1
|
Lee J, Song J, Jung G, Song SH, Hong SK. Prognosis after radical prostatectomy in men older than 75 years: long-term results from a single tertiary center. Prostate Int 2024; 12:15-19. [PMID: 38523903 PMCID: PMC10960082 DOI: 10.1016/j.prnil.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 03/26/2024] Open
Abstract
Background Despite longer lifespans, guidelines for prostate cancer treatment recommend surgery for those with over 10 years of life expectancy, potentially leaving older patients undertreated. This study examines the outcomes of radical prostatectomy (RP) in a large cohort of men older than 75 years. Materials and methods We retrospectively analyzed 636 patients from a pool of 4,500 RP cases at a single tertiary institution from 2004 to 2022. Patients younger than 75 years or with incomplete records were excluded. Baseline clinical variables, including PSA and biopsy grade group (GG), as well as postoperative pathology and oncological outcomes, were assessed. Achievement of continence based on no pads and ≤1 pad at last follow-up were evaluated. Results Mean age and PSA were 76.4 years and 15.3 ng/ml, respectively. At biopsy, GG1 and 2 were found in 18.1% and 31.5%, respectively, with 28.5% harboring GG4-5 tumors. After RP, 41.5% had GG upgrade compared to biopsy results, with 46.5% with ≥pT3 tumors. In a mean follow-up of 41.5 months, 82.3% were able to attain total continence of 0 pads, and 89.5% used ≤1 pads at the last follow-up. Overall and cancer-specific mortality was observed in 4.3% and 0.9%, respectively, and biochemical recurrence (BCR) occurred in 20.3% after a median of 154 months. At multivariate analysis, age was not a significant factor for BCR, whereas preoperative PSA, biopsy GG, margin positivity, and lymph node invasion were significant. Conclusion RP is feasible in men older than 75 years with decent oncological outcome, with absolute age insignificant within this age group. Risk of undertreatment should be acknowledged, and definite treatment must be considered.
Collapse
Affiliation(s)
- Jaewon Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jungkeun Song
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Gyoohwan Jung
- Department of Urology, Hanyang University Seoul Hospital, Seoul, Korea
| | - Sang Hun Song
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
2
|
Zhanghuang C, Zhu J, Li Y, Wang J, Ma J, Li L, Yao Z, Ji F, Wu C, Tang H, Xie Y, Yan B, Yang Z. Prognostic significance of surgery and radiotherapy in elderly patients with localized prostate cancer: establishing and time-based external validation a nomogram from SEER-based study. BMC Urol 2024; 24:12. [PMID: 38184526 PMCID: PMC10771675 DOI: 10.1186/s12894-023-01384-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 11/28/2023] [Indexed: 01/08/2024] Open
Abstract
OBJECTIVE Prostate cancer (PC) is a significant disease affecting men's health worldwide. More than 60% of patients over 65 years old and more than 80% are diagnosed with localized PC. The current choice of treatment modalities for localized PC and whether overtreatment is controversial. Therefore, we wanted to construct a nomogram to predict the risk factors associated with cancer-specific survival (CSS) and overall survival (OS) in elderly patients with localized PC while assessing the survival differences in surgery and radiotherapy for elderly patients with localized PC. METHODS Data of patients with localized PC over 65 years were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression models were used to determine independent risk factors for CSS and OS. Nomograms predicting CSS and OS were built using multivariate Cox regression models. The consistency index (C-index), the area under the subject operating characteristic curve (AUC), and the calibration curve were used to test the accuracy and discrimination of the prediction model. Decision curve analysis (DCA) was used to test the potential clinical value of this model. RESULTS A total of 90,434 patients over 65 years and diagnosed with localized PC from 2010 to 2018 were included in the study. All patients were randomly assigned to the training set (n = 63,328) and the validation set (n = 27,106). Univariate and multivariate Cox regression model analysis showed that age, race, marriage, T stage, surgical, radiotherapy, prostate-specific antigen (PSA), and Gleason score (GS) were independent risk factors for predicting CSS in elderly patients with localized PC. Age, race, marriage, surgery, radiotherapy, PSA, and GS were independent risk factors for predicting OS in elderly patients with localized PC. The c-index of the training and validation sets for the predicted CSS is 0.802(95%CI:0.788-0.816) and 0.798(95%CI:0.776-0.820, respectively). The c-index of the training and validation sets for predicting OS is 0.712(95%:0.704-0.720) and 0.724(95%:0.714-0.734). It shows that the nomograms have excellent discriminatory ability. The AUC and the calibration curves also show good accuracy and discriminability. CONCLUSION We have developed new nomograms to predict CSS and OS in elderly patients with localized PC. After internal validation and external temporal validation with reasonable accuracy, reliability and potential clinical value, the model can be used for clinically assisted decision-making.
Collapse
Affiliation(s)
- Chenghao Zhanghuang
- Department of Urology, Kunming Children's Hospital (Children's Hospital affiliated to Kunming Medical University), Kunming, People's Republic of China
- Department of Oncology; Yunnan Children solid Tumor Treatment Center, Kunming Children's Hospital (Children's Hospital affiliated to Kunming Medical University), Kunming Children's Solid Tumor Diagnosis and Treatment Center, Kunming, People's Republic of China
- Yunnan Key Laboratory of Children's Major Disease Research, Kunming Children's Hospital (Children's Hospital affiliated to Kunming Medical University); Yunnan Province Clinical Research Center for Children's Health and Disease, Kunming Children's Solid Tumor Diagnosis and Treatment Center, Yunnan Clinical Medical Center for Pediatric Diseases, Kunming, People's Republic of China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering; Chongqing Key Laboratory of Pediatrics; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders; Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400015, China
| | - Jianjun Zhu
- Department of Oncology; Yunnan Children solid Tumor Treatment Center, Kunming Children's Hospital (Children's Hospital affiliated to Kunming Medical University), Kunming Children's Solid Tumor Diagnosis and Treatment Center, Kunming, People's Republic of China
| | - Ye Li
- Department of Oncology; Yunnan Children solid Tumor Treatment Center, Kunming Children's Hospital (Children's Hospital affiliated to Kunming Medical University), Kunming Children's Solid Tumor Diagnosis and Treatment Center, Kunming, People's Republic of China
| | - Jinkui Wang
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering; Chongqing Key Laboratory of Pediatrics; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders; Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400015, China
| | - Jing Ma
- Yunnan Key Laboratory of Children's Major Disease Research, Kunming Children's Hospital (Children's Hospital affiliated to Kunming Medical University); Yunnan Province Clinical Research Center for Children's Health and Disease, Kunming Children's Solid Tumor Diagnosis and Treatment Center, Yunnan Clinical Medical Center for Pediatric Diseases, Kunming, People's Republic of China
- Department of Otolaryngology, Kunming Children's Hospital (Children's Hospital affiliated to Kunming Medical University), Kunming, People's Republic of China
| | - Li Li
- Yunnan Key Laboratory of Children's Major Disease Research, Kunming Children's Hospital (Children's Hospital affiliated to Kunming Medical University); Yunnan Province Clinical Research Center for Children's Health and Disease, Kunming Children's Solid Tumor Diagnosis and Treatment Center, Yunnan Clinical Medical Center for Pediatric Diseases, Kunming, People's Republic of China
| | - Zhigang Yao
- Department of Urology, Kunming Children's Hospital (Children's Hospital affiliated to Kunming Medical University), Kunming, People's Republic of China
| | - Fengming Ji
- Department of Urology, Kunming Children's Hospital (Children's Hospital affiliated to Kunming Medical University), Kunming, People's Republic of China
| | - Chengchuang Wu
- Department of Urology, Kunming Children's Hospital (Children's Hospital affiliated to Kunming Medical University), Kunming, People's Republic of China
| | - Haoyu Tang
- Department of Urology, Kunming Children's Hospital (Children's Hospital affiliated to Kunming Medical University), Kunming, People's Republic of China
| | - Yucheng Xie
- Department of Pathology, Kunming Children's Hospital (Children's Hospital affiliated to Kunming Medical University), Kunming, People's Republic of China
| | - Bing Yan
- Department of Urology, Kunming Children's Hospital (Children's Hospital affiliated to Kunming Medical University), Kunming, People's Republic of China.
