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Jones MR, Joshu CE, Kanarek N, Navas-Acien A, Richardson KA, Platz EA. Cigarette Smoking and Prostate Cancer Mortality in Four US States, 1999-2010. Prev Chronic Dis 2016; 13:E51. [PMID: 27079649 PMCID: PMC4852753 DOI: 10.5888/pcd13.150454] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION In the United States, prostate cancer mortality rates have declined in recent decades. Cigarette smoking, a risk factor for prostate cancer death, has also declined. It is unknown whether declines in smoking prevalence produced detectable declines in prostate cancer mortality. We examined state prostate cancer mortality rates in relation to changes in cigarette smoking. METHODS We studied men aged 35 years or older from California, Kentucky, Maryland, and Utah. Data on state smoking prevalence were obtained from the Behavioral Risk Factor Surveillance System. Mortality rates for prostate cancer and external causes (control condition) were obtained from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research. The average annual percentage change from 1999 through 2010 was estimated using joinpoint analysis. RESULTS From 1999 through 2010, smoking in California declined by 3.5% per year (-4.4% to -2.5%), and prostate cancer mortality rates declined by 2.5% per year (-2.9% to -2.2%). In Kentucky, smoking declined by 3.0% per year (-4.0% to -1.9%) and prostate cancer mortality rates declined by 3.5% per year (-4.3% to -2.7%). In Maryland, smoking declined by 3.0% per year (-7.0% to 1.2%), and prostate cancer mortality rates declined by 3.5% per year (-4.1% to -3.0%).In Utah, smoking declined by 3.5% per year (-5.6% to -1.3%) and prostate cancer mortality rates declined by 2.1% per year (-3.8% to -0.4%). No corresponding patterns were observed for external causes of death. CONCLUSION Declines in prostate cancer mortality rates appear to parallel declines in smoking prevalence at the population level. This study suggests that declines in prostate cancer mortality rates may be a beneficial effect of reduced smoking in the population.
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Affiliation(s)
- Miranda R Jones
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Office E6518, Baltimore, MD 21205 E-mail:
| | - Corinne E Joshu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Norma Kanarek
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ana Navas-Acien
- Department of Epidemiology and Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kelly A Richardson
- Center for Cancer Prevention and Control, Maryland Department of Health and Mental Hygiene, Baltimore, Maryland
| | - Elizabeth A Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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O'Neill RF, Haseen F, Murray LJ, O'Sullivan JM, Cantwell MM. A randomised controlled trial to evaluate the efficacy of a 6-month dietary and physical activity intervention for patients receiving androgen deprivation therapy for prostate cancer. J Cancer Surviv 2015; 9:431-40. [PMID: 25916660 DOI: 10.1007/s11764-014-0417-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/19/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE Treatment of prostate cancer with androgen deprivation therapy (ADT) is associated with an increased fat mass, decreased lean mass, increased fatigue and a reduction in quality of life (QoL). The aim of this study was to evaluate the efficacy of a 6-month dietary and physical activity intervention for prostate cancer patients receiving ADT, to help minimise these side effects. METHODS Patients (n = 94) were recruited to this study if they were planned to receive ADT for prostate cancer for at least 6 months. Men randomised to the intervention arm received a dietary and exercise intervention, commensurate with UK healthy eating and physical activity recommendations. The primary outcome of interest was body composition; secondary outcomes included fatigue, QoL, functional capacity, stress and dietary change. RESULTS The intervention group had a significant (p < 0.001) reduction in weight, body mass index and percentage fat mass compared to the control group at 6 months; the between-group differences were -3.3 kg (95% confidence interval (95% CI) -4.5, -2.1), -1.1 kg/m(2) (95% CI -1.5, -0.7) and -2.1% (95% CI -2.8, -1.4), respectively, after adjustment for baseline values. The intervention resulted in improvements in functional capacity (p < 0.001) and dietary intakes but did not significantly impact fatigue, QoL or stress scores at endpoint. CONCLUSIONS A 6-month diet and physical activity intervention can minimise the adverse body composition changes associated with ADT. IMPLICATIONS FOR CANCER SURVIVORS This study shows that a pragmatic lifestyle intervention is feasible and can have a positive impact on health behaviours and other key outcomes in men with prostate cancer receiving ADT.
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Affiliation(s)
- Roisin F O'Neill
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK,
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Serpa Neto A, Tobias-Machado M, Wroclawski ML, Akerman M, Pompeo ACL, Giglio AD. A descriptive study of prostate cancer mortality in the state of São Paulo, from 1980 to 2007. EINSTEIN-SAO PAULO 2010; 8:433-6. [DOI: 10.1590/s1679-45082010ao1707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: Prostate cancer is the second most common neoplasm among men worldwide. This study aimed to examine the trend in mortality rates of prostate cancer among the population in the state of São Paulo, Brazil, from 1980 to 2007. Methods: a descriptive study of temporal series was conducted using mortality data due to prostate cancer between1980 and 2007 in the state of São Paulo. Mortality rates were obtained from the SUS Information System on Mortality (SIM/SUS – DATASUS). The age-specific mortality rates were calculated as well as linear regression and temporal trend analysis. Results: It could be observed that mortality increased according to age, being very similar only between the age group 70-79 years and ≥ 80 years (p = 0.047). The mortality peak in the age group 50-79 years occurred at the same time; however, the drop in mortality rates since then has been much more pronounced in the group of 50-59 years. There was a linear increase and direct association between the number of biopsies and the incidence of prostate cancer (r = 0.714, p = 0.024). Conclusions: Prostate cancer is a major cause of mortality in São Paulo and effective screening and treatment measures should be adopted to improve this scenario.
