1
|
Efficacy of an additional flap operation in bladder-preserving surgery with radical prostatectomy and cystourethral anastomosis for rectal cancer involving the prostate. Surg Today 2017; 47:1119-1128. [PMID: 28260135 PMCID: PMC5532415 DOI: 10.1007/s00595-017-1484-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/12/2017] [Indexed: 02/07/2023]
Abstract
Purpose Sphincter-preserving operations performed with bladder-preserving surgery and a cystourethral anastomosis (CUA) do not require a urinary stoma, but leakage from the CUA may develop. The aim of this study was to evaluate the efficacy of performing an additional flap operation. Methods The subjects were 39 patients who underwent bladder-preserving surgery for advanced rectal cancer involving the prostate, between 2001 and 2015.32 of whom had a CUA and one of whom had a neobladder. Five of these 32 patients underwent an ileal flap operation, 2 underwent an omental flap operation, and 3 underwent an operation using both flaps. Results Leakage developed in 3 (30%) of the 10 patients who underwent additional flap operations, but in 14 (60.9%) of the 23 patients who did not undergo a flap operation. The mean periods of catheterization for the patients who suffered leakage were 31 weeks (8–108 weeks) in those without a flap and 16 weeks (8–20 weeks) in those with a flap. Four (33.3%) of the 12 patients with leakage after surgery without a flap had a period of urinary catheterization >30 weeks, and 2 (16.7%) had leakage of CTCAE grade 3. There were no cases of leakage after flap surgery. Conclusion An additional flap operation may decrease the risk of leakage from a CUA.
Collapse
|
2
|
Atallah V, Leduc N, Creoff M, Sargos P, Taouil T, Escarmant P, Vinh-Hung V. Curative brachytherapy for prostate cancer in African-Caribbean patients: A retrospective analysis of 370 consecutive cases. Brachytherapy 2017; 16:342-347. [PMID: 28024937 DOI: 10.1016/j.brachy.2016.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/15/2016] [Accepted: 11/16/2016] [Indexed: 11/21/2022]
Abstract
PURPOSE Prostate cancer is the most frequent malignancy in African-Caribbean men, a population sharing common genetic traits with African-American (AA) but presenting also genomic and epidemiologic specificities. Despite socioeconomic disparities with French mainland, all patients were treated within the French state-financed equal-access health care system. In this study, we report biochemical outcomes of patients treated by brachytherapy in our department from 2005 to 2014 in an African-Caribbean population. METHODS AND MATERIALS Three hundred seventy consecutive patients receiving 125I brachytherapy as a curative treatment for early-stage (localized) disease between 2005 and 2014 were recorded. Selected patients presented with low-risk disease: initial prostate-specific antigen (PSA) <10 ng/mL, clinical stage ≤ T2c, and Gleason score <7. Patients with intermediate risk of recurrence were also included on a case-to-case basis with prostate-specific antigen <15 or Gleason score 7 (3 + 4). Biochemical failure free-survival was defined according to the American Society for Radiation Oncology nadir+2 definition. RESULTS The 3-year and 5-year biochemical failure free-survival for the entire cohort were 98.3% and 91.6%, respectively. For patients with low- and intermediate-risk disease, the 5-year BBFS rates were 92.1% and 90.8%, respectively. In univariate and multivariate analyses, only Gleason score (<7 vs. 7; p = 0.030 vs. p < 0.05) was a significant predictor of biochemical failure. The overall rate of late and acute Grade 2 or higher genitourinary toxicity was 12.6% and 10.3%. CONCLUSIONS In this large single-center series, brachytherapy achieved excellent rates of medium-term biochemical control in both low and selected intermediate-risk localized prostate cancer in African-Caribbean patients. Brachytherapy seems to be an excellent choice of treatment, with excellent outcomes and limited morbidity for African-Caribbean populations.
Collapse
Affiliation(s)
- V Atallah
- Department of Radiation Oncology, University Hospital of Martinique, Fort-de-France, France.
| | - N Leduc
- Department of Radiation Oncology, University Hospital of Martinique, Fort-de-France, France
| | - M Creoff
- Department of Radiation Oncology, University Hospital of Martinique, Fort-de-France, France
| | - P Sargos
- Department of Radiation Oncology, Bergonie Institute, Bordeaux, France
| | - T Taouil
- Department of Surgical Urology, University Hospital of Martinique, Fort-de-France, France
| | - P Escarmant
- Department of Radiation Oncology, University Hospital of Martinique, Fort-de-France, France
| | - V Vinh-Hung
- Department of Radiation Oncology, University Hospital of Martinique, Fort-de-France, France
| |
Collapse
|
3
|
Jeffers A, Sochat V, Kattan MW, Yu C, Melcon E, Yamoah K, Rebbeck TR, Whittemore AS. Predicting Prostate Cancer Recurrence After Radical Prostatectomy. Prostate 2017; 77:291-298. [PMID: 27775165 PMCID: PMC5877452 DOI: 10.1002/pros.23268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 10/05/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Prostate cancer prognosis is variable, and management decisions involve balancing patients' risks of recurrence and recurrence-free death. Moreover, the roles of body mass index (BMI) and race in risk of recurrence are controversial [1,2]. To address these issues, we developed and cross-validated RAPS (Risks After Prostate Surgery), a personal prediction model for biochemical recurrence (BCR) within 10 years of radical prostatectomy (RP) that includes BMI and race as possible predictors, and recurrence-free death as a competing risk. METHODS RAPS uses a patient's risk factors at surgery to assign him a recurrence probability based on statistical learning methods applied to a cohort of 1,276 patients undergoing RP at the University of Pennsylvania. We compared the performance of RAPS to that of an existing model with respect to calibration (by comparing observed and predicted outcomes), and discrimination (using the area under the receiver operating characteristic curve (AUC)). RESULTS RAPS' cross-validated BCR predictions provided better calibration than those of an existing model that underestimated patients' risks. Discrimination was similar for the two models, with BCR AUCs of 0.793, 95% confidence interval (0.766-0.820) for RAPS, and 0.780 (0.745-0.815) for the existing model. RAPS' most important BCR predictors were tumor grade, preoperative prostate-specific antigen (PSA) level and BMI; race was less important [3]. RAPS' predictions can be obtained online at https://predict.shinyapps.io/raps. CONCLUSION RAPS' cross-validated BCR predictions were better calibrated than those of an existing model, and BMI information contributed substantially to these predictions. RAPS predictions for recurrence-free death were limited by lack of co-morbidity data; however the model provides a simple framework for extension to include such data. Its use and extension should facilitate decision strategies for post-RP prostate cancer management. Prostate 77:291-298, 2017. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
| | - Vanessa Sochat
- Department of Biomedical Data Sciences, Stanford University School of Medicine, Stanford, California
| | - Michael W Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Changhong Yu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Erin Melcon
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Kosj Yamoah
- Department of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Timothy R Rebbeck
- Department of Epidemiology, Harvard University School of Public Health, Boston, Massachusetts
| | - Alice S Whittemore
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
4
|
Klaassen Z, Howard L, Terris MK, Aronson WJ, Cooperberg MR, Amling CL, Kane CJ, Freedland SJ. Does larger tumor volume explain the higher prostate specific antigen levels in black men with prostate cancer--Results from the SEARCH database. Cancer Epidemiol 2015; 39:1066-70. [PMID: 26452418 DOI: 10.1016/j.canep.2015.09.007] [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: 06/25/2015] [Revised: 08/25/2015] [Accepted: 09/12/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess whether larger tumor volume in black men explains higher presurgical PSA levels versus white men with prostate cancer. METHODS We retrospectively analyzed 1904 men from the Shared Equal Access Regional Cancer Hospital database who underwent radical prostatectomy from 1990 to 2013. Geometric mean of tumor volume and preoperative PSA for each race were estimated from multivariable linear regression models. RESULTS There were 1104 (58%) white men and 800 (42%) black men. Black men were younger (60.2 vs. 62.9 years, p<0.001) had a higher PSA (6.7 vs. 6.0 ng/mL, p<0.001), more positive margins (47 vs. 38%, p<0.001), and seminal vesicle invasion (13 vs. 9%, p=0.007). White patients had higher clinical stage (p<0.001) and greater median tumor volume (6.0 vs. 5.3 gm, p=0.011). After multivariable adjustment (except for PSA), white men had smaller mean tumor volumes (5.2 vs. 5.8 gm, p=0.011). When further adjusted for PSA, there was no racial difference in mean tumor volume (p=0.34). After multivariable adjustment, black men had higher mean PSAs vs. white men (7.5 vs. 6.1 ng/mL, p<0.001). Results were similar after further adjusting for tumor volume: black men had 16% higher mean PSAs versus white men (7.4 vs. 6.2 ng/mL, p<0.001). CONCLUSIONS In this study of men undergoing radical prostatectomy at multiple equal access medical centers, racial differences in tumor volume did not explain higher presurgical PSA levels in black versus white men. The exact reason for higher PSA values in black men remains unclear.
