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Ha JS, Kim DK, Lee HS, Jeon S, Jeon J, Kim D, Kim JS, Kim B, Kim M, Cho KS. Androgen Deprivation Therapy and Newly Developed Neovascular Age-Related Macular Degeneration Risk in Patients with Prostate Cancer. J Clin Med 2024; 13:2978. [PMID: 38792519 PMCID: PMC11121844 DOI: 10.3390/jcm13102978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: to evaluate the association between androgen deprivation therapy (ADT) and newly developed neovascular age-related macular degeneration (AMD) in patients with prostate cancer. Methods: We identified 228,803 men from the nationwide claims database in the Republic of Korea diagnosed with prostate cancer between 1 August 2009 and 31 December 2018 and followed until April 2021. Cases were defined as those newly diagnosed with neovascular AMD during follow-up. Cases were matched with controls based on age, index date, and follow-up duration, at a case-to-control ratio of 1:4. Adjusted odds ratios (aORs) of incident neovascular AMD associated with ADT were estimated using conditional logistic regression. Results: The main analysis included 1700 cases and 6800 controls, with a median follow-up of 3.42 years. ADT was associated with a reduced risk of incident neovascular AMD in patients with prostate cancer (aOR = 0.840; 95% confidence interval [CI], 0.743-0.951; p = 0.0058) in the multivariable analysis. A cumulative ADT duration less than 1 year was associated with a reduced risk of neovascular AMD (aOR = 0.727; 95% CI, 0.610-0.866; p = 0.0004); however, no association was observed when the duration of ADT was between 1 and 2 years (aOR = 0.862; 95% CI, 0.693-1.074; p = 0.1854) or more than 2 years (aOR = 1.009; 95% CI, 0.830-1.226; p = 0.9304). Conclusions: In patients with prostate cancer, medical castration for less than a year is associated with a reduced risk of incident neovascular AMD. These results suggest that androgens are involved in the pathogenesis of neovascular AMD.
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Affiliation(s)
- Jee Soo Ha
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.S.H.); (D.K.K.); (J.J.); (D.K.); (J.S.K.); (B.K.)
| | - Do Kyung Kim
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.S.H.); (D.K.K.); (J.J.); (D.K.); (J.S.K.); (B.K.)
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (H.S.L.); (S.J.)
| | - Soyoung Jeon
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (H.S.L.); (S.J.)
| | - Jinhyung Jeon
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.S.H.); (D.K.K.); (J.J.); (D.K.); (J.S.K.); (B.K.)
| | - Daeho Kim
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.S.H.); (D.K.K.); (J.J.); (D.K.); (J.S.K.); (B.K.)
| | - June Seok Kim
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.S.H.); (D.K.K.); (J.J.); (D.K.); (J.S.K.); (B.K.)
| | - Byeongseon Kim
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.S.H.); (D.K.K.); (J.J.); (D.K.); (J.S.K.); (B.K.)
| | - Min Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea;
| | - Kang Su Cho
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.S.H.); (D.K.K.); (J.J.); (D.K.); (J.S.K.); (B.K.)
