^(68)Gallium-labelled PSMA-PET/CT as a diagnostic and clinical decision-making tool in Asian prostate cancer patients following prostatectomy

Objective: Prostate cancers(PCa) in Asian individuals are molecularly distinct from those found in their Caucasian counterparts.There is no risk stratification tool for Asian men with rapid biochemical recurrence(BCR) following radical prostatectomy(Rad P). This study aims to assess the detection rate of ^(68)Ga-prostate-specific membrane antigen-positron emission tomography/computed tomography(PSMA-PET/CT) for diagnosis of clinical recurrence and as a treatment decision making tool in Asian patients with BCR post-Rad P.Methods: ^(68)Ga PSMA-PET and CT body with/without bone scan [conventional workup(CWU)] were performed in 55 Asian patients with BCR within 36 months post-Rad P. Two blinded reviewers assessed the images. Detection rates of ^(68)Ga PSMAPET/CT were evaluated, and impact on management was reviewed by comparison with CWU.Results: Median time to BCR post-Rad P was 8.1 months. Detection rate for ^(68)Ga PSMA-PET/CT was 80%(44/55). A positive scan was significantly associated with increasing prostate-specific antigen(PSA) level [odds ratio(OR) = 1.13(95% CI 1.05–1.30), P =0.017], but not with higher Gleason grade or shorter PSA doubling time. Compared to CWU, ^(68)Ga PSMA-PET/CT detected an additional 106 lesions in 33/44 patients with a positive scan, resulting in a change in management in 25/44(56.8%) patients: 10 to hormonal therapy(HT) and whole pelvis radiotherapy(RT) in addition to bed RT, and 15 to palliative HT alone.Conclusions: In the present report, we demonstrated the diagnostic and treatment decision utility of ^(68)Ga PSMA-PET/CT in Asian men with rapid BCR. Detection of small volume nodal and systemic recurrences at low PSA levels(< 1.0 ng/mL) highlights the role of the tool in assigning patients to treatment intensification with HT-RT or palliative HT in polymetastatic disease.

Transcriptomic analyses of localized prostate cancers of East Asian and North American men reveal race-specific luminal-basal and microenvironmental differences

Dear editor,Prostate cancer(PCa)remains a major healthcare burden in men globally[1].Most patients present with localized disease,and treatment is recommended based on risk classification systems like the National Comprehensive Cancer Network(NCCN)[2].However,these methods are imprecise for estimating metastasis-free survival and prostate cancer-specific mortality and thus biomarkers that can predict tumor aggression are needed[3–5].Several studies have since characterized the molecular landscape of localized PCa in White[4,5]and Black/African-American men[6],but data is lacking in Asian men.The Chinese Prostate Cancer Genome and Epigenome Atlas(CPGEA)reported on the genomic and epigenomic landscape of 208 PCa of men from China[7].Comparative analyses between the CPGEA cohort and data from The Cancer Genome Atlas(TCGA)revealed higher frequencies of Forkhead box A1(FOXA1)and chromodomain-helicase DNA-binding 1(CHD1)mutations,and lower frequencies of phosphatase and tensin homolog(PTEN)mutations and transmembrane protease serine 2-E26 transformationspecific related gene(TMPRSS2-ERG)fusion in Chinese compared with White men[7].These preliminary findings highlight the presence of race-specific differences in molecular phenotypes of PCa.

The impact of the COVID-19 pandemic on nasopharyngeal carcinoma patients-a national cancer centre experience

Purpose or objective The COVID-19 pandemic has resulted in significant healthcare implications,with care for can-cer patients compromised due to resource diversion towards battling the pandemic.We aim to investigate the impact of the peak wave of the pandemic in 2020 on the delivery of cancer care in Singapore,specifically via our nasopharyn-geal carcinoma(NPC)treatment data.This study applies real world numbers to the impact of COVID-19 on cancer care delivery in Singapore.The choice of nasopharyngeal cancer allows a good direct estimate of common treatment measures such as time to biopsy,time to staging scans,time to treatment commencement,due to its clear protocol and algorithms for staging and treatment;thus serving as an excellent surrogate for the effectiveness and timeliness of the different aspects of cancer care delivery.Materials and methods In this retrospective study,we included all patients with newly diagnosed NPC from 1st January to 31st May from 2017 to 2020 at our centre.This time period was chosen as it coincided with the period in 2020 during the COVID-19 pandemic where there was the most strain on healthcare resources and the most restrictions on population movement within Singapore,which may impact on healthcare seeking behaviour.Narrowing down the time period to the first 5 months of the 4 respective years also allowed us to reduce the effect of annual seasonal variation in patient numbers seen as a result of holidays and festive periods such as the Lunar New Year and scheduled school holidays.Electronic medical records(EMR)were accessed.Only newly diagnosed NPC cases were included in our analysis.Patients with second synchronous primary malignancies or NPC disease recurrence were excluded.Data analysis was carried out using a combination of SPSS and Microsoft Excel.Results Significantly,there was a reduction of 37-46.3%in newly diagnosed NPC cases during the peak of the COVID-19 pandemic from January to end May 2020 compared to the preceding three years.Despite the reduction in numbers of newly diagnosed NPC,there was no statistically significant differences in delay from biopsy to the first radiation oncology visit and from biopsy to the first day of treatment in 2020 compared to the preceding years.All the patients treated in our centre also received the standard NPC treatment for their disease stage as per international guidelines.Conclusion We recommend a heightened awareness of the dangers of delaying cancer presentation and care in healthcare policies and resource allocation and at the same time,encourage patient’s confidence in their ability to seek care.With the resurgence of new COVID-19 variants and case numbers worldwide and in Singapore,this study focuses upon the need to be aware of the exigencies of other clinical groups in resource utilization.It would be instructive to compare this study with future long term follow up to investigate the trajectory of our cancer care delivery,as well as survival outcomes.