INTRODUCTION:In 2025, prostate cancer is the most common cancer in Australia, regardless of gender, and is the second most common cause of cancer death despite the opportunities for cure. In 2016, Australian Clinical Practice Guidelines for Prostate Specific Antigen (PSA) testing were published to improve early detection and management of prostate cancer. This study reports on a public consultation into the implementation and impact of these guidelines on prostate cancer diagnosis and outcomes. METHODS:Thematic analysis of responses from a public consultation conducted in accordance with best-practice guideline development processes. A national Call for Submissions, using a coordinated public notification strategy, was made, inviting consumers with an interest in PSA testing for prostate cancer to share their experiences via an online platform. Seven questions were posed to all respondents. RESULTS:Consumers described the 2016 Guidelines as ineffective based on negative message framing, lack of uptake of the guidelines by key primary care groups, and low community awareness. Although a small number of men reported that they were able to access early detection and subsequent curative treatment, the majority of men reported missed opportunities for testing, resulting in diagnoses with late-stage disease. Suggestions for future successful implementation included a consumer companion to the guidelines, regular guideline review, a national education and awareness program, and targeted education for health professionals. CONCLUSIONS:Australia's future response to the growing burden of prostate cancer rests on key stakeholders across the health system to ensure alignment and compliance with updated Guidelines. Effective implementation of such guidelines in the future requires a well-resourced education and awareness program for both the lay and clinician communities, and consistency in adoption and practice across key medical groups.

IntroductionAndrogen deprivation therapy (ADT) is commonly used to treat men with locally advanced or metastatic prostate cancer. Men receiving ADT experience numerous side effects and frequently report unmet supportive care needs. An essential part of quality cancer care is survivorship care. To date, an optimal effective approach to survivorship care for men with prostate cancer on ADT has not been described. This protocol describes a randomised trial of tele-based nurse-led survivorship that addresses this knowledge gap: (1) determine the effectiveness of a nurse-led survivorship care intervention (PCEssentials), relative to usual care, for improving health-related quality of life (HR-QoL) in men with prostate cancer undergoing ADT and (2) evaluate PCEssentials implementation strategies and outcomes, including cost-effectiveness, compared with usual care.Methods and analysisThis is an effectiveness-implementation hybrid (type 1) trial with participants randomised to one of two arms: (1) minimally enhanced usual care and (2) nurse-led prostate cancer survivorship essentials (PCEssentials) delivered over four tele-based sessions, with a booster session 5 months after session 1. Eligible participants are Australian men with prostate cancer commencing ADT and expected to be on ADT for a minimum of 12 months. Participants are followed up at 3, 6 and 12 months postrecruitment. Primary outcomes are HR-QoL and self-efficacy. Secondary outcomes are psychological distress, insomnia, fatigue and physical activity. A concurrent process evaluation with participants and study stakeholders will be undertaken to determine effectiveness of delivery of PCEssentials.Ethics and disseminationEthics approval was obtained from the Metro South Health HREC (HREC/2021/QMS/79429). All participants are required to provide written informed consent. Outcomes of this trial will be published in peer-reviewed journals. The findings will be presented at conferences and meetings, local hospital departments, participating organisations/clinical services, and university seminars, and communicated at community and consumer-led forums.Trial registration numberACTRN12622000025730.

Background and objective: Radical prostatectomy (RP) is a common and widely used treatment for localized prostate cancer. Sequela following RP may include urinary incontinence and sexual dysfunction, outcomes which are recorded within a bi-national Prostate Cancer Outcomes Registry. The objective was to report population-wide urinary incontinence and sexual function outcomes recorded at 12 months following RP; and to quantify and explore factors associated with variation in outcome. Materials and methods: The Prostate Cancer Outcomes Registry of Australia and New Zealand (PCOR-ANZ) was used for this study. Participants were treated with radical prostatectomy between 2016 and 2020. Domain summary scores for urinary incontinence and sexual function from the EPIC-26 instrument were the main outcomes, taken at 12 months following surgery (6- 18 months). "Major" urinary and sexual function bother were also assessed. Variation in outcomes was investigated using linear and logistic multivariable regression models adjusted for covariates: age, socioeconomic status, PSA at diagnosis, surgical technique, surgical specimen grade group, margin status, and clinician surgical volume. Results and conclusions: The analytic cohort included 13,083 men with the mean urinary incontinence domain score being 76/ 100 (SD = 25) with 9.2% reporting major bother. For sexual function, the mean score was 29/100 (SD = 26) with 46% reporting major bother. Of the examined variables, age at surgery and surgical volume category were most predictive of function, with disparities exceeding minimally important differences, though large variation was observed between urologists within volume categories. There is considerable variation in 12-month postprostatectomy functional outcomes. Variation is explained by both patient and clinician factors, though some confounders are unmeasured in this cohort. (c) 2022 Elsevier Inc. All rights reserved.