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul 03722, Republic of Korea
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Mouzannar A, Delgado J, Kwon D, Atluri VS, Mason MM, Prakash NS, Zhao W, Nahar B, Swain S, Punnen S, Gonzalgo ML, Parekh DJ, Deane LA, Ritch CR. Racial disparity in the utilization of immunotherapy for advanced prostate cancer. J Natl Med Assoc 2023; 115:566-576. [PMID: 37903694 DOI: 10.1016/j.jnma.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/16/2023] [Accepted: 09/26/2023] [Indexed: 11/01/2023]
Abstract
PURPOSE To identify whether there was a disparity in the utilization of immunotherapy in the treatment of black patients with metastatic castration resistant prostate cancer (mCRPC). METHODS Using the National Cancer Database, we identified patients between 2010- 2015 with likely minimally/asymptomatic mCRPC. We analyzed annual trends for chemotherapy and immunotherapy use and compared utilization by demographic and clinical features. Multivariable analysis was performed to determine predictors of receiving immunotherapy vs chemotherapy. RESULTS We identified 1301 patients with likely mCRPC. The majority were non Hispanic White (NHW - 63 %) and 23 % were non-Hispanic Black (NHB). Overall, there was increased utilization of immunotherapy in mCRPC from 2010 onwards, with the peak occurring in 2014 (4.6 %). Chemotherapy use increased significantly, peaking in 2014 to 26.1 %. However, the increased utilization of immunotherapy in the mCRPC was mainly seen in White patients: from 50 % to 74.2 % of the cohort. Conversely, there was a decrease in utilization of immunotherapy among Black mCPRC patients: from 50 % to 25.8 %. On multivariable analysis, there was no statistically significant difference between treatment types by race. CONCLUSION FDA approval of Sipuleucel-T for mCRPC led to increased utilization of immunotherapy shortly thereafter, but this was mainly noted in white patients. Black patients comparatively did not exhibit increased utilization of this novel agent after 2010. Further studies are necessary to help understand barriers to access to new treatment in mCRPC and eliminate the burden of disease in minority populations."
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Affiliation(s)
| | | | - Deukwoo Kwon
- Biostatistics, University of Miami, Miller School of Medicine, 1120 NW 14th Street, 15th Floor, Miami, FL 33136, USA; Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL 33136, USA
| | | | | | | | - Wei Zhao
- Biostatistics, University of Miami, Miller School of Medicine, 1120 NW 14th Street, 15th Floor, Miami, FL 33136, USA
| | - Bruno Nahar
- Department of Urology, USA; Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL 33136, USA
| | - Sanjaya Swain
- Department of Urology, USA; Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL 33136, USA
| | - Sanoj Punnen
- Department of Urology, USA; Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL 33136, USA
| | - Mark L Gonzalgo
- Department of Urology, USA; Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL 33136, USA
| | - Dipen J Parekh
- Department of Urology, USA; Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL 33136, USA
| | | | - Chad R Ritch
- Department of Urology, USA; Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL 33136, USA
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Ha JS, Lee HS, Park JY, Jeon J, Kim DK, Kim M, Hwang HS, Kim TH, Ahn HK, Cho KS. Relationship between Androgen Deprivation Therapy and Normal-Tension Glaucoma in Patients with Prostate Cancer: A Nationwide Cohort Study. Yonsei Med J 2022; 63:908-914. [PMID: 36168243 PMCID: PMC9520039 DOI: 10.3349/ymj.2022.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/10/2022] [Accepted: 07/29/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study assessed the relationship between newly developed normal-tension glaucoma (NTG) and androgen deprivation therapy (ADT) in patients with prostate cancer. MATERIALS AND METHODS A retrospective population-based cohort study was performed. During the period between 2008 and 2017, a total of 218203 prostate cancer patients were identified in a nationwide claims database in the Republic of Korea. The final analysis included 170874 patients (42909 in the ADT group, 127965 in the control group) after applying the inclusion and exclusion criteria. The incidences of NTG according to ADT duration were compared with controls. Exact matching was conducted to adjust comorbidities between cohorts. Cox proportional hazard regression models were performed after controlling for latent confounding factors, and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of NTG according to ADT were obtained. RESULTS In the matched cohort, the ADT group was associated with a significantly reduced risk of NTG in multivariable analysis compared to the control group. The risk of NTG decreased in patients who underwent ADT for less than 2 years (HR=0.824; 95% CI, 0.682-0.995; p=0.0440) and in those using ADT over 2 years (HR=0.796; 95% CI, 0.678-0.934; p=0.0051), compared to the controls. CONCLUSION Medical castrations for patients with prostate cancer results in a lower incidence of newly diagnosed NTG compared to no ADT. These findings suggest that testosterone may be involved in the pathogenesis of NTG.
