Long-term outcomes of SBRT for PSMA PET detected oligometastatic prostate cancer.

BACKGROUND: Oligometastatic disease in prostate cancer (PCa) is a challenging clinical scenario encountered more frequently with the widespread adoption of PSMA-PET. SBRT aims to defer androgen deprivation and may deliver sustained biochemical failure (BF) free survival in selected patients. Little long-term data is currently available regarding the effectiveness of this approach. METHODS: A retrospective single institution study of PSMA-PET directed SBRT without initial ADT for oligo-metachronous PCa. Median dose/fractionation was 24 Gy in 2# to bones and 30 Gy in 3# to lymph nodes. The primary endpoint was time to BF (PSA + 0.2 ug/L above nadir). Secondary endpoints included time to ADT for relapse (i.e. palliative ADT), BF defined as PSA nadir + 2 ug/L, toxicity, patterns of failure and survival. Patients were excluded if they received ADT with their SBRT, had short disease-free interval, or > 3 metastases on PSMA-PET. RESULTS: 103 patients treated from November-2014 to December-2019 were analysed from our prospective database. Median follow-up was 5 years. 64 patients were treated for nodal only disease, 35 bone only and 4 mixed. 15% were free of any BF at 5 years with median time to BF of 1.1 years. 32% (33/103) of patients had further curative-intent radiation treatment following their first BF after SBRT, including subsequent SBRT. Eight patients underwent potentially curative treatment for their second or third relapse. Allowing for salvage treatment, 29/103 (28%) were biochemically disease free at last follow up. At 5 years, 39% of patients had never received any ADT and 55% had not started ADT for relapse with a median time to ADT for relapse of 5.5 years. There were 2 grade 3 toxicities (rib fracture and lymphoedema), and no local failures. CONCLUSION: PSMA-PET guided SBRT for oligo-metachronous PCa recurrence in appropriately triaged patients results in excellent local control, low toxicity and over 50% ADT free at 5 years.

Prospective Randomized Cohort Study to Explore the Acceptability of Patient-Reported Outcome Measures to Patients of Hand Clinics.

Purpose: The purpose of this randomized prospective cohort study was to assess the acceptability of administering patient-reported outcome measures (PROMs) in the waiting room of hand clinics. Methods: Participants were randomly assigned to receive the Patient-Rated Wrist and Hand Evaluation (PRWHE), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, or Michigan Hand Questionnaire (MHQ). Acceptability was measured in terms of data quality, participation, and retention rates. Data quality was determined by the number of incomplete questionnaires, unanswered questions, and unscorable questionnaires. Most frequently unanswered questions were identified. The participant-reported time taken to complete the questionnaires was collected. Results: A total of 491 participants enrolled in this study. A participation rate of 85% with a retention rate of 94% indicated that patients found the administration of PROMs in the waiting room of the clinic to be acceptable. The proportion of missing data for each questionnaire was 4.2% for PRWHE, 3.9% for DASH and 6.3% for MHQ. Whether a questionnaire could be used to generate a score was determined by the scoring rules of each instrument. The proportion of questionnaires that were not completed sufficiently for a score to be generated was 0% for PRWHE, 9% for DASH, and 4% for MHQ. No association was found between whether a questionnaire could generate a score and participants' sex, age, or the nature of the condition. Over 80% of participants reported taking 10 minutes or less to complete the questionnaire. Conclusions: This study shows that hand clinic patients will complete PROMs while waiting for the clinical review. The PRWHE and MHQ groups demonstrated good usability, because less than 5% were unable to produce a score. The usability of the DASH group was lower, because 9% were unable to be scored. This indicates that PRWHE and MHQ are more suitable than DASH to application in a hand clinic setting. Type of study/level of evidence: Therapeutic III.

Aripiprazole and impulse-control disorders in high-risk patients.

A case study demonstrating the association between aripiprazole and impulse-control disorders and a call for caution when prescribing aripiprazole to high-risk patients.