ORCID Profile
0000-0002-9798-1479
Current Organisations
University of South Australia
,
University of South Australia Sansom Institute for Health Research
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Related Links
Publications
Choice of imputation method for missing metastatic status affected estimates of metastatic prostate cancer incidence
Publisher: Elsevier BV
Date: 03-2023
Understanding reasons for non-adherence to active surveillance for low-intermediate risk prostate cancer
Publisher: AME Publishing Company
Date: 06-2021
DOI: 10.21037/TAU-20-1254
Development of the consensus-based recommendations for podiatry care of neuropathy in cancer survivors (PodNICS): a delphi consensus study of Australian podiatrists
Publisher: Springer Science and Business Media LLC
Date: 09-06-2023
DOI: 10.1186/S13047-023-00632-0
Abstract: Chemotherapy Induced Peripheral Neuropathy (CIPN) is the most common presenting side effect of chemotherapy. As a sensory based neuropathy, this condition can persist for a long time after cessation of chemotherapy and impact the quality of life of cancer survivors. Podiatrists in Australia have been managing people with CIPN related lower limb complications, however guidelines on management of CIPN do not exist. The aim of this study was to achieve consensus and agreement of Australian podiatrists on strategies to best manage people presenting with symptoms of CIPN. An online three-round modified Delphi survey of Australian podiatrists with expertise in CIPN was conducted in line with recommendations for conducting and reporting of Delphi studies (CREDES). Panellists responded to open-ended questions in Round 1, whereupon their responses were themed into statements and analysed for existing consensus. Statements not reaching consensus were returned during Round 2 to seek agreement from responders using a five-point Likert scale and to allow responders to make further comments. For a statement to reach consensus or agreement, 70% or more of panellists needed to make the same comment or agree or strongly agree with the same themed statement. Statements reaching 50 to 69% consensus or agreement were returned to panellists in Round 3 for them to consider their responses in the light of group outcomes. Round one resulted in 229 comments from 21 of 26 podiatrists who agreed to participate. These comments were themed into 53 statements with 11 consensus statements accepted. Round 2 resulted in 22 statements reaching agreement, and 15 new statements being generated from 18 comments made by 17 respondents. Round 3 resulted in 11 statements reaching agreement. Outcomes were developed into a set of clinical recommendations for diagnosis and management of people presenting with CIPN. These recommendations provide guidance on 1) identifying common signs and symptoms of CIPN including sensory, motor and autonomic symptoms 2) diagnosis and assessment of CIPN including neurological, motor and dermatological assessment modalities and 3) best clinical practice and management strategies for CIPN identified by podiatrists including both podiatry and non-podiatry specific care. This is the first study in podiatry literature to develop expert-informed consensus-based recommendations for clinical presentation, diagnosis and assessment and management of people with CIPN. These recommendations aim to help guide podiatrists in the consistent care of people with CIPN.
Surgical margins and risk of locoregional recurrence in invasive breast cancer: An analysis of 10-year data from the breast cancer treatment quality assurance project
Publisher: Elsevier BV
Date: 10-2013
DOI: 10.1016/J.BREAST.2013.02.018
Abstract: There is debate as to what constitutes an adequate excision margin to reduce the risk of locoregional recurrence (LRR) after breast cancer surgery. We have investigated the relationship between surgical margin distance and LRR in women with invasive breast cancer (IBC). Tumour free margin distances were extracted from histopathology reports for women with IBC, treated by either breast conserving surgery or mastectomy, enrolled in the Breast Cancer Treatment Group Quality Assurance Project from July 1997 to June 2007. Cox proportional hazards regression analyses were conducted to compare the risk of LRR for involved margins compared with negative margins, measured in increments rounded to the nearest mm. 88 of 2300 patients (3.8%) experienced an LRR after a mean follow-up of 7.9 years. An involved margin, or a margin of 1 mm was associated with an increased risk of LRR (HR 2.72, 95% CI 1.30-5.69), whilst margin distances of 2 mm or greater were not. Risk of LRR with margin distances <2 mm was particularly high amongst those not receiving radiotherapy (RT). Based on our findings, we recommend that a tumour free margin distance of 2 mm be adopted as an adequate margin of excision for IBC, in the setting of patients receiving standard adjuvant RT and adjuvant drug therapies as dictated by the current clinical treatment paradigms.
Tools for Predicting Clinical and Patient-reported Outcomes in Prostate Cancer Patients Undergoing Androgen Deprivation Therapy: A Systematic Review of Prognostic Accuracy and Validity
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.CLGC.2017.03.011
Abstract: Androgen deprivation therapy (ADT) can result in a range of adverse symptoms that reduce patients' quality of life. Careful patient counseling on the likely clinical outcomes and adverse effects is therefore vital. The present systematic review was undertaken to identify and characterize all the tools used for the prediction of clinical and patient-reported outcome measures (PROMs) in patients with prostate cancer undergoing ADT. PubMed and EMBASE were systematically searched from 2007 to 2016. Search terms related to the inclusion criteria were: prostate cancer, clinical outcomes, PROMs, ADT, and prognosis. Titles and abstracts were reviewed to find relevant studies, which were advanced to full-text review. The reference lists were screened for additional studies. The Centre for Evidence Based Medicine critical appraisal of prognostic studies tool was applied. The search strategy identified 8755 studies. Of the 8755 studies, 22 on clinical outcomes were identified. However, no studies of PROMs were found. Nine tools could be used to predict clinical outcomes in treatment-naive patients and 10 in patients with recurrence. The Japan Cancer of the Prostate Risk Assessment (J-CAPRA) nomogram was the best performing and validated tool for the prediction of clinical outcomes in treatment-naive patients, and the Chi and Shamash prognostic indexes have been validated for use in patients with castration-resistant disease in different clinical contexts. Using the J-CAPRA nomogram should help clinicians deliver accurate, evidence-based counseling to patients undergoing primary ADT. A strong need exists for primary studies that derive and validate tools for the prediction of PROMs in patients undergoing ADT under any circumstance because these are currently absent from the literature.
Is there any association between prostate-specific antigen screening frequency and uptake of active surveillance in men with low or very low risk prostate cancer?
Publisher: Springer Science and Business Media LLC
Date: 05-08-2019
Comparison of Characteristics, Follow-up and Outcomes of Active Surveillance for Prostate Cancer According to Ethnicity in the GAP3 Global Consortium Database
Publisher: Elsevier BV
Date: 12-2021
Radical radiotherapy for prostate cancer: patterns of care in Sweden 1998–2016
Publisher: Informa UK Limited
Date: 03-03-2020
Chromosomal localization of ARSB, the gene for human N-acetylgalactosamine-4-sulphatase
Publisher: Springer Science and Business Media LLC
Date: 04-1989
DOI: 10.1007/BF00288275
Abstract: The significance of occupational violence in general practice is well established, but research has focused almost exclusively on the experiences of GPs. Only limited research has examined the role of general practice receptionists despite their acknowledged vulnerability to violent patient behaviour. No qualitative research has explored this problem. To explore the experiences of general practice receptionists regarding occupational violence and the effects of violence on their psychological and emotional wellbeing and on their work satisfaction and performance. Qualitative study. Constituent practices of an Australian network of research general practices. Practices were located in a range of socioeconomic settings. Semi-structured interviews were conducted with practice receptionists. The interviews were audiotaped, transcribed, and subjected to thematic analysis employing a process of constant comparison in which data collection and analysis were cumulative and concurrent. Qualitative written responses from a cross-sectional questionnaire-based study performed concurrently with the qualitative study were similarly analysed. Nineteen interviews were conducted and 12 written responses were received. Violence was found to be a common, sometimes pervasive, experience of many receptionists. Verbal abuse, both 'across the counter' and telephone abuse, was the most prominent form of violence, although other violence, including assault and threats with guns, was reported. Experiences of violence could have marked emotional and psychological effects and could adversely affect job satisfaction, performance, and commitment. It is apparent that occupational violence is a whole-of-practice problem and strategies for GP and staff safety will need to take a whole-of-practice approach.
Margin status and survival outcomes after breast cancer conservation surgery: prospectively registered systematic review and meta-analysis
Publisher: BMJ
Date: 21-09-2022
Abstract: To determine if margin involvement is associated with distant recurrence and to determine the required margin to minimise both local recurrence and distant recurrence in early stage invasive breast cancer. Prospectively registered systematic review and meta-analysis of literature. Medline (PubMed), Embase, and Proquest online databases. Unpublished data were sought from study authors. Eligible studies reported on patients undergoing breast conserving surgery (for stages I-III breast cancer), allowed an estimation of outcomes in relation to margin status, and followed up patients for a minimum of 60 months. Patients with ductal carcinoma in situ only or treated with neoadjuvant chemotherapy or by mastectomy were excluded. Where applicable, margins were categorised as tumour on ink (involved), close margins (no tumour on ink but mm), and negative margins (≥2 mm). 68 studies from 1 January 1980 to 31 December 2021, comprising 112 140 patients with breast cancer, were included. Across all studies, 9.4% (95% confidence interval 6.8% to 12.8%) of patients had involved (tumour on ink) margins and 17.8% (13.0% to 23.9%) had tumour on ink or a close margin. The rate of distant recurrence was 25.4% (14.5% to 40.6%) in patients with tumour on ink, 8.4% (4.4% to 15.5%) in patients with tumour on ink or close, and 7.4% (3.9% to 13.6%) in patients with negative margins. Compared with negative margins, tumour on ink margins were associated with increased distant recurrence (hazard ratio 2.10, 95% confidence interval 1.65 to 2.69, P .001) and local recurrence (1.98, 1.66 to 2.36, P .001). Close margins were associated with increased distant recurrence (1.38, 1.13 to 1.69, P .001) and local recurrence (2.09, 1.39 to 3.13, P .001) compared with negative margins, after adjusting for receipt of adjuvant chemotherapy and radiotherapy. In five studies published since 2010, tumour on ink margins were associated with increased distant recurrence (2.41, 1.81 to 3.21, P .001) as were tumour on ink and close margins (1.44, 1.22 to 1.71, P .001) compared with negative margins. Involved or close pathological margins after breast conserving surgery for early stage, invasive breast cancer are associated with increased distant recurrence and local recurrence. Surgeons should aim to achieve a minimum clear margin of at least 1 mm. On the basis of current evidence, international guidelines should be revised. CRD42021232115.
Changes in five‐year survival for people with acute leukaemia in South Australia, 1980–2016
Publisher: Wiley
Date: 16-02-2022
DOI: 10.5694/MJA2.51423
Negative first follow‐up prostate biopsy on active surveillance is associated with decreased risk of upgrading, suspicion of progression and converting to active treatment
Publisher: Wiley
Date: 15-11-2020
DOI: 10.1111/BJU.15281
Abstract: To determine the risk of disease progression and conversion to active treatment following a negative biopsy while on active surveillance (AS) for prostate cancer (PCa). Men on an AS programme at a single tertiary hospital (London, UK) between 2003 and 2018 with confirmed low–intermediate‐risk PCa, Gleason Grade Group , clinical stage T3 and a diagnostic prostate‐specific antigen (PSA) level of ng/mL. This cohort included men diagnosed by transrectal ultrasonography guided (12–14 cores) or transperineal (median 32 cores) biopsy. Multivariate Cox hazards regression analysis was undertaken to determine (i) risk of upgrading, (ii) clinical or radiological suspicion of disease progression, and (iii) transitioning to active treatment. Suspicion of disease progression was defined as any biopsy upgrading, % positive cores, magnetic resonance imaging (MRI) Likert score /T3 or PSA level of ng/mL. Conversion to treatment included radical or hormonal treatment. Among the 460 eligible patients, 23% had negative follow‐up biopsy findings. The median follow‐up was 62 months, with one to two repeat biopsies and two MRIs per patient during that period. Negative biopsy findings at first repeat biopsy were associated with decreased risk of converting to active treatment (hazard ration [HR] 0.18, 95% confidence interval [CI] 0.09–0.37 P 0.001), suspicion of disease progression (HR 0.56, 95% CI: 0.34–0.94 P = 0.029), and upgrading (HR 0.48, 95% CI 0.23–0.99 P = 0.047). Data are limited by fewer men with multiple follow‐up biopsies. A negative biopsy finding at the first scheduled follow‐up biopsy among men on AS for PCa was strongly associated with decreased risk of subsequent upgrading, clinical or radiological suspicion of disease progression, and conversion to active treatment. A less intense surveillance protocol should be considered for this cohort of patients.
