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Active Surveillance: Are We Failing Multiethnic Patients at Safety-Net Hospitals?
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Volume 96 Number 2S Supplement 2016 SRT recommendations. Decision quality was improved among patients considering SRT after RP exposed to their GC test results. Author Disclosure: S.D. Perrapato: None. J. Gore: None. M. du Plessis: None. M. Santiago-Jimenez: Stock; GenomeDx Biosciences. K. Yousefi: Stock; GenomeDx Biosciences. D. Thompson: Independent Contractor; GenomeDx Biosciences. D. Chen: Honoraria; UroToday. Consultant; UroToday. Stock; Pfizer. W. Clark: None. M. Franks: Speaker’s Bureau; Asrellas. L. Karsh: Honoraria; Astellas, Bayer, Medivation Janssen, Dendreon, Medivation. Consultant; Astellas, Bayer, Medivation Janssen, Dendreon, Medivation. Speaker’s Bureau; Astellas, Bayer, Medivation Janssen, Dendreon, Medivation. A. Kibel: Consultant; Dendreon, Sanofi Aventis, MTG, Tokai Pharmaceuticals, Inc., Profound. B. Lane: None. Y. Lotan: Consultant; Danone Inc., Pacific Edge. W. Lowrance: Consultant; MDx Health. P. Maroni: None. E. Trabulsi: None. R. Waterhouse: Partner; Carolina Urology Partners. Honoraria; Asrellas, Myriad. Consultant; Astellas, Myriad. Speaker’s Bureau; Astellas, Myriad. Stock; Carolina Urology Partners. Medical Director, Chief Medical Officer; Carolina Urology Partners. E. Davicioni: Partner; GenomeDx Biosciences. Stock; GenomeDx Biosciences. Partnership; GenomeDx Biosciences. Royalty; GenomeDx Biosciences. Patent/License Fees/Copyright; GenomeDx Biosciences. CSO, Board Member and Director; GenomeDx Biosciences. D. Lin: Consultant; Myriad, Astellas.
2544 Active Surveillance: Are We Failing Multiethnic Patients at SafetyNet Hospitals? L.K. Ballas, R. Kraus, L. Ji, R. Jennelle, and S. Groshen; University of Southern California, Keck School of Medicine, Los Angeles, CA Purpose/Objective(s): Active surveillance (AS) has increasingly been accepted as a safe approach for the management of favorable-risk prostate cancer (PCa) patients. AS, as opposed to observation, requires men to adhere to a defined follow-up protocol. Multiple large prospective studies have shown low rates of PCa progression, PCa mortality, and long periods without intervention 5-10 years after initiating AS. These large prospective studies evaluating safety and outcomes have, for the most part, neglected to include multi-ethnic populations. These studies have also been prospective in nature and thus have high compliance rates. Based on our experience at a large safety-net hospital with a multi-ethnic patient population, we hypothesize that many men do not comply with active surveillance and are lost to follow up. Materials/Methods: We performed a retrospective chart review of patients with non-metastatic prostate cancer who initiated radiation therapy (RT), radical prostatectomy (RP), or active surveillance (AS) at Los Angeles County Hospital (LAC) between 1/1/2008-6/1/2015. The AS cohort was categorized into four groups based on their AS status on 6/ 1/2015: 1) Still on AS, 2) Ended AS for PCa-related reasons, 3) Ended AS due to other reasons (comorbidities, moved, or transferred care), and 4) Lost to follow-up (missed two consecutive visits with no explanation). Results: We found 116 patients who met the AS criteria of this study. The median age was 62 years (range: 47-79). The median Gleason score of men who opted for AS was 6 and their median PSA was 6.23 ng/mL. Sixty-six percent of all patients seen during the study time period with Gleason 6 disease opted for AS. Fifty-nine percent of men who chose AS were Hispanic, and of the Latino population seen at LAC with PCa, 42% selected AS compared to 24% of non-Latinos (P < 0.001). At the time of data collection, 31/116 (27%) of men were still on AS. The majority of patients came off AS because they were lost to follow-up. Thirty-three percent of patients on AS were lost to follow-up within the first year, with 50% lost to follow-up within 2 years. This pattern was seen across all ethnic groups. Interestingly, the further a patient lived from LAC, the more likely he was to continue follow-up on AS.
