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Chen MS, Howard LE, Stock S, Dolgner A, Freedland SJ, Aronson W, Terris M, Klaassen Z, Kane C, Amling C, Cooperberg M, Daskivich TJ. Validation of the prostate cancer comorbidity index in predicting cause-specific mortality in men undergoing radical prostatectomy. Prostate Cancer Prostatic Dis 2023; 26:715-721. [PMID: 35668181 DOI: 10.1038/s41391-022-00550-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/17/2022] [Accepted: 04/22/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Accurate prediction of competing risks of mortality remains a key component of prostate cancer treatment decision-making. We sought to validate the Prostate Cancer Comorbidity Index (PCCI) score for predicting other-cause mortality (OCM) and cancer outcomes in men undergoing radical prostatectomy (RP). MATERIALS AND METHODS We sampled 4857 men with prostate cancer treated with RP in the VA from 2000-2018. Risks of OCM, 90-day all-cause mortality (ACM), prostate cancer-specific mortality, metastasis, and biochemical recurrence by PCCI score were assessed using Cox proportional hazards and logistic regression. We compared prediction of 90-day ACM between PCCI and the American Society of Anesthesiology (ASA) score, a validated predictor of short-term mortality. RESULTS Over median follow-up of 6.7 years (IQR 3.7-10.3), there was a stepwise increase in risk of OCM with higher PCCI score, with hazards (95%CI) of 1.53 (1.14-2.04), 2.11 (1.55-2.88), 2.36 (1.68-3.31), 3.61 (2.61-4.98), and 4.99 (3.58-6.96) for PCCI 1-2, 3-4, 5-6, 7-9, and 10 + (vs. 0), respectively. Projected 10-year cumulative incidence of OCM was 8%, 12%, 16%, 19%, 26%, and 32% for scores of 0, 1-2, 3-4, 5-6, 7-9, and 10+ , respectively. Men with PCCI 7+ had greater odds of 90-day ACM (OR 3.48, 95%CI 1.26-9.63) while men with higher ASA did not. Higher PCCI score was associated with worse cancer outcomes, with the highest categories driving the associations. CONCLUSIONS The PCCI is a robust measure of short- and long-term OCM after RP, validated for use in clinical care and health services research focusing on surgical patient populations.
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Affiliation(s)
- Michelle S Chen
- University of California, San Diego School of Medicine, La Jolla, CA, USA
| | - Lauren E Howard
- Section of Urology, Durham VA Medical Center, Durham, NC, USA
- Department of Urology, Duke University, Durham, NC, USA
| | - Shannon Stock
- Section of Urology, Durham VA Medical Center, Durham, NC, USA
- Department of Mathematics and Computer Science, College of the Holy Cross, Worcester, MA, USA
| | | | - Stephen J Freedland
- Section of Urology, Durham VA Medical Center, Durham, NC, USA
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - William Aronson
- Division of Urology, West Los Angeles VA Medical Center, Los Angeles, CA, USA
- Department of Urology, UCLA Medical Center, Los Angeles, CA, USA
| | - Martha Terris
- Divison of Urology, Charlie Norwood VA Medical Center, Augusta, GA, USA
- Division of Urology, Department of Surgery, Augusta University-Medical College of Georgia, Augusta, GA, USA
| | - Zachary Klaassen
- Divison of Urology, Charlie Norwood VA Medical Center, Augusta, GA, USA
- Division of Urology, Department of Surgery, Augusta University-Medical College of Georgia, Augusta, GA, USA
| | - Christopher Kane
- Department of Urology, University of California, San Diego, CA, USA
| | - Christopher Amling
- Department of Urology, Oregon Health Sciences University, Portland, OR, USA
| | - Matthew Cooperberg
- Department of Urology, University of California, San Francisco, CA, USA
- Section of Urology, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Timothy J Daskivich
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Courtney PT, Deka R, Kotha NV, Cherry DR, Salans MA, Nelson TJ, Kumar A, Luterstein E, Yip AT, Nalawade V, Parsons JK, Kader AK, Stewart TF, Rose BS. Metastasis and Mortality in Men With Low- and Intermediate-Risk Prostate Cancer on Active Surveillance. J Natl Compr Canc Netw 2022; 20:151-159. [PMID: 35130495 PMCID: PMC10399925 DOI: 10.6004/jnccn.2021.7065] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/27/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Active surveillance (AS) is a safe treatment option for men with low-risk, localized prostate cancer. However, the safety of AS for patients with intermediate-risk prostate cancer remains unclear. PATIENTS AND METHODS We identified men with NCCN-classified low-risk and favorable and unfavorable intermediate-risk prostate cancer diagnosed between 2001 and 2015 and initially managed with AS in the Veterans Health Administration. We analyzed progression to definitive treatment, metastasis, prostate cancer-specific mortality (PCSM), and all-cause mortality using cumulative incidences and multivariable competing-risks regression. RESULTS The cohort included 9,733 men, of whom 1,007 (10.3%) had intermediate-risk disease (773 [76.8%] favorable, 234 [23.2%] unfavorable), followed for a median of 7.6 years. The 10-year cumulative incidence