BJU InternationalVolume 127, Issue S1 p. 30-31 CommentOpen Access Prostate cancer survivorship care: if not now, when? Jeffrey Dunn, Prostate Cancer Foundation of Australia, Sydney, NSW, Australia Division of Research and Innovation, University of Southern Queensland, Springfield, Qld, Australia Cancer Council Queensland, Brisbane, Qld, Australia Faculty of Health, University of Technology Sydney, Ultimo, NSW, AustraliaSearch for more papers by this authorPeter Heathcote, Australian Prostate Cancer Research Centre, Queensland University of Technology, Brisbane, Qld, Australia Department of Urology, Princess Alexandra Hospital, Brisbane, Qld, AustraliaSearch for more papers by this authorSuzanne K. Chambers, Corresponding Author suzanne.chambers@uts.edu.au orcid.org/0000-0003-2369-6111 Division of Research and Innovation, University of Southern Queensland, Springfield, Qld, Australia Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia Correspondence: Suzanne Chambers, Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, Ultimo, NSW 2007, Australia. e-mail: suzanne.chambers@uts.edu.auSearch for more papers by this author Jeffrey Dunn, Prostate Cancer Foundation of Australia, Sydney, NSW, Australia Division of Research and Innovation, University of Southern Queensland, Springfield, Qld, Australia Cancer Council Queensland, Brisbane, Qld, Australia Faculty of Health, University of Technology Sydney, Ultimo, NSW, AustraliaSearch for more papers by this authorPeter Heathcote, Australian Prostate Cancer Research Centre, Queensland University of Technology, Brisbane, Qld, Australia Department of Urology, Princess Alexandra Hospital, Brisbane, Qld, AustraliaSearch for more papers by this authorSuzanne K. Chambers, Corresponding Author suzanne.chambers@uts.edu.au orcid.org/0000-0003-2369-6111 Division of Research and Innovation, University of Southern Queensland, Springfield, Qld, Australia Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia Correspondence: Suzanne Chambers, Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, Ultimo, NSW 2007, Australia. e-mail: suzanne.chambers@uts.edu.auSearch for more papers by this author First published: 10 February 2021 https://doi.org/10.1111/bju.15358AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Prostate cancer is the most common cancer diagnosed in Australian men, excluding non-melanoma skin cancer, and it is estimated that there are over 220 000 Australian men living with a diagnosis of prostate cancer [1]. Survival for men with prostate cancer is excellent in countries that have accessible screening and treatment services, and in Australia 5-year relative survival is over 95% [1]. High incidence, coupled with improving long-term survival, leads to a correspondingly high prevalence rate and high community disease burden. Many men with prostate cancer experience long-term decrements in their mental and physical quality of life, overall they have a greater suicide risk than their non-cancer peers, and unmet supportive care needs are pervasive [2]. In this context, survivorship care for men with prostate cancer is crucial in both the short and long term. The recent development of a Prostate Cancer Survivorship Essentials Framework in the Australian and New Zealand setting provides an example of a regional response to this issue that delivers guidance for policy makers, clinicians, community and consumers on what is essential for step change in prostate cancer survivorship outcomes [3]. Definitions of survivorship vary, particularly between the medical professional and consumers. Narayan et al. [4] recently proposed that, in the case of prostate cancer, a broad definition where survivorship begins at diagnosis and continues until the end of life was a better fit for a cancer with a prolonged treatment course and often complex and demanding treatment regimens. Current gaps in prostate cancer survivorship evidence and practice are problematic and well described [4, 5]. These include a lack of data on effective models of care coordination, survivorship care implementation, a heavy reliance on expert opinion, and little attention to health disparities, resulting in fragmented care that is not patient-centred. More broadly, a recent review of cancer survivorship-focused goals and objectives in comprehensive cancer control plans across the USA concluded that, although in principle support for cancer survivorship was generally strong, evidence of implementation and effect was less evident [6]. The need for multiple coordinated strategies that take a longitudinal focus was noted if indeed the survivorship needs of cancer populations are to be addressed. The question then arises, how do we best advance well-coordinated and responsive survivorship care for men with prostate cancer? We would argue that there are three critical elements for forward movement. The first concerns recognition and inclusion of the consumer voice. The second is clarity around the evidence base and where the most likely gains in quality of life and survivorship outcomes might be made. Third, a coalition of the willing is needed. Men with prostate cancer and the health professionals who care for them describe the prostate cancer survivorship experience as challenging, medically focused, and uncoordinated, leading to unmet supportive care needs and anxiety for patients [3]. They report the need for improved