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Haseen F, Murray LJ, O'Neill RF, O'Sullivan JM, Cantwell MM. A randomised controlled trial to evaluate the efficacy of a 6 month dietary and physical activity intervention for prostate cancer patients receiving androgen deprivation therapy. Trials 2010; 11:86. [PMID: 20704726 PMCID: PMC2925820 DOI: 10.1186/1745-6215-11-86] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Accepted: 08/12/2010] [Indexed: 11/10/2022] Open
Abstract
Background Treatment with Androgen Deprivation Therapy (ADT) for prostate cancer is associated with changes in body composition including increased fat and decreased lean mass; increased fatigue, and a reduction in quality of life. No study to date has evaluated the effect of dietary and physical activity modification on the side-effects related to ADT. The aim of this study is to evaluate the efficacy of a 6-month dietary and physical activity intervention for prostate cancer survivors receiving ADT to minimise the changes in body composition, fatigue and quality of life, typically associated with ADT. Methods Men are recruited to this study if their treatment plan is to receive ADT for at least 6 months. Men who are randomised to the intervention arm receive a home-based tailored intervention to meet the following guidelines a) ≥ 5 servings vegetables and fruits/day; b) 30%-35% of total energy from fat, and < 10% energy from saturated fat/day; c) 10% of energy from polyunsaturated fat/day; d) limited consumption of processed meats; e) 25-35 gm of fibre/day; f) alcoholic drinks ≤ 28 units/week; g) limited intake of foods high in salt and/or sugar. They are also encouraged to include at least 30 minutes of brisk walking, 5 or more days per week. The primary outcomes are change in body composition, fatigue and quality of life scores. Secondary outcomes include dietary intake, physical activity and perceived stress. Baseline information collected includes: socio-economic status, treatment duration, perceived social support and health status, family history of cancer, co-morbidities, medication and supplement use, barriers to change, and readiness to change their health behaviour. Data for the primary and secondary outcomes will be collected at baseline, 3 and 6 months from 47 intervention and 47 control patients. Discussion The results of this study will provide detailed information on diet and physical activity levels in prostate cancer patients treated with ADT and will test the feasibility and efficacy of a diet and physical activity intervention which could provide essential information to develop guidelines for prostate cancer patients to minimise the side effects related to ADT. Trial registration ISRCTN trial number ISCRTN75282423
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Affiliation(s)
- Farhana Haseen
- Centre for Public Health, Queen's University Belfast, Northern Ireland, UK.
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5
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Carsin AE, Drummond FJ, Black A, van Leeuwen PJ, Sharp L, Murray LJ, Connolly D, Egevad L, Boniol M, Autier P, Comber H, Gavin A. Impact of PSA testing and prostatic biopsy on cancer incidence and mortality: comparative study between the Republic of Ireland and Northern Ireland. Cancer Causes Control 2010; 21:1523-31. [PMID: 20514514 DOI: 10.1007/s10552-010-9581-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Accepted: 05/08/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To investigate the impact of different PSA testing policies and health-care systems on prostate cancer incidence and mortality in two countries with similar populations, the Republic of Ireland (RoI) and Northern Ireland (NI). METHODS Population-level data on PSA tests, prostate biopsies and prostate cancer cases 1993-2005 and prostate cancer deaths 1979-2006 were compiled. Annual percentage change (APC) was estimated by joinpoint regression. RESULTS Prostate cancer rates were similar in both areas in 1994 but increased rapidly in RoI compared to NI. The PSA testing rate increased sharply in RoI (APC = +23.3%), and to a lesser degree in NI (APC = +9.7%) to reach 412 and 177 tests per 1,000 men in 2004, respectively. Prostatic biopsy rates rose in both countries, but were twofold higher in RoI. Cancer incidence rates rose significantly, mirroring biopsy trends, in both countries reaching 440 per 100,000 men in RoI in 2004 compared to 294 in NI. Median age at diagnosis was lower in RoI (71 years) compared to NI (73 years) (p < 0.01) and decreased significantly over time in both countries. Mortality rates declined from 1995 in both countries (APC = -1.5% in RoI, -1.3% in NI) at a time when PSA testing was not widespread. CONCLUSIONS Prostatic biopsy rates, rather than PSA testing per se, were the main driver of prostate cancer incidence. Because mortality decreases started before screening became widespread in RoI, and mortality remained low in NI, PSA testing is unlikely to be the explanation for declining mortality.
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Affiliation(s)
- A-E Carsin
- National Cancer Registry Ireland, Cork, Ireland.
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Abstract
In the United States, disparities in health care delivery and access are apparent between different racial and ethnic groups. Minorities, including African Americans, often suffer disproportionately from disease compared to Caucasians. In the urologic arena, this is apparent in urologic cancer screening, treatment choices, and survival, as well as in the arena of chronic kidney disease, transplant allocation, and transplant outcomes. Latino men also seem to be affected more often by erectile dysfunction than Caucasian counterparts. Disparities such as these have been identified as a problem in the delivery of health care in the United States, and resources have been allocated to help allay the disparity. Through organizations such as the Cleveland Clinic Minority Men's Health Center, policy initiatives, and increased cultural awareness by physicians, steps can be made to reduce and eliminate health care disparities.
