1
|
Bryant AK, Nelson TJ, McKay RR, Kader AK, Parsons JK, Einck JP, Kane CJ, Sandhu AP, Mundt AJ, Murphy JD, Rose BS. Impact of age on treatment response in men with prostate cancer treated with radiotherapy. BJUI COMPASS 2021; 3:243-250. [PMID: 35492227 PMCID: PMC9045578 DOI: 10.1002/bco2.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/02/2021] [Accepted: 11/25/2021] [Indexed: 01/09/2023] Open
Abstract
Objective To analyse the effect of age at diagnosis on clinical outcomes of localized prostate cancer (PCa) treated with radiation therapy. Subjects and methods We identified 12 784 patients with intermediate‐ or high‐risk localized PCa treated with radiation therapy (RT) and neoadjuvant androgen deprivation therapy (ADT) between 2000 and 2015 from nationwide Veterans Affairs data. Patients were grouped into three age categories (≤59, 60–69, and ≥70 years old). Outcomes included immediate PSA response (3‐month post‐RT PSA and 2‐year PSA nadir, grouped into <0.10 ng/ml, 0.10–0.49 ng/ml, and ≥0.50 ng/ml), biochemical recurrence, and PCa‐specific mortality. Multivariable regression models included ordinal logistic regression for short‐term PSA outcomes, Cox regression for biochemical recurrence, and Fine‐Gray competing risks regression for PCa‐specific mortality. Results A total of 2136 patients (17%) were ≤59 years old at diagnosis, 6107 (48%) were 60–69 years old, and 4541 (36%) were ≥70 years old. Median follow‐up was 6.3 years. Younger age was associated with greater odds of higher 3‐month PSA group (≤59 vs. ≥70: adjusted odds ratio [aOR] 1.90, 95% CI 1.64–2.20; p < 0.001) and higher 2‐year PSA nadir group (≤59 vs. ≥70: aOR 1.89, 95% CI 1.62–2.19, p < 0.001). Younger age was associated with greater risk of biochemical recurrence (≤59 vs. ≥70: adjusted hazard ratio 1.45, 95% CI 1.26–1.67, p < 0.001) but not PCa‐specific mortality (p = 0.16). Conclusion In a large nationwide sample of US veterans treated with ADT and RT for localized PCa, younger age was associated with inferior short‐term PSA response and higher risk of biochemical recurrence.
Collapse
Affiliation(s)
- Alex K. Bryant
- Department of Radiation OncologyUniversity of MichiganAnn ArborMichiganUSA
- Department of Radiation OncologyVeterans Affairs Ann Arbor Healthcare SystemAnn ArborMichiganUSA
| | - Tyler J. Nelson
- Department of Radiation Medicine and Applied SciencesUniversity of California San DiegoLa JollaCaliforniaUSA
- Veterans Affairs San Diego Healthcare SystemLa JollaCaliforniaUSA
| | - Rana R. McKay
- Division of Hematology‐Oncology, Department of Internal MedicineUniversity of California San DiegoLa JollaCaliforniaUSA
| | - A. Karim Kader
- Department of UrologyUniversity of California San DiegoLa JollaCaliforniaUSA
| | - J. Kellogg Parsons
- Department of UrologyUniversity of California San DiegoLa JollaCaliforniaUSA
| | - John P. Einck
- Department of Radiation Medicine and Applied SciencesUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Christopher J. Kane
- Department of UrologyUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Ajay P. Sandhu
- Department of Radiation Medicine and Applied SciencesUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Arno J. Mundt
- Department of Radiation Medicine and Applied SciencesUniversity of California San DiegoLa JollaCaliforniaUSA
- Clinical and Translational Research InstituteUniversity of California San DiegoLa JollaCaliforniaUSA
| | - James D. Murphy
- Department of Radiation Medicine and Applied SciencesUniversity of California San DiegoLa JollaCaliforniaUSA
- Clinical and Translational Research InstituteUniversity of California San DiegoLa JollaCaliforniaUSA
- Veterans Affairs San Diego Healthcare SystemLa JollaCaliforniaUSA
| | - Brent S. Rose
- Department of Radiation Medicine and Applied SciencesUniversity of California San DiegoLa JollaCaliforniaUSA
- Clinical and Translational Research InstituteUniversity of California San DiegoLa JollaCaliforniaUSA
- Veterans Affairs San Diego Healthcare SystemLa JollaCaliforniaUSA
| |
Collapse
|
2
|
Guo XX, Xia HR, Hou HM, Liu M, Wang JY. Comparison of Oncological Outcomes Between Radical Prostatectomy and Radiotherapy by Type of Radiotherapy in Elderly Prostate Cancer Patients. Front Oncol 2021; 11:708373. [PMID: 34350122 PMCID: PMC8327087 DOI: 10.3389/fonc.2021.708373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
