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Kord E, Jung N, Boehm B, Conti G, Kuo HC, Frankel J, Flores J, Levie K, Ho O, Elsamanoudi S, Jiang J, Stroup SP, Musser J, Ernest A, Speir R, Chesnut G, Tausch TJ, Porter C. Prospective quality of life in men choosing open vs. robotic radical prostatectomy: long-term results from a racially diverse multi-institutional database. World J Urol 2022; 40:1427-1436. [DOI: 10.1007/s00345-022-03975-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/24/2022] [Indexed: 11/30/2022] Open
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Zhang L, Jiang D, Chen C, Yang X, Lei H, Kang Z, Huang H, Pang J. Development and validation of a multiparametric MRI-based radiomics signature for distinguishing between indolent and aggressive prostate cancer. Br J Radiol 2022; 95:20210191. [PMID: 34289319 PMCID: PMC8978240 DOI: 10.1259/bjr.20210191] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To develop and validate a non-invasive MRI-based radiomics signature for distinguishing between indolent and aggressive prostate cancer (PCa) prior to therapy. METHODS In all, 139 qualified and pathology-confirmed PCa patients were divided into a training set (n = 93) and a validation set (n = 46). A total of 1576 radiomics features were extracted from the T2WI (n = 788) and diffusion-weighted imaging (n = 788) for each patient. The Select K Best and the least absolute shrinkage and selection operator regression algorithm were used to construct a radiomics signature in the training set. The predictive performance of the radiomics signature was assessed in the training set and then validated in the validation set by receiver operating characteristic curve analysis. We computed the calibration curve and the decision curve to evaluate the calibration and clinical usefulness of the signature. RESULTS Nine radiomics features were identified to form the radiomics signature. The radiomics score (Rad-score) was significantly different between indolent and aggressive PCa (p < 0.001). The radiomics signature exhibited favorable discrimination between the indolent and aggressive PCa groups in the training set (AUC: 0.853, 95% CI: 0.766 to 0.941) and validation set (AUC: 0.901, 95% CI: 0.793 to 1.000). The decision curve analysis showed that a greater net benefit would be obtained when the threshold probability ranged from 20 to 90%. CONCLUSION The multiparametric MRI-based radiomics signature can potentially serve as a non-invasive tool for distinguishing between indolent and aggressive PCa prior to therapy. ADVANCES IN KNOWLEDGE The multiparametric MRI-based radiomics signature has the potential to non-invasively distinguish between the indolent and aggressive PCa, which might aid clinicians in making personalized therapeutic decisions.
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Affiliation(s)
| | - Donggen Jiang
- Department of Urology, Kidney and Urology Center, Pelvic Floor Disorders Center,The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Chujie Chen
- Department of Urology, Kidney and Urology Center, Pelvic Floor Disorders Center,The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Xiangwei Yang
- Department of Urology, Kidney and Urology Center, Pelvic Floor Disorders Center,The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Hanqi Lei
- Department of Urology, Kidney and Urology Center, Pelvic Floor Disorders Center,The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Zhuang Kang
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hai Huang
- Department of Urology, The Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Pang
- Department of Urology, Kidney and Urology Center, Pelvic Floor Disorders Center,The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
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Patient-Reported Quality of Life Outcomes after Moderately Hypofractionated and Normofractionated Proton Therapy for Localized Prostate Cancer. Cancers (Basel) 2022; 14:cancers14030517. [PMID: 35158785 PMCID: PMC8833499 DOI: 10.3390/cancers14030517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 02/04/2023] Open
Abstract
We retrospectively evaluated the three-year patient-reported quality of life (QOL) after moderately hypofractionated proton therapy (MHPT) for localized prostate cancer in comparison with that after normofractionated PT (NFPT) using the Expanded Prostate Cancer Index Composite-50. Patients who received MHPT (60-63 Gy (relative biological effectiveness equivalents; RBE)/20-21 fractions) (n = 343) or NFPT (74-78 Gy (RBE)/37-39 fractions) (n = 296) between 2013 and 2016 were analyzed. The minimum clinically important difference (MCID) threshold was defined as one-half of a standard deviation of the baseline value. The median follow-up was 56 months and 83% completed questionnaires at 36 months. Clinically meaningful score deterioration was observed in the urinary domain at 1 month in both groups and in the sexual domain at 6-36 months in the NFPT group, but not observed in the bowel domain. At 36 months, the mean score change for urinary summary was -0.3 (MHPT) and -1.6 points (NFPT), and that for bowel summary was +0.1 and -2.0 points; the proportion of patients with MCID was 21% and 24% for urinary summary and 18% and 29% for bowel summary. Overall, MHPT had small negative impacts on QOL over three years, and the QOL after MHPT and NFPT was similar.
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Xie X, Zhang Y, Ge C, Liang P. Effect of Brachytherapy vs. External Beam Radiotherapy on Sexual Function in Patients With Clinically Localized Prostate Cancer: A Meta-Analysis. Front Cell Dev Biol 2022; 9:792597. [PMID: 35127711 PMCID: PMC8807475 DOI: 10.3389/fcell.2021.792597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/29/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: The aim of this study was to compare the effect of brachytherapy (BT) versus external beam radiotherapy (EBRT) on sexual function in patients with localized prostate cancer (PCa). Methods: Data were retrieved from the PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang Database until March 4, 2021. Analysis was performed by using RevMan 5.4.1. The main clinical outcomes were the Prostate Cancer Symptom Indices (PCSI) scale and the Expanded Prostate Cancer Index Composite (EPIC) scale scores for sexual function. A meta-analysis was performed to calculate standardized mean differences (SMDs) and their 95% CI. This study has undergone PROSPERO registration (No. CDR42021245438). Results: Among the 962 studies retrieved, eight prospective cohort studies met the inclusion criteria, covering a total of 2,340 patients, including 1,138 treated with BT alone and 1,202 treated with EBRT alone. The results demonstrated that BT was to some extent advantageous over EBRT in overall sexual function scores in patients with localized PCa during the immediate post-treatment period (SMD = −0.09, 95% CI: −0.18 to −0.01, p = 0.03), but this difference was not detectable at 3 months (SMD = −0.07, 95% CI: −0.18–0.05, and p = 0.25), 12 months (SMD = −0.01, 95% CI: −0.21–0.20, and p = 0.96), and 24 months (SMD = −0.09, 95% CI: −0.20–0.01, and p = 0.09) after treatment. Conclusion: Our analysis showed that BT showed a short-term advantage over EBRT in terms of sexual function in patients with localized PCa, but this difference diminished over time, though the conclusion needs to be further verified by a longer-term follow-up study.
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Prostate-Specific Antigen Screening According to Health Professional Counseling and Age in the United States. Prostate Cancer 2022; 2022:8646314. [PMID: 35036010 PMCID: PMC8758274 DOI: 10.1155/2022/8646314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background In 2018, the US Preventive Services Task Force recommended that PSA screening for prostate cancer involve men aged 55–69, based on a personal decision following consultation with a health professional. PSA screening in men aged 70 or older should only occur if symptoms exist. This study identifies the association between having a PSA test in the past two years and whether or not there was consultation with a health professional about the benefits and/or harms of PSA screening. Methods Analyses were based on data involving men aged 40 years or older, who responded to PSA related questions in the 2018 BRFSS survey. Results Approximately 32.0% (14.6% for ages 40–54, 41.7% for ages 55–69, and 49.8% for ages 70 years and older) of respondents had a PSA test in the past two years. Approximately 81.7% of these men had talked with a health professional about the benefits and/or harms of PSA screening, with 42.4% having discussed the benefits and harms, 54.6% having discussed the benefits only, and 3.0% having discussed the harms only. The odds of a PSA test in the past two years in men having talked with a health professional about the benefits and harms of the test versus no talk are 10.1 (95% CI 9.3–10.8), in men who talked with a health professional about the benefits only versus no talk are 10.8 (95% CI 10.0–11.6), and in men who talked with a health professional about the harms only versus no talk are 3.9 (95% CI 2.9–5.1). Conclusion PSA screening is most common in men aged 70 or older, which is counter to the US Preventive Task Force recommendation. Most men having a PSA test have talked with a health professional about the test, but the talks tended to focus on just the benefits of screening and not both potential benefits and harms.
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Broghammer JA. EDITORIAL COMMENT. Urology 2022; 159:239. [PMID: 35027182 DOI: 10.1016/j.urology.2021.08.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Basak R, Usinger DS, Chen RC, Shen X. Patient Decision-Making Factors in Aggressive Treatment of Low-Risk Prostate Cancer. JNCI Cancer Spectr 2022; 6:6506527. [PMID: 35699497 PMCID: PMC8857916 DOI: 10.1093/jncics/pkac003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/28/2021] [Accepted: 10/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background Active surveillance (AS) is underutilized for low-risk prostate cancer. This study examines decision-making factors associated with AS vs aggressive treatment in a population-based cohort of low-risk patients. Methods Newly diagnosed patients (n = 599) were enrolled through the North Carolina Central Cancer Registry from 2011 to 2013 and surveyed regarding 5 factors that may impact treatment decision making: perceived cancer aggressiveness, aggressiveness of treatment intent, most important goal (eg, cure, quality of life), primary information source, and primary decision maker. We examined the association between treatment decision-making factors with patient choice for AS vs aggressive treatment using multivariable logistic regression analysis. Results This is a sociodemographically diverse cohort reflective of the population-based design, with 37.6% overall (47.6% among very low-risk patients) choosing AS. Aggressive treatment intent (odds ratio [OR] = 7.09, 95% confidence interval [CI] = 4.57 to 11.01), perceived cancer aggressiveness (OR = 4.93, 95% CI = 2.71 to 8.97), most important goal (cure vs other, OR = 1.72, 95% CI = 1.12 to 2.63), and primary information source (personal and family vs physician, OR = 1.76, 95% CI = 1.10 to 2.82) were associated with aggressive treatment. Overall, 88.4% of patients (92.2% among very low-risk) who indicated an intent to treat the cancer “not very aggressively” chose AS. Conclusions These data from the patient’s perspective shed new light on potentially modifiable factors that can help further increase AS uptake among low-risk patients. Helping more low-risk patients feel comfortable with a “not very aggressive” treatment approach may be especially important, which can be facilitated through patient education interventions to improve the understanding of the cancer diagnosis and AS having a curative intent.
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Affiliation(s)
- Ramsankar Basak
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Deborah S Usinger
- University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Ronald C Chen
- University of Kansas Medical Center, Department of Radiation Oncology, Kansas City, KS, USA
| | - Xinglei Shen
- University of Kansas Medical Center, Department of Radiation Oncology, Kansas City, KS, USA
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Network models of prostate cancer immune microenvironments identify ROMO1 as heterogeneity and prognostic marker. Sci Rep 2022; 12:192. [PMID: 34996995 PMCID: PMC8741951 DOI: 10.1038/s41598-021-03946-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/07/2021] [Indexed: 02/07/2023] Open
Abstract
Prostate cancer (PCa) is the fifth leading cause of death from cancer in men worldwide. Its treatment remains challenging due to the heterogeneity of the tumor, mainly because of the lack of effective and targeted prognostic markers at the system biology level. First, the data were retrieved from TCGA dataset, and valid samples were obtained by consistent clustering and principal component analysis; next, key genes were analyzed for prognosis of PCa using WGCNA, MEGENA, and LASSO Cox regression model analysis, while key genes were screened based on disease-free survival significance. Finally, TIMER data were selected to explore the relationship between genes and tumor immune infiltration, and GSCAlite was used to explore the small-molecule targeted drugs that act with them. Here, we used tumor subtype analysis and an energetic co-expression network algorithm of WGCNA and MEGENA to identify a signal dominated by the ROMO1 to predict PCa prognosis. Cox regression analysis of ROMO1 was an independent influence, and the prognostic value of this biomarker was validated in the training set, the validated data itself, and external data, respectively. This biomarker correlates with tumor immune infiltration and has a high degree of infiltration, poor prognosis, and strong correlation with CD8+T cells. Gene function annotation and other analyses also implied a potential molecular mechanism for ROMO1. In conclusion, we putative ROMO1 as a portal key prognostic gene for the diagnosis and prognosis of PCa, which provides new insights into the diagnosis and treatment of PCa.
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Taylor KL, Luta G, Zotou V, Lobo T, Hoffman RM, Davis KM, Potosky AL, Li T, Aaronson D, Van Den Eeden SK. Psychological predictors of delayed active treatment following active surveillance for low‐risk prostate cancer: The Patient REported outcomes for Prostate cARE prospective cohort study. BJUI COMPASS 2021; 3:226-237. [PMID: 35492225 PMCID: PMC9045562 DOI: 10.1002/bco2.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/04/2021] [Accepted: 10/20/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives In a prospective, comparative effectiveness study, we assessed clinical and psychological factors associated with switching from active surveillance (AS) to active treatment (AT) among low‐risk prostate cancer (PCa) patients. Methods Using ultra‐rapid case identification, we conducted pretreatment telephone interviews (N = 1139) with low‐risk patients (PSA ≤ 10, Gleason≤6) and follow‐up interviews 6–10 months post‐diagnosis (N = 1057). Among men remaining on AS for at least 12 months (N = 601), we compared those who continued on AS (N = 515) versus men who underwent delayed AT (N = 86) between 13 and 24 months, using Cox proportional hazards models. Results Delayed AT was predicted by time dependent PSA levels (≥10 vs. <10; HR = 5.6, 95% CI 2.4–13.1) and Gleason scores (≥7 vs. ≤6; adjusted HR = 20.2, 95% CI 12.2–33.4). Further, delayed AT was more likely among men whose urologist initially recommended AT (HR = 2.13, 95% CI 1.07–4.22), for whom tumour removal was very important (HR = 2.18, 95% CI 1.35–3.52), and who reported greater worry about not detecting disease progression early (HR = 1.67, 1.05–2.65). In exploratory analyses, 31% (27/86) switched to AT without evidence of progression, while 4.7% (24/515) remained on AS with evidence of progression. Conclusions After adjusting for clinical evidence of disease progression over the first year post‐diagnosis, we found that urologists' initial treatment recommendation and patients' early treatment preferences and concerns about AS each independently predicted undergoing delayed AT during the second year post‐diagnosis. These findings, along with almost one‐half undergoing delayed AT without evidence of progression, suggest the need for greater decision support to remain on AS when it is clinically indicated.