- Yunnan Key Laboratory of Children's Major Disease Research, Kunming Children's Hospital (Children's Hospital affiliated to Kunming Medical University); Yunnan Province Clinical Research Center for Children's Health and Disease, Kunming Children's Solid Tumor Diagnosis and Treatment Center, Yunnan Clinical Medical Center for Pediatric Diseases, Kunming, People's Republic of China.
| | - Zhen Yang
- Department of Oncology; Yunnan Children solid Tumor Treatment Center, Kunming Children's Hospital (Children's Hospital affiliated to Kunming Medical University), Kunming Children's Solid Tumor Diagnosis and Treatment Center, Kunming, People's Republic of China.
| |
Collapse
|
3
|
Marotte D, Chand-Fouche ME, Boulahssass R, Hannoun-Levi JM. Irradiation of localized prostate cancer in the elderly: A systematic literature review. Clin Transl Radiat Oncol 2022; 35:1-8. [PMID: 35492872 PMCID: PMC9046879 DOI: 10.1016/j.ctro.2022.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/14/2022] [Accepted: 04/16/2022] [Indexed: 11/17/2022] Open
Abstract
Oncological benefit for elderly patients with optimal treatment. Elderly patients often received inadequate treatment. Elderly comorbidities can influence oncological outcomes and treatment tolerance. Optimal curative treatment after oncogeriatric assessment.
Purpose To analyze the literature that addresses radiation therapy for intermediate and high-risk prostate cancer (PC) in the elderly. Patients and methods A PubMed literature search was conducted including articles from 01/01/2000 to 30/06/21, with the following keywords: PC, radiotherapy/brachytherapy and elderly. The analysis mainly focused on the issue of under-treatment in the elderly and the benefit/risk balance of irradiation. Results Of the 176 references analyzed, 24 matched the selection criteria. The definition of “elderly patient” varied from 70 to 80 years. The analysis was impacted by the inhomogeneous primary end points used in each cohort. Age was often an obstacle to radical treatment, with a subsequent risk of under-treatment, particularly in patients with a poorer prognosis. However, comparable elderly oncological outcomes were compared to younger patients, both with external beam radiotherapy alone or combined with brachytherapy boost. Late toxicity rates are low and most often comparable to younger populations. However, a urinary over- toxicity was observed in the super-elderly (>80 years) after brachytherapy boost. The use of ADT should be considered in light of comorbidities, and may even be deleterious in some patients. Conclusion Due to the increase in life expectancy, the management of PC in the elderly is a challenge for patients, clinicians and health insurance payers. Except for unfit men, elderly patients remain candidates for optimal curative treatment (i.e. regardless of age) after oncogeriatric assessment. More solid data from prospective trials conducted specially in this population will provide better guidance in our daily clinical practice.
Collapse
Affiliation(s)
- Delphine Marotte
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d’Azur, 33 avenue Valombrose, 06189 Nice Cedex 2, Nice, France
| | - Marie-Eve Chand-Fouche
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d’Azur, 33 avenue Valombrose, 06189 Nice Cedex 2, Nice, France
| | - Rabia Boulahssass
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est, CHU de NICE, University of Cote d’Azur, Oncoage Nice, France
| | - Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d’Azur, 33 avenue Valombrose, 06189 Nice Cedex 2, Nice, France
- Corresponding author at: Department of Radiation Oncology, Antoine Lacassagne Cancer Center – University Cote d’Azur, 33 Avenue Valombrose, 06107 Nice CEDEX, France.
| |
Collapse
|
4
|
Marotte D, Gal J, Schiappa R, Gautier M, Boulahssass R, Chand-Fouche ME, Hannoun-Levi JM. High-Dose-Rate brachytherapy boost for elderly patients with intermediate to high-risk prostate cancer: 5-year clinical outcome of the PROSTAGE cohort. Clin Transl Radiat Oncol 2022; 35:104-109. [PMID: 35692263 PMCID: PMC9184865 DOI: 10.1016/j.ctro.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/01/2022] [Accepted: 05/12/2022] [Indexed: 12/02/2022] Open
Abstract
Intermediate/high risk elderly prostate cancer benefits less from received standards of care. Age is an independent factor for disease control and tolerance. Brachytherapy boost remains efficient and feasible in the elderly. Careful discussion for super elderly patients (>80 y) is warranted. Oncogeriatric assessment is necessary to identify best candidates.
Purpose To analyze the oncological outcome in elderly (>70 years) prostate cancer after high-dose rate brachytherapy (HDB) boost. Materials/methods In this retrospective study, patients with intermediate (IR) and high-risk (HR) prostate cancer underwent external beam radiation therapy (EBRT) followed by HDB boost with/without androgen deprivation therapy (ADT). The impact of age (≤70y vs. > 70y) was investigated. Oncological outcome focused on biochemical relapse-free survival (bRFS), cause-specific (CSS) and overall survival (OS). Late genito-urinary (GU) and gastro-intestinal (GI) toxicities were investigated. Results From 07/08 to 01/22, 518 pts received a HDB boost, and 380 were analyzed (≤70y:177pts [46.6%] vs. > 70y:203pts [53.4%]). Regarding NCCN classification, 98 pts (≤70y: 53pts; >70y: 45pts; p = 0.107) and 282 pts (≤70y: 124pts; >70y: 158pts; p = NS) were IR and HR pts respectively. Median EBRT dose was 46 Gy [37.5–46] in 23 fractions [14–25]. HDB boost delivered a single fraction of 14/15 Gy (79%). ADT was used in 302 pts (≤70y: 130pts; >70y: 172pts; p = 0.01). With MFU of 72.6 months [67–83] for the whole cohort, 5-y bRFS, 5-y CSS and 5-y OS were 88% [85–92], 99% [97–100] and 94% [92–97] respectively; there was no statistical difference between the two age groups except for 5-y CSS (p = 0.05). Late GU and GI toxicity rates were 32.4% (G ≥ 3 7.3%) and 10.1% (no G3) respectively. Conclusions For IR and HR prostate cancers, HDB boost leads to high rates of disease control with few late G ≥ 3 GU/GI toxicities. For elderly pts, HDB boost remains warranted mainly in HR pts, while competing comorbidity factors influence OS.
Collapse
|
5
|
Robot-assisted radical prostatectomy in indian men of age 75 years and above: a propensity score-matched analysis. J Robot Surg 2021; 16:799-806. [PMID: 34455530 DOI: 10.1007/s11701-021-01301-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
Older men undergoing robot-assisted radical prostatectomy (RARP) have been thought to have worse perioperative, functional and oncological outcomes than younger men. However, there is a dearth of matched studies on this subject in the currently available literature. Our study is a matched pair analysis of perioperative, oncological and functional outcomes of RARP in men < 75 years of age versus ≥ 75 years (62 in each group). There was no statistically significant difference in complications, length of stay, pathological stage, positive surgical margins (PSM) and nodal involvement. Older men were less likely to undergo nerve sparing in our study (8.0 vs 75.8% p = 0.01). Potency rates were too low to be compared. The 1-year continence rates, time to continence and the proportion of men with biochemical recurrence (BCR) were similar between the groups. Men ≥ 75 years developed BCR much earlier than < 75 years (30 versus 78 months p = 0.07). However, this was not statistically significant. Age ≥ 75 years was associated with a statistically insignificant 53.5% rise in the risk of BCR. It was also not associated with any increased risk of postoperative complications or PSM. RARP is a safe procedure in senior adults. The oncological and functional outcomes of RARP in senior adults are similar to younger men.
Collapse
|
6
|
Otto JJ, Correll VL, Engstroem HA, Hitefield NL, Main BP, Albracht B, Johnson‐Pais T, Yang LF, Liss M, Boutros PC, Kislinger T, Leach RJ, Semmes OJ, Nyalwidhe JO. Targeted Mass Spectrometry of a Clinically Relevant PSA Variant from Post-DRE Urines for Quantitation and Genotype Determination. Proteomics Clin Appl 2020; 14:e2000012. [PMID: 32614141 PMCID: PMC7674190 DOI: 10.1002/prca.202000012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 06/08/2020] [Indexed: 01/03/2023]
Abstract
PURPOSE The rs17632542 single nucleotide polymorphism (SNP) results in lower serum prostate specific antigen (PSA) levels which may further mitigate against its clinical utility as a prostate cancer biomarker. Post-digital rectal exam (post-DRE) urine is a minimally invasive fluid that is currently utilized in prostate cancer diagnosis. To detect and quantitate the variant protein in urine. EXPERIMENTAL DESIGN Fifty-three post-DRE urines from rs17632542 genotyped individuals processed and analyzed by liquid chromatography/mass spectrometry (LC-MS) in a double-blinded randomized study. The ability to distinguish between homozygous wild-type, heterozygous, or homozygous variant is examined before unblinding. RESULTS Stable-isotope labeled peptides are used in the detection and quantitation of three peptides of interest in each sample using parallel reaction monitoring (PRM). Using these data, groupings are predicted using hierarchical clustering in R. Accuracy of the predictions show 100% concordance across the 53 samples, including individuals homozygous and heterozygous for the SNP. CONCLUSIONS AND CLINICAL RELEVANCE The study demonstrates that MS based peptide variant quantitation in urine could be useful in determining patient genotype expression. This assay provides a tool to evaluate the utility of PSA variant (rs17632542) in parallel with current and forthcoming urine biomarker panels.