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Affiliation(s)
- Jee Soo Ha
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Ju-Young Park
- Department of Statistics and Data Science, Yonsei University, Seoul, Korea
| | - Jinhyung Jeon
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Do Kyung Kim
- Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Min Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Sik Hwang
- Department of Ophthalmology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae Hyo Kim
- Department of Urology, Dong-A University Hospital, Busan, Korea
| | - Hyun Kyu Ahn
- Department of Urology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Kang Su Cho
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea.
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Paul CJ, Garje R, Kreder KJ, Mott SL, Gellhaus PT. Significant financial differences of chemical and surgical androgen deprivation in a contemporary cohort. Transl Androl Urol 2022; 11:1252-1261. [PMID: 36217391 PMCID: PMC9547165 DOI: 10.21037/tau-22-191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/08/2022] [Indexed: 01/13/2023] Open
Abstract
Background Androgen deprivation therapy (ADT) remains a cornerstone of treatment for advanced prostate cancer. Few men elect for surgical castration via bilateral orchiectomy. We sought to compare the relative difference in financial charges between chemical and surgical ADT in men. Methods Billing data was obtained for patients with metastatic prostate cancer receiving chemical ADT and who had bilateral orchiectomy from 2014-2019. Men had chosen intervention based on personal preference. We compared charges of ADT administration for chemical ADT and overall charges for bilateral orchiectomy. We determined the time chemical ADT patient charges surpassed those of surgical charges, as well as the net present value (NPV) of hypothetical savings for electing surgery over various ADT agents. Results One hundred and thirty-seven patients receiving chemical ADT and 7 patients who had undergone bilateral orchiectomy were analyzed. Median and mean surgical charges were $13,000. By 38 weeks following treatment initiation, 50% of chemical ADT patients had surpassed surgical charges, with 95% at 2 years. The NPV in savings for a median patient varied between ADT agent and was highest at $167,000 for leuprolide. Conclusions In less than a year, the median chemical ADT patient charges were greater than surgical castration. The NPV of electing surgery over ADT was the highest with leuprolide. Despite under-utilization, surgical castration remains a medically appropriate and cost-effective option for permanent ADT.
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Affiliation(s)
- Charles J. Paul
- Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Rohan Garje
- Holden Comprehensive Cancer Center, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Karl J. Kreder
- Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Sarah L. Mott
- Holden Comprehensive Cancer Center, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Paul T. Gellhaus
- Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
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Concurrent Androgen Deprivation Therapy for Prostate Cancer Improves Survival for Synchronous or Metachronous Non-Small Cell Lung Cancer: A SEER-Medicare Database Analysis. Cancers (Basel) 2022; 14:cancers14133206. [PMID: 35804979 PMCID: PMC9265064 DOI: 10.3390/cancers14133206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: The crosstalk between receptor kinase signaling, such as EGFR and androgen receptor signaling, suggests a potential interaction between androgen deprivation therapy (ADT) and lung cancer outcome. Methods: We employed the SEER−Medicare data of lung cancer patients diagnosed between 1988 and 2005 to test for an association between ADT for prostate cancer and lung cancer outcome. We employed the Kaplan−Meier method and Cox proportional hazard with log-rank test model to assess any significant impact of ADT on survival. Results: We included data from 367,750 lung cancer patients; 17.4%, 2.9%, 33.6% and 46.1% with stages I, II, III and IV, respectively; 84.5% were >65 years; 57.2% males; 84.2% Caucasians and 9.3% Blacks. There were 11,061 patients (3%) with an initial prostate cancer diagnosis followed by lung cancer (P-L group); 3017 (0.8%) with an initial diagnosis of lung cancer and subsequent prostate cancer diagnosis (L-P group); the remainder had only lung cancer (L group). Stage I lung cancer was most common in the L-P group compared to the L and P-L groups—54% vs. 17.13% vs. 17.92%, p < 0.0001 for L-P, L and P-L, respectively. The median OS for lung cancer diagnosis was 93 months versus 10 and 9 months, respectively, for the L-P, L and P-L subgroups. ADT was associated with improved survival on multivariate analysis, especially in Caucasian patients (HR of death: 0.86; 95% CI: 0.76−0.97; p = 0.012). Conclusion: ADT was associated with improved outcome for NSCLC, in line with the hypothesis of a role for the androgen receptor in lung cancer. Our findings support a systematic evaluation of the potential benefit of ADT as a therapy for lung cancer.