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Affiliation(s)
- Kathryn L. Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center Georgetown University Washington District of Columbia USA
| | - George Luta
- Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center Georgetown University Washington District of Columbia USA
| | - Vasiliki Zotou
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center Georgetown University Washington District of Columbia USA
| | - Tania Lobo
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center Georgetown University Washington District of Columbia USA
| | - Richard M. Hoffman
- Division of General Internal Medicine University of Iowa Carver College of Medicine/Iowa City VA Medical Center Iowa City Iowa USA
| | - Kimberly M. Davis
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center Georgetown University Washington District of Columbia USA
| | - Arnold L. Potosky
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center Georgetown University Washington District of Columbia USA
| | - Tengfei Li
- Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center Georgetown University Washington District of Columbia USA
| | - David Aaronson
- Department of Urology Kaiser Permanente East Bay Oakland California USA
| | - Stephen K. Van Den Eeden
- Division of Research Kaiser Permanente Northern California Oakland California USA
- Department of Urology UCSF San Francisco California USA
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Radiation Proctitis: The Potential Role of Hyaluronic Acid in the Prevention and Restoration of Any Damage to the Rectal Mucosa among Prostate Cancer Patients Submitted to Curative External Beam Radiotherapy. GASTROENTEROLOGY INSIGHTS 2021. [DOI: 10.3390/gastroent12040043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim: To evaluate if hyaluronic acid reduces proctitis episodes with respect to corticosteroids in prostate cancer patients submitted to radical or adjuvant radiotherapy. Methods: A consecutive series of eligible patients received hyaluronic acid enemas as supportive care (experimental group, from January 2013 to June 2015). A historical group (control group), treated from October 2011 to December 2012, received beclomethasone dipropionate suppositories. We registered each patient’s data regarding acute and chronic proctitis. All patients were treated with static-intensity-modulated radiotherapy coupled to a daily set-up verification with orthogonal anterior–posterior/lateral X-ray pairs. Results: A total of 269 patients, 175 in the experimental group and 94 in the control group, was evaluated; 2 Gy/day (up to a total median dose of 80 Gy) and 2.7 Gy/day (up to a total median dose of 67.5 Gy) fractionation schemes were used for 216 and 53 patients, respectively. All patients had a good tolerance to radiotherapy, reporting no G3 or greater proctitis. No significant difference was reported concerning the total rate of proctitis between the two groups but only with respect to its grade: a higher G2 rate within the control group. There was no correlation between daily dose fractionation and toxicity grade. Conclusions: Hyaluronic acid enemas might be effective in reducing the severity of radiation proctitis.
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Vehawn J, O'Neil B. Identifying Top Talent to Improve Prostatectomy Sexual Outcomes: Is the Juice Worth the Squeeze? JAMA Surg 2021; 157:144-145. [PMID: 34851362 DOI: 10.1001/jamasurg.2021.6257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jeffery Vehawn
- Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Brock O'Neil
- Huntsman Cancer Institute, University of Utah, Salt Lake City
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Eiriksdottir VK, Jonsdottir T, Valdimarsdottir HB, Taylor KL, Schwartz MD, Hilmarsson R, Gudmundsson EO, Fridriksson JO, Baldursdottir B. An Adaptation, Extension and Pre-Testing of an Interactive Decision Aid for Men Diagnosed with Localized Prostate Cancer in Iceland: A Mixed-Method Study. Behav Med 2021; 49:137-150. [PMID: 34791986 DOI: 10.1080/08964289.2021.2000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In this study an interactive decision aid (DA) for men diagnosed with localized prostate cancer was adapted, extended and pre-tested. The DA's prototype was based on a literature review and other empirically tested DAs. Semi-structured interviews with 12 men (age 65-80) diagnosed with localized prostate cancer were conducted to get feedback on content, usability, and the DA's layout. The interviews were analyzed using thematic analysis and themes were identified using deductive and inductive coding. Participants found the accessibility of the information and the explicit values clarification tool helpful. Four themes were identified: (1) usability and design, (2) content and knowledge, (3) deciding factors of decision-making, and (4) social support. Participants valued receiving extensive and realistic information on surgery/radiation therapy side effects and getting unbiased presentations of treatment options. Following the thematic analysis, the DA was revised and tested in a survey among 11 newly diagnosed prostate cancer patients (age 60-74). The participants valued the DA and found it helpful when making a treatment decision, and all reported that they would recommend it to others making a prostate cancer treatment decision. The DA is currently being tested in a randomized clinical trial (RCT). This is the first DA developed for prostate cancer patients in Iceland and if the results of the RCT show that it is more effective than standard care in assisting newly diagnosed patients with their treatment decision, the DA can be easily translated and adapted to cultures similar to Iceland such as the Nordic countries.
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Affiliation(s)
| | | | - Heiddis B Valdimarsdottir
- Department of Psychology, Reykjavik University, Reykjavik, Iceland.,Cancer Prevention and Control, Ruttenberg Cancer Center, Mount Sinai School of Medicine
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Changes in quality of life and lower urinary tract symptoms over time in cancer patients after a total prostatectomy: systematic review and meta-analysis. Support Care Cancer 2021; 30:2959-2970. [PMID: 34642791 DOI: 10.1007/s00520-021-06595-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to clarify associations between and changes over time in lower urinary tract symptoms (LUTS) and quality of life (QOL) in cancer patients after a total prostatectomy. METHODS The subjects were cancer patients who had undergone total prostatectomy and had participated in non-randomized controlled trials, cohort studies, or case-control studies with outcomes of changes over time in LUTS or QOL. Fourteen studies were included for systematic review and meta-analysis. RESULTS Compared to preoperatively, the International Prostate Symptom Score (IPSS)-a LUTS indicator-yielded the following, 3 months after operation (MD [95% confidence interval, CI] = -0.27 [-2.22 to 1.68], p = .7855), 6 months after operation (MD [95% CI] = -2.12 [-3.04 to -1.20], p < .0001), and 12 months after operation (MD [95% CI] = -2.27 [-2.63 to -1.92], p < .0001), demonstrating significant decrease and, therefore, improvement of symptoms after 6 months. International Prostate Symptom Score-Quality of Life (IPSS-QOL), a QOL indicator, was significantly reduced at 12 months after surgery, indicating improved QOL (MD [95% CI] = -0.49 [-0.87 to -0.11], p = .0107), but there was heterogeneity between different studies (I2 = 89.19%). A cumulative meta-analysis showed a tendency for greater improvements in IPSS-QOL at 12 months after surgery, the older the mean age and the higher the mean pre-surgery IPSS. Factors of age, prostate volume, and pre-surgery IPSS were related to postoperative LUTS; exacerbation of both urinary incontinence and urinary tract obstruction was related to QOL. CONCLUSION While LUTS improves over time after total prostatectomy, it takes 6 to 12 months after surgery. As there is an association between LUTS and QOL, support to promote self-management of LUTS is important.
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Chun SJ, Kim JH, Ku JH, Kwak C, Lee ES, Kim S. Comparison of radical prostatectomy and external beam radiotherapy in high-risk prostate cancer. Radiat Oncol J 2021; 39:231-238. [PMID: 34610662 PMCID: PMC8497867 DOI: 10.3857/roj.2021.00486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/01/2021] [Indexed: 01/30/2023] Open
Abstract
Purpose We evaluated clinical outcomes of high-risk prostate cancer patients receiving external beam radiotherapy (EBRT) or radical prostatectomy (RP). Materials and Methods Patients were classified as high-risk prostate cancer and received definitive treatment between 2005 and 2015. Patients with previous pelvic radiotherapy, positive lymph node or distant metastasis were excluded. The primary outcomes were prostate cancer-specific survival (PCSS) and distant metastasis-free survival (DMFS). Results Of 583 patients met the inclusion criteria (77 EBRT and 506 RP), the estimated 10-year PCSS was 97.0% in the RP and 95.9% in the EBRT (p = 0.770). No significant difference was seen in the DMFS (p = 0.540), whereas there was a trend in favor of RP over EBRT in overall survival (OS) (p = 0.068). Propensity score matching analysis with confounding variables was done, with 183 patients (66 EBRT and 117 RP) were included. No significant difference in DMFS, PCSS or OS was found. Conclusion Our data demonstrated similar oncologic PCSS, OS, and DMFS outcomes between EBRT and RP patients.
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Affiliation(s)
- Seok-Joo Chun
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Sik Lee
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Suzy Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiation Oncology, SMG-SNU Boramae Medical Center, Seoul, Korea
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Zapatero A, Maldonado Pijoan X, Gómez-Caamaño A, Pardo Masferrer J, Macías Hernández V, Hervás Morón A, Muñoz García JL, Palacios Eito A, Anguita-Alonso P, González-Junco C, López Torrecilla J. Health-related quality of life in men with localized prostate cancer treated with radiotherapy: validation of an abbreviated version of the Expanded Prostate Cancer Index Composite for Clinical Practice in Spain. Health Qual Life Outcomes 2021; 19:223. [PMID: 34563208 PMCID: PMC8466718 DOI: 10.1186/s12955-021-01856-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/29/2021] [Indexed: 12/03/2022] Open
Abstract
Background Health-related quality of life (HRQoL) is greatly affected by prostate cancer (PCa) and associated treatments. This study aimed to measure the impact of radiotherapy on HRQoL and to further validate the Spanish version of the 16-item Expanded Prostate Cancer Index Composite (EPIC-16) in routine clinical practice. Methods An observational, non-interventional, multicenter study was conducted in Spain with localized PCa patients initiating treatment with external beam radiotherapy (EBRT) or brachytherapy (BQT). Changes from baseline in EPIC-16, University of California-Los Angeles Prostate Cancer Index (UCLA-PCI), and patient-perceived health status were longitudinally assessed at end of radiotherapy (V2) and 90 days thereafter (V3). Psychometric evaluations of the Spanish EPIC-16 were conducted. Results Of 516 patients enrolled, 495 were included in the analysis (EBRT, n = 361; BQT, n = 134). At baseline, mean (standard deviation [SD]) EPIC-16 global scores were 11.9 (7.5) and 10.3 (7.7) for EBRT and BQT patients, respectively; scores increased, i.e., HRQoL worsened, from baseline, by mean (SD) of 6.8 (7.6) at V2 and 2.4 (7.4) at V3 for EBRT and 4.2 (7.6) and 3.9 (8.2) for BQT patients. Changes in Spanish EPIC-16 domains correlated well with urinary, bowel, and sexual UCLA-PCI domains. EPIC-16 showed good internal consistency (Cronbach’s alpha = .84), reliability, and construct validity. Conclusion The Spanish EPIC-16 questionnaire demonstrated sensitivity, strong discriminative properties and reliability, and validity for use in clinical practice. EPIC-16 scores worsened after radiotherapy in different HRQoL domains; however, a strong tendency towards recovery was seen at the 3-month follow-up visit. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-021-01856-z.
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Affiliation(s)
- Almudena Zapatero
- Department of Radiation Oncology, Hospital Universitario de La Princesa, Madrid, Spain.
| | | | - Antonio Gómez-Caamaño
- Department of Radiation Oncology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - José Pardo Masferrer
- Department of Radiation Oncology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | | | | | - Amalia Palacios Eito
- Department of Radiation Oncology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | | | - José López Torrecilla
- Department of Radiation Oncology, ERESA, Hospital General Universitario de València, València, Spain
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King MT, Keyes M, Frank SJ, Crook JM, Butler WM, Rossi PJ, Cox BW, Showalter TN, Mourtada F, Potters L, Stock RG, Kollmeier MA, Zelefsky MJ, Davis BJ, Merrick GS, Orio PF. Low dose rate brachytherapy for primary treatment of localized prostate cancer: A systemic review and executive summary of an evidence-based consensus statement. Brachytherapy 2021; 20:1114-1129. [PMID: 34509378 DOI: 10.1016/j.brachy.2021.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/28/2021] [Accepted: 07/14/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this guideline is to present evidence-based consensus recommendations for low dose rate (LDR) permanent seed brachytherapy for the primary treatment of prostate cancer. METHODS AND MATERIALS The American Brachytherapy Society convened a task force for addressing key questions concerning ultrasound-based LDR prostate brachytherapy for the primary treatment of prostate cancer. A comprehensive literature search was conducted to identify prospective and multi-institutional retrospective studies involving LDR brachytherapy as monotherapy or boost in combination with external beam radiation therapy with or without adjuvant androgen deprivation therapy. Outcomes included disease control, toxicity, and quality of life. RESULTS LDR prostate brachytherapy monotherapy is an appropriate treatment option for low risk and favorable intermediate risk disease. LDR brachytherapy boost in combination with external beam radiation therapy is appropriate for unfavorable intermediate risk and high-risk disease. Androgen deprivation therapy is recommended in unfavorable intermediate risk and high-risk disease. Acceptable radionuclides for LDR brachytherapy include iodine-125, palladium-103, and cesium-131. Although brachytherapy monotherapy is associated with increased urinary obstructive and irritative symptoms that peak within the first 3 months after treatment, the median time toward symptom resolution is approximately 1 year for iodine-125 and 6 months for palladium-103. Such symptoms can be mitigated with short-term use of alpha blockers. Combination therapy is associated with worse urinary, bowel, and sexual symptoms than monotherapy. A prostate specific antigen <= 0.2 ng/mL at 4 years after LDR brachytherapy may be considered a biochemical definition of cure. CONCLUSIONS LDR brachytherapy is a convenient, effective, and well-tolerated treatment for prostate cancer.