of metastasis was significantly higher for patients with favorable (9.6%; 95% CI, 7.1%-12.5%; P<.001) and unfavorable intermediate-risk disease (19.2%; 95% CI, 13.4%-25.9%; P<.001) than for those with low-risk disease (1.5%; 95% CI, 1.2%-1.9%). The 10-year cumulative incidence of PCSM was also significantly higher for patients with favorable (3.7%; 95% CI, 2.3%-5.7%; P<.001) and unfavorable intermediate-risk disease (11.8%; 95% CI, 6.8%-18.4%; P<.001) than for those with low-risk disease (1.1%; 95% CI, 0.8%-1.4%). In multivariable competing-risks regression, favorable and unfavorable intermediate-risk patients had significantly increased risks of metastasis and PCSM compared with low-risk patients (all P<.001). CONCLUSIONS Compared with low-risk patients, those with favorable and unfavorable intermediate-risk prostate cancer managed with AS are at increased risk of metastasis and PCSM. AS may be an appropriate option for carefully selected patients with favorable intermediate-risk prostate cancer, though identification of appropriate candidates and AS protocols should be tested in future prospective studies.
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Affiliation(s)
- P Travis Courtney
- 1Veterans Health Administration San Diego Health Care System, and.,2Department of Radiation Medicine and Applied Sciences
| | - Rishi Deka
- 1Veterans Health Administration San Diego Health Care System, and.,2Department of Radiation Medicine and Applied Sciences
| | - Nikhil V Kotha
- 1Veterans Health Administration San Diego Health Care System, and.,2Department of Radiation Medicine and Applied Sciences
| | - Daniel R Cherry
- 1Veterans Health Administration San Diego Health Care System, and.,2Department of Radiation Medicine and Applied Sciences
| | - Mia A Salans
- 1Veterans Health Administration San Diego Health Care System, and.,2Department of Radiation Medicine and Applied Sciences
| | - Tyler J Nelson
- 1Veterans Health Administration San Diego Health Care System, and.,2Department of Radiation Medicine and Applied Sciences
| | - Abhishek Kumar
- 1Veterans Health Administration San Diego Health Care System, and.,2Department of Radiation Medicine and Applied Sciences
| | - Elaine Luterstein
- 1Veterans Health Administration San Diego Health Care System, and.,2Department of Radiation Medicine and Applied Sciences
| | - Anthony T Yip
- 2Department of Radiation Medicine and Applied Sciences
| | | | - J Kellogg Parsons
- 1Veterans Health Administration San Diego Health Care System, and.,3Department of Urology, School of Medicine, University of California, San Diego.,4Janssen Pharmaceuticals Research and Development, LCC; and
| | - A Karim Kader
- 1Veterans Health Administration San Diego Health Care System, and.,3Department of Urology, School of Medicine, University of California, San Diego
| | - Tyler F Stewart
- 1Veterans Health Administration San Diego Health Care System, and.,4Janssen Pharmaceuticals Research and Development, LCC; and
| | - Brent S Rose
- 1Veterans Health Administration San Diego Health Care System, and.,2Department of Radiation Medicine and Applied Sciences
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3
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Courtney PT, Deka R, Kotha NV, Cherry DR, Salans MA, Nelson TJ, Kumar A, Luterstein E, Yip AT, Nalawade V, Parsons JK, Kader AK, Stewart TF, Rose BS. Active surveillance for intermediate-risk prostate cancer in African American and non-Hispanic White men. Cancer 2021; 127:4403-4412. [PMID: 34347291 DOI: 10.1002/cncr.33824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/26/2021] [Accepted: 06/21/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND The safety of active surveillance (AS) for African American men compared with non-Hispanic White (White) men with intermediate-risk prostate cancer is unclear. METHODS The authors identified patients with modified National Comprehensive Cancer Network favorable ("low-intermediate") and unfavorable ("high-intermediate") intermediate-risk prostate cancer diagnosed between 2001 and 2015 and initially managed with AS in the Veterans Health Administration database. They analyzed definitive treatment, disease progression, metastases, prostate cancer-specific mortality (PCSM), and all-cause mortality by using cumulative incidences and multivariable competing-risks (disease progression, metastasis, and PCSM) or Cox (all-cause mortality) regression. RESULTS The cohort included 1007 men (African Americans, 330 [32.8%]; Whites, 677 [67.2%]) followed for a median of 7.7 years; 773 (76.8%) had low-intermediate-risk disease, and 234 (23.2%) had high-intermediate-risk disease. The 10-year cumulative incidences of definitive treatment were not significantly different (African Americans, 83.5%; 95% confidence interval [CI], 78.5%-88.7%; Whites, 80.6%; 95% CI, 76.6%-84.4%; P = .17). Among those with low-intermediate-risk disease, there were no significant differences in the 10-year cumulative incidences of disease progression (African Americans, 46.8%; 95% CI, 40.0%-53.3%; Whites, 46.9%; 95% CI, 42.1%-51.5%; P = .91), metastasis (African Americans, 7.1%; 95% CI, 3.7%-11.8%; Whites, 10.8%; 95% CI, 7.6%-14.6%; P = .17), or PCSM (African Americans, 3.8%; 95% CI, 1.6%-7.5%; Whites, 3.8%; 95% CI, 2.0%-6.3%; P = .69). In a multivariable regression including the entire cohort, African American race was not associated with increased risks of definitive treatment, disease progression, metastasis, PCSM, or all-cause mortality (all P > .30). CONCLUSIONS Outcomes in the Veterans Affairs Health System were similar for African American and White men treated for low-intermediate-risk prostate cancer with AS.