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Haseen F, Murray LJ, Cardwell CR, O'Sullivan JM, Cantwell MM. The effect of androgen deprivation therapy on body composition in men with prostate cancer: systematic review and meta-analysis. J Cancer Surviv 2010; 4:128-39. [PMID: 20091248 DOI: 10.1007/s11764-009-0114-1] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 12/22/2009] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The use of androgen deprivation therapy (ADT) in the treatment of prostate cancer is associated with changes in body composition including increased fat and decreased lean mass. Limited information exists regarding the rate and extent of these changes. This systematic review was conducted to determine the effects of ADT on body composition in prostate cancer patients. METHODS Literature searches were conducted on MEDLINE, EMBASE and Web of Science for studies until January 2009. Only longitudinal studies that examined ADT and body composition in prostate cancer patients were included. Data were extracted on body weight, BMI, percentage of fat mass and lean body mass. RESULTS Sixteen studies (14 cohorts and 2 RCTs) met the inclusion criteria. Pooled data, calculated according to a random effects model, showed that ADT increased % body fat by on average 7.7% (95% CI 4.3, 11.2, from seven studies, P < 0.0001) and decreased % lean body mass by on average -2.8% (95% CI -3.6, -2.0, from six studies, P < 0.0001) but for both there was marked heterogeneity between studies (I2 = 99% I2 = 73%, respectively). Similarly, body weight (2.1%, P < 0.0001 from nine studies) and BMI (2.2%, P < 0.0001, from eight studies) increased significantly. More extensive changes were seen with longer duration of treatment. CONCLUSIONS Substantial increases in fat and declines in lean mass were observed in prostate cancer patients treated with ADT. Lifestyle changes or suitable interventions to minimize the effect of ADT on body composition need to be investigated. IMPLICATIONS FOR CANCER SURVIVORS Prostate cancer survivors should be made aware of the side effect of treatment on body composition and further work is required to determine what interventions can minimize the impact of ADT on body composition and therefore what evidence based advice they should be provided with. In general, though recommendation of a healthy diet and moderate exercise is reasonable.
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Affiliation(s)
- Farhana Haseen
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK.
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8
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Salminen EK, Wickström JE, Vahlberg T, Duchesne GM. Trends in the use of androgen deprivation in prostate cancer. Acta Oncol 2009; 43:382-7. [PMID: 15303500 DOI: 10.1080/02841860410029500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of this study was to assess current management of prostate cancer patients with elevated prostate-specific antigen (PSA) among Finnish urologists and oncologists. Four case scenarios were presented: postprostatectomy PSA relapse, postradiotherapy (RT) relapse with a slowly or rapidly rising PSA, elderly patients prior to treatment. Management preferences and the use of androgen deprivation (AD) in prostate cancer were surveyed. Eighty-two informative replies, 60 from 90 practicing urologists (67%) and 22 from 70 practicing oncologists (31%) were received. For postprostatectomy relapse, salvage RT or follow-up until significant rise of PSA were the favored recommendations. For post RT with slowly or rapidly rising PSA and treatment of non-radical cases an active approach with even small PSA rises and immediate androgen deprivation were favored. For intervention, the recommended PSA border values ranged from 0.5 to > 100 ng/mL. More research is needed focusing on criteria and timing of AD in the treatment of prostate cancer.
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Affiliation(s)
- Eeva K Salminen
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland.
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9
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Holmes L, Chan W, Jiang Z, Ward D, Essien EJ, Du XL. Impact of androgen deprivation therapy on racial/ethnic disparities in the survival of older men treated for locoregional prostate cancer. Cancer Control 2009; 16:176-85. [PMID: 19337204 PMCID: PMC2664971 DOI: 10.1177/107327480901600210] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Racial disparities persist in prostate cancer (CaP) treatment and survival, but disparities in androgen deprivation therapy (ADT) and the degree to which it affects racial differences in survival remains to be fully assessed. METHODS Using the Surveillance, Epidemiology and End Results-Medicare linked data, we examined a large cohort of men (N = 64,475) diagnosed with locoregional CaP during 1992 to 1999 and followed through 2003. The effects of ADT and race on survival were analyzed using a Cox proportional hazards model. RESULTS The receipt of ADT was significantly lower in African Americans (24%) relative to Caucasians (27%), Asians (34%), and Hispanics (28.7%) (P < .05). Compared with Caucasian race, African American race was associated with a statistically significant increased mortality (HR = 1.26, 95% CI = 1.21-1.32), which remained significant after adjusting for ADT but was substantially decreased after controlling for primary therapies such as radical prostatectomy, radiation, and watchful waiting (HR = 1.06, 95% CI = 1.01-1.10) and was no longer statistically significant after controlling for comorbidities (HR = 0.98, 95% CI = 0.94-1.03). CONCLUSIONS There were marked racial variations in the receipt of ADT, primary therapies (namely surgery and surgery combined with radiation), and comorbidities. However, racial disparities in survival were not affected by racial variations in ADT but were explained by racial variations in primary therapies and by racial differences in comorbidities.
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Affiliation(s)
- Laurens Holmes
- Epidemiology Laboratory at the Nemours Center for Childhood Cancer Research, Wilmington, Delaware 19803, USA.
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10
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Mohile SG, Mustian K, Bylow K, Hall W, Dale W. Management of complications of androgen deprivation therapy in the older man. Crit Rev Oncol Hematol 2008; 70:235-55. [PMID: 18952456 DOI: 10.1016/j.critrevonc.2008.09.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Revised: 08/12/2008] [Accepted: 09/03/2008] [Indexed: 02/07/2023] Open
Abstract
Prostate cancer is the most common malignancy in older men. With the aging of the population, the number of older men with prostate cancer will grow rapidly. Androgen deprivation therapy (ADT) is the mainstay of treatment for men with systemic disease and is increasingly utilized as primary therapy or in combination with other therapies for localized disease. Side effects of therapy are multifold and include hot flashes, osteoporosis, and adverse psychological and metabolic effects. Recent research has illustrated that ADT can negatively impact the functional, cognitive, and physical performance of older men. Patients with prostate cancer, despite recurrence of the disease, have a long life expectancy and may be subjected to the side effects of ADT for many years. This review highlights the complications of ADT and approaches to management. We also provide recommendations for assessment and management of ADT complications among the most vulnerable and frail older male patients.
