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Emery JD, Jefford M, King M, Hayne D, Martin A, Doorey J, Hyatt A, Habgood E, Lim T, Hawks C, Pirotta M, Trevena L, Schofield P. ProCare Trial: a phase II randomized controlled trial of shared care for follow-up of men with prostate cancer. BJU Int 2016; 119:381-389. [PMID: 27431584 DOI: 10.1111/bju.13593] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To test the feasibility and efficacy of a multifaceted model of shared care for men after completion of treatment for prostate cancer. PATIENTS AND METHODS Men who had completed treatment for low- to moderate-risk prostate cancer within the previous 8 weeks were eligible. Participants were randomized to usual care or shared care. Shared care entailed substituting two hospital visits with three visits in primary care, a survivorship care plan, recall and reminders, and screening for distress and unmet needs. Outcome measures included psychological distress, prostate cancer-specific quality of life, satisfaction and preferences for care and healthcare resource use. RESULTS A total of 88 men were randomized (shared care n = 45; usual care n = 43). There were no clinically important or statistically significant differences between groups with regard to distress, prostate cancer-specific quality of life or satisfaction with care. At the end of the trial, men in the intervention group were significantly more likely to prefer a shared care model to hospital follow-up than those in the control group (intervention 63% vs control 24%; P<0.001). There was high compliance with prostate-specific antigen monitoring in both groups. The shared care model was cheaper than usual care (shared care AUS$1411; usual care AUS$1728; difference AUS$323 [plausible range AUS$91-554]). CONCLUSION Well-structured shared care for men with low- to moderate-risk prostate cancer is feasible and appears to produce clinically similar outcomes to those of standard care, at a lower cost.
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Affiliation(s)
- Jon D Emery
- Department of General Practice, University of Melbourne, Carlton, Vic., Australia.,Western Health and the Victorian Comprehensive Cancer Centre, Melbourne, Vic., Australia.,School of Primary Aboriginal and Rural Health Care, University of Western Australia, Crawley, WA, Australia
| | - Michael Jefford
- Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Vic., Australia.,Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Vic., Australia
| | - Madeleine King
- Quality of Life Office, Psycho-oncology Co-operative Research Group, School of Psychology, University of Sydney, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Dickon Hayne
- School of Surgery, University of Western Australia, Crawley, WA, Australia.,Department of Urology, Fiona Stanley Hospital, Perth, WA, Australia
| | - Andrew Martin
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Juanita Doorey
- School of Primary Aboriginal and Rural Health Care, University of Western Australia, Crawley, WA, Australia
| | - Amelia Hyatt
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Vic., Australia
| | - Emily Habgood
- Department of General Practice, University of Melbourne, Carlton, Vic., Australia
| | - Tee Lim
- Genesis Cancer Care, Department of Radiation Oncology, Fiona Stanley Hospital, Perth, WA, Australia
| | - Cynthia Hawks
- School of Surgery, University of Western Australia, Crawley, WA, Australia.,Department of Urology, Fiona Stanley Hospital, Perth, WA, Australia
| | - Marie Pirotta
- Department of General Practice, University of Melbourne, Carlton, Vic., Australia
| | - Lyndal Trevena
- Primary Health Care, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Penelope Schofield
- Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Vic., Australia.,Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Vic., Australia.,Department of Psychology, Swinburne University of Technology, Melbourne, Vic., Australia
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52
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Beckmann KR, O'Callaghan ME, Ruseckaite R, Kinnear N, Miller C, Evans S, Roder DM, Moretti K. Prostate cancer outcomes for men who present with symptoms at diagnosis. BJU Int 2016; 119:862-871. [PMID: 27489140 DOI: 10.1111/bju.13622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare clinical features, treatments and outcomes in men with non-metastatic prostate cancer (PCa) according to whether they were referred for symptoms or elevated prostate-specific antigen (PSA) level. PATIENTS AND METHODS This study used data from the South Australia Prostate Cancer Clinical Outcomes Collaborative database; a multi-institutional clinical registry covering both the public and private sectors. We included all non-metastatic cases from 1998 to 2013 referred for urinary/prostatic symptoms or elevated PSA level. Multivariate Poisson regression was used to identify characteristics associated with symptomatic presentation and compare treatments according to reason for referral. Outcomes (i.e. overall survival, PCa-specific survival, metastasis-free survival and disease-free survival) were compared using multivariate Cox proportional hazards and competing risk regression. RESULTS Our analytical cohort consisted of 4 841 men with localized PCa. Symptomatic men had lower-risk disease (incidence ratio [IR] 0.70, 95% confidence interval [CI] 0.61-0.81 for high vs low risk), fewer radical prostatectomies (IR 0.64, CI: 0.56-0.75) and less radiotherapy (IR 0.86, CI: 0.77-0.96) than men presenting with elevated PSA level. All-cause mortality (hazard ratio [HR] 1.31, CI: 1.16-1.47), disease-specific mortality (HR 1.42, CI: 1.13-1.77) and risk of metastases (HR 1.36, CI: 1.13-1.64) were higher for men presenting with symptoms, after adjustment for other clinical characteristics; however, risk of disease progression did not differ (HR 0.90, CI: 0.74-1.07) amongst those treated curatively. Subgroup analyses indicated poorer PCa survival for symptomatic referral among men undergoing radical prostatectomy (HR 3.4, CI: 1.3-8.8), those aged >70 years (HR 1.4, CI: 1.0-1.8), men receiving private treatment (HR 2.1, CI: 1.3-3.3), those diagnosed via biopsy (HR 1.3, CI: 1.0-1.7) and those diagnosed before 2006 (HR 1.6, CI: 1.2-2.7). CONCLUSION Our results suggest that symptomatic presentation may be an independent negative prognostic indicator for PCa survival. More complete assessment of disease grade and extent, more definitive treatment and increased post-treatment monitoring among symptomatic cases may improve outcomes. Further research to determine any pathophysiological basis for poor outcomes in symptomatic men is warranted.
