JR; Xu, L; Srivastava, S; Moul, JW; Phillips, B
MLA Citation
Rao, CN, Segawa, T, Navari, JR, Xu, L, Srivastava, S, Moul, JW, and Phillips, B. "Methylation of TFPI-2 gene is not the sole cause of its silencing." Int J Oncol 22.4 (April 2003): 843-848.
PMID
12632077
Source
pubmed
Published In
International journal of oncology
Volume
22
Issue
4
Publish Date
2003
Start Page
843
End Page
848

Effect of age on biochemical disease-free outcome in patients with T1-T3 prostate cancer treated with definitive radiotherapy in an equal-access health care system: a radiation oncology report of the Department of Defense Center for Prostate Disease Research.

PURPOSE: It has traditionally been a common perception that young age is a negative prognostic factor in prostate cancer (CaP). Furthermore, many urologists believe that younger patients are better suited to surgery rather than radiotherapy (RT) because of this perception. However, the data on the effect of age on outcome in patients with CaP are unclear. The records of the Department of Defense Center for Prostate Disease Research were queried for the biochemical disease-free results of patients after definitive RT and analyzed by age. MATERIALS AND METHODS: The records of 1018 patients with T1-T3 CaP treated with definitive RT between 1988 and 2000 were reviewed. The records of patients receiving adjuvant hormonal therapy or adjuvant or salvage RT postoperatively were excluded. Biochemical failure was calculated by the American Society for Therapeutic Radiology and Oncology criteria. The median potential follow-up was 85.3 months as of December 31, 2001. RESULTS: Age did not affect biochemical disease-free survival significantly when considered as <60 vs. >/=60 years (p = 0.646), by decade (p = 0.329), or as a continuous variable (correlation coefficient r = 0.017, regression slope = 0.007, with p = 0.588 and R(2) < 0.001). Using multiple regression analysis, age was still not significant (p = 0.408). Other variables analyzed were pretreatment prostate-specific antigen level (p < 0.001), Gleason sum (p = 0.023), stage (p = 0.828), and RT dose (p = 0.033). CONCLUSIONS: Age and biochemical disease-free survival after RT for CaP are not related. Age may not be a valid factor in choosing between primary treatment options for CaP.

Authors
Johnstone, PAS; Riffenburgh, RH; Moul, JW; Sun, L; Wu, H; McLeod, DG; Kane, CJ; Martin, DD; Kusuda, L; Lance, R; Douglas, R; Donahue, T; Beat, MG; Foley, J; Chung, A; Soderdahl, D; Do, J; Amling, CL; Department of Defense Center for Prostate Disease Research,
MLA Citation
Johnstone, PAS, Riffenburgh, RH, Moul, JW, Sun, L, Wu, H, McLeod, DG, Kane, CJ, Martin, DD, Kusuda, L, Lance, R, Douglas, R, Donahue, T, Beat, MG, Foley, J, Chung, A, Soderdahl, D, Do, J, Amling, CL, and Department of Defense Center for Prostate Disease Research, . "Effect of age on biochemical disease-free outcome in patients with T1-T3 prostate cancer treated with definitive radiotherapy in an equal-access health care system: a radiation oncology report of the Department of Defense Center for Prostate Disease Research." Int J Radiat Oncol Biol Phys 55.4 (March 15, 2003): 964-969.
PMID
12605974
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
55
Issue
4
Publish Date
2003
Start Page
964
End Page
969

Using the percentage of biopsy cores positive for cancer, pretreatment PSA, and highest biopsy Gleason sum to predict pathologic stage after radical prostatectomy: the Center for Prostate Disease Research nomograms.

