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Salami SS, George AK, Montgomery JS, Morgan TM, Palapattu GS. Diagnostic accuracy of the PROMIS study. Lancet 2017; 390:362. [PMID: 28745602 DOI: 10.1016/s0140-6736(17)31598-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 05/10/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Simpa S Salami
- Department of Urology, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Arvin K George
- Department of Urology, University of Michigan, Ann Arbor, MI 48109, USA; Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jeffrey S Montgomery
- Department of Urology, University of Michigan, Ann Arbor, MI 48109, USA; Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI 48109, USA; Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ganesh S Palapattu
- Department of Urology, University of Michigan, Ann Arbor, MI 48109, USA; Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA
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1652
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Haymart MR, Miller DC, Hawley ST. Active Surveillance for Low-Risk Cancers - A Viable Solution to Overtreatment? N Engl J Med 2017; 377:203-206. [PMID: 28723330 PMCID: PMC5921045 DOI: 10.1056/nejmp1703787] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Megan R Haymart
- From the Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine (M.R.H.), the Institute for Healthcare Policy and Innovation (M.R.H., D.C.M., S.T.H.), the Department of Urology (D.C.M.), and the Division of General Medicine, Department of Internal Medicine (S.T.H.), University of Michigan, Ann Arbor
| | - David C Miller
- From the Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine (M.R.H.), the Institute for Healthcare Policy and Innovation (M.R.H., D.C.M., S.T.H.), the Department of Urology (D.C.M.), and the Division of General Medicine, Department of Internal Medicine (S.T.H.), University of Michigan, Ann Arbor
| | - Sarah T Hawley
- From the Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine (M.R.H.), the Institute for Healthcare Policy and Innovation (M.R.H., D.C.M., S.T.H.), the Department of Urology (D.C.M.), and the Division of General Medicine, Department of Internal Medicine (S.T.H.), University of Michigan, Ann Arbor
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1653
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Wade J, Elliott D, Avery KNL, Gaunt D, Young GJ, Barnes R, Paramasivan S, Campbell WB, Blazeby JM, Birtle AJ, Stein RC, Beard DJ, Halliday AW, Donovan JL. Informed consent in randomised controlled trials: development and preliminary evaluation of a measure of Participatory and Informed Consent (PIC). Trials 2017; 18:327. [PMID: 28716064 PMCID: PMC5513045 DOI: 10.1186/s13063-017-2048-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 06/09/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Informed consent (IC) is an ethical and legal prerequisite for trial participation, yet current approaches evaluating participant understanding for IC during recruitment lack consistency. No validated measure has been identified that evaluates participant understanding for IC based on their contributions during consent interactions. This paper outlines the development and formative evaluation of the Participatory and Informed Consent (PIC) measure for application to recorded recruitment appointments. The PIC allows the evaluation of recruiter information provision and evidence of participant understanding. METHODS Published guidelines for IC were reviewed to identify potential items for inclusion. Seventeen purposively sampled trial recruitment appointments from three diverse trials were reviewed to identify the presence of items relevant to IC. A developmental version of the measure (DevPICv1) was drafted and applied to six further recruitment appointments from three further diverse trials to evaluate feasibility, validity, stability and inter-rater reliability. Findings guided revision of the measure (DevPICv2) which was applied to six further recruitment appointments as above. RESULTS DevPICv1 assessed recruiter information provision (detail and clarity assessed separately) and participant talk (detail and understanding assessed separately) over 20 parameters (or 23 parameters for three-arm trials). Initial application of the measure to six diverse recruitment appointments demonstrated promising stability and inter-rater reliability but a need to simplify the measure to shorten time for completion. The revised measure (DevPICv2) combined assessment of detail and clarity of recruiter information and detail and evidence of participant understanding into two single scales for application to 22 parameters or 25 parameters for three-arm trials. Application of DevPICv2 to six further diverse recruitment appointments showed considerable improvements in feasibility (e.g. time to complete) with good levels of stability (i.e. test-retest reliability) and inter-rater reliability maintained. CONCLUSIONS The DevPICv2 provides a measure for application to trial recruitment appointments to evaluate quality of recruiter information provision and evidence of patient understanding and participation during IC discussions. Initial evaluation shows promising feasibility, validity, reliability and ability to discriminate across a range of recruiter practice and evidence of participant understanding. More validation work is needed in new clinical trials to evaluate and refine the measure further.
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Affiliation(s)
- Julia Wade
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS UK
| | - Daisy Elliott
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS UK
| | - Kerry N. L. Avery
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS UK
| | - Daisy Gaunt
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS UK
| | - Grace J. Young
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS UK
| | - Rebecca Barnes
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS UK
| | - Sangeetha Paramasivan
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS UK
| | | | - Jane M. Blazeby
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS UK
| | - Alison J Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Sharoe Green Lane North, Fulwood, Preston, Lancashire, PR2 9HT4 UK
- University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Rob C. Stein
- National Institute for Health Research (NIHR), University College London Hospitals (UCLH), Biomedical Research Centre (BMC), University College London Hospitals, 1st Floor Central, 250 Euston Road, London, NW1 2PG UK
| | - David J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD UK
| | - Alison W Halliday
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 9DU UK
| | - Jenny L. Donovan
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) West, University Hospitals Bristol NHS Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT UK
| | - On behalf of the ProtecT study group
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS UK
- Royal Devon and Exeter Hospital, Exeter, EX2 5DW UK
- Rosemere Cancer Centre, Royal Preston Hospital, Sharoe Green Lane North, Fulwood, Preston, Lancashire, PR2 9HT4 UK
- University of Manchester, Oxford Road, Manchester, M13 9PL UK
- National Institute for Health Research (NIHR), University College London Hospitals (UCLH), Biomedical Research Centre (BMC), University College London Hospitals, 1st Floor Central, 250 Euston Road, London, NW1 2PG UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 9DU UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) West, University Hospitals Bristol NHS Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT UK
| | - CLASS study group
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS UK
- Royal Devon and Exeter Hospital, Exeter, EX2 5DW UK
- Rosemere Cancer Centre, Royal Preston Hospital, Sharoe Green Lane North, Fulwood, Preston, Lancashire, PR2 9HT4 UK
- University of Manchester, Oxford Road, Manchester, M13 9PL UK
- National Institute for Health Research (NIHR), University College London Hospitals (UCLH), Biomedical Research Centre (BMC), University College London Hospitals, 1st Floor Central, 250 Euston Road, London, NW1 2PG UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 9DU UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) West, University Hospitals Bristol NHS Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT UK
| | - Chemorad study group
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS UK
- Royal Devon and Exeter Hospital, Exeter, EX2 5DW UK
- Rosemere Cancer Centre, Royal Preston Hospital, Sharoe Green Lane North, Fulwood, Preston, Lancashire, PR2 9HT4 UK
- University of Manchester, Oxford Road, Manchester, M13 9PL UK
- National Institute for Health Research (NIHR), University College London Hospitals (UCLH), Biomedical Research Centre (BMC), University College London Hospitals, 1st Floor Central, 250 Euston Road, London, NW1 2PG UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 9DU UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) West, University Hospitals Bristol NHS Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT UK
| | - POUT study group
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS UK
- Royal Devon and Exeter Hospital, Exeter, EX2 5DW UK
- Rosemere Cancer Centre, Royal Preston Hospital, Sharoe Green Lane North, Fulwood, Preston, Lancashire, PR2 9HT4 UK
- University of Manchester, Oxford Road, Manchester, M13 9PL UK
- National Institute for Health Research (NIHR), University College London Hospitals (UCLH), Biomedical Research Centre (BMC), University College London Hospitals, 1st Floor Central, 250 Euston Road, London, NW1 2PG UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 9DU UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) West, University Hospitals Bristol NHS Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT UK
| | - OPTIMA prelim study group
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS UK
- Royal Devon and Exeter Hospital, Exeter, EX2 5DW UK
- Rosemere Cancer Centre, Royal Preston Hospital, Sharoe Green Lane North, Fulwood, Preston, Lancashire, PR2 9HT4 UK
- University of Manchester, Oxford Road, Manchester, M13 9PL UK
- National Institute for Health Research (NIHR), University College London Hospitals (UCLH), Biomedical Research Centre (BMC), University College London Hospitals, 1st Floor Central, 250 Euston Road, London, NW1 2PG UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 9DU UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) West, University Hospitals Bristol NHS Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT UK
| | - CSAW study group and ACST-2 study group
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS UK
- Royal Devon and Exeter Hospital, Exeter, EX2 5DW UK
- Rosemere Cancer Centre, Royal Preston Hospital, Sharoe Green Lane North, Fulwood, Preston, Lancashire, PR2 9HT4 UK
- University of Manchester, Oxford Road, Manchester, M13 9PL UK
- National Institute for Health Research (NIHR), University College London Hospitals (UCLH), Biomedical Research Centre (BMC), University College London Hospitals, 1st Floor Central, 250 Euston Road, London, NW1 2PG UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 9DU UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) West, University Hospitals Bristol NHS Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT UK
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1654
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Wilt TJ, Jones KM, Barry MJ, Andriole GL, Culkin D, Wheeler T, Aronson WJ, Brawer MK. Follow-up of Prostatectomy versus Observation for Early Prostate Cancer. N Engl J Med 2017; 377:132-142. [PMID: 28700844 DOI: 10.1056/nejmoa1615869] [Citation(s) in RCA: 364] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND We previously found no significant differences in mortality between men who underwent surgery for localized prostate cancer and those who were treated with observation only. Uncertainty persists regarding nonfatal health outcomes and long-term mortality. METHODS From November 1994 through January 2002, we randomly assigned 731 men with localized prostate cancer to radical prostatectomy or observation. We extended follow-up through August 2014 for our primary outcome, all-cause mortality, and the main secondary outcome, prostate-cancer mortality. We describe disease progression, treatments received, and patient-reported outcomes through January 2010 (original follow-up). RESULTS During 19.5 years of follow-up (median, 12.7 years), death occurred in 223 of 364 men (61.3%) assigned to surgery and in 245 of 367 (66.8%) assigned to observation (absolute difference in risk, 5.5 percentage points; 95% confidence interval [CI], -1.5 to 12.4; hazard ratio, 0.84; 95% CI, 0.70 to 1.01; P=0.06). Death attributed to prostate cancer or treatment occurred in 27 men (7.4%) assigned to surgery and in 42 men (11.4%) assigned to observation (absolute difference in risk, 4.0 percentage points; 95% CI, -0.2 to 8.3; hazard ratio, 0.63; 95% CI, 0.39 to 1.02; P=0.06). Surgery may have been associated with lower all-cause mortality than observation among men with intermediate-risk disease (absolute difference, 14.5 percentage points; 95% CI, 2.8 to 25.6) but not among those with low-risk disease (absolute difference, 0.7 percentage points; 95% CI, -10.5 to 11.8) or high-risk disease (absolute difference, 2.3 percentage points; 95% CI, -11.5 to 16.1) (P=0.08 for interaction). Treatment for disease progression was less frequent with surgery than with observation (absolute difference, 26.2 percentage points; 95% CI, 19.0 to 32.9); treatment was primarily for asymptomatic, local, or biochemical (prostate-specific antigen) progression. Urinary incontinence and erectile and sexual dysfunction were each greater with surgery than with observation through 10 years. Disease-related or treatment-related limitations in activities of daily living were greater with surgery than with observation through 2 years. CONCLUSIONS After nearly 20 years of follow-up among men with localized prostate cancer, surgery was not associated with significantly lower all-cause or prostate-cancer mortality than observation. Surgery was associated with a higher frequency of adverse events than observation but a lower frequency of treatment for disease progression, mostly for asymptomatic, local, or biochemical progression. (Funded by the Department of Veterans Affairs and others; PIVOT ClinicalTrials.gov number, NCT00007644 .).