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Affiliation(s)
- Kerri R Beckmann
- Centre for Population Health Research, School of Health Science, University of South Australia, Adelaide, SA, Australia
| | - Michael E O'Callaghan
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Department of Urology, Repatriation General Hospital, Daw Park, SA, Australia.,Flinders Centre for Innovation in Cancer, Adelaide, SA, Australia.,Discipline of Medicine and Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, SA, Australia
| | - Rasa Ruseckaite
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Ned Kinnear
- Department of Urology, Austin Hospital, Melbourne, Vic., Australia
| | - Caroline Miller
- Population Health Research Group, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Sue Evans
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - David M Roder
- Centre for Population Health Research, School of Health Science, University of South Australia, Adelaide, SA, Australia
| | - Kim Moretti
- Centre for Population Health Research, School of Health Science, University of South Australia, Adelaide, SA, Australia.,South Australian Prostate Cancer Clinical Outcomes Collaborative, Department of Urology, Repatriation General Hospital, Daw Park, SA, Australia.,Discipline of Medicine and Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, SA, Australia.,Department of Urology, The Queen Elizabeth Hospital, Woodville South, SA, Australia
| | -
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Department of Urology, Repatriation General Hospital, Daw Park, SA, Australia
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53
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Ruseckaite R, Beckmann K, O’Callaghan M, Roder D, Moretti K, Millar J, Evans S. A retrospective analysis of Victorian and South Australian clinical registries for prostate cancer: trends in clinical presentation and management of the disease. BMC Cancer 2016; 16:607. [PMID: 27496055 PMCID: PMC4974765 DOI: 10.1186/s12885-016-2655-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 07/30/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Prostate cancer (PCa) is the most commonly diagnosed malignancy reported to Australian cancer registries with numerous studies from individual registries summarizing diagnostic and treatment characteristics. The aim of this study was to describe annual trends in clinical and treatment characteristics, and changes in surveillance practice within a large combined cohort of men with PCa in South Australia (SA) and Victoria, Australia in 2008-2013. METHODS Common data items from clinical registries in SA and Victoria were merged to develop a cross-jurisdictional dataset consisting of 13,598 men with PCa. Frequencies were used to describe these variables using the National Comprehensive Cancer Network risk of disease progression categories in 10 year age groups. A logistic regression analysis was performed to assess the impact of a number of factors (both individually and together) on the likelihood of men receiving no active treatment within twelve months of the diagnosis (i.e. managed with active surveillance/watchful waiting). RESULTS Trend analysis showed that over time: (1) men in SA and Victoria are being diagnosed at older age in 2013, 66.1 (SD = 9.7) years compared to 2009 (64.5 (SD = 9.7)); (2) diagnostic methods and characteristics have changed with time; and (3) types of the treatments have changed, with more men having no active treatment. The majority of men were diagnosed with Prostate-Specific Antigen (PSA) <10 ng/mL (66 %) and Grade Group < 4 (65 %). Nearly seventy percent received radical treatment within 12 months of diagnosis, while ~20 % had no active treatment. In 14 % of cases treatment was not recorded or had not commenced. Having no active treatment was strongly associated older age, lower PSA and lower Grade Group at diagnosis, and in 2013 it was offered more frequently (more than 3 times) than in 2009 (OR = 2.63, 95 % CI: 2.16-3.22). CONCLUSIONS Findings of this study provide the first cross-jurisdictional description of PCa characteristics and management in Australia. These findings will provide benchmarking for ongoing monitoring and feedback of disease management and outcomes of PCa through the Prostate Cancer Outcomes Registry-Australia New Zealand to improve evidence-based practice.
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Affiliation(s)
- Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - Kerri Beckmann
- Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, Adelaide, SA Australia
| | - Michael O’Callaghan
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Department of Urology, Repatriation General Hospital, Adelaide, SA Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA Australia
- Freemasons Foundation Centre for Men’s Health and Discipline of Medicine, University of Adelaide, Adelaide, SA Australia
| | - David Roder
- Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, Adelaide, SA Australia
| | - Kim Moretti
- Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, Adelaide, SA Australia
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Department of Urology, Repatriation General Hospital, Adelaide, SA Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA Australia
- Freemasons Foundation Centre for Men’s Health and Discipline of Medicine, University of Adelaide, Adelaide, SA Australia
| | - Jeremy Millar
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC Australia
- Radiation Oncology, Alfred Health, Melbourne, VIC Australia
| | - Sue Evans
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC Australia
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54
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McGrath S, Christidis D, Perera M, Hong SK, Manning T, Vela I, Lawrentschuk N. Prostate cancer biomarkers: Are we hitting the mark? Prostate Int 2016; 4:130-135. [PMID: 27995111 PMCID: PMC5153438 DOI: 10.1016/j.prnil.2016.07.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 07/13/2016] [Accepted: 07/24/2016] [Indexed: 01/08/2023] Open
Abstract
Purpose Localised prostate cancer diagnosis and management is increasingly complex due to its heterogeneous progression and prognostic subgroups. Pitfalls in current screening and diagnosis have prompted the search for accurate and invasive molecular and genetic biomarkers for prostate cancer. Such tools may be able to distinguish clinically significant cancers from less aggressive variants to assist with prostate cancer risk stratification and guide decisions and healthcare algorithms. We aimed to provide a comprehensive review of the current prostate cancer biomarkers available and in development. Methods MEDLINE and EMBASE databases searches were conducted to identify articles pertaining to the use of novel biomarkers for prostate cancer. Results A growing number of novel biomarkers are currently under investigation. Such markers include urinary biomarkers, serology-based markers or pathological tissue assessments of molecular and genetic markers. While limited clinical data is present for analysis, early results appear promising. Specifically, a combination of serum and urinary biomarkers (Serum PSA + Urinary PCA3 + Urinary TMPRSS2-ERG fusion) appears to provide superior sensitivity and specificity profiles compared to traditional diagnostic approaches (AUC 0.88). Conclusion The accurate diagnosis and risk stratification of prostate cancer is critical to ensure appropriate intervention. The development of non-invasive biomarkers can add to the information provided by current screening practices and allows for individualised risk stratification of patients. The use of these biomarkers appears to increase the sensitivity and specificity of diagnosis of prostate cancer. Further studies are necessary to define the appropriate use and time points of each biomarker and their effect on the management algorithm of prostate cancer.