Objective We aimed compare the oncologic outcomes of radical prostatectomy (RP) with those of external beam radiotherapy (EBRT), brachytherapy (BT), or EBRT + BT (EBBT) in elderly patients with localised prostate cancer (PCa). Methods Localised PCa patients aged ≥70 years who underwent RP, EBRT, BT, or EBBT between 2004 and 2016 were identified from the Surveillance, Epidemiology, and End Results database. Multivariable competing risks survival analyses were used to estimate prostate cancer-specific mortality (CSM) and other-cause mortality (OCM). Subgroup analyses according to risk categories were also conducted. Results Overall, 14057, 37712, 8383, and 5244 patients aged ≥70 years and treated with RP, EBRT, BT, and EBBT, respectively, were identified. In low- to intermediate-risk patients, there was no significant difference in CSM risk between RP and the other three radiotherapy modalities (all P > 0.05). The corresponding 10-year CSM rates for these patients were 1.2%, 2.3%, 2.0%, and 1.8%, respectively. In high-risk patients, EBRT was associated with a higher CSM than RP (P = 0.003), whereas there was no significant difference between RP and BT or RP and EBBT (all P > 0.05). The 10-year CSM rates of high-risk patients in the RP, EBRT, BT, and EBBT groups were 7.5%, 10.2%, 8.3%, and 7.6%, respectively. Regarding OCM, the risk was generally lower in RP than in the other three radiotherapy modalities (all P < 0.001). Conclusions Among men aged ≥70 years with localised PCa, EBRT, BT, and EBBT offer cancer-specific outcomes similar to those of RP for individuals with low- to intermediate-risk disease. In patients with high-risk disease, EBBT had outcomes equally favourable to those of RP, but RP is more beneficial than EBRT. More high-quality trials are warranted to confirm and expand the present findings.
Collapse
Affiliation(s)
- Xiao-Xiao Guo
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Hao-Ran Xia
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Hui-Min Hou
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Ming Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Jian-Ye Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
| |
Collapse
|
3
|
Couderc AL, Nicolas E, Boissier R, Boucekine M, Bastide C, Badinand D, Rossi D, Mugnier B, Villani P, Karsenty G, Cowen D, Lechevallier E, Muracciole X. Impact of Androgen Deprivation Therapy Associated to Conformal Radiotherapy in the Treatment of D'Amico Intermediate-/High-Risk Prostate Cancer in Older Patients. Cancers (Basel) 2020; 13:E75. [PMID: 33383957 PMCID: PMC7795189 DOI: 10.3390/cancers13010075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/18/2020] [Accepted: 12/24/2020] [Indexed: 11/16/2022] Open
Abstract
PURPOSE/OBJECTIVE The association of 3D Conformal External Beam Radiotherapy (3D-CEBRT) with adjuvant Androgen Deprivation Therapy (ADT) proved to treat patients with intermediate- and high-risk localized prostate cancer (IR and HR). However, older patients were underrepresented in literature. We aimed to report the oncological results and morbidity 3D-CEBRT +ADT in ≥80 years patients. MATERIAL AND METHODS From June 1998 to July 2017, 101 patients ≥80 years were included in a tertiary center. The median age was 82 years. ADT was initiated 3 months prior 3D-CEBRT in all patients, with a total duration of 6 months for IR prostate cancer (group A; n = 41) and 15 months for HR prostate cancer (group B; n = 60). Endpoints included overall survival (OS), metastasis-free survival (DMFS), biochemical recurrence-free survival (BRFS) and toxicity. RESULTS Five years-OS was 95% and 86.7% in groups A and B, respectively. Cardiovascular events occurred in 22.8% of ≥80 years patients with no impact on OS. In the multivariate analysis, age <82 years, Karnofsky index and normalization of testosterone levels were significantly associated with better OS. CONCLUSION Age ≥80 years should not be a limitation for the treatment of IR and HR prostate cancer patients with 3D-CEBRT and ADT, but cardiovascular monitoring and prevention are mandatory.