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Affiliation(s)
- Supriya G Mohile
- James Wilmot Cancer Center, University of Rochester, Rochester, NY 14642, USA.
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11
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Collin SM, Martin RM, Metcalfe C, Gunnell D, Albertsen PC, Neal D, Hamdy F, Stephens P, Lane JA, Moore R, Donovan J. Prostate-cancer mortality in the USA and UK in 1975-2004: an ecological study. Lancet Oncol 2008; 9:445-52. [PMID: 18424233 PMCID: PMC2760747 DOI: 10.1016/s1470-2045(08)70104-9] [Citation(s) in RCA: 194] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is no conclusive evidence that screening based on serum prostate-specific antigen (PSA) tests decreases prostate-cancer mortality. Since its introduction in the USA around 1990, uptake of PSA testing has been rapid in the USA, but much less common in the UK. Our aim was to study trends over time in prostate-cancer mortality and incidence in the USA and UK in 1975-2004, and compare these patterns with trends in screening and treatment. METHODS Joinpoint regression analysis of cancer-mortality statistics from Cancer Research UK (London, UK) and from the US National Cancer Institute Surveillance, Epidemiology and End Results (SEER) programme from 1975 to 2004 was used to estimate the annual percentage change in prostate-cancer mortality in both countries and the points in time when trends changed. The ratio of USA to UK age-adjusted prostate-cancer incidence was also assessed. FINDINGS Age-specific and age-adjusted prostate-cancer mortality peaked in the early 1990s at almost identical rates in both countries, but age-adjusted mortality in the USA subsequently declined after 1994 by -4.17% (95% CI -4.34 to -3.99) each year, four-times the rate of decline in the UK after 1992 (-1.14% [-1.44 to -0.84]). The mortality decline in the USA was greatest and most sustained in patients aged 75 years or older (-5.32% [-8.23 to -2.32]), whereas death rates had plateaued in this age group in the UK by 2000. The mean ratio of USA to UK age-adjusted prostate-cancer incidence rates in 1975-2003 was 2.5, with a pronounced peak around the time that PSA testing was introduced in the USA. Numbers needed to treat to prevent one death from prostate cancer were 33 000 in the 55-64-year age group. INTERPRETATION The striking decline in prostate-cancer mortality in the USA compared with the UK in 1994-2004 coincided with much higher uptake of PSA screening in the USA. Explanations for the different trends in mortality include the possibility of an early effect of initial screening rounds on men with more aggressive asymptomatic disease in the USA, different approaches to treatment in the two countries, and bias related to the misattribution of cause of death. Speculation over the role of screening will continue until evidence from randomised controlled trials is published.
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Affiliation(s)
- Simon M Collin
- Department of Social Medicine, University of Bristol, Canynge Hall, Bristol, UK.
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Hussain S, Gunnell D, Donovan J, McPhail S, Hamdy F, Neal D, Albertsen P, Verne J, Stephens P, Trotter C, Martin RM. Secular trends in prostate cancer mortality, incidence and treatment: England and Wales, 1975-2004. BJU Int 2008; 101:547-55. [PMID: 18190630 DOI: 10.1111/j.1464-410x.2007.07338.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To aid the interpretation of the trends in prostate cancer mortality, which declined in the UK in the early 1990 s for unknown reasons, by investigating prostate cancer death rates, incidence and treatments in England and Wales in 1975-2004. METHODS Join-point regression was used to assess secular trends in mortality and incidence (source: Office of National Statistics), radical prostatectomy and orchidectomy (source: Hospital Episode Statistics database) and androgen-suppression drugs (source: Intercontinental Medical Statistics). RESULTS Prostate cancer mortality declined from 1992 (95% confidence interval, CI, 1990-94). The relative decline in mortality to 2004 was greater and more sustained amongst men aged 55-74 years (annual percentage mortality reduction 2.75%; 95% CI 2.33-3.18%) than amongst those aged >or=75 years (0.71%, 0.26-1.15%). The use of radical prostatectomy increased between 1991 (89 operations) and 2004 (2788) amongst men aged 55-74 years. The prescribing of androgen suppression increased between 1987 (33,000 prescriptions) and 2004 (470,000). CONCLUSIONS The decrease in prostate cancer mortality was greater amongst men aged 55-74 years than in those aged >or=75 years, but pre-dated the substantial use of prostate-specific antigen screening and radical prostatectomy in the UK. An increase in radical therapy amongst younger groups with localized cancers and screen-detected low-volume locally advanced disease as a result of stage migration, as well as prolonged survival from increased medical androgen suppression therapy, might partly explain recent trends.