An appraisal of analytical tools used in predicting clinical outcomes following radiation therapy treatment of men with prostate cancer: A systematic review
Publisher: Springer Science and Business Media LLC
Date: 21-03-2017
Carcinosarcomas of the uterus: prognostic factors and impact of adjuvant treatment
Publisher: Informa UK Limited
Date: 06-2021
DOI: 10.2147/CMAR.S309551
Do breast cancer risk factors differ among those who do and do not undertake mammography screening?
Publisher: SAGE Publications
Date: 23-10-2013
Abstract: There is considerable interest in whether mammography screening leads to over-diagnosis of breast cancer. However self-selection into screening programmes may lead to risk differences that affect estimates of over-diagnosis. This study compares the breast cancer risk profiles of participants and non-participants of population-based mammography screening. Risk profiles are also compared between those who have and have not used private screening services. This study involved 1162 women aged 40–84 who participated in the 2012 Health Omnibus, an annual face-to-face interview-based survey of a representative s le of the population in the state of South Australia. Data were collected on participation in mammography screening, demographic characteristics and breast cancer risk factors (including reproductive, familial and lifestyle factors). Missing data were multiply imputed. Factors independently associated with ever having been screened were identified using multivariable logistic regression, for population-based and ad hoc, private mammography screening separately. Compared with non-participants, participants of population-based screening were more likely to have used hormone replacement therapy (odds ratio [OR] = 3.72), experienced breast biopsy or surgery (OR = 2.22), and be overweight or obese (OR = 1.57). They were less likely to be sufficiently active (OR = 0.57) or be born in a non-English speaking country (OR = 0.50) or aged under 50 (OR = 0.09). Women who were screened privately were more likely to have a family history of breast cancer (OR = 1.66) and have experienced breast biopsy or surgery (OR = 3.17) than those who had not. South Australian women who participated in the population-based mammography screening have a slightly higher prevalence of breast cancer risk factors. This also applies to those who undertook private screening.
Breast cancer screening—opportunistic use of registry and linked screening data for local evaluation
Publisher: Wiley
Date: 22-09-2017
DOI: 10.1111/JEP.12640
Abstract: Screening has been found to reduce breast cancer mortality at a population level in Australia, but these studies did not address local settings where numbers of deaths would generally have been too low for evaluation. Clinicians, administrators, and consumer groups are also interested in local service outcomes. We therefore use more common prognostic and treatment measures and survivals to gain evidence of screening effects among patients attending 4 local hospitals for treatment. To compare prognostic, treatment, and survival measures by screening history to determine whether expected screening effects are occurring. Employing routine clinical registry and linked screening data to investigate associations of screening history with these measures, using unadjusted and adjusted analyses. Screened women had a 10-year survival from breast cancer of 92%, compared with 78% for unscreened women and 79% of screened surgical cases had breast conserving surgery compared with 64% in unscreened women. Unadjusted analyses indicated that recently screened cases had earlier tumor node metastasis stages, smaller diameters, less nodal involvement, better tumor differentiation, more oestrogen and progesterone receptor positive lesions, more hormone therapy, and less chemotherapy. Radiotherapy tended to be more common in screening participants. More frequent use of adjunctive radiotherapy applied when breast conserving surgery was used. Results confirm the screening effects expected from the scientific literature and demonstrate the value of opportunistic use of available registry and linked screening data for indicating to local health administrations, practitioners, and consumers whether local screening services are having the effects expected.
Tools for predicting patient-reported outcomes in prostate cancer patients undergoing radical prostatectomy: A systematic review of prognostic accuracy and validity
Publisher: Springer Science and Business Media LLC
Date: 06-06-2017
DOI: 10.1038/PCAN.2017.28
Abstract: Radical prostatectomy is a common surgical procedure performed to treat prostate cancer. Patient-reported outcomes after surgery include urinary incontinence, erectile dysfunction, decreased quality of life and psychological effects. Predictive tools to assess the likelihood of an in idual experiencing various patient-reported outcomes have been developed to aid decision-making when selecting treatment. A systematic review was undertaken to identify all papers describing tools for the prediction of patient-reported outcome measures in men with prostate cancer treated with radical prostatectomy. To be eligible for inclusion, papers had to provide a summary measure of accuracy. PubMed and EMBASE were searched from July 2007. Title/abstract screening, and full-text review were undertaken by two reviewers, while data extraction and critical appraisal was performed by a single reviewer. The search strategy identified 3217 potential studies, of which 191 progressed to full-text review and 14 were included. From these studies, 27 tools in total were identified, of which 18 predicted urinary symptoms, six predicted erectile function and one predicted freedom from a group of three outcomes ('trifecta') (biochemical recurrence, incontinence and erectile dysfunction). On the basis of tool accuracy (>70%) and external validation, two tools predicting incontinence and two tools predicting erectile dysfunction are ready for implementation. A small number of tools for the prediction of patient-reported outcomes following radical prostatectomy have been developed. Four tools were found to have adequate accuracy and validation and are ready for implementation for the prediction of urinary incontinence and erectile dysfunction.
The incidence of fatal breast cancer measures the increased effectiveness of therapy in women participating in mammography screening
Publisher: Wiley
Date: 08-11-2018
DOI: 10.1002/CNCR.31840
The Value of Real-World Data in Understanding Prostate Cancer Risk and Improving Clinical Care: Examples from Swedish Registries
Publisher: MDPI AG
Date: 19-02-2021
Abstract: Real-world data (RWD), that is, data from sources other than controlled clinical trials, play an increasingly important role in medical research. The development of quality clinical registers, increasing access to administrative data sources, growing computing power and data linkage capacities have contributed to greater availability of RWD. Evidence derived from RWD increases our understanding of prostate cancer (PCa) aetiology, natural history and effective management. While randomised controlled trials offer the best level of evidence for establishing the efficacy of medical interventions and making causal inferences, studies using RWD offer complementary evidence about the effectiveness, long-term outcomes and safety of interventions in real-world settings. RWD provide the only means of addressing questions about risk factors and exposures that cannot be “controlled”, or when assessing rare outcomes. This review provides ex les of the value of RWD for generating evidence about PCa, focusing on studies using data from a quality clinical register, namely the National Prostate Cancer Register (NPCR) Sweden, with longitudinal data on advanced PCa in Patient-overview Prostate Cancer (PPC) and data linkages to other sources in Prostate Cancer data Base Sweden (PCBaSe).
Estimates of over-diagnosis of breast cancer due to population-based mammography screening in South Australia after adjustment for lead time effects
Publisher: SAGE Publications
Date: 20-04-2015
Abstract: To estimate over-diagnosis due to population-based mammography screening using a lead time adjustment approach, with lead time measures based on symptomatic cancers only. Women aged 40–84 in 1989–2009 in South Australia eligible for mammography screening. Numbers of observed and expected breast cancer cases were compared, after adjustment for lead time. Lead time effects were modelled using age-specific estimates of lead time (derived from interval cancer rates and predicted background incidence, using maximum likelihood methods) and screening sensitivity, projected background breast cancer incidence rates (in the absence of screening), and proportions screened, by age and calendar year. Lead time estimates were 12, 26, 43 and 53 months, for women aged 40–49, 50–59, 60–69 and 70–79 respectively. Background incidence rates were estimated to have increased by 0.9% and 1.2% per year for invasive and all breast cancer. Over-diagnosis among women aged 40–84 was estimated at 7.9% (0.1–12.0%) for invasive cases and 12.0% (5.7–15.4%) when including ductal carcinoma in-situ (DCIS). We estimated 8% over-diagnosis for invasive breast cancer and 12% inclusive of DCIS cancers due to mammography screening among women aged 40–84. These estimates may overstate the extent of over-diagnosis if the increasing prevalence of breast cancer risk factors has led to higher background incidence than projected.
Prostate cancer outcomes for men who present with symptoms at diagnosis
Publisher: Wiley
Date: 03-09-2016
DOI: 10.1111/BJU.13622
Abstract: To compare clinical features, treatments and outcomes in men with non-metastatic prostate cancer (PCa) according to whether they were referred for symptoms or elevated prostate-specific antigen (PSA) level. This study used data from the South Australia Prostate Cancer Clinical Outcomes Collaborative database a multi-institutional clinical registry covering both the public and private sectors. We included all non-metastatic cases from 1998 to 2013 referred for urinary rostatic symptoms or elevated PSA level. Multivariate Poisson regression was used to identify characteristics associated with symptomatic presentation and compare treatments according to reason for referral. Outcomes (i.e. overall survival, PCa-specific survival, metastasis-free survival and disease-free survival) were compared using multivariate Cox proportional hazards and competing risk regression. Our analytical cohort consisted of 4 841 men with localized PCa. Symptomatic men had lower-risk disease (incidence ratio [IR] 0.70, 95% confidence interval [CI] 0.61-0.81 for high vs low risk), fewer radical prostatectomies (IR 0.64, CI: 0.56-0.75) and less radiotherapy (IR 0.86, CI: 0.77-0.96) than men presenting with elevated PSA level. All-cause mortality (hazard ratio [HR] 1.31, CI: 1.16-1.47), disease-specific mortality (HR 1.42, CI: 1.13-1.77) and risk of metastases (HR 1.36, CI: 1.13-1.64) were higher for men presenting with symptoms, after adjustment for other clinical characteristics however, risk of disease progression did not differ (HR 0.90, CI: 0.74-1.07) amongst those treated curatively. Subgroup analyses indicated poorer PCa survival for symptomatic referral among men undergoing radical prostatectomy (HR 3.4, CI: 1.3-8.8), those aged >70 years (HR 1.4, CI: 1.0-1.8), men receiving private treatment (HR 2.1, CI: 1.3-3.3), those diagnosed via biopsy (HR 1.3, CI: 1.0-1.7) and those diagnosed before 2006 (HR 1.6, CI: 1.2-2.7). Our results suggest that symptomatic presentation may be an independent negative prognostic indicator for PCa survival. More complete assessment of disease grade and extent, more definitive treatment and increased post-treatment monitoring among symptomatic cases may improve outcomes. Further research to determine any pathophysiological basis for poor outcomes in symptomatic men is warranted.
A novel case-control design to estimate the extent of over-diagnosis of breast cancer due to organised population-based mammography screening
Publisher: Wiley
Date: 18-08-2015
DOI: 10.1002/IJC.29124
Abstract: Debate about the extent of breast cancer over-diagnosis due to mammography screening has continued for over a decade, without consensus. Estimates range from 0 to 54%, but many studies have been criticized for having flawed methodology. In this study we used a novel study design to estimate over-diagnosis due to organised mammography screening in South Australia (SA). To estimate breast cancer incidence at and following screening we used a population-based, age-matched case-control design involving 4,931 breast cancer cases and 22,914 controls to obtain OR for yearly time intervals since women's last screening mammogram. The level of over-diagnosis was estimated by comparing the cumulative breast cancer incidence with and without screening. The former was derived by applying ORs for each time window to incidence rates in the absence of screening, and the latter, by projecting pre-screening incidence rates. Sensitivity analyses were undertaken to assess potential biases. Over-diagnosis was estimated to be 8% (95%CI 2-14%) and 14% (95%CI 8-19%) among SA women aged 45 to 85 years from 2006-2010, for invasive breast cancer and all breast cancer respectively. These estimates were robust when applying various sensitivity analyses, except for adjustment for potential confounding assuming higher risk among screened than non-screened women, which reduced levels of over-diagnosis to 1% (95%CI 5-7%) and 8% (95%CI 2-14%) respectively when incidence rates for screening participants were adjusted by 10%. Our results indicate that the level of over-diagnosis due to mammography screening is modest and considerably lower than many previous estimates, including others for Australia.