communication by healthcare professionals and better coordinated and men-centred care that responds and articulates with masculine ways of being. Further, although there remain gaps in knowledge around aspects of prostate cancer survivorship care, such as care coordination and surveillance, good evidence exists for effective interventions in many key areas such as psychosocial care, health promotion, physical rehabilitation and exercise medicine [5]. There is much we can do. The Prostate Cancer Survivorship Essentials Framework developed by leading clinical, nursing and allied health groups and agencies and consumer groups in Australia and New Zealand identified six domains of care for which consensus was high: Health Promotion and Advocacy; Shared Management; Vigilance; Personal Agency; Care Coordination and Evidence-based Survivorship Interventions (Fig. 1) [3]. Stakeholders confirmed that the defined elements within these domains were important. There now exists a critical momentum with a key coalition to improve care for men with prostate cancer in these countries from which real change may occur. Fig. 1Open in figure viewerPowerPoint Prostate Cancer Survivorship Essentials Framework. The Essentials Framework provides a road map for improvements in cancer for men with prostate cancer that can be expressed in multiple policy and programme initiatives to suit different communities and different patient scenarios. One-size-fits all is rarely indicated or effective in healthcare system change and improvement and hence we encourage creativity and flexibility in how the framework is applied. It is likely that different settings with different resourcing and specific community characteristics will require different solutions. The key is to act now, because as prostate cancer prevalence continues to grow globally, if not now, when? Conflict of Interest None declared. References 1 Australian Institute of Health and Welfare. Cancer data in Australia 2020. Web Report, 20 June 2020, AIHW, Cat no. CAN122. Canberra, ACT: AIHW, 2020Google Scholar 2Chambers SK, Galvão DA, Green A et al. A Psychosocial Care Model for Men with Prostate Cancer. Sydney, NSW: Prostate Cancer Foundation of Australia and University of Technology Sydney, 2019Google Scholar 3Dunn J, Green A, Ralph N et al. Prostate cancer survivorship essentials framework: guidelines for practitioners. BJUI 2020. https://doi.org/10.1111/bju.15159Wiley Online LibraryPubMedWeb of Science®Google Scholar 4Narayan V, Harrison M, Cheng H et al. Improving research for prostate cancer survivorship: a statement from the Survivorship Research in Prostate Cancer (SuRECaP) working group. Urol Oncol 2020; 38: 83– 93CrossrefPubMedWeb of Science®Google Scholar 5Crawford-Williams F, March S, Goodwin BC et al. Interventions for prostate cancer survivorship: a systematic review of reviews. Psychooncology 2018; 27: 2339– 48Wiley Online LibraryPubMedWeb of Science®Google Scholar 6Mollica MA, Falisi AL, Geiger AM et al. Survivorship objectives in comprehensive cancer control plans: a systematic review. J Cancer Surviv 2020; 14: 235– 43CrossrefPubMedWeb of Science®Google Scholar Volume127, IssueS1Special Issue: Urological Society of Australia and New ZealandMay 2021Pages 30-31 FiguresReferencesRelatedInformation

Abstract Objective Androgen deprivation therapy (ADT) reduces muscle and bone mass, increasing frailty in men with prostate cancer. The liver mediates the whole body anabolic effects of testosterone. Based on first-pass metabolism, liver-targeted testosterone treatment (LTTT) entails oral delivery of a small dose of testosterone that does not raise peripheral blood testosterone levels. LTTT reduces blood urea and stimulates protein anabolism in hypogonadal men and postmenopausal women. We investigated whether LTTT prevents loss of lean and bone mass during ADT. Method A 6-month, double-blind, placebo-controlled study of testosterone 40 mg/day in 50 men. Primary outcome measures were lean mass and bone mineral content (BMC). Testosterone, urea and prostate-specific antigen (PSA) were monitored. Patients were withdrawn if PSA exceeded 4 ng/mL. Results 42 patients completed the study. Mean (95% CI) testosterone rose during LTTT but not placebo treatment [∆ 2.2 (1.3-3.0) vs −0.7 (−1.5 to 0.2) nmol/L; P < 0.01]. Mean PSA level did not change significantly during either treatment. Blood urea fell [∆ −0.4 (−0.9 to −0.1) mmol/L] during LTTT but not placebo [∆ 0.05 (−0.8 to 0.9) mmol/L]. BMC [∆ 49 (5 to 93) g; P < 0.02] and lean mass [∆ 0.8 (−0.1 to 1.7) kg; P = 0.04) increased compared to placebo. Five patients on LTTT withdrew from increased PSA levels, all returning to baseline levels. Conclusion LTTT shows promise as a simple therapy for preventing sarcopenia and bone loss during ADT. LTTT may induce reversible PSA rise in some patients. Further studies are required to optimize LTTT dose in ADT. LTTT has potential application in other catabolic states in men and women.

Spearman R [ 0.47 and AUC [ 0.78, predicting EPE more accurately than any individual feature and the control model (p [ 0.01). CONCLUSIONS: Tracked biopsy features (i.e. the spatial coordinates of positive and negative cores), when used alongside other clinical parameters, improved prediction of PCa volume and stage. These metrics, once validated in prospective trials, may improve PCa risk classification and disease management.