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Affiliation(s)
- Martin T King
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA.
| | - Mira Keyes
- Department of Radiation Oncology, British Columbia Cancer Agency, University of British Columbia, Vancouver, Canada
| | - Steven J Frank
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Juanita M Crook
- Department of Radiation Oncology, British Columbia Cancer Agency, University of British Columbia, Kelowna, Canada
| | - Wayne M Butler
- Department of Radiation Oncology, Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV
| | - Peter J Rossi
- Calaway Young Cancer Center, Valley View Hospital, Glenwood Springs, CO
| | - Brett W Cox
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA
| | - Firas Mourtada
- Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, DE
| | - Louis Potters
- Department of Radiation Oncology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Richard G Stock
- Department of Radiation Oncology, Mt. Sinai Medical Center, New York, NY
| | - Marisa A Kollmeier
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Gregory S Merrick
- Department of Radiation Oncology, Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV
| | - Peter F Orio
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA
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Wang K, Tepper JE. Radiation therapy-associated toxicity: Etiology, management, and prevention. CA Cancer J Clin 2021; 71:437-454. [PMID: 34255347 DOI: 10.3322/caac.21689] [Citation(s) in RCA: 142] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 12/25/2022] Open
Abstract
Radiation therapy (RT) is a curative treatment for many malignancies and provides effective palliation in patients with tumor-related symptoms. However, the biophysical effects of RT are not specific to tumor cells and may produce toxicity due to exposure of surrounding organs and tissues. In this article, the authors review the clinical context, pathophysiology, risk factors, presentation, and management of RT side effects in each human organ system. Ionizing radiation works by producing DNA damage leading to tumor death, but effects on normal tissue may result in acute and/or late toxicity. The manifestation of toxicity depends on both cellular characteristics and affected organs' anatomy and physiology. There is usually a direct relationship between the radiation dose and volume to normal tissues and the risk of toxicity, which has led to guidelines and recommended dose limits for most tissues. Side effects are multifactorial, with contributions from baseline patient characteristics and other oncologic treatments. Technological advances in recent decades have decreased RT toxicity by dramatically improving the ability to deliver RT that maximizes tumor dose and minimizes organ dose. Thus the study of RT-associated toxicity is a complex, core component of radiation oncology training that continues to evolve alongside advances in cancer management. Because RT is used in up to one-half of all patients with cancer, an understanding of its acute and late effects in different organ systems is clinically pertinent to both oncologists and nononcologists.
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Affiliation(s)
- Kyle Wang
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio
| | - Joel E Tepper
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
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Jones S, White N, Holt T, Graves N. Cost-effectiveness analysis of hydrogel spacer for rectal toxicity reduction in prostate external beam radiotherapy. J Med Imaging Radiat Oncol 2021; 65:931-939. [PMID: 34397158 DOI: 10.1111/1754-9485.13311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/16/2021] [Accepted: 07/31/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Contemporary methods of external beam radiotherapy for prostate cancer have reduced toxicity rates through beam modulation and image guidance, however, rectal injury has not been eliminated completely in this population. For patients at greatest risk of developing rectal toxicities, hydrogel spacers are a viable option for risk reduction. Translation of clinical trial results into routine clinical practice relies on an understanding of the economic implications. This study completed a cost-effectiveness analysis of hydrogel spacers in the Australian healthcare setting. METHOD Simulation of possible health states following treatment was performed using a Markov model. Model outcomes included the incremental cost-effectiveness ratio and the net monetary benefit (NMB) at three published willingness-to-pay thresholds derived from literature. Probabilistic sensitivity analyses were provided on these results. A baseline cohort without hydrogel spacer use was compared to treat all and selective use cohorts. Cost variation scenarios were also investigated to assess the impact of hydrogel spacer cost on outcomes. RESULTS Using hydrogel spacers in a selective cohort was more likely to be cost-effective than giving to all patients (NMB -$43 versus -$997, respectively); however, the incremental cost-effectiveness ratio was not below the $28 000 willingness-to-pay threshold for a healthcare provider perspective. These outcomes were influenced by large parameter uncertainty. Cost variation strategies are worth investigating further as a method to achieve willingness-to-pay threshold targets. CONCLUSION The influence of parameter uncertainty currently limits the cost-effectiveness of this intervention in the Australian public health setting. However, a cost variation solution has been demonstrated to improve cost-effectiveness estimates for selected patients and should be examined further.
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Affiliation(s)
- Scott Jones
- Radiation Oncology, Princess Alexandra Hospital, Raymond Terrace, Brisbane, Queensland, Australia.,Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Nicole White
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Tanya Holt
- Radiation Oncology, Princess Alexandra Hospital, Raymond Terrace, Brisbane, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
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Papadopoulos E, Gillen JB, Moore DR, Au D, Kurgan N, Klentrou P, Finelli A, Alibhai SM, Santa Mina D. High-intensity interval training or resistance training versus usual care in men with prostate cancer on active surveillance: A three-arm feasibility randomized controlled trial. Appl Physiol Nutr Metab 2021; 46:1535-1544. [PMID: 34380000 DOI: 10.1139/apnm-2021-0365] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND This study assessed the feasibility of a phase II randomized controlled trial of high-intensity interval training (HIIT), resistance training (RT), and usual care (UC) in men with prostate cancer (PCa) on active surveillance (AS) and evaluated changes in clinically relevant outcomes. METHODS Eighteen men undergoing AS for PCa were randomized to HIIT (n=5), RT (n=7), or UC (n=6). Exercise participants attended two supervised sessions weekly and were instructed to complete one home-based session weekly for 8 weeks. UC participants were provided with physical activity guidelines. RESULTS Feasibility was met for attendance, compliance, and retention, but not recruitment. HIIT increased leg press (mean: +8.2kg, 95%CI 1.1, 15.3) from baseline to 8 weeks. RT increased seated row (mean: +11.7kg, 95%CI 6.1, 17.3) and chest press (mean: +10.4kg, 95%CI 5.3, 15.5), leg press (mean: +13.1kg, 95%CI 5.9, 20.3), serum insulin-like binding protein-3 (IGFBP-3) (mean: +400.0ng/ml, 95%CI 94.5, 705.5), and decreased interferon-γ (mean: -3.1pg/ml, 95%CI -5.7, -0.4). No changes were observed in the UC group. CONCLUSION HIIT and RT may be effective strategies for improving muscle strength; however, only RT may increase serum IGFBP-3. Strategies that can enhance recruitment in men on AS are important prior to conducting a phase II trial. TRIAL REGISTRATION NUMBER ClinicalTrials.gov number NCT04266262 Novelty bullets • High-intensity interval training or resistance training are feasible during active surveillance for prostate cancer. • Resistance training may suppress the tumor-promoting effects of insulin-like growth factor-I (IGF-I) via increased expression of IGFBP-3.
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Affiliation(s)
| | - Jenna B Gillen
- University of Toronto, 100 Devonshire Pl, Toronto, Ontario, Canada, m5s 2c9;
| | - Daniel R Moore
- University of Toronto, Faculty of Kinesiology and Physical Education, 55 Harbord St., Toronto, Ontario, Canada, M5S 2W6;
| | - Darren Au
- University Health Network, 7989, Toronto, Ontario, Canada;
| | - Nigel Kurgan
- Brock University, Health Sciences, St. Catharines, Ontario, Canada;
| | - Panagiota Klentrou
- Brock University, Kinesiology, 1812 Sir Isaak Brock Way, L2S 3A1, St. Catharines, Ontario, Canada, L2S 3A1;
| | | | - Shabbir Mh Alibhai
- University of Toronto, Medicine, 200 Elizabeth St, Room EN14-214, Toronto, Ontario, Canada, M5G 2C4;
| | - Daniel Santa Mina
- University of Toronto, Kinesiology & Physical Education, 55 Harbord St., Toronto, Ontario, Canada, M5S 2W6;
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Farris JC, Hughes RT, Steber CR, Craven TE, Frizzell BA. Patient assessment of lower urinary tract symptoms using the international prostate symptom score following low-dose-rate prostate brachytherapy. Brachytherapy 2021; 20:1107-1113. [PMID: 34353749 DOI: 10.1016/j.brachy.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/13/2021] [Accepted: 05/21/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To correlate changes in urinary patient-reported outcomes including the International Prostate Symptom Score (IPSS), acute urinary retention and urethral stricture with urethral dose in those treated with low dose rate (LDR) prostate brachytherapy. MATERIALS AND METHODS Patients treated with prostate LDR between 2012 and 2019 (n=117) completed IPSS urinary symptom assessments prior to treatment and at each follow-up. CT simulation was obtained with urinary catheter 1-month post-implant for dosimetric analysis. 113 patients with pre- and ≥1 post-LDR IPSS score available were analyzed. Urethral dosimetric parameters including U75, U100, U125, U150 and U200 were abstracted from post-implant dosimetry and assessed for association with urinary toxicity using bivariate logistic regression and Spearman correlation. Outcomes included clinically significant change (CSC, defined as 4 or more points or 25% rise above baseline) in IPSS score at 6 and 12 months, acute urinary retention (AUR), and urethral stricture (US). RESULTS 89 (79%) patients were treated with LDR monotherapy (145 Gy) and 24 (21%) with LDR boost (110 Gy) with external beam radiation therapy. Twenty (18%) had baseline IPSS ≥15. Median IPSS scores were: baseline 6 (3-12; n=113), 1-month 17 (10-25; n=110), 6 months 12 (7-18; n=77), 1 year 8 (5-14; n=52). CSC-6 was observed in 59 (77%), CSC-12 in 26 (50%), AUR in 12 (11%), and US in 4 (4%). No association was identified between urethral dose parameters and CSC-6, CSC-12, AUR, or US. No correlation between urethral dose and IPSS at 6- and 12-months was identified. The IPSS ≥15 group exhibited lower rates of CSC-12 (13% v. 57%, p=0.05) but not CSC-6 (55% v. 80%, p=0.12). CONCLUSIONS We did not find a relationship between urethral dose and IPSS elevation, AUR or US. We did identify a significantly lower change in IPSS at 12 months for those with baseline IPSS ≥15 compared to those with low baseline scores.
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Affiliation(s)
- J C Farris
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, NC.
| | - R T Hughes
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, NC
| | - C R Steber
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, NC
| | - T E Craven
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC
| | - B A Frizzell
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, NC
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71
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Zhang L, Hsieh MC, Allison C, Devane M, Hicks C, Yu Q, Shi L, Wu J, Wu XC. Racial differences in the risk of second primary bladder cancer following radiation therapy among localized prostate cancer patients. Cancer Epidemiol 2021; 73:101967. [PMID: 34146916 PMCID: PMC8357014 DOI: 10.1016/j.canep.2021.101967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To investigate the race-specific second primary bladder cancer (SPBC) risk following prostatic irradiation. METHODS Louisiana residents who were diagnosed with localized prostate cancer (PCa) in 1996-2013 and received surgery or radiation were included. Patients were followed until SPBC diagnosis, death, or Dec. 2018. The exposure variable was type of treatment (radiation only vs. surgery only). The outcome was time from PCa diagnosis to SPBC diagnosis, stratified by race. Fine and Gray's competing risk model was applied with death as a competing event and adjustment of sociodemographic and tumor characteristics. We used 5 years and 10 years as lag time in the analyses. RESULTS A total of 26,277 PCa patients with a median follow-up of 10.7 years were analyzed, including 18,598 white and 7679 black patients. About 42.9 % of whites and 45.7 % of blacks received radiation. SPBC counted for 1.84 % in the radiation group and 0.90 % in the surgery group among white patients and for 0.91 % and 0.58 %, respectively, among black patients. The adjusted subdistribution hazard ratio of SPBC was 1.80 (95 % CI: 1.30-2.48) for radiation recipients compared to surgery recipients among white patients; 1.93 (95 % CI: 1.36-2.74) if restricted to external beam radiation therapy (EBRT). The SPBC risk was not significantly different between irradiated and surgically treated among blacks. CONCLUSIONS The SPBC risk is almost two-fold among white irradiated PCa patients compared to their counterparts treated surgically. Our findings highlight the need for enhanced surveillance for white PCa survivors receiving radiotherapy, especially those received EBRT.
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Affiliation(s)
- Lu Zhang
- Department of Public Health Sciences, Clemson University, United States.
| | - Mei-Chin Hsieh
- Epidemiology Program, School of Public Health Sciences, Louisiana State University Health Sciences Center, United States; Louisiana Tumor Registry, School of Public Health Sciences, Louisiana State University Health Sciences Center, United States
| | - Claire Allison
- Department of Public Health Sciences, Clemson University, United States
| | - Michael Devane
- Department of Radiology, Prisma Health, United States; Clemson University School of Health Research, United States
| | - Chindo Hicks
- Department of Genetics, School of Medicine, Louisiana State University Health Sciences Center, United States
| | - Qingzhao Yu
- Biostatistics Program, School of Public Health Sciences, Louisiana State University Health Sciences Center, United States
| | - Lu Shi
- Department of Public Health Sciences, Clemson University, United States
| | - Jiande Wu
- Department of Genetics, School of Medicine, Louisiana State University Health Sciences Center, United States
| | - Xiao-Cheng Wu
- Epidemiology Program, School of Public Health Sciences, Louisiana State University Health Sciences Center, United States; Louisiana Tumor Registry, School of Public Health Sciences, Louisiana State University Health Sciences Center, United States
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Lamers RED, Cuypers M, de Vries M, van de Poll-Franse LV, Bosch JLHR, Kil PJM. Differences in treatment choices between prostate cancer patients using a decision aid and patients receiving care as usual: results from a randomized controlled trial. World J Urol 2021; 39:4327-4333. [PMID: 34272972 PMCID: PMC8602175 DOI: 10.1007/s00345-021-03782-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/02/2021] [Indexed: 12/12/2022] Open
Abstract
Objective To determine whether or not decision aid (DA) use influences treatment decisions in patients with low and intermediate risk prostate cancer (PC).