Collapse
Affiliation(s)
- Anne-Laure Couderc
- Internal Medicine, Geriatric and Therapeutic Unit, Assistance Publique-Hôpitaux de Marseille (AP-HM), and Coordination Unit for Geriatric Oncology (UCOG), PACA West, 13009 Marseille, France; (B.M.); (P.V.)
- Medical School, Aix-Marseille University, 13005 Marseille, France; (R.B.); (C.B.); (D.R.); (G.K.); (D.C.); (E.L.)
| | - Emanuel Nicolas
- Department of Medical Oncology, University Hospital of Nimes, 30000 Nimes, France;
- IDESP Institute Desbrest of Epidemiology and Public Health, Research Unit INSERM, University of Montpellier, 34000 Montpellier, France
| | - Romain Boissier
- Medical School, Aix-Marseille University, 13005 Marseille, France; (R.B.); (C.B.); (D.R.); (G.K.); (D.C.); (E.L.)
- Urology Department, Conception Hospital, AP-HM, 13005 Marseille, France
| | - Mohammed Boucekine
- Department of Public Health, EA 3279 Self-Perceveid Health Assessment Research Unit, Medical School, Aix-Marseille University, 13005 Marseille, France;
| | - Cyrille Bastide
- Medical School, Aix-Marseille University, 13005 Marseille, France; (R.B.); (C.B.); (D.R.); (G.K.); (D.C.); (E.L.)
- Urology Department, Nord Hospital, AP-HM, 13015 Marseille, France
| | - Delphine Badinand
- Radiotherapy Department, La Timone Hospital, AP-HM, 13005 Marseille, France; (D.B.); (X.M.)
| | - Dominique Rossi
- Medical School, Aix-Marseille University, 13005 Marseille, France; (R.B.); (C.B.); (D.R.); (G.K.); (D.C.); (E.L.)
- Urology Department, Nord Hospital, AP-HM, 13015 Marseille, France
| | - Benedicte Mugnier
- Internal Medicine, Geriatric and Therapeutic Unit, Assistance Publique-Hôpitaux de Marseille (AP-HM), and Coordination Unit for Geriatric Oncology (UCOG), PACA West, 13009 Marseille, France; (B.M.); (P.V.)
| | - Patrick Villani
- Internal Medicine, Geriatric and Therapeutic Unit, Assistance Publique-Hôpitaux de Marseille (AP-HM), and Coordination Unit for Geriatric Oncology (UCOG), PACA West, 13009 Marseille, France; (B.M.); (P.V.)
- Medical School, Aix-Marseille University, 13005 Marseille, France; (R.B.); (C.B.); (D.R.); (G.K.); (D.C.); (E.L.)
| | - Gilles Karsenty
- Medical School, Aix-Marseille University, 13005 Marseille, France; (R.B.); (C.B.); (D.R.); (G.K.); (D.C.); (E.L.)
- Urology Department, Conception Hospital, AP-HM, 13005 Marseille, France
| | - Didier Cowen
- Medical School, Aix-Marseille University, 13005 Marseille, France; (R.B.); (C.B.); (D.R.); (G.K.); (D.C.); (E.L.)
- Radiotherapy Department, La Timone Hospital, AP-HM, 13005 Marseille, France; (D.B.); (X.M.)
| | - Eric Lechevallier
- Medical School, Aix-Marseille University, 13005 Marseille, France; (R.B.); (C.B.); (D.R.); (G.K.); (D.C.); (E.L.)