OBJECTIVES: To develop probability nomograms to predict pathologic outcome at the time of radical prostatectomy (RP) on the basis of established prognostic factors and prostate biopsy quantitative histology. METHODS: Using information from the database of the Center for Prostate Disease Research (CPDR), univariate and multivariate analyses were performed on 1510 men who had undergone transrectal ultrasound and biopsy for diagnosis and had radical prostatectomy as primary therapy, with variables of age, race, clinical stage, pretreatment prostate-specific antigen (PSA), biopsy Gleason sum, and percentage of biopsy cores positive for cancer (total number of cores positive for cancer divided by the total number of cores obtained). The percentages of biopsy cores positive were grouped as less than 30%, 30% to 59%, and greater than or equal to 60%. The three most significant variables were used to develop probability nomograms for pathologic stage. RESULTS: PSA, biopsy Gleason sum, and percentage of cores positive were the three most significant independent predictors of pathologic stage. The assigned percentage of biopsy core-positive subgroups along with pretreatment PSA and highest Gleason sum were used to develop probability nomograms for pathologic stage. CONCLUSIONS: Pretreatment PSA, highest biopsy Gleason sum, and the percentage of cores positive for cancer are the most significant predictors for pathologic stage after radical prostatectomy. On the basis of these findings, CPDR probability nomograms were developed to predict pathologic outcome at the time of RP.

Authors
Gancarczyk, KJ; Wu, H; McLeod, DG; Kane, C; Kusuda, L; Lance, R; Herring, J; Foley, J; Baldwin, D; Bishoff, JT; Soderdahl, D; Moul, JW
MLA Citation
Gancarczyk, KJ, Wu, H, McLeod, DG, Kane, C, Kusuda, L, Lance, R, Herring, J, Foley, J, Baldwin, D, Bishoff, JT, Soderdahl, D, and Moul, JW. "Using the percentage of biopsy cores positive for cancer, pretreatment PSA, and highest biopsy Gleason sum to predict pathologic stage after radical prostatectomy: the Center for Prostate Disease Research nomograms." Urology 61.3 (March 2003): 589-595.
PMID
12639653
Source
pubmed
Published In
Urology
Volume
61
Issue
3
Publish Date
2003
Start Page
589
End Page
595

Limited value of bone scintigraphy and computed tomography in assessing biochemical failure after radical prostatectomy.

OBJECTIVES: To define the utility of bone scan and computed tomography (CT) in the evaluation of patients with biochemical recurrence after radical prostatectomy. METHODS: A retrospective analysis of the Center for Prostate Disease Research database was undertaken to identify patients who underwent radical prostatectomy between 1989 and 1998. Patients who developed biochemical recurrence (two prostate-specific antigen [PSA] levels greater than 0.2 ng/mL) and underwent either bone scan or CT within 3 years of this recurrence were selected for analysis. The preoperative clinical parameters, pathologic findings, serum PSA levels, follow-up data, and radiographic results were reviewed. RESULTS: One hundred thirty-two patients with biochemical recurrence and a bone scan or CT scan were identified. Of the 127 bone scans, 12 (9.4%) were positive. The patients with true-positive bone scans had an average PSA at the time of the bone scan of 61.3 +/- 71.2 ng/mL (range 1.3 to 123). Their PSA velocities, calculated from the PSA levels determined immediately before the radiographic studies, averaged 22.1 +/- 24.7 ng/mL/mo (range 0.14 to 60.0). Only 2 patients with a positive bone scan had a PSA velocity of less than 0.5 ng/mL/mo. Of the 86 CT scans, 12 (14.0%) were positive. On logistic regression analysis, PSA and PSA velocity predicted the bone scan result (P <0.001 each) and PSA velocity predicted the CT scan result (P = 0.047). CONCLUSIONS: Patients with biochemical recurrence after radical prostatectomy have a low probability of a positive bone scan (9.4%) or a positive CT scan (14.0%) within 3 years of biochemical recurrence. Most patients with a positive bone scan have a high PSA level and a high PSA velocity (greater than 0.5 ng/mL/mo).

Authors
Kane, CJ; Amling, CL; Johnstone, PAS; Pak, N; Lance, RS; Thrasher, JB; Foley, JP; Riffenburgh, RH; Moul, JW
MLA Citation
Kane, CJ, Amling, CL, Johnstone, PAS, Pak, N, Lance, RS, Thrasher, JB, Foley, JP, Riffenburgh, RH, and Moul, JW. "Limited value of bone scintigraphy and computed tomography in assessing biochemical failure after radical prostatectomy." Urology 61.3 (March 2003): 607-611.
PMID
12639656
Source
pubmed
Published In
Urology
Volume
61
Issue
3
Publish Date
2003
Start Page
607
End Page
611

Predictors of extracapsular extension and positive margins in African American and white men.

