Martin G Sanda

Emory University, Atlanta, Georgia, United States

Are you Martin G Sanda?

Claim your profile

Publications (206)1199.28 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the ability of the prostate health index to discern aggressive prostate cancer from indolent or no cancer on a biopsy-naïve population. Two independent prospective cohorts of 561 and 395 subjects with no prior prostate biopsy and enrolled at different clinical sites were used for validation of the results. We compared the diagnostic specificity of the prostate health index to pre-biopsy total PSA and percent free PSA using prostate biopsy results and determined the optimal threshold of the prostate health index to discern aggressive prostate cancer (Gleason 7 or worse) from indolent or no prostate cancer (Gleason 6 or less). In the primary cohort, higher prostate health index values were significantly associated with Gleason 7 score or worse, and AUC for detection of aggressive prostate cancer was 0.815. At 95% sensitivity the prostate health index specificity was 36.0% versus 17.2% and 19.4% for total PSA and percent free PSA respectively. At 95% sensitivity in detecting aggressive prostate cancer, the optimal prostate heath index cut point was 24, which would help avoid 41% of unnecessary biopsies. A prostate health index cutoff of 24 led to 36% biopsies avoided and very few aggressive cancers missed, and these results were confirmed with the validation cohort. The prostate health index detects aggressive prostate cancer with a better specificity than total PSA and percent free PSA in a biopsy-naïve population, and could be a useful tool to decrease unnecessary prostate biopsies. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
    The Journal of Urology 01/2015; DOI:10.1016/j.juro.2015.01.091 · 3.75 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To establish a score threshold that constitutes a clinically relevant change for each domain of the Expanded Prostate Cancer Index Composite (EPIC) Short Form (EPIC-26). Although its use in clinical practice and clinical trials has increased worldwide, the clinical interpretation of this 26-item disease-specific patient-reported quality of life questionnaire for men with localized prostate cancer would be facilitated by characterization of score thresholds for clinically relevant change (the minimally important differences [MIDs]). We used distribution- and anchor-based approaches to establish the MID range for each EPIC-26 domain (urinary, sexual, bowel, and vitality/hormonal) based on a prospective multi-institutional cohort of 1201 men treated for prostate cancer between 2003 and 2006 and followed up for 3 years after treatment. For the anchor-based approach, we compared within-subject and between-subject score changes for each domain to an external "anchor" measure of overall cancer treatment satisfaction. We found the bowel and vitality/hormonal domains to have the lowest MID range (a 4-6 point change should be considered clinically relevant), whereas the sexual domain had the greatest MID values (10-12). Urinary incontinence appeared to have a greater MID range (6-9) than the urinary irritation/obstruction domain (5-7). Using 2 independent approaches, we established the MIDs for each EPIC-26 domain. A definition of these MID values is essential for the researcher or clinician to understand when changes in symptom burden among prostate cancer survivors are clinically relevant. Copyright © 2015 Elsevier Inc. All rights reserved.