Collapse
Affiliation(s)
- Joseph J. Otto
- Leroy T. Canoles Jr. Cancer Research CenterEastern Virginia Medical SchoolNorfolkVA23507USA
| | - Vanessa L. Correll
- Leroy T. Canoles Jr. Cancer Research CenterEastern Virginia Medical SchoolNorfolkVA23507USA
| | - Hampus A. Engstroem
- Leroy T. Canoles Jr. Cancer Research CenterEastern Virginia Medical SchoolNorfolkVA23507USA
| | - Naomi L. Hitefield
- Leroy T. Canoles Jr. Cancer Research CenterEastern Virginia Medical SchoolNorfolkVA23507USA
- Department of Microbiology and Molecular Cell BiologyEastern Virginia Medical SchoolNorfolkVA23507USA
| | - Brian P. Main
- Leroy T. Canoles Jr. Cancer Research CenterEastern Virginia Medical SchoolNorfolkVA23507USA
| | - Brenna Albracht
- Department of UrologyThe University of Texas Health San AntonioSan AntonioTX78229USA
| | - Teresa Johnson‐Pais
- Department of UrologyThe University of Texas Health San AntonioSan AntonioTX78229USA
| | - Li Fang Yang
- Leroy T. Canoles Jr. Cancer Research CenterEastern Virginia Medical SchoolNorfolkVA23507USA
- Department of Microbiology and Molecular Cell BiologyEastern Virginia Medical SchoolNorfolkVA23507USA
| | - Michael Liss
- Department of UrologyThe University of Texas Health San AntonioSan AntonioTX78229USA
- Mays Cancer Center at UT Health San Antonio/MD AndersonSan AntonioTX78229USA
| | - Paul C. Boutros
- Departments of Human Genetics and UrologyJonsson Comprehensive Cancer CenterInstitute for Precision Health University of California Los AngelesLos AngelesCA90095USA
- University of TorontoDepartment of Medical BiophysicsTorontoON M5G 1L7Canada
| | - Thomas Kislinger
- University of TorontoDepartment of Medical BiophysicsTorontoON M5G 1L7Canada
| | - Robin J. Leach
- Department of UrologyThe University of Texas Health San AntonioSan AntonioTX78229USA
- Department of Cell Systems and AnatomyThe University of Texas Health San AntonioSan AntonioTX78229USA
| | - Oliver J. Semmes
- Leroy T. Canoles Jr. Cancer Research CenterEastern Virginia Medical SchoolNorfolkVA23507USA
- Department of Microbiology and Molecular Cell BiologyEastern Virginia Medical SchoolNorfolkVA23507USA
| | - Julius O. Nyalwidhe
- Leroy T. Canoles Jr. Cancer Research CenterEastern Virginia Medical SchoolNorfolkVA23507USA
- Department of Microbiology and Molecular Cell BiologyEastern Virginia Medical SchoolNorfolkVA23507USA
| |
Collapse
|
7
|
Calvocoressi L, Uchio E, Ko J, Radhakrishnan K, Aslan M, Concato J. Prostate cancer aggressiveness and age: Impact of p53, BCL-2 and microvessel density. J Investig Med 2018; 66:1142-1146. [DOI: 10.1136/jim-2018-000804] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 01/01/2023]
Abstract
Older men are more likely to have advanced prostate cancer at time of their diagnosis, but whether prostate tumors are inherently (biologically) more aggressive with advancing age is uncertain. To address this gap in knowledge, we analyzed data from veterans (n=971) diagnosed with prostate cancer during 1991–1995. Factors included age, detection of prostate cancer by screening, prostate-specific antigen (PSA) level, anatomic stage, and Gleason score. Information on molecular markers obtained from immunohistochemical staining of prostate tissue, included B cell lymphoma-2 (bcl-2), p53, and microvessel density (MVD), each having a previously documented association with disease progression and increased risk of prostate cancer death. We first examined the bivariate association of demographic, clinical, and molecular factors with age, and found evidence that race, screening status, Gleason score, PSA, bcl-2, p53, and MVD varied across categories of age in this study population. After further characterizing the association between age and Gleason score, we used logistic regression to examine the association between age and molecular markers—accounting for race, screening status, PSA, and Gleason score. Comparing men older than 80 years to those younger than 70 years, adjusted ORs and 95% CIs were 1.89 (0.73 to 4.92), 1.91 (1.05 to 3.46), and 2.00 (1.06 to 3.78), for positive bcl-2, p53, and MVD markers, respectively; no statistically significant associations were found for men 70–79 years old, compared with men younger than 70 years. These novel findings suggest that very elderly men often present with biologically aggressive prostate cancer; the results also have potential implications for therapeutic decision-making.
Collapse
|
8
|
Impact of age at diagnosis on overall and disease-free survival in men with prostate cancer following conformal 3D radiation therapy. TUMORI JOURNAL 2018; 98:722-7. [DOI: 10.1177/030089161209800608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background The impact of age on prostate cancer outcome has been controversial. The aim of the study was to evaluate the role of age on overall survival and disease-free survival in patients affected by prostate cancer when treated with 3D conformal radiation therapy. Methods and study design From 1999 to 2005, 1002 patients with T1–T3 prostate cancer were treated with 3D conformal radiation therapy, delivering a median dose of 75.6, 66.6 and 45 Gy to the prostate, seminal vesicles and pelvic nodes (if necessary), respectively. Patients were divided into four groups (<65, 65–70, 70–75, >75 years) according to age at diagnosis. The relationship between age and both overall survival and disease-free survival was calculated with Kaplan-Meier analysis and the comparison between curves was performed by the logrank test. ROC analysis allowed assessment of the best age cutoff. Results Mean age was 71 ± 6 years (median, 72). Median and mean follow-up was 71.4 and 69 months, respectively. In multivariate analysis, there was no significant difference in the distribution of disease risk between age groups. Analysis demonstrated that older age is a strong positive predictor of survival (odds ratio for stratified patients older than 70 years was <1). In fact, at the 90 month follow-up, overall survival and disease-free survival varied with age, increasing from 85% to 95% and from 78% to 94%, respectively. ROC curve analysis yielded a cutoff age value discriminating overall survival and disease-free survival of 72 years. Conclusions Age is a strong positive predictor of overall survival and disease-free survival, playing a protective role for stratified patients up to 72 years of age.
Collapse
|
9
|
Hehemann MC, Baldea KG, Quek ML. Prostate Cancer in the Elderly Male: Diagnostic and Management Considerations. CURRENT GERIATRICS REPORTS 2017. [DOI: 10.1007/s13670-017-0213-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
10
|
Moretti K, Coombe R. Comorbidity assessment in localized prostate cancer: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:942-947. [PMID: 28398980 DOI: 10.11124/jbisrir-2016-003097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The objective of this study is to review and summarize the methods and tools used to measure comorbidity in localized prostate cancer (PCa) and in particular to assess whether these tools are adequately validated and reliable for determining the impact of comorbidity on survival and treatment decisions for this disease.Specifically, the review questions are.
