Survivorship health information counseling for patients with prostate cancer.

Cancer survivorship has been recognized in recent years as a critical variable in the cancer care continuum. The Institute of Medicine issued a special report in 2006 addressing cancer survivorship issues. One intervention within these reports is cancer survivorship education about chronic effects following cancer treatment. This evidence-based practice (EBP) project provided a survivorship discharge health information counseling program for patients with localized prostate cancer who were treated with external beam radiation. The results of this pilot program resulted in improved patient satisfaction with survivorship discharge health information for cancel care.

Hyaluronic Acid Spacer for Hypofractionated Prostate Radiation Therapy: A Randomized Clinical Trial.

Importance: Hypofractionated radiation therapy (RT) for prostate cancer has been associated with greater acute grade 2 gastrointestinal (GI) toxic effects compared with conventionally fractionated RT. Objective: To evaluate whether a hyaluronic acid rectal spacer could (1) improve rectal dosimetry and (2) affect acute grade 2 or higher GI toxic effects for hypofractionated RT. Design, Setting, and Participants: This randomized clinical trial was conducted from March 2020 to June 2021 among 12 centers within the US, Australia, and Spain, with a 6-month follow-up. Adult patients with biopsy-proven, T1 to T2 prostate cancer with a Gleason score 7 or less and prostate-specific antigen level of 20 ng/mL or less (to convert to µg/L, multiply by 1) were blinded to the treatment arms. Of the 260 consented patients, 201 patients (77.3%) were randomized (2:1) to the presence or absence of the spacer. Patients were stratified by intended 4-month androgen deprivation therapy use and erectile quality. Main Outcomes and Measures: For the primary outcome, we hypothesized that more than 70% of patients in the spacer group would achieve a 25% or greater reduction in the rectal volume receiving 54 Gy (V54). For the secondary outcome, we hypothesized that the spacer group would have noninferior acute (within 3 months) grade 2 or higher GI toxic effects compared with the control group, with a margin of 10%. Results: Of the 201 randomized patients, 8 (4.0%) were Asian, 26 (12.9%) Black, 42 (20.9%) Hispanic or Latino, and 153 (76.1%) White; the mean (SD) age for the spacer group was 68.6 (7.2) years and 68.4 (7.3) years for the control group. For the primary outcome, 131 of 133 (98.5%; 95% CI, 94.7%-99.8%) patients in the spacer group experienced a 25% or greater reduction in rectum V54, which was greater than the minimally acceptable 70% (P < .001). The mean (SD) reduction was 85.0% (20.9%). For the secondary outcome, 4 of 136 patients (2.9%) in the spacer group and 9 of 65 patients (13.8%) in the control group experienced acute grade 2 or higher GI toxic effects (difference, -10.9%; 95% 1-sided upper confidence limit, -3.5; P = .01). Conclusions and Relevance: The trial results suggest that rectal spacing with hyaluronic acid improved rectal dosimetry and reduced acute grade 2 or higher GI toxic effects. Rectal spacing should potentially be considered for minimizing the risk of acute grade 2 or higher toxic effects for hypofractionated RT. Trial Registration: ClinicalTrials.gov Identifier: NCT04189913.

Quality of life of men treated for localized prostate cancer: outcomes at 6 and 12 months.

GOALS OF WORK: Treatments for early-stage prostate cancer (PCa) are highly effective; therefore, research studies that explore quality of life (QOL) issues associated with different treatments are important. The purposes of this study were to (a) examine differences among treatment groups of men treated with either radiation therapies or radical prostatectomy for PCa and (b) examine quality of life outcomes over time. PATIENTS AND METHODS: We report outcomes 6 and 12 months after 159 men began treatment for PCa with either one of two types of radiation treatment (intensity-modulated radiation therapy plus high dose rate or intensity-modulated radiation therapy plus seed implantation) or radical prostatectomy. MAIN RESULTS: Significant differences among groups are described. Significant predictors of QOL at 6 months included urinary, bowel, and sexual symptoms, anxiety, depression, problem-focused coping, and physiological self-efficacy. Significant predictors of QOL at 12 months were urinary and bowel symptoms, stress, depression, problem-focused coping, and physiological self-efficacy. Demographic variables, race, and living status were significant predictors of quality of life at 12 months. CONCLUSIONS: Physiological symptoms and psychological symptoms were both significant predictors of QOL. The psychological factors that predicted quality of life in this study have potential for intervention and point to the next stage of the research.