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Affiliation(s)
- Shannon McGrath
- Department of Surgery, University of Melbourne, Austin Health, Melbourne, Australia
| | - Daniel Christidis
- Department of Surgery, University of Melbourne, Austin Health, Melbourne, Australia
| | - Marlon Perera
- Department of Surgery, University of Melbourne, Austin Health, Melbourne, Australia
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Todd Manning
- Department of Surgery, University of Melbourne, Austin Health, Melbourne, Australia
| | - Ian Vela
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Queensland University of Technology, Australian Prostate Cancer Research Center-Queensland, Brisbane, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, University of Melbourne, Austin Health, Melbourne, Australia; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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55
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Bece A, Bucci J. Prostate brachytherapy: Why do we ignore the evidence? J Med Imaging Radiat Oncol 2016; 60:528-30. [DOI: 10.1111/1754-9485.12472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 04/16/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Andrej Bece
- Cancer Care Centre; St George Hospital; Kogarah New South Wales Australia
| | - Joseph Bucci
- Cancer Care Centre; St George Hospital; Kogarah New South Wales Australia
- Genesis CancerCare Hurstville; Hurstville New South Wales Australia
- Faculty of Medicine; University of New South Wales; Kensington New South Wales Australia
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56
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Analysis of active surveillance uptake for low-risk localized prostate cancer in Canada: a Canadian multi-institutional study. World J Urol 2016; 35:595-603. [PMID: 27447989 DOI: 10.1007/s00345-016-1897-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Although the uptake of active surveillance (AS) appears to be increasing in published series, the uptake in most geographic regions remains largely unknown. Our aim was to examine practice patterns around the use of AS in low-risk prostate cancer in Canada. In addition, we examined regional variations in AS uptake, predictors of AS uptake, and persistent use for 12 months. METHODS This is a retrospective multicentre review of low-risk patients who underwent a prostate biopsy in 2010 in six centres in four provinces (BC, QC, MB and ON). AS was identified based on chart review and required a minimum of 6 months of follow-up after diagnosis without any active treatment. RESULTS Of 986 patients, 781 patients (mean age 64 years) were incident cases and over three-quarters (77.3 %) chose AS at diagnosis. There were significant differences in uptake of AS by centre (range 65.0-98.0 %, p ≤ 0.05). Key multivariate predictors of pursuing AS included older age (OR 1.34, p = 0.044), centre (p = 0.021), lower number of cores (OR 1.09, p = 0.025), lower number of positive biopsy cores (OR 0.52, p < 0.001), and lower percent core involvement (OR 0.84, p < 0.001). In total, 516 (85.4 %) men remained on AS over 12 months. Maintenance with AS over 12 months differed by centre, ranging from 64.1 to 93.9 % (p = 0.001). Predictors of maintenance with AS over 12 months included older age, centre, and lower number of positive cores. CONCLUSIONS Active surveillance is widely practiced across Canada, but important regional differences were observed. Further analyses are required to understand the root causes of differences and to determine whether AS uptake is changing over time.
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57
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Krishnananthan N, Lawrentschuk N. Active surveillance in intermediate risk prostate cancer: is it safe? Opinion: No. Int Braz J Urol 2016; 42:418-21. [PMID: 27286102 PMCID: PMC4920556 DOI: 10.1590/s1677-5538.ibju.2016.03.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Nathan Lawrentschuk
- University of Melbourne, Department of Surgery, Austin Health, Melbourne, Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Olivia Newton-John Cancer Research Institute, Melbourne, Australia
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58
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Xi Z, Yao M, Li Y, Xie C, Holst J, Liu T, Cai S, Lao Y, Tan H, Xu HX, Dong Q. Guttiferone K impedes cell cycle re-entry of quiescent prostate cancer cells via stabilization of FBXW7 and subsequent c-MYC degradation. Cell Death Dis 2016; 7:e2252. [PMID: 27253416 PMCID: PMC5143372 DOI: 10.1038/cddis.2016.123] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 04/08/2016] [Accepted: 04/11/2016] [Indexed: 11/26/2022]
Abstract
Cell cycle re-entry by quiescent cancer cells is an important mechanism for cancer progression. While high levels of c-MYC expression are sufficient for cell cycle re-entry, the modality to block c-MYC expression, and subsequent cell cycle re-entry, is limited. Using reversible quiescence rendered by serum withdrawal or contact inhibition in PTEN(null)/p53(WT) (LNCaP) or PTEN(null)/p53(mut) (PC-3) prostate cancer cells, we have identified a compound that is able to impede cell cycle re-entry through c-MYC. Guttiferone K (GUTK) blocked resumption of DNA synthesis and preserved the cell cycle phase characteristics of quiescent cells after release from the quiescence. In vehicle-treated cells, there was a rapid increase in c-MYC protein levels upon release from the quiescence. However, this increase was inhibited in the presence of GUTK with an associated acceleration in c-MYC protein degradation. The inhibitory effect of GUTK on cell cycle re-entry was significantly reduced in cells overexpressing c-MYC. The protein level of FBXW7, a subunit of E3 ubiquitin ligase responsible for degradation of c-MYC, was reduced upon the release from the quiescence. In contrast, GUTK stabilized FBXW7 protein levels during release from the quiescence. The critical role of FBXW7 was confirmed using siRNA knockdown, which impaired the inhibitory effect of GUTK on c-MYC protein levels and cell cycle re-entry. Administration of GUTK, either in vitro prior to transplantation or in vivo, suppressed the growth of quiescent prostate cancer cell xenografts. Furthermore, elevation of FBXW7 protein levels and reduction of c-MYC protein levels were found in the xenografts of GUTK-treated compared with vehicle-treated mice. Hence, we have identified a compound that is capable of impeding cell cycle re-entry by quiescent PTEN(null)/p53(WT) and PTEN(null)/p53(mut) prostate cancer cells likely by promoting c-MYC protein degradation through stabilization of FBXW7. Its usage as a clinical modality to prevent prostate cancer progression should be further evaluated.
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Affiliation(s)
- Z Xi
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Shanghai Colleges for TCM New Drug Discovery, Shanghai, China
| | - M Yao
- Discipline of Endocrinology, Royal Prince Alfred Hospital and Charles Perkins Centre, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Y Li
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Shanghai Colleges for TCM New Drug Discovery, Shanghai, China
| | - C Xie
- Discipline of Endocrinology, Royal Prince Alfred Hospital and Charles Perkins Centre, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- School of Science and Health, The University of Western Sydney, Penrith South, Sydney, NSW, Australia
| | - J Holst
- Origins of Cancer Program, Centenary Institute, Camperdown, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - T Liu
- Children's Cancer Institute Australia for Medical Research, Sydney, NSW, Australia
- School of Women's and Children's Health, UNSW Medicine, Sydney, Australia
| | - S Cai
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Shanghai Colleges for TCM New Drug Discovery, Shanghai, China
| | - Y Lao
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Shanghai Colleges for TCM New Drug Discovery, Shanghai, China
| | - H Tan
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Shanghai Colleges for TCM New Drug Discovery, Shanghai, China
| | - H-X Xu
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Shanghai Colleges for TCM New Drug Discovery, Shanghai, China
| | - Q Dong
- Discipline of Endocrinology, Royal Prince Alfred Hospital and Charles Perkins Centre, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- School of Science and Health, The University of Western Sydney, Penrith South, Sydney, NSW, Australia
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Gandaglia G, Bray F, Cooperberg MR, Karnes RJ, Leveridge MJ, Moretti K, Murphy DG, Penson DF, Miller DC. Prostate Cancer Registries: Current Status and Future Directions. Eur Urol 2016; 69:998-1012. [PMID: 26056070 DOI: 10.1016/j.eururo.2015.05.046] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 05/26/2015] [Indexed: 01/08/2023]
Abstract
CONTEXT Disease-specific registries that enroll a considerable number of patients play a major role in prostate cancer (PCa) research. OBJECTIVE To evaluate available registries, describe their strengths and limitations, and discuss the potential future role of PCa registries in outcomes research. EVIDENCE ACQUISITION We performed a literature review of the Medline, Embase, and Web of Science databases. The search strategy included the terms prostate cancer, outcomes, statistical approaches, population-based cohorts, registries of outcomes, and epidemiological studies, alone or in combination. We limited our search to studies published between January 2005 and January 2015. EVIDENCE SYNTHESIS Several population-based and prospective disease-specific registries are currently available for prostate cancer. Studies performed using these data sources provide important information on incidence and mortality, disease characteristics at presentation, risk factors, trends in utilization of health care services, disparities in access to treatment, quality of care, long-term oncologic and health-related quality of life outcomes, and costs associated with management of the disease. Although data from these registries have some limitations, statistical methods are available that can address certain biases and increase the internal and external validity of such analyses. In the future, improvements in data quality, collection of tissue samples, and the availability of data feedback to health care providers will increase the relevance of studies built on population-based and disease-specific registries. CONCLUSIONS The strengths and limitations of PCa registries should be carefully considered when planning studies using these databases. Although randomized controlled trials still provide the highest level of evidence, large registries play an important and growing role in advancing PCa research and care. PATIENT SUMMARY Several population-based and prospective disease-specific registries for prostate cancer are currently available. Analyses of data from these registries yield information that is clinically relevant for the management of patients with prostate cancer.