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Affiliation(s)
- Timothy J Wilt
- From the Minneapolis Veterans Affairs (VA) Health Care System and Center for Chronic Disease Outcomes Research and the Section of General Medicine, University of Minnesota School of Medicine, Minneapolis (T.J.W.); the VA Cooperative Studies Program Coordinating Center, Perry Point, MD (K.M.J.); the General Medicine Division, Massachusetts General Hospital, Boston (M.J.B.); the Division of Urology, Washington University School of Medicine, St. Louis (G.L.A.); the Department of Urology, University of Oklahoma College of Medicine, Oklahoma City (D.C.); the Department of Pathology and Immunology, Baylor College of Medicine, Houston (T.W.); VA Medical Center, Greater Los Angeles Healthcare System, Los Angeles (W.J.A.); and Myriad Genetics Laboratories, Salt Lake City (M.K.B.)
| | - Karen M Jones
- From the Minneapolis Veterans Affairs (VA) Health Care System and Center for Chronic Disease Outcomes Research and the Section of General Medicine, University of Minnesota School of Medicine, Minneapolis (T.J.W.); the VA Cooperative Studies Program Coordinating Center, Perry Point, MD (K.M.J.); the General Medicine Division, Massachusetts General Hospital, Boston (M.J.B.); the Division of Urology, Washington University School of Medicine, St. Louis (G.L.A.); the Department of Urology, University of Oklahoma College of Medicine, Oklahoma City (D.C.); the Department of Pathology and Immunology, Baylor College of Medicine, Houston (T.W.); VA Medical Center, Greater Los Angeles Healthcare System, Los Angeles (W.J.A.); and Myriad Genetics Laboratories, Salt Lake City (M.K.B.)
| | - Michael J Barry
- From the Minneapolis Veterans Affairs (VA) Health Care System and Center for Chronic Disease Outcomes Research and the Section of General Medicine, University of Minnesota School of Medicine, Minneapolis (T.J.W.); the VA Cooperative Studies Program Coordinating Center, Perry Point, MD (K.M.J.); the General Medicine Division, Massachusetts General Hospital, Boston (M.J.B.); the Division of Urology, Washington University School of Medicine, St. Louis (G.L.A.); the Department of Urology, University of Oklahoma College of Medicine, Oklahoma City (D.C.); the Department of Pathology and Immunology, Baylor College of Medicine, Houston (T.W.); VA Medical Center, Greater Los Angeles Healthcare System, Los Angeles (W.J.A.); and Myriad Genetics Laboratories, Salt Lake City (M.K.B.)
| | - Gerald L Andriole
- From the Minneapolis Veterans Affairs (VA) Health Care System and Center for Chronic Disease Outcomes Research and the Section of General Medicine, University of Minnesota School of Medicine, Minneapolis (T.J.W.); the VA Cooperative Studies Program Coordinating Center, Perry Point, MD (K.M.J.); the General Medicine Division, Massachusetts General Hospital, Boston (M.J.B.); the Division of Urology, Washington University School of Medicine, St. Louis (G.L.A.); the Department of Urology, University of Oklahoma College of Medicine, Oklahoma City (D.C.); the Department of Pathology and Immunology, Baylor College of Medicine, Houston (T.W.); VA Medical Center, Greater Los Angeles Healthcare System, Los Angeles (W.J.A.); and Myriad Genetics Laboratories, Salt Lake City (M.K.B.)
| | - Daniel Culkin
- From the Minneapolis Veterans Affairs (VA) Health Care System and Center for Chronic Disease Outcomes Research and the Section of General Medicine, University of Minnesota School of Medicine, Minneapolis (T.J.W.); the VA Cooperative Studies Program Coordinating Center, Perry Point, MD (K.M.J.); the General Medicine Division, Massachusetts General Hospital, Boston (M.J.B.); the Division of Urology, Washington University School of Medicine, St. Louis (G.L.A.); the Department of Urology, University of Oklahoma College of Medicine, Oklahoma City (D.C.); the Department of Pathology and Immunology, Baylor College of Medicine, Houston (T.W.); VA Medical Center, Greater Los Angeles Healthcare System, Los Angeles (W.J.A.); and Myriad Genetics Laboratories, Salt Lake City (M.K.B.)
| | - Thomas Wheeler
- From the Minneapolis Veterans Affairs (VA) Health Care System and Center for Chronic Disease Outcomes Research and the Section of General Medicine, University of Minnesota School of Medicine, Minneapolis (T.J.W.); the VA Cooperative Studies Program Coordinating Center, Perry Point, MD (K.M.J.); the General Medicine Division, Massachusetts General Hospital, Boston (M.J.B.); the Division of Urology, Washington University School of Medicine, St. Louis (G.L.A.); the Department of Urology, University of Oklahoma College of Medicine, Oklahoma City (D.C.); the Department of Pathology and Immunology, Baylor College of Medicine, Houston (T.W.); VA Medical Center, Greater Los Angeles Healthcare System, Los Angeles (W.J.A.); and Myriad Genetics Laboratories, Salt Lake City (M.K.B.)
| | - William J Aronson
- From the Minneapolis Veterans Affairs (VA) Health Care System and Center for Chronic Disease Outcomes Research and the Section of General Medicine, University of Minnesota School of Medicine, Minneapolis (T.J.W.); the VA Cooperative Studies Program Coordinating Center, Perry Point, MD (K.M.J.); the General Medicine Division, Massachusetts General Hospital, Boston (M.J.B.); the Division of Urology, Washington University School of Medicine, St. Louis (G.L.A.); the Department of Urology, University of Oklahoma College of Medicine, Oklahoma City (D.C.); the Department of Pathology and Immunology, Baylor College of Medicine, Houston (T.W.); VA Medical Center, Greater Los Angeles Healthcare System, Los Angeles (W.J.A.); and Myriad Genetics Laboratories, Salt Lake City (M.K.B.)
| | - Michael K Brawer
- From the Minneapolis Veterans Affairs (VA) Health Care System and Center for Chronic Disease Outcomes Research and the Section of General Medicine, University of Minnesota School of Medicine, Minneapolis (T.J.W.); the VA Cooperative Studies Program Coordinating Center, Perry Point, MD (K.M.J.); the General Medicine Division, Massachusetts General Hospital, Boston (M.J.B.); the Division of Urology, Washington University School of Medicine, St. Louis (G.L.A.); the Department of Urology, University of Oklahoma College of Medicine, Oklahoma City (D.C.); the Department of Pathology and Immunology, Baylor College of Medicine, Houston (T.W.); VA Medical Center, Greater Los Angeles Healthcare System, Los Angeles (W.J.A.); and Myriad Genetics Laboratories, Salt Lake City (M.K.B.)
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1655
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Influence of Men's Personality and Social Support on Treatment Decision-Making for Localized Prostate Cancer. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1467056. [PMID: 28785574 PMCID: PMC5529637 DOI: 10.1155/2017/1467056] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/31/2017] [Accepted: 06/11/2017] [Indexed: 11/24/2022]
Abstract
Background Optimal treatment for localized prostate cancer (LPC) is controversial. We assessed the effects of personality, specialists seen, and involvement of spouse, family, or friends on treatment decision/decision-making qualities. Methods We surveyed a population-based sample of men ≤ 75 years with newly diagnosed LPC about treatment choice, reasons for the choice, decision-making difficulty, satisfaction, and regret. Results Of 160 men (71 black, 89 white), with a mean age of 61 (±7.3) years, 59% chose surgery, 31% chose radiation, and 10% chose active surveillance (AS)/watchful waiting (WW). Adjusting for age, race, comorbidity, tumor risk level, and treatment status, men who consulted friends during decision-making were more likely to choose curative treatment (radiation or surgery) than WW/AS (OR = 11.1, p < 0.01; 8.7, p < 0.01). Men who saw a radiation oncologist in addition to a urologist were more likely to choose radiation than surgery (OR = 6.0, p = 0.04). Men who consulted family or friends (OR = 2.6, p < 0.01; 3.7, p < 0.01) experienced greater decision-making difficulty. No personality traits (pessimism, optimism, or faith) were associated with treatment choice/decision-making quality measures. Conclusions In addition to specialist seen, consulting friends increased men's likelihood of choosing curative treatment. Consulting family or friends increased decision-making difficulty.