    Urology 01/2015; 85(1):101-6. DOI:10.1016/j.urology.2014.08.044 · 2.13 Impact Factor
  • Mehrdad Alemozaffar, Martin G Sanda
    European Urology 12/2014; DOI:10.1016/j.eururo.2014.12.003 · 12.48 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Prostate Health Index (phi) is a new test combining total, free and [-2]proPSA into a single score. It was recently approved by the US FDA and is now commercially available in the US, Europe and Australia. Our objective was to investigate whether phi improves specificity for detecting clinically- significant prostate cancer and can help reduce prostate cancer over-diagnosis*. From a multicenter prospective trial, we identified 658 men age ≥50 years with PSA levels from 4-10 ng/ml and normal digital rectal examination that underwent prostate biopsy. In this population, we compared the performance of PSA, % free PSA, [-2]proPSA, and phi to predict biopsy results and, specifically, the presence of clinically-significant prostate cancer using multiple criteria. Phi was significantly higher in men with Gleason ≥7 and "Epstein-significant" cancer. On receiver operating characteristic analysis, phi had the highest AUC for overall cancer (AUC's: phi 0.708, %fPSA 0.648, [-2]proPSA 0.550, and PSA 0.516), Gleason ≥7 (AUC's: phi 0.707, %fPSA 0.661, [-2]proPSA 0.558, PSA 0.551), and significant cancer (AUC's: phi 0.698, %fPSA 0.654, [-2]proPSA 0.550, PSA 0.549). At the 90% sensitivity cutpoint for phi (a score <28.6), 30.1% of patients could have been spared an unnecessary biopsy for benign disease or "insignificant" prostate cancer compared to 21.7% using %fPSA. The new phi test outperforms its individual components of total, free and [-2]proPSA for the identification of clinically-significant prostate cancer. Phi may be useful as part of a multivariable approach to reduce prostate biopsies and over-diagnosis. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
    The Journal of Urology 11/2014; DOI:10.1016/j.juro.2014.10.121 · 3.75 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Given the limited sensitivity and specificity of prostate-specific antigen (PSA), its widespread use as a screening tool has raised concerns for the overdiagnosis of low-risk and the underdiagnosis of high-grade prostate cancer. To improve early-detection biopsy decisions, the National Cancer Institute conducted a prospective validation trial to assess the diagnostic performance of the prostate cancer antigen 3 (PCA3) urinary assay for the detection of prostate cancer among men screened with PSA.
    Journal of Clinical Oncology 11/2014; 32(36). DOI:10.1200/JCO.2013.52.8505 · 17.88 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Cure rates for localized high-risk prostate cancers (PCa) and some intermediate-risk PCa are frequently suboptimal with local therapy. Outcomes are improved by concomitant androgen-deprivation therapy (ADT) with radiation therapy, but not by concomitant ADT with surgery. Luteinizing hormone-releasing hormone agonist (LHRHa; leuprolide acetate) does not reduce serum androgens as effectively as abiraterone acetate (AA), a prodrug of abiraterone, a CYP17 inhibitor that lowers serum testosterone (< 1 ng/dL) and improves survival in metastatic PCa. The possibility that greater androgen suppression in patients with localized high-risk PCa will result in improved clinical outcomes makes paramount the reassessment of neoadjuvant ADT with more robust androgen suppression.
    Journal of Clinical Oncology 10/2014; 32(33). DOI:10.1200/JCO.2013.53.4578 · 17.88 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The National Cancer Institute (NCI) Symptom Management and Health-Related Quality of Life Steering Committee convened four working groups to recommend core sets of patient-reported outcomes to be routinely incorporated in clinical trials. The Prostate Cancer Working Group included physicians, researchers, and a patient advocate. The group's process included 1) a systematic literature review to determine the prevalence and severity of symptoms, 2) a multistakeholder meeting sponsored by the NCI to review the evidence and build consensus, and 3) a postmeeting expert panel synthesis of findings to finalize recommendations. Five domains were recommended for localized prostate cancer: urinary incontinence, urinary obstruction and irritation, bowel-related symptoms, sexual dysfunction, and hormonal symptoms. Four domains were recommended for advanced prostate cancer: pain, fatigue, mental well-being, and physical well-being. Additional domains for consideration include decisional regret, satisfaction with care, and anxiety related to prostate cancer. These recommendations have been endorsed by the NCI for implementation.