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Approach to the Treatment of Metastatic Castration-Sensitive Prostate Carcinoma: A Single Center Experience. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.1057317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ahn HK, Lee HS, Park JY, Kim DK, Kim M, Hwang HS, Kim JW, Ha JS, Cho KS. Androgen deprivation therapy may reduce the risk of primary open-angle glaucoma in patients with prostate cancer: a nationwide population-based cohort study. Prostate Int 2021; 9:197-202. [PMID: 35059357 PMCID: PMC8740392 DOI: 10.1016/j.prnil.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/22/2021] [Accepted: 05/10/2021] [Indexed: 11/25/2022] Open
Abstract
Background We evaluated the risk of developing primary open-angle glaucoma (POAG) according to androgen deprivation therapy (ADT) status in patients with prostate cancer. Materials and methods From the nationwide claims database in South Korea, 218,203 men with prostate cancer were identified between 2008 and 2017. After applying the inclusion and exclusion criteria, a total of 170,701 patients (42,877 in the ADT and non-ADT groups and 127,824 in the non-ADT group) were included in the analysis. To adjust for comorbidities between cohorts, exact matching was performed. Cox proportional hazard regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of POAG associated with ADT after controlling for potential confounding factors. Results In the matched cohort, the ADT group had a lower proportion of newly developed POAG than the non-ADT group (2.10% vs. 2.88%, respectively; P < 0.0001). Multivariable analysis revealed that the ADT group had a significantly lower risk of POAG than the non-ADT group (HR, 0.808; 95% CI, 0.739–0.884; P < 0.0001). The risk of POAG was lower in patients who underwent ADT for less than 2 years (HR, 0.782; 95% CI, 0.690–0.886; P = 0.0001) and in those receiving ADT for over 2 years (HR, 0.825; 95% CI, 0.744–0.916; P = 0.0003) compared with the non-ADT group. Conclusions The use of ADT was associated with a decreased risk of POAG in Korean patients with prostate cancer. Our findings suggest that testosterone may be involved in the pathophysiology of POAG, and this should be confirmed through further studies.
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Affiliation(s)
- Hyun Kyu Ahn
- Department of Urology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Ju-Young Park
- Department of Statistics and Data Science, Yonsei University, Seoul, Korea
| | - Do Kyung Kim
- Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Min Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Sik Hwang
- Department of Ophthalmology, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jong Won Kim
- Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Jee Soo Ha
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Su Cho
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Corresponding author. Departments of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea.
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Kim DK, Lee HS, Park JY, Kim JW, Hah YS, Ha JS, Kim JH, Cho KS. Risk of cardiovascular intervention after androgen deprivation therapy in prostate cancer patients with a prior history of ischemic cardiovascular and cerebrovascular disease: A nationwide population-based cohort study. Urol Oncol 2021; 40:6.e11-6.e19. [PMID: 34315660 DOI: 10.1016/j.urolonc.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/16/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Androgen deprivation therapy for prostate cancer is known to increase the risk of cardiovascular disease, but there is controversy regarding the cardiovascular risk in patients with preexisting cardiovascular disease. This study assessed the risk of cardiovascular intervention after androgen deprivation therapy in patients with a history of cardiovascular disease, cerebrovascular disease, and cardiovascular intervention. MATERIALS AND METHODS Between 2008 and 2017, 195,308 men with newly diagnosed prostate cancer were identified from the nationwide claims database in South Korea. Among them, 49,090 men with a history of ischemic cardiovascular and cerebrovascular diseases were analyzed. The patients were divided into the androgen deprivation therapy (n = 14,092) and non-androgen deprivation therapy (n = 34,988) groups. The primary outcome was cardiovascular interventions (percutaneous transluminal angioplasty and coronary bypass surgery). Cox proportional hazard regression models were used to estimate the adjusted hazard ratios and 95% confidence intervals of the events. RESULTS After balancing the covariates with 1:1 exact matching, the two groups had 10,514 subjects each. Multivariable analysis demonstrated that androgen deprivation therapy was not significantly associated with an increased risk of cardiovascular interventions (hazard ratio, 1.060; 95% confidence interval, 0.923-1.217; P = 0.4104), regardless of the duration of therapy. A history of cardiovascular intervention, diabetes mellitus, antithrombotic medication use, and cardiovascular events significantly increased the risk of cardiovascular intervention. CONCLUSIONS Androgen deprivation therapy was not associated with cardiovascular intervention in patients with a previous history of cardiovascular disease, regardless of the duration of therapy. Therefore, the cardiovascular risk of androgen deprivation therapy should be reassessed in this population.