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Affiliation(s)
- Sabina Hussain
- Department of Social Medicine, University of Bristol, Bristol, UK
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13
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Espey DK, Wu XC, Swan J, Wiggins C, Jim MA, Ward E, Wingo PA, Howe HL, Ries LAG, Miller BA, Jemal A, Ahmed F, Cobb N, Kaur JS, Edwards BK. Annual report to the nation on the status of cancer, 1975–2004, featuring cancer in American Indians and Alaska Natives. Cancer 2007; 110:2119-52. [PMID: 17939129 DOI: 10.1002/cncr.23044] [Citation(s) in RCA: 389] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- David K Espey
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Clay CA, Perera S, Wagner JM, Miller ME, Nelson JB, Greenspan SL. Physical function in men with prostate cancer on androgen deprivation therapy. Phys Ther 2007; 87:1325-33. [PMID: 17684084 DOI: 10.2522/ptj.20060302] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE Androgen deprivation therapy (ADT) has become an increasingly standard intervention for both early and advanced stages of prostate cancer; however, decreased physical function and hypogonadism have been reported in men receiving ADT. The objectives of this study were: (1) to determine whether ADT (and hypogonadism) resulted in decreased strength and mobility and (2) to examine the effect of ADT on an associated test of cognitive and motor function by assessing visuomotor performance. SUBJECTS AND METHODS Physical function, walking speed, visuomotor performance, gonadal status, body composition, and Comorbidity Disease Index (CMDI) scores were assessed in a cohort of 100 participants that included: (1) men with prostate cancer who were not on ADT, (2) men with prostate cancer who were on short-term ADT (<6 months), (3) men with prostate cancer who were on long-term ADT (> or =6 months), and (4) control subjects who did not have prostate cancer. RESULTS Walking speed varied significantly across the 4 groups, even after adjusting for age, CMDI, and percentage of body fat. Age and CMDI were significantly associated with measurements of physical performance. Adjusted for covariates, men on long-term ADT walked 0.18 m/s slower than the control subjects. Physical function also varied significantly across the 4 groups. Androgen deprivation therapy did not have a significant effect on visuomotor performance. DISCUSSION AND CONCLUSION The results suggest that ADT has a significant effect on walking speed and physical performance in men with prostate cancer.
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Mohile SG, Bylow K, Dale W, Dignam J, Martin K, Petrylak DP, Stadler WM, Rodin M. A pilot study of the vulnerable elders survey-13 compared with the comprehensive geriatric assessment for identifying disability in older patients with prostate cancer who receive androgen ablation. Cancer 2007; 109:802-10. [PMID: 17219443 DOI: 10.1002/cncr.22495] [Citation(s) in RCA: 183] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Impairments in geriatric domains adversely affect health outcomes of the elderly. The Comprehensive Geriatric Assessment (CGA) is a key component of the treatment approach for older cancer patients, but it is time consuming. In this pilot study, the authors evaluated the validity of a brief, functionally based screening tool, the Vulnerable Elders Survey-13 (VES-13), for identifying older patients with prostate cancer (PCa) with impairment in the oncology clinic setting. METHODS Patients with PCa aged >or=70 years who actively were receiving androgen ablation treatment and who were followed within the clinics at the University of Chicago were eligible. Patients self-completed the VES-13 and CGA instruments and repeated the VES-13 1 month later. Physical performance and cognitive assessments were administered by a research assistant. RESULTS Of 50 participating patients, 50% were identified as impaired by the VES-13 (score >or=3). Sixty percent of patients scored as impaired on >or=2 tests within the CGA, exhibiting deficits in multiple domains. The reliability of the VES-13 (Pearson correlation coefficient) was 0.92. The cut-off score of 3 on the VES-13 had 72.7% sensitivity and 85.7% specificity for CGA deficits and was highly predictive for identifying impairment (area under the receiver operating characteristic curve, 0.90). Patients who had mean VES-13 scores >or=3 performed significantly worse on evaluations of activities of daily living (P = .001), physical performance (P = .002), comorbidity (P = .004), and cognitive impairment (P = .003). CONCLUSIONS Functional and cognitive impairments are highly prevalent among older patients with PCa who receive androgen ablation in oncology clinics. The current results indicated that the brief VES-13 performed nearly as well as a conventional CGA in detecting geriatric impairment in this population.
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Affiliation(s)
- Supriya G Mohile
- Department of Medicine (Oncology), Columbia Presbyterian Medical Center, New York, New York, USA
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Dacal K, Sereika SM, Greenspan SL. Quality of Life in Prostate Cancer Patients Taking Androgen Deprivation Therapy. J Am Geriatr Soc 2006; 54:85-90. [PMID: 16420202 DOI: 10.1111/j.1532-5415.2005.00567.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the effect of androgen deprivation therapy (ADT) on health-related quality of life (HRQOL), self-reported HRQOL was compared in prostate cancer patients receiving short- (< 6 months) or long-term (> or = 6 months) ADT and healthy controls. DESIGN Cross-sectional study. SETTING Academic medical center in Pittsburgh, Pennsylvania. PARTICIPANTS Ninety-six men, including those with prostate cancer receiving short-term, long-term, and no ADT and healthy controls. Men taking medications or having diseases known to affect bone mineral metabolism were excluded. MEASUREMENTS The 36-item Short Form Medical Outcomes Study Health Survey (an HRQOL assessment) and a comorbidity index were administered to each participant. Characteristics, including body composition (assessed using dual-energy x-ray absorptiometry) and gonadal status (serum total and free testosterone) were measured approximately 3 months or less before the HRQOL assessment. RESULTS As expected, men receiving ADT had significantly lower levels of testosterone, free testosterone, and lean body mass, as well as greater body fat and comorbidity index (all P<.01) than men not receiving ADT (i.e., men with prostate cancer and healthy controls). Participants receiving ADT reported significantly poorer QOL in the areas of physical function (P<.001), general health (P<.001), and physical health component summary (P<.001) than men not receiving ADT. There were no significant differences in HRQOL outcomes between participants receiving short- or long-term ADT. Comorbidity and testosterone levels were associated with several QOL scales. After controlling for the significant joint predictors of comorbidity and total testosterone using hierarchical regression analysis, ADT was no longer a significant predictor, and only comorbidity and total testosterone contributed to the explanation of the variance of the physical health component summary. Comorbidity alone contributed to the explanation of the variance in physical function, bodily pain, general health, and vitality. CONCLUSION Patients with prostate cancer who were receiving ADT experience worse HRQOL than those not receiving ADT, but duration of ADT was not a contributing factor. After controlling for comorbidity, total testosterone level rather than ADT accounted for a small yet statistically significant percentage of the total variance of the physical health component summary. These findings have important clinical implications regarding the decision to treat prostate cancer patients with ADT.
