Kevin A. Nguyen

Negative Multiparametric Magnetic Resonance Imaging of the Prostate Predicts Absence of Clinically Significant Prostate Cancer on 12-Core Template Prostate Biopsy

OBJECTIVE To determine the negative predictive value of multiparametric magnetic resonance imaging (mpMRI), we evaluated the frequency of prostate cancer detection by 12-core template mapping biopsy in men whose mpMRI showed no suspicious regions. METHODS Six hundred seventy patients underwent mpMRI followed by transrectal ultrasound (TRUS)-guided systematic prostate biopsy from December 2012 to June 2016. Of this cohort, 100 patients had a negative mpMRI. mpMRI imaging sequences included T2-weighted and diffusion-weighted imaging, and dynamic contrast enhancement sequences. RESULTS The mean age, prostate-specific antigen, and prostate volume of the 100 men included were 64.3 years, 7.2 ng/mL, and 71 mL, respectively. Overall cancer detection was 27% (27 of 100). Prostate cancer was detected in 26.3% (10 of 38) of patients who were biopsy-naïve, 12.1% (4 of 33) of patients who had a prior negative biopsy, and in 44.8% (13 of 29) of patients previously on active surveillance; Gleason grade ≥7 was detected in 3% of patients overall (3 of 100). The negative predictive value of a negative mpMRI was 73% for all prostate cancer and 97% for Gleason ≥7 prostate cancer. CONCLUSION There is an approximately 3% chance of detecting clinically significant prostate cancer with systematic TRUS-guided biopsy in patients with no suspicious findings on mpMRI. This information should help guide recommendations to patients about undergoing systematic TRUS-guided biopsy when mpMRI is negative.

Racial disparity in mycosis fungoides: An analysis of 4495 cases from the US National Cancer Database

Background: Studies have shown contradictory results regarding the survival outcomes among white, African American, and Asian patients with mycosis fungoides (MF). Objective: To evaluate the survival outcomes among white, African American, and Asian patients with MF and to determine other prognostic factors of the disease. Methods: The US National Cancer Database was used to identify patients with histologically confirmed MF from 2004 to 2014. Clinicopathologic, socioeconomic, and treatment data were compared among the races by using the chi‐square test. Overall survival was evaluated by using the log‐rank test, multivariable Cox proportional hazard regression, and propensity score–matched analysis. Results: Of 4459 patients with MF, 77.7% were white, 19.2% were African American, and 3.2% were Asian. Older age, treatment received in a community facility, government insurance, higher Charlson‐Deyo score, male sex, higher clinical stage, receipt of radiotherapy or chemotherapy, and African American race were predictors of poor overall survival on multivariate analysis (P < .001), whereas Asian race trended toward improved outcomes (P = .07). Limitations: Retrospective analysis. Conclusion: African American patients with MF demonstrated poorer survival than white patients after accounting for disease characteristics, socioeconomic factors, and types of treatment, warranting further investigation into the underlying biology of MF and prescribed treatment modalities.

Comparison of chemoradiotherapy with radiotherapy alone for early-stage extranodal natural killer/T-cell lymphoma, nasal type in elderly patients

Abstract It remains controversial whether concurrent or subsequent chemoradiotherapy (CRT) provides additional survival benefits when compared to radiotherapy (RT) alone in localized extranodal natural killer/T-cell lymphoma (ENKTL), nasal type We identified 248 patients from the US National Cancer Data Base who were diagnosed with localized ENKTL from 2004–2014; 68.9% received CRT and 31.1% received RT alone. Over time, the use of CRT increased, while the use of RT alone decreased (p < .001). On multivariate analysis, CRT was associated with longer OS than RT alone (HR: 0.504; 95% CI: 0.338–0.751; p < .001), while uninsured status and African–American race were associated with shorter OS. The survival advantages of CRT over RT alone persisted on propensity score matching for the entire cohort (p = .0014) and in a subgroup analysis of elderly patients (p < .001). In conclusion, patients who received CRT had significantly longer OS than those who received RT alone. These results also apply to elderly patients.