Collapse
Affiliation(s)
- Zachary Klaassen
- Medical College of Georgia-Georgia Regents University, Augusta, GA, United States
| | - Lauren Howard
- Duke University Medical Center, Durham, NC, United States
| | - Martha K Terris
- Medical College of Georgia-Georgia Regents University, Augusta, GA, United States; Augusta Veterans Affairs Medical Center, Augusta, GA, United States
| | - William J Aronson
- West Los Angeles Veterans Affairs Medical Center, West Los Angeles, CA, United States; University of California, Los Angeles School of Medicine, Los Angeles, CA, United States
| | - Matthew R Cooperberg
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States; University of California, San Francisco, CA, United States
| | | | - Christopher J Kane
- San Diego Veterans Affairs Medical Center, San Diego, CA, United States; University of California, San Diego, CA, United States
| | - Stephen J Freedland
- Durham Veterans Affairs Medical Center, Durham, NC, United States; Cedars Sinai Medical Center, Los Angeles, CA, United States.
| |
Collapse
|
5
|
Moses KA, Chen LY, Sjoberg DD, Bernstein M, Touijer KA. Black and White men younger than 50 years of age demonstrate similar outcomes after radical prostatectomy. BMC Urol 2014; 14:98. [PMID: 25495177 PMCID: PMC4269868 DOI: 10.1186/1471-2490-14-98] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 12/01/2014] [Indexed: 12/02/2022] Open
Abstract
Background Black men with prostate cancer are diagnosed at a younger age, present with more aggressive disease, and experience higher mortality. We sought to assess pathological features and biochemical recurrence (BCR) in young men undergoing radical prostatectomy (RP) to determine if there is a difference between black and white men closer to the time of disease initiation. Methods We identified 551 white and 99 black men at a tertiary cancer center who underwent RP at ≤50 years of age. Baseline and pathological features were compared between the two groups. Cox proportional hazards models were utilized to examine the association of race and BCR, and Kaplan-Meier curves were generated to determine biochemical recurrence-free survival (bRFS). Results There were no differences in median age at surgery, biopsy Gleason score, or comorbidity. Black men had higher preoperative PSA (6.1 ng/ml vs 4.7 ng/ml, p = 0.004), but a greater percentage were cT1c (78% vs 63%), compared to white men. On multivariate analysis, black men demonstrated significantly lower odds of non-organ confined disease (OR 0.39; 95% CI: 0.18, 0.81; p = 0.01) and extracapsular extension (ECE) (OR 0.38; 95% CI: 0.18, 0.81, p = 0.01), and had no difference in Gleason score upgrading and seminal vesicle invasion compared to white men. There was no significant difference in bRFS in men with organ-confined disease; however, among men with locally advanced disease black men trended towards greater BCR (p = 0.052). Black men had 2-year bRFS of 56% vs 75% in white men. Conclusions In this single institution study, there does not appear to be a racial disparity in outcomes among younger men who receive RP for prostate cancer. Black and white men in our cohort demonstrate similar bRFS with pathologically confirmed organ-confined disease. There may be greater risk of BCR among black men locally advanced disease compared to white men, suggesting that locally advanced disease is biologically more aggressive in black men.
Collapse
Affiliation(s)
- Kelvin A Moses
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 353 East 68th Street, New York, NY 10065, USA.
| | | | | | | | | |
Collapse
|
6
|
Impact of race in a predominantly African-American population of patients with low/intermediate risk prostate cancer undergoing radical prostatectomy within an equal access care institution. Int Urol Nephrol 2014; 46:1941-6. [PMID: 24969031 DOI: 10.1007/s11255-014-0773-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 06/13/2014] [Indexed: 12/31/2022]
Abstract
PURPOSE To study the impact of race in an equal access care institution with a predominantly African-American (AA) population. METHODS We retrospectively reviewed data from 222 men with low risk (LR) or intermediate risk (IR) prostate cancer who underwent radical prostatectomy at the New York Harbor VA between 2003 and 2011. Biochemical relapse, distant control, and prostate cancer-specific survival were analyzed using the Kaplan-Meier method and compared using the log-rank test. Univariate and multivariate Cox regression modeling was performed to determine the impact of covariates on biochemical outcome. RESULTS Most patients (65.3 %) were AA. The median follow-up was 58 months, and 89.6 % of patients were followed for a minimum of 2 years after their surgery. Analyzing the whole cohort, the biochemical control was improved in Caucasian patients compared with AA (90.2 vs. 75.4 %, p = 0.008). On subgroup analysis, for IR disease, this difference was no longer significant, 80.5 % for Caucasians versus 69.8 % for AA (p = 0.36). However, for LR disease, the 5-year biochemical control remained significantly improved for Caucasians compared with AA, with a 5-year biochemical control of 97.6 versus 81.7 %, p = 0.006. On multivariate analysis, AA race was a significant predictor for biochemical recurrence (HR 2.69, 95 % CI 1.27-5.65, p = 0.009). There were no differences between the two groups regarding distant control (p = 0.14) or prostate cancer-specific survival (p = 0.29). CONCLUSIONS In this predominant AA population with equal access to medical care, AA race is an independent predictor of biochemical recurrence after prostatectomy in men with LR or IR prostate cancer.
Collapse
|
7
|
Hong MK, Yao HH, Rzetelski-West K, Namdarian B, Pedersen J, Peters JS, Hovens CM, Corcoran NM. Prostate weight is the preferred measure of prostate size in radical prostatectomy cohorts. BJU Int 2012; 109 Suppl 3:57-63. [DOI: 10.1111/j.1464-410x.2012.11049.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
8
|
Winkfield KM, Chen MH, Dosoretz DE, Salenius SA, Katin M, Ross R, D'Amico AV. Race and survival following brachytherapy-based treatment for men with localized or locally advanced adenocarcinoma of the prostate. Int J Radiat Oncol Biol Phys 2011; 81:e345-50. [PMID: 21514066 DOI: 10.1016/j.ijrobp.2011.02.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 12/01/2010] [Accepted: 02/05/2011] [Indexed: 12/24/2022]
Abstract
PURPOSE We investigated whether race was associated with risk of death following brachytherapy-based treatment for localized prostate cancer, adjusting for age, cardiovascular comorbidity, treatment, and established prostate cancer prognostic factors. METHODS The study cohort was composed of 5,360 men with clinical stage T1-3N0M0 prostate cancer who underwent brachytherapy-based treatment at 20 centers within the 21st Century Oncology consortium. Cox regression multivariable analysis was used to evaluate the risk of death in African-American and Hispanic men compared to that in Caucasian men, adjusting for age, pretreatment prostate-specific antigen (PSA) level, Gleason score, clinical T stage, year and type of treatment, median income, and cardiovascular comorbidities. RESULTS After a median follow-up of 3 years, there were 673 deaths. African-American and Hispanic races were significantly associated with an increased risk of all-cause mortality (ACM) (adjusted hazard ratio, 1.77 and 1.79; 95% confidence intervals, 1.3-2.5 and 1.2-2.7; p < 0.001 and p = 0.005, respectively). Other factors significantly associated with an increased risk of death included age (p < 0.001), Gleason score of 8 to 10 (p = 0.04), year of brachytherapy (p < 0.001), and history of myocardial infarction treated with stent or coronary artery bypass graft (p < 0.001). CONCLUSIONS After adjustment for prostate cancer prognostic factors, age, income level, and revascularized cardiovascular comorbidities, African-American and Hispanic races were associated with higher ACM in men with prostate cancer. Additional causative factors need to be identified.
Collapse
Affiliation(s)
- Karen M Winkfield
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts, USA.
| | | | | | | | | | | | | |
Collapse
|
9
|
Migowski A, Silva GAE. Survival and prognostic factors of patients with clinically localized prostate cancer. Rev Saude Publica 2011; 44:344-52. [PMID: 20339635 DOI: 10.1590/s0034-89102010000200016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 08/26/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess survival rates and clinical (pretreatment) prognostic factors in patients with clinically localized adenocarcinoma of the prostate. METHODS Hospital cohort including 258 patients registered in the National Cancer Institute, in the city of Rio de Janeiro, southeastern Brazil, from 1990 to 1999. Five- and ten-year survival functions were estimated using the Kaplan-Meier estimator from the histological diagnosis (initial time of follow-up) to death due to prostate cancer (events). Prognostic factors were assessed using hazard ratios (HR) with confidence intervals of 95%, following the Cox's proportional hazards model. The assumption of proportionality of risks was tested using Schoenfeld residuals and the impact of outliers in the model fitness was analyzed using martingale and score residuals. RESULTS Of 258 patients studied, 46 died during follow-up. The overall five-year and ten-year survival rates were 88% and 71%, respectively. A Gleason score higher than 6, PSA levels higher than 40 ng/mL, B2 stage, and white skin color were independent markers of poor prognosis. CONCLUSIONS Gleason score, digital rectal examination and PSA levels have great predictive power and must be used in pretreatment risk stratification of patients with localized prostate cancer.
Collapse
Affiliation(s)
- Arn Migowski
- Núcleo de Saúde Coletiva, Coordenação de Ensino e Pesquisa, Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brasil.
| | | |
Collapse
|
10
|
Mazaheri Y, Shukla-Dave A, Muellner A, Hricak H. MRI of the prostate: Clinical relevance and emerging applications. J Magn Reson Imaging 2011; 33:258-74. [DOI: 10.1002/jmri.22420] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
|
11
|
Xiao H, Warrick C, Huang Y. Prostate cancer treatment patterns among racial/ethnic groups in Florida. J Natl Med Assoc 2010; 101:936-43. [PMID: 19806852 DOI: 10.1016/s0027-9684(15)31042-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Prostate cancer is the second leading cause of cancer death among men in the United States. Blacks have the highest incidence and mortality rates. Treatment differences have been observed between black and white men. Brachy monotherapy (BMT) has become popular for localized prostate cancer because of its convenience, being the least invasive, and resulting in better quality of life during and after treatment. No studies have specifically examined BMT in treating localized prostate cancer by race/ethnicity. OBJECTIVES We sought to (1) describe treatment patterns among men with localized prostate cancer, (2) identify factors affecting the use of BMT, and (3) examine if there was any difference in BMT use by race and ethnicity. METHODS Florida cancer incidence data of 1994-2003 were used to extract information on men diagnosed with localized prostate cancer along with their demographics, primary payer at diagnosis, tumor stage and treatments. Logistic regression was performed to assess the likelihood of receiving BMT. RESULTS The study found that surgery and radiation were the 2 major single treatments for localized prostate cancer. The percent of patients receiving BMT treatment increased from 1994 through 2003. Men with the following characteristics were more likely to receive BMT than their counterparts: Non-Hispanic white, older, married, Medicare beneficiaries and military personnel, with well-differentiated tumor, and receiving treatment in facilities with high practice volume and/or located in urban counties. CONCLUSION There were racial/ethnic differences in localized prostate cancer treatment. Possible reasons for the differences require further research.
