Understanding the Adoption and Impact of New Risk Assessment Technologies in Prostate Cancer Care

了解新风险评估技术在前列腺癌护理中的采用和影响

• 批准号: 10526667
• 负责人: Michael Stuart Leapman
• 金额: $ 12.72万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-01 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10526667
• 关键词: Address; Adoption; Affect; Clinical; Clinical Management; Clinical Trials; Controlled Study; Data; Data Set; Decision Making; Development; Diagnosis; Disease; Disease Management; Genomics; Goals; Health Sciences; High Prevalence; Image; Indolent; Interview; Knowledge; Learning; Magnetic Resonance Imaging; Malignant Neoplasms; Malignant neoplasm of prostate; Mentored Research Scientist Development Award; Methods; Monitor; Nature; Outcome; Patient Care; Patients; Phase; Physicians; Positioning Attribute; Prostate; Qualitative Research; Research; Research Personnel; Risk; Risk Assessment; Shapes; Surgeon; Technology; Technology Assessment; Testing; Training Programs; Uncertainty; Universities; Work; cancer care; cancer risk; comparative; cost; implementation science; improved; men; new technology; overtreatment; patient oriented; practice setting; prostate cancer risk; side effect; skills; tool; unnecessary treatment

PROJECT SUMMARY/ABSTRACT New, expensive risk assessment technologies are rapidly being integrated into the care of patients with prostate cancer. Advanced imaging (prostate MRI) and genomic tests have been developed and are now deployed to overcome a central challenge in the management of the disease: a remarkably high prevalence, yet comparatively low lethality. For decades, uncertainty regarding the true nature of a patient's prostate cancer has led to the unnecessary treatment of indolent (`low-risk') disease in millions of men resulting in lasting side-effects for many. By improving the ability to distinguish low-risk from aggressive cancers, it is believed that more accurate tools will allow many patients to safely observe low-risk cancers with careful monitoring (active surveillance). Although these two ascendant technologies have been evaluated in controlled studies, no real-world evidence is available to understand their impact. Specifically, it is not known which patients are receiving testing, whether use of these technologies reduces unnecessary treatment, or how patients and doctors perceive of their benefit. To address these knowledge gaps, we aim to comprehensively understand how prostate MRI and genomic testing impact the management of prostate cancer. We will accomplish this goal through two complementary phases aimed at: (1) defining how adoption of prostate MRI and/or genomic testing has affected clinical management, and (2) understanding how patients and physicians perceive of these tools during decision-making. We hypothesize that whether or not prostate MRI and/or genomic testing are performed is dependent on the doctor that they see, but that testing is associated with lower rates of treatment. We will use large national datasets of men with prostate cancer and examine the adoption of prostate MRI and/or genomic testing, and whether the use of these technologies is associated with increased use of observation versus treatment. To learn how these tools are used in decision-making for low- risk prostate cancer, we will conduct in-depth interviews of both patients with prostate cancer and doctors who diagnose and treat the disease. The results from this research will shape efforts to improve how these tools are used in the management of men with prostate cancer. Candidate: this proposal supports the professional development of the candidate as an independent, patient-oriented surgeon-investigator focusing on improving prostate cancer care. This application is centered around a rigorous training program including coursework that leverages the candidate's background as a prostate cancer surgeon and clinical outcomes researcher whose prior work has focused on risk assessment technologies and active surveillance of low-risk prostate cancer. The applicant will build upon his expertise by earning a Masters in Health Science from Yale University, and develop a skill set in qualitative research and implementation science. The completion of this mentored training award will position the candidate to develop and test a framework for refining the use of new technologies for patients with prostate cancer, potentially reducing over-treatment and cost.

