Clinical Comparison of Decipher 1.0 and 1.1 for Localized Prostate Cancer: Results in Prostatectomy and Active Surveillance Patients.

Decipher is a 22-gene genomic risk classifier that utilizes a whole-transcriptome microarray assay to provide a score ranging from 0 to 1. Recently, the individual gene scores that defined Decipher v1.0 were reweighted to define updated Decipher v1.

The Role of Liquid Biopsy in the Management of Patients with Genitourinary Malignancies.

Background And Objective: Liquid biopsy testing refers to the use of specific analytical methods to detect disease-related biomarkers in blood or its components. These tests can be either qualitative or quantitative. Liquid biopsy testing is increasingly used in patient care.

Automated Extraction of Imaging and Pathology Data From Diverse Prostate Cancer Electronic Records.

Purpose: To develop and validate an algorithm to extract clinically relevant data elements for prostate cancer (PCa) from prostate biopsy reports and magnetic resonance imaging (MRI) reports.

Patients And Methods: MRI reports and biopsy pathology reports were extracted from a cohort of 1,360,866 patients with PCa in the VA Cancer Registry System or the VA Corporate Data Warehouse, with 155,570 patients having the relevant reports for inclusion. We hand-annotated a sample of these reports, which were used to develop a rule-based natural language processing (NLP) algorithm for extracting Gleason score, positive cores, and total cores taken during biopsy from biopsy pathology reports and Prostate Imaging Reporting and Data System (PI-RADS) score, prostate-specific antigen (PSA) density, prostate volume, and prostate dimensions from MRI reports.

Determining Optimal Patient Selection for High-intensity Focused Ultrasound for Prostate Cancer.

Background And Objective: Magnetic resonance imaging (MRI)/ultrasound-guided high-intensity focused ultrasound (HIFU) ablates prostate cancer with promising cancer control and minimal impact on sexual or urinary function. However, recurrence remains a concern. This study identifies factors associated with recurrence and treatment failure to optimize patient selection.

Transcriptome profiling of prostatic tumours from ENACT trial patients with or without enzalutamide.

Objectives: To evaluate the longitudinal transcriptomic changes that occurred over time in patients from the ENACT trial (ClinicalTrials.gov identifier: NCT02799745). ENACT evaluated patients with low- or intermediate-risk prostate cancer, comparing the efficacy and safety of enzalutamide plus active surveillance (AS) to AS alone.

Smarter Screening and Treatment (S3T): Mitigating Harm via Age- and Prostate-Specific Antigen-Stratified Screening.

Introduction: Consensus on optimal prostate cancer screening remains elusive. Prostate-specific antigen (PSA) testing of patients in their 40-50 s is highly predictive of aggressive disease, yet remains underutilized; Black patients face excess mortality burden, particularly at younger ages. We describe a novel age and baseline PSA-stratified protocol to mitigate harms of overdiagnosis and reduce burden of disease, particularly for Black patients, with implementation by primary care providers (PCPs) in an academic healthcare system.

The Natural History of Confirmed Grade Group 1 Prostate Cancer Managed with Active Surveillance in the Modern Era.

Background And Objective: Grade group 1 (GG1, Gleason 3 + 3) prostate cancer (PCa) is considered low risk but can upgrade, and is managed with active surveillance (AS). Amidst recent controversy of whether GG1 PCa should be called cancer, we determined the nature of progression of GG1 disease in a modern AS cohort with multiparametric magnetic resonance imaging (mpMRI) and genomic testing.

Methods: The Urologic Outcomes Database at the University of California San Francisco was queried for men with confirmed GG1 PCa.

Evolving Risk of Urinary Adverse Events Across Localized Prostate Cancer Treatments: A Propensity-weighted Analysis of Surveillance, Epidemiology and End Results-Medicare Data.

Prostate cancer treatments can cause long-term urinary adverse events (UAEs), but time-varying risks across treatments remain understudied. Using Surveillance, Epidemiology and End Results-Medicare data, we evaluated men aged ≥66 yr with localized prostate cancer treated with radical prostatectomy (RP), external beam radiotherapy (EBRT), brachytherapy (BT), EBRT + BT, RP + EBRT, or ablation between 2000 and 2017. The primary outcome was any UAE requiring a procedure, with follow-up from treatment initiation and censoring at disease progression.