Collapse
Affiliation(s)
- Hong Xiao
- Florida A&M University College of Pharmacy and Pharmaceutical Sciences, Tallahassee, Florida 32312, USA.
| | | | | |
Collapse
|
12
|
Winkfield KM, Albert MA. Unanswered Questions Regarding the Effect of Androgen Deprivation Therapy for Prostate Cancer on Cardiovascular Disease Risk in Black Men. CURRENT CARDIOVASCULAR RISK REPORTS 2010. [DOI: 10.1007/s12170-010-0110-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
13
|
Rabbani F, Herran Yunis L, Vora K, Eastham JA, Guillonneau B, Scardino PT, Touijer K. Impact of ethnicity on surgical margins at radical prostatectomy. BJU Int 2009; 104:904-8. [DOI: 10.1111/j.1464-410x.2009.08550.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
14
|
Schroeck FR, Sun L, Freedland SJ, Jayachandran J, Robertson CN, Moul JW. Race and prostate weight as independent predictors for biochemical recurrence after radical prostatectomy. Prostate Cancer Prostatic Dis 2008; 11:371-6. [PMID: 18427570 DOI: 10.1038/pcan.2008.18] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We hypothesized that factors beyond pathological stage, grade, PSA and margin status would be important predictors of biochemical recurrence (BCR) after radical prostatectomy (RP). A cohort of 3194 patients who underwent RP between 1988 and 2007 and who had neither neoadjuvant therapy nor postoperative adjuvant hormonal therapy was retrieved from the Duke Prostate Center database. Age, prostate-specific antigen (PSA), pathological Gleason score (pG), lymph node status, seminal vesicle invasion (SVI), extracapsular extension (ECE), positive surgical margin (PSM) status, year of surgery, race, adjuvant radiation therapy (XRT), percent tumor involvement in the RP specimen and prostate weight were evaluated as possible predictors of BCR in multivariate Cox regression analysis. BCR was defined as a PSA of 0.2 ng ml(-1) or higher at least 30 days after surgery. A nomogram was developed from the Cox model. Predictive accuracy was obtained by calculating bias-corrected Harrell's c and by bootstrap calibration. In multivariate analysis, PSA (hazard ratio 1.39 (95% confidence interval 1.29-1.51)), ECE (1.22 (1.04-1.44)), pG score (1.38 (1.14-1.68), 2.23 (1.76-2.84), 2.69 (2.12-3.40) for pG 3+4, 4+3, >7, respectively), SVI (1.72 (1.40-2.12)), PSM (2.05 (1.73-2.42)), year of surgery (0.65 (0.54-0.77)), African-American race (1.37 (1.13-1.66)), adjuvant XRT (0.19 (0.11-0.34)) and prostate weight (0.83 (0.76-0.92)) were identified as independent predictors of BCR (P< or =0.018 for all factors). Predictive accuracy of the nomogram was 0.75. Race and prostate weight were independent predictors for BCR after RP. By incorporating these variables, we developed a nomogram, which provides a highly accurate means for estimating risk of BCR after RP.
Collapse
Affiliation(s)
- F R Schroeck
- Division of Urology, Department of Surgery, Duke Prostate Center (DPC), Duke University Medical Center, Durham, NC 27710, USA
| | | | | | | | | | | |
Collapse
|
15
|
Mavropoulos JC, Partin AW, Amling CL, Terris MK, Kane CJ, Aronson WJ, Presti JC, Mangold LA, Freedland SJ. Do racial differences in prostate size explain higher serum prostate-specific antigen concentrations among black men? Urology 2007; 69:1138-42. [PMID: 17572202 PMCID: PMC3275802 DOI: 10.1016/j.urology.2007.01.102] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Revised: 11/03/2006] [Accepted: 01/30/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To determine whether elevated serum prostate-specific antigen (PSA) values in black men are due, at least partially, to larger prostate size among black men. METHODS The study population consisted of two cohorts: (1) 1410 men undergoing radical prostatectomy between 1988 and 2005 at five equal-access medical centers comprising the Shared Equal Access Regional Cancer Hospital (SEARCH) Database; and (2) 9601 men undergoing radical prostatectomy between 1988 and 2004 at the Johns Hopkins Hospital. We evaluated the association between race and serum PSA value and prostate weight using multivariable linear regression while adjusting for demographic and clinicopathologic cancer characteristics. RESULTS In both cohorts, black men had higher serum PSA values (P < or = 0.001). After adjusting for either demographic characteristics or demographic and cancer-specific characteristics, there were no significant associations between race and prostate size in either cohort. After adjusting for multiple demographic, clinical, and pathologic cancer-specific characteristics, black men had 15% higher serum PSA values relative to white men in both the SEARCH (P = 0.001) and Hopkins cohorts (P < 0.001). CONCLUSIONS In this study of patients undergoing radical prostatectomy in two very different practice settings, black men in both cohorts had higher serum PSA values relative to white men, despite adjustment for demographic and cancer-specific characteristics, including prostate weight. The lack of significant association between race and prostate size suggests that alternative reasons are needed to explain higher serum PSA values in black men.
Collapse
Affiliation(s)
- John C Mavropoulos
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina 27710, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Rose AJ, Backus BM, Gershman ST, Santos P, Ash AS, Battaglia TA. Predictors of aggressive therapy for nonmetastatic prostate carcinoma in Massachusetts from 1998 to 2002. Med Care 2007; 45:440-7. [PMID: 17446830 DOI: 10.1097/01.mlr.0000257144.29928.f0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Most studies have found that black men are less likely to receive aggressive therapy for nonmetastatic prostate cancer, even after controlling for covariates. However, previous studies have not accounted for the clustering of outcomes by facility. OBJECTIVE We sought to compare the proportions of black and white men receiving aggressive therapy for newly diagnosed nonmetastatic prostate cancer between 1998 and 2002, accounting for the clustering of outcomes by facility. METHODS We used the Massachusetts Cancer Registry of all cancer diagnosed in residents of Massachusetts. We used logistic regression, clustering by the facility where the tumor was diagnosed, to predict the probability that a patient would receive any aggressive therapy, and the specific therapeutic choices of radical prostatectomy, external-beam radiation therapy, and brachytherapy. Predictors included race, age, poverty, insurance status, marital status, year of diagnosis, and tumor grade. RESULTS Black men were similarly likely to receive aggressive therapy compared with white men (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.62-1.01). However, there was a racial difference in the receipt of particular types of therapy: black men were significantly more likely to receive radiation therapy (OR 1.39, 95% CI 1.16-1.68) and less likely to receive radical prostatectomy (OR 0.53, 95% CI 0.38-0.74). CONCLUSIONS Among men diagnosed with nonmetastatic prostate cancer in Massachusetts from 1998 to 2002, black men received aggressive therapy at rates approaching those of whites. However, they were more likely to receive radiation therapy and less likely to receive radical prostatectomy.
Collapse
Affiliation(s)
- Adam J Rose
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts 02118-2644, USA.
| | | | | | | | | | | |
Collapse
|
17
|
Hamilton RJ, Aronson WJ, Presti JC, Terris MK, Kane CJ, Amling CL, Freedland SJ. Race, biochemical disease recurrence, and prostate–specific antigen doubling time after radical prostatectomy. Cancer 2007; 110:2202-9. [PMID: 17876838 DOI: 10.1002/cncr.23012] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Whether black men are at increased risk for biochemical disease recurrence after radical prostatectomy (RP) is debatable. Once black men have developed disease recurrence, it is unknown whether they have more aggressive disease than white men. To address this issue, the authors examined racial differences in pathologic features, time to disease recurrence, and prostate-specific antigen (PSA) doubling time (PSADT) among a cohort of patients treated with RP. METHODS The authors analyzed 953 white and 659 black men who were treated at 5 medical centers comprising the Shared Equal Access Regional Cancer Hospital (SEARCH) Database between 1988 and 2006. The association between race, adverse pathologic features, and biochemical disease recurrence was examined. Among those patients who developed disease recurrence, time to recurrence and PSADT were compared between the races. RESULTS Black men were on average 2.1 years younger (P < .001) and had higher median preoperative PSA levels (7.6 ng/mL vs 7.0 ng/mL; P < .001), yet presented with a lower clinical stage of disease (T1: 62% vs 44%; P < .001) and similar biopsy Gleason scores (P = .59). After adjusting for multiple clinical characteristics, black men were found to be as likely as white men to have adverse pathologic features (Gleason score >or=7, positive surgical margins, and seminal vesicle invasion) in the RP specimen and were less likely to have extracapsular extension (P = .03). Black men were more likely to have a biochemical disease recurrence (hazards ratio [HR] of 1.28; 95% confidence interval [95% CI, 1.07-1.54 [P = .006]). This increased risk was reduced slightly after adjustment for multiple clinical and pathologic features, and no longer achieved statistical significance (HR of 1.19; 95% CI, 0.97-1.45 [P = .09]). Among men who developed disease recurrence, the median PSADT was found to be similar among black men (17.0 months) and white men (14.6 months) (P = .26). CONCLUSIONS Despite presenting with earlier clinical stage and similar pathologic features at RP, black men were found to be at a slightly increased risk for biochemical disease recurrence. However, these recurrences appear to be no more aggressive than those found in white men.