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Affiliation(s)
- P Travis Courtney
- Veterans Health Administration San Diego Health Care System, La Jolla, California.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California
| | - Rishi Deka
- Veterans Health Administration San Diego Health Care System, La Jolla, California.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California
| | - Nikhil V Kotha
- Veterans Health Administration San Diego Health Care System, La Jolla, California.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California
| | - Daniel R Cherry
- Veterans Health Administration San Diego Health Care System, La Jolla, California.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California
| | - Mia A Salans
- Veterans Health Administration San Diego Health Care System, La Jolla, California.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California
| | - Tyler J Nelson
- Veterans Health Administration San Diego Health Care System, La Jolla, California.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California
| | - Abhishek Kumar
- Veterans Health Administration San Diego Health Care System, La Jolla, California.,Department of Medicine, University of California San Diego School of Medicine, La Jolla, California
| | - Elaine Luterstein
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California
| | - Anthony T Yip
- Veterans Health Administration San Diego Health Care System, La Jolla, California.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California
| | - Vinit Nalawade
- Veterans Health Administration San Diego Health Care System, La Jolla, California.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California
| | - J Kellogg Parsons
- Veterans Health Administration San Diego Health Care System, La Jolla, California.,Department of Urology, University of California San Diego School of Medicine, La Jolla, California
| | - A Karim Kader
- Veterans Health Administration San Diego Health Care System, La Jolla, California.,Department of Urology, University of California San Diego School of Medicine, La Jolla, California
| | - Tyler F Stewart
- Division of Hematology-Oncology, Department of Medicine, University of California San Diego, La Jolla, California
| | - Brent S Rose
- Veterans Health Administration San Diego Health Care System, La Jolla, California.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California
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Rude T, Walter D, Ciprut S, Kelly MD, Wang C, Fagerlin A, Langford AT, Lepor H, Becker DJ, Li H, Loeb S, Ravenell J, Leppert JT, Makarov DV. Interaction between race and prostate cancer treatment benefit in the Veterans Health Administration. Cancer 2021; 127:3985-3990. [PMID: 34184271 DOI: 10.1002/cncr.33643] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/09/2021] [Accepted: 04/06/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Studies have demonstrated that Black men may undergo definitive prostate cancer (CaP) treatment less often than men of other races, but it is unclear whether they are avoiding overtreatment of low-risk disease or experiencing a reduction in appropriate care. The authors' aim was to assess the role of race as it relates to treatment benefit in access to CaP treatment in a single-payer population. METHODS The authors used the Veterans Health Administration (VHA) Corporate Data Warehouse to perform a retrospective cohort study of veterans diagnosed with low- or intermediate-risk CaP between 2011 and 2017. RESULTS The authors identified 35,427 men with incident low- or intermediate-risk CaP. When they controlled for covariates, Black men had 1.05 times the odds of receiving treatment in comparison with non-Black men (P < .001), and high-treatment-benefit men had 1.4 times the odds of receiving treatment in comparison with those in the low-treatment-benefit group (P < .001). The interaction of race and treatment benefit was significant, with Black men in the high-treatment-benefit category less likely to receive treatment than non-Black men in the same treatment category (odds ratio, 0.89; P < .001). CONCLUSIONS Although race does appear to influence the receipt of definitive treatment in the VHA, this relationship varies in the context of the patient's treatment benefit, with Black men receiving less definitive treatment in high-benefit situations. The influence of patient race at high treatment benefit levels invites further investigation into the driving forces behind this persistent disparity in this consequential group.