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1656
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Hoffman RM, Lo M, Clark JA, Albertsen PC, Barry MJ, Goodman M, Penson DF, Stanford JL, Stroup AM, Hamilton AS. Treatment Decision Regret Among Long-Term Survivors of Localized Prostate Cancer: Results From the Prostate Cancer Outcomes Study. J Clin Oncol 2017; 35:2306-2314. [PMID: 28493812 PMCID: PMC5501361 DOI: 10.1200/jco.2016.70.6317] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose To determine the demographic, clinical, decision-making, and quality-of-life factors that are associated with treatment decision regret among long-term survivors of localized prostate cancer. Patients and Methods We evaluated men who were age ≤ 75 years when diagnosed with localized prostate cancer between October 1994 and October 1995 in one of six SEER tumor registries and who completed a 15-year follow-up survey. The survey obtained demographic, socioeconomic, and clinical data and measured treatment decision regret, informed decision making, general- and disease-specific quality of life, health worry, prostate-specific antigen (PSA) concern, and outlook on life. We used multivariable logistic regression analyses to identify factors associated with regret. Results We surveyed 934 participants, 69.3% of known survivors. Among the cohort, 59.1% had low-risk tumor characteristics (PSA < 10 ng/mL and Gleason score < 7), and 89.2% underwent active treatment. Overall, 14.6% expressed treatment decision regret: 8.2% of those whose disease was managed conservatively, 15.0% of those who received surgery, and 16.6% of those who underwent radiotherapy. Factors associated with regret on multivariable analysis included reporting moderate or big sexual function bother (reported by 39.0%; OR, 2.77; 95% CI, 1.51 to 5.0), moderate or big bowel function bother (reported by 7.7%; OR, 2.32; 95% CI, 1.04 to 5.15), and PSA concern (mean score 52.8; OR, 1.01 per point change; 95% CI, 1.00 to 1.02). Increasing age at diagnosis and report of having made an informed treatment decision were inversely associated with regret. Conclusion Regret was a relatively infrequently reported outcome among long-term survivors of localized prostate cancer; however, our results suggest that better informing men about treatment options, in particular, conservative treatment, might help mitigate long-term regret. These findings are timely for men with low-risk cancers who are being encouraged to consider active surveillance.
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Affiliation(s)
- Richard M. Hoffman
- Richard M. Hoffman, University of Iowa Carver College of Medicine; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; Mary Lo and Ann S. Hamilton, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Jack A. Clark, Edith Nourse Rogers Veterans Affairs Memorial Hospital, Bedford; Boston University School of Public Health; Michael J. Barry, Massachusetts General Hospital; Harvard Medical School, Boston, MA; Peter C. Albertsen, University of Connecticut Health Center, Farmington, CT; Michael Goodman, Emory University, Atlanta, GA; David F. Penson, Vanderbilt University, Nashville, TN; Janet L. Stanford, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antoinette M. Stroup, Rutgers School of Public Health, Piscataway; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Mary Lo
- Richard M. Hoffman, University of Iowa Carver College of Medicine; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; Mary Lo and Ann S. Hamilton, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Jack A. Clark, Edith Nourse Rogers Veterans Affairs Memorial Hospital, Bedford; Boston University School of Public Health; Michael J. Barry, Massachusetts General Hospital; Harvard Medical School, Boston, MA; Peter C. Albertsen, University of Connecticut Health Center, Farmington, CT; Michael Goodman, Emory University, Atlanta, GA; David F. Penson, Vanderbilt University, Nashville, TN; Janet L. Stanford, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antoinette M. Stroup, Rutgers School of Public Health, Piscataway; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Jack A. Clark
- Richard M. Hoffman, University of Iowa Carver College of Medicine; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; Mary Lo and Ann S. Hamilton, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Jack A. Clark, Edith Nourse Rogers Veterans Affairs Memorial Hospital, Bedford; Boston University School of Public Health; Michael J. Barry, Massachusetts General Hospital; Harvard Medical School, Boston, MA; Peter C. Albertsen, University of Connecticut Health Center, Farmington, CT; Michael Goodman, Emory University, Atlanta, GA; David F. Penson, Vanderbilt University, Nashville, TN; Janet L. Stanford, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antoinette M. Stroup, Rutgers School of Public Health, Piscataway; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Peter C. Albertsen
- Richard M. Hoffman, University of Iowa Carver College of Medicine; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; Mary Lo and Ann S. Hamilton, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Jack A. Clark, Edith Nourse Rogers Veterans Affairs Memorial Hospital, Bedford; Boston University School of Public Health; Michael J. Barry, Massachusetts General Hospital; Harvard Medical School, Boston, MA; Peter C. Albertsen, University of Connecticut Health Center, Farmington, CT; Michael Goodman, Emory University, Atlanta, GA; David F. Penson, Vanderbilt University, Nashville, TN; Janet L. Stanford, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antoinette M. Stroup, Rutgers School of Public Health, Piscataway; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Michael J. Barry
- Richard M. Hoffman, University of Iowa Carver College of Medicine; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; Mary Lo and Ann S. Hamilton, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Jack A. Clark, Edith Nourse Rogers Veterans Affairs Memorial Hospital, Bedford; Boston University School of Public Health; Michael J. Barry, Massachusetts General Hospital; Harvard Medical School, Boston, MA; Peter C. Albertsen, University of Connecticut Health Center, Farmington, CT; Michael Goodman, Emory University, Atlanta, GA; David F. Penson, Vanderbilt University, Nashville, TN; Janet L. Stanford, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antoinette M. Stroup, Rutgers School of Public Health, Piscataway; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Michael Goodman
- Richard M. Hoffman, University of Iowa Carver College of Medicine; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; Mary Lo and Ann S. Hamilton, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Jack A. Clark, Edith Nourse Rogers Veterans Affairs Memorial Hospital, Bedford; Boston University School of Public Health; Michael J. Barry, Massachusetts General Hospital; Harvard Medical School, Boston, MA; Peter C. Albertsen, University of Connecticut Health Center, Farmington, CT; Michael Goodman, Emory University, Atlanta, GA; David F. Penson, Vanderbilt University, Nashville, TN; Janet L. Stanford, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antoinette M. Stroup, Rutgers School of Public Health, Piscataway; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - David F. Penson
- Richard M. Hoffman, University of Iowa Carver College of Medicine; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; Mary Lo and Ann S. Hamilton, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Jack A. Clark, Edith Nourse Rogers Veterans Affairs Memorial Hospital, Bedford; Boston University School of Public Health; Michael J. Barry, Massachusetts General Hospital; Harvard Medical School, Boston, MA; Peter C. Albertsen, University of Connecticut Health Center, Farmington, CT; Michael Goodman, Emory University, Atlanta, GA; David F. Penson, Vanderbilt University, Nashville, TN; Janet L. Stanford, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antoinette M. Stroup, Rutgers School of Public Health, Piscataway; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Janet L. Stanford
- Richard M. Hoffman, University of Iowa Carver College of Medicine; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; Mary Lo and Ann S. Hamilton, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Jack A. Clark, Edith Nourse Rogers Veterans Affairs Memorial Hospital, Bedford; Boston University School of Public Health; Michael J. Barry, Massachusetts General Hospital; Harvard Medical School, Boston, MA; Peter C. Albertsen, University of Connecticut Health Center, Farmington, CT; Michael Goodman, Emory University, Atlanta, GA; David F. Penson, Vanderbilt University, Nashville, TN; Janet L. Stanford, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antoinette M. Stroup, Rutgers School of Public Health, Piscataway; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Antoinette M. Stroup
- Richard M. Hoffman, University of Iowa Carver College of Medicine; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; Mary Lo and Ann S. Hamilton, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Jack A. Clark, Edith Nourse Rogers Veterans Affairs Memorial Hospital, Bedford; Boston University School of Public Health; Michael J. Barry, Massachusetts General Hospital; Harvard Medical School, Boston, MA; Peter C. Albertsen, University of Connecticut Health Center, Farmington, CT; Michael Goodman, Emory University, Atlanta, GA; David F. Penson, Vanderbilt University, Nashville, TN; Janet L. Stanford, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antoinette M. Stroup, Rutgers School of Public Health, Piscataway; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Ann S. Hamilton
- Richard M. Hoffman, University of Iowa Carver College of Medicine; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; Mary Lo and Ann S. Hamilton, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Jack A. Clark, Edith Nourse Rogers Veterans Affairs Memorial Hospital, Bedford; Boston University School of Public Health; Michael J. Barry, Massachusetts General Hospital; Harvard Medical School, Boston, MA; Peter C. Albertsen, University of Connecticut Health Center, Farmington, CT; Michael Goodman, Emory University, Atlanta, GA; David F. Penson, Vanderbilt University, Nashville, TN; Janet L. Stanford, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antoinette M. Stroup, Rutgers School of Public Health, Piscataway; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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1657
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Masaoka H, Ito H, Yokomizo A, Eto M, Matsuo K. Potential overtreatment among men aged 80 years and older with localized prostate cancer in Japan. Cancer Sci 2017; 108:1673-1680. [PMID: 28594447 PMCID: PMC5543472 DOI: 10.1111/cas.13293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 05/31/2017] [Accepted: 06/02/2017] [Indexed: 02/06/2023] Open
Abstract
Despite treatment guidelines recommending observation for men with low‐risk prostate cancer with life expectancy <10 years, a majority of elderly patients choose active treatment, which may result in overtreatment. Given the growing burden of prostate cancer among men aged ≥80 years (super‐elderly men), accumulation of survival data for evaluation of overtreatment among super‐elderly patients is imperative. Here, we report results of a population‐based cohort study to clarify potential overtreatment of super‐elderly men with localized prostate cancer. We used cancer registry data from the Monitoring of Cancer Incidence in Japan project, which covers 47% of the Japanese population. The subjects were men diagnosed with prostate cancer between 2006 and 2008. Follow‐up period was 5 years. We calculated 5‐year relative survival rates among the active treatment and observation groups after imputation for missing values. Of the 48 782 patients with prostate cancer included in the analysis, 15.1% were super‐elderly men. The 5‐year relative survival rates of super‐elderly men with localized cancer were 105.9% and 104.1% among the active treatment and observation groups, respectively. This excellent relative survival rate in the observation group remained consistent even after stratification by tumor grade. Of the 2963 super‐elderly men with localized cancer, 252 (8.5%) with curative treatment and 1476 (49.8%) with hormone therapy were assumed to have been overtreated. The proportion of overtreatment was estimated to reach 80% after imputation. These specific survival data in super‐elderly men in the observation group can be useful in shared decision‐making for these patients and may lead to a reduction in overtreatment.