Advances in the diagnosis of hereditary kidney cancer: Initial results of a multigene panel test

Panel testing has been recently introduced to evaluate hereditary cancer; however, limited information is available regarding its use in kidney cancer.

Disease site as a determinant of survival outcome in patients with primary cutaneous peripheral T-cell lymphoma, unspecified: an analysis of 4057 cases from the US National Cancer Database

Abstract Primary cutaneous peripheral T-cell lymphoma, unspecified (PCPTL) accounts for <6% of cutaneous T-cell lymphoma cases. Due to its rarity, no large study exists in the literature on PCPTL. Among 4057 patients with PCPTL diagnosed from 2004 to 2014 in the National Cancer Database, 428, 913, 517, 754, and 1435 had lesions localized primarily to the upper extremity, head and neck, lower extremity, trunk, and overlapping lesion or unspecified site, respectively. PCPTL that primarily involved the head and neck had the longest overall survival (OS), followed by PCPTL that primarily involved the trunk, upper extremity, and lower extremity. Patients with lesions localized to the lower extremity had significantly shorter OS when compared to those with disease localized to other primary sites after adjusting for confounding factors. The difference in OS among disease sites was only significant in stage I disease, but not higher stages, and persisted in younger patients.

Ethnic disparity in primary cutaneous CD30+ T-cell lymphoproliferative disorders: an analysis of 1496 cases from the US National Cancer Database

Primary cutaneous CD30+ T cell lymphoproliferative disorders (PCLPD), the second most common type of primary cutaneous T cell lymphomas, accounts for approximately 25–30% of cutaneous T‐cell lymphoma cases. However, only small retrospective studies have been reported. We aimed to identify prognostic factors and evaluate the overall survival (OS) of patients with PCLPD stratified by ethnicity. We identified 1496 patients diagnosed with PCLPD between 2004 and 2014 in the US National Cancer Database. Chi‐square test and anova were used to evaluate differences in demographic and disease characteristics, socioeconomic factors and treatments received. OS was evaluated with the log‐rank test, Cox proportional hazard regression analysis, and propensity score matching. The study included 1267 Caucasians, 153 African Americans (AA), 43 Asians, and 33 of other/unknown ethnicity. Older age, higher Charlson‐Deyo score, higher clinical stage and receipt of chemotherapy were predictors of shorter OS. Primary disease site on a lower extremity was associated with shorter OS, while a head and neck location was associated with longer OS. AA patients had shorter OS when compared to Caucasian patients on multivariate analysis. This ethnic disparity persisted on propensity‐score matched analysis and after matching Caucasian and AA patients on demographic and disease characteristics, socioeconomic factors and treatments received, and age and gender‐matched relative survival analyses.

Prostate zonal anatomy correlates with the detection of prostate cancer on multiparametric magnetic resonance imaging/ultrasound fusion–targeted biopsy in patients with a solitary PI-RADS v2–scored lesion

PURPOSE To evaluate the positive predictive value (PPV) of the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) assessment method in patients with a single suspicious finding on prostate multiparametric magnetic resonance imaging (mpMRI). PATIENTS AND METHODS A total of 176 patients underwent MRI/ultrasound fusion-targeted prostate biopsy after the detection of a single suspicious finding on mpMRI. The PPV for cancer detection was determined based on PI-RADS v2 assessment score and location. RESULTS Fusion biopsy detected prostate cancer in 60.2% of patients. Of these patients, 69.8% had Gleason score (GS) ≥7 prostate cancer. Targeted biopsy detected 90.5% of all GS≥7 prostate cancer. The PPV for GS≥7 detection of PI-RADS v2 category 5 (P5) and category 4 (P4) lesions was 70.2% and 37.7%, respectively. This increased to 88% and 38.5% for P5 and P4 lesions in the peripheral zone (PZ), respectively. Targeted biopsy did not miss GS≥7 disease compared with systematic biopsy in P5 lesions in the PZ and transition zone. CONCLUSION The PPV of PI-RADS v2 for prostate cancer in patients with a single lesion on mpMRI is dependent on PI-RADS assessment category and location. The highest PPV was for a P5 lesion in the PZ.