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Affiliation(s)
- Kirsten Dacal
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Morote J, Esquena S, Orsola A, Salvador C, Trilla E, Cecchini L, Raventós CX, Planas J, Catalán R, Reventós J. Effect of androgen deprivation therapy in the thyroid function test of patients with prostate cancer. Anticancer Drugs 2005; 16:863-6. [PMID: 16096434 DOI: 10.1097/01.cad.0000173474.82486.74] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We have assessed the effect of androgen deprivation therapy (ADT) in the thyroid function test in prostate cancer patients. Serum levels of tri-iodothyronine (T3), thyroxine (T4), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) were determined in a cross-sectional study that included 279 patients diagnosed with prostate cancer. A subset of 96 patients free of prostate-specific antigen relapse after radical prostatectomy became a control group and 183 patients under continuous ADT formed the study group. Sixty-four patients out of the study group were treated with luteinizing hormone-releasing hormone (LHRH) agonist and 119 with LHRH agonist plus bicalutamide. The average time of ADT was 42.5 months (3-218). Results were as follows. Mean T3 level was 122.7 ng/dl (72.6-213.0) in the control group and 123.8 ng/dl (64.4-228.2) in patients under ADT, p=0.472. Mean T4 level was 7.66 (1.81-4.30) and 7.66 microg/dl (3.60-13.30), respectively, p=0.884. Mean TSH level was 1.58 (0.44-11.70) and 1.81 mU/dl (0.15-6.58), respectively, p=0.007. Mean FT4 level was 1.24 (0.80-1.90) and 1.18 ng/dl (0.80-1.90), respectively, p=0.018. No statistically significant differences between the T3, T4, TSH and FT4 serum levels were detected according to the modality of ADT. The serum level of TSH was higher than 5 mU/l in six patients (2.1%); however, all cases had a normal FT4 serum level. This mild hypothyroidism was detected in two of the 96 patients of the control group (2.1%) and in four of the 183 under ADT (2.2%). Our data show that ADT seems to alter the thyroid function test. A statistically significant increase in TSH serum level and a decrease in FT4 serum level were detected in patients under ADT. However, only a mild hypothyroidism was detected in about 2% of the patients with prostate cancer, independently of ADT.
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Affiliation(s)
- Juan Morote
- Departments of Urology, Vall d'Hebron Hospital, Autònoma University of Barcelona, Barcelona, Spain.
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Zeliadt SB, Potosky AL, Etzioni R, Ramsey SD, Penson DF. Racial disparity in primary and adjuvant treatment for nonmetastatic prostate cancer: SEER-Medicare trends 1991 to 1999. Urology 2004; 64:1171-6. [PMID: 15596192 DOI: 10.1016/j.urology.2004.07.037] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2004] [Accepted: 07/08/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess trends in the initial care of nonmetastatic prostate cancer, including the use of primary and adjuvant androgen deprivation therapy (ADT), using population-based treatment claims from 1991 to 1999. METHODS We used a database linking the Surveillance, Epidemiology, and End Results (SEER) registry with Medicare claims to extract treatment information for 90,128 men aged 65 years and older, who were newly diagnosed with nonmetastatic prostate cancer. RESULTS The use of aggressive therapy has increased among white men over time; but aggressive therapy has recently declined among African-American men. Accounting for age, grade, socioeconomic status, and comorbidity, African-American men were 26% less likely to receive aggressive therapy than white men (odds ratio 0.74; 95% confidence interval 0.70 to 0.79). The use of ADT has increased substantially in both the primary and the adjuvant settings. By 1999, 45.6% of white men and 35.8% of African-American men who selected conservative management received primary ADT; among men treated with external beam radiotherapy, the proportion receiving adjuvant ADT was 53.7% for white men and 42.4% for African-American men (P <0.001). CONCLUSIONS Racial differences in the use of aggressive and conservative therapies are increasing. ADT is becoming a widely adopted component of initial treatment for localized prostate cancer. It is crucial to understand the impact of treatment patterns, including the increased use of ADT, on patient survival, morbidity, and costs of care.
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Affiliation(s)
- Steven B Zeliadt
- Department of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1024, USA.
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Potosky AL, Davis WW, Hoffman RM, Stanford JL, Stephenson RA, Penson DF, Harlan LC. Five-year outcomes after prostatectomy or radiotherapy for prostate cancer: the prostate cancer outcomes study. J Natl Cancer Inst 2004; 96:1358-67. [PMID: 15367568 DOI: 10.1093/jnci/djh259] [Citation(s) in RCA: 437] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Men treated for clinically localized prostate cancer with either radical prostatectomy or external beam radiotherapy usually survive many years with the side effects of these treatments. We present treatment-specific quality-of-life outcomes for prostate cancer patients 5 years after initial diagnosis. METHODS The cohort consisted of men aged 55-74 years who were newly diagnosed with clinically localized prostate cancer in 1994-1995 and were treated with radical prostatectomy (n = 901) or external beam radiotherapy (n = 286). We used clinical and quality-of-life data previously collected at the time of diagnosis (i.e., baseline) and at the 2-year follow-up and data newly collected at 5 years after diagnosis to compare urinary, bowel, and sexual function and to examine temporal changes in those functions. Odds ratios (ORs) and adjusted percentages were calculated by logistic regression. All statistical tests were two-sided. RESULTS At 5 years after diagnosis, overall sexual function declined in both groups to approximately the same level. However, at 5 years after diagnosis, erectile dysfunction was more prevalent in the radical prostatectomy group than in the external beam radiotherapy group (79.3% versus 63.5%; OR = 2.5, 95% confidence interval [CI] = 1.6 to 3.8). Approximately 14%-16% of radical prostatectomy and 4% of external beam radiotherapy patients were incontinent at 5 years (OR = 4.4, 95% CI = 2.2 to 8.6). Bowel urgency and painful hemorrhoids were more common in the external beam radiotherapy group than in the radical prostatectomy group. All of these differences remained statistically significant after adjustment for confounders and for differences between treatment groups in some baseline characteristics. CONCLUSIONS At 5 years after diagnosis, men treated with radical prostatectomy for localized prostate cancer continue to experience worse urinary incontinence than men treated with external beam radiotherapy. However, the two treatment groups were more similar to each other with respect to overall sexual function, mostly because of a continuing decline in erectile function among the external beam radiotherapy patients between years 2 and 5.