Patients and methods In a cluster randomized controlled trial, patients were randomized to either DA use (DA group) or no DA use (control group). Between 2014 and 2016, newly diagnosed patients with low or intermediate risk PC were recruited in 18 hospitals in the Netherlands. DA users had access to a web-based DA that provided general PC information, PC-treatment information, and values clarification exercises to elicit personal preferences towards the treatment options. Control group patients received care as usual. Differences in treatment choice were analysed using multilevel logistic regressions. Differences in eligible treatment options between groups were compared using Pearson Chi-square tests.
Results Informed consent was given by 382 patients (DA group N = 273, control group N = 109). Questionnaire response rate was 88% (N = 336). Active surveillance (AS) was an option for 38%, radical prostatectomy (RP) for 98%, external beam radiotherapy (EBRT) for 88%, and brachytherapy (BT) for 79% of patients. DA users received AS significantly more often than control group. Patients (29 vs 16%, p = 0.01), whereas the latter more often chose BT (29 vs 18%, p < 0.01). No differences were found between groups regarding RP and EBRT. DA users who were not eligible for AS, received surgery more often compared to the control group (53 vs 35%, p = 0.01). Patient and disease characteristics were evenly distributed between groups. Conclusion DA-using PC patients chose the AS treatment option more often than non-DA-using patients did.
Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03782-7.
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Affiliation(s)
- Romy E D Lamers
- Department of Urology, University Medical Center, Utrecht, The Netherlands.
| | - Maarten Cuypers
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, Nijmegen, The Netherlands
| | - Marieke de Vries
- Institute for Computing and Information Sciences (iCIS) and Social and Cultural Psychology, Behavioural Science Institute, Radboud University, Mercator I, Toernooiveld 216, 6525, Nijmegen, The Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Department of Medical and Clinical Psychology, CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J L H Ruud Bosch
- University Medical Cancer Center Utrecht, Heidelberglaan 100, 3584, Utrecht, The Netherlands
| | - Paul J M Kil
- Andros Clinics, Mr. E.N. van Kleffensstraat 5, 6842 CV, Arnhem, The Netherlands
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Sud S, Gerringer BC, Wacaser BS, Tan X, Tatko SS, Royce TJ, Wang AZ, Chen RC. Underascertainment of Clinically Meaningful Symptoms During Prostate Cancer Radiation Therapy-Does This Vary by Patient Characteristics? Int J Radiat Oncol Biol Phys 2021; 110:1122-1128. [PMID: 33539967 DOI: 10.1016/j.ijrobp.2021.01.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE It is well known that physicians underascertain chemotherapy-related toxicity compared with patient self-report. However, symptom underascertainment in radiation therapy and characterization of patient groups at increased risk for underascertainment have not been examined. METHODS AND MATERIALS As part of routine clinical care, 7 urinary and gastrointestinal symptoms were prospectively collected with both patient-report outcomes (PROs) using the validated Prostate Cancer Symptom Indices and physician-graded symptoms using Common Terminology Criteria for Adverse Events (CTCAE) for 544 consecutive patients from 2010 to 2018 who received intensity modulated radiation therapy to the prostate or prostate bed. Data from weekly treatment visits and the first posttreatment follow-up were analyzed. Underascertainment was defined as an occurrence when a clinically meaningful symptom was indicated on PROs but not physician CTCAE assessment. Univariate and multivariable logistic regression examined characteristics associated with underascertainment. RESULTS Overall, 85.3% of patients had underascertainment of at least 1 symptom. Per PRO, 16.9% of assessments reported clinically meaningful symptoms, in contrast to only 3.4% per CTCAE, representing an approximate 5-fold difference. Multivariable analysis showed underascertainment was more common in patients who were unmarried (odds ratio [OR] 1.28; 95% confidence interval [CI], 1.18-1.38), lived in rural regions (OR 1.10; 95% CI, 1.01-1.21), incarcerated (OR 1.58; 95% CI, 1.36-1.84), retired/unemployed (OR 1.29; 95% CI, 1.18-1.40), received prostate gland (vs prostate bed) treatment (OR 1.43; 95% CI, 1.31-1.58), and received concurrent hormone therapy (OR 1.16; 95% CI, 1.04-1.29). Patients age >70 years were less likely to have underascertainment compared with those age <60 years (OR 0.82; 95% CI, 0.73-0.92). CONCLUSIONS This is the first study to show underascertainment of clinically meaningful symptoms in radiation therapy patients in routine clinical care and further to demonstrate that certain patient groups are especially vulnerable to underascertainment. These results highlight the importance of incorporating PROs in the clinical care of radiation therapy patients. If PROs are not routinely used, vulnerable patient groups may need additional attention during cancer treatment to ensure accurate toxicity assessment and management.
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Affiliation(s)
- Shivani Sud
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Brandon S Wacaser
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Xianming Tan
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Sarah S Tatko
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Trevor J Royce
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Andrew Z Wang
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ronald C Chen
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Radiation Oncology, University of Kansas Cancer Center, Kansas City, Kansas.
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Kishan AU, Collins SP. Quality of Life After Prostate Cancer Treatment. Int J Radiat Oncol Biol Phys 2021; 110:727-730. [PMID: 34089679 DOI: 10.1016/j.ijrobp.2021.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/01/2021] [Accepted: 03/06/2021] [Indexed: 01/05/2023]
Affiliation(s)
- Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California; Department of Urology, University of California, Los Angeles, Los Angeles, California.
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
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Hale GR, Shahait M, Lee DI, Lee DJ, Dobbs RW. Measuring Quality of Life Following Robot-Assisted Radical Prostatectomy. Patient Prefer Adherence 2021; 15:1373-1382. [PMID: 34188454 PMCID: PMC8236265 DOI: 10.2147/ppa.s271447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/02/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Prostate cancer (PCa) represents the most common solid organ malignancy in men. Fortunately, at the time of diagnosis, the majority of cases are staged as localized or regional disease, conferring excellent 5- and 10-year cure rates. There are several first line treatment options including surgical approaches such as robot-assisted radical prostatectomy (RARP) and radiation therapy (RT) available to patients with localized disease that offer similar PCa oncologic outcomes but are associated with potentially significant side effects which may impact health-related quality of life (HRQOL) domains. Recently, clinicians and investigators have sought to better understand these changes in HRQOL metrics with the utilization of patient-reported outcomes (PRO). Given that RARP represents the most common surgical treatment for PCa in the United States, there has been a particular interest in assessing these outcomes derived by patient perspectives to more fully appreciate treatment-related impact on quality of life following RARP. OBJECTIVE This narrative review sought to explore the instruments available to measure quality of life after RARP, a review of the PRO data after RARP, and future directions for assessing and improving quality of life outcomes following this surgery. CLINICAL USE There are several treatment options for men diagnosed with local and regional prostate cancer with similar oncologic outcomes but differing patterns of side effects affecting post-treatment quality of life. Understanding data reported directly by patients following RARP about their side effects and quality of life gives providers additional information for appropriate preoperative counseling for patients choosing between treatment options for their prostate cancer.
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Affiliation(s)
- Graham R Hale
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Mohammed Shahait
- Department of Urology, King Hussein Cancer Foundation and Center, Amman, Jordan
| | - David I Lee
- Department of Urology, University of California at Irvine, Irvine, CA, USA
| | - Daniel J Lee
- Division of Urology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ryan W Dobbs
- Division of Urology, Cook County Health and Hospitals System, Chicago, IL, USA
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76
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Smith A'B, Rincones O, Mancuso P, Sidhom M, Wong K, Berry M, Forstner D, Ngo D, Bokey L, Girgis A. Low conflict and high satisfaction: Decisional outcomes after attending a combined clinic to choose between robotic prostatectomy and radiotherapy for prostate cancer. Urol Oncol 2021; 40:8.e1-8.e9. [PMID: 34116935 DOI: 10.1016/j.urolonc.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Decisional conflict and post-treatment decisional regret have been documented in men with localised prostate cancer (LPC). However, there is limited evidence regarding decisional outcomes associated with the choice between robotic-assisted radical prostatectomy (RARP) and radiotherapy, when both treatment options are available in the public health system. There is increasing support for multidisciplinary approaches to guide men with LPC in their decision-making process. This study assessed decisional outcomes in men deciding between RARP or radiotherapy treatment before and after attending a LPC combined clinic (CC). METHODS Quantitative longitudinal data were collected from 52 men who attended a LPC CC, where they saw both a urologist and radiation oncologist. Patients completed questionnaires assessing involvement in decision-making, decisional conflict, satisfaction and regret before and after the CC, three months, six months and 12 months post-treatment. Urologists and radiation oncologists also reported their perceptions regarding patients' suitability for, openness to, perceived preferences and appropriateness for each treatment. Data was analysed using paired/independent samples t-tests and McNemar's tests. RESULTS Most participants (n = 37, 71%) opted for RARP over radiotherapy (n = 14, 27%); one participant deferred treatment (2%). Urologists and radiation oncologists reported low agreement (κ = 0.26) regarding the most appropriate treatment for each patient. Participants reported a desire for high levels of control over their decision-making process (77.5% patient-led, 22.5% shared) and high levels of decisional satisfaction (M = 4.4, SD = 0.47) after the CC. Decisional conflict levels were significantly reduced (baseline: M = 29.3, SD = 16.9, post-CC: M = 16.3, SD = 11.5; t = 5.37, P < 0.001) after the CC. Mean decisional regret scores were 'mild' at three-months (M = 16.0, SD = 17.5), six-months (M = 18.8, SD = 18.7) and 12-months (M = 18.2, SD = 15.1) post-treatment completion. CONCLUSION This is the first Australian study to assess decisional outcomes when patients are offered the choice between RARP and radiotherapy in the public health system. A CC seems to support decision-making in men with LPC and positively impact some decisional outcomes. However, larger-scale controlled studies are needed to confirm these findings.
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Affiliation(s)
- Allan 'Ben' Smith
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, NSW; South Western Sydney Clinical School, University of New South Wales, Liverpool , NSW.
| | - Orlando Rincones
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, NSW
| | - Pascal Mancuso
- South Western Sydney Clinical School, University of New South Wales, Liverpool , NSW; Department of Urological Surgery, Liverpool Hospital, South Western Sydney Local Health District, Liverpool , NSW
| | - Mark Sidhom
- South Western Sydney Clinical School, University of New South Wales, Liverpool , NSW; Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool , NSW
| | - Karen Wong
- South Western Sydney Clinical School, University of New South Wales, Liverpool , NSW; Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool , NSW
| | - Megan Berry
- South Western Sydney Clinical School, University of New South Wales, Liverpool , NSW; Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool , NSW
| | - Dion Forstner
- Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool , NSW; School of Medicine, Western Sydney University, Penrith , NSW
| | - Diana Ngo
- Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool , NSW
| | - Lesley Bokey
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, NSW; Division of Surgery, Liverpool Hospital, South Western Sydney Local Health District, Liverpool , NSW
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, NSW; South Western Sydney Clinical School, University of New South Wales, Liverpool , NSW
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77
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Goy BW, Burchette R. Ten-year treatment complication outcomes of radical prostatectomy vs external beam radiation vs brachytherapy for 1503 patients with intermediate risk prostate cancer. Brachytherapy 2021; 20:1083-1089. [PMID: 34090815 DOI: 10.1016/j.brachy.2021.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/14/2021] [Accepted: 04/22/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare 10-year late complications of radical prostatectomy (RP) versus external-beam-radiation-therapy (EBRT) versus brachytherapy (BT). METHODS Retrospective analysis was performed on 1503 intermediate-risk-prostate-cancer patients treated from 2004 to 2007, using univariate comparisons. Eight hundred and nineteen underwent RP, 574 EBRT, and 110 BT. RP urinary and rectal complications were graded severe if patients required ≥3 pads/diapers per day, chronic condom catheter or penile clamp, daily clean-intermittent-catheterization, sling, artificial-urinary-sphincter, or rectal fistula. Complications for EBRT/BT were severe if graded 3/4 on the Radiation-Therapy-Oncology-Group scale for late effects. The prevalence of erectile-dysfunction-devices (EDD) of injections, pumps and/or penile implants were compared. RESULTS Median follow-up for RP versus EBRT versus BT were 10.0, 9.6, and 9.8 years. Median age were 62.1, 70.8, 65.3, p < 0.0001. The 10-year prevalence of severe urinary complications for RP versus EBRT versus BT were 10.1%, 12.5%, 4.6%, p = 0.03, and were less for RP <64 years, p = 0.03, and lower Charlson score, p = 0.05. Pretreatment American-Urological-Association (AUA) score existed for 7.3%, 11.5%, 97.3% of RP versus EBRT versus BT, p < 0.0001, and the 10-year prevalence of EDD were 24.3%, 6.6%, 8.2%, respectively, p< 0.0001. Severe rectal complications were slightly higher for EBRT, p = 0.06. CONCLUSIONS BT had lower prevalence of severe urinary complications, possibly by using AUA score to avoid patients with obstructive uropathy. Urinary complications may be reduced by limiting RP to younger, healthier patients, and by avoiding EBRT/BT with obstructive symptoms. RP had higher prevalence of EDD, despite having younger, healthier patients.