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III (MP54)1 Apr 2019MP54-05 LOWER URINARY TRACT SYMPTOMS (LUTS) AFTER ROBOTIC ASSISTED LAPAROSCOPIC PROSTATECTOMY (RALP) IN A LARGE, MULTI-SURGEON COHORT: IMPLICATIONS FOR SURVIVORSHIP AND TREATMENT SELECTION Thomas Ahn, Matthew Roberts*, Andrew Strahan, Gregory Malone, Jason Paterdis, Glen Wood, and Peter Heathcote Thomas AhnThomas Ahn More articles by this author , Matthew Roberts*Matthew Roberts* More articles by this author , Andrew StrahanAndrew Strahan More articles by this author , Gregory MaloneGregory Malone More articles by this author , Jason PaterdisJason Paterdis More articles by this author , Glen WoodGlen Wood More articles by this author , and Peter HeathcotePeter Heathcote More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556690.39331.8dAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Prostate cancer (CaP) survivorship after prostatectomy is plagued by negative functional outcomes, such as incontinence and erectile dysfunction. Despite being prevalent in this age group, the effects on lower urinary tract symptoms (LUTS) after surgery are minimally described, thus the aim of this study was to assess LUTS and QOL using the International Prostate Severity Score (IPSS) following RALP. METHODS: A prospectively curated database of 1917 consecutive robotic assisted laparoscopic prostatectomies (RALPs) undertaken over an 8-year period from January 2009 to January 2017 was assessed. Pre-operative information including age, prostate specific antigen (PSA), body mass index (BMI), International Prostate Severity Score (IPSS) and quality of life (QoL) scores were compared to IPSS and QOL scores reported at 12 months post-surgery. RESULTS: Of the 1917 men who underwent RALP, 1470 with complete data were included in the analysis. The mean age, prostate weight and BMI were 62 (± 6.7) years, 51 (± 17.6) g, and 28 kg/m2, respectively. Overall, 57% of men had an improved IPSS score, with 76% (from 60%) scoring IPSS 7 or less post-operatively. 41% reported an improved QoL. 32% of men reported a worse IPSS or QoL. In a subgroup analysis, 63.7% and 90.3% of patients with pre-surgery moderate LUTS (IPSS 8-19) and severe LUTS (20-35) respectively, demonstrated significantly improved IPSS scores (IPSS change of 5 or more) at 1-year post RALP whilst 81.3% with pre-surgery mild LUTS (IPSS 0-7) remained stable (-5 to 5 IPSS change). Our post-RALP mean IPSS scores were lower (less urinary symptoms) when compared with existing literature post-radiation therapy especially in the baseline moderate and severe IPSS scores (IPSS 8 or more). CONCLUSIONS: At 12-months post-RALP, most men reported improved overall LUTS and QoL, with greater benefit seen in those patients with high pre-RALP IPSS and worse LUTS with low IPSS. Further analyses on specific IPSS domains and longer follow up are needed. Source of Funding: None Brisbane, Australia© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e786-e786 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thomas Ahn More articles by this author Matthew Roberts* More articles by this author Andrew Strahan More articles by this author Gregory Malone More articles by this author Jason Paterdis More articles by this author Glen Wood More articles by this author Peter Heathcote More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Cancer: Staging I (MP09)1 Apr 2019MP09-14 HYBRID PSMA PET/MRI FOR PRIMARY STAGING IN PRESUMED LOCALISED PROSTATE CANCER: A CONTEMPORARY, TERTIARY HOSPITAL SERIES Georges Mehawed*, Paria Saadat, Michelle Ong, Andre Joshi, Matthew Roberts, Marlon Perera, Handoo Rhee, Alex Yeates, Ian McKenzie, Janelle Munns, Greg Malone, Eric Chung, Peter Heathcote, John Preston, Malcolm Lawson, Simon Wood, Sonja Gustafson, Kenneth Miles, Stanley Ngai, and Ian Vela Georges Mehawed*Georges Mehawed* More articles by this author , Paria SaadatParia Saadat More articles by this author , Michelle OngMichelle Ong More articles by this author , Andre JoshiAndre Joshi More articles by this author , Matthew RobertsMatthew Roberts More articles by this author , Marlon PereraMarlon Perera More articles by this author , Handoo RheeHandoo Rhee More articles by this author , Alex YeatesAlex Yeates More articles by this author , Ian McKenzieIan McKenzie More articles by this author , Janelle MunnsJanelle Munns More articles by this author , Greg MaloneGreg Malone More articles by this author , Eric ChungEric Chung More articles by this author , Peter HeathcotePeter Heathcote More articles by this author , John PrestonJohn Preston More articles by this author , Malcolm LawsonMalcolm Lawson More articles by this author , Simon WoodSimon Wood More articles by this author , Sonja GustafsonSonja Gustafson More articles by this author , Kenneth