Toxicity and Patient-Reported Quality-of-Life Outcomes After Prostate Stereotactic Body Radiation Therapy With Focal Boost to Magnetic Resonance Imaging-Identified Prostate Cancer Lesions: Results of a Phase 2 Trial.

PURPOSE: In this prospective phase 2 trial, we investigated the toxicity and patient-reported quality-of-life outcomes in patients treated with stereotactic body radiation therapy (SBRT) to the prostate gland and a simultaneous focal boost to magnetic resonance imaging (MRI)-identified intraprostatic lesions while also de-escalating dose to the adjacent organs at risk. METHODS AND MATERIALS: Eligible patients included low- or intermediate-risk prostate cancer (Gleason score ≤7, prostate specific antigen ≤20, T stage ≤2b). SBRT was prescribed to 40 Gy in 5 fractions delivered every other day to the prostate, with any areas of high disease burden (MRI-identified prostate imaging reporting and data system 4 or 5 lesions) simultaneously escalated to 42.5 to 45 Gy and areas overlapping organs at risk (within 2 mm of urethra, rectum, and bladder) constrained to 36.25 Gy (n = 100). Patients without a pretreatment MRI or without MRI-identified lesions were treated to dose of 37.5 Gy with no focal boost (n = 14). RESULTS: From 2015 to 2022, a total of 114 patients were enrolled with a median follow-up of 42 months. No acute or late grade 3+ gastrointestinal (GI) toxicity was observed. One patient developed late grade 3 genitourinary (GU) toxicity at 16 months. In patients treated with focal boost (n = 100), acute grade 2 GU and GI toxicity was seen in 38% and 4% of patients, respectively. Cumulative late grade 2+ GU and GI toxicities at 24 months were 13% and 5% respectively. Patient-reported outcomes showed no significant long-term change from baseline in urinary, bowel, hormonal, or sexual quality-of-life scores after treatment. CONCLUSIONS: SBRT to a dose of 40 Gy to the prostate gland with a simultaneous focal boost up to 45 Gy is well tolerated with similar rates of acute and late grade 2+ GI and GU toxicity as seen in other SBRT regimens without intraprostatic boost. Moreover, no significant long-term changes were seen in patient-reported urinary, bowel, or sexual outcomes from pretreatment baseline.

Use of crowdsourced images for determining 2D:4D and relationship to pro-environmental variables.

The primary purpose of this study was to examine whether 2D:4D ratios (a putative measure of prenatal androgen exposure) could be determined using participant-submitted hand images. The secondary purpose was to examine whether 2D:4D ratio was associated with pro-environmental behaviors, attitudes, and empathy, given the recent literature linking sex to environmental attitudes and actions. Participants (N = 1065) were asked via an online survey to submit a clear photograph of their right hand, palm side up. Participants also completed a questionnaire to assess (a) demographics, (b) dispositional empathy, and (c) environmental attitudes and behavior. A 2D:4D ratio was calculated for each participant, and the quality of each image was classified as poor, moderate, or good. We then examined the reliability of the 2D:4D image measurements, and the relationship between 2D:4D and our environmental measures. 2D:4D ratios fell somewhat outside of previously reported ranges, but the measurements did show acceptable intra-rater consistency. Although we did not find a sex difference in 2D:4D, we did find a sex by ratio interaction for both empathy and the number of pro-environmental behaviors in which individuals had engaged. Specifically, as 2D:4D ratio increased, males reported lower empathy and less engagement in pro-environmental behaviors, whereas females reported more engagement in pro-environmental behaviors (but no differences in empathy). These findings were contrary to expectations, as we anticipated that greater digit ratios (i.e., feminized) would be associated with greater empathy and pro-environmental behaviors. Overall, the findings of this study present a preliminary examination of the utility of measuring digit ratio with online samples. Furthermore, our results provide information regarding the complex relationship between sex and pro-environmental behaviors. Supplementary Information: The online version contains supplementary material available at 10.1007/s10211-022-00401-5.