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Affiliation(s)
- Giorgio Gandaglia
- Unit of Urology/Department of Oncology, San Raffaele Hospital, Milan, Italy.
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Matthew R Cooperberg
- Departments of Urology and Epidemiology & Biostatistics, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | | | | | - Kim Moretti
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Repatriation General Hospital, Daw Park, and the University of South Australia and the University of Adelaide, South Australia, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, University of Melbourne, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - David F Penson
- Department of Urologic Surgery, Vanderbilt University, and the VA Tennessee Valley Geriatric Research, Education, and Clinical Center (GRECC), Nashville, TN, USA
| | - David C Miller
- Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, MI, USA
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60
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Lawrentschuk N. PSA testing and early management of test-detected prostate cancer- consensus at last. BJU Int 2016; 117 Suppl 4:5-6. [DOI: 10.1111/bju.13481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Nathan Lawrentschuk
- Department of Surgery and Olivia Newton-John Cancer Research Institute; Austin Hospital and Peter MacCallum Cancer Centre; University of Melbourne; Melbourne VIC Australia
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Tosoian JJ, Carter HB, Lepor A, Loeb S. Active surveillance for prostate cancer: current evidence and contemporary state of practice. Nat Rev Urol 2016; 13:205-15. [PMID: 26954332 DOI: 10.1038/nrurol.2016.45] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Prostate cancer remains one of the most commonly diagnosed malignancies worldwide. Early diagnosis and curative treatment seem to improve survival in men with unfavourable-risk cancers, but significant concerns exist regarding the overdiagnosis and overtreatment of men with lower-risk cancers. To this end, active surveillance (AS) has emerged as a primary management strategy in men with favourable-risk disease, and contemporary data suggest that use of AS has increased worldwide. Although published surveillance cohorts differ by protocol, reported rates of metastatic disease and prostate-cancer-specific mortality are exceedingly low in the intermediate term (5-10 years). Such outcomes seem to be closely associated with programme-specific criteria for selection, monitoring, and intervention, suggesting that AS--like other management strategies--could be individualized based on the level of risk acceptable to patients in light of their personal preferences. Additional data are needed to better establish the risks associated with AS and to identify patient-specific characteristics that could modify prognosis.
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Affiliation(s)
- Jeffrey J Tosoian
- Brady Urological Institute, Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Baltimore, Maryland 21287-2101, USA
| | - H Ballentine Carter
- Brady Urological Institute, Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Baltimore, Maryland 21287-2101, USA
| | - Abbey Lepor
- Department of Urology, New York University, 550 1st Avenue (VZ30 #612), New York, New York 10016, USA
| | - Stacy Loeb
- Department of Urology, New York University, 550 1st Avenue (VZ30 #612), New York, New York 10016, USA.,Depatment of Population Health, New York University. 550 1st Avenue (VZ30 #612), New York, New York 10016, USA.,The Laura &Isaac Perlmutter Cancer Center, New York University, 550 1st Avenue (VZ30 #612), New York, New York 10016, USA
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62
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Cristea O, Lavallée LT, Montroy J, Stokl A, Cnossen S, Mallick R, Fergusson D, Momoli F, Cagiannos I, Morash C, Breau RH. Active surveillance in Canadian men with low-grade prostate cancer. CMAJ 2016; 188:E141-E147. [PMID: 26927971 DOI: 10.1503/cmaj.150832] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recent guidelines recommend against routine screening for prostate cancer, partly because of the risks associated with overtreatment of clinically indolent tumours. We aimed to determine the proportion of patients whose low-grade prostate cancer was managed by active surveillance instead of immediate treatment. METHODS We reviewed data for patients who were referred to the Ottawa regional Prostate Cancer Assessment Clinic with abnormal results for prostate-specific antigen (PSA) or prostate examination between Apr. 1, 2008, and Jan. 31, 2013. Patients with subsequent biopsy-proven low-grade (Gleason score 6) cancer were included. Active surveillance was defined a priori as monitoring by means of PSA, digital rectal examination and repeat biopsies, with the potential for curative-intent treatment in the event of disease progression. RESULTS Of 477 patients with low-grade cancer, active surveillance was used for 210 (44.0%), and the annual proportion increased from 32% (11/34) in 2008 to 67% (20/30) in 2013. Factors associated with immediate treatment were palpable tumour, PSA density above 0.2 ng/mL(2) and more than 2 positive biopsy cores. Factors associated with surveillance were age over 70 years and higher Charlson comorbidity index. Of 173 men who received immediate surgical treatment, 103 (59.5%) had higher-grade or advanced-stage disease on final pathologic examination. Of the 210 men with active surveillance, 62 (29.5%) received treatment within a median of 1.3 years, most commonly (52 [84%]) because of upgrading of disease on the basis of surveillance biopsy. INTERPRETATION Active surveillance has become the most common management strategy for men with low-grade prostate cancer at our regional diagnostic centre. Factors associated with immediate treatment reflected those that increase the risk of higher-grade tumours.