Collapse
Affiliation(s)
- Kim Moretti
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | | |
Collapse
|
11
|
Leach DA, Trotta AP, Need EF, Risbridger GP, Taylor RA, Buchanan G. The prognostic value of stromal FK506-binding protein 1 and androgen receptor in prostate cancer outcome. Prostate 2017; 77:185-195. [PMID: 27718274 DOI: 10.1002/pros.23259] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 09/07/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Improving our ability to predict cancer progression and response to conservative or radical intent therapy is critical if we are to prevent under or over treatment of individual patients. Whereas the majority of solid tumors now have a range of molecular and/or immunological markers to help define prognosis and treatment options, prostate cancer still relies mainly on histological grading and clinical parameters. We have recently reported that androgen receptor (AR) expression in stroma inversely associates with prostate cancer-specific survival, and that stromal AR reduces metastasis. For this paper, we tested the hypothesis that the AR-regulated gene FKBP51 could be used as a marker of AR activity to better predict outcome. METHODS Using immunohistochemistry on a cohort of 64 patient-matched benign and malignant prostate tissues, we assessed patient outcome by FKBP51 and AR levels. Immunoblot and RT-qPCR were used to demonstrate androgen regulation of FKBP51 in primary and primary human prostatic fibroblasts and fibroblast cell-lines. RESULTS As predicted by FKBP51 level, high AR activity in cancer stroma was associated with longer median survival (1,306 days) compared with high AR alone (699 days), whereas those with low AR and/or low FKBP51 did poorly (384 and 338 days, respectively). Survival could not be predicted on the basis cancer epithelial AR levels or activity, and was not associated with immunoreactivity in patient matched benign tissues. CONCLUSION FKBP51 improves the ability of stromal AR to predict prostate cancer-specific mortality. By adding additional immunological assessment, similar to what is already in place in a number of other cancers, we could better serve patients with prostate cancer in prognosis and informed treatment choices. Prostate 77:185-195, 2017. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Damien A Leach
- The Basil Hetzel Institute for Translational Health Research, and Divisions of Medicine and Surgery, University of Adelaide, Adelaide, SA, Australia
| | - Andrew P Trotta
- The Basil Hetzel Institute for Translational Health Research, and Divisions of Medicine and Surgery, University of Adelaide, Adelaide, SA, Australia
| | - Eleanor F Need
- The Basil Hetzel Institute for Translational Health Research, and Divisions of Medicine and Surgery, University of Adelaide, Adelaide, SA, Australia
| | - Gail P Risbridger
- Cancer Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Victoria, Australia
| | - Renea A Taylor
- Cancer Program, Monash Biomedicine Discovery Institute and Department of Physiology, Monash University, Victoria, Australia
| | - Grant Buchanan
- The Basil Hetzel Institute for Translational Health Research, and Divisions of Medicine and Surgery, University of Adelaide, Adelaide, SA, Australia
| |
Collapse
|
12
|
Hjälm-Eriksson M, Ullén A, Johansson H, Levitt S, Nilsson S, Kälkner KM. Comorbidity as a predictor of overall survival in prostate cancer patients treated with external beam radiotherapy combined with HDR brachytherapy boosts. Acta Oncol 2017; 56:21-26. [PMID: 27882806 DOI: 10.1080/0284186x.2016.1253864] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The risk stratification currently applied prior to curative treatment for localized prostate cancer (PC) does not take into account comorbidity or age. Therefore, we investigated the impact of comorbidity on overall survival (OS) in PC patients treated with external beam radiotherapy (EBRT) and high-dose rate (HDR) brachytherapy boost. MATERIAL AND METHODS At a single center, 611 consecutive patients diagnosed with localized PC from 1998 to 2004 underwent definitive EBRT (50 Gy) and HDR brachytherapy boosts (2 × 10 Gy) combined with neoadjuvant total androgen blockade. Comorbidity was assessed with the Charlson comorbidity score. The impact of risk factors on OS and disease-free survival (DFS) was calculated using Cox proportional hazard ratios. Risk groups were defined as follows: low-risk PC: PSA <10, WHO grade 1 and T stage 1; high-risk PC: PSA >20 and/or WHO grade 3 and/or T stage 3a; intermediate-risk PC representing patients who did not fit either the low- or high-risk PC group. RESULTS Mean age in the study cohort was 66.4 years, and 51% of the patients reported some degree of comorbidity. Divided into risk groups 8.2% were categorized as low-risk, 64% as intermediate-risk and 27.8% as high-risk PC. Overall 10-year survival was 72.2%, and 89% of the patients were relapse-free. In the univariate and multivariate analyses using Cox proportional hazard ratios, age, comorbidity and T stage were statistically significant predictors of OS: hazard ratios 1.56, 1.44 and 1.2 (p-values .002, .04 and .05), respectively. WHO grade, PSA at diagnosis, T stage and comorbidity were also significant predictors of DFS (p-values .0001, .0001, .009 and .003, respectively). CONCLUSION Comorbidity assessed with the Charlson score predicts OS in patients with localized PC treated with curative intent using combined EBRT and HDR brachytherapy boost, and should be considered when making decisions before radical treatment.
Collapse
Affiliation(s)
- Marie Hjälm-Eriksson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Ullén
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Hemming Johansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Seymoure Levitt
- Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sten Nilsson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | | |
Collapse
|
13
|
Ryu JH, Kim YB, Jung TY, Kim SI, Byun SS, Kwon DD, Kim DY, Oh TH, Yoo TK, Ko WJ. Radical Prostatectomy in Korean Men Aged 75-Years or Older: Safety and Efficacy in Comparison with Patients Aged 65-69 Years. J Korean Med Sci 2016; 31:957-62. [PMID: 27247506 PMCID: PMC4853676 DOI: 10.3346/jkms.2016.31.6.957] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/12/2016] [Indexed: 11/29/2022] Open
Abstract
Prostate cancer is the most common type of male cancer worldwide. Although radical prostatectomy (RP) is advised for prostate cancer in patients with a life expectancy of more than 10 years by various guidelines, most elderly men still do not undergo the procedure regardless of increasing life expectancy. This study aimed to determine whether RP is suitable for patients with prostate cancer aged 75 years or older. A retrospective study of patients who underwent RP at 6 institutions between 2005 and 2012 was conducted. Patients were divided into 2 groups at the time of surgery: 65-69 years (younger group) and 75 years or older (older group). We compared clinical characteristics, pathological results, complication rates, and recurrence-free survival between the two groups. Compared with the younger group, the older group had significantly higher preoperative serum prostate-specific antigen level, pre- and postoperative Eastern Cooperative Oncology Group (ECOG) performance status grade, hypertension prevalence, and Gleason score at biopsy and RP. However, except urinary incontinence, there were no statistically significant differences in the peri- and post-operative complications. After median follow-up periods of 36 months (younger group) and 40 months (older group), the biochemical recurrence-free survival rates were not significantly different (P = 0.581). Although the urinary incontinence rate was higher in the older group, RP was a suitable option for selected Korean men aged 75 years or older with limited complication rates and excellent outcomes similar to those for patients aged 65-69 years.
Collapse
Affiliation(s)
- Jae Hyun Ryu
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Yun Beom Kim
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Tae Young Jung
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Sun Il Kim
- Department of Urology, Ajou University School of Medicine, Suwon, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Duk Yoon Kim
- Department of Urology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Tae Hee Oh
- Department of Urology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Tag Keun Yoo
- Department of Urology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Woo Jin Ko
- Department of Urology, National Health Insurance Corporation Ilsan Hospital, Yonsei University College of Medicine, Goyang, Korea
| |
Collapse
|
14
|
Prostate Cancer in the Elderly. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
15
|
|
16
|
McKibben MJ, Smith AB. Evaluation and Management of the Geriatric Urologic Oncology Patient. CURRENT GERIATRICS REPORTS 2015; 4:7-15. [PMID: 25678987 PMCID: PMC4321682 DOI: 10.1007/s13670-014-0106-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The geriatric population presents a unique set of challenges in urologic oncology. In addition to the known natural history of disease, providers must also consider patient factors such as functional and nutritional status, comorbidities and social support when determining the treatment plan. The development of frailty measures and biomarkers to estimate surgical risk shows promise, with several assessment tools predictive of surgical complications. Decreased dependence on chronologic age is important when assessing surgical fitness, as age cutoffs prevent appropriate treatment of many elderly patients who would benefit from surgery. Within bladder, kidney and prostate cancers, continued refinement of surgical techniques offers a broader array of options for the geriatric patient than previously available.
Collapse
Affiliation(s)
- Maxim J McKibben
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Angela B Smith
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
17
|
Shumway DA, Hamstra DA. Ageism in the undertreatment of high-risk prostate cancer: how long will clinical practice patterns resist the weight of evidence? J Clin Oncol 2015; 33:676-8. [PMID: 25559801 DOI: 10.1200/jco.2014.59.4093] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
18
|
Hurria A, Dale W, Mooney M, Rowland JH, Ballman KV, Cohen HJ, Muss HB, Schilsky RL, Ferrell B, Extermann M, Schmader KE, Mohile SG. Designing therapeutic clinical trials for older and frail adults with cancer: U13 conference recommendations. J Clin Oncol 2014; 32:2587-94. [PMID: 25071116 DOI: 10.1200/jco.2013.55.0418] [Citation(s) in RCA: 237] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
A majority of cancer diagnoses and deaths occur in patients age ≥ 65 years. With the aging of the US population, the number of older adults with cancer will grow. Although the coming wave of older patients with cancer was anticipated in the early 1980s, when the need for more research on the cancer-aging interface was recognized, many knowledge gaps remain when it comes to treating older and/or frailer patients with cancer. Relatively little is known about the best way to balance the risks and benefits of existing cancer therapies in older patients; however, these patients continue to be underrepresented in clinical trials. Furthermore, the available clinical trials often do not include end points pertinent to the older adult population, such as preservation of function, cognition, and independence. As part of its ongoing effort to advance research in the field of geriatric oncology, the Cancer and Aging Research Group held a conference in November 2012 in collaboration with the National Cancer Institute, the National Institute on Aging, and the Alliance for Clinical Trials in Oncology. The goal was to develop recommendations and establish research guidelines for the design and implementation of therapeutic clinical trials for older and/or frail adults. The conference sought to identify knowledge gaps in cancer clinical trials for older adults and propose clinical trial designs to fill these gaps. The ultimate goal of this conference series is to develop research that will lead to evidence-based care for older and/or frail adults with cancer.