MilesKenneth Miles More articles by this author , Stanley NgaiStanley Ngai More articles by this author , and Ian VelaIan Vela More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555138.43594.e0AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Hybrid (68) Ga-labelled Prostate Specific Membrane Antigen (PSMA) positron emission tomography (PET) with magnetic resonance imaging (MRI) serves to combine detailed resolution of MRI with whole body molecular tumour localisation to improve sensitivity and specificity for metastasis detection during primary staging of prostate cancer. Reports on hybrid PSMA PET/MRI are limited, hence we sought to evaluate the utilisation and diagnostic accuracy within a large series from our institution. METHODS: A retrospective review of all PSMA PET/MRI studies performed in our tertiary referral institution between April 2015 to April 2017 was conducted. Indications for scans, PSA levels, findings of positive scans including lymph nodes, bone and soft tissue, detection rate, prior histology and further treatment was reviewed. RESULTS: Of 300 PSMA PET/MRI studies performed, 115 studies were for primary staging purposes prior to therapy of curative intent in high risk prostate cancer. 106 studies demonstrated uptake within the prostate and soft tissue. The proportion of patients with PSMA avid lesion Gleason score of 8 or above was 37.7% while the median PSA level at the time of scan was 15 ng/ml. 105 (91%) of these scans demonstrated uptake in the primary prostate tumor, of which 66 were localized to only to the prostate. 39 diagnosed with additional extra-prostatic disease with 13 cases having only bone lesions,15 cases with only lymph node positive disease and 3 patients with soft tissue disease, such as lung or urethra. 8 cases had mixed disease. Among tumours without PSMA avidity, one patient had a Gleason score of 9, others had a Gleason score of 7. Median PSA in this group was 6.9 ng/ml. CONCLUSIONS: The use of PSMA PET/MRI in primary staging of high risk prostate cancer appears promising. PSMA PET/MRI had a high detection rate of 92.1% of avid prostatic lesions in our cohort including a 34% metastatic rate. In the staging setting, this modality could be used to assist in therapeutic planning, and can potentially reduce the need for multiple imaging modalities in preparation for curative treatment of patients with prostate cancer. Source of Funding: None Brisbane, Australia© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e113-e113 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Georges Mehawed* More articles by this author Paria Saadat More articles by this author Michelle Ong More articles by this author Andre Joshi More articles by this author Matthew Roberts More articles by this author Marlon Perera More articles by this author Handoo Rhee More articles by this author Alex Yeates More articles by this author Ian McKenzie More articles by this author Janelle Munns More articles by this author Greg Malone More articles by this author Eric Chung More articles by this author Peter Heathcote More articles by this author John Preston More articles by this author Malcolm Lawson More articles by this author Simon Wood More articles by this author Sonja Gustafson More articles by this author Kenneth Miles More articles by this author Stanley Ngai More articles by this author Ian Vela More articles by this author Expand All Advertisement PDF downloadLoading ...

Asia-Pacific Journal of Clinical OncologyVolume 15, Issue S9 p. 56-102 ABSTRACTS Oral Abstracts First published: 31 October 2019 https://doi.org/10.1111/ajco.13262Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume15, IssueS9Special Issue: COSA's 46th Annual Scientific Meeting, Urological cancer; Age and gender in cancer practice; Digital health in cancer, 12–14 November 2019, Adelaide Convention Centre, South AustraliaNovember 2019Pages 56-102 RelatedInformation

Psycho-OncologyVolume 29, Issue 2 p. 444-449 CLINICAL CORRESPONDENCE Ten-year quality of life outcomes in men with prostate cancer Nicholas Ralph, Corresponding Author Nicholas Ralph nicholasralph@cancerqld.org.au orcid.org/0000-0002-7404-9996 Cancer Council Queensland, Brisbane, Australia Division of Research and Innovation, University of Southern Queensland, Springfield, Australia Faculty of Health, University of Technology Sydney, Sydney, Australia Correspondence Nicholas Ralph, Cancer Council Queensland, Brisbane 4006, Australia. Email: nicholasralph@cancerqld.org.auSearch for more papers by this authorShu Kay Ng, Shu Kay Ng Menzies Health Institute Queensland, Griffith University, Gold Coast, AustraliaSearch for more papers by this authorLeah Zajdlewicz, Leah Zajdlewicz Cancer Council Queensland, Brisbane, AustraliaSearch for more papers by this