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Affiliation(s)
- Do Kyung Kim
- Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ju-Young Park
- Department of Statistics and Data science, Yonsei University, Seoul, Republic of Korea
| | - Jong Won Kim
- Department of Urology, Inha University Hospital, Seoul, Republic of Korea
| | - Yoon Soo Hah
- Department of Urology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jee Soo Ha
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Kang Su Cho
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Surgical versus Medical Castration for Metastatic Prostate Cancer: Use and Overall Survival in a National Cohort. J Urol 2020; 203:933-939. [PMID: 31746656 DOI: 10.1097/ju.0000000000000684] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Surgical castration for metastatic prostate cancer is used less frequently than medical castration yet costs less, requires less followup and may be associated with fewer adverse effects. We evaluated temporal trends and factors associated with the use of surgical castration. MATERIALS AND METHODS This retrospective cohort study sampled 24,805 men with newly diagnosed (de novo) metastatic prostate cancer from a national cancer registry in the United States (2004 to 2016). Multivariable logistic regression assessed the association between sociodemographic factors and surgery. Multivariable Cox regression evaluated the association between castration type and overall survival. RESULTS Overall 5.4% of men underwent surgical castration. This figure decreased from 8.5% in 2004 to 3.5% in 2016 (per year later OR 0.89, 95% CI 0.87-0.91, p <0.001). Compared to Medicare, private insurance was associated with less surgery (OR 0.73, 95% CI 0.61-0.87, p <0.001) while Medicaid or no insurance was associated with more surgery (OR 1.68, 95% CI 1.34-2.11, p <0.001 and OR 2.12, 95% CI 1.58-2.85, p <0.001, respectively). Regional median income greater than $63,000 was associated with less surgery (vs income less than $38,000 OR 0.61, 95% CI 0.43-0.85, p=0.004). After a median followup of 30 months castration type was not associated with differences in survival (surgical vs medical HR 1.02, 95% CI 0.95-1.09, p=0.6). CONCLUSIONS In a contemporary, real-world cohort surgical castration use is low and decreasing despite its potential advantages and similar survival rate compared to medical castration. Men with potentially limited health care access undergo more surgery, perhaps reflecting a provider bias toward the perceived benefit of permanent castration.
