Patterns of care for prostate cancer treatment and improving outcomes – are national registries the answer?

O’Callaghan, Michael; Papa, Nathan; Pase, Marie; Frydenberg, Mark; Mark, Stephen; Moretti, Kim; Maqsood, Saad; Smith, David P.; Walker, Tony; White, Craig; Millar, Jeremy; Zealand, New

doi:10.1111/bju.15366

Cited by 12 publications

(10 citation statements)

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“…The study analysed HRQoL outcomes at baseline and one-year post-treatment. Across Australia, radical prostatectomy is reported in 50% of newly diagnosed prostate cancer cases [ 44 ] and our dataset did not deviate from this expected proportion with majority of the men undergoing prostatectomy (77%) and 10% each on active surveillance and radiation therapy.…”

Section: Discussionmentioning

confidence: 62%

Responsiveness and construct validity of EPIC-26, AQoL-6D and SF-6D following treatment in prostate cancer

et al. 2023

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Purpose To assess construct validity and responsiveness of the Expanded Prostate Cancer Index Composite Instrument (EPIC-26) relative to the Short-Form Six-Dimension (SF-6D) and Assessment of Quality of Life 6-Dimension (AQoL-6D) in patients following treatment for prostate cancer. Methods Retrospective prostate cancer registry data were used. The SF-6D, AQoL-6D, and EPIC-26 were collected at baseline and one year post treatment. Analyses were based on Spearman's correlation coefficient, Bland–Altman plots and intra-class correlation coefficient, Kruskal Wallis, and Effect Size and the Standardised Response Mean for responsiveness. Results The study sample was comprised of 1915 patients. Complete case analysis of 3,697 observations showed moderate evidence of convergent validity between EPIC-26 vitality/hormonal domain and AQoL-6D (r = 0.45 and 0.54) and SF-6D (r = 0.52 and 0.56) at both timepoints. Vitality/hormonal domain also showed moderate convergent validity with coping domain of AQoL-6D (r = 0.45 and 0.54) and with role (r = 0.41 and 0.49) and social function (r = 0.47 and 0.50) domains of SF-6D at both timepoints, and with independent living (r = 0.40) and mental health (r = 0.43) of AQoL-6D at one year. EPIC-26 sexual domain had moderate convergent validity with relationship domain (r = 0.42 and 0.41) of AQoL-6D at both timepoints. Both AQoL-6D and SF-6D did not discriminate between age groups and tumour stage at both timepoints but AQoL-6D discriminated between outcomes for different treatments at one year. All EPIC-26 domains discriminated between age groups and treatment at both timepoints. The EPIC-26 was more responsive than AQoL-6D and SF-6D between baseline and one year following treatment. Conclusions AQoL-6D can be used in combination with EPIC-26 in place of SF-12. Although EPIC-26 is not utility based, its popularity amongst clinicians and ability to discriminate between disease-specific characteristics and post-treatment outcomes in clinical trials makes it a candidate for use within cost-effectiveness analyses. The generic measure provides a holistic assessment of quality of life and is suitable for generating quality adjusted life years (QALYs).

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Section: Discussionmentioning

confidence: 62%

Responsiveness and construct validity of EPIC-26, AQoL-6D and SF-6D following treatment in prostate cancer

et al. 2023

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“…Further trials are needed to investigate biomarker‐guided approaches (clinical, imaging, molecular features) for optimal oncological outcomes. The incorporation of imaging such as PSMA‐PET into clinical practice and the subsequent oncological outcomes can be captured by national registries and provide benchmarking for evidence‐based care [21]. Other considerations include different PSA thresholds to define BCR [22] or other imaging [23,24] or molecular tests [25].…”

Section: Discussionmentioning

confidence: 99%

Event‐free survival after radical prostatectomy according to prostate‐specific membrane antigen‐positron emission tomography and European Association of Urology biochemical recurrence risk groups