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Affiliation(s)
- Octav Cristea
- Division of Urology (Cristea, Lavallée, Cagiannos, Morash, Breau), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital Research Institute (Montroy, Stokl, Cnossen, Mallick, Fergusson, Momoli, Breau), Ottawa, Ont.; Children's Hospital of Eastern Ontario Research Institute (Momoli), Ottawa, Ont.; University of Ottawa (Cristea, Lavallée, Momoli, Cagiannos, Morash, Breau), Ottawa, Ont
| | - Luke T Lavallée
- Division of Urology (Cristea, Lavallée, Cagiannos, Morash, Breau), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital Research Institute (Montroy, Stokl, Cnossen, Mallick, Fergusson, Momoli, Breau), Ottawa, Ont.; Children's Hospital of Eastern Ontario Research Institute (Momoli), Ottawa, Ont.; University of Ottawa (Cristea, Lavallée, Momoli, Cagiannos, Morash, Breau), Ottawa, Ont
| | - Joshua Montroy
- Division of Urology (Cristea, Lavallée, Cagiannos, Morash, Breau), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital Research Institute (Montroy, Stokl, Cnossen, Mallick, Fergusson, Momoli, Breau), Ottawa, Ont.; Children's Hospital of Eastern Ontario Research Institute (Momoli), Ottawa, Ont.; University of Ottawa (Cristea, Lavallée, Momoli, Cagiannos, Morash, Breau), Ottawa, Ont
| | - Andrew Stokl
- Division of Urology (Cristea, Lavallée, Cagiannos, Morash, Breau), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital Research Institute (Montroy, Stokl, Cnossen, Mallick, Fergusson, Momoli, Breau), Ottawa, Ont.; Children's Hospital of Eastern Ontario Research Institute (Momoli), Ottawa, Ont.; University of Ottawa (Cristea, Lavallée, Momoli, Cagiannos, Morash, Breau), Ottawa, Ont
| | - Sonya Cnossen
- Division of Urology (Cristea, Lavallée, Cagiannos, Morash, Breau), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital Research Institute (Montroy, Stokl, Cnossen, Mallick, Fergusson, Momoli, Breau), Ottawa, Ont.; Children's Hospital of Eastern Ontario Research Institute (Momoli), Ottawa, Ont.; University of Ottawa (Cristea, Lavallée, Momoli, Cagiannos, Morash, Breau), Ottawa, Ont
| | - Ranjeeta Mallick
- Division of Urology (Cristea, Lavallée, Cagiannos, Morash, Breau), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital Research Institute (Montroy, Stokl, Cnossen, Mallick, Fergusson, Momoli, Breau), Ottawa, Ont.; Children's Hospital of Eastern Ontario Research Institute (Momoli), Ottawa, Ont.; University of Ottawa (Cristea, Lavallée, Momoli, Cagiannos, Morash, Breau), Ottawa, Ont
| | - Dean Fergusson
- Division of Urology (Cristea, Lavallée, Cagiannos, Morash, Breau), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital Research Institute (Montroy, Stokl, Cnossen, Mallick, Fergusson, Momoli, Breau), Ottawa, Ont.; Children's Hospital of Eastern Ontario Research Institute (Momoli), Ottawa, Ont.; University of Ottawa (Cristea, Lavallée, Momoli, Cagiannos, Morash, Breau), Ottawa, Ont
| | - Franco Momoli
- Division of Urology (Cristea, Lavallée, Cagiannos, Morash, Breau), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital Research Institute (Montroy, Stokl, Cnossen, Mallick, Fergusson, Momoli, Breau), Ottawa, Ont.; Children's Hospital of Eastern Ontario Research Institute (Momoli), Ottawa, Ont.; University of Ottawa (Cristea, Lavallée, Momoli, Cagiannos, Morash, Breau), Ottawa, Ont
| | - Illias Cagiannos
- Division of Urology (Cristea, Lavallée, Cagiannos, Morash, Breau), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital Research Institute (Montroy, Stokl, Cnossen, Mallick, Fergusson, Momoli, Breau), Ottawa, Ont.; Children's Hospital of Eastern Ontario Research Institute (Momoli), Ottawa, Ont.; University of Ottawa (Cristea, Lavallée, Momoli, Cagiannos, Morash, Breau), Ottawa, Ont
| | - Christopher Morash
- Division of Urology (Cristea, Lavallée, Cagiannos, Morash, Breau), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital Research Institute (Montroy, Stokl, Cnossen, Mallick, Fergusson, Momoli, Breau), Ottawa, Ont.; Children's Hospital of Eastern Ontario Research Institute (Momoli), Ottawa, Ont.; University of Ottawa (Cristea, Lavallée, Momoli, Cagiannos, Morash, Breau), Ottawa, Ont
| | - Rodney H Breau
- Division of Urology (Cristea, Lavallée, Cagiannos, Morash, Breau), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital Research Institute (Montroy, Stokl, Cnossen, Mallick, Fergusson, Momoli, Breau), Ottawa, Ont.; Children's Hospital of Eastern Ontario Research Institute (Momoli), Ottawa, Ont.; University of Ottawa (Cristea, Lavallée, Momoli, Cagiannos, Morash, Breau), Ottawa, Ont.
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Dowrick AS, Wootten AC, Howard N, Peters JS, Murphy DG. A prospective study of the short-term quality-of-life outcomes of patients undergoing transperineal prostate biopsy. BJU Int 2016; 118:60-7. [PMID: 26780550 DOI: 10.1111/bju.13413] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate in a prospective, observational study whether transperineal prostate biopsy (TPbx) results in patient-reported quality-of-life (QoL) changes from baseline in the first 3-months after TPbx. PATIENTS AND METHODS Consenting patients completed the 26-item Expanded Prostate cancer Index Composite (EPIC-26), the Sexual Health Inventory for Men, the International Prostate Symptom Score, the Generalised Anxiety Disorder seven-item scale, the Patient Health Questionnaire nine-item scale, and a global question about willingness to have a repeat TPbx in a years' time. The instruments were scored using published scoring methods. Wilcoxon signed-rank tests and Mann-Whitney U-tests were used to investigate statistically significant differences. Clinically significant differences were also investigated defined by published minimal important differences for the EPIC-26 and changes in established categorical groups for the other instruments. RESULTS In all, 53 patients consented to participate and completed the baseline questionnaire, in addition to at least one of the 1- or 3-month follow-up questionnaires. We found that most patients having a TPbx had no clinically significant change in QoL in the first 3 months after TPbx. However, 24% had clinically worse urinary function and 18% had worse sexual function at 1 month. At 3 months, 3% of patients had clinically worse urinary function and 25% continued to have worse sexual function compared with baseline. Patients who were subsequently diagnosed with cancer based on the results of the TPbx, had statistically significantly reduced QoL for the EPIC-26 urinary scales and reduced improvements in scores on the psychological scales at the 1-month follow-up compared with those who were not diagnosed with cancer. CONCLUSIONS Most patients having a TPbx had no clinically significant change in QoL in the first 3 months after TPbx. However, patients should be advised that a quarter may have clinically worse urinary function and nearly 20% have clinically worse sexual function in the first month, and that sexual function deficits may continue up to 3 months. The results of this study provide a resource that the clinician can use when discussing TPbx with patients.