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Tan YG, Poon RJ, Pang LJ, Villanueva A, Huang HH, Chen K, Ng TK, Tay KJ, Ho HS, Yuen JS. Comparative study of surgical orchidectomy and medical castration in treatment efficacy, adverse effects and cost based on a large prospective metastatic prostate cancer registry. Urol Oncol 2020; 38:682.e1-682.e9. [PMID: 32475745 DOI: 10.1016/j.urolonc.2020.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 04/26/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Androgen deprivation therapy (ADT) remains the mainstay of treatment for metastatic prostate cancer (mPCa) but is associated with significant morbidities. Comparisons of medical castration (MC) and surgical orchidectomy (SO) have yielded varied results. We aimed to evaluate the oncological outcomes, adverse effect (AE) profiles and costs of MC and SO in patients with mPCa. METHODS AND MATERIALS We reviewed 523 patients who presented with de novo mPCa from a prospectively maintained prostate cancer database over 15 years (2001-2015). All patients received ADT (either MC or SO) within 3 months of diagnosis. The data were analyzed with chi-square, binary and logistics regression models. RESULTS One hundred and fifty one (28.9%) patients received SO while 372 (71.1%) patients had MC. The median age of presentation was 73 [67 -79] years old. The median prostate-specific antigen (PSA) was 280ng/ml [82.4-958]. Three hundred and thirty one patients (66.3%) had high volume bone metastasis and 57 patients (10.9%) had visceral metastasis. Clinical demographics and clinicopathological were similar across both groups. Similar oncological outcomes were observed in both groups. The proportion of PSA response (PSA <1ng/ml) was 65.6% for SO and 67.2% for MC (P = 0.212). Both therapies achieve >95% of effective androgen suppression (testosterone <50ng/dL). Time to castrate-resistance was similar (18 vs 16 months, P = 0.097), with comparative overall survival (42 vs. 38.5 months, P = 0.058) and prostate cancer mortality (80.1 vs. 75.9%, P = 0.328). Similarly, no difference was observed for the 4 AE profiles between SO and MC respectively; change in Haemoglobin (-0.75 vs. -1.0g/dL, P = 0.302), newly diagnosed Diabetes mellitus (4.6 vs. 2.9%, P = 0.281), control measured by HbA1c (0.2 vs. 0.25%, P = 0.769), coronary artery disease events (9.9 vs. 12.9%, P = 0.376) and skeletal-related fractures (9.3 vs. 7.3%, P = 0.476). After adjusting for varying governmental subsidies and inflation rates, the median cost of SO was $5275, compared to MC of $9185.80. CONCLUSION Both SO and MC have similar oncological outcomes and AE profiles. However, SO remains a much more cost-effective form of ADT for the long-term treatment of mPCa patients.
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Affiliation(s)
- Yu Guang Tan
- Singapore General Hospital, Department of Urology, Bukit Merah, Singapore.
| | - Randy Jy Poon
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore
| | - Leonard Jw Pang
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore
| | - Andre Villanueva
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore
| | - Hong Hong Huang
- Singapore General Hospital, Department of Urology, Bukit Merah, Singapore
| | - Kenneth Chen
- Singapore General Hospital, Department of Urology, Bukit Merah, Singapore
| | - Tze Kiat Ng
- Singapore General Hospital, Department of Urology, Bukit Merah, Singapore
| | - Kae Jack Tay
- Singapore General Hospital, Department of Urology, Bukit Merah, Singapore
| | - Henry Ss Ho
- Singapore General Hospital, Department of Urology, Bukit Merah, Singapore
| | - John Sp Yuen
- Singapore General Hospital, Department of Urology, Bukit Merah, Singapore
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Borno HT, Dixit N. Tailoring survivorship to diverse populations with genitourinary malignancies. Urol Oncol 2019; 38:118-120. [PMID: 31307880 DOI: 10.1016/j.urolonc.2019.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
Socioeconomic and racial/ethnic disparities in genitourinary malignancies remain a critical problem. Variations in initial and subsequent treatments, including survivorship care, likely contribute to these disparities. While the prevalence of genitourinary cancer survivors continues to grow, heterogeneity in survivorship care threatens to increase disparities. Several social factors, such as insurance status, language, and geography, drive heterogeneity observed in survivorship care. Linguistically tailored, culturally relevant survivorship is an essential component of a multidisciplinary effort to address racial/ethnic disparities among patients with genitourinary malignancies. Survivorship care is an essential component of cancer treatment, however if it is not developed and tested among a diverse patient population, it can lead to a widening of disparities observed among patients with genitourinary malignancies.
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Affiliation(s)
- Hala T Borno
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, CA; Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.
| | - Niharika Dixit
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, CA; Zuckerberg San Francisco General Hospital, San Francisco, CA
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