Clinical and socio-demographic profile of an Australian multi-institutional prostate cancer cohort
Publisher: Wiley
Date: 12-2009
Extent and predictors of grade upgrading and downgrading in an Australian cohort according to the new prostate cancer grade groupings
Publisher: Elsevier BV
Date: 10-2019
Association Between Antidiabetic Medications and Prostate-Specific Antigen Levels and Biopsy Results
Publisher: American Medical Association (AMA)
Date: 06-11-2019
Guy’s and St Thomas NHS Foundation active surveillance prostate cancer cohort: a characterisation of a prostate cancer active surveillance database
Publisher: Springer Science and Business Media LLC
Date: 19-05-2021
DOI: 10.1186/S12885-021-08255-Z
Abstract: The routine clinical use of serum prostatic specific antigen (PSA) testing has allowed earlier detection of low-grade prostate cancer (PCa) with more favourable characteristics, leading to increased acceptance of management by active surveillance (AS). AS aims to avoid over treatment in men with low and intermediate-risk PCa and multiple governing bodies have described several AS protocols. This study provides a descriptive profile of the Guy’s and St Thomas NHS Foundation Trust (GSTT) AS cohort as a platform for future research in AS pathways in PCa. Demographic and baseline characteristics were retrospectively collected in a database for patients at the GSTT AS clinic with prospective collection of follow-up data from 2012. Seven hundred eighty-eight men being monitored at GSTT with histologically confirmed intermediate-risk PCa, at least 1 follow-up appointment and diagnostic characteristics consistent with AS criteria were included in the profile. Descriptive statistics, Kaplan-Meier survival curves and multivariable Cox proportion hazards regression models were used to characterize the cohort. A relatively large proportion of the cohort includes men of African/Afro-Caribbean descent (22%). More frequent use of magnetic resonance imaging and trans-perineal biopsies at diagnosis was observed among patients diagnosed after 2012. Those who underwent trans-rectal ultrasound diagnostic biopsy received their first surveillance biopsy 20 months earlier than those who underwent trans-perineal diagnostic biopsy. At 3 years, 76.1% men remained treatment free. Predictors of treatment progression included Gleason score 3 + 4 (Hazard ratio (HR): 2.41, 95% Confidence interval (CI): 1.79–3.26) and more than 2 positive cores taken at biopsy (HR: 2.65, CI: 1.94–3.62). A decreased risk of progressing to treatment was seen among men diagnosed after 2012 (HR: 0.72, CI: 0.53–0.98). An organised biopsy surveillance approach, via two different AS pathways according to the patient’s diagnostic method, can be seen within the GSTT cohort. Risk of patients progressing to treatment has decreased in the period since 2012 compared with the prior period with more than half of the cohort remaining treatment free at 5 years, highlighting that the fundamental aims of AS at GSTT are being met. Thus, this cohort is a good resource to investigate the AS treatment pathway.
Prognostic value of comorbidity measures among Australian men with non-metastatic prostate cancer
Publisher: Elsevier BV
Date: 12-2023
Identification of a metastable uranium metal–organic framework isomer through non-equilibrium synthesis
Publisher: Royal Society of Chemistry (RSC)
Date: 2022
DOI: 10.1039/D2SC04783G
Abstract: Identifying the relationship between structure and energetics in a uranium MOF isomer system reveals how non-equilibrium synthetic conditions can be used as a strategy to target metastable MOFs.
Factors impacting on sexual function among men on active surveillance for prostate cancer
Publisher: Wiley
Date: 24-02-2023
DOI: 10.1002/PROS.24502
Abstract: Active surveillance (AS) aims to reduce overtreatment and minimize the negative side effects of radical therapies (i.e., prostatectomy or radiotherapy) while preserving quality of life. However, a substantial proportion of men can experience a decline in sexual function during AS follow‐up. The aim of this study was to identify predictors of declining sexual function among men on AS. Men enrolled from 2008 to 2018 in the South Australian Prostate Cancer Clinical Outcomes Collaborative registry—a prospective clinical registry—were studied. Sexual function outcomes were measured using expanded prostate cancer index composite (EPIC‐26) at baseline and 12‐months postdiagnosis. Multivariable regression models adjusted for baseline score and other sociodemographic and clinical factors were applied to identify predictors of sexual function score at 12‐months. A total of 554 men were included. Variables that showed significant association with decline in sexual function score at 12‐months were: having two or more biopsies after diagnosis (mean change score (MCS): –16.3, p 0.001) compared with no biopsy, higher number of positive biopsy cores (MCS: –1.6, p = 0.004), being in older age category (above 70 vs. below 60: MCS: –16.7, p 0.001 65−70 vs. below 60: MCS: –9.7, p = 0.024), having had depression (MCS: –9.0, p = 0.020), and impaired physical function (MCS: –10.0, p = 0.031). Greater socioeconomic advantage (highest vs. lowest quintile: MCS: 15.7, p = 0.022) and year of diagnosis (MCS: 2.6 for every year, p 0.001) were positively associated with 12‐months sexual function score. Neither biopsy type, biopsy timing nor PSA velocity were associated with declines in sexual function. Our findings suggest that multiple factors affected sexual function during AS. Interventions toward reducing the number of biopsies through less invasive monitory approaches, screening for physical and mental well‐being, and targeted emotional support and counseling services may be helpful for men on AS.
Chronic inflammatory diseases, anti-inflammatory medications and risk of prostate cancer: a population-based case-control study
Publisher: Springer Science and Business Media LLC
Date: 21-06-2019
Development of South Australian-Victorian Prostate Cancer Health Outcomes Research Dataset
Publisher: Springer Science and Business Media LLC
Date: 22-01-2016
Dietary, physical activity and sedentary behaviour among Australian secondary students in 2005
Publisher: Oxford University Press (OUP)
Date: 11-05-2007
Abstract: The aim of this study was to provide a current assessment of Australian secondary students' self-reported dietary, physical activity and sedentary behaviour. This study also examined the relationship between television viewing and students' dietary behaviour. Data are from a cross-sectional survey of 18 486 secondary students in 2005 from all Australian states except Western Australia. Participants reported their usual daily consumption (number of serves) of vegetables and fruit their weekly consumption of unhealthy/non-core foods including fast food meals, snack foods and high-energy drinks their engagement in moderate-vigorous physical activity over the previous week and hours spent using electronic media for entertainment and doing homework on school days. The study found that 20% of students were meeting the daily requirement of four serves of vegetables, whereas 39% were eating the recommended three daily serves of fruit. Consumption of unhealthy/non-core foods was high, with 46% of students having fast food meals at least twice a week, 51% eating snack foods four or more times per week and 44% having high-energy drinks four or more times per week. Fourteen per cent of students engaged in recommended levels of physical activity and 29% engaged in recommended levels of sedentary behaviour. Age and gender differences occurred for most measures, and there were some socio-economic status differences. Heavier television use was associated with lower consumption of fruit and higher consumption of unhealthy/non-core foods. On the basis of the results of this study, it appears that a significant proportion of Australian secondary students fall short of current, national dietary and physical activity recommendations for teenagers. Continual monitoring of these behaviours is essential to help inform research and policy and identify where future efforts should be directed.
Population screening and intensity of screening are associated with reduced breast cancer mortality: Evidence of efficacy of mammography screening in Australia
Publisher: Springer Science and Business Media LLC
Date: 22-05-2008
DOI: 10.1007/S10549-007-9609-5
Abstract: Efficacy of breast screening may differ in practice from the results of randomized trials. We report one of the largest case-control evaluations of a screening service. Subjects included 491 breast-cancer deaths affecting 45-80-year-old South Australian females during 2002-2005 (diagnosed after BreastScreen commencement) and 1,473 live controls (three per death) randomly selected from the State Electoral Roll after birth-date matching. Cancer Registry and BreastScreen records provided cancer and screening details. Risk estimates were calculated by BreastScreen participation, using conditional logistic regression. Interpretation was assisted by a population survey of risk factor prevalence by BreastScreen participation in 1,684 females aged > or =40 years. The relative odds (OR) (95% confidence limits) of breast-cancer death in BreastScreen participants compared with non-participants were 0.59 (0.47, 0.74). Compared with non-participants, the OR was 0.70 (0.47, 1.05) for women last screened through BreastScreen more than 3 years before diagnosis of the index case, and 0.57 (0.44, 0.72) for women screened more recently. The OR of 0.47 (0.34, 0.65) for women screened more frequently in the pre-diagnosis phase was lower than the 0.64 (0.50, 0.82) for other screened women. The overall OR of 0.59 approximated 0.70 when corrected for the screening self-selection bias observed in five randomized trials. However, multivariable analysis of survey data did not indicate a lower prevalence of breast-cancer risk factors among BreastScreen participants, suggesting that this correction may be inappropriate. Participation in screening was associated with a breast-cancer mortality reduction of between 30 and 41%, depending on assumptions about screening self-selection bias. A downward mortality risk by recency of last screen prior to cancer diagnosis, and frequency of recent screening, is consistent with a screening effect.
Association Between Vitamin D and Novel SARS-CoV-2 Respiratory Dysfunction – A Scoping Review of Current Evidence and Its Implication for COVID-19 Pandemic
Publisher: Frontiers Media SA
Date: 26-11-2020
DOI: 10.3389/FPHYS.2020.564387
Abstract: To assess the association between vitamin D deficiency and increased morbidity/mortality with COVID-19 respiratory dysfunction. Scoping review. Ovid MEDLINE (1946 to 24 of April 2020) and PubMed (2020 to 17 of September 2020). A search using the search terms: [(cholecalciferol or ergocalciferol or vitamin D2 or vitamin D3 or vitamin D or 25OHD) and (SARS-CoV-2 or coronavirus or COVID or betacoronavirus or MERS-CoV or SARS-CoV or respiratory infection or acute respiratory distress syndrome or ARDS)]m.p. was conducted on the 24/04/2020 (Search A) and 17/09/2020 (Search B). 91 studies were identified as being concerned with Acute Respiratory Infection (ARI)/Acute Respiratory Distress Syndrome (ARDS) and vitamin D, and 25 publications specifically explored the role of vitamin D deficiency in the development and progression of SARS-CoV-2/COVID-19 related ARDS. Search “A” identified three main themes of indirect evidence supporting such an association. Consistent epidemiological evidence exists linking low vitamin D levels to increased risk and severity of respiratory tract infections. We also report on plausible biological processes supporting such an association and present weaker evidence supporting the benefit of vitamin D supplementation in reducing the risk and severity of ARIs. Uncertainty remains about what constitutes an appropriate dosing regimen in relation to reducing risk/severity of ARI/ARDS. More recent evidence (Search B) provided new insights into some direct links between vitamin D and COVID-19 with a number of cohort and ecological studies supporting an association with PCR-positivity for SARS-CoV-2 and vitamin D deficiency. The exact efficacy of the vitamin D supplementation for prevention of, or as an adjunct treatment for COVID-19 remains to be determined but a number of randomized control trials (RCTs) currently underway are actively investigating these potential benefits. Our rapid review of literature supports the need for observational studies with COVID-19 infected populations to measure and assess vitamin D levels in relation to risk/severity and outcomes alongside RCTs designed to evaluate the efficacy of supplementation both in preventive and therapeutic contexts. The overlap in the vitamin D associated biological pathways with the dysregulation reported to drive COVID-19 outcomes warrants further investigation.
ISUP Group 4 – a Homogenous Group of Prostate Cancers?