    JNCI Journal of the National Cancer Institute 07/2014; 106(7). DOI:10.1093/jnci/dju132 · 15.16 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aurora kinase A (AURKA) gene amplification has been documented in 67% of hormone-naive prostate cancer cases that progress to a highly aggressive variant of castrate-resistant disease, clinically referred to as "neuroendocrine" prostate cancer, "small cell" prostate carcinoma, or "anaplastic" prostate cancer. Therefore, AURKA amplification is a potential prognostic biomarker that may help to identify patients with prostate cancer who are at high risk for developing castrate-resistant disease with clinical features of small cell carcinoma. Furthermore, AURKA inhibitors are currently being tested in clinical trials. In a previous study, we found AURKA amplification in 6 cases of prostate cancer with Paneth cell-like cells. This morphologic pattern has been suggested to represent low-grade neuroendocrine differentiation (NED) with generally favorable prognosis. We sought to investigate the frequency of AURKA amplification and the histologic characteristics of prostate cancer with Paneth cell-like NED. Twenty-five cases from 172 prostatectomies were evaluated for the presence of 18 morphologic features and AURKA amplification. Most prostate cancers with Paneth cell-like NED had macronucleoli (92%), basophilic appearance (88%), perineural invasion (72%), and nuclear stratification (76%). The frequency of AURKA amplification was 45%, present throughout the examined tumor nodule including areas without Paneth cell-like cells. When histologically similar cases with and without AURKA amplification were compared, this gene alteration was associated with larger extent of Paneth cell-like NED identified at magnification ×20 (P = .015), higher percentage of Paneth cell-like NED throughout the tumor nodule (P = .033), ductal features (P = .02), and higher overall Gleason grade (P = .039). AURKA amplification was not associated with age, serum prostate specific antigen, or tumor stage. The high frequency of AURKA amplification (45%) in localized prostate cancer with Paneth cell-like NED and its potential prognostic significance warrant further investigation.
    Human pathology 06/2014; 45(10). DOI:10.1016/j.humpath.2014.06.008 · 2.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The hormonal milieu influences immune tolerance and the immune response against viruses and cancer, but the direct effect of androgens on cellular immunity remains largely uncharacterized. We therefore sought to evaluate the effect of androgens on murine and human T cells in vivo and in vitro. We found that murine androgen deprivation in vivo elicited RNA expression patterns conducive to IFN signaling and T-cell differentiation. Interrogation of mechanism showed that testosterone regulates T-helper 1 (Th1) differentiation by inhibiting IL-12-induced Stat4 phosphorylation: in murine models, we determined that androgen receptor binds a conserved region within the phosphatase, Ptpn1, and consequent up-regulation of Ptpn1 then inhibits IL-12 signaling in CD4 T cells. The clinical relevance of this mechanism, whereby the androgen milieu modulates CD4 T-cell differentiation, was ascertained as we found that androgen deprivation reduced expression of Ptpn1 in CD4 cells from patients undergoing androgen deprivation therapy for prostate cancer. Our findings, which demonstrate a clinically relevant mechanism by which androgens inhibit Th1 differentiation of CD4 T cells, provide rationale for targeting androgens to enhance CD4-mediated immune responses in cancer or, conversely, for modulating androgens to mitigate CD4 responses in disorders of autoimmunity.
    Proceedings of the National Academy of Sciences 06/2014; 111(27). DOI:10.1073/pnas.1402468111 · 9.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE To modify the Prostate Cancer Prevention Trial risk calculator (PCPTRC) to predict low-vs high-grade (Gleason grade >= 7) prostate cancer and incorporate percent freeeprostate-specific antigen (PSA). METHODS Data from 6664 Prostate Cancer Prevention Trial placebo arm biopsies (5826 individuals), where prostate-specific antigen and digital rectal examination results were available within 1 year before the biopsy and PSA was <= 10 ng/ mL, were used to develop a nominal logistic regression model to predict the risk of no vs low-grade (Gleason grade < 7) vs high-grade cancer (Gleason grade >= 7). Percent free-PSA was incorporated into the model based on likelihood ratio analysis of a San Antonio Biomarkers of Risk cohort. Models were externally validated on 10 Prostate Biopsy Collaborative Group cohorts and 1 Early Detection Research Network reference set. RESULTS Of all the Prostate Cancer Prevention Trial biopsies, 5468 (82.1%) were negative for prostate cancer, 942 (14.1%) detected low-grade, and 254 (3.8%) detected high-grade disease. Significant predictors were (log base 2) PSA (odds ratio for low-grade vs no cancer, 1.29*; high-grade vs no cancer, 2.02*; high-grade vs low-grade cancer, 1.57*), digital rectal examination (0.96, 1.49*, 1.55*, respectively), age (1.02*, 1.05*, 1.03*, respectively), AfricanAmerican race (1.13, 2.83*, 2.51*, respectively), prior biopsy (0.63*, 0.81, 1.27, respectively), and family history (1.31*, 1.25, 0.95, respectively), where * indicates P value <. 05. The new PCPTRC 2.0 either with or without percent free-PSA (also significant by the likelihood ratio method) validated well externally. CONCLUSION By differentiating the risk of low-vs high-grade disease on biopsy, PCPTRC 2.0 better enables physician-patient counseling concerning whether to proceed to biopsy. (C) 2014 Elsevier Inc.