- Urology Department, Conception Hospital, AP-HM, 13005 Marseille, France
| | - Xavier Muracciole
- Radiotherapy Department, La Timone Hospital, AP-HM, 13005 Marseille, France; (D.B.); (X.M.)
| |
Collapse
|
4
|
Dong X, Ma G, Chen F. Age at diagnosis and prognosis among prostate cancer patients treated with radiotherapy: evidenced from three independent cohort studies. Ann Oncol 2019; 29:2019-2020. [PMID: 29992296 DOI: 10.1093/annonc/mdy234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- X Dong
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing
| | - G Ma
- Clinical Metabolomics Center, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China.
| | - F Chen
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing.
| |
Collapse
|
5
|
Pettersson A, Robinson D, Garmo H, Holmberg L, Stattin P. Age at diagnosis and prostate cancer treatment and prognosis: a population-based cohort study. Ann Oncol 2019; 29:377-385. [PMID: 29161337 DOI: 10.1093/annonc/mdx742] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Old age at prostate cancer diagnosis has been associated with poor prognosis in several studies. We aimed to investigate the association between age at diagnosis and prognosis, and if it is independent of tumor characteristics, primary treatment, year of diagnosis, mode of detection and comorbidity. Patients and methods We conducted a nation-wide cohort study including 121 392 Swedish men aged 55-95 years in Prostate Cancer data Base Sweden 3.0 diagnosed with prostate cancer in 1998-2012 and followed for prostate cancer death through 2014. Data were available on age, stage, grade, prostate-specific antigen (PSA)-level, mode of detection, comorbidity, educational level and primary treatment. We used Cox regression to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results With increasing age at diagnosis, men had more comorbidity, fewer PSA-detected cancers, more advanced cancers and were less often treated with curative intent. Among men with high-risk or regionally metastatic disease, the proportion of men with unknown M stage was higher among old men versus young men. During a follow-up of 751 000 person-years, 23 649 men died of prostate cancer. In multivariable Cox-regression analyses stratified by treatment, old age at diagnosis was associated with poorer prognosis among men treated with deferred treatment (HRage 85+ versus 60-64: 7.19; 95% CI: 5.61-9.20), androgen deprivation therapy (HRage 85+ versus 60-64: 1.72; 95% CI: 1.61-1.84) or radical prostatectomy (HRage 75+ versus 60-64: 2.20; 95% CI: 1.01-4.77), but not radiotherapy (HRage 75+ versus 60-64: 1.08; 95% CI: 0.76-1.53). Conclusion Our findings argue against a strong inherent effect of age on risk of prostate cancer death, but indicate that in current clinical practice, old men with prostate cancer receive insufficient diagnostic workup and subsequent curative treatment.
Collapse
Affiliation(s)
- A Pettersson
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
| | - D Robinson
- Department of Urology, Ryhov Hospital, Jönköping, Sweden
| | - H Garmo
- Regional Cancer Centre Uppsala Örebro, Uppsala University Hospital, Uppsala, Sweden; Division of Cancer Studies, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - L Holmberg
- Division of Cancer Studies, Faculty of Life Sciences and Medicine, King's College London, London, UK; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - P Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden
| |
Collapse
|
6
|
Definitive Radiotherapy for Older Patients with Prostate Cancer: Experience of a Medical Center in Taiwan. Sci Rep 2017; 7:13880. [PMID: 29066834 PMCID: PMC5655670 DOI: 10.1038/s41598-017-13119-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 09/19/2017] [Indexed: 12/12/2022] Open
Abstract
Whether age predicts treatment outcome of prostate cancer remains controversial. With the aging of the world population, properly understanding the effect of age may facilitate both treatment decision-making and defining the natural history of prostate cancer. Consecutive 581 patients with locally-confined adenocarcinoma of the prostate who received radical definitive radiotherapy(RT) (76-78 Gy) between 2004 and 2015 at a medical center in Taiwan were reviewed retrospectively. Median age was 78 years. The median follow-up was 66 months. The 5-year biochemical failure-free survival(BFFS), distant metastasis-free survival(DMFS), disease-specific survival(DSS), and overall survival(OS) rates were 84.9%, 93.8%, 97.8%, and 86.6%, respectively, for all patients. Comparing those above and below the age of 80, no difference in 5-year BFFS, DMFS, or DSS was found. Multivariate Cox regression analysis showed that tumor stage, Gleason score, initial PSA, and latency before RT were significant risk factors of BFFS. The latency before RT was significantly longer in the older group than in the under 80 group. Delay to start RT might explain the previous finding of inferior disease control in older patients in other studies. With the exception of OS, no other differences in outcomes or toxicities were observed in older patients.