Collapse
|
19
|
Yang S, Alibhai SMH, Kennedy ED, El-Sedfy A, Dixon M, Coburn N, Kiss A, Law CHL. Optimal management of colorectal liver metastases in older patients: a decision analysis. HPB (Oxford) 2014; 16:1031-42. [PMID: 24961482 PMCID: PMC4487755 DOI: 10.1111/hpb.12292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 04/22/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Comparative trials evaluating management strategies for colorectal cancer liver metastases (CLM) are lacking, especially for older patients. This study developed a decision-analytic model to quantify outcomes associated with treatment strategies for CLM in older patients. METHODS A Markov-decision model was built to examine the effect on life expectancy (LE) and quality-adjusted life expectancy (QALE) for best supportive care (BSC), systemic chemotherapy (SC), radiofrequency ablation (RFA) and hepatic resection (HR). The baseline patient cohort assumptions included healthy 70-year-old CLM patients after a primary cancer resection. Event and transition probabilities and utilities were derived from a literature review. Deterministic and probabilistic sensitivity analyses were performed on all study parameters. RESULTS In base case analysis, BSC, SC, RFA and HR yielded LEs of 11.9, 23.1, 34.8 and 37.0 months, and QALEs of 7.8, 13.2, 22.0 and 25.0 months, respectively. Model results were sensitive to age, comorbidity, length of model simulation and utility after HR. Probabilistic sensitivity analysis showed increasing preference for RFA over HR with increasing patient age. CONCLUSIONS HR may be optimal for healthy 70-year-old patients with CLM. In older patients with comorbidities, RFA may provide better LE and QALE. Treatment decisions in older cancer patients should account for patient age, comorbidities, local expertise and individual values.
Collapse
Affiliation(s)
- Simon Yang
- Division of General Surgery, University of TorontoToronto, ON
| | - Shabbir MH Alibhai
- Department of Medicine, University Health NetworkToronto, ON,Department of Health Policy Management & Evaluation, University of TorontoToronto, ON
| | - Erin D Kennedy
- Division of General Surgery, University of TorontoToronto, ON,Department of Health Policy Management & Evaluation, University of TorontoToronto, ON,Division of General Surgery, Mount Sinai HospitalToronto, ON
| | - Abraham El-Sedfy
- Department of Surgery, Saint Barnabas Medical CenterLivingston, NJ
| | - Matthew Dixon
- Department of Surgery, Maimonides Medical CenterBrooklyn, NY
| | - Natalie Coburn
- Division of General Surgery, University of TorontoToronto, ON,Department of Health Policy Management & Evaluation, University of TorontoToronto, ON,Division of General Surgery, Sunnybrook Health Sciences CentreToronto, ON
| | - Alex Kiss
- Department of Health Policy Management & Evaluation, University of TorontoToronto, ON,Institute for Clinical Evaluative SciencesToronto, ON
| | - Calvin HL Law
- Division of General Surgery, University of TorontoToronto, ON,Department of Health Policy Management & Evaluation, University of TorontoToronto, ON,Division of General Surgery, Sunnybrook Health Sciences CentreToronto, ON,Correspondence, Calvin H.L. Law, Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Suite T2-025, Toronto, Ontario, Canada M4N 3M5. Tel: +1 416 480 4825. Fax: +1 416 480 5804. E-mail:
| |
Collapse
|
20
|
Bui CN, Wang L, Baser O. Resource utilization and use of life-extending therapies and corticosteroids in prostate cancer patients with corticosteroid-sensitive comorbidities. Curr Med Res Opin 2014; 30:2355-64. [PMID: 25133961 DOI: 10.1185/03007995.2014.955170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Corticosteroids (CSs) are used concomitantly with life-extending therapies (LETs) in patients with castration-resistant prostate cancer (CRPC). This study examined time to LETs, LETs and concomitant CS adherence, and monthly all-cause healthcare utilization and costs in patients with CPRC with and without CS-sensitive comorbidities in the Veterans Health Administration population. METHODS Patients had CRPC if records showed prostate cancer diagnosis, medical/surgical castration and ≥2 prostate-specific antigen increases through 1 June 2007-31 May 2012. CS-sensitive comorbidities were assessed 6 months prior to the index date. Adherence, defined as medication possession ratio (MPR) ≥0.8, among patients initiating LETs (cabazitaxel, docetaxel, or abiraterone acetate) before 30 November 2011, resource utilization and costs among patients with concomitant CS were assessed. Statistical analysis included descriptive, Cox proportional hazards, and logistic regression models. RESULTS Common CS-sensitive conditions among 12,128 patients with CRPC included hypertension (75.74%) and hyperlipidemia (54.69%). Those with glaucoma (hazard ratio [HR] = 0.67), ischemic heart disease (HR = 0.78), and peripheral vascular disease (PVD) (HR = 0.78) were less likely to be prescribed LETs (all p < 0.01). Duration of LET was shorter among patients with CS-sensitive comorbidities (125.02 vs 133.08 days; p = 0.04) in the 6 month follow-up period. Among LET-treated patients with and without CS-sensitive comorbidities, less than half had MPR ≥ 0.8 (LET: 48.72% vs 54.05%; concomitant CS: 42.19% vs 40.54%, respectively). Cerebrovascular disease (odds ratio = 0.107; 95% confidence interval = 0.012 to 0.966) and PVD (odds ratio = 0.523; 95% confidence interval = 0.276 to 0.991) were associated with reduced CS adherence. Among patients with concomitant CS, those with CS-sensitive comorbidities had more inpatient stays than those without (20.45% vs 12.88%; p = 0.033), incurring higher monthly inpatient costs ($1157 vs $342; p < 0.0001) and total costs ($5725 vs $4772; p = 0.036). CONCLUSION CS-sensitive conditions influence initiation and duration of LETs, concomitant CS adherence, inpatient stays, and total costs. Future efforts should focus on specific strategies for treating prostate cancer patients with CS-sensitive comorbidities to ensure that they have appropriate access to LETs and to reduce costs and inpatient stays. Study limitations include the use of retrospective claims data and the relatively restricted subpopulation of older North American males.
Collapse
Affiliation(s)
- Cat N Bui
- Astellas Scientific and Medical Affairs , Northbrook, IL , USA
| | | | | |
Collapse
|
21
|
Prognostic significance of YWHAZ expression in localized prostate cancer. Prostate Cancer Prostatic Dis 2014; 17:310-4. [PMID: 25156059 DOI: 10.1038/pcan.2014.32] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 05/30/2014] [Accepted: 06/27/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Prostate cancer (PCa) patients are often over-treated because of the lack of biomarkers needed to distinguish the lethal from the indolent form of PCa. YWHAZ was recently identified as a potential therapeutic target in castration-resistant PCa (CRPC). Therefore, this study focused on determining the prognostic significance of YWHAZ in localized PCa. METHODS YWHAZ expression was assessed by immunohistochemistry on formalin-fixed paraffin-embedded tissue from 213 men who underwent radical prostatectomy. Kaplan-Meier analysis and Cox proportional-hazards models were used to assess the prognostic value of YWHAZ intensity. RESULTS High YWHAZ expression was strongly associated with high Gleason score at the time of diagnosis (P < 0.001) and PSA relapse (P = 0.001). Importantly, patients with high expression of YWHAZ had a higher risk of CRPC development (P = 0.002) and reduced survival time (P = 0.002). CONCLUSIONS Our findings indicate that YWHAZ could serve as a promising prognostic biomarker in localized PCa to predict poor prognosis and to identify a subgroup of tumors, which might benefit from earlier adjuvant or YWHAZ-targeted therapy.
