Ryan Hutchinson

Testing and referral patterns in the years surrounding the US Preventive Services Task Force recommendation against prostate-specific antigen screening.

Since the US Preventive Services Task Force (USPSTF) recommended against prostate‐specific antigen (PSA) screening, there have been conflicting reports regarding the impact on the behavior of providers. This study analyzed real‐world data on PSA ordering and referral practices in the years surrounding the recommendation.

Decision analysis model evaluating the cost of a temporary hydrogel rectal spacer before prostate radiation therapy to reduce the incidence of rectal complications

PURPOSE We conducted a decision analysis to evaluate the cost effectiveness of a newly Food and Drug Administration approved rectal spacer gel (SpaceOAR, Augmenix) for the reduction of rectal toxicity of prostate radiation therapy (RT). METHODS A decision tree model (TreeAge Pro) was used to compare the strategy of pretherapy placement of a spacing hydrogel before RT to RT alone. The model compared costs associated with rectal complications because of rectal toxicity over a 10-year period across 3 different RT modalities. Rectal toxicity rates were estimated from studies on conformal RT dose escalation, high-dose stereotactic body radiotherapy (SBRT) and low-dose SBRT. Rectal toxicity reduction rates (baseline reduction 70%) were estimated from recently published 15 month data using a rectal spacer. Direct and indirect cost estimates for established grades of rectal toxicity were based on national and institutional costs. Reduction in short-term complications were assumed to carry forward to a reduction in long-term toxicity. One-way and two-way sensitivity analyses were performed. RESULTS The overall standard management cost for conformal RT was

The economic effect of using magnetic resonance imaging and magnetic resonance ultrasound fusion biopsy for prostate cancer diagnosis.

3,428 vs.

Integrin signaling potentiates transforming growth factor-beta 1 (TGF-β1) dependent down-regulation of E-Cadherin expression – Important implications for epithelial to mesenchymal transition (EMT) in renal cell carcinoma

3,946 with rectal spacer for an incremental cost of

Prognostic Value of PD-1 and PD-L1 Expression in Patients with High Grade Upper Tract Urothelial Carcinoma

518 over 10 years. A 1-way sensitivity analyses showed the breakeven cost of spacer at

Spotlight on atezolizumab and its potential in the treatment of advanced urothelial bladder cancer

2,332 or a breakeven overall risk reduction of 86% at a cost of

Impact of hospital case volume on testicular cancer outcomes and practice patterns

2,850. For high-dose SBRT, spacer was immediately cost effective with a savings of

Androgen Receptor Variants Mediate DNA Repair after Prostate Cancer Irradiation

2,640 and breakeven risk reduction at 36%. However, 2-way spacer cost to risk reduction sensitivity analyses were performed. CONCLUSION The use of a rectal spacer for conformal RT results in a marginal cost increase with a significant reduction in rectal toxicity assuming recently published 15 month rectal toxicity reduction is maintained over 10 years. For high-dose SBRT it was cost effective. Further studies would be necessary to validate the long-term benefits of rectal spacers.

The ubiquitin ligase TRIM25 targets ERG for degradation in prostate cancer

Prostate magnetic resonance imaging (MRI) is a maturing imaging modality that has been used to improve detection and staging of prostate cancer. The goal of this review is to evaluate the economic effect of the use of MRI and MRI fusion in the diagnosis of prostate cancer. A literature review was used to identify articles regarding efficacy and cost of MRI and MRI-guided biopsies. There are currently a limited number of studies evaluating cost of incorporating MRI into clinical practice. These studies are primarily models projecting cost estimates based on meta-analyses of the literature. There is considerable variance in the effectiveness of MRI-guided biopsies, both cognitive and fusion, based on user experience, type of MRI (3T vs. 1.5T), use of endorectal coil and type of scoring system for abnormalities such that there is still potential for improvement in accuracy. There is also variability in assumed costs of incorporating MRI into clinical practice. The addition of MRI to the diagnostic algorithm for prostate cancer has caused a shift in how we understand the disease and in what tumors are found on initial and repeat biopsies. Further risk stratification may allow more men to pursue noncurative therapy, which in and of itself is cost-effective in properly selected men. As prostate cancer care comes under increasing scrutiny on a national level, there is pressure on providers to be more accurate in their diagnoses. This in turn can lead to additional testing including Multiparametric MRI, which adds upfront cost. Whether the additional cost of prostate MRI is warranted in detection of prostate cancer is an area of intense research.

A Multi-Institutional Comparison of Clinicopathological Characteristics and Oncologic Outcomes of Upper Tract Urothelial Carcinoma in China and the United States

Abstract Signal transduction through the transforming growth factor‐beta 1 (TGF‐&bgr;1) pathway affects epithelial to mesenchymal transition (EMT), partly by modulation of E‐Cadherin expression. The concurrent impact of extracellular matrix driven regulation of integrin signaling on EMT has not been well characterized. We assessed the cumulative effect and molecular mechanisms of TGF‐&bgr;1 and integrin signal transduction on E‐Cadherin in a renal cell cancer (RCC) model. Stimulation of RCC cells with TGF‐&bgr;1 demonstrated a three‐fold increased expression of integrin &agr;v. A ligand of integrin &agr;v‐&bgr;3, (cyclopentapeptide containing Arginyl‐Glycyl‐Aspartic acid motif, RGD), was used to mimic integrin signaling. Treatment of cells with RGD and TGF‐&bgr;1 demonstrated significantly greater E‐cadherin depletion than either ligand alone. This cooperative action on E‐Cadherin expression is regulated by transcription factor Snai1 and is followed on a cellular level by increased cellular mobility as evidenced in a wound healing assay. Subsequent silencing of potential downstream mediators of the cumulative action of RGD and TGF‐&bgr;1 was carried out by small interfering RNA transfection and confirmed by Western blotting and/or RT‐PCR. SiRNA mediated silencing of FAK and PINCH1 independently abrogated the cumulative effect of RGD and TGF‐&bgr;1 on E‐Cadherin expression. We have identified a novel mechanism through which extracellular matrix event transduction by integrins further augments TGF‐&bgr;1 related effects on EMT. Molecular machinery involved in the integrin &agr;v‐TGF‐&bgr;1 interplay may represent a therapeutic target in RCC. HighlightsIn a renal cell carcinoma model, integrin signaling with RGD was synergistic with TGF‐&bgr;1 in causing e‐cadherin depletion.Silencing of downstream mediators FAK and PINCH1 prevented this synergism.These proteins may represent therapeutically‐targetable steps in the pathogenesis of renal cell carcinoma.