Publisher: Springer Science and Business Media LLC
Date: 27-10-2018
DOI: 10.1007/S12253-017-0331-2
Abstract: The International Society of Urological Pathology (ISUP) and the World Health Organisation have adopted a five-tiered prognostic grade group for prostate cancer in 2014. Grade group 4 is comprised of Gleason patterns 4 + 4, 3 + 5 and 5 + 3. Recent articles have suggested heterogeneity in their prognostic outcomes. We aimed to determine whether there was a difference in mortality outcomes within the ISUP 4 grouping, as identified on needle biopsy. A total of 4080 men who were diagnosed with non-metastatic (N0 M0) prostate cancer on biopsy with Gleason scores of 7, 8 and 9 were included. Multi-variable Cox Regression and Fine and Grey competing risk analysis were used to determine the All-Cause Mortality (ACM) and the Prostate Cancer Specific Mortality (PCSM) as a function of Gleason Scores (Gleason 3 + 4, 4 + 3, 4 + 4, 3 + 5/5 + 3, 9). Gleason score 4 + 4 was utilized as the referent. The 60 months' prostate cancer specific mortality with Gleason patterns 4 + 4 and 3 + 5/5 + 3 were 17% and 20% respectively (P < 0.01). Patients with 3 + 5/5 + 3 disease, had no statistically significant difference in the ACM (adjusted hazard ratio [aHR] 0.99, 95% confidence interval [Cl] 0.68-1.4, p = 0.99) and PCSM risk (aHR 0.77, 95% Cl 0.47-1.2, p = 0.31) when compare with the referent group of patients. Patients with Gleason patterns 4 + 3 and 9 had statistically significant difference in their PCSM risk (aHR 0.70, 95% CI 0.54-0.91, P < 0.001 and aHR 1.5, 95% Cl 1.2-1.9, P < 0.001) when compared to the referent group. Our analysis suggest that ISUP group 4 is homogenous in terms of the all-cause mortality and the prostate cancer specific morality risk as differentiated by the presence of Gleason 5 score.
Risk of progression following a negative biopsy in prostate cancer active surveillance
Publisher: Springer Science and Business Media LLC
Date: 25-08-2022
DOI: 10.1038/S41391-022-00582-X
Abstract: Currently, follow-up protocols are applied equally to men on active surveillance (AS) for prostate cancer (PCa) regardless of findings at their initial follow-up biopsy. To determine whether less intensive follow-up is suitable following negative biopsy findings, we assessed the risk of converting to active treatment, any subsequent upgrading, volume progression ( % positive cores), and serious upgrading (grade group ) for negative compared with positive findings on initial follow-up biopsy. 13,161 men from 24 centres participating in the Global Action Plan Active Surveillance Prostate Cancer [GAP3] consortium database, with baseline grade group ≤2, PSA ≤ 20 ng/mL, cT-stage 1–2, diagnosed after 1995, and ≥1 follow-up biopsy, were included in this study. Risk of converting to treatment was assessed using multivariable mixed-effects survival regression. Odds of volume progression, any upgrading and serious upgrading were assessed using mix-effects binary logistic regression for men with ≥2 surveillance biopsies. 27% of the cohort ( n = 3590) had no evidence of PCa at their initial biopsy. Over 50% of subsequent biopsies in this group were also negative. A negative initial biopsy was associated with lower risk of conversion (adjusted hazard ratio: 0.45 95% confidence interval [CI]: 0.42–0.49), subsequent upgrading (adjusted odds ratio [OR]: 0.52 95%CI: 0.45–0.62) and serious upgrading (OR: 0.74 95%CI: 0.59–92). Radiological progression was not assessed due to limited imaging data. Despite heterogeneity in follow-up schedules, findings from this global study indicated reduced risk of converting to treatment, volume progression, any upgrading and serious upgrading among men whose initial biopsy findings were negative compared with positive. Given the low risk of progression and high likelihood of further negative biopsy findings, consideration should be given to decreasing follow-up intensity for this group to reduce unnecessary invasive biopsies.
Predicting Biopsy Outcomes During Active Surveillance for Prostate Cancer: External Validation of the Canary Prostate Active Surveillance Study Risk Calculators in Five Large Active Surveillance Cohor
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.EURURO.2019.07.041
Abstract: Men with prostate cancer (PCa) on active surveillance (AS) are followed through regular prostate biopsies, a burdensome and often unnecessary intervention, not without risks. Identifying men with at a low risk of disease reclassification may help reduce the number of biopsies. To assess the external validity of two Canary Prostate Active Surveillance Study Risk Calculators (PASS-RCs), which estimate the probability of reclassification (Gleason grade ≥7 with or without >34% of biopsy cores positive for PCa) on a surveillance biopsy, using a mix of months since last biopsy, age, body mass index, prostate-specific antigen, prostate volume, number of prior negative biopsies, and percentage (or ratio) of positive cores on last biopsy. We used data up to November 2017 from the Movember Foundation's Global Action Plan (GAP3) consortium, a global collaboration between AS studies. External validity of the PASS-RCs for estimating reclassification on biopsy was assessed by calibration, discrimination, and decision curve analyses. Five validation cohorts (Prostate Cancer Research International: Active Surveillance, Johns Hopkins, Toronto, Memorial Sloan Kettering Cancer Center, and University of California San Francisco), comprising 5105 men on AS, were eligible for analysis. The in idual cohorts comprised 429-2416 men, with a median follow-up between 36 and 84 mo, in both community and academic practices mainly from western countries. Abilities of the PASS-RCs to discriminate between men with and without reclassification on biopsy were reasonably good (area under the receiver operating characteristic curve values 0.68 and 0.65). The PASS-RCs were moderately well calibrated, and had a greater net benefit than most default strategies between a predicted 10% and 30% risk of reclassification. Both PASS-RCs improved the balance between detecting reclassification and performing surveillance biopsies by reducing unnecessary biopsies. Recalibration to the local setting will increase their clinical usefulness and is therefore required before implementation. Unnecessary prostate biopsies while on active surveillance (AS) should be avoided as much as possible. The ability of two calculators to selectively identify men at risk of progression was tested in a large cohort of men with low-risk prostate cancer on AS. The calculators were able to prevent unnecessary biopsies in some men. Usefulness of the calculators can be increased by adjusting them to the characteristics of the population of the clinic in which the calculators will be used.
Children's sun exposure and sun protection: Prevalence in Australia and related parental factors
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.JAAD.2011.06.015
Abstract: Reducing childhood exposure to ultraviolet radiation is important to minimize lifetime skin cancer risk. We sought to describe the prevalence of children's sun-related behaviors and associated parental and other factors. In weekly cross-sectional telephone interviews during summer, 1140 parents/guardians of children aged 0 to 11 years were recruited. Parents provided proxy reports for one of their children. Key questions related to weekend sun protection and sunburn, parent's sun-related attitudes, and demographic characteristics. Potential predictors of children's sun protection and sunburn were analyzed adjusting for covariates including weather conditions on the previous weekend. On summer weekends, 73% of children spent longer than 15 minutes outdoors in peak ultraviolet radiation periods. Of these, 64% were protected by a hat and 58% by sun-protection factor 15 or higher sunscreen, 32% stayed under shade, and 18% wore three-quarter or long-sleeved tops. Overall, 8% of children had sunburn. Parental attitudes were typically supportive of children's sun protection. Parental use of hats (odds ratio [OR] 3.1 95% confidence interval [CI] 1.6-6.2), shade (OR 9.6 95% CI 4.4-20.8), sunscreen (OR 12.6 95% CI 5.2-30.4), longer leg cover (OR 10.3 95% CI 4.4-24.0), and two or more protective behaviors (OR 5.7 95% CI 2.8-11.9) increased the odds of their children practicing these behaviors, as did some parental attitudes. We relied on cross-sectional parent reports. Although children's sun protection was favorable, there was room for improvement. Health promotion to improve sun-protection practices in adults may benefit children's sun-safe behaviors.
Antibodies as biomarkers for cancer risk: a systematic review
Publisher: Oxford University Press (OUP)
Date: 04-04-2022
DOI: 10.1093/CEI/UXAC030
Abstract: Increasing evidence has linked the humoral immune response with the development of various cancers. Therefore, there is growing interest in investigating the predictive value of antibodies to assess overall and tissue site-specific cancer risk. Given the large amount of antibody types and the broad scope of the search (i.e. cancer risk), the primary aim of this systematic review was to present an overview of the most researched antibodies (i.e. immunoglobulin (Ig) isotypes (IgG, IgM, IgA, and IgE), tumour and self-antigen-reactive antibodies, infection-related antibodies) in relation to overall and site-specific cancer risk. We identified various antibody types that have been associated with the risk of cancer. While no significant associations were found for IgM serum levels, studies found an inconsistent association among IgE, IgA, and IgG serum levels in relation to cancer risk. When evaluating antibodies against infectious agents, most studies reported a positive link with specific cancers known to be associated with the specific agent recognized by serum antibodies (i.e. helicobacter pylori and gastric cancer, hepatitis B virus and hepatocellular carcinoma, and human papillomavirus and cervical cancer). Several reports identified autoantibodies, as single biomarkers (e.g. anti-p53, anti-MUC1, and anti-CA125) but especially in panels of multiple autoantibodies, to have potential as diagnostic biomarkers for specific cancer types. Overall, there is emerging evidence associating certain antibodies to cancer risk, especially immunoglobulin isotypes, tumour-associated antigen-specific, and self-reactive antibodies. Further experimental studies are necessary to assess the efficacy of specific antibodies as markers for the early diagnosis of cancer.
Variation in the management of early breast cancer in rural and metropolitan centres: Implications for the organisation of rural cancer services
Publisher: Elsevier BV
Date: 10-2010
DOI: 10.1016/J.BREAST.2010.03.032
Abstract: The study examines the management and outcomes of women with early invasive breast cancer treated in rural and metropolitan centres over a nine-year observation period. A prospective audit of the treatment and outcomes of 2081 women with early breast cancer who underwent potentially curative surgery between 1997 and 2006 in metropolitan Canberra or in the surrounding rural region was completed. Overall, there was good agreement between published guidelines and the treatment received by the women in the study. However, women treated in rural centres were less likely to receive postoperative radiotherapy after breast-conserving surgery, or to undergo axillary lymph node surgery or sentinel lymph node biopsy compared with women treated in metropolitan centres. Surgery in a rural centre was associated with increased breast cancer recurrence (HR = 1.54, p < 0.001) and increased breast cancer mortality (HR = 1.84, p < 0.001), after adjustment for age and tumour characteristics. Non-cancer related mortality was increased in women treated in rural centres compared with women travelling to a metropolitan centre for surgery (HR = 2.08 p = 0.005). There were differences in both the care provided and treatment outcomes between women treated in rural centres and women treated in metropolitan centres. However, the increased non-cancer related mortality in women treated in rural centres suggests an increased medical comorbidity in this group. Initiatives supporting rural-based surgeons to adopt new procedures such as sentinel node biopsy may help to optimise rural breast cancer treatment.
Short-term outcomes after surgical resection for colorectal cancer in South Australia
Publisher: Wiley
Date: 02-08-2017
DOI: 10.1111/JEP.12612
Abstract: Short-term outcomes (unplanned readmission, post-surgical complication rates, 30-day and 90-day post-surgical mortality) are often used as indicators of quality of surgical care for colorectal cancer (CRC). Differences in these immediate outcomes can highlight disparities in care across patient subpopulations. This study aimed to document short-term outcomes following major surgery for CRC and to identify whether there were any sociodemographic differences across South Australia (SA). This population-based study included all CRC resections among SA residents diagnosed with CRC aged 50-79 years in 2003-2008 (n = 3940). Clinical, treatment, comorbidity and outcomes data were compiled through linkage of administrative and surveillance datasets across SA. A retrospective cohort design was used to examine short-term outcomes including post-operative complications, 28-day emergency readmission and 30-day and 90-day mortality. We used multivariable logistic regression to identify factors associated with each outcome. Post-operative complications occurred in 28% of cases. Thirty-day and ninety-day mortality were 1.3% and 3%, respectively. Later stage, older age, multiple comorbidities and emergency admissions were associated with poorer short-term outcomes. Risk of complications was lower among patients from higher socio-economic areas (OR = 0.77, 95%CI 0.62-0.98). Risk of 30-day mortality was higher among non-metropolitan patients (OR = 2.33, 95%CI 1.22-4.46). Post-operative complications increased the risk of emergency readmission and short-term mortality. Short-term outcomes following CRC surgery may be improved through strategies to increase earlier detection and reduce emergency admissions. Socioeconomic and regional disparities require further examination of health system factors.