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Affiliation(s)
- Temitope Rude
- Department of Urology, New York University, New York, New York
| | - Dawn Walter
- Department of Urology, New York University, New York, New York.,Department of Population Health, New York University, New York, New York.,Perlmutter Cancer Center, New York University, New York, New York.,VA New York Harbor Healthcare System, New York, New York
| | - Shannon Ciprut
- Department of Urology, New York University, New York, New York.,Department of Population Health, New York University, New York, New York.,Perlmutter Cancer Center, New York University, New York, New York.,VA New York Harbor Healthcare System, New York, New York
| | - Matthew D Kelly
- Department of Urology, New York University, New York, New York.,Department of Population Health, New York University, New York, New York.,Perlmutter Cancer Center, New York University, New York, New York.,VA New York Harbor Healthcare System, New York, New York
| | - Chan Wang
- Department of Population Health, New York University, New York, New York
| | - Angela Fagerlin
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences Center for Innovation, Salt Lake City, Utah.,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Aisha T Langford
- Department of Population Health, New York University, New York, New York
| | - Herbert Lepor
- Department of Urology, New York University, New York, New York.,Perlmutter Cancer Center, New York University, New York, New York
| | - Daniel J Becker
- Perlmutter Cancer Center, New York University, New York, New York.,VA New York Harbor Healthcare System, New York, New York
| | - Huilin Li
- Perlmutter Cancer Center, New York University, New York, New York
| | - Stacy Loeb
- Department of Urology, New York University, New York, New York.,Department of Population Health, New York University, New York, New York.,Perlmutter Cancer Center, New York University, New York, New York.,VA New York Harbor Healthcare System, New York, New York
| | - Joseph Ravenell
- Department of Population Health, New York University, New York, New York
| | - John T Leppert
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California.,Department of Urology, Stanford University School of Medicine, Palo Alto, California.,Division of Nephrology, Department of Urology, VA Palo Alto Health Care System, Palo Alto, California
| | - Danil V Makarov
- Department of Urology, New York University, New York, New York.,Department of Population Health, New York University, New York, New York.,Perlmutter Cancer Center, New York University, New York, New York.,VA New York Harbor Healthcare System, New York, New York.,Robert F. Wagner Graduate School of Public Service, New York University, New York, New York
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5
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Patient-reported Health Status, Comorbidity Burden, and Prostate Cancer Treatment. Urology 2020; 149:103-109. [PMID: 33352164 DOI: 10.1016/j.urology.2020.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/03/2020] [Accepted: 12/10/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine whether patient-reported health status, more so than comorbidity, influences treatment in men with localized prostate cancer. METHODS Using Surveillance, Epidemiology, and End Results data linked with Medicare claims and CAHPS surveys, we identified men aged 65-84 diagnosed with localized prostate cancer from 2004 to 2013 and ascertained their National Cancer Institute (NCI) comorbidity score and patient-reported health status. Adjusting for demographics and cancer risk, we examined the relationship between these measures and treatment for the overall cohort, low-risk men aged 65-74, intermediate/high-risk men aged 65-74, and men aged 75-84. RESULTS Among 2724 men, 43.0% rated their overall health as Excellent/Very Good, while 62.7% had a comorbidity score of 0. Beyond age and cancer risk, patient-reported health status was significantly associated with treatment. Compared to men reporting Excellent/Very Good health, men in Poor/Fair health less often received treatment (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.56-0.90). Younger men with intermediate/high-risk cancer in Good (OR 0.60, 95% CI 0.41-0.88) or Fair/Poor (OR 0.49, 95% CI 0.30-0.79) health less often underwent prostatectomy vs radiation compared to men in Excellent/Very Good health. In contrast, men with NCI comorbidity score of 1 more often received treatment (OR 1.37, 95% CI 1.11-1.70) compared to men with NCI comorbidity score of 0. CONCLUSION Patient-reported health status drives treatment for prostate cancer in an appropriate direction whereas comorbidity has an inconsistent relationship. Greater understanding of this interplay between subjective and empiric assessments may facilitate more shared decision-making in prostate cancer care.