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Affiliation(s)
- Hiroyuki Masaoka
- Division of Molecular and Clinical Epidemiology, Aichi Cancer Center Research Institute, Nagoya, Japan.,Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hidemi Ito
- Division of Molecular and Clinical Epidemiology, Aichi Cancer Center Research Institute, Nagoya, Japan.,Department of Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akira Yokomizo
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keitaro Matsuo
- Division of Molecular and Clinical Epidemiology, Aichi Cancer Center Research Institute, Nagoya, Japan.,Department of Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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1658
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Impact of Radical Prostatectomy on Long-Term Oncologic Outcomes in a Matched Cohort of Men with Pathological Node Positive Prostate Cancer Managed by Castration. J Urol 2017; 198:86-91. [DOI: 10.1016/j.juro.2017.01.063] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 11/23/2022]
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1659
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1660
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Early Stage Cancer in Older Adults: Prostate—Avoiding Overtreatment and Undertreatment. Cancer J 2017. [DOI: 10.1097/00130404-201707000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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1661
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Stavrinides V, Parker C, Moore C. When no treatment is the best treatment: Active surveillance strategies for low risk prostate cancers. Cancer Treat Rev 2017; 58:14-21. [DOI: 10.1016/j.ctrv.2017.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 05/14/2017] [Accepted: 05/16/2017] [Indexed: 01/02/2023]
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1662
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Barry MJ, Simmons LH. Prevention of Prostate Cancer Morbidity and Mortality: Primary Prevention and Early Detection. Med Clin North Am 2017; 101:787-806. [PMID: 28577627 DOI: 10.1016/j.mcna.2017.03.009] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
More than any other cancer, prostate cancer screening with the prostate-specific antigen (PSA) tests increases the risk a man will have to face a diagnosis of prostate cancer. The best evidence from screening trials suggests a small but finite benefit from prostate cancer screening in terms of prostate cancer-specific mortality, about 1 fewer prostate cancer death per 1000 men screened over 10 years. The more serious harms of prostate cancer screening, such as erectile dysfunction and incontinence, result from cancer treatment with surgery or radiation, particularly for men whose PSA-detected cancers were never destined to cause morbidity or mortality.
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Affiliation(s)
- Michael J Barry
- General Medicine Division, Massachusetts General Hospital, 50 Staniford Street, Suite 957, Boston, MA 02114, USA.
| | - Leigh H Simmons
- General Medicine Division, Massachusetts General Hospital, 50 Staniford Street, Suite 957, Boston, MA 02114, USA
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1663
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1664
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1665
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Gordetsky J, Rais-Bahrami S, Epstein JI. Pathological Findings in Multiparametric Magnetic Resonance Imaging/Ultrasound Fusion-guided Biopsy: Relation to Prostate Cancer Focal Therapy. Urology 2017; 105:18-23. [DOI: 10.1016/j.urology.2017.02.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 02/01/2017] [Accepted: 02/15/2017] [Indexed: 10/20/2022]
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1666
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Zaorsky NG, Davis BJ, Nguyen PL, Showalter TN, Hoskin PJ, Yoshioka Y, Morton GC, Horwitz EM. The evolution of brachytherapy for prostate cancer. Nat Rev Urol 2017; 14:415-439. [PMID: 28664931 PMCID: PMC7542347 DOI: 10.1038/nrurol.2017.76] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Brachytherapy (BT), using low-dose-rate (LDR) permanent seed implantation or high-dose-rate (HDR) temporary source implantation, is an acceptable treatment option for select patients with prostate cancer of any risk group. The benefits of HDR-BT over LDR-BT include the ability to use the same source for other cancers, lower operator dependence, and - typically - fewer acute irritative symptoms. By contrast, the benefits of LDR-BT include more favourable scheduling logistics, lower initial capital equipment costs, no need for a shielded room, completion in a single implant, and more robust data from clinical trials. Prospective reports comparing HDR-BT and LDR-BT to each other or to other treatment options (such as external beam radiotherapy (EBRT) or surgery) suggest similar outcomes. The 5-year freedom from biochemical failure rates for patients with low-risk, intermediate-risk, and high-risk disease are >85%, 69-97%, and 63-80%, respectively. Brachytherapy with EBRT (versus brachytherapy alone) is an appropriate approach in select patients with intermediate-risk and high-risk disease. The 10-year rates of overall survival, distant metastasis, and cancer-specific mortality are >85%, <10%, and <5%, respectively. Grade 3-4 toxicities associated with HDR-BT and LDR-BT are rare, at <4% in most series, and quality of life is improved in patients who receive brachytherapy compared with those who undergo surgery.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, Pennsylvania 19111-2497, USA
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Charlton Bldg/Desk R - SL, Rochester, Minnesota 5590, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital, 75 Francis St BWH. Radiation Oncology, Boston, Massachusetts 02115, USA
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia, 1240 Lee St, Charlottesville, Virginia 22908, USA
| | - Peter J Hoskin
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex HA6 2RN, UK
| | - Yasuo Yoshioka
- Department of Radiation Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Gerard C Morton
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, Pennsylvania 19111-2497, USA
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1667
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Tay KJ, Schulman AA, Sze C, Tsivian E, Polascik TJ. New advances in focal therapy for early stage prostate cancer. Expert Rev Anticancer Ther 2017. [PMID: 28635336 DOI: 10.1080/14737140.2017.1345630] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Prostate focal therapy offers men the opportunity to achieve oncological control while preserving sexual and urinary function. The prerequisites for successful focal therapy are to accurately identify, localize and completely ablate the clinically significant cancer(s) within the prostate. We aim to evaluate the evidence for current and upcoming technologies that could shape the future of prostate cancer focal therapy in the next five years. Areas covered: Current literature on advances in patient selection using imaging, biopsy and biomarkers, ablation techniques and adjuvant treatments for focal therapy are summarized. A literature search of major databases was performed using the search terms 'focal therapy', 'focal ablation', 'partial ablation', 'targeted ablation', 'image guided therapy' and 'prostate cancer'. Expert commentary: Advanced radiological tools such as multiparametric magnetic resonance imaging (mpMRI), multiparametric ultrasound (mpUS), prostate-specific-membrane-antigen positron emission tomography (PSMA-PET) represent a revolution in the ability to understand cancer function and biology. Advances in ablative technologies now provide a menu of modalities that can be rationalized based on lesion location, size and perhaps in the near future, pre-determined resistance to therapy. However, these need to be carefully studied to establish their safety and efficacy parameters. Adjuvant strategies to enhance focal ablation are under development.
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Affiliation(s)
- Kae Jack Tay
- a Department of Urology , Singapore General Hospital, SingHealth Duke-NUS Academic Medical Center , Singapore.,b Division of Urology, Department of Surgery , Duke University Medical Center , Durham , NC , USA.,c Duke Cancer Institute , Durham , NC , USA
| | - Ariel A Schulman
- b Division of Urology, Department of Surgery , Duke University Medical Center , Durham , NC , USA.,c Duke Cancer Institute , Durham , NC , USA
| | - Christina Sze
- b Division of Urology, Department of Surgery , Duke University Medical Center , Durham , NC , USA.,c Duke Cancer Institute , Durham , NC , USA
| | - Efrat Tsivian
- b Division of Urology, Department of Surgery , Duke University Medical Center , Durham , NC , USA.,c Duke Cancer Institute , Durham , NC , USA
| | - Thomas J Polascik
- b Division of Urology, Department of Surgery , Duke University Medical Center , Durham , NC , USA.,c Duke Cancer Institute , Durham , NC , USA
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1668
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Kwon T, Lee C, Jung J, Kim CS. Neurovascular bundle size measured on 3.0-T magnetic resonance imaging is associated with the recovery of erectile function after robot-assisted radical prostatectomy. Urol Oncol 2017. [PMID: 28648413 DOI: 10.1016/j.urolonc.2016.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Erectile dysfunction is one of the complications occurring after radical prostatectomy (RP), and recovery of erectile function is quantitatively related to the preservation of the neurovascular bundles (NVB).We evaluated the significance of NVB area on functional outcomes after RP. MATERIALS AND METHODS Preoperative magnetic resonance imaging was performed on 141 patients who underwent bilateral, nerve-sparing, robot-assisted RP for clinically localized prostate cancer (clinically T2N0M0 on magnetic resonance imaging) and were evaluated at least 12 months after surgery. NVB area was measured as a region of interest that coincided with the outline of the maximum area of the posterolateral region of the prostate on T2-weighted axial imaging. Factors associated with functional outcomes were evaluated using logistic regression analysis. RESULTS Of 141 patients, 36 patients (25.5%) had no preoperative potency (group 1), 66 patients (46.8%) recovered potency (group 2), and 39 patients (27.7%) did not recover potency (group 3). Although the mean age of the entire cohort was 65.4 years, the mean age of group 1 was greater than groups 2 and 3 (P = 0.001). The NVB area of group 2 was larger than those of groups 1 and 3 (P = 0.001). Potency evaluations involved 105 patients (74.5%; groups 2 and 3), and patients with pre-existing erectile dysfunction were excluded. The median time to potency recovery was 3.0 months after surgery. The multivariable analysis revealed that the NVB area was the only significant factor predictive of potency recovery. CONCLUSIONS The NVB area in the posterolateral region of the prostate is an independent factor for predicting potency recovery. The degree of postoperative erectile function can be predicted based on the preoperative NVB area.