Collapse
|
7
|
Affiliation(s)
- M Froehner
- Department of Urology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.
| | | |
Collapse
|
8
|
Brassell SA, Rice KR, Parker PM, Chen Y, Farrell JS, Cullen J, McLeod DG. Prostate Cancer in Men 70 Years Old or Older, Indolent or Aggressive: Clinicopathological Analysis and Outcomes. J Urol 2011; 185:132-7. [DOI: 10.1016/j.juro.2010.09.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Stephen A. Brassell
- Urology Service, Department of Surgery, Walter Reed Army Medical Center, Washington, D. C
- Center for Prostate Disease Research, Bethesda, Maryland
| | - Kevin R. Rice
- Urology Service, Department of Surgery, Walter Reed Army Medical Center, Washington, D. C
| | - Patrick M. Parker
- Urology Service, Department of Surgery, Walter Reed Army Medical Center, Washington, D. C
| | - Yongmei Chen
- Center for Prostate Disease Research, Bethesda, Maryland
| | - James S. Farrell
- Urology Service, Department of Surgery, Walter Reed Army Medical Center, Washington, D. C
| | | | - David G. McLeod
- Urology Service, Department of Surgery, Walter Reed Army Medical Center, Washington, D. C
- Center for Prostate Disease Research, Bethesda, Maryland
| |
Collapse
|
9
|
Kane CJ, Im R, Amling CL, Presti JC, Aronson WJ, Terris MK, Freedland SJ. Outcomes after radical prostatectomy among men who are candidates for active surveillance: results from the SEARCH database. Urology 2010; 76:695-700. [PMID: 20394969 DOI: 10.1016/j.urology.2009.12.073] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 11/24/2009] [Accepted: 12/05/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We sought to evaluate outcomes after radical prostatectomy among men with low-risk prostate cancer who would be candidates for active surveillance. METHODS Using the Shared Equal Access Regional Cancer Hospital (SEARCH) database of men treated with radical prostatectomy at multiple equal-access medical centers between 1988 and 2007, 398 of 2062 men (19%) met our criteria for potential active surveillance: clinical stage T1c or T2a, prostate-specific antigen (PSA) <10 ng/mL, Gleason sum ≤6, and no more than 1 or 2 positive cores on at least a sextant biopsy. We examined the risk of adverse pathology, biochemical progression, and PSA doubling time (PSADT) at the time of recurrence. We used a Cox proportional hazards model to determine the significant predictors of PSA progression. RESULTS Of the men with low-risk prostate cancer, 85% had organ-confined disease, only 2% had seminal vesicle invasion, and no patient had lymph node metastasis. The 5- and 10 year PSA-free survival rates were 81% (95% CI: 76-86%) and 66% (95% CI: 54-76%). On multivariate analysis, older age (P = .005), Agent Orange exposure (P = .02), and obesity (P = .03) were all significantly associated with biochemical failure. Mean and median PSADT among men who experienced recurrence were 37 and 20 months. Only 3 patients experienced recurrence with PSADT < 9 months. CONCLUSIONS Most men with low-risk prostate cancer treated with radical prostatectomy experience long-term PSA control. Those who did experience recurrence often did so with a long PSADT. Consistent with prior SEARCH database reports, older age, Agent Orange exposure, and obesity increased the risk of recurrence.
Collapse
Affiliation(s)
- Christopher J Kane
- Division of Urology, Department of Surgery, University of California-San Diego, San Diego, CA 92103-8897, USA.
