‘Hidden’ Prostate Cancer on Biopsy Usually Means Good Outcome: Study | Health News

By Robert Preidt, HealthDay Reporter

(HealthDay)

MONDAY, Nov. 23, 2020 (HealthDay News) — Negative biopsies among early-stage prostate cancer patients who’ve chosen active surveillance are associated with a low risk of disease progression, but they aren’t a sign that their cancer has completely vanished, a new study indicates.

Active surveillance refers to close monitoring for signs of cancer progression — what’s often called “watchful waiting.” Patients sometimes get regular prostate-specific antigen (PSA) testing, prostate exams, imaging and repeat biopsies.

The objective of active surveillance is to avoid or delay treatment and its side effects without putting patients at risk of cancer progression and death.

Sometimes, active surveillance patients have negative biopsies that show no evidence of prostate cancer. While some of these patients may believe that their cancer has “vanished,” they most likely have low-volume or limited, hidden areas of prostate cancer that weren’t detected in the biopsy sample, according to the authors of the study published recently in The Journal of Urology.

“While a negative biopsy is good news, the long-term implications associated with such ‘hidden’ cancers remain unclear,” said study author Dr. Carissa Chu, from the University of California, San Francisco.

For the study, Chu and colleagues analyzed data from 514 men undergoing active surveillance for early-stage prostate cancer between 2000 and 2019. All of them had at least three surveillance biopsies after their initial prostate cancer diagnosis. Median follow-up time was nearly 10 years.

Of those patients, 37% had at least one negative biopsy, including 15% with consecutive negative biopsies, according to the report.

Men with negative biopsies had more favorable disease characteristics, including low PSA density and fewer samples with cancer at the initial prostate biopsy. Negative biopsies were also associated with good long-term outcomes, the researchers said.

After 10 years, rates of survival with no need for prostate cancer treatment (such as surgery or radiation) were 84% for men with consecutive negative biopsies, 74% for those with one negative biopsy and 66% for those with no negative biopsies.

After adjusting for other factors, the researchers concluded that men with one or more negative biopsies were much less likely to have cancer detected on a later biopsy.

“For men undergoing active surveillance, negative biopsies indicate low-volume disease and lower rates of disease progression,” Chu said in a journal news release. “These ‘hidden’ cancers have excellent long-term outcomes and remain ideal for continued active surveillance.”

SOURCE: The Journal of Urology, news release, Nov. 17, 2020

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‘Cardio-obstetrics’ Tied to Better Outcome in Pregnancy With CVD

A multidisciplinary cardio-obstetrics team-based care model may help improve cardiovascular care for pregnant women with cardiovascular disease (CVD), according to a recent study.

“We sought to describe clinical characteristics, maternal and fetal outcomes, and cardiovascular readmissions in a cohort of pregnant women with underlying CVD followed by a cardio-obstetrics team,” wrote Ella Magun, MD, of Columbia University, New York, and coauthors. Their report is in the Journal of the American College of Cardiology.

The researchers reported the outcomes of a retrospective cohort analysis involving 306 pregnant women with CVD, who were treated at a quaternary care hospital in New York City.

They defined cardio-obstetrics as a team-based collaborative approach to maternal care that includes maternal fetal medicine, cardiology, anesthesiology, neonatology, nursing, social work, and pharmacy.

More than half of the women in the cohort (53%) were Hispanic and Latino, and 74% were receiving Medicaid, suggesting low socioeconomic status. Key outcomes of interest were cardiovascular readmissions at 30 days, 90 days, and 1 year. Secondary endpoints included maternal death, need for a left ventricular assist device or heart transplantation, and fetal demise.

The most frequently observed forms of CVD were arrhythmias (29%), cardiomyopathy (24%), congenital heart disease (24%), valvular disease (16%), and coronary artery disease (4%). The median Cardiac Disease in Pregnancy (CARPREG II) score was 3, and 43% of women had a CARPREG II score of 4 or higher.

After a median follow-up of 2.6 years, the 30-day and 90-day cardiovascular readmission rates were 1.9% and 4.6%, which was lower than the national 30-day postpartum rate of readmission (3.6%). One maternal death (0.3%) occurred within a year of delivery (woman with Eisenmenger syndrome).

“Despite high CARPREG II scores in this patient population, we found low rates of maternal and fetal complications with a low rate of 30- and 90-day readmissions following delivery,” the researchers wrote.

Experts Weigh In

“We’re seeing widely increasing interest in the implementation of cardio-obstetrics models for multidisciplinary collaborative care and initial studies suggest these team-based models improve pregnancy and postpartum outcomes for women with cardiac disease,” said Lisa M. Hollier, MD, past president of the American College of Obstetricians and Gynecologists and professor at Baylor College of Medicine in Houston.

Magun and colleagues acknowledged that a key limitation of the present study was the retrospective, single-center design.

“With program expansions over the next 2-3 years, I expect to see an increasing number of prospective studies with larger sample sizes evaluating the impact of cardio-obstetrics teams on maternal morbidity and mortality,” Hollier said.

“These findings suggest that our cardio-obstetrics program may help provide improved cardiovascular care to an otherwise underserved population,” the authors concluded.

In an editorial accompanying the reports, Pamela Ouyang, MBBS, and Garima Sharma, MD, wrote that, although this study wasn’t designed to assess the benefit of cardio-obstetric teams relative to standard of care, its implementation of a multidisciplinary team-based care model showed excellent long-term outcomes.

The importance of coordinated postpartum follow-up with both cardiologists and obstetricians is becoming increasingly recognized, especially for women with

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