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Affiliation(s)
- Arnold L Potosky
- Division of Cancer Control and Population Sciences, National Cancer Institute, EPN Rm. 4005, 6130 Executive Blvd., MSC 7344, Bethesda, MD 20892-7344, USA.
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Abstract
Within the last decade prostate cancer mortality rates have started to decrease in some countries. Although it is tempting to assume that these trends are a result of earlier diagnosis and aggressive therapeutic intervention, as a consequence of prostate-specific antigen screening, definitive results from randomized trials of screening will not be available for several years. Moreover, there is mounting evidence that the effects of screening cannot be entirely responsible for this reduction in mortality rates. This review explores the possibility that other factors, particularly the increased uptake of early hormonal therapy, are contributing to the observed changes in mortality.
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Affiliation(s)
- J-E Damber
- Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden
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Salminen E, Koskinen A, Backman H, Nurmi M. Effect of adjuvant androgen deprivation on thyroid function tests in prostate cancer patients. Anticancer Drugs 2004; 15:351-6. [PMID: 15057139 DOI: 10.1097/00001813-200404000-00007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Androgen deprivation (AD) used in the treatment of prostate cancer is known to alter concentrations of sex hormones and their binding globulins. Less is known as to its effect on thyroid hormones. In this prospective study the effects of AD on thyroid function were clarified. Levels of serum thyroid stimulating hormone (TSH), free thyroxine (FT4) and thyroid binding globulin concentrations were measured in prostate cancer patients treated with either radical radiotherapy and androgen deprivation for 12 months (AD) or radical radiotherapy alone (RT). Measurements were made at baseline, and at 3, 6 and 12 months. At baseline and at 3 months the results of thyroid function tests did not differ significantly between groups. A significant decline in serum testosterone in the AD group was accompanied by a significant decline in FT4 at 6 and 12 months, while no significant changes in thyroid function were observed in the RT group. The decline in FT4 among AD patients did not evoke a normal TSH response. Prolonged use of AD hampers the interpretation of thyroid test results. This finding has substantial implications for the follow-up of patients in hormonally treated prostate cancer.
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Affiliation(s)
- E Salminen
- Department of Oncology, Turku University Hospital, Turku, Finland.
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Gil Sanz MJ. Supresión andrógena en cáncer de próstata ¿tratamiento paliativo? Actas Urol Esp 2004; 28:79-83. [PMID: 15074054 DOI: 10.1016/s0210-4806(04)73044-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Salminen E, Portin R, Korpela J, Backman H, Parvinen LM, Helenius H, Nurmi M. Androgen deprivation and cognition in prostate cancer. Br J Cancer 2003; 89:971-6. [PMID: 12966411 PMCID: PMC2376935 DOI: 10.1038/sj.bjc.6601235] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Androgen deprivation (AD) is commonly used in neoadjuvant and adjuvant setting with prostate cancer (PC) radiotherapy. This prospective study assessed whether cognitive functioning is impaired during 12 months of AD therapy. Longitudinal testing of 25 patients treated with AD and curative radiotherapy was undertaken at baseline, and at 6 and 12 months. CogniSpeed software was used for measuring attentional performances. Other cognitive performances were evaluated using verbal, visuomotor and memory tests. The Beck depression inventory was employed to evaluate depressive mood and EORTC QLQ-C30 for quality of life (QoL). During longitudinal testing of the AD group, no impairment in cognitive performances was found. Instead, improvement was observed in object recall (immediate, P=0.035; delayed, P<0.001), and in semantic memory (P=0.037). In QoL, impairment in physical function was observed. Androgen deprivation of 12 months appears to be associated with preserved cognitive functioning, although physical impairment occurs. These results have implications for counseling and psychosocial support of patients in the context of treatment options in PC.
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Affiliation(s)
- E Salminen
- Department of Oncology, Turku University Hospital, Kiinamyllynkatu 4-8, Fin-20520 Turku, Finland.
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Abstract
The most appropriate time to introduce hormonal therapy for patients with advanced prostate cancer is a contentious issue. Recent prospective studies comparing immediate and deferred hormonal therapy (medical or surgical castration) on survival outcome are reviewed with the aim of redefining the most appropriate time to initiate hormonal therapy for individual patients. The evidence supports the use of immediate hormonal therapy in previously untreated patients with advanced disease (M1) and also the use of adjuvant hormonal therapy after radical prostatectomy and lymphadenectomy for node-positive (but clinically localized) disease. Immediate hormonal therapy may also be advantageous in advanced local/regional disease when it is the primary treatment contemplated (i.e., without any definitive curative therapy to the prostate), although not all studies show this. Adjuvant hormonal therapy has significantly improved survival in some studies in the radiotherapy setting; the lack of statistically significant benefits in other studies may be a result of the timing of hormonal therapy in relation to the administration of external beam irradiation. Decisions on the immediate initiation of hormonal therapy should also take into account the patient's life expectancy and the side effects and long-term complications of androgen deprivation therapy. Recent epidemiological studies indicate that prostate cancer mortality has fallen in the USA. This decline in prostate cancer mortality is likely to be multifactorial with early application of hormonal therapy being one potential contributory factor. It is recommended that after an assessment of their disease risk, patients should be informed about the benefits and side effects of all potential treatment options and allowed to make an informed choice about their treatment.