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Affiliation(s)
- Adam S Dowrick
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Urology, Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - Addie C Wootten
- Department of Urology, Royal Melbourne Hospital, Melbourne, Vic., Australia.,Australian Prostate Cancer Research Centre Epworth, Melbourne, Vic., Australia
| | - Nicholas Howard
- Australian Prostate Cancer Research Centre Epworth, Melbourne, Vic., Australia
| | - Justin S Peters
- Department of Urology, Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - Declan G Murphy
- Department of Urology, Royal Melbourne Hospital, Melbourne, Vic., Australia.,Peter MacCallum Cancer Centre, Division of Cancer Surgery, University of Melbourne, Melbourne, Vic., Australia
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64
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Birch E, van Bruwaene S, Everaerts W, Schubach K, Bush M, Krishnasamy M, Moon DA, Goad J, Lawrentschuk N, Murphy DG. Developing and evaluating Robocare; an innovative, nurse-led robotic prostatectomy care pathway. Eur J Oncol Nurs 2016; 21:120-5. [PMID: 26952687 DOI: 10.1016/j.ejon.2016.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/22/2016] [Accepted: 02/01/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE A Robotic Prostatectomy Care Pathway ("Robocare"), aiming to prepare men for robotic-assisted radical prostatectomy (RARP) and manage side-effects and long-term follow-up in a multidisciplinary fashion was established. The pathway enhances patient care by providing adequate information and support and optimizes efficiency by reducing length of stay and minimizing hospital visits. Our study assesses the pathway for patient satisfaction, co-ordination of care between disciplines, length of stay and readmission rates. METHOD We analysed our database of all patients undergoing RARP with Robocare between July 2012 and December 2013 at Peter MacCallum Cancer Centre, Australia (PMCC). Compliance, Length of Stay and Postoperative Course were analysed. Patient satisfaction was assessed. RESULTS Overall 124 patients underwent RARP with 105 (85%) being discharged day 1 post-op (mean 1.3 days). Post-operative support phone calls were received by >95% of patients. Thereafter, 74 patients (60%) were followed in the long-term follow-up phone clinic. Twenty-nine complications were identified of which 19 (66%) were resolved by the nurse specialist. Eighteen patients had psychologist, 44 sexual health and 44 physiotherapist referral. Patient satisfaction in 74 (60%) returned surveys revealed 71 (96%) being well/very well supported. CONCLUSIONS The Robocare pathway is safe with high patient satisfaction. It contributes to reducing post-operative length of stay and readmission rates as well as the outpatient follow-up. A true multidisciplinary approach that is nurse-led likely improves care and outcomes for RARP patients and may lower impact on hospital resources.
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Affiliation(s)
- Emma Birch
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Univeristy of Melbourne, Melbourne, Australia.
| | - Siska van Bruwaene
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Univeristy of Melbourne, Melbourne, Australia
| | - Wouter Everaerts
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Univeristy of Melbourne, Melbourne, Australia; Department of Urology, University Hospitals Leuven, Belgium
| | - Kathryn Schubach
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Univeristy of Melbourne, Melbourne, Australia
| | - Matiu Bush
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Univeristy of Melbourne, Melbourne, Australia
| | - Mei Krishnasamy
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Daniel A Moon
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Univeristy of Melbourne, Melbourne, Australia
| | - Jeremy Goad
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Univeristy of Melbourne, Melbourne, Australia; Department of Surgery, St Vincent's Hospital, University of Melbourne, Australia
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Univeristy of Melbourne, Melbourne, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Univeristy of Melbourne, Melbourne, Australia
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Tran K, Rahal R, Fung S, Louzado C, Porter G, Xu J, Bryant H. Patterns of care and treatment trends for Canadian men with localized low-risk prostate cancer: an analysis of provincial cancer registry data. ACTA ACUST UNITED AC 2016; 23:56-9. [PMID: 26966405 DOI: 10.3747/co.23.3011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Many prostate cancers (pcas) are indolent and, if left untreated, are unlikely to cause death or morbidity in a man's lifetime. As a result of testing for prostate-specific antigen, more such cases are being identified, leading to concerns about "overdiagnosis" and consequent overtreatment of pca. To mitigate the risks associated with overtreatment (that is, invasive therapies that might cause harm to the patient without tangible benefit), approaches such as active surveillance are now preferred for many men with low-risk localized pca (specifically, T1/2a, prostate-specific antigen ≤ 10 ng/mL, and Gleason score ≤ 6). Here, we report on patterns of care and treatment trends for men with localized low-risk pca. RESULTS The provinces varied substantially with respect to the types of primary treatment received by men with localized low-risk pca. From 2010 to 2013, many men had no record of surgical or radiation treatment within 1 year of diagnosis-a proxy for active surveillance; the proportion ranged from 53.3% in Nova Scotia to 80.8% in New Brunswick. Among men who did receive primary treatment, the use of radical prostatectomy ranged from 12.0% in New Brunswick to 35.9% in Nova Scotia. The use of radiation therapy (external-beam radiation therapy or brachytherapy) ranged from 4.1% in Newfoundland and Labrador to 17.6% in Alberta. Treatment trends over time suggest an increase in the use of active surveillance. The proportion of men with low-risk pca and no record of surgical or radiation treatment rose to 69.9% in 2013 from 46.1% in 2010 for all provinces combined. CONCLUSIONS The provinces varied substantially with respect to patterns of care for localized low-risk pca. Treatment trends over time suggest an increasing use of active surveillance. Those findings can further the discussion about the complex care associated with pca and identify opportunities for improvement in clinical practice.