Effect of Mammography Screening on Mortality by Histological Grade
Publisher: American Association for Cancer Research (AACR)
Date: 02-2018
DOI: 10.1158/1055-9965.EPI-17-0487
Abstract: Background: It has been asserted that mammography screening preferentially benefits those with less aggressive cancers, with lesser or no impact on more rapidly progressing and therefore more life-threatening tumors. Methods: We utilized data from the Swedish Two-County Trial, which randomized 77,080 women ages 40 to 74 to invitation to screening and 55,985 for usual care. We tabulated cancers by histologic grade and then compared mortality from cancers specific to histologic grade between the invited and control group using Poisson regression, with specific interest in the effect on mortality from grade 3 cancers. We used incidence-based mortality from tumors diagnosed within the screening phase of the trial. Finally, we cross-tabulated grade with tumor size and node status, to assess downstaging within tumor grades. Results: There was a major reduction in mortality from grade 3 tumors (RR = 0.65 95% CI, 0.53–0.80 P & 0.001), and more deaths prevented from grade 3 tumors (n = 95) than grade 1 and 2 tumors combined (n = 48) in the invited group. The proportions of tumors ≥15 mm or larger and node-positive tumors were substantially reduced in the grade 3 tumors in the invited group. Conclusions: The combination of prevention of tumors progressing to grade 3 and detection at smaller sizes and lesser rates of lymph node metastases within grade 3 tumors results in a substantial number of deaths from grade 3 cancers being prevented by invitation to mammographic screening. Impact: Mammography screening prevents deaths from aggressive cancers. Cancer Epidemiol Biomarkers Prev 27(2) 154–7. ©2017 AACR.
Androgen Deprivation Therapies and Changes in Comorbidity: A Comparison of Gonadotropin-releasing Hormone Agonists and Antiandrogen Monotherapy as Primary Therapy in Men with High-risk Prostate Cancer
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.EURURO.2018.11.022
Abstract: Some studies suggest that gonadotropin-releasing hormone (GnRH) agonists are associated with higher risk of adverse events than antiandrogens (AAs) monotherapy. However, it has been unclear whether this is due to indication bias. To investigate rates of change in comorbidity for men on GnRH agonists versus AA monotherapy in a population-based register study. Men with advanced nonmetastatic prostate cancer (PCa) who received primary AA (n=2078) or GnRH agonists (n=4878) and age- and area-matched PCa-free men were selected from Prostate Cancer Database Sweden 3.0. Increases in comorbidity were measured using the Charlson Comorbidity Index (CCI), from 5yr before through to 5yr after starting androgen deprivation therapy (ADT). Multivariable linear regression was used to determine differences in excess rate of CCI change before and after ADT initiation. Risk of any incremental change in CCI following ADT was assessed using multivariable Cox regression analyses. Men on GnRH agonists experienced a greater difference in excess rate of CCI change after starting ADT than men on AA monotherapy (5.6% per yr, p<0.001). Risk of any new CCI change after ADT was greater for GnRH agonists than for AA (hazard ratio, 1.32 95% confidence interval, 1.20-1.44). Impact on comorbidity was lower for men on AA monotherapy than for men on GnRH agonists. Our results should be confirmed through randomised trials of effectiveness and adverse effects, comparing AA monotherapy and GnRH agonists in men with advanced nonmetastatic PCa who are unsuitable for curative treatment. Hormone therapies for advanced prostate cancer can increase the risk of other diseases (eg, heart disease, diabetes). This study compared two common forms of hormone therapy and found that the risk of another serious disease was higher for those on gonadotropin-releasing hormone agonists than for those on antiandrogen monotherapy.
A case-control study of lower urinary-tract infections, associated antibiotics and the risk of developing prostate cancer using PCBaSe 3.0
Publisher: Public Library of Science (PLoS)
Date: 12-04-2018
Oncological outcomes in an Australian cohort according to the new prostate cancer grading groupings
Publisher: Springer Science and Business Media LLC
Date: 10-08-2017
Spironolactone use is associated with lower prostate cancer risk: a population-wide case-control study
Publisher: Springer Science and Business Media LLC
Date: 02-03-2020
Influence of mammographic screening on breast cancer incidence trends in South Australia
Publisher: Asian Pacific Organization for Cancer Prevention
Date: 04-2014
DOI: 10.7314/APJCP.2014.15.7.3105
Abstract: To examine breast cancer (BC) incidence trends in relation to mammographic screening and risk factor prevalence in South Australia (SA). Trends in annual BC incidence rates were calculated using direct standardisation and compared with projected incidence derived from Poisson regression analysis of pre-screening rates. Annual percentage change and change time points were estimated using Joinpoint software. Biennial mammography screening participation rates were calculated using data from BreastScreen SA. Trends in overweight/obesity, alcohol use and hormone replacement therapy (HRT) use were examined using 1991-2009 Health Omnibus Survey data. Trends in total fertility were examined using data from the Australian Bureau of Statistics. BC incidence increased around the time BreastScreen commenced and then stabilised in the mid-1990s. However rates have remained higher than projected, even though the proportion and age distribution of first time screening attendees stabilised around 1998. A decrease in BC incidence was observed among women aged 50-59yrs from the late-1990's but not among older women. Obesity and alcohol use have increased steadily in all age groups, while HRT use declined sharply from the late-1990s. BC incidence has remained higher than projected since mammography screening began. The sustained elevation is likely to be due to lead time effects, though over-diagnosis cannot be excluded. Declining HRT use has also impacted incidence trends. Studies using in idual level data, which can account for changes in risk factor prevalence and lead time effects, are required to evaluate 'over-diagnosis' due to screening.
Patient-Reported Outcomes After Radiation Therapy in Men With Prostate Cancer: A Systematic Review of Prognostic Tool Accuracy and Validity
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.IJROBP.2017.02.024
Abstract: To identify, through a systematic review, all validated tools used for the prediction of patient-reported outcome measures (PROMs) in patients being treated with radiation therapy for prostate cancer, and provide a comparative summary of accuracy and generalizability. PubMed and EMBASE were searched from July 2007. Title/abstract screening, full text review, and critical appraisal were undertaken by 2 reviewers, whereas data extraction was performed by a single reviewer. Eligible articles had to provide a summary measure of accuracy and undertake internal or external validation. Tools were recommended for clinical implementation if they had been externally validated and found to have accuracy ≥70%. The search strategy identified 3839 potential studies, of which 236 progressed to full text review and 22 were included. From these studies, 50 tools predicted gastrointestinal/rectal symptoms, 29 tools predicted genitourinary symptoms, 4 tools predicted erectile dysfunction, and no tools predicted quality of life. For patients treated with external beam radiation therapy, 3 tools could be recommended for the prediction of rectal toxicity, gastrointestinal toxicity, and erectile dysfunction. For patients treated with brachytherapy, 2 tools could be recommended for the prediction of urinary retention and erectile dysfunction. A large number of tools for the prediction of PROMs in prostate cancer patients treated with radiation therapy have been developed. Only a small minority are accurate and have been shown to be generalizable through external validation. This review provides an accessible catalogue of tools that are ready for clinical implementation as well as which should be prioritized for validation.
System archetypes underlying the problematic behaviour of construction activity in Kenya
Publisher: Informa UK Limited
Date: 2011
Variation in radiotherapy patterns of care in the radical treatment of South Australian men with non-metastatic prostate cancer between 2005-2015.
Publisher: Elsevier BV
Date: 04-2020
DOI: 10.1016/J.RADONC.2019.12.022
Abstract: To investigate associations between socio-demographic characteristics and radiotherapy patterns of care in non-metastatic prostate cancer [nmPCa] in South Australia [SA] between 2005-2015 and document practice patterns over time. Men with nmPCa receiving primary curative radiotherapy were identified from SA Prostate Cancer Clinical Outcomes Collaborative database. Adjuvant, salvage and palliative therapies were excluded. Associations between socio-demographic factors (age, residence, socio-economic status, diagnostic period) and radiotherapy mode (external beam radiotherapy [EBRT] vs. brachytherapy [BT]) and technique (low-dose-rate vs. high-dose-rate brachytherapy) were investigated using multivariable logistic regression with separate models for clinical risk categories. Of the 1874 men who underwent primary RT, 80% received EBRT and 20% BT. For low and intermediate risk disease, likelihood of receiving EBRT was higher among older men (OR Over the last decade substantial changes in RT for nmPCa were observed. Older age and more remote residence may be barriers to accessing specific types of RT. Further research to understand how these factors affect access is warranted to improve service provision.
Reporting Real-World Data on Prostate Cancer Treatment Outcomes to Consumers: The Prostate Cancer Report Card
Publisher: Hindawi Limited
Date: 13-10-2023
DOI: 10.1155/2023/6660371
Estimating over-diagnosis of breast cancer (Authors' Reply)
Publisher: Wiley
Date: 18-11-2015
DOI: 10.1002/IJC.29271
Metabolic syndrome biomarkers and prostate cancer risk in the
UK
Biobank
Publisher: Wiley
Date: 11-09-2020
DOI: 10.1002/IJC.33255
Cancer outcomes in patients requiring immunosuppression in addition to corticosteroids for immune‐related adverse events after immune checkpoint inhibitor therapy
Publisher: Wiley
Date: 04-2020
DOI: 10.1111/AJCO.13177
Abstract: To examine the cancer-specific outcomes for patients who experience immune-related adverse events requiring immunosuppression beyond corticosteroids. We performed a retrospective case series of patients between January 1, 2009 and April 1, 2018, across three metropolitan hospitals in Adelaide, South Australia. Eligible patients were identified from pharmacy records. Patients with a solid organ malignancy had discontinued checkpoint inhibitor therapy due to toxicity, and required immunosuppression in addition to corticosteroids to treat any immune-related adverse event. From 3860 patient dispensation records of immunosuppressive medications, 19 eligible patients were identified. Eight received a CTLA-4 inhibitor, four a PD-1 inhibitor, five combination immunotherapy, and two remained blinded. Sixteen patients had melanoma and three had non-small cell lung cancer. Median time to treatment failure was 8.7 months, and median overall survival was 9.4 months. Of those evaluable, the objective response rate was 35%, while 53% had progressive disease. Four patients died due to complications of their irAE, while six died from progressive disease. Patients who received immunosuppression for checkpoint inhibitor therapy toxicity had variable outcomes. This in part reflects a heterogeneous population, and the evolution of irAE management over time. Several patients continued to derive a benefit after cessation of therapy despite the use of immunosuppressive medications conversely, four died as a direct consequence of their irAE. Physicians should promptly introduce immunosuppressive therapy in patients not responding to corticosteroids to mitigate the risk of life-threatening adverse events, given that current evidence does not clearly demonstrate a detriment to cancer-specific outcomes.
A Single Educational Seminar Increases Confidence and Decreases Dropout from Active Surveillance by 5 Years After Diagnosis of Prostate Cancer
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.EUO.2018.09.007
Abstract: Researchers remain ided on the major causes of dropout from active surveillance (AS), with rates of up to 38% among men with no evidence of prostate cancer (PC) progression. To develop and evaluate an educational intervention in terms of adherence to AS among men with low- to intermediate-risk PC. We first carried out focus group discussions with men who had remained on and dropped out of AS to inform an intervention to increase adherence to AS. A total of 255 consecutive men who had selected AS were then recruited to either standard care (written information and access to a nurse specialist) or standard care and the intervention. An educational seminar was designed by patients and clinicians including information on imaging, biopsy techniques, understanding pathology, large AS cohorts - mortality and morbidity risk and diet and lifestyle advice. The proportion of men dropping out of AS for reasons other than disease progression was assessed at 1 and 5yr after AS selection using multivariate logistic regression. Common themes influencing decision-making by men on AS were identified: (1) clinical consistency (2) information and (3) lifestyle advice. Addition of an educational seminar led to significantly fewer men dropping out of AS: at 1 and 5yr the dropout rate was 25% and 42%, respectively, in the standard care group, compared to 11% and 22% (p=0.001) in the intervention group. In the intervention group, 18 men failed to attend the seminar. The AS dropout rate was halved following a single educational seminar delivered to groups of men with intermediate- or low-risk PC, even at 5yr. Men on active surveillance (AS) for prostate cancer feel more supported when provided with an educational seminar within 3 mo of their treatment choice. The seminar halved the number of men dropping-out of AS, even at 5yr.