| | | | | | | | | | | | | |
Collapse
|
10
|
Aaronson D, Cowan J, Carroll P, Konety B. Association of age and response to androgen-deprivation therapy with or without radiotherapy for prostate cancer: data from CaPSURE. BJU Int 2010; 105:951-5. [DOI: 10.1111/j.1464-410x.2009.08886.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
11
|
Validation of the partin nomogram for prostate cancer in a national sample. J Urol 2010; 183:105-11. [PMID: 19913246 DOI: 10.1016/j.juro.2009.08.143] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE The Partin tables are a nomogram that is widely used to discriminate prostate cancer pathological stages, given common preoperative clinical characteristics. The nomogram is based on patients undergoing radical prostatectomy at The Johns Hopkins Medical Institutions. We validated the Partin tables in a large, population based sample. MATERIALS AND METHODS The National Cancer Institute Surveillance, Epidemiology and End Results database was used to identify patients treated from 2004 to 2005 who underwent radical prostatectomy. The 2007 Partin tables were used to estimate the prevalence of positive lymph nodes, seminal vesicle invasion, extraprostatic extension and organ confined disease in men with prostate cancer in the database using clinical stage, preoperative prostate specific antigen and Gleason score. The discriminative ability of the tables was explored by constructing ROC curves. RESULTS We identified 11,185 men who underwent radical prostatectomy for prostate cancer in 2004 to 2005. The Partin tables discriminated well between patient groups at risk for positive lymph nodes and seminal vesicle invasion (AUC 0.77 and 0.74, respectively). The discrimination of extraprostatic extension and organ confined disease was more limited (AUC 0.62 and 0.68, respectively). The AUC for positive lymph nodes was 0.78 in white men, 0.73 in black men and 0.83 in Asian/Pacific Islander men (p = 0.17). The AUC for positive lymph nodes in men 61 years old or younger was 0.80 vs 0.74 in men older than 61 years (p = 0.03). CONCLUSIONS The Partin tables showed excellent discrimination for seminal vesicle invasion and positive lymph nodes. Discrimination of extraprostatic extension and organ confined disease was more limited. The Partin tables performed best in young men.
Collapse
|
12
|
Droz JP, Balducci L, Bolla M, Emberton M, Fitzpatrick JM, Joniau S, Kattan MW, Monfardini S, Moul JW, Naeim A, van Poppel H, Saad F, Sternberg CN. Background for the proposal of SIOG guidelines for the management of prostate cancer in senior adults. Crit Rev Oncol Hematol 2010; 73:68-91. [PMID: 19836968 DOI: 10.1016/j.critrevonc.2009.09.005] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 09/23/2009] [Accepted: 09/23/2009] [Indexed: 12/27/2022] Open
Affiliation(s)
- Jean-Pierre Droz
- Department of Medical Oncology, Centre Léon-Bérard, 69008 Lyon, France.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
|
14
|
|
15
|
Alibhai SMH, Gogov S, Allibhai Z. Long-term side effects of androgen deprivation therapy in men with non-metastatic prostate cancer: A systematic literature review. Crit Rev Oncol Hematol 2006; 60:201-15. [PMID: 16860998 DOI: 10.1016/j.critrevonc.2006.06.006] [Citation(s) in RCA: 169] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Revised: 05/30/2006] [Accepted: 06/14/2006] [Indexed: 11/24/2022] Open
Abstract
Increasing numbers of men with non-metastatic disease are receiving androgen deprivation therapy (ADT) for a variety of indications, some of which are supported by evidence from randomized trials. Balanced against possible survival benefits and better disease control are data that ADT adversely affects quality of life, particularly in the areas of sexual function, physical function, and energy. There is some evidence of worsening upper extremity physical strength but no clear evidence of decline in daily function with ADT. The impact of ADT on cognitive function is not clear at this time. ADT is associated with declines in bone mineral density within 6-12 months of commencing treatment, with increased fracture rates within 5 years of treatment. ADT use is also associated with a 10-15g/L decline in hemoglobin, although the clinical significance of this drop appears to be limited for most patients. It is reasonable for physicians who are about to start men on ADT to obtain a baseline bone mineral density, to counsel them about the impact on sexual function and possible treatments for sexual dysfunction, and to encourage regular exercise. Further insight into adverse effects of ADT and strategies to minimize these adverse effects await data from ongoing studies.
Collapse
Affiliation(s)
- Shabbir M H Alibhai
- Division of General Internal Medicine & Clinical Epidemiology, University Health Network, Toronto, Canada.
| | | | | |
Collapse
|
16
|
Abstract
The purpose of this review is to highlight aspects of radiation oncology specifically related to aging and caring for the older patient with cancer. Particular emphasis is placed on the preclinical and clinical studies focusing on the efficacy and toxicity of RT in this population. Special techniques are also reviewed that have particular relevance to the treatment of the elderly.