    Urology 06/2014; 83(6):1362-8. DOI:10.1016/j.urology.2014.02.035 · 2.13 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND Data continue to emerge on the relative merits of different treatment modalities for prostate cancer. The objective of this study was to compare patient-reported quality-of-life (QOL) outcomes after proton therapy (PT) and intensity-modulated radiation therapy (IMRT) for prostate cancer. METHODSA comparison was performed of prospectively collected QOL data using the Expanded Prostate Cancer Index Composite (EPIC) questionnaire. QOL data were collected during the first 2 years after treatment for men who received PT and IMRT. PT was delivered to 1243 men at a single center at doses from 76 grays (Gy) to 82 Gy. IMRT was delivered to 204 men who were included in the Prostate Cancer Outcomes and Satisfaction with Treatment Quality Assessment (PROSTQA) study in doses from 75.6 Gy to 79.4 Gy. The Wilcoxon rank-sum test was used to compare EPIC outcomes by modality using baseline-adjusted scores at different time points. Individual questions were assessed by converting to binary outcomes and testing with generalized estimating equations. RESULTSNo differences were observed in summary score changes for bowel, urinary incontinence, urinary irritative/obstructive, and sexual domains between the 2 cohorts. However, more men who received IMRT reported moderate/big problems with rectal urgency (P = 0.02) and frequent bowel movements (P = 0.05) than men who received PT. CONCLUSIONS There were no differences in QOL summary scores between the IMRT and PT cohorts during early follow-up (up to 2-years). Response to individual questions suggests possible differences in specific bowel symptoms between the 2 cohorts. These outcomes highlight the need for further comparative studies of PT and IMRT. Cancer 2014;. © 2014 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.
    Cancer 04/2014; 120(7). DOI:10.1002/cncr.28536 · 4.90 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Here, we sought to determine whether peptide vaccines designed harbor both class I as well as class II restricted antigenic motifs could concurrently induce CD4 and CD8 T cell activation against autologous tumor antigens. Based on our prior genome-wide interrogation of human prostate cancer tissues to identify genes over-expressed in cancer and absent in the periphery, we targeted SIM2 as a prototype autologous tumor antigen for these studies. Using humanized transgenic mice we found that the 9aa HLA-A*0201 epitope, SIM2237-245, was effective at inducing an antigen specific response against SIM2-expressing prostate cancer cell line, PC3. Immunization with a multi-epitope peptide harboring both MHC-I and MHC-II restricted epitopes induced an IFN-γ response in CD8 T cells to the HLA-A*0201-restricted SIM2237-245 epitope, and an IL-2 response by CD4 T cells to the SIM2240-254 epitope. This peptide was also effective at inducing CD8+ T-cells that responded specifically to SIM2-expressing tumor cells. Collectively, the data presented in this study suggest that a single peptide containing multiple SIM2 epitopes can be used to induce both a CD4 and CD8 T cell response, providing a peptide-based vaccine formulation for potential use in immunotherapy of various cancers.