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Affiliation(s)
- Barry W Goy
- Department of Radiation Oncology, Kaiser Permanente, Los Angeles Medical Center, 4950 Sunset Blvd, Los Angeles, CA.
| | - Raoul Burchette
- Department of Research and Evaluation, Kaiser Permanente, Pasadena, CA
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78
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Vaculik K, Luu M, Howard LE, Aronson W, Terris M, Kane C, Amling C, Cooperberg M, Freedland SJ, Daskivich TJ. Time Trends in Use of Radical Prostatectomy by Tumor Risk and Life Expectancy in a National Veterans Affairs Cohort. JAMA Netw Open 2021; 4:e2112214. [PMID: 34081138 PMCID: PMC8176332 DOI: 10.1001/jamanetworkopen.2021.12214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Guidelines endorse using tumor risk and life expectancy (LE) to select appropriate candidates for radical prostatectomy (RP), recommending against treatment of most low-risk tumors and men with limited LE. OBJECTIVE To investigate time trends in the use of RP by tumor risk and Prostate Cancer Comorbidity Index (PCCI) score in a contemporary, nationally representative Veterans Affairs (VA) cohort. DESIGN, SETTING, AND PARTICIPANTS This cohort study of 5736 men treated with RP at 8 VA hospitals from January 1, 2000, to December 31, 2017, used a nationally representative, multicenter sample from the VA SEARCH (Shared Equal Access Regional Cancer Hospital) database. Statistical analysis was performed from June 30, 2018, to August 20, 2020. MAIN OUTCOMES AND MEASURES Stratified linear and log-linear Poisson regressions were used to estimate time trends in the proportion of men treated with RP across American Urological Association tumor risk and PCCI (a validated predictor of LE based on age and comorbidities) subgroups. RESULTS Among 5736 men (mean [SD] age at surgery, 62 [6] years) treated with RP from 2000 to 2017, the proportion of low-risk tumors treated with RP decreased from 51% to 7% (difference, -44%; 95% CI, -50% to -38%). The proportion of intermediate-risk tumors treated with RP increased from 30% to 59% (difference, 29%; 95% CI, 23%-35%), with unfavorable intermediate-risk tumors increasing from 30% to 41% (difference, 11%; 95% CI, 4%-18%) and favorable intermediate-risk tumors decreasing from 61% to 41% (difference, -20%; 95% CI, -24% to -15%). The proportion of high-risk tumors treated with RP increased from 18% to 33% (difference, 15%; 95% CI, 9%-21%). Among men treated with RP, the proportion with the highest PCCI scores of 10 or more (ie, LE <10 years) increased from 4% to 13% (difference, 9%; 95% CI, 4%-14%). Within each tumor risk subgroup, no significant difference in the rate of tumors treated with RP over time was found across PCCI subgroups. CONCLUSIONS AND RELEVANCE In this study, the use of RP shifted from low-risk and favorable intermediate-risk to higher-risk prostate cancer. However, its use among men with limited LE appears unchanged across tumor risk subgroups and increased overall.
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Affiliation(s)
- Kristina Vaculik
- Los Angeles County Department of Public Health, Los Angeles, California
- Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California
| | - Michael Luu
- Divison of Urology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Lauren E. Howard
- Section of Urology, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - William Aronson
- Division of Urology, West Los Angeles Veterans Affairs Medical Center, Los Angeles, California
- Department of Urology, University of California at Los Angeles School of Medicine, Los Angeles
| | - Martha Terris
- Divison of Urology, Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia
- Section of Urology, Medical College of Georgia, Augusta
| | - Christopher Kane
- Urology Department, University of California at San Diego Health System, San Diego
| | | | - Matthew Cooperberg
- Department of Urology, University of California at San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco
| | - Stephen J. Freedland
- Divison of Urology, Cedars-Sinai Medical Center, Los Angeles, California
- Section of Urology, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Timothy J. Daskivich
- Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California
- Divison of Urology, Cedars-Sinai Medical Center, Los Angeles, California
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79
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Kesch C, Heidegger I, Kasivisvanathan V, Kretschmer A, Marra G, Preisser F, Tilki D, Tsaur I, Valerio M, van den Bergh RCN, Fankhauser CD, Zattoni F, Gandaglia G. Radical Prostatectomy: Sequelae in the Course of Time. Front Surg 2021; 8:684088. [PMID: 34124138 PMCID: PMC8193923 DOI: 10.3389/fsurg.2021.684088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Radical prostatectomy (RP) is a frequent treatment for men suffering from localized prostate cancer (PCa). Whilst offering a high chance for cure, it does not come without a significant impact on health-related quality of life. Herein we review the common adverse effects RP may have over the course of time. Methods: A collaborative narrative review was performed with the identification of the principal studies on the topic. The search was executed by a relevant term search on PubMed from 2010 to February 2021. Results: Rates of major complications in patients undergoing RP are generally low. The main adverse effects are erectile dysfunction varying from 11 to 87% and urinary incontinence varying from 0 to 87% with a peak in functional decline shortly after surgery, and dependent on definitions. Different less frequent side effects also need to be taken into account. The highest rate of recovery is seen within the first year after RP, but even long-term improvements are possible. Nevertheless, for some men these adverse effects are long lasting and different, less frequent side effects also need to be taken into account. Despite many technical advances over the last two decades no surgical approach can be clearly favored when looking at long-term outcome, as surgical volume and experience as well as individual patient characteristics are still the most influential variables. Conclusions: The frequency of erectile function and urinary continence side effects after RP, and the trajectory of recovery, need to be taken into account when counseling patients about their treatment options for prostate cancer.
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Affiliation(s)
- Claudia Kesch
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Veeru Kasivisvanathan
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Department of Urology, University College London Hospital, London, United Kingdom
| | | | - Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, Mainz University Medicine, Mainz, Germany
| | - Massimo Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois (CHUV) Lausanne, Lausanne, Switzerland
| | | | | | - Fabio Zattoni
- Urology Unit, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan, Italy
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80
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Time pressure predicts decisional regret in men with localized prostate cancer: data from a longitudinal multicenter study. World J Urol 2021; 39:3755-3761. [PMID: 34021406 PMCID: PMC8519821 DOI: 10.1007/s00345-021-03727-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/04/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE A substantial proportion of men with localized prostate cancer (lPCa) later regret their treatment decision. We aimed to identify factors contributing to decisional regret. METHODS We conducted a longitudinal study, in which men with lPCa were surveyed at four measurement points: T0 (baseline) = prior to treatment; T1 = 6; T2 = 12; T3 = 18 months after baseline. χ2-tests and independent t-tests were used to compare men undergoing different treatments [Active Surveillance (AS) vs. local treatment]. Logistic regression models were fitted to investigate the associations between predictors (time pressure, information provided by the urologist, impairment of erectile functioning, satisfaction with sexual life) and the criterion decisional regret. RESULTS At baseline, the sample included N = 176 men (AS: n = 100; local treatment: n = 76). At T2 and T3, men after local therapies reported higher regret than men under AS. Decisional regret at T3 was predicted by time pressure at baseline (OR 2.28; CI 1.04-4.99; p < 0.05), erectile dysfunction at T2 and T3 (OR 3.40; CI 1.56-7.42; p < 0.01), and satisfaction with sexual life at T1-T3 (OR 0.44; CI 0.20-0.96; p < 0.05). CONCLUSIONS Time pressure, erectile dysfunction, and satisfaction with sexual life predict decisional regret in men with lPCa. Mitigating time pressure and realistic expectations concerning treatment side effects may help to prevent decisional regret in PCa survivors. TRIAL REGISTRATION NUMBER DRKS00009510; date of registration: 2015/10/28.
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81
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Tillier CN, Vromans RD, Boekhout AH, Veerman H, Wollersheim BM, van Muilekom HAM, Boellaard TN, van Leeuwen PJ, van de Poll-Franse LV, van der Poel HG. Individual risk prediction of urinary incontinence after prostatectomy and impact on treatment choice in patients with localized prostate cancer. Neurourol Urodyn 2021; 40:1550-1558. [PMID: 34004044 DOI: 10.1002/nau.24703] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/10/2021] [Accepted: 04/27/2021] [Indexed: 11/12/2022]
Abstract
AIMS Individualized information about the risk of incontinence after prostatectomy could help patients in shared decision-making. METHODS We compared a historical control cohort (n = 254; between June 2016 and 2017) that received standardized information about the risk of incontinence after robot-assisted radical prostatectomy (RARP) with a prospective patient cohort (n = 254; between June 2017 and May 2018) that received individualized information of the chance of recovery of incontinence within 6 months postoperatively based on the continence prediction tool (CPRED). We measured switch in treatment choice, health-related quality of life (QoL) in both cohorts and the accuracy of the CPRED tool. RESULTS Patients in the individualized information group with RARP as initial preference switched more often to another treatment than patients who received standardized information (16% vs. 5%; p = 0.001). Patients in the individualized information group with a high risk of incontinence and with RARP as initial preference switched more often to other treatments than patients in intermediate/low risk of incontinence (35% vs. 9.8%; p = 0.001). Patients with a low risk of incontinence choosing RARP after individualized information were less likely to use more than one diaper a day at any time postoperative (p = 0.001) compared to men with an intermediate/high incontinence risk. Overall QoL was worse in patients with incontinence than patients with continence 6 and 12 months after RARP (respectively; p < 0.0001 and p = 0.007). CONCLUSION Personalized information about the risk of incontinence after RARP makes more patients reconsidering their initial treatment preference. The CPRED correlated strongly with continence outcome after RARP and is a useful tool for shared decision-making.
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Affiliation(s)
- Corinne N Tillier
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Ruben D Vromans
- Department of Communication and Cognition, Tilburg University, Tilburg, The Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Annelies H Boekhout
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Hans Veerman
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Barbara M Wollersheim
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Henricus A M van Muilekom
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Thierry N Boellaard
- Department of Radiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Pim J van Leeuwen
- Department of Urology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lonneke V van de Poll-Franse
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
| | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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82
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Ma TM, Lamb JM, Casado M, Wang X, Basehart TV, Yang Y, Low D, Sheng K, Agazaryan N, Nickols NG, Cao M, Steinberg ML, Kishan AU. Magnetic resonance imaging-guided stereotactic body radiotherapy for prostate cancer (mirage): a phase iii randomized trial. BMC Cancer 2021; 21:538. [PMID: 33975579 PMCID: PMC8114498 DOI: 10.1186/s12885-021-08281-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 05/02/2021] [Indexed: 02/07/2023] Open
Abstract
Background Stereotactic body radiotherapy (SBRT) is becoming increasingly used in treating localized prostate cancer (PCa), with evidence showing similar toxicity and efficacy profiles when compared with longer courses of definitive radiation. Magnetic resonance imaging (MRI)-guided radiotherapy has multiple potential advantages over standard computed tomography (CT)-guided radiotherapy, including enhanced prostate visualization (abrogating the need for fiducials and MRI fusion), enhanced identification of the urethra, the ability to track the prostate in real-time, and the capacity to perform online adaptive planning. However, it is unknown whether these potential advantages translate into improved outcomes. This phase III randomized superiority trial is designed to prospectively evaluate whether toxicity is lower after MRI-guided versus CT-guided SBRT. Methods Three hundred men with localized PCa will be randomized in a 1:1 ratio to SBRT using CT or MRI guidance. Randomization will be stratified by baseline International Prostate Symptom Score (IPSS) (≤15 or > 15) and prostate gland volume (≤50 cc or > 50 cc). Five fractions of 8 Gy will be delivered to the prostate over the course of fourteen days, with or without hormonal therapy and elective nodal radiotherapy (to a dose of 5 Gy per fraction) as per the investigator’s discretion. The primary endpoint is the incidence of physician-reported acute grade ≥ 2 genitourinary (GU) toxicity (during the first 90 days after SBRT), as assessed by the CTCAE version 4.03 scale. Secondary clinical endpoints include incidence of acute grade ≥ 2 gastrointestinal (GI) toxicity, 5-year cumulative incidences of physician-reported late grade ≥ 2 GU and GI toxicity, temporal changes in patient-reported quality of life (QOL) outcomes, 5-year biochemical recurrence-free survival and the proportion of fractions of MRI-guided SBRT in which online adaptive radiotherapy is used. Discussion The MIRAGE trial is the first randomized trial comparing MRI-guided with standard CT-guided SBRT for localized PCa. The primary hypothesis is that MRI-guided SBRT will lead to an improvement in the cumulative incidence of acute grade ≥ 2 GU toxicity when compared to CT-guided SBRT. The pragmatic superiority design focused on an acute toxicity endpoint will allow an early comparison of the two technologies. Trial registration Clinicaltrials.gov identifier: NCT04384770. Date of registration: May 12, 2020. https://clinicaltrials.gov/ct2/show/NCT04384770 Protocol version Version 2.1, Aug 28, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08281-x.
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Affiliation(s)
- Ting Martin Ma
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA
| | - James M Lamb
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA
| | - Maria Casado
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA
| | - Xiaoyan Wang
- Department of Medicine Statistics Core, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA
| | - T Vincent Basehart
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA
| | - Yingli Yang
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA
| | - Daniel Low
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA
| | - Ke Sheng
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA
| | - Nzhde Agazaryan
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA
| | - Nicholas G Nickols
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA
| | - Minsong Cao
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA
| | - Michael L Steinberg
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA. .,Department of Urology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA.
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83
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Pessoa RR, Maroni P, Kukreja J, Kim SP. Comparative effectiveness of robotic and open radical prostatectomy. Transl Androl Urol 2021; 10:2158-2170. [PMID: 34159098 PMCID: PMC8185666 DOI: 10.21037/tau.2019.12.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Radical prostatectomy (RP) has undergone a remarkable transformation from open to minimally-invasive surgery over the last two decades. However, it is important to recognize there is still conflicting evidence regarding key outcomes. We aimed to summarize current literature on comparative effectiveness of robotic and open RP for key outcomes including oncologic results, health-related quality of life (HRQOL) measures, safety and postoperative complications, and healthcare costs. The bulk of the paper will discuss and interpret limitations of current data. Finally, we will also highlight future directions of both surgical approaches and its potential impact on health care delivery.