Sociodemographic disparities in survival from colorectal cancer in South Australia: A population-wide data linkage study
Publisher: Springer Science and Business Media LLC
Date: 12-2016
Optimum Tools for Predicting Clinical Outcomes in Prostate Cancer Patients Undergoing Radical Prostatectomy: A Systematic Review of Prognostic Accuracy and Validity
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.CLGC.2017.06.001
Abstract: Prostate cancer is a heterogeneous disease whose therapies frequently have adverse effects. Informed patient counseling regarding likely clinical outcomes is therefore important. In this systematic review we aimed to identify all external validations of tools that are used to predict clinical outcomes in patients undergoing radical prostatectomy and evaluate which are optimum for clinical implementation. PubMed and EMBASE were searched from 2007 to 2016. Search terms related to the inclusion criteria were: prostate cancer, clinical outcomes, radical prostatectomy, and prognosis. Titles and abstracts were screened and relevant studies were advanced to full-text review. Reference lists were reviewed for further studies. The Centre for Evidence Based Medicine prognostic tool was used for critical appraisal. Seventy-three studies externally validated 13 pre- and 41 postoperative tools for the prediction of biochemical recurrence (BCR), aggressive BCR, metastasis, and prostate cancer-specific mortality (PCSM). Recommendations for clinical implementation were made on the basis of accuracy, cohort sizes, and consistency. The accuracy of recommended tools ranged from 68% to 79% and 72% to 92% among the largest validation cohorts for pre- and postoperative tools. For preoperative prognosis we recommended the Cancer of the Prostate Risk Assessment (CAPRA) and Stephenson nomograms for BCR, the CAPRA nomogram for aggressive BCR as well as metastasis, and the D'Amico criteria for PCSM. For postoperative prognosis we recommended the CAPRA-Surgery (CAPRA-S), Stephenson, Kattan, Duke prostate cancer (DPC), and the Suardi nomograms for the prediction of BCR, the DPC nomogram for aggressive BCR, the CAPRA-S and Eggener nomograms for metastasis, and the Eggener nomogram for PCSM. Use of these tools should help clinicians deliver accurate, evidence-based counseling to patients undergoing prostatectomy.
Presentation, follow-up, and outcomes among African/Afro-Caribbean men on active surveillance for prostate cancer: experiences of a high-volume UK centre
Publisher: Springer Science and Business Media LLC
Date: 08-02-2021
DOI: 10.1038/S41391-020-00313-0
Abstract: Experiences of African/Afro-Caribbean men on active surveillance (AS) for prostate cancer (PCa) in the United Kingdom (UK) are not well documented. We compared follow-up appointments, adherence, and clinical outcomes among African/Afro-Caribbean men on AS at a high-volume UK hospital with other ethnicities. Men with confirmed low-intermediate risk Pca who attended the AS clinic (2005-2016) and had undergone ≥1 follow-up biopsy (n = 458) were included. Non-adherence (defined as >20% missed appointments), suspicion of disease progression (any upgrading, >30% positive cores, cT-stage > 3, PIRADS > 3), any upgrading from diagnostic biopsy and conversion to active treatment (prostatectomy, radiotherapy or hormone therapy) according to ethnicity (African/Afro-Caribbean versus other ethnicities) were assessed using multivariable regression analysis. Twenty-three percent of eligible men were recorded as African/Afro-Caribbean, while the remainder were predominantly Caucasian. African/Afro-Caribbean men had slightly lower PSA at diagnosis (median 5.0 vs. 6.0 ng/mL) and more positive cores at diagnosis (median 2 vs. 1). They had a substantially higher rate of non-attendance at scheduled follow-up visits (24% vs. 10%, p < 0.001). Adjusted analyses suggest African/Afro-Caribbean men may be at increased risk of disease progression (hazard ratio [HR]: 1.38 95% confidence interval [CI] 0.99-1.91, P = 0.054) and upgrading (HR: 1.29 95% CI 0.87-1.92, P = 0.305), though neither reached statistical significance. No difference in risk of conversion to treatment was observed between ethnic groups (HR: 1.03 95% CI 0.64-1.47, P = 0.873). African/Afro-Caribbean men on AS for PCa in the UK are less likely to adhere to scheduled appointments, suggesting a more tailored service addressing their specific needs may be required. While African/Afro-Caribbean men were no more likely to convert to treatment than Caucasian/other men, findings of a potentially higher risk of disease progression signal the need for careful selection and monitoring of African/Afro-Caribbean men on AS. Larger prospective, multicentre studies with longer follow-up are required to provide more definitive conclusions.
Developing a consensus statement for psychosocial support in active surveillance for prostate cancer
Publisher: Wiley
Date: 06-05-2022
DOI: 10.1002/BCO2.155
Abstract: Our objective was to prioritise the psychosocial support needs of men on active surveillance for prostate cancer and to develop a consensus statement to provide guidance on best practice psychosocial support for men choosing active surveillance and their families. We undertook a patient and public involvement Delphi process over two rounds, informed by qualitative data and a comprehensive literature review, to prioritise the information and support needs of men on active surveillance for prostate cancer. Two panels were surveyed, a patient/carer panel ( n = 55) and a health care provider panel ( n = 114). Based on the findings of the Delphi surveys, an expert active surveillance discussion group developed a consensus statement to guide best practice. Patients and health care professionals differed slightly in their ideas concerning priorities for active surveillance psychosocial support. Broadly, agreed priority areas included ‐patients being involved in decision‐making, continuity of care, more streamlined access to health care teams, improved understanding of the risk of prostate cancer progression and information and support provided through both health care professionals and peers. Based on the identified priorities, the expert discussion group agreed on 22 consensus statements for best practice in psychosocial care for active surveillance in respect of (1) principles of an active surveillance programme (2) structure of consultations (3) content of information and support and (4) delivery of information. This consensus statement provides a framework for patient‐focused psychosocial support, which, if adopted, should increase uptake and adherence to active surveillance among men with prostate cancer.
Comparison of outcomes of different biopsy schedules among men on active surveillance for prostate cancer: An analysis of the G.A.P.3 global consortium database
Publisher: Wiley
Date: 07-03-2022
DOI: 10.1002/PROS.24330
Abstract: The optimal interval for repeat biopsy during active surveillance (AS) for prostate cancer is yet to be defined. This study examined whether risk of upgrading (to grade group ≥ 2) or risk of converting to treatment varied according to intensity of repeat biopsy using data from the GAP3 consortium's global AS database. Intensity of surveillance biopsy schedules was categorized according to centers’ protocols: (a) Prostate Cancer Research International Active Surveillance project (PRIAS) protocols with biopsies at years 1, 4, and 7 (10 centers 7532 men) (b) biennial biopsies, that is, every other year (8 centers 4365 men) and (c) annual biopsy schedules (4 centers 1602 men). Multivariable Cox regression was used to compare outcomes according to biopsy intensity. Out of the 13,508 eligible participants, 56% were managed according to PRIAS protocols (biopsies at years 1, 4, and 7), 32% via biennial biopsy, and 12% via annual biopsy. After adjusting for baseline characteristics, risk of converting to treatment was greater for those on annual compared with PRIAS biopsy schedules (hazard ratio [HR] = 1.66 95% confidence interval [CI] = 1.51–1.83 p 0.001), while risk of upgrading did not differ (HR = 0.96 95% CI = 0.84–1.10). Results suggest more frequent biopsy schedules may deter some men from continuing AS despite no evidence of grade progression.
Female breast cancer management and survival: The experience of major public hospitals in South Australia over 3 decades—trends by age and in the elderly
Publisher: Wiley
Date: 08-10-2017
DOI: 10.1111/JEP.12819
Abstract: Clinical registry data from major South Australian public hospitals were used to investigate trends in invasive breast‐cancer treatment and survival by age. Disease‐specific survival was calculated for the 1980 to 2013 diagnostic period using Kaplan‐Meier product‐limit estimates, with a censoring of live cases on December 31, 2014. Cox proportional hazards regression was used to examine differences in survival by age and tumour characteristic. First‐round treatments following diagnosis were analysed, using multiple logistic regression to adjust for confounding. Five‐year survival increased from 75% in the 1980s to 87% in 2000 to 2013, consistent with national trends, and with increases occurring irrespective of age. There was an increased use of breast conserving surgery, radiotherapy, chemotherapy, and hormone treatments. Five‐year survival was lower for women aged 80+ years, increasing from 65% in the 1980s to 74% in 2000 to 2013. Lower survival in these older women persisted after adjusting for TNM stage, other clinical variables, and diagnostic year, without evidence of a reduced disparity over time. Older women were less likely to have surgery, radiotherapy, and chemotherapy throughout 1980 to 2013. By comparison, their use of hormone therapy was elevated. The adjusted relative odds of mastectomy (as opposed to breast conserving surgery) were lower for the 80+ year age range. Breast‐cancer survival increases applied to all ages, including 80+ years, but poorer outcomes persisted in this older group and the gap did not reduce. A key question is whether the best trade‐off now exists between optimally therapeutic cancer treatment and accommodations for frailty and co‐morbidity in the aged, or whether opportunities exist for better trade‐offs and better survival. Local registry data are important for describing local service activity and outcomes by age for local service providers, health administrations and consumer groups monitoring disparities and indicating effects of local initiatives.
PCASTt/SPCG-17—a randomised trial of active surveillance in prostate cancer: rationale and design
Publisher: BMJ
Date: 08-2019
DOI: 10.1136/BMJOPEN-2018-027860
Abstract: Overtreatment of localised prostate cancer is substantial despite increased use of active surveillance. No randomised trials help define how to monitor patients or when to initiate treatment with curative intent. A randomised, multicentre, intervention trial designed to evaluate the safety of an MRI-based active surveillance protocol, with standardised triggers for repeated biopsies and radical treatment. The aim is to reduce overtreatment of prostate cancer. 2000 men will be randomly allocated to either surveillance according to current practice or to standardised triggers at centres in Sweden, Norway, Finland and the UK. Men diagnosed in the past 12 months with prostate cancer, ≤T2a, prostate-specific antigen (PSA) ng/mL, PSA density ≤0.2 ng/mL/cc, any International Society of Urological Pathology (ISUP) grade 1 are eligible. Men with ISUP grade 2 in % of cores on systematic biopsy and mm cancer in one core on systematic or targeted biopsy are also eligible. Men diagnosed on systematic biopsy should have an MRI and targeted biopsies against Prostate Imaging and Reporting Data System V.2 3–5 lesions before inclusion. Identical follow-up in the two study arms: biannual PSA testing, yearly clinical examination and MRI every second year. In the experimental arm, standardised triggers based on MRI and PSA density elicit repeated biopsies. MRI and histopathological progression trigger radical treatment. Primary outcome measure is progression-free survival. Secondary outcome measures are cumulative incidence of metastatic disease, treatments with curative intent, pT3-4 at radical prostatectomy, switch to watchful waiting, prostate cancer mortality and quality of life. Inclusion started in October 2016 and in October 2018 275 patients have been enrolled. Ethical approval was obtained in each participating country. Results for the primary and secondary outcome measures will be submitted for publication in peer-reviewed journals. NCT02914873 .
GxE PRS: Genotype-environment interaction in polygenic risk score models for quantitative and binary traits
Publisher: Cold Spring Harbor Laboratory
Date: 21-07-2023
DOI: 10.1101/2023.07.20.549816
Abstract: The use of polygenic risk score (PRS) models has transformed the field of genetics by enabling the prediction of complex traits and diseases based on an in idual’s genetic profile. However, the impact of genotype-environment interaction (GxE) on the performance and applicability of PRS models remains a crucial aspect to be explored. Currently, existing GxE PRS models are often inappropriately used, which can result in inflated type 1 error rates and compromised results. In this study, we propose a novel GxE PRS model that correctly incorporates the GxE component to analyze complex traits and diseases. Through extensive simulations, we demonstrate that our proposed model outperforms existing models in terms of controlling type 1 error rates and enhancing statistical power. Furthermore, we apply the proposed model to real data, and report significant GxE effects. Specifically, we highlight the impact of our model on both quantitative and binary traits. For quantitative traits, we uncover the GxE modulation of genetic effects on body mass index (BMI) by alcohol intake frequency (ALC). In the case of binary traits, we identify the GxE modulation of genetic effects on hypertension (HYP) by waist-to-hip ratio (WHR). These findings underscore the importance of employing a robust model that effectively controls type 1 error rates, thus preventing the occurrence of spurious GxE signals. To facilitate the implementation of our approach, we have developed an innovative R software package called GxE PRS, specifically designed to detect and estimate GxE effects. Overall, our study highlights the importance of accurate GxE modeling and its implications for genetic risk prediction, while providing a practical tool to support further research in this area.