Corrigendum: Incorrect Spelling of Author's Name: US Preventive Services Task Force prostate-specific antigen screening guidelines result in higher Gleason score diagnoses.

[This corrects the article on p. 423 in vol. 58.].

US Preventive Services Task Force prostate-specific antigen screening guidelines result in higher Gleason score diagnoses.

Purpose: To evaluate the impact that the 2012 US Preventive Services Task Force (USPSTF) prostate-specific antigen (PSA) screening guidelines have had on the diagnosis of prostate cancer, we compared the incidence and distribution of new cases diagnosed in 2011-before the USPSTF PSA screening recommendations versus 2014 at which time the guidelines were widely adopted. Materials and Methods: We identified all prostate biopsies performed by a large urology group practice utilizing a centralized pathology lab. We examined total biopsies performed, percentage of positive biopsies, and for those with positive biopsies examined for differences in patient age, PSA, and Gleason score. Results: A total of 4,178 biopsies were identified - 2,513 in 2011 and 1,665 in 2014. The percentage of positive biopsies was 27% in 2011 versus 34% in 2014 (p<0.0001). Among patients with positive biopsies, we found statistically significant differences between the 2 cohorts in the median ages and Gleason scores. Patients were about 1 year younger in 2014 compared to 2011 (t-test; p=0.043). High Gleason scores (8-10) were diagnosed in 19% of the 2014 positive biopsies versus 9% in the 2011 positive biopsies (chi square; p<0.0001). Conclusions: After the widespread implementation of the 2011 USPTF PSA screening guidelines, 34% fewer biopsies were performed with a 29% increase in positive biopsy rates. We found a significantly higher incidence of high grade disease in 2014 compared with 2011. The percentage of patients with positive biopsies having Gleason scores 8-10 more than doubled in 2014. The higher incidence of these more aggressive cancers must be part of the discussion regarding PSA screening.

Prostate HDR radiation therapy: a comparative study evaluating the effectiveness of pain management with peripheral PCA vs. PCEA.

INTRODUCTION: High dose rate (HDR) brachytherapy is considered one of the most advanced treatment technologies currently available for treatment of localized prostate cancer. It gives the advantage of applying higher dose radiation, with greater precision, directly to the tumor while sparing healthy tissue and surrounding organs, thereby resulting in fewer side effects. In this facility, the treatment requires an overnight stay in the hospital, in a supine position, with a perineal template sutured to the perineum to prevent catheter movement or dislodgement. PURPOSE: To compare the effectiveness of pain management for men with prostate cancer being treated with HDR brachytherapy using a peripheral patient controlled analgesia (PCA) or patient controlled epidural analgesia (PCEA). METHOD: A comparative study was conducted evaluating the effectiveness of two pain management methods for men with prostate cancer receiving HDR brachytherapy. Pain assesments were conducted by scoring pain from the Foley catheter, interstitial catheter (perineal) and back (lumbosacral), using the Brief Pain Inventory Scale. RESULTS: Patients receiving pain management with the PCEA experienced significantly less pain. CONCLUSIONS: These finding suggest that use of PCEA with bupivacaine and fentanyl is more effective in managing pain related to HDR brachytherapy for prostate cancer, and results in a positive patient outcome thereby improving patient satisfaction.

Analysis of serial CT scans to assess template and catheter movement in prostate HDR brachytherapy.