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Affiliation(s)
| | - Paul Maroni
- Division of Urology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Janet Kukreja
- Division of Urology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Simon P Kim
- Division of Urology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.,Cancer Outcomes and Public Policy Effectiveness Research (COPPER), Yale University, New Haven, Connecticut
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Auffenberg GB, Qi J, Dunn RL, Linsell S, Kim T, Miller DC, Tosoian J, Sarle R, Johnston WK, Kleer E, Ghani KR, Montie J, Peabody J. Evaluation of Patient- and Surgeon-Specific Variations in Patient-Reported Urinary Outcomes 3 Months After Radical Prostatectomy From a Statewide Improvement Collaborative. JAMA Surg 2021; 156:e206359. [PMID: 33471043 DOI: 10.1001/jamasurg.2020.6359] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Understanding variation in patient-reported outcomes following radical prostatectomy may inform efforts to reduce morbidity after this procedure. Objective To describe patient-reported urinary outcomes following radical prostatectomy in the diverse practice settings of a statewide quality improvement program and to explore whether surgeon-specific variations in observed outcomes persist after accounting for patient-level factors. Design, Setting, and Participants This prospective population-based cohort study included 4582 men in the Michigan Urological Surgery Improvement Collaborative who underwent radical prostatectomy as primary management of localized prostate cancer between April 2014 and July 2018 and who agreed to complete validated questionnaires prior to surgery and at 3, 6, and 12 months after surgery. Data were analyzed from 2019 to June 2019. Exposures Radical prostatectomy. Main Outcomes and Measures Patient- and surgeon-level analyses of patient-reported urinary function 3 months after radical prostatectomy. Outcomes were measured using validated questionnaires with results standardized using previously published methods. Urinary function survey scores are reported on a scale from 0 to 100 with good function established as a score of 74 or higher. Results For the 4582 men undergoing radical prostatectomy within the Michigan Urological Surgery Improvement Collaborative who agreed to complete surveys, mean (SD) age was 63.3 (7.1) years. Survey response rates varied: 3791 of 4582 (83%) responded at baseline, 3282 of 4137 (79%) at 3 months, 2975 of 3770 (79%) at 6 months, and 2213 of 2882 (77%) at 12 months. Mean (SD) urinary function scores were 88.5 (14.3) at baseline, 53.6 (27.5) at 3 months, 68.0 (25.1) at 6 months, and 73.7 (23.0) at 12 months. Regression analysis demonstrated that older age, lower baseline urinary function score, body mass index (calculated as weight in kilograms divided by height in meters squared) of 30 or higher, clinical stage T2 or higher, and lack of bilateral nerve-sparing surgery were associated with a lower probability of reporting good urinary function 3 months after surgery. When evaluating patients with good baseline function, the rate at which individual surgeons' patients reported good urinary function 3 months after surgery varied broadly (0% to 54.5%; P < .001). Patients receiving surgery from top-performing surgeons were more likely to report good 3-month function. This finding persisted after accounting for patient risk factors. Conclusions and Relevance In this study, patient- and surgeon-level urinary outcomes following prostatectomy varied substantially. Documenting surgeon-specific variations after accounting for patient factors may facilitate identification of surgical factors associated with superior outcomes.
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Affiliation(s)
- Gregory B Auffenberg
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ji Qi
- Department of Urology, University of Michigan, Ann Arbor
| | - Rodney L Dunn
- Department of Urology, University of Michigan, Ann Arbor
| | - Susan Linsell
- Department of Urology, University of Michigan, Ann Arbor
| | - Tae Kim
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor
| | - David C Miller
- Department of Urology, University of Michigan, Ann Arbor
| | | | - Richard Sarle
- Department of Urology, Sparrow Hospital, Lansing, Michigan
| | | | - Eduardo Kleer
- IHA Urology, St Joe's Ann Arbor, Ann Arbor, Michigan
| | | | - James Montie
- Department of Urology, University of Michigan, Ann Arbor
| | - James Peabody
- Department of Urology, Henry Ford Health System, Detroit, Michigan
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85
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Wagaskar VG, Sobotka S, Ratnani P, Young J, Lantz A, Parekh S, Falagario UG, Li L, Lewis S, Haines K, Punnen S, Wiklund P, Tewari A. A 4K score/MRI-based nomogram for predicting prostate cancer, clinically significant prostate cancer, and unfavorable prostate cancer. Cancer Rep (Hoboken) 2021; 4:e1357. [PMID: 33661541 PMCID: PMC8388161 DOI: 10.1002/cnr2.1357] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/28/2021] [Accepted: 02/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background The detection of prostate cancer requires histological confirmation in biopsy core. Currently, number of unnecessary prostate biopsies are being performed in the United States. This is due to the absence of appropriate biopsy decision‐making protocol. Aim To develop and validate a 4K score/multiparametric magnetic resonance imaging (mpMRI)‐based nomogram to predict prostate cancer (PCa), clinically significant prostate cancer (csPCa), and unfavorable prostate cancer (uPCa). Methods and Results Retrospective, single‐center study evaluating a cohort of 574 men with 4K score test >7% or suspicious digital rectal examination (DRE) or Prostate Imaging Reporting and Data System (PI‐RADS) scores 3, 4, or 5 on mpMRI that underwent systematic and/or mpMRI/ultrasound fusion–targeted prostate biopsy between 2016 and 2020. External cohort included 622 men. csPCa and uPCa were defined as Gleason score ≥3 + 4 and ≥4 + 3 on biopsy, respectively. Multivariable logistic regression analysis was performed to build nomogram for predicting PCa, csPCa, and uPCa. Validation was performed by plotting the area under the curve (AUC) and comparing nomogram‐predicted probabilities with actual rates of PCa, csPCa, and uPCa probabilities in the external cohort. 4K score, a PI‐RADS ≥4, prostate volume and prior negative biopsy were significant predictors of PCa, csPCa, and uPCa. AUCs were 0.84, 0.88, and 0.86 for the prediction of PCa, csPCa, and uPCa, respectively. The predicted and actual rates of PCa, csPCa, and uPCa showed agreement across all percentage probability ranges in the validation cohort. Using the prediction model at threshold of 30, 30% of overall biopsies, 41% of benign biopsies, and 19% of diagnosed indolent PCa could be avoided, while missing 9% of csPCa. Conclusion This novel nomogram would reduce unnecessary prostate biopsies and decrease detection of clinically insignificant PCa.
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Affiliation(s)
- Vinayak G Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Stanislaw Sobotka
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - James Young
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Anna Lantz
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Sneha Parekh
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Ugo Giovanni Falagario
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Li Li
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Kenneth Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Sanoj Punnen
- Department of Urology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
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86
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Sutton E, Lane JA, Davis M, Walsh EI, Neal DE, Hamdy FC, Mason M, Staffurth J, Martin RM, Metcalfe C, Peters TJ, Donovan JL, Wade J. Men's experiences of radiotherapy treatment for localized prostate cancer and its long-term treatment side effects: a longitudinal qualitative study. Cancer Causes Control 2021; 32:261-269. [PMID: 33394204 PMCID: PMC7870600 DOI: 10.1007/s10552-020-01380-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/04/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate men's experiences of receiving external-beam radiotherapy (EBRT) with neoadjuvant Androgen Deprivation Therapy (ADT) for localized prostate cancer (LPCa) in the ProtecT trial. METHODS A longitudinal qualitative interview study was embedded in the ProtecT RCT. Sixteen men with clinically LPCa who underwent EBRT in ProtecT were purposively sampled to include a range of socio-demographic and clinical characteristics. They participated in serial in-depth qualitative interviews for up to 8 years post-treatment, exploring experiences of treatment and its side effects over time. RESULTS Men experienced bowel, sexual, and urinary side effects, mostly in the short term but some persisted and were bothersome. Most men downplayed the impacts, voicing expectations of age-related decline, and normalizing these changes. There was some reticence to seek help, with men prioritizing their relationships and overall health and well-being over returning to pretreatment levels of function. Some unmet needs with regard to information about treatment schedules and side effects were reported, particularly among men with continuing functional symptoms. CONCLUSIONS These findings reinforce the importance of providing universal clear, concise, and timely information and supportive resources in the short term, and more targeted and detailed information and care in the longer term to maintain and improve treatment experiences for men undergoing EBRT.
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Affiliation(s)
- E. Sutton
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
| | - J. A. Lane
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
- Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, Canynge Hall, 39 Whatley Road, Clifton, Bristol, BS8 2PS UK
| | - M. Davis
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
| | - E. I. Walsh
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
| | - D. E. Neal
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - F. C. Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - M. Mason
- Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - J. Staffurth
- Department of Oncology, Cardiff University, Cardiff, UK
| | - R. M. Martin
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
| | - C. Metcalfe
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
| | - T. J. Peters
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
| | - J. L. Donovan
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) West, University Hospitals Bristol NHS Trust, Bristol, UK
| | - J. Wade
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
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87
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Five-year quality of life in patients with high-risk localized prostate cancer treated with external beam radiotherapy alone versus external beam radiotherapy with high-dose-rate brachytherapy boost: a prospective multicenter study. J Contemp Brachytherapy 2021; 13:1-11. [PMID: 34025730 PMCID: PMC8117716 DOI: 10.5114/jcb.2021.103580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/24/2020] [Indexed: 11/26/2022] Open
Abstract
Purpose Brachytherapy (BT) and external beam radiation therapy (EBRT) are effective treatments for high-risk prostate cancer (PCa). However, the impact of these treatments on health-related quality of life (HRQL) remains unclear. In this study, we compared EBRT alone with EBRT plus a boost with high-dose rate (HDR)-BT to determine the impact on HRQL in patients with high-risk PCa. Material and methods Prospective, multicenter study comparing patients with high-risk PCa treated with EBRT alone or EBRT + HDR-BT from 2004 to 2006. HRQL was assessed at baseline (pre-treatment) and periodically over the 5-year follow-up, using the SF-36 (v.2), EPIC, and FACT-G and FACT-P questionnaires. Results A total of 129 patients were included in the study, of these, 41 received EBRT alone and 88 EBRT + HDR-BT. All patients received hormonotherapy. Baseline clinical characteristics were similar, except for a slightly higher mean number of comorbidities in the EBRT group. During follow-up, the only significant between-group difference was a greater worsening on EPIC hormonal domain in the EBRT alone group (p = 0.028). There were no significant differences in time and interaction of treatment in SF-36, and FACT-G and FACT-P questionnaires or EPIC urinary incontinence, urinary irritative-obstructive, and bowel and sexual domains over the 5-year follow-up. Oncological outcomes were similar in both groups. Conclusions After five years of follow-up, EBRT alone or combined with HDR-BT boost had a similar impact on HRQL in patients with high-risk localized PCa. However, patients in the EBRT alone group experienced greater worsening of hormonal domain according to EPIC questionnaire.
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88
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Palumbo C, Bruni A, Antonelli A, Artibani W, Bassi P, Bertoni F, Borghetti P, Bracarda S, Cicchetti A, Corvò R, Gacci M, Ingrosso G, Magrini SM, Maruzzo M, Mirone V, Montironi R, Muto G, Noale M, Porreca A, Russi E, Triggiani L, Tubaro A, Valdagni R, Maggi S, Conti GN. Health-related quality of life 24 months after prostate cancer diagnosis: an update from the Pros-IT CNR prospective observational study. Minerva Urol Nephrol 2021; 74:11-20. [PMID: 33439570 DOI: 10.23736/s2724-6051.20.04032-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study analyzes patient health-related quality of life (QoL) 24-month after prostate cancer (PCa) diagnosis within the PROState cancer monitoring in ITaly from the National Research Council (Pros-IT CNR) study. METHODS Pros-IT CNR is an ongoing, longitudinal and observational study, considering a convenience sample of patients enrolled at PCa diagnosis and followed at 6, 12, 24, 36, 48 and 60 months from the diagnosis. Patients were grouped according to the treatment received: nerve sparing radical prostatectomy (NSRP), non-nerve sparing radical prostatectomy (NNSRP), radiotherapy (RT), RT plus androgen deprivation (RT plus ADT) and active surveillance (AS). QoL was measured through the Italian versions of SF-12 and UCLA-PCI questionnaires at diagnosis and at 6-12 and 24-month. The minimal clinically important difference (MCID) was defined as half a standard deviation of the baseline domain. RESULTS Overall, 1537 patients were included in the study. The decline in urinary function exceeded the MCID at each timepoint only in the NSRP and NNSRP groups (at 24 months -14.7, P<0.001 and -19.7, P<0.001, respectively). The decline in bowel function exceeded the MCID only in the RT (-9.1, P=0.02) and RT plus ADT groups at 12 months (-10.3, P=0.001); after 24 months, most patients seem to recover their bowel complaints. The decline in sexual function exceeded the MCID at each timepoint in the NNSRP, NSRP and RT plus ADT groups (at 6 months -28.7, P<0.001, -37.8, P<0.001, -20.4, P<0.001, respectively). CONCLUSIONS Although all the treatments were relatively well-tolerated over the 24 month period following PCa diagnosis, each had a different impact on QoL.