et al. 2022

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Objective To assess European Association of Urology (EAU) risk groups for biochemical recurrence (BCR) of prostate cancer relative to prostate‐specific membrane antigen‐positron emission tomography (PSMA‐PET) status and oncological outcomes. Patients and Methods A retrospective analysis of a study that incorporated PSMA‐PET for men with BCR after radical prostatectomy (RP) was undertaken. EAU risk groups were considered relative to clinical variables, PSMA‐PET findings, and deployment of salvage radiotherapy (SRT). The primary oncological outcome was event‐free survival (EFS) and this was analysed relative to clinical and imaging variables. An ‘event’ occurred if prostate‐specific antigen (PSA) level rose >0.2 ng/mL above nadir or additional therapies were introduced. Results A total of 137 patients were included, most of whom had EAU high‐risk disease (76%) and/or low PSA levels (80% <0.5 ng/mL) at the time of PSMA‐PET. EAU risk group was not associated with regional nodal/distant metastasis on PSMA‐PET. Regional nodal/distant metastasis on PSMA PET (compared to negative/local recurrence: hazard ratio [HR] 2.2; P = 0.002) and SRT use (vs no SRT: HR 0.44; P = 0.004) were associated with EFS. EAU high‐risk status was not significantly associated with worse EFS (HR 1.7, P = 0.12) compared to EAU low‐risk status. Among patients who received SRT, both regional/distant metastasis on PSMA‐PET (HR 3.1; P < 0.001) and EAU high‐risk status (HR 2.9; P = 0.04) were independently associated with worse EFS, which was driven by patients in the EAU high‐risk group with regional/distant metastases (38%; HR 3.1, P = 0.001). Conclusions In patients with post‐RP BCR, PSMA‐PET findings and receipt of SRT predicted EFS. In patients receiving SRT, PSMA status combined with EAU risk grouping was most predictive of EFS. These findings suggest that the EAU risk groups could be improved with the addition of PSMA‐PET.

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“…The concept of ‘PSMA‐positive recurrence’ as a unique entity in those with BF is of interest and may have distinct clinical implications in terms of treatment selection and long‐term outcomes. Including PSMA in national data registries is likely to significantly contribute to further understanding of this entity, as well as mapping the impact of pending and established funding pathways for this modality in the global care of patients with prostate cancer [35].…”

Section: Discussionmentioning

confidence: 99%

Pathological predictors of ¹⁸F‐DCFPyL prostate‐specific membrane antigen‐positive recurrence after radical prostatectomy

et al. 2022

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To assess the correlation of pathological radical prostatectomy (RP) specimen features and prostate-specific antigen (PSA) characteristics to imaging findings on subsequent 18 F-DCFPyL positron emission tomography/computed tomography (PET/ CT) in patients with biochemical failure (BF). Patients and MethodsRetrospective analysis of combined 18 F-DCFPyL PET/CT database of patients from centres in Australia and New Zealand was performed. A total of 205 patients presenting with BF after RP were included in this study. Imaging findings on 18 F-DCFPyL PET/CT were recorded and correlated with the PSA characteristics at BF and pathological features of the original tumour. ResultsOf the 205 patients, 120 (58.5%) had evidence of abnormal prostate-specific membrane antigen (PSMA) expression compatible with recurrent prostate cancer. Increasing PSA velocity (P = 0.01), International Society of Urological Pathology (ISUP) Grade Group (P = 0.02), lymphovascular invasion (P = 0.05) and nodal positivity (P = 0.02) at the time of RP were more likely to demonstrate PSMA positivity. Multivariable logistic regression revealed a higher PSA level prior to PSMA PET/CT (P < 0.01), adjuvant radiotherapy (P = 0.09), Gleason score ≥8 (P < 0.01) and nodal positivity (P = 0.05) were all predictive of PSMA positivity. Conclusion18 F-DCFPyL PET/CT positivity, both generally and site specific, correlates with PSA and RP pathological factors. Our results echo cohorts focussing on post-RP patients, those imaged with 68 Ga-PSMA and those concerning biochemical persistence. Nomograms that include risk factors for 'PSMA-positive recurrence' in the BF population may increase the catchment of patients with disease confined to the prostate bed or pelvis who have a greater probability of prolonged disease-free survival.

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Patterns of care for prostate cancer treatment and improving outcomes – are national registries the answer?

Cited by 12 publications

References 4 publications

Responsiveness and construct validity of EPIC-26, AQoL-6D and SF-6D following treatment in prostate cancer

Responsiveness and construct validity of EPIC-26, AQoL-6D and SF-6D following treatment in prostate cancer

Event‐free survival after radical prostatectomy according to prostate‐specific membrane antigen‐positron emission tomography and European Association of Urology biochemical recurrence risk groups

Pathological predictors of ¹⁸F‐DCFPyL prostate‐specific membrane antigen‐positive recurrence after radical prostatectomy

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Patterns of care for prostate cancer treatment and improving outcomes – are national registries the answer?

Cited by 12 publications

References 4 publications

Responsiveness and construct validity of EPIC-26, AQoL-6D and SF-6D following treatment in prostate cancer

Responsiveness and construct validity of EPIC-26, AQoL-6D and SF-6D following treatment in prostate cancer

Event‐free survival after radical prostatectomy according to prostate‐specific membrane antigen‐positron emission tomography and European Association of Urology biochemical recurrence risk groups

Pathological predictors of 18F‐DCFPyL prostate‐specific membrane antigen‐positive recurrence after radical prostatectomy

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Pathological predictors of ¹⁸F‐DCFPyL prostate‐specific membrane antigen‐positive recurrence after radical prostatectomy