Australian validation of the Cancer of the Prostate Risk Assessment Post-Surgical score to predict biochemical recurrence after radical prostatectomy
Publisher: Wiley
Date: 04-05-2018
DOI: 10.1111/ANS.13954
Abstract: The Cancer of the Prostate Risk Assessment Post-Surgical (CAPRA-S) score is a simple post-operative risk assessment tool predicting disease recurrence after radical prostatectomy, which is easily calculated using available clinical data. To be widely useful, risk tools require multiple external validations. We aimed to validate the CAPRA-S score in an Australian multi-institutional population, including private and public settings and reflecting community practice. The study population were all men on the South Australian Prostate Cancer Clinical Outcomes Collaborative Database with localized prostate cancer diagnosed during 1998-2013, who underwent radical prostatectomy without adjuvant therapy (n = 1664). Predictive performance was assessed via Kaplan-Meier and Cox proportional regression analyses, Harrell's Concordance index, calibration plots and decision curve analysis. Biochemical recurrence occurred in 342 (21%) cases. Five-year recurrence-free probabilities for CAPRA-S scores indicating low (0-2), intermediate (3-5) and high risk were 95, 79 and 46%, respectively. The hazard ratio for CAPRA-S score increments was 1.56 (95% confidence interval 1.49-1.64). The Concordance index for 5-year recurrence-free survival was 0.77. The calibration plot showed good correlation between predicted and observed recurrence-free survival across scores. Limitations include the retrospective nature and small numbers with higher CAPRA-S scores. The CAPRA-S score is an accurate predictor of recurrence after radical prostatectomy in our cohort, supporting its utility in the Australian setting. This simple tool can assist in post-surgical selection of patients who would benefit from adjuvant therapy while avoiding morbidity among those less likely to benefit.
Use of Warfarin or Direct Oral Anticoagulants and Risk of Prostate Cancer in PCBaSe: A Nationwide Case-Control Study
Publisher: Frontiers Media SA
Date: 08-10-2020
Hormonal patterns in men with prediabetes and diabetes in NHANES III: possible links with prostate cancer
Publisher: Springer Science and Business Media LLC
Date: 21-01-2022
Pumped-Up SU(1,1) Interferometry
Publisher: American Physical Society (APS)
Date: 11-04-2017
Prevalence and determinants of Australian adolescents' and adults' weekend sun protection and sunburn, summer 2003-2004
Publisher: Elsevier BV
Date: 10-2008
DOI: 10.1016/J.JAAD.2008.06.011
Abstract: Reducing people's exposure to ultraviolet radiation is the primary strategy for skin cancer prevention. We sought to provide comprehensive national data on preventive behaviors and risk assessment for Australia. A national survey was conducted in summer 2003-2004. In 8 weekly cross-sectional surveys, adults and adolescents were interviewed about their sun protection and sunburn on the previous summer weekend. Adjustments were made for specific weather and ultraviolet radiation conditions relevant to time and location. Adolescents were relatively homogeneous in their low compliance with sun protection (significantly less use of hats, covering clothing, shade, and sunglasses than adults) on weekends, and consequently were more likely to be sunburned than adults (25% compared with 18% odds ratio=1.80, P<.001). Temperature was a significant predictor of sun-protective behaviors and a strong determinant of sunburn, as was ultraviolet radiation for adults' sunburn. Using shade, spending less time outdoors, and, for adults, wearing clothing covering were associated with reduced odds of sunburn. The study relied on self-reported behaviors and sunburn. Further improvement in Australians' sun-protective behaviors is needed.
Multi-jurisdictional Prostate cancer registry linkage
Publisher: Swansea University
Date: 25-08-2022
Abstract: ObjectiveThe Prostate Cancer Outcomes Registry for Australian and New Zealand (PCOR-ANZ) aims to monitor population-wide prostate cancer characteristics, treatments, and outcomes. However, long-term follow-up of secondary treatments, disease progression, and side effects is limited. This novel project provides increased utility, enhancing this clinical registry by integrating national and jurisdictional data. ApproachThe Tasmanian and South Australian jurisdictional registries (PCOR-Tas and PCOR-SA) are being treated as pilots for this nationally relevant data linkage project. Each contains descriptive data on clinical characteristics, primary treatments, survival, and patient-reported outcomes for prostate cancer in their jurisdictions. Data linkages include state-based hospital patient records and central cancer registries, with additional linkages to national data on prescribed medicines, procedures, and deaths refer Figure 1. Authorisation by contributing custodians and ethics committees, and funding from the Movember charity, has enabled the more detailed evaluation of patient follow-up after the initial treatment to examine historical trends, health service utilisation, disparities and gaps, and long-term patient outcomes. ResultsSouth Australian study cohort consists of all men in the SACR (South Australia's central cancer registry) who were diagnosed with prostate cancer [ICD10=C61] as well as any additional men recorded in the PCOR-SA diagnosed from January 2002 to June 2021 (n=25,000). Men who do not have SA addresses recorded in either source are excluded from the South Australian pilot. The Tasmanian cohort is younger (established 2015) and smaller (n=2080), but for comparison is linked with the equivalent local and national datasets The South Australian data linkage is being undertaken by SA NT DataLink, with the Tasmanian linkage undertaken by the Tasmania Data linkage Unit. For both jurisdictions, the national datasets are being linked by the Australian Institute for Health and Welfare (AIHW). ConclusionSince the Australian health system involves components managed at both the State and Federal levels, multijurisdictional data linkage adds additional complexity to linkage projects. Undertaking this project was not without its challenges, but it demonstrates what can be achieved and the value of enhancing high-quality clinical registry data to address important outcomes in prostate cancer.
Assessing impact of organised breast screening across small residential areas—development and internal validation of a prediction model
Publisher: Hindawi Limited
Date: 07-03-2017
DOI: 10.1111/ECC.12673
Abstract: Monitoring screening mammography effects in small areas is often limited by small numbers of deaths and delayed effects. We developed a risk score for breast cancer death to circumvent these limitations. Screening, if effective, would increase post-diagnostic survivals through lead-time and related effects, as well as mortality reductions. Linked cancer and BreastScreen data at four hospitals (n = 2,039) were used to investigate whether screened cases had higher recorded survivals in 13 small areas, using breast cancer deaths as the outcome (M1), and a risk of death score derived from TNM stage, grade, histology type, hormone receptor status, and related variables (M2). M1 indicated lower risk of death in screened cases in 12 of the 13 areas, achieving statistical significance (p < .05) in 5. M2 indicated lower risk scores in screened cases in all 13 areas, achieving statistical significance in 12. For cases recently screened at diagnosis (<6 months), statistically significant reductions applied in 8 areas (M1) and all 13 areas (M2). Screening effects are more detectable in small areas using these risk scores than death itself as the outcome variable. An added advantage is the application of risk scores for providing a marker of screening effect soon after diagnosis.
Serum Total Bilirubin and Risk of Cancer: A Swedish Cohort Study and Meta-Analysis
Publisher: MDPI AG
Date: 04-11-2021
Abstract: Bilirubin has strong antioxidant properties that have been hypothesized to be preventive against the development of cancer. Thus, we aimed to investigate the association between serum total bilirubin (STB) and risk of overall and site-specific cancers in the large Swedish Apolipoprotein Mortality Risk (AMORIS) cohort. We also performed a systematic review and meta-analysis for specific cancer types (colorectal, breast and lung). We found no association between high levels of STB and risk of overall cancer. Regarding site-specific cancer, there was an inverse association between increased STB and lung cancer (Hazard Ratio (HR) for the 4th quartile (Q4) vs. Q1: 0.50 95%CI: 0.44–0.59) and gynecological cancer (HR for Q4 vs. Q1: 0.86 95%CI: 0.76–0.99). A positive association was found with melanoma (HR for Q4 vs. Q1: 1.25 95%CI: 1.06–1.47) and breast cancer (HR for Q4 vs. Q1: 1.13 95%CI: 1.01–1.25) risk. The meta-analysis showed an inverse association between high levels of STB and risk of lung cancer (Relative risk (RR): 0.69 95%CI: 0.55–0.86). No associations were seen for colorectal and breast cancer risk. Further studies are required to establish if bilirubin can be used as a biomarker for risk assessment and/or as a novel therapeutic target.
Treatment patterns among colorectal cancer patients in South Australia: a demonstration of the utility of population-based data linkage
Publisher: Wiley
Date: 22-05-2014
DOI: 10.1111/JEP.12183
Abstract: Population level data on colorectal cancer (CRC) management in Australia are lacking. This study assessed broad level patterns of care and concordance with guidelines for CRC management at the population level using linked administrative data from both the private and public health sectors across South Australia. Disparities in CRC treatment were also explored. Linking information from the South Australian Cancer Registry, hospital separations, radiotherapy services and hospital-based cancer registry systems provided data on the socio-demographic, clinical and treatment characteristics for 4641 CRC patients, aged 50-79 years, diagnosed from 2003 to 2008. Factors associated with receiving site/stage-specific treatments (surgery, chemotherapy and radiotherapy) and overall concordance with treatment guidelines were identified using Poisson regression analysis. About 83% of colon and 56% of rectal cancer patients received recommended treatment. Provision of neo-adjuvant/adjuvant therapies may be less than optimal. Radiotherapy was less likely among older patients (prevalence ratio 0.7, 95% confidence interval 0.5-0.8). Chemotherapy was less likely among older patients (0.7, 0.6-0.8), those with severe or multiple co-morbidities (0.8, 0.7-0.9), and those from rural areas (0.9, 0.8-1.0). Overall discordance with treatment guidelines was more likely among rectal cancer patients (3.0, 2.7-3.3), older patients (1.6, 1.4-1.8), those with multiple co-morbid conditions (1.3, 1.1-1.4), and those living in rural areas (1.2, 1.0-1.3). Greater emphasis should be given to ensure CRC patients who may benefit from neo-adjuvant/adjuvant therapies have access to these treatments.
Evaluation issues in the Swedish Two-County Trial of breast cancer screening: An historical review
Publisher: SAGE Publications
Date: 23-06-2016
Abstract: To summarize debate and research in the Swedish Two-County Trial of mammographic screening on key issues of trial design, endpoint evaluation, and overdiagnosis, and from these to infer promising directions for the future. A cluster-randomized controlled trial of the offer of breast cancer screening in Sweden, with a single screen of the control group at the end of the screening phase forms the setting for a historical review of investigations and debate on issues of design, analysis, and interpretation of results of the trial. There has been considerable commentary on the closure screen of the control group, ascertainment of cause of death, and cluster randomization. The issues raised were researched in detail and the main questions answered in publications between 1989 and 2003. Overdiagnosis issues still remain, but methods of estimation taking full account of lead time and of non-screening influences on incidence (taking place mainly before 2005) suggest that it is a minor phenomenon. Despite resolution of issues relating to this trial in peer-reviewed publications dating from years, or even decades ago, issues that already have been addressed continue to be raised. We suggest that it would be more profitable to concentrate efforts on current research issues in breast cancer diagnosis, treatment, and prevention.
Patient and carer perceptions of cancer care in South Australia
Publisher: CSIRO Publishing
Date: 2009
DOI: 10.1071/AH090645
Abstract: Quality of care from the patient?s perspective is an increasingly important outcome measure for cancer services. Patients? and carers? perceptions of cancer care were assessed through structured telephone interviews, 4?10 months post-discharge, which focused on experiences during the most recent hospital admission. A total of 481 patients with a primary diagnosis of cancer (ICD-10 C codes) were recruited, along with 345 carers nominated by the patients. Perceptions of clinical care were generally positive. Less positive aspects of care included not being asked how they were coping, not being offered counselling, and not receiving written information about procedures. Results also highlighted inadequate discharge processes. Carers were more likely than patients to report negative experiences. Perceptions of care also differed by cancer type.