    PLoS ONE 04/2014; 9(4):e93231. DOI:10.1371/journal.pone.0093231 · 3.53 Impact Factor
  • The Journal of Urology 04/2014; 191(4):e601. DOI:10.1016/j.juro.2014.02.1666 · 3.75 Impact Factor
  • 02/2014; 2(Suppl 1):P2. DOI:10.1186/2051-1426-2-S1-P2
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose To evaluate rectal dose and post-treatment patient-reported bowel quality of life (QOL) following radiation therapy for prostate cancer. Methods Patient-reported QOL was measured at baseline and 2-years via the expanded prostate cancer index composite (EPIC) for 90 patients. Linear regression modeling was performed using the baseline score for the QUANTEC normal tissue complication probability model and dose volume histogram (DVH) parameters for the whole and segmented rectum (superior, middle, and inferior). Results At 2-years the mean summary score declined from a baseline of 96.0–91.8. The median volume of rectum treated to ⩾70 Gy (V70) was 11.7% for the whole rectum and 7.0%, 24.4%, and 1.3% for the inferior, middle, and superior rectum, respectively. Mean dose to the whole and inferior rectum correlated with declines in bowel QOL while dose to the mid and superior rectum did not. Low (V25–V40), intermediate (V50–V60) and high (V70–V80) doses to the inferior rectum influenced bleeding, incontinence, urgency, and overall bowel problems. Only the highest dose (V80) to the mid-rectum correlated with rectal bleeding and overall bowel problems. Conclusions Segmental DVH analysis of the rectum reveals associations between bowel QOL and inferior rectal dose that could significantly influence radiation planning and prognostic models.
    Radiotherapy and Oncology 02/2014; 110(2). DOI:10.1016/j.radonc.2014.01.007 · 4.86 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Robot-assisted laparoscopic radical prostatectomy (RALP) has become increasingly common; however, there have been no nationwide, population-based, non–claims-based studies to evaluate differences in outcomes between RALP and open radical retropubic prostatectomy (RRP). Objective To determine surgical, oncologic, and health-related quality of life (HRQOL) outcomes following RALP and RRP in a nationwide cohort. Design, setting, and participants We identified 903 men in the Health Professionals Follow-up Study diagnosed with prostate cancer between 2000 and 2010 who underwent radical prostatectomy using RALP (n = 282) or RRP (n = 621) as primary treatment. Intervention Radical prostatectomy. Outcome measurements and statistical analysis We compared patients undergoing RALP or RRP across a range of perioperative, oncologic, and HRQOL outcomes. Results and limitations Use of RALP increased during the study period, constituting 85.2% of study subjects in 2009, up from 4.5% in 2003. Patients undergoing RALP compared to RRP were less likely to have a lymph node dissection (51.5% vs 85.4%; p < 0.0001), had less blood loss (207.4 ml vs 852.3 ml; p < 0.0001), were less likely to receive blood transfusions (4.3% vs 30.3%; p < 0.0001), and had shorter hospital stays (1.8 d vs 2.9 d; p < 0.0001). Surgical, oncologic, and HRQOL outcomes did not differ significantly among the groups. In multivariate logistic regression models, there were no significant differences in 3- or 5-yr recurrence-free survival comparing RALP versus RRP (hazard ratios: 0.98 [95% confidence interval (CI), 0.46–2.08] and 0.75 [95% CI, 0.18–3.11], respectively). Conclusions In a nationwide cohort of patients undergoing surgical treatment for prostate cancer, RALP was associated with shorter hospital stay, and lower blood loss and transfusion rates than RRP. Surgical oncologic and HRQOL outcomes were similar between groups. Patient summary We studied men throughout the United States with prostate cancer who underwent surgical removal of the prostate. We found that robot-assisted laparoscopic radical prostatectomy resulted in shorter hospital stay, less blood loss, and fewer blood transfusions than radical retropubic prostatectomy. There were no differences in cancer control or health-related quality of life.