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Affiliation(s)
- Carlotta Palumbo
- Department of Urology, Maggiore della Carità Hospital, Novara, Italy
| | - Alessio Bruni
- Unit of Radiotherapy, University Hospital of Modena, Modena, Italy
| | | | | | - Pierfrancesco Bassi
- Department of Urology, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Filippo Bertoni
- Prostate Group of the Italian Association for Radiation Oncology (AIRO), Milan, Italy
| | - Paolo Borghetti
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | | | | | - Renzo Corvò
- Department of Radiation Oncology, IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy
| | - Mauro Gacci
- Department of Urologic Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Gianluca Ingrosso
- Section of Radiation Oncology, Department of Surgical and Biomedical Science, University of Perugia, Perugia, Italy
| | - Stefano M Magrini
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Marco Maruzzo
- Medical Oncology Unit 1, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Vincenzo Mirone
- Department of Urology, University of Naples Federico II, Naples, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, School of Medicine, United Hospitals, Polytechnic University of the Marche Region, Ancona, Italy
| | - Giovanni Muto
- Department of Urology, Humanitas Gradenigo University Hospital, Turin, Italy
| | - Marianna Noale
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy -
| | - Angelo Porreca
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Elvio Russi
- Department of Radiotherapy, S. Croce e Carle Teaching Hospital, Cuneo, Italy
| | - Luca Triggiani
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Andrea Tubaro
- Unit of Urology, Sant'Andrea Hospital, La Sapienza University of Rome, Rome, Italy
| | | | - Stefania Maggi
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy
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Neuzillet Y, Rouanne M, Dreyfus JF, Raynaud JP, Schneider M, Roupret M, Drouin S, Galiano M, Cathelinau X, Lebret T, Botto H. Metabolic syndrome, levels of androgens, and changes of erectile dysfunction and quality of life impairment 1 year after radical prostatectomy. Asian J Androl 2021; 23:370-375. [PMID: 33565427 PMCID: PMC8269836 DOI: 10.4103/aja.aja_88_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Robust data evaluating the association of preoperative parameters of the patients with quality of life after radical prostatectomy are lacking. We investigated whether clinical and biological preoperative characteristics of the patients were associated with impaired patient-reported quality of life (QoL) and sexual outcomes 1 year after radical prostatectomy. We evaluated patient-reported outcomes among the 1343 men participating in the AndroCan trial (NCT02235142). QoL and erectile dysfunction (ED) were assessed before and 1 year after radical prostatectomy using validated self-assessment questionnaires (Aging Male's Symptoms [AMS] and the 5-item abridged version of the International Index of Erectile Function [IIEF5]). At baseline, 1194 patients (88.9%) accepted to participate. A total of 750 (55.8%) patients answered the 1-year postoperative questionnaires. Out of them, only 378 (50.4% of responders) provided answers that could be used for calculations. One year after prostatectomy, ED had worsened by 8.0 (95% confidence interval [CI]: 7.3–8.7; P < 0.0001) out of a maximum of 20. The global AMS score has worsened by 2.8 (95% CI: 1.7–3.8; P < 0.0001). ED scores 1 year postsurgery were positively correlated with preoperative age and percentage of fat mass, and negatively correlated with total cholesterol, dehydroepiandrosterone (DHEA), and androstenediol (D5); AMS were poorly correlated with preoperative parameters. QoL and sexual symptoms significantly worsened after radical prostatectomy. Baseline bioavailable testosterone levels were significantly correlated with smaller changes on AMS somatic subscores postprostatectomy. These findings may be used to inform patients with newly diagnosed prostate cancer.
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Affiliation(s)
- Yann Neuzillet
- Department of Urology, Hospital Foch, UVSQ-Paris-Saclay University, Suresnes 92150, France
| | - Mathieu Rouanne
- Department of Urology, Hospital Foch, UVSQ-Paris-Saclay University, Suresnes 92150, France
| | - Jean-François Dreyfus
- Department of Clinical Research and Innovation, Hospital Foch, UVSQ-Paris-Saclay University, Suresnes 92150, France
| | | | - Marc Schneider
- Department of Urology, Hospital Louis Pasteur, Colmar 68000, France
| | - Morgan Roupret
- Department of Urology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris 75013, France
| | - Sarah Drouin
- Department of Urology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris 75013, France
| | - Marc Galiano
- Department of Urology, Montsouris Institute, Paris-Descartes University, Paris 75014, France
| | - Xavier Cathelinau
- Department of Urology, Montsouris Institute, Paris-Descartes University, Paris 75014, France
| | - Thierry Lebret
- Department of Urology, Hospital Foch, UVSQ-Paris-Saclay University, Suresnes 92150, France
| | - Henry Botto
- Department of Urology, Hospital Foch, UVSQ-Paris-Saclay University, Suresnes 92150, France
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90
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Tang C, Lei X, Smith GL, Pan HY, Hoffman KE, Kumar R, Chapin BF, Shih YCT, Frank SJ, Smith BD. Influence of Geography on Prostate Cancer Treatment. Int J Radiat Oncol Biol Phys 2020; 109:1286-1295. [PMID: 33316361 DOI: 10.1016/j.ijrobp.2020.11.055] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/18/2020] [Accepted: 11/22/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Several definitive treatment options are available for prostate cancer, but geographic access to those options is not uniform. We created maps illustrating provider practice patterns relation to patients and assessed the influence of distance to treatment receipt. METHODS AND MATERIALS The patient cohort was created by searching the National Medicare Database for patients diagnosed and treated for prostate cancer from 2011 to 2014. The provider cohort was created by querying the American Medical Association Physician Masterfile to identify physicians who had treated patients with prostatectomy, intensity modulated radiation therapy (IMRT), brachytherapy, stereotactic body radiation therapy (SBRT), or proton therapy. Maps detailing the location of providers were created for each modality. Multivariate multinomial logistic regressions were used to assess the association between patient-provider distance and probability of treatment. RESULTS Cohorts consisted of 89,902 patients treated by 5518 physicians. Substantial numbers of providers practicing established modalities (IMRT, prostatectomy, and brachytherapy) were noted in major urban centers, whereas provider numbers were reduced in rural areas, most notably for brachytherapy. Ninety percent of prostate cancer patients lived within 35.1, 28.9, and 55.6 miles of a practitioner of prostatectomy, IMRT, and brachytherapy, respectively. Practitioners of emerging modalities (SBRT and proton therapy) were predominantly concentrated in urban locations, with 90% of patients living within 128 miles (SBRT) and 374.5 miles (proton). Greater distance was associated with decreased probability of treatment (IMRT -3.8% per 10 miles; prostatectomy -2.1%; brachytherapy -2%; proton therapy -1.6%; and SBRT -1.1%). CONCLUSIONS Geographic disparities were noted for analyzed treatment modalities, and these disparities influenced delivery.
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Affiliation(s)
- Chad Tang
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Xiudong Lei
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Grace L Smith
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hubert Y Pan
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Karen E Hoffman
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rachit Kumar
- Department of Radiation Oncology, Banner MD Anderson, Phoenix, Arizona
| | - Brian F Chapin
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ya-Chen Tina Shih
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven J Frank
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Benjamin D Smith
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas.
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Stabholz Y, Sandhu JS. Management of voiding dysfunction associated with pelvic malignancies. Int J Urol 2020; 28:17-24. [PMID: 33159341 DOI: 10.1111/iju.14405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/14/2020] [Indexed: 11/27/2022]
Abstract
Voiding dysfunction is common after surgical and radiation treatments in patients diagnosed with non-urological pelvic malignancies. Presentation might vary with lower urinary tract symptoms and/or overactive bladder, urinary retention, or incontinence. We reviewed the most recent literature with the aim of describing various types of urinary dysfunction that manifest after radical treatments for non-urological pelvic malignancies. Radical surgical or radiation treatment adversely affect other adjacent pelvic organ function, including viscera, pelvic musculature and the peripheral nervous system. This results in direct organ and indirect functional damage to the genitourinary tract. Multiple surgical and radiation modifications are available nowadays, allowing urologists to offer various treatments for better functional lower urinary tract outcomes. Diagnosing and understanding the type and severity of voiding dysfunction plays a key role in tailoring an appropriate treatment plan. The objective to better functional results relies on maintaining adequate bladder compliance and capacity while permitting volitional emptying, ideally through voiding. Management should routinely start with conservative measures, including pelvic floor muscle training with or without a combination of oral medication for urgency incontinence and clean intermittent catheterization for the management of urinary retention. Concomitant or isolated urinary incontinence can be further managed through multiple established surgical approaches. We attempted to address various treatment available for known lower urinary tract symptoms that might have been caused secondary to non-urological pelvic surgery or radiation. We discuss different diagnostic and treatment modalities individualized for patients with various entities, to help achieve optimal urinary function and improve quality of life.
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Affiliation(s)
- Yariv Stabholz
- Department of Surgery/Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jaspreet S Sandhu
- Department of Surgery/Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Taylor JM, Chen VE, Miller RC, Greenberger BA. The Impact of Prostate Cancer Treatment on Quality of Life: A Narrative Review with a Focus on Randomized Data. Res Rep Urol 2020; 12:533-546. [PMID: 33150144 PMCID: PMC7605665 DOI: 10.2147/rru.s243088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/06/2020] [Indexed: 01/03/2023] Open
Abstract
Despite excellent oncologic outcomes, the management of localized prostate cancer remains complex and is dependent on multiple factors, including patient life expectancy, medical comorbidities, tumor characteristics, and genetic risk factors. Decades of iterative clinical trials have improved the optimization and utilization of surgical and radiation-based modalities, as well as their combinatorial use with anti-androgen and systemic therapies. While cure rates are high and converging on equivalent disease control should an upfront surgical or radiotherapeutic approach be optimized, the long-term side effects of surgical and radiation-based treatments can differ significantly in nature. Decisions regarding the selection of therapy are therefore best made in an informed and shared medical decision-making process between clinician and patient with respect to cancer control as well as adverse effects. We outline in this narrative review an understanding regarding implications of surgical and radiation treatment on quality of life after treatment, and how these data may be considered in the context of advising patients regarding the selection of therapy. This narrative review largely focuses on the quality of life data obtained from prospective randomized trials of men treated for prostate cancer. We believe this provides the best assessment of the quality of life and can be used to inform patients when making treatment decisions.
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Affiliation(s)
- James M Taylor
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | - Victor E Chen
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | - Ryan C Miller
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | - Benjamin A Greenberger
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
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93
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Papadopoulos G, Fragkoulis C, Stasinopoulos K, Stathouros G, Glykas I, Theocharis G, Lamprou S, Ntoumas K. Does radical prostatectomy result in lower urinary tract symptom improvement in high-risk and locally advanced prostate cancer? A Single-center experience. Urologia 2020; 88:110-114. [PMID: 33040689 DOI: 10.1177/0391560320964611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Radical prostatectomy represents the most popular method of prostate cancer treatment, including cases with high-risk and locally advanced cancer. Besides, men with this disease often experience lower urinary tract symptoms (LUTS) and report high International Prostate Symptom Scores (IPSS), pathological post-void residual (PVR) urine volumes and low levels of maximum urinary flow rates (Qmax). In this study we assessed the effect of radical prostatectomy on the above parameters in patients with high-risk and locally advanced disease. METHODS A number of 240 individuals were enrolled in the study. Patients that required any post-operative manipulation up to the completion of 12 months after surgery were excluded. All patients were assessed pre- and post-operatively at 3, 6 and 12 months. Evaluation included IPSS, Qmax and PVR. RESULTS Mean age was 66.8 years. Mean PSA value was 12.7 ng/ml and mean Gleason score was 7.9. At baseline 41.3% of the patients had Qmax ⩽10 and 42.5% had IPSS >8. There was a significant increase in Qmax during the follow-up (median value was 12 at baseline and increased to 21 at 12 months). Also, IPSS and PVR decreased significantly during the follow-up. IPSS median value decreased from 9 at baseline to 5 at 12 months. Improvement was observed in all grades of symptoms.
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Affiliation(s)
| | | | | | - Georgios Stathouros
- Department of Urology, General Hospital of Athens "G.Gennimatas", Athens, Greece
| | - Ioannis Glykas
- Department of Urology, General Hospital of Athens "G.Gennimatas", Athens, Greece
| | - Georgios Theocharis
- Department of Urology, General Hospital of Athens "G.Gennimatas", Athens, Greece
| | - Stavros Lamprou
- Department of Urology, General Hospital of Athens "G.Gennimatas", Athens, Greece
| | - Konstantinos Ntoumas
- Department of Urology, General Hospital of Athens "G.Gennimatas", Athens, Greece
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94
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Nishikawa R, Honda M, Teraoka S, Shimizu R, Kimura Y, Iwamoto H, Morizane S, Hikita K, Takenaka A. Effects of nerve-sparing procedures on bowel function after robot-assisted radical prostatectomy: A longitudinal study. Int J Med Robot 2020; 16:1-10. [PMID: 32931133 DOI: 10.1002/rcs.2156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND This study aimed to evaluate rectal pain and bowel function of the patients following robot-assisted radical prostatectomy (RARP). METHODS We divided 296 patients who underwent RARP into two groups depending on the intervention: NS (nerve-sparing) group (bilateral NS, unilateral NS and bilateral partial NS) and non-NS group (unilateral partial NS, bilateral non-NS). Bowel function was assessed using the Extended Prostate Cancer Index Composite for 24 months after RARP. RESULTS The bowel function score and rectal urgency at 1-6 months after RARP were more significantly impaired in the non-NS group than in the NS group (p < 0.05). In a multivariate analysis of factors affecting the bowel function score at 6 months after RARP, only NS procedure had a significant effect. CONCLUSIONS In the initial period after RARP, bowel symptoms were significantly impaired. This impairment was affected by the degree of NS. These results could guide patients in their decision to choose RARP.