Collapse
|
22
|
Abstract
The incidence of prostate cancer increases with age. Current evidence suggests that prostate cancer is under treated in patients aged ≥70 years, despite evidence of efficacy and acceptable toxicity. Radical cystectomy and definitive radiotherapy are often denied owing to fears of post-operative complications and radiotherapy-associated gastrointestinal and genitourinary toxicity. However, modern radical prostatectomy techniques provide excellent clinical outcomes with low perioperative morbidity. Moreover, volume-restricted intensity-modulated radiation therapy is a significant improvement over previous 2D conformal radiotherapy with similar efficacy and lower toxicity. Androgen-deprivation therapy is also under-prescribed among the elderly, owing to concerns of increases in cardiac deaths and osteoporosis acceleration. However, prospective trials have not identified any increase in cardiovascular mortality among elderly men receiving androgen-deprivation therapy compared to age-matched controls. Most patients on androgen deprivation eventually progress to a castration-resistant state. At this stage, the disease still responds to newer agents that target the androgen pathway and to chemotherapy. Among the elderly, chemotherapy is under-prescribed even though it has been demonstrated to be palliative and improve survival. We describe the trends in prostate cancer management in the elderly and the importance of assessing comorbidity status, tumour characteristics, and health status, including a complete geriatric evaluation, before making treatment recommendations.
Collapse
Affiliation(s)
- Gautam G Jha
- Division of Haematology, Oncology and Transplantation, University of Minnesota, MMC394, 420 Delaware Street, Minneapolis, MN 55455, USA
| | - Vidhu Anand
- Department of Urologic Surgery, University of Minnesota, MMC394, 420 Delaware Street, Minneapolis, MN 55455, USA
| | - Ayman Soubra
- Department of Urology, University of Minnesota, MMC394, 420 Delaware Street, Minneapolis, MN 55455, USA
| | - Badrinath R Konety
- Department of Urology, University of Minnesota, MMC394, 420 Delaware Street, Minneapolis, MN 55455, USA
| |
Collapse
|
23
|
Abstract
Elderly men comprise a large percentage of men diagnosed with prostate cancer (PrCa). Although localized PrCa is often indolent, older men tend to be diagnosed with higher-stage disease and are more likely to die from PrCa than younger men. Multiple factors other than age play an important role in determining who will benefit from active treatment, such as comorbid conditions, life expectancy, and tumor characteristics. Careful consideration of such factors can help prevent the overtreatment of elderly men with low-risk disease and undertreatment of elderly men with high-risk disease. Management decisions should be individualized by weighing the benefits of treatment against potential risks and side effects pertinent to the elderly population, whether evaluating for surgery, radiation, or androgen deprivation.
Collapse
Affiliation(s)
- Shelly X Bian
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA
| | | |
Collapse
|
24
|
Population Based Study of Predictors of Adverse Pathology among Candidates for Active Surveillance with Gleason 6 Prostate Cancer. J Urol 2014; 191:350-7. [DOI: 10.1016/j.juro.2013.09.034] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2013] [Indexed: 11/18/2022]
|
25
|
Abstract
The purpose of this review is to identify clinical risk factors for prostate cancer and to assess the utility and limitations of our current tools for prostate cancer screening. Prostate-specific antigen is the single most important factor for identifying men at increased risk of prostate cancer but is best assessed in the context of other clinical factors; increasing age, race, and family history are well-established risk factors for the diagnosis of prostate cancer. In addition to clinical risk calculators, novel tools such as multiparametric imaging, serum or urinary biomarkers, and genetic profiling show promise in improving prostate cancer diagnosis and characterization. Optimal use of existing and future tools will help alleviate the problems of overdiagnosis and overtreatment of low-risk prostate cancer without reversing the substantial mortality declines that have been achieved in the screening era.
Collapse
|
26
|
Hatiboglu G, Hadaschik B, Teber D, Duensing S, Hohenfellner M, Pahernik S. [Management of prostate cancer in the elderly]. Urologe A 2013; 52:832-7. [PMID: 23695158 DOI: 10.1007/s00120-013-3152-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The management of prostate cancer in elderly patients is a topic of controversial discussion. The current guidelines recommend diagnosis and treatment of prostate cancer only in patients with a life expectancy of more than 10 years. Especially in elderly patients pre-existing comorbidities play a crucial role in life expectancy. In clinical practice mostly patient age alone is considered for the treatment decision; however, a guideline-based therapy of prostate cancer should also be offered to elderly patients. The treatment decision should be based on patient general health status and the oncological risk. The patient individual health status can be determined on the basis of comorbidities present and patient nutritional and performance status. For an optimal therapy regime the oncological risk has to be considered in treatment decisions. The aim of this article is to give an overview of risk stratification and treatment options for localized and metastatic prostate cancer in elderly patients.
Collapse
Affiliation(s)
- G Hatiboglu
- Klinik für Urologie und Kinderurologie, Urologische Universitätsklinik Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Deutschland.
| | | | | | | | | | | |
Collapse
|
27
|
Rogers CG, Sammon JD, Sukumar S, Diaz M, Peabody J, Menon M. Robot assisted radical prostatectomy for elderly patients with high risk prostate cancer. Urol Oncol 2013; 31:193-7. [DOI: 10.1016/j.urolonc.2010.11.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 11/23/2010] [Accepted: 11/30/2010] [Indexed: 11/26/2022]
|
28
|
Quon JL, Yu JB, Soulos PR, Gross CP. The relation between age and androgen deprivation therapy use among men in the Medicare population receiving radiation therapy for prostate cancer. J Geriatr Oncol 2013; 4:9-18. [PMID: 23482846 PMCID: PMC3591488 DOI: 10.1016/j.jgo.2012.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Neoadjuvant and concurrent androgen deprivation therapy (ncADT) is recommended for men with high-risk prostate cancer, but not low-risk cancer or short life expectancy. It is unclear whether the use of ncADT among older men in the community setting is aligned with the potential for clinical benefit. MATERIALS AND METHODS We used the Surveillance, Epidemiology, and End Results–Medicare database to assess patterns of ncADT use among men diagnosed with prostate cancer during 2004–2007 who received radiation therapy. Men were stratified according to tumor risk groups and life expectancy. We used logistic regression to identify factors associated with ncADT use within each risk group. RESULTS There were 10,686 men in the sample (mean age 74.2 years; 83.4% white). The use of ncADT was 80.7%, 54.1%, and 27.8% in the high-, intermediate-, and low-risk groups, respectively. Men with a life expectancy<5 years had higher rates of ncADT use than men with a life expectancy≥10 years in all risk groups. Within each risk group, advancing age was associated with higher likelihood of receiving ncADT (odds ratio for men aged 80–84 compared to 67–69=1.93 (95% CI 1.37–2.70); 1.51 (95% CI 1.22–1.87); and 1.71 (95% CI 1.14–2.57) for high-, intermediate-, and low-risk groups, respectively). CONCLUSION ncADT use is not consistent with guideline recommendations and is more frequent among men who are older, have shorter life expectancy, and are less likely to benefit from therapy.
Collapse
Affiliation(s)
- Jennifer L. Quon
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Comprehensive Cancer Center, PO Box 208056 333 Cedar Street, New Haven, CT, USA 06520-8056
| | - James B. Yu
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Comprehensive Cancer Center, PO Box 208056 333 Cedar Street, New Haven, CT, USA 06520-8056
- Department of Therapeutic Radiology, Yale University School of Medicine, P.O. Box 208040, New Haven, CT, USA 06520-8040
| | - Pamela R. Soulos
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Comprehensive Cancer Center, PO Box 208056 333 Cedar Street, New Haven, CT, USA 06520-8056
- Section of General Internal Medicine, Yale University School of Medicine, PO Box 208025, New Haven, CT, USA 06520-8025
| | - Cary P. Gross
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Comprehensive Cancer Center, PO Box 208056 333 Cedar Street, New Haven, CT, USA 06520-8056
- Section of General Internal Medicine, Yale University School of Medicine, PO Box 208025, New Haven, CT, USA 06520-8025
| |
Collapse
|
29
|
Gillan C, Briggs K, Pazos AG, Maurus M, Harnett N, Catton P, Wiljer D. Barriers to accessing radiation therapy in Canada: a systematic review. Radiat Oncol 2012; 7:167. [PMID: 23062109 PMCID: PMC3551743 DOI: 10.1186/1748-717x-7-167] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 09/26/2012] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Radiation therapy (RT) is effective treatment for curing and palliating cancer, yet concern exists that not all Canadians for whom RT is indicated receive it. Many factors may contribute to suboptimal use of RT. A review of recent Canadian literature was undertaken to identify such barriers. METHODS MEDLINE, CINAHL, and EMBase databases were used to search keywords relating to barriers to accessing or utilizing RT in Canada. Collected abstracts were reviewed independently. Barriers identified in relevant articles were categorized as relating to the health systems, patient socio-demographic, patient factors, or provider factors contexts and thematic analysis performed for each context. RESULTS 535 unique abstracts were collected. 75 met inclusion criteria. 46 (61.3%) addressed multiple themes. The most cited barriers to accessing RT when indicated were patient age (n = 26, 34.7%), distance to treatment centre (n = 23, 30.7%), wait times (n = 22, 29.3%), and lack of physician understanding about the use of RT (n = 16, 21.6%). CONCLUSIONS Barriers to RT are reported in many areas. The role of provider factors and the lack of attention to patient fears and mistrust as potential barriers were unexpected findings demanding further attention. Solutions should be sought to overcome identified barriers facilitating more effective cancer care for Canadians.