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Affiliation(s)
- Taekmin Kwon
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Chanwoo Lee
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jaeyoon Jung
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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1669
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Mannas MP, Chedgy ECP, Black PC. You Pays Your Money, You Takes Your Choice: Functional Outcomes Following Curative Treatment for Clinically Localized Prostate Cancer: Commentary on: Association Between Radiation Therapy, Surgery, or Observation for Localized Prostate Cancer and Patient-reported Outcomes After 3 Years. Urology 2017. [PMID: 28625593 DOI: 10.1016/j.urology.2017.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Miles P Mannas
- Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edmund C P Chedgy
- Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter C Black
- Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada
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1670
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Kibel AS. Intermediate Risk Prostate Cancer and Active Surveillance: Maximize Utilization while Minimizing Failure. J Urol 2017. [PMID: 28628758 DOI: 10.1016/j.juro.2017.06.055] [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]
Affiliation(s)
- Adam S Kibel
- Department of Surgery, Harvard Medical School, Dana Farber Cancer Institute, Boston, Massachusetts; Division of Urology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, Massachusetts
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1671
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Weiner AB, Matulewicz RS, Schaeffer EM, Liauw SL, Feinglass JM, Eggener SE. Contemporary management of men with high-risk localized prostate cancer in the United States. Prostate Cancer Prostatic Dis 2017. [DOI: 10.1038/pcan.2017.5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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1672
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Basourakos SP, Hoffman K, Kim J. Active surveillance in prostate cancer: new efforts, new voices, new hope. BJU Int 2017. [PMID: 28621062 DOI: 10.1111/bju.13722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Spyridon P Basourakos
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karen Hoffman
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeri Kim
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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1673
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Chin S, Aherne NJ, Last A, Assareh H, Shakespeare TP. Toxicity after post-prostatectomy image-guided intensity-modulated radiotherapy using Australian guidelines. J Med Imaging Radiat Oncol 2017. [PMID: 28623847 DOI: 10.1111/1754-9485.12632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION We evaluated single institution toxicity outcomes after post-prostatectomy radiotherapy (PPRT) via image-guided intensity-modulated radiation therapy (IG-IMRT) with implanted fiducial markers following national eviQ guidelines, for which late toxicity outcomes have not been published. METHODS Prospectively collected toxicity data were retrospectively reviewed for 293 men who underwent 64-66 Gy IG-IMRT to the prostate bed between 2007 and 2015. RESULTS Median follow-up after PPRT was 39 months. Baseline grade ≥2 genitourinary (GU), gastrointestinal (GI) and sexual toxicities were 20.5%, 2.7% and 43.7%, respectively, reflecting ongoing toxicity after radical prostatectomy. Incidence of new (compared to baseline) acute grade ≥2 GU and GI toxicity was 5.8% and 10.6%, respectively. New late grade ≥2 GU, GI and sexual toxicity occurred in 19.1%, 4.7% and 20.2%, respectively. However, many patients also experienced improvements in toxicities. For this reason, prevalence of grade ≥2 GU, GI and sexual toxicities 4 years after PPRT was similar to or lower than baseline (21.7%, 2.6% and 17.4%, respectively). There were no grade ≥4 toxicities. CONCLUSIONS Post-prostatectomy IG-IMRT using Australian contouring guidelines appears to have tolerable acute and late toxicity. The 4-year prevalence of grade ≥2 GU and GI toxicity was virtually unchanged compared to baseline, and sexual toxicity improved over baseline. This should reassure radiation oncologists following these guidelines. Late toxicity rates of surgery and PPRT are higher than following definitive IG-IMRT, and this should be taken into account if patients are considering surgery and likely to require PPRT.
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Affiliation(s)
- Stephen Chin
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia.,Rural Clinical School, University of New South Wales, Coffs Harbour, New South Wales, Australia
| | - Noel J Aherne
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia.,Rural Clinical School, University of New South Wales, Coffs Harbour, New South Wales, Australia
| | - Andrew Last
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Port Macquarie, New South Wales, Australia.,Rural Clinical School, University of New South Wales, Port Macquarie, New South Wales, Australia
| | - Hassan Assareh
- Department of Epidemiology and Health Analytics, Western Sydney Local Health District, Sydney, New South Wales, Australia.,Rural Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas P Shakespeare
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia.,Rural Clinical School, University of New South Wales, Coffs Harbour, New South Wales, Australia
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1674
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Chatzikonstantinou G, Zamboglou N, Rödel C, Zoga E, Strouthos I, Butt SA, Tselis N. High-dose-rate brachytherapy as salvage modality for locally recurrent prostate cancer after definitive radiotherapy : A systematic review. Strahlenther Onkol 2017. [PMID: 28623436 DOI: 10.1007/s00066-017-1157-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To review the current status of interstitial high-dose-rate brachytherapy as a salvage modality (sHDR BRT) for locally recurrent prostate cancer after definitive radiotherapy (RT). MATERIALS AND METHODS A literature search was performed in PubMed using "high-dose-rate, brachytherapy, prostate cancer, salvage" as search terms. In all, 51 search results published between 2000 and 2016 were identified. Data tables were generated and summary descriptions created. The main outcome parameters used were biochemical control (BC) and toxicity scores. RESULTS Eleven publications reported clinical outcome and toxicity with follow-up ranging from 4-191 months. A variety of dose and fractionation schedules were described, including 19.0 Gy in 2 fractions up to 42.0 Gy in 6 fractions. The 5‑year BC ranged from 18-77%. Late grade 3 genitourinary and gastrointestinal toxicity was 0-32% and 0-5.1%, respectively. CONCLUSIONS sHDR BRT appears as safe and effective salvage modality for the reirradiation of locally recurrent prostate cancer after definitive RT.
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Affiliation(s)
| | - Nikolaos Zamboglou
- Department of Radiotherapy and Oncology, J. W. Goethe University of Frankfurt, Frankfurt am Main, Germany
| | - Claus Rödel
- Department of Radiotherapy and Oncology, J. W. Goethe University of Frankfurt, Frankfurt am Main, Germany
| | - Eleni Zoga
- Department of Radiotherapy and Oncology, Sana Klinikum Offenbach, Offenbach am Main, Germany
| | - Iosif Strouthos
- Department of Radiotherapy and Oncology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Saeed Ahmed Butt
- Department of Medical Physics and Engineering, Sana Klinikum Offenbach, Offenbach am Main, Germany
| | - Nikolaos Tselis
- Department of Radiotherapy and Oncology, J. W. Goethe University of Frankfurt, Frankfurt am Main, Germany
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1675
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Ganesan V, Dai C, Nyame YA, Greene DJ, Almassi N, Hettel D, Zabell J, Arora H, Haywood S, Crane A, Reichard C, Zampini A, Elshafei A, Stein RJ, Fareed K, Jones JS, Gong M, Stephenson AJ, Klein EA, Berglund RK. Prognostic Significance of a Negative Confirmatory Biopsy on Reclassification Among Men on Active Surveillance. Urology 2017. [PMID: 28625591 DOI: 10.1016/j.urology.2017.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine the association between absence of disease on confirmatory biopsy and risk of pathologic reclassification in men on active surveillance (AS). MATERIALS AND METHODS Men with grade groups 1 and 2 disease on AS between 2002 and 2015 were identified who received a confirmatory biopsy within 1 year of diagnosis and ≥3 biopsies overall. The primary outcomes were pathologic reclassification by grade (any increase in primary Gleason pattern or Gleason score) or volume (>33% of sampled cores involved or increase in the number of cores with >50% involvement). The effect of a negative confirmatory biopsy survival was evaluated using Kaplan-Meier analysis and a Cox proportional hazards modeling. RESULTS Out of 635 men, 224 met inclusion criteria (median follow-up: 55.8 months). A total of 111 men (49.6%) had a negative confirmatory biopsy. Decreased grade reclassification (69.7% vs 83.9%; P = .01) and volume reclassification (66.3% vs 87.4%; P = .004) was seen at 5 years for men with a negative confirmatory biopsy compared with those with a positive biopsy. On adjusted analysis, a negative confirmatory biopsy was associated with a decreased risk of grade reclassification (hazard ratio, 0.51; 95% confidence interval, 0.28-0.94; P = .03) and volume reclassification (hazard ratio, 0.32; 95% confidence interval, 0.17-0.61; P = .0006) at a median of 4.7 years. CONCLUSION Absence of cancer on the confirmatory biopsy is associated with a significant decrease in rate of grade and volume reclassification among men on AS. This information may be used to better counsel men on AS.
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Affiliation(s)
- Vishnu Ganesan
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH
| | - Charles Dai
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH
| | - Yaw A Nyame
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel J Greene
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Nima Almassi
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel Hettel
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH
| | - Joseph Zabell
- Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Hans Arora
- Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Samuel Haywood
- Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Alice Crane
- Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Chad Reichard
- Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Anna Zampini
- Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Ahmed Elshafei
- Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Robert J Stein
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Khaled Fareed
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - J Stephen Jones
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Michael Gong
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Andrew J Stephenson
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Eric A Klein
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Ryan K Berglund
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH.
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1676
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Prostate cancer: Comparing quality of life outcomes after prostate cancer treatment. Nat Rev Urol 2017; 14:396-397. [PMID: 28607497 DOI: 10.1038/nrurol.2017.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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1677
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Eleven-year management of prostate cancer patients on active surveillance: what have we learned? TUMORI JOURNAL 2017. [PMID: 28623636 PMCID: PMC6379800 DOI: 10.5301/tj.5000649] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To evaluate the outcomes of active surveillance (AS) on patients with low-risk prostate cancer (PCa) and to identify predictors of disease reclassification. METHODS In 2005, we defined an institutional AS protocol (Sorveglianza Attiva Istituto Nazionale Tumori [SAINT]), and we joined the Prostate Cancer Research International: Active Surveillance (PRIAS) study in 2007. Eligibility criteria included clinical stage ≤T2a, initial prostate-specific antigen (PSA) <10 ng/mL, and Gleason Pattern Score (GPS) ≤3 + 3 (both protocols); ≤25% positive cores with a maximum core length containing cancer ≤50% (SAINT); and ≤2 positive cores and PSA density <0.2 ng/mL/cm3 (PRIAS). Switching to active treatment was advised for a worsening of GPS, increased positive cores, or PSA doubling time <3 years. Active treatment-free survival (ATFS) was assessed using the Kaplan-Meier method. Factors associated with ATFS were evaluated with a multivariate Cox proportional hazards model. RESULTS A total of 818 patients were included: 200 in SAINT, 530 in PRIAS, and 88 in personalized AS monitoring. Active treatment-free survival was 50% after a median follow-up of 60 months. A total of 404/818 patients (49.4%) discontinued AS: 274 for biopsy-related reclassification, 121/404 (30%) for off-protocol reasons, 9/404 (2.2%) because of anxiety. Biopsy reclassification was associated with PSA density (hazard ratio [HR] 1.8), maximum percentage of core involvement (HR 1.5), positive cores at diagnostic biopsy (HR 1.6), older age (HR 1.5), and prostate volume (HR 0.6) (all p<0.01). Patients from SAINT were significantly more likely to discontinue AS than were the patients from PRIAS (HR 1.65, p<0.0001). CONCLUSIONS Five years after diagnosis, 50% of patients with early PCa were spared from active treatment. Wide inclusion criteria are associated with lower ATFS. However, at preliminary analysis, this does not seem to affect the probability of unfavorable pathology.