OBJECTIVE: Radical retropubic prostatectomy (RRP) pathology from African American (AA) and White men from 1988 to 1999 was examined to determine if the pre-treatment factors PSA, clinical stage, biopsy grade, age at surgery, and year of surgery (YOS) were predictive of extracapsular extension (ECE) and positive margins for each ethnic group. METHODS: Clinical and pathologic data was collected on 179 AA and 548 white men undergoing RRP from 1988 to 1999 at a tertiary military medical facility. Logistic regression with multivariate analysis was used to determine which pre-operative data-points were predictive of pathologic ECE and positive margins for each ethnic group. RESULTS: PSA, biopsy grade, age, and YOS (more recent years had better surgical pathology) were predictive of ECE for AA and white men. PSA, biopsy grade, and YOS were predictive of positive margins for AA men, while PSA and YOS were predictive of positive margins for white men. PSA continues to be a strong predictor of ECE and positive margins for both AA and white men. However, we describe for the first time, YOS being predictive of ECE and positive margins for both AA and White men, using multivariate regression analysis. CONCLUSION: This is thought to be reflective of the improving public awareness of prostate cancer that has occurred during the PSA-era, resulting in patients participating in screening programs and being diagnosed earlier. Close follow-up of these patients is warranted to determine if the improved pathologic stage of those patients treated more recently translates into improved disease-specific mortality.

Authors
Paquette, EL; Connelly, RR; Sun, L; Paquette, LR; Moul, JW
MLA Citation
Paquette, EL, Connelly, RR, Sun, L, Paquette, LR, and Moul, JW. "Predictors of extracapsular extension and positive margins in African American and white men." Urol Oncol 21.1 (January 2003): 33-38.
PMID
12684125
Source
pubmed
Published In
Urologic Oncology: Seminars and Original Investigations
Volume
21
Issue
1
Publish Date
2003
Start Page
33
End Page
38

PSA progression following radical prostatectomy and radiation therapy: new standards in the new Millennium.

Prostate-specific antigen (PSA) progression following radical treatments of clinically localized prostate cancer is a common problem facing both the patient and the urologist. Not all patients with relapsing disease have an equal risk of death due to prostate cancer. After surgery, biochemical failure can be defined as persisting detectable levels of PSA after radical prostatectomy or a PSA rise after a period of normalization. On the other hand, definitions of PSA progression after radiation therapy vary and no clear consensus can be found. This review of the recent international literature updates the knowledge about the diagnostic procedures used in relapsing patients. Predictors of progression are precised leading to a better patient selection, based on currently available tables and nomograms. Indeed, identification of high risk patients may allow a more appropriate treatment decision. After radical treatment, the analysis of time to recurrence, PSA doubling time, PSA kinetics combined to modern imaging techniques such as 111In capromab penditide scan may allow a better identification of the recurrence site. Thus, an optimal treatment strategy may be envisaged such as local irradiation, salvage surgery, hormone therapy or combinations for which indications and results are provided. Alternative options such as cryotherapy still need further investigation. At last, the use of artificial neural networks will certainly enhance the selection of patients submitted to radical treatments as well as the selection of relapsing patients to allow a more appropriate adjuvant therapy.

Authors
Djavan, B; Moul, JW; Zlotta, A; Remzi, M; Ravery, V
MLA Citation
Djavan, B, Moul, JW, Zlotta, A, Remzi, M, and Ravery, V. "PSA progression following radical prostatectomy and radiation therapy: new standards in the new Millennium." Eur Urol 43.1 (January 2003): 12-27. (Review)
PMID
12507539
Source
pubmed
Published In
European Urology
Volume
43
Issue
1
Publish Date
2003
Start Page
12
End Page
27

Limitations of tissue microarrays in the evaluation of focal alterations of bcl-2 and p53 in whole mount derived prostate tissues.

Several investigators have reported the correlation of p53 and bcl-2 immunoreactivity with post operative prostate specific antigen (PSA) recurrence. Focal and or clustered expression is typical for these biomarkers. The purpose of this study was to compare the effectiveness of tissue microarrays to detect p53 and bcl-2 overexpression and their prognostic significance. Tissue microarrays (TMA) of 99 patients with mean follow-up of 61 months contained 760 samples from 241 carcinomas, 431 benign glands, and 88 foci of prostatic intraepithelial neoplasia (PIN). Overexpression of p53 was seen in 43.3% of 97 patients, whereas bcl-2 overexpression was noted in 23.7% of 97 patients using TMA technology, compared to 66.0% and 26.9%, respectively in the corresponding radical prostatectomy samples. The tissue microarray technology is a powerful tool to study the multifocal and heterogeneous nature of prostate cancer. However, the prognostic value of p53 and bcl-2 could not be confirmed using this technology in contrast to radical prostatectomy sections. The TMA technique is probably more informative and reliable in evaluating the prognostic value of homogeneously expressed biomarkers.