Collapse
Affiliation(s)
- Caitlin Gillan
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Kaleigh Briggs
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Canada
| | | | - Melanie Maurus
- ELLICSR: Health, Wellness, and Cancer Survivorship Centre, Toronto, Canada
| | - Nicole Harnett
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Pamela Catton
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- ELLICSR: Health, Wellness, and Cancer Survivorship Centre, Toronto, Canada
| | - David Wiljer
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- ELLICSR: Health, Wellness, and Cancer Survivorship Centre, Toronto, Canada
| |
Collapse
|
30
|
Hoffman KE. Management of Older Men With Clinically Localized Prostate Cancer: The Significance of Advanced Age and Comorbidity. Semin Radiat Oncol 2012; 22:284-94. [DOI: 10.1016/j.semradonc.2012.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
31
|
Kim JK, Cho SY, Jeong CW, Lee SB, Ku JH, Hong SK, Byun SS, Kwak C, Him HH, Lee SE, Jeong H. Patients aged more than 70 had higher risk of locally advanced prostate cancers and biochemical recurrence in Korea. BJU Int 2012; 110:505-9. [PMID: 22314007 DOI: 10.1111/j.1464-410x.2011.10927.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
32
|
B. Holliday E, P. Swanson G, Du F, W. Basler J. Older Men with Intermediate to High Risk Prostate Cancer-Patterns of Care and Outcomes of Treatment. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/jct.2012.35073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
33
|
Trinh QD, Schmitges J, Sun M, Shariat SF, Sukumar S, Tian Z, Bianchi M, Sammon J, Perrotte P, Rogers CG, Graefen M, Peabody JO, Menon M, Karakiewicz PI. Open radical prostatectomy in the elderly: a case for concern? BJU Int 2011; 109:1335-40. [DOI: 10.1111/j.1464-410x.2011.10554.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
34
|
Sajid S, Mohile SG, Szmulewitz R, Posadas E, Dale W. Individualized decision-making for older men with prostate cancer: balancing cancer control with treatment consequences across the clinical spectrum. Semin Oncol 2011; 38:309-25. [PMID: 21421119 DOI: 10.1053/j.seminoncol.2011.01.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Prostate cancer (PCa) is the most prevalent non-skin cancer among men and is the second leading cause of cancer death in men. PCa has an increased incidence and prevalence in older men. Age-associated incidence is on the rise due to increased screening in the older population. This has led to a sharp rise in the detection of early stage PCa. Given the indolent nature of many prostatic malignancies, a large proportion of older men with PCa will ultimately die from other causes. As a result, physicians and patients are faced with the challenge of identifying optimal treatment strategies for localized PCa, biochemically recurrent PCa and later-stage PCa. Age-related changes can impact tolerance of hormonal therapy and chemotherapy in men with metastatic disease and shift the risk-benefit ratio of these treatments. Tools such as the Comprehensive Geriatric Assessment (CGA) can help estimate remaining life expectancy and can help predict treatment-related morbidity and mortality in older men. Application of CGA in older men with PCa is important to help individualize and optimize treatment strategies. Research that integrates multidisciplinary and multidimensional assessment of PCa and the patient's overall health status is needed.
Collapse
Affiliation(s)
- Saleha Sajid
- Department of Medicine, The University of Chicago, Chicago, IL 60637, USA
| | | | | | | | | |
Collapse
|
35
|
Older age does not impact perioperative complications after robot-assisted radical prostatectomy. J Robot Surg 2011; 5:201-8. [DOI: 10.1007/s11701-011-0251-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 01/10/2011] [Indexed: 11/26/2022]
|
36
|
Berglund A, Garmo H, Tishelman C, Holmberg L, Stattin P, Lambe M. Comorbidity, treatment and mortality: a population based cohort study of prostate cancer in PCBaSe Sweden. J Urol 2011; 185:833-9. [PMID: 21239002 DOI: 10.1016/j.juro.2010.10.061] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE We examined associations among comorbidity, treatment decisions and mortality in patients with prostate cancer. MATERIALS AND METHODS A total of 77,536 men diagnosed with prostate cancer between 1997 and 2006 were identified in PCBaSe Sweden from the National Prostate Cancer Register of Sweden. Logistic, Cox and competing risk regression were used to assess associations among Charlson comorbidity index, treatment and mortality. The Charlson comorbidity index was categorized into no (0), mild (1) and severe comorbidity (2+). RESULTS In men with low risk prostate cancer 5,975 of the 13,245 (45.1%) patients without comorbidity underwent radical prostatectomy compared to 256 of the 1,399 (18.9%) men with severe comorbidity. Following adjustment for age and period of diagnosis, radical prostatectomy was less likely to be offered to men with severe comorbidity (OR 0.48, 95% CI 0.41-0.55). In men with high risk prostate cancer, radiotherapy was more common (range 7.7% to 21.3%) than radical prostatectomy (range 3.0% to 11.2%) regardless of comorbidity burden. All cause and competing cause but not prostate cancer specific mortality were increased in men with severe comorbidity (all cause HR 1.99, 95% CI 1.93-2.05; competing cause sHR 2.66, 95% CI 2.56-2.78; prostate cancer specific sHR 0.98, 95% CI 0.93-1.03). The cumulative probability of prostate cancer death given no death from competing causes was significantly higher in men with severe comorbidity in all risk groups (p<0.01). CONCLUSIONS Comorbidity affects treatment choices, and is associated with all cause, competing cause and conditional prostate cancer specific mortality. An increased conditional prostate cancer specific mortality in men with severe comorbidity may reflect less aggressive treatment, impaired tumor defense, lifestyle factors and poor general health behavior.
Collapse
Affiliation(s)
- Anders Berglund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | | | | | | | | | | |
Collapse
|
37
|
Brassell SA, Rice KR, Parker PM, Chen Y, Farrell JS, Cullen J, McLeod DG. Prostate Cancer in Men 70 Years Old or Older, Indolent or Aggressive: Clinicopathological Analysis and Outcomes. J Urol 2011; 185:132-7. [DOI: 10.1016/j.juro.2010.09.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Stephen A. Brassell
- Urology Service, Department of Surgery, Walter Reed Army Medical Center, Washington, D. C
- Center for Prostate Disease Research, Bethesda, Maryland
| | - Kevin R. Rice
- Urology Service, Department of Surgery, Walter Reed Army Medical Center, Washington, D. C
| | - Patrick M. Parker
- Urology Service, Department of Surgery, Walter Reed Army Medical Center, Washington, D. C
| | - Yongmei Chen
- Center for Prostate Disease Research, Bethesda, Maryland
| | - James S. Farrell
- Urology Service, Department of Surgery, Walter Reed Army Medical Center, Washington, D. C
| | | | - David G. McLeod
- Urology Service, Department of Surgery, Walter Reed Army Medical Center, Washington, D. C
- Center for Prostate Disease Research, Bethesda, Maryland
| |
Collapse
|
38
|
Bechis SK, Carroll PR, Cooperberg MR. Impact of age at diagnosis on prostate cancer treatment and survival. J Clin Oncol 2010; 29:235-41. [PMID: 21135285 DOI: 10.1200/jco.2010.30.2075] [Citation(s) in RCA: 274] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Older men are more likely to be diagnosed with high-risk prostate cancer and to have lower overall survival. As a result, age often plays a role in treatment choice. However, the relationships among age, disease risk, and prostate cancer-specific survival have not been well established. PATIENTS AND METHODS We studied men in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database with complete risk, treatment, and follow-up information. High-risk patients were identified by using the validated Cancer of the Prostate Risk Assessment (CAPRA) score. Competing risks regression was used to identify the independent impact of age on cancer-specific survival. We also analyzed the effect of local treatment on survival among older men with high-risk disease. RESULTS In all, 26% of men age ≥ 75 years presented with high-risk disease (CAPRA score 6 to 10). Treatment varied markedly with age across risk strata; older men were more likely to receive androgen deprivation monotherapy. Controlling for treatment modality alone, or for treatment and risk, age did not independently predict cancer-specific survival. Furthermore, controlling for age, comorbidity, and risk, older men with high-risk tumors receiving local therapy had a 46% reduction in mortality compared with those treated conservatively. CONCLUSION Older patients are more likely to have high-risk prostate cancer at diagnosis and less likely to receive local therapy. Indeed, underuse of potentially curative local therapy among older men with high-risk disease may in part explain observed differences in cancer-specific survival across age strata. These findings support making decisions regarding treatment on the basis of disease risk and life expectancy rather than on chronologic age.