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Affiliation(s)
- K Tran
- Canadian Partnership Against Cancer, Toronto, ON
| | - R Rahal
- Canadian Partnership Against Cancer, Toronto, ON
| | - S Fung
- Canadian Partnership Against Cancer, Toronto, ON
| | - C Louzado
- Canadian Partnership Against Cancer, Toronto, ON
| | - G Porter
- Canadian Partnership Against Cancer, Toronto, ON;; Faculty of Medicine, Dalhousie University, Halifax, NS
| | - J Xu
- Canadian Partnership Against Cancer, Toronto, ON
| | - H Bryant
- Canadian Partnership Against Cancer, Toronto, ON;; Departments of Community Health Sciences and of Oncology, University of Calgary, Calgary, AB
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66
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Evans SM, Nag N, Roder D, Brooks A, L Millar J, Moretti KL, Pryor D, Skala M, J. McNeil J. Development of an International Prostate Cancer Outcomes Registry. BJU Int 2016; 117 Suppl 4:60-7. [DOI: 10.1111/bju.13258] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sue M. Evans
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Vic. Australia
| | - Nupur Nag
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Vic. Australia
| | - David Roder
- Centre for Population Health Research; University of South Australia; Adelaide SA Australia
| | - Andrew Brooks
- Department of Urology Westmead Hospital; Westmead NSW Australia
| | | | - Kim L Moretti
- Centre for Population Health Research; University of South Australia; Adelaide SA Australia
| | - David Pryor
- Department of Radiation Oncology; Princess Alexandra Hospital; Wooloongabba Qld Australia
| | | | - John J. McNeil
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Vic. Australia
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67
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Tosoian JJ, Loeb S, Epstein JI, Turkbey B, Choyke P, Schaeffer EM. Active Surveillance of Prostate Cancer: Use, Outcomes, Imaging, and Diagnostic Tools. Am Soc Clin Oncol Educ Book 2016; 35:e235-45. [PMID: 27249729 PMCID: PMC4917301 DOI: 10.1200/edbk_159244] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Active surveillance (AS) has emerged as a standard management option for men with very low-risk and low-risk prostate cancer, and contemporary data indicate that use of AS is increasing in the United States and abroad. In the favorable-risk population, reports from multiple prospective cohorts indicate a less than 1% likelihood of metastatic disease and prostate cancer-specific mortality over intermediate-term follow-up (median 5-6 years). Higher-risk men participating in AS appear to be at increased risk of adverse outcomes, but these populations have not been adequately studied to this point. Although monitoring on AS largely relies on serial prostate biopsy, a procedure associated with considerable morbidity, there is a need for improved diagnostic tools for patient selection and monitoring. Revisions from the 2014 International Society of Urologic Pathology consensus conference have yielded a more intuitive reporting system and detailed reporting of low-intermediate grade tumors, which should facilitate the practice of AS. Meanwhile, emerging modalities such as multiparametric magnetic resonance imaging and tissue-based molecular testing have shown prognostic value in some populations. At this time, however, these instruments have not been sufficiently studied to consider their routine, standardized use in the AS setting. Future studies should seek to identify those platforms most informative in the AS population and propose a strategy by which promising diagnostic tools can be safely and efficiently incorporated into clinical practice.
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Affiliation(s)
- Jeffrey J Tosoian
- Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, Phone: 410-955-2139, , Fax: 410-955-0833
| | - Stacy Loeb
- Department of Urology and Population Health, New York University, New York, NY 10016, , Phone: 646-825-6358
| | - Jonathan I Epstein
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA, , Phone: 410-955-5043
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, Bethesda, MD, USA, , Phone: 301-443-2315
| | - Peter Choyke
- Molecular Imaging Program, National Cancer Institute, Bethesda, MD, USA, , Phone: 301-402-8409
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68
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Lo J, Papa N, Bolton DM, Murphy D, Lawrentschuk N. Australian patterns of prostate cancer care: Are they evolving? Prostate Int 2015; 4:20-4. [PMID: 27014660 PMCID: PMC4789340 DOI: 10.1016/j.prnil.2015.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 10/21/2015] [Accepted: 11/10/2015] [Indexed: 12/02/2022] Open
Abstract
Background Approaches to prostate cancer (PCa) care have changed in recent years out of concern for overdiagnosis and overtreatment. Despite these changes, many patients continue to undergo some form of curative treatment and with a growing perception among multidisciplinary clinicians that more aggressive treatments are being favored. This study examines patterns of PCa care in Australia, focusing on current rates of screening and aggressive interventions that consist of high-dose-rate (HDR) brachytherapy and pelvic lymph node dissection (PLND). Methods Health services data were used to assess Australian men undergoing PCa screening and treatment from 2001 to 2014. Age-specific rates of prostate-specific antigen (PSA) screening were calculated. Ratios of radical prostatectomy (RP) with PLND to RP without PLND, and HDR brachytherapy to low-dose-rate (LDR) brachytherapy were determined by state jurisdictions. Results From 2008, the rate of PSA screening trended downward significantly with year for all age ranges (P < 0.02) except men aged ≥ 85 (P = 0.56). PLND rates for 2008–2014 were lower than rates for 2001–2007 across all states and territories. From 2008 to 2014, PLND was performed ≥ 2.7 times more frequently in New South Wales and the Australian Capital Territory than in other jurisdictions. Since 2007, brachytherapy practice across Australia has evolved towards a relatively low use of HDR brachytherapy (ratio of HDR to LDR brachytherapy < 0.5 for all jurisdictions except the Australian Capital Territory). Conclusion Rates of PLND and HDR brachytherapy for PCa have declined in Australia, providing evidence for the effect of stage migration due to widespread PSA screening. Currently, PSA screening rates remain high among older men, which may expose them to unnecessary investigations and treatment-related morbidity.