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Affiliation(s)
- Ryoma Nishikawa
- Division of Urology, Tottori University Faculty of Medicine, Tottori, Japan
| | - Masashi Honda
- Division of Urology, Tottori University Faculty of Medicine, Tottori, Japan
| | - Shogo Teraoka
- Division of Urology, Tottori University Faculty of Medicine, Tottori, Japan
| | - Ryutaro Shimizu
- Division of Urology, Tottori University Faculty of Medicine, Tottori, Japan
| | - Yusuke Kimura
- Division of Urology, Tottori University Faculty of Medicine, Tottori, Japan
| | - Hideto Iwamoto
- Division of Urology, Tottori University Faculty of Medicine, Tottori, Japan
| | - Shuichi Morizane
- Division of Urology, Tottori University Faculty of Medicine, Tottori, Japan
| | - Katsuya Hikita
- Division of Urology, Tottori University Faculty of Medicine, Tottori, Japan
| | - Atsushi Takenaka
- Division of Urology, Tottori University Faculty of Medicine, Tottori, Japan
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95
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Sanghera S, Mohiuddin S, Coast J, Garfield K, Noble S, Metcalfe C, Lane JA, Turner EL, Neal D, Hamdy FC, Martin RM, Donovan JL. Modelling the lifetime cost-effectiveness of radical prostatectomy, radiotherapy and active monitoring for men with clinically localised prostate cancer from median 10-year outcomes in the ProtecT randomised trial. BMC Cancer 2020; 20:971. [PMID: 33028256 PMCID: PMC7542698 DOI: 10.1186/s12885-020-07276-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 08/09/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Optimal management strategies for clinically localised prostate cancer are debated. Using median 10-year data from the largest randomised controlled trial to date (ProtecT), the lifetime cost-effectiveness of three major treatments (radical radiotherapy, radical prostatectomy and active monitoring) was explored according to age and risk subgroups. METHODS A decision-analytic (Markov) model was developed and informed by clinical input. The economic evaluation adopted a UK NHS perspective and the outcome was cost per Quality-Adjusted Life Year (QALY) gained (reported in UK£), estimated using EQ-5D-3L. RESULTS Costs and QALYs extrapolated over the lifetime were mostly similar between the three randomised strategies and their subgroups, but with some important differences. Across all analyses, active monitoring was associated with higher costs, probably associated with higher rates of metastatic disease and changes to radical treatments. When comparing the value of the strategies (QALY gains and costs) in monetary terms, for both low-risk prostate cancer subgroups, radiotherapy generated the greatest net monetary benefit (£293,446 [95% CI £282,811 to £299,451] by D'Amico and £292,736 [95% CI £284,074 to £297,719] by Grade group 1). However, the sensitivity analysis highlighted uncertainty in the finding when stratified by Grade group, as radiotherapy had 53% probability of cost-effectiveness and prostatectomy had 43%. In intermediate/high risk groups, using D'Amico and Grade group > = 2, prostatectomy generated the greatest net monetary benefit (£275,977 [95% CI £258,630 to £285,474] by D'Amico and £271,933 [95% CI £237,864 to £287,784] by Grade group). This finding was supported by the sensitivity analysis. Prostatectomy had the greatest net benefit (£290,487 [95% CI £280,781 to £296,281]) for men younger than 65 and radical radiotherapy (£201,311 [95% CI £195,161 to £205,049]) for men older than 65, but sensitivity analysis showed considerable uncertainty in both findings. CONCLUSION Over the lifetime, extrapolating from the ProtecT trial, radical radiotherapy and prostatectomy appeared to be cost-effective for low risk prostate cancer, and radical prostatectomy for intermediate/high risk prostate cancer, but there was uncertainty in some estimates. Longer ProtecT trial follow-up is required to reduce uncertainty in the model. TRIAL REGISTRATION Current Controlled Trials number, ISRCTN20141297: http://isrctn.org (14/10/2002); ClinicalTrials.gov number, NCT02044172: http://www.clinicaltrials.gov (23/01/2014).
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Affiliation(s)
- S Sanghera
- Health Economics Bristol (HEB), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK.
| | - S Mohiuddin
- Health Economics Bristol (HEB), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care West at University Hospitals Bristol, Bristol, BS1 2NT, UK
| | - J Coast
- Health Economics Bristol (HEB), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - K Garfield
- Health Economics Bristol (HEB), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, BS8 2PS, UK
| | - S Noble
- Health Economics Bristol (HEB), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - C Metcalfe
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, BS8 2PS, UK
| | - J A Lane
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, BS8 2PS, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - E L Turner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - D Neal
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 7DQ, UK
| | - F C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 7DQ, UK
| | - R M Martin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
- National Institute for Health Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, BS8 2PS, UK
| | - J L Donovan
- NIHR Collaboration for Leadership in Applied Health Research and Care West at University Hospitals Bristol, Bristol, BS1 2NT, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
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96
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Royce TJ, Wang AZ, Chen RC. Quality-of-life Benefits and Harms from Prostate Radiotherapy in Patients with Low-burden Metastatic Prostate Cancer. Eur Urol 2020; 79:198-199. [PMID: 32981803 DOI: 10.1016/j.eururo.2020.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 09/10/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Trevor J Royce
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Andrew Z Wang
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ronald C Chen
- Department of Radiation Oncology, University of Kansas, Kansas City, KS, USA
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97
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Groarke A, Curtis R, Skelton J, Groarke JM. Quality of life and adjustment in men with prostate cancer: Interplay of stress, threat and resilience. PLoS One 2020; 15:e0239469. [PMID: 32941547 PMCID: PMC7498057 DOI: 10.1371/journal.pone.0239469] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/04/2020] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Diagnosis and treatment of prostate cancer can generate many challenges which impact on adjustment, so understanding the psychosocial factors which contribute to individual vulnerability to poor adaptation warrants further investigation. This study investigates stress and masculine identity threat as predictors of quality of life and emotional adjustment in men with localized prostate cancer and the role of resilience as a potential protective psychological factor. METHODS Participants were invited to complete a survey study via online prostate cancer forums. Participants were 204 men ranging in age from 44-88 years (M = 65.24±7.51) and who were diagnosed with early localized prostate cancer within the previous five years. Measures used included the Perceived Stress Scale, Cancer-Related Masculine Threat Scale and the Conor-Davidson Resilience Scale. Using a cross-sectional online survey design, the extent to which perceived stress, masculine threat and psychological resilience are associated with quality of life, positive and negative affect and distress was assessed. RESULTS Hierarchical regression analysis demonstrated that perceived stress accounted for 26%-44% of variance on quality of life and adjustment indices, with high stress associated with low mood and poor quality of life. Low masculine threat and high resilience predicted better quality of life and emotional adjustment accounting for between 1-7% of the variance. Resilience moderated the relationship between stress and distress and mediated the association between masculine threat and distress and negative affect. CONCLUSION Perceived stress was the most powerful predictor in the model and findings suggest it contributes significantly to functional and affective status in survivors of prostate cancer. Psychological resilience is a protective factor which buffers the negative effect of stress and masculine identity threat on emotional adjustment. Findings indicate that men should be screened as part of the diagnostic and treatment process for high perceived stress and low resilience to identify those at risk for poor adjustment during survivorship.
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Affiliation(s)
- AnnMarie Groarke
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Ruth Curtis
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Jean Skelton
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Jenny M. Groarke
- Centre for Improving Health-Related Quality of Life, School of Psychology, Queen’s University Belfast, Belfast, United Kingdom
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98
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Mouillet G, Efficace F, Thiery-Vuillemin A, Charton E, Van Hemelrijck M, Sparano F, Anota A. Investigating the impact of open label design on patient-reported outcome results in prostate cancer randomized controlled trials. Cancer Med 2020; 9:7363-7374. [PMID: 32846465 PMCID: PMC7571808 DOI: 10.1002/cam4.3335] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 01/19/2023] Open
Abstract
Background While open‐label randomized controlled trials (RCT) are common in oncology, some concerns have been expressed with regard to Patient‐Reported Outcomes (PRO)‐based claims stemming from these studies. We aimed to investigate the impact of open‐label design in the context of prostate cancer (PCa) RCTs with PRO data. Methods Randomized controlled trials of PCa with a PRO endpoint published between 2004 and 2018 were considered. RCTs were systematically evaluated on the basis of previously defined criteria, including international PRO reporting quality standards and the Cochrane Collaboration's tool for assessing Risk of Bias. The rate of concordance was estimated and compared between traditional clinical outcomes (eg, survival or tumor response) and PRO in open and blinded RCTs. Results We identified 110 RCTs published between 2004 and 2018, of which 62% (n = 68) were open‐label. The general characteristics of PCa RCTs were not different according to their design (open‐label vs blinded). The proportion of PCa RCTs with high‐quality PRO reporting was not different between open‐label RCTs and blinded RCTs (41.2% vs 38.1%; P = .75). No statistically significant difference was found between PRO results and concordance with traditional clinical outcomes according to the study design. Conclusion Our findings suggest that there is no evidence of significant bias for PROs due to the absence of blinding in the context of PCa RCTs. Further analyses should be conducted in other cancer disease sites.
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Affiliation(s)
- Guillaume Mouillet
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France.,Methodological and Quality of Life Unit in Oncology, University Hospital of Besançon, Besançon, France.,INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, Besançon, France
| | - Fabio Efficace
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Antoine Thiery-Vuillemin
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France.,INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, Besançon, France
| | - Emilie Charton
- Methodological and Quality of Life Unit in Oncology, University Hospital of Besançon, Besançon, France.,INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, Besançon, France
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK
| | - Francesco Sparano
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Amélie Anota
- Methodological and Quality of Life Unit in Oncology, University Hospital of Besançon, Besançon, France.,INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, Besançon, France.,French National Platform Quality of Life and Cancer, Besançon, France
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99
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Togashi K, Hatakeyama S, Kojima Y, Momota M, Narita T, Iwamura H, Hamano I, Hamaya T, Fujita N, Okamoto T, Yoneyama T, Yamamoto H, Yoneyama T, Hashimoto Y, Ohyama C. The effect of frailty on the quality of life and lower urinary symptoms following robot-assisted radical prostatectomy: A longitudinal analysis (FRARP-QL Study). Urol Oncol 2020; 39:192.e7-192.e14. [PMID: 32861619 DOI: 10.1016/j.urolonc.2020.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/08/2020] [Accepted: 08/05/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We aimed to evaluate the effect of frailty on health-related quality-of-life (HRQOL) and lower urinary symptoms (LUTS) following robot-assisted radical prostatectomy (RARP) in patients with prostate cancer (CaP). MATERIALS AND METHODS We longitudinally evaluated geriatric 8 (G8), HRQOL, and LUTS for 12 months in 118 patients with RARP from January 2017 to April 2020. Patients were divided into frail (G8 ≤14) and nonfrail (G8 >14) groups. We compared the effect of frailty on HRQOL and LUTS between the frail and nonfrail groups before and 12 months after RARP. RESULTS The median age of patients was 68 years. The number of patients in the frail and nonfrail groups were 41 and 77, respectively. No significant difference in patients' background was observed between the groups, except for the presence of cardiovascular disease (22% vs. 7.8%, P = 0.041). There was no significant difference in HRQOLs and LUTS between the groups at baseline. Similarly, HRQOLs, LUTS, and pad-free continence rates were not significantly different between the groups at 12 months after RARP. In the nonfrail group, LUTS at 12 months following RARP significantly improved compared to those at the baseline, but it did not significantly improve in the frail group. Multivariable logistic regression analysis demonstrated that frailty was not significantly associated with LUTS worsening. CONCLUSIONS Frailty was not significantly associated with the worsening of HRQOL, LUTS, and pad-free continence rates in patients treated with RARP.
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Affiliation(s)
- Kyo Togashi
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Yuta Kojima
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masaki Momota
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takuma Narita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiromichi Iwamura
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Itsuto Hamano
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tomoko Hamaya
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Naoki Fujita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Teppei Okamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tohru Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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100
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Houédé N, Rébillard X, Bouvet S, Kabani S, Fabbro-Peray P, Trétarre B, Ménégaux F. Impact on quality of life 3 years after diagnosis of prostate cancer patients below 75 at diagnosis: an observational case-control study. BMC Cancer 2020; 20:757. [PMID: 32787797 PMCID: PMC7424648 DOI: 10.1186/s12885-020-07244-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prostate cancer patients are known to suffer from poor sexual and urinary long-term side-effects following treatment, potentially impacting quality of life. The purpose of our study was to compare health-related quality of life at 3 years between prostate cancer patients and healthy controls according to key life-style characteristics. Secondary objectives were to compare urological dysfunction, sexual function, anxiety and depression. METHODS Multicentric, case-control, observational prospective, open, follow-up study including 819 prostate cancer patients < 75 years old from the EPICAP cohort, newly diagnosed from 1 December 2011 to 31 March 2014 and 879 healthy controls. Participants were excluded if they experienced a relapse. Controls from the same geographical region were age-matched and were excluded if they were diagnosed with prostate cancer. Patients received one of the following treatments: active surveillance (AS), radical prostatectomy (RP), external beam radiotherapy (EBRT), High-intensity Focused Ultrasound (HIFU), chemotherapy (CT), or androgen deprivation therapy (ADT) as appropriate. The primary outcome was the quality of life as evaluated by the QLQ-C30 questionnaire. Scores were analyzed by multivariate analysis to adjust for predefined socio-demographic confounding effects. RESULTS In total, 564 participants were included (mean age 67.9 years): 376 patients and 188 controls. Treatment breakdown was: 258 underwent RP, 90 received EBRT, 52 brachytherapy or HIFU, 15 CT, 26 ADT and 61 AS. There was no difference in median global quality of life between patients and controls (94.87 vs 94.15, p = 0.71). Multivariate analysis showed poorer social functioning in patients (24.3% vs. 16.3%, p = 0.0209), more dyspnea (22% vs. 12.4%, p = 0.0078), and yet less current pain (23% vs 33%, p = 0.0151). CONCLUSIONS Global health status score at 3 years after diagnosis was similar between patients and controls, though patients showed a significantly worse social functioning. Prostate cancer diagnosis per se does not seem to impact the quality of life of patients < 75 years at diagnosis. However, the therapeutic option that will be chosen following diagnosis should be carefully discussed with the medical staff in terms of benefit-risk ratios as it could have a long-term impact on urinary or erectile dysfunction. TRIAL REGISTRATION clinicaltrials.gov, NCT02854982 . Registered 4 August 2016, retrospectively registered.
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Affiliation(s)
- Nadine Houédé
- Institut de Cancérologie du Gard, CHU Nîmes, Rue du Pr Henri Pujol, 30029, Nîmes Cedex 9, France. .,INSERM U1194, Montpellier Cancer Research Institute & Université de Montpellier, Montpellier, France.
| | | | - Sophie Bouvet
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, (BESPIM), CHU Nîmes, Nîmes, France
| | - Sarah Kabani
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, (BESPIM), CHU Nîmes, Nîmes, France
| | - Pascale Fabbro-Peray
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, (BESPIM), CHU Nîmes, Nîmes, France
| | | | - Florence Ménégaux
- Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France
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