Collapse
Affiliation(s)
- Robert J Hamilton
- Division of Urologic Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina 27710, USA
| | | | | | | | | | | | | |
Collapse
|
18
|
Nielsen ME, Han M, Mangold L, Humphreys E, Walsh PC, Partin AW, Freedland SJ. Black race does not independently predict adverse outcome following radical retropubic prostatectomy at a tertiary referral center. J Urol 2006; 176:515-9. [PMID: 16813880 DOI: 10.1016/j.juro.2006.03.100] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2005] [Indexed: 01/22/2023]
Abstract
PURPOSE There is controversy in the literature as to whether black race is associated with poorer oncological outcomes among men undergoing radical prostatectomy for clinically localized prostate cancer. To address this issue we examined the outcomes of a cohort of black and white men treated by multiple surgeons at our institution. MATERIALS AND METHODS The study population consisted of 4,962 white and 326 black men treated with anatomical radical retropubic prostatectomy between 1988 and 2004 by 10 different surgeons at the Johns Hopkins Hospital, a tertiary care referral center. We evaluated the association between race and adverse pathological features, and biochemical progression. RESULTS Black men had significantly higher preoperative serum prostate specific antigen (mean 7.2 vs 6.0 ng/ml, p <0.001), body mass index (median 27.4 vs 26.3 kg/m, p <0.001) and incidence of higher grade disease (Gleason sum 4 + 3 or greater) on prostate biopsy (17% vs 14%, p = 0.011). After adjustment for multiple clinical variables there was no statistically significant association between race and the adverse pathological characteristics of high grade disease, positive surgical margins, extraprostatic extension or seminal vesicle invasion. Black race was associated with a significantly increased risk of biochemical progression on univariate analysis (HR 1.52, 95% CI 1.16-2.00, p = 0.002). However, after adjusting for clinical and pathological characteristics, black race was not an independent predictor of biochemical progression (HR 1.09, 95% CI 0.81-1.45, p = 0.578). CONCLUSIONS Black men were more likely to be obese and present with adverse preoperative clinical features at a younger age, and have a higher rate of biochemical progression. However, on multivariate analysis black race was not an independent predictor of adverse pathological outcome or biochemical recurrence. Further efforts are needed to detect prostate cancer earlier among black men.
Collapse
Affiliation(s)
- Matthew E Nielsen
- Department of Urology, The Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA
| | | | | | | | | | | | | |
Collapse
|
19
|
Abstract
Although differences in prostate cancer incidence and mortality between black and white men are widely accepted, the existence of racial differences in treatment outcomes remains controversial. We conducted a systematic review of racial differences in prostate cancer treatment outcomes. Systematic review of literature from 1992-2002 was conducted. Database searches were performed using the terms: "prostate cancer" (keyword) or "prostate neoplasm" (subject heading) + "blacks" (subject heading) or "blacks" (keyword) + "African-Americans" (subject heading or "African-Americans" (keyword). Two hundred fifty-eight relevant articles were identified; 29 fit the inclusion criteria. All but 3 were retrospective. Seven (24%) studies were conducted at Veterans Affairs medical centers. Treatment included radical prostatectomy (15 studies), hormonal therapy (5 studies), and radiotherapy (12 studies). Three studies included more than 1 treatment. Twenty-three (79%) studies, observed no significant difference in treatment outcomes between races. The remainder found worse outcomes among black men, including worse 5-year survival (HR range, 2.35-96.74) and higher rates of PSA failure (OR range, 1.15-1.69). Most studies investigating racial differences in prostate cancer treatment outcomes over the past 10 years found no difference between races after controlling for tumor and patient characteristics. Efforts to narrow the gap between black and white prostate cancer mortality should focus on ensuring that all patients receive optimal treatment and that all patients become informed about the use of screening for early cancer detection. Research should focus on interventions to reduce advanced presentation of the disease and disease-related mortality among black men.
Collapse
Affiliation(s)
- Nikki Peters
- University of Pennsylvania School of Nursing, Pennsylvania, USA.
| | | |
Collapse
|
20
|
Freedland SJ, Isaacs WB. Explaining racial differences in prostate cancer in the United States: sociology or biology? Prostate 2005; 62:243-52. [PMID: 15389726 DOI: 10.1002/pros.20052] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Black men in the United States have the highest incidence and mortality from prostate cancer in the world. Even after adjusting for stage at diagnosis, black men have higher mortality rates than white men. Multiple reasons have been postulated to explain these findings including access to care, attitudes about care, socioeconomic and education differences, differences in type and aggressiveness of treatment, dietary, and genetic differences. While each reason may contribute to the higher incidence or higher mortality, likely combinations of reasons will best explain all the findings. Racial differences in socioeconomic status have been well established and we review the significance of these findings in relationship to prostate cancer. Also, with recent advances in the understanding of genetic variation in the human genome, in general, and in the genes involved in pathways relevant to prostate cancer biology, in particular, a number of genes with alleles which differ in frequency between black and white men have been proposed as a genetic cause or contributor to the increased prostate cancer risk in black men. However, the clinical significance of these genetic differences is not fully known. Finally, we conclude with some thoughts as to how to integrate the findings from sociological as well as biological studies and touch upon methods to reduce the disparate burden of prostate cancer among blacks in the United States.
Collapse
Affiliation(s)
- Stephen J Freedland
- The Brady Urological Institute, Department of Urology, The Johns Hopkins School of Medicine, Baltimore, Maryland 21287-2101, USA.
| | | |
Collapse
|
21
|
Williams H, Powell IJ, Land SJ, Sakr WA, Hughes MR, Patel NP, Heilbrun LK, Everson RB. Vitamin D receptor gene polymorphisms and disease free survival after radical prostatectomy. Prostate 2004; 61:267-75. [PMID: 15368470 DOI: 10.1002/pros.20103] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Vitamin D has been linked with prostate cancer risk in epidemiologic studies and has antiproliferative, prodifferentiation, and antimetastatic properties in experimental systems. Its hormonal activity is mediated by the vitamin D receptor. We investigated whether germ-line genetic variation in the vitamin D receptor impacts progression of prostate cancer after radical prostatectomy. METHODS We analyzed BsmI and TaqI polymorphisms using archived specimens from a large series of radical prostatectomy patients at a single institution. Our series included 428 white men (WM) and 310 African-American men (AAM) who were carefully and uniformly staged and followed for 5-10 years. RESULTS The distribution of polymorphisms varied between WM and AAM. There was little association between genotype and extent of disease at diagnosis, Gleason score, preoperative PSA, or recurrence overall. Among WM with locally advanced disease, however, the BsmI B allele protected against recurrence in models examining gene dose (P = 0.04) and dominant effects (P = 0.05). CONCLUSIONS Overall vitamin D receptor polymorphisms did not predict pathologic features of prostate cancer but may impact on risk of recurrence among men in certain risk groups. Analysis of polymorphisms may provide clues about the mechanisms through which vitamin D exerts its inhibitory effects on prostate cancer in vivo in men.
Collapse
Affiliation(s)
- Heinric Williams
- The Barbara Ann Karmanos Cancer Institute and Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Lam JS, Sclar JD, Desai M, Mansukhani MM, Benson MC, Goluboff ET. IS HISPANIC RACE AN IMPORTANT PREDICTOR OF TREATMENT FAILURE FOLLOWING RADICAL PROSTATECTOMY FOR PROSTATE CANCER? J Urol 2004; 172:1856-9. [PMID: 15540738 DOI: 10.1097/01.ju.0000141783.67470.55] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Hispanic-Americans are the fastest growing minority group in the United States. Many studies have compared prostate cancer treatment outcomes between black and white men, but few such studies have been done with Hispanic men. We compared clinical and pathological features as well as the treatment failure rate of radical prostatectomy in contemporaneously treated groups of Hispanic and white men with prostate cancer. MATERIALS AND METHODS Between 1995 and 2002, 136 Hispanic men and 315 white men underwent radical prostatectomy. Treatment failure was defined as having a prostate specific antigen (PSA) of 0.2 or greater more than 8 weeks after surgery or receiving any adjuvant therapy. Known predictors of failure and race were evaluated for their ability to predict treatment failure. RESULTS Median followup was 32 months for Hispanic and 36 months for white patients. Hispanic men were older, had a higher percentage of abnormal rectal examinations, Gleason 7 tumors and preoperative PSA levels greater than 10. Preoperative PSA, specimen Gleason score, pathological stage and surgical margin were all strongly associated with treatment failure (p<0.001). Despite differences in clinical characteristics, overall failure rates did not differ between Hispanic and white men (18.7% vs 17.8%). The odds ratio for treatment failure for Hispanic relative to white men after adjusting for the previously mentioned risk factors was 0.87 (95% CI [0.44, 1.68], p = 0.670). CONCLUSIONS This study shows that Hispanic race does not influence the treatment failure rate of radical prostatectomy in contemporaneously treated patients with prostate cancer at 1 institution. To our knowledge this study represents the largest of its kind, but longer followup and other confirmatory studies are needed.