authorStephen J. Lepore, Stephen J. Lepore College of Public Health, Temple University, Philadelphia, PennsylvaniaSearch for more papers by this authorPeter Heathcote, Peter Heathcote Princess Alexandra Hospital, Brisbane, AustraliaSearch for more papers by this authorAndrew Kneebone, Andrew Kneebone University of Sydney, Sydney, Australia Royal North Shore Hospital, St. Leonards, AustraliaSearch for more papers by this authorJeffrey C. Dunn, Jeffrey C. Dunn Cancer Council Queensland, Brisbane, Australia Division of Research and Innovation, University of Southern Queensland, Springfield, Australia Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia Prostate Cancer Foundation of Australia, Sydney, AustraliaSearch for more papers by this authorSuzanne K. Chambers, Suzanne K. Chambers orcid.org/0000-0003-2369-6111 Cancer Council Queensland, Brisbane, Australia Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia Prostate Cancer Foundation of Australia, Sydney, AustraliaSearch for more papers by this author Nicholas Ralph, Corresponding Author Nicholas Ralph nicholasralph@cancerqld.org.au orcid.org/0000-0002-7404-9996 Cancer Council Queensland, Brisbane, Australia Division of Research and Innovation, University of Southern Queensland, Springfield, Australia Faculty of Health, University of Technology Sydney, Sydney, Australia Correspondence Nicholas Ralph, Cancer Council Queensland, Brisbane 4006, Australia. Email: nicholasralph@cancerqld.org.auSearch for more papers by this authorShu Kay Ng, Shu Kay Ng Menzies Health Institute Queensland, Griffith University, Gold Coast, AustraliaSearch for more papers by this authorLeah Zajdlewicz, Leah Zajdlewicz Cancer Council Queensland, Brisbane, AustraliaSearch for more papers by this authorStephen J. Lepore, Stephen J. Lepore College of Public Health, Temple University, Philadelphia, PennsylvaniaSearch for more papers by this authorPeter Heathcote, Peter Heathcote Princess Alexandra Hospital, Brisbane, AustraliaSearch for more papers by this authorAndrew Kneebone, Andrew Kneebone University of Sydney, Sydney, Australia Royal North Shore Hospital, St. Leonards, AustraliaSearch for more papers by this authorJeffrey C. Dunn, Jeffrey C. Dunn Cancer Council Queensland, Brisbane, Australia Division of Research and Innovation, University of Southern Queensland, Springfield, Australia Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia Prostate Cancer Foundation of Australia, Sydney, AustraliaSearch for more papers by this authorSuzanne K. Chambers, Suzanne K. Chambers orcid.org/0000-0003-2369-6111 Cancer Council Queensland, Brisbane, Australia Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia Prostate Cancer Foundation of Australia, Sydney, AustraliaSearch for more papers by this author First published: 03 November 2019 https://doi.org/10.1002/pon.5255Citations: 10Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat CONFLICT OF INTEREST The authors declare they have no conflict of interest. Open Research DATA AVAILABILITY STATEMENT The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Citing Literature Volume29, Issue2February 2020Pages 444-449 RelatedInformation

OBJECTIVE:To assess changes in lower urinary tract symptoms (LUTS) and quality of life (QoL) after robot-assisted radical prostatectomy (RARP).PATIENTS AND METHODS:A prospectively curated database of 1917 consecutive RARPs undertaken over an 8-year period from January 2009 to January 2017 was assessed. Preoperative information including age, prostate-specific antigen (PSA) level, body mass index (BMI), International Prostate Symptom Score (IPSS) and QoL score was collected, with IPSS and QoL score compared between baseline (preoperatively) and 12 months post-surgery.RESULTS:Of the 1917 patients who underwent RARP, 1470 with complete data were included in the analysis. Their mean ± sd age, prostate weight and BMI were 62 (±6.7) years, 51 (±17.6) g, and 28 kg/m2 , respectively. Overall, 57% of patients reported an improved IPSS score, whilst 76% reported an IPSS of ≤7 postoperatively. A total of 41% of patients reported an improved QoL and 90.3% of patients with severe preoperative LUTS (IPSS 20-35) demonstrated clinically improved LUTS at 1 year post RARP. The post-RARP mean IPSS in the present study was lower than those reported in the existing post-radiotherapy literature, especially in patients with moderate to severe baseline LUTS (IPSSs ≥ 8).CONCLUSIONS:At 12 months post RARP, most patients reported improved overall LUTS and QoL, with the greatest benefit seen in those patients with a high pre-RARP IPSS. This has implications for treatment selection and preoperative counselling in men being offered active treatment for their prostate cancer. Further analyses of specific IPSS domains and longer follow-up are needed.