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1678
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Galofré JC. Thyroid cancer incidence: The discovery of the hidden iceberg. ACTA ACUST UNITED AC 2017; 64:285-287. [PMID: 28604337 DOI: 10.1016/j.endinu.2017.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 04/07/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Juan C Galofré
- Departamento de Endocrinología y Nutrición, Clínica Universidad de Navarra, Universidad Navarra, Instituto de investigación en la Salud de Navarra (IdiSNA), Pamplona, España.
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1679
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Focal application of low-dose-rate brachytherapy for prostate cancer: a pilot study. J Contemp Brachytherapy 2017; 9:197-208. [PMID: 28725242 PMCID: PMC5509985 DOI: 10.5114/jcb.2017.68424] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/12/2017] [Indexed: 11/27/2022] Open
Abstract
Purpose To evaluate the feasibility and to report the early outcomes of focal treatment of prostate cancer using low-dose-rate brachytherapy (LDR-PB). Material and methods Seventeen patients were screened with multi-parametric magnetic resonance imaging (mpMRI), 14 of whom proceeded to receive trans-perineal template mapping biopsy (TTMB). Focal LDR-PB was performed on five eligible patients using dual air kerma strength treatment plans based on planning target volumes derived from cancer locations and determined by TTMB. Patient follow-up includes prostate specific antigen (PSA) measurements, urinary and sexual function questionnaires, repeated imaging and TTMB at specific intervals post-treatment. Results Feasibility of focal LDR-PB was shown and short-term outcomes are promising. While the detection rate of tumors, a majority of which were low grade GS 3 + 3, was found to be low on mpMRI (sensitivity of 37.5%), our results suggest the potential of mpMRI in detecting the presence of higher grade (GS ≥ 3 + 4), and bilateral disease indicating its usefulness as a screening tool for focal LDR-PB. Conclusions Low-dose-rate brachytherapy is a favorable ablation option for focal treatment of prostate cancer, requiring minimal modification to the standard (whole gland) LDR-PB treatment, and appears to have a more favorable side effect profile. Further investigation, in the form of a larger study, is needed to assess the methods used and the long-term outcomes of focal LDR-PB.
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1680
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Wallis CJD, Glaser A, Hu JC, Huland H, Lawrentschuk N, Moon D, Murphy DG, Nguyen PL, Resnick MJ, Nam RK. Survival and Complications Following Surgery and Radiation for Localized Prostate Cancer: An International Collaborative Review. Eur Urol 2017; 73:11-20. [PMID: 28610779 DOI: 10.1016/j.eururo.2017.05.055] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/30/2017] [Indexed: 10/24/2022]
Abstract
BACKGROUND Evaluation of treatment options for localized prostate cancer (PCa) remains among the highest priorities for comparative effectiveness research. Surgery and radiotherapy (RT) are the two interventions most commonly used. OBJECTIVE To provide a critical narrative review of evidence of the comparative effectiveness and harms of surgery and RT in the treatment of localized PCa. EVIDENCE ACQUISITION A collaborative critical narrative review of the literature was conducted. EVIDENCE SYNTHESIS Evidence to clearly guide treatment choice in PCa remains insufficient. Randomized trials are underpowered for clinically meaningful endpoints and have demonstrated no difference in overall or PCa-specific survival. Observational studies have consistently demonstrated an absolute survival benefit for men treated with radical prostatectomy, but are limited by selection bias and residual confounding errors. Surgery and RT are associated with comparable health-related quality of life following treatment in three randomized trials. Randomized data regarding urinary, erectile, and bowel function show few long-term (>5 yr) differences, although short-term continence and erectile function were worse following surgery and short-term urinary bother and bowel function were worse following RT. There has been recent recognition of other complications that may significantly affect the life trajectory of those undergoing PCa treatment. Of these, hospitalization, the need for urologic, rectoanal, and other major surgical procedures, and secondary cancers are more common among men treated with RT. Androgen deprivation therapy, frequently co-administered with RT, may additionally contribute to treatment-related morbidity. Technological innovations in surgery and RT have shown inconsistent oncologic and functional benefits. CONCLUSIONS Owing to underpowered randomized control studies and the selection biases inherent in observational studies, the question of which treatment provides better PCa control cannot be definitively answered now or in the near future. Complications following PCa treatment are relatively common regardless of treatment approach. These include the commonly identified issues of urinary incontinence and erectile dysfunction, and others including hospitalization and invasive procedures to manage complications and secondary malignancies. Population-based outcome studies, rather than clinical trial data, will be necessary for a comprehensive understanding of the relative benefits and risks of each therapeutic approach. PATIENT SUMMARY Surgery and radiotherapy are the most common interventions for men diagnosed with prostate cancer. Comparisons of survival after these treatments are limited by various flaws in the relevant studies. Complications are common regardless of the treatment approach.
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Affiliation(s)
- Christopher J D Wallis
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Adam Glaser
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Jim C Hu
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Hartwig Huland
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nathan Lawrentschuk
- Department of Surgery, University of Melbourne, Austin Health, Melbourne, Australia; Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia; Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Daniel Moon
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Central Clinical School, Monash University, Clayton, Australia; The Epworth Prostate Centre, Epworth Hospital, Richmond, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; The Epworth Prostate Centre, Epworth Hospital, Richmond, Australia
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Matthew J Resnick
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research, Education, and Clinical Center, Tennessee Valley VA Health Care System, Nashville, TN, USA
| | - Robert K Nam
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ON, Canada.
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1681
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Tosoian JJ, Chappidi MR, Bishoff JT, Freedland SJ, Reid J, Brawer M, Stone S, Schlomm T, Ross AE. Prognostic utility of biopsy-derived cell cycle progression score in patients with National Comprehensive Cancer Network low-risk prostate cancer undergoing radical prostatectomy: implications for treatment guidance. BJU Int 2017; 120:808-814. [PMID: 28481440 DOI: 10.1111/bju.13911] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine the prognostic utility of the cell cycle progression (CCP) score in men with National Comprehensive Cancer Network (NCCN)-defined low-risk prostate cancer (PCa) undergoing radical prostatectomy (RP). PATIENTS AND METHODS Men who underwent RP for Gleason score ≤6 PCa at three institutions (Martini Clinic [MC], Durham Veterans Affairs Medical Center [DVA] and Intermountain Healthcare [IH]) were identified. The CCP score was obtained from diagnostic (DVA, IH) or simulated biopsies (MC). The primary outcome was biochemical recurrence (BCR; prostate-specific antigen ≥0.2 ng/mL) after RP. The prognostic utility of the CCP score was assessed using Kaplan-Meier analysis and multivariable Cox proportional hazards models in the subset of men meeting NCCN low-risk criteria and in the overall cohort. RESULTS Among the 236 men identified, 80% (188/236) met the NCCN low-risk criteria. Five-year BCR-free survival for the low (<0), intermediate (0-1) and high (>1) CCP score groups was 89.2%, 80.4%, 64.7%, respectively, in the low-risk cohort (P = 0.03), and 85.9%, 79.1%, 63.1%, respectively, in the overall cohort (P = 0.041). In multivariable models adjusting for clinical and pathological variables with the Cancer of the Prostate Risk Assessment (CAPRA) score, the CCP score was an independent predictor of BCR in the low-risk (hazard ratio [HR] 1.77 per unit score, 95% confidence interval [CI] 1.21, 2.58; P = 0.003) and overall cohorts (HR 1.41 per unit score, 95% CI 1.02, 1.96; P = 0.039). CONCLUSION In a cohort of men with NCCN-defined low-risk PCa, the CCP score improved clinical risk stratification of men who were at increased risk of BCR, which suggests the CCP score could improve the assessment of candidacy for active surveillance and guide optimum treatment selection in these patients with otherwise similar clinical characteristics.
