Publications by authors named "Freedland S"

Preclinical studies suggest synergistic effects between androgen receptor inhibitors and poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitors. This phase 2 trial (NCT05223582) evaluates neoadjuvant fuzuloparib plus abiraterone in 35 treatment-naive men with localized high-risk prostate cancer. Patients receive six cycles of therapy followed by radical prostatectomy.

View Article and Find Full Text PDF

EMBARK demonstrated prolonged metastasis-free survival with enzalutamide ± leuprolide versus leuprolide alone for patients with high-risk biochemical recurrence of prostate cancer, with health-related quality of life (HRQoL) maintained. To evaluate treatment effects on sexual activity (SA), item-level analyses of SA-related HRQoL were performed. HRQoL was assessed (baseline, every 12 wk) until metastasis or death.

View Article and Find Full Text PDF

Background: It is important to understand the relationship between drug efficacy measured in randomized clinical trials (RCTs) and real-world drug effectiveness. We estimate how RCT overall survival (OS) and RCT radiographic progression-free survival (rPFS) benefits predict the association between treatments and real-world OS gains for metastatic castration-resistant prostate cancer (mCRPC) drugs.

Methods: Using the National Cancer Institute list of approved cancer drugs and the National Comprehensive Cancer Network Treatment Guidelines, we identified all pharmaceutical therapies for mCRPC approved between 2010 and 2019.

View Article and Find Full Text PDF

Introduction: Racial disparities in prostate cancer (PC) are well studied among Black or African American (BAA) patients but not among Hispanics, a quickly growing US minority group. This study compared overall survival (OS) and healthcare resource utilization (HRU) by race in Medicaid-insured patients with metastatic castration-sensitive PC (mCSPC) and metastatic castration-resistant PC (mCRPC).

Materials And Methods: A retrospective longitudinal cohort study of Medicaid claims was conducted to estimate racial disparities in OS (with a multivariable Cox proportional hazards model) and in HRU (with a multivariable Poisson model), adjusting for confounding by demographic and clinical characteristics.

View Article and Find Full Text PDF

Background: Adverse pathology (AP) is often used as an intermediate end point for long-term outcomes in men with prostate cancer (PCa) who are active surveillance candidates. The association between a commonly used AP definition and long-term outcomes was tested, which identified definitions more strongly linked to a high risk of metastasis.

Methods: Data were reviewed from the Shared Equal Access Regional Cancer Hospital cohort of men undergoing radical prostatectomy (RP) from 1988 to 2020 at nine Veterans Affairs hospitals.

View Article and Find Full Text PDF

Background: Guidelines for prostate cancer treatment in men with limited life expectancy are based on expert opinion. Patient preferences for when to defer treatment based on longevity are unknown. We sought to define life expectancy thresholds at which men are more likely to choose conservative management in the context of varying risks of cancer death and treatment-related side effects.

View Article and Find Full Text PDF

Importance: Clarifying the underutilization of treatment intensification (TI) for metastatic castration-sensitive prostate cancer (mCSPC) may improve implementation of evidence-based medicine and survival outcomes.

Objective: To investigate physicians' beliefs about TI in mCSPC to understand the gap between evidence-based guidelines and clinical practice.

Design, Setting, And Participants: This survey study analyzed data from the Adelphi Real World retrospective survey, which comprised physician surveys that were linked to medical record reviews of US adult patients treated for mCSPC between July 2018 and January 2022.

View Article and Find Full Text PDF

Importance: Prostate cancer (PC) care has evolved rapidly as a result of changes in prostate-specific antigen testing, novel imaging, and newer treatments. The impact of these changes on PC epidemiology and racial disparities across disease states remains underexplored.

Objective: To characterize racial and ethnic differences in the epidemiology of PC states, including nonmetastatic hormone-sensitive PC (nmHSPC), metastatic HSPC (mHSPC), nonmetastatic castration-resistant PC (nmCRPC), and metastatic CRPC (mCRPC).

View Article and Find Full Text PDF

Objectives: The objective of this study is to investigate the association between the use of beta-adrenergic antagonist atenolol and risk of pathologic upgrade in patients on active surveillance, considering growing literature implicating adrenergic innervation with disease progression mediated through beta-adrenergic signalling.

Patients And Methods: Men with low-risk or favourable intermediate-risk prostate cancer who were placed on an active surveillance protocol between 2006 and 2020 across three diverse urban hospitals were included. Exposure was duration of atenolol use, and outcome was pathologic grade group upgrading (to GG ≥ 3) on final prostate biopsy.

View Article and Find Full Text PDF

Background: Patients with high-risk localized and locally advanced prostate cancer (HR-LPC/LAPC) have increased risk of metastasis, leading to reduced survival rates. Segmenting the disease course [time to recurrence, recurrence to metastasis, and post-metastasis survival (PMS)] may identify disease states for which the greatest impacts can be made to ultimately improve survival.

Objective: Evaluate real-world PMS of patients with HR-LPC/LAPC who received primary radical prostatectomy (RP) or radiotherapy (RT) with or without androgen deprivation therapy (ADT).