Current Management Strategy for Active Surveillance in Prostate Cancer

Purpose of ReviewActive surveillance has been increasingly utilized as a strategy for the management of favorable-risk, localized prostate cancer. In this review, we describe contemporary management strategies of active surveillance, with a focus on traditional stratification schemes, new prognostic tools, and patient outcomes.Recent FindingsPatient selection, follow-up strategy, and indication for delayed intervention for active surveillance remain centered around PSA, digital rectal exam, and biopsy findings. Novel tools which include imaging, biomarkers, and genetic assays have been investigated as potential prognostic adjuncts; however, their role in active surveillance remains institutionally dependent. Although 30–50% of patients on active surveillance ultimately undergo delayed treatment, the vast majority will remain free of metastasis with a low risk of dying from prostate cancer.SummaryThe optimal method for patient selection into active surveillance is unknown; however, cancer-specific mortality rates remain excellent. New prognostication tools are promising, and long-term prospective, randomized data regarding their use in active surveillance will be beneficial.

Disease site as a determinant of survival outcome in patients with systemic anaplastic lymphoma kinase positive anaplastic large cell lymphoma with extranodal involvement: an analysis of 1306 cases from the US National Cancer Database

Systemic anaplastic lymphoma kinase positive (ALK+) anaplastic large cell lymphoma with extranodal involvement (ALCL‐E) is a rare form of non‐Hodgkin lymphoma. No large study in the literature has compared the survival outcomes among different primary extranodal sites of involvement in ALK+ ALCL‐E. We identified 1306 patients with ALK+ ALCL‐E diagnosed between 2004 and 2014 in the US National Cancer Database, among whom 387 had primary extranodal site in the chest/abdomen/pelvis, 103 in the bone, 62 in the central nervous system, 134 in the head and neck and 620 in the cutaneous/soft tissue. Younger age, lower Charlson‐Deyo score, lower clinical stage, receipt of chemotherapy and receipt of radiotherapy were predictors of longer overall survival. Patients with extranodal involvement of central nervous system and chest/abdomen/pelvis had shorter overall survival than those with involvement of head and neck, bone, and cutaneous/subcutaneous tissue after adjusting for confounding variables. We recommend treating these patients upfront with more aggressive therapy.

Genetic testing for hereditary prostate cancer: Current status and limitations

A significant proportion of prostate cancer diagnoses may be associated with a strong hereditary component. Men who have multiple single‐gene polymorphisms and a family history of prostate cancer have a significantly greater risk of developing prostate cancer. Numerous single‐gene alterations have been confirmed to increase the risk of prostate cancer. These include breast cancer genes 1 and 2 (BRCA1 and BRCA2, respectively), mutL homolog 1 (MLH1), mutS homologs 2 and 6 (MSH2 and MSH6, respectively), postmeiotic segregation increased 2 (PMS2), homeobox B13 (HOXB13), checkpoint kinase 2 (CHEK2), nibrin (NBN), BRCA1‐interacting protein C‐terminal helicase 1 (BRIP1), and ataxia telangiectasia mutated (ATM). Currently, there are no uniform guidelines on the definition of hereditary prostate cancer and genetic testing. With the advent of next‐generation sequencing, which is capable of testing multiple genes simultaneously, and the approval of olaparib for BRCA1/BRCA2 or ATM‐mutated, metastatic, castrate‐resistant prostate cancer, it is being recognized that the results of genetic testing have an impact on therapeutic strategies. In this review, the authors examine the role of genetic counseling and testing, the challenges of insurance coverage for testing, the available germline and somatic testing panels, and the complexity of each testing method and its implications. Cancer 2018.