Gleason Grade Group 3 Represents a Spectrum of Disease: Results from a Large Institutional Cohort.

Background And Objective: A biopsy diagnosis of Gleason grade group (GG) 3 prostate cancer (PC) automatically classifies patients as having at least unfavorable intermediate-risk disease warranting definitive treatment. We hypothesized that GG3 PCs are not equally unfavorable.

Methods: The Urologic Outcomes Database at University of California-San Francisco was queried for men with localized, nonmetastatic PC diagnosed after 2000 who underwent radical prostatectomy (RP).

Trends in Prostate Cancer Incidence and Mortality Rates.

Importance: Incidence of distant stage prostate cancer is increasing in the United States. Research is needed to understand trends by social and geographic factors.

Objective: To examine trends in prostate cancer incidence and mortality rates in California by stage, age, race and ethnicity, and region.

Alternate definitions of adverse pathology to predict a very high risk of metastasis in men with intermediate- and low-risk prostate cancer.

Background: Adverse pathology (AP) is often used as an intermediate end point for long-term outcomes in men with prostate cancer (PCa) who are active surveillance candidates. The association between a commonly used AP definition and long-term outcomes was tested, which identified definitions more strongly linked to a high risk of metastasis.

Methods: Data were reviewed from the Shared Equal Access Regional Cancer Hospital cohort of men undergoing radical prostatectomy (RP) from 1988 to 2020 at nine Veterans Affairs hospitals.

Risks of grade reclassification among patients with Gleason grade group 1 prostate cancer and PI-RADS 5 findings on prostate MRI.

Background And Objective: As most Prostate Imaging Reporting and Data System (PI-RADS) 5 lesions on MRI harbor Gleason grade (GG) group ≥2 disease on biopsy, optimal management of patients with imaging-biopsy discordance remains unclear. To estimate grade misclassification, we evaluated the incidence of Gleason upgrading among patients with GG1 disease in the setting of a PI-RADS 5 lesion.

Methods: We conducted a single-institution retrospective analysis to identify patients with GG1 prostate cancer on fusion biopsy with MRI demonstrating ≥1 PI-RADS 5 lesion.

Androgen Receptor Inhibition Increases MHC Class I Expression and Improves Immune Response in Prostate Cancer.

Immunotherapy options for immune cold tumors, like prostate cancer, are limited. We show that AR downregulates MHCI expression/antigen presentation and that AR inhibition improves T-cell responses and tumor control. This suggests that treatments combining AR inhibitors and checkpoint blockade may improve tumor immune surveillance and antitumor immunity in patients.

County-level racial disparities in prostate cancer-specific mortality from 2005 to 2020.

Background: Local conditions where people live continue to influence prostate cancer outcomes. By examining local characteristics associated with trends in Black-White differences in prostate cancer-specific mortality over time, we aim to identify factors driving county-level prostate cancer-specific mortality disparities over a 15-year period.

Methods: We linked county-level data (Area Health Resource File) with clinicodemographic data of men with prostate cancer (Surveillance, Epidemiology, and End Results registry) from 2005 to 2020.

Feasibility of Pay for Performance and Transparency Interventions on the Selection and Quality of Observational Management for Patients With Low-Risk Prostate Cancer in the Community Practice.

Introduction: Practice-level strategies to improve the use of conservative management for low-risk prostate cancer have not been rigorously evaluated. We examined the feasibility of implementation and preliminary outcomes of a pay-for-performance (P4P) and a transparency intervention at the practice level.

Methods: We conducted a pilot study within a Southern California urology practice network.

When is prostate cancer really cancer?

Prostate cancer (PC) is a major cause of cancer-related deaths worldwide, with far more diagnoses than deaths annually. Recent discussions have challenged whether Grade Group 1 (GG1) PC should be labeled "cancer" due to its indolent nature. To address this question, an international symposium convened stakeholders from various fields.