Collapse
Affiliation(s)
- John S Lam
- Department of Urology, Columbia University, New York, New York 10034, USA
| | | | | | | | | | | |
Collapse
|
23
|
Tewari A, Gamito EJ, Crawford ED, Menon M. Biochemical recurrence and survival prediction models for the management of clinically localized prostate cancer. ACTA ACUST UNITED AC 2004; 2:220-7. [PMID: 15072605 DOI: 10.3816/cgc.2004.n.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A number of new predictive modeling techniques have emerged in the past several years. These methods, which have been developed in fields such as artificial intelligence research, engineering, and meteorology, are now being applied to problems in medicine with promising results. This review outlines our recent work with use of selected advanced techniques such as artificial neural networks, genetic algorithms, and propensity scoring to develop useful models for estimating the risk of biochemical recurrence and long-term survival in men with clinically localized prostate cancer. In addition, we include a description of our efforts to develop a comprehensive prostate cancer database that, along with these novel modeling techniques, provides a powerful research tool that allows for the stratification of risk for treatment failure and survival by such factors as age, race, and comorbidities. Clinical and pathologic data from 1400 patients were used to develop the biochemical recurrence model. The area under the receiver operating characteristic curve for this model was 0.83, with a sensitivity of 85% and specificity of 74%. For the survival model, data from 6149 men were used. Our analysis indicated that age, income, and comorbidities had a statistically significant impact on survival. The effect of race did not reach statistical significance in this regard. The C index value for the model was 0.69 for overall survival. We conclude that these methods, along with a comprehensive database, allow for the development of models that provide estimates of treatment failure risk and survival probability that are more meaningful and clinically useful than those previously developed.
Collapse
Affiliation(s)
- Ashuthosh Tewari
- Institute for Clinical Research at the Veterans Affairs, Medical Center Vattikuti Urology Institute and Josephine Ford Cancer Center, Henry Ford Health System, Detroit, MI, USA
| | | | | | | |
Collapse
|
24
|
Kang JS, Maygarden SJ, Mohler JL, Pruthi RS. Comparison of clinical and pathological features in African-American and Caucasian patients with localized prostate cancer. BJU Int 2004; 93:1207-10. [PMID: 15180606 DOI: 10.1111/j.1464-410x.2004.04846.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine patient characteristics, prostate specific antigen (PSA) levels, and established preoperative and pathological prognostic factors to determine differences between Caucasian and African-American patients with localised prostate cancer, as it remains controversial whether African-American men present with more aggressive disease. PATIENTS AND METHODS One hundred consecutive patients (aged 53-76 years) undergoing radical retropubic prostatectomy (RRP) at an equal-access tertiary-care centre were retrospectively reviewed. All patients had preoperative PSA levels, a physical examination (including clinical staging), and sextant biopsy. Insurance information was also collected. The same urological oncologist determined clinical staging and performed all the RRPs, and the same genitourinary pathologist determined the Gleason grade for biopsies and surgical specimens, pathological stage, percentage of tumour involvement, and specimen weight. African-American and Caucasian patients were compared for PSA, clinical stage, pathological stage, biopsy and pathological Gleason grade, organ confinement, margin status and specimen weight. Using preoperative and pathological data, both groups were also compared for over- and under-staging and -grading. The Wilcoxon rank test with P < 0.05 was used to determine statistically significant differences. RESULTS African-American patients were more likely to be Medicaid or self-insured than Caucasian patients. Age, biopsy grade and clinical stage were not significantly different between the groups. African-American patients presented with a mean PSA level of 11.9 ng/mL and Caucasians with a mean of 8.5 ng/mL (P = 0.03). When clinical and biopsy data were compared with pathological data there were no differences between the groups in under/over-grading or under/over-staging. African-American patients had larger prostates per surgical specimen than their Caucasian counterparts (59.3 g vs 51.6 g, respectively; P = 0.04). CONCLUSIONS In a referred, equal-access system, African-American patients presented with higher serum PSA levels and had larger prostates in the surgical specimen. However, African-American patients did not present at an earlier age or with higher Gleason grade or clinical stage, nor were pathological grade and stages higher. Other pathological features were no different. African-American patients were not under- or over-staged or under- or over-graded more than their Caucasian counterparts. This retrospective study does not suggest that African-American men present with more aggressive disease.
Collapse
Affiliation(s)
- J S Kang
- University of North Carolina School of Medicine, Division of Urologic Surgery, Chapel Hill, NC, USA
| | | | | | | |
Collapse
|
25
|
Underwood W, De Monner S, Ubel P, Fagerlin A, Sanda MG, Wei JT. RACIAL/ETHNIC DISPARITIES IN THE TREATMENT OF LOCALIZED/REGIONAL PROSTATE CANCER. J Urol 2004; 171:1504-7. [PMID: 15017208 DOI: 10.1097/01.ju.0000118907.64125.e0] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE Racial/ethnic disparities in the utilization of definitive therapy for prostate cancer are well recognized in the United States. The effect of race on the use of contemporary definitive therapies, including brachytherapy, and the assessment of Hispanic men with regard to racial/ethnic disparity has not been fully characterized. MATERIALS AND METHODS We evaluated treatment patterns using Surveillance, Epidemiology and End Results registry data on 142340 localized/regional stage cases between 1992 and 1999 in white, black and Hispanic American men. Definitive therapy was defined as radical prostatectomy, external beam radiation, brachytherapy or combinations thereof. Logistic regression models were constructed to determine the odds of receiving definitive treatment, adjusting for age, marital status, tumor grade, and Surveillance, Epidemiology and End Results site. RESULTS Black and Hispanic men were less likely to receive definitive therapy than white men (p <0.001). Higher tumor grade was associated with decreasing odds of definitive therapy for black and Hispanic men (p <0.001) compared to white men. The racial/ethnic disparities in the use of definitive therapy decreased between 1992 and 1999 with the greatest decrease in Hispanic men. CONCLUSIONS Hispanic and black men were less likely than white men to receive definitive therapy. The disparity in the use of definitive therapy between 1992 and 1999 decreased significantly in Hispanic men, although a significant disparity in the use of definitive therapy persisted in black men. Our observation of an association between tumor grade and the racial/ethnic disparity in definitive therapy ties together relevant biological and social factors that may contribute to the observed racial/ethnic disparity in mortality.
Collapse
Affiliation(s)
- Willie Underwood
- Department of Urology, University of Michigan, Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor, Michigan 48109-0759, USA
| | | | | | | | | | | |
Collapse
|
26
|
Pruthi RS, Derksen JE, Moore D. A pilot study of use of the cyclooxygenase-2 inhibitor celecoxib in recurrent prostate cancer after definitive radiation therapy or radical prostatectomy. BJU Int 2004; 93:275-8. [PMID: 14764122 DOI: 10.1111/j.1464-410x.2004.04601.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the efficacy of the cyclooxygenase (COX)-2 inhibitor celecoxib in prostate-specific antigen (PSA) recurrent prostate cancer after definitive radiation therapy (RT) or radical prostatectomy (RP), as recent evidence showed that COX-2 inhibitors have potent antitumour activity in prostate cancer both in vitro and in vivo but there are no human trials. PATIENTS AND METHODS Twelve patients who had biochemical relapse after RT or RP were treated with celecoxib 200 mg twice daily. Follow-up PSA levels to assess efficacy were obtained at 3, 6 and 12 months after initiating treatment. Data were evaluated by calculating PSA doubling times and the slope of the curve of logPSA vs time, to assess rate of PSA rise before and after celecoxib treatment for each patient. Serum testosterone levels were also measured. RESULTS Eight of the 12 patients had significant inhibition of their serum PSA levels after 3 months of treatment; five had a decline in their absolute PSA level and three a stabilization of the level. Of the remaining four patients, three had a marked decrease in their PSA doubling time, with a mean increase (i.e. slowing) of 3.1 times that before treatment. The short-term responses at 3 months also continued at 6 and 12 months. From the slope of log PSA vs time there was a significant flattening of the rate of PSA rise (P = 0.001). There was a significant change of patients with rapid doubling times towards slower doubling times or even stable/declining PSA values after treatment with celecoxib (P = 0.029). There was no significant change in testosterone levels, suggesting an androgen-independent mechanism. CONCLUSIONS COX-2 inhibitors may have an effect on serum PSA levels in patients with biochemical progression after RT or RP. These results suggest that COX-2 inhibitors may help to delay or prevent disease progression in these patients, and thereby help extend the time until androgen deprivation therapy. Further study with more patients is currently underway to better evaluate the clinical potential of COX-2 inhibitors as an antitumour agents in prostate cancer.
Collapse
Affiliation(s)
- R S Pruthi
- Division of Urologic Surgery, The University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | | | | |
Collapse
|
27
|
Carver BS, Bozeman CB, Venable DD, Eastham JA. Do concerns about more advanced pathological features increase the likelihood of neurovascular bundle resection in black men undergoing radical prostatectomy? J Urol 2004; 171:700-2. [PMID: 14713790 DOI: 10.1097/01.ju.0000103884.51753.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Traditionally black men undergoing radical prostatectomy have presented with higher serum prostate specific antigen (PSA) levels, Gleason grade and pathological stage compared to white men. We evaluated men undergoing radical prostatectomy at our institutions to determine if race was an independent predictor of neurovascular bundle resection and if racial differences existed with regard to clinical and pathological outcomes in men undergoing a nerve sparing procedure. MATERIALS AND METHODS Between July 1995 and March 2000, 316 men underwent radical retropubic prostatectomy for clinically localized prostate cancer. Patient data were gathered prospectively and reviewed with regard to age, race, preoperative serum PSA, operative procedure, pathological findings and patient followup. Racial differences were analyzed by the chi-square test or student's t statistic. Predictors of neurovascular bundle resection were evaluated using multiple logistic regression. RESULTS Of the 316 men who underwent a radical retropubic prostatectomy, 126 were black and 190 were white. Overall, a nerve sparing procedure was performed in 77 (40.5%) white men and 44 (34.9%) black men. When evaluating only potent men preoperatively, a nerve sparing prostatectomy was performed in 69.3% of white men and 58.6% of black men. There was no statistically significant racial difference with regard to the proportions of men undergoing a nerve sparing procedure. Predictors of neurovascular bundle resection during radical prostatectomy were preoperative erectile function, serum PSA level before prostate biopsy, biopsy Gleason score and number of cores positive for cancer. In men undergoing a nerve sparing radical prostatectomy there were no significant racial differences with regard to age, preoperative serum PSA, Gleason score, pathological stage, postoperative potency, continence or disease-free survival (mean followup 44 months). CONCLUSIONS At our institutions a similar proportion of black and white men undergo nerve sparing radical prostatectomy, which appears to produce similar clinical outcomes in black and white men.