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Affiliation(s)
- Edward Messing
- Department of Urology, University of Rochester, Rochester, NY 14642, USA.
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Miller DC, Litwin MS, Sanda MG, Montie JE, Dunn RL, Resh J, Sandler H, Wei JT. Use of quality indicators to evaluate the care of patients with localized prostate carcinoma. Cancer 2003; 97:1428-35. [PMID: 12627506 DOI: 10.1002/cncr.11216] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The goal of quality assurance in health care is to preserve and improve patient care. Recently, RAND developed a set of evidence-based candidate indicators for evaluating the quality of care for patients with localized prostate carcinoma; however, the feasibility and sensitivity of these indicators have not been tested in a clinical setting. The objectives of this study were to evaluate the feasibility of measuring these quality indicators and to determine their sensitivity to change in practice patterns over time. METHODS One hundred sixty-eight men who presented in either 1995 or in 2000 and were treated for localized prostate carcinoma were selected randomly from the University of Michigan tumor registry. A combination of electronic data base review and explicit chart review was used to assess the feasibility of measuring compliance for each indicator. For each indicator in which assessment was feasible, compliance with the RAND indicators was determined for patients in both years. Multivariate regression analysis was used to adjust for potential confounding effects of disease stage, tumor grade, prostate specific antigen (PSA) level, patient age, and therapy. RESULTS Based on review of available clinical data, measurement of compliance was feasible for 19 of 22 RAND candidate quality indicators (86%). For five indicators, significant differences in documentation (compliance) were detected between 1995 and 2000 (P < 0.05). Treatment received and higher PSA levels were associated independently with documentation of compliance for several indicators (P < 0.05). CONCLUSIONS Measurement of the majority of the RAND quality indicators for the treatment of patients with localized prostate carcinoma was feasible, and improvements in several indicators were observed between 1995 and 2000. Demonstration of such variation, even within a single institution, suggests that the indicators are sufficiently sensitive to detect differences in practice patterns.
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Affiliation(s)
- David C Miller
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109, USA
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Mimeault M, Pommery N, Hénichart JP. New advances on prostate carcinogenesis and therapies: involvement of EGF-EGFR transduction system. Growth Factors 2003; 21:1-14. [PMID: 12795332 DOI: 10.1080/0897719031000094921] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The prostate cancers (PCs) are among the major causes of death because therapeutic treatments are not effective against advanced and metastatic forms of this cellular hyperproliferative disorder. In fact, although androgen-deprivation therapies permit to cure localized PC forms, the metastatic PC cells have acquired multiple functional features that confer to them resistance to ionizing radiations and anticarcinogenic drugs currently used in therapy. The present review describes last advances on molecular mechanisms that might be responsible for sustained growth and survival of PC cells. In particular, emphasis is on intracellular signaling cascades which are involved in the mitogenic and antiapoptotic effects of epidermal growth factor EGF-EGFR system. Of therapeutic interest, recent advances and prospects for development of new treatments against incurable forms of metastatic PC forms are also discussed.
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Affiliation(s)
- Murielle Mimeault
- Institut de Chimie Pharmaceutique Albert Lespagnol, Faculté de Pharmacie, 3 Rue du Professeur Laguesse, BP83, 59006 Lille, Cédex, France.
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Wirth MP, Hakenberg OW. Antiandrogen monotherapy for prostate cancer. Curr Probl Cancer 2003; 27:45-8. [PMID: 12569350 DOI: 10.1067/mcn.2003.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Manfred P Wirth
- Department of Urology, Carl Gustav Carus Faculty of Medicine, Technical Univeristy of Dresden, Germany
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Prognostic Value of Bone Scan in Patients With Metastatic Prostate Cancer Treated Initially With Androgen Deprivation Therapy. J Urol 2002. [DOI: 10.1097/00005392-200210010-00029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rigaud J, Tiguert R, Le Normand L, Karam G, Glemain P, Buzelin JM, Bouchot O. Prognostic value of bone scan in patients with metastatic prostate cancer treated initially with androgen deprivation therapy. J Urol 2002; 168:1423-6. [PMID: 12352409 DOI: 10.1016/s0022-5347(05)64465-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE We analyzed whether classifying bone prostate cancer metastases correlates with survival in patients treated primarily with androgen deprivation. MATERIALS AND METHODS We identified 86 patients with bone metastases who were followed between September 1988 and September 1999. Only those treated initially with androgen deprivation as monotherapy were included in this study. Clinical, pathological and radiological information were obtained by patient chart review. The 86 patients were divided into 2 groups according to metastasis grade on bone scan at diagnosis. Group 1 included patients with metastases on the axial skeleton and group 2 included those with bone metastases on the appendicular skeleton. In addition to our classification, we stratified patients according to the Soloway and Crawford et al classifications, and analyzed survival. RESULTS There were no statistical differences in the groups with axial versus appendicular metastases in terms of patient age, biopsy Gleason score, serum prostate specific antigen or clinical stage. Median survival was 53 and 29 months in patients with axial and appendicular bone metastases, respectively. Those with axial disease had better survival than those with appendicular bone metastases (p = 0.048). No statistical difference was observed when grading bone scan according to the Soloway and Crawford et al classifications. CONCLUSIONS Classifying bone scans according to the site of metastases (axial versus appendicular) had many advantages. It is easy to understand and helps urologist better predict the patient prognosis. Axial metastases carries a better prognosis than appendicular metastasis.
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