You have accessJournal of UrologyImaging/Radiology: Uroradiology III1 Apr 2018PD37-01 THE CLINICAL EFFICACY OF PSMA PET/MRI IN BIOCHEMICALLY RECURRENT PROSTATE CANCER COMPARED WITH STANDARD OF CARE IMAGING MODALITIES - RESULTS OF A MULTI-CENTRE, PROSPECTIVE CLINICAL TRIAL Andre Joshi, Handoo Rhee, David Pryor, Margot Lehman, Ian McKenzie, Janelle Munns, Greg Malone, Eric Chung, Peter Heathcote, John Preston, Malcolm Lawson, Simon Wood, Sonja Gustafson, Kenneth Miles, and Ian Vela Andre JoshiAndre Joshi More articles by this author , Handoo RheeHandoo Rhee More articles by this author , David PryorDavid Pryor More articles by this author , Margot LehmanMargot Lehman More articles by this author , Ian McKenzieIan McKenzie More articles by this author , Janelle MunnsJanelle Munns More articles by this author , Greg MaloneGreg Malone More articles by this author , Eric ChungEric Chung More articles by this author , Peter HeathcotePeter Heathcote More articles by this author , John PrestonJohn Preston More articles by this author , Malcolm LawsonMalcolm Lawson More articles by this author , Simon WoodSimon Wood More articles by this author , Sonja GustafsonSonja Gustafson More articles by this author , Kenneth MilesKenneth Miles More articles by this author , and Ian VelaIan Vela More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1736AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is a clinical need for more accurate imaging modalities to detect micro-metastatic or low volume disease in early biochemical recurrence (BCR) after primary treatment for prostate cancer. Hybrid Prostate specific membrane antigen (PSMA) Positron emission tomography (PET)/Magnetic resonance imaging (MRI) scanners combining MRI characterisation of lesions with PET avidity have recently become available, aiming to improve the sensitivity and specificity of PSMA PET imaging. The clinical role and efficacy of this imaging modality is not yet established. In a prospective clinical trial, we aimed to evaluate the accuracy and clinical implications of PSMA PET/MRI in men with BCR following therapy for curative intent. METHODS A multi-centre, prospective study initiated at the Princess Alexandra Hospital (PAH) has completed recruiting a total of 30 patients with BCR. Patients underwent PSMA PET/MRI and concurrent standard of care (SOC) imaging (CT chest, abdomen, pelvis and whole body bone scan). Biopsy was performed in patients with amenable lesions for histological correlation of PET avidity. Clinical efficacy and impact of positive PSMA PET scans were evaluated. RESULTS 30 patients with BCR were recruited (median PSA 0.7ng/ml, median Gleason score 7, median age 68). PSMA avid lesions were present in 21 patients (70%) with a median PSA of 1.5 ng/ml. 23 patients were previously treated with definitive surgery, 6 patients received external beam radiotherapy with neoadjuvent androgen depravation therapy and 1 patient had low dose rate brachytherapy. A total of 9 lesions were identified for biopsy (42.8% biopsy rate); 8 biopsies were positive, with 1 negative biopsy (88.9% histological correlation). There were only 8 patients with positive SOC imaging, all identified on CT imaging with no positive bone scans in this study. All patients with a positive PSMA scan had a change in their planned clinical management as a result of findings. Only 5 patients (16%) would have had a change in their planned management based on SOC imaging. When compared, PSMA PET/MRI detected local recurrence (p=0.001) and lesions in the pelvis (p=0.011) more accurately than SOC imaging. CONCLUSIONS Hybrid PSMA PET/MRI may be useful in staging men with biochemical recurrence, especially when PSA is low. Our data demonstrates a high detection rate, especially for locally recurrent disease in the pelvis, outperforming SOC imaging. This modality has the potential to significantly improve prostate cancer detection and allow early identification and management of recurrent disease. This may have implications for earlier salvage treatment, avoidance of futile local therapy with distant disease and change patient management to potentially allow better survival outcomes. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e731 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Andre Joshi More articles by this author Handoo Rhee More articles by this author David Pryor More articles by this author Margot Lehman More articles by this author Ian McKenzie More articles by this author Janelle Munns More articles by this author Greg Malone More articles by this author Eric Chung More articles by this author Peter Heathcote More articles by this author John Preston More articles by this author Malcolm Lawson More articles by this author Simon Wood More articles by this author Sonja Gustafson More articles by this author Kenneth Miles More articles by this author Ian Vela More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Matta et al. report that men with prostate cancer who underwent surgery or radiotherapy, but not active surveillance, had greater odds of receiving antidepressants than controls. However, methodological limitations preclude the interpretation of a psychological benefit for men on active surveillance. Screening for distress and referral to evidence-based intervention should be a priority.