Clinical characteristics and outcomes of bilateral breast cancer in an Australian cohort
Publisher: Elsevier BV
Date: 04-2011
DOI: 10.1016/J.BREAST.2010.10.004
Abstract: Uncertainty remains about the impact of bilateral breast cancer. Characteristics and outcomes of unilateral and bilateral breast cancer were compared within an Australian multi-institutional cohort. Demographic, tumour and treatment characteristics were compared among unilateral (n = 2336) and bilateral cases (52 synchronous, 35 metachronous) using descriptive analyses. Disease-specific outcomes were investigated using Cox regression modelling to adjust for prognostic and treatment factors. Factors associated with increased risk of bilateral breast cancer included lobular histology (p = 0.046), family history (p = 0.025) and metropolitan residence (p = 0.006). Mastectomy was more common for bilateral cases (p = 0.001) while radiotherapy was less common (p = 0.015). Index metachronous cases were less likely to receive hormonal therapy (p = 0.001). Five-year survivals for metachronous, synchronous and unilateral cases were 79%, 88% and 94%, respectively. Poorer outcomes remained after adjusting for prognostic factors [HR = 2.26, 1.21-4.21]. Our results confirm international findings indicating worse outcomes from bilateral compared with unilateral breast cancer.
Adjuvant therapy following neoadjuvant chemotherapy and surgery for oesophageal adenocarcinoma in patients with clear resection margins
Publisher: Informa UK Limited
Date: 15-02-2021
Clinical outcomes for men with positive surgical margins after radical prostatectomy-results from the South Australian prostate cancer clinical outcomes collaborative community-based registry
Publisher: Elsevier BV
Date: 09-2023
Exploring the epidemiological characteristics of cancers of unknown primary site in an Australian population: Implications for research and clinical care
Publisher: Elsevier BV
Date: 08-2008
DOI: 10.1111/J.1753-6405.2008.00260.X
Abstract: To investigate incidence, mortality and case survival trends for cancer of unknown primary site (CUP) and consider clinical implications. South Australian Cancer Registry data were used to calculate age-standardised incidence and mortality rates from 1977 to 2004. Disease-specific survivals, socio-demographic, histological and secular predictors of CUP, compared with cancers of known primary site, and of CUP histological types, using multivariable logistic regression were investigated. Incidence and mortality rates increased approximately 60% between 1977--80 and 1981--84. Rates peaked in 1993--96. Male to female incidence and mortality rate ratios approximated 1.3:1. Incidence and mortality rates increased with age. The odds of unspecified histological type, compared with the more common adenocarcinomas, were higher for males than females, non-metropolitan residents, low socio-economic areas, and for 1977--88 than subsequent diagnostic periods. CUP represented a higher proportion of cancers in Indigenous patients. Case survival was 7% at 10 years from diagnosis. Factors predictive of lower case survival included older age, male sex, Indigenous status, lower socio-economic status, and unspecified histology type. Results point to poor CUP outcomes, but with a modest improvement in survival. The study identifies socio-demographic groups at elevated risk of CUP and of worse treatment outcomes where increased research and clinical attention are required.
Pre-treatment serum lactate dehydrogenase as a biomarker in small cell lung cancer.
Publisher: Wiley
Date: 08-03-2020
DOI: 10.1111/AJCO.12674
Abstract: Small cell lung cancer is a rapidly progressive disease with high fatality. No sensitive and specific biomarker to assist in managing this disease exists currently. Role of pretreatment serum lactate dehydrogenase as a biomarker in small cell lung cancer. A hospital-based cancer registry was used to identify eligible patients from 1999 to 2009. Demographic data, lactate dehydrogenase level and clinical outcome of patients were collected for analysis. One hundred and sixty-eight patients were identified: 61% (n = 103) males and 39% (n = 65) females. Majority had extensive stage (67%). High lactate dehydrogenase (≥230 U/L) was present in 60.4% (n = 75) mean reading 260 U/L (range 148-898 U/L) in limited stage and 470 U/L (range 116-5462 U/L) in extensive stage. Extensive stage patients with high lactate dehydrogenase had lower treatment response rate compared to those with normal lactate dehydrogenase (39% vs 79%, P = 0.002) no difference in treatment response was seen among patients with limited stage. High lactate dehydrogenase conferred a worse survival mean overall survivals in limited and extensive stage were 8.0 and 5.2 months, respectively, in patients with elevated lactate dehydrogenase. Those with normal lactate dehydrogenase had an overall survival of 16.5 and 8.2 months, respectively. The association remained significant after adjustment for age, sex and treatment (HR 1.8, 95% CI 1.16-2.80, P = 0.009). High pretreatment lactate dehydrogenase is a prognostic marker of survival in both stages of small cell lung cancer. It is also a predictive marker of response to therapy in extensive stage. Larger prospective studies to validate our findings would be beneficial.
Clinical and functional outcomes for risk‐appropriate treatments for prostate cancer
Publisher: Wiley
Date: 12-09-2023
DOI: 10.1002/BCO2.288
Impact of hormone replacement therapy use on mammographic screening outcomes
Publisher: Springer Science and Business Media LLC
Date: 07-05-2013
DOI: 10.1007/S10552-013-0221-1
Abstract: This study aims to measure the impact of HRT use at the time of screening on rates of screen-detected invasive breast cancer (IBC) and ductal carcinoma in situ (DCIS), interval cancers and investigative procedures, within a well-established population-based mammography screening program. Using South Australian BreastScreen data from 1998 to 2009 pertaining to 819,722 screening episodes, Poisson regression models were undertaken to estimate the incidence risk ratios (IRR) for various screening outcomes at both the first and subsequent screening rounds, among women who had been using HRT in the 6 months prior to screening compared with those who had not. Current HRT use was associated with increased risk of recall for assessment, biopsy procedures, and breast cancer diagnosis among BreastScreen participants. Risk of screen-detected breast cancer was increased at subsequent screening rounds (IRR = 1.30, 95% confidence interval 1.18-1.34), but not at women's first screening round (1.05, 0.88-1.25). This increased risk applied to IBC (1.35, 1.27-1.45), but not to DCIS (1.04, 0.89-1.23). Interval cancer risk was elevated among HRT users following both the first screen (1.77, 1.33-2.37) and subsequent screening episodes (1.92, 1.72-2.15). Increased risks of recall, biopsy rates, screen-detected, and interval cancers among HRT users have important implications for population-based breast cancer screening programs. Our findings support the concept that HRT use may increase the growth of preexisting cancers. Lack of effect on DCIS could imply different etiology or time frames for DCIS and IBC development or increased transition from preinvasive to invasive disease due to HRT use.
Imaging Biomarkers as Predictors for Breast Cancer Death
Publisher: Hindawi Limited
Date: 10-04-2019
DOI: 10.1155/2019/2087983
Abstract: Background . To differentiate the risk of breast cancer death in a longitudinal cohort using imaging biomarkers of tumor extent and biology, specifically, the mammographic appearance, basal phenotype, histologic tumor distribution, and conventional tumor attributes. Methods . Using a prospective cohort study design, 498 invasive breast cancer patients diagnosed between 1996 and 1998 were used as the test cohort to assess the independent effects of the imaging biomarkers and other predictors on the risk of breast cancer death. External validation was performed with a cohort of 848 patients diagnosed between 2006 and 2010. Results . Mammographic tumor appearance was an independent predictor of risk of breast cancer death (P=0.0003) when conventional tumor attributes and treatment modalities were controlled. The casting type calcifications and architectural distortion were associated with 3.13-fold and 3.19-fold risks of breast cancer death, respectively. The basal phenotype independently conferred a 2.68-fold risk compared with nonbasal phenotype. The observed deaths did not differ significantly from expected deaths in the validation cohort. The application of imaging biomarkers together with other predictors classified twelve categories of risk for breast cancer death. Conclusion . Combining imaging biomarkers such as the mammographic appearance of the tumor with the histopathologic distribution and basal phenotype, accurately predicted long-term risk of breast cancer death. The information may be relevant for determining the need for molecular testing, planning treatment, and determining the most appropriate clinical surveillance schedule for breast cancer patients.
Patient-reported functional outcome measures and treatment choice for prostate cancer
Publisher: Springer Science and Business Media LLC
Date: 05-11-2022
DOI: 10.1186/S12894-022-01117-1
Abstract: The aim of this study was to describe changes in patient-reported functional outcome measures (PROMs) comparing pre-treatment and 12 months after radical prostatectomy (RP), external beam radiation therapy (EBRT), brachytherapy and active surveillance (AS). Men enrolled from 2010 to 2019 in the South Australian Prostate Cancer Clinical Outcomes Collaborative registry a prospective clinical registry were studied. Urinary, bowel, and sexual functions were measured using Expanded Prostate Cancer Index Composite (EPIC-26) at baseline and 12 months post-treatment. Higher scores on the EPIC-26 indicate better function. Multivariable regression models were applied to compare differences in function and extent of bother by treatment. Of the 4926 eligible men, 57.0% underwent RP, 20.5% EBRT, 7.0% brachytherapy and 15.5% AS. While baseline urinary and bowel function varied little across treatment groups, sexual function differed greatly (adjusted mean scores: RP = 56.3, EBRT = 45.8, brachytherapy = 61.4, AS = 52.8 p 0.001). Post-treatment urinary continence and sexual function declined in all treatment groups, with the greatest decline for sexual function after RP (adjusted mean score change − 28.9). After adjustment for baseline differences, post-treatment sexual function scores after EBRT (6.4 95%CI, 0.9–12.0) and brachytherapy (17.4 95%CI, 9.4–25.5) were higher than after RP. Likewise, urinary continence after EBRT (13.6 95%CI, 9.0-18.2), brachytherapy (10.6 95%CI, 3.9–17.3) and AS (10.6 95%CI, 5.9–15.3) were higher than after RP. Conversely, EBRT was associated with lower bowel function (− 7.9 95%CI, − 12.4 to − 3.5) than RP. EBRT and AS were associated with lower odds of sexual bother (OR 0.51 95%CI, 0.29–0.89 and OR 0.60 95%CI, 0.38–0.96, respectively), and EBRT with higher odds of bowel bother (OR 2.01 95%CI, 1.23–3.29) compared with RP. The four common treatment approaches for prostate cancer were associated with different patterns of patient-reported functional outcomes, both pre- and 12 months post-treatment. However, after adjustment, RP was associated with a greater decline in urinary continence and sexual function than other treatments. This study underscores the importance of collecting baseline PROMs to interpret post-treatment functional outcomes.
Human α-L-fucosidase: Complete coding sequence form cDNA clones
Publisher: Elsevier BV
Date: 10-1989
DOI: 10.1016/0006-291X(89)91739-7
Abstract: The human lysosomal storage disorder fucosidosis results from the deficiency of alpha-L-fucosidase, a lysosomal enzyme essential for the catabolism of oligosaccharides containing alpha-L-fucosides. cDNA clones coding for human alpha-L-fucosidase have been isolated from lambda gt10 and lambda gt11 cDNA libraries derived from human liver, placenta and colon. Compilation of cDNA sequences results in a nucleotide sequence of 2053 base pairs encoding alpha-L-fucosidase. The sequence contains an open reading frame of 461 amino acids beginning with the first in-frame methionine and includes 439 amino acids which comprise the mature protein in addition to a hydrophobic signal peptide sequence of 22 amino acids.
A retrospective analysis of Victorian and South Australian clinical registries for prostate cancer: trends in clinical presentation and management of the disease
Publisher: Springer Science and Business Media LLC
Date: 05-08-2016
Related Organisations
King's College London
Location: United Kingdom of Great Britain and Northern Ireland
University Of South Australia Sansom Institute For Health Research
Location: Australia
Related Funding Activities
Quantifying Breast Cancer Overdiagnosis In An Organised Mammography Screening Program
Start Date: 2011
End Date: 2014
Funder: National Breast Cancer Foundation
View Funded Activity