Authors
Merseburger, AS; Kuczyk, MA; Serth, J; Bokemeyer, C; Young, DY; Sun, L; Connelly, RR; McLeod, DG; Mostofi, FK; Srivastava, SK; Stenzl, A; Moul, JW; Sesterhenn, IA
MLA Citation
Merseburger, AS, Kuczyk, MA, Serth, J, Bokemeyer, C, Young, DY, Sun, L, Connelly, RR, McLeod, DG, Mostofi, FK, Srivastava, SK, Stenzl, A, Moul, JW, and Sesterhenn, IA. "Limitations of tissue microarrays in the evaluation of focal alterations of bcl-2 and p53 in whole mount derived prostate tissues." Oncol Rep 10.1 (January 2003): 223-228.
PMID
12469173
Source
pubmed
Published In
Oncology Reports: an international journal devoted to fundamental and applied research in oncology
Volume
10
Issue
1
Publish Date
2003
Start Page
223
End Page
228

Pentosan polysulfate decreases prostate smooth muscle proliferation and extracellular matrix turnover.

Benign prostatic hyperplasia (BPH) involves proliferation of smooth muscle cells and increased deposition of extracellular matrix (ECM). We recently found that pentosan polysulfate (PPS) has marked effects on growth and ECM of smooth muscle cells derived from vascular tissues. We examined smooth muscle cells cultured from human prostates and the effects of PPS on their growth and ECM production. Fragments of surgical prostatectomy specimens were diced, digested with collagenase (0.01%), and placed in culture medium supplemented with 20% fetal bovine serum. Outgrowths of elongated cells were characterized by light microscopic examination and immunohistochemical techniques by the presence of F-actin, alpha-smooth muscle actin, and myosin, which is a characteristic of smooth muscle cells. Two independent isolates were propagated, and growth curves and ECM production were assessed in the presence and absence of PPS (10 or 100 microg/ml). PPS decreased cell number beginning at day 1 and throughout the incubation period, up to 4 days. The amount of the ECM degradative enzymes, metallo-proteinases MMP-9 and MMP-2, was examined by zymography. PPS did not alter the amount of MMP-2 in the supernatants but MMP-9 was increased 234.4 +/- 17.23-fold over control cells. Tissue inhibitor of MMP (TIMPS), examined by reverse zymography, increased 200% over control. The amount of alpha I type (IV) and alpha I type (I) collagen released in the supernatant, measured by ELISA, significantly decreased in PPS-treated cultures. In conclusion, we found that the administration of PPS decreased proliferation as well as ECM production in prostate smooth muscle. Since smooth muscle proliferation and ECM are involved in the pathophysiology of BPH, PPS may have therapeutic potential.

Authors
Elliot, SJ; Zorn, BH; McLeod, DG; Moul, JW; Nyberg, L; Striker, LJ; Striker, GE
MLA Citation
Elliot, SJ, Zorn, BH, McLeod, DG, Moul, JW, Nyberg, L, Striker, LJ, and Striker, GE. "Pentosan polysulfate decreases prostate smooth muscle proliferation and extracellular matrix turnover." Prostate Cancer Prostatic Dis 6.2 (2003): 138-142.
PMID
12806372
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
6
Issue
2
Publish Date
2003
Start Page
138
End Page
142
DOI
10.1038/sj.pcan.4500632

p53 Immunostaining guided laser capture microdissection (p53-LCM) defines the presence of p53 gene mutations in focal regions of primary prostate cancer positive for p53 protein.