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European Society for Sexual Medicine Consensus Statement on the Use of the Cavernous Nerve Injury Rodent Model to Study Postradical Prostatectomy Erectile Dysfunction. Sex Med 2020; 8:327-337. [PMID: 32674971 PMCID: PMC7471127 DOI: 10.1016/j.esxm.2020.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/16/2020] [Accepted: 06/14/2020] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Rodent animal models are currently the most used in vivo model in translational studies looking into the pathophysiology of erectile dysfunction after nerve-sparing radical prostatectomy. AIM This European Society for Sexual Medicine (ESSM) statement aims to guide scientists toward utilization of the rodent model in an appropriate, timely, and proficient fashion. METHODS MEDLINE and EMBASE databases were searched for basic science studies, using a rodent animal model, looking into the consequence of pelvic nerve injury on erectile function. MAIN OUTCOME MEASURES The authors present a consensus on how to best perform experiments with this rodent model, the details of the technique, and highlight possible pitfalls. RESULTS Owing to the specific issue-basic science-Oxford 2011 Levels of Evidence criteria cannot be applied. However, ESSM statements on this topic will be provided in which we summarize the ESSM position on various aspects of the model such as the use of the Animal Research Reporting In Vivo Experiments guideline and the of common range parameter for nerve stimulation. We also highlighted the translational limits of the model. CONCLUSION The following statements were formulated as a suggestive guidance for scientists using the cavernous nerve injury model. With this, we hope to standardize and further improve the quality of research in this field. It must be noted that this model has its limitations. Weyne E, Ilg MM, Cakir OO, et al. European Society for Sexual Medicine Consensus Statement on the Use of the Cavernous Nerve Injury Rodent Model to Study Postradical Prostatectomy Erectile Dysfunction. Sex Med 2020;8:327-337.
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7
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Contemporary Management of Incident Prostate Cancer in Large Community Urology Practices in the United States. Urology 2019; 129:79-86. [DOI: 10.1016/j.urology.2019.01.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/08/2019] [Accepted: 01/31/2019] [Indexed: 01/17/2023]
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Daskivich TJ, Wood LN, Skarecky D, Ahlering T, Freedland S. Limitations of the National Comprehensive Cancer Network
®
(NCCN
®
) Guidelines for Prediction of Limited Life Expectancy in Men with Prostate Cancer. J Urol 2017; 197:356-362. [DOI: 10.1016/j.juro.2016.08.096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Timothy J. Daskivich
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California
- Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, California
| | - Lauren N. Wood
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Douglas Skarecky
- Department of Urology, University of California, Irvine, Irvine, California
- Long Beach Veterans Affairs Medical Center, Long Beach, California
| | - Thomas Ahlering
- Department of Urology, University of California, Irvine, Irvine, California
| | - Stephen Freedland
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California
- Durham Veterans Affairs Medical Center, Durham, North Carolina
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Tosoian JJ, Chappidi M, Feng Z, Humphreys EB, Han M, Pavlovich CP, Epstein JI, Partin AW, Trock BJ. Prediction of pathological stage based on clinical stage, serum prostate-specific antigen, and biopsy Gleason score: Partin Tables in the contemporary era. BJU Int 2016; 119:676-683. [PMID: 27367645 DOI: 10.1111/bju.13573] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To update the Partin Tables for prediction of pathological stage in the contemporary setting and examine trends in patients treated with radical prostatectomy (RP) over the past three decades. PATIENTS AND METHODS From January 2010 to October 2015, 4459 men meeting inclusion criteria underwent RP and pelvic lymphadenectomy for histologically confirmed prostate cancer at the Johns Hopkins Hospital. Preoperative clinical stage, serum prostate-specific antigen (PSA) level, and biopsy Gleason score (i.e. prognostic Grade Group) were used in a polychotomous logistic regression model to predict the probability of pathological outcomes categorised as: organ-confined (OC), extraprostatic extension (EPE), seminal vesicle involvement (SV+), or lymph node involvement (LN+). Preoperative characteristics and pathological findings in men treated with RP since 1983 were collected and clinical-pathological trends were described. RESULTS The median (range) age at surgery was 60 (34-77) years and the median (range) PSA level was 4.9 (0.1-125.0) ng/mL. The observed probabilities of pathological outcomes were: OC disease in 74%, EPE in 20%, SV+ in 4%, and LN+ in 2%. The probability of EPE increased substantially when biopsy Gleason