PURPOSE: As prostate high-dose-rate (HDR) brachytherapy becomes more prevalent, varying amounts of catheter displacement have been noted. To investigate the constancy of catheter position and its impact on dose distribution, we analyzed serial dosimetric CT scans. METHODS AND MATERIALS: The data from 50 patients were analyzed. During initial CT treatment planning, transverse images of the implant volume were collected, and all structures were digitized into the Nucletron Brachytherapy Planning System. Digitally reconstructed radiographs were generated with rendering of the catheter tips, ischial tuberosity, and perineal template. The distance from each catheter tip to the template and to the ischial tuberosity was measured. The distance between the ischial tuberosity and the template was similarly measured. A second CT set was obtained at different intervals and compared with the first measurement to assess catheter and/or template movement. In 10 patients, the second CT set was obtained before the third fraction in both 2-mm and 5-mm slice sequences, and the latter was used to re-create the HDR plan. RESULTS: Although no interfraction catheter movement relative to the template was found, the template-catheter unit moved in a caudal direction between HDR fractions. The amount of displacement was time dependent: 2 mm before the second fraction, 8 mm before the third, and 10 mm before the fourth. When comparing the first HDR treatment with the third, median decreases in the following dosimetric parameters were noted: dose to 90% of the prostate volume, 35% (r = 0-60); minimal dose to the base, 35% (r = 17-65); and maximal dose to 1 cm(3), 13% (r = 3-19%). CONCLUSION: The interstitial catheters did not slip within the template and were not caudally displaced independently but rather in conjunction with the template. The displacement occurred in a time-dependent fashion, and, without redress, significant dosimetric changes are encountered by the third fraction.

Quality of life of men treated with brachytherapies for prostate cancer.

BACKGROUND: Most studies of men undergoing treatment for prostate cancer examine physical symptoms as predictors of Quality of Life (QOL). However, symptoms vary by treatment modality in this population, and psychosocial variables, shown to be important to QOL, have rarely been examined. Litwin noted a need for analysis of QOL data in men treated for prostate cancer with different modes of therapy, as studies focusing on specific treatments will increase the homogeneity of research findings. METHODS: This cross-sectional study explored physical and psychosocial predictors of QOL in men receiving one of two types of radiation treatment for prostate cancer: Intensity Modulated Radiation Therapy (IMRT) + High Dose Rate (HDR) Brachytherapy or IMRT + seed implantation. Subjects completed a biographic questionnaire; quality of life measures, which were the eight subscales of the Medical Outcome Study Short Form Health Survey (SF-36); measures of physical symptoms including the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer (RTOG/EORTC) and the Prostate Symptom Self-Report (PSSR); and measures of psychological factors, the Ways of Coping Scale (WOC), Perceived Stress Scale, the Anxiety Subscale of the SCL-90, and Strategies Used by Patients to Promote Health (SUPPH). Eight regression models including both physical and psychosocial variables were used to predict quality of life. RESULTS: Sixty-three subjects with complete data on all variables were studied. Treatment effect sizes were medium to large in predicting each of the quality of life subscales of the SF-36. Psychosocial variables were related to physical function, role function, bodily pain, general health, social function, emotional role, and mental health. Physical symptoms were related to subjects' perceived general health and mental health. DISCUSSION: The number of significant relationships among psychosocial variables and indicators of QOL exceeded the number of relationships among symptoms and QOL suggesting that psychosocial variables associate strongly with prostate cancer patients' reports of quality of life. Findings of the study may provide patients and families with knowledge that contributes to their understanding of quality of life outcomes of IMRT+ HDR and IMRT + seed implantation and their ability to make more informed treatment choices.

Endobronchial brachytherapy and external-beam radiotherapy in patients with endobronchial obstruction and extrabronchial extension.