View Article and Find Full Text PDF

Background: For metastatic and certain advanced prostate cancer (PC), guidelines support intensified androgen deprivation therapy (ADT) as first-line (1L) systemic treatment for improved outcomes. However, some patients receive ADT alone, leading to tumor progression requiring 2nd line therapy. Despite significant racial disparities in PC outcomes, there are no population-level studies assessing racial differences in time to subsequent treatment after 1L ADT.

View Article and Find Full Text PDF

Purpose: Prior studies testing the association between insulin resistance (IR) and prostate cancer (PC) risk are inconsistent. We examined the association between Homeostatic Assessment of Insulin Resistance (HOMA-IR; calculated from fasting baseline insulin and glucose) and PC in REDUCE, a 4-year randomized trial of dutasteride vs. placebo for PC prevention.

View Article and Find Full Text PDF
Article Synopsis
  • Racial disparities in prostate cancer care were studied, revealing improved MRI utilization for detection over time, particularly from 3.8% in 2012 to 32.6% in 2019 among nearly 91,000 patients.
  • The gap in MRI use between non-Hispanic Black and non-Hispanic White patients narrowed significantly, though rural residents remained less likely to receive the procedure.
  • The study suggests focusing public health interventions on geographical disparities, as income and education also influence MRI usage, and emphasizes the need for further research into the causes of these inequities.
View Article and Find Full Text PDF
Article Synopsis
  • - The study investigates the impact of prostate-specific antigen doubling time (PSADT) on patients with biochemical recurrence (BCR) of nonmetastatic castration-sensitive prostate cancer (nmCSPC), analyzing data from the Veterans Health Administration between 2006 and 2020.
  • - Patients were grouped based on rapid (≤9 months) and less rapid (>9 to ≤15 months) PSADT; rapid PSADT correlated with significantly shorter times to first treatment and worse outcomes in terms of metastasis, metastasis-free survival, and overall survival.
  • - The findings suggest that patients with rapid PSADT typically started secondary treatment within a year of BCR, and early treatment appears to yield better outcomes compared to historical data
View Article and Find Full Text PDF

Background: Patients with advanced prostate cancer (PC) commonly experience fatigue related to the disease itself and its treatment, which affects their quality of life. There are limited real-world data available on patients' experiences of fatigue while receiving PC treatment and its management.

Patients And Methods: This was a cross-sectional, noninterventional qualitative study involving individual concept-elicitation interviews with patients in the United States.

View Article and Find Full Text PDF
Article Synopsis
  • The review discusses the effectiveness of novel hormonal therapies (NHTs) and androgen receptor pathway inhibitors in treating castration-sensitive prostate cancer (CSPC), particularly in metastatic cases (mCSPC).
  • Despite strong evidence showing that combining NHT with androgen deprivation therapy (ADT) extends life and improves quality of life, many patients are still only receiving single-agent ADT due to various barriers, including patient and physician misconceptions and access issues.
  • For patients facing biochemical recurrence without metastasis, treatment strategies are being developed based on risk factors and characteristics, and early initiation of NHT may be beneficial for high-risk patients, alongside lifestyle management to counteract treatment side effects.
View Article and Find Full Text PDF

Dynamic alterations in cellular phenotypes during cancer progression are attributed to a phenomenon known as 'lineage plasticity'. This process is associated with therapeutic resistance and involves concurrent shifts in metabolic states that facilitate adaptation to various stressors inherent in malignant growth. Certain metabolites also serve as synthetic reservoirs for chromatin modification, thus linking metabolic states with epigenetic regulation.

View Article and Find Full Text PDF

Importance And Objective: Partial gland ablation (PGA) is increasingly popular as a treatment for men with intermediate-risk prostate cancer (IR-PCa) to preserve functional outcomes while controlling their cancer. We aimed to determine the impact of race and clinical characteristics on the risk of upstaging (≥pT2c) and having adverse pathological outcomes including seminal vesicle invasion (SVI), extra prostatic extension (EPE) and lymph node invasion (LNI) at radical prostatectomy (RP) among men with IR disease eligible for PGA with hemi-ablation (HA).

Design: Retrospective analysis.

View Article and Find Full Text PDF

Background: Black men are at a higher risk of prostate cancer (PC) diagnosis and present with more high-grade PC than White men in an equal access setting. This study aimed to identify differential transcriptional regulation between Black and White men with PC.

Methods: We performed microarray of radical prostatectomy tissue blocks from 305 Black and 238 White men treated at the Durham Veterans Affairs Medical Center.

View Article and Find Full Text PDF

Background: Despite the rise in gender-affirming care, our understanding of prostate cancer (PCa) in transgender women (TGW) remains in its infancy. Health disparities and lack of PCa awareness and screening are possible barriers to providing quality care for this population. In addition, the implication of hormonal manipulation for the aggressiveness of PCa in TGW is yet to be determined.

View Article and Find Full Text PDF

Background: There are no population-level studies assessing F-fluciclovine (fluciclovine) utilization of Positron emission tomography/computed tomography (PET/CT) for biochemically recurrent prostate cancer (PC). We assessed fluciclovine PET/CT in the Veterans Affairs Health Care System.

Methods: Of 1153 men with claims suggesting receipt of fluciclovine PET/CT, we randomly reviewed charts of 300 who indeed underwent fluciclovine PET/CT.

View Article and Find Full Text PDF