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Affiliation(s)
- Jeffrey J Tosoian
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Meera R Chappidi
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jay T Bishoff
- Intermountain Urological Institute, Intermountain Health Care, Salt Lake City, UT, USA
| | - Stephen J Freedland
- Durham VA Medical Center, Durham, NC, USA.,Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Julia Reid
- Myriad Genetics, Inc., Salt Lake City, UT, USA
| | | | | | - Thorsten Schlomm
- Institute for Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ashley E Ross
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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1682
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Garzotto M. Is Low-Risk Prostate Cancer More Indolent in Younger Patients? J Clin Oncol 2017; 35:1870-1871. [DOI: 10.1200/jco.2017.72.3684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mark Garzotto
- Mark Garzotto, Veterans Administration Portland Health Care System, and Oregon Health & Science University, Portland, OR
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1683
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Schulman AA, Sze C, Tsivian E, Gupta RT, Moul JW, Polascik TJ. The Contemporary Role of Multiparametric Magnetic Resonance Imaging in Active Surveillance for Prostate Cancer. Curr Urol Rep 2017; 18:52. [DOI: 10.1007/s11934-017-0699-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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1684
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Wilt TJ, Dahm P. Value of Prostate Cancer Care: New Information on New Therapies Suggest Less is More. Eur Urol 2017; 72:736-737. [PMID: 28571885 DOI: 10.1016/j.eururo.2017.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/12/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Timothy J Wilt
- Minneapolis VA Center for Chronic Disease Outcomes Research, Minneapolis, MN, USA; Department of Medicine, the University of Minnesota School of Medicine, Minneapolis, MN, USA.
| | - Philipp Dahm
- Minneapolis VA Health Care System, Urology Section, Minneapolis, MN, USA; Department of Urology, University of Minnesota School of Medicine, Minneapolis, MN, USA
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1685
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Wysock JS, Lepor H. Multi-parametric MRI imaging of the prostate-implications for focal therapy. Transl Androl Urol 2017; 6:453-463. [PMID: 28725587 PMCID: PMC5503978 DOI: 10.21037/tau.2017.04.29] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The primary goal of a focal therapy treatment paradigm is to achieve cancer control through targeted tissue destruction while simultaneously limiting deleterious effects on peri-prostatic structures. Focal therapy approaches are employed in several oncologic treatment protocols, and have been shown to provide equivalent cancer control for malignancies such as breast cancer and renal cell carcinoma. Efforts to develop a focal therapy approach for prostate cancer have been challenged by several concepts including the multifocal nature of the disease and limited capability of prostate ultrasound and systematic biopsy to reliably localize the site(s) and aggressiveness of disease. Multi-parametric MRI (mpMRI) of the prostate has significantly improved disease localization, spatial demarcation and risk stratification of cancer detected within the prostate. The accuracy of this imaging modality has further enabled the urologist to improve biopsy approaches using targeted biopsy via MRI-ultrasound fusion. From this foundation, an improved delineation of the location of disease has become possible, providing a critical foundation to the development of a focal therapy strategy. This chapter reviews the accuracy of mpMRI for detection of “aggressive“ disease, the accuracy of mpMRI in determining the tumor volume, and the ability of mpMRI to accurately identify the index lesion. While mpMRI provides a critical, first step in developing a strategy for focal therapy, considerable questions remain regarding the relationship between MR identified tumor volume and pathologic tumor volume, the accuracy and utility of mpMRI for treatment surveillance and the optimal role and timing of follow-up mpMRI.
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Affiliation(s)
- James S Wysock
- Department of Urology, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Herbert Lepor
- Department of Urology, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA
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1686
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Sundaram KM, Chang SS, Penson DF, Arora S. Therapeutic Ultrasound and Prostate Cancer. Semin Intervent Radiol 2017; 34:187-200. [PMID: 28579687 PMCID: PMC5453783 DOI: 10.1055/s-0037-1602710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Therapeutic ultrasound approaches including high-intensity focused ultrasound (HIFU) are emerging as popular minimally invasive alternative treatments for localized, low-to-intermediate risk prostate cancer. FDA approval was recently granted for two ultrasound-guided HIFU devices. Clinical trials for devices using MRI guidance are ongoing. The current level of evidence for whole-gland ultrasound ablation suggests that its clinical efficacy and adverse event rates including erectile dysfunction and urinary incontinence are similar to current definitive therapies such as radical prostatectomy and external-beam radiotherapy. Short-term data suggest that more focal therapy could reduce the rates of adverse events.
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Affiliation(s)
- Karthik M. Sundaram
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sam S. Chang
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David F. Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sandeep Arora
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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1687
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Wallis CJD, Haider MA, Nam RK. Role of mpMRI of the prostate in screening for prostate cancer. Transl Androl Urol 2017; 6:464-471. [PMID: 28725588 PMCID: PMC5503955 DOI: 10.21037/tau.2017.04.31] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Prostate cancer screening offers the opportunity to significantly reduce morbidity and mortality from this disease. Currently, serum prostate-specific antigen (PSA) testing is the most widely used screening modality. However, PSA testing continues to have low positive and negative predictive value leading to unnecessary invasive prostate biopsy while missing patients with aggressive forms of the disease. Magnetic resonance imaging (MRI) has been gaining an increasingly large role in the management of patients with early stage prostate cancer including diagnosis in patients with abnormal PSA levels, monitoring of patients on active surveillance, and staging prior to definitive interventions. MRI-based prostate cancer risk assessment has been shown to better distinguish between clinically-significant and insignificant tumors than PSA testing alone or from nomograms. Preliminary data indicate that, among unselected patients, MRI outperforms PSA in the identification of patients with clinically significant prostate cancer. Further work is needed to examine the role of mpMRI in prostate cancer screening.
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Affiliation(s)
- Christopher J D Wallis
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Masoom A Haider
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Robert K Nam
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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1688
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Pinkawa M, Berneking V, Schlenter M, Krenkel B, Eble MJ. Quality of Life After Radiation Therapy for Prostate Cancer With a Hydrogel Spacer: 5-Year Results. Int J Radiat Oncol Biol Phys 2017; 99:374-377. [PMID: 28871986 DOI: 10.1016/j.ijrobp.2017.05.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/16/2017] [Accepted: 05/22/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate quality of life changes up to 5 years after prostate cancer radiation therapy (RT) with a hydrogel spacer. METHODS AND MATERIALS In the years 2010 to 2011, 114 patients received external beam radiation therapy to the prostate; 54 patients were selected for a hydrogel injection before the beginning of RT. Treatment was performed applying fractions of 2 Gy up to a total dose of 76 Gy (n=96) or 78 Gy (n=18, all with hydrogel). Patients were surveyed before RT; at the last day of RT; and a median time of 2 months, 17 months, and 63 months after RT using a validated questionnaire (Expanded Prostate Cancer Index Composite). A mean score change of >5 points was defined as clinically relevant. RESULTS For patients treated with a hydrogel spacer, mean bowel function and bother score changes of >5 points in comparison with baseline levels were found only at the end of RT (10-15 points; P<.01). No spacer patient reported moderate or big problems with his bowel habits overall. Mean bother score changes of 21 points at the end of RT, 8 points at 2 months, 7 points at 17 months, and 6 points at 63 months after RT were found for patients treated without a spacer. A bowel bother score change >10 points was found in 6% versus 32% (P<.01) at 17 months and in 5% versus 14% (P=.2) at 63 months with versus without a spacer. CONCLUSIONS The first 5-year quality of life results in a group of prostate cancer patients treated with a hydrogel spacer demonstrate excellent treatment tolerability, in particular regarding bowel problems. Further studies with dose-escalated or re-irradiation concepts can be encouraged.
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Affiliation(s)
- Michael Pinkawa
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany; Department of Radiation Oncology, MediClin Robert Janker Klinik, Bonn, Germany.
| | - Vanessa Berneking
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany
| | - Marsha Schlenter
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany
| | - Barbara Krenkel
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany
| | - Michael J Eble
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany
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1689
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Lange JM, Trock BJ, Gulati R, Etzioni R. A Framework for Treatment Decision Making at Prostate Cancer Recurrence. Med Decis Making 2017; 37:905-913. [PMID: 28564551 DOI: 10.1177/0272989x17711913] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Of the 50,000 men in the US who elect for radical prostatectomy for prostate cancer, 24% to 40% will have a prostate-specific antigen (PSA) recurrence (PSA-R) within 10 years. Deciding whether to administer salvage therapy (ST) at PSA-R presents challenges, as treatment reduces the risk of progression to clinical metastasis but incurs unnecessary side effects should the man die before metastasis. We have developed a new harm-benefit framework using a clinical cohort to inform shared decision making between patients and physicians at PSA-R. METHODS Records of 1,045 Johns Hopkins University Hospital patients diagnosed between 1984 and 2013 who had PSA-R following radical prostatectomy were analyzed using marginal structural models to estimate the baseline risk of metastasis and the effect of ST (radiation therapy with or without hormone therapy) while accounting for selection into ST on the basis of PSA growth. The estimated model predicts the harm-benefit tradeoffs of ST within patient subgroups. The benefit of ST is the absolute reduction in the risk of metastasis within 10 years; the harm is the frequency of cancers that would not have metastasized in the patient's lifetime in the absence of ST (overtreatment). RESULTS The adjusted hazard ratio associated with ST was 0.41 (95% CI, 0.31 to 0.55). Providing ST to all men at PSA-R reduced the risk of metastasis from 43% to 23% but led to 31% of men being overtreated (harm/benefit = 31/(43-23) = 1.6). Providing ST to men with Gleason score >7 reduced the risk of metastasis from 67% to 39%, with 13% of men being overtreated (harm/benefit = 13/(67-39) = 0.5). CONCLUSIONS A quantitative framework that evaluates primary harms and benefits of ST after PSA-R will facilitate informed decision making. Immediate ST may be more appropriate in patient subgroups at elevated risk of metastasis.
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Affiliation(s)
- Jane M Lange
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle WA (JML, RG, RE)
| | - Bruce J Trock
- Department of Urology, Johns Hopkins School of Medicine, Baltimore MD (BJT)
| | - Roman Gulati
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle WA (JML, RG, RE)
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle WA (JML, RG, RE)
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1690
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Gasnier A, Parvizi N. Updates on the diagnosis and treatment of prostate cancer. Br J Radiol 2017; 90:20170180. [PMID: 28555500 DOI: 10.1259/bjr.20170180] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Prostate cancer is the second most prevalent cancer in males worldwide and the commonest cancer in males in the UK. The recent updates on the diagnosis and treatment of prostate cancer were discussed at a multidisciplinary day event organized by the British Institute of Radiology and held in London in November 2016. This day covered the use of the prostate-specific antigen biomarker and of advanced imaging techniques such as multiparametric and whole-body MRI, choline positron emission tomography/CT and gallium-labelled prostate-specific membrane antigen for the detection of prostate cancer. In addition, the results of several trials assessing the management of the disease were discussed, in particular the Prostate Cancer Intervention Versus Observation Trial and Prostate Testing for Cancer and Treatment trials which evaluated the gain of intervention vs observation, and four randomized controlled trials comparing hypofractionated and standard radiotherapy regimen. Further to this event, this commentary highlights the topical issues relating to recently published guidelines and to trials for the management of prostate cancer where these were discussed.