PURPOSE: To evaluate the efficacy of high-dose rate endobronchial brachytherapy (HDR-EB) with concomitant short-course external-beam radiotherapy (EBRT) in patients with both endobronchial and extrabronchial tumor. METHODS AND MATERIALS: Patients with endobronchial disease and extrabronchial lesions greater than 2.5cm were treated with three 5Gy HDR-EB and 37.5Gy EBRT delivered over 3.5 weeks. Flexible fiberoptic bronchoscopy was performed with the patient under conscious sedation, and tumor location, length of lesion, percentage of lumen occlusion, and presence of bleeding were recorded. Fluoroscopic visualization of the guide wire in the catheter tip assisted in demarcating the proximal and distal extent of the intraluminal tumor. 5Gy was prescribed to a distance of 1cm from the catheter and a computerized treatment planning system was used to optimize the dose distribution to the gross target volume with 1.5-2cm margins at the distal and proximal ends. Bronchoscopic and symptomatic response rates were assessed at the third HDR-EB and patients were seen in follow-up every 2 months. RESULTS: One hundred seventeen endobronchial treatments were delivered to 33 patients with primary carcinoma, and 8 patients with metastatic carcinoma. The median age was 69 (range = 36-94); 95% reported dyspnea; 71% cough and 22% hemoptysis. Seventy-two percent of patients reported resolution of their symptoms and 54% achieved a bronchoscopic response (at least 50% decrease in intraluminal obstruction). In a multivariate logistic model including stage, age, primary tumor type, and Karnofsky performance status (KPS) as predictors, only KPS was statistically associated with bronchoscopic response (OR = 1.1; 95%CI = 1.01-1.13) and palliation of symptoms (OR = 1.3; 95%CI = 1.05-1.59). The overall median survival was 5.2 months and was associated with bronchoscopic response (11 months in responders vs 4 in nonresponders) and symptom resolution (8 months in responders vs 1.5 in nonresponders). In a multivariate Cox survival model with stage, age, primary tumor type, and KPS as predictors, only KPS was significantly associated with survival (RR = 0.92;95%CI = 0.88-0.95). CONCLUSIONS: HDR-EB with concomitant EBRT is an effective treatment regimen for patients with both endobronchial and extrabronchial tumor. Patients with higher performance status are more likely to have resolution of disease and have longer median survival.

A clinical application of an automated phantom-film QA procedure for validation of IMRT treatment planning and delivery.

To quantify the correlation between planned and delivered intensity-modulated radiation therapy (IMRT) dose distributions, IMRT plans for 37 prostate carcinoma patients were analyzed. IMRT treatment plans were converted into hybrid phantom plans using a commercially available treatment planning system and delivered to a specialized film phantom via a static-tomotherapy technique. The films were analyzed using a commercial film dosimetry system. Hybrid phantom axial dose maps and film images were normalized, registered to one another, and subtracted to calculate the overall relative dose difference throughout the entire film area on a pixel-by-pixel basis. The average percentage of pixels with dose-difference values greater than +/- 3% among analyzed hybrid patient plans was 8.6% +/- 3%. The average percentage of pixels with dose differences greater than +/- 5% was 1.7% +/- 1.0%. The number of pixels with more than +/- 10% dose differences was negligible. An initial subset of hybrid plans was used to develop a quantitative criterion to verify for positional accuracy based on dosimetric verification of intensity map of IMRT plans for prostate patients in our institution. Plans with less than 5% of the pixels outside the +/- 5% dose-difference range were accepted. This method could be implemented for other anatomical sites or treatment planning and delivery systems.

The effects of edema on urethral dose following palladium-103 prostate brachytherapy.