Conclusion: Active Surveillance is failing multi-ethnic patients in safety net hospitals. This patient population is lost to follow up at high rates within the first two years of active surveillance. More investigation is needed to evaluate the potential barriers to AS for patients in safety net hospitals. Author Disclosure: L.K. Ballas: None. R. Kraus: Employee; USC Department of Family Medicine. L. Ji: None. R. Jennelle: None. S. Groshen: None.
2545 Exploring Heterogeneity Within Hispanic/Latino Men Diagnosed With Prostate Cancer to Identify at-Risk US Populations F.M. Chinea, V. Patel, N. Lamichhane, D. Kwon, S. Punnen, E.N. Kobetz, M.C. Abramowitz, and A. Pollack; University of Miami, Miami, FL Purpose/Objective(s): Non-Hispanic Black men have the highest incidence in and mortality from prostate cancer (PCa) compared to any other racial/ethnic group. Little has been studied within the U.S. Hispanic / Latino community, a heterogeneous population consisting of individuals from numerous countries and various regions of the world. To our knowledge this is the first study to evaluate the differences in diagnosis and cause-specific mortality within PCa for specific Hispanic subgroups compared to non-Hispanic White (NHW), non-Hispanic Black (NHB), and Asian American/Pacific Islander (AAPI) men. Materials/Methods: Men diagnosed between 2000 and 2012 with localized or regional PCa and a documented T stage (n Z 452,322) were collected from the Surveillance, Epidemiology, and End Results (SEER) database. We compared racial/ethnic groups: NHW (n Z 326,688), NHB (n Z 65,898), Hispanic (n Z 38,537), and AAPI (n Z 21,199). Additionally, we compared Hispanic subgroups: Mexican, Puerto Rican, South or Central American, Cuban, and Dominican. Prostate cancer-specific mortalities (PCSM) for Hispanic subgroups were provided using cumulative incidence curves and risk of PCSM for these subgroups compared to NHW was reported using Fine-Gray competing risks regression. In multivariable analysis, we included age at diagnosis, localized vs. regional disease, no radiation therapy (RT) vs. external beam radiation therapy (EBRT) vs. brachytherapy vs. other vs. refused, a socioeconomic status composite score, insurance status, marital status, and rural vs. urban residence type for adjustment. Results: Compared to NHWs, NHBs and Hispanics had significantly worse outcomes. In multivariable analysis, NHB (HR Z 1.38, 95% CI 1.25 to 1.53, P <0.0001) and Hispanic (HR Z 1.15, 95% CI 1.08 to 1.23, P <0.0001) men had significantly worse PCSM with AAPI (HR Z 0.88, 95% CI 0.81 to 0.96, P Z 0.003) men having better. After disaggregation of Hispanic men into subgroups, we found that Puerto Rican (HR Z 1.72, 95% CI 1.42 to 2.09, P <0.0001) and Mexican (HR Z 1.51, 95% CI 1.38 to 1.66, P <0.0001) men had the higher PCSM. Conclusion: This study suggests the existence of heterogeneity within the Hispanic/Latino population that was previously unknown. We identified a considerably increased PCSM in Puerto Rican and Mexican men diagnosed within the US. Further investigation is warranted to uncover the underlying contributing factors including sociocultural and biological influences to explain why these disparities exist. Author Disclosure: F.M. Chinea: None. V. Patel: None. N. Lamichhane: None. D. Kwon: None. S. Punnen: None. E.N. Kobetz: None. M.C. Abramowitz: None. A. Pollack: None.