Collapse
Affiliation(s)
- Seth K Bechis
- Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, CA 94143-1695, USA
| | | | | |
Collapse
|
39
|
Janssen-Heijnen ML, Szerencsi K, van de Schans SA, Maas HA, Widdershoven JW, Coebergh JWW. Cancer patients with cardiovascular disease have survival rates comparable to cancer patients within the age-cohort of 10 years older without cardiovascular morbidity. Crit Rev Oncol Hematol 2010; 76:196-207. [DOI: 10.1016/j.critrevonc.2009.11.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 11/19/2009] [Accepted: 11/26/2009] [Indexed: 11/26/2022] Open
|
40
|
Hoffman KE, Chen MH, Moran BJ, Braccioforte MH, Dosoretz D, Salenius S, Katin MJ, Ross R, D'Amico AV. Prostate cancer-specific mortality and the extent of therapy in healthy elderly men with high-risk prostate cancer. Cancer 2010; 116:2590-5. [DOI: 10.1002/cncr.24974] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
41
|
Droz JP, Balducci L, Bolla M, Emberton M, Fitzpatrick JM, Joniau S, Kattan MW, Monfardini S, Moul JW, Naeim A, van Poppel H, Saad F, Sternberg CN. Background for the proposal of SIOG guidelines for the management of prostate cancer in senior adults. Crit Rev Oncol Hematol 2010; 73:68-91. [PMID: 19836968 DOI: 10.1016/j.critrevonc.2009.09.005] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 09/23/2009] [Accepted: 09/23/2009] [Indexed: 12/27/2022] Open
Affiliation(s)
- Jean-Pierre Droz
- Department of Medical Oncology, Centre Léon-Bérard, 69008 Lyon, France.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
Prostate cancer is the most frequent malignancy in men and predominantly in elderly men. The issue of prostate cancer is likely to assume greater importance with progressive aging of the population. With frequent use of PSA testing most patients were diagnosed with localized cancer even in senior adults. Cancer-specific mortality is low in elderly men with prostate cancer and is dependent on the aggressiveness of the tumor. Currently, no established guidelines for the management of prostate cancer in the elderly exist, and treatment of senior adults with localized cancer is not optimal. While elderly men with indolent disease will not benefit from curative treatment, some patients with aggressive cancers will progress if not adequately treated. Comorbidity is the main predictor of life expectancy in the elderly. In everyday clinical practice, treatment decisions are much more influenced by age than by comorbidity. Curative treatment is an effective treatment option for selected elderly with localized prostate cancer. Conversely, most elderly men with prostate cancer received hormonal therapy, although the benefit of hormonal therapy in localized cancer is not clear and is associated with severe toxicities in some patients. In conclusion, there is a need for more risk stratified approaches for the management of prostate cancer in the elderly to avoid unnecessary intervention in men who unlikely benefit from such intervention, and allow treatment in those who might benefit from it.
Collapse
|
43
|
Mongiat-Artus P, Peyromaure M, Richaud P, Droz JP, Rainfray M, Jeandel C, Rebillard X, Moreau JL, Davin JL, Salomon L, Soulié M. Recommandations pour la prise en charge du cancer de la prostate chez l’homme âgé : un travail du comité de cancérologie de l’association française d’urologie. Prog Urol 2009; 19:810-7. [DOI: 10.1016/j.purol.2009.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 01/19/2009] [Accepted: 02/04/2009] [Indexed: 11/16/2022]
|
44
|
Prostate cancer in senior adults: over- or undertreated? Wien Med Wochenschr 2009; 159:521-8. [DOI: 10.1007/s10354-009-0697-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 08/05/2009] [Indexed: 11/26/2022]
|
45
|
Hennequin C, Quéro L. Cancers urologiques du sujet âgé : rôle de la radiothérapie. Prog Urol 2009; 19 Suppl 3:S96-9. [DOI: 10.1016/s1166-7087(09)73352-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
46
|
[Prostate cancer: what role for curative radiotherapy in elderly?]. Cancer Radiother 2009; 13:623-7. [PMID: 19695936 DOI: 10.1016/j.canrad.2009.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 06/03/2009] [Accepted: 06/05/2009] [Indexed: 11/21/2022]
Abstract
PURPOSE Discuss the place of radiotherapy given in a curative intent in elderly patients with localised prostate cancer according to complications, local control, survival observed in a specific and a review of the literature. PATIENTS AND METHODS The cohort consisted of 65 males aged 80 or more with localised prostate cancer who choose radiotherapy as a curative modality. Twelve radiotherapy centres affiliated to the Rare Cancer Network participated to the study. The retrospective analysis was carried out on immediate and late side-effects, biological free of relapse survival and global survival. Multivariate analysis took into account the comorbidities, the initial prostatic specific antigen (PSA) value, the Gleason score and the therapeutic modalities. RESULTS From January 1990 to December 2000, 65 patients were included into the cohort. Mean age was 81 years. The specific series consisted of 10 T1, 40 T2 and 15 T3 N0M0. Median follow up was 65 months. Immediate and late complications were comparable to those described in younger patients who received a similar irradiation. There were no negative impact of the treatment on disease free survival and global survival. Recent literature did suggest analogous results. CONCLUSIONS Radiation therapy with a curative intent should not be systematically withheld in elderly patients with localised prostate cancer.
Collapse
|
47
|
Nguyen TD, Azria D, Brochon D, Poortmans P, Miller RC, Scandolaro L, Majewski W, Krengli M, Abacioglu U, Moretti L, Villa S, Akyol F, Jovenin N. Curative external beam radiotherapy in patients over 80 years of age with localized prostate cancer: a retrospective rare cancer network study. Crit Rev Oncol Hematol 2009; 74:66-71. [PMID: 19419885 DOI: 10.1016/j.critrevonc.2009.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 03/26/2009] [Accepted: 04/02/2009] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To analyse tolerance and outcome of patients over 80 years of age who choose external beam radiation therapy to the prostate as a curative treatment. METHODS AND MATERIAL We evaluated acute and late side effects, biological DFS (bDFS) and actuarial survival as well as causes of death in relation to the clinical status including co-morbidity, PSA value, Gleason score and modalities of external radiotherapy in patients with localised prostate cancer >80 years of age. RESULTS From January 1990 to December 2000, 65 eligible cases (median age: 81) were treated by 12 different participating institutions in the Rare Cancer Network. Tumour stage was T1N0M0, T2N0M0 and T3N0M0 for 10, 40, and 15 patients, respectively. Median follow-up was 65 months (range 22-177). Five-year overall survival rate was 77% with a 5-year bDFS rate of 73%. The incidence of grade 3 early toxicity was 12% and 9% for urinary and digestive tract, respectively. CONCLUSIONS Radiation therapy given with curative intent is well tolerated in this selected group of patients aged over 80 years with localised prostate cancer. Results in terms of survival do not suggest a deleterious impact of this treatment. Therefore the authors recommend that radiation therapy with curative intent should not be withheld in selected elderly patients with localised prostate cancer.
Collapse
Affiliation(s)
- Tan Dat Nguyen
- Department of Radiation Oncology, Institute Jean-Godinot, Reims, France.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
|
49
|
|
50
|
Gallina A, Suardi N, Montorsi F, Capitanio U, Jeldres C, Saad F, Graefen M, Shariat SF, Widmer H, Arjane P, Péloquin F, Perrotte P, Karakiewicz PI. Mortality at 120 days after prostatic biopsy: A population-based study of 22,175 men. Int J Cancer 2008; 123:647-52. [DOI: 10.1002/ijc.23559] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|