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Affiliation(s)
- Jonathon Lo
- University of Melbourne, Department of Surgery, Austin Health, Melbourne, Australia
| | - Nathan Papa
- University of Melbourne, Department of Surgery, Austin Health, Melbourne, Australia
| | - Damien M Bolton
- University of Melbourne, Department of Surgery, Austin Health, Melbourne, Australia
| | - Declan Murphy
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nathan Lawrentschuk
- University of Melbourne, Department of Surgery, Austin Health, Melbourne, Australia; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia
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69
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Chin JL. A Brief Survey of Active Surveillance. Eur Urol 2015; 68:812-3. [DOI: 10.1016/j.eururo.2015.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 04/01/2015] [Indexed: 11/16/2022]
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Sathianathen NJ, Murphy DG, van den Bergh RCN, Lawrentschuk N. Gleason pattern 4: active surveillance no more. BJU Int 2015; 117:856-7. [DOI: 10.1111/bju.13333] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Niranjan J. Sathianathen
- Division of Cancer Surgery; University of Melbourne; Peter MacCallum Cancer Centre; Melbourne Vic. Australia
- Faculty of Medicine Monash University Melbourne Vic. Australia
| | - Declan G. Murphy
- Division of Cancer Surgery; University of Melbourne; Peter MacCallum Cancer Centre; Melbourne Vic. Australia
- Australian Prostate Cancer Research Centre; Epworth Healthcare; Richmond Vic. Australia
| | | | - Nathan Lawrentschuk
- Division of Cancer Surgery; University of Melbourne; Peter MacCallum Cancer Centre; Melbourne Vic. Australia
- Department of Surgery; University of Melbourne; The Austin Hospital; Heidelberg Vic. Australia
- Department of Surgery; University of Melbourne and Olivia Newton-John Cancer Research Institute; The Austin Hospital; Heidelberg Vic. Australia
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71
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Basto M, Sathianathen N, Te Marvelde L, Ryan S, Goad J, Lawrentschuk N, Costello AJ, Moon DA, Heriot AG, Butler J, Murphy DG. Patterns-of-care and health economic analysis of robot-assisted radical prostatectomy in the Australian public health system. BJU Int 2015; 117:930-9. [PMID: 26350758 DOI: 10.1111/bju.13317] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To compare patterns of care and peri-operative outcomes of robot-assisted radical prostatectomy (RARP) with other surgical approaches, and to create an economic model to assess the viability of RARP in the public case-mix funding system. PATIENTS AND METHODS We retrospectively reviewed all radical prostatectomies (RPs) performed for localized prostate cancer in Victoria, Australia, from the Victorian Admitted Episode Dataset, a large administrative database that records all hospital inpatient episodes in Victoria. The first database, covering the period from July 2010 to April 2013 (n = 5 130), was used to compare length of hospital stay (LOS) and blood transfusion rates between surgical approaches. This was subsequently integrated into an economic model. A second database (n = 5 581) was extracted to cover the period between July 2010 and June 2013, three full financial years, to depict patterns of care and make future predictions for the 2014-2015 financial year, and to perform a hospital volume analysis. We then created an economic model to evaluate the incremental cost of RARP vs open RP (ORP) and laparoscopic RP (LRP), incorporating the cost-offset from differences in LOS and blood transfusion rate. The economic model constructs estimates of the diagnosis-related group (DRG) costs of ORP and LRP, adds the gross cost of the surgical robot (capital, consumables, maintenance and repairs), and manipulates these DRG costs to obtain a DRG cost per day, which can be used to estimate the cost-offset associated with RARP in comparison with ORP and LRP. Economic modelling was performed around a base-case scenario, assuming a 7-year robot lifespan and 124 RARPs performed per financial year. One- and two-way sensitivity analyses were performed for the four-arm da Vinci SHD, Si and Si dual surgical systems (Intuitive Surgical Ltd, Sunnyvale, CA, USA). RESULTS We identified 5 581 patients who underwent RP in 20 hospitals in Victoria with an open, laparoscopic or robot-assisted surgical approach in the public and private sector. The majority of RPs (4 233, 75.8%), in Victoria were performed in the private sector, with an overall 11.5% decrease in the total number of RPs performed over the 3-year study period. In the most recent financial year, 820 (47%), 765 (44%) and 173 patients (10%) underwent RARP, ORP and LRP, respectively. In the same timeframe, RARP accounted for 26 and 53% of all RPs in the public and private sector, respectively. Public hospitals in Victoria perform a median number of 14 RPs per year and 40% of hospitals perform <10 RPs per year. In the public system, RARP was associated with a mean (±sd) LOS of 1.4 (±1.3) days compared with 3.6 (±2.7) days for LRP and 4.8 (±3.5) days for ORP (P < 0.001). The mean blood transfusion rates were 0, 6 and 15% for RARP, LRP and ORP, respectively (P < 0.001). The incremental cost per RARP case compared with ORP and LRP was A$442 and A$2 092, respectively, for the da Vinci S model, A$1 933 and A$3 583, respectively, for the da Vinci Si model and A$3 548 and A$5 198, respectively for the da Vinci Si dual. RARP can become cost-equivalent with ORP where ~140 cases per year are performed in the base-case scenario. CONCLUSIONS Over the period studied, RARP has become the dominant approach to RP, with significantly shorter LOS and lower blood transfusion rate. This translates to a significant cost-offset, which is further enhanced by increasing the case volume, extending the lifespan of the robot and reductions in the cost of consumables and capital.
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Affiliation(s)
- Marnique Basto
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic., Australia.,Department of Urology, Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - Niranjan Sathianathen
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Luc Te Marvelde
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Vic., Australia
| | - Shane Ryan
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Jeremy Goad
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Department of Urology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Department of Surgery, Austin Hospital, Heidelberg, Germany
| | - Anthony J Costello
- Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic., Australia.,Department of Urology, Royal Melbourne Hospital, Melbourne, Vic., Australia.,Australian Prostate Cancer Research Centre, Epworth Healthcare, Richmond, Melbourne, Vic., Australia
| | - Daniel A Moon
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Department of Urology, Royal Melbourne Hospital, Melbourne, Vic., Australia.,Australian Prostate Cancer Research Centre, Epworth Healthcare, Richmond, Melbourne, Vic., Australia.,Cabrini Healthcare, Melbourne, Vic., Australia
| | - Alexander G Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic., Australia
| | - Jim Butler
- Australian Centre for Economic Research on Health, Australian National University, Canberra, ACT, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic., Australia.,Department of Urology, Royal Melbourne Hospital, Melbourne, Vic., Australia.,Australian Prostate Cancer Research Centre, Epworth Healthcare, Richmond, Melbourne, Vic., Australia
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Van Bruwaene S, Murphy DG. Case Discussion: Intermediate-risk Prostate Cancer: The Case for Radical Treatment. Eur Urol Focus 2015; 1:210-211. [PMID: 28723437 DOI: 10.1016/j.euf.2015.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 06/11/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Siska Van Bruwaene
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia; Australian Prostate Cancer Research Centre, Epworth Richmond Hospital, Melbourne, Australia
| | - Declan G Murphy
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia; Australian Prostate Cancer Research Centre, Epworth Richmond Hospital, Melbourne, Australia.
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74
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Van Bruwaene S, Murphy DG. Editorial Comment to Current use of active surveillance for localized prostate cancer: A nationwide survey in Japan. Int J Urol 2015; 22:760. [PMID: 26147189 DOI: 10.1111/iju.12881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Siska Van Bruwaene
- Peter MacCallum Cancer Center, The University of Melbourne, Melbourne, Victoria, Australia.,Australian Prostate Cancer Research Center, Epworth Richmond Hospital, Melbourne, Victoria, Australia
| | - Declan G Murphy
- Peter MacCallum Cancer Center, The University of Melbourne, Melbourne, Victoria, Australia. .,Australian Prostate Cancer Research Center, Epworth Richmond Hospital, Melbourne, Victoria, Australia.
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