score increased from 6 (Grade Group 1, GG1) to 3 + 4 (GG2), with smaller increases for higher grades. The probability of LN+ was substantially higher for biopsy Gleason score 9-10 (GG5) as compared to lower Gleason scores. Area under the receiver operating characteristic curves for binary logistic models predicting EPE, SV+, and LN+ vs OC were 0.724, 0.856, and 0.918, respectively. The proportion of men treated with biopsy Gleason score ≤6 cancer (GG1) was 47%, representing a substantial decrease from 63% in the previous cohort and 77% in 2000-2005. The proportion of men with OC cancer has remained similar during that time, equalling 73-74% overall. The proportions of men with SV+ (4.1% from 3.4%) and LN+ (2.3% from 1.4%) increased relative to the preceding era for the first time since the Partin Tables were introduced in 1993. CONCLUSIONS The Partin Tables remain a straightforward and accurate approach for projecting pathological outcomes based on readily available clinical data. Acknowledging these data are derived from a tertiary care referral centre, the proportion of men with OC disease has remained stable since 2000, despite a substantial decline in the proportion of men with biopsy Gleason score 6 (GG1). This is consistent with the notion that many men with Gleason score 6 (GG1) disease were over treated in previous eras.
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Affiliation(s)
- Jeffrey J Tosoian
- The James Buchanan Brady Urological Institute and Department of Urology at the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Meera Chappidi
- The James Buchanan Brady Urological Institute and Department of Urology at the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zhaoyong Feng
- The James Buchanan Brady Urological Institute and Department of Urology at the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth B Humphreys
- The James Buchanan Brady Urological Institute and Department of Urology at the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Misop Han
- The James Buchanan Brady Urological Institute and Department of Urology at the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christian P Pavlovich
- The James Buchanan Brady Urological Institute and Department of Urology at the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan I Epstein
- The James Buchanan Brady Urological Institute and Department of Urology at the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alan W Partin
- The James Buchanan Brady Urological Institute and Department of Urology at the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bruce J Trock
- The James Buchanan Brady Urological Institute and Department of Urology at the Johns Hopkins University School of Medicine, Baltimore, MD, USA
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10
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Tosoian JJ, Carter HB, Lepor A, Loeb S. Active surveillance for prostate cancer: current evidence and contemporary state of practice. Nat Rev Urol 2016; 13:205-15. [PMID: 26954332 DOI: 10.1038/nrurol.2016.45] [Citation(s) in RCA: 166] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Prostate cancer remains one of the most commonly diagnosed malignancies worldwide. Early diagnosis and curative treatment seem to improve survival in men with unfavourable-risk cancers, but significant concerns exist regarding the overdiagnosis and overtreatment of men with lower-risk cancers. To this end, active surveillance (AS) has emerged as a primary management strategy in men with favourable-risk disease, and contemporary data suggest that use of AS has increased worldwide. Although published surveillance cohorts differ by protocol, reported rates of metastatic disease and prostate-cancer-specific mortality are exceedingly low in the intermediate term (5-10 years). Such outcomes seem to be closely associated with programme-specific criteria for selection, monitoring, and intervention, suggesting that AS--like other management strategies--could be individualized based on the level of risk acceptable to patients in light of their personal preferences. Additional data are needed to better establish the risks associated with AS and to identify patient-specific characteristics that could modify prognosis.
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Affiliation(s)
- Jeffrey J Tosoian
- Brady Urological Institute, Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Baltimore, Maryland 21287-2101, USA
| | - H Ballentine Carter
- Brady Urological Institute, Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Baltimore, Maryland 21287-2101, USA
| | - Abbey Lepor
- Department of Urology, New York University, 550 1st Avenue (VZ30 #612), New York, New York 10016, USA
| | - Stacy Loeb
- Department of Urology, New York University, 550 1st Avenue (VZ30 #612), New York, New York 10016, USA.,Depatment of Population Health, New York University. 550 1st Avenue (VZ30 #612), New York, New York 10016, USA.,The Laura &Isaac Perlmutter Cancer Center, New York University, 550 1st Avenue (VZ30 #612), New York, New York 10016, USA
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