2546 The Feasibility and Toxicity Analysis of Simultaneous Integrated Boost of 86 Gy to Intraprostatic Tumor Delivered in 39 Fractions C. Onal,1 G. Erbay,2 O.C. Guler,1 B. Akkus Yildirim,1 G. Arslan,3 and S. Sonmez3; 1Baskent University Faculty of Medicine, Department of
Volume 96 Number 2S Supplement 2016 SRT recommendations. Decision quality was improved among patients considering SRT after RP exposed to their GC test results. Author Disclosure: S.D. Perrapato: None. J. Gore: None. M. du Plessis: None. M. Santiago-Jimenez: Stock; GenomeDx Biosciences. K. Yousefi: Stock; GenomeDx Biosciences. D. Thompson: Independent Contractor; GenomeDx Biosciences. D. Chen: Honoraria; UroToday. Consultant; UroToday. Stock; Pfizer. W. Clark: None. M. Franks: Speaker’s Bureau; Asrellas. L. Karsh: Honoraria; Astellas, Bayer, Medivation Janssen, Dendreon, Medivation. Consultant; Astellas, Bayer, Medivation Janssen, Dendreon, Medivation. Speaker’s Bureau; Astellas, Bayer, Medivation Janssen, Dendreon, Medivation. A. Kibel: Consultant; Dendreon, Sanofi Aventis, MTG, Tokai Pharmaceuticals, Inc., Profound. B. Lane: None. Y. Lotan: Consultant; Danone Inc., Pacific Edge. W. Lowrance: Consultant; MDx Health. P. Maroni: None. E. Trabulsi: None. R. Waterhouse: Partner; Carolina Urology Partners. Honoraria; Asrellas, Myriad. Consultant; Astellas, Myriad. Speaker’s Bureau; Astellas, Myriad. Stock; Carolina Urology Partners. Medical Director, Chief Medical Officer; Carolina Urology Partners. E. Davicioni: Partner; GenomeDx Biosciences. Stock; GenomeDx Biosciences. Partnership; GenomeDx Biosciences. Royalty; GenomeDx Biosciences. Patent/License Fees/Copyright; GenomeDx Biosciences. CSO, Board Member and Director; GenomeDx Biosciences. D. Lin: Consultant; Myriad, Astellas.
2544 Active Surveillance: Are We Failing Multiethnic Patients at SafetyNet Hospitals? L.K. Ballas, R. Kraus, L. Ji, R. Jennelle, and S. Groshen; University of Southern California, Keck School of Medicine, Los Angeles, CA Purpose/Objective(s): Active surveillance (AS) has increasingly been accepted as a safe approach for the management of favorable-risk prostate cancer (PCa) patients. AS, as opposed to observation, requires men to adhere to a defined follow-up protocol. Multiple large prospective studies have shown low rates of PCa progression, PCa mortality, and long periods without intervention 5-10 years after initiating AS. These large prospective studies evaluating safety and outcomes have, for the most part, neglected to include multi-ethnic populations. These studies have also been prospective in nature and thus have high compliance rates. Based on our experience at a large safety-net hospital with a multi-ethnic patient population, we hypothesize that many men do not comply with active surveillance and are lost to follow up. Materials/Methods: We performed a retrospective chart review of patients with non-metastatic prostate cancer who initiated radiation therapy (RT), radical prostatectomy (RP), or active surveillance (AS) at Los Angeles County Hospital (LAC) between 1/1/2008-6/1/2015. The AS cohort was categorized into four groups based on their AS status on 6/ 1/2015: 1) Still on AS, 2) Ended AS for PCa-related reasons, 3) Ended AS due to other reasons (comorbidities, moved, or transferred care), and 4) Lost to follow-up (missed two consecutive visits with no explanation). Results: We found 116 patients who met the AS criteria of this study. The median age was 62 years (range: 47-79). The median Gleason score of men who opted for AS was 6 and their median PSA was 6.23 ng/mL. Sixty-six percent of all patients seen during the study time period with Gleason 6 disease opted for AS. Fifty-nine percent of men who chose AS were Hispanic, and of the Latino population seen at LAC with PCa, 42% selected AS compared to 24% of non-Latinos (P < 0.001). At the time of data collection, 31/116 (27%) of men were still on AS. The majority of patients came off AS because they were lost to follow-up. Thirty-three percent of patients on AS were lost to follow-up within the first year, with 50% lost to follow-up within 2 years. This pattern was seen across all ethnic groups. Interestingly, the further a patient lived from LAC, the more likely he was to continue follow-up on AS.