Collapse
Affiliation(s)
- Brett S Carver
- Department of Urology, Louisiana State University Health Sciences Center and Overton Brooks Veterans Administration Medical Center, Shreveport, USA
| | | | | | | |
Collapse
|
28
|
Abstract
Although prostate cancer tends to be a slow-growing neoplasm affecting older men, there is clearly a subset of patients at high risk for developing early and possibly more aggressive disease. This group of high-risk patients includes men with a family history of prostate cancer and various histologic features such as PIN and ASAP identified on an initial biopsy. Black American men have a much higher risk of developing prostate cancer when compared with white men and especially Asian men. This finding may reflect both genetic and environmental factors. Screening men at increased risk of developing prostate cancer appears to be a logical strategy, especially in light of recent reports that suggest a benefit to aggressive treatment.
Collapse
Affiliation(s)
- Kisseng Hsieh
- Division of Urology, Department of Surgery, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-3955, USA
| | | |
Collapse
|
29
|
Barrett WL, Kassing WM, Shirazi R. Efficacy of brachytherapy for prostate cancer in African Americans compared with Caucasians. Brachytherapy 2004; 3:30-3. [PMID: 15110311 DOI: 10.1016/j.brachy.2003.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2003] [Revised: 11/13/2003] [Accepted: 11/17/2003] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare the biochemical response to prostate brachytherapy between African Americans and Caucasians in a consecutive series of patients treated at a single institution. METHODS AND MATERIALS Between July 1995 and October 2001, 173 patients were treated with permanent (125)I seed implantation alone for presumed localized adenocarcinoma of the prostate. Twelve patients were African American and their biochemical response to treatment was compared with the 161 Caucasian patients. The patients were evaluated for biochemical recurrence according to the ASTRO consensus statement and for achieving and maintaining PSA nadirs of < or = 1.0, < or = 0.5, and < or = 0.2. Median pretreatment PSA level was 8 for the African American group and 6 for the Caucasian group. Median Gleason score for each group was 6 and no patients had palpable extraprostatic disease at the time of treatment. RESULTS None of the African American patients have experienced biochemical recurrence compared with 7.5% of the Caucasian patients (p=0.34). The percentage of African American patients achieving and maintaining a PSA level of < or = 1.0 was 83% compared with 89% for the Caucasian patients (p=0.61). PSA nadir of < or = 0.5 was achieved in 75% of the African American patients and 81% of the Caucasian patients (p=0.52) and 50% of the African American patients experienced PSA levels of < or = 0.2 compared with 59% of the Caucasian patients (p=0.88). CONCLUSION African American patients with prostate cancer have in general been reported to have worse prognosis compared with Caucasians. This series suggests similar outcome between African American and Caucasian patients treated with brachytherapy for prostate cancer.
Collapse
Affiliation(s)
- William L Barrett
- Division of Radiation Oncology, University of Cincinnati, Cincinnati, OH 45267-0757, USA.
| | | | | |
Collapse
|
30
|
Underwood W, Wei J, Rubin MA, Montie JE, Resh J, Sanda MG. Postprostatectomy cancer-free survival of African Americans is similar to non-African Americans after adjustment for baseline cancer severity. Urol Oncol 2004; 22:20-4. [PMID: 14969799 DOI: 10.1016/s1078-1439(03)00119-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2003] [Revised: 04/14/2003] [Accepted: 07/16/2003] [Indexed: 01/02/2023]
Abstract
African American men with localized prostate cancer are less likely than White men to receive a radical prostatectomy. This disparity may exist because African American men have prostate cancers that are more biologically aggressive. We investigated if similar stage cancers of African American men and White men show differences in cancer control after radical prostatectomy. Men with localized prostate cancer who underwent radical prostatectomy during a 6-yr period were stratified by race, and time to prostate-specific antigen recurrence was measured. We used Chi-square and t-tests to compare baseline clinical and pathological factors based on race. Cox proportional hazards model was used to determine effects of race on cancer control while controlling for baseline measures of cancer severity. There were 1,228 cases evaluated. At baseline, African American men were treated at a significantly younger age than White men (P = 0.0027) but showed no significant difference in prostate-specific antigen PSA, Gleason score, pathology stage, maximum tumor dimension, and surgical margin status. Multivariable Cox proportional hazards analysis controlling for cancer severity at prostatectomy revealed that cancer-free survival was not worse among African Americans compared to other subjects (P = 0.16). The responsiveness of prostate cancers among African American men to radical prostatectomy was similar to White men of similar stage and grade. Early detection in African American men may facilitate diagnosis of cancer amenable to prostatectomy. Studies are needed to evaluate the possible interaction of prostate cancer stage and grade shift in African American men and the disease free survival in this population.
Collapse
Affiliation(s)
- Willie Underwood
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.
| | | | | | | | | | | |
Collapse
|
31
|
Gomez P, Manoharan M, Sved P, Kim SS, Soloway MS. Radical retropubic prostatectomy in Hispanic patients. Cancer 2004; 100:1628-32. [PMID: 15073849 DOI: 10.1002/cncr.20127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Hispanics are the largest minority group in the U.S. Most studies assessing race as a predictor of biochemical disease recurrence after radical retropubic prostatectomy (RRP) have focused on African-American patients. To the authors' knowledge, little has been published to date regarding radical prostatectomy in Hispanic patients. Hispanics represent 29% of the patients in the current study. The authors analyzed the presentation and outcome of Hispanic males managed with radical prostatectomy. METHODS In the current study, 1163 RRPs were performed. Patients were categorized by ethnicity as Hispanics, white non-Hispanics, African-Americans, and other ethnicities. African-American and other minority group patients were excluded from the analysis because of the small number in the current series. A comparative analysis of Hispanics and white non-Hispanics was performed. RESULTS RRP was performed in 1163 patients. Two hundred seven Hispanic and 518 white non-Hispanic patients met the study criteria. The mean follow-up was 46.9 months. Twenty-three percent of the Hispanic patients received neoadjuvant therapy. RRP Gleason scores of 2-6, 7, and 8-10 were found in 45% of patients, 38% of patients, and in 17% of patients, respectively. Lymph node metastases were present in 3%, seminal vesicle invasion in 13%, and extraprostatic extension in 23% of Hispanic patients. Adjuvant hormonal therapy was administered to 6% of the Hispanic patients. The biochemical disease recurrence rate was 12%. The mean time to biochemical disease recurrence was 29.7 months. A comparison between the Hispanic and the white non-Hispanic groups showed no significant differences in the analyzed variables. CONCLUSIONS Hispanic patients managed with radical prostatectomy for prostate carcinoma were found to have similar presentation, pathologic findings, and outcome as the white non-Hispanic patients.
Collapse
Affiliation(s)
- Pablo Gomez
- Department of Urology, University of Miami School of Medicine, Miami, Florida 33101, USA
| | | | | | | | | |
Collapse
|
32
|
Rosser CJ, Kuban DA, Levy LB, Pettaway CA, Chichakli R, Kamat AM, Sanchez-Ortiz RF, Pisters LL. Clinical features and treatment outcome of Hispanic men with prostate cancer following external beam radiotherapy. J Urol 2003; 170:1856-9. [PMID: 14532792 DOI: 10.1097/01.ju.0000092880.23660.de] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE We retrospectively analyzed the clinical characteristics and outcomes of Hispanic men compared with other groups who underwent radiotherapy alone for localized or locally advanced prostate cancer. MATERIALS AND METHODS Between April 1987 and January 1998, 964 men who underwent full dose external beam radiotherapy alone for localized or locally advanced prostate cancer were included in the study. Patient medical records were reviewed for pertinent information. RESULTS Of the 964 men 810 were non-Hispanic white, 54 were Hispanic and 86 were black Americans. The most significant difference among the groups was in the proportion of patients who presented with initial prostate specific antigen (PSA) greater than 20 ng/ml (22% of Hispanic vs 11% of white men, p = 0.0012). In addition, 17% of Hispanic men had a Gleason score of 8 or greater compared with 11% of white men (p = 0.0265). A greater proportion of Hispanic patients also had a less favorable posttreatment PSA nadir of greater than 1 ng/ml compared with white patients, (44% vs 26%, p = 0.0214), which may have translated into a trend toward a lower 5-year disease-free survival rate in Hispanics vs white men (52% vs 65%, p = 0.07). CONCLUSIONS Hispanic men presented with higher PSA and higher grade prostate cancer than white men. Furthermore, a higher percent of Hispanic men had a PSA nadir of 1 ng/ml or greater after radiotherapy, which may have been responsible for their trend toward a decreased 5-year disease-free survival rate compared with white men. Improved screening and early detection may improve disease-free survival in Hispanic men with localized prostate cancer.