OBJECTIVES: A wide range of p53 mutations (5-65%), detected by various methods, has been reported in primary prostate cancers (CaP). IHC staining of radical prostatectomy specimens shows marked heterogeneity of focally distributed p53-positive cells. However, a significant relationship between the focal staining of p53 and cancer recurrence after radical prostatectomy has been noted. Increased frequency of p53 mutations has been generally observed in advanced stage CaP and metastatic prostate cancer cell lines. The significance of focal p53 immunostaining in primary CaP remains uncertain with respect to the p53 gene mutation or tumor progression. The goal of this study was to evaluate p53 gene mutations in focal regions of primary prostate cancers positive by p53 immunostaining. METHODS: Whole-mount prostates from men with clinically organ-confined prostate cancer were immunostained for p53 protein. Laser capture microdissection (LCM) was used to harvest p53 positive cells from areas of tumor and prostatic intraepithelial neoplasia and benign gland. DNA from microdissected cells were amplified for p53 exons 5-8 by polymerase chain reaction (PCR) and analyzed for mutations by single strand conformation polymorphism and DNA sequencing. Mutation analysis of the p53 gene exons 5-8 was performed in the p53 immunostaining positive focal regions (1+ to 4+) of whole-mount prostate sections from 16 patients. RESULTS: Of 16 patients with p53 IHC positive tumors, 11 (69%) had p53 gene mutations as determined by DNA sequence analysis. However, randomly microdissected tumor cells from 4 of 18 patients (22%) negative for p53 IHC also demonstrated mutations in the p53 gene. A significant fraction of prostate tumors with focally positive immunostaining for p53 have been confirmed to contain mutations in the p53 gene. CONCLUSIONS: p53 immunostaining guided LCM combined with DNA-based analyses emphasizes the presence of focal p53 mutations in primary prostate cancers and underscores the significance of previous observations showing a correlation between focal p53 immunostaining in primary CaP and cancer recurrence after radical prostatectomy.

Authors
Griewe, GL; Dean, RC; Zhang, W; Young, D; Sesterhenn, IA; Shanmugam, N; McLeod, DG; Moul, JW; Srivastava, S
MLA Citation
Griewe, GL, Dean, RC, Zhang, W, Young, D, Sesterhenn, IA, Shanmugam, N, McLeod, DG, Moul, JW, and Srivastava, S. "p53 Immunostaining guided laser capture microdissection (p53-LCM) defines the presence of p53 gene mutations in focal regions of primary prostate cancer positive for p53 protein." Prostate Cancer Prostatic Dis 6.4 (2003): 281-285.
PMID
14663467
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
6
Issue
4
Publish Date
2003
Start Page
281
End Page
285
DOI
10.1038/sj.pcan.4500665

Editorial

Authors
Kirby, R; Brawer, M; Moul, J
MLA Citation
Kirby, R, Brawer, M, and Moul, J. "Editorial." Prostate Cancer and Prostatic Diseases 6.1 (2003): 1--.
Source
scival
Published In
Prostate Cancer and Prostatic Diseases
Volume
6
Issue
1
Publish Date
2003
Start Page
1-
DOI
10.1038/sj.pcan.4500651

Radical prostatectomy nomograms in black American men: Accuracy and applicability. Editorial comment

Authors
Moul, JW
MLA Citation
Moul, JW. "Radical prostatectomy nomograms in black American men: Accuracy and applicability. Editorial comment." Journal of Urology 170.1 (2003): 76-77.
Source
scival
Published In
Journal of Urology
Volume
170
Issue
1
Publish Date
2003
Start Page
76
End Page
77
DOI
10.1016/S0022-5347(01)69340-6

Cancer-specific mortality after surgery or radiation for patients with clinically localized prostate cancer managed during the prostate-specific antigen era

Purpose: To determine whether pretreatment risk groups shown to predict time to prostate cancer-specific mortality (PCSM) after treatment at a single institution retained that ability in a multi-institutional setting. Patients and Methods: From 1988 to 2002, 7,316 patients treated in the United States at 44 institutions with either surgery (n = 4,946) or radiation (n = 2,370) for clinical stage T1c-2, NO or NX, MO prostate cancer made up the study cohort. A Cox regression analysis was performed to determine the ability of pretreatment risk groups to predict time to PCSM after treatment. The relative risk (RR) of PCSM and 95% confidence intervals (CIs) were calculated for the intermediate- and high-risk groups relative to the low-risk group. Results: Estimates of non-PCSM 8 years after prostate-specific antigen (PSA) failure were 4% v 15% (surgery versus radiation; Plog rank = .002) compared with 13% v 18% (surgery versus radiation; Plog rank = .35) for patients whose age at the time of PSA failure was less than 70 as compared with > 70 years, respectively. The RR of PCSM after treatment for surgery-managed patients with high- or intermediate-risk disease was 14.2 (95% CI, 5.0 to 23.4; P Cox < .0001) and 4.9 (95% CI, 1.7 to 8.1; PCox = .0037), respectively. These values were 14.3 (95% CI, 5.2 to 24.0; P Cox < .0001) and 5.6 (95% CI, 2.0 to 9.3; PCox = .0012) for radiation-managed patients. Conclusion: This study provided evidence to support the prediction of time to PCSM after surgery or radiation on the basis of pretreatment risk groups for patients with clinically localized prostate cancer managed during the PSA era. © 2003 by American Society of Clinical Oncology.