You have accessJournal of UrologyImaging/Radiology: Uroradiology III1 Apr 2017MP18-11 EXPLORING THE CLINICAL UPTAKE AND USE OF PSMA PET MRI HYBRID IMAGING IN PROSTATE CANCER PATIENTS AT AN ACADEMIC CENTER IN AUSTRALIA Andre Joshi, Cheryl Nicholson, Handoo Rhee, Ian McKenzie, Janelle Munns, Greg Malone, Eric Chung, Malcolm Lawson, Peter Heathcote, John Preston, Simon Wood, Sonja Gustafson, Ken Miles, and Ian Vela Andre JoshiAndre Joshi More articles by this author , Cheryl NicholsonCheryl Nicholson More articles by this author , Handoo RheeHandoo Rhee More articles by this author , Ian McKenzieIan McKenzie More articles by this author , Janelle MunnsJanelle Munns More articles by this author , Greg MaloneGreg Malone More articles by this author , Eric ChungEric Chung More articles by this author , Malcolm LawsonMalcolm Lawson More articles by this author , Peter HeathcotePeter Heathcote More articles by this author , John PrestonJohn Preston More articles by this author , Simon WoodSimon Wood More articles by this author , Sonja GustafsonSonja Gustafson More articles by this author , Ken MilesKen Miles More articles by this author , and Ian VelaIan Vela More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.621AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Positron emission tomography (PET) using prostate specific membrane antigen (PSMA) detects prostate cancer lesions with a higher sensitivity and specificity when compared to standard imaging. Hybrid PET Magnetic Resonance Imaging (MRI) has now been introduced to provide potentially improved characterization of lesions with added PET avidity. We evaluate the utilization of this novel imaging modality at the Princess Alexandra Hospital (PAH) and assess our initial outcomes. METHODS A retrospective review of all PSMA PET MRI scans undertaken at the PAH since the introduction of the technology was performed. Imaging data was collected alongside baseline clinical data, PSA, previous histology, previous treatments, indication of scans, requesting clinicians and clinical outcomes. RESULTS A total of 187 PSMA PET MRI scans were performed at the PAH from April 2015 to October 2016. The median age of imaged patients was 68, with a median PSA of 6ng/ml and Gleason score of 7 at the time of scan. 153 scans were positive for PSMA avid disease (81.8%). Scans were requested in the setting of biochemical recurrence (n=94), preoperative staging (n=77), evaluation of treatment response (n=11) and diagnostic purposes (n=5). Urologists requested PSMA PET MRI most frequently with 111 scans, of which 58.6% requested for preoperative staging. Radiation oncologists requested 69 scans with 75.4% of these in the biochemical recurrence setting. Only 7 scans were requested by medical oncologists. Amongst patients with biochemical recurrence the lowest PSA of a positive scan was 0.02 ng/ml. In this group 43 patients had prior surgery with 19 positive scans (44%). 51 patients were treated with ADT and or EBRT and 46 had positive scans (90.2%). 29 patients had tissue samples to validate PSMA PET MRI. 26 patients (89.7%) had adenocarcinoma on histology correlating with avid lesions on PSMA PET. CONCLUSIONS PSMA PET MRI has had rapid uptake in use since introduction at the PAH. Urologists and radiation oncologists appear to utilize this imaging modality most; Urologists for a preoperative “one stop shop” staging study and radiation oncologists in biochemical recurrence. From this data is also appears that a positive PSMA PET/MRI is highly suggestive of prostate cancer, with a specificity of 89.7%. Hybrid PET/MRI may be used to stage men locally and systemically with one scan, with lower radiation and at PSA ≤1 ng/ml. This modality has the potential to significantly improve prostate cancer staging and allow early identification of recurrent disease. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e224 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Andre Joshi More articles by this author Cheryl Nicholson More articles by this author Handoo Rhee More articles by this author Ian McKenzie More articles by this author Janelle Munns More articles by this author Greg Malone More articles by this author Eric Chung More articles by this author Malcolm Lawson More articles by this author Peter Heathcote More articles by this author John Preston More articles by this author Simon Wood More articles by this author Sonja Gustafson More articles by this author Ken Miles More articles by this author Ian Vela More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

BACKGROUND:The development, monitoring, and reporting of indicator measures that describe standard of care provide the gold standard for assessing quality of care and patient outcomes. Although indicator measures have been reported, little evidence of their use in measuring and benchmarking performance is available. A standard set, defining numerator, denominator, and risk adjustments, will enable global benchmarking of quality of care. OBJECTIVE:To develop a set of indicators to enable assessment and reporting of quality of care for men with localised prostate cancer (PCa). DESIGN, SETTING, AND PARTICIPANTS:Candidate indicators were identified from the literature. An international panel was invited to participate in a modified Delphi process. Teleconferences were held before and after each voting round to provide instruction and to review results. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:Panellists were asked to rate each proposed indicator on a Likert scale of 1-9 in a two-round iterative process. Calculations required to report on the endorsed indicators were evaluated and modified to reflect the data capture of the Prostate Cancer Outcomes Registry-Australia and New Zealand (PCOR-ANZ). RESULTS AND LIMITATIONS:A total of 97 candidate indicators were identified, of which 12 were endorsed. The set includes indicators covering pre-, intra-, and post-treatment of PCa care, within the limits of the data captured by PCOR-ANZ. CONCLUSIONS:The 12 endorsed quality measures enable international benchmarking on the quality of care of men with localised PCa. Reporting on these indicators enhances safety and efficacy of treatment, reduces variation in care, and can improve patient outcomes. PATIENT SUMMARY:PCa has the highest incidence of all cancers in men. Early diagnosis and relatively high survival rates mean issues of quality of care and best possible health outcomes for patients are important. This paper identifies 12 important measurable quality indicators in PCa care.