Collapse
Affiliation(s)
- Charles J Rosser
- Department of Urology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Bianco FJ, Kattan MW, Scardino PT, Powell IJ, Pontes JE, Wood DP. Radical prostatectomy nomograms in black American men: accuracy and applicability. J Urol 2003; 170:73-6; discussion 76-7. [PMID: 12796648 DOI: 10.1097/01.ju.0000068037.57553.54] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Nomograms have been developed to allow the prediction of disease recurrence based on clinical and pathological parameters in patients with clinically localized prostate cancer. However, they have been constructed using predominantly white American male (CAM) cohorts. We have previously shown that black American males (AAMs) have worse disease-free survival after radical prostatectomy after controlling for known prognostic factors. We tested the accuracy of prognostic nomograms in a population of AAMs with prostate cancer treated with radical prostatectomy. MATERIALS AND METHODS We tested the performance of published preoperative and postoperative prognostic nomograms in a cohort of patients treated with radical prostatectomy as monotherapy for localized prostate cancer at Wayne State University in the prostate specific antigen era. Predictions made with the nomogram were stratified by race and compared with actual outcomes. The summary statistic used to evaluate the nomogram was the concordance index. A value of 0.5 indicates no predictive discrimination, whereas a value of 1.0 indicates perfect discrimination. RESULTS A total of 1,043 patients, including 331 AAMs (32%) and 712 CAMs (68%), comprised the study cohort. Treatment failure was defined as increasing prostate specific antigen, which occurred in 193 patients (18.5%). The preoperative concordance index for CAMs and AAMs was 0.78 and 0.74, respectively (p = 0.8). The postoperative index was 0.85 and 0.83, respectively (p = 0.9). CONCLUSIONS Preoperative and postoperative nomograms can be applied accurately to an individual regardless of race.
Collapse
Affiliation(s)
- Fernando J Bianco
- Department of Urology, Wayne State University, 4160 John R., Suite 1017, Detroit, MI 48201, USA
| | | | | | | | | | | |
Collapse
|
34
|
Grossfeld GD, Latini DM, Downs T, Lubeck DP, Mehta SS, Carroll PR. Is ethnicity an independent predictor of prostate cancer recurrence after radical prostatectomy? J Urol 2002; 168:2510-5. [PMID: 12441951 DOI: 10.1016/s0022-5347(05)64179-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Prostate cancer incidence and mortality are higher in black than in white American men. We determined whether ethnicity is an independent predictor of disease recurrence in men undergoing radical prostatectomy. MATERIALS AND METHODS We studied 1,468 patients who underwent radical prostatectomy at the University of California, San Francisco or as part of the Cancer of the Prostate Strategic Urological Research Endeavor database, a longitudinal disease registry of patients with prostate cancer. Preoperative characteristics, including age, race, prostate specific antigen (PSA) at diagnosis, clinical T stage, biopsy Gleason score and percent positive prostate biopsies at diagnosis were determined in each patient. Disease recurrence was defined as PSA 0.2 ng./ml. or greater on 2 consecutive occasions after radical prostatectomy or second cancer treatment at least 6 months after surgery. Cox proportional hazards analysis was performed to determine independent predictors of time to disease recurrence. To control for pretreatment disease characteristics simultaneously patients were assigned to previously described risk groups based on clinical tumor stage, PSA at diagnosis and biopsy Gleason score. The likelihood of disease recurrence per risk group stratified according to ethnicity was determined using the Kaplan-Meier method and compared using the log rank test. Additional multivariate analysis was performed in the subset of patients enrolled in Cancer of the Prostate Strategic Urological Research Endeavor on whom education and income information was available. RESULTS Disease recurred in 304 of the 1,468 patients (21%). Black ethnicity, serum PSA at diagnosis, biopsy Gleason score and percent positive prostate biopsies were independent predictors of recurrence on multivariate analysis. Black ethnicity remained an independent predictor of disease recurrence in the multivariate model after stratifying patients into risk groups (p = 0.0007). Ethnicity was most important in patients at high risk, in whom estimated 5-year disease-free survival was 65% and 28% in white and black men, respectively. Education, income and ethnicity correlated highly. When education and income were entered into the multivariate model, ethnicity was no longer an independent predictor of outcome after prostatectomy. CONCLUSIONS Ethnicity appears to be an independent predictor of disease recurrence after adjusting for pretreatment measures of disease extent in patients undergoing radical prostatectomy. It appears to be particularly important in those with high risk disease characteristics. However, black ethnicity, education and income are highly correlated variables, suggesting that sociodemographic factors may contribute to the poorer outcomes in black patients even after adjusting for differences in pretreatment disease characteristics.
Collapse
Affiliation(s)
- Gary D Grossfeld
- Department of Urology, Program in Urologic Oncology, Urology Outcomes Research Group, University of California-San Francisco, USA
| | | | | | | | | | | |
Collapse
|
35
|
GROSSFELD GARYD, LATINI DAVIDM, DOWNS TRACY, LUBECK DEBORAHP, MEHTA SHILPAS, CARROLL PETERR. Is Ethnicity an Independent Predictor of Prostate Cancer Recurrence After Radical Prostatectomy? J Urol 2002. [DOI: 10.1097/00005392-200212000-00037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
36
|
Freedland SJ, Amling CL, Dorey F, Kane CJ, Presti JC, Terris MK, Aronson WJ. Race as an outcome predictor after radical prostatectomy: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. Urology 2002; 60:670-4. [PMID: 12385931 DOI: 10.1016/s0090-4295(02)01847-2] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Whether race is an independent predictor of prostate-specific antigen (PSA) recurrence after RP is controversial. To compare racial differences in clinical and pathologic features and biochemical recurrence in men undergoing radical prostatectomy (RP), we used a newly established multicenter database of patients from four equal-access healthcare centers in California, the Shared Equal Access Regional Cancer Hospital (SEARCH) database. METHODS A retrospective survey of 1547 patients treated with RP at four different equal-access medical centers in California between 1988 and 2001 was undertaken. Race was categorized as white (n = 1014), black (n = 338), or nonwhite-nonblack (n = 195). Patients were analyzed for racial differences in preoperative variables (age at surgery, clinical stage, PSA, and biopsy Gleason score) and surgical variables (pathologic stage, surgical Gleason score, incidence of seminal vesicle invasion, positive surgical margins, capsular penetration, and pelvic lymph node involvement). Patients were followed up for PSA recurrence. Multivariate analysis was used to determine whether race was an independent predictor of biochemical failure. RESULTS Significant differences were found among the races in the preoperative factors of clinical stage, age, serum PSA, and biopsy Gleason score, although the absolute differences were small. No differences were found among the races in the pathologic features of the RP specimens, including Gleason score, pathologic stage, and incidence of positive surgical margins, capsular penetration, seminal vesicle invasion, or lymph node involvement. In both univariate and multivariate analyses, only serum PSA (P <0.001) and biopsy Gleason score (P <0.001) were significant independent predictors of time to biochemical recurrence. CONCLUSIONS In a large multicenter cohort of patients from four equal-access medical care facilities in California, although racial differences were found in clinical stage, age, biopsy Gleason score, and serum PSA level at diagnosis, we found race was not an independent predictor of biochemical recurrence after RP. Race should not be used in models or nomograms predicting PSA failure after RP. The current study represents the largest series of black patients and the first large series of nonwhite-nonblack patients treated with RP reported to date. The Shared Equal Access Regional Cancer Hospital database is a valuable resource for studying patients treated with RP.
Collapse
Affiliation(s)
- Stephen J Freedland
- Department of Urology, University of California, Los Angeles, School of Medicine, Los Angeles, California 90095-1738, USA
| | | | | | | | | | | | | |
Collapse
|
37
|
Cross CK, Shultz D, Malkowicz SB, Huang WC, Whittington R, Tomaszewski JE, Renshaw AA, Richie JP, D'Amico AV. Impact of race on prostate-specific antigen outcome after radical prostatectomy for clinically localized adenocarcinoma of the prostate. J Clin Oncol 2002; 20:2863-8. [PMID: 12065563 DOI: 10.1200/jco.2002.11.054] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare prostate-specific antigen (PSA) outcome after radical prostatectomy (RP) for prostate cancer in African-American and white men using previously established risk groups. PATIENTS AND METHODS Between 1989 and 2000, 2,036 men (n = 162 African-American men, n = 1,874 white men) underwent RP for clinically localized prostate cancer. Using pretreatment PSA, Gleason score, clinical T stage, and percentage of positive biopsy specimens, patients were stratified into low- and high-risk groups. For each risk group, PSA outcome was estimated using the actuarial method of Kaplan and Meier. Comparisons of PSA outcome between African-American and white men were made using the log-rank test. RESULTS The median age and PSA level for African-American and white men were 60 and 62 years old and 8.8 and 7.0 ng/mL, respectively. African-Americans had a statistically significant increase in PSA (P =.002), Gleason score (P =.003), clinical T stage (P =.004), and percentage of positive biopsy specimens (P =.04) at presentation. However, there was no statistical difference in the distribution of PSA, clinical T stage, or Gleason score between racial groups in the low- and high-risk groups. The 5-year estimate of PSA outcome was 87% in the low-risk group for all patients (P =.70) and 28% versus 32% in African-American and white patients in the high-risk group (P =.28), respectively. Longer follow-up is required to confirm if these results are maintained at 10 years. CONCLUSION Even though African-American men presented at a younger age and with more advanced disease compared with white men with prostate cancer, PSA outcome after RP when controlled for known clinical predictive factors was not statistically different. This study supports earlier screening in African-American men.