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Affiliation(s)
- Anne Gasnier
- 1 Department of Physics, Royal Marsden Hospital, London, UK
| | - Nassim Parvizi
- 2 Clinical Radiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
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1691
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Qiu J, Peng S, Si-Tu J, Hu C, Huang W, Mao Y, Qiu W, Li K, Wang D. Identification of endonuclease domain-containing 1 as a novel tumor suppressor in prostate cancer. BMC Cancer 2017; 17:360. [PMID: 28532481 PMCID: PMC5440950 DOI: 10.1186/s12885-017-3330-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 05/08/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Endonuclease domain containing 1 (ENDOD1) is implicated in tumorigenesis and aggressiveness of multiple tumors. In this study, we aimed to investigate the role of ENDOD1 in prostate cancer (PCa). METHODS Immunohistochemistry were performed in 30 cases of benign prostatic hyperplasia (BPH) and 50 cases of PCa to identify its association with clinicopathological characteristics. Real-time PCR and western blot were used to detect ENDOD1 mRNA and protein expression in normal prostatic epithelial and PCa cell lines. MTT assays were employed to determine the effect of cell proliferation. Flow cytometry was used to explore the cell cycle distribution and apoptotic effects. Transwell migration and invasion assays were done to evaluate changes in the ability of cell migration and invasion. RESULTS Immunoreactivity scores of ENDOD1 showed no statistical difference between BPH and low-grade PCa, whereas lower immunostaining scores were observed in high-grade compared with low-grade PCa. Real-time PCR data indicated that ENDOD1 mRNA expression was markedly increased in LNCaP and 22Rv1 cells and decreased in PC3 and DU145 cells compared to the normal epithelial cells RWPE1. Western blot showed that androgen-sensitive LNCaP cells had the highest protein expression level of ENDOD1, whereas castration-resistant PCa cell lines PC3 and DU145 had significantly lower protein levels. Meanwhile, overexpression of ENDOD1 suppressed cell proliferation, induced G0/G1 cell cycle arrest and inhibited cell migration and invasion. Conversely, siRNA-mediated silencing of ENDOD1 promoted cell proliferation, migration and invasion. No apoptotic effects occurred upon manipulation of ENDOD1 expression. CONCLUSION Our results indicate that ENDOD1 is a novel tumor suppressor in PCa, which may be employed as a new drug target of preventing progression to metastatic castration-resistant prostate cancer.
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Affiliation(s)
- Jianguang Qiu
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630 China
| | - Shubin Peng
- Department of Urology and Liver Disease Laboratory, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jie Si-Tu
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630 China
| | - Cheng Hu
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630 China
| | - Wentao Huang
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630 China
| | - Yunhua Mao
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630 China
| | - Wenhan Qiu
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630 China
| | - Ke Li
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630 China
| | - Dejuan Wang
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630 China
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1692
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Wilt TJ, Dahm P. WITHDRAWN: Value of Prostate Cancer Care: New Information on New Therapies Suggest Less is More. Eur Urol 2017:S0302-2838(17)30402-5. [PMID: 28535949 DOI: 10.1016/j.eururo.2017.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.eururo.2017.05.023. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Timothy J Wilt
- Minneapolis VA Center for Chronic Disease Outcomes Research, Minneapolis, MN, USA; Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.
| | - Philipp Dahm
- Minneapolis VA Health Care System, Urology Section, Minneapolis, MN, USA; Department of Urology, University of Minnesota School of Medicine, Minneapolis, MN, USA
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1693
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Abstract
Long-term data demonstrate a higher oncological risk associated with active surveillance (AS) than initially anticipated. In particular, patients with more than two tumor-involved biopsy cores and/or Gleason-7a foci must be regarded as having an increased risk of developing an incurable stage of disease after an initial attempt of AS. For patients with Gleason-7a foci, the 15-year risk of suffering from an incurable tumor stage is reported as high as 60%. Furthermore, life expectancy must be regarded as one of the major risk factors to finally develop symptomatic incurable disease. A discussion has therefore started as to whether a high life expectancy should be regarded as an exclusion criterion against AS. An estimated life expectancy exceeding 15 or 20 years has been proposed for patients suffering from Gleason 7a or 6 foci at initial biopsy, respectively. Furthermore, it must be expected that a number of molecular risk factors will gain importance in the near future for the decision-making process for or against AS.
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Affiliation(s)
- M Stöckle
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Kirrberger Str., 66421, Homburg/Saar, Deutschland.
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1694
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Saad F. ‘The prostate’ in patients with metastatic prostate cancer: to treat or not to treat? Nat Rev Urol 2017; 14:398-399. [DOI: 10.1038/nrurol.2017.72] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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1695
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Brindle LA. GP-patient communication about possible cancer in primary care: Re-evaluating GP as gatekeeper. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28489299 DOI: 10.1111/ecc.12699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2017] [Indexed: 12/12/2022]
Abstract
As possibilities for the early detection of indolent cancers, and precursors to cancer, multiply, GPs will increasingly be involved in discussions with patients about risks and benefits of early diagnosis and treatment. Over time, improvements in evidence may decrease uncertainty about outcomes for patients and clinicians. However, where survival benefits are small, or uncertain, or risks are unacceptable to patients, grounds for preference-sensitive decision-making will remain. How risks and benefits of early detection, and the significance of indolent or low risk cancers, are communicated, will be key, if overtreatment and overdiagnosis are to be avoided.
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1696
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Penson DF, Resnick MJ. Reply to I.E. Haines. J Clin Oncol 2017; 35:1626-1627. [PMID: 28113013 DOI: 10.1200/jco.2016.71.6621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- David F Penson
- David F. Penson and Matthew J. Resnick, Vanderbilt University, Nashville, TN
| | - Matthew J Resnick
- David F. Penson and Matthew J. Resnick, Vanderbilt University, Nashville, TN
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1697
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Henry MA, Howard DH, Davies BJ, Filson CP. Variation in Use of Prostate Biopsy Following Changes in Prostate Cancer Screening Guidelines. J Urol 2017; 198:1046-1053. [PMID: 28487099 DOI: 10.1016/j.juro.2017.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE Prostate biopsy rates have paralleled decreasing prostate specific antigen screening rates since 2012. We hypothesized that biopsy rates and the change in rates since 2012 would vary considerably across hospital referral regions. MATERIALS AND METHODS Using Medicare data from 2012 through 2014 we identified prostate biopsies performed by physicians who performed 11 or more biopsies annually. We calculated annual biopsy rates and changes in rates from 2012 to 2014 across 306 hospital referral regions. We performed multivariable regression adjusting for factors associated with annual biopsy rates (eg percent of patients older than 75 who were screened with prostate specific antigen and percent of the population that was African American). We also estimated adjusted prostate biopsy rates and changes with time across regions. RESULTS We identified 395,993 biopsies. The overall rates decreased from 11.68 biopsies per 1,000 men in 2012 to 10.23 per 1,000 in 2014 (-12.4%, p = 0.11). Biopsy rates were higher in regions in which a greater percentage of the population was African American (β = 0.810, 95% CI 0.235-1.384, p = 0.006), ambulatory surgical centers were available where biopsy could be performed (β = 0.892, 95% CI 0.108-1.676, p = 0.026) and prostate specific antigen testing occurred more frequently (β = 2.462, 95% CI 1.153-3.771, p <0.001). There was marked geographic variation in the adjusted average biopsy rate (median adjusted rate 9.08 biopsies per 1,000 men, IQR 7.65-10.76) and in the change in biopsy rates with time (median adjusted rate change -1.49 biopsies per 1,000 men, IQR -1.94--1.22 per 1,000). CONCLUSIONS Since 2012 there has been considerable geographic variation in the performance of prostate biopsies as well as changes with time after prostate specific antigen recommendations changed. Characterizing the role of unmeasured patient and physician level factors is crucial to optimize the use and minimize the harms of prostate biopsy.
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Affiliation(s)
- Mark A Henry
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - David H Howard
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Benjamin J Davies
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia; Atlanta Veterans Affairs Medical Center, Decatur, Georgia.
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1698
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Rodgers L, Peer CJ, Figg WD. Diagnosis, staging, and risk stratification in prostate cancer: Utilizing diagnostic tools to avoid unnecessary therapies and side effects. Cancer Biol Ther 2017; 18:470-472. [PMID: 28475407 DOI: 10.1080/15384047.2017.1323600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
A lack of appropriate diagnostic tools for prostate cancer has led to overdiagnosis and over treatment. In a recent publication in the New England Journal of Medicine, Hamdy et al showed no difference in the outcomes of patients that had undergone either radical prostatectomy, radiotherapy, or active monitoring. In an effort to enhance clinical stratification, the development of improved, more accurate diagnostic tools is actively being pursued. Herein, we explore recent advances in prostate cancer screening, including biomarker assays, genetic testing, and specialized fields, such as mathematical oncology. These newly developed, highly sensitive diagnostic assays may potentially aid clinicians in selecting appropriate therapies for patients in the very near future.
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Affiliation(s)
- Louis Rodgers
- a Clinical Pharmacology Program , Office of the Clinical Director, National Cancer Institute, National Institutes of Health , Bethesda , MD , USA
| | - Cody J Peer
- a Clinical Pharmacology Program , Office of the Clinical Director, National Cancer Institute, National Institutes of Health , Bethesda , MD , USA
| | - William D Figg
- a Clinical Pharmacology Program , Office of the Clinical Director, National Cancer Institute, National Institutes of Health , Bethesda , MD , USA.,b Molecular Pharmacology Section , Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health , Bethesda , MD , USA
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1699
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Media reporting of ProtecT: a disconnect in information dissemination? Prostate Cancer Prostatic Dis 2017; 20:401-406. [DOI: 10.1038/pcan.2017.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/21/2017] [Accepted: 03/30/2017] [Indexed: 11/09/2022]
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1700
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Catto JW, Blazeby JM, Holmberg L, Hamdy FC, Brown J. In Defense of Randomized Clinical Trials in Surgery: Let Us Not Forget Archie Cochrane's Legacy. Eur Urol 2017; 71:820-821. [DOI: 10.1016/j.eururo.2016.12.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022]
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