Characterizing the high-risk prostate cancer patient: evaluation of clinical, oncological, and functional outcomes following robot-assisted radical prostatectomy
Bobby Shayegan, M.D., St. Joseph’s Healthcare Hamilton, St. Joseph’s Healthcare Foundation, McMaster University
Jen Hoogenes, Ph.D.
Ali Al-Hashimi, Ph.D.
Edward D. Matsumoto, M.D.
Richard Austin, Ph.D.
Lead Investigator Bio:
Dr. Bobby Shayegan is a urologic oncologist, an Associate Professor in the Division of Urology at McMaster University, the Head of Surgical Oncology and Cancer Surgery, the Deputy Chief of Surgery, and the Chair of the Robotic Surgical Program at St. Joseph’s Healthcare Hamilton. His clinical practice at St. Joseph’s is devoted to the treatment and management of all risk groups of patients with prostate and bladder cancer, with a specialty in robot-assisted surgical procedures. Dr. Shayegan is heavily involved in clinical research, including clinical trials for new cancer treatments and longitudinal follow-up of cancer patients. Dr. Shayegan will serve as the principal investigator and will provide clinical resources and patient data and remain actively involved throughout the entire study, including data analysis and interpretation and the dissemination of findings.
In Canada, we know that 1 in 7 men will be diagnosed with prostate cancer in their lifetime. It remains the most commonly diagnosed cancer in Canadian men, and the incidence rate continues to increase with proactive screening. Since 2001 however, the mortality rate for prostate cancer has decreased at 3% per year with advances in research to improve diagnosis, treatment and care. At St. Joe’s, our research strives to continue this promising trend and to provide hope to men living with prostate cancer.
Even with recent advances in research and education, we know that pinpointing the optimal treatment for prostate cancer, especially for patients with “high-risk” prostate cancer, remains controversial. Often healthcare professionals are unclear on what constitutes high-risk prostate cancer and, therefore, are unclear on a consistent and proven treatment path. That is why it’s vital we characterize what defines high-risk prostate cancer and work towards developing treatment guidelines so we can provide patients with the best possible treatment. This study will examine patient data and contribute much-needed evidence to support the development of treatment guidelines for high-risk prostate cancer at our Hospital and beyond. Our goal is to ultimately improve patients’ quality of life and cancer control.
Recent data show that 1 in 7 Canadian men will be diagnosed with prostate cancer (PCa) in their lifetime. Of an estimated 21,300 Canadian men diagnosed in 2017, approximately 19% will die from the disease. The mortality rate has declined by an average of 3.3% per year since 2001; however, the incidence rate has risen significantly due to increased screening via prostate-specific antigen (PSA) testing. Most patients present at an early localized stage, with a five-year survival rate of 99%, while the same rate of those with advanced disease (high-risk) is approximately 29%. A lack of consensus exists as to what defines high-risk PCa, and research to characterize this population is vital to determining best practice treatment guidelines. Radical prostatectomy has been increasingly performed as a first-line treatment for high-risk PCa with a curative intent, yet outcomes reported in the literature vary considerably. We aim to characterize high-risk patients who have undergone robot-assisted radical prostatectomy at St. Joseph’s Healthcare Hamilton by analyzing oncological and functional outcomes. We anticipate that our data will improve our understanding of the disease process in high-risk patients, allowing us to be better equipped to tailor treatment modalities to improve cancer control and quality of life.
Impact on prostate cancer patients:
Results from this proposed study have the potential to significantly advance the knowledge of the high-risk PCa patient population in terms of characterizing the “high-risk patient” upon initial presentation (baseline) and longitudinally evaluating the oncological, clinical, and functional outcomes following RARP. Evaluating these outcomes can inform best practice guidelines for the initial treatment of high-risk patients and any subsequent treatments required in cases of biochemical recurrence. The results of this research can guide high-risk PCa treatment and implementation of different modalities based on specific patient attributes, which can improve cancer control, thereby significantly impacting health-related quality of life in high-risk patients. Furthermore, the anticipated results of this study can inform treatment decision-making, allowing urologists to provide evidence-based treatment options, allowing patients to have the knowledge to weigh the benefits and risks of different modalities in order to make informed treatment choices with increased levels of confidence. Importantly, we anticipate that the results will equip urologists to better tailor treatment to the individual PCa patient. Furthermore, with improved evidence-based treatment decision-making, patients can play a more active role in their own course of PCa treatment.