Authors
D'Amico, AV; Moul, J; Carroll, PR; Sun, L; Lubeck, D; Chen, M-H
MLA Citation
D'Amico, AV, Moul, J, Carroll, PR, Sun, L, Lubeck, D, and Chen, M-H. "Cancer-specific mortality after surgery or radiation for patients with clinically localized prostate cancer managed during the prostate-specific antigen era." Journal of Clinical Oncology 21.11 (2003): 2163-2172.
PMID
12775742
Source
scival
Published In
Journal of Clinical Oncology
Volume
21
Issue
11
Publish Date
2003
Start Page
2163
End Page
2172
DOI
10.1200/JCO.2003.01.075

Editorial

Authors
Kirby, R; Moul, J
MLA Citation
Kirby, R, and Moul, J. "Editorial." Prostate Cancer and Prostatic Diseases 6.4 (2003): 267--.
Source
scival
Published In
Prostate Cancer and Prostatic Diseases
Volume
6
Issue
4
Publish Date
2003
Start Page
267-
DOI
10.1038/sj.pcan.4500702

PCPD editorial

Authors
Moul, JW; Kirby, R
MLA Citation
Moul, JW, and Kirby, R. "PCPD editorial." Prostate Cancer and Prostatic Diseases 6.3 (2003): 199--.
Source
scival
Published In
Prostate Cancer and Prostatic Diseases
Volume
6
Issue
3
Publish Date
2003
Start Page
199-
DOI
10.1038/sj.pcan.4500682

PCPD editorial

Authors
Kirby, RS; Moul, JW
MLA Citation
Kirby, RS, and Moul, JW. "PCPD editorial." Prostate Cancer and Prostatic Diseases 6.2 (2003): 107--.
Source
scival
Published In
Prostate Cancer and Prostatic Diseases
Volume
6
Issue
2
Publish Date
2003
Start Page
107-
DOI
10.1038/sj.pcan.4500659

Leuprolide acetate: Viewpoints

Authors
Moul, JW; Vaughn, DJ
MLA Citation
Moul, JW, and Vaughn, DJ. "Leuprolide acetate: Viewpoints." American Journal of Cancer 2.1 (2003): 65--.
Source
scival
Published In
American Journal of Cancer
Volume
2
Issue
1
Publish Date
2003
Start Page
65-

Androgen-induced expression of endoplasmic reticulum (ER) stress response genes in prostate cancer cells.

Evaluations of androgen regulated gene (ARG) repertoire provide new insights into the androgen receptor (AR) mediated signaling at the transcriptional level. Definition of ARGs having critical functions in the biology of normal and malignant prostate should aid in identifying new bio-markers and therapeutic targets for prostate cancer (CaP). Using Affymetrix HuGene FL oligonucleotide arrays, temporal expression profiles of ARGs in widely used hormone responsive LNCaP cells, were analysed by hierarchical clustering methods and functional classification. ARGs in response to different androgen concentrations showed temporal co-regulation of genes involved in specific biochemical pathways. This study focuses on our new observations of the coordinated androgen induction of genes (NDRG1, PDIR, HERPUD1, ORP150) involved in the endoplasmic reticulum (ER) stress response pathway. Expression analysis of the two selected ER stress responsive genes, NDRG1 and HERPUD1 in primary CaPs revealed a significantly reduced tumor associated expression. Intriguing linkage of the androgen signaling to ER stress responsive genes, a protective response to protein unfolding or protein damage resulting from cellular stress signals, suggests that androgens may induce such stress sign