Collapse
Affiliation(s)
- Loren K Mell
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois 60637, USA
| | | |
Collapse
|
17
|
Jani AB, Gratzle J. Analysis of impact of age and race on biochemical control after radiotherapy in different prostate cancer settings. Urology 2005; 66:124-9. [PMID: 15992908 DOI: 10.1016/j.urology.2005.01.057] [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] [Received: 11/30/2004] [Revised: 01/12/2005] [Accepted: 01/27/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To provide a single-institution analysis of the impact of age and race on biochemical control after radiotherapy (RT) administered in different prostate cancer scenarios. Age and race are among the most controversial prognostic factors in determining outcome after RT. Proper understanding of these prognostic factors can assist in both treatment decision-making and the general understanding of the natural history of prostate cancer. METHODS The records of 527 consecutive nonmetastatic patients undergoing RT at a single institution and for whom demographic, disease, treatment, and follow-up information were available were reviewed. The cohort was divided into two categories: locally advanced/localized (458 patients) and postprostatectomy (69 patients). Biochemical failure-free survival (BFFS) curves were compared within each group to determine the influence of age and race on biochemical control. RESULTS BFFS curves for the entire study population did not reveal any statistically significant difference when separated by age (younger than 60 years versus 60 to 69 years versus 70 years or older; 4-year BFFS 75% versus 70% versus 72%, respectively; P = 0.773) or by race (African American versus white; 4-year BFFS 74% versus 70%, respectively; P = 0.469). Additionally, no statistically significant differences were observed as a function of stage or age within either category (intact prostate or postprostatectomy). CONCLUSIONS Age and race did not, in our study, independently influence biochemical control after RT for nonmetastatic prostate cancer. On the basis of the results of this study, age and race should not be used as independent factors in treatment decision-making and in patient counseling concerning prostate cancer.
Collapse
Affiliation(s)
- Ashesh B Jani
- Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, Illinois 60637, USA.
| | | |
Collapse
|
18
|
Jani AB, Parikh SD, Vijayakumar S, Gratzle J. Analysis of influence of age on acute and chronic radiotherapy toxicity in treatment of prostate cancer. Urology 2005; 65:1157-62. [PMID: 15913725 DOI: 10.1016/j.urology.2004.12.041] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2004] [Revised: 11/23/2004] [Accepted: 12/15/2004] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To provide a single-institution analysis of the influence of age on acute and late genitourinary (GU) and gastrointestinal (GI) toxicity after radiotherapy (RT) administered in different prostate cancer scenarios. Improved understanding of the influence of age on toxicity outcome after RT for prostate cancer can assist in treatment decision-making. METHODS The records of 527 consecutive nonmetastatic patients receiving RT at a single institution and for whom demographic, disease, treatment, and follow-up information were available were reviewed. The cohort was divided into four major categories as a function of age: younger than 60 years, 60 to 69 years, 70 to 74 years, and 75 years and older. The toxicity rates in each of these categories were tabulated according to the Radiation Therapy Oncology Group toxicity scales and compared using the chi-square test. Additionally, an ordered logit regression analysis was performed for each of these categories using all major patient, disease, and treatment factors. RESULTS The toxicity rates were not significantly different as a function of age for either acute GU (P = 0.10) or acute GI (P = 0.19) toxicity or for either late GU (P = 0.22) or late GI (P = 0.09) toxicity. The ordered logit regression analysis showed that age was not a factor that correlated with toxicity in any setting (acute GU, P = 0.44; acute GI, P = 0.55; late GU, P = 0.65; late GI, P = 0.14). CONCLUSIONS Patient age did not independently influence GI or GU toxicity after RT for nonmetastatic prostate cancer and should not be used as an independent factor in treatment decision-making or in patient counseling with regard to GI and GU toxicity outcomes after RT.
Collapse
Affiliation(s)
- Ashesh B Jani
- Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, Illinois 60637, USA.