Conclusion: Active Surveillance is failing multi-ethnic patients in safety net hospitals. This patient population is lost to follow up at high rates within the first two years of active surveillance. More investigation is needed to evaluate the potential barriers to AS for patients in safety net hospitals. Author Disclosure: L.K. Ballas: None. R. Kraus: Employee; USC Department of Family Medicine. L. Ji: None. R. Jennelle: None. S. Groshen: None.
2545 Exploring Heterogeneity Within Hispanic/Latino Men Diagnosed With Prostate Cancer to Identify at-Risk US Populations F.M. Chinea, V. Patel, N. Lamichhane, D. Kwon, S. Punnen, E.N. Kobetz, M.C. Abramowitz, and A. Pollack; University of Miami, Miami, FL Purpose/Objective(s): Non-Hispanic Black men have the highest incidence in and mortality from prostate cancer (PCa) compared to any other racial/ethnic group. Little has been studied within the U.S. Hispanic / Latino community, a heterogeneous population consisting of individuals from numerous countries and various regions of the world. To our knowledge this is the first study to evaluate the differences in diagnosis and cause-specific mortality within PCa for specific Hispanic subgroups compared to non-Hispanic White (NHW), non-Hispanic Black (NHB), and Asian American/Pacific Islander (AAPI) men. Materials/Methods: Men diagnosed between 2000 and 2012 with localized or regional PCa and a documented T stage (n Z 452,322) were collected from the Surveillance, Epidemiology, and End Results (SEER) database. We compared racial/ethnic groups: NHW (n Z 326,688), NHB (n Z 65,898), Hispanic (n Z 38,537), and AAPI (n Z 21,199). Additionally, we compared Hispanic subgroups: Mexican, Puerto Rican, South or Central American, Cuban, and Dominican. Prostate cancer-specific mortalities (PCSM) for Hispanic subgroups were provided using cumulative incidence curves and risk of PCSM for these subgroups compared to NHW was reported using Fine-Gray competing risks regression. In multivariable analysis, we included age at diagnosis, localized vs. regional disease, no radiation therapy (RT) vs. external beam radiation therapy (EBRT) vs. brachytherapy vs. other vs. refused, a socioeconomic status composite score, insurance status, marital status, and rural vs. urban residence type for adjustment. Results: Compared to NHWs, NHBs and Hispanics had significantly worse outcomes. In multivariable analysis, NHB (HR Z 1.38, 95% CI 1.25 to 1.53, P <0.0001) and Hispanic (HR Z 1.15, 95% CI 1.08 to 1.23, P <0.0001) men had significantly worse PCSM with AAPI (HR Z 0.88, 95% CI 0.81 to 0.96, P Z 0.003) men having better. After disaggregation of Hispanic men into subgroups, we found that Puerto Rican (HR Z 1.72, 95% CI 1.42 to 2.09, P <0.0001) and Mexican (HR Z 1.51, 95% CI 1.38 to 1.66, P <0.0001) men had the higher PCSM. Conclusion: This study suggests the existence of heterogeneity within the Hispanic/Latino population that was previously unknown. We identified a considerably increased PCSM in Puerto Rican and Mexican men diagnosed within the US. Further investigation is warranted to uncover the underlying contributing factors including sociocultural and biological influences to explain why these disparities exist. Author Disclosure: F.M. Chinea: None. V. Patel: None. N. Lamichhane: None. D. Kwon: None. S. Punnen: None. E.N. Kobetz: None. M.C. Abramowitz: None. A. Pollack: None.
2546 The Feasibility and Toxicity Analysis of Simultaneous Integrated Boost of 86 Gy to Intraprostatic Tumor Delivered in 39 Fractions C. Onal,1 G. Erbay,2 O.C. Guler,1 B. Akkus Yildirim,1 G. Arslan,3 and S. Sonmez3; 1Baskent University Faculty of Medicine, Department of