项目摘要/摘要 新的，昂贵的风险评估技术正在迅速整合到患者的护理中 前列腺癌。已经开发了高级成像（前列腺MRI）和基因组检验，现在正在 部署以克服疾病管理中的核心挑战：一个非常高的患病率， 但相对较低的致命性。几十年来，关于患者前列腺的真实本质的不确定性 癌症导致不必要地治疗数百万男性的懒惰（“低风险”）疾病 许多人的持久副作用。通过提高将低风险与侵略性癌症区分开的能力，这是 相信更准确的工具将使许多患者谨慎地发现低风险癌症 监视（主动监视）。尽管这两种上升技术已在受控中评估 研究，没有现实世界的证据可以理解其影响。具体来说，尚不清楚哪个 患者正在接受测试，使用这些技术是否会减少不必要的治疗，或者如何 患者和医生认为自己的利益。为了解决这些知识差距，我们旨在全面 了解前列腺MRI和基因组测试如何影响前列腺癌的管理。我们将 通过两个互补阶段来实现这一目标：（1）定义如何采用前列腺MRI 和/或基因组测试影响了临床管理，以及（2）了解患者和医生如何 在决策过程中感知这些工具。我们假设是否前列腺MRI和/或 进行基因组测试取决于他们看到的医生，但是该测试与 较低的治疗率。我们将使用大型国家患有前列腺癌男性的国家数据集并检查 采用前列腺MRI和/或基因组测试，以及这些技术的使用是否与 观察与治疗的使用增加。要了解如何将这些工具用于决策中的低 - 风险前列腺癌，我们将对前列腺癌患者和医生进行深入的访谈 诊断和治疗疾病。这项研究的结果将构成改善这些工具的努力 用于治疗前列腺癌男性。候选人：该建议支持专业人士 将候选人作为独立的，以患者为导向的外科医生评估者的发展，致力于改善 前列腺癌护理。该应用程序集中于严格的培训计划，包括课程 利用候选人的背景作为前列腺癌外科医生和临床结果研究人员 先前的工作重点是风险评估技术和对低风险前列腺癌的积极监视。 申请人将通过从耶鲁大学获得健康科学硕士学位，并以其专业知识为基础 发展定性研究和实施科学方面的技能。这项指导培训的完成 奖项将使候选人定位，以开发和测试一个框架，以完善新技术的使用 前列腺癌的患者可能会降低过度治疗和成本。

项目成果

Adoption of New Risk Stratification Technologies Within US Hospital Referral Regions and Association With Prostate Cancer Management.

• DOI: 10.1001/jamanetworkopen.2021.28646
• 发表时间: 2021-10-01
• 期刊: JAMA network open
• 影响因子: 13.8
• 作者: Leapman MS;Wang R;Park HS;Yu JB;Sprenkle PC;Dinan MA;Ma X;Gross CP
• 通讯作者: Gross CP

How should radiologists incorporate non-imaging prostate cancer biomarkers into daily practice?

• DOI: 10.1007/s00261-020-02496-5
• 发表时间: 2020-12
• 期刊: Abdominal radiology (New York)
• 作者: Rajwa P;Syed J;Leapman MS
• 通讯作者: Leapman MS

National trends in the management of patients with positive surgical margins at radical prostatectomy.

根治性前列腺切除术中手术切缘阳性患者管理的全国趋势。

• DOI: 10.1007/s00345-020-03298-6
• 发表时间: 2021
• 期刊: World journal of urology
• 影响因子: 3.4
• 作者: Ghabili,Kamyar;Park,HenryS;Yu,JamesB;Sprenkle,PrestonC;Kim,SimonP;Nguyen,KevinA;Ma,Xiaomei;Gross,CaryP;Leapman,MichaelS
• 通讯作者: Leapman,MichaelS

Trends in prostatectomy utilization: Increasing upfront prostatectomy and postprostatectomy radiotherapy for high-risk prostate cancer.

• DOI: 10.1002/cam4.3482
• 发表时间: 2020-12
• 期刊: Cancer medicine
• 影响因子: 4
• 作者: Kaps B;Leapman M;An Y
• 通讯作者: An Y

When and How Should Active Surveillance for Prostate Cancer be De-Escalated?

• DOI: 10.1016/j.euf.2020.01.001
• 发表时间: 2021-03-30
• 期刊: EUROPEAN UROLOGY FOCUS
• 影响因子: 5.4
• 作者: Rajwa, Pawel;Sprenkle, Preston C.;Leapman, Michael S.
• 通讯作者: Leapman, Michael S.