| | | | | | | |
Collapse
|
19
|
Ferrer González F, Casas Duran F, Biete Solà A. Impacto de la edad y de la comorbilidad en la supervivencia y toxicidad del paciente con cáncer de próstata irradiado. Med Clin (Barc) 2005; 125:121-6. [PMID: 15989851 DOI: 10.1157/13076949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE We intended to assess the impact of age on radiation outcome in patients treated for prostate cancer with 2D planning radiation therapy in clinical practice at the Hospital Clínic of Barcelona Radiation Oncology Department. PATIENTS AND METHOD One hundred eighty three patients, treated from November 1993 to April 1999, were included. Median follow-up was 41.8 months and median age was 70 years old. Median dose to prostate was 70 Gy. Univariate (Kaplan-Meier with log rank test comparison) and multivariate analysis (Cox's regression models) were done to assess the effect of age on toxicity and to study prognostic factors for disease control, survival and radiation treatment toxicity. RESULTS Five years disease free survival probability was 61.94%, with an overall survival probability of 82.83%. Although comorbidity increased significantly with age, reduced overall survival by a factor of 0.4, from 94.85% to 78.55% at 5 years. No differences were seen with regard to age in acute or late toxicity. Five years toxicity free probability was 66.46%. CONCLUSIONS Comorbidities decrease life expectancy in prostate cancer patients treated with radiation. Age does not necessarily suppose an increased risk of late toxicity for selected patients.
Collapse
Affiliation(s)
- Ferran Ferrer González
- Institut d'Oncologia Radioteràpica, IMAS, Avda. Sant Josep de la Muntanya 12, 08024 Barcelona, Spain.
| | | | | |
Collapse
|
20
|
Hall WH, Jani AB, Ryu JK, Narayan S, Vijayakumar S. The impact of age and comorbidity on survival outcomes and treatment patterns in prostate cancer. Prostate Cancer Prostatic Dis 2005; 8:22-30. [PMID: 15700051 DOI: 10.1038/sj.pcan.4500772] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The management of localized prostate cancer is based on stage, grade, PSA, and subjective assessment of comorbidity and life expectancy. Over the last 15 y, stage migration and the improved use of Gleason sum, PSA and TNM staging have led to many treatment options for patients with newly diagnosed localized prostate cancer. At the same time, advances in treatment techniques have helped decrease the long-term complications of surgery and radiotherapy. However, the importance of age and comorbidity, in survival outcomes and treatment decision-making has been largely overlooked. Currently, stage, grade, and PSA are the only quantifiable variables consistently used in research and treatment decision-making. Comorbidity and life expectancy have remained largely subjective variables. Increasing longevity and a rapidly aging population have made age and comorbidity increasingly important factors in clinical research and treatment decision-making. This article reviews the importance of age and comorbidity on treatment decisions and survival outcomes in prostate cancer, as well as their use as objectively quantifiable variables. Examples from the general oncology literature are given. The overview also examines validated comorbidity indices and advocates the use of the Charlson Comorbidity Index (CCI) in research outcomes and treatment decision-making in prostate cancer. Several clinical vignettes are provided to demonstrate the potential clinical utility of the CCI as applied to prostate cancer.
Collapse
Affiliation(s)
- W H Hall
- Department of Radiation Oncology, UC Davis Cancer Center, University of California, Davis, 4501 X Street, Sacramento, CA 95817, USA
| | | | | | | | | |
Collapse
|
21
|
Villa S, Bedini N, Fallai C, Olmi P. External beam radiotherapy in elderly patients with clinically localized prostate adenocarcinoma: age is not a problem. Crit Rev Oncol Hematol 2003; 48:215-25. [PMID: 14607384 DOI: 10.1016/j.critrevonc.2003.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The files of 183 elderly patients aged >70 years, with localized prostate cancer (T1-3, N0-X, M0), treated with radical external radiation therapy (ERT) from January 1992 to December 2001 at the Radiotherapy Department of the Istituto Nazionale Tumori of Milan, were reviewed. Median age was 75 years. ERT represented the sole treatment for 73 patients (39.9%); in 110 cases (60.1%) hormonal therapy (HT) was associated with neoadjuvant intent. Five-year overall, disease-specific and biochemical NED (bNED) survival rates were 90.2, 93.7 and 63.2%, respectively. A subset of 23 patients aged 80 years and over were analyzed and compared to 160 men aged 70-79 years. Acute toxicity and late complications were analyzed in the two groups of patients according to the RTOG scoring system. Only 10 patients (5.4%) showed grades 2-3 (G2-3) late sequelae. The results obtained in this single-institute series highlight the pivotal role of ERT in the management of clinically localized prostate cancer in the elderly.
Collapse
Affiliation(s)
- Sergio Villa
- Department of Radiotherapy, Istituto Nazionale Tumori, Milan, Italy.
| | | | | | | |
Collapse
|