The effects of edema on urethral dose after interstitial prostate brachytherapy with palladium-103 (103Pd) were studied. Fifty patients underwent a 90-Gy 103Pd implant followed by dosimetric computed tomography (CT). Twenty-one days later, a Foley catheter was reinserted and a dosimetric CT was repeated. The mean reduction in prostate volume between day 0 and day 21 was 16%. Median prostate D90 on day 0 was 89.7 Gy (range 59.5 to 127) and 99.5 Gy (range 62.5 to 130) on day 21. Median prostate V100 was 90% (range 63 to 98%) on day 0 and 96% (range 66 to 99%) on day 21. Median V150 was 61% (range 31 to 85%) on day 0 and 75% (range 39 to 93%) on day 21. Median urethral D50 was 107 Gy (range 57 to 201) on day 0 and 126 Gy (range 64 to 193) on day 21. Regression analysis demonstrated a significant correlation between the decrease in the prostate volume and the increased urethral D50 (r 0.58, p < 0.05). Acute urinary toxicity was 32% grade 0, 38% grade 1, and 30% grade 2. The median urethral D50 increased by a mean of 18% with a correlation coefficient of 0.58 (p < 0.05). Catheterization of the urethra was well tolerated and was of value in better characterizing urethral dose after 103Pd brachytherapy.

Exploratory factor analysis: strategies used by patients to promote health.

Strategies used by patients to promote health (SUPPH) was used to measure self-care self-efficacy in patients with cancer. The objectives of this study were (1) to determine the extent to which self-efficacy theory explained the factor structure of the SUPPH and (2) to determine the relationship of demographic data with factors of the SUPPH. Subjects were diagnosed with prostate cancer (PCa) and treated with either: (a) radical prostatectomy, (b) intensity modulated radiation therapy (IMRT) + radioactive seed implantation, or (c) IMRT + high dose rate. Subjects completed a demographic questionnaire and the SUPPH. Exploratory factor analysis of the SUPPH was performed using a varimax rotation. Subjects (n = 265) were predominately white and averaged 68 years of age. The model explained 81.3% of the total sum of eigenvalues. Two factors of the SUPPH were identified: physiological efficacy information and performance efficacy information. Younger subjects who were fully employed and earning more money had significantly higher performance self-efficacy than older subjects who were working part time and earning less money. Results are congruent with Bandura's (1997) description of self-efficacy. Use of the SUPPH may facilitate research validating Bandura's (1997) assertion that an individual's self-efficacy is related to quality of life (QOL) during chronic illness. Additional research focusing on self-efficacy and PCa patients' QOL may lead to efficacy enhancing interventions that will improve QOL of patients with PCa.

Prospective study of quality of life of patients receiving treatment for prostate cancer.

BACKGROUND: No research was found that compared quality of life (QOL) outcomes of prostate cancer patients receiving intensity-modulated radiation therapies with prostate cancer patients receiving radical prostatectomy. OBJECTIVES: To (a) describe differences in QOL before and after three types of treatment for prostate cancer: radical prostatectomy, intensity-modulated radiation therapy + seed implantation (permanent brachytherapy), or intensity-modulated radiation therapy + high dose rate radiotherapy (temporary brachytherapy); and (b) investigate demographic, physical, and psychosocial variables that impact QOL of men with prostate cancer. METHODS: Data were collected on three occasions: baseline (prior to treatment), 1 month, and 3 months after beginning treatment. Measures included biographic data, physiological, and psychological measures. Analysis of variance and hierarchical regression were used to examine patterns, describe differences, and identify predictors of QOL in the three treatment groups. QOL was conceptualized as a multidimensional construct that included physical, psychological, social, and functional well-being and prostate cancer concerns. RESULTS: Groups differed significantly in bowel and urinary symptom scores and prostate cancer concerns at baseline, and in urinary and depressive symptoms at 3 months. There were no significant group differences at 1 month. DISCUSSION: Significant differences were found in QOL as measured with the Functional Assessment of Cancer Treatment-Prostate after treatment with radical prostatectomy, intensity-modulated radiation therapy + seed implantation, or intensity-modulated radiation therapy + high dose rate radiotherapy. Findings may provide healthcare providers with knowledge about treatment sequelae for prostate cancer, enable healthcare providers to educate patients about QOL outcomes of treatment for prostate cancer, and enable patients to make more informed treatment decisions.