Collapse
Affiliation(s)
- Chaundre K Cross
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA 02115, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Lee LN, Barnswell C, Torre T, Fearn P, Kattan M, Potters L. Prognostic significance of race on biochemical control in patients with localized prostate cancer treated with permanent brachytherapy: multivariate and matched-pair analyses. Int J Radiat Oncol Biol Phys 2002; 53:282-9. [PMID: 12023131 DOI: 10.1016/s0360-3016(02)02747-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare PSA relapse-free survival (PSA-RFS) between African-American (AA) and white American (WA) males treated with permanent prostate brachytherapy (PPB) for clinically localized prostate cancer. METHODS AND MATERIALS One thousand eighty-one consecutive patients, including 246 African-Americans, underwent PPB with 103Pd or 125I, alone or with external beam radiation therapy between September 1992 and September 1999. Computer-generated matching was performed to create two identical cohorts of WA and AA males, based on the use of neoadjuvant androgen ablation (NAAD), pretreatment PSA, and Gleason score. Presenting characteristics were used to define risk groups, as follows: Low risk had PSA 10 or Gleason score >or=7, and high risk had PSA >10 and Gleason score >or=7. PSA-RFS was calculated using the Kattan modification of the ASTRO definition, and the log-rank test was used to compare Kaplan-Meier PSA-RFS curves. Univariate and multivariate analyses were performed to determine predictors of PSA-RFS. RESULTS Overall, univariate analysis revealed that AA males at presentation had lower disease stage (p = 0.01), had lower Gleason scores (p = 0.017), were younger (p = 0.001), and were more likely to receive NAAD (p = 0.001) than their WA counterparts. There were no differences in pretreatment PSA, isotope selection, use of external beam radiation therapy, median follow-up, or risk group classification between AA and WA males. Pretreatment PSA and Gleason score were significant predictors of PSA-RFS in multivariate analysis, and race was not significant. There was no significant difference between the 5-year PSA-RFS for AA males (84.0%) and the matched cohort of WA males (81.2%) (p = 0.384). Race was not a predictor of 5-year PSA-RFS among patients treated with or without NAAD and within low-, intermediate-, and high-risk groups. CONCLUSION Race is not an independent predictor of 5-year PSA-RFS in patients with localized prostate cancer treated with PPB. This result is consistent with other studies that also show that race does not contribute to differences in outcome after definitive therapies for localized prostate cancer.
Collapse
Affiliation(s)
- Lucille N Lee
- Department of Radiation Oncology, Memorial Sloan-Kettering at Mercy Medical Center, Rockville Center, NY 11570, USA
| | | | | | | | | | | |
Collapse
|
39
|
Eastham JA, Carver B, Katz J, Kattan MW. Clinical stage T1c prostate cancer: pathologic outcomes following radical prostatectomy in black and white men. Prostate 2002; 50:236-40. [PMID: 11870801 DOI: 10.1002/pros.10055] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The incidence of prostate cancer in black men is 50% to 70% higher than among age-matched white men. Black men have a twofold higher mortality rate and overall tend to have higher serum prostate-specific antigen (PSA) levels than white men. To determine whether racial differences exist in men whose prostate cancer was diagnosed based solely on an elevated serum PSA level, we compared clinical and pathologic features in black and white men undergoing radical prostatectomy (RP) for clinical stage T1c prostate cancer. METHODS We used a prospectively collected database to identify all men undergoing RP for clinical T1c prostate cancer between July 1995 and October 2000. A total of 129 consecutive men (56 black men and 73 white men) were compared for age at diagnosis, serum PSA level, biopsy Gleason score, pathologic stage, RP specimen Gleason score, incidence of lymph node metastasis, and incidence of positive surgical margins. RESULTS Statistically significant differences were not found by race in patients' ages, serum PSA levels, biopsy Gleason score, pathologic stage, incidence of lymph node metastases, or incidence of positive surgical margins. The RP specimen Gleason score was more heterogeneous in black men than white men (P=0.02). CONCLUSIONS Racial differences in the incidence and mortality rate of prostate cancer are well known, but differences in the clinical and pathologic features between black and white men with prostate cancer identified solely based on an elevated serum PSA level with negative results on digital rectal examination (clinical stage T1c ) have been poorly studied. Our results suggest that men with clinical stage T1c prostate cancer have similar clinical and pathologic findings regardless of race. These results suggest that early-detection programs using serum PSA testing for prostate cancer in black men potentially can result in improvements in prostate cancer outcomes in this high-risk group.
Collapse
Affiliation(s)
- James A Eastham
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
| | | | | | | |
Collapse
|
40
|
Freedland SJ, Dorey F, Aronson WJ. Multivariate analysis of race and adverse pathologic findings after radical prostatectomy. Urology 2000; 56:807-11. [PMID: 11068307 DOI: 10.1016/s0090-4295(00)00754-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Adverse pathologic features that predict disease recurrence after radical prostatectomy (RP) include positive surgical margins, non-organ-confined disease, and seminal vesicle invasion. Given that black men have a higher incidence of, and mortality from, prostate cancer compared with white men, we sought to determine whether race was an independent predictor of adverse pathologic findings among men who underwent RP at an equal access health care center. Results from previous studies evaluating whether race predicts positive surgical margins have been conflicting. No prior studies have evaluated whether race is an independent predictor of non-organ-confined disease or seminal vesicle invasion. METHODS A retrospective survey of 274 patients (126 black, 148 white) who underwent RP at the West Los Angeles Veterans Affairs Medical Center between 1991 and 1999 was undertaken. Multivariate analysis was used to determine the preoperative clinical variables that were most significant in predicting positive surgical margins, non-organ-confined disease, and seminal vesicle invasion. The preoperative variables analyzed were race, age, serum prostate-specific antigen, clinical stage, and biopsy Gleason score. RESULTS No differences in the incidence of positive surgical margins, non-organ-confined disease, or seminal vesicle invasion were found between black and white men undergoing RP. After controlling for the preoperative variables of age, serum prostate-specific antigen level, clinical stage, and biopsy Gleason score, race was not an independent predictor of positive surgical margins, non-organ-confined disease, or seminal vesicle invasion. CONCLUSIONS This is the first study to show that black race was not an independent predictor of non-organ-confined disease or seminal vesicle invasion among patients undergoing RP. Furthermore, race was not an independent predictor of positive surgical margins.
Collapse
Affiliation(s)
- S J Freedland
- Department of Urology, University of California, Los Angeles, School of Medicine, Los Angeles, California, USA
| | | | | |
Collapse
|
41
|
Freedland SJ, Jalkut M, Dorey F, Sutter ME, Aronson WJ. Race is not an independent predictor of biochemical recurrence after radical prostatectomy in an equal access medical center. Urology 2000; 56:87-91. [PMID: 10869631 DOI: 10.1016/s0090-4295(00)00587-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To compare the racial differences in clinical and pathologic features between black and white men who underwent radical prostatectomy (RP) in an equal access health care center and to determine whether race is an independent predictor of biochemical recurrence. METHODS A retrospective survey of 273 patients (125 black, 148 white) who underwent RP at the West Los Angeles Veterans Affairs Medical Center between 1991 and 1999 was undertaken. Patients were analyzed for racial differences in age at diagnosis, clinical stage, preoperative serum prostate-specific antigen (PSA), and Gleason score of the prostate biopsy specimens. Surgical specimens were studied to determine pathologic stage, Gleason score, incidence of seminal vesicle invasion, positive surgical margins, capsular penetration, and pelvic lymph node involvement. Patients were followed for PSA recurrence (greater than 0.2 ng/mL). Multivariate analysis was used to determine the clinical and pathologic variables that were significant in predicting biochemical recurrence after RP and to determine whether race was an independent predictor of biochemical failure. RESULTS No significant differences were found between black and white men in the preoperative factors (clinical stage, age at diagnosis, biopsy Gleason score, and serum PSA) or in the pathologic features of the RP specimens (Gleason score, pathologic stage, incidence of positive surgical margins, capsular penetration, seminal vesicle invasion, or lymph node involvement). In addition, no differences were found between black and white men in the PSA recurrence rates after RP using Kaplan-Meier survival curves (P = 0.651). Multivariate analysis revealed that serum PSA (P = 0.010), biopsy Gleason score (P = 0. 003), younger age (P = 0.010), surgical Gleason score (P = 0.005), and lymph node involvement (P = 0.022) were all independent predictors of biochemical recurrence. Race was not a significant predictor of biochemical failure in multivariate analysis (P = 0. 199). CONCLUSIONS In an equal access medical care facility, no differences were evident between black and white men in the preoperative clinical factors or the pathologic features of the RP specimens. In addition, no differences were observed in the PSA recurrence rates after RP. Serum PSA, biopsy Gleason score, younger age, surgical Gleason score, and lymph node involvement were all independent predictors of biochemical recurrence. Race was not an independent predictor of biochemical recurrence.
Collapse
Affiliation(s)
- S J Freedland
- Department of Urology, University of California, Los Angeles, School of Medicine, 90095-1738, USA
| | | | | | | | | |
Collapse
|
42
|
Abstract
African American men are known to have a higher risk of developing prostate cancer. Historically, African American men have presented at a higher stage and had a worse outcome from the disease than non-African American men. There is an ongoing debate whether this disparity is due to biologic, environmental, or behavioral factors, or a combination of these factors. Furthermore, lack of access to care is implicated. Despite this debate, there is emerging data that African American men and their families are receptive to education and early detection. Encouraging data from the military, Veteran's Administration, and private sector suggest that African American men can have a similar outcome to non-African American men if diagnosed early and treated effectively. Early detection efforts depend on prostate-specific antigen (PSA) testing. This article discusses various options for using the PSA test to more effectively screen African American men. In general, testing starting at age 40 is recommended using an upper limit of normal for PSA at 2.0 to 2.5 ng/mL for men between 40 and 49 years of age. In older men, maintaining this lower PSA threshold is reasonable to optimize curable cancer; however, published guidelines of 0 to 4.0, 0 to 4.5, and 0 to 5.5 ng/mL in African American men in their 50s, 60s, and 70s, respectively, are also recognized to balance the sensitivity and specificity of testing. Population-based prospective clinical trials of African American men are needed to further fine-tune the use of PSA in early detection, and to assess whether screening will improve the disease-specific mortality of prostate cancer in the population.
Collapse
Affiliation(s)
- J W Moul
- Center for Prostate Disease Research, 1530 East Jefferson Street, Rockville, MD 20852, USA.
| |
Collapse
|