    European Urology 02/2014; 67(3). DOI:10.1016/j.eururo.2014.01.039 · 12.48 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In men with PCa, large variations of PROs after RP or high-dose RAD might be related to between-country differences of medical and sociodemographic variables, and differences in PROs before treatment in the sexual and urinary domains. In 1908 patients with localized PCa from Norway, the United States, or Spain, the relation between medical (prostate-specific antigen, Gleason score, cT-category) and sociodemographic variables (age, education, marital status) before treatment was investigated. Using the Expanded Prostate Cancer Index Composite questionnaire, PROs before treatment within the sexual and urinary domains were also considered. Compared with the European patients, American patients were younger, fewer had comorbid conditions, and more had a high education level. Fifty-three percent of the US men eligible for RP had low-risk tumors compared with 42% and 31% among the Norwegian and the Spanish patients, respectively. Among the Spanish RAD patients, 54% had had low-risk tumors compared with 34% of the American and 21% of the Norwegian men planned for RAD, respectively. Compared with the European patients, significantly fewer US patients reported moderate or severe sexual dysfunction and related problems. In most subgroups, the number of patients with sexual or urinary dysfunction exceeded that of patients with bother related to the reported dysfunction. Statistically significant between-country differences were observed in medical and sociodemographic variables, and in PROs before treatment within the sexual and urinary domains. Large differences between reported dysfunction and related problems within the sexual and urinary domains indicate that dysfunction and bother should be reported separately in addition to calculation of summary scores. The documented differences, not at least regarding PROs, might in part explain the large variation of side effects after treatment evident in the medical literature.
    Clinical Genitourinary Cancer 01/2014; DOI:10.1016/j.clgc.2013.12.007 · 1.69 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background In men with prostate cancer ( PCa) large variations of patient-reported outcomes ( PROs) after radical prostatectomy (RP) or high-dose radiotherapy (RAD) may be related to between-country differences of pre-treatment medical and socio-demographic variables , as well as to differences in pre-treatment PROs in the sexual and urinary domain. Methods In 1908 patients with localized PCa from Norway, USA or Spain the relation was investigated between pre-treatment data on medical (PSA, Gleason score , cT-category ) and socio-demographic variables (age, education ,marital status). Using the EPIC questionnaire pre-treatment PROs within the sexual and urinary domain were also considered . Results Compared to the European patients American patients were younger, fewer had co-morbid conditions and more had a high education level. Fifty-three % of the US-men eligible for RP had low-risk tumors compared to 42% and 31% among respectively the Norwegian and the Spanish patients. Among the Spanish RAD patients 54% had had low- risk tumors compared to respectively 34% of the American and 21% of the Norwegian men planned for RAD. Compared to the European patients significantly fewer US patients reported moderate or severe sexual dysfunction and related problems. In most subgroups the number of patients with sexual or urinary dysfunctions exceeded that of patients with bother related to the reported dysfunction. Conclusions Statistically significant between-country differences were observed in pre-treatment medical and socio-demographic variables, as well as in pre-treatment PROs within the sexual and urinary domain. Large differences between reported dysfunction and related problems within the sexual and urinary domain indicate that dysfunction and bother should be reported separately in addition to calculation of summary scores. The documented differences, not at least regarding PROs, may in part explain the large variation of post-treatment side effects evident in the medical literature.
    Clinical Genitourinary Cancer 01/2014; · 1.69 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: After being diagnosed with prostate cancer, men must assimilate information regarding their cancer. Satisfaction with information reflects the evaluation of information sources used prior to treatment to select a therapy. We sought to describe the use and helpfulness of several information sources available to prostate cancer survivors and to identify factors associated with satisfaction with information. A total of 1204 men with newly diagnosed prostate cancer enrolled in the prospective, multi-center Prostate Cancer Outcomes and Satisfaction with Treatment Quality Assessment (PROST-QA) study. The validated Satisfaction with Information (SWI) domain of the Service Satisfaction Scale-Cancer (SCA) was administered to subjects two months following treatment, and the relationship between several factors, such as demographics, socioeconomic factors, cancer severity and types of information sources used, and satisfaction with information were evaluated using multiple regression. Sources of information endorsed by subjects varied by race, education, and study site. The most helpful sources were treatment description by the treating physician (33.1%), internet sites (18.9%) and books (18.1%). In multiple variable models, patient age (p=0.005) and information provided by the physician regarding their own patients' outcomes (p=0.01) were independently associated with patient satisfaction with information provided. A variety of information sources were used and endorsed as helpful by subjects, although results for a physician's own patients was the only source independently associated with satisfaction with information. Providing patients with information about possible or expected courses of care and outcomes may improve satisfaction.
    The Journal of urology 12/2013; 191(5). DOI:10.1016/j.juro.2013.12.008 · 3.75 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives:Prevalence of urinary problems(UP) after prostate cancer treatment is as high as 40% with significant quality of life impact. We compared direct costs of UP treatment across treatment groups and determined predictors of long-term UP costs. Methods:Longitudinal, observational cohort study analyzed demography, treatment, and quality-of-life data from Cancer of Prostate Strategic Urologic Research Endeavor (CaPSURE) registry. UP medication and surgical treatment costs were compared among treatment groups: radical prostatectomy(RP), electron beam radiation therapy(EBRT), brachytherapy(BT), and watchful waiting(WW), for a maximum 14 years and using 2009 costs. Means and proportions were compared using Chi-square and F-statistics to determine significant differences among treatment groups. Bootstrapped regression models compared the relative effects of primary treatment, D'Amico risk groups, age, change in urinary function (UF) and urinary bother (UB) on 3-monthly UP treatment costs. Results: The 3,276 patients were 64.3 years at diagnosis. Distribution of treatment groups was RP(61.6%), BT(17.34%), EBRT(12.45%), BT+EBRT(5.40%), WW(2.08%), and RP+EBRT(1.13%). Mean UP treatment costs across all patients were $144/year. Those greater than 74 years old had highest UP treatment costs($289/year). Multivariate results showed patients in the RP group incurred significantly(18.1%, p<.0001) lower UP treatment costs post-prostate treatment compared to WW, with other treatments not significant. UF change from baseline was not significant but UB changes were associated with 85.6%(p=0.052) higher UP treatment costs. Conclusions:Cost of UP treatment, along with UB score change from baseline, can be an indicator of both the extent of dysfunction and the desire for success and adherence to UP treatments after prostate cancer treatment.
    141st APHA Annual Meeting and Exposition 2013; 11/2013

Publication Stats

8k Citations
1,199.28 Total Impact Points

Institutions

  • 2013–2015
    • Emory University
      • Department of Urology
      Atlanta, Georgia, United States
    • Washington University in St. Louis
      • Department of Radiation Oncology
      San Luis, Missouri, United States
  • 2004–2014
    • Beth Israel Deaconess Medical Center
      • • Division of Urology
      • • Department of Surgery
      Boston, Massachusetts, United States
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2008–2012
    • Harvard Medical School
      • Department of Surgery
      Boston, Massachusetts, United States
  • 2011
    • Beverly Hospital, Boston MA
      BVY, Massachusetts, United States
  • 2009
    • University of California, Los Angeles
      • Department of Urology
      Los Ángeles, California, United States
  • 1994–2008
    • Johns Hopkins Medicine
      • • Department of Pathology
      • • Department of Medicine
      • • Department of Urology
      Baltimore, Maryland, United States
  • 2007
    • Sheba Medical Center
      Gan, Tel Aviv, Israel
  • 2004–2006
    • Brigham and Women's Hospital
      • Department of Pathology
      Boston, MA, United States
  • 1999–2006
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
  • 1999–2003
    • University of Michigan
      • • Department of Urology
      • • Department of Surgery
      • • Department of Internal Medicine
      • • Comprehensive Cancer Center
      Ann Arbor, Michigan, United States
  • 2000
    • Prostate Cancer Research Institute
      Los Angeles, California, United States
  • 1995–1997
    • Johns Hopkins